Dentistry Uncensored with Howard Farran

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Capacity Management consultants have helped build some of the best practices nationwide for over thirty years. We have helped thousands of practices double in size and profitability. At Capacity Management, you are assured that you are working with top notch consultants and trainers who have an in-depth understanding of your profession. Our systems, diagnostics, coaching, and work ethic are unparalleled in helping you build the practice you've always wanted.

At Capacity Management, we have a proven track record of increasing profitability. We have been in thousands of practices, so we know what works. Our approach is business oriented and dedicated to improving your bottom line. On average, our clients have enjoyed a 40% increase in collections the first year they work with Capacity Management. Our consultants are known for cutting to the real issues in practice development and removing the underlying cause, not just the symptom. Skilled at identifying personal and practice blockages, we build practices without resorting to gimmicks and false motivation. Our consulting services are not based on "be like me" management, but the individual needs and goals of each Doctor. We go beyond the cookie cutter consulting model which is all too common in today's consulting market.

The CM team also provides another level of coaching by helping your team implement the systems and dialogs needed for growth. Our team is well experienced in front and back office systems. The CM team stands ready to help with marketing, scheduling, patient processing, recare system, receivables, team building, treatment planning, and many other systems that will forever change your practice for the better.

www.capacitymanagement.com

Howard: It is just a huge honor today to be sitting in my house with two friends for, I don’t know, twenty, thirty years? How long have we all know each other?

Greg : Thirty-plus years.

Howard: Thirty-plus years, my God. Did I have hair when we met?

Greg : (inaudible 00:20).

Howard: Did I? Did I? So right next to my…

Greg : And Howard, this wasn't that white either.

Howard: That's not white. That's all blond hair. I'm a natural blond.

Greg : Okay. I'm buying that.

Howard: I have no gray. So, Greg Jack is the CEO of Capacity Management. Throughout his thirty years in the practice consulting industry, Greg Jack has always had a passion for building practice capacity and developing the systems needed to fill it. Early in his career, Greg realized that increasing practice capacity always precedes real practice growth. He was a pioneer in developing the systems and strategies needed to efficiently increase practice capacity by identifying and eliminating key growth blockages. As a result, he has helped thousands of doctors throughout the United States develop larger and more profitable practices. Greg's practice diagnostic skills allow him to quickly fix the root causes that affect practice capacity and profitability. Greg created many of the concepts that are now considered indispensable in running successful practices and remains on the cutting edge of high-growth consulting. Doctors appreciate Greg's professionalism, dedication, integrity, and straight talk. As a result, he has been called the doctor's doctor for practice Billing. Let me tell you how far back we all go back. So my idol and mentor in dental school was Craig Steichen, who grew up in Farmington, New Mexico, where—is that where you were born and raised?

Greg: That's where I was born and raised.

Howard: And you actually met another legendary consultant, Greg Stanley.

Greg: Right.

Howard:  He lived there for a few years…

Greg: He was living there for a couple of years and that's where I met Greg originally.

Howard: And the reason I love Craig Steichen the most—big shout-out to Craig Steichen in Albuquerque, New Mexico—is in dental school, if I did my denture and turned it in, I would get a C, but if I had Craig make my denture for me I would get an A. So the reason I got so many A’s in dental laboratory, because I would do my work for practice, but when it got time for the project to turn it in for a letter grade Craig Steichen would do it for me. So thank you, Craig Steichen, for helping me cheat all through dental school laboratories. I'm sure you're glad that's on the record and on a podcast on YouTube for—your great-grandchildren might look you up someday and say, “My Dad cheated in lab.” But, oh man, he was amazing, fabulous, so hilarious.

One time we had this lab work and this real nerdy older professor, he was looking at it and everything. He was just looking at it like it was a dinosaur egg or something. He goes, “That is just perfect. Tell Dr. Steichen he did a good job.” And I was like, “Oh, what do I say to that?” And tell us your story. I'm sorry, I didn't print out a bio for you. We have known each other, Bill, for…

Bill: Well, since you started to come over to Whitehall office down in Phoenix to do recordings with Whitehall (inaudible 03:11).

Howard: Back when it was audio cassettes.

Bill: Back when it was audio cassettes, before we even had CDs.

Howard: And tell the millenials what an audio cassette is.

Bill: That’s the little thing you stick in your car, yeah. But it was so ancient we would record it on cassettes, take it down to AVR, keep putting on reel to reel, and we'd sit down and edit it and he'd edit it with a razor blade when he edited the tape.

Howard: Wow.

Bill: The guy who did it would sit there chain smoking and edit with a razor blade while we were in there doing those things.

Howard: I remember my baby, my baby Zac, he is twenty-two, and I remember, well, a long time ago he asked me one day after school, he said, “Dad, what's a CD?” I said, “CD?

You know, the music, the CD.” He goes, “I know, but what is it?” I explained to him. He goes, “Do you have one?” I said, “Well, sure.” So I jumped up and I couldn't find a CD player. I went out to my car and it’s like, god dang, I don’t even know have a CD player (inaudible 04:00).

Bill: (inaudible 04:00).

Howard: And then I have my old VCR tapes, but I can't show it to my grandkids because I don’t have a VCR player. But anyway, so that's where you met Greg Stanley. Is that where you cut your teeth, with Greg Stanley?

Bill: Yeah, right out of college. I'd grown up with Greg's younger brother who was working with Greg at the time right out of college. I have a degree in journalism, of all things, and they said, “Well, you want to come do our newsletter?” He was trying to do a newsletter and the rest is just kind of history. Just I hung around for a long time doing whatever.

Howard: Well, what I credit Greg Stanley with in this industry more than I think anybody out there is teaching these dentists that they don't have an income problem, they have a spending problem. And it's like, do you remember when we were out here and Keating went bankrupt?

Bill: Mm-hmm.

Howard: And the amount of money he made for every year, for year to year, and when he went bankrupt they go, “Well, obviously you have money.” He had no money. He had islands and helicopters and jets, and you looked at his yearly income for thirty, forty years, he didn't save a penny. In fact, he had tons of debt. And it's like, a normal person could have made that money for one year and his entire pedigree would have been set for life.

Bill: It could have been municipal bonds and just lived off the interest.

Howard: Yeah, and these dentists, and what's weird, it's a disease. It's a cat chasing its tail because they become a doctor, so they attract some young girl who's impressed, “Well, oh my God, I'm going to marry a rich doctor?” So now they've got a spender who’s unemployed, and then his ego says, “Well, I can't have an average house. I got to have a bigger house.” Well, then that means you can't go camping to the lake, you got to go to London, Paris and France, and you can't drive an old Chevy, you've got to drive a Benz or a Mercedes. So it's just this disease, and you still see them in debt at 65 years old. I know dentists who after they were sixty, upgraded their house on a thirty-year mortgage. Hey dude, are you going to live to be ninety? I mean…

Bill: And have income the whole time? (inaudible 06:03).

Howard: And it's across the board and with everybody. I'll never forget that book, The Millionaire Next Door, where these two Ph.D.’s,  and the occupation that had the most millionaires is a percentile—do you remember what it was? Schoolteachers.

Bill: (inaudible 06:17)

Howard: And the reason it was schoolteachers is because, “Well, I'm just a poor school teacher. I'm going to live in a modest house. I'm going to buy the Chevy, not a Cadillac, and we'll go camping at the lake not fly off in an airplane or go on a cruise.” So their mindset is “I'm a poor teacher” but they had the discipline to put away their monthly retirement, and when they were sixty-five they were the most likely to be a millionaire. And then doctors, dentists, lawyers – most likely to be spending problems, right? But anyway, enough of me talking. So what’s got both of you guys passionate for today? What’s flipping your flipper these days?

Greg: Well, what I wanted to kind of share with your group is the name Capacity Management was born out of when I would take on a practice, and the way we started early on was Greg Stanley went into money management and I started Whitehall with Greg and about six months later I stayed practice building and he stayed money management.

Howard: So you were a founder of Whitehall Management?

Greg: Mm-hmm.

Howard: Wow.

Greg: For a few months.

Howard: Oh, just a few months?

Greg: There wasn't enough money to go around, Howard, so I started doing practice building. So at the inception of Whitehall for probably first five, six, seven years, all Greg did was money management and then I always did the practice building.

Howard: And you know what the problem with the name back then when you guys started? I still remember. I have Whitehall, was the capital building. It was like the White House of England, right? So we have the White House they had the Whitehall, right?

Greg: That's not where it came from though.

Howard: Oh, okay.

Greg: That's good.

