Dentistry, Legacies, Education and “Genius” by Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine

An uncensored, unedited interview with the outspoken founder of Comfort Dental, Dr. Rick Kushner

by Thomas Giacobbi, DDS, FAGD Editorial Director, Dentaltown Magazine

Dr. Rick A. Kushner is President, Founder, CEO and CFO of Comfort Dental, the largest and most successful dental franchise in the world. He graduated from Marquette University School of Dentistry in 1977. He recently made a significant donation to Marquette for it’s upcoming clinic expansion. Kushner has always advocated and taught a low overhead, high volume, expanded hour, bread-and-butter, group partnership concept geared towards middle-income patients.

When did you transform from dentist to practice management lecturer and owner of a large group practice organization?
Kushner: I never made the transformation. It was an evolution in every sense. I would like to say I had a master plan in place from the start but I wasn’t that smart and I’m still not. It all happened concurrently and on a trial-and-error basis. I lectured for about 15 years from the early ’80s through the late ’90s while I was developing what became the Comfort Dental monster of today. Comfort Dental has been in its present configuration since the early ’90s. I only lecture these days to the Comfort partners and dental students. And of course, I’m not invited to lecture any longer.

The practice management model that you developed for Comfort Dental is called “Lean & Mean.” What experiences outside of dentistry influenced this concept?
Kushner: About a dozen jobs working my way through school selling everything from ladies shoes to garden tractors must have taught me a lot. Also, I must have been gifted with a great ability to observe life, a nice dose of street smarts and common sense. Practice management has always been so simply obvious to me, yet is clearly so difficult for most dentists. For example, the observation skill I just mentioned mostly involved observing what other dentists did and doing the opposite. I always felt they were doing things so very wrong.

What are your roles and responsibilities at Comfort Dental? Do you still practice clinical dentistry?
Kushner: First, let me say that I have four of the finest practice management minds and four of the finest people on Earth at my disposal full time. Roy Martin, Bruce Irick, Neil Norton and Mike Bloss are all dentists, have been in my system for decades, and are minority partners at Comfort Dental, Inc. They each have special skills and work in different areas but are all masters of Lean & Mean. I had a personal tragedy five years ago which obviously set me back but I am now involved daily and responsible for every aspect of Comfort Dental. For example, I personally approve all Comfort Dental locations, meet face-to-face with every new Comfort partner, and visit each of 100 offices in 10 states at least once a year. My surviving son Paul is, in effect, our COO and is involved full-time. He has his master’s (real estate finance/construction management), is not a dentist and therefore makes great business decisions. We all have our hands full helping our 300+ Comfort Dental partners achieve Lean & Mean practice management. I maintained a clinical schedule for a quarter century until 2002 and have not practiced clinically since.

You recently made a generous donation of $1 million to the Marquette University School of Dentistry. Tell me about your passion for this school.
Kushner: First, the donation is a result of the efforts of all Comfort partners as well as my boss, Cindy Kushner. I just seem to get the credit. I am a Marquette alumnus but that is not the reason for the donation. The reason is that the Dean of the dental school, Bill Lobb, is the greatest Dean ever anywhere. OK, I’m prone to hyperbole but that’s the way all of us here at Comfort feel about Bill. You see, Bill Lobb will not allow his dental school instructors (DSIs) to criticize outside dentists or otherwise impart practice philosophy to students. At Marquette, DSIs simply present the facts of various options, teach students to fix teeth and avoid denigrating practicing dentists and styles of practice. This concept, I have found, is very rare in dental schools. For example, we have seven practices in the Kansas City area with many more to come. Yet, a DSI at UMKC dental school has banned me from speaking to his students because I presented to them honestly the conditions they face upon graduation and he didn’t like it. I have concluded that the administration at my local dental school, University of Colorado, must encourage its DSIs to denigrate outside dentists and practice styles since they do it so often. Recently, a DSI admissions interviewer at the Colorado dental school didn’t even wait for the student to enter dental school. The DSI criticized us to the applicant and incorrectly referred to Comfort Dental as “Corporate Dentistry.” So that’s why we donated to Marquette. DSIs often do great disservice to their students.

