Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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867 Shift Your Mindset with Dr. Josh Renken : Dentistry Uncensored with Howard Farran

867 Shift Your Mindset with Dr. Josh Renken : Dentistry Uncensored with Howard Farran

10/23/2017 5:54:39 PM   |   Comments: 0   |   Views: 278

867 Shift Your Mindset with Dr. Josh Renken : Dentistry Uncensored with Howard Farran

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867 Shift Your Mindset with Dr. Josh Renken : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #867 - Josh Renken

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AUDIO - DUwHF #867 - Josh Renken

Dr Josh Renken is a full time practicing dentist in Springfield IL. He started and owns two dental practices- Renken Dentistry and schon dental and is in the process of building his third and fourth. He is a member of the ADA, Illinois State Dental Society, AGD, AAFE, and the ICOI. 

As he has grown his practices, he has managed to develop unique tools and concepts to dramatically improve practice performance. In turn, he wants others in dentistry to succeed in dentistry without resorting to short term gimmicky tactics and low value transactional approaches.  To offer help to other dentists, he wrote his first ebook, Dr FriesWithThat- How you can deliver compassionate care in a drive through world. He recently released his second ebook “Subscribe Your Practice to Success”-Why a subscription model is healthier for your patients and more profitable for your dental practice.

He continues to develop and offer these tools and services to dental teams through his companies Health Assurance and practicewater.


Howard: It is just a huge honor for me today to be podcast interviewing Josh Renken. My gosh, Josh, you're amazing man. You have so many things going on. Josh is a full time practicing dentist in Springfield, Illinois. He started and owns two dental practices: Renken Dentistry and Schön Dental, and Schön has an umlaut. So, did I pronounce it wrong. Is it Shon?

Josh: I think, the Schön Dental is the German, but we go by Shown Dental.

Howard: But it ... the umlaut means it's Shoon Dental?

Josh: Schön. Yeah, it's not ... it's a little bit tough for us to pronounce. But, yeah, it stands ... it's "beautiful" in German, so.

Howard: Schön means "beautiful" in German?

Josh: Yeah.

Howard: Huh. No one's ever called me that before. I wonder why? Maybe I don't know any German! And he's in the process of building his third and his fourth. He's a member of the American Dental Association, Illinois State Dental Society, AGD, AAFE and the ICOI. As he has grown his practices, he has managed to develop unique tools and concepts to dramatically improve practice performance. In turn, he wants others in dentistry to succeed in dentistry without resorting to short-term, gimmicky tactics and low-value transactional approaches. To offer help to other dentists, he wrote his first book, 'Dr. Fries-With-That: how you can deliver compassionate care in a drive-thru world'. He recently released his second book, 'Subscribe Your Practice to Success: why a subscription model is healthier for your patients and more profitable for your dental practice'. He continues to develop and offer these tools and services to dental teams through his companies, Health Assurance and PracticeWater. I called you, you didn't call me. I'm a big fan, I mean. You know, your first two [00:01:45] [...] sized [0.4] Renken Dentistry and Schön Dental, those are free dental practices. But I really spent a lot of time on your websites,,, DrFriesWithThat. You're an amazing man. First of all, where is Springfield? Is that ... where is Springfield, Illinois?

Josh: We are in the middle of Illinois, Central Illinois...

Howard: By Effingham?

Josh: ... in the middle of the United States. So, yeah, we're kind of in between Chicago and St. Louis.

Howard: Is it near Effingham?

Josh: Well, it's a little north but we are the heart of Heartland and there's a lot of Heartland offices in town here.

Howard: Yeah, and Heartland is where the north-south interstate and the east-west interstate meet. What two interstates collide there?

Josh: So, I can see all four of the … or all ... I can see that intersection from my house and from my practice. The I-55 and I-72.

Howard: So, 72 is north west and 55 is east west?

Josh: Opposite. 55 is North and South, 72 is east and west.

Howard: Huh, yeah, I ... but the cool thing about going to Effingham is, Rick knew the lady who owned the McDonald's there, and, I guess, she owned, like, four and I grew up in Sonic and I always told her that it had been so long since I cooked a Big Mac in a McDonald's - because one of my friends had a McDonald's when I was in high school - and so she took me and Rick back there and let me make the Big Mac with all the new equipment because, like, when you put down the patties, you push a button and then a top grill would come down, so they could grill it on both sides at the same time - and the reason I'm saying all this because you wrote a book, 'Dr. Fries-With-That'. But I always thought it was amazing - going back to my dad's Sonic Drive-Ins when I was ten years old - they had better business systems at my dad's Sonic Drive-In at ten than I have at age fifty-five at my damn dental office, 'cause I don't have a franchisee who's sitting there working on my systems twenty-four hours a day, seven days a week, decade after decade. I mean, my dad's cash register was made by NCR - remember that? National Cash Register, which later was bought and swallowed by IBM. My dad had more practice management knowledge of his hamburger-French fries stand than I do. I mean, my dad's been dead fifteen years, or 1999, so, what is that? Seventeen, eighteen years and I still don't have what my old man had when I was ten years old. What the hell's going on with that?

Josh: I just watched "The Founder" a couple weeks ago and...

Howard: I met that guy.

Josh: Fascinating.

Howard: I was ten years old and my dad ... we went to - you know, like we go to a dental convention - we went to a restaurant convention. Ray Kroc was speaking. I was ten years old so, it would have been '72. We got on Interstate 35. My dad drove his Lincoln town car literally eighty, ninety miles an hour. He was so excited. Sat in the front row and I only have one memory of Ray, when I was ten, for that seminar. You want to hear my Ray Kroc memory?

Josh: Sure.

Howard: Something ... he came out with something like this ... he's going down, "Now, there's a difference between boys and girls. Mama decides where you're gonna go eat, not Daddy. And when they're driving down that interstate and they're coming into that next town, Mama, she squats. Daddy, he'll pee on anything. He'll be on the side of his truck. He'll play on a tree. He'll write his name in the snow. But Mama, she's a squatter and she's going to see a gas station, some convenience store and a McDonald's. She'll know that gas station bathroom looks like a camel just used it. She'll know the convenience store man will lie through his teeth and say, 'We don't have a bathroom.' 'Well, then, what do you do? You got a 12-hour shift.' What do you mean you don't have a bathroom?' And she's gonna look at that McDonald's and we're going to clean the woman's bathroom every hour on the hour. We don't even have to clean the men's bathroom, clean it one time at the end of the day. Hell, they'll pee on the damn dumpster out in the back of the driveway. And when Mama sees that McDonald's, she's going to say, 'Let's go there!' and when she's in there squatting on a clean toilet, with paper and soap and deal, Daddy Bear and Baby Bear, they're going to be ordering hamburgers and salty French fries and delicious Coca-Cola!" and I'm just like ... I was like, "Yeah, that makes sense to me." And now founder's dead, dad's dead, thirty years later, how many times has your wife, mom or sister stopped in McDonald's because they knew they had a clean bathroom?