Howard: But everybody thought it was some Sterling Management...

Greg: Right, right.

Howard: Do you remember that back then?

Greg: And Bill, a lot of people thought it was his name. They'd say that Greg Whitehall guy.

Bill: Can I talk to Mr. Whitehall?

Howard: Why did they think it was Sterling Management?

Bill: I don't know.

Greg: I don't know. That's weird.

Howard: But do you remember that back in the day?

Greg: I remember Sterling, yeah.

Bill: Did they think it was like Scientology?

Howard: Yeah, well, Sterling Management was Scientology.

Bill: I know. Did they think Whitehall was too? I didn't really (inaudible 08:19) at the time.

Howard: Yeah, for some reason they confuse—Scientology had a dental division with Sterling Management and then they thought Greg was part of that or Whitehall Management was part of that.

Bill: Oh, okay.

Howard: I don't know, Sterling Management, Whitehall. Anyway. But where did the name come from?

Greg: Another person that Greg and I were starting all of this with had—he was a big proponent of Ayn Rand, and in Atlas Shrugged there was a company called Whitehall that went around and fixed the other companies and made them cleaned up so that they could perform. So that vision was that Whitehall would be this company who would come in and sterilise these companies and make sure they were highly profitable.

Howard: Wow.

Greg: That's really where the name came from.

Howard: And you know what Atlas Shrugged and Woodstock have in common?

Greg: What?

Howard: If every American who said they went to Woodstock would have been there, there would have been like a hundred million people at the concert.

Bill: (inaudible 09:11).

Howard: A hundred percent of all the people I've ever met in my life said, “Oh yeah, I'm a big fan Ayn Rand fan. I love Atlas Shrugged.” Okay, well, I read Atlas Shrugged. Just ask any fricking question on the book. No one's ever read the book. (inaudible 09:25) So you read the book? Well, tell me what you do remember of the book. “Smaller government.”  Okay, that's a concept, but tell me about the book. Everyone who said they read Atlas Shrugged,

shit, it's the size of the Bible.

Bill: It's a grind to read through it because it's the same book three times. It's like the book within the book and…

Howard: Yeah. Yeah. So you actually read it. Did you get through the whole damn thing?

Bill: I don't remember but it was (inaudible 09:51).

Howard: You know what my secret is to reading these books? Some of these, when I was raising four kids and you come home, all I hear is, “Dad! Dad! Dad! Dad!” and these books and try to get into and everything—and I've lectured in Australia, New Zealand and all these deals, and all these people are like, “Oh my God, you're flying to L.A., then you have New York, then you have a fifteen-hour flight to New Delhi.” And I said, man, that's (inaudible 10:16). “Are you going to take a sleeping pill? No. I'm going to get an eight-hundred-page book that's impossible to read in my lifestyle. The greatest book I ever read on— I had a hard time with understanding monetary supply, and my MBA teacher said, “Howard, you got to read the book called Secrets of the Temple.” And he goes, “But it's fricking as big as the Bible.” And so I flew to L.A. caught my layover on the way to Sydney, Australia—it's a fifteen-hour flight—and I told the flight attendants, “Look, I don't want to eat because I’ll get sleepy and tired and fall asleep. (inaudible 10:49) I just want black coffee. If you got the coffee pot, you walk by and it’s all the way filled, just top it off. I started on the tarmac. I finished it right when the pilot was saying, “We are descending.” Fifteen-hour trance reading this Secrets of the Temple, eight-hundred-page book, and that's where I've read all my… Like I'll get a book, Misch’s new book, Complications in Implant Dentistry, or Pathways of the Pulp by Stephen Cohen, it's like 14th edition, that are eight-hundred-page books. Well, you just can't sit down and read an eight-hundred-page dental textbook, but you can if you're flying fifteen hours from New York to New Delhi in first class where you've got a nice big seat, you've got a light. And that's where I read all the long-distance stuff. Sorry to interrupt with that rant. But I want to tell that story because that's the cheapest fastest way to learn knowledge. Millennials, they want to learn one little thing on occlusion, so they fly across the country in an aeroplane, stay in a resort, drop $3000 on the weekend, and come back with two pages of notes. I'm like, well, I'm pretty sure on Dentaltown we have a course that covered all that for $18 for one hour. What was your cab fare from the airport to the resort? “Twenty-seven.”  Well, you would have saved $10 if you stayed at home. But, the textbooks.

I mean, the greatest knowledge in any subject – pediatric, endo, perio, anything, the most expensive textbooks may be two hundred bucks and they'll be eight hundred pages with a thousand pictures, but they don't want to sit in a chair and read it for $200. They want to learn 5% of that information on a $3000 weekend course. So what’s got you passionate now? You've been in this game thirty years. It's a changing game. Where is the game of dentistry at now?

Greg: And throughout all of that time, found that if we could accomplish something with an office that that would induce the high referral factor.

Howard: The what?

Greg: The high referral factor.

Howard: High referral factor.

Bill: Just like in your practice, if patients get a product, they get served right, if they have a good experience, they’re prone to refer it. So early on, I said I don't want to be that guy who has to go out and spend a fortune marketing. So right after Greg and I started Whitehall, I developed Capacity Management, he stayed Whitehall, and we went down similar tracks and we'd refer back and forth to each other. But when somebody said to Greg, “I don't have enough money to complete my plan and to get out of bed,” then I'd show up and I'd show them how to make more money. So I never was talented at telling people how to spend their money, how to save their money or where to go invest it. I was always the guy who showed people how to make more money. So I was in the trenches. I was always in practices. So I had been in and out of thousands of practices. But you know, the thing Howard that I think really hit me early on was the concept of capacity. And you've talked about that, because I've listened to you over the years. You understand capacity. They'd say, “Greg, I want more new patients.” And I'd say, “Well, you're getting about thirty and that's producing this size practice.” They go, “I just need more new patients. Don't talk to me about anything else.” I'd say, “Okay.” So we’d do marketing, their new patients would go up, collections stayed the same.

So they'd still have limited capacity on the front, they’d still have the inability to process a new patient, and then when they'd go up front they didn't have a closer who could put the production in the book. So I'd go in and I say, “My job is to spot blockages and when I spot a blockage fix that and know which one’s the most important.” So my concept, Howard, over the years that’s served me super-well is, it's like if you have a pipe of water and it's coming up the pipe this way, it'll go automatically because of the pressure till that first blockage. Now, many times you don't know what it is. Doctors, because they're in the game, seldom will be able to know what that blockage is to pull that pin and let it go to the next level. Now, back in the day, people would get all lathered up over, “Greg, tell me how many people do I need at my front desk?” or “Come in and look at my office because I think my girls are wasting time. My team isn't doing what they're supposed to be doing.” And so most of my career, I have gone in and watched it move and just like there's something that is somewhat intuitive, but I would look at that and go, “It's that.” And they go, “What? No, you're supposed to come out and give me more new patients.” I go, “Mm-hmm, but if you don't fix that it doesn't matter what we do for new patients.” So part of my diagnostic skill, doctors then find out what that critical blockage is. The fixing it has always been fairly easy, so I've never had a problem figuring out what to do and when. I mean, the diagnostic side, once you've got that done, then you say, “Oh, it's that person and she really doesn't want to be here, and she's angry and she's the one that's kind of the face on your practice.” So, I might say, “Doc, the best thing for you to do is she needs to go somewhere else.” Or, they didn't have enough at the front, or they didn't have anybody processing their new patients. They didn't put a face on it that would make somebody the old adage, “Stay, pay and refer.” And so doctors want the practice to get larger, more profitable, but most of the time they're so deep in the forest they can't see what needs to fix first, second, third, and fourth. So as capacity management, I knew that if I could double your practice I'd always have clients. So my calling card’s always been and so I work with somebody and they go, “I got two guys I went to dental school with, they're kind of struggling. Would you talk to them?” And so I've always had a really thriving practice without having to spend fortunes in marketing. And maybe I should have—it would have been a better branding tool—but my point is I've never had to do that. So I'm highly referred because of that thing I'd learned to do early on, was to spot capacity. And I've heard you talk about this capacity issue. You go into a grocery store, there's twelve lanes but only two are open.

And the normal person would go, “Well, that's really inefficient.” They have all twelve lanes open with cash register. Why did they spend that money? But (inaudible 17:40) on a Saturday afternoon and they're all rocking. So a doctor who wants to get a certain size practice, there is an equation that follows that pattern. There’s a certain number of ops, there's a certain number of people, and then you have the capacity to move forward. So it never ends. I've had clients that I've worked with for ten years, they're still clients of mine—they're big producers—and I ask them, “Why do you still pay me?” And they say, “Greg Jack, when you come to our office, I'm always amazed. You come out and you watch the machine move. Then we go to dinner that night. What do you see?” I'll bring up two or three things. And they go, “And we go fix those and then it all smoothes out.”

So I'm a spotter at times, I'm a diagnostician at times. The solutions, Howard, I believe are easy to come by. So let's say that somebody was having difficulty hiring the right staff, training the right staff. Is there not a hundred places they could go on Dentaltown and get the best info they need to know how to fix those? Information’s everywhere. You have done a fabulous job at assembling that and you're the go-to place, so if I said, “I need to know how to do this,” I can go there and I can get whatever I need to. You don't have to run off and do a four-day seminar to learn how to get your team built. Let's say a doctor had a concern and said, “You know, I got to figure out how to incentivize my team.” Well, some of the best information out there I could read on bonus and I could put something together. Now, I might go in and diagnose that your bonus is ill-constructed, it's de-incentivizing people, they hate it, they don't like it, and I change those out many times. Sometimes I'm in there and it really is about—I was in a practice, I guess thirty days ago and it's a big practice in Scottsdale. And it's a great practice. I've worked with them for years and years, Bill did some time with them too. And you know what's interesting? They're wigging out because they have a bonus that when they get three hundred it doubles. And they were like going…

Howard: Three hundred what?

Greg: Three hundred thousand a month in collections. And I kept saying, “Well, if you hit two fifty, two eighty, two sixty,” I said, “Why are you guys not hitting three?” So anyway, Howard, I went back and I watched them and they had these goals set out for what they're supposed to produce. And I go—I'm on my calculator on my phone—I go, “That doesn’t match three, because you got to do about three fifty to land in the right number for collections.” And they go, “Yeah, but that's our number.” But it doesn't get you there. See, I believed that—and this happened. So the entire team got their head together and said, “Wow, these doctors need X number in restorative and so much in hygiene,” and we calculated all that. Two months in a row since then, they've gone over three. See, the whole team has a consciousness to look at a schedule and go, “Dr. Farran expects me to put 25,000 on that book today.”  How are we going to do that? Well, see, then coaching comes in. Then I can say, “Where are you going to get that? Do you have enough hygiene to drive twenty-five G’s in production, legitimate production?” So my point being, Howard, is if you do not get all of those things moving in the right direction, then it's very difficult to hit that number. When I go to a new doctor that's doing seventy, eighty grand, and he goes, “Yeah, I met one of your doctors. They're like doing three fifty, four hundred,” and they go, “They've either got to be a lousy dentist, they're cheating somebody. You can't do that,” and I go, “In your paradigm, that's true.” Because see, they're sitting there on two ops, empty rooms in the other two but they have (inaudible 21:53) for it, they got one hygienist that shows up two days a week and they don't have anybody up front that could close a case, and they go, “You can't do three hundred thousand, you can't do four hundred thousand in collections.” I have single doctors with one associate doing three fifty, four hundred, all the time.  What I'm saying, Howard, is in their mind they're going…

Howard: One doctor, one associate, or just one doctor?

Greg: One doctor and an associate.

Howard: Doing three hundred a month?

Greg: Most of them single guys are two fifty. Yeah, you meant two fifty, right.

Howard: So most of your single guys do two fifty.

Greg: Right.

Howard: And a single guy with an associate does three fifty.

Greg: Right. Three fifty before.

Howard: And all the published research on speed says that speed correlates to a higher quality. So Regina Herzlinger out of Harvard shows that she'll go study ten guys that do appendectomies and your surgery time is five minutes, yours is ten minutes, mine is 15, the failure rate correlates straight with it.

Gregl: Mm-hmm.

Howard: Because, I mean, look at general dentists. The endodontists do their molar in an hour. The general dentists do an hour and a half. Who do you think does a better job? The oral surgeon removes all four wisdom teeth in twenty minutes.

The general dentists take an hour to remove one. Guess who gets more paresthesias? So it's called the focused factory when you talk to a PhD economist and the people…

Greg: Do you know how hard that is? You do because you're in the business. That is so difficult. Bill will remember years ago Greg Stanley used to talk about that, how doctors will hide behind quality to throw you off the trail that they have a problem (inaudible 23:30) It’s a hidebehind.

Howard: Oh yeah. You don’t want a very slow, dumb and stupid doctor doing the surgery on you.

Greg: Right.

Howard: You want a guy who does a bypass in six-and-a-half hours. You don’t want the guy that can go in there and do it in forty. Because the guy doing it in forty has a trained team, they've done all the CE, they have all the equipment, they know every movement has purpose, they go in, then they do it in thirty minutes, and then dumbass takes two-and-a-half hours… Have you seen the mortality rate of bypasses? Do you know they're paid for by Medicaid/Medicare so they have to track their twenty-four-hour mortality rate? And in America, a bypass, the doctor has anywhere between a 1 and 11% twenty-four-hour mortality rate. And then your friend goes, “Oh yeah, go to Jimmy. He's the best cardiologist in town.” What’s his twenty-four-hour mortality rate? “I don't know.” Is he board-certified? “I don't know.” How many people has he killed in the last year? “I don’t fricking know.” So then why are you referring? Because you're a fricking monkey.But the difference between a 1 and 11% mortality rate also correlates to speed. There's research on that. So the guys that are in there doing the fastest are closer to the 1% mortality rate and the slowest are 11%.

Greg: See, when I have a client and we're consulting with them and I said, “You know, you really got to speed up. So you go to courses, you study, you want to do whatever you've got to do to learn how to put that crown in less time. Because in a schedule, they'll put an hour and a half in there.” And I go, “So how much is the doctor timeout in that hour and a half?” I'll turn to the staff because they are the ones that know and they’ll say, “He's with that patient an hour.” I go, “What?” Most of my offices schedule patient time an hour and the doctor's time’s about ten, fifteen minutes to cut a crown. The team member then, Howard, on the back side of that, building the temp and doing those kind of things, then that hits. So I go to the doctor and all I'm trying to do is move up from an hour and a half to an hour to forty-five.

See, we want to schedule for high profitability, and you just put cement on what I've always believed and known. So the new doc comes to me and goes, “Greg, I know you've got guys that can cut a crown in fifteen minutes. I want to tell you right now, it'll be junk, and I got to tell you when that crown comes back it won't fit.” I go, “What?” So I've got people like, I'll just mention his name, John Buzza, he teaches for Kois, super-sharp guy…

Howard: What’s his name?

Greg: John Buzza.

Howard: How do you spell his name?

Greg: B-U-Z-Z-A.

Howard: B-U-Z-Z-A. Is he  Italian, Italian or Italian?

Greg: Yeah, he's all Italian, believe me, and he's a Genovese.

Howard: When there's a couple of pizzas, he's Italian.

Greg: Anyway, this guy is so phenomenal in that he understands that concept that speed and quality are—in other words, quality’s not driven by how much time you take. It's that guy who says—Now, heaven forbid, Howard, that you and I would ever go eat at McDonald's, but let me ask you this question. If you ever did do that, wouldn't you rather go when they're serving crowds of people and rocking through their system or do you want to wait till three o'clock in the afternoon when that burger’s been sitting under that lamp for two hours? So, as bad as that is, they understood capacity. So my point being is, when you're trying to help a doctor kick it in the pants and really get a practice that they can say, “This is the one I wanted,” it all comes back to “what are the blockages?” and knowing what they are. Now, if treatment time is a blockage, hell, there's thousands of ways to get that fixed. If it's team, which is typically more often than not, then you've got to really understand and learn what you need to do to have that team that will back your play. And so years ago, when I first met Paul, he and I had worked on a couple of agreements for doctors. And that's where I met Paul, at CEDR. And so my point being is, I think the clarity is we’re in the people business. You're a dentist serving dentistry to people. You are in the people business because you're a dentist working with your team and vice-versa. We're all in the people business and if you don't know how to handle people the rest of it doesn't work. Because I've had practitioners, Howard, who come to me and they say, “Greg, I was first in my class and that guy down the street, he wouldn't even have a license, Greg Jack, if I had not helped him through school. Look at his parking lot. Look at mine. I'm smarter. My gold work is unbelievable. Tell me why he's successful three times what I am.”

And I go, “Because we're in the people business and he learns how to sell dentistry and he learns how to give patients the confidence to be treated by him.” So I said, “If you really want to have a practice that knocks it out of the park, I'm proposing that you learn how to deal with people and learn the nuances of that. So a doctor who is a jerk to his staff and can't really learn what they need and what they want and how to get them trained up, they leave and go somewhere else. And so that guy down the street had a rocking staff that would take a bullet for him. They were trained. They knew how to answer the phone. They knew what to say to a patient when that handoff came from back to front. They knew exactly to get that in oral picture up on that screen to be able to get the x-rays up there so that the back office would hand off by saying, ‘Dr. Jones is really concerned about that tooth 28. There's the picture and he wants Julie to have a copy to take home. But that's the tooth we're worried about and I want you to know Doctor’s very concerned and said get her in here tomorrow morning, do whatever you've got to do to make that schedule work.’ And we've already said that in front of her, right? But this is another handoff. And if the front grabs that and they can't close that case, you got the wrong person.” Now, I believe that there's a few things you can get a team member to learn. We can all get better. There's no doubt about that.  But Howard, you can't take somebody who is timid, unsure, doesn't want to be speaking to that patient, keeps her head down, not look a person in the eye, and get them to buy a $5000, $6000, $7000, $8000, $9000, $10,000 case. It's just hard. So what they do is they go out and they hire people like them who typically aren't more on the sell side. See, I've watched you for years. I think you could sell ice cubes to Eskimos. You're a people person. When you used to come to—and I'd watch you when you'd come to the Whitehall (inaudible 30:23) and do that. It would throw Greg Stanley into a fit just because he was always afraid of what you were going to say (inaudible 30:29).

Howard: Oh my God.

Greg: You know what? Bill and I (inaudible 30:31), “Okay, here it comes. Here it comes.” And then you would say something and Greg would go, “Oh God,” like, “I'm going to get hundreds of letters.”

Howard: But you know why it's better now? You know why it's better now? Because now my reputation is out there. So I just got invited to some old, old, old prosthodontic society and the guy said, “Well, you can’t have him, he'll piss off half the people.” And the guy said, “Yeah, but those half already know who our friend is and they won't show up.”

Greg: Well, but in truth people will show up and say, “That's who he is and I love it,” and they'll come anyway.  So what I'm saying is if you really want your practice to be bigger, or more profitable is what I always like—because see, as a consultant, I don't put my stock in numbers. If you said, “Greg Jack, why should I pay you?” Because right now you're barely taking home fifteen grand a month and you're leveraged to the hilt. So if you want to take home seventy-five to a hundred grand a month and do seven, eight hundred thousand a year…

Howard: Well, fifteen grand a month, here's the problem I have with that. Fifteen thousand dollars a month times twelve is $180,000 a year. What I think is appalling is how many dentists think that they should get the Mahatma Gandhi Mother Theresa of the Year award because they only made $180,000 a year. What percent of America would trade their job and make $180,000 a year?

Greg: Most. Most…

Howard: When you say most, give me a number between one and a hundred.

Greg: Oh, I'd say probably 85, 90% of people.

Howard: Yeah. So first of all, your expectations are off the fricking charts.

Greg: And Howard, even people in medicine, other formats of medicine, you take a surgeon or somebody, even though they make a lot of money, they hate their life. They want to do it until they can get the money made and get out because they're telling people, they're doing surgeries, they run that high risk, they're up all night. I have a set of trauma surgeons I worked with in the past and they made incredible money, but they were all, “Greg Jack, tell me when I get here because I'm out.” I go, “Don’t you like what you do?” “No. I tell people. People die. I have to go to their family.” You know what I'm saying? And they said, “My life is I'm on call twenty-four/seven. Some big auto accident, I'm in there.” They hate it.

Howard: Yeah.

Greg: Dentistry, they can go, it's seven to four, Howard…

Howard: And there's another weird bizarre thing about expectations, not it's $180,000 a year, but when you put in an implant a lot of people complain that after five years 20% have their implant (inaudible 32:58). There's orthopedic surgeons that live within a block of my house where they'll put in a hip and the lady will die three months later of a staph infection. When they put in an artificial knee or a hip, I mean, they’re telling you, “Hopefully you can get five to ten out of this.” Then a dentist has an implant fail after eight years and he’s ready for psychiatric treatment. And I say, “How many implants have you placed with a lady dying of a staph infection?” I can't say his occupation but another really good friend of mine, right up the street from me,  got an artificial hip. He got a staph infection. He was in the hospital on I.V., gentamicin, (inaudible 33:36), he didn't get out of the hospital for half a year. And then here's a dentist, he's walking the plank because his implant didn't integrate and it's like, “Dude, lighten up.”And the other thing about all my physician friends, when they get out of school they’ll get a job in a hospital and they’ll say, “Okay, you're going to work Monday and Thursday and that's it. Each day's a twenty-four-hour shift.” So you're here 6:00 a.m. at St. Joe and you leave 6:00 a.m. the next morning, you come back Thursday again. Then you hire a dentist from AT Stiller Mid Western and say, “Well, Mondays and Wednesdays but you stay till seven.” “Stay till seven? Are you out of your fricking mind?” “And once a month you have to work a Thursday from eight till noon.” “No way. No way. I’m into that work-life balance and it includes me being the laziest son of a bitch in the entire valley.”

Greg: So you just identified another hidebehind, right?

Howard: Yeah.

Greg: In other words, it's—and the same thing with implants. So if I've got a young guy and he says, “Greg, I really want to be on the upper-edge profitability,” I say, “You need to learn to do implants. You need to learn to do a lot of that stuff yourself because they're referring everything out.” And they go, “No, I've read. I know a lot about implants and, Greg, they fail all the time.  I'm not going there. And I go, “Well, don’t you think you could learn how to do them? I mean, you have a dental degree. Certainly, you learned to do something. Come on, learn how to do them. Go take the right courses. Figure it out.” But they hide behind that because they don't want to take that risk.

Howard: When did you get into dentistry? What year was that?

Greg: Probably ‘79, ‘80. About ‘80.

Howard: So how many years is that? So that's ‘79, so let's say 2017 minus what, 1979?

Greg: Probably ‘80. I'd say ’80. Yeah, ’80.

Howard: So you've been in this thirty years. You see what we're doing here. You're not even thirty-eight years old watching this. You got out of school at twenty-five. I bring these guys in. And how many practices have you seen in thirty-eight years?

Greg: I would say probably forty-seven, forty-eight hundred, somewhere in that, that I actually consulted.

Howard: So you've seen five thousand practices and you only see yourself (inaudible 35:58) the most successful, they’re humble and hungry. Humble means you're not that, “Well, I'm a doctor. I know, I'm a doctor. I know everything.” No, humble is you barely know how your own office works, and they've seen five thousand offices, forty years. We've been doing all the talking. What are you seeing these days? What are you most passionate about?

Bill: Well, since I work with Greg, I mean, we really are big on capacity.

Howard: You only work for Greg.You worked for Greg Stanley for two decades.

Bill: I only work for the name Greg, yes. That's the first rule, is they have to be named Greg for whatever reason.

Greg: And they have to have two first names.

Howard: They have to have two first…

Bill: Greg Jack and Greg Stanley, yeah.

Howard: Oh, right on. So how long have you been in this industry?

Bill: It's about ’87, ’88.

Howard: And you're an amazing man. I mean, I've been listening to you since the (inaudible 36:45) days. But what do you see in this industry? What are you passionate about? How are you seeing the problems? How are you helping people?

Bill: Well, basically it's about helping them realize that in order to achieve growth they've got to make the capacity first. I mean, because so many doctors go, “You know, I'm doing the forty thousand or fifty thousand. When I hit the bigger numbers, then I'll have the operatory.” They're like they don’t have the money. And he was like, “Well, no, it doesn't work that way. You've got it backwards. You've got to buy the operatory, take the leap of faith, and then you get that money.” It's like taking this, what’s this hold, sixteen ounces? And the doctor says, “When you can show me how to fill that with twenty-four ounces, then I'll get you a bigger bottle.”  Well, it's like you have to buy the big bottle first.

Howard: Yeah, and I think a lot of it is because they understood Henry Ford’s assembly line

and they don't realize the difference in product versus service where if your analysts say, “Okay, we'll probably sell one million Ford Tauruses a year,” then I'm going to build a factory that knocks out eighty-three thousand, three hundred and thirty-three cars a month, where everything's uniform. A service is not an iPhone, a mug or a car. It comes in flows. So you're at Barnes and Noble and you have twelve checkout lanes, only one person’s working because they’re all wrapped up in the movie It. And then It lets out and all these people don’t want to go back home, they got a babysitter, they wander into the bookstore, and they see the movie let out and a big flow of people came in and they get on the deal and they say, “I need all checkers to the front, all checkers to the front.” So you were cleaning up, you were vacuuming, you were stocking books, you were ordering books, you leave all that task, you run to the front, because if I grab a book and I get in line and there's six people in there, I'm just going to leave. I'm not going to stand behind six people.

You mentioned grocery stores. Another one is banks. There's a hundred and sixty-eight hours in a week. Banks have three drive-throughs. They only use one for a hundred and sixty hours. But on Friday, when everybody gets a paycheck, they open up all three lanes and they work the flow. And we have shown them data for twenty-five, thirty years that the dentists, you add chairs until you have a chair that no one just gets to the point where he goes, “We have extra capacity at room four.” Dude, there's people scheduled in all four of those rooms. You have to have an extra operatory and you have to have an extra operatory that no one sat in one time every other day. You go into every office and you call up, “Yeah, I'd like to make an appointment.” They're looking for a chair. I go into the dentist, they're on Dentaltown. What are you doing back here? You're not making any money back here. Well, Amy has to dismiss that patient, then clean up the room, then set up the next room, and then go get the next patient and seat it, so I'm going to sit back here being a dumbass for twenty minutes. It's like, dude, your cost is 35%, your staff twenty-five, labs ten, supplies six, rent five. Operatories ain't even on your overhead sheet. And I always see the number one expense, 53-1/2% go to human beings in the average dental office and they're always standing around waiting on a chair.

Bill: On space, yeah.

Howard: It's so stupid. It's so stupid. And then every dentist says, “Well, I don’t have room for an operatory.” It's like, really? It seems like you're always in a break room waiting for an op or you're in your private room waiting for an op. I see two operatories right there. Get rid of your damn break room, get rid of your damn office, and then talk to me.

Bill: Then make a space so you can fill it up.

Howard: Yeah.

Bill: Well, what we see is it kind of comes back to the whole thing about this is a people business, and the doctors and people, there's what we used to call peak demand times. It's like for hygiene, it's not steady through the day. People want to come see their hygienist because they've got to do it every six months. They want to come before work or after work. They want to do it around their regular job. I don't want to take a day off vacation or a sick day to come see my hygienist since I do it every six months. So there's that peak demand time. In the afternoon, the doctors go, “Oh no, we just tell people when they need to come in and they'll just come in.” It's like, maybe once or twice, but for regular visits…

Howard: Yeah, and then that same dentist is like…

Bill: They move on. They’ll move on to somewhere else.

Bill: Yeah, (inaudible 41:01) and he'll say,

Howard: “How do you get rid of no-shows and cancellations?” Quit giving them shit they didn't ask for. “When would you like to come in?” “I'd like to come in the Day.” “Well, how about tomorrow at three?” “All right.” And then tomorrow at three they don’t come in, I say because they typed in—the number one search in dentistry is “dentist near me.” So, “Oh, you can come in tomorrow at three.” Okay, take that just in case everyone else can't. Then they type in “dentist near me” and then someone will get them right now.

Greg: And early on too, Dr. Farran, we knew early on where dentists would come to me and they would say, “I'm booked out two weeks.” And I go, “What does that mean to you?” And he goes, “Well, I'm good. I'm booked out two weeks.” And I'd say, “Doctor, let me explain something to you. You have a perception that if you're booked out two weeks that you're really good. Patients don't care that you're booked out two weeks. You know what they care about? That tooth hurts right there and I need somebody to take care of that.” And I said, “So the minute you can get somebody to do and get them in same day,” Howard, anybody in pain in my offices, they're in the same day. We do same-day dentistry. We don't (inaudible 42:14)

Howard: But how many weeks out is Wal-Mart booked?

Greg: Yeah, really.

Howard: How many weeks out is the Hyatt Regency booked?

Greg: Yeah, really.

Howard: Nobody's booked out. And that's what the dentists say, “Well, we see all of our same-day emergencies.” So they'll call them and they’ll say, “Yeah, I'd really like to get my teeth clean because I got a job interview tomorrow.” Well, that's not an emergency. Emergency is (inaudible 42:31) taking aspirin. So they define their perverted emergency when a human is—what's emergency to them is what they want now.

Greg: Right.

Howard: And here's the dead giveaway on his capacity. The minute your receptionist says, “Well, I can't have you come in and give me money today. You're going to have to get in line and wait one day to give me…” The minute you say you have to get in line to come and give you money, then I already know what's going to happen. That's your plateau. So ten years later, you'll be doing the same amount. Because once you say, “I can't take your money today. Stand in line and wait and I'll take your money,” I don't care if you're booked one day, a week, two weeks, a month. It doesn't matter. Once you tell them, “You have to stand in line and wait,” to give you money, that's the end of your growth.

Bill: They never see that sometimes because people, like you said, they'll say, “Okay, I'll stand in line,” and then they just go find somebody who gets them in.

Greg: People do that with restaurants. I was eating—and you know usually you’ll go to eat at a restaurant around here. There's usually four or five right in the area. And I watch the guy come in and get the little beeper or the little thing, and he goes, “Yeah, okay, it's a twenty-minute wait. Alright,” and he walked right over to the next restaurant. And I watched him, because we were standing out front waiting like (inaudible 43:54), and he goes next door and he gets another beeper and theirs was like a forty-minute wait, and he came back and got another one and he’s sitting there with three beepers. He would just wait and see which one's going to pop first and that's where they were going to eat. Patients don't want to wait. But see, that's another hidebehind because the doctor's going, “I am so good, Greg, that I'm booked out three weeks,” and I go, “Wow.” See, I see that as capacity blockage. Fix that, and when the phone rings your team is looking at, “Man, I need somebody to be in that hole on that schedule right now because that's going to turn into same-day dentistry and I got to get twenty-five G’s on my book today.”

Howard: And let me show you how you're hour-and-a-half for a crown is insane. So thirty years ago I charged $1000 for a crown, sent it to Delta Dental, and they paid half of it. I charged $1000 for a root canal, sent it to Delta Dental, and they paid 80% of it.Those days are gone. Now they send me the fee, and I think the fee for each one of those is about six fifty. So when your PPO reduces the fee by 40%, you got to go 40% faster. But I just want to walk you through two crowns.

Greg: Dr. Farran, would you say that again? It's really important to me what you just said.

Howard: When you accept a fee reduction PPO that's 40% cheaper, you have to do it 40% faster. And let me tell you why your hide behind of being lazy, dumb and slow is— that's your thought. No one else—you can't get Regina Herzlinger, a PhD medical economist from Harvard University, to buy into your bullshit. Let me show you what I see. Let me see what I see. You got two doctors and one doctor gets $1000 for a crown. He doesn’t take any insurance at all and he just gets $1000 for a crown, books an hour and a half. The other dentist is this lowlife that takes a PPO and he's doing a crown for six hundred, but he schedules doctor time, thirty minutes. So he walks in there and numbs, and he numbs with septocaine instead of lidocaine. Septocaine is 4%—lidocaine is 2%—and numbs it in four minutes. But he doesn't get up and leave. He sits down there and next he takes (inaudible 46:01), and then he sits there and he takes an impression for the temporary. And when he does the septocaine, he's set a timer for four minutes. When it goes ding, it's already numb, he's already got the impression for a temporary, he's already taking the (inaudible 46:14). Then he packs a 0 cord and a 1 cord, pushes down the tissue, down and out. The best way to stop bleeding is not to start it. Then he takes out the inner proximals, the reduction, and he gets his whole prep done—no bleeding—then he makes a temporary. When you get done, you just leave and have the assistant make the temporary. Well, how are you going to take the final impression? You work everything out in your temporary. So he makes a temporary with an assistant. It only takes like five minutes. He gets the impression. He's got his three-and-a-half loupes on. He's carving it back because he realizes

that margin is not quite right. He looks in the tooth. Yeah, it isn't quite right. You learn so much in your temporary. So then he refines his prep, starts temporary number two, and then he's making number two and he's like, “That's a good impression.” You can pick it up in your temporary or you can pick it up in your Impregum. So then he's adjusting the occlusion and he goes through. See, when you get a reduction coping every month for your whole fricking forty years, it's because you took the impression after you made your temporary. You make the temporary first. You learn everything in your temporary. So then he goes through and then he's like, “Oh my God, I don't have enough reduction. Maybe I'll use a plunger cusp to fix that.”

Now he's on the third temporary. He's got the margin, got the occlusion perfect. Now he's taking an Impregum. “While that's setting up for five minutes, I'm going to go do a hygiene check. I come back, I pull that, I look at the deal. Perfect. I cement the temporary. Gone in 30 minutes.” So he makes $600 every thirty minutes. So three, six, nine, six, twelve – he makes $1800 in ninety minutes and you make $1000 and tell 82% of your patients in your (inaudible 47:45) that are visiting dentists, “If you have dental insurance, you're more likely to visit the dentist.” And so you're making $1000, he's making $1800, and then when you get the crown back it has a reduction coping, yours doesn't fit because you didn't even work out your problems. So some of the biggest producers I see in the world are faster. And another one, the oral surgeon, does all four quadrants all day long. I know dentists all day long that you have five fillings, numbs up all five, does it. For some weird crazy reason, you're like, “Well, what do you want on this appointment? Schedule a whole hour for it, and then come back in two weeks and we'll do one over here.” By the time you come back to the third appointment, who the shit wants to go back to the dentist three times in one month? So they never even come and get it done. Whereas other dentists say, “It's not the PPO fee.” You say, “Well, I used to get $250 for a filling, but this PPO is only giving me two hundred.” That's a unit price. It's got to be a time price. I don't care if it's $200 for a filling, hundred and fifty, three hundred. Iit doesn't matter. You got seven fillings and I'm going to schedule one hour and knock out all seven. Well, hell, if they were a hundred apiece, that's a $700 hour. If they were two hundred apiece, that's a $1400 hour. But you're like, “Well, I can only do one at a time and you have to come in nine times.” Just knock that shit out. It's not the PPO fee schedule. It's how much you produce per hour. And then for the 50% overhead, you walk in there, you have your break even point for the day, but your entitled staff won't do it because they're guaranteed a lunch at noon. My staff goes to lunch after we pay the Bills. And they'll have a cancellation at eleven, all sit around and do nothing and then at twelve go to lunch, when there's people at 11:15 saying, “I broke my tooth.” Their staff’s like, “Well, you could come on down right now.”

Oh, but your entitled staff, it's only dental offices and the Department of Motor Vehicles say, “We're entitled to a lunch at twelve even if we're losing money, and then at five o'clock we're going home.” You know how many threads there are on Dentaltown? How do you (inaudible 49:45) someone in severe pain when they come in and it's 4:30 and you're leaving at five?

Greg: They’ll leave at five.

Howard: Well, maybe you don’t leave at five, asshole. Maybe when a fireman shows up to a house on fire they don’t say, “Well, should we even get the hoses out?”

Greg: Yeah, it's almost quitting time.”

Howard: “Because it's almost quitting time and Jesus Christ, I mean, this baby’s just going to have to burn.”

Greg: There you go.

Howard: I mean, dentists, I love you guys. But if I don't love you, if I sugarcoat it and tell you what you want to hear, you want to hear, “Oh, I feel sorry for you, poor thing. Oh, you have student loan indebtedness,” when there's two hundred and twenty countries, you can only borrow other people's money in the twenty richest countries. You can't get $300,000 of student loans in Somalia and Ethiopia and Afghanistan and Syria where you're born a peasant, you'll die a peasant. You got access to other people's money. It's not the government's fault that you took student loan money and went on spring break in Florida and bought an $80,000 Honda Accord. You've been in more airplanes before you got to dental school than the average American ever did in their entire lifetime. I know a fifty-two-year-old lady patient who's all nervous because she's flying for the first time.

Greg: Geez.

Howard: Well, she’s Hispanic. She's a certified nurse, a CNA, who makes $11 an hour. She's never flown in an airplane. You go to AT Still, Midwestern, it looks like a new car lot, and ask them, “In dental school, how many times did those two loans buy you an airplane ticket to a vacation?” I mean, they're crazy. And that's why the ones who are crushing it are humble, because they listen to guys like you and they hustle. And before—I've told you this eight million thousand trillion times—before you buy a laser, before you buy a chairside milling, before you buy a CBCT, when everybody I know that's placed over ten thousand implants hit the ten thousand mark on a 2D pano without a surgical guide—oh, but you have to have the $100,000 CBCT, blah, blah, blah— the number one major investment is the consultant. And I don't even care which consultant it is because everybody at my age, everybody crushing in the two to four million, they've tried every consultant known to man over thirty years because you might come in and teach me some capacity, you might come in and teach me some scheduling. I mean, everybody I know in the $2- to $4 -million mark says, “I've never paid a consultant fifty grand where I didn’t earn that fifty grand back and a buck more that very year, and they always reduce my stress because they solve the problems so I'm doing everything faster, easier, higher quality, lower cost. And the more consultants I buy, the less stress I have, the more it runs like a Swiss clock, and I get rich.” And what's your answer to that? “Well, I'm a doctor. I know everything.”

Greg: “I know everything.”

Howard: “I know everything. I don't have a doctorate in dental surgery. I’m a DOE. I'm a doctor of everything. I'm the smartest guy in the room. Even when I'm at a Cardinals football game, I'm the smartest guy in the world.” And, oh my God, I'm sorry. But back to money, how much is your service? What does it cost? Contracts, fees.

Greg: Twenty-five hundred a month.

Howard: Twenty-five hundred a month? With or without a contract?

Greg: Mm-hmm. We have a contract but after three months they can give us a thirty-day notice and they're gone. I'm the only guy that I know of…

Howard: So then you're locked in for ten grand.

Greg: Right.

Howard: Because if you're twenty-five hundred a month, three months, and then then I quit, ten grand.

Greg: Right. Right. And so what I want is, give it a shot. And rarely do people leave. The ones that do are the people that really aren't going to do this stuff anyway and they need to go somewhere else because I haven't got time for that.

Howard: And do you think—Dentistry is the small industry in the world. It's like John Cougar Mellencamp, pink houses for you and me. if you fart in dentistry, someone smells it on the other side of the (inaudible 53:46). Do you think he could be in business for thirty-eight years fixing no problems and making everyone unhappy? Could you do that?

Greg: No. And see, the truth is anything anybody comes up with, you know I hear about that. I mean, this community, I can go on your Dentaltown—if I had a brand new guy and he said, “Greg I want to be a consultant,” I'd say, “Go on to Dentaltown and study like crazy,” because they'd learn everything they need to know. Now, when I listened to you just a minute ago, and I need to let your group know this—I've known this forever but I want to make sure your group understands—you have that capacity gene. You've always been able—see, when you sit here and say, “Greg, here's why you got to get your doctors to look at that in the right way and say, ‘It isn't about the fee I charge, it's about how many can I do, what's my rate per minute I'm making to do those,’ get faster, see, you've known, Howard, forever how to get capacity. You think like that. But that's not normally what I see in dentists. My biggest client, Dr. Buzza that we mentioned earlier, he is the easiest guy to coach. He'll sit there and he'll think about it and he'll go, “Really? I need another op? I need two more ops?” Mm-hmm.

Howard: Oh how.

Greg: And he's sitting there looking at that and I go, “We pushed you and pushed you and now…” and then he'll go, “So to get an associate, I need those other two ops.”

Howard: You're the only two groups of people that understand capacity in dentistry and it's for purely emotional reasons. The average dentist is making one seventy-five. Average endodontist and oral surgeon are closer to three seventy-five to four hundred. And why? The dentists say, “Well, that’s because they do a bigger procedure…” No, no, it's not. You know what it is? It's ego. If you refer to me as an endodontist, all endodontists and oral surgeons have two extra chairs that aren't in the schedule. Because my ego is, if you said your tooth aches to me and my front desk Valerie says, “Well, Greg, I can't get in your emergency (inaudible 55:55), I can't see you till tomorrow,” well, you're going to call up and call another endodontist. And that's who he's competing with, and he's going to have an extra chair. By God, he is not going to feed that other endodontist—his ego won't allow it—because he doesn't want you to ever be satisfied by another specialist. So the endodontists and oral surgeons all make double the general dentist not because the average fee is $1000 because, I mean, what's the difference between an endodontist doing a $1000-an-hour root canal versus you doing four fillings for two hundred fifty in an hour? It’s not that. And if you call up an endodontist or an oral surgeon and say, “Man, I'm sorry, but I got a kid (inaudible 56:34). She's got to be seen today,” that receptionist is trained, “No, you cannot say no. We’ll miss lunch. We’ll stay late.” All my oral surgeon and endodontist friends routinely miss lunch and routinely stay late because they don't want you to start another relationship with another endodontist or oral surgeon.

