Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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814 Benefits of Group Practice with Dr. Roshan “Ro” Parikh : Dentistry Uncensored with Howard Farran

814 Benefits of Group Practice with Dr. Roshan “Ro” Parikh : Dentistry Uncensored with Howard Farran

8/20/2017 6:50:35 AM   |   Comments: 0   |   Views: 414

814 Benefits of Group Practice with Dr. Roshan “Ro” Parikh : Dentistry Uncensored with Howard Farran

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814 Benefits of Group Practice with Dr. Roshan “Ro” Parikh : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #814 - Roshan Parikh

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AUDIO - DUwHF #814 - Roshan Parikh

Dentist and entrepreneur Dr. Roshan Parikh is the Founder and President of Chicagoland Smile Group. His vision is to build a best-in-class dental support organization in the Chicago area, offering dentists and dental specialists the opportunity to focus on the clinical aspects of dentistry, providing exceptional care for every patient. In 2008, Dr. Ro bought his first practice in the south suburbs of Chicago, with three employees in 650 square feet, and he has since developed Chicagoland Smile Group into a growing network of 12 multi-specialty dental practices, all dedicated to advancing dental healthcare in the greater Chicago area.

Howard:  It is such a huge honor for me today to be podcast interviewing Dr Ro, all the way from Chicago, Illinois.  He is the founder of Chicago Smile Group which is just crushing it.  This young lad graduated only in 2008, so he hasn’t even been out of school 10 years.  He's already got 12 offices, 220 employees, 45 dentists, and 35 hygienists.  He is a dentist and entrepreneur. His vision is to build a besting class dental support organization in the Chicago area, offering dentists and dental specialists the opportunity to focus on the clinical aspects of dentistry, and providing exceptional care for every patient.  In 2008, Dr Ro bought his first practice in the south suburbs of Chicago, with three employees in a 650-square foot, and he has since developed Chicagoland Smile Group into a growing network of 12 multi-specialty dental practices; all dedicated to advancing dental healthcare in the greater Chicago area. Good to have you on the show buddy.

Dr Ro:  Hey Dr Farran, my pleasure. Longtime reader and listener, so to be on this side is truly an honor.

Howard:  You know, it reminds me of the funniest joke.   You say on there that you have offering dentists and dental specialists.  It's so funny because in my 30 years I've seen it gazillion times when someone says “I am an Orthodontist” and I say “oh are you a dentist?"  "No, I’m an orthodontist" I only met one oral surgeon whoever I saw alive.  Someone said, "Are you a dentist" and he just said "yes" and that was when I climbed Mount Kilimanjaro with 4 dentists and one of them was an oral surgeon from Seattle, and I talked to him.  I said, "dude, you're the only oral surgeon that admitted that you're a dentist."  So, I think that's just funny.

Dr Ro:  Yeah, I mean that's right.  We try to acknowledge the dentists and the dental specialists.  They like it better that way huh?

Howard:  Yeah, they do.  I think the funniest especially is paediatric dentists.  What do you specialize in?  "Oh, just smaller sapiens.  We don’t do the big sapiens; we just do small sapiens around 50 pounds so we're a specialty."

Dr Ro:  Exactly right!

Howard:  So, you know this is dentistry uncensored so let’s just get frank.  When I got out of school 30 years ago the big scary monster was capitation and it was going to ruin dentistry, dental HMO's and then it was OSHA and then 10 years later then it was HIPAA.   There's always some scary thing that's going to ruin our lives and right now, probably the scariest word on Dentaltown is Corporate dentistry; the evil monster corporate dentistry. I don’t think it is evil because of number one, who hires most of the graduates when they come out of school?  Not all of the 50 or 60-year-old dentists who have dental offices closed on Friday, Saturday and Sunday while their patients sit home in pain and it's like, well you didn’t hire the 6 thousand kids after school; You didn’t even look at their ads.  When they advertise for an associate they say you must have 5 years experience.  So, corporate is doing an A plus in giving our new  sovereign and professional dentist colleagues a job and at the other end they offer liquidity because you can sell a 3-bedroom, 2 bath house in Phoenix in a day or a week or a month for $175k but if you’re sitting on a million-dollar home that's 6 bedrooms that thing may be  liquid for a year and all my friends who had offices over 2 million, like 2, 3, 4 million, the only person that would offer them liquidity was Heartland.  Heartland was the only big enough beast to go in and buy these practices.  So, I want to ask you, my point question is, you know, what do you think the consolidation trends are and the benefits of group dentistry?  What was going on in your journey where you thought this is a good idea for dentistry?

Dr Ro:   In 2008 after I graduated dental school.  I acquired my first dental office in the south suburbs of Chicago and. Iit was 650 square feet and 2 operatories and I grew it to 2 dentists and then a specialist and I started to see the value in multi-doctor, multi-specialty dental office within one physical 4-walls.  So, I had that model and you know, in 2008 kind of when there was a recession in the economy we were growing quite a bit and as we were growing I looked at my patients and the trend in dentistry just in my practice and I wanted to keep growing.  And so, I acquired a second dental office in 2013 and the third in 2014 and, we were at 7 dentists and dental specialists and then I was still working.  I talk a lot about it, I was still working in the business and on the business  so I was working 5 days a week as a dentist and then using my MBA  I was doing marketing and finance and everything else at night.  I recognized through lessons, my own lessons, that a human being wasn’t scalable but I recognized that if I had the right processes and I was surrounded by the right people, I could grow this business into something and effect change in thousands of patient's lives on a weekly basis.  So, in 2015, I partnered with a local private equity fund that had shared my vision in best class healthcare and want to grow this to something that we could all be proud of.

Howard:  Man!  That is amazing.  So, I call it you know, being patient centered and sort of being dentist centered and when you go to dentists they don’t want to be referred out to 9 different specialties.  So, you saw the vision of rotating the specialties through your office instead of rotating the patients around Chicago?

Dr Ro:  Exactly!  And you know, you're absolutely right.  I talk a lot about the money value of time and patients have a growing money value of time and they don’t want to go anywhere else.  They want to stay in your practice, I mean how many times do dentists hear while the patient is horizontal in the chair, "Hey doc can’t you just do that?  Do you have to refer me somewhere else?"  And so, I saw the possibilities of it being a patient-centered group versus a doctor-centered group and you know, I wanted to build around the patient versus building around a doctor schedule.

Howard:  Yeah, and you know what's weird?  The human mind is so bizarre like, you're meeting a dentist, you're talking to him and he is the most dentist centered person you've ever met and you ask him, "are you dentist centered or patient centered?" and he says, "Oh, we're very patient centered” We go "oh, your hours are Monday through Thursday, 08h00 to 17h00.   What are all your patients doing that time? Working?  They try to call you on their way to work and you get voice mail and when does your staff decide to take lunch?  The only time they could call on their lunch hour and you're closed 12h00 to 13h00” You know, they truly believe.  So, are you purchasing these 12-offs?  Of those 12, how many were mergers and acquisitions versus de Novo start-up from scratch?

