Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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833 Unleash Your Practice with Sandy Pardue, Laura Hatch, and Rohit Garg : Dentistry Uncensored with Howard Farran

833 Unleash Your Practice with Sandy Pardue, Laura Hatch, and Rohit Garg : Dentistry Uncensored with Howard Farran

9/5/2017 3:09:39 PM   |   Comments: 0   |   Views: 360

833 Unleash Your Practice with Sandy Pardue, Laura Hatch, and Rohit Garg : Dentistry Uncensored with Howard Farran

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833 Unleash Your Practice with Sandy Pardue, Laura Hatch, and Rohit Garg : Dentistry Uncensored with Howard Farran

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AUDIO - DUwHF #833 - Unleash Your Practice

Howard brought back three amazing podcast guests for an epic group discussion on managing your phone calls, hiring and firing, watching the numbers, and a whole lot more!

Sandy Pardue, Senior Consultant and Lecturer with Classic Practice Resources, has consulted with offices throughout the U.S., Canada and Mexico. 

Dentistry Uncensored #32

Laura Hatch is the founder and owner of Front Office Rocks a company with the goal of helping other dental offices train and learn new policies and procedures that her team and has proven very successful in making dental offices work better. 

Dentistry Uncensored #235

Rohit Garg is one of the co-founders of Practice by Numbers alongside his wife, Dr. Aditi Agarwal, DMD. 

Dentistry Uncensored #740

Howard: My god, it is a triple huge honor today. I cannot believe I'm gonna be podcasting interviewing Sandy Pardue, Laura Hatch, Rohit Garg. You guys all know these people. Sandy Pardue was episode thirty two and I credit her for why the show got so big. I think that was my breakout when I got on Sandy Pardue on episode thirty two. She's a senior consultant lecturer with Classic Practice Resources, has consulted with offices throughout the United States, Canada and Mexico. Her website, Laura Hatch is a legend in my mind, has always been. She's the founder and owner of Front Office Rocks, the company with the goal of helping other dental offices train and learn new policies and procedures that her team has proven very successful in making dental offices work better. Her website is She was on podcast episode 235. She's from California. Rohit Garg is one of the co-founders of Practice by Numbers alongside his wife, Dr. Agarwal. His website is He was just on podcast episode 740. He's from Seattle and I thought wouldn't it be cool to get you three legends on at the same time and how I want to open this up is you guys are out in the field in the biggest ways. What are you seeing in the field? What's the state of the dental industry? What problems are you seeing and solving out there in dentistry? Who wants to start? Shall we start with Sandy since she was on the first? She's the one who made this show possible on episode thirty two. By the way, that was a big breakout episode. I mean, I was putted along and then I had you and I think this show doubled at that moment.

Sandy: I get a lot of positive feedback from that episode. Absolutely still. Okay, what do I see? Wow. I talk to dentists daily. I talk to dentists daily on and they call me. I hear the same things over and over again. They are trying to gain control over their practice and they have staff issues, that's number one. If you ask a dentist it's gonna be staff issues. They're clueless about how to start and get organized and motivate their team and raise their income but you know, I'll ask them basics. Like, “How many new patients are you getting every month?” “You know, I'll have to check with my girl at the front desk”. What's your full-time equivalent statistic? Which is something that we've been keeping since the ‘80s where we take the number of full-time staff equivalent and divide by the collections in the practice and we get a number which we like that. Our clients, we can kind of tell if somebody's hanging around 150, 175,000 per staff member. We know we can help them a lot and if they're closer to the $200,000 mark, we know that they're probably doing well and we can help them with some systems. They are clueless about how their practices are doing and that's what I'm seeing and we're helping them by organization.

Howard: Okay. Explain get full time equivalents one more time. So, you take the total collected revenue divided by number of employees?

Sandy: Full-time. If you've got two part-time hygienist and the two of them together equal one person then that counts as one person. So, it's full-time equivalent and then we – okay.

Howard: So, you have total collection divided by a number of full-time equivalent employees and what would you like that number to be?

Sandy: If they're close to 200,000 or above I know that office has a lot of good things happening. That they are pretty much organized and they're getting the most out of their team members that they can.

Howard: What would the average be?

Sandy: What I'm seeing is anywhere from 150 to 175.

Howard: So, A would be 200 above, what would you put 175? Would that be a B or C?

Sandy: Yeah. I can really help that guy.

Howard: Okay, but what letter grade would you give that?

Sandy: I would say that they're lower. Anybody there is low like they need a lot of help.

Howard: So, 175 you put it as a C and 150 you'd put as a D or not?

Sandy: A D or an F, yeah. D or an F.

Howard: Okay.

Sandy: I’ve only seen one or two people below 150 actually.

Howard: Yeah.

Rohit: Yeah, we’ve only seen 150.

Howard: No matter what though remember, if the earth goes around the Sun everybody gets a dollar raise because it's based on the zodiac.

Sandy: Yeah, that's the way it is. That's what they think.

Howard: All right. Laura Hatch, what are you seeing?

Laura: I'm agreeing with Sandy a 100%. I think that dentists want to have better control over their practice and they don't know how. The great thing is there's so many more resources now. I think when I got started in 2002 we didn't have the internet. We had to go to courses, go to seminars, go to conferences. Now we have the internet. We have software. We have a lot of tools but like Sandy said the doctors need to know where to start. Like what do I do first? What do I fix first? They're challenged by that. Do I fix new patients? Do I fix marketing? Do I fix my staff? All they know is to produce, produce, produce, produce, which is great but if you're not effective and you're not efficient you're doing dentistry. At the end like Sandy said, at the end of the week they don't know their numbers. They have to go to the girls up front and it's almost like they're working for their staff versus their staff working for them. I believe that now there's a lot of resources that can help them which is great. They just need to know where they need to fix and where they need to focus first.

Howard: Rohit, what are you seeing?

Rohit: Well, what I saw and again I've been involved in dentistry only through my wife because she is dentist and I hope to grow her first practice and then a second practice is that there's so many moving parts in our dental offices, okay. I mean any dental office you can see a month for dental offices that doctors and dentists and (inaudible 6:19) they cannot keep track of all the moving parts. Moving parts I mean of course there's all the different processes but there's also different numbers and keeping your staff in your office accountable. That's one of the reasons we started Practice by Numbers is just to be able to bring accountability to your front office staff, to your back office staff, to your marketing organization, to your doctors and hygienists and the associates. Without knowing numbers it's kind of shooting in the dark and that's one of the problems that we have had that we go into an office and we ask them, “So, how do you think you're doing like?” “I think we’re doing pretty well. We have patients that are coming back and patients are scheduling and our treatment acceptance are signed ”. Most times people are unpleasantly surprised that well this is not what I expected. So, that's what I see that people just shoot off the hip, shoot from the hip or whatever the saying goes. Laura?

Laura: Well, what I was gonna say is and it's not just the doctors, unfortunately. It's also the team, it's the staff. So, a lot of times they want to do better. They want to fix the practice. They don't know where to start and if you don't know where you are you don't know what you can improve. The doctor comes up and says, “Fill my schedule” and then the staff sitting there going, “With what? So, not having the tools and resources and knowing where you are, everyone's kind of spinning trying to do their best. I mean, I think everyone's trying to do their best. They’re just not working in a unified manner with the team and the doctors all going towards the same direction.

Rohit: Right. Right. One other thing I want to add is that there are a lot of doctors who do create goals and their goals are great. They do have goals for production and what is it that you want to do profitability, but remember those goals are so high and lofty that it's hard to take those goals and translate those goals into meaningful actions. That's when you need to be able to really understand what's going on in the practice, to be able to take those high-level goals. Maybe let's say there's a goal of half a million dollar profitability. How does that goal relate to an assistant who's working in the back? The assistant doesn't care. So, you have to make the goals small enough and bite-size enough that your individual staff members would care.

Howard: You know it's funny how the first thing you said, Sandy, Laura was that they're complaining about staff issues, right? You both agreed that was number one.

Sandy: Absolutely.

Howard: I heard you know the other day, Ryan burst that often. His dentist is whining to me about how he feels like his stay-home wife doesn't support him and doesn't help him and that all of his problems, or because his wife staying home and having kids and he has no support or help or anything. I just said, “Dude, could you imagine a press conference with Steve Jobs from when the Macintosh was falling and he's like, “Well, my wife isn't helping me. My stay-home was a-“ Could you imagine if Andy Grover of Intel is at a press conference someone says to him, “Well, my office manager won't help me and my assistant is like” Dude, can you ever just call bullshit and look at the man in the mirror? Nobody in the Fortune 500 would blame shit on their stay-home, poor wife raising babies, and their poor receptionist who's named after a piece of furniture, my front desk lady, they just never man up and grow a pair. So, do you think the staff issus is basically a way of saying just deflection. It's not me, it's my staff. They won't do anything. They won’t do anything. Instead of just realizing there's other dentists that own the ball on the court. So, how do you see that staff issue? Is that just whining and they don't have a mirror in their house. They can't see the man in the mirror or their staff really just freaking clueless?

Sandy: Lack of leadership. It totally 100% lack of leadership. Say, every other month I have a whole new group of clients coming in and we just did it this past weekend. Great dentists, a quality dentistry, the staff having a lot of respect for the dentist, a great team members but they don't know what to do. Rohit mentioned production targets and goals and I think that's great but they give them these huge targets and they're not based on anything real. So, Practice by Numbers allows you to go and see what they're actually producing so that we can bump that up about 15% of what they're doing now and have new targets that they can watch them. Then the next thing that we're gonna do to help with that is to divide duties and put some of those numbers on Practice by Numbers with each section of the practice and make them accountable and then teach them to do their job to improve those members for the staff or assign specific numbers that relate to their position in the practice. Then a lot of stress comes off the doctor and the results are amazing because they get a higher production and (inaudible 11:26) stability.

Laura: I think that's one of the reasons that Sandy and I both love Practice by

Numbers because I was actually in a client's office a couple months ago and they fill out these forms at the end of the day and what was their pre-appointment rate percentage and what was their production. They did really poor. I mean they only pre-appointed 46% of their patients that day. I said, “Well, what do you do with this number?” and they said, “We send it to our consulting company”. I go, “And what do you do with that?” and they go - I don't know. They come once a quarter and we go over the numbers. I'm like, what's the point of tracking the numbers if you're not looking to improve them? So, I think being accountable like you said leadership being accountable and then they can get the real. If you give them the training they know, okay if I get my patients to pre-appoint that means we're gonna have a full schedule, we're gonna be productive. So, they can actually play a part versus just giving them a lofty goal like you said and then hoping they understand because the staff’s not trained usually much better than the doctor is when it comes to running the office.

