For more than 20 years, DMI Coaching has worked with Dentists across the country that realized, no matter how much they knew about their profession, there are a lot of areas about running a Thriving Dental Practice that they don’t teach you in Dental School.
There is a big difference between Knowing something and Doing something. That difference is where DMI shines. Just because you know what to do or even how to do it, doesn’t guarantee you will do it. Most high-level professionals, like Dentists, know exactly what needs to happen to grow their practice, and for many, those things still aren’t happening or are not happening effectively.
Many of DMI’s clients achieve a 40% increase in Revenue within the first year of training with their team. The secret to their success is Simple; they know how to get to the root causes of the issues holding you, your team and your practice back from True Success.
Their Dynamic approach Achieves and Sustains real change and results. As part of their delivery, they work Side-By-Side with your team to provide training, standardized methodologies, customized dialogues and the coaching needed to make effective transformation happen.
At the end of the day, you don’t want your team to learn some things and walk away with a binder full of information they will never implement. The truly better way is when your team learns to take ownership and pride in the part they play and then they begin to perform at their peak, becoming a more Valuable Asset to you and to your patients.
DMI is your Partner in Success.
http://www.dmicoaching.com/
VIDEO - DUwHF #980 - DMI Coaching
AUDIO - DUwHF #980 - DMI Coaching
Howard: It is just a huge honor for me today to be podcast interviewing, Patrice Bonnell, Shelly Goff and Kenyon Curtis. They are right here in my backyard, Phoenix, Arizona, they are the number one consultants in Arizona for twenty years. I have had so many requests to get them on the show, mostly from all my alcoholic drinking friends.
Patrice: Don’t give our secrets away.
Howard: So I don't know they might have been drunk when they told me to invite them. Patrice, for more than twenty years she has helped dentists overcome so many of the incredible challenges they face each and every day. She is an expert in connecting the clinical aspects of dentistry with the management tools and implementation necessary to achieve the results you want. Since she was very young, her parents raised her to always think outside the box. Her father was a successful entrepreneur since his early twenties and like most business owners through trial and error, he figured out how to create financial success for himself and so many others.
He raised her with the mindset you should always say, “To be a successful entrepreneur search for what is missing, examine the challenges, the problems people are having and create the solution for them, that is the key to being a great leader.” So she started paying attention to what the successful dentists were doing and began asking lots and lots of questions. She quickly realized there were small tweaks that simply needed to be made here and there to help the less successful dentists succeed and with this she became hooked. Here were the incredible dentist skills who simply needed guidance on how to maximize their business and communication skills as well as the other teams.
She found her niche and she loved it, she dove into every management book she could find and attended seminar after seminar and training that applied these things. Next thing she knew, she had a thriving consulting business right here in Arizona, making people and practices successful and helping dentists achieve the success that they truly deserve and the kind of life they choose to live. She is a forward thinking, results driven coach, I could go on, I could read your bios forever. Same goes for Shelly and Kenyon. So now are most of your clients in Arizona and Utah?
Patrice: Yes.
Howard: Yes. So when go out with my friends or just on Dentaltown, if I lined up a hundred dentists, and I said you know, “What keeps you up at night? What is disturbing you?” It is never my bonding agent; it is never what sealer to use in a root canal. No orthodontist has ever said, “I can't figure out which bracket to use.” It is always the staff, the staff, the staff, the staff and so I want you to talk a little bit about that.
The second would be, you know, I'm fifty-five; my dental office right up the street here just celebrated its thirty year anniversary last month. When I got here in ‘87, I do a root canal and crown, I just went up to Delta Dental the crown was a thousand, the root canal was a thousand and they would pay half the crown [inaudible 00:02:55].
Now it is different, now they send you the fee schedule and it is 42% less. So I'm doing crowns and root canals for six fifty when thirty years ago I was doing them for a thousand. Yet my staff, wants a dollar raise every time the earth goes around the sun and you started seeing all these old man legacy dental practices where they love their right-hand man ‘Shirley’ but my god, the labor just keeps going up, the prices keep going down.
Then when I got here thirty years ago, there's no fluoride in the water and I was the idiot who spearheaded that charge and got the Arizona award. You probably know that because your cousin Eric Curtis is a dentist in Safford and he did an amazing job as editor for our local Arizona magazine ‘Forever’. In fact, when I started ‘Dentaltown’, he was my role model dental editor as I was becoming a dental editor and journalist. I really, really admired your – he is your cousin?
Kenyon: Yeah, he's a cousin,
Howard: Cousin or cellmates, you served time together?
Kenyon: That is whole other story.
Howard: That’s another story. But now there is fluoride in the water and there’s two dental schools. Mason is cranking out seventy; Glendale is cranking out a hundred. Your other state, you work in Utah, it had no water fluoridation, no dental schools. Now they got two, they got what, Rosewood is one and the other one is --
Patrice: It’s newer, I’m not certain of the name.
Howard: Yeah, Rosewood and… So man this business is ten times more challenging today…
Patrice: Absolutely
Howard: ...than it was thirty years ago.
Shelly: And competitive.
Howard: So what do you recommended to dentists? Are you recommending most of your clients become veterinarians or chiropractors?
Patrice: You know, you are right, and that's what we've noticed as well. There are so many more dentists coming out into the market. You mentioned insurance; insurance is paying the same now as they did thirty years ago.
Howard: No, less
Patrice: Well, still they cover the maximum, the max is still the same and that is a lot of what we teach our clients, is they think they have to be insurance driven and they don't. And their teams have the mentalities of okay, well, let's focus on our dream plan on what the insurance is going to pay. You can't thrive with that mindset.