Dr Ro:  Yeah, well they've all been acquisitions.  We looked to partner with dental offices that have been long-standing parts of the community.  Their own respective community in the Chicagoland area so, our youngest office has been in that community for 18 years and our oldest office is about 49 years old.

Howard:  Wow!  Now that's not old.  I'm 54; a 49-year-old office is very young.  Very young!

Dr Ro:  It's true.

Howard:  I think you're not old until you’re 55 so I have another month before I reach oldness.  So, you know, the hardest thing of any corporation is HR.  I mean, all your problems are either with your own people getting them on the same team or your customers.  I mean, it's never the electric bill, it's never figuring out how the washing machine works, it is always the people.  How do you... The biggest joke in the world is that you couldn't get 45 dentists to agree that today's Friday, how do you keep 45 dentists on the same page?

Dr Ro:  It's a great question.  So, we know that human beings themselves as dentists, one of the principles of the ADA is autonomy and so we know that dentists themselves are autonomists but I can’t get dentists to all be at the 50 yard line but I can get them to be between the 40's and kind of calibrate them and look at their emphasis on comprehensive care and be able to take their processes and hopefully make them a little bit better but for us at Chicagoland Smile Group, we're looking to partner with like-minded dentists that believe in comprehensive care, that believe in multi-doctor multi-specialty practice and truly do want to keep their patients and put their patient first.

Howard:  So, of those 12 locations all of those have 2 dentists or more?

Dr Ro:  Yes, they are.  At least 2 dentists.

Howard:  Is there like a blueprint that you aim for?  I mean, is your ideal like 2 dentists, 8 ops... Is it something like that?  Or is it just acquisition by acquisition all different?

Dr Ro:  We like to think that we have a box that we want to stay in of 2 dentists and 8 or 10 operatories but what we find is, to your point, every acquisition is different.  So, it's on an acquisition by acquisition basis.  We have an office right now that is 28 operatories and 12 000 square feet.  So, it kind of runs the gamut perse.

Howard:  And are you branding them all?  Are they all named Chicagoland Smile group?  Are you branding that name?  Like Heartland when they do a merging acquisition they never change the name.  Aspen, every one of their stores is Aspen.  So, what're your thoughts on the name brand?

Dr Ro:  We actually leave the name as it has been in the community for you know, sometimes upwards of 40 years.  So, we look at the local office as still being OldPark dental group or Olympia Fields Dental Associates that it has been in the community for decades.  So, we don’t change any of the names because to patients it's still   Manus Dental or OldPark Dental so we keep the names the same.

Howard:  Well that's what Kroger Grocery store does.  I mean, Kroger you know, it's Walmart and then Kroger is number two then I think Cusco's is three and then Amazon is four.  They leave the names.  Cali foods, Citi Markets, Cops, Dillon’s, Foods Co, Fred Meyers, Fries; that is what they had when I grew up in Kansas with Dillon’s, King Shoppers, Mariano's Fresh Market, Metro Market, Pick N Save.  So, you're doing the Kroger Foods?

Dr Ro:  Exactly right and you know, out of those in Chicago, we have Mariano's so, if you change the name of my Mariano's that I walk to on a weekly basis to Kroger Foods, I would think that I'm going somewhere different.

Howard:  Yeah, and I think it's funny how you know when Amazon bought Whole Foods last month.  I mean, all those stocks lost 15% of their value that day and I thought to myself, "Do you really think Amazon's going to replace all the grocery stores?" I mean really?  Sometimes you go to the grocery store you don’t even know what you’re hungry for.  You're just going to go down there and pick something up and the CEO from Kroger, I mean, who was almost laughing during the press conference.   Also, little things like so many people love the points off their gas so; if they go buy a bunch of groceries they can go get gas just a few cents over the cost of gas.  He's like, "Man, we sell better (00:13:04 unclear).

Dr Ro:  Well, yeah.  On the grocery store front, I'd love to have an Amazon drone deliver milk directly to my house on my balcony but when I go to the grocery store, I end up buying 10 other things outside of milk.

Howard:  Yeah, I just keep having nightmares of that drone landing on your front porch delivering milk and then your dog goes and attacks the drone, and the next thing you know you've got a complete a veterinary emergency on your doorstep.  So, a lot of the dentists, the reason I love getting guys like you on is that, these dentists listening, they have a really hard time managing one office that they're inside of 40 hours a week.  So, you’re out there, you are managing 12 offices!  So, give us some management tips that you’ve learned from managing 12 for a decade that this guy's having a hard time, I mean, he's in his own little practice, his own little world, he's been in there 10 years.  Number one, let's start with the math.  You have goals.  If you talk to any dentist they say, "Here’s my problem,   85% of my practice is PPO so I charge $1,000.00 for a crown but I got it just off $400.00 on probably 85% of my crowns."  So, the number one question is, do you take PPO's?  And then the second question is labor.  I mean, there are guys out there I mean, anymore it’s like the average dental office you go to, and staff labor is 28%.  There are dentists out there listening right now who have staff labor at 33% and so, talk about first things first.  Adjusted production.  What percent of these 12 practices are PPO's and what percent do you have to adjust off? What percent of your dentistry do you have to adjust off from what you charge to the adjusted production VISA by the PPO?

Dr Ro:  Yeah, so we are a PPO fee for service group.  So, I would say rough math, probably 75% of our patients are in network with a PPO.  So, when you look at it, you brought up a lot of good points.  Something that’s central to us is being able to maximize the amount of savings as being part of a group.  So, as you grow larger, different from a traditional one office doctor, we are able to get some savings on the supply side or we're able to get some savings on the lab side by partnering with some amazing local labs and then, on the insurance reimbursement side we're able to negotiate with insurance companies to tell them why it is that Chicagoland Smile Group office has better quality assurance, quality  improvement measures compared to a single doctor practice.  

Howard:  So, that is a huge advantage I mean, I've heard people that are out there that work for like Heartland and things like that I mean, one of their big work accomplishments is when you have 700 offices, you can negotiate higher fees.  Whereas if you have one office like Chicagoland, what's the chance one single, solo office in Chicago could call the PPO and raise your fee versus you calling them, representing 45 dentists in 12 locations?

Dr Ro:  Yeah, exactly and that's what I talk a lot about like the principle.  What it takes a team and we have a corporate team support centre of 25 individuals and I kind of affectionately refer to them as the ‘dream team’ and we delegate a lot of these duties to people that are experts in the field of insurance relationships and talking to insurance companies about why we are better and from that  to your point, I think for a single doctor office or 2 doctor office that’s busy taking care of the patient first and then having to secondarily or tertiarily go and talk to an insurance company about insurance fees and things that when you take into account accounting  then HR and hiring, continuing education and all those things that kind of ends up ranking pretty low on a dentist's list of things to do.

Howard:  So, when you're buying these practices you’re going to mostly, number one, you can negotiate higher fees for their PPO's?

Dr Ro:  Yes.