Sandy: Nobody's assigned to specific things. That one thing is very powerful. Putting someone in charge over an area instead of just having everyone sharing all of the duties so that goes with Practice by Numbers as well.

Laura: Completely.

Rohit: Yeah. There's also the issue that sometimes the expectations are not even communicated. So, the office just shows up and they do the best thing they can but they have never been communicated to say I want my pre-appointment rate to be at 85 or 90% okay. Then watching it and measuring it day in and day out. Communication just doesn't happen and that's also the same exact thing that Sandy said which is lack of leadership where the doctor is not setting expectation and then measuring those expectations, then improving those expectations as well.

Laura: I think that one of the things that's great about Practice by Numbers that I love is that the doctors didn't know. You couldn't get this information out of your practice management software before. I mean it would be very hard to find out how many patients walked out today without an appointment, how many patients and the doctors don't know how to get it but now with Practice by Numbers it's easy to get the data you need because it pulls it right out of the softwares to help the doctors start to make the staff more accountable. That's what I love about it. I mean we can track in our office how many times the girls picked up the phone, how many phone calls did they make? How many outstanding treatment plan calls they make. Where before, the doctor would walk up and go, “What are you guys doing today?” and they're like, “Well, we're busy”. Well, you're busy doing what? Like what are you doing? So, it's a lot better to help the doctor hold the team more accountable.

Howard: Let me stop there. Sandy said she's open with that. You both agree with the staff issues, we talked about full-time equivalents that an A would be $200,000 of the revenue per full-time equivalent. Or C would probably be 175 and 150 or less via failure but let's talk about letter grades on running a business with Dentrix or Eaglesoft. What letter grade, Sandy, would you give Dentrix or Eaglesoft? What letter grade would you give them?

Sandy: Well, I'm gonna give Dentrix higher than Eaglesoft. I hope they're not listening.

Howard: Is that like saying a dog turd smells better than horse shit?

Sandy: Yeah, actually it does I think.

Howard: Seriously, because some people think I pick on Dentrix or Eaglesoft too much and I mean they don't realize that I flew, I went up to Provo twenty years ago. I flew down to Melville and talked to Stan Bergman in 1999. I flew to Effingham, Illinois which is in the middle of effing nowhere to tell these people that and they've been stone cold deaf. I think they're responsible for the state of the industry.

Sandy: I (inaudible 15:07) when you talk whenever you stood up about five years ago and told all the VIPs over there at Dentrix. I know exactly where you're headed with this in regards to the software integrating with QuickBooks or the accounting software and they have been slow to do that.

Howard: Slow?

Sandy: They’re not.

Howard: I think that they're solely responsible for the total explosion of PPO's because when these dentists didn't know their cost and they didn't know that it costs them $200 to be in the room for an hour and they signed up for these plans that they'd be in the room for an hour, they don't know that their cost. Anyway, continue Sandy. You were picking up where Laura left off. Laura, would you agree though? I mean am I picking on Dentrix or Eaglesoft or they completely dropped the ball?

Laura: No, and actually you were the first one. I think we talked about or I saw you in an interview talked about it and it made so much sense to go. We know this part of our business but we're missing the bottom line. We're missing how much are we spending.

Howard: I can’t find it in any other business where the accounting is not seamlessly involved with the practice management. We have all the insurance and all the schedule and there's no connection to accounting.

Laura: I'll take it one more step. There's a statistic in Practice by Numbers that I absolutely love. Rohit, you can tell the exact one but it's like percentage of deposits where it's like it shows you how much should be going into the bank. That seems like an obvious thing to me, right? This is what Eaglesoft said you made today, this is what you should be putting in your bank. Think about the embezzlement in our industry and if I go ask the doctors how much you put in the bank. Oh, I don't know. Suzy goes to the bank. Suzy deposits the checks. Suzy puts everything in Eaglesoft and they have no idea what they're making and I'm like that's just crazy to me. So, that's just one thing right there that just to know that your Eaglesoft and your QuickBooks match and you're actually getting the money you're supposed to be getting. It's crazy that a business doesn't have that information right in front of them as an owner.

Sandy: Right. Yeah, but Rohit, I have a question for you, Rohit. With Practice by Numbers because I'm noticing a trend with our Practice by Number users. We're putting every client when they sign up they go, we're paying for them to have Practice by Numbers. Now, how many of those are connecting to QuickBooks?

Rohit: I haven't checked your client list but I think, Sandy, overall I think it's about 50%-60% of people are connecting to QuickBooks Online.

Sandy: So, that’s what we have to work on.

Howard: I gotta stop right there though but you know I got a MBA from ASU. QuickBooks Online is Kool-Aid stance. I mean, QuickBooks desktop you could kind of run a million dollar business. QuickBooks Online you really couldn't. That's what I've been asking our programmers is the person that makes me the most mat of this whole deal was actually Bill Clinton. Bill Clinton blocked Microsoft from buying Quicken and he thought it was monopolistic because they already controlled PowerPoint, Excel and Word. It's like who gives a shit about that? The accounting? So, then after Clinton was gone they went back and bought Great Plains accounting and they call that a Microsoft - what does it called? Microsoft GP and the GP is for Great Plains. We run on Peachtree. We could never run because I got a dental office and a magazine and other things. We could barely run Today's Dental on QuickBooks desktop. QuickBooks Online, never, but Peachtree - anyway I was wondering if somebody could find a programmer and find, do we have to use SAP accounting? The Fortune 500 almost all of them run on SAP. Microsoft has Microsoft GP. Yeah, QuickBooks Online that's a thing. Then all your corporates done by corporate not just like 50 or more locations but you can have a satellite office or let alone five locations and do that on QuickBooks Online.

Laura: Howard, it’s kind of like baby steps. We gotta get them crawling before they learn to walk and we gotta get them walking before they start running. So, just looking at the numbers even if I mean I understand that you have a huge enterprise versus a lot of dentists out there who aren't even looking at what's going on.

Howard: You know what the red flag is, the biggest red flag that everyone's talking about? There's only been three banks funding all these corporate. Last year, one of the big three East West Bank in North Carolina pulled out. They said, “We're having so much trouble with this DSO portfolio”. They're not lending anymore. When you know people that are in the DSO business they'll tell you, “Hell, 80% of our offices are losing money” and even that still comes back to accounting issues. The accounting issue has to be solved and it's not gonna be done with QuickBooks Online but I agree with baby steps.

Rohit: Yeah, I think you're absolutely right Dr. Farran that QuickBooks –

Howard: Rohit, you should be able to look that. Can you look at the Microsoft and then the Peachtree and try to find, see if there's something more sophisticated in the Cloud than Quicken Online?

Rohit: Yes, absolutely. Xero is our next software that's on the pipeline and we'll definitely add Peachtree there as well. I do agree that QuickBooks Online is lacking. Actually it's gotten a lot better so if you looked at it two or three years ago it was a at least quite basic. The gap has been reduced quite a bit between what QuickBooks desktops used to be and what QuickBooks Online is now. I switched over my wife's offices about a year and a half ago. Personally I couldn't be happier based on QuickBooks desktop and Online. Now, with that said does it solve the needs of larger 1,500 location more? Perhaps not but for offices one to ten location QuickBooks Online does a pretty nice job and the reason we haven't added other systems like Xero or Peachtree is just not enough people are using it right now.

Howard: Can you look up Microsoft for me because you're smarter in that area and Microsoft’s a monster. I mean they just bought LinkedIn. Will you look at their accounting though?

Rohit: Yes. Yes, I would look into the Great Plains Peachtree stuff.

Howard: Thanks.

Laura: Now, Sandy, to get your clients connected, I know that you said you want them all connected. It's so easy. We actually did, Rohit and I did like a quick little tutorial to just connect and it might not be a 100% correct but for our doctors to sit down and look at it, it was really easy. It takes like a half an hour to just go through it. It's super easy to get in.

Sandy: They have to wanna do it. They don't see the value, it's right there. So, that's what we have to work them it’s just amazing. I mean they have to buy in.

Laura: They've never had to look at it before.

Sandy: They're like, we're gonna hook you up. You know how easy it is to hook up to Practice by Numbers? I mean that is a very easy. A lot of them are like, “Now, what are we gonna be doing with this?”

Laura: Yeah.

Howard: So, by the way Microsoft was called Microsoft Dynamics GP. Microsoft Dynamics GP. They bought Great Plains. They change it to Microsoft Dynamics and the GP is for Great Plains but if some kid is working in Aspen right now and they want to start up a De novo next year, what practice management software would you tell them to go use?

Sandy: Open Dental 100%.

Howard: Laura, what would you say?

Laura: You know, I've never worked with Open Dental. I worked with Dentrix and Eaglesoft so I don't know.

Sandy: I’d say 90, well not gonna go that half. A 70% of our clients are probably Open Dental.

Laura: Are they really? I've never worked with Open Dental.

Howard: Rohit, what would you say?

Rohit: Well, based on the fact that they are open source and very easy to work with I do like all three, but if I have to put a gun to my head I will pick Open Dental.

Sandy: Citrix is number two for me.

Rohit: I would agree, yes.

Laura: I think the one thing that with Dentrix and Eaglesoft for me just because they're supported by the big suppliers. They're always gonna compete and keep up with each other. I think Dentrix actually is a better software but I think Eaglesoft is user friendly for the staff. It's click and point but you can't get all the information out of it that you can get out of Dentrix. If you're working with Practice by Numbers, my staff barely - I mean they put their notes in Eaglesoft and they do the treatment plans but we're running our day-to-day out of Practice by Numbers. Our calls, who are we calling, all of that. So, it's good for you Rohit, but it's kind of sad that we needed to get another software to get what we actually needed out of what we have. Yeah, that's what you've got.

Howard: Okay, you guys started the program saying that staff was the first, the concern. My resolve was yeah, okay. What would you say, can we get agreement on what the number two would be?

Laura: I think systems. Systems and if in the office. I just spoke this past weekend in Michigan and everyone's like, “We don't know what to do with cancellations and no-shows”. “We don't know what to do with our late patients”. “We don't know where the-“ And I'm like, “How are you sitting here not knowing how to handle this?” They haven't been trained. They're just kind of going on gut feeling which they bring –

Sandy: They bring what they did in the last place they were over to the new office and that becomes the system and the doctors clueless.