Josh: Hey, this is coming full circle to me. We just drove a family trip down to Florida, Rosemary Beach. I've got four kids in the car and my wife. We're taking a total road trip. The whole way we're listening to ‘Dentistry Uncensored’. So, I've got you piped in in the car, we're listening to the podcast, so, the kids all love your voice. They're learning stuff about dental practice management. And every hour and a half, when you've got four kids, you've got to stop somewhere. And it's so true. But I think that's an interesting perspective, that he knew that ... that that ... and I think in dentistry we could look at our practice, our business, in a little bit more of a humanistic way like that, sometimes. You know, Ray Kroc was a lot of things, but he was obviously very perceptive and understood why people came to his business. And I think sometimes we could stand to revisit that ourselves as dentists.

Howard: Well, take that segue to 'Dr. Fries-With-That'. I mean, that's a perfect segue for ... I mean, you wrote 'Dr.'.

Josh: Yeah. Yeah. So, you know, it's interesting, like, I feel like dentistry is quickly becoming ... and it's sometimes confused with like a short term impersonal transaction. There's a lot of times when I think people, and dentists included, like, we're looking for a short-term fix just like patients often are. We're looking for that gimmick or that laser we can buy or that that quick thing that's going to make our practice better and we're confusing the care model with, like, this quick short term transaction, when it's really more of a long term relationship over time, and Dr. Fries-With-That is just about that idea of how we need to spend ... maybe we need to stop looking at ourselves as such a short term, impersonal deal and trying to look at it more like over the long run and how we can do a better job with patients over time.

Howard: What do you mean on Dr. Fries, how you can deliver compassionate care in a drive-thru world, why a subscription model is healthier for your patients and more profitable for your dental practice. Which website is your subscription model on? Is that PracticeWater or Health Assurance?

Josh: Yeah, so, Health Assurance is a great example of what I'm talking about. So, with Dr. Fries-With-That, basically the whole concept is like to build for the long run and to build great systems that are going to deliver better care over time. Like I said earlier I am in the heart of Heartland. We are surrounded by Heartland offices and I think that that's a great thing because that is one model but certainly within our local market it's been a nice thing to compete against, 'cause when you have a model that really connects with people, tries to move them to health and then tries to support them for the long run over time, it's extremely valuable to the practice. It's a better thing for the patients and it’s a, like, way more enjoyable thing to rally the team around. So, I find that one of our best examples of that is we built this ... I might have mentioned being here in Springfield, Illinois, about three years ago we basically ... I don't know if you watch the news, but the State of Illinois didn't pass a budget and has not paid its bills for two and a half years. So, as a contracted Delta Dental dentist, premier dentist, here we have to basically wait on our insurance claims we've paid out. So, we're contractually obligated to see the patients without any expectation of when our claims might get paid. So, we have claims that have been, or are two and a half years old. We just finally passed a budget under duress here, but we have claims that are, you know, upwards of three years old now. So...

Howard: And how ... I mean, that is complete criminal neglect, incompetency of the government. Why don't Illinois ... why don't they just storm the damn capital and impeach them all?

Josh: Exactly. It is a fascinating thing. You know, I grew up here in the capital so I ... my whole life I've kind of been exposed to what it, I don't know, kind of the inner workings of government. I always remember my grandfather was a janitor, as he was older, a janitor for the State of Illinois and he always donated - he had one envelope for the Republicans and one envelope for the Democrats, right, so he could keep his job. But it's just one of those things where it's kind of an antiquated model. Our State's got some issues at the, you know, governmental level. But when you're in the capital, a third of our patients are all State of Illinois employees, their dependents, their family members and other businesses around us. So, you can't just, you know, somebody will say, "Well, just stop treating those patients", right. But when they are your major economy in town and if you forego that relationship all of your other Delta Dental insured businesses that surround us are also vulnerable. So, we ... to sever that contract we'd have to sever others. And plus, we have these great relationships with patients that we've had for years. And, you know, it's just a fascinating thing to suddenly get an email and be told, "Hey, we're not going to pay until we have a budget", and then it goes on for a year and then it goes on for another year.

Howard: So, how much do they owe you right now?

Josh: It's in the seven figures.

Howard: Seven figures is a million.

Josh: Yeah, over that, yeah.

Howard: So, you've paid all your employees, rent, mortgage, equipment, [00:11:30] build out, [0.3] computers, insurance, malpractice - you've paid all your bills - so, that one million is profit.

Josh: Yeah.

Howard: Well, you know, I don't want, you know, to be an expert you need to just stay on subject and never talk about religion, sex, politics, violence, but, my god, Illinois, I mean, it ... is it four out of your last seven governors went to prison? It has to be the most corrupt State, if you just measured governors who go to prison.

Josh: Yeah.

Howard: Is it not? Is it not the most corrupt State?

Josh: It's a very sad thing to watch because...

Howard: I mean, is that a fair statement or is that is that a bad statement? I'm just potshotting here from Arizona.

Josh: I would say, based on all the evidence, I mean, going this long without a budget is unprecedented in American history at a State level. Like you said no other States had as many governors go to jail. We just have a real problem in terms of our, you know, from a government standpoint and it's a legacy problem, it's been going on [00:12:30] back. [0.2] So, for me it's what I've grown up around our whole life.

Josh: Where does the statement Chicago, the Windy City? Does the Windy City mean the wind blowing off the lakes or does that mean windy telling stories and lies? Where does that statement even come from, the Windy City?

Josh: I think it's more of the latter, it's more of the politicians blowing wind, right. But, it's just been an ongoing problem for years. There is ... Chicago has issues, we have issues. You name it. A lot of contention, legacy programs like our pension system, inefficient [00:13:04] government. [0.1]

Howard: Well, there's threads on Dentaltown where people are ... dentists are owed so much money from Illinois that they're going to go out of business. And now I'm reading that in some of those small towns some of these hospitals are having to close down because they haven't been paid in, like you say, years.

Josh: Yeah, so what I did, Howard, when this happened about three years ago, a lot of things. I kind of have always been ... I feel a little vulnerable because we are so dependent. So, about three years ago, the first thing we did was open our competition. So, we wanted to have a more diverse revenue stream in our practice. We didn't want to be overly dependent on the State of Illinois and so we ... anytime we did lose patients it was over being some sort of in-network issue or in that, you know, that type of thing, and when you're surrounded by Heartland offices it's easy for patients to spin on. So, we opened a second office near our first office that ... so, now it's pretty cool. We don't lose patients to in-network insurance issues.