Howard:  I mean, pretend you're trying to buy me.  You’re trying to buy my office and get me to join your team.  What would be your key features?  You said you have 25 people in headquarters and I want to explain to the young kids, one of the best books I ever read back in the day was Emmett and the Emmett was what he was saying about his dream team.  That you have 2 types of people I mean, before McDonald's everybody that owned a hamburger stand, he and his wife spent all day.  The wife was taking the orders and setting the tables and getting the drinks, the husband at the back there making hamburgers and fries and they worked all day, every day just serving their customers.  But how McDonald's crushed everyone is they had this dream team of franchise headquarters where they are working all day on the business and they are sitting there watching the stuff, so like, every time you make a hamburger you walk all the way back to the freezer to go get 3 pickles.  "Let’s move the pickles closer" and they took that average.. before McDonald's, the average length of time in all of America to get a hamburger and fries in a basket and drink was an hour and McDonald's working on the business reduced that to 3 minutes and so you have a dream team.  The problem that dentists have today is that they wear too many hats I mean, it’s almost impossible to learn root canals, fillings, crowns and invisalign, implants but you can’t learn it all.  And you understand that so now you've got dental specialties.  Every time these dentists say to me, "well I’m going to go learn sleep apnoea” I said, "that’s fantastic, what are you going to give up?" and they are like, "I’m not going to give up anything."  I’m like, dude!  There are people that have only done sleep apnoea for 20 years who still barely understand it."

Dr Ro:  Right.

Howard:  So you're going add that and then you're going to master Endo and then you’re going to master oral surgery and master fillings, I mean it's crazy.  So, you've got to have specialties and you’ve got to have people working on the business. The other thing dentists do badly is they take Friday.  So, most dentists say, "well I only see patients Monday to Thursday because Friday I’m going to work on the business. And then Friday comes and they are exhausted from the week.  They say screw it, hit the alarm, they roll over and sleep until 10 and then they go play golf.

Dr Ro:  Yeah!

Howard:  So, those people are the ones negotiating higher PPO's.  So what type of overhead are you shooting for in these offices?  Go through labor, lab and supplies.

Dr Ro:  Yeah.  So, in terms of overall overhead, if we're running at a 30% margin.  So, 70% overhead I think we're pretty happy.

Howard:  But does that include the cost and include the dentist though? And specialists?

Dr Ro:  It does not include the dentist.

Howard:  So, you want an overhead of 70% before you pay the dentist?

Dr Ro:  Yes.  Well actually, I guess we might have to start this question over.  It does actually include. Maybe we can edit this part.  We look at, as a group if we're doing 25% overhead including the dentists’ salary and then the other part that we don’t include is the cost of the corporate labor.  So, we don’t put that into the individual office.

Howard:  Ok.  Go through that again.  Just  stick to the  details.  Go through overhead.

Dr Ro:  Yeah.  So, overhead as far as you know, labor cost to your point, we want to be in the 28% range.  Lab cost we want to be in the 5-7% range and then supply cost we want to be at 4-5%.  We actually do include the dentist wages into that equation.

Howard:  Now, are all the dentists, general dentists paid the same?

Dr Ro:  Yes.  For the most part, yeah.  There’s you know, they are paid on a percentage of collections minus some component of the lab.

Howard:  So, can you tell us what that is?

Dr Ro:  Yeah.  I think with legacy contracts I can’t give you all the details because sometimes somebody that's been in a practice for 30 years or 20 years might have a little bit different percentage.  So, I don’t want to...

Howard:  Ok.  What would your standard goal be though?

Dr Ro:  Yeah, the goal is 32-33% of collections.

Howard:  33% of collections?

Dr Ro:  Yeah.

Howard:  And so...

Dr Ro:  Minus 50% of lab, sorry.

Howard:  Minus 50% of lab.  And so, what I wanted to tell the kids on that is.  These are the ones that, a lot of times we're speaking over their head because we forget how old we are.  So, you charge a dollar for the dentistry but the PPO only gives you 60c?  So, a collection is also known as adjusted production?

Dr Ro:  Right.

Howard:  So you get a dollar but you signed up for Blue Cross, Blue Shield, PPO…  They’re only going to give you 60c and then let’s say you did cash patient.  Let’s say you did a dollar for the dentistry but you didn’t get the treatment plan done, you didn’t have the lady up front come, collect the money and the dollar went out the door while you were so focused on doing that filling for a dollar, there was no money collected so, you're not going to be paid.  So, you only pay a collection and so if an insurance company or a patient did not pay, the dentist didn’t get 33% of it?

Dr Ro:  Exactly.

Howard:  And then with the lab fee, I've seen this so many times.  When the dentist pays the lab, the associate doesn’t give a shit what the lab bill costs and they’re sending him to all these crazy labs and it’s all crazy.  Humans can justify anything. "Well, I want to have it done better because this is for my mom or whatever."  But the minute the dentist has to pay half the lab bill... And America, on these socialized medical schemes, it's completely insane because if you do dentistry without collecting the co-payment, that’s fraud.  That is absolutely go to jail stuff.  But that's what Medicare and Medicaid does.  So, they'll walk in there and say to their grandma, "you need to have your knee replaced and it's $50,000.00" and it's not out of pocket so she's like, "ok well you’re the doctor."  If America instituted a 5% of the deal, or say 10%.  Ok, it's $50,000.00 you're going to have to come up with $5,000.00.  What percentage of grandmas would say "screw that, I'm just going to take a Motrin and I'm not having this done."  I mean, then you say that to most government people they think you're a socialist Nazi.  People have to have skin in the game.  They look at Medicare and Medicaid as fraudulent.  Well, it is fraudulent because no one looks at the bill.  If you had to pay 10% of the bill, you would be in Chicago and say, "you know what, and I’m going to drive down to this small town.  I'm going to go to South Bend, Indiana."  What's it? It is only an hour’s drive from Chicago?

Dr Ro:  Yeah.

Howard:  "I’m going to go to south end.  These doctors quoted me $50,000.00 for a knee replacement and I heard in South Bend you can get it done for $35,000.00.  So, my copayment would go from $5,000.00 to $3,500.00” And it’s so obvious how you could save money on these entitlements.  So, I love the fact that you do that.  

Dr Ro:  In this game, it's very important yeah.

Howard:  So back to lab 5-7.  Of those 12 locations, what percent of those locations did you decide to do Chairside milling or switch from impressions to scanner?

Dr Ro:  We do digital scanning and milling at 2 of the 12 locations right now.  We have a clinical quality committee that we're just getting started with right now but we have 7 dentists with about 175 years of combined experience and what we're going to do is start to look at technology like CAD/CAM milling and digital impression technology and say, "Is this something that should go to all of the offices?  Is this a direction that the company wants to go?"  But we definitely, as a clinical quality committee, we want to be able to have experts.  Our own experts sitting around the room and asking the right questions so that overall, we could look at the patient experience and continuously have people that are working in the business but also want to help improve the business and say, "how do we make the patient experience better and better?"

Howard:  And, what percent of those 12 offices have digital x-rays versus film?

Dr Ro:  100% are all digital.

Howard:  And that's my point!  There are so many people out there speaking like everyone does CAD/CAM so everybody should do it.  Look at the adoption rate!  You have 100% adoption rate in digital dentistry but in America for the 150 000 general practitioners, only 15 000 have CAD/CAM  

Dr Ro:  Right.