Comfort Dental has considerable experience with new dentists. What are your thoughts on dental education based on this experience?
Kushner: I might surprise you by saying that I believe dental schools generally do a great job under very difficult circumstances these days. Clearly, our recent graduates (we do sell lots of partnerships to experienced dentists, as well) begin their real education when they buy their Comfort partnership, but most are pretty well prepared when they graduate. I’ve always said that DSIs could prepare their students even better if they focused more on achieving more reps (repetitions) for their students at bread-and-butter services (single unit crowns, RCTs, non-surgical perio, basic prosthodontics, amalgam – yes, amalgam – and exodontia, exodontia, exodontia) and less on imparting their practice philosophy to them. Likewise, I’ve always believed we’d all be better off if dentists spent less time worrying about what other dentists are doing and more time on figuring out how to provide more affordable primary care services to more patients in need of care.

The majority of dentists are in solo or small group practice. Do you think the profession is making a shift to large group practices to the point that they will employ the majority of dentists in the future?
Kushner: Wow! I guess you’re serious. Of course the profession has shifted. Traditional private practice has been dying for decades but too many dentists, always late to the party, don’t know it yet. Prospering in a traditional fee-for-service, low volume, high fee, high tech, “cosmetic” practice has always been rare for all but the most talented. Today, it still exists but only by a miniscule and shrinking percentage of the most ultra-talented. Continuing Ed today is nearly all geared towards big fee, high tech, traditional practice and I sincerely believe it harms far more dentists than it helps. At Comfort Dental, our dentists average $365K net income before taxes annually on a 42 percent overhead and most are not ultra-tal ented dentists. We have a good many fine clinical dentists with great skill sets but they all understand what it really takes to be very prosperous in dentistry today: hard work and bread-and-butter dentistry.

What concerns you the most about the future of our profession?
Kushner: This one is really easy and the most important thing I can say in this small venue. No contest, my biggest concern is the tremendous student debt load with which our graduates enter the profession. Too many dentists have made too many bad professional and business decisions for too long as it is. Young dentists with huge debt make even poorer professional and business decisions even more often. Like taking jobs in “corporate dentistry” for $75K (if they’re lucky) because they fear going even deeper into debt. Thus fodder for “corporate dentistry.” Eight years of higher education, hundreds of thousands of dollars debt and they take jobs for $75K. How did all of this happen? In large part, not enough dentists paid attention to me for a third of a century ranting about high overheads, expanded schedules, inefficiencies and fees that were unaffordable. Now, as much as ever, dentistry is too expensive and dentists manage badly while trying to perform services which are out of reach for 95 percent of our population. DSIs and I probably agree on one thing: corporate dentistry. Corporate dentistry scares the hell out of me for two reasons: first, whether they get their money from the public or from private equity, corporate dentistry will always have only one priority: demonstrate more profit. (By the way, Comfort Dental has only one original money source: me. Oh and a couple of local banks. Of course, every single Comfort partner is equity invested in his/her own Comfort partnership.) And secondly, as a dental “chain” we are unfairly lumped together with corporate dentistry by ignorant dentists including DSIs and of course, some patients. Structurally and philosophically we at Comfort are as far from corporate dentistry as traditional private practice. Had the profession listened to me instead of attacked me over the past few decades, the professional landscape would be saturated with Lean & Mean group type practices so prosperous that there would have been neither need nor room for corporate dentistry. So again, how did corporate dentistry happen? It’s dentists’ fault. It’s DSIs fault. It’s not my fault; it’s their fault. Dental practices were so bad for so long with their 80 percent overheads and their hygiene-heavy practices that businessmen in business suits looked at them and instinctively knew they could do better and keep the difference in profits. And guess what? They were right. Businessmen in business suits looked at dental practice and knew they could handle our business better than dentists. So they did. Not my fault. I warned dentists but they were smarter than me. Graduates laden with debt and corporate dentistry are a match made in heaven.