Laura: Yeah, and it's the most dominant person on the staff. So, whoever's the most vocal says this is how we do things here and the quiet ones who might actually have a better idea because nothing's documented, because there's not systems. The doctor would rather be in the back doing the dentistry and hoping everything is going well in the front. If it's not trained, if we don't have systems in place it's all kind of on the mood of the day.

Rohit: It's completely ad-hoc.

Howard: I did a podcast with Nathan Sparks who runs Open Dental. His brother Jordan is a dentist. He started but then he kind of moved on and Nathan's running it. I told him I pitched him an idea on my podcast. Did you guys see that show? You guys go back because I pitched this idea and I dropped you guys names that I think one of the biggest problems with the systems is that when you pull up Eaglesoft or Dentrix you're overwhelmed with 40,000 options to do, but whenever I go to Hertz Rent-A-Car or Hyatt Hilton whatever, the practice management software has been reduced to these are the four things you do to check-in or Hertz Rent-A-Car. These are the five things you do to check in at the hotel. These are the three things you do. So, what I wanted is a box so you could sit there and say, I'm gonna quote and when consultants go into an office they can run report generators to show you like 85% of software's never used. So, if it's never used it needs to be all turned off. I said I want to do a brainstorming session where I get like you guys to come down with Nathan, we all meet and so if you said, “Okay, I'm gonna use Open Dental but I want to use Sandy Pardue's still. So, it would close out every single thing else. So, then if someone calls and I need to schedule an appointment I have to do these eight things. I can't even close it out until  I've done eight steps. I can't do step eight until I've done step seven. I can't do seventh till I've done six. That we don't come back and say, “Well, how come you didn't enter this?” It's all overwhelming and he agreed that that was a great idea. So, if we're not using 85% of the software. I mean, imagine a Hertz Rent-A-Car, when they pull out that little personal, digital at that PDA. Imagine if it was Dentrix, there are forty five thousand icons on that thing. Nobody can figure out how to check in your damn car. Would you guys be interested in doing that?

Sandy: Sure.

Rohit: Yeah. That would be awesome. That would be awesome.

Laura: Are you familiar with Kois’ new software? John Kois up in Seattle?

Howard: Yes. I had dinner with him at the townie meeting.

Laura: Yeah.

Howard: Yeah.

Laura: So, his whole idea with his software is a lot of the issues that - my husband's done training at Kois’ and it's so intensive what they learn there and it's very hard to come back and implement it into the practice. So, I believe with his new software it's kind of that same concept except for it's more clinical. It's about the exam portion and that you're running on through the right processes to develop the treatment plan and he's developed a software because you couldn't find any other software that helps support the implementation. You know, the doctors learned all this and they go back to the practice. I mean to make a medical history update form that's customized there's a lot of people in dental that doesn't even know, they don't even know how to do that in their software. So, it's really hard to get this advanced training and then come back and try to make it work and what we have. It's not easy to do.

Howard: Well, we said bring him into the party. I mean I love John. I think he's just an amazing man. We had him speak at townie meeting in Vegas. I've only ever disagree with John on one thing ever and that is he's Greek. So, he always uses Windex on the crowns before you see (inaudible 28:43) You don’t know what that joke means if you didn't see my Big Fat Greek Wedding. Sandy, I don't think you saw that movie, did you?

Sandy: Of course, I've seen that ten times.

Howard: Oh, so did you catch the Windex joke?

Sandy: Yeah.

Howard: So, staff is using number one. Systems was number two. What do you think is number three?

Sandy: Training.

Howard: Training?

Laura: I'm gonna agree there but I'm gonna say it's the importance of customer service and which is training but like that the staff understands that our patients can go across the street and get their dentistry somewhere else. That the experience overrides the actual dentistry. Unfortunately, I mean patients aren't walking around judging their crowns and the match and isn't CAD/CAM. They're judging the girl at the front desk? Did she smile? Was it easy to schedule?

Howard: Laura, I'll get you one step further. I've been a dentist for thirty years. You'll have only one gold crown in your whole mouth. I'll point to it. Who did that gold crown? They don't even remember.

Laura: No. Yeah.

Howard: They’ll never remember who did the dentistry. They only remember who they liked and who pissed him off.

Laura: Yeah and the number one complaint on the internet about dental offices has to do with the front. It's not usually about the dentistry. It has to do with the girls weren't nicer. It was they got upset with me when I cancelled or might think the percentage was off on what the insurance was gonna cover. So, I think it's vital that the doctors and the team understand that's how patients are judging us. They're judging us when the moment they walk in the door or the moment they call our office. We don't put enough like Sandy said, training into that part of it. We go to clinical training, we learn how to do implants, we learn how to do Invisalign, but what about how do we talk to patients about it and the importance behind their customer service.

Sandy: Yeah. One thing –

Howard: Speaking of – go ahead Sandy.

Sandy: Well, I was gonna say that one thing that dentists need to realize is that they want predictability. They all tell me that. I want predictability. My production’s like a rollercoaster. The only way to have predictability, and you guys can quote me on this, is consistent actions equal predictability. That's the only way. I mean, they have to do the same things. It's like a good recipe, you know. Down here in Louisiana we make good gumbo and it's consistent if you change anything it's not gonna be as good. So, consistency will give you predictability.

Howard: You can't have consistent gumbo. Nobody does what's in that ball.

Sandy: Same thing in there. So, what happens is with Practice by Numbers you could assign these tasks. I put people in charge and make sure that they're consistent in their actions to give you consistent statistics and Practice by Numbers is gonna allow you to do that.

Rohit: Yeah. I'm gonna extend what Sandy is saying here that most practices, meaning one of the important things, right. The third one which training and Sandy said consistency I would also add a third one would be a follow-up. No matter which practice I've gone into, all is they have been using a software like this in tracking everything. The lack of follow ups with patients in any practice is a killer and consistently doing that over and over and over again is very important to be able to save a patient came in. People just say they just hope that they won't call them back and there is no follow-ups.

Sandy: I'll give you a good example of that. I see this all the time. You can go into and almost every day you're gonna see a doctor fussing or bitching about an empty schedule. Oh my goodness, the schedule. We have open time. I'm about to die. We're gonna all just crawl up and die over here. Okay, go to your software and print a report that shows you everyone that hasn't had a cleaning in a year. Go back like eight months to three years. There's gonna be a thousand people on the list and you're gonna tell me you can't put two or three people on the schedule? So, that's huge.

Laura: Now, Sandy like you just said, print a report. That's what we used to do in my office. We print the report out Eaglesoft and the girls. Yeah, now we've practiced by numbers and my husband, we talk because I can remote in from home. I'm working from home today and I can message them and say, “Nobody's made calls today” or the girls only made one or two calls. The dentist, they're not upfront, they don't know what should be done but the girls look busy. The staff looks busy but now we can measure how many calls did you make? So, when they say, “Well, I can't fill the schedule this week”. Well, guess what? You haven't made any calls. You got to get on the phones. So, we sent goals with our office and this is how many calls everybody needs to make throughout the day to make them more accountable because we didn't have that before. We would print that report, hand it over and cross our fingers that they were making calls.

Sandy: A lot of calls do not happen in practices.

Laura: Yep. Yep. You've got to be on the phones. I mean, patients aren't gonna call us until their teeth hurt. We gotta call them. My big thing is if they're in the office and they're told they need this and then they leave and you don't follow up with phone calls, what are the patients start to think? Do I really need it? Were they after just my insurance or my money? If we're not putting a priority into those phone calls.

Sandy: Yeah. Being proactive.

Laura: Exactly. Howard, Sandy and I could talk about this all day long.

Sandy: Forever. Yeah.

Howard: One more thing. You said customer service and a lot of dentists talk about they call that the new patient experience. The new patient experience, just the name of it shows you how messed up the industry is because again dentists always talk about advertising for new patients. Nobody at the SMP 500 talks about new patients. They all talk about loyalty programs. I mean, they assume everybody's gone to Walmart, American Airlines, and Amazon one time. They're trying to keep their patients with great customer service. The dentist’s walnut brain - like I'll go into a town of 5,000. There's three dentists there. I'll meet a guy who's 65. He's been there from 25 to 65. I say, “Well, what do you need at 65?” He says, “Well, I really need is new patients. What do you recommend for marketing? Would it be Facebook or direct mails?” Like, “Dude, you've been in a town for forty years with only 5,000 people. You've pissed everyone off in the county three times and you're asking me if you're gonna use Twitter and LinkedIn and Facebook and build your success”. I mean point number two, when people throw corporate dentistry on your bridge I like to remind them to look at the man in the mirror. You almost will never find a dentist that doesn't accept new patients. So, this is what we know. I want you to fill in the backdoor of how we see by the time the average dental office gets to 5,000 charts, 4,000 of them have never been back. My definition of an active patient is if you're scheduled for something. I mean if you come in for a cleaning you should be scheduled for your next cell. So, here's the front door. I'll explain the front door. So, the front door, ten people have to land on your crappy website before it converts one to call your office. Three people have to call your office before your receptionist named after a piece of furniture can convert one to come in. Three people have to come in with a cavity for you to convert one to get a drill Phil and Bill. So, to get one person to drill Phil and Bill I need three patients, to get three patients, I need nine to call. To get nine to call I need ninety to land on my website. So, then the sweet spot in the middle is this average general dentist is doing 650,000 a year netting one eighty unless you're a specialist they're collecting 1 million netting 320. I want you to fill in the customer service. How do you lose 80% of your practice? I mean, obviously if the hygienist has eight people today and she only scheduled six of them for a recall. Hell, that alone was 25% of your practice. I just filled in the funnel to get to what the dentist's do in the middle but how is the customer service losing 80% out the back door?

Sandy: Poor customer service but a lot of it has to do with the, I'm gonna say lack of systems. I'm telling you I just stood in front of a group of practices and asked them, “Who has a recall process?” and they look at me like I asked some question that I was from outer space and came down and asked this question. “What do you mean recall process?” Yes, what's your recall process? Does everybody have one here? No hands come up. No, they don't. It's inconsistent actions. One month they do it like this, one month they do it like that. They quit calling people. They don't call it all like Laura said earlier. Patient retention and practices when they first jump on board with us we see it at 40 and 50%. I asked Rohit what he's seeing, I think he told me around sixty an average. Is that what you told me?

Rohit: Yeah. We see about 60-65%.