Howard: So, you mean you have a high end and a low end? Is that what you mean? So, you're ... instead of being Ford where you only sell a Model T, you decide to be GM and have a Chevy, a Pontiac, an Olds, a Buick, a Chrysler. So, which one's low fee? Which one's low fee, high volume and which one’s high fee, low volume?

Josh: Schön Dental is our lower fee, higher volume office. But the idea is like we build our same practice systems into the back end. We built the practice for far less than we built our first practice because I've learned so much over the years and how we've ... our care delivery system that we've worked on, we've built this drop delivery system which is amazing. It's a whole shape and color delivery system in the operatories, we've built the operatories for very little money. But all the same we have our same amazing programs. We have our path to health for patients, we have our Fish School for kids. So, we don't compromise our values necessarily but we ... it's also a place where our newer dentists who are interested in joining our group start in that practice. So, it's a real win for a new dentist to kind of start in that practice.

Howard: So, you have two offices right now. High fee, low volume and that's the Renken, right?

Josh: Yeah.

Howard: And then you have a low fee, high volume which is Shoon. Is that how you say that in German? Shoon?

Josh: We say Schön. Yeah.

Howard: S-C-H-O-N, with an umlaut. You say Schön?

Josh: Yup.

Howard: Schön. And they're both in Springfield, Missouri?

Josh: Illinois.

Howard: Springfield, Illinois, but ... oh, I can't believe I said that! You know why I said it? What's that cartoon? The Simpsons.

Josh: Yeah.

Howard: What town are they in?

Josh: Well, that's debatable. I forget who won.

Howard: It's Springfield, right?

Josh: Yeah.

Howard: They went with Springfield because that was ... the most States - I think forty three out of fifty States - had a Springfield in it.

Josh: Right. Yeah. We have a Shelbyville. We have a nuclear power plant not far away. We have all the things that the Simpsons had. I think we just lost out on the online voting though.

Howard: So, how many operatories in each one? How many dentists in each one? I mean...

Josh: So, ten dentists ... I'm sorry, ten operatories at Renken Dentistry and then we have six right now, plumbed for twelve, at Schön Dental.

Howard: And so, you have an associate in each one?

Josh: We have ... no, just the ... well, we have more of the graduation to partnership path at Renken Dentistry and we have an associate and then some of our part time associates filtering back to help out there because of the volume.

Howard: Wow, you're quite the businessman. So, you started the ... so, to get off the State of Illinois, who won't pay their bills and you're owed money, you decided to start your own in-office dental insurance plan called Health Assurance Plan.

Josh: Yes, 'cause ...

Howard: Is that what you mean by the subscription model?

Josh: Yeah, that's right. Yeah.

Howard: And you're using that in Renken and Schön?

Josh: Yeah, but it's lot more prevalent Renken.

Howard: The high fee, low volume?

Josh: Yeah, because we have three tiers of membership that we offer there, you know, I always ... I've always felt like we could offer dentistry in a different way. I feel like I honestly think that subscription of value-driven relationship over time is the future of chronic disease health care. I think in dentistry it puts both the patient and the practice on the same bias toward health. It removes that annual maximum filter that everyone seems to use when they're deciding on what care to receive to get to health. And it's oriented towards a long-term relationship over time. And I love that. I think that that's the type of world I want to practice in. And, you know, as we continue to grow that community of patients that are within our practice it's just been a really great thing. I love it. I just think that it's...

Howard: So, tell us how it works. And can my homies do this too? Is this open to them?

Josh: Yeah.

Howard: So, if my homies go to Health Assurance Plan, what does it cost? How does it work?

Josh: Yes, so, Honestly, welcoming membership into your practice and offering it to your patients should be simple. So, I ... basically we built this program. I tested it for two years in our own practices just to see because I was reluctant - probably like other people, like, "Ah, well, man if I discount some of my services it is just is my revenue going to drop, am I going to have all these problems?" - so we basically, you know, started it out. We tested it and we basically put out membership in our practice, offered it to our patients without insurance, started marketing it to outside patients who don't have insurance. And the way that what we learned was, “Oh, my gosh, our per patient revenue on an annual basis is way better for our membership patients than for our insured patients.” So, then I thought, you know, after experiencing that for a little bit of time, offering a single membership, I realized, "Man, it would be really nice if we had a little bit, like, just health maintenance membership once we get people to health, to incentivize them to get to a stable comprehensive health. And then give them a lower cost membership over time. But also for the people who need a lot of work" - most uninsured patients, they've got a lot of issues, they've got a lot of troubles and they've been putting off care, they haven't been to the dentist forever. I mean, that's half of America almost is this swamp of people just waiting for someone to make it easier for them to come in. You know, in the past someone would call our office and they'd say, "Well, how much does it cost to come in as, you know, a new patient?" And I, you know, you hear your receptionist or administrator speaking to them and they're trying their best but they're saying, "Well, an NPEX is this and a FMX is this and if you need a pano it's that and if it...". You know, we've made it so hard to receive dental care in the United States by using this antiquated dental insurance filter. I really love the idea, when a patient calls, they don't have insurance, they're asking about cost, it's really easy for us to say, "Listen, we've got a super-simple plan for people without insurance to help you get started. And when you come in we'll help you understand which level of care you might need." And it's been amazing. We offer three tiers: we have a higher end one, a medium tier and a low end. For other dentists, if they want to do it...

Howard: Talk specifics. How much is the high end, medium and ... how much is the high, medium, low?

Josh: OK. So, in my office it's up ... for the basic support plan it's twenty-five bucks to maintain, a month.

Howard: For the high, medium or low?

Josh: For the low.

Howard: $25 for the low - that's per person?

Josh: Per person per month.

Howard: Per person per month. And what does ... so $25 per person per month ... per person per month ... what is that? What is twenty-five times twelve? That'd be two fifty a year?

Josh: Yeah.

Howard: So, two fifty a year. And what do I get for two fifty a year?

Josh: Well, that's why we call it Health Assurance, because we're in the business of assuring health, right. That's just if you have great health, you get a minimum discount on all the extra services you might need. But it's mainly ... mostly it's the patients who either come in and they're just healthy as can be, they're there to get their oral cancer screening, they're there to get that every six months support, so.

Howard: But, I mean, does it cover my six-month cleanings?

Josh: Oh, yeah.

Howard: ... x-rays, exams?

Josh: Anything you need to be healthy.

Howard: Everything you need ... cleaning, exams, x-rays.

Josh: Yep.

Howard: What about fillings?

Josh: No. Everything to maintain health. So, once you're healthy, that's your monthly support cost, right.

Howard: So, twenty-five ... so, two fifty a month, I'd get two cleanings, two exams, x-rays, per year?