Bill: But what’s funny is dentists will easily start that other relationship but they can't transfer that thought process to, “That's what my patients do if I turn them away.” It's just like you're acting just like people because you're people too, and your patients are people and that's how they act. When you say, “No, come in in three days or two weeks or whenever it is,” they're going to move on to somebody else. They just go, “Next,” and they're gone.

Howard: Yeah.

Bill: They just slowly, quietly evaporate into another practice.

Greg: If you're the only dentist in Swamp Bucket, Oklahoma, and there ain't anybody else anywhere near, you can be a little more abusive to patients by just saying, “Oh, I can't get you for two weeks,” or “I can't see you until Thursday.”

Howard: Yeah, rural, but they're not going to go rural. You know why? Because their dad moved all the way from India to come to this country for a better opportunity, so the millennial can't go one hour out of town.

Greg: Right.

Howard: I mean, his dad came eight thousand miles, the millennial’s like, “Eight thousand miles. Maybe I'll go eight miles out of town, but my dad came eight thousand miles so the next three generations don't have to do shit.”

Greg: There's a part of the town that we're in this valley. It's over on the Gilbert side. They average five hundred and forty patients is the demographics per dentist.

Howard: In East Mesa?

Greg: Yeah.

Howard: Is it worse than North Scottsdale?

Greg: Yes because North Scottsdale has a weed-out factor. They come there and if they can't get their stuff together very quick they'll fail fast. In Mesa, they'll stay over there and they'll stay over there and it's actually Gilbert. But what I'm saying is…

Howard: Is a lot of that because I've seen a lot of dentists tell me—10% of all my dentist friends are LDS, and when they come from Utah or whatever they'll say, “Well, I want to live and practice in Gilbert even though it's a really bad decision. I know if I went to Maricopa, Eloy or Florence I'd crush it.”  But is that the LDS factor in East Mesa and Gilbert?

Greg: That’s the LDS factor in East Mesa. They're willing to live there and compete on that high level because of the close proximity of the church and being able to say, “My kids go here, my kids go to this school.” They will choose that over…

Howard: But from Gilbert, which is probably what, 60% Mormon? They call it South Utah.

Greg: All right.

Howard: I mean, how long of a commute is it to Maricopa?

Bill: Like an hour.

Howard: Why can't they commute an hour to drive from one dentist for five hundred to one dentist for four…? Eloy still doesn't have a dentist.

Greg: A lot of those practices out there…

Bill: No, really?

Howard: And you know what’s going to be the game-changer? You know what's going to make them feel really dumb? We are on the precipice of the biggest game-changer ever, which is the driverless car. So when you look at that $30,000 average of a new car, half of that shit is for the driver. Now it's going to be a box on four wheels with a GPS and a Tesla battery underneath it and you can have your desk. You could be doing all your email and work or surfing downtown. It could be a bed. You could just go in there and get under the covers and fall asleep and one hour later you hear, “Ding! You have arrived at your location.”

This driverless car is going to be—and how I see it's going to be even better is all my employees that work for like Google, “ No offices, everybody has a cubicle. It's overwhelming. You can't get anything done. You go sit down, everybody’s like, “Hey, how's your dog? How’s your wife? How's your kid? What’d you do this weekend? What are you going to do? Let me tell you what we did this weekend.” So if I live two hours out in the country and then I'm at home and it's all, “Dad, Dad, Dad, Dad, Dad,” and all that stuff, get in your car – driverless, do two hours of all your work, then you get to Intel, have your staff meetings be interrupted a thousand times, then you find out what you got to do, now you go back into your privacy and on the two-hour commute home get all your work done. I think we're five, ten years away for lots of people saying, “I fricking love the hour or two commute. I watch a Netflix film. I get all my e-mail done.”

Greg: Right.

Howard: “I get all this shit.” I mean, oh my God, even at my own office when they when they walk in the morning, the talkers, it's like they almost need to be there an hour early because they're going to come in and tell you everything about last night, what they watched, and they're social animals. Primates are social animals and they have a huge need to talk. And when you're talking to me, I ain't working. And then you go home and your kid wants to tell you about stuff, you can't say, “Can you just shut up? I've been talking all day.” So yeah, I think a lot of people who bought land and building and built these dental offices in Glendale and Gilbert and East Mesa, North Scottsdale, now they own that Taj Mahal, when that driverless car comes out they’re going to say—I mean, Eloy still doesn't have a dentist.

Greg: Right. Right.

Howard: I mean, how could you go to Gilbert or Scottsdale when Eloy doesn’t have a dentist?

Greg: And see, if somebody came saying, “Well, Greg, you live in Arizona. Where should I set a practice?” I would look at the demographic and say, “Not in Gilbert, not in Scottsdale.”

Howard: Oh.

Greg: You know what I'm saying?

Howard: Yeah.

Greg: Because there are so many. Tempe has got too many. I'm just saying I would find that place where it has about fifteen to two thousand people (inaudible 1:02:10).

Howard: You know how you find it? You know how you find that place? You go to, who's the people pushing all these dental therapists in Congress, trying to get these dental therapists to go to the underserved areas?

Greg: It's small town people.

Howard: It's Pew Trust. You go to Pew Trust. This is a gazillion-dollar nonprofit. They have all the data on all the counties of the underserved area that they're pushing the legislation. So you should go to the Pew Trust and say—okay, they're lobbying in all 50 states to get dental therapists because there's no dentists in these spots and they got all the counties color-coded and it's like that's where you need to go. That's where you need to go. And then you're like, “Well, I don't want to go there.” Well, here's what I’ve seen. I see dentists go to those areas, work four ten-hour days, crush it, then Thursday night get in their $100,000 black Porsche they bought in cash because they're so rich, and drive down to Newport Beach where they have a condo on the beach. Whereas the dentists who practice in Newport never go to the beach because they're broke and they live three days a week like they’re a rock star, then they drive back to Shitville and crush it, four ten-hour days where there's a dentist for every seven thousand. I just talked to a kid the other day on the phone that found a small town of eighteen hundred with no dentists and it was two hours out of the big town, and what he didn't realize is that the—until he set a practice, basically that little, it was smaller than a county but I think it was a county, actually didn't have a dentist for sixty-seven hundred people. He thought he was going to a town of eighteen hundred, but there are sixty-seven hundred people that don’t have a dentist. No insurance. He's charging fifteen hundred for a crown and he has the highest fee schedule I know. No Medicaid, no Medicare, no nothing. I mean, I think the guy the first year did one million and took home three forty one year out of dental school. What’s the chance of doing that in Gilbert?

Greg: He won't. He just can't.

Howard: Yeah.

Greg: There's not enough. It's too overpacked. And what's interesting, Howard, I remember early on in my career a dentist invited me out. He was in Little Rock, Arkansas. Anyway, I get out there, I land at the airport, it was raining like crazy outside and we're driving down through Little Rock, and I'm thinking, “What the hell? Who wants to live here?” And I thought I was a bit uppity because I'm thinking, “Well, why don’t you live out in Arizona where it's like not raining all the time?” And I just thought, “This is an ugly place.” And I went to his practice and it was downtown, and it was pretty rough but he was doing good. I mean, the money was good because I'd already done all the stats before. And I'm thinking, “Man, what’s the matter with this guy?” So anyway, that night he says, “Greg, come on home. We're going to have dinner at the house.” So I get in the car with him, he drives home, he drives about thirty minutes away, we go through a gated community, he punches in the code, the gates open up, and we come over this little rise and there's a beautiful lake and there's all these homes around the lake. We pull in. It's a gorgeous home. His wife’s got the barbecue going. We get out there. We had some dinner.

We watched (inaudible 1:05:18) I go, “Damn, I could live here,” when before I was going, “Who in their right mind would live here?” So what it proved to me was a couple of things. One, if you're living anywhere and you got money, you could get the lifestyle. And even if it was that I would drive to Ajo and get an apartment to stay a couple of nights and did my three days, four days, and then went back home to a different community, most people don't think that way. And so again, what we're always competing with is the thought process of somebody who doesn't get it. And so, I mean, I'm just overstoked at the fact of how capacity-ized you are, to use a word that isn't a word.

Howard: You know who taught me capacity? So I'm born and raised in Wichita, Kansas, seven kids, dad delivered rainbow bread for like $11 an hour, just so damn poor. We were so damn poor none of the kids knew we were poor. Saved up money, bought a Sonic franchise. Eventually he had nine Sonics. His friend from the same Catholic Church was Dan Carney, founder of Pizza Hut, and I thought of him because you said Little Rock. I can still remember going to the White River. I think it's where the White River meets the Brown River. Anyway, it's two rivers meet in Arkansas. I think it's the White River. Does that ring a bell?

Greg: No.

Howard: So there we are catching trout and breading them and frying them, and there’s Dan Carney, founder of Pizza Hut, and there's some Sonic guys, I think Roger (inaudible 1:06:52) was there, Jim (inaudible 1:06:53), my dad, Duane somebody. And Dan explain to everybody that when he puts in a Pizza Hut, he's got about seven hundred grand in for every store. He's got to buy the land, the little pizza building, and it costs about $700,000 and it'll net about $70,000 a year. It's a 10%-return asset. But what he figured out is, every time everybody eats, the flow, you're not making a car every hour on the hour. They all flow in at lunch. So you’ve got $700,000 and it's got twenty tables. And the process was your labor, your number one cost, would seat you, take your drink order, go get your drinks, come back, then take your food order, and then take that to the cooks. They cook it up, they can get your food about forty-five minutes (inaudible 1:07:40) hour, then you would eat it, and then you go home. So you got $700,000 in a pizza and you flip twenty tables one time during lunch. So they kept adding up the tickets, dividing it by the number of people, and they kept coming back to it's about $2.90 on average. So it was actually not Dan Carney. It was actually his wife, Beverly, that figured this out. She goes, “Well let's do this: Let's change the operation logistics. So when you come in, seat yourself – no labor; there's your drinks – go make your own drinks; and we'll have a buffet, all you can eat, two ninety-nine.

So now people would just walk in, they'd go set their purse down the table, they'd go make their own Coke, Dr. Pepper, mix it all up—they think they're going to game the system by eating all this food when their food cost was always 31%—but they would all eat and be gone in a half an hour. And that's when the flow is there, so they'd reload twenty tables. So they basically just got a free $700,000 Pizza Hut without making a Pizza Hut. So you go in these dental offices where they got two, three extra rooms, I don't have time to break down this room and clean it and set up the next room. I'm just going to leave this one getting dirty, just set her in the next room.

And then after a big fricking rush, they go back, they got three, four rooms completely trashed with all these insurance. And then you go into a dental office and it's a routine procedure—it's a root canal, it's a filling, extraction—and three times during the procedure the assistant has to get up and leave the room. Why the frick are you leaving the room? “Well, we only have one of these and we need like five of them.”

Greg: Moving around, yeah.

Howard: It's like, well, okay, the doc gets thirty-five, you get twenty-five, lab gets ten, supplies six, mortgage five – fricking  you can't leave the room. When I'm going to get a tumor removed off my fricking brain and a bypass, and I don't want the doctor’s scrub nurse to have to leave three times and fetch something. They don't know their costs. Another big, huge stupid thing is Southwest Airlines, every plane is the same. They're all 737-300s. You go in the hygiene room and you're on a PPO cleaning, they're giving me $55 for a cleaning and the damn hygienist makes forty. So then he has a little filling patient center (inaudible 1:09:53), “Hey you got a little filling. You (inaudible 1:09:55) knock that out now? Let's do it now.” And 99% of dental offices, “Well, you can't do it in my room. You have to move them. You got to go set up another room and move the patient and…” Well, why? “Well, this room doesn’t have one thing.  And it's like, no. And then you tell the hygienist, “No, every room is a 737-300. If I come in here and I want to stay and knock out a quick filling because you're losing $15 an hour out of my back fricking pocket, and if I do one filling a day we’re in the black and I'm making money…” And she'll say, “Well, this is my room.” Really, this is your room? Imagine getting on a plane at Southwest Airlines and the pilot gets on the plane and says, “I'm sorry, this is not my plane. My plane is two hours out. I'm going to ask everybody to get off the plane and unload the luggage and move all this shit down there because in this drawer is supposed…” Every room, every drawer, everything is the same.  I walk in any operatory, pull door three, same damn shit. Everything's a 737-300. And if a hygienist tells me, “This is my room,” you know what? You are not walking in this room again for thirty fricking days because you fell in love with a room. I mean, you (inaudible 1:11:07) have sex with it. You platonically, pervertedly… you're so fricking out of your mind that you fell in love with… So I can't be Southwest Airlines and have you say, “Why don’t we fly that plane because it has a Garfield on it and my room has a picture of my granddaughter in it?”

I tell them, “If you've got to bring in a picture of your newborn bloody rat jaundice baby, bring in fricking eight of them because that baby only looks good to you and a shark. No one else wants to look at it, okay? So if you got to look at that bloody newborn, put eight of them in there. And these are all operations and logistics things. And their answer to that is, “I don't need to listen to you three idiots. I'm going to go take a bone-grafting course in the Dominican Republic.”

Greg: Because that's the future of the industry, is more bone-grafting, yeah.

Howard: Yeah, keep bone-grafting your way to success. So how do these guys contact you? How do they get help?

Greg: Well, if they'll go to the website, which is capacitymanagement.com—so just think of capacity, we’re a management team, so capacitymanagement.com. It'll take you to our website. There's Contact Us, gives you the phone numbers, gives us what we do. It'll go through and you can look at some of the programs. But more importantly, I would encourage people to contact us and we always stand ready to do a thirty-minute consult. The purpose of that is so a doctor can get on and say, “Greg, here's what I'm…”

Howard: How much is a thirty-minute consult?

Greg: It's no charge. I've done that my entire career. So if the person’s sending us their basic stats, just six months of numbers, I can look at that and it tells me what we need to see and I can say, “It appears to me this is your key blockage.” Now, if they roll with that and want to do business with us, then we can take that step. So if I have in any one given month, let's say I have twenty-five people contact us to do business with us, it is true that maybe four or five a month will sign up. The others got fabulous information. They just weren't compelled to need my help all the time.

Howard: That's because they really need a laser.

Greg: That's probably true.

Howard: Which stands for “losing all savings equals reality.”

Greg: So what we do—and Bill is really good in that, and I've always said about Bill he's the smartest guy I know in dentistry. He knows more about practice building than most other consultants, these guys that have never been a consultant, they don't know dentistry, and two years later they're running a big dental firm but they've never been in a practice ever. And so what I'm saying is with the tools we have, I can spot the blockage, we can send them on their way, and Dr. Farran, we can get people to grow. And I know how I make my money. We get paid when the doctor takes home more money. So all of those things, anything that has to do with growing a practice, whether it be scheduling or whether it be, “What kind of staff do you need?” “Is it time to move out of that facility and go to another one to get the capacity you need?” nothing gets in the way of finding the right blockage, giving them capacity, and the practice just grows. It always has. It's not rocket science to us. It's just following the systems. And you have that capacity gene that I've known forever.

Howard: What’s your number? You said they can call you for a free consult. What’s your number?

Greg: 480- 832-1546.

Howard: That's 480-832-1546. Do you give out your email?

Greg: Yes.

Howard: What is that?

Greg: It's gregjack@capacitymanagement.com

[01:14:41] Howard: Gregjack?

Greg: Uh-huh.

Howard: Gregjack or Gregoryjack?

Greg: Just Gregjack.

Howard: Gregjack…

Greg: At…

Howard: At…

Greg: capacitymanagement.com.

Howard: And if you can't remember Gregjack, you can send at info@capacitymanagement.com

Greg: Right.

Howard: How do they reach you?

Bill: Same. Info.

Howard: Info@capacitymanagement. What’s your personal email?

Bill: Bill@capacitymanagement.com.

Howard: Thank you so much.

Greg: And our capacity is that if anybody makes contact with us and wants to do that consult, we get them done and then they choose what direction they want to go after that. But we're there. We've been there for years.

Howard: Another way to get amazing information, a lot of dentists are sitting there thinking, “Sometimes I think I should sell my practice,” or “Sometimes I think maybe I should sell my practice (inaudible 1:15:26).” Just do it. Because it's like when you go to sell your house,  that real estate agent comes out here, they do an examination, they say, “Okay, we can't even put this in the market till you do all these fricking repairs.” Almost everybody I know have thought, “You know, I've been thinking about selling my practice (inaudible 1:15:45).” I say do it. Do it. Call them right now. Because number one, they're not going to buy your practice, and number two, they're going to tell you all the fricking reasons why. And then they’ll say, “And if you fix all this shit, maybe we will buy it.” So I'm telling you, before you get a laser, before you get chairside milling, before you get a CBCT, god dang get your house in order. Get poised for growth. Get rich. Then buy all the boy toys you want and your only decision should be, “Should I get a chairside milling machine or a black Porsche or,” if you're really going for it, “a girlfriend on the side?” And then spend all your damn money. But thanks so much for all that you do...

Greg: Howard, thank you.