Sandy: Yeah. I'm seeing as low one practice 28% retention. What are they doing to these people? I had somebody last week I was lecturing in New Orleans, we did our Spice Up Your Practice seminar and someone was telling me over there that they're getting 200 new patients a month and you're doing that for free. What are you doing to the people when they arrive? I don’t know. I mean, why are they staying here? I have a good idea what’s happening.

Howard: What was a good idea he was having?

Sandy: Well, what I see, and Laura you've probably seen this as well, is they want the patient to become part of their dental family and the patient doesn't give a crap about being part of a dental family. That's not why they called and they called because they wanted to get in maybe for a cleaning. Okay, well you know what? That's what they wanted. Maybe that's not the most optimum thing but they don't want to come twice for that cleaning and that’s what a lot of these practices that are getting 150, 200, 300 new patients a month are doing. They don't stay and a lot of new patient broken appointments do in this practice.

Howard: So, you're recommending a first appointment cleaning then if that's what they want.

Sandy: If that's what they want. Okay, I'm not saying that I'm just telling you what the stats show me. We've been keeping stats for many, many –

Howard: What are the stats show you?

Sandy: The stats show me without a doubt a doctor can call me and tell me how many new patients he's getting the month and I pretty much know how he's bringing in new patients.

Howard: Okay. Tell us.

Sandy: I’ll say this. Do you do marketing? No. How many new patients do you get a month? Well, I mean if they know they tell me eight, ten.

Howard: Eight, ten.

Sandy: Eight, ten, twelve. They should be getting about 1 to 2% of their patient base is what I consider healthy and internal referrals. So, a practice it’s not marketing and so if they tell me they're not marketing then they're getting twenty, twenty five, thirty, fifty, boy they have a great customer service. They're doing something right. So, but I've noticed over the years, again I've been doing this for thirty years so I've noticed over the years that when someone, it's just like an observation. That's like, okay isn’t that strange that these low, new patient numbers are from practices that bring them to doctor’s chair first. Over and over again. Then I got to thinking, well you know well it's a good thing because if the doctor was really busy and getting forty new patients a month, there's no way they would have time to do any dentistry because they'd be seeing just new patients. Then I had one doctor that I worked with and he said, “I always see them first, Sandy. I will work with you and we'll do everything else you say”. (inaudible 41:03) I'm never gonna not do that. So, we were trying to work on his target like how much he should be producing each day. What I like to do is figure the target. break it down by the hour and then break it down by the unit. So, when I did that with him he soon realized that he'll never make his target when he's seen three new patients a day. You follow me? So, there's a lot to be set up.

Howard: So, how do you think a new patients should be brought in?

Sandy: Say that again?

Howard: How do you think a new patient should be brought in?

Sandy: I think if someone calls the practice and they're not having an emergency. Let's say they're not having an emergency. They say they want a cleaning, put them with a hygienist. Now the doctor must meet them first. Somebody will come on and say on Dentaltown they'll say, “Well, I think in my state you have to see them first”. Well, yeah in all state. So, I'm not saying the doctor doesn't mean that.

Howard: Yeah, but even that is bullshit. They'll say the hygienist can't and I examine the x-rays. I say, “Okay well name me one hygienist in prison for reading an x-ray. She just drove by your office with a pound of meth and is drunk and you're afraid that you have to meet the patient first.

Sandy: Right. So, you meet the patient first. You get the patient in and meet the patient first. See him in hygiene. Doctor goes in, takes a look at the patient, the hygienist proceeds. Or maybe the patients in the chair and it's like, oh my goodness. This patient has perio. Oh, well let's get started on something, right? At the end of the appointment the doctor goes back in and then they decide where to proceed from there but you're delegating. It's like now the dentist is over there doing a root canal, maybe a couple of crowns. So, when you start looking at their production numbers by the unit of time or by provider it gets pretty interesting and their time becomes valuable and they realize it for the first time.

Laura: I'm actually gonna agree with Sandy and one of the things she said was delegate and the biggest, that's what we were talking about, training and customer service. Like retaining your patients means that every moment counts with them. If your hygienist, I talked to doctors all time that want to try to do shorter profis, shorter, get them in faster, more patients. We only see some of our healthy patients two hours a year. Those two hours matter. That's the customer service because that's the important. So, the patient remembers why did I come to this practice? I always feel like, you know if they feel like they're a number, they're getting advertisements from all the competition. I get mailers from five different dentists in my neighborhood. They're easily gonna go somewhere else if they feel like they're a number in your practice. So, that's the importance of making sure that your staff’s trained and the doctors. The more you have a team that communicate and help the patients understand their treatment and take the time with the patients, the less the doctor has to do that, right? The other thing I think is, and this is huge and if I could change this this is my mantra, answer the freaking phones. You want to retain your patients? Answer the freaking phones. Do you know how many dental offices, I just wrote an article on this, I’ll call at lunchtime and I get voicemail. I'll call during the day and they say, “I must be helping another patient. Your call is important to us but leave a message”. I don't care if you're helping another patient or not. My call is important answer the phone. So, that would be for me as like train your team.

Howard: Laura, they won't talk about they're entitled. There's nothing I think is more hilarious than a conservative Republican dentist talking about how effed up the government is. I'm like, “Dude, look at you. You're worse than the DMV”. I mean they work Monday through Thursday 8:00 to 5:00.

Laura: Yeah.

Howard: If they have a cancellation eleven, they'll all sit around 11:00 and if someone calls up and say, “Well, I could be there by noon”. “Oh, no. We closed down at noon and we're all going to lunch” even though we've all been sitting on our ass from 11:00 to 12:00 we're all entitled to lunch at noon and then they will go home. There's a thread on Dentaltown where I tore into some guy. Maybe I was too hard on him. He says, “Well, what do you do when someone has a toothache and it's like 4:30 and you leave at 5:00. They're talking about how to temporize. I’m like, “Well, maybe you should just do your damn job. Maybe you should just stay after past 5:00”. I mean can you imagine a fireman leaving a fire. “Oh, it's 12 o'clock we're all entitled for lunch we're like the dentist and the DMV. We're gonna let this thing burn for an hour”.

Laura: There was one on Dentaltown, I don't know Sandy if you comment on there or not. Sandy and I both love the same topics, where a dentist that his schedule was getting low and is falling apart and so he took a longer lunch than expected that he had normally planned. Came back early to find his office manager and the dental assistant in back getting high on nitrous and went on Dentaltown and asked what he should do. Every dentist performed he told them don't fire them.

Stop. Patients don't like turnover. Don't let him go because you'll have unemployment. I got on and said, “Why do you think your schedules falling apart? Your staff’s in the back getting high on nitrous”. Like their focus is on the wrong targets, on the wrong thing. We need to invest in our team, you need to have the right team. At the end of the day I hear dentists all the time we're family. You know what? We're not family. I mean, unless you're actually –

Howard: Yeah, but when they say they're family, I mean almost every family I know is the most dysfunctional part of the person's life.

Laura: Right.

Howard: Usually. I've had so many employees over the last thirty years say, “You know, the best thing about working for you is when I was going through a hard time in my divorce or I was going through hurts on my life, is like my god”. Their families are crazy. The dental office should be better and less dysfunctional than anyone's family.

Laura: Right. I think it's just a justification for them to say well we’re family. She's worked for me for ten years or she's got a single mom. I understand and you get but at the end of the day they got a job to do. We give them a great environment, a great place to work but they've got a job to do.

Rohit: I think and it's more than just being family. I think it's a lot of the dentist I had hostage and I use that very lightly is they are actually held hostage by their employees because the dentist doesn't know what about how to run their business. So, they're just scared. The family word is just coming in because they don't want to say anything else that I'm scared of my employee because if the employee leaves, I'm gonna be on the street. That's how a lot of them feel that they don't know and they're not in control and if they let somebody go they will lose control even more. That's complete lack of leadership and that begins and the buck stops with them but everything else is an employee's problem. We have had people join Practice by Numbers and they call it and say, “Well, joining Practice by Numbers will my practice suddenly get better? I’m like, “No. It's not going to get better. What will get better is that you'll have a better understanding of your practice but if you don't take an action and if you don't work with a great consultant or a trainer and improve something, nothing is gonna change. Absolutely, nothing is gonna change.

Howard: Rohit, I want you to finish the - I talked about the funnel of getting into the practice and how do you lose 80% of your existing practice. They were talking about they don't have recall processes. Laura said they don't confirm, they don't reappoint. How can you explain how 80% of the patients fall out the backdoor by number?

Rohit: Alright. No, if you have to think about it, think about it like a leaky bucket, right? The only way the patients are coming in is that spigen at the top where you have new patients being fed entry through a marketing source and that's a pretty tight marketing source because as you already pointed out for ten patients to click your website one of them might call you. Actually it gets even worse because if let's say, twenty people click their website, two people call you and one people, one person is missed by your office because they were at lunch. So, the conversion is even lower than that sometimes but now that that's set, a lot of practices focus on new patient and I don't disagree that. Many patients are important to our practice they are very important to our practice and then some consultants set, which I don't know which I'm gonna repeat, which is there's no problem in the practice you cannot solve with more new patients. That given that a fact but with that said there's a there's a huge aspect of patients just leaving the door, that's leaky bucket where your patients are coming from the top and patients are leaving from bottom end. What are the sources of patients leaving at the bottom? Let’s look at a few examples. One is canceling and fail appointments. Patient calls fails, appointments canceled, appointments there's no follow-up. Nobody's following them back to say let's send these patients back on the schedule. If this is not a repeat offender and yes, they failed in the appointment. Let's get them back on the schedule. There are six other people of their family, let’s not lose the whole family because we already lost him. Fail and cancel appointment, a huge source of losing patients. Another huge source of losing patients is that nobody does no real recall system and patients don't come back. They just won't come back. Another important aspect is pre-appointments. When patient comes in for a recall visit he don't point the appointment for the next visit. Well, guess what? It might be seven months, five, eight months. It might end up being a year and then they might get another postcard from five other dentists in a neighborhood offering them something new, something shiny. If you don't have a relationship with that patient on an ongoing basis that patient is going to the next doctor who offered them something new. Maybe they offered them a masonic care. That's you lost that patient. Then you have other things like patients come in and you don't appoint them. You don't make it a point any measure. They didn't even come in for a hiking visit they came in just for a concert. Now they came in just for a new patient exam and they left your practice without their next appointment. At any given point we should have and here's how I measure active patients. Any patient that was seen in your practice in the past eighteen months. It’s a little bit different than what you were mentioning about that any patient that's appointed. Now, if I measure it based on your definition most of my practice’s active patient count will go from X to X by 2 because most practices the activation count that is actually appointed for their next visit is half, okay? So, let's say a practice has five thousand charts. Out of that, two thousand of them have been seen in the last eighteen months. If I truly measure how many of them have future appointments, that's half of that. So, now we're down to a thousand people and that number keeps. That number just doesn't increase that number just stays flat. We're going to practices and you see like how my production is not growing and we bring up the active patient chart and the active patient charts are completely flat. I mean there's just no growth happening in there. Like, well I keep getting new patients, why am I not growing? Well, because you have a leaky bucket. You keep putting patient from the top and tons of them keep leaving from the bottom.