It is about serving your patients, it is about getting them healthy, it is about finding out what is important to them and what they need, and then marrying the treatment that you want them to be getting so that they can get healthy and that you can help them reach their goals. Whether they have insurance or not, doesn't matter.
Howard: But isn’t it easier to get off of crack cocaine than PPO’s?
Shelly: What's your experience been with that?
Howard: I haven’t hit that rock bottom yet.
Shelly: With crack cocaine? Okay, just making sure.
Howard: I’m fifty-five and if I live another twenty-five, I’m not really getting anything out. But really, a lot of dentists it is kind of a fantasy when people say, “Well, I'm going to get off PPO’s”. I can see getting off PPO’s like where your cousin Eric is. You know in a small town like Safford where there are only three, you know, like Eloy doesn't even have a dentist. Well hell, if you went to Eloy you wouldn't have to do anything.
Patrice: Right.
Howard: But if you are in Phoenix or Salt Lake City is it even rational to say to this guy, you should drop all your PPO’s. Is that what you're even talking about?
Patrice: There are different thoughts inside of that and patients, they are going to go first to find out if you take their insurance and then they are going to go ‘Google’ you. And so you know, there's that fine line of what insurance to take and what insurance you really don't need. You've experienced that. What insurances do you take?
Howard: Oh you know off the top of my head I don’t even know, I mean Delta. So many dentists say, “Well, I don't take any PPO's”. Because I'm pretty sure on the Delta website it says 95% of all American dentists say Delta and they give you a fee schedule, what do you think that is? Then they go, “Oh, I don't mean Delta”, don't you call Delta a PPO?
Patrice: Yes you have got Delta Premier and --
Howard: But the thing with Delta is, people talk about like, its McDonald’s and it is not, there are nineteen different Deltas. So dental insurance started in 1948 and that was on the upper west coast, it was the Longshoreman's club. So after World War Two, when our parents generation thought war was good for the economies because World War Two was great for the economy because you destroyed Japan and Germany who made everything.
So the only factories making dishwashers and cars that were unscathed was in the United States. So this massive transfer of wealth and nothing could come into this country in or out without passing through the Longshoremen's union. So they started Delta dental up in Washington and in Oregon, but there are nineteen different Deltas.
But the thing about Delta is you know who the pack leaders are, so over the 30 years of watching them you know like some guy in Minnesota will do this, then the next thing you know they are doing it in California. So to me it looks like Delta Premier, many states aren't even taking any new members for that and so I sell my practice to an associate and they cancel, they don't accept them on the Delta Premier, take them down to the Delta PPO. So it is all going to go PPO from Delta and the prices are going to drift downwards.
Shelley: So I think for me a really important thing, having been the staff in several different positions, is to train the staff to be prepared on how to handle the no insurance patients. If you're that highly trained that you can make the value of what you are asking, then you can start shifting your team into the mindset of knowing how to handle with insurance or without, and then you make that jump between “Do we really even need this? Do we need to be on this role? Do we have to accept everything? Do we need these patients over here that are only here to pay $5 for a filling?
It starts so much more up here than it does down there on the paper with those insurance plans.
Howard: I agree and I’ve seen so many people, they walk in there, the persons got ten cavities and needs all this work and the first thing out of their mouth, “Well, I just called your insurance company and here is this and this”. It’s like; they came to a doctor, if you are just a representative of the insurance company, where is the patient supposed to go when they need a doctor?
Shelley: Right and I have noticed even with different hygienists that would be at different jobs in different locations and see the way the culture was with these practices and the doctors that they worked for. One would charge full fees over here with no shame whatsoever and they would be the type to say, “Oh, well, what does their insurance cover? Can I give him fluoride or can I do this kind of a [inaudible 00:09:44] on them?”
Then she would go over to this other practice where it wasn't that mentality and she would go, “Shelley, I really understand what you are saying now because it doesn't make a difference. It has so much more to do with me as a provider and what I really believe and what I am telling this patient they need and owning my position and owning the fact that I am a practitioner and I have the right to say that.” Then the treatment planner is the one that has the ability to really help a patient find a way to finance that. If it is what they truly need and your team supports you, there is no reason to have it have anything to do with insurance at all. I believe firmly that is how you make that jump from getting away from the insurances and letting it rule your life.
Howard: Riddle me this, it seems like every orthodontist I know, within two years they realized they should stop presenting treatment and they get a treatment coordinator. If you look at national data for the whole United States as a whole, which I hate because no one ever talks about the EU because no one would compare Germany to Greece or France to Sweden. Why do we compare Alabama to New York City? I'll never understand.
But for the country as a whole the average new patient is worth $368 and it has been pretty flat. It's like three sixty eight and go down to three sixty seven, three seventy, so it's around about that. But whereas the average orthodontist it's a $6,500 deal. So I think when a dentist presents, you need a two fillings for three sixty and they don't schedule, she doesn’t even think about it. But when I present you a $6,500 ortho case and you walk out and don't call? They don't forget that.
So then in two years every orthodontist I know gets a dream plan presenter but when you go into the hundred and fifty thousand general dentists that work more than thirty hours a week, you don't see that at all. So what is better the dentist presenting the treatment or a treatment plan coordinator?
Patrice: Both
Shelley: In my opinion it is the dentists knowing what they need and the treatment coordinator, they are totally separate topics. The Treatment Coordinator has to know how to work with that individual, how to really help the person find a way to fit it in. The dentist is the one that has to own what they say the education happens in the back, the money, your treatment coordinator girl; she has to know how to do that. They are separate topics completely create the one and then the help.
Kenyon: When you look at it from the patients’ perspective, who is the patient going to have the most trust and confidence in? Giving them the treatment and asking what should be done for them?