Josh: Fluoride, if you need it.

Howard: Right.

Josh: Yeah.

Howard: Okay. Then, what if I need ... had a cavity?

Josh: Yeah, so.

Howard: Is it ... then it turns into a fee schedule ... a discounted fee schedule or ...?

Josh: We basically, and this is the thing with Health Assurance, any practice can decide what's right for them. That was what was important to me. So, but for our office it's thirty-five bucks a month for the kind of ... it's more like thirty-five bucks a month and then it's thirty percent off of those extra services.

Howard: That's for the middle? That's for the want to have it?

Josh: Yeah.

Howard: So, the $25 ... so the low end's twenty-five per month just covers free cleaning, exams and x-rays but you have to pay the usual customary fee for fillings, crowns, root canals and all the dentistry?

Josh: Yeah, sans a little discount - maybe ten percent, fifteen percent.

Howard: Okay, ten percent. What ... which is it? Ten or fifteen?

Josh: You'd have to look on the website. I think it's ten, maybe fifteen. About that.

Howard: Okay, so ten percent off. So, if I pay a little more - $35 a month - then I get thirty percent off?

Josh: Yup.

Howard: So, what do you think the low one is? Do you think it's ten or fifteen?

Josh: I think it's ten.

Howard: Okay, so twenty-five a month, ten percent off; thirty-five a month, thirty percent off. What's the top tier, the Cadillac?

Josh: Eighty-five.

Howard: $85 a month, and then what's that ... then what's the discount off the dentistry?

Josh: Fifty percent.

Howard: Fifty percent. That is amazing! And I wanna just keep saying one thing: every Ph.D., you know, the good thing about ... the best thing about Illinois is the University of Chicago was actually ... who's ... Norton ... Rockefeller's University.

Howard: Yeah.

Howard: So, the guys that built Stanford and Hopkins and all those billionaires wanted their name on there, but Rockefeller ... I think it was ... was he ... what religion was Rockefeller? Will you Google that? I think it was Presbyterian, which was what? Church of England? What was ... After the Revolutionary War, they couldn't call it Church of England anymore. But anyway, he believed that if you put your name on your charity, you'd get credit on Earth from the people, and if charity was private, you get charity from God in the afterlife. So, he never put his name on the University of Chicago, but it was the most over-funded university ever created in America. And there's more Nobel Prize winners from the University of Chicago, especially in the economics department. If you ever go to the University of Chicago, when you're walking down the economics department, I mean, I swear to god, it's like every twenty, thirty feet ... What is it?

Off Camera: Northern Baptists.

Howard: Northern Baptists? But anyway, I think it was Church of England which after the Revolutionary War had to change their name to ... what would they change their name to? Presbyterian or...? I mean, it's like every fifty feet down the hallway is a big eight foot by six foot painting of some economist that won a Nobel Prize and that ... it seems like sixty of them or something. But anyway, there's so much research shows that if you offer someone a price then they say yes or no; if you offer someone two choices, the amount of people that say low or high, it goes up like half. But when you offer them three choices - high, medium, low - you get the most closures. So, if I say to you, “Well, do you want to get that filling or not?” they're more likely to say, “Well, not.” If you say to them, “Well, you know, that filling, you know, it's a $100 if it's silver or metal and it's $200 if it's composite.” Now they're not thinking about yes or no, they're thinking, “Well, I want to go cheap, a $100 amalgam or $200 composite.” But if you said "Well, you know, the low is $100 amalgam, the medium is a $200 tooth-colored composite resin but the deluxe is a $500 gold. Are you thinking more, you know, low?" Then everybody jumps in the middle.

Josh: Yeah.

Howard: And so, having ... when you ... so, the way the human condition is, you know, you don't say, “Do you want insurance or not? And it's $25 a month.” You say, “Do you want the twenty-five, the thirty-five or the eighty-five?” and then their walnut brain goes into, “Well, what's the difference?” And they start looking at all the difference and everything. And then they get all focused on which one's the better, then they're going to pick one. And it's just so important in treatment when presentation that who's ever talking to the human knows how their walnut brain works.

Josh: Sure. Well...

Howard: By walnut brain I mean that the, you know ... I always thought the core of the human brain there were telling [00:26:11] cortex that [0.6] we share with a reptile, like a snake or a turtle, which basically controls all your eating, drinking and reproducing, pretty much looks like a walnut.

Josh: Yeah.

Howard: But anyway ... so this has been ... so what percent of your patients in the high fee, low volume Renken office have your Health Assurance plan?

Josh: Well, we're up to about three hundred and fifty patients in the Health Assurance model and with various participation in each. It's distributed obviously like you said it follows the what the economists would predict with the majority in the middle and a minority at each end. However, what we're finding is, so many patients come in ... here's ... there's a lot to the subscription model. Part of it is yes having that initial choice. The other part of it is giving people an objective over time to lower their cost of dental care. So, when someone comes in without insurance in the traditional dental model, they get that root canal, they've got a toothache, they haven't come in in five years. They go ... they do that, right? But you don't see him again for five years 'til it's time for the next root canal. But in this model, someone might come in and they need four root canals, they need ten crowns, they need scaling and root planing, they need all these things, right. The idea of having this low, medium and high model is they might start at the high subscription rate but there's an incentive in place to complete that care plan to get them to health and then move them down to the lower supported model if that makes sense. So, health is cheap. Health doesn't involve a lot of anxiety. Health is easy to plan time around and we try to give them a reward for getting to health, right, like a lower cost on a monthly basis so the patients can move from one level to another which is great. It is a really good thing when you're working together as a partner over time with somebody.

Howard: So, how much does it cost for my homies if they go to and they want to do this in their office, what does that cost for the dentist listening to you? How does that work?