Howard:  So the adoption rate and digital impression I don’t even think.  What percent of the dental market do you think is using digital impressions?

Dr Ro:  I would say 10-15% max?

Howard:  So, you guys out there!?  When people are making you believe if you want to be a good dentist you've got to do this.  Well, all your homies have 8-12 years of college and when 90% of your homies don’t do it, there is probably some very, very good reasons why they don’t do it.  Starting with the fact that it raises your overhead.

Dr Ro:  Yeah.

Howard:  Now here's a businessman who happens to be a dentist.  He has 12 locations and if he thought chairside milling would drop his total overhead cost by 5%, all 12 of those offices would have it tomorrow.

Dr Ro:  Yeah, and it's something that we are looking at the offices that we have that do CAD/CAM milling and chairside restorations.  They do a good job of it and they live and breathe it every day.  They do about 50 a month and it makes a lot of sense there but their adoption rate of it is; they live and breathe the technology every day.  So, for us, when we look at us as a bigger organization of 45 dentists and specialists, we want to make sure that there's going to be adoption across the network and if there's a ton of dilution as you know, it goes from one office to the other.  It is us at the end kind of lost and dropped the ball on it.  So, that's why we have something like a clinical quality committee that takes technology, what vendors, TV advertisements and things talk about and we put it into a forum, look at it with our own experts, and say, "how do we incorporate this technology into our company and is this the route that we want to go for the next 5 to 10 years?"

Howard:  Yeah, and you always want to follow your passion like, I know a dentist named Gigi in San Fran.  She loves lab work and not only does she not use the lab, she does removable and she just wants to do it herself and she loves it.  Yeah, if you love removable don’t let a businessman say, "Well, it will be cheaper to send it to a lab."  I mean, she likes to put on music and do all that.  I don’t ever want to make a denture again the rest of my life, you know.  The 3 units I made in dental school was more than enough and my friend Greg Stykin from dental school, we both graduated from dental school. His CEREC machine, I swear to God, he'd marry that thing if he could.

Dr Ro:  Yeah.

Howard:  So buying a CEREC machine or waxing up your own dentures is your passion, absolutely do it.  But you have to separate; I don’t want you doing something because you think you have to for economic reasons when you don’t have to.  Go through CE.  So, how do you handle the CE policy?  You have 45 dentists.  What if they all said, "Well I want to go to Poise this weekend and it is $3,500.00 a piece?  How do you handle that?

Dr Ro:  Yeah that's a great question.  So, on the Continued Education (CE) front, this year we offer about a 100 hour of CE across the group.  We have partnerships with Dawson Academy as well as Pacific Aesthetic continuum.  So, when we talk about continued education and speakers, we're really talking about the best of the best but, we're looking at our CE continuum and we're looking at restructuring a little bit so that a dentist chooses one to two out of school.  We're really getting them trained up in the bread and butter dentistry.  Efficient and effective composites, effective like PSV impressions, the Case acceptance, Chairside manner, and Endo.  We're getting them trained on what sometimes people refer to as not the sexiest of stuff but this is what we see on a day to day basis.  It's 80% of our day and single tooth implant restoration.  We're getting them trained up on that stuff before they start to look at smile design, echo-collaboration and things like that.  It's all part of a harmonious pathway but we are really putting some framework around tier 1, tier 2 and tier 3 continuing education as it applies to Chicagoland Smile Group and our doctors so that we could get them to be successful in the bread and butter dentistry.  And as they continue to grow, we have a CE program that can continue to grow with them and offer more and more in terms of,   anything that the Dawson Academy has and Pacific Aesthetic Team in terms of smile design and full art restorations.  Things like that.

Howard:  So you’re the best online CE.  I mean the best CE's?

Dr Ro:  Yeah.

Howard:  On Dentaltown, I mean, we have an Endo curriculum that the guys spent a million dollars on.  He's an Endodontist, I mean, he filmed this stuff over a decade of all these rare cases and all this stuff and then we put up another one.  ‘The Essentials of Endodontic Emergencies’.   we have like 19-hour online CE's.  So, we take our CE very serious.  We have 450 or something like that.  The course views are amazing and you can just... These young dentists with $350,000.00 student loans, every time they take a course again they get on an airplane and fly across the country and stay in a resort.  And you could be lying in your bed.  Like if you have an apple phone you can plug in apple TV, throw it on your big screen and you could watch this in your favorite chair at home.  Watching them, how to place implants and stuff.  So, the online stuff is high quality and low cost.  But do you have a budget?  Like, even if you get a discount at Dawson Academy and Pacific aesthetic teams, that’s expensive stuff.  Do you have a dollar limit per year or?

Dr Ro:  So, because of some of these partnerships, my own personal goal at Chicagoland Smile Group is to make it where our doctors do not pay anything for continued education.  so, we don’t necessarily have a budget for them but a lot of these partnerships that we've had and cultivated over the course of  10 plus years, Dr Robin Gay, is  the director of Clinical Education for us and a lot of these partnerships that she's had for 10 plus years, we have it where the fees for our doctors are reduced because of the partnership level that we have with them.  But for our doctors personally, when we onboard doctors I tell them that I want to be able to offer you 50 plus CE use on an annual basis but at the cost of zero dollars.

Howard:  What did you mean when you said continuing education and CSG's approach?  What's a CSG?

Dr Ro:  Yeah.  A CSG is just our abbreviation for Chicagoland Smile Group.

Howard:  Oh!  Ok, because I'm starting to think is that cost to goods and services sold?

Dr Ro:  No!

Howard:  My accounting brain went off and I'm like, "there is not an accounting term called CSG."  But I thought it was cost to goods...  Ok!  Ok, how old are you?

Dr Ro:  I'm 36.

Howard:  Ok, so I'm 54, you're 36.  Most people listening to you right now are all under 30 so this is a millennial thing.  Probably 20% are juniors and seniors in dental school and they are kind of getting afraid.  It's kind of like they know they’re going to get kicked out of home in 2 years and they are going to have to get a real job and work for a living.  So, what advice would you give?  I mean, this is June 30th, we're coming up.  So, this month 6 000 young, baby dentists just walked out of school.  They are 25, bright-eyed and bushy-tailed.  They think they learned everything and they don’t realize they just left dental kindergarten and it just started.  There's going to be a very rude awakening for them really quick.  What advice, if you were giving the commencement speech, what advice would you give them?  And are you looking to hire?  Some of these kids are in Chicago; do you have any jobs open for them?

Dr Ro:  Yeah, so there's a grade …

Howard:  Do you hire kids out of school or are you one of those older dentists that say, "No you need 5 years’ experience"?

Dr Ro:  No.  So, I'll answer all of the questions.

Howard:  I'm such a horrible interviewer!  I throw out 20 questions and just praying that one of them is good in sticks.