Laura: There's a statistic in Practice by Numbers where you can look at this month how many new patients have you gotten and how many patients are going inactive. That was one of the first wake-up calls we gotten when we got into Practice by Numbers. I was like, well no wonder were flat. We're inactivating eighteen months as many as we're bringing in. We need a reactivation program that's much stronger. It's a big wake up call to see that you're paying all this money to get in new patients while you're letting the same amount or more go out the back door.

Sandy: Well, or do you guys, one thing that I've found I've been watching for three years that's very interesting because I love numbers. I’ve loved numbers for many years and as a practice management consultant I'm always wanting to have something that of course help the client. So, I noticed that with all the automated recall systems, what do you think that's doing the patient retention? You think it's improving patient retention with automation? I don't think so. That's not what the numbers are showing. So, retention is less once they quit. When they started emailing people and texting people all the time. I'm sorry it's not the most popular but I don't get any kickbacks from any company. I'm really happy about that. So, I can stand here and say this is the real results. The real results are. You know what? There's some things missing.

Howard: So, what do you say? You should call?

Sandy: Well, Dan Kennedy, you know who Dan Kennedy is?

Howard: Of course.

Sandy: Okay. Dan Kennedy says that postcard still work best and I'm telling you my job is to make practice successful. If it's popular I don't care. If it makes more money for the doctor it makes the practice better I'm doing it. It's not popular. Really? I don't care.

Howard: Where's Dan Kennedy up these days?

Sandy: He's doing a little mastermind with some dentist. I think this week or next and I said please ask them –

Howard: Where is he living at?

Sandy: I think Ohio.

Howard: Huh.

Sandy: So, that’s where he lives, Ohio. So, I said make sure you give this answer. They jumped in they said, “No, I already know the answer”. He says, yes. That works better.

Howard: I know texting is better than phone calls because whenever I call my four boys they don't answer and they text me right back and say, “What up, dad? Why can’t you FaceTime me?”

Sandy: I want to be real clear about something. I didn't say texts and emails could not benefit. I didn't say that. I want to be real clear. You need to incorporate a few things to retain more patients and keep a strong recall system.

Laura: Well, you know what and I would add to that, Sandy. You know, 30% of the dentists in the United States don't have some sort of an appointment reminder service, right? Like one of the services out there which I'm shocked at that, right? The concept behind it, the reason I asked and they said because they want personalized confirmations for the patients. They want to call. Well, I gotta tell you. I sit at the front desk at my dental office. Most of the time when I call the patients I get voicemail. They don't answer their cell phones. They're at work, they’re whatever.

Sandy: You need all the system. You need that and –

Laura: I was gonna say. So, what happens is I think dentists who do get any one of these softwares they then stop making calls and they just rely on emails. You can't. You have to customize your communication to the best results for that patient and if that patient text then text them. If that patient needs a phone call, call them but when the team just stops making calls and only relies on that, some people want phone calls some people need that voice.

Sandy: Yes, but they kept too many and that's what we see. Like a lot of patient, like some systems wanting to send tons of emails and they're saying like only 28% of emails are opened and you can't just turn your recall system over to a third party and be out of sight, out of mind. You need a little bit of all of them and that (inaudible 56:03) strong system. Now, I'll tell you if two hours are saved for doctor and I haven't that person appointed three weeks ago I want to hear their voice and I think that ruined me is I recorded calls for fifteen years. Confirmation calls and they compared them. The people that showed up or broke the appointment if they broke up appointment I go listen to the call. I did that fifteen years and I learned that you can hear it in their voice if they're not coming.

Laura: Exactly.

Sandy: They asked questions and voicemails and I'm sorry, emails and texts don't hear that. So, if it's implant case coming in I want to hear that voice. I wanna hear the apprehension.

Laura: At the end of the day we're dealing the people and we do something that people don't like people. They'll find any reason not to come to the dentist. So, yeah definitely. I think we definitely agree on that.

Howard: Yeah. People are gonna blog like they'll say, “Well, you know. I can't really afford that”. How many people have you heard the last week say, “Oh, my god. That Floyd Mayweather fight, it's only a $110 but I'm gonna go buy a brand-new 60 inch screen because there's no way I'm gonna watch that fight on a 48 inch screen. So, here's somebody that's wearing a flipper and they're gonna watch the Floyd Mayweather or O’Connor, McGregor fight. They're gonna upgrade a new deal. They're gonna have a party. They're gonna drop a grand for about a 30-second boxing fight when Floyd Mayweather knocks his shit out of that guy. I wanna say one more thing on the recall. It seems like when everybody's talking about a reappointment they always talk about hygiene but standard of care we have four thousand endodontists in America and they all schedule a one-year follow-up PA of the root canal to see if it worked. There's another opportunity just to get you back into the deal, implants. We're showing that the data is showing as sixty months we have a 20% peri-implantitis failure rate going on which could have been picked up a one-year that someone let the spicule of cement, that it wasn't down all the way. So, we need to move reappointing from just a cleaning to every root canal needs a one-year follow-up x-ray and every implant needs a one-year follow-up by wing and when they come back we tell him, “I can't warranty this implant for five years because without seeing an x-ray one year, because what if something was wrong that I could have fixed in ten seconds at one year and now five years the whole case needs to be taken out and redone. Same thing with endo. So, we need to talk about endo reappointment in rate and tie that to the warranty. Same with implants and now you have another opportunity to keep that patient and then when they come back for their one bill checkout then you can say, “By the way, you have two cavities in your mouth. You don't want them to turn into root canals. Let's get those done”.

Laura: The big thing about that and I agree with you is as the doctors listening to this, they're gonna go, yes. This sounds I agree with what Howard says. They're gonna go to their front office staff and say I need to see them in a year and the front office staff’s not gonna be trained and then the handles don't happen correctly. The patient maybe schedules, maybe doesn't. The girls up front don't know the importance about it so they say, “Well, the doctor wants to see you in a year if you want” and then they leave and they cancel and that's where that whole system things Sandy's talking about. Really training, I mean the team needs to understand the why. Why is this important? You know, because right now the doctors telling what to do, the staff doesn't really understand the why, the handoffs aren't happening correctly. We don't know if the patient's being appointed. There's no way for the doctor to know unless he has something like Practice by Numbers and then he goes on Dentaltown and complains that his front office employees don't know what they're doing because it's that leadership part, that communication part, that training part, that I think is really missing. I think it's great. I mean every patient should be back to get things checked but the staff upfront need to know why. Why is that important and how are we gonna make that happen?

Sandy: Yeah. True. What Practice by Numbers is gonna do it's gonna be like going as a scoreboard. That's really what it is, it’s a scoreboard. I couldn't imagine go and watch the LSU Tigers on Saturday night without a scoreboard right? So that's what dentists need. They need to know what's happening in their practice. They need to know what to look for and what team members are doing their jobs.

Laura: I'm gonna tell you guys a quick story on Practice by Numbers where we were having an issue on our sales weren't super great that month. Where we were like cut it down and before that my husband would be like, “I don't know. It's just the wrong time of the month” or whatever. We went to Practice by Numbers. We started pulling numbers. We started realizing how many exams where the associates doing versus the owner doctors.

Sandy: Yeah.

Laura: Yeah. Just to know ‘cuz I said, do you realize that the associates are doing more exams than you. You're the owner of the practice and he's like, “Oh, this might be for me” and just really looking at the numbers and like you said, the man in the mirror, Howard. Like to stop and go. Oh, like Sandy said, I got out of this habit. I started letting other people do this whatever step and now my numbers are down but you can track it and go fix that versus just kind of wondering why the numbers are over there.

Sandy: That [1:01 unclear] too to compare hygienist than their production.

Rohit: Yeah.

Laura: Yeah.

Howard:  I want to talk about associates because I won't talk about that for a second. It seems like whenever I talk to my DSO, CEO friends, the number one problem, big corporate dentistry has is turnover of associates. Just a revolving door and it's no different in private practice. When you go talk to private practice they just say these associates just come and go. They jump at the next opportunity.  There’s a lot of individual dentists listening this right now. They're commuting to work and they're like, “You know what? I'd probably really make a lot more money if I brought on an associate”. What do you think of associates in general? Do you think they’re a necessary evil to cover more hours? Do you think it's a faster way to double your income? Do you see these problems with associates? I mean do you see the turnover with associates?

Sandy: Absolutely [1:02:20 unclear]

Howard: In just corporate or private too?

Sandy: Private.

Howard: Yeah.

Sandy: I can only think of a handful of practices that have done it successfully and I mean very few.

Howard: What percent of the private practices have high turnover with associates?

Sandy: Well, I'd say out of ten practices maybe one. Maybe one has kept an associate over two years.

Howard: I know.

Rohit: Yeah.

Howard: It’s really a failed business model, isn't it? It seems like to me it seems like the only dentist that are making a return on investment have skin in the game. They either own the practice or they're a partner.

Sandy: The associates are traveling through. It's just like let me buy some time until I decide or can get a loan for my dream practice and so the guy a lot of dentists. I noticed this new generation coming up. They want to have an associate. It's almost like that's how they measure their success and so we start looking at their numbers and they can't support it. They’re basically only booked out a week themselves right?

Rohit: Yeah.

Sandy: The production is low. They can't afford to have an associate. There’s not enough dentistry there I think we’ll all market and get some more. No not necessarily.

Howard: Seems like only the owners will work through lunch.

Sandy: Yeah.

Howard: It seems like only the owners will stay after five. It seems like only the owners do what it takes to get it done to pass their break-even point and enter the profit zone.

Sandy: I know this when -

Howard: The associates are looking for just one. Someone will miss their appointment nine times and they'll start saying, “Well, schedule that person only at Fridays at four”. Just so they know they can leave an hour early. I just don't really see evidence of employee mentality making done in dentistry.