Josh: Well, so the way we've set it up, is try to make it as simple as possible and as easy as possible to get started. To get your own Health Assurance website so you can offer it to your patients, it just costs forty-nine bucks a month to get your platform set up, just for a single tier, like I talked about earlier, and then you pay three bucks per member per month as you ... so it gets you started. But as you grow, as you offer more and more memberships to more and more patients, we have a graduated, tiered-up thing. So, for the next tier, if you start to feel like you're getting some traction, you're getting some memberships in your practice, you can move up to ninety-nine bucks a month and it moves down to $2 per month per patient. But if you want to get to like what I'm doing with three tiers, with everything that you need to offer that type of membership tier level, and you can offer monthly and yearly, and have those different distinctions, it's a hundred and ninety-nine a month but just a Dollar per month per patient. So, it's pretty affordable. It's very straightforward. We actually have an online training course, so a dentist and their team can set it up easily on their own. If they need support, obviously we can help them, but we try to make it as simple as possible for dentists and their practice and their team to offer this to their patients and as simple as possible for their patients to sign up. They can sign up online. It's a web-based platform. So, it's pretty cool. It allows dentists though the freedom to pick their monthly what they want to charge and to pick ... it kind of depends on what your practice needs too, right. Like, if your practice has wide open chair time and you're really struggling, there's a whole community of people out there that need a better way to consume care. If you're a practice that's super-full and not a lot of chair time but you love those big cases, you can have a membership model that's more designed to those cases that you want to treat. So, I always tell doctors when I talk to them about this, like, it's really up to what your needs are and what your ... but I should say, Howard, I think one of the best things about this was me kind of testing it over the last few years and learning what the per patient revenue looked like from our membership model patients compared to our average patients in the practice. So, it's been awesome to just learn about offering care in a different way, how much better that can be for patients and how ... I think it's pretty cool. Our per patient revenue goes up and - as you know, most of the costs in dentistry are fixed - as your per patient revenue goes up, more revenue falls to the bottom line as profit. And for patients, they're getting care at a discount, at a much simpler proposal than they were, kind of, in the old model.

Howard: You have a podcast too?

Josh: Yeah.

Howard: Dr. Fries-With-That. I ... man, it's an amazing podcast. I wish you would also post them on Dentaltown.

Josh: Yeah. We've got to get them on there. I think we started to try. You know, two and a half years ago I started getting to this idea of offering stuff to other dentists and trying to help other dentists. But then when the State of Illinois stopped its revenue, I really had to dig in and I'm just now starting to get back into more and more outreach and I want to connect with more dentists. I want to offer more value out there to our community of dentists. You do an amazing job. I love listening to your podcasts. I got to compliment you, I feel like you exponentially create value in the dental industry with all the work that you're doing.

Howard: Well, I think who I owe credit to is the Chicago politicians, Obama and the Trump election, because when you plot the explosion of podcast it was about a year before the election. I think if you look at politics analytically, half of Americans didn't vote, and they couldn't commute. The average person on a podcast has an hour commute. They could not listen to Obama and Hillary and Putin and Russia and ISIS and Afghanistan and North Korea. I mean, it's just all such toxic stuff that by the time you get to work, you're like you hate life, you know, you're mad, you're ... they haven't paid their bills, you're going to do dentistry on someone and you haven't been paid a million dollars for last several years. So, podcast has exploded, and we started our show one year before that election where ... and they all say the same thing, they say, "I love it because number one I can't listen to the toxic radio and news, I can't do that.” And they say, “I listen to a podcast and I always get fired up and I always learn one thing.” They always get to their office and learn one thing and the dentists that ... like forty of them have listed their podcasts on the Dentaltown app. And a lot of times they just open up that Dentaltown app and they're just seeing new things. So, they eventually subscribed to them on iTunes. But I think that Dentaltown's a great way to market and you have a lot of amazing podcasts: ‘How T.J. Maxx nearly ruined my practice’; ‘What an amazing hibachi chef knows that could totally change your practice’; ‘How I used dental insurance advice to win over a girl who was way out of my league’; ‘One way to tell if you have the most welcoming dental practice in your area’; ‘A patient reviews the pay’; ‘A simple tip to increase collections of your over ninety account’; ‘A better way to answer the question why is dentistry so expensive’; ‘Why an anchor is more important than a drill in your practice when it comes to health and profit’; ‘The best part of the elephant to eat first: A guide to know what to focus on when you are overwhelmed by running your practice’; ‘Three reasons to make learning a core value in your practice’; ‘A big reason most patients don't follow through with a comprehensive treatment plan and a few things you can do about it’. Dive in on some of those. Any of those trigger anything you want to rant on?

Josh: All sorts of stuff. You know, I honestly, like ... the ... some of the coolest stuff that ... I feel like dentists are sold like ... it's because dentists are just so focused on, I want to find some tactic to get a hundred new patients this month, right. I want to find some laser that's going to, like, change everything for me. I think there's so much more to the soft side of dentistry and the soft side of caring for people that we could learn and that I want to share with people. It's been great. I love to talk about ... like our Fish School. We talk about ... I don't know if ... have we talked about this before, Howard? Have you heard about this?

Howard: The Fish School?

Josh: Yes. Have I talked to you about this?

Howard: No.

Josh: Well, what this is is, basically about five years ago - so, we have all these patients who sit in our chairs, right. And they're anxious and they say they hate dentistry because (not us, you know) but they had a bad experience when they were a kid - and about six years ago I was sitting in the chair and a patient was in there getting a root canal and they had been avoiding care for years and was lamenting that they just hate it, they had a bad experience as a kid. We’ve got all ... the same time in August, we’ve got all these kids trying to get in there before school visits, their parents trying to get them in, so I'm kind of running around while I'm doing this root canal, and it just hit me over the head like, why don't we just, like, stop this craziness and do a better job with giving kids a better first impression of care. So, one of the most powerful things that we've done in our practice is start a Fish School. So, we decided we're going to start this way where we're going to have an event at the beginning of every school year where we have in as many kids as possible, they have their first dental visits, they get face painting, jump house, we do science experiments, so they learn about dentistry. There's no drilling. It's all fun and we ... like this past August we just saw two hundred and some kids came through our practices. The parents love it. It's a great thing. And then we've got an ongoing, graduated, age-supported kind of system where we basically graduate healthy kids at thirteen is the goal, because, you know, if we graduate a healthy kid that's thirteen or fourteen years old, they're going to have a great life, they're not going to be scared of the dentist. They're not going to avoid us forever. It's going to be a great thing and I think there's way more health created in our community via something like that, than our drill or some advanced All-on-7 implant thing. So, I found that to be one of the most ... and that started six years ago right. And everyone thought we were weird, we're going to, like, start this weird program. Now, I mean, we've got … the next one's booked out six months from now and people are booking out for a year from now. And guess what? Those two hundred and fifty kids, their parents then decide, you know, "Hey, we haven't been in a while. We've been busy having babies. It's time for us to get into the dentist, so we'd like to get started." It's been a huge practice-builder but also, I think, a huge health creation thing in our community and it's nothing sophisticated. It's just taking a couple days a year to change the perspective of some kids when they start off with dental care.

Howard: So, what science experiment do you do that teaches dentistry? What's a good science experiment?

Josh: So, we do stuff ... we've done these things where we put eggs in various things, like an egg in soda, an egg in different pHs so they can kind of ... and we put food coloring in there to make it like crazy and weird. We've done where we do the acetone in the Styrofoam cups and they get to put sugar bugs on the cups and watch that and we draw little faces on the cups and we do, kind of, I guess, call it a science experiment, we put disclosing, you know - we call it fish food - we give them like a little disclosing tablet and then we, you know, coach the kids and parents. We do healthy snack exhibits, like, where they learn about protein-based snacking. Like I said, we also have face painting, we also have tons of balloons and decorations and we pick a theme every six months. It's just fun for our team too, to take a day when we're not so, you know, where all the drills aren't spinning and we're just taking a day to give kids a good first experience.

