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VIDEO - DUwHF #877 - Nate Williams
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AUDIO - DUwHF #877 - Nate Williams
Nate Williams graduated from Brigham Young University with a Masters Degree in Accounting. He is a Certified Public Accountant (CPA) and Certified Financial Planner (CFP). He started his career at the Big 4 public accounting firm Deloitte, then worked at Cain Watters in Dallas before founding his current firm, Practice Financial Group, in 2010.
Nate works as the managing partner of Practice Financial Group provides comprehensive tax, accounting and financial planning services exclusively to dental practice owners across the country.
Howard: It is a huge honor for me today to be podcast interviewing Nate Williams with Practice Financial Group.com. He graduated from Brigham Young University with a Master's degree in accounting. He's a Certified Public Accountant and Certified Financial Planner. He started his career at the big four public accounting firm Deloitte, then worked at Cain Watters in Dallas before founding his current firm, Practice Financial Group, in 2010. Nate works as the managing partner of Practice Financial Group.com, provides comprehensive tax, accounting and financial planning services exclusively to dental practice owners across the country. I called you to be on the show, you didn't call me, and the exact reason I called you is because one of the craziest things I ever posted was an amazing article you wrote, and it's called... let me, God the thread on it's a mile long, the article was called “The multi-practice model, an epidemic in Dentistry” by Nate Williams CPA, CFP. And my gosh, they're still talking about it, that thread on that is five pages long. I love my dentists, I love them to death, and all they want to do is fix teeth, they want to get you out of pain, they want to get rid of your gum disease, they want to treat your occlusal disease, but gosh darn it, none of them know their numbers. And they're doing dentistry, they signed up for ten different PPO prices so you'll say, “ Hey buddy, you just did a filling on Nate in there for an hour, how much did you charge for that filling?” The price he gives me is never even right, he'll say, oh, I get two twenty five for an MOD composite, I'm like, dude, that was a PPO plan, you got one forty five, how do you not know within a hundred dollar bill, a Benjamin, what your price is? Then I say, well, how much does that room cost you for an hour? No idea. I mean, it's just, the biggest epidemic in dentistry is they don't know their accounting. So, then there's these weird people like you that actually go out and get a Master's degree in accounting. So, you work with a hundred and fifty dental offices spread out all over the country, what do these guys need to know more? What do they not know about their numbers? And start off with that unbelievably controversial article you wrote, the multi- practice model, an epidemic in dentistry by Nate Williams. What made you write that article and what did you think of that thread which is now five pages long?
Nate: Well, first of all I appreciate you having me on the show, I'm a big fan of yours and I've learned a lot from your website, from the knowledge that other people share, and I think it's a great forum for people to share ideas and for doctors to learn. One of the things I love about the dental community is that it's just that, a community where people are willing to help each other, and it's such a local business that I don't mind sharing ideas with a guy who's just one town over because there isn't a general feeling of competition, there's more of a feeling of abundance. And I think you've been a big contributor to that, so thanks for having me on here. As far as that article goes, it's tough, it has been a very controversial article and some people were unhappy about what I wrote and other people were very relieved to hear what I had to say.
Howard: Well, it's called an inconvenient fact, whenever you tell a human a fact that doesn't fit their bubble they get mad, and you popped a lot of people's bubble, but you did it with data, you have numbers you see a hundred and fifty practices, you have a Master's degree in accounting, you work for Cain Watters. I mean, these guys, so many of them just want to believe stuff that's not true.
Nate: Yeah, I think one important thing on this idea of, should you open up more than one practice? That article that I wrote clearly isn't for everybody, I assume that there are people who are opening up many practices and doing very well at it. Everybody knows about Heartland, Pacific Dental, Aspen Dental, and they see those numbers and they hear the words private equity and they get really excited. Who I'm trying to talk to is the dentist who actually wants to be a dentist, actually wants to help fix people's teeth and is under the false impression that in order to do well financially I ought to go and open up another practice. And the reason I wrote the article isn't because I had an agenda, in fact as an accounting firm you're charging fees for doing accounting work, and the more complicated people can make their life the more money we make. And so, I wrote the article, not to be self-serving, but because I've found over the last ten years that the vast majority of doctors who try to open up a second practice they flounder, and they don't take very much money and their lives are really chaotic. And I think a lot of times they went into it with a false premise of, I ought to do this, or I should do this if I want to be successful in my career. And I'm just trying to hold up a mirror and trying to share some other ideas without violating confidentiality for the many, many doctors who we've helped through and out of this mess.
Howard: Well, when you said that it's for the smaller dentist who wants to be a dentist, I mean, East West Bank, they've stopped lending to dental group practices, and I mean, they've left a hundred group practices and DSOs wondering whether to turn for capital and this should have been the biggest news in dentistry. I mean, that was November 30th of 2016, I mean, that wasn't even a year ago. When East West Bank said, hey, this space is... we're not lending any more money there. That's another huge data point, that all these big DSOs aren't as rosy as everyone thinks they are, agree or disagree? Did you see, did you know that East West Bank quit lending to dental?
Nate: I didn't know that Howard, but I'm not surprised at all. I've talked to a lot of startup dental lending firms or banks and a lot of the startups are really aggressively going after the multi-practice model. But it's really easy... you have to work really hard, if you're a bank you have to work really hard to find a dentist who's willing to borrow money from you. And so if you can find one and get that guy to borrow 2 or 3 or $4 million from you that's a lot better than finding one person and only lending 5 or 6 or $700000. But it doesn't surprise me at all that a reputable bank who has a lot of experience and a lot of history and a lot of knowledge like East West Bank, it doesn't surprise me at all that they just pull the plug on that.
Howard: Why do you think dentists don't know their numbers? I mean, of your hundred and fifty dentists that you work with, how many are taking PPOs?
Nate: Yeah, good question, I'd say probably about half of them are taking PPOs. And in my personal opinion that's one of the biggest issues in dentistry right now, is the growth of managed care, and I think it's probably the most pernicious foe that dentists face right now that's threatening their livelihood. But as far as why don't dentists know their numbers, they're really busy and they have an important job to do, and the value of their time is very, very high chair-side. And I think that the accounting world and the finance world, those of us who are supposed to support them in their business, I don't think we've done a very good job of organizing and preparing the data in a digestible way. For example, if you look at a... most dental practices in America use QuickBooks as their underlying accounting software, well, if you've ever looked at a QuickBooks P&L it... I mean, you have to pull out a calculator and a slide rule and a compass in order to make heads or tails of what the P&L is telling you. And if you pull a report out of Dentrix or Eaglesoft, same thing, they're very confusing, so the data hasn't been organized and packaged in a way where dentists can actually easily understand it and make decisions about it.
Howard: I mean, I know, I use Peachtree Accounting. I have an MBA from Arizona State University, I couldn't run my office off QuickBooks or QuickBooks Online. And I mean, the dentists, they know what they know, they don't know what they don't know, what do you think... what is your favorite accounting software?
Nate: Well, who really wants to talk about accounting software, Howard? We use a software we've designed...
Howard: Well, if there was a... I mean, there's a lot of millennials listening this, podcasters are weighted towards people born after 1980. If she was listening, she's driving to work, she's working for Aspen, she's working for Heartland, Pacific, she wants to own her office one day, what accounting would you have her set up? Would you have her go to Peachtree? Microsoft bought Great Plains back in the day and called it Microsoft GP, GP standing for the Great Plains. What...?
Nate: What would I do, what would I tell her to do? Well, if she's working for Heartland or Aspen or one of those the first thing I would tell her is to learn everything you can clinically to become a clinical expert. If I'm going to bet on somebody who's going to become a very wealthy dentist I'll take the clinical superstar any day over somebody who's lacking in that area. So, I'd Be thankful for the opportunity to practice my clinical skills and to expand the scope of services that I can do. And the second thing I would do is I would try to be learning everything I can from the business that I'm working for. The reason that Heartland and Pacific and those have been successful is they are really good at the business of dentistry, and so I'd try to learn everything I can from them. But then, to answer your question directly, if I'm a dentist and I want to make a lot of money and I want to become wealthy, I'm going to focus on being a really exceptional dentist, and I'm going to delegate the accounting work to somebody else. So, I want an accounting firm or a service who can support me and who can do that work that... I think for the dentist to do their own accounting is the most expensive way to get it done.
Howard: Well, you said if she's working at corporate dentistry or as an associate for a private practice, it's both the same, to learn her clinical dentistry and that you want the best bet, she's a clinical superstar and that's true. I mean, look at restaurants, according to Professor Dr. H.G. Parsa, 59% of restaurants fail in the period of the first three years, compare that to dentistry that when the banks have a 0.4% failure rate. So, dentistry is not even competitive, I mean, 59% of restaurants fail in three years and not even a 0.5% of dental offices fail. But again, those restaurants that make it, what did they excel in? They work clinically excellent dishes, I mean, the rule of thumb in restaurants is, you've got to have that one dish. I mean, you go to that Mexican restaurant because you crave something, whether it's their chips or... I mean, every restaurant that... you're addicted to one thing, you've got to have that one thing in a restaurant, and you've got to be a clinically excellent dentist, that is so true. And that's why I do a daily, free podcast with all these clinical endodontists and specialists, because I've noticed that the dentists that take a hundred to three hundred hours of continuing education a year in dentistry, they just crush it, so, that's a given. But most restaurants and dental offices that's only 49% of your job, the other 51% percent is the business of restaurants, the business of dentistry, and they've got to learn that business, how would you recommend they learn their business? And my biggest advice, is why I got you on the show, is that, they do the right thing, they go to the church they go to their pastor, they go to their priest, their rabbi and they say, hey, I need an accountant, and he or she recommends a very morally great guy, and you think that's good. But then they're using a CPA that they're, you're only dentist this person does, and I wouldn't want an ear, nose and throat doctor doing my bypass, I wouldn't want a dentist fixing my broken leg. And I am a huge fan of dentists who get their accounting done by people who specialize in dentistry. And I want you to know right now, here's an inconvenient fact, here's your Howie homework for the day, I want you to go find out how many dentists does your CPA service? And if he's talking to you then hangs up and talks to a dry cleaner then an Italian restaurant then a soybean farmer then a dairy farmer, you're not going to do well, you need somebody who focuses on dentistry. And then my last tip is that, most people when they work for a CPA, the CPA is only helping them with tax accounting for the IRS, they're not giving them any help on managerial accounting for their dental office. So, when you're the only dentist client for your CPA, you have a CPA doing IRS tax accounting or if you're publicly traded SCC accounting, that's not what we're talking about, we're talking about managerial accounting. What do you do differently from an IRS tax accountant for dentists that you do from a managerial accounting, helping them understand the numbers of their business.
Nate: That's a great question, Howard. So, I couldn't agree with you more, I would never go to a veterinarian to get my teeth fixed just because that veterinarian also fixes the teeth of dogs and cats. I think the more we can get people who are specialized in what they do to help us, the better off we'll be. As far as the accounting world goes, I've been really perplexed by the fact that so few dentists are financially able to retire when their bodies are wanting to retire. The statistics on the percentage of dentists who can stop working at age sixty five and continue their standard of living is very, very low and, I've heard as low as 4%. I heard in the last couple of months that the average age of retiring dentists is sixty eight point three, I think female dentists retire about a decade earlier, so the average male dentist is retiring in his seventies right now. And I've always been perplexed by his question, why is that, what's happening? And I think there are a lot of reasons for this issue, but one of them is the advice that they're getting is very disheveled and it's disconnected. For example, they have their CPA, and let's say that their CPA works with three dozen other dentists and assures them, oh yeah, I understand dentistry very well, oftentimes the CPA is focused on one thing and that's tax avoidance and tax compliance, meaning preparing tax returns. Well, we provide that service too, we file all of our clients tax returns and we make sure that they're clean and upright before the law, but if you work your whole career and you... how many years did you work in dentistry, Howard, before you left the clinical side of dentistry?
Howard: I saw a patient yesterday, no, I still have a dental office it's three point zero miles from my house. I still see patients, I mean, if I sold my dental office then what I would have to do is I would have to come in my house and put the operatory somewhere in the house. I mean, I could never not be a dentist or help fix my granddaughter's tooth or my son's girlfriend or whatever, so. Basically, what I do is, I've still got a bunch of whining, old, little, cute, adorable grandmas that insist that they see me and that gives me a big fat head, so I keep going in and seeing them and I enjoy... it's great, I mean, I love to see my team, I love to see my patients I've worked on for thirty years, so I'm still a clinical dentist, and I will always be a clinical dentist until I can't physically do it. I mean, I'd rather, I mean, I've said this a million times, I'd rather pull four wisdom teeth than go play eighteen holes of golf any day of the week. I mean, I think golf is fun for the first hole, a little bit fun the second hole, by the third hole I'm done, I mean... wisdom teeth, to get someone out of pain, to see a family member... but anyway. And also a big shout out, thank you so much for all the referrals, all the new patients I get from dentists when their patients are moving to Phoenix so many of them come in it's just so amazing, oh, my dentists in Indiana, now how does he know you? And I say, well, we must have met at a course or something. But yeah, so I love clinical, but your point was?
Nate: Yeah, my point was... well, that's great to hear, my point was that after a thirty or forty year career the goal is not to have thirty or forty accurately prepared tax returns, the goal is actually to accomplish something and to get somewhere financially. Several years ago, maybe fifteen years ago, I was talking to my father-in-law who's a heart surgeon, and he told me, he said, if you can figure out how to make people money then you're going to accomplish something in life. And so now, when people ask me what I do my answer is, I help rich people get richer and that's a good conversation starter. So... but the point is that the accounting piece is really only one piece of the puzzle, the goal isn't to have an accurately filed tax return, the goal is to actually progress towards your financial goals, to actually get your debts paid off, save and invest money so one day you can walk away from your practice. And that's what we're trying to help people do.
Howard: So, when you said the average dentist... I mean, I like data, I like numbers, when you say the average male dentist retires at sixty eight point three and the average female dentist is a decade earlier, that'd be fifty eight, I think a huge thing that stands out is women dentists always marry a man that has a job, and male dentists oftentimes marry a stay home mom that has kids, so there's a huge difference. The next biggest variable is divorce, when you get divorced you're going to work at the office an extra decade, by the time you've been divorced three times they will find you dead at your chair. I mean, you just... so I mean, every time they get divorced they blow up their money in half, and when a female dentist marries a male dentist they only have a 9% divorce rate, the only time you find a 9% divorce rate is in arranged marriages, I mean, you have so much in common. So, female dentists, what I'm saying is they marry with their brain, and male dentists marry the cutest chick they ever seen in their life and they just... that's why arranged marriages are just better decisions, your dad could make you a better decision on who to marry than you could, especially when you're twenty one years old running around in heat. So, male dentists make horrible marriage decisions, don't you think? I mean, you've got to see that, I mean.
Nate: That's some really good parenting advice, Howard, in fact I'm going to have my kids listen to this podcast and tell them, see, even Howard agrees that I should pick your spouse.
Howard: Well, a love marriage is the rarity, kicking your kids out at eighteen, letting them have a love marriage, and then throwing away your parents in a nursing home when they get old, that's only a billion people in twenty countries. The other six billion people don't have nursing homes, don't believe in that, and the arranged marriage isn't your dad says you have to marry this guy, it's they serve you the leads, they qualify leads. And a lot of the best telemarketers will have an associate that qualifies their leads, they don't want to make sales calls the people that are useless, they want qualified leads. So, if your parents are screening your dates, you might go on five or ten dates and it might take you from age sixteen to twenty six, but if all your dates are screened by your parents you're going to make a lot better decision.
Nate: Amen. I bet that's a piece of advice that your listeners weren't expecting today, Howard.
Howard: Well, it's called Dentistry Uncensored, I know I just... I try to talk from my heart, I know a lot of people don't like a lot of things they hear but just an inconvenient fact, I'd rather tell you what I honestly think than lie to you or tell you what you want to hear. So, back to managerial accounting, what are red flags? I mean, let's go to the biggest overhead labor, I see so many offices that have given their staff a dollar raise every time the earth went around the sun and their labor has creeped up to thirty, thirty two, thirty five, thirty eight, what should labor be and what is the most common...? what overhead parameters would you say? I always say Labor twenty eight, lab under ten, supply six and a half, rent five, advertising three. Do you think Labor is the most out of hand overhead expenditure when you're working with your hundred and fifty dentists?
Nate: Yeah, that's a really good question. If I were to just throw a number on the board I would probably say I'd like to see all my labor costs under 25%, but so much goes into that, Howard, and the tough thing about labor is that the decision for Labor isn't a decision you make every day. What we try to get our... if I'm advising a client and I'm trying to help them drive a more profitable practice. I want an inexpensive building, I want a building that is nice enough to where it doesn't detract from the quality of my work, but any nicer than that and I'm just throwing my money away. The other thing that I want to do is I want to watch my supplies like a hawk.
Howard: Wait, let's stay with the first one first, so, what you're talking about is the infamous Taj Mahal, and and the 2008 financial meltdown, which was a decade ago, and if you're fifty five like me, and got an MBA from ASU, these corrections are usually about every ten years, so just the fact that the last correction was ten years ago already makes me nervous. But in that last crash about eighty dental offices went under in Phoenix, and half of them were these dentists who built these $million Taj Mahals in North Scottsdale. That's what you're talking about, right?
Nate: That's right, I actually know one of those dentists personally [00:25:02] [inaudible] in Phoenix, went under. And it was, yeah, it was a big fancy building, but not just the building, you can't have a big fancy building and stop there. You've got to drive up in a car that fits the building, and then you've got to drive home to a house that fits the car. And so, it's kind of, this web of... we have a client right now in Colorado, and I'll be that specific, this guy, a general dentist, is netting over a $million a year.
Howard: Please tell me it's a single woman who's fifty five
Nate: Howard, I wish I could tell you that.
Howard: Ah, my God, but anyway.
Nate: But I might have some warm leads for you, so we can talk after the show.
Howard: Yeah, send me all the fifty five year old women dentists who are debt free and have a $million in their 401k. See, I want pre-qualified leads.
Nate: Hey, we can talk afterwards, maybe I can help you with that.
Howard: So, he nets a million a year?
Nate: So, he nets a million a year. And the last conversation we had with him was... and he's in an unassuming four operatory practice, just him, small staff, one hygienist. And everybody around him has a much bigger, nicer facility, a much bigger staff, all of his buddies are talking about bringing on an associate, and we know a lot of his buddies because we get to look behind the scenes of what's actually happening. See, when most people look at other people all they can see is what's on the outside, but we get to look behind the scenes and see how much money they're actually making. So, this guy, he's netting $million and he's in this small building, and his question was, gosh, shouldn't I build a bigger, nicer building? And we asked him why? He said, well, that's what everybody else does and I was just thinking well, maybe I should do that. And we tried to help him understand that what's important is how much you keep after paying your overhead, not what the top line is and not what all of your friends think and what they talk about you.
Howard: So, you like to see labor 25%, what's the highest you’re seeing now, what is the median, what would be first degree standard deviation, second degree, third degree? What is the norm, what are you seeing?
Nate: Oh, what we're seeing is low, I mean, the lowest I've seen in labor is about 15%. Some doctors have figured out a really good way to be very efficient with their team. And we see as high as 35%. Most of our clients have a practice that grosses over a $million, and so I think... but again, if what we're talking about is how to make a practice more profitable I think that there are things other than labor that a doctor ought to focus on.
Howard: Okay well, let's stay on labor though, when a dental office has 35% labor what are you going to do? And the reason I point that out is, back in the early days of Heartland's expansion they were buying a lot of dental offices, and nowadays they say it's just easier to start a de novo because we're going to buy a dental office and it has 32% labor and by the time you go up to all the staff and say you're no longer making $20 an hour we're going to lower you to $21 an hour, then their attitude and then the toxicity of that and then they quit or you've got to let them go or, they're just like, damn, I'd rather just start a de novo and have it not make any money for a year. They'd rather... it's kind of, like a golf game, I remember the first time I told my dad I wanted to go golf with him he said okay, and I was all excited, I was ten years old and we're going to the deal. But when we got there he said, well, you’re not going with me, you're going to take a lesson, he goes, the first ten times you swing a club it's got to be at the pro because if you learn bad habits you'll never be able to un-break them, the first ten times you golf for an hour it's going to be with the pro. And so, that's the way these corporates are, they're just like, I'd rather just start a de novo than go out there and fix a dental office with 35% labor.
Nate: Yeah, that's a good point. I think there are a couple of things there, the first thing is with the growth in managed care we find that a lot of practices are having to support a much higher production number in order to get the collections to where they want them to be. So, a lot of practices when you're looking... and typically the overhead percentages are a percentage of production. And so... I'm thinking of one doctor we have, the guy was producing $2.1 million, and this last year he netted about, or he collected about $1.4 million.
Howard: So, he produced 2.2 and collected 1.4?
Nate: Yeah, 2.1 and collected 1.4 , so he wrote off.
Howard: Okay, 2.1, they don't know the terms, some call that production. And then the 1.4 would be collection or adjusted production. So it doesn't matter, people call up your office, how much is a crown? $1000, well, if they come in with Delta and you only get six hundred, who cares that you did a $1000 crown and you only got $600? So, thousand would be production, but six hundred would be your adjusted collection. So, do you call the 1.4 collections or adjust production, or is that a tangible?
Nate: Well, adjusted production and collections are two different things. Adjusted production is how much can I expect to collect of the production that I did, so, if I do a crown $1000 is my fee, that's my production, my adjusted production is the six hundred that I can expect to collect from Delta, and so there's a $400 insurance adjustment. And then the collections is when the $600 actually lands in your bank account.
Howard: And right now... when I got out of school the number one overhead was labor, you say you like it at 25%, and now, thirty years later, the number one overhead in dentistry is the adjusted production, which in this case is 40%. I mean, dentists, their biggest overhead is a 40% adjusted production of their fee to the PPO price. I mean, that 40%... I mean, if you say Labor 25%, what do you like lab at?
Nate: Well, good question, let me get back to lab, let's go back to Labor. So, this doctor who's collecting, or producing $2.1 million of dentistry, that's a lot of dentistry in a single doctor practice. I mean, anybody'll tell you that this guy's working his tail off, but the thing about it also is that he has to hire staff to support $2.1 million of production. So, his staff costs are really high because he's producing so much. He has to pay lab bills on $2.1 million of production and he has to pay dental supplies and $2.1 million of production. But then, so when he's collecting only 1.4, when we look at the numbers and all of the numbers as a percentage of... it's always run as a percentage of collections, and that makes sense because collections is really the only thing that matters referring to production versus collections, all that matters is what lands in your bank account. And so, we'll tell this guy, gosh, your dental supplies are 11%, and we'll say, you've got a big problem with supplies, you need to cut that back, and your employee costs are 35%, gosh, you've got a bloated staff. And this is what you might think on first glance when looking at this practice is that as guy has an overhead problem. But he doesn't have an overhead problem at all when you look at all the same numbers as a percentage of production, and we see this time and time again, Howard. These guys are actually running really efficient, profitable practices, the problem is they're just not collecting what they produce, there's this huge write-off. And so, it's almost like you're trying to ride your bike and you've got a big headwind in front of you, you've got all these overhead expenses that you've got to pay but you're paying extra because you have to support all of this production that you're never going to see. So, it's a double negative, you're losing it on the collection side and you're losing the overhead side, and that's one of the biggest problems and most pervasive problems that we see in dentistry. So, the solution this guy's looking at and going gosh, now this doctor, he's producing 2.1 million and he's saying I'm really busy, I'm so busy my hygienist's booked out six months I need to get a new hygienist and I need to bring in an associate, and that's a very common next move, is the doctor brings on another hygienist to help free up the hygiene backlog. And now, because you've got three or four hygienists you need another doctor to help support that, so he brings in an associate. And so, the production keeps climbing but the income for this doctor is going in the opposite direction, and in the meanwhile the doctor's just burning out, and we see this over and over and over. I think, back to answer your question about overhead, for so much of dentistry the biggest overhead problem, or the biggest overhead item, are the collections they're not... or it's the money that collecting on because of the insurance write-offs. I think that's the financial elephant in the room in dentistry.
Howard: What's the financial elephant in the room?
Nate: The managed care, the PPO write-offs.
Howard: Okay, the adjustment process, yeah no doubt. But I want to... I know dentists want me to be on their side and I should be because I'm a dentist, but what does the average dentist make per year according to the ADA?
Nate: Oh no, I don't pay attention to that.
Howard: $175000 a year, okay? And according to the Bureau of Labor statistics only 5.12% of Americans make that much money, so they're still in the top five percentile. So, they complain a lot, they whine a lot, they say, man I'm working my ass off, and it's like, I'm pretty sure you're fifty pounds overweight and your ass is still there, and if I took away your dental degree you probably couldn't make $75000 a year. So, while you're driving to work and you're having a pity party, oh my God, I work my butt off, even though your butt's three feet wide, $175000 is still a lot of money, agree or disagree? How many of your... you're in Medford, Oregon, how many people in Oregon would love to make a $175000 a year?
Nate: I'm sure there's quite a few of them.
Howard: Yeah, a lot.
Nate: Yeah, that's a good point, Howard, I'm not crying for these people and I don't feel sorry for these people I'm talking about. But my job isn't to feel sorry for them or not, my job is to help them be as profitable as they can with their labor.
Howard: And so, what advice would you give them if they have high labor?
Nate: If they have high labor, it would depend on the unique circumstances of that individual.
Howard: Yeah, I agree, the devil's always in the detail. Okay so, you said labor should be 25%, and again when I see the lowest labor, I always come back to this after thirty years, you can only try to be cheap and cut costs so much, but your electric bill isn't negotiable, your IRS tax rate isn't negotiable, hygienists pretty much all make the same per hour in the city, so do dental assistants, so much of our costs are set by a free market that we can't control. So, if your overhead is $1 and you do $1 of dentistry your overheads 100%, but you get that same team and facility to now crank out $2, now you're overhead's 50%, so I still think the biggest impacts on overhead are they're always high producers, and they produce more because they keep in-house, they do their molar endos, they pull their wisdom teeth, they place implants, and then the people who refer out all the molar endos, all the extractions, all the wisdom teeth, all the implants, and just sit around and do PPO cleaning, exams, x-rays, fillings and crowns, $1000 crowns that get adjusted to $600, they always have high overhead. And then the second biggest thing would be the collection policy, I mean... so, let's talk about collections, what is the average... what do you recommend your collection ratio should be?
Nate: You mean what percentage...?
Howard: Of the money that's due to you, not the adjusted production what you expect, but what do you see? What is the range of just collections of what you did after the adjusted production? I mean, you're not billing them for $1000 for a crown, they had a Blue Shield PPO for $600 but you billed them $600, what did they pay? What do you see the collections at? And the younger dentists seem to have a collections problem, they do the dentistry and then they think that when they check out they'll pay. And when you go to McDonald's you order a hamburger, then they get the $2, then they give you the hamburger. You go into a young dental office you order a hamburger, she gives you a hamburger, you eat it you go home, and then she wants to send you a bill. So, what kind of collection ratios are you seeing?
Nate: Why would we expect anything less than 100%?
Howard: Well yeah, exactly, pay to play. And then they say, well, I don't get paid until Friday, great, what time do you get paid Friday? Do you want to come in, I mean, we're only open till two on Friday, do you get paid Friday morning can you come in before two or shall we schedule for Monday? And then they say, well, I don't have a credit card, I'm thinking okay, I've got four kids and they were sending them credit card applications when they turned ten years old, so let's see, all these big banks advertising on TV no one will give you a credit card? And what you want me to give you credit? Chase won't give you credit, Bank of America won't give you credit but you want me to give you credit? So, you say you would expect 100%, and so many of these low overhead doctors have 100% collection agency, in fact a lot of them will collect 101% because they're collecting stuff that hasn't even been done yet, I mean, they are they're collecting for all...
Nate: They're doing such a good job that their patients are tipping them.
Howard: Well, they'll collect for four fillings even though they only did two today and then you're coming back in two weeks to do two more. Okay, so now let's go to...
Nate: Hold on, let me... I just want to validate a point that you made. I wrote a series of blog posts a while back on how to have a profitable practice, and I answered this question in great detail focusing on the things that I actually want the doctors to focus on. Because there's a lot of stuff when it comes to overhead that we just tell our clients to just forget it and ignore it, like you said, you're not going to negotiate your utility bill. But the most profitable practices are the practices with high producers, I just want to really validate that point. And you're right, if you look at the cost structure of a dental practice, you've got... the vast majority of your costs are fixed costs, your rent, your utilities, your labor costs even, I mean, in order to open up your office today with the expectation of seeing patients, let's say it costs you $1500, just to open your doors, fixed costs. And so, a lot of doctors make the mistake by sharing their overhead as a percentage, you ask them, what's your overhead? 50%, what's your overhead? 60%, well that's a misunderstanding of the true cost structure of a dental practice, and now I'm getting really geeky as an accountant by bringing this up, but I think it really matters, you're talking about managerial accounting, you're talking about managing your business and running a profitable business. What you have to understand as a dental practice owner is that your overhead is not 50%, your overhead is, I'll just throw some numbers out there, $40000 a month of fixed costs, you don't make a dime until you clear that $40000 every month. And then after that, then you're only paying for lab and supply. And lab and dental supply, we like to see those... you asked the question, we like to see those as a combination between 10% and 12%, between the two of them, however the lab bill will fluctuate a lot depending on the services you're providing. And so, I think that's an important understanding, is to understand that my overhead is $40000 a month, and after that my overhead is only 10% or 12%, and I get to keep 88% or 90% of everything that I collect after that fixed cost number. So, why is it so important? Because if a doctor wants to have a profitable practice, if you want to have a low overhead, you've got to get as much production as you can out of that fixed costs which is very hard to change. And so, the doctors who are the most profitable, they're not nickeling and diming on their costs, they're focusing their time and their attention and their effort on treating patients, providing an exceptional patient experience and producing dentistry. For example, we had a client one time who used to keep a stopwatch on his arm, and every time he would stop producing, every time he would stop doing the clinical production he would start his watch, and then when he got a new patient in the chair he would stop his watch when he was doing dentistry. And at the end of the day he would gather his employees around and he would say, I spent thirteen minutes and thirty seconds today not doing dentistry, what were you doing to change that and to make sure I was doing dentistry?
Howard: Man, that's an intense dude. That sounds [00:44:20] [inaudible], that's intense. When you told me that story you didn't even have to tell me it was a dentist, when you told me that story I'm like, that's my homie, they're intense people, aren't they?
Howard: But I've got to say one thing about that, it's because they don't understand the cost structure. I go into dental offices and the dentists always waiting for a chair, and I say, dude, after you pay your staff, your lab, your labor, supplies, rent, mortgage, [00:44:44] [inaudible], computers, insurance, all that stuff like that operatories aren't your costs. And they just don't have an extra operatory to throw the next patient in and the doctor's back there, so the assistant's got to clean up the room, dismiss the patient, set the room up. See, they're back there for thirteen minutes because they don't have a chair, I mean, chairs aren't your costs. Another variable, not only are the low overhead people high producers, they always have one or two extra operatories that no one was scheduled in that day, we're talking overflow operatories. A lot of dentists say, oh, room four is overflow, dude, room four has four people scheduled in it today, that ain't overflow, that's scheduled, I need overflow.
Nate: Yeah, that's a great point. Back to that really intense dude who would start and stop the stopwatch, I'm not necessarily recommending that, Howard, that really wouldn't jive with a lot of people's personalities. But I think the important lesson of that story is that guy had an unbelievably profitable practice and he made a lot of money, and he understood the value of his time, and he taught that to his employees. And he understood how he made money, and it wasn't by sitting in the back playing Angry Birds or whatever the video game du jour is.
Howard: Yeah, I don't like to play video games because I actually got addicted to one with my four boys. It was, when was that Ryan? It was when Mario Brothers came out, Super Mario Brothers came out and I had four boys, and I came home from work and I bought this Nintendo thing and I had no idea that I was going to get all one hundred and twenty stars or one hundred and twenty four, I think it was a hundred and twenty or a hundred and twenty four, and my God, it just kept getting... but anyway, it turned out that I had to come home from work, [00:46:35] [inaudible] intense, the boys loved it, and four of us would play, and then Zach was too little, but it took me half a year like, an hour or two hours every night after work for a half year, when I got that last star. I said, I ain't ever playing a video game again, because I got addicted to that Mario Brothers like crack cocaine. I thought I was going to have to go to rehab to get off that damn game, so no more, I don't even know what Angry Birds is.
Nate: Howard, I love that story it's really good that you were able to acknowledge your addiction and recover from it. And it's also nice to hear that you haven't played a video game since 1985.
Howard: Yeah, I don't. And then a lot of people ask me how I have so much time to post on Dentaltown or... and I just tell them, well, I don't watch TV. I mean, I look at this thing... I mean, all these people talking about Game of Thrones and all this shit, I mean, I don't watch any of that crap. The only thing I waste time on, and it's a complete waste, is the NFL, I am addicted to the Arizona Cardinals. And I love these fights like Saturday night is Conor McGregor versus Floyd Mayweather, we will have a blast. But when I'm looking at a screen it's on Dentaltown, it's not on Game of Thrones. And then...
Nate: Yeah, if anybody asks me the same question, I'm with you. My wife and I were married for thirteen years before we bought our first television. I just tell people I can't afford to watch TV and I can't afford to play video games, I can't afford the money.
Howard: And I can't afford golf. These dentists that want to go golf, by the time they leave their house go to the golf course, warm up hitting a [00:48:19] [inaudible] to get going there, that's an hour, the game's four hours, they'll spend six hours on a game of golf. Dude, find a... you can hike up and down Squaw Peak in an hour, but no one wants to hear my opinion on that.
Nate: Yeah so, I mean, I think the point is, if you want a low overhead, if you want a profitable practice you need to be a big producer. If you're going to be a big producer you have to understand and come to an understanding of the value of time.
Howard: Yeah, time is money. And also know their costs constraints and having labor, by the time you pay the dentist 35%, the staff 25% percent, when 55 cents of every dollar goes for humans why are we waiting around for a chair? Another big pet peeve of mine is you'll watch him, that dentist, where he said thirteen and a half minutes a day he wasn't doing dentistry, I mean, you go into any dental office and the dentist, during every procedure, oh, will you hand me this and the assistant has to take off her gloves, leaves the room and goes and gets one, oh, that's in Room three or that's Room five or I've got to get that out of the autoclave, well, then you don't have enough. I mean, my rule is that when you say go... I mean, how would you like to be having a brain tumor removed and three times during the operation the scrub nurse has to leave the room and go get something? I mean, wouldn't you hope that your neurosurgeon had all that shit laid out on the table and knew everything he was going to need, and knew what the hell he was doing? I mean, and they'll say, well, we only have one three hundred rpm NiTi, well, if you have to leave the room then get another. You have to have... what I want is every operatory to be a 747, I mean a Southwest Airlines 737 every drawer's the same, everything's the same, and when you start to do a root canal boom, no one leaves. when you have to leave you order whatever you had to leave for because we obviously don't have enough, because time is money. Because if you can fill in, if you are efficient, if you know what you're doing and you can get in one extra filling, crown or root canal, and you've already made your BAM number, your bare ass minimum or your break even point, you're BEP... and I think every day should start with, the whole team should know what their break even point is for the day. I mean, who cares what the overhead is for a month? I can't adjust in a month, I've got to do it a day at a time, if you want 50% overhead then you start the day with, what is our break even point today? I mean, most dental offices are only open sixteen days a month, so if you take every check you've been writing every month, and they're pretty stable I mean, it's not like their staff goes from five employees to ten then down to eight then up to twelve then down to five, I mean, they have very steady overhead with their staff, number of hygienists, number of assistants, number of team members, it's pretty steady, so what's your break even point? So go in there and do it, pay your bills, then do it again, and it's just that simple. And that means sometimes you're going to have to work through lunch, sometimes you're going to have to stay late, but I'd rather not go home at five and go home at six thirty and hit my 50% overhead mark than sit there and be all glad that your four o'clock canceled, oh good, I get to go home early and play Angry Birds on the video game, and then your overhead that day was 88%. So, I like the way you use combined lab and supplies for 10% to 12% because a lot of people they'll buy chair-side milling so their lab will go down. But then they're buying these blocks, these CAD/CAM blocks and they put them under their supplies, so their lab bill goes down, their supplies goes up and they really should be together. And all the publicly traded dental companies in the world, two of them on the ASX in Australia, one in Singapore, they do combine the lab and supplies into one number, they don't break those apart. So, labor you say 25% lab 10% to 12%, what other... working with a hundred and fifty clients, what other lessons have you learned macro-economically that you could share with my homies driving to work today? What other things have you noticed?
Nate: Lessons about money or lessons about life?
Howard: No, lessons about money. Like, are the dentists that are making more money more likely to have chairside milling or use a lab? Are they more likely to have a CBCT or not? Are they more likely... what are they more likely to do? The ones that are making the most money, what are they more likely to do versus the ones that are not making much money?
Nate: Yeah, that's a good question. I think it's a progression of things. The first thing is you have to be a clinical superstar and you've got to get to that point, until you become that you just don't have the, you can't get off the runway unless you're clinically excellent. And that means that you've got a broad scope of services that you can provide, that means that you're really good at the work, that other dentists would come in and look at your work and say, yeah, that's good stuff. Because even though your patient may or may not know how good your work is, over time word's going to get out. And that you can do it fast, I mean, if it's taken you an hour and a half to do a root canal versus thirty minutes to do a root canal or a crown or whatever the procedure is, that's a big difference. So, that's the first thing is, the dentists who we work with who are making the most money do that. The second thing is, after they learn how to be clinically exceptional, the wealthy dentists learn how to make money with that, and there's a big difference between being really good clinically and being able to use those skills to make money. And you hope that those two things are connected, and there's definitely a high correlation there, but they're not the same. So, the ability to diagnose, the ability to treatment plan, the ability to present a case to a patient. The term that most frequently we use is sell, sell dentistry, and most people think of selling as tricking somebody into buying something that they don't want or they don't need, and that's what they think of selling as. I don't think that that's selling at all, I think that selling is helping discover what somebody really wants, what somebody really values and helping them make good decisions to get there, that's what selling is for me. And so, the really wealthy dentists will do that, they learn how to make money. And then the third process, which is very different from the first and very different from the second, is who cares how much money you make and spend? It really matters how much you're able to keep and how much you want to get that money working for you so that one day, whether it's by choice or whether you're forced out, one day you can stop doing the clinical work of dentistry without running out of money. And that's learning how to build wealth and get you money working for you. With that third part, and with the first two, I think that the wealthiest dentist that I know, they get help, they don't try to know everything and do everything themselves. I mean, we live in an amazing time in the history of the world, we live in a time where there's been more wealth and more opportunity, especially for Americans, than ever before. I mean, the average dentist, like you said, makes $175000, our average client probably makes two or three times that much but maybe we just attract a certain type of clients. But in this complicated day and age you just cannot be an expert on everything. And a lot of times when you're really, really smart in one thing you expect yourself to be the smartest guy in the room on everything, and those people don't seem to do very well, Howard, the ones who do very well they become the smartest guy in the room on their craft and they surround themselves with smarter people on their, on what they do.
Howard: Yeah well, I always say I can spot success because they're humble, and you have to be humble to ask for help. You ask anybody in Medford, just walk around all day long and say, if you had to describe a dentist in three words what would it be? Humble would never come up. Arrogant, know it all, condescending, that's what comes up for dentists, physicians and lawyers, not humble. And another thing that's interesting, now that the dental school class sizes have gone from mostly males to half females, these dental office consultants are exploding with young women because young women dentists are more humble and they ask for help. Back in the day they used to say, they thought that TMJ mostly occurred in women because 95% of the patients are women, then they found out later it was because the men never ask for help. And men die five years earlier than women, and one of the biggest reasons is that when grandpa has a lump and a bump he doesn't go show it to anyone. And then when it finally turns out to be some twelve inch kidney tumor sticking out and they say, well, how long's it been there? And he's like, two years, why the hell didn't you look at it for two years? Why didn't you have someone look at it? Because I'm a man. When you were little how many times did your dad not ask for instructions and you guys were lost, before MapQuest, and your mom was screaming and yelling, will you just go to the filling station and ask them for directions? And your know it all father's like, no, that would mean I'm not a man, I will find this even though we've been lost for forty days and forty nights. So, you've got to be humble and ask for help and you've got to stay hungry and hustle. Hey, I want to ask you... gosh, I can't believe we've already gone an hour, holy crap we've actually gone over an hour, but I'm not letting you go, you've got to stay for overtime because the thing I want to ask you the most is, the biggest thing new is, you say it's managed care, PPOs, I totally agree, but the other thing that's totally new is the amount of student loan indebtedness. What advice would you give to my homies listening to you, that are driving to work and they're $350000, $450000 in debt, what would you tell them about that debt? What's your advice about that debt? A lot of them think, well, I should just work at Aspen and just pay down this debt for five years or ten years. What would you say to that kid who had $350000 to $450000 in student loans?
Nate: I'd tell them good luck. Just kidding.
Howard: I hope you're kidding, this is supposed to be a motivational show not a depressing show.
Nate: A couple of things,Howard, and I'll try to be brief on this because I know [00:59:29] [inaudible].
Howard: No, take your time, this is a very important subject.
Nate: So, the first thing is, I'm a religious guy and in God's dealing with man, as recorded in the Holy Scriptures, back to the beginning of time, even back as far as the book of Exodus, the Lord refers to his people as a peculiar people. And what does that mean? Peculiar can have a lot of meetings and it can have different translations, but I think what God wants for us is that we're happy and that we live an abundant life and that we have joy in life. But in order to experience those things, Howard, I think you have to be willing to be different from the crowd. And if you look across the average American, most Americans are overweight physically, they're overweight financially, they've overextended themselves, they're not healthy. They're not healthy physically, they're not healthy with their dental hygiene, and they're not healthy emotionally. We've got rising depression, rising anxiety, but I think there's still a lot, so much opportunity for joy and happiness and abundance in life. But in order to experience those things you have to be different. I know you're a father to four boys, if you want to raise good kids and you want them to be contributing, stable, well-adjusted members of society, you can't just jump into the river of modern parenting and do what everybody else is doing, you have to be willing to stand up and have some values and to be a little bit different, would you agree?
Howard: Oh yeah.
Nate: So, financially speaking, I think the principle is if you want to be excellent at something you have to be willing to pay the price and you have to be willing to be different. And if you want, specifically, if you want freedom and abundance in your life, freedom and abundance don't just come because you're a millennial or because you're a dentist or because you were born in America, freedom and abundance come as the fruits of discipline. And so, the first thing I would say to those people who are deciding how much debt to have, I would tell them that dental school is a time to live almost a life of poverty, and to live very inexpensively, and there's no shame in that, in fact I think there's a lot of honor in living beneath your means and learning to live frugally. I think the biggest scam in dental school right now is this idea that one day I'm going to be a successful, high income dentist and I'll pay it all back then. Let me tell you, it is never fun and never easy to pay off your student loan debt. So, that's the first thing I would tell them I would exhort young dental students to be willing to sacrifice, to be willing to be disciplined, and to go without and wait till the money comes before you start spending. I was talking to my young brother-in-law, who's a medical student right now, and he told me, I want to take vacations now, and of course his whole life is on debt, he's married, he's got a young family, he said, I want to take vacations now, I'd rather take a vacation now than a vacation when I'm older. And what I told him was, yeah, I get that, I get to feel that way, but what you have to understand is that it's not a one for one trade-off, it's not one vacation now versus one vacation later. If you look at the compounding and how money grows over time, it's one vacation now versus ten vacations later, that's the trade-off that you're making when you indulge now when you're young. On that note, the financial decisions you make when you're young, when you're in dental school and the first ten years of practice, they are far more important than the financial decisions you make later on. So yeah, rule number one would be, be willing to be different, don't fall into the trap of one day I'm going to be a high income dentist and I'm going to make all this money then and I'll pay it off all then, it's never fun to pay that off. The second thing is, to the doctor who comes out of school with a high amount of debt, and the highest that I've seen with one doctor was just under a $million, Howard, over $900000 of student loan debt. And in fact if I went and checked today it might have crossed a million with the interest that's compounding on this debt. So, this guy has a lot of stress, lot of anxiety coming out of school.
Howard: But how did he get a million dollars in debt? Well, let me guess, he's LDS, he got married in dental school and graduated with three kids.
Nate: And he's got...
Howard: Was I right on that, was I right?
Nate: You're right on that.
Howard: I know my homies, Ryan, it's like, I know my homies. 10% of every dental school in America are LDS and they're mostly the ones who have children in school.
Nate: Yeah, which actually isn't a bad thing. My father-in-law, the heart surgeon, had children in school and he... one of his co-residents told him he was crazy, he couldn't believe that he had kids in residency. And he told me that twenty years later, when he was about fifty years old, he got a phone call from this guy and he said, hey, I haven't talked to you in twenty years, and the guy said, hey, I'm just calling to tell you that you were right. And he said what do you mean? He said, I used to make fun of you all the time because you had kids in medical school, but I'm fifty years old, I've got two young kids and I've just had a heart attack, and now I can't enjoy them. So, maybe having kids in dental school isn't such a bad thing after all. But, as far as to the dentist who's coming out of school already has the debt, what would I tell them, there's a lot of talk out there that because of the debt dentists are going to be less entrepreneurial, less likely to start a practice, less likely to buy a practice, well, I would say that the opposite should be true. And I know that there's a lot of fear that comes with debt, but the doctor who owns, the practice owning doctor makes a lot more money than the guy who's getting a paycheck from Aspen Dental. You said that the average dentist makes a $175000 a year, 100% of our clients are dental practice owners, I would say our average makes $half a million a year, and on the low end we're seeing $300000. When we see $300000 of income from a practice owner we're trying to figure out what's wrong and we're trying to figure out how we can get this guy up to half a million and above. And so, people think, well, I've got a student loan debt so I've got to take a low paying job, and listen, we're not crying for these people, we're not feeling sorry for them on $175000, like you pointed out earlier, but I hear it all the time, I'm going to work for this government clinic because they're going to give me $20000 a year in student loan reimbursement, and we say, well, what's your salary? A hundred and twenty, we say okay, so your total package is a hundred and forty, if you go and buy a practice you could make two or three times that much.
Howard: Well, I want to explain for the young millennials born after 1980 what you just said, that flew straight over their head. When the American Dental Association says the average dentist makes $175000 okay, what did I say? You don't use a CPA that only has one dentist client. The dentist who uses CPAs that have a hundred and fifty clients, that's a different breed and your average dentist makes two or three times that. You ask any dental consultant, what does the average dentist make? Oh, I don't know, what would you say a million, million two? No, the dentists who use dental consultants, who are humble and ask for help, yeah, they average a million two, but the average dentist does seven fifty. So, you've got to stay humble and ask for help. It's a humble person who calls [01:08:12] [inaudible] and says, hey, by the way I'm not your regular arrogant dentist, if I'm sending in dental work and it could be better please feel safe to call me up and school me on how to be a better dentist. They're the ones that have dental consultants. A lot of arrogant dentists don't want... they're embarrassed, they don't want to have anybody come in and see all the crap going on in their office or the overhead or the insanity, but the humble ones do. So, the ones who use dental CPAs, who concentrate on dentists, yeah, they're making two to three times average. Every dentist I know that collects $2 million to $4 million a year could name you all the five, six biggest dental consultants in dentistry have all came to their office, that's why their house is in order. So, it's an arrogant ego who doesn't raise their hand and ask for help and, get help, fix your problems. And about the guy, about the stay home wife, and here's another thing I see, I mean, I've had more dinners with dentists and their spouses than I could count, I mean, I'm out there lecturing every week, some dentist's stay home wives have three or four kids learn how to cook. A lot of dentists, if they want to hide something from their wife, they put it in the oven and she'll never find it, and they always eat out. Some, on vacations, go to Hawaii, some just go pitch a tent at the lake, others have to buy a $100000 RV, I mean, you can't say I want a stay home wife and have five kids, but I also want to always eat out nineteen out of thirty meals, take five star resort vacations to Maui, and go to Europe, and... you've got to make choices. But what I've seen is this, the dentists, the families, the spouses, the families, that choose a minimalist lifestyle, they have so much less stress and they're so much more happy. Because when you build that Taj Mahal dentists, when you buy that big old mansion on the hill, when you buy that Mercedes Benz and the Range Rover and you buy all that stuff you are going to pay for that in so much blood and stress and anxiety that it's not going to make you happy. Happiness is an inside job, and to me, the happiest dentists I've always seen had the lowest overhead from a minimalist lifestyle, it's not what you produce it's what you save, it's what you spend. Do you agree with that or disagree?
Nate: 100% agree.
Howard: I mean, I'm talking to you, you don't even have anything on your wall, all you have is one plant, you don't even have anything plugged in, he's got an electrical outlet and nothing's even using electricity. Yeah, minimalism is awesome, just stay minimalism and don't trade in your spouse, I mean, divorces are costly, I don't know why you need to... I mean, what's really the difference in going to Maui and going to the lake up here in Arizona? I mean, really, at the end of day what's the difference? Oh, about thirty grand.
Nate: There you go. That's a great point, Howard, that's a really good lecture and a lot of wisdom in what you just said.
Howard: Well man, it was an honor that you came on my show. I called you, you didn't call me, you've got to go. Go to Dentaltown and do a search, I want everybody to use that search box because that damn thing cost me $50000 from Google, and every time they want me to upgrade it it's not a software upgrade I've got to buy a new $50000 box. But if you do a search for Nate Williams the first thing you'll pull up is the multi-practice model, an epidemic in dentistry by Nate Williams CPA. Go to his site, Practice Financial Group, your homework for the day is find out how many dentist your CPA serves, and Nate serves a hundred and fifty. Why are you using a CPA that only knows three dentists and couldn't tell you anything about dentistry that Nate just shared for you in an hour? So, if you want a bypass find a cardiologist, stay humble ask for help, use a dental CPA, use a dental consultant. A dental consultant, a dental CPA, it's the best return on investment in dentistry, not lasers and bone grafting and sleep apnea, it's getting your house in order, get your house in order. Nate Williams, thank you so much for coming on the show today, I hope you have a rocking hot day.
Nate: Thank you Howard.