Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard:

It is a huge honor for me today to be interviewing a senior dental student. We always try to mix the show up with endodontists, periodontists, everything from a to z and we don't hear enough from what it's like to be a dental student. I went to Creighton too in Omaha, Nebraska for undergrad. You're a senior in Creighton and you're just a hell of a dental student. You've already got five hundred posts on Dentaltown, you started a private group on Dentaltown. A lot of people don't know we have a private group section called The Ambitious Dental Students. If you're on Dentaltown and you just want to have a group, tell us about why you started The Ambitious Dental Students and how that all started.

Derek:

Sure. I love Dentaltown, by the way. It's been such a huge asset to my dental school experience, but I wasn't getting enough of the business material. I don't necessarily blame dental school because there's so much to teach. There's not a lot of time to supplement with other things. I figured I could do that on my own. I started reading business books and reading some threads from Dentaltown and then I thought, there's got to be other students like me that are trying to learn business things. Sometimes I feel like students are afraid to post because we know so little and we're fairly naïve. I felt like if we had a private group with mainly students and some mentors then it would facilitate conversation a little bit better and help students to be more comfortable. I started it a little over a year ago and now we have over a hundred and seventy members in it and it's been a lot of fun.

Howard:

I'm sure everyone listening to this is already a member of Dentaltown or they probably wouldn't have heard of this podcast. How does someone on Dentaltown find a private group? How does that work, logistically?

Derek:

There's a section that you can click on, groups, private and public groups, and it'll have a list of them. My group is not hidden. Anyone can go on and see the group and see the topics of the posts and how many members there are and different things like that but they won't be able to view the posts and the threads in that forum. If they just go and click and they can find that group and there's a place where you can send a request to join the group and that sends it to me or some other people in the group. Then we can accept it. I get private messages a lot too of people wanting to join the group and I can just add their name in too. That works [inaudible 00:02:59] well.

Howard:

Where were you born and raised? How did you get out to Omaha? Are you Nebraskan?

Derek:

No. I was born and raised in a small town in Utah. It's called Salem. It's about an hour sound of Salt Lake, a little more south of Provo. I went to undergrad at Utah Valley University in Orem which is fairly close to Provo. Then, I'm in a program where I went to the University of Utah my first year of dental school and then came to Creighton in Omaha for the last three.

Howard:

University of Utah, was that a dental school? When I got out of school, Utah didn't have any dental school. Doesn't Utah have two dental schools now? What are the names of those and when did those open?

Derek:

Roseman is a private university.

Howard:

Roseman?

Derek:

Yeah. That's a suburb of Salt Lake. I think their first graduating class, they just graduated this last year if I'm right. The program that I'm in, coming to Creighton, has been a program that's existed for about thirty years and the University of Utah just started a dental school the year after I attended. That would mean they're in the third year right now.

Howard:

What city is that in?

Derek:

That's in Salt Lake.

Howard:

They're both in Salt Lake, then?

Derek:

Yeah.

Howard:

What suburb is Roseman in?

Derek:

I think it's South Jordan.

Howard:

That's where Ultradent is. Do you know Dan Fischer?

Derek:

No.

Howard:

Oh, my God. Next time you go home you go have to go to South Jordan and meet Dan Fischer. He's the founder of Ultradent. He's one of the greatest. In fact I did a podcast with him. You should go back and watch the podcast of Dan Fischer. He might be the most amazing dentist that ever lived. Then you've got Provo, you've got Gordon Christen, who is the modern living Pierre Fauchard, G.V. Black, of dentistry up there in Provo. What are you learning, reading these business books and being on your private group on Dentaltown, Ambitious Dental Students? You're in your senior year, what are you thinking you're going to do when you graduate in May?

Derek:

I've tried to be as open as possible to different options. I enjoy working through different scenarios. The last time I bought a car I probably talked to forty people before I bought a car. I enjoy the negotiation process. Even if I know I'm probably not going to pursue it, I like going through the motions to learn how to act on any actual situation. I've talked to a few dentists about becoming a partner, working as an associate. From the beginning I haven't really planned on specializing. I've hoped to go into private practice, soon. At this point I'm looking at different practices and trying to look for a transition where I could possibly purchase the practice, keep the senior doc on for six months to a year and transition through that phase into ownership.

Howard:

Are you working back from first, I want to go back home because I want to be by my family or are you more of a mindset, I want to go that's the business deal? Do you have any emotional things? People say they don't. I say, you're not going to go to the Congo. You're not going to go to Zimbabwe. What do you mostly think about geographic location?

Derek:

That's a good question. It's funny because growing up, when I decided to be a dentist I'd just go back to Utah. That's where my family is.

Howard:

You said they're in Orem?

Derek:

Salem, which is thirty minutes south of Orem.

Howard:

Is that where they drowned those witches two hundred years ago?

Derek:

Yeah. That's the one.

Howard:

What a bad rap. They first have to drown you to find out if you floated. What is it, if you floated you were witch and if you sunk you weren't? How did work? Do you remember?

Derek:

I don't know.

Howard:

Oh, my God. I thought, that's a raw deal because if you come out innocent you're still drowned. You're from Salem. How big a town is that?