Laura: I think it's gonna be harder nowadays too because the corporate dentistry, they're offering them so much more than a private dentist can offer them. It's not even competitive anymore because they're going there getting their college paid off, their loans, getting all the CE they need and so that's not even feasible for a private practice dentists anymore.

Sandy: I noticed that sometimes when, not all the time but sometimes, so if any of our clients are listening. I noticed the associates that they'll come to our classes when we're basically putting solutions on a silver platter and handing it over and they're on their phone texting or maybe they don't come back after lunch because they're going out with their girlfriend or to New Orleans or something and they're not here 100%.

Rohit: One thing that I also I wanna add to all this. Associates is not for everybody. It's not for every practice and if you try to put an associate in the practice as Sandy you mentioned this, practice doesn't support two doctors and that's one thing that I've seen is the owner doctor says, well I work four days a week. What if I bring an associate and I start working two days a week and bring the associate? That's the wrong reason to bring an associate and the reason to bring an associate in is when your business is growing. You can actually absorb. As far as a revolving door concerns with an associate, I don't see there's anything wrong with that. If you have an associate that comes works for you two years and then leave I just don't see anything wrong with that. Where the associate comes in if they're gonna work for you two, three years and then they're gonna leave. The associate is tracked well. They’re compensated well. That’s a completely fine for all of them.

Sandy: [1:05:54 unclear] the headache of finding the replacement. A lot of dentists struggling that finding that replacement.

Howard: I want to ask you another question because this is Dentistry Uncensored and I like to piss off as many companies as I can per episode. We all love the dentist. I'm a dentist. It’s a sovereign profession. I love my homies but it seems like they're complete practice is in chaos and turmoil and they're gonna solve it by getting into chair side milling or get a CBCT for a hundred grand to start placing implants or they're gonna buy some $80,000 laser. Do you see these high-tech toys really associated with success? A no-brainer will say, “Yeah. If you want to be successful, you need to have CAD/CAM, be placing implants, have a CBCT, and a big expensive laser.

Laura: I actually speak on this, Howard, and I talk about the small business cycle and what we need to do for small businesses, any business and it's you need to market your business. You need to deliver quality products. You need to get referrals and reviews and then you need to deliver quality products and then you need to get referrals and in that cycle, dentist understand producing. Producing, producing, producing. That’s what they taught in dental school and so when you’re -

Howard: Say those four things again.  Market your practice.

Laura: You gotta market your practice, you gotta sell your product, you gotta deliver quality product, and then you need to ask for referrals and reviews. So, if I had a small business store, a clothing store. I would need to market my store. Now the clothing that we have in the store, it needs to be quality clothing so they'll go out and tell their family and friends to come to my store and in that small business cycle, the dentist is only trained really in dental school on delivery. Delivering a quality product which is great, otherwise we would have a lot of unethical -

Howard: Even that's bullshit. Thirty years ago they delivered a silver filling. It lasted thirty eight years.

Laura: Right.

Howard: Now they deliver this plastic shit that last six and a half years.

Laura: Yeah.

Howard: They absolutely think they're a better dentist.

Sandy: [1:08:02 unclear]

Howard: They would sit and say, “Well, the problem is my old man” and he’ll say, “He ain't very good. He’s still doing amalgams”. Like dude, his amalgams last four times longer than your tooth color and they're putting tooth colored fillings in bold grandpa s like me where you couldn't see one of my molars if you had a telescope in your hand.

Laura: Right.

Howard: So that’s even deliver quality.

Laura: Well and then, that's where so that's where they get into this like we need to have better technology. I mean, we're a CEREC office, we have 3D (inaudible 1:08:31) like we have all of that but that's about delivery. That's not fixing the practice. That's about the newest high-tech fun toy because that's what dentists love. They love that delivery.

Sandy: They love that little (inaudible 1:08:44)

Laura: Yeah, and I joke about this and no offense to the sales reps that are out there but the sales reps will come in and they'll talk to the doctor and they'll say, “How was your month last month?” The doctors like, “Well it was a little slow, people were busy, they don't have time to come to the dentist”. Next thing you know they own a $130,000 CEREC because the rep -

Sandy: They pay dentistry.

Laura: Yeah, and so the dentist has this CEREC now and the schedule still apart. They don't know how to ask for a referral. They don't know how to market and now they have this $130,000 loan and it's all because they think in delivery production, production, production which isn't a bad thing but you need to know the rest of the small business model. You need to know everything.

Rohit: But also Laura, they don't know exactly what's going on in their practice in terms of - they ask the doctor, “What was your lab fees last month?” The doctor says almost $5,000. Like, wow we can replace that lab fees and you get the CEREC machine. All you need to buy is those $15 blocks and then the dentist doesn't understand that the lease payment for the CEREC machine. Now just began their (inaudible 1:09:48).

Laura: Yeah.

Rohit: Even after they paid off after six years. Well guess what? That machine is useless after six years because you’re gonna have to replace and buy a new machine because that's going to be outdated.

Howard: They’re all not get even five, just like your iPhone.

Rohit: Yeah, exactly.

Howard: What do you think of the CEREC? Do you think that's something you should buy if you only wanna make more money?

Sandy: You know, I like to look at numbers. I'm a realist. I am a realist and I only look at numbers. I don't care what somebody says or what’s cool. I don't care. I said that. It's all about results for me and I look at all our practices. I look at the one million dollar, the two, the three million dollar. Let me tell you. A lot of two and three million dollar practices without a CEREC. In fact for a long time, it was the people doing under a million that have CERECs.

Howard: Yeah. It’s crazy like they'll take a $17 Impregum Impression. They'll send it up the street to their lab buddy who makes some zirconia and crown for $99 and a replica come and say, “Well, why spend $17 on a three Impregum Impression when you could buy a $17,000 oral scanner”.

Laura: Right.

Howard: Then your buddy up the street, he’s not even equipped to take your impressions and I have to send it. It's like every time they have an idea, they go deeper in debt.

Laura: I usually tell -

Sandy: [1:11:12 unclear] dentist.

Laura: I usually say what's the most important piece of technology in the dental office? The dentist in the room are like, oh it's my CEREC. No. You know what it is? It's your freaking telephone. Your telephone is the most important piece of technology in your office because if we aren't answering the phones well you're not doing a lot of CERECs. So, if that's not ringing and if you're not on it, that machine sits in back in it. It holds your lab jackets. The CERECs amazing but if it’s -

Howard: Let's go to there. It’s pretty obvious that there's a hundred and sixty eight hours in a week. Anybody I know whose got data has shown me data shows that the dental office is open thirty-two hours a week which is 19% of the week. So, obviously 50% of the incoming calls come in when you're closed and it takes about thirteen incoming calls when you're closed before one leaves a message and that's usually some stay-home alcoholic woman with three cats. So, then we look at the ones coming in when you're open which is the other half of the calls and 50% go to voicemail.

Laura: Yup.

Howard: Then the ones that are answered, most are answered like, can you please hold?

Laura: Yup.

Howard:  Then they put on hold. That's why I tell people never start a dental marketing company because they're gonna blame the poor results on you because they'll never know that your marketing brought them a hundred phone calls and half of them come in when you were closed, half of them when you're open went into voicemail, and the ones that your front desk lady could only convert one out of three to an appointment. How do you break that cycle?

Laura: Practice by Numbers. We just looking at when our calls come in. It even hit me and I'm a trainer and it’s that when we're cycling through lunches, the phones ring more during that time so we actually move more people at lunch and take our lunches later or earlier because between 11:00 and 1:00 our phones are the highest. Just looking at it, we answer our phones Monday through Friday 8:00 to 5:00 and it kills me when I'm speaking on a Friday and I'm like so in this audience, how many people have your phones being answered right now? Nobody. They’re letting it all go to voicemail. Just get a college kid to answer your phone. Get a service to help something but people are calling your office and they're gonna hang up like you said, Howard. They're gonna move on or think they're gonna call back and they don't.

Howard: What percent do you think leave a message?

Laura: I would say probably 25% maybe. I don't even know.

Sandy: [1:13:44 unclear] percent on that but I'm not sure what they are but it's like probably like 25%.

Rohit: Well it depends if you had new patients or not. I think in terms of new patients, fewer new patients leave messages than if it’s an existing patient I think that chances of them leaving message is much higher than if it's a new patient. In every practice the first thing that should be doing is, okay if they don't have an answering service the next day morning when they walk in, they should be need to look at, not just the voicemail. Let me look at every single missed calls and that's what Practice by Numbers does. It gives you a list of all the missed calls that you had from the last time you were close to time when you're open and tells you these were the new patients versus these one with your existing patients.

Howard: Now for that to work, does it have to be a VoIP call?  Voice over Internet Protocol or can be a landline?

Rohit: It's working in Laura's office. I believe right it’s a landline.

Howard: I want to say on that though. Okay, so again. So, three people call on average. Some say it's three and a half. I've seen one person say it's four before the front desk. First of all, what do you girls call the front desk lady? What’s the -

Laura:  She's a receptionist, the one who sits at the front desk.

Howard: When I see that, that pisses a lot of them.

Sandy: (inaudible 1:14:55) Team members at the front office. You stay they’re front desk but you don’t call them a front desk lady.

Howard: So, on average about three people have to call before she can convert one to schedule a butt in the chair. How do you address that? How do you try to get the conversion to one at a two?

Laura: Training. Training.

Sandy: Get them in. Get them in. You know what? It’s like I just did a helpful day of this on Saturday of this training but I’ll tell you what. You start by I recommend that people record their calls and let the staff listen (inaudible 1:15:35)

Howard:  How would your record it? What technology? What do you use?

Sandy: Well, it depends on the state because there's about 16 states where you have to have a two party. You have to get permission of the patient but the rest of them you don't have to, like Texas, Louisiana for instance. We can record any call without getting the other person's permission. So, we just record every call going out, every call coming in and train (inaudible 1:16:00).

Howard: What software do you use to record it?

Sandy: You go down to RadioShack and get an Olympus digital recorder. They've got this cutest little device for $15 that you plug into the digital recorder. Put it in your ear. You can hook it to your phone at all but the receiver up to your ear records both sides of the phone call. Somebody breaks an appointment after a confirmation on there, you listen to that call and you would believe you could hear the patient say, “What is that? What’s he gonna do?” You wouldn't believe what you hear on those calls. It's amazing. So, if calls coming in. I just recently listened to one with the patient called for an appointment. I would like to get an appointment. My husband was at an accident. He needs five implants and a bridge and the girl tried to be the doctor. She went into this long twenty two minute call. Finally, the husband walks in the room it says, takes the phone and says, “I just want an appointment a bit. I don't care about the insurance”. The dental staff person was saying, “What insurance?” And doing all this. No. Just get me the appointment. That's what we hear.