Howard: The dentists are like, they come in for a dentistry line, “You know what would be great is, we will just place these four little titanium pegs in your jaw and then we'll make a beautiful movie star set of teeth on top it, does that sound great?” And she’s like “Oh that’s great.” Then he leaves her and the treatment coordinator says, “That's $25,000 an arch so that is 50 grand and then the patient [inaudible 00:12:45]. So if the dentist is talking about dentistry and he says, well I don't like talking about money? Well, the patients not even listening until you say money.
Shelley: What is missing?
Patrice: What do you see that is missing there?
Howard: The doctors aren't talking money.
Shelley: They shouldn’t be.
Howard: My belief is that, people don't really start listening until they find out how much it costs. I mean when you are selling an all on four to someone and they have no idea it is twenty-five thousand an arch, the minute your treatment coordinator comes back and says it is twenty-five thousand an arch, you have to call 911 because the patient just fell out of the chair and you know, they didn't see that coming.
In fact, what is weird, we were at a Suns game, four dentists and drank way too much and this dentist was telling me he couldn't charge more for a root canal and I said, “Dude you are in a medical [inaudible 00:13:43]] and the endodontist next door to you is charging twelve hundred, he is charging twice as much as you.
Why do you say no one in your area in Glendale will not pay more than six fifty for a root canal when the guy next to you has been there for 10 years selling for twelve hundred? So we went around the stadium and we asked every single person how much… we’re dentists, we’re just curious, how much do you think a root canal is on your front tooth?
The lowest guess was like twenty five hundred and so many people said five thousand, ten thousand. So like, I've only had one surgery in my life, I'm not going to ask you, I'm just asking because these are girls. The man surgery, I had a vasectomy after my fourth kid, what do you think that costs?
Patrice: Five Thousand, four thousand, I have no idea.
Howard: What do you think it costs?
Shelley: I have no clue. I would guess … are we using insurance or no insurance?
Kenyon: Well it’s the total cost though, right?
Howard: I have medical insurance, I provide it for my whole staff but how much was the total cost?
Shelley: Oh gosh if it is medical you are going to be up into the $10,000 range, at least.
Howard: You notice how she thought it was twice as big a job as she did? She thought it was a really small job.
Patrice: Back that up and we’re going to say it again.
Howard: It was $500 and everything he used, I have on my dental tray.
Shelley: Complete and total? Out of cash, out of pocket?
Howard: Five hundred total.
Shelley: Really?
Howard: And it took like three minutes. He put topical, he used the same dental syringe and he took the 15 blade with the Shepherds head explorer pulled out the vas deferens, clipped it with a pair of scissors that I have on my crown and bridge tray.
Patrice: Are going to start offering that same service here in your office?
Howard: I mean, I looked at it because no one's...
Shelley: Ryan’s cringing over here as you are describing it.
Howard: When I had it done, Ryan's grandpa without even blinking, he is a farmer from a Kansas said, “Oh, I'll do that for you.”
Shelley: You know, my Dad says that all the time.
Howard: He was dead serious he said “I've done this a thousand times.” But you know, castrating cattle and all that. You know dude, that's a true story did you know that?
Ryan: No!
Howard: You were only about three.
Shelley: My father still says that, he’s from a farm in Montana. He’s still there.
Howard: Oh, we are digressing but I got to tell you my first experience with that. I was ten years old, I was with David Hoffer on the ‘Rockin R Ranch’ in Kansas and we watched this sixty year old guy knock a baby boy over and a tie up its four legs and then castrate it. We were standing there and I said to him “What the hell did you do that for?” And he goes, “That will take his mind from ass to grass. I don't want him chasing the girls all time, I want him eating and getting fat” and then he took a knife and he held it up. Then he goes, “That's the source of all trouble. If someone breaks down my fence, gets in the middle of the highway, tries to walk through the damn pond and gets stuck, they always got these. At Rockin R Ranch we only need one dumbass bull with his balls attached then you castrate all the rest of them.”
Shelley: Have to say guys, it’s all true.
Howard: Anyway, how the hell did we… Oh, back to the price.
Shelly: There’s a lot of squirrels in this room.
Howard: Let’s just say you have had enough kids and someone came up in and said, would you like a vasectomy and they said sure. Then someone comes back and says, it's five thousand or ten thousand. I believe, maybe this is my bias; I believe that humans don't start paying attention to the purchasing decision until at least they know what it costs.
Kenyon: Well, here is a couple, what do you think the two motivators are and someone making a decision in taking any kind of an action?
Howard: I believe there are three.
Kenyon: Okay
Howard: Okay so, I believe you have got to move down the torso. So I believe that you start with the brain, an analytical decision. I know this is bottled water and you look at the SP 500 and things that are made on a brain decision, I believe have got a 5% profit margin.
Then you start moving down the torso and then come to the heart (inaudible: 17.43) you should put your kid in private school using, emotions. Then you see the profit margins started going from about 5% to about 15%.
Then you drop below the torso where the number one goal of the species is to keep spinning its DNA and reproduce enough offspring. And now you are talking $5,000 Gucci purses, I mean obviously if you have an iPhone you have a greater chance of someone mating with you than if you have a droid.
Patrice: That’s not true.
Howard: Obviously you wear an apple watch; drive a Mercedes Benz because it's basically saying it's your peacock thing. If I drive a Mercedes Benz, your children will have a greater chance of surviving and making you grandchildren
Kenyon: Then it's not about the money though with that, is it? The Mercedes Benz is a product of the money, but it's not the money that's really deciding that.