Derek:

When I was growing up it was around two thousand. It's probably closer to somewhere around five thousand now.

Howard:

You always thought you would go back there. What are you thinking now?

Derek:

Since being in dental school and learning more about different opportunities that are out there, I haven't really planned on going back to Utah. A lot of metro, bigger cities, it sounds like the gist of what I get from a lot of people is that they seem to be saturated. I don't know if Utah is super different. I think it's probably fairly saturated but the competition also seems a little bit higher. There are more dentists doing more procedures. More advertising. It's a little bit more competitive. I haven't planned on going back to Utah for a couple years. At this point I'm looking at all the different practice opportunities that are out there. I'm married and have kids.

Howard:

How old are your kids?

Derek:

I have three girls. Oldest will turn five in a couple days and then three and one.

Howard:

Man. When you're as old as me we've got to compare stories. I raised four boys. You're going to raise three girls, maybe four. We'll have to compare war notes to see who had a tougher life. I notice you still have all your hair. I don't know if that's because you had girls and I had boys. You know your mother in law, then. Where does she live?

Derek:

It's Centerville. It's a little bit north of Salt Lake. My parents and my wife's parents are about an hour apart from each other.

Howard:

Are they putting the bands on you that says, don't move my three granddaughters more than this far away or is there a rule that you have to be in Utah or a one hour flight on Southwest Airlines? What are they telling you?

Derek:

I've told them several times I'm looking at different areas. The further away it was the more sad they are, but there's never been any kind of rule. It's mainly my wife. As long as my wife's happy and we're in a good area for our family, that's the main priority.

Howard:

If your wife is happy we should just only talk about that for the rest of the hour. How do you make your wife happy? I think that could be a nine hour podcast. You've got your wife happy so you're an amazing man there. Where are you looking at practices? Where are you finding these practices? Are you finding them on the Dentaltown classified ads or is there other websites? How are you finding practices to evaluate? Where are you going to to find them?

Derek:

Reps. There's the reps of all the supply companies. They know of practices that are out there. I do look at the Dentaltown classified fairly often and speak to the brokers on there. When you look in the classifieds you're going to find a lot of different brokers and then they're going to let you know about the different opportunities that are out there as well. I still look at the classifieds in a couple different areas but mainly I'm talking to brokers at this point.

Howard:

These are brokers you met on the classified ads section of Dentaltown?

Derek:

Yeah.

Howard:

Any of them that you want to give their names or companies or any of them helpful, because we're going to name this podcast Ambitious Dental Students so you'll probably be getting far more share of dental students. You can post this in your group, Ambitious Dental Students. Is there any of them that are more helpful?

Derek:

There's one guy in Texas. His name is Rich Nicely.

Howard:

That's a nice name.

Derek:

It is, isn't it? His group is called Texas Practice Transitions. The thing that's been most helpful about it is he takes a lot of time to put together a report and it's a sixty page report. Easy to read. It seems to be fairly non-biased the way that he explains the evaluation.

Howard:

A sixty page report?

Derek:

Yeah.

Howard:

On every one of his practices he's carrying?

Derek:

Yeah. It seems like a lot of brokers are going to send, they might have a two page summary report on the practice and then maybe they'll send you five to ten other PDFs of reports and then you've got to pull it all together and make sense of it. He puts it together in one big PDF and it flows a little bit better.

Howard:

is his website, www.texaspracticetransitions.com?

Derek:

I do know for sure. I can look at it real quick.

Howard:

What city is he in?

Derek:

I couldn't even tell you that. Let's see. His website is tx-pt.com.

Howard:

[inaudible 00:12:50] tx ...

Derek:

-pt

Howard:

-pt

Derek:

.com.

Howard:

.com. He does a sixty page report for every practice. You know what that reminds me of? When I was in MBA school they said, you know what you need to do? You need to buy one share of stock of every publicly traded dental company because then by law they have to mail you their quarterly 10Q and then their yearly 10K or whatever, annual report, and you'll get used to reading their balance sheet, their statement and cash flow, their profit and loss, their balance, their notes. In the quarterlies it's got to be extremely factual and if anything's not factual you're legally liable, but at the year end report they let you loosen the reigns and let you be a little optimistic to say, I'm excited about this.

I think this is going to grow or this or that. I started doing that with dental companies and it really edumacated me a great deal and I imagine, you talk to forty people before you buy a car. Reading a bunch of sixty page reports from Rich Nicely about practices. How many of these reports do you have to read before you finally felt like you're ready to buy a car or buy a practice, as far as understanding the metrics?

Derek:

I've had help. We've discussed some practice transitions and some numbers in the dental student group. Somebody will post on Dentaltown and say, I'm looking at this practice and looking at what different people are posting and giving advice, that's really helpful to know how to evaluate different situations.

Howard:

Let me just throw a curve ball at you. Humans are social animals. They like people but males are territorial. I don't care if you have a dog or a cat, you let your dog out in the back yard it wants to pee on all four corners and mark its territory. Young boys want to own their own practice. Have you thought about if you weren't a boy and you weren't territorial that maybe you would make more money as an associate for a big practice as opposed to owning your whole thing or do you just look at that like you don't care? You're just thinking long term right out of the gate?

Derek:

That's a good question. I thought about being an associate for a while. I've tried really hard in dental school to get as much experience as I can. I know that anyone coming out of dental school their experience is going to be very limited. I have thought that through and thought about that. I don't think that I would make more money as an associate than the potential as an owner. I think if I struggle that first year I will probably make the same amount as an average first year associate.

Howard:

Are you finding a generalized different in valuations from say, practices in large metros like Salt Lake, Phoenix, or Dallas, versus small rural towns like Salem and towns of five, ten thousand? Do you see trends in difference in valuations and profitability and stuff?

Derek:

I haven't seen trends in that way. It seems like there's so much variation to the valuation that some of [inaudible 00:16:28] practice. The biggest thing for me is that, an evaluation has to be based on the profit of the practice and a lot of times people make an evaluation based on just the gross, just the collections of the year and even if they have a really high overhead for some reason it doesn't come into their evaluation of what practice should be. There's maybe some more rural areas that smaller that maybe dentists are trying to sell for less because they get a little more desperate but overall I've seen a lot of variation and can see fewer trends.

Howard:

I wish every dentist would watch Shark Tank because the first question out her mouth is what are your sales and then what do you make it for? What do you sell it for? If that margin isn't well over fifty percent they're like, I'm not interested. I'm out. Or the second question will be, your product cost is twelve bucks but your batch is a thousand. How big would your batch have to be to get this thing from twelve bucks to eight bucks? Or six bucks? You're right. Gross means nothing. I know practices did three million dollars last year and went bankrupt. You see dentists taking home twenty-five thousand dollars a month and some will only have to do forty-five thousand to do that. Some will have to do fifty thousand. Some will have a hundred and twenty-five thousand to take home twenty-five thousand. It's a game of net, not gross. Any areas of the country you're leaning towards?

Derek:

I'm limited to the western half of the United States. At this point, of all the practices that I've seen the best opportunities and the most common ones seem to be in Texas.

Howard:

Texas is booming. They have oil, even though oil's fallen from a hundred to twenty bucks. They're right on the Mexico border. They've got tons of immigration which is a fuel of labor. It's a robust economy. I think right now, of all fifty states it's the number one healthiest economy of all fifty states. Everything I read, Texas is the bomb. Man, what a big state. I'm in Phoenix. When I get to El Paso and turn left to Houston, it's a twelve hour drive. It's just a monster. What dentists are you following on Dentaltown that are helping you think more clearly about business, practice, buying a practice? Just the business of dentistry?

Derek:

Scott Leune has definitely been the most influential. He's not as active on Dentaltown now as he was several years ago but those threads are still there. I really like the way that he thinks. I agree with the way that he analyses situations and how to manage practices. That's definitely been the most helpful to me.

Howard:

I did a podcast with him about a month ago and when we were done, I said, dude we've got to keep going. We did a second podcast, when we're all done he said, can we do one more? We did three back to back and those were some of the most highly viewed podcasts. Those things exploded.

Derek:

I listened to all three.

Howard:

You listened to all three?

Derek:

Yeah.

Howard:

Isn't he in Texas?

Derek:

Yeah. He's in San Antonio.

Howard:

San Antonio? That's the boardwalk?

Derek:

Yep.

Howard:

That's the Alamo?

Derek:

That's right.

Howard:

Have you met Scott?

Derek:

Yeah. It's cool. When I created the group on Dentaltown, I had been part of a private group before but there wasn't enough people posting and it died fairly quickly. I wanted to create a group and I wanted it to thrive. I wanted there to be people posting and asking question and have different mentors. Scott was one of the first people that I invited to the group and told him what we were doing. We started to work through a couple different things and he posted and he said, I've got an awesome facility. We do a lot of different things and you guys could learn a ton If you came down here. He said, if you'll give me the dates and you coordinate it then I will open up my staff to you and give you some awesome training. He also let us stay for the three and a half days of the seminar at the end. It was an amazing experience.

Howard:

Did he give you a good deal on the price?

Derek:

He let us go for free.

Howard:

I know. I love dentists. They're all helpful like that. I love dentists. I don't know of a single fifty-six year old dentist who wouldn't take a kid like you under his wing in a heartbeat and it's a damn cool fraternity to be into. They love to help. They love to share. I pulled that trick on Omar Reed. When I got here in '87 he was the biggest dog on the circuit. He had this big expensive course. I didn't have a dime and I thought, I'm going to go down there and I'm going to shake his hand, tell him that some day I'm going to save up my money and I'm going to go back and go to this course and he said, sit down. Here I am eating his free doughnuts and coffee all day and everyone else had paid thousands. I was twenty-four. That's so cool. I love Scott even more after that. What is Scott teaching you? What have you learned from Scott?

Derek:

We went and we spent a day in each section in his call center. We spent a day in inbound calls, a day in outbound calls. We spent time with claims, processing, with insurance verification. I think those were the main rotations. He took us out to lunch several times and had us in his office for hours at a time answering any questions that we had. Then of course the seminar is after that where you get the huge binders and you go through all of the information and it's all there for you at the end to review and to go back through.

Howard:

Probably a lot of dental students listening. Explain why does Scott have an inbound call center. Why does he have an outbound call center. Explain what's going on there and what did you learn from his inbound call center and his outbound call center?

Derek:

I'll answer your first question first. Why does he have it? The amount of inbound calls that come in are very variable throughout the day. You might have only a few for several hours and then maybe at ten or eleven you've got this peak time where you have ten to twenty calls come in during that hour. If you only have one person, maybe even two people on the phones, they're still going to have times where they're both on the phones, someone else calls, maybe they're checking out patients and they're not going to have time to get to the phone. Scott has it arranged so that your practice can be the first one to pick up the phone and if you don't get it it will go to his site and they'll answer it.

Or they can be the first line to pick up the phone. When you're doing that you basically for phone calls instead of paying, if you wanted to meet the capacity that you would need at the high peak volume time you would have to hire more staff and then during the slower times they wouldn't have anything to do. He's found a way to supplement a practice to allow you to outsource something where that you're only paying for it during those peak times.

Howard:

That's a great concept. A lot of people learn business from watching the news and all that and they think of G.M. assembly line where car manufacture G.M. matches the assembly line flow with total demand. They make one care every hour and at the beginning of the years they say, I think we'll sell one million units of this car so the assembly will crank out one million, when you're in a service like dentists, Barnes and Nobles, the bank, you have to match capacity with flow. Like a bank will have three drivethru lanes and for a hundred and sixty eight hours a week, a hundred and sixty hours, you only use one, but Friday everyone gets paid so they open up all three. They've matched their capacity with the flow. You go into Barnes and Nobles, they have eight check out lines and there's only one lady there, but as soon as the movie lets out everybody runs and they man eight more stations.

They match their capacity to the flow. What's Scott's doing, nobody knows when incoming calls are going to come in. You just got little Betty Sue up there and if all of a sudden the phone starts ringing off the hook, they overflow. He's providing a service where his capacity will match your overflow. Is he doing this mostly for his own offices which he owns or is he selling this service to any dentist who wants to be a customer?

Derek:

As far as I understand, the majority of them are all other practices. In fact, he had seven practices and I believe he sold them recently. I don't know that he owns any practices at this time right now. They're all other dentists that he's providing this service for.

Howard:

What else have you learned from Scott?

Derek:

Let me answer your other question. You said, what did I learn about the inbound calls and things like that? Two things. One is scripts. How important your wording is. It's important that you take control of the conversation, if someone calls and asks how much a crown is. There might be some variation and most people are going to say, it just depends. You just have to come in the office first. He would say, we provide a range that the crown is going to cost and you say, why? Do you need a crown? You take control of the conversation and you start asking them the questions. The more questions the patients are able to ask the more likely they are to find a flag that's going to come up that's going to persuade them not to come to your office.

The first thing would be the way that you manage the calls. The second thing that I learned that was probably one of the most important things while I was there is the importance of audits. Scott talks a lot about audits and how to audit your staff. If you're going to grow you're not going to be able to macro manage everything the same as when you have a very small staff. Creating check lists and reviewing them occasionally at certain time frames is going to allow your employees to know specifically what they're responsible before while still allowing you to do the dentistry.

Howard:

You are wise beyond your years. I can tell you at fifty-three, watching dental students graduate for twenty-eight years, you are going to knock it out of the ball park. I've been calling dental students like that in my mind for twenty-eight years and I've never been wrong. You are going to crush it. I mean, crush it. Just unbelievable. What did you learn about outbound? That's inbound call. Explain to listeners what is an outbound call center and how is that different than an inbound call center?

Derek:

In Scott's setup the outbound is the most simple job that there is. You're making confirmation calls for appointments. If there was a missed call from a patient then they can call back. Those are the easiest phone calls because you know exactly what you're going to say. Imagine how hard that would be if, you're not in the practice but you're trying to show that you are in the practice and that you have all the knowledge that you are. The inbound calls are the ones that are a lot more technical. You've got to be quick on the computer to be able to jump through the different parts of information with each practice. To be able to get into the practice management software and look at openings, look at their treatment history, their balance.

Howard:

That really explains a lot to me because I remember when I called Scott and asked for job he said I was only qualified to do outbound calls. Now I know why he said that. On the inbound calls these people are connected into the dental office's practice management system and can pull up ... ? If Derek Williams calls me up from an office in Nebraska I can pull up his chart?

Derek:

Yeah.

Howard:

Is there any practice management software that he liked more than the others?

Derek:

When I was talking to the employees it sounded like most of them liked Open Dental. It seemed to have the best interface and it seemed to be the most user friendly.

Howard:

It's funny. That's what I love the most about Dentaltown is you get to hear what real dentist who bought this with their own money say. It seems like all the threads of all the other systems are just, you just pull out your embroidery and stitch and bitch, stitch and bitch. That's all it is, and the Open Dental software are raving fans. I'm this close to switching. I've been on [inaudible 00:30:20] since '87. The only reason I don't switch yet is because I think of all the things I want to do in my office and it hasn't really reached the, that that's the most important thing to do. It's never made the top three things I need to work on this year. Open Dental, that's a good lead. You spent the day in insurance?

Derek:

Yeah.

Howard:

You said inbound calls, outbound calls, and insurance?

Derek:

There's insurance verification where basically the staff have a list of information that they need to call the insurance company and verify everything before the new patient comes into the office. Then there's a different section that manages claims.

Howard:

A lot of companies try to automate that with software but in our office we've always made the executive decision that someone has to call and we have Kalani. That's all she does is verify each one. Is Scott, has he tried to use automation software to do that or is he still believe that a human has to call the insurance company and go line by line?

Derek:

I don't know for sure. From what I saw when I was there, they were calling and they were talking to a live person. Sometimes, if they could find on a website or had information that they could enter in they would do that but most of the time they were calling.

Howard:

It makes you wonder what's going on. You go into a dental office and like in my office you got Kalani, who has to call every single person. Then we have another person doing all this insurance and billing. Why do you have two employees doing all that? You've decided to take that PPO and where your crown is twelve seventy-five you're accepting eight ninety-five for it. You're giving them a four hundred dollar discount and you've got two employees. So many dentists do the math and say, my God, if I got rid of my insurance for the two people doing insurance and dropped all of these PPOs I would have only twenty percent of my practice less and I would actually net more money.

I think that's what the UK is looking at right now. When you go to England so many of these dentist on the NHS system are looking at this and saying, my God, I could drop the national dental insurance, get rid of eighty percent of my patients and actually make more money. It's a bizarre scenario. Do you think you'll be a PPO practice or do you think you'll be fee for service? What are your thoughts?

Derek:

A lot of it depends on where I'm at. There's still areas that are predominantly fee for service. There's a lot that are PPO though. It depends on where I am. It would be really nice to be fee for service but I recognize that I'm in a different time frame of dentistry and there's a good likelihood that I'll probably end up having it after the participating plans to be able to get the volume I would need.

Howard:

In 1950 the average dentist overhead was under fifty percent and now at 2015 it's over sixty five percent. The overhead's gone up fifteen percent and the main reason why is because these PPOs have lowered your fee. They've lowered a lot of the profit margin. You can't whine for dentists. The average household income in America's about just a tab under fifty thousand and the average dentist's personal income is over three times that. You're not going to get many people sympathizing that one person makes what the next three houses, where everybody living in that house throws their paycheck in a hat. You're making three household incomes for one dentist. We're not going to get any sympathy for that. You said at the very beginning that you were reading business books. What business books have you read that have helped your business acumen?

Derek:

Rich Dad, Poor Dad, by Robert Kiyosaki, Good to Great by Jim Collins. There's The E Myth. Let's see. The Four Hour Work Week by Timothy Ferriss. Those are all really good ones that seem to come up a lot in my conversations when we're talking about business things.

Howard:

Rich Dad, Poor Dad, Good to Great, Four Hour Work Week. What was the other one you said?

Derek:

E Myth.

Howard:

Yeah. Those are all classics. When I was in MBA school if you asked anybody with a PHD in Economics what is the greatest business author of all times, they all say Jim Collins, where you said, Good to Great. He wrote Built to Last which is probably a little outdated. All those companies, a lot of them are gone now. He wrote Good to Great. My favorite Jim Collins' books was when he took the reverse. He said, we always talk about the good to great, we always talk about the great, and he wrote a book called How the Mighty Fall. It was the shortest book and he summarized, this is what all the companies do that fail. How the Mighty Fall is still my favorite Jim Collins' book. If you could only read one business book in your life it'd be Jim Collins?

Derek:

Yeah. I'll have to read that other one.

Howard:

Are you typing that in now?

Derek:

Yeah.

Howard:

Did you find it?

Derek:

Yeah.

Howard:

What else do you want to talk about? You talk about stepping out of your comfort zone and maximizing your dental school experience. What are your thoughts there?

Derek:

That's probably the thing that I'm most passionate about at this point in my life. The beginning point has to do with your vision. What do you want to get out of dental school? There's a lot of people that don't really care too much. They'll jump through the hoops and get their degree and things will come with time. There's nothing wrong with that at all. For me, paying over two hundred thousand dollars for my education I wanted to learn as much as possible. Getting out of your comfort zone has been one of the biggest ones for me.

That's applied mostly clinically for me. Being willing to do more procedures that I might not have been comfortable with in the beginning, reaching out to instructors and asking for critical feedback to learn how to improve. One of the greatest things for me has been Dentaltown. It's been such an amazing resource clinically. As students we have free access to all the CE that is on Dentaltown. There's countless threads.

Howard:

That's why I have to give plasma every two weeks, because the whole damned site's free.

Derek:

I'm doing it twice a week. You've got it better than me.

Howard:

That's so cool you like Dentaltown. It's guys like you that make Dentaltown. It's the guys that get on there and share. I think it's the biggest fraternity in dentistry. In Phoenix here, the Creighton alumni is like the mafia. Of all the dental schools that I've ever witnessed, it could be the tightest alumni group I've ever seen. I only went there undergrad and I did more things with their alumni than University of Missouri, Kansas City. Dentaltown is really the ultimate fraternity. You can go to any city, any country on earth, and find a towny and the minute he finds out he's a towny you're sleeping in his home and eating at his dining room table. It's so cool.

Derek:

Yeah, it is. One thing that's been interesting for me is as I've read different threads and learned how to do different procedures, I'm reading about something before I've even ever done it. Then when I get into that position in the clinic things come a lot more naturally because I've visualized in my mind. Then when I'm actually in the situation it's a lot easier to manage. It accelerates your growth in a way that's amazing.

Howard:

I want to play with your mind on one procedure. Have you placed any implants?

Derek:

Yes.

Howard:

We have dentists out there, like the in Colorado who started ClearChoice, where they open up these facilities and he wasn't going to hire a bunch of young kids like you and spend all this time teaching them how to place implants. He opened it up and he found implantologists, periodontists, oral surgeons, to come in and place all the implants and gave them a percentage of it. Do you think it's a better use of your time to go to all these hands on courses, buy drills, buy equipment, buy all this overhead, to place your own implants? We're just talking about business. We're not talking about love of surgery. I love blood and gut surgery. I love it, but take the love of that out.

Just business. Put on your MBA Jim Collins' hat. Do you think it's a smarter deal that when you open up your office that you know what? I'm just going to have a periodontist, someone who's sunk five thousand of these things, and he's going to come in one Friday of every month and every implant, sinus lift, bone grafting, everything I lined up, we're going to put them all on Friday and we're going to have this guy come in and we're going to pay him forty percent of production and I'm not going to spend one dollar on implants, bone grafting, none of that stuff? What do you think is the better clean lean business decision on that?

Derek:

It depends on your practice and your patient base. It also depends how much experience you have with implants. When I graduate hopefully I'll be able to have one system to start out with and do some of the very simple implants and then as i get a little bit more comfortable I can grow and do more. If you have to spend the money on several systems and a lot of different training and don't end up placing that many implants then obviously it's not worth it at that point. If you're going to make the decision to do it you need to be committed. You need to realize that there are going to be some failures and that you can work through them. If you're committed to it and you're going to keep trying and learning more I think eventually you can be doing enough volume that it easily makes it worth it.

Howard:

You're twenty-seven. You're a senior in dental school so you're an millennial?

Derek:

Sure.

Howard:

Us older guys that are fifty-three year old grandpas, we hear different reports on the mindset of a dental student. You're in a dental school. Some people tell us that half the millennials don't even want to own their own practice. They just want a job. Other people say, no. I've talked to a dental student group and they all wanted to own their own practice. Do you think the millennials are thinking different than the baby boomers? I opened up my dental school four months after graduation. I graduated in May 11, I had my office open September 21. What percent of the dental students, they want to own their own office and that is the end goal. Even if they have to temporarily work for Heartland or Pacific or Aspen and join the Navy.

Their end goal is I'm going to own my own dental office. What percent of the dental students at your class of Creighton University 2016 would probably say that is absolutely the goal versus what percent says, hell no? I'm a lazy millennial. I have a balanced life. I want to leave at five o'clock, spend time with my three daughters. I'm a moderate.

Derek:

We've had a lunch [inaudible 00:42:40] recently about someone, I can't remember who it was but they asked all of us students that were sitting there, raise your hand if you want to end up owning your own practice. I'm guessing it was probably about sixty to seventy percent. There was a pretty good shown. I've still talked to several students that dentistry for them is just going to be their job. They go to work and come home. I don't see anything wrong with that. It's what they want to do. Things are definitely more different now then they were then. It's probably ore difficult.

Howard:

You're saying, two thirds said I want to own my own place and a third said, I'd rather just have a corporate job?

Derek:

Yeah. That'd be my guess.

Howard:

Of that third that says I just want a corporate job, was there any demographic to it? Were they more likely to be a boy or girl? Where they more likely to be married or single? Were they more likely to want to have kids or not have kids? Did you see any other demographic tag to that one third that just wants to be an employee?

Derek:

No. They only just asked who wants to own a practice. They didn't have the people raise their hand if they didn't want to own a practice. Didn't give me enough time to scan through things. I'd hate to make any biased comments toward any kind of group.

Howard:

Come. Donald Trump does it every day.

Derek:

I'm not Donald Trump.

Howard:

That is interesting. When I got out of school it was very prestigious for a kid to say, you know what? I want more experience. I'm going to go join the military, or I'm going to go do public health or things like that? Now when some of these corporate places like Heartland they got some of the best continued education for dental students. You can get a job at Heartland and have access to more CE and amazing, what is your classes' thoughts or what is your thought about doing a residency? Doing an GPR? Joining the Navy, getting more experience before you dive into an office?

Derek:

Creighton's not a super well know dental school throughout the nation. There's a kid that got interviewed at VSU for ortho school last year. He told them that he was from Creighton and they said, that's in Kansas? They didn't even know where it was.

Howard:

VSU, what was that, Virginia?

Derek:

Yeah. Virginia Commonwealth.

Howard:

I'm going to call Michael Jordan when I hang up the phone and have him send up a nasty letter to them.

Derek:

Sorry. I blanked. What was your questions?

Howard:

Residencies. In specialty school.

Derek:

Creighton tends to be a really good school to go to if you're planning on being a general dentist. We don't have a lot that applies for special programs here. I'm guessing that this year, out of the eighty, close to ninety students there's maybe ten to fifteen that applied. There's other schools that a lot of them specialize and the majority of them end up applying for specialty programs. I don't know that there's anything against it at Creighton but most people are not really planning on specializing.

Howard:

You take the online CE courses for free on Dentaltown because you're a dental student or if you're from a poor country, the GDP of your country is under a certain amount, it's free too. Tell us about online course at Dentaltown. There's three hundred and fifty courses. How many have you taken? What do you think of the quality? What have you learned? Where there any ones that you recommend to take or you recommend to only take if you have insomnia and can't sleep?

Derek:

Let's see. I find that the quality if fairly good for most of them. I recently took Bill Shafer's new CE on short implants. That's been a really interesting topic in the dental world. That was a lot of fun to watch. I've watched several different practice management ones. I should pull up a list but I've watched some on veneer preps. I like to watch things that I don't have a lot of experience with.

Howard:

Do you take them at home on your PC? Do you watch on your iPad? They're no available on Android smartphone and they will be available on the iPhone this month. We've already uploaded it to Apple. Where are you taking these courses?

Derek:

Most of them are on my PC. I pull up Google Drive and I make a Google doc and I take notes and screenshots of the presentation so that later if I have a question and I remember that CE I can go back in and usually find the answer pretty quick. Sometimes if I don't have my laptop I'll just watch it on my Android, though.

Howard:

Do you take the test afterwards or does it not apply since you don't need credit?

Derek:

As far as I've seen I don't think that I have the ability to take it.

Howard:

You don't have the ability?

Derek:

I've never seen a test, it just always ends. Maybe I haven't noticed it.

Howard:

Check out that. If a dental student can't take the test, I always a test was a good part of the learning process. You take the test afterwards and then suddenly you're like wow, I didn't see that or think about that or that's different or I have to go back. Send me the email, howard@dentaltown next time you take a course. If you can't take an online test then I'll reply back to you and hogo, hogo@dentaltown.com. He's in charge of the online CE and I'll see what that test thing is about. You said there's eighty graduating classmates in your dental school class?

Derek:

Right.

Howard:

What percent of them would you guess are on Dentaltown and taking advantage of these free online CE courses?

Derek:

Very few. I try not to be someone that pushes things on other people. I don't want to be that guy that acts like I know everything and I know what you should be doing right now. If somebody asks me a question I'm more than happy to tell them whatever I know. I don't know. If I had to guess I'd say maybe five out of the class.

Howard:

Are taking online CE or just on Dentaltown, period?

Derek:

Are probably taking the CE. There's probably a good number that look up things when they are looking for something. I've had a few classmates say, I saw your post on Dentaltown the other day. There's a few on there.

Howard:

Huh. This is so good. We have an annual issue every year. We have one special issue magazine that we put out a year called The New Grad Edition. Have you seen that?

Derek:

My favorite edition.

Howard:

Is it your favorite edition? Tell me why is that your favorite edition. We do it for you guys, the new grads. What do you think of that?

Derek:

I love it. It's nice because pretty much everything in it applies to me. I enjoy the magazines, overall. I think there's always really good stuff in it. Sometimes there's some things clinically that I read and it's a little bit over my head or it's maybe just not as interesting to me but The New Grad Edition is a hundred percent applicable to issues that I'm facing. It's really good stuff. My wife knows that's the one edition not to chuck after a few months.

Howard:

It's funny. You're twenty-seven, so you're humble enough to say some of this is over my head, then you'll go through about a twenty-five year period where you start really thinking you're just learning and knowing it all. Then you'll learn so much that at the very end you'll realize, I actually know nothing. Seriously. That's the phases. You start out with, I don't know. It's over my head, and in twenty-five years, oh my God, I'm learning everything. Then after twenty-five years, you've learned so much that you finally just realize, man, I know nothing.

I remember St. Thomas Aquinas was the biggest writer in the Catholic church and all of a sudden, his thing, he was this prolific writer that wrote all these books and on and on. Then he was thinking one day and he realized, I know nothing. I have nothing else to say and he just stopped writing. I almost wonder, what the hell he was thinking. You're going to feel this way. When you've got grandchildren you're going to feel the same way. Enjoy the ride when you think you know it all but so many things. Take that fat implant. When I was your age it had to be the longest implant that went out the back of your head and wrapped around Saturn three times.

Now they're realizing, no,, just surface area. You can get that surface area in five to eight millimeters. Just a big ole fat, and that Bill Shafer from London, bless his heart, he's so cool because when he started posting all those cases everyone was like, that won't work. That won't work. That won't work. He's like, here's the ten year follow up. Here's the eight year post opt, and another one which I don't even want to say. I don't even want to deal with the hate mail but there's a lot of dentists out there thinking, I'm just not seeing that the failure's in the smokers.

They're saying, I think there maybe something else going. You just can't say the person smokes so their implant's going to fail. There's a lot of people saying I don't see that. Carl Misch said that the other day. Carl Misch and his brother is divided. His brother's an amazing Implantologist. Craig won't place implants on a smoker. Carl is like, I never saw it as an issue. A lot of the things you believe at twenty-seven, when you're fifty-seven, you'll do a u turn on. You'll keep doing that your whole life. I only got you a few more minutes. Have you checked out the new mentorship program that we just launched?

Derek:

Yeah. I joined. I'm a mentee. I've got a mentor. Talked with him a couple times.

Howard:

Tell everybody about the mentorship. We just launched it. When did you join?

Derek:

Probably a month.

Howard:

Tell everybody what it is and what it's about.

Derek:

I actually don't know a ton about it. I just saw that there was a program where if you're a new dentist or a student you can ask for to have a mentor and work through some things. You basically send an email. If you would look on Dentaltown I think there's a drop down somewhere where it talks about the mentor program. Or you can search for it. Send an email and they send you a link. Click on it and it's got a list of mentors and you select one.

Howard:

How many was there to pick from?

Derek:

When I was looking, there was probably twenty. Twenty, twenty-five, thirty.

Howard:

Did you pick one because it was a name you recognized from posts or did you pick one ... ?

Derek:

They have a little bio on each one. I picked a guy that went Creighton and I looked his website and looked at what he was doing. That's how I picked a guy.

Howard:

Come one. We're talking to thousands of people and they're all over the age [inaudible 00:54:51]. If you're over forty, come on, you're listening to a podcast. Listen to these kids. They're all heart. If you're over forty or you know a lot, sign up and be a mentor and if you're a dental student, find a mentee. It's not always what you know but it's what you know and who you know and there's nothing better than having a friend in the biz where you can run an idea over. It's six degrees of separation, it's only six different humans between you and anybody from Putin to Donald Trump. It's, connections, connections, connections.

Derek:

You just reminded me of something else that I wanted to say when you talked about stepping out of your comfort zone. Dentaltown is a place where you can do that. It takes guts to post a case. I've posted several root canals that I've done. Some operative, some [inaudible 00:55:48] cases, some implants. It would be awesome if there was more dental students posting and trying to get feedback on certain cases. Sometimes you can get tough comments but the experience is just so valuable. I remember i posted a couple of root canals and within a few hours I had probably fifteen different dentists that were giving me feedback and talking, saying, I don't that's that big of a deal. You need to focus on this. It's amazing.

Howard:

I love that. You know what? A lot of dentists think they can go on there and say anything they want because hey believe in free speech. Free speech is a constitutional right between you and your government. It has nothing to do with inside my house or Dentaltown. I own Dentaltown and it's a party at my house and we all act like we're in the same frat, in the same party. That's why we have the report abuse button. Don't be afraid to post a case because of someone is rude. All you've got to do is click the report abuse and we ban them.

We have banned so many dentists because they're called cyber bullies. They're crazy. Humans are crazy. I might be the craziest one but the bottom line is, it's so cool. You'd never learn from anything you did right. You only learn if someone's tapping on your shoulder, saying, move that to the left or you did it red. Try blue. Do this and that, and if you feel safe and you're having fun and you want to play in the sandbox with these other townies then it's a beautiful thing. I congratulate you having the guts and the thirst for knowledge, an insatiable appetite for knowledge that you overcame your fear of public speaking or public postings and said, I don't care if it puts a [inaudible 00:57:43] on my stomach, I want to see what they think of this root canal. I saw those posts. You started with go easy on the dental student? Right ?

Derek:

Yeah.

Howard:

I saw that. Everyone loved it. Everybody loves a kid. Anything else you want to talk about?

Derek:

I don't think so. I would encourage other students to get out there and get their hands dirty and jump all in to anything. Dental school is the time of your life to do things clinically because you can do what you can to learn it but ultimately you're under the supervision of others. Your license is not on the line if you screw up. Obviously you don't want to make mistakes or anything. You want to do the best job you can, but if there is a time to make a mistake and to learn from something, dental school's a good time to do that.

Howard:

Remember, when you open your own practice you will have an unlimited supply of research monkeys that you can experiment on. They're called your family. That's what your dad's for. I saw so many dads drugged into dental school for the first [inaudible 00:58:56]. You never done something before? That's what your dad and your uncle Larry is for.

Derek:

I've seen several posts of somebody saying, I just placed my first implant on my mother in law or posts like that.

Howard:

My first sinus life. Mother in law. That's what family's for, is to try new dental procedures on. That's the main benefit of all your extended family.

Derek:

I'll explain that to my wife when I get home. So far she hasn't trusted me enough.

Howard:

Thank you so much. It was so fun. I'm sure all the dental students loved listening to another dental student. There's an age gap between us, so if there's other guests or people you think I should podcast on or if there's any things Dentaltown should do to cater more to dental students, that you think the older guys, it's been so long that they don't remember or your perspective, just email me, howard@dentaltown.com. Derek, I think you should practice in Memphis. You've definitely got that Elvis Presley thing going on. You got the hair, the smile, the dimples. Have you thought about Memphis?

Derek:

No, but if that's what you recommend, I'll go.

Howard:

Has anyone every told you you could be an Elvis impersonator?

Derek:

I have got that a couple times.

Howard:

See. I didn't pull that out of thin air. You've definitely got the Elvis thing going on. On that note, buddy, don't worry about your success. I've been calling them for twenty-eight years. You are going to crush it. Congratulations to you and remember at the end of the day the most important thing is those three little girls. Best of luck with those three little girls.

Derek:

Thank you Howard.