What is the best thing going for the profession of dentistry in 2012?
Kushner: I won’t speak for the profession but from our standpoint here at Comfort, the answer is the same for 2012 as it has been every year for a third of a century. Other dentists have set the bar so low, chasing five percent of the market with big fees, it’s really easy for us to do what we do. I have significant challenges recruiting dentists to invest in a Comfort partnership and then schooling them in Lean & Mean management but we do not lack for patients. We’ve got patients: 50-75 new patients per Comfort partner per month, month in and month out, year after year. With our competition being corporate dentistry and traditional private practice, there is no mystery why we are so prosperous. Thank you dentists and DSIs. Desperate dental dinosaurs hang on to the failed ideology of traditional practice with a (literal) death grip. I’m a Western American History buff. I’ve read numerous accounts of plains Indians longing to again live the life of their fathers and grandfathers. How ‘d that work out for ’em? I mentioned being attacked by the profession. Before I continue, let me say that there is a group of dentists I love unconditionally: Comfort Dental Partners. I love each and every one of them for dedicating themselves to hard work, bread-and-butter dentistry, all kinds of patients, and me. Having said that, I must say, certainly with many exceptions but too often, I have found dentists to be lazy, jealous, backstabbing, elitist, narrowminded, arrogant, not very cerebral, and frankly lacking in character generally. The professional attacks on us have run the gamut from deeply impolite, to highly unethical, through grossly unprofessional and even to criminal. By the way, and FYI: The most vicious of these attacks over the years have come from hygienists and hygienists cum dentists. We have been continually sandbagged by neighboring dentists, hated for marketing, advertising, accepting managed care, our community service, our charity, our branding, our locations and our fees. We have been treated unfairly by dental associations, dental schools, DSIs, dental boards and state legislatures. There is one and only one underlying reason for our career-long upstream battle with the profession: Dentists have an elitist bent and can’t or won’t compete with us at our fee level, our schedule or our work ethic. I’ll admit to being bitterly frustrated over this and trying to confront these personal, professional and political attacks historically. Not any more. For the past five years, I’ve worked hard to take the high road and embrace the massive differences between the others and us. I simply try to channel the energy into opening another Comfort office. So again, thank you, dentistry. What’s the best thing going for the profession in 2012? For us, it’s competing with elitist traditional dentists and elitist corporate dentistry.

What is your legacy for the dental profession?
Kushner: Legacy? I am 60 but I’m on anti-aging and feel 40. Just ask the divine Mrs. K who, by the way is a 30-year old 60 year-old herself. So I haven’t thought much of legacy because I don’t plan on going anywhere for a long time. I have been called a genius but here’s how complex my genius is: “Make it cost less, be open and be nice to people.” There you have it. I’m a genius with stuff I think I learned in the third grade but dentists don’t get it. Now let’s get really crazy and add, “since our fees are so affordable, let’s be well managed and collect all of those fees at the time of service or even before service and create 42 percent overheads,” and finally, “focus on bread-and-butter dentistry.” That’s it! I’m a genius. My first and only true love is the divine Mrs. K but my passion is Comfort Dental. This passion gives me something euphoric every day. Competitively sticking it to this elite profession using “the kind of patients” they always told me they didn’t want anyway. My legacy should be the Comfort Dental model. It should be Lean & Mean Group practices saturating the professional landscape, which allow dentists to retain the greatest parts of the profession… maintaining equity ownership in his/her own practice and management input… while benefitting from the economies and multitude of other advantages of our partnership concept. But it’s not going to happen. Not in this profession. My legacy will just have to be a Comfort Dental office on every intersection. I realize I’ve just scratched the surface on a number of topics. I might be persuaded to write follow up articles to explore these topics further, but you probably won’t invite me after you see the hate messages you get as a result of this one, assuming you have the courage to publish it. On the other hand, they didn’t listen to me before, maybe this time? Nawwwwww.


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