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Male 1:
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Hey, I hope you enjoy this episode of Dentistry Uncensored. Wanted to let you know that you know that after 15 years of having the annual Townie meeting in Vegas, we have signed up, the next two years are gonna be in Orlando. We have exclusive registration, opening pricing available June 1st to June 30th. Visit towniemeeting.com/Orlando to learn more and register today.
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Male 2:
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Good evening. Welcome to late night with Howard Foran. He graduated from dental school 30 years ago. 11 years later, he bet his life savings on a website that would allow dentists to talk to each other for free. His uncensored podcast has more than two million downloads on iTunes. Ladies and gentlemen, here's Doctor Howard Foran.
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Howard Foran:
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Tommy start playing that song from Prince, and gosh darn, I forgot my Vicodin. I was ... Sorry Tom, that was a bummer. Hey, it's an honor to be here. I feel like it's a friends and family, Sandy Purdue, the list goes on and on. How was Townie this time?
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We've done it 15 years in a row and we thought, "Why not? We think we're gonna try it in Orlando." We signed Orlando up for the next two years and the reason, our thinking was is number one, East the Mississippi River, three out of four Americans live, so only one in four live out here. And I'm 54, our generation thinks that Vegas is a rat pack. Like, Sammy Davis Junior and Frank Sinatra, and all these guys in Vegas with martinis, and hookers, and gambling, and all that stuff, and the millennials are into yogurt and all this stuff, so we thought we'll go to Orlando and try some concerto stuff. Thank you so much for buying my book. Thanks for the ... How many people have read my book? You bought 50? Thank you, Sandy. You're always ... 50 books. And she's from Louisiana and can't read. Think of that. That is amazing. How ironic? But that was ...
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I wrote that for my first grandchild, Taylor, and I just had my second one, Gunner was born last week. Yeah, the whole deal with the book is that I realize when my granddaughter was born that my dad and both grandfathers died at 60. I was looking at little Taylor and thought, you know, "If genetics has anything to do with that, when she's 10, I'll be dead." So, I laid down every column I'd ever written since 1994 and I took out all the root canals, fillings, and crowns, and all that stuff, because I didn't know what business Taylor would be in. I didn't know if she'd be a dentist, I didn't know if she'd own a restaurant, I assume she'll be a stripper like her mother. But I don't really know.
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So, it was actually a love story to Taylor. I know the business of writing is make it short, so the secret to writing is rewriting. So, I wrote that book. The first round, it was like 600 pages. The second round, I got it down to 400. And the third round, I got it down to 275. And I think it has 57 five star reviews on Amazon, so I'm really proud of that.
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And then here's a thing I started ... I needed a podcast section on Dental Town, so I started podcasting just because, you know, like in 1998, I did a first post. Now we have a quarter million dentists posting. And then I started the first blog, now we have thousands of dentists blogging. I needed a podcast section, so I started a podcast two years ago. Little would I know, I've done it every day for two years. I've done 700 of them. Sandy was one of my earliest guests. You need to come back on the show. I saw you taping out there. What's the name of your podcast?
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Sandy Purdue:
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Dental Drill Bits.
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Howard Foran:
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And is it on the Dental Town? But is it ...
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Sandy Purdue:
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[inaudible 00:04:17].
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Howard Foran:
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Yeah, so I started that section, because what is was is, you're driving to work, so you go to the Dental Town app, and then you go to this three section here, and then there's the podcast. I think it's a total success, because I'm into user generated content. I did the first one, now I got 20 dentist podcasts, but look at the views on that one, How to Open a Dental Office. How many views are on that?
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Female 1:
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672,844.
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Howard Foran:
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He's a big deal. He's not as big as Sandy Purdue. But anyway, I just think it's amazing that there's a quarter million dentists on Dental Town, and Jamie Amos starts a podcast and has 672,000 views. So now, you have a podcast on there. What is your podcast called?
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Male 3:
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The Dental Marketing Guy Show.
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Howard Foran:
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There he goes. So here's the Dental Marketing Guy podcast, and you put up 14 shows. Thank you very, very much. So, any other podcasters here? Tell them about your podcast.
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Emily Letron:
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It's called Fast Track to High Performance.
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Howard Foran:
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And where's it on, iTunes?
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Emily Letron:
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Yes, it's on iTunes.
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Howard Foran:
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I mean, how many shows you have?
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Emily Letron:
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42.
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Howard Foran:
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Nice. Emily Letron ... Did I say that right? Stand up, Emily, and take a bow. This is the American success story. From growing up in Vietnam during not so good times ... When you grew up in Vietnam, was that the best of Vietnam times?
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Emily Letron:
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It was in the late 60s, during the Vietnam War.
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Howard Foran:
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Yeah, and made it all the way to America, and is a legend. I'm so proud of you. You are the American dream.
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Emily Letron:
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Thank you.
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Howard Foran:
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Thank you very much. When you read her story, and I have read her book ... What's the name of your book, and where can they buy it? From Refugee to Renaissance Woman, and it's an eye opening story, but what was neat is when I started a podcast, I realized the only core competency I had was I have all these friends on Dental Town that I could get come on the show. And for all you fine people, and so I did one, did two, did three. When did we do our show, Steve? When did we do our podcast?
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Steve:
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When was it, like six months ago?
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Howard Foran:
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It was six months ago. And then YouTube blocked it. They took it down. That is just can't be legal. We grew up, Wichita, went to UMKC Dental School. We've known each other for 30 years. We've gotten in more trouble than anyone could even write a book about. We should write a book about all the trouble that we've been in. But, the bottom line is, it was a law of unintended consequences. I didn't realized, I mean, imagine that my 30 year class reunion was last Friday, and I was so excited to go. It was gonna be so fun, and then Thursday night, my grandson was born, so I missed that out, but I can't believe I've been out 30 years.
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But imagine you played piano for 30 years, and then out of nowhere, you decided you were gonna have the greatest piano teacher you could find every day for a one on one piano lesson. That's how I feel the podcasts have been. So every day, it's not lecturing to people, it's just one on one. I'm just asking them what I don't know or what I don't understand. I mean, it has been amazing. From Gordon, this guy, Next Level Endo, he put a online CE course on Dental Town that's 19 hours long. I mean, just amazing. That's the guy who wrote pathways to the Pathways to the Pulp by Stephen Cohen, that's the number one selling endodontic textbook of all time, to Christian Coachman out of Brazil.
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There are 32 dentists alive in his family tree right now. Can anybody say that? I've been to his home in Rio [inaudible 00:08:12], Carl Misch, that thing on YouTube, he went two and a half hours long. That was the most epic idea, because talk about politically incorrect. He was on his deathbed. Do you know how no holds barred people are when they know that they'll be dead tomorrow, the next day? I mean, he told me at the time that he didn't think he'd be alive for a week, and he talked like he was gonna be shot at the end of the show. It was just amazing to hear a legend like that talking on his deathbed.
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There's the guy that invented All-on-4 out of Portugal. Peter Dawson, number one selling textbook on occlusion. Taiwan, there's Australia. I mean, just amazing, and a lot of these guys have done online ... Where's Harold Goldstein? Howard, thank you so much for what you've done with Online CE. I mean, it's true.
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There's so many dentists out there always whining about their student loans. It's like they're $350,000 in student loans. It's like, cry me a river. My first divorce was 3.8 million. You're whining about $350,000, but for them to learn anything, they got to fly across the country in a $500 plane fare, and for the cab fare from the airport to the hotel, is how much an online CE course says that they're ... They average like 18 bucks, 36 bucks.
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But, dentists are always whining about their student loans, but then they gotta go drop $3500 a weekend to go learn anything. Then, they come back and I'll say, "Okay, you spent $3500 on an occlusion course. What were your notes, like one page?" "CR, canine guidance, eliminate prematurities." I'm like, "Dude, you could've done a Google search on YouTube and learned that in four minutes," but they always have to pay the big bucks. What I love about Dental Town is, for the price of any weekend course anywhere in dentistry, you could take all 350 online CE courses on Dental Town and learn everything. I mean, look at this CE series. 19 hours long on Endo. 19 hours long by Martin Trope, Next Level Endo. That is the ultimate course. It is, Sandy. You're keeping in real for Louisiana.
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Sandy Purdue:
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[inaudible 00:10:41] change the order.
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Howard Foran:
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Yeah. No, I mean it's an amazing course. I also love your course on embezzlement, and you wrote that course after you found out your daughter had been embezzling from you for years, and first, you had to stop her drinking, and then you got her to stop stealing, and I love that whole course. It was such a family affair.