Laura: So, you were asking for some of the tricks. I think the biggest thing and Sandy was kind of touching on this is that, our staff, our team, our people answering the phones, they become very insurance driven. We’ve got certain things and what they're forgetting is we need to be getting them in. We need to understand insurance but at the end of the day from the other under the phone. That person has issues and concerns and feelings and get them in the office. You can't sell them over the phone. You can't help them over the phone. The first thing we do when you call in a dental office. I do mystery calls in the dental offices. Usually they say, “What's your name? How did you hear about us?” The third question out of their mouth is what insurance do you have? Like our patients are walking in with a sticky note on their forehead like they're an insurance plan not a person. So that's where the staff needs to be trained on understanding that that's a person on the other end of the phone and we have to offer that amazing experience from that first phone call to really convert that patient to be a long-term patient in the practice.

Rohit: Yeah. Dr. Farran answer your question about what software and what something to use. One of the things Practice by Numbers is working on right now is being able to record every single new patient call. So, what will happen is it will start recording every single new patient call and they'll do the two state confirmation thing. I also made sure that the patient is notified and so is the staff that the call is being harvest. We can do it in the cross all the fifty states but then what it will go ahead and do further is it will flag the calls that did not convert. So that those become digital moments. So, those become calls that you can go ahead and listen to.

Sandy: When is that gonna be ready?

Rohit: It's beta in the next I think the next month and a half or so. So, it's going to be out as beta and then it's going to be a real big to our existing customers and then we'll use it to everybody else.

Howard: Okay I want to follow Laura still. She says you only need four things. Market your practice. Sell your product. Deliver quality. Ask for referrals, reviews. Let’s go sell your product. It seems this is my belief. Tell me if you believe it's right or wrong. The insurance data says just on fillings, that America has the 38 drill, fill, and bill rate. So, for every hundred million fillings diagnosed, cavities diagnosed, 38% are turned into MOs, Dos, occlusive whatever. So that's one third. I think one third of Americans will never buy anything. There’s people who have insulin dependent diabetic who are going to drink a case of beer tonight and smoke a pack of cigarettes. People are crazy and I'm just talking about my uncles. It’s that middle third. What I believe is that the average guy which is going to do that six hundred forty seven thousand collected take home 179 is three people come to the cavity, he drills, fills, and bills one. One will never do it but it's that other guy that gets two out of three people to do it. How do you present the treatment? Some people say that you got to take the dentist out of it completely and get a treatment plan presenter. So, talk about how can the dentist increase his conversion rate from diagnosed decay to drill, fill, and bill?

Laura: I'll go first on that one. I'd actually don't think the dentist should be taken out of the equation personally. I think the dentist should be trained in sales.

Howard: Hell, you’re sleeping with your dentist. You’re completely biased.

Laura: Not all my dentists. I have three of them. I think the thing is that doctors and staff they value production over sales and they're afraid of that sales word but if you think about it you just said this week we put drills and needles in their mouth and this person's not gonna want to do that but they're gonna go pay for the fight and they're gonna go get a big 60 inch screen TV because which would you rather have? Drills and needles in your mouth or a big screen TV? We rush through the case presentation. We do a chair side, we send the patient upfront. Patients standing there we let them look at the money and insurance at the front desk and they are only five steps away from leaving. So, they're gonna do everything they can to get out because people don't want what we sell but what we give them is dental health. We give them something that's gonna make them live longer and live a better life. So, we as a team need to value the treatment plan presentation part. We need to value that patient. There's a buying cycle. People when they first hear about this like Sandy was saying, they're coming in for a cleaning. They don't have a toothache. They didn't know anything was wrong. We tell them they need a crown. They thought they were here for cleaning. So, I suggest we sit down in the consultation room. If you've got a consult room we use it for every treatment plan presentation and actually have a discussion with a patient. Educate them, answer their questions, go over the insurance, go over the money. Don't do it at the front desk. Don't do it when the patient's leg back in the chair and we've got gloves and masks on. We have to recognize that a person has to be sold on this. They don't want it. It would be weird for patients to go, “Yeah, root canal. I can't wait”. Right? So, we have to value the sales process. I think a lot more as a team and a lot of that comes with training.

Sandy: Yeah. I think that what's happening practices really don't handle patient objections. We focus a lot on training staff to recognize the main objections. They usually go past it. I mean I'm not hearing anyone really showing them the pus and using trigger words and things like that. So, we focus in a lot on that. I'm using those trigger words –

Howard: Sandy, do you think the doctors should tell them they have three cavities or do you think the treatment plan presenter?

Sandy: I think the doctor should in the treatment room say, “We're gonna get you back. You've got some decay. Let me show you this” and they're gonna get you set up and the doctor leaves and then the dental assistant raises the chair, leaves the bib on. Once you take the bib off you know what happens. They wanna run out of there. Leave the bib on and look at the patient and make sure there's no questions and repeat what the doctor said and I'm gonna bring you to Suzy and we're gonna get that scheduled. That's where it could be in a private area or not, depending on the logistics of the practice and get that patient's finances handle the agreement, signed, and lastly the appointment. You don't give them the appointment until financials are done.

Laura: Right.

Sandy: The objections to scheduling are not handled and a lot of times patients because people are afraid to go to the dentist. They'll put up some phony excuse about why they can't get the work done and you know, I can't afford it. Well, are you kidding me? You know got all this decay you can't afford not to do it. But who's telling them that, who's showing them, and telling them and what will happen if they don't proceed with the treatment and that's what needs to happen.

Laura: I want to ask you, Sandy, because one of the things that I feel is that until the patient actually sees the dollar amount, till they see what the insurance is gonna cover or not, what their out-of-pocket is, we don't really get their true objections. So, that's where I feel that they do this to the dentist. Yep, that sounds good. They do this to the dentist.

Sandy: Yeah, and will get out of there as fast as they can.

Laura: Then they stand at the front desk and if their staff’s not trained and they show them the treatment plan, they go and this is your out-of-pocket, that's when we're really gonna get the objections and if they're ten feet away from the front door they're gonna say anything they can to get out and I agree with you. Don't give an appointment till they're close but I think the money part should come sooner in the process because that's when we're really going to hear, “Well, wait a minute”.

Sandy: I was listening to a call recently and the patient said, they're actually confirming the appointment, and the patient said, “Oh, you know I've been having a crick in my neck” and the scheduler who's trained said, “Oh. I'm sorry to hear that. Tell you what, I'll let the hygienist know to be real gentle there. We could put a pillow there”. She said, “Well, my left knee has been bothering me a lot” and she said, “Well, we'll help you get in the chair and everything will be okay” and then the patient said, “Can you bill me for it?” There's the real objection. So, because the computer screen was up and the staff member just didn't say. “Well, okay” and reschedule the appointment. Yes, we can bill you for it because she had been a patient for 15 years and her Social Security check was gonna be coming in next week. You see?

Laura: Right. Yeah, and one of the other things, Howard, I want to mention I like the dentist presenting treatment. I think they need to be trained I think because they didn't teach him in dental school how to present you know $5,000 or whatever but I think that you know if you were to go to a business if the owner can't talk to you about what their fees are that seems suspicious to me. It seems odd like the dentist should be at least comfortable enough to do it. I like Practice by Numbers now because you know most dentists think they present it to the treatment to the patient. The patient would like this so they're accepted. They accepted the treatment. Then when they don't appoint, they could get on Dentaltown and they complain about their front desk employees and your staff. They can't get my patients to schedule. So, now they can look at Practice by Numbers and actually look at a list of all the patients they presented to. Did they close or not? Was there follow-up? So they can become more accountable to the sales process too because if the doctor doesn't know how to be able to present the dentistry and they're relying on their front office employee. That's where Rohit was saying earlier where they feel like they work for them. They feel hostage to them because they're afraid to do anything and we really need to help them get the training to be able to get the patients to accept.

Howard: So what are you seeing on the conversion rate of diagnosed to deliver dentistry?

Rohit: So, that's something that depends on the size, the type of the practice and how if the doctor is presenting immediate needed treatment plan versus a comprehensive treatment plan but what I do see, there's two things that we measure. One is treatment acceptance which is the total amount of let's say $100,000 is presented at how much was actually scheduled and completed. That’s treatment exceptions but we also measure patient acceptance which in turn is actually even more important which is to say if I present a treatment to about a hundred patients, how many of them scheduled at least one item out of that? Those numbers we see anywhere that patient acceptance of treatment. You see anywhere from about 60% to about 95%. Most practices falling in the range of around 60-70% but ideally if you have treatment being presented and 30-40% of your patients are walking out without scheduling anything. That's a big red flag right there. That's something we actually work with them to say you have to look at these patients who are walking out. Understand why are they walking out without scheduling any aspect of it. We’re not talking about 50, $60,000 treatment plans. You're presenting a thousand dollar treatment plan with three fillings and something else and patient walked out. What’s going on in the practice that's making these patients to run out the door, okay? Is it finances? Is it the way it's being presented? Maybe it is the lack of education or whatever might be happening. So that number we measure. Once you started measuring the number of our patient acceptance, that's when start converting and understanding how much treatment is being accepted. That is anywhere from thirty to sixty, to seventy five percent and that's a very wide range. I never have one practice compare that number to another practice because it could be completely different. You may be practicing in a very different way than your dentist down the street.

Howard: So, Laura when I said what's a dentist and he said, market your practice, sell your product, deliver quality, ask for referrals and reviews. You really think ask for referrals or reviews? Is that a serious component these days?

Laura: Huge, huge. I think it's huge because the patients when they leave, they're not thinking about us. When they're done with their six month appointment and they're moving on. Now there are some patients who do go out and tell their family and friends and all of that but our patients need to know that we would love them to go out and talk about us. We would love them to put reviews and referrals and it's important that the whole staff is trained on this. Any time a patient gives your office a compliment, whoever is with them at that moment has to be comfortable to say, thank you. We love feedback like that. If you wouldn't mind telling other people about our practice, we would love more patients like you and the dentist, this is part of the leadership thing, if the dentist isn't comfortable doing that the staff’s not gonna do it and then they're gonna have to rely on paid marketing to get new patients in when really we've got and we can have internal systems to do it. You've got to get people out talking about you and it's the best way. People put reviews out about your practice. That’s where when somebody gets your postcard or they hear about you. They're gonna go read the reviews before they pick up the phone and call you. So I think it's a huge part of growing the practice.

Rohit: Yeah, when we measure the new patient where they're coming from I look at internal referrals. We at least occurred on more of all your patients coming into your practice that I just showed you how to market a friend or family.

Sandy: That’s the best patients.

Rohit: Yeah.

Laura: That goes back to where we started with experience. People are not going to go out of their way to put reviews out about you or to talk about you to other people unless they had an amazing experience or an awful experience. If your practice is just average and when their appointment is just average and they got their cleaning and they pay their bill and they left. They're not going to go out of their way to talk about you. So that's where that customer service part comes in. When they feel like they're not a number and you've really taken care of them they're gonna go out and talk about you and then you have to ask them of course. So, yeah I agree 100%.

Howard: Okay, now I was at the last. Are you guys still good?

Sandy: Yeah. Good.

Howard: So, someone said earlier. I think Rohit said it that there's no problem in dentistry that can't be solved by marketing. I've always said that advertising is just a bad drug. If you get addicted to a hundred new patients a month you're never gonna solve any of your problems. I also think it was very interesting that Sears was headquartered in downtown Chicago in a metro of five, six million people and Walmart was started in Bentonville, Arkansas, a town of about five thousand and all of his policies was because he had that patient retention. I remember in his book he was talking about he sold a pair of shoes and the hill fell off and the lady brought it back to me so that's not my responsibility. Then that Sunday, the lady goes to his wife, Helen. Your husband sold me a pair of shoes that didn't last a week and I'm never going to your store again. So, then Helen is like, well we just can’t lose her damn family. There's only five thousand people in this town. We just lost five of them. So, that was patient retention is where he pushed, no questions asked return policy and then he didn't even pay for it. He pushed up the supply line. Next time the old man came in stole ten shoes, he gives you I’m gonna exchange this. So, he pushed quality up the control deal. The dentist don't want to hear anything about the new patient experience. The customer service. They just want a crap load of new patients to overwrite every failure they have so embellished them. What do you recommend for marketing, your practice? What's the best thing for my homies to get a bunch of new patients to replace all the ones that left their office and are never coming back?

Sandy: Well, what do you hear? Okay. Direct Mail. I see people in some places have great success with Direct Mail right? Some not so much success but your best marketing is going to be your existing patients. Then of course you've got the internet, the Facebook. That's the big thing. I know doctors are getting a ton of new patients now working Facebook. Not so good for others so it just depends. I think it depends a lot about where you are. Where you are, where you located. Facebook's doing pretty well right now.

Laura: For me I would just say you gotta have regular reviews. You've got to have people talking about your practice. If I go on the internet and I look up a dental office and they haven't had a review in four, five months, I'm gonna move on to the next dental office. People feel that's like a word of mouth referral when they read the reviews about the practice. So I'm gonna say your online presence is huge and for offices that aren't watching it, the negative things that people are saying about your practice. You need to know what's out there. You need to make sure that your online presence is huge because your marketing is not going to work if your reviews online aren't great.

Sandy: That's another thing Laura. Good point and you have to drive people to give those reviews. So, while giving those compliments you're asking them to go tell their friends and neighbors and co-workers but you're also asking them to give a review. So companies like Banyan are doing a great job with that but they have that patent system where you can take a photograph of a patient in the office and then it guides the staff through the process and that's working really well too for those reviews.

Rohit: Yeah.

Howard: Go ahead.

Rohit; I was going to just add to that as of course in general referrals online presence, Facebook of course. I've heard it's starting to work the jury's still out so many. I haven't seen a huge successful Facebook even though I see lots of courses out there people trying to do it. Google is number one. How many times I talked to doctors and they say well we allowed (inaudible 1:35:03) because it's too expensive. If you're advertising at all and not advertising on Google, it's probably the wrong thing to do right now.

Howard: Sandy, I have to take you to the woodshed on one thing. Your Twitter is not on your website and I just want to remind you guys. Who's the president of the United States today? How did he get there?

Laura: Exactly.

Howard: He had fifty million Twitter followers. Here’s the deal. On Facebook, you have to give them money to boost your ad, boost your ad, boost your ad. If your practice has 2,000 followers on your Facebook page, you post something. Facebook isn't gonna pushed any of them unless you boost the ad. Twitter is different. You never give Twitter money. In Twitter if your office has five hundred followers and you tweet something, it goes to all 500. My god. Donald Trump tweeted eighteen times yesterday and fifty million people got it like that and then primetime television in the evening CNN only has 1 million viewers. Fox News only has three million viewers and Trump tweeted something to fifty million people and so you need to build your Twitter following because it's free. Sandy, I retweeted all you guys - he'll find us and Sandy’s on there because there wasn't on our website but I tell everybody go from Facebook to Twitter. Mark Cuban was the first one explaining. Cuban said, I paid all this money and built up a million followers and then I find out that when I post something it doesn't go to a million people -

Laura: Yeah.

Howard: Like I put up I have three hundred thousand people following me on Facebook @howardfarran and I’ll post this podcast and if I give them $300, they'll show it to a hundred thousand. No, no. $100. It’s basically a dollar person. If I boost it for a hundred bucks, a hundred thousand people see it and if I boost it for $300 about a hundred ninety thousand will see it, but when I push that on Twitter, to my twenty one thousand Twitter followers all twenty one thousand people get it for free. The deeper you get in with Facebook - It was ideal joke when they started Medicare in 1961 with John F. Kennedy then he got killed and then Lyndon B. Johnson. I think it got signed in at ’63 and what did all the old physician said? They said, “Don't get him better with the government. If you're getting better with the government, you're gonna get screwed”. Now it is fifty years later. It's like don't get in better in Facebook because if you get in better with Facebook you are gonna get screwed. There's a reason that guy's worth fifty six billion dollars and doesn't have a college degree.

Sandy: Yeah. Okay. It's gonna get fixed today.

Howard: Yeah. I see all these people putting all this boosting on Facebook and they don't even have the free Twitter option. Yet they're talking about Trump twenty four hours a day. It’s like how do you not put two and two together? Twitter is a gold mine. It's just an absolute goldmine. You should go with the social media platforms that you never give them money. Who do you never give money? LinkedIn. I got thirty three thousand followers on LinkedIn. I've never given them a penny. Twitter, twenty one thousand followers. I never give them a penny. Facebook, it's a never-ending money machine.

Laura: I'm gonna say though. I think that one of the things for dentists listening to this is it's just one more thing on the checklist of things to do. So the more you can get help I know that I'm on all the social media with Front Office Rocks. I built my business online. It’s all from social media but I have help with that. There’s not enough time in the day to be a dentist, run your practice, get your phone's answer, do your training, and go on Twitter. You need to make sure you get help and like Sandy was saying, there's a lot of resources out there but don't go to your front desk employees and say, “Okay, great. Fill the schedule tomorrow and I want you guys tweeting every hour” because it’s just not gonna happen.

Howard: Well, what I can't believe happened is that I was able to get you three little studs on my show at the same time. This has been just unbelievable. I hope you guys all email and ask him you could write a number. I almost think Rohit, you and Tom should talk about having a yearly summary. Kind of a State of the Union numbers. Every year we should pick a month like say, June, July, August. Something in the summer were once a year, and I don't know I said in the summer. Just once a year, we should do a State of the Union of numbers and this is what your numbers say. A lot of people have asked me they wanted to do that but our team didn't really - We believed a lot of the numbers was junk in, junk out. You know what I mean? We didn't really believe there's just big tons of data but we didn't know about the accuracy but that'd been fun. Laura and Sandy, obviously. Oh, Sandy you're speaking in Portland, the Oregon Dale. Plug that.

Sandy: I can’t wait. I’m looking forward to that.

Howard: When is that?

Sandy: September. Last weekend in September.

Howard: Is it in Portland?

Sandy: Yes.

Howard: Will you be drinking before, during, or just after at that show? Because that’s at a brewery, isn’t it?

Sandy: Yeah, and all about beer. Drinking beer and learning.

Howard: So, if you're drinking beer and they're drinking beer while you're talking, will anyone remember anything that even happen?

Sandy: I’ve got the best handouts ever. They’re gonna be able to access them on my website later.

Howard: Oh my god. That reminds a confession story. Do you think I should tell a deep, dark secret confession? So, when we were little, my mom made us all go to mass every single day and sometimes they would all go at eight o'clock. Sometimes I go at six o'clock mass because me and my friend David Hornrag and we'd run it back to church get them a slot then we go to Winchell's donuts. Need a chocolate donut and I got a cart of chocolate milk and then we came home. Mom would say, “Well, did you go to mass?” and we just, “Here's our receipt. Here's our handout. It means a lot”. I don't know why I said that on podcast. Hey, Laura seriously, all you guys. I hope you work with Tom Jacoby. Email him Tom@DentalTown.

Rohit: Yeah.

Howard: Laura, I think that'd be a great article about the four things you said. Market your practice, sell your product, deliver quality, ask for referrals. Sandy, I always think, we love your stuff. I think you're one of the most well-read authors we've ever had on DentalTown.

Sandy: I have an announcement. I just turned twenty nine thousand posts this weekend.

Howard: Nice, nice.

Sandy: Oh, and it’s fifteen years this month well actually August.

Howard: Fifteen years this August.

Sandy: Yeah on Yes, sir. Part of my life. First thing I do every morning, last thing I do every night.

Laura: Actually and Howard, that's how Sandy and I became friends is through DentalTown. I started posting and I'm like who is this person and we finally got to meet last year at townie so it's awesome.

Sandy: Yeah.

Howard: Yeah, we've had people get married off at DentalTown.

Sandy: Yeah it's true. I witnessed it. Absolutely.

Howard: We've actually had people meet their spouse. Love you guys all the death. Rohit, everyone, thank you so much for coming on. I bet you and also if this is too much for you, remember Ryan, it's a transcript of the program and when we post this online on DentalTown, there's always a transcript after it but thank you so much for coming on the show today and talking to my homies. This has been really, really amazing.

Sandy: Yeah I enjoyed it. Thank you.

Laura: Thank you.

Rohit: Thank you Dr. Farran.

Howard: Thank you buddy, Rohit and always call me Howard. I'll talk to you later.

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