Howard: You know, I really like how you did the GM where you realize that there are two distinct markets in dentistry and most of the experts I talk to have dated, [00:38:13] driveling data. [1.2] They say the United States is about 50/50 wants high fee, low volume and about fifty - the other half - wants low fee, high volume. So, half see dentistry as a commodity and they want to come in and get a clean, exam and x-ray for the lowest price. The other half very concerned in particular who touches them, they don't want to buy a Lamborghini, but they will pay more for a lower volume, more time. I notice a lot of crown and bridge labs are doing that. A lot of labs have set up their competition, you know, because they're competing against like Glidewell. So like BonaDent has been traditionally a high fee, low volume but they set up their low fee compare. Lots, I know half a dozen labs that did the same thing you did - they have their low-end lab and their high-end lab. Do you use different labs for Renken versus Schön?

Josh: Sometimes, for some things. Some things though, you know, a lot of the creature comforts between the two, you know, some ... a lot of it's creature comfort. A lot of it's more time and a lot of it at Renken, since the fees are higher we can spend more time. The dentists with more experience or longer, you know, more discretion, more skill set, can expect, you know, hopefully a little bit more of ... and the patients can make a value-based decision right. So, do they want to be with a person who is more of a partner, long term, a little bit more advanced skill set, more experience; or is that insurance in-network thing, is it just they want, you know, the basic streamlined, they're just ... they just want to get their kids in for a cleaning and they don't want a big co-pay. Those are the two types of mentalities that I've noticed. And it also kind of matches up with the other side of the paradigm, right, like the dental side. We have dentists who are coming in and, you know, there's all these like, "Well, how do we start with an associate?" and "How do we ...?" Well, why don't we just all agree that ... why don’t, you know, we set up a place to where, for a couple years a dentist can learn our model and how we kind of do things and they get a chance to really learn about us, we get a chance to learn about them, make sure things are right, it's what fits for welcoming an associate dentist also. It just works in a lot of ways. It's not just the patient's side. It's also on the on the practice business side - it makes a lot of sense too with our workforce.

Howard: Do you ever go down to Effingham and hang out with Rick Workman?

Josh: No, I never have.

Howard: Have you ever met him?

Josh: I've never, well, I've seen him. He came to our dental school, you know, and lectured at a lunchtime when I was in Chicago. But beyond that, no.

Howard: Well I put him on a podcast. You should listen to his podcast. Did you see his on ‘Dentistry Uncensored’?

Josh: I know you've podcasted, but I've not listened to it.

Howard: You should listen to that then send him an email or I'll send both your e-mail and say, "Hey, you guys have both been podcast and you guys should meet!" So, you have a high fee, low volume Renken, you have a low fee, high volume Schön. Where would you see Rick Workman's Heartland in that competitive mix? What is it like competing against Heartland? And what is your expectation? I mean, do you think they're going to someday be the Walgreens of dentistry or the CBC? Do you ... what are your thoughts on Heartland, since you live right in the epicenter, like, say, how many Heartlands are in Springfield, Illinois?

Josh: Yeah, no, I think there's like eight offices of Heartland.

Howard: Yeah, so, you're right at ground zero for Heartland and they're absolutely the number one, biggest four-hundred-pound gorilla in that whole corporate space. And of course, nothing gets dentists more riled up on Dentaltown than corporate. That's great. So, give us your Heartland Dental report, and where are they in the competitive mix, how big do you think they'll get, you know?

Josh: Right. So, the way I see it is like this right. Like I think my perspective is, you know, for years we were a cottage industry of solo dentists, solo offices. And then on the other end of the spectrum we have I know I listen to your podcasts, I've heard of some of the older models but now the main one is Heartland that we hear about, so we have these two ends of the spectrum, right. I kind of think there's something that's better that will exist in the middle. I don't know that being on a solo island by yourself without the benefits of any scale is great, but I also think, you know ... I love, I mean ... I don't want to be ... I'm not offending anyone, but I love being surrounded by Heartland. Right. Like, my biggest fear isn't another Heartland office going up around me. My fear is some other young, hungry dentist that's willing to be a big part of the community, that's willing to get involved with their staff, that's willing to totally take it to a whole new level with being different and trying new concepts, trying things like Fish School, trying ... there's just ... I feel like for ... I don't think that's part of my thinking in Dr. Fries-With-That. I think big companies ... the tough part with a big company is they are what they're going to be, right. They ... for a company of a thousand offices to change or be dynamic or to come up with a new idea or to take a different approach - it's virtually impossible to roll out a new thing, it may take two years right for it to, like, roll down to the bottom at a practice level. And so, I love competing against that. My biggest worry would be someone who's just energetic, is ready to go door-to-door to meet everybody, get involved, take the long-term approach with patients, like that's the competition that I'm most worried about. And frankly, like, I ... so we ... both of our offices take this model that I'm describing. So, it's just ... so, when you ask me, like, where do I fit in? Like, that's the way I view it. Like, for my whole practice career - I started up from scratch twelve or thirteen years ago here, like, in the heart of Heartland, right. You know, Springfield is not a growing community, it's flat. We've actually contracted in terms of population. So, it's a very, like … it's a one-in, one-out market at best. And so, you know, to grow a practice you have to do something different. And I found it to be great to kind of have a place that doesn't have a point of distinction from the corporate offices. And so, I don't know, does that answer your question?

Howard: Well, I agree that it's not going to be one market. I mean, there's ... in any mature market you have at least high, medium, low on so many deals. I think humans are very hypocritical. They, you know, they ... I think they say things within a single paragraph, within a single thought, that usually contains mutually exclusive principles. I mean, there ... I mean, you're talking to a human for five minutes, you're like, "Okay, you just said one plus one equals negative one and now you just said it's two and now it equals zero.” So, humans are complex animals, but they'll say they hate corporate yet they ... corporate is the only one hiring all the associates straight out of school. You say to all the 50-year old dentists, "Would you hire a kid straight out of school?" "Oh, hell, no! I'd want him to have at least five years' experience." And then again, if you're a patient or consumer, which we should all be patient-oriented, not consumer-oriented, almost all the dentists I know are Monday through Thursday, 8 to 5. So, if you break your leg on Friday, Saturday or Sunday, the hospital will take you, the ambulance will pick you up, the fire department will show up, the policeman will come to your house, but the dentists are like, "Screw you and go to hell. I'll see you Monday at 8 o'clock", and probably won't even be able to get you in that day. So, I think corporate has done a better job of raising the competitive analysis, I think. I'm in Phoenix, Arizona. You can't see a dentist on Sunday. There's three point eight million people and twenty-eight hundred dentists and no one will treat you on Friday. Yet if I had a heart attack, they'd do, you know, they'd do brain surgery on you on a Sunday. But they wouldn't ... but, you know ... so I think it's good for the industry. And the only practice selling these days is the three-bedroom, two bath, as liquid as $750000. Once your practice is over one and a half million Dollars you're sitting on a illiquid asset and the only person who will write you a check for that is Rick Workman and he's bought out ... every one of my friends that had an office doing over two and a half to four million, Rick was the only guy that could offer them liquidity. So ...