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J Reznick, orthodontist. This is amazing. We have nine specialists, and the orthodontists wouldn't post on Dental Town, because they refuse to let you learn anything. So, I had to fill all of our ortho curriculum with orthodontists not from America. Like, he's Canadian. Or Sydney, Australia. Nobody from America that's an ... The orthodontists from America say, "Well, if the orthodontists see me helping a general dentist, they'll never talk to me again." I'm like "Oh that's nice. That's nice. When you look in the mirror, what do you see? A piece of shit?" I mean, the patient comes first, not your turf, not your ego. I call dentistry ... They need to learn the remote control.
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Have you ever noticed that anytime you've been over to anyone's house, there's a remote control. Nobody knows how to work it. Because the remote control ... When they meet, the people from TV want all their buttons on, and the people from cable want their buttons on, the people from the DVR want their ... Everybody wants their cable buttons on, and now you got a remote with 864 buttons, and no one knows how to use it.
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Very few companies, like Apple, or Google say, "No, no, no, the customer's first," and the customer doesn't want more than four buttons, up, down, left, right, stop, on. I mean, what the shit do you need 80 buttons for? And that's orthodontists. It's not about the patient. It's not about what's best for the patient, it's about what's best for orthodontists. Like, these young specialists, I don't even know why they set up their own office.
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I mean the research is clear that when the physician sees grandpa and he says, "Okay, I need you to go to an internist to get your diabetes checked, I need you to go to a cardiologist and get an echogram," and he gives him three referrals. One third of grandpas, as they walk out the door, just throw their referrals on the ground. Because it's beyond anyone to think, "Maybe grandpa should have one stop shopping." I mean if I was a specialist, I just got out of school, does the patient want to hear, "Oh you need to go to endodontist on the other side of town."
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I mean, if I was an endodontist, I'd get out of school, I'd find the biggest five bad ass general dentist in town, and say, "I don't even want to build an office, because I already have $350,000 student loans. I'm gonna come in and be your endodontist on Monday, yours on Tuesday, yours on Wednesday. We'll split it 50/50. I'll have no land, building, staff, no overhead, but more importantly, when the doctor says 'You need a root canal and we can do it right here. We'll do it on Monday.'"
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I mean, we need the patient first, the customer first. And right now in dentistry, it's all about the nine specialties. When you go into the physicians, it's all about the 58 specialties. Everybody's so busy protecting their turf, the patient's the one that's an afterthought. You see that in orthodontics.
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You know, we just got the best online CE ever. This guy is ... I went to Creighton with him, in Swanson hall. This guy is unbelievable. His brother just passed away, Joe Dovegen. He was one of the greatest endodontists of all time. This guy does a all day long course on what all lawsuits are about. I think John has seen almost every lawsuit that's been filed in the United States, in dentistry, in the last 10 years. Truly amazing stuff.
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So, it just goes on and on, silver diamine fluoride, there so many new paradigms, but I think this is why you're listening to me. I've had the same message forever, but what happened is this 2005. So, right here, 2005, your income peaked. Your income peaked at $218,000, 219,378, and it's been dropping 3800 bucks a year for a decade. And you know what, as it was going up, and up, and up, they were just saying, "Oh, Howard's an idiot. He's just some short, fat, bald, dumb guy. He don't know." Then, the trends reverse, and then it keeps going down $3800 a year. Every time the earth goes around the sun, you make $4000 a year less, and now, you're starting to say, "What did he say? What's going on?"
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The nutshell, the bottom line nutshell is this, if I could sum up everything that's wrong with dentistry in one second, it's simply this. You go to 7-Eleven, or Circle K, and they buy this for $.80, and they sell it for a dollar. Here's dentistry, "I don't even know what this costs, and I'm signed up for 18 different PPO plans. I do and MOD composite anywhere from $90 to 220. I don't know what it cost me, and I sell it for 18 different prices."
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The problem is very simple. The problem is very simple, Henry Schein sells Dentrics, and it's not hooked up to an accounting software. So, all your bills, your rent, your mortgage, your equipment, your labor clocking in and out, all that's on Quicken, and then all your patient information and schedules on Dentrics, or Eagle Soft. They're not connected. I have flown my fat ass to Melville New York, and told Stan Bergman, and screamed at him, and yelled, and used profanity, and he doesn't care. Then, I flew to Effingham, where they make Eagle Soft. Do you know are having ham is? In the middle of effing nowhere. I told this asshole what's going on, and then every time they come out with an update, it's like, "Well, now you can change the color and the font of the notes."
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I mean, to go to a desert ... I mean, when people say that Dentrics is awesome, I mean, you're either Stevie wonder, or Ray Charles. I mean, and if you think Dentrics and Eagle is good, you're not smart enough to know how dumb you are. I mean, really, I mean you're just raising your hand saying, "If you think Neanderthal and Cro-Magnon were dumb, meet me. Meet me. I sell shit that I don't even know what it costs."
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And you're losing $4000 a year, and then we go into your office and we start analyzing stuff. We say, "Well, if you drop these four PPO plans ... I mean, come on, how can you be doing an MOD composite for 105 all the way up to 220?" I mean, if you are doing it at 220, if you thought you were at 50% overhead, that would be 110, you'd still know the one at 95 was a loss. I mean, you would just say, "Do you know that you're doing shit at a loss?"
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Usually, these offices, you just get them to quit doing the shit at a loss, and their sales will go down from like 800,000 to 600,000, but their net will go from like 145 to 185. Then, the bozo calls you up and says, "I don't feel good about this, because tomorrow, I have a two hour opening. I have an opening." I say, "Oh, so you'd rather have it filled, doing dentistry at a loss? Why don't you be a woman? When they want to lose money, they go shopping, not to free dentistry for Blue Cross/Blue Shield."
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Go to the mall, buy socks and underwear that you don't need. Just, you know, just don't do free dentistry for a loss. So, I'm switching next month to Open Dental, and I'm jaded about that, because I'm doing it because I think that maybe Jordan and Nathan Sparks one day will connect to Quicken. Do you think they will?
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Sandy Purdue:
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Well, either that or get something like Practice By Numbers, that has QuickBooks in ... QuickBooks is in like Practice By Numbers, and it can pull out, it can do what you've been wanting things to happen for years, you've been saying it.
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Howard Foran:
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Yeah. Well, I hope that Practice By Numbers ... Where's that guy? Right there. Ooh, you're sitting by him. You just paid her to say that, didn't you? You did, didn't you? I saw the 20 under the table. So, the bottom line ... And then, everybody's telling you ... Okay, so I mean get this through your head. Look at this chart. So, you're going down $4000 a year. That means everything you're hearing, all the noise is the wrong way. Here's how a dentist thinks, and by the way, talking about [inaudible 00:19:54], I'm the only guy that owns a magazine. Every other magazine, they say, "We'll buy and add if you print this propaganda puff piece." I don't play that game. My companies by an ad, and then I badmouth them all day long. On my podcast, on my lecture. Like right now, like 3M has bought a booth out there, they're our largest advertiser, so I'm going to start my seminar with throwing them under a bus.
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So, here's how a dentist thinks. I've been using 3M Impregum for 30 years, and in a sightless premier triple trait, that cost me, you know, 17 bucks. But, you can buy a true definition scanner, oral scanner for 17,000. I don't know, $17 Impregum, send it to the lab, he mills out a crown for $99, and sends it back, or a $17,000 scanner. I know what you're thinking, "Well, the $17,000 scanner has to be cheaper, because it costs more."
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I mean, I swear to God, you'd screw up a wet dream. Here's your [inaudible 00:21:06], "Okay, my assistants never made a crown, my lab man's made 10,000. I know what I'll do, I'll buy a $150,000 Syriac machine, and have my assistant, who's never made a crown, make all my crowns. I mean, that's a good idea, isn't it? I mean, why would I want to use some ass hole bench monkey that's made 10,000 crowns, when I have a dental assistant who's never made a crown. That's a good idea." I mean, you can't make the shed up that you decide.
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I mean, you just can't, it just gets worse. I mean, here's your implant deal, "Okay, I've never placed an implant in my life, so I'll buy a $100,000 CBCT." You know what a $100,000 CBCT is? What was your first cell phone? A Motorola ...
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Sandy Purdue:
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I remember it was through Sprint. Okia, I don't know, Nokia.