Howard: Yeah, I believe that it's analytical. It's three times probability that it is with the heart. Which we do in dentistry all the time, “You want to get your kids sealants, all the best mothers put sealants on their kids”, and they are like “Oh I don't want to be a bad mother.” Then they come in, and then below the belt. Then they come in and they have got gum disease and cavities and all they want is their teeth bleached. I mean look at Invisalign, Invisalign and dental implants are the fastest growing segments of the economy, of the dental economy and Invisalign is because I want whiter, brighter, sexier teeth so I can get a mate.
It is so funny how beauty is different around the world. We just lectured in Malaysia and Cambodia and it was just so bizarre because I'm from the United States, a lot of the races in the United States have big noses, Europeans, Italians, all big noses. So they are puffing up their lips with Botox, because they are trying to make that proportional.
Then you go to Asia and they have got really tiny little noses. So if their lip touches their finger, they think it makes your lip look too big and makes your nose look too small. So they pull their first bicuspids and wear Invisalign for two years to pull their teeth back. And you're talking these little waitresses at the bar and you are like, oh my god, there is not one boy in Asia that gives a shit where your lip is. Spending $25,000 in Cambodia, that is like you buying a new car here in the United States.
Kenyon: That goes back to you know, you said there are three things. Here's a couple things that we've focused on is that people are either going to do it for one for pleasure or for pain. Most people are not going to take action until there's enough pain going on, so what we worked with a lot of dentists on when their treatment planning is to you have got to look at what the future pain. Look, if you don't do something right now, this is what's going to happen.
In fact, I was talking to a cardiologist one time, years ago about some health and nutrition and I asked him, I said, “So what do you tell your patients, when you are doing surgery or they are getting ready for surgery to help them start to change their lifestyle?” and his answer was really interesting. He said, “I don't tell them anything.” And I said “What do you mean?” He says, “I used to and then I realized people are just going to do what they do, they are going to come in here when there's enough pain to actually do something.”
Patrice: That is emotional. It is all emotionally based, the decision making is, a majority of the time. So if you are coming in all clinical, it's like going to a financial planner for the first time, when they start giving you all that information, you just go into that zone, that zombie zone that patients go into. You have got all the touch points you have with the patient, you have got to make it an emotional journey for them because that's where they are buying in. Otherwise, if you are always staying logical with them, that's when the money becomes an issue.
Kenyon: Howard, you did an Ironman a while back, didn’t you?
Howard: Three in a row.
Kenyon: Three in a row, unbelievable.
Patrice: You did three of them?
Howard: My goal is to be the oldest, fattest Ironman ever. Ryan they don't believe my Ironman, go get my Ironman.
Kenyon: No I saw it
Patrice: I was excited to do a sprint triathlon, like that was a challenge.
Kenyon: And what was your motivation for that?
Howard: My motivation was my first granddaughter being born, Taylor Marie, and I had been living in an airplane for thirty years. Every time I get to a city, you know, a bunch of dentists want to take me out --
See all those? Those are all my deal; I'm the fattest iron man that ever lived. So what I did is I realized that I needed a big hairy audacious goal. And what I loved about the Ironman and the body is so bizarre because, say you run a mile and then you just say, “Okay, I can't run another foot” and then you ... Then a mile later you are thinking, “Okay, I couldn't run another foot after the last one I just ran two” that turns into three to four to five or six.
The swimming, I mean, it's a two point two mile swimming. After a hundred yards, your body says “I'm done”. And what's amazing, what I loved most about the Ironman is if you just quit listening -- and I'm trying to do it with hunger because that's what I think. I think my family’s brain just always tells you to eat, I seriously believe that it is always saying “You are hungry”. But the neat thing about Ironman is, it is all in your head. I tell my boys, the most important real estate in the world is the six inches between your ears and who is telling you the most worst stuff in your life? It is your own self.
Kenyon: Well, have you ever heard of this book called the ‘Running Revolution’? It's a guy, a doctor, I think he was out of Russia or something and he started to study, like how people run and things. And one of the things he just said in that book was that, your brain, you are right, he says your brain, as soon as your body is getting to the point of, “Hey, I've never done this before”. I've never swam past a mile before or something, let's say if you're training or even in that event, you are like, now you have done the swim and the bike ride, like you are doing all that. Your body gets to this point of – well you know, because your subconscious has one goal, right? Keep you alive.
As soon as you start to head into this uncharted territory, it's sending all these signals, “Hey, stop, you might die”, like you don't know what is going to happen. Your heart rates have never been this high for this long before, you are in water what are you doing? And so it really does that.
So what happens is a lot of people that shows up for them in business also, I've never been, in a two million a year practice before and I've got to stop and they start to look at things that don't really matter.
Howard: It's so true because you look at plateaus. The minute you say, well, I can't take you today you have to come tomorrow. I don't care if you are doing thirty thousand a month, sixty thousand a month, a hundred thousand a month. They are all on plateaus. So, you go to a medical dental building with eight dentists, they have all been at the same level for a decade, at eight different levels.
One thing I've noticed also, you remember Lance Armstrong was always, he was always trying to get more oxygen carrying red blood cells and the secret to those marathons is in Arizona, is your training at Flagstaff. All the Kenyans, because Kenya is 6,000 feet above the ground, so all the races are in major cities and every major city is next to the ocean. So when you come down from 6,000 feet to London, Paris, France, Tokyo, or whatever, I mean their oxygen capacity is off the charts.
I have NFL players in my practice and they sleep in oxygen tents, they try to mimic. You know who has the most endurance?
Shelley: I’ve seen their rooms are all set up with the crazy canisters and everything it's pretty intense.
Howard: And pilots, planes are only pressurized at eight thousand feet. So those pilots are always at eight thousand feet. Flagstaff is at eight or nine thousand. Those pilots, man, they just have more oxygen carrying capacity.
Kenyon: Well just to kind of tie this in together a little bit. I was talking to; I did some attorney coaching awhile back, with another...