Josh: Sure.

Howard: So, I think it's good for the consumer and ... but I do disagree with the dental schools and I do disagree with Pew Trust who thinks that, you know ... where they think that we need mid-level therapists. Because when I look at dentists, when they come out of school as a full dentist they barely know enough to even get going. And the only ones that are successful take that doctorate and add a hundred or two hundred or three hundred hours of CE for decade after decade after decade to get good. So, the answer isn't give someone half the training. Sh*t, the training they got is only half enough for what they need. But if they want to put their money where their mouth is it's not building a bigger bureaucracy, winking, saying it's all for the poor. Why don't you put your money where your mouth is and go take a bunch these kids $500000 in debt, pay off their student loans if you go to this underserved area of this county that only has one dentist for every five thousand people, we'll pay off your student loans if you go there. But they don't want that. They kind of use the poor for their ... they ride the back of the poor to expand their government bureaucracy. And I'm not getting into politics, I'm just saying, "No!" I mean, would you want your children to go to a doctor with half the training or would you want your children to go to a doctor with twice as much training? You know what I mean?

Josh: Right, I mean, a watered-down generalist would be the worst. Like a less ... a generalist with less training would be, like, the worst thing we could do. I mean, I don't know if you've ever heard of Clayton Christensen at Harvard?

Howard: Clayton Christian? No.

Josh: Clayton Christensen is the head of innovation science at Harvard. He wrote a book called 'The Innovator's Prescription'. He's kind of the guy who coined the term 'disruption in business' and has written several books and he did an 11-year retrospective study from 2000 like to 2011 I think, and then published his results. And it would be like an innovative ... so, basically what ... if we apply the same disruption principles - an easy way to understand disruption would be like what Honda did when it came into the automotive market in the United States, right. Like it came, it was a low-end disruptor, where it came in and basically provided ... there was a very precise problem that existed, and a very precise solution was provided by Honda and they slowly moved up into the market and now look what they're doing, right?

Howard: Is that 'The Innovator's Prescription' or 'The Innovator's Dilemma'?

Josh: Sorry, Dilemma's one book but that's not about medicine. It's a great book but ‘The Innovator's Prescription’.

Howard: Oh, is about health care?

Josh: Yeah.

Howard: Oh, so you're recommending his ... Clayton Christian's book 'The Innovator's Prescription' because it's about health care, a disruptive solution for health care.

Josh: Yeah. So ...

Howard: Nice! I will order that right now.

Josh: It's very textbook-y. But I'll tell you what, man ... and you know what's interesting about it and what's interesting about dentistry is, like I said earlier, disruption occurs when there's a precise problem and a precise solution. But in dentistry, have you ever met two dentists agree on any problem or any two dentists that agree on any solution?

Howard: No.

Josh: We have a highly, highly subjective profession. And it's interesting, in the book they mentioned dental care early on, but he fails to draw a conclusion. We actually like ... he mentions it early and then just totally drops off because we ... honestly what's lacking in dental care to make it work is, kind of, more precise problems and more precise solutions. Absent that, I'm totally with you. I think that there ... but after reading that book I'd love to talk to you about what your thoughts are on how we would disrupt dentistry because it's a whole other discussion than I think what's currently being...

Howard: Well, you know, these mid-level therapists, I mean, if, you know, so much government expansion has been because they claim they're representing the poor and that - I don't want to get into politics - what I'm saying is from a business point of view, it's like, well, why don't they go in and spend all that effort on trying to cut half the costs out of a dental school. I mean these dental students - because a lot of these big supporters ... like in my backyard A.T. Still is a private dental school by a friend that I love - now, I can love people that I complete disagree with, trust me. My two older sisters are Catholic nuns. I disagree with ninety percent of all their thoughts - and what's funny, you said two dentists don't necessarily agree on everything. My two sisters incredibly disagree on the same stuff the church is saying, and I've got two sisters that disagree with that. Look at the Supreme Court. They all went to law school, they were reading one Constitution and all the big votes are five to four. So, it's the human condition that they're all bat shit crazy and when people ask me stuff like, “Well what percent of humans do you think are psychotics?” Well, what percent of elephants are psychotic? What percent of giraffes are? You're an animal. I mean it's not that. Yeah, and then people say, "Well I think he's crazy." Well, what percent of hippopotamuses are crazy? You're a flippen' animal. At the end of the day you're a monkey with clothes on, missing a tail.

Josh: It's such a bad idea. You know, it's interesting though, like, I think there are so many different ways though that we could ... as dentists, we could lower the cost of training our dentists, we could ... I think that it would just be so much better for our community. G.V. Black, right? So, we live not only in Heartland, heart of Heartland, we live ... G.V. Black is our local dental society. G.V. Black's from Jacksonville, Illinois, right down the street and, you know, he was a civil war scout, and he learned dentistry over the shoulder, three months of watching a cousin, I think, and just look at all that he did for the profession. I sometimes wonder if our old bureaucratic model of the way we're ... the way we've designed our education system that's costing. I mean, we have new dentists starting with us with multiple hundreds of thousands of Dollars in student loan debt. It's just everybody is handcuffed. And it would make so much sense if we could just go to that rural Medicaid office forty-five minutes down the way for our first three to five years and let us knock a Dollar for Dollar off of our student loan debt. I'll tell you what. There would be more care delivered and more health created across the United States than any other solution that anyone else has got. But, you know, that's just ... more bureaucracy leads to more bureaucracy.

Howard: So G.V. Black, Greene Vardiman Black. And his first name was Greene. Greene Vardiman Black. He did not go to dental school, did he?

Josh: Right. Over the shoulder.

Howard: Yeah, and that's ... what do they also call over the shoulder?

Josh: Apprenticeship.

Howard: Apprenticeship. That's how all the farmers and plumbers and blacksmiths and [00:53:34] G.V. Black and [0.9] then the first dental school, you know, in the world was University of Baltimore and that was long after G.V. Black. By the way, I had the first three books autographed and signed by G.V. Black. I bought them on ... when eBay first came out in '94, that was my first search: dental textbooks.