Dr Ro:  No, I think they are all good.  First off, in terms of dentists graduating from school and 6 000 dentists that are, graduating last month or this month, I help out.  I'm on the UIC College of Dentistry.  It's an alumni board and I was at the College of Dentistry yesterday and these are some of the things that we were talking about.  My advice to general dentists and young graduating dentists is, learn as much clinical dentistry as you can, I mean CE.  We talk about, Dentaltown's online CE program.  Take advantage of those things and just become an expert in what your hands and your mind have been trained to do over the last 4 years.  I don’t think there is any more valuable education and continuing education than that.  You know, be the best of the best.  Michael Gladwell talks about this in his Outliers book.  The rule of 10,000 hours.  I want to get to 10,000 hours to be an expert in dentistry, get to that and be the best that you can be in terms of clinical skill.  In terms of hiring, we have a great customized, I call it a customized, clinical prescription program but a customized on boarding program. So we do to look to hire young graduates sometimes and we have a custom clinical prescription on boarding program where I'm working with them on chairside and getting them up to speed and all things clinical and looking ahead and saying “6 months or 12 month down the road what does success look like to you clinically? What things do you want to be able to get more and more proficient at?” But we are always looking to hire at Chicagoland Smile Group and we're always looking for the best of the best and being able to train them. So that 5 years from now we could say that these are our guys, we trained these guys and they have been with us for the last 5 plus years.

Howard: Now are you the only owner of the whole group?

Dr Ro:  I am backed by a private equity fund here in Chicago. So I do have some investors as well.

Howard: So do they do other DSO's?

Dr Ro:  They don't have any other DSO's right now. But they're short capital partners. And they are only involved in multi site health care, under microcap sites. So everything that they do is health care whether it's concierge medicine, veterinary medicine, urgent care but they're always looking for other DSO's and high quality dental groups to partner with.

Howard: So back to CE, a lot of these kids are 25. They are coming out and saying again they believed all these things and our job as leaders trying to evaluate their thoughts. A lot of them think, well I have to learn how to place implants or I have to learn Invisalign or I have to learn sleep apnea or I have to learn CAD/CAM Chairside milling. What would you say to those forethoughts as they're walking out of school?

Dr Ro: Yeah.

Howard: Because some of them are scared that they did not learn any of that in dental school.

Dr Ro:  In January I gave a lecture at the University of Michigan's dental school and what I put together was a road map of when you graduate dental school, what do the first 5 years out of dental school look like? In my clinical road map for them I put learning dental implants or learning a new skill, sleep apnea, CAD/CAM restoration whatever it was, I put that in year 4 or 5 post graduation learning curve because you don't know what you don't know. When you get out in the private practice it’s a very different world than it was in dental school. I remember that quite well and lots of our listeners remember that all too well and it's getting your $10,000 in before you're looking to stand back.

Howard: And that's what the coaches all say in college football. “They say you want to make the pros? There are 4 things to do; perfect a block, a tackle, a pass and a reception. Don't worry about all the other noise. You’ve got to nail that.  If you're going to NFL, you got to perfect those 4 basic things”. When they come out of school they need to do a filling, a crown, a root canal and they start learning all this other stuff without nailing the basics…Go ahead.

Dr Ro: I was just going to say with our continuing education program we look at bread and butter dentistry like our tier 1 of our continuing education program then it's not something especially you get to read a lot and view a lot in dental school of what everybody in the outside world is doing and our human nature is to look at the higher class sexier things and say I want to learn how to do it all in 4 restoration. I want to learn how to place implants but you have to be able to crawl before you can walk and then walk before you can run. Some of the stuff that we're talking about whether it's composite restorations or simple crown and bridge dentistry, it doesn't seem sexy but it's a foundation for so much other stuff.

Howard: There's only one thing I want to caution about. This is Dentistry uncensored, and I've been pissing people off for 30 years, I piss them off because in my wound up brain I really love and adore and respect you. I'm going to tell you exactly what I think and I'm not going to sugar coat it. I'm not going to hide stuff from you but you know there's another threat on Dentaltown and you see it all the time, this one is called “Another death”. An 18-year-old kid goes in to have his wisdom teeth, the doctor does sedation and he dies. I want to tell you something that when you think you're going to learn IV sedation; my God, you're playing with someone's life! I know several dentists who in their course absolute accidentally the person did not wake up and it ruins their life. They cry, they're sad, they're depressed! When you go sit on that witness stand and you think you're a doctor and all that, they're going to bring a board certified anesthesiologist to that trial. Guess what he is going to make you look like? The person who has a dead patient!  So I want to go into that especially because you have got a lot of liabilities, If you’ve  got 12 locations and the lawyer is saying “this guy”, it is you they're going to go up to, the big dog! No one sues the little old lady who knocks you down in the grocery store when her wheelchair runs over your foot. As you get more and more money you are a bigger target. I mean how often do you hear of a death in dentistry on Facebook and the newspapers? It seems that we can't even go 3 months without someone dying in a dental office and they all have one thing in common; IV sedations! So do you let general dentists do IV sedation in your 12 offices?

Dr Ro: We don't. We have 2 oral surgeons, 2 board certified oral surgeons that do IV sedation, other than that we look at specialty at Chicagoland smile group to complement the general dental practice but again when you're part of a larger group the processes and procedures that we have in place is different than what a single practitioner can get to do and be more cavalier and want to do all of these sexy things like IV sedation for us at Chicagoland smile group. We really focus on bread and butter comprehensive care dentistry and we leave a lot of that level of specialty care practice to a board certified specialist.

Howard: Yeah and that is the only thing. Do you have any children?

Dr Ro: I don't. I have a fiancé and no kids yet.

Howard: You are so smart. My God no contracts yet! But you know when your wife goes into delivery it could be 3 o'clock in the morning when the OBG walks in and says and he is not going to do an epidural he's not going to do that. He just pulls out his pager and pages an anesthesiology service and some guy shows up like 5 minutes. Every time this happened to my boy I said “were you like in the cafeteria?”  No, you know I just sit at the office and read or I'm at a coffee shop, whatever. So in a place like Chicago, you have so many anesthesiologists on call. Why would a dentist in Chicago go try to learn something as dangerous as this I just do not like it and it's always all over the media. Do a Google search just type in ‘died in dental office’ and see how many search hits you see. It’s crazy! So what specialties do you rotate and do they rotate to all 12 because there are 9 specialties? How many of the 9 specialties do you have rotating in Chicagoland smile group?

Dr Ro: Yeah so as far as the rotation goes with the specialist we have a Periodontist, we have a few Oral Surgeons, we have a Pediatric Dentist, we have a 4 certified Prosthodontists, we have a few Endodontists, and we do have some specialties that go to every office but depending on the office sometimes we have multiple specialties within one practice as well.

Howard: Like the larger ones at a full time.

Dr Ro: Yes.

Howard: Okay so basically periodontist, pediatric dentist, prosthodontist, endodontist?

Dr Ro: And oral surgeon.

Howard: And oral surgeon. So I didn't hear orthodontist.

Dr Ro: We do have 2, I left that out accidentally. We do have 3 actually great orthodontists that rotate through some of our offices.

Howard: So the orthodontist they just rotate through some, not all 12. Which ones rotate to all 12?