Howard: What kind of coaching?
Kenyon: I was coaching some attorneys.
Howard: Oh attorneys.
Kenyon: They were a lot of fun to work with.
Shelly: Is that possible?
Kenyon: Yeah, but what was interesting just like you said, so this one law firm, the husband was running this law firm and the wife was the attorney and she had two streams of income coming in and no matter what she did when one went down the other went up and vice versa. So she could never break a threshold of I think seven hundred thousand a year or something like that.
So when I got with her I didn't provide like a new system or something. She has some great systems in place and her husband kept saying, “well she just needs to sell better, she needs to sell better, she needs to sell better.” But I got talking to her and found out that you are right, she had this threshold, her brain had this little thing of “I can't do this much, I've never done this much before.” So I worked with her for about an hour and then figured out that she had some money challenges, she needed to hire some staff and that was making her nervous of hiring extra staff. And so I was helping her overcome those fears and take that uncomfortable and make it more comfortable so she could grow her firm finally.
Howard: I love that, I love case studies. I went back and I think the smartest decision I ever made was I went back to (inaudible: 26.59) and got my MBA on the evening programs, Monday, Wednesday from six to ten, for two years, just loved it. But they would always show you case studies, case studies and it was amazing. So who is the perfect client for you? You say Arizona and Utah but I'm sure your travels the right case.
Patrice: Right, anywhere.
Howard: Anywhere. But who is calling you? What are you hearing in the field? What or who is calling you and what are you fixing? What's your ideal client? How does it work? What's it cost? How much is your consultation?
Kenyon: Is it less than a million dollars.
Patrice: Yes.
Howard: Less than a million?
Patrice: We will actually work with our clients and do a performance analysis for them.
Howard: I know dentists, every one of them will say, “Well you don't understand, my problems are all unique.”
Shelley: Isn’t it strange when they’re just like their patients.
Howard: Yeah.
Kenyon: It’s funny that you’re asking their price. What no-one realizes is they are not going to call us unless there is enough pain in their practice.
Howard: How do you like them to contact you? Is it go to your website DMI Coaching?
Patrice: You can go to our website and then --
Kenyon: And then we have a new service we just added.
Patrice: Yes and if they want to send us a text
Shelly: To, six- zero- two- four- six- one- seven, six- one- three, they text ‘Howard’ to that that is a good way to get a hold of us.
Howard: They text Howard to that number?
Kenyon: We set that up just for you.
Shelly: Yes, they text Howard. Just for you Howard.
Patrice: Now you are iconic in texting, how about that?
Howard: So your website is DMI coaching, but what are you doing?
Patrice: We are so referral based, we are constantly getting referrals. You were talking about case studies earlier one of our greatest clients is out of Tucson. They started off, as you said; the treatment coordinator was doing all of their treatment planning with the patients and when we shifted it into the doctor becoming more involved with that because that is where the objections and that is where all the complaints come in.
And getting mindset training for their team because it does, it all starts with mindset. If they don't have the mindset they need to be essentially selling treatment and explaining treatment and overcoming objections, you are going to be stuck, you are going to be plateaued and ten years from now you are still going to be producing the same amount. The client that we have in Tucson, they took the leadership on and they understood that to make changes, it has got to come from the top, down, and in a year and a half went from a million dollar practice and now they are almost three million this year, in a year and a half. Staff of six to a staff of fourteen and it is having that mindset. Systems, you know, you set up your goals and you set up your vision and what is missing is, they don't create systems for their team that can be duplicated to reach the goals. They just say, “Oh, this is what my goal is, or this is what our vision is.” Great … How are you going to get there?
Because when you have your systems in place and you are creating retention, you are creating growth and you are creating duplication from it. Once those are in place, you can be with your patient and that is what is missing in so many of the practices. They are so focused on the next thing that they are not with the patient. They are not present, they are not right here, they are not listening, they are not paying attention to body language, and that is where you get to know your patient.
That is where you connect with your patient, that is where you are finding out what is their journey, what is important to them. So you go from just being okay to being extraordinary and that is the difference. Systems, great … Get those in place. Being with your patient, giving them that extraordinary experience, because our patients now compared to ten years ago, compared to twenty years ago, are savvy and they are smart and they have expectations and if you want to stay competitive, if you want to have that loyalty -- You know my dentist, thirty years ago I was loyal to him because you just never left your dentist, you just stayed with them. He put a sign out and you stayed with them. Now it's a click of the button and all day long we are getting sent millions of advertisements, whether it's through the radio, driving down the street, whatever it is.
You are not just competing with other dentists you are competing against going on vacation, buying a car, buying clothing, buying this, buying that. So you have got to shift to extraordinary to really keep that commitment so you are not spending thousands and thousands of dollars on trying to attain all these new patients. You have got so much money inside your practice that is just not being tapped. I mean, if, you know, the national average is twenty, 25% of how many patients are getting converted over the phone.
That's a touch point. Your mailers are a touch point and even if you are just converting, you know so many offices when we evaluate them, when we ask them what do you think your case acceptance is? We are at 70%. We go in there only at twenty-five and that is a shock to them and the doctor needs to be with the patients. You need to be in the operatory with a patient and when you are, how do you know what the rest of your team is doing?
How do you know that Amy properly trained Lisa? You don't. And as long as they are making money and as Kenyon mentioned earlier, unless it becomes painful, it doesn’t become a problem. You know negativity pushes people more than positivity does to get them moving, to get them out of that plateau.
Shelley: In the initial stages.