Josh: No kidding.

Howard: And it was some very old guy in Kentucky. That was '94. Oh, my god. What is that? How many years ago was that? Twenty-three years ago. And he unloaded all three of those books to me for five grand. And I was a little nervous because he was from Kentucky and he said he wanted me to mail him the check in cash first time and I thought, "Okay, he's a dentist", you know. So, I sent him a check, he cashed it and, sure enough, he sent me those books and I really love reading those books because ... in fact, Ryan, I think I want to do an audio of that. Just read them as audio but I don't know legally if it's a copyright issue or not.

Josh: Hey, you know what?

Howard: But the reason I wanted to read it is because everyone knows what they know but they don't know what they don't know. And if you listen to G.V., the smartest guy a century ago, and you realize how much everything he believed was somewhere between wrong and bat shit crazy, it would make you be more humble that today all of our trues that we know, we swear by, a hundred years from now, two hundred years, a thousand years from now, we're going to look like cave men from ... I mean, agreed?

Josh: Oh my gosh. Do you think that? I hope that our ... that ten generations from now look back and laugh at the fact that we're gluing plastic to the human body, for god's sakes. I mean, did ... it's just I ... yes, I am glad that dentistry is starting to move. I think there's just so much ... we've been kind of stuck, I think. We've been a little bit inhibited as a profession and I do think though that there's room for growth. I do think that there's all sorts of new ways that dentists can serve our communities. I don't think that watered down, [00:55:39] Pew suggestions [1.9] are the method to get there. It's ... on the flip side everything is changing, and I do think that a lot of times we're not the ones coming up with new models and testing new models. One of things I talk about in Dr. Fries-With-That is, like, we have this room - Room Two is our opportunity, right - where we're always ... that's our room where we try new stuff, where we try it, where we built our new care delivery model. We kind of tore out all of our old dental equipment and cabinetry and we put up this drop delivery system when we built the shape and color system, we ... anytime we try new things. But I think dentistry needs a little bit more of that that's internally driven and kind of refining our model and what new ways can we reach more people across our rural communities like you're describing, the different models other than just some top down ... something that's delivered as a solution from government level. It's not a good thing.

Howard: Well, I can't believe we went over an hour, but I want to ask you one question, it's my last question, if you don't want to answer this question I'll just cut it off and everyone listening won't even know I asked it. But, I've got two older sisters that went into the nunnery straight out of high school but the sister underneath me is what you would call 'special'. And she's actually my favorite sister because my entire life she laughed at all my jokes. She thinks I'm the funniest guy in the world and my mom and dad, they would get mad at the dinner table if my other sisters laughed at my inappropriate jokes, but they couldn't say anything to Kaylene because she was special, and she would just laugh her ass off and, so I was always performing for my younger sister, Kaylene. But you have a 'special' daughter?

Josh: Yeah.

Howard: And what ... how was that? And I know that you've ... well, anyway, it's had a big impact on you and your thoughts and even your dental office where you want to employ special needs people.

Josh: Yeah. So, this is a really big thing for me and I'm glad you asked because, you know, I got out of dental school. My wife and I had our first child like two months later. It completely changed my world. We had a girl ... it's really crazy. There's no one like her at all in the genetic registry. She has, you know … some kids with genetic differences have … Down's Syndrome would be one that's well described. Our daughter, there's no one like her. She's missing part of her twenty first chromosome. She's got extra material somewhere else but it's unbalanced. But there's just no one like her. We have no idea what to expect, right. But having her completely flipped my value system on its head. It changed the way that I look at the world around us, look at our community. It's changed the way I spend my time, how we've grown our practice. And, you know, when you have ... you know, then you know full well and when you have someone that precious, kind of, authentic expression of humanity in your family you start to, I don't know, you start ... you can't look at the world the same way, so, like, so, for example I want her to have a job someday, right. She can't read or write. She's cognitively at some ... in some ways she's at age three, she's got a rare epilepsy where she has subclinical seizures all night long, so she never really grows cognitively. But on the flip side, despite all that craziness - she's had [00:58:52] multiple eyes, hearts, [0.8] right, all these things - but despite all that craziness she still is an extremely social being. She loves people, she's connected to people - it sounds like your sister. And, you know, I thought to myself years ago, it's, like, well, I want my daughter someday to be employed. I want her to be part of the community. I don't want her to be off on the fringe or in our basement or hidden away but I'm an employer right. I'm a local employer and I don't, you know, I'm not employing anyone with special needs. So, I challenged us to try to, like, figure out a way to make it happen in our practice. I happen to be ... because of her I got involved with a local charity years ago, it's a large midwestern charity for ... provides educational, residential, therapeutic services to people with autism and cognitive difficulties. Long story short, there's a chairman of the board of that organization for years, it's a large organization, but one of their divisions is a vocational program for adults. I was at ... our dental office became a test pilot office for developing a vocational program within our dental practice so someone with cognitive differences could first have a job coach on site and then we would have some team members who would then learn to be her natural supports over time so that they could move away, and now we have what we have where we have a woman with Down's syndrome. She's fully employed. She supports about sixty percent of our care delivery model. We built this drop delivery system with the shape and color delivery. So, she seats patients. She helps bill trays. She writes letters to patients after care. She provides all sorts of that meaningful work around the practice. But you know what's better? Patients look at what's possible, like, in their own lives. Our team members - it really changes the teamwork perspective in our practice. And for me as a business owner, it really does help reinforce our values of creating a healthier community. And so, I'm glad you asked because that is like probably one of the most meaningful parts of our day, is working with Hannah. She's all over our social media doing videos, so if anybody wants to check that out or learn more about that I'd be happy to talk to people if they want to reach out, but it's really cool. And thanks for asking me because it's ... one in sixty-eight kids is diagnosed with autism now, and then for every kid with autism there's a variety of other developmental disabilities. And this isn't ... you know, going forward in the world, we're not pushing people off to the fringe, you know, off to the basements of the world. We're, I think, it's our mission to kind of bring them into the middle of the community and to celebrate individuals with all abilities and make them ... you know, give them the opportunity to have just as fulfilling a life as you or I.

Howard: Well, that's a beautiful thing. My ... I got ... my staff is blowing up my phone saying I have to go to work now. But, love you to death. Thanks for all that you do. You're a leader, you're an innovator, you're all over this space, you're helping everyone. Big, big fan of yours. Hope you upload those podcasts on Dentaltown. I want more people to listen to your show. But thank you so much Josh for all that you do for dentistry, your community. Good luck with your family and peace out.

Josh: Hey, thanks, Howard. Take care.

Howard: Alright, have a great day, buddy.

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