Dr Ro: Nobody rotates to all 12. We like to…

Howard: No I'm talking about a person. I'm talking about an individual specialty. Which of your 12, how many of your 12 locations do any of this specialties show up in all 12?

Dr Ro: It would be Peoria would be the one.

Howard: Peoria that would be the only one.

Dr Ro: Yeah.

Howard: And then pediatric dentistry, God loves those people, isn't that amazing? Seriously if you are to be a full-time pediatric dentist and all you do is install crowns on crying kids. I'm looking at your Chicagoland smile group and I'm thinking would you climb to the top of the Sears Tower and jump or what would you do?

Dr Ro: We're very blessed to have a great paediatric dentist that has been doing it for decades; Dr Morin, yeah we bless him for keeping it all together

Howard: They don’t call it Sears Tower anymore do they? What do they call them now?

Dr Ro: They call it the Willis Tower but I was born and raised in Chicago. I will forever call it Sears Tower.

Howard: It's a great icon of what went wrong. I mean their number one mistake is what went wrong.  Their best idea was to spend 1 billion dollars of overhead to build this monster building while Walmart started in Bentonville Arkansas and Sam Walton's desk was two horses, what do you call those Cardinal horses and a door lane over it? And when that guy was worth $50 billion, his desk was still a door sitting on 2 wooden benches and he had a picture of that Sears Tower.

Dr Ro: He did.

Howard: His was about keeping one eye on the customer and one eye on cost. Once you take one eye off the customer and one eye on cost, your customers can't afford what you sell. And those guys went and built a billion dollar flex symbol in downtown Chicago and the low-cost provider Walmart custom. The reason I'm bringing out these point is because a lot of dentists believed in unicorns and fairy tales that the PPO's are going to go away and it's going to go back to the way it was in the 50's where you just send Delta your fees and they're just going to pay it. And those days are truly gone, aren't they?

Dr Ro: Yes. I think that my own research shows at least 80% of Americans have had some form of PPO dental insurance. And I don't…

Howard: Well, it's 95% take Delta's PPO; Delta premier and by definition of PPO's they're telling you the fee and you are not sending the fee, you are paying only a percent. So 95% of the dentist pay delta correct?

Dr Ro: Yeah. That's, I think that…

Howard: But what was your research? Continue on the research

Dr Ro: No I was saying, I think 80% of patients have some form of dental insurance; PPO dental insurance. We see that as the norm and about the unicorn in going back to fee for service dentistry. I think for us at Chicagoland smile group we look at the PPO market as the norm and still provide a high-quality patient care in terms of quality of patient care and patient experience, so that they keep coming back and they bring their families and they refer a lot their family and friends to us. That's kind of what our mantra is around here at Chicagoland smile group dream team office.

Howard: So why do you have a periodontist, as the specialist that goes in those 12 offices. Why do you think it was that as opposed supposed to pediatric dentistry or endodontics or oral surgery?

Dr Ro: Perio was the first one because of the dental implants standard up care.

Howard: Periodontist is placing your implants?

Dr Ro: Yes. And so

Howard: Okay.

Dr Ro: It was kind of the lowest CAPEX cost to bring in a specialist. We have an Endodontist that goes to about 5 or 6 locations and when we look at the standard of care for an Endodontist we're talking about a microscope and bigger investment which we want to make. We believe that for an Endodontist that is the standard of care.

Howard: Yeah and that's exactly young kids magnification of everything. I mean, you want to be a better dentist well instead of using your naked eyes, put on loops. The biggest error in loops is if this Dentist is working with loops and then he leaves, the assistant or a temporary does something while she is not wearing loops. You know I say anybody that has to have her hands in her mouth. The hygienist will clean teeth better and not miss as many cavities and tartar if she's wearing loops. And like the Endodontist, they want a microscope. The only advantage I see of those scanning the impressions which got me interested is the fact that when you take a scan you can see the tooth, the impression for the arcs(00:52:33 unclear). That's the only thing that has caught my interest but you know in my wound-up brain if I can buy 3M dental gum for $17 impression and they say, well we will buy your $17,000 scanner. My dear, that's a lot of impressions and it's not just buying the scanner or 17,000, I need the investment, I got to sign a contract where they still get dig me for a couple of hundred dollars a month in perpetuity. And I look at that in perpetuity and I could still do all my Impregum impressions with just that amount of money.

Dr Ro: Yeah. Then you can't calculate the ramp time and the adoption rate but we look at those numbers too. How much time do you have to spend at out of a patient's mouth or without being able to help a patient to learn the technology and how likely is your office going to adopt that technology? I don't know the answers to some of those questions and because of that is why we rely on something like our clinical quality committee to sit and have very smart people at the table discussing what we should do in Dentistry, what's new & great and how does it apply to a bigger group?

Howard: The reason you hear so much noise on it is, going back to passion! Some Dentists just think doing their own lab work is cool, some Dentists think technology in and out just of itself is just cool. I mean they are just enamored by the technology but don't let your passion for all things technology cloud your business advice. So the next most logical question is marketing advertising. How do you feed that beast? I mean you have to feed a Godzilla whereas mostly we just feed a Doberman. How does your marketing feed 12 offices?

Dr Ro: We have a dedicated marketing resource. Molly is our director of marketing and patient experience and she is absolutely amazing. The programs that we put together for offices, some programs like online scheduling or email confirmation and text communication is a platform program that we do at every office. But it is also dependent on the office because they're locally branded and they have their own local flavors. We're able to take marketing programs and be able to customize them per office. So that we look at their community and say what does make our remunerable practice most successful and what does make our down town Manis North western office most successful and Molly is very good at those nuances. To your point, to feed the patient volume of Godzilla versus a one office dental group, it does take a dedicated and a very quality resource like Molly.

Howard: So how do you work on the obvious dilemma? Where and what's more important getting them in the front door or not losing me at the back door? I mean, it's very obvious that you build a website and 10 people land on it and maybe 3 convert to call it and the receptionist only converts 1 of those 3 to come in the office. So if you look at the average dentist to a 675,000 a year and getting 145,000 a year to do that one filling the treatment plan acceptance case is only one third. So he has to get 3 people to come in that each has a cavity in order to do this one filling which is 600 and say 5000 Euros. So to get 3 people in whereas conversion ratio of call to come is 3 to 1. So he has got to get 9 people to call. So now his website has to get 90 people to land on his website because your website so bad because it doesn't have a video. Like you, you know you have an amazing persona. Look at that smile. But you can't see that and feel that on a mug shot. It's got to be a YouTube video and these websites are ecstatic there. So 90 people have to land on their site for 9 people to convert to call. So 3 people come in each to do one cavity. So what percent of Molly's time is on that versus the back door where the hygienist saw 8 people today but she only scheduled six for a 6-month cleaning so you just lost 25% on the gate? Then when it is 6months and it is time to come in, one has to reschedule. Everyone loses that and just keeps losing because you don't do things like when you do a root canal. Another way to save them is not just hygiene recall but you have to tell the patient "I have to take a 1 year PA of this to ensure good health. See the realist thinking around there. Doing the root canal you're out of pain because you don't have a nerve but I won't know if this has worked until the bone the fills in so I want to schedule you 1 year from today to make sure that you don't have a bone loss". There's another recall that happens and that is the implant, if in 60 months 20% of implants have peri-implantitis then you’ve got to say “look I put this implant as your warranty but I have to take an x-ray at 1 year to make sure you do not get periodontal disease around it. By the way, the reason we pulled that tooth you is that you have periodontal disease”. So they don't focus on the back door to the point that the average dentist will say I get up to 5,000 charts but that's your 10-year deal only because 4,000 don't have an appointment. Which is the only definition of that if you know what I mean? If you're a young kid and you're trying to buy old McGregor’s practice, u say, "yeah I've got 5,000 patients". No, he has 5,000 charts. If they're not scheduled for something they're gone. And by the time the average Dentistry is the 5000, 4000 of them have never been inside one time in 24 months. So my question to you is simply this because I read between the lines you said Molly is in charge of marketing new patient experience that is, keeping your patients. I look at the fortune 500 like Chicago is headquarters of Chase and my Idol runs Chase. What's his name?

Dr Ro: Jamie Dimon

Howard: Jamie Dimon who I've had dinner with 3 times. Whenever he comes to town my branch manager at Chase is in the same parking lot of my dental office for 30 years and she knows I read his boss’ book, his mentor was Sandy Weill's who started Citigroup. Then Jamie Dimon was number 2 in command till the rumor has it, asked his daughter out and then that was the end of that relationship. So it went to Chase but you know you look at big guys like Jamie Dimon, they're not trying to get new patients. They're doing loyalty programs, airlines, American airlines. They want to spend all their money keeping patients for life. Whereas dentists are still back in this last generation where they're trying to get a new customer on the door and the silliest thing you keep seeing is when you go to a town of 5,000 out there in middle of nowhere Oklahoma, is Dentist who has been practicing for 25 to 65 years and you ask him "hey buddy what do you need? What do you want to learn today?" He replies "I want to learn how to get new patients". Buddy, you've treated everyone in the town twice, how would you need a new patient in a town of 5,000 after 4 decades? So my question to you is this, is Molly more concerned about blowing open the front door or closing the back door or how does she balance loyalty program back door marketing front door?

Dr Ro: The cost of acquisition of a new patient of somebody who doesn't know your address, doesn't know your location, hasn't been there, hasn't met Meeky at the front desk, the cost of acquisition of that patient is very high. The cost of the retention of the patient is significantly lower I would say.

Howard: If you were in a shark tank and Mark Cuban said to you "what is your acquisition cost of a new patient?” What would you tell him?

Dr Ro: I would say our patient acquisition cost is roughly about $100 a patient.

Howard: Okay a hundred a head, that's low. That's good.

Dr Ro: But the cost of acquiring a new patient and getting them in for a hygiene appointment and if we didn't wow them, and we didn't give them a great patient experience, if they never come back, we actually lost money on that patient. And so for the back end of being able to keep patients in the practice, we do look at a number, a KPI that came to mind when you were talking. We measure reappointment rate and we want to know when a patient comes into our practice and leaves. What percentage of the time do they schedule? Do they have their next appointment schedule?

Howard: The kids don't know what a KPI is.

Dr Ro: Key Performance Indicator. So for us, reappointment rate is essential. If you ask a general dentist they say yeah 104% of my patients come back, they always come back. They make an appointment duty of the front desk always make sure they make the first appointment. We say "okay, well here's our measure" and in my perfect world mind, I want to shoot for a 100% but sometimes people don't have their work scheduled than this. So we're shooting for 85 to 90%. And…

Howard: So think about this, guys, he's got 25 people on a dream team that only work on the business and his goal is an 85%. What do think yours is? I know in your wound up brain you've never had a root canal filled never mind that there are 4,000 Endodontists in the United States, they spend 80% of their time retreating failed root canals. I've never met a dentist who has actually had a root canal filled working out. So I guess Endodontists only treat immigrants from other countries that have had root canals done before they landed and so 10% of root canals according to insurance are extracted in 60 months. Number 1 cause is you didn't input the final crown on. If they can't afford a root canal and a crown then don't do it! Use that thousand dollars they have to pull that tooth and do three other cavities. Most Endodontists have 5% of their teeth extracted after 5 years, why? Because they were too aggressive on a fractured tooth. But if you are shooting for 85% reappointment, what do you think the average hommie listening to this thing has right now?

Dr Ro: Yeah I would say it is between 65 and 70%.

Howard: I would say it's fewer than 40.

Dr Ro: You are the uncensored one, I am just an interviewee

Howard: You're the nice guy. Yeah. But you are giving them something. How would he listen to you? How could he go to work and you know half of them are on dentrix and eaglesoft and they think that's good software, just like they did the root canals filled. You know, when you think dentrix and eaglesoft are greater on your business, how would they get on dentrix and eaglesoft to figure out their re-appointment rate?

Dr Ro: It's a tough week. So we as a company at Chicagoland smile group, we run dentrix enterprise and we actually end up working with third party data sourcing to extract data and we run our own statistics and numbers. Because a lot of these practice management software are not sensitive to data and information because for decades I mean it's not valuable. Dentist don't need that, they only want to know how many crowns they did, how many root canals they did, they want to know how many implants they placed. That's they all need to know according to some bigger retailers.

Howard: Now you are a sweetheart, I actually love you. I mean you just referred to dentrix and eaglesoft as not sensitive to data and information. That's the nicest way of saying dentrix and eaglesoft should rename themselves, one should be Stevie Wonder and one should be Ray Charles. If you're trying to run your business with those 2 to call them management information and I'm never going to shut up about it until they fix it. A lot of people say to me, "guy go easy on them". How can I go easy on them when these dentists don't know what it costs for them to do a filing. I mean they just were in the room for an hour and did 2 filling and have no idea what it costs. They signed up for 12 different PPO plans. So they have 12 different prices of selling something that they don't know the cost. The problem is if most of the Dentists went to Chicago they wouldn't be smart enough to visit you, they would go over t Briscoe and find out what's eighteenth generation bonding agent.

Dr Ro: Yeah I know.

Howard: That would be the answer to all their prayers.

Dr Ro: You know business intelligence and data we talk a lot about it a lot in our company that if you can't measure it you can't manage it. So for us, we want to be able to measure some of the things like reappointment percentage and clinical outcomes. We want to be able to measure those things so that we could look at our Dentists and Hygienists help them be better. Our RCFO works essentially day and night to be able to get this numbers and data together. But it's something that we do on our own.

Howard: Yeah and I want to go back to the passion deal. Corporate dentistry versus owning your own practice. I'm telling you that if you don't have the passion for business intelligence data, you should focus on the dentistry. Because if you just wanted the dentistry since I know you are talking a lot about balancing work and life if you want to have balanced life and work 9 to 5, you need to be in corporate; because 9 to 5, if you own a business, means 95 hours a week; that is 13 and half hours a day, seven days a week. It is a lifestyle that never goes away. So if 9 to 5 means Monday to Thursday you need to be in corporate and If 9 to 5 means 95 hours a week then you need to be an owner. If you are 9 to 5 I'm sure dentrix is wonderful but if you are a 95 hour per week then that is horrific business intelligence and data. Are you thinking about switching to open dental seems like everybody that's really in the business senses and data switching open. That is because it's open, and then you could actually hire a programmer to sit next to your bookkeeper and just add on program in it, it's open. I mean basically, once you signed to open dental you can program to your own code.

Dr Ro: We are. I think because of the back end structure we have with being able to manipulate our own data we are for the time being happy with dentrix enterprise not to say I wouldn't love a custom practice management system but it is a work in progress.

Howard: Well, I switched to open and anybody that is listening knows this is really in the business intelligence and data. The owner, Jordan Sparks is a dentist but he is kind of not involved whereas his brother, Nathan, is very open minded and we might get a group of people that are really in the business intelligence and data. It is a layout of the framework; we could use my office as a prototype. I've called my office, today's dental number 1 prototype since 1987; I stole that from the EPCOT center. Remember EPCOT; Experimental Prototype Community of the future? What is it? E P...

Dr Ro: C O T

Howard: Community of Tomorrow.

Dr Ro: Yeah.

Howard: Experimental Prototype Community of Tomorrow. So I called it the case dental prototype number 1. So 30 years later you know you're still just altering it and that is the business because remember the SMP 500 listed in 1950 and by 2015, 88% of those companies were gone. So there was only a 12% survival rate in 65 years. So I'm telling you business is constantly moving and it's a lifestyle. So if you have a passion for chairside milling, do it; Passion for laser, do it; If you just really want to place implants among them, do it; but if you're going to open up your own office, you better be passionate about business.

Dr Ro: Yeah 100% and you know I'm on the open dental if you guys are going to get a group together to look at something like that definitely put me in the mix. I'd love to be part of that discussion.

Howard: Well I think I'm going to do that. So I think what I'm going to do is maybe we will have a what is it called when you are brainstorming? What is this group called?

Dr Ro: Roundtable, absorption.

Howard: Round table, think tank kind of a business intelligence where you can get people, wet glove, I like the wet gloves for clinical, and I like the dry hands for business and where you could get some of the smartest dry hands in dentistry that work the walk talk. I mean now we can work on an open system like what do we need to know on just little things? Dentists believe in fairy tales because they don't have any data but when you give them data like trigonometry, geometry, calculus they got A's, applied mathematics physics they got A's, applied physics chemistry they got A's, applied chemistry biology they got A's. The problem in their business is they have no idea of the data. Like they'll say to Dentists "Is your website good? they say it's awesome. Really? Well how many hits does it get a month and how many of those convert to a phone call?"

Dr Ro: No idea.

Howard: So that guy is smart. He's smart as hell; he got A's in physics. If he sits there and said well, the Chicagoland smile group every time they get 10 hits, 1 person calls. Your office gets 98 hits for a call then he knows, "okay I get it". Now he starts studying it and what the difference was. Then the receptionist, "what do you think about your receptionist? She's awesome" and that is because she's nice, smiles, and cracks up jokes and laughs at all your stupid jokes but you don't know what her conversion rate is? Your favorite little girl over there, 4 people have to call her before she converts one into the chair and then you present a treatment because you are the doctor and you only have a 38% conversion rate. When I pulled you out of it, I put in a treatment plan coordinator. She goes to a 65% close rate so she is twice as good a dentist as you because if you were a fireman you're only going to 1 out of every 3 houses on fire. So I don't care about your bombing agent. I would rather just remove all decaying and packed them with butter and sit there to just remove the decay on 1 out of 3 and put whatever Briscoe restoring bombing agent you want. Then the back door, if someone as is amazing as you because you are amazing if your goal is the 85% reappointment rate. Well, I'm telling you, just the dentists in Illinois are not even about a third. They're probably 35 to 40%. I mean I've been in this field for 30 years. I had my MBA in 1998, they don't know their numbers but they are smart. My homies are smart, they're doctors. You show them the numbers, they'll get an A and my goal is that with open dental, we can bring in our programmers; we can use theirs, whatever. If my homies actually had a dashboard that works and another thing they have to do which Nathan agrees with me, is that when you go to Rich Carlton who has the greatest service in the world, they only have like 9 things on their computer to check you in: you open that denture, you hire some new girl and she opens up the screen. There are 84 million things you can do and they'll tell you on the report generally that 80% of it's not used ever. Whatever that is not used is clutter, it is noise and now she forgot to do an incredible thing. So the most important thing we have to do with open dental is to post out all the things we don't use. I mean could you imagine taking in your car back to her training park to Chicago airport and the guy opened up dentures to check in your car.

Dr Ro: I would never make a plate

Howard: So if your business has decided not to use this, it needs to go off the screen so that you get a template. If you want to close that back door, I can't check you out until I've done one of these 5 things including scheduling your reappointment rate. For the staff meeting to start, we have to know how many patients we had yesterday that we started it. Do we have a thousand? How come today we have a thousand eleven? Who's not scheduled for something? It's not rocket science; everything we're talking about, McDonalds’ was doing in the 50's. You know?

Dr Ro: Yeah and that's exactly right.

Howard: And my old man, I'll tell you what, he had 9 sonic drive-ins. What's so funny is the cash register back then was the national cash register and it was eventually bought by IBM, but my old man had more business data to run a sonic drive-in off the cash register than his son, the doctor, did 40 years later. How sad is that? I mean, the cash register, the employees, they clock in and they clock out, had a little roll of paper, and when you ended out the day this big log tape came out and you'd know all kinds of little things. Like how come you sold 118 medium drinks but you used 119 cups. I mean just all those stuff, so that's my goal in passion. I want to help these kids run a business. All I want for Dentists is to be happier and healthier. That's what all I want to do. Be happy, healthy, be passionate and have fun. You only live once and you die and it's this source of massive stress that is easily fixable.

Dr Ro: Right. And for Chicagoland smile group, our goal for our Dentists is for them to be able to focus. You made this point a little bit earlier and I thought it was wonderful. I want them to be able to focus on what their passion is about, which is most of the time it's their high quality of dental and/or specialty training and talking for us, we want our on the business dream team people to be able to take off all of the back end functions so that they don't have to worry about those things. They could just focus on patient care, high-quality patient care, patient experience and that's one of our passions here at Chicagoland smile group. To be able to do that on a day-to-day basis.

Howard: Well I'm your biggest fan, I called you, and you didn't call me. I'm so honored today that on a Friday before fourth of July you decided that come on my show and talk to all my homies and they really appreciated having someone come on that's running 12 offices with a couple of hundred employees because they're stressed out as 1 dentist with 5 employees and I really want to thank you so much for taking your time to come on the show today.

Dr Ro: No problem, I really appreciate and I am always happy to help and better the profession of dentistry.

Howard: And we'll get that

Dr Ro: Thank you so much, Howard.

Howard: We'll get on that thing.

Dr Ro: I'm going to hold you too. Because business intelligence is what we need.

Howard: Yeah that's it

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