Patrice: In the initial stages and so most dentists, there are so many blind spots that if you just make some soft, small tweaks, you are going to have so much growth and you don't have to go out and do the marketing. Yes, are you going to have attrition rate? Of course, but you are going to be raising the volume of your production naturally, just with the patient base you have, and it is just shifting of ,be with your patients, be with them, understand them, get to know them, find out what drives them because dentistry is an emotional decision.
Even if they are in pain, it is an emotional decision and to tip the scales of, well, do I want to go on this trip or do I want to spend five thousand on implant? What do I want to do? Because it doesn't hurt, it doesn't taste bad, doesn't have all the objections that they give you. So it's finding out what is important to them so that they can make that emotional decision and justify it with logic and be able to say yes.
Shelly: Something that I really love to impress with the team and the doctors when we are working with them, is in the absence of another bar, to judge anything on a patient is always going to default to money. It being about money and here is why, we all speak money. I don't care what continent you are on, I don't care what language you speak, what background you have, we all speak money and without a solid reason or excellence, why would they choose you as a doctor? Why would they choose to stay there with all these other options at their fingertips. It is a very important factor.
Kenyon: The doctors in practices they have really got to stand out a little bit more, give the patient a different experience. You are a big proponent of consulting, aren’t you, for the consulting of the dental practices.
Howard: I think it is the number one return on investment, in dentistry, I can say that every one of my friends that does two to $4,000,000 a year and is my age, fifty-five or greater, they have used a dozen consultants. But my homies, they think the way to build an office, they got to buy a CEREC machine or buy a LANAP. They always think if they buy... in fact I'm going to start a new business, I'm just going to sell this... I'm just going to make a big, audacious box with lights on it, and antennas, directional, omnidirectional, just bullshit and they will buy it every time. You could sell one thousand, this is a fact… This is what CEO’s of Dentsply told me over the years. Who was that guy Jon, who was the big guy from Dentsply that the biggest boat in the Chesapeake Bay … Jon Miles. Jon Miles said that a thousand dentists would buy anything. By the way, I got to tell you a story about Jon Miles. Jon Miles, CEO of Dentsply, back in the day, he had the largest speedboat in Chesapeake Bay, his wife was Puerto Rican and he could take that boat all the way down the coast all the way to Puerto Rico. It had like four propellers in the back…
Kenyon: It was monstrous.
Howard: ... and when his baby doll wanted to go see mama, they just went on the boat.
The best analogy for me is a restaurant, your restaurant is going bankrupt so you say, “you know what? We need to add beef stroganoff to the menu.” It’s like, “Dude that is not why you are going bankrupt” and when I look at a return on investment of spending twenty-five, fifty, $60,000 on a consultant, they always get their money back. You were talking about a practice that was doing a million and a year and a half later doing three million. They always get their money back that year but let us say they decide that they want to start placing implants. So you go buy $100,000 CBCT, they go to some foreign country and drop twenty-five grand on implants and systems and then they are going to all these courses and they probably dug themselves into a $200,000 hole before they placed their first implant for one thousand.
Then they keep learning how to do bone grafting and membranes and other courses and you look at this ten year journey is like, “dude, you just dug a really deep hole, you haven't even come back up on the other side”. Whereas I would say, why don't you just, if you are in Phoenix, why don't you just go down to Tucson and get a periodontist who is not busy to come up once a month and drop all your implants and give him a split it fifty-fifty. Place an implant a thousand bucks, you get five hundred, so now I have spent $0 and I am getting a dollar back.
Here is another thing us old dentists have seen, you get these young associates, they go to all these courses and they come in your practice and they place a hundred implants and then they go, they leave and go start up their own or go somewhere else or whatever. Then those hundred implants they placed, twenty of them are going to fail, but that periodontist has already placed a thousand or two thousand or five thousand.
Then it comes back to, my oldest sister, Mary Kay, is a Catholic nun and she’s studied every major religion, Hinduism, Buddhism, Taoism, Christianity, Islam. The golden rule is the only sentence that is in every major religion, it is not a name of a person, place, city, thing. Only gold rule, which is her belief, that everybody is praying to the same God because it is pure plagiarism. So who would you want to place the implant on you? Some associate who just got out of school and took a Holiday Inn course or some periodontist who has placed a thousand, two thousand, five thousand?
So get your house in order and then when you get your house in order then follow your passion. If your passion is learning how to place implants, boys have toys, flying around the world, learning how to place implants is damn cool, damn fun, I did it. I loved it, I mean I was in love with Carl Misch, I swear to God. My house is in order, I can go do that in cash and when I got out, when I opened up my own office within, one year I called at the time, the big one back then was Sally Mckinsey.
Patrice: I still read her blogs.
Howard: Sally you need to come on this show! Then there was Jennifer de St. Georges. In fact, my staff, thirty years later, I still hear things like, well, you know Laurie Solowski, my president of twenty years, she will say “Well you know Jennifer de St Georges always”… or “Sally Mckinsey always said this” and then other staff would say “ Well Jennifer de St Georges….” I mean it was a huge impact.
Kenyon: But what do you think stops most dentists from finally looking into getting a consultant to help them out? There’s a couple of reasons...
Howard: I think it is embarrassment, I think they are ashamed. Like how many people have said “I'm all that and a bag of chips, I'm doctor you are not. I walk on water ask my mom.” And then you come into the deal and just find out, holy shit, this place is freaking upside down.
Patrice: Their most important investment is in their team, is in their practice, is in themselves. They should be reinvesting, like you said, you should be reinvesting every single year to learn something new because you are not going to get it at a convention in a one hour presentation. It is great when you get those ideas but then who is going to implement it and after two weeks it is not being implemented again so it not sustainable.