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Howard Foran:
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Nokia, out of Finland. Could you imagine if you would've bought a $100,000 Nokia, and then That cell phone for life? How would that cell phone be looking right now? I mean, the only thing you want to do with a cell phone, and a CBCT, is throw it away every five years, because in five years, the new CBCT will make the old one look like a Nokia flip phone. It'll actually look like a Motorola pager. So, you'll go buy a $100,000 CBCT that will probably be outdated and extinct before they get it installed, and then you're going to buy an implant system, then you're going to go to, I don't know, Dominican Republic with a [inaudible 00:22:50], and spend another $50,000. You now dug yourself $200,000 into a whole, and you haven't even placed one.
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Then, I hear somebody who doesn't want to lose money, says, "I'll tell you what I'm going to do. I'm going to go into a market next door, or some periodontist oral surgeon who's not getting any money, and I'm going to have him come into my office one day a month, and he's going to place all my implants, and I'll split it with him 50/50. I have not one dollar invested in this shit, he's already placed several thousand, he's better than me, and he'll come in and placed 10 a month, and I'll make five grand, and that will increase my return asset, and my return equity."
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Then, I say, "No, no, no. I'm going to lose a quarter million dollars." Then, you come back five years later, he hasn't even dug himself out of his implant hole. I mean, every time you have an idea, it's wrong. What you should do is, screw the morning huddle, I won all morning huddles stopped. I do, I think they're a bad idea. What I want is a chalkboard, and I want you to come in every morning and say, "Hey, team, this was my best idea," and then write it down. Then, say, "Please, don't let me do this! This is my best idea. We lose more money every year. Every time I think, I lose more money."
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Dentists are one of the few businessmen in the world where if you drop them on their head, they'd make more money. So, I mean, you're going down. You're going down, and everybody that you listen to makes money selling you shit to go down. Then, some guy is going to come tell you that it ain't so. And, they always tell you what you want to hear. It's almost like practice management is some self-help Kumbaya deal. You know, just tell me what you want to believe, and will all sing Kumbaya until we go bankrupt, and believe it together.
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Let me tell you some facts. Okay, first of all, it's a general dentist making 175. The endodontists are making 325, and you know why? Because millennial's come out of school, and they say, "Well, you know, I don't like blood." Hey, dumb ass, you became a doctor. Where on your medical education did you not find out that monkeys were filled with blood? You say, "Well, I just don't like blood and guts." Yeah, that's called an engineer. How did you end up a doctor, and you tell me you don't like human shit? "I don't like blood and guts, I don't like anything bloody." Yeah, well you should be working at Intel, or a programmer.
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You always want to do this white fluffy stuff, like you want to learn like sleep apnea, or do veneers. You know how hard it is to sell a woman veneers? You know, it's anthropology. There's only one reason we've been alive for 2 million years. It's because you have three drives in your reptilian cortex. You got to eat, drink, and screw. You were born ... That's why you're always hungry, you're always thirsty, and you're always horny. Your only job was to make a little baby. And mom, that's why she will by orthodontics on her baby 10,000 times for veneers on herself. Then, every dentist will go to 100 veneer courses, and not learn ortho. You go to mom and you say, "Well, you want veneers?" She'll say, "Well, look at my 12-year-old daughter. She looks like she ate corn on the cob through a chain-link fence. No one's going to screw my daughter. [inaudible 00:26:46] daughter. I want to give you $6000 to fix up my daughter so someone will pork her someday, and make me a granddaughter."
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Now, that's not exactly Word for Word how she says it, but that's what her monkey brain is saying. I mean, they don't want her daughter to have to grow up and join a convent because no one would touch her. Then, you're like, "Well, I don't know how to do orthodontics. I don't know how, but I went to the Spanky Institute, and learn occlusion, and I want to do veneers on you."
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Or, then you go to these other institutes that teach you how to do full mouth rehab on grandpa. You explain this whole full mouth rehab, and grandpa's looking at you like, "Dude, can you see the liver spot? It's the size of a quarter. You want me to spend 50,000? Who's going to look at my teeth, they're staring at the liver spot." When you're taking a shade on a man with a liver spot, it's just an A1, screw it. You can put that thing in purple, and he wouldn't even know it. And then, when you're done, you're like, "It's $50,000," and grandma's like, "Well, we can take him to the vet, and put him down for 50."
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So, your best idea is 50 grand, and the vets say, "I'll knock his ass out for 50 bucks. He'll just phone a little at the mouth for a minute or two, and he'll be all good." See, I mean you got to follow the trail. Mom spends 10 to 1 on boo-boos, because she's a human, she's an animal. I mean, everyone knows, I mean, you never get in the middle between any animal and its baby. I mean, you think, "Oh, it's just a donkey." Yeah, go pet it's baby. You're going to be killed by a jackass. I mean, that's just the way it works.
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So, the bottom line, look at Endo. Endo, they come in begging you, they go, "God dang, I'm in pain. I've been up all night, I can't sleep, can you do a root canal?" You go, "Well, I don't like Endo." Okay, so our species, 100 billion humans have died since we became a species, 2 million years ago, and you're saying, "Well, I don't like Endo." Well, the last 2 million years, do you think any of them sapiens didn't like their job? You think any of those sapiens are like, "You know, I really don't like living in a cave, eating mastodon shit." It's like, "I don't really care if you like living in a cave. It's freezing outside, and the only thing we have to eat is a bunch of dried mastodon poop." You said, "Well, I ain't eating it." Well, then you wouldn't be here.
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A lot of people ate a lot of mastodon shit for millions of years so that you could just be a live here today, and then you tell me you don't like Endo. You just like the fluffy stuff. "Oh, yeah, I'm losing my ass, so you know how I'm going to save it? I'm going to learn sleep apnea." That's good. Why don't you learn crochet while you're at it?
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"Oh, I can't make any money on root canals, fillings, and crowns, so I'm going to learn sleep apnea, and Invisalign." Does that even make sense to you? As you lose $3800 a year, you learn Endo. I don't give a shit if you like it or not. And I want to tell you this, I got into a lot of trouble, I actually recently got banned again from speaking in the great state of Ontario, province of Canada. So far, I've been band to speak in Rhode Island, my own state of Missouri, and now I get to add Ontario.
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You know what I said that they didn't like? It was actually the truth, and the truth was this, I've been practicing 30 years, so I don't care what you say. Like, this whole same-day dentistry shit. Okay, 30 years I've been practicing dentistry. I'm in Phoenix Arizona. A quarter of my five-mile radius is Guadeloupe, speaking Spanish is the primary language. When I say, "You need a crown," they only have two questions. "Oh my God, how much is that going to cost? 1000 bucks? Do you take my insurance? I don't get paid until Friday." It's just money, and the other half is fear. "Oh my God, are you going to give me a shot? Is that going to hurt? Can you knock me out? Can you give me laughing gas? Can I have Vicodin, or whatever the hell Prince took?"
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Then, what did you hear? "Oh, I just want to have it on the same day, that's all I care about. I woke up this morning, I said, 'I don't care what I need, as long as I can have it on the same day.'" I mean, you'd have to be on ... The only way you could hear that is because I know the first thing you do when you hit your snooze alarm every morning ... Okay, dude, you need a crown. "How much is it? Are you going to hurt me?" "Hey, don't worry, I can do it the same day. That's right, I bought a $150,000 machine, I got an assisting who's never made one before, this is going to come out nice. It's all going to work out, just hang in there."
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So, then I sit there and I said, "Look, in my life, I have never pulled a wisdom tooth, ever in my life, where any sapien came back a week or a month later and said, 'You know what, I miss that tooth. I can't chew on that tooth.'" Never had it happen, ever. For 30 years, I've been telling the working class poor, "Look, it's a second molar. You chew one sixth on your second molar, a third on your first molar, a third on your second bicuspid, and a sixth on your [inaudible 00:32:31]. I can pull that tooth for 250, I can do a root canal and a crown for 2500. I don't give a shit, I really don't, but I'll tell you this, if I pull that damn tooth, you ate going to miss it, because if I was you, you got $2500 and put that in one tooth, when you got 10 other cavities that need $250 filling each. I'd rather you throw that tooth in a dumpster and fix the other 10, so they don't end up in the shape."
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Every man says, "Cool," and they never miss it, and women say, "Well, I am a girl, and I'm just not going to have the body part extracted, so here's $2500." So I said, on second molar, "You always refer the second molars." I said, "That is the best practice to in the world. That's where you cut your teeth, on a useless tooth no one needs. So, you try your best to do that second molar." Halfway through it, you take a [inaudible 00:33:32] film, and you got three files in the sinus, and the bleeding won't stop, you just say, "You know, I did my best, but this ain't really going to work, and I'm just going to pull this damn tooth, and you're not going to miss it anyway, and we're all good." And that's the truth.
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I've had one person a decade miss a second molar that I extracted. I've done three single unit implants in the second molar with a crown on. I've done three. I've done one per decade. I got my diplomat on the international Congress on [inaudible 00:34:05], my fellowship [inaudible 00:34:07], back when all the x-rays were Panos. By the way, everybody thinks that the CBCT is the greatest thing that's ever invented in oral radiology, I'll call horse shit right now. You know the greatest advance in all of oral radiology was on that panel update, where somebody figured out how to put an R on one side, and an L on the other.
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Holy shit that was awesome. You could have a head injury and say, "Is that my right side?" "Hell yeah, Spanky." I mean, the R and the L. So then, you just do your own Endo, and you sit there and you say, "Well ..." And then here's what the endodontists say, "Well, you know, you should've sent them to me, because I went to Endo school, and I did 25 molars in end of school." 25 molars. Really, that's Endo school?
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And what happens to all the specialists? They're all in the 117 big metros, where half of America live, and they're not in the 19,028 towns, where the other half of America lives. When you tell Frank that, to save his tooth with a root canal, he's got to drive two hours to the big city, what does grandpa say? "No." So, his healthcare is worse because you won't do Endo, he's not going to drive, and you're afraid that a useless unnecessary tooth will have to be extracted.
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So, the bottom line, look at what the endodontists are making, 375. Next is oral surgery. They're making 413. And what you say, you don't like blood. I mean, look with that attitude is costing you. Look at what that attitude is costing you. I mean, you don't like blood, you don't like something ... I love blood. Orthodontics. Here's what I don't understand about orthodontics. It's glue, and its rubber bands. Let me tell you about orthodontics. Are there any orthodontists in the room, because this is really going to hurt.
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So, here's your options, you could go learn from Richard [Let 00:36:09], who's the only, we learn from Richard Let. He's the only board-certified orthodontist in America, Hammond Harry Greene out of Phoenix are the only two board-certified orthodontists who teach us lowlife scum bug general dentists, just two. Me and Steve, we've taken all that, we've done all that stuff for 30 years, but if you had to pick between that, or hiring an orthodontist assistant who worked 10 years in an orthodontist office, and you have the first two rooms are hygiene, and you're going to give her room three, that's going to be the ortho room, who do you think would be better at ortho? You after your two ortho classes, or having a dental assistant who was an orthodontic assistant for 10 years, and when you go doing the ortho checks, they blindfold you, and they put on headphones, and you're jamming out to Prince?
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I mean, that's what I did when I first started. I hired me an orthodontic assistant who's been there for 10 years. I took her with me to the courses. It took her years to teach me ortho. Because it's so small. I mean, those cases take two years. You do a filling in 20 minutes, you do aa root canal in ortho. I mean, orthodontists, it's like ... I mean, it's two years to even see what the shit happened. I mean, really. So, the bottom line is, ortho's big.
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Pediatric dentistry. Now, I'll admit I'm a little bitch when it comes to pediatric dentistry, and that's why I'm a good man, because I think if I did go to hell, I would be put in charge of pedo for eternity. It just be me, and Hitler, and Pol Pot, and [inaudible 00:37:51] doing chrome steel crowns for eternity in hell. So, the bottom line ...
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And Perio. Perio is an interesting disease. So, everybody keeps telling you that perio is dead, because you just fix that tooth with forceps, and treat it with titanium, and I can't tell you, that's how much propaganda there is in dentistry. When they do those implant studies, they do them all on the anterior bone, which is like oak wood. They never do it on the mandibular poster, which is like balsa wood, and the whole [inaudible 00:38:24], that's like a warm Styrofoam cow patty of soft shit. You pull these teeth, and then you replace them with implants, and everybody tells you, "Well, the implant failure in the United States is somewhere between 4 and 4.5%." Hey, asshole, it's more like 20. It's more like 20. I mean, it's crazy.
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By the way, I'm loving insurance data. Like, when you do a molar Endo in 60 months ... we're not talking about judgment, did it fail, did the [inaudible 00:39:00] go away, blah, blah, blah, blah, blah. We're talking about was the tooth extracted? When a general dentist does a molar, in 60 months, 10% are extracted. When an endodontist does a molar, 5% are extracted. So, one out of every 20 molars done by an endodontist fails in five years, and yours is one in 10. So, the real question is, why do one in 10 fail for you, and why does one in five fail for the endodontist?
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So, why do root canals fail? Because you still don't realize that when you find all the canals, and you get to the bottom, and you file it all out, when you go to fill it, it looks beautiful on x-ray, everything you see is about 50% of the root canal. So, the only reason you're finding your old canal is cleaning and shaping to the end, is so that you can get bleach in there, and the bleach is the only thing that does the root canal. If it kills all the bugs, you could fill it with horse shit. I'm talking about sterile autoclaved horse shit, not fresh horse shit, right out of the horses ass. You want to get some, put it in the autoclave, you know, mix it with some warm water, whatever.
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You always talk about, "Well, what sealer do you use?" Who gives a shit? I mean, if you had a basement and it was filled with crocodiles, and you killed half the crocodiles, guess what happens when you leave. They're going to eat, drink, mate, and have baby crocodiles, and someday, there's going to be a shit load of crocodiles down there again. And you say, "But, I killed half of them." Well, the other half could still eat and screw.
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You don't leave bleach down there long enough, and that's when, you know, you want to double your success in Endo, when you're all done and ready to fill, fill that up with bleach, and just let it keep soaking, have your assistant in there scrubbing it, or whatever the hell, go do a filling, go do a hygiene check, go do something, but let that bleach work. Until that bleach has been sitting in those canals for like five minutes, and it's still just crystal clear, every time you go back in there, you leave it there for a minute, and it turns all milky, and it's all filled with dead crap again, and then you just dry and fill. Let it keep working, it's all about the bugs.
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That's a good segue into perio, because perio is still the craziest part of dentistry. You know, the craziest part of dentistry is this. I go in your office ... Where the hygienists in here. Come on, raise it high. Gay people came out of the closet, why are you like, "Well, I haven't told my dad yet."
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So, here's what you still see in hygiene. You still see, they see the mom every three months for perio for like five years, and I go, "Is she married?" "Yeah, to grandpa." "Does she sleep with him?" "I guess." "Well, where's grandpa, I've never seen him?" Well, hey, hygienists, what if you are treating her every three months for chlamydia, and every three months, she came in and you gave her another shot of Pen VK? I mean, after five years, wouldn't you say, "Hey, grandma, are you banging someone with chlamydia?"
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I mean, it's so weird. I mean, we're in this stage where no one ... We're so into drill, fill, and bill, no one will talk about the real thing. Like, do you realize that when archeologists dig up Homo sapiens, they can find Homo sapiens back to almost the beginning? I mean, we got sapiens that are 1.8 million years old. There's no malocclusions, 400 years to zero. There's almost no malocclusions 150 years ago to zero. And now, almost every kid has a malocclusion. Why? Because, they were nursing for a couple of years, and then the kid's pulling on it, and the boob's in his face, and there's all this pressure.
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When mom fed his son, it was like a bone with some meat on it, varies, and there are all these forces, and pressures, and spreading the bone in the face, and everything was fine. Now, the first time the baby light poles twice, like, "Oh, I think she's using effort, force," so you switch her to a sippy cup, now milk just free volumes in her mouth. You give her some baby bottle with a nipple the size of a nipple on an elephant. Then, you feed it jars of pureed applesauce shit. The babies never use any of its muscles, there's never been any force, and then he shows up in your office, 12 years old, and he doesn't even have room for any of his teeth, he's got a VR, I high pallet, all this shit, and you immediately go into extractions, ortho, rapid pallet extenders, and nobody gets on TV and says, "When your fat ass baby can't nurse anymore, well, eventually it will get so hungry it will figure out how to nurse some more."
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I mean, do you really think, "Yeah, my baby died." "What happened?" "Well, she got tired of nursing. She just starved to death right there on the couch." And when you're feeding your daughter applesauce shit out of a jar, don't you tell people, then why would you need teeth? I mean, if that worked, we wouldn't have any teeth. Nobody's talking about the only reason babies need ortho is because they never use any of their muscles of mastication, ever. And by the time it's all formed, it's all malocclusion. Babies need to fight that boob. They need to fight that meat on a dead mastodon, or in elk, or whatever. In fact, when you see roadkill on the way home, you should pick it up, and take it home to your baby.
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And then, perio is the same thing. I mean, what's weird with diseases, if it's below the belt, everyone focuses on it, because the species eats, drinks, reproduces, has offspring. So, like when AIDS came out, everybody on the planet figured it out. They all learned, hey, you can trade diseases below the belt. Then, they all decided they're all going to have condoms, they put on their little party hat, and then they go stick their tongue in some stranger's mouth.
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When we were little, they told us that, "Oh, oral cancer. Oh, yeah, it's all from smoking and drinking," because that's religious judgmental stuff. Religious people love to judge. They love to just go walk by Mcdonalds and see you eating in there and say, "Ah, I caught you! I'm better than you. You were eating at Mcdonalds, you evil monkey." They're very judgmental.
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Then, we sit there and, in the mouth, we don't realize that these babies are born with zero disease in the mouth. They were born without HPV, and that HPV causing their oral cancer is causing the uterine cancer, the cervical cancer. I mean, you're one body, one virus. And then, they say you're never born with Streptococcus mutants, but then you hand the baby to grandma, and she kisses it on the mouth. This baby would've never, ever had to brush its teeth, and get a cavity. It would've never had [inaudible 00:46:30] and got gum disease. It would've never had HPV and got oral cancer, or never would've had a canker sore. It would've never had a dozen diseases, and then you hand it to your mother, who you know is wearing a flipper, and then she kisses it on the mouth, and it doesn't even ring a bell with you.
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I mean, do you know how much you grow your practice when the hygienist comes in and says, "Mary, when's the last time your husband was at the dentist? Five years? Okay, so this is what's happening. Every time you come in, I clean out all your mouth, from gonorrhea, syphilis, and periodontal disease, and then you go home, and you click on grandpa.
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We need to either, you need to divorce him, we need to take him to the vet and put him down ..." I watch those crime shows on TV. Where's the number one place to get rid of the body where they'll never find it? Ooh, you know you know. What is it? If you throw a body away in the dumpster, it's almost never found. Even when you tell them when you through the body away ... If you throw them in the lake, they'll float to the top, if you bury them in the ground, there'll be erosion. You throw him in the dumpster, there's 1 million smells, all this trash, they never find the body on those crime shows if you threw it in the dumpster, and it went to the public landfill.
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But, I can't have you kissing grandpa, and beat this gum disease. It would be no difference if he had gonorrhea, or syphilis, or chlamydia, or all those things I got the first semester at Creedon. I mean, it was a Catholic school, so you know those girls were ready. They were like living at home, under an oppressed father for all those years. They're like, "I'm at Creedon now."
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But, the bottom line is, we're not even there yet. We don't talk to pregnant mothers ... Now, you know when that baby was born, you wouldn't let anybody have sex with it, and if it did, it get AIDS, and gonorrhea, and herpes, and chlamydia, it be horrible. So, why would you let anybody kiss on it. If you never kiss your baby, it will never need a dentist. It can't get a cavity, it cannot get a cavity unless there's an infection in the biofilm.
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I mean, imagine, in the backyard, if you walked into the backyard, and let's say you didn't ... Because they always say, "Well, if you don't brush and clean, you'll get gum disease." Well, really? So, if I didn't clean my closet for a year, someday there'll be like 10 giraffes living in there? I mean, do you think giraffes are made from not cleaning your closet? "Well, if you don't clean your closet, giraffes and monkeys and lions and tigers will all appear, and it'll be the line kingdom in your backyard." I'm pretty sure that's not how it works.
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I mean, you have to get an infection. That bacteria, that p gingivalis, that Streptococcus mutants, do you realize it came from adults, who came from grandparents, and great grandparents, and that living stream has been going about three and a half billion years? And if anybody interrupts that stream, it's over. I mean, that bacteria came from some sapien. I hate to say this, because it sounds sexist, but when they do the DNA testing, it almost always comes from the mother. It's like 995% of all those pathogens come from the mother.
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Here's how mother feeds her baby. "Okay, I'm going to take your applesauce shit, and mic it. Okay, now the sauce is too hot, so I'm going to stick my spoon in it, and then I'm going to blow on it. I'm going to blow ... There's some Strep, there's some more Streptococcus. Let me taste it to get some HPV on it. Okay, you should have everything. You should have Strep, hepatitis, fecal matter, I mean, you got it all. Here, baby." That's what you do to your babies. Imagine what you do to your husband.
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So, there's the price is right there. There's the typical dental office, making 10% on this one, barely losing, barely losing, getting their ass handed to them on a deal over here. They have no idea they're making 10% on this plan, and losing 8% on that plan. Dentistry for nothing, and your chicks are free. And, some of these are your biggest plans. Like, look at this. This might be Blue Cross/Blue Shield, and they're losing 32% on a plan, and then you go into the practice, and it's 20% of their charts. So, 20% of their patients, their losing 32% of their net income, and they never have any idea. I mean, they don't have a remote idea. They're clueless.
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So, you can take courses on renegotiating PPOs, I just say you just find out ... You know, the deal on the PPOs, I just want you to know how much you're making. By the way, give it up for Tom Giacobbi, the editor of Dental Town. I can't believe Tom started working for us in 2000, and it's 2017. Unbelievable. Tom and I are the same age, so guess who did more drugs. Yeah, but the bottom line is, I don't really care about the PPO negotiations, because here's what I know, I just want you to know the price. You're not dumb. I mean, I went to school with you guys.
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I mean, dentists are smart. They learn calculus, and algebra, and trig, and physics, and applied physics is chemistry, and applied chemistry is biology, and applied biology is dentistry. You ain't dumb. You a lot of things, but you ain't dumb. You just don't see the math on your overhead, because it's not connected to QuickBooks online, so you just have no idea what you're doing.
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Then, here's why the government's not worried, because in 2000, the average American had to wait 10 days to get in the office. By 2012 it got all the way down to four and a half, and now it's creeping back up to five. I mean, America, you can get a hooker and a pizza delivered in 30 minutes. You know, in America, you can have anything but a cleaning. If I walked out in that casino at 3 o'clock in the morning and said, "I'd like a hooker, some heroine, and an eight ball of coke," they'd say, "Okay, great. We'll have it here in a minute." Three minutes. Then, I walked back out there with $1 million cash in a briefcase and say, "I want to get my teeth cleaned right now. "Oh, dude, I could get you an AK-47. I could get you uranium and a silencer. I could get you a blonde, a redhead, and a Burnett to jump out of the cake naked." "No, I just want a cleaning." "Shit, dude, I'm sorry, I can't help you. I don't even know how you would, sorry."
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You know, when you're in Phoenix, and a lot of its culture, and were not allowed to talk about culture, because it's racist, and all of this bull shit, so let's just start with racism. In Phoenix, all the Chinese will deliver me food to my home. All the Italians who own pizza places will deliver their pizza to my house. Call any Mexican restaurant, "Can you deliver?" "No, we don't deliver." And then you go to the physicians, the MDs, they come out of school, they say, "Okay, our hospitals are open 24 hours a day, seven days a week. You're going to work Monday and Thursday. You're going to come in at seven, do a 24 hour shift, you come in Thursday, do a 24 hour shift," and they're like, "Cool."
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So, you'll work two days, Monday, Thursday, 48 hours a week, and we're going to pay you $140,000 a year. Okay. Then, you hire a dentist. "On Thursdays, instead of going home at five, we want you to stay until seven." "What? Stay until seven? You think I went to eight years of college to work until seven?" It's like on Sunday in Phoenix Arizona, you'd be lucky if you broke your leg, because they take you to a hospital, fully staffed. Break your tooth, take you to a hospital. 8% of emergency room visits in the United States are dental related.
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"We can fix your broken leg, we can pull a cancerous ping-pong ball out of your ass, we can rewire your heart, we can pull a grapefruit tumor out of your brain, but a tooth, I mean, come on. How could we fix a tooth? It's not even part of the body." I mean, how weird is that? 8% of emergency room visits our odontogenic in origin, and a physician doesn't know what to do. Could you imagine what would happen at Walmart if 8% of the customers come in and said, "We want this." What would Walmart sell? Then, they say, "We need to find a shit load of this."
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Here's healthcare. Yeah, 8% of our customers want this in the emergency room. Yeah, but we don't sell that. We're doctors, we don't give a shit what our patients need. And, you can even call them customers. You have to call them patients, because you want them to be patient with your bull shit. You say, "Well, I don't like to sell dentistry." Yeah, I'd say that too, when you realize you had a 38% treatment plan acceptance.
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You know it's the weirdest thing about dentistry? The insurance data shows that every time you diagnose 100 cavities, you drill, fill, and bill 38. So, you drill one, and you don't drill two out of three. Then, you go to all these courses, like you have to see Gordon Christian every year, and the whole morning, Gordon Christian talks about all the wear rates. Like, "Healing molar wears at 14 µm a year, [inaudible 00:56:31] wears at 17 µm a year," and you learn all the wear rates, as if your problem was all the fillings wore down. Then, you come back in the afternoon, he talks about all the bonding rates. Like, "The bonding rate of [inaudible 00:56:46] molar is 18 mega pascals, [inaudible 00:56:49] 21 is 27.9 mega pascals," and you get like a puge in your pants at anything over 25. You're like, "Oh my God, 27! I'm aroused!"
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It's like, really? That's your problem? All your feelings wear down, and then they'll fall out? So, if you could just get the feeling that doesn't wear down or fall out, that solves our ... Dude, you don't remove the decay two out of three times. Do you realize dentistry would be better if we outlawed all composites, and all we did is remove all the decay impacted with butter? That would be immensely better. Then, she could go home and French kiss her husband in an F150 pickup truck and not transmit disease.
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I mean, so everything we focus on doesn't matter, but the government looking at this and saying, "Look, it takes an American five days to get into the doctor, so we're going to keep building dental schools." They're building dental schools, because your closed Friday, Saturday, and Sunday. They're leaving messages on answering machines. You got 6000 graduates that one a job, and there's 168 hours in a week, and you leave Thursday at five, and you come back Monday at eight, and when someone calls, you're just like, "Thank you for calling my dental office, go fuck yourself until Monday."
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So, they go to the emergency room. The emergency room says, "Sorry, we're doctors, we only remove brain tumors and cancer, and fix broken legs, we have no idea what to do with a molar. So, they just keep building schools. Then, you can hire an associate to come into your office ... By the way, all they need is one employee, a girl that can answer the phone, and be your assistant. You didn't have an assistant in dental school. They can work 12 hours on Friday, 12 hours on Saturday, 12 hours on Sunday, hell if they did one toothache. A root canal been uncrowned for $2500 on that three day shift, you're already paid for yourself.
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I mean, it's a no-brainer, but you don't give a shit. You're like, "Well, why would I give a shit? It's not my toothache. We are closed today. Imagine if all the hospitals closed down Thursday at five, and opened up Monday morning at eight. Could you imagine that? But, the bottom line is, these four boys went to the emergency room so many times, that we would walk in there, we would know that we were the Foran family. I mean, really, we go in there and they go, "Oh, hi Dr. Foran. How are you? Who did what?" I mean, it was a trampoline, who knows what it was.
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It's crazy. Could you imagine if the physicians, if the hospitals closed Thursday at five, had the same hours as the dentist, and opened backup Monday at eight? We wouldn't even be talking about Obama care, we'd be talking about shoot all the physicians. I mean, it be crazy, that's what you do. And then, you tell me that it's always someone else's fault.
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Here's another thing we got to transfer from. You're the only people still talking about new customers. Nobody talks about trying to get new patients. You sit there and talk, "Well, we spent 3% on new patients, we like to get 30 new patients a month." You know, every major league business on the Fortune 500 company, they assume every American, at least one time, has gone to Walmart, Amazon Prime, shopped at Costco, flown United, or used a Chase Visa card. Nobody wants a new customer. They've already had every American one time.
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Raise your hand in this room if you've never been to Amazon. You've never been to Amazon? I mean, everybody's been there once. So, they spend all their money on loyalty programs, keeping customers for life. When I got out of school, advertising was taboo. Within 10 years out of school, it was like mandatory 3% of collection goes to advertising. Now, most of the gurus are saying five to seven percent on advertising. So, here's the math on that. Acquiring one new customer costs the same as retaining five. Just a 5% increase in retention rate is a 95% increase in profits. But here's the deal, if a hygienist works 50 weeks a year, 40 hours a week, let's say hygienist works 40 hours a week. We've never seen a hygienist work 40 hours a week. Your hygienist? How many hours a week do you work?
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Female 2:
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[inaudible 01:01:17].
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Howard Foran:
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36? Wow.
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Female 2:
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32.
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Howard Foran:
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332 really, you're just saying 36 for bull shit, right?
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Female 2:
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[inaudible 01:01:27].
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Howard Foran:
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It's 32. I mean, it would be like getting ran over by a unicorn. No, I did. One time I saw a hygienist that worked 40 hours a week, riding a unicorn who ran into the tooth fairy, and then left me a note. But, let's say ... Do you really work 40 hours a week?
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Female 3:
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I work six days.
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Howard Foran:
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You work six days a week? For Steve?
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Female 3:
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No.
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Howard Foran:
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Because I'll move you to Phoenix. I'll pay all moving costs.
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Female 3:
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[inaudible 01:01:55] 40 hours a week.
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Howard Foran:
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Do you want to move to Phoenix? We'll do a signing bonus today, after the seminar.
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Female 3:
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No.
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Howard Foran:
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We're doing the signing bonus right now, Steve. So, the bottom line is this, let's say a hygienist worked 40 hours a week for 50 weeks, that's 2000 hours. I get my teeth cleaned twice a year, for an hour. A hygienist could see 1000 people, twice a year. So, the average dentist gets 25 new patients a month. Well, that means, every 2 1/2 years, you'd add another hygienist. So, that means 10 years of 25 new patients a month, you have four full-time hygienists. After 20 years, you have eight. After 30 years, you have 12, than in 40 years, you have 16.
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You go to every 65-year-old dentist in America, and he's in like Parsons, Kansas, with 30,000, say, "How many hygienists do you have?" "One." Dude, what do you need? "Well, I'd like to learn how to get new patients." Dude, you've seen everybody in Parsons, Kansas, twice. "I know, and no one will ever come back, so I think I'm going to build a Facebook ad. What do you think of Facebook?" Well, I guess it's a lot easier to make a Facebook add them to find out why you're an asshole.
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So, let's say you've had four wives, none of your patients ever came back, and the longest any staff member stayed with you is two years. So, you're going to fix this with Facebook, right? Oh, no, no, no, Pinterest. Yeah, you're going to Pin your way to success. Just a few more Pins, and people will come back to you. Why wouldn't you stop and ask why, at 10 new patients a month, you need a hygienist every 8.3 years, 220 every four years, 30 every 2.75 years, 40 new patients a month every two years, 50 new patients a month every 1.7 years? There's your hygiene capacity.
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Now, once your hygienist is booked up a day in advance, once your receptionist says, "Well, I can't clean your teeth today, but I can clean your teeth tomorrow," once she says that one freaking time, you're max capacity. So, every time you pour coffee into that cop, new fresh coffee, what happens to the old coffee? It just spills over. You've been pouring new patients into a cup of coffee for 40 years, and there's one question you can't say. I mean, if you call up your drug dealer and say, "Can I give you money today?" He says, "Bitch, I'll be straight over." You go to Walmart, "Can I buy something now?" "Hell yeah." You call the dental office, "Can I give you money today for a cleaning?" "No. No."
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We're the only place you can call on the Internet that says no to more money. "Yeah, I'm sorry. I can't take your money today," and I'll say, "Well, you only got one hygienist, why don't you get two?" "Well, I live in fear, and I'm afraid if I got a second hygienist, maybe she'd have an opening. I mean, I'd only get another hygienist if I can go back to, 'I'm sorry, I can't clean your teeth today, because now I got two bitches filled.' I can only add another hygienist if I can keep saying, 'No, I can't take your money.'"
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So, since you don't increase any capacity, you always will need new patients, because you're always telling people know. You go in the hygiene room, "Yeah, I got two cavities, can you do that today?" "No. No, no, no. I know there's 6000 dentists that just graduated dental school, they all want a job for like $12 an hour, but I thought it be best to tell you, 'No, you can't have it done today. We close Thursday at five, we won't open up until Monday at five, because it's all about me.' Remember, it's not about you, the patient, it's all about all this. Do you see this? It's not about you and your cavities, it's about all this, and all this doesn't have time to do your cavities today, and we can't clean your teeth today. We're the only place in the whole food chain that says, 'No, we can't take your money today.'"
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I said to her, "Well, you know, I feel safe when I'm booked out two weeks in advance. If I had an opening tomorrow, I'd feel scared." Oh, so you'd rather be booked out two weeks in advance, then to have like 300,000 in your checking account? "Yeah, I don't want to have any cash in my checking account. I'd rather be servicing a bunch of dads, a bunch of leases, and be booked out a month in advance. That's what makes me feel better."
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Most people, when they want to feel better, they just take a shot of Gray Goose. You have to go buy a $100,000 shiny object, laser CAD cam, C4D, whatever the shit, and be booked out a month in advance. So, here's another thing dentistry does wrong. You always think the money's with the rich people. Why are people rich? Rich people don't part with their money. A full and their money will soon be parted. You give the poorest 43 million people, you give them a $1 million lottery jackpot winning, they'd be chapter 7 bankruptcy in a year. Half of the NFL declares bankruptcy, four years out, because a full and money never stay together.
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So, you present all this shit to Ms. Jones who's rich. Well, why is she rich? Because she doesn't give her money away to anybody. She keeps it. So, you learn all of this implants, you learn all of this all-on-4 bull shit. So, let me tell you about Clear Choice. Clear Choice does a $25,000 arch of all-on-4 implants, and do you know how many they did last year? 18,000 arches. In a population of 323 million Americans, 17,000 isn't a rounding error. It's not a rounding error at two decimal places. Where do you think the money is? One implant in the symphysis, so a poor grandma can snap her denture onto an O-ring? Would you rather own Nordstrom's, or Walmart? Would you rather on Ruth's Chris, or Taco Bell? Taco Bell, not dentist.
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I'll tell you, 96% of all crowns are done on the first molars. Almost all Endo is done on the first molar. Almost all implants are done on the first molar. Then, when you go take a course, you go take a course on full mouth reconstruction. I bet you this, what is this, April 21st? 21st? And, what, 90% of this room hasn't done a full mouth construction this year? Nine out of 10? Raise your hand if you have not done a full mouth reconstruction in the first four months of the year. Raise your hand, come on, raise your hand. Quit being a lying fool. Come on, you're not even a dentist, raise your hand! If you did a full mouth reconstruction, I'm calling the police.
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So, you go learn all-on-4, and then I say, "Well, do you do mini implants?" "Well, I don't believe in mini implants." "What do you mean you don't believe in mini implants?" Really? You don't believe in them? What if I shoved one up your ass? Then you say, "Well, I don't believe in them, but I feel something up my ass." Yeah, well start believing. And, you put two down here. This is why I love lecturing around the world, the Australians just put up one, and if you talk to a mechanical engineer, they'd say, "Well, if you set up to, you got this fulcrum bar thing, that's tough. You put one up the middle, that's an easy play."
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But, the bottom line is, you just don't think there's any money in poor people. Poor people spend more money at Taco Bell and McDonald's then Ruth's Chris, and all these food chains. So, you sit there and you say that, "Well, people don't get dentistry because of cost." 40% of that is true, but 33% is they don't know they need it, and that's where probably the best booth out there is the DigiDoc booth. I mean, they got a $5000 camera that, I mean, it's crazy.
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You know, how many times have you been to a party? Where someone says, "What is your name," and you tell them, "I'm Howard," and then before they leave, they go, "I'm sorry, what was your name again?" Because, see, a monkey remembers with its eyes. I remember it was you, but my ear ain't hooked up to my brain, I didn't hear the sound, Howard, Eugene, Fran the second, DDS, who gives a GD, I don't remember shit through my ears. Then, you have a one third treatment plan acceptance.
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So, here's what I want you to focus on with the DigiDoc ... And I don't get any money from these guys, I don't even think they advertise. I don't know. I mean, I don't know, or give a shit. I'm so busy passing off my biggest advertisers, I don't have time to even see who my small ones are. So, here's the deal with DigiDoc. So, here's what's doable. The average American, for every 100 million cavities diagnosed, you drill, fill, and bill 38%, so you're doing a third. So, a third come in, and they see the whole, they want it done.
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A third will never get it done, but the middle guy in the middle, he can be sold if you learn how to sell. But, you say you don't like to sell, and that's doable. How many times have you seen two offices in the same building? They have the same number of charts, same number of chairs, same everything. One dentist has a 38% treatment plan acceptance rate, and is doing 750,000, taking home a buck 45, and the guy next door has a 68% treatment plan acceptance, has a $1.5 million practice, and is taking home 350.
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That has nothing to do with the bonding agent, has nothing to do with the implant, has nothing to do with anything other than they're better at selling. How do you sell to a monkey? Visually. And it doesn't have to be you. I mean, it could be your assistant, it could be your hygienist. And you say all this weird shit, like, "Well, I don't let my hygienist diagnose." "Why?" "Well, it's illegal in Texas." Well, I mean, I just say, "Okay, well then let's stop now. I'm going to go visit all the hygienists in prison today from diagnosing dentistry."
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Then, you say, "Well, there's no hygienists in jail." Really? Well, right now in Dallas, someone's driving down the street with a pound of cocaine in his trunk, and you won't let your hygienist diagnose x-rays. Do you see a problem with that? So, the bottom line is, no one's ever gone to jail for reading a damn x-ray. And I'll tell you why dentists never go to jail, because you show up in the morning ... And like everybody tells me, my advertising is illegal, because when you come in, I sign you a card, and if you give it to a friend and they come in, they get a $25 visa card, you get a $25 visa card, and in my office, whoever signed it get a $25 Visa card. So, that cost me $75 for a new head of sapien in my office, and everybody tells me that's illegal.
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Okay, so now you're the Atty. Gen. Of Arizona. You get to work on Monday, you only got nine lawyers working for you. You only got nine detectives and lawyers working for you. "We found a dead body in a dumpster. Mrs. Jones was shot in the head. Someone robbed a Circle K. And, we found a dentist giving a $25 coupon for anyone referred to his office." "Yeah, will screw the bitch in the dumpster. We're going to get to the bottom of this coupon." I mean, you've got to be kidding me, take a risk. Take a risk, I mean, my God.
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Demographics matters. Here's another thing that dentists are doing wrong. So, here's downtown San Francisco. There's 450 Sutter St. in San Fran, 162 dental offices in there. What's amazing, if you stand there at that building long enough, you'll see a dentist jump out the window. Yeah, and you say demographics don't matter. Well, if demographics don't matter, what I want you to do is sell your office, and move to Afghanistan. Then, after that doesn't work out, I want you to move to the Congo, maybe Yemen, because real estate ...
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You'll have [inaudible 01:15:24] in Yemen, because all the buildings have been blown up. Syria has rock bottom prices on commercial real estate right now. You can rent rubble for almost a dollar a square foot. Really? Demographics don't matter? Here's what I see in the field, and I've been doing this for three decades, everybody that takes two hours to drive to an airport, they're all taking no PPOs, they're all doing $1 million of dentistry a year, fee for schedule, and they're taking home 350.
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I ask you, "What is your number one overhead?" You know you say to me? "Well, it's labor, it's 28%." No, it's not. It's adjusted production at 42%. You tell everybody your crown is 1000, you sign up for 18 PPOs where you're doing a crown at 600. Your number one overhead is adjusting that crown from 1000 to 600. 42% adjusted production is the number one overhead in America. Now, number two is labor, at 28%, because you give your monkeys a dollar raise every time the earth goes around the sun. Your staff always comes up to you once a year and says, "Look dawg, the Earth just passed Uranus, time for a raise. Whenever the earth passes Uranus, we get a raise." You're like, "Okay, well to pay for this, let's sign up for Medicaid."
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You can't make this up, can you? So, the bottom line is, so here's what you do. So, there's very few people, REALscore does one. Who's the guy in Utah that does dental demographics? What is it? Scott McDonald. I just did a podcast on him, we're releasing that [inaudible 01:17:19]. So, here's what happens when we do demographics on you. Most dentists wake up in the morning at their house, and they're living where there's a dentist for every 2000 people. Then, they commute an hour into town, and when they get out of their car, now they're down to a dentist for every 500 people. Most dentists, when they woke up in the morning, it would be better to have a dental office in their freaking garage, or commute an hour out of town.
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But see, it's counterintuitive, because it doesn't make sense. I go show you a town that's got like 1280 people, with no dentist. Well, the 1280 people, the draw is minimum times two, sometimes times three. So now, there's 2400 people that don't have a dentist. So, there's no PPOs, or none of that shit, and then you go to those small towns. You know, Delta Dental, in Iowa has a list of a dozen cities, where if you go to that city, the state of Iowa gives you a check for 100 grand, and Delta Dental matches 100 grand. Then, the mayor walks you down town, and half the buildings are boarded up on Main Street, and they say, "You want a building?" You pick that building, and they give you some 6000 square foot brick building.
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So now, you got a 100,000 from the government, 100,000 from Delta, a free dam building, and what do you think a kick ass job is in a town of 2000 in the middle of bumble butt Iowa, where you married your first cousin? What do you think a good job is? Eight bucks an hour? 10? 10 is bank. And then, they sign up for no PPOs, and they're booked out out of the gate, they do 1 million, and take home 350 in cash on a four-day workweek. Then, you know what they do on Thursday night? They get in their plane, their Porsche, their Mercedes, Winnebago, whatever the shit, and they have a pigeon hot condo in Cedar Rapids.
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Are you thinking about killing yourself now? I mean, the bottom line is, it's supply and demand, dude. You got to create a supply where they demand it. You at five dental schools in California, and here's your best idea, "I want to get out of school, and open a dental office where you can see the ocean. Oh my God, that's my best idea!" I'm like, "What was your next best idea? I mean, if that's your best idea, I want to know your next best?"
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In 1900, there were no specialties, and healthcare was 1% of the GDP. What do you think about this? 1900, United States of America, the greatest country ever, healthcare, 1%. By the end of the century, healthcare's 14%, the physicians have 58 specialties, and the dentists have nine. Now, it's 2017, healthcare is 17% of the GDP, it just passed $3 trillion, and the reason is why? Everybody's concerned about the rise of healthcare cost, and it's only rising for one reason, the ultimate wealth is health. When rich people get rich, they want to live one day longer. So, the economists came out with this one little plan. So, here's your option. What's your name?
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Dahlia:
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Dahlia.
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Howard Foran:
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What is it?
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Dahlia:
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Dahlia.
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Howard Foran:
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Dahlia, and where are you from?
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Dahlia:
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San Antonio.
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Howard Foran:
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San Antonio. Do you know Steve Vase? No, you're in Austin, right? Yeah, he's got the best shit. So, here's your choice, you either die tonight, or you by this little pill from me, and you die one year from tonight. So, how much would you give me for this pill? You want to live longer, so I assume you're not married, you have no children? Are you single with no kids?
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Dahlia:
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[inaudible 01:21:18].
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Howard Foran:
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You have kids, and you're married, and you still want to live. God, you're an inspiration to so many. So, how much would you give me? Oh, forget ... So, how old are your kids?
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Dahlia:
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[inaudible 01:21:29].
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Howard Foran:
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Okay, the five-year-old. Let's key in on the five-year-old. How much would you give me to keep the five-year-old from dying?
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Dahlia:
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Anything.
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Howard Foran:
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You give me anything. Would you give me your house? Nobody says, in government, we spend too much money on houses. Would you give me your car? Nobody in government says we spend too much money at GM, Chrysler, and Ford, and Tesla. Would you give me your iPhone? Nobody says we sell too many Apple products, and iPhones, and Samsungs. But then, when you say, "I'll give me all I got to save my baby," the government says, "Well, you know, we just spent too much money on healthcare."
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See, you cannot get in between a mama and her baby. And the Mayo brothers figured this out, and dentistry hasn't figured it out, the Mayo brothers figured out that there were all these multimillionaire ranchers and farmers in Minnesota, and when you said, "Mom's going to die of cancer, and she's dead," the grandpa said, "I'll sell the damn weed form, the tractors, I'll sell freaking everything if you can keep my 80-year-old wife alive another year."
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The Mayo brothers said, "Do you see this shit? They'll sell their John Deere tractor to keep grandma a live one more year." See, healthcare is way ahead of DSOs, and dentistry. Healthcare, it's like, "We are Mayo Clinic. Oh, we're Houston, we're Cleveland clinic. Oh, we're the Sloan [inaudible 01:22:56] center. We're all about quality. All the dental DSOs, "Oh, we're cheaper, we're faster, we're a coupon, we're 24 hours, we have a drive through hygienist." It's all about low-cost shit. "We're cheaper, cheaper, cheaper." The physicians are like, "We know you'll sell your iPhone and your car." You got two kids, but I saw on Facebook last week, you are ready to sell two of them, totally. And I checked on eBay, they were both listed. I saw pictures of them both.
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But, the bottom line is, these people will spend anything to keep their teeth. They'll do anything. And I'll go back to you, are you married? How much money what I have to give you, cash, to pull number eight, your front tooth, and you never replace it the rest of your life? You just tell everyone you're from Austin.
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Dahlia:
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[inaudible 01:23:49].
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Howard Foran:
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It's not, come on, a million bucks?
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Dahlia:
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No, but I'm not going to [inaudible 01:23:56].
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Howard Foran:
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You better call your husband, he might talk some sense into you. He might say, "Dahlia, pull it! We'll get an F150 pickup truck, and we'll pull a boat to the lake." I'll say, "That Dahlia, she's missing her front tooth, but the bitch has got money." I mean, I'm telling you, I'm telling you, this is valuable stuff. And, you know what the government doesn't want to hear? The government doesn't want to hear that, in about 25 years, in about 50 years, healthcare is not going to be 17%, it's going to be a quarter.
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And in 500 years, when you have all the joy, and you inherit everything from your grandmother, and you got a free house, and car, and everything lasts forever, and then you wake up in the morning to have your cup of coffee, and your eyeball falls out and rules across the floor, you're going to sell everything you freaking inherited to go to the doctor and say, "Can you put my eyeball back in?" Then, your ear quits working, and then you're going to give all your money to get your sound back.
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Last year, Steve, his things stopped working. He had to sell his practice, he now works at Aspen just so he could get his dingdong to work again. The only wealth is health. It's the only thing. Look at the specialties that popped up. When I got out of dental school, there were no accounting specialties. Now, these guys have 8000 clients, no, 6000, these guys have 2000. I think the best one is Cain Waters, in Dallas. And, all these institutes do is they just want you to know your costs.
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Your accountants, you just send them all your stuff, and all he makes you is a statement of income, a PNL, and that's only for the IRS. That's only for tax collection. They don't give you a statement of cash flow, they don't give you a balance sheet, they don't go over your numbers, and you know what the top three causes of divorce are? Money, sex, substance abuse. Money and sex, especially if you're paying money for sex, you mix those two, that's a double whammy.
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But, you know how many dentists are stressed out about money? Because they come home and they tell their wife, "Oh my God, I did five crowns today." "How much did you get for a crown?" "1000." She doesn't know those were all adjusted at 600, and all your overhead. Cain Waters, those guys won't even do your accounting unless you and your spouse come down every year for two days, and they're not going to let you out and keep you as a client until you can answer all the accounting questions. What is your overhead ... You got to know your amount, and so many wives, especially young couples, "God, honey, I couldn't believe it, because you come home and say you did for crowns, and then I'd hint at the mall on Saturday, 'Hey, can I get me a Louis Vuitton, it's only for grand, it's only one day's worth of crowns?'" You'd say, "Yeah, right, I don't have a dime."
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She's getting all these mixed messages. As now, there's a lot of women, who now the women is the doctor, and now the husband is the home [inaudible 01:27:01]. I have so many men that come up to me and say, "Well, my wife is a dentist, and I feel emancipated, because she makes more money than me." And I say, "Just don't think about it while you're vacuuming."
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So, the bottom line is you know your math, know your accounting. Tom, I'm out of time, come up here, Tom, kick me out. But, here's for dentists making $25,000 a month. 40% overhead, this guy's drill, fill, and billing 41,000, this guy has 250, this guy has 271, this guy's do 125. Come on, know your math, join an accounting firm, tried to be the dentist making 25,000 at 50% overhead. The average is 65% overhead, but right now, 20% of dentists have [inaudible 01:27:46] percent overhead. But, Tom, I want to tell you, seriously, this guy's been the editor of Dental Town magazine for 20 years. Do we look like twins raised apart at birth? He tells me I'm an appropriate, and I tell him I don't even own a tie, but seriously, thanks for coming to Townie meeting. Love you much, thank you so much.
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