Howard: I just can't believe that you graduate $350,000 in debt and don't want to get your house in order. You come out of school $350,000 in debt that these consultants say, okay. Your Dean just left; your Dean just literally molested you. I mean, really, I mean these dental schools, I hear it, I tell these guys... What they tell me is, and this is going back fifteen years, they said, you know what, we raised our tuition from thirty thousand to forty thousand, we had no decrease. They know applicants are price inelastic. So then they raised them another ten thousand. Now several of them are over $100,000 a year and they have still got five thousand applicants for a hundred seats.
So now Delta … and you say, “Well they are evil.” Oh, come on, like if Delta wouldn't pay you three thousand for a crown, you wouldn't take it? If Delta said from now on, we are paying everybody three thousand a crown the dentists would have a parade. That is what the dental schools are doing.
So you come out, they took three hundred and fifty thousand from you. So now you are going to have to spend the next decade of your life paying off the dental school faculty. Then the first thing you get barraged with is the Fortune 500 dental companies are going to say you need a CEREC machine, it’s a hundred and fifty thousand. You need a CBCT it’s a hundred thousand. You need a LANAP laser, it is a hundred and thirty five. So then you buy a bunch of shit because you want to be good.
Patrice: And the Taj Mahal don’t forget the Taj Mahal.
Shelly: And the chairs and everything else.
Howard: So now you are going to work another decade, I mean when a dentist tells you to buy something, they are selling it. I wish all the lectures wore a NASCAR suit.
Kenyon: So we know who their sponsors are.
Shelly: Why don’t they start doing that?
Howard: Why don’t they just force all the speakers... Because when you are talking to a NASCAR guy, you don't really believe that he drinks Gatorade while he is driving, but at least you know he is honest with it. So then the dentist by the time he gets to forty, when he gets the student loans paid off for three hundred and fifty thousand. Now he gets divorced and that is a million. My divorce was three point eight million. When people say, are you going to get married again? My heart starts defibrillating
Shelley: Post traumatic stress
Patrice: Ryan is laughing over here.
Howard: When I sell my office I am only selling it to a woman. I will not sell to a man because I want to see a woman hand me three million. Yeah, I'm going to sell that office for three point eight million to a girl and I'm going to say a girl is going to give me a check for three million. But so then they get divorced, then their kids are in college, most of the dentists I know that just crushed it, came from nothing had all these student loans and then what does that dentist do? Well, I got to pay for my kids. So then they were paying for their kid's school and about a quarter of them have kids that go to dental school at $100,000 a year and this old damn dentist, his first break is when he dies at seventy.
Kenyon: Well here are a couple of reasons. I know we kind of went… We took a big circle.
Shelly: It was a fun journey. I liked it.
Kenyon: I’ve watched some of your podcasts so I know you take a thought all the way round. But here are a couple of reasons that a lot of people are talking about why dentists aren’t looking into hiring a consultant or working with someone to make their practice better. You’re right, maybe an embarrassment of, “well, I don't want to have it be seen that I made a mistake and done something wrong.” But here is one of the bigger challenges, is that things are already working okay. In other words you are a million a year or just under a million a year, in fact there was a buddy of mine in Tucson, he says, “No, I don't need a consultant. Why? “Well, I've got one practice doing one point five a year, another one that's almost a million a year and another one that's this…” and so sometimes things are just going good enough, that they don't realize how much better they can be.
Howard: I have just got to put clarity. He just said something so subtle. Send me an email, howard@dentaltown.com and tell me who you are because you know; I don't know who is downloading this on iTunes. It is crazy the numbers of views on Facebook or whatever, but 5% are applying to dental school, a quarter of them are in dental school and all the rest are pretty much thirty-- I'm only getting like one email a month where some guy says “Dude, I am a grandpa too, I'm as old as you. But these kids, look at the ADA numbers, the ADA numbers are clear. With statistics it is not how big your sample size is it, it’s how you draw your sample. So it has got to be a random, so you put all the names there or you take a name, you write down that data, you throw the name back in the pot.
I think what Marco, the Chief Economist at the ADA does the statistics, he used to work for the World Bank, he used to work for the United Nations and Healthcare, the American Dental Association, Marco Vujicic, he is so genius. But the average dental office only does seven fifty and takes home one forty-five, but you notice when you talk to consultants, every price you talk about, “Well, he does a million and we took him to three.” “Well, he has one office doing a million five of the other one is doing a million” because all the guys that do a million use consultants. So every time you talk to a consultant, they have this perverted sense of the average median, mean mode dental office.
You ask any consultant and they’ll say, “what does the average dental office do? “I don't know one, one point two, one point three?” No, that's the average of dentists smart enough to use consultants. While you are at the chairside milling machine staining and glazing your crown, these guys are working with all the big boys who take home two, three, four. What is some of the net incomes you have seen over the years from dentists?
Patrice: Even at five million.
Howard: No I mean net.
Patrice: If we are talking net, golly, when we usually start with them, their overhead is high and as you know, one of the first places that dentists who haven't been coached start thinking about, “okay, well how am I going to decrease this and decrease this cost, because they are thinking decreasing things, getting, you know, less quality products...
Shelly: Saving your way to prosperity.
Patrice: Saving your way to prosperity is not the way to do it. It's just not, it's investing in yourself. It's investing in the team.
Howard: So what she just said there, I will translate it to the dental students.
Shelly: Please.
Howard: Since you are talking over their heads.
Patrice: Dental Students speak.
Howard: Dental students, so my cost is a dollar and I do a dollar for the dentistry and my overhead is 100%. Well, to get my over head at 50%, the only way to do that is to do $2 for the dentistry and now my overhead is finished and I did two dollars with a dollar cost.
What dentists try to do is the try to take that dollar cost and shrink it to 50%. Well, if every hygienists in Arizona gets $40 an hour, I can't tell them I to take twenty, I can't call the utility company and say, lower my electrical bill. Most costs are set by supply and demand. So you settle your way out of it, you can't save your way to prosperity you have got to increase sales.
Patrice: Amazingly, we see that. Where we have run across that is the doctors who have been an associate for a couple years and now they are ready to buy their practice. So they buy their practice they are about two or three years in and they are not getting the growth and the retention that they thought they would get. They don't know why, they just know they are staying static and so they start trying to cut costs.
Like, okay well let us get cheaper gloves, let us get cheaper material and not realizing that those gloves are going to rip. You are going to use a second glove, not realizing that material, you know what? It's going to fracture, so you're just going to have to redo it again and not thinking. It's not just material, you are talking employee time, your time, chair time, everything that is involved with it. You now just pay two times more for something that, if you were using proper materials and having a team that is trained, you would be making money instead of losing money. That is what is missed, that is what is missing and it sometimes it takes them a little while to get to that space of understanding,
Shelley: You know, Patrice and I were just coming back this weekend, yesterday, in fact, from our own CE that we like to do.
Howard: What does that mean?
Shelley: Attending different conferences and --
Howard: Oh you two went to a conference.
Shelley: Yes and making sure we are up on the latest and greatest as well in our field. And there was a team of doctors coming back our same plane and they had their team with them. And I asked, I turned and ask the doctor, I said so --
Patrice: Don’t mention names.
Shelley: I won’t. She has to put me in check.
Howard: Write it down.
Patrice: No, no.
Shelley: I do need to be put in check with it. And, he says, well you know, “She knows, she knows that staff, she knows that she needs to change this and this and this about her.” So it was interesting because we got to talking and I said to Patrice, I said, “How do they know that they are being trained?” They just assume that, that staff member can go and have this wonderful ra-ra weekend and they are back there practicing dentistry. How do they know how that staff members -- what do they bringing to the table? Are they bringing a good attitude? Are they being with the patient? Are they being influential?
Howard: You know what? That is one thing I learned in MBA School, hard as a rock that so much is fluff, its ra-ra all of them say “We will have a balance score card, will be first or second in your field.” It is all this ra- ra stuff. You know what practice management is? It is strategy, it is chess, you have to bust a move and strategy is saying I'm going to do this and I'm not going to do that.
The teams always said we want to retain our patients; we want to convert more calls. I mean look at the macro economics of the screwed up [inaudible 00:49:40] dentistry. We know factually on average twenty dentists have to land on your website, you know, it's gone from yellow pages 30 years ago to the smartphone. So they googled number one searches dentist near me, so twenty people have to land on your website before one calls. Fix that.
Three people have to call before your front desk can get one to come in. Fix that. Three people have to come in with a cavity. You are saying the average [inaudible 00:50:09] conversion is 25%, so four people have to come in with a cavity before you convert, one to get filled. So to do that six hundred and seventy five thousand based on that one, filling four had to come in, three for each one hundred calls, for four times three, twelve had to fricking call for twelve to call, what that hell is twelve times nineteen, I am not that smart. Two hundred twenty eight people had to google search dentists near me, which on a smartphone is 25% of his voice and then they come back and say, well fix all that stuff, there has got to be some decisions made.
Like the website you know, I can't believe these dentists say, “Well, I’ve got a website”, they bought it 10 years ago at the Arizona State Dental Convention they haven’t even looked at it.
Kenyon: It doesn't work on the mobile devices.
Patrice: They get a bill every month and they have no idea what it is doing.
Shelley: And they probably don’t own it either.
Howard: If you don't have a picture on of the dentist, it's just like online dating. If you don't have a rocking hot picture, by the way I joined ‘Plenty of fish’. I did it and they took down my pictures and said “Dude, you are a fat whale, lose fifty pounds and re-apply.
Kenyon: Come back and see us.
Howard: If you replace that picture with a one minute Youtube video of the doctor, you will triple the conversion rate. When they call, they don't train their staff.
Shelley: Howard let me ask you real quick on that point. Why would that matter? How would you know if they are a good dentist or not from that one YouTube video? Why would that matter?
Howard: Why would it matter? Because like you said, it's all an emotional decision. So my belief is that humans, your very existence is to feel something. Why do people like roller coasters, like scary movies? Why do they like Halloween, eating, kissing, holding hands? They want to feel something and when you go to a website and you see a stock photo and it looks like a doctors DUI arrest picture.
But if you know, half the market is afraid of the dentist and half the markets afraid of the cost and there is a one minute Youtube video that says, “Hey, are you afraid of the dentist? That is why I went to dental school, come see me, I love dentistry. It is my life.” Make them feel something. Then the next video is one minute of your treatment plan coordinator saying, “Are you afraid of how much dentists cost?
By the way one tidbit that I'm really excited about, there are only three publicly traded dental offices in the world. There are none in the United States, in the United States it is all roll-outs. I mean, roll-ups, a roll up is just to go get a million dollar line of credit and they just buy a bunch of dental offices and everybody says that Heartland and all these companies are doing so well. If they were doing well they would be publicly traded on NASDAQ. Snapchat is a piece of shit and it is publicly traded on NASDAQ.
Every time they do a million dollars or more sales, it is because they have a million dollars more debt. They just went and bought dental offices. A profitable business grows in earnings. You couldn't go on Shark Tank and get Mr. Wonderful and those guys to just sit there and say, “What are you going to do?” “Oh, I want a million dollars. I'm going to go buy a dental office.” “Okay then how am I going to get my money back?” “Oh no, I'm going to come back next week and ask for another million.” Every week I’m going to come and ask for another million. Cuban would be like, “Get the hell out of here.”
That's everything you see around the world except two in Australia one is 300 Smiles and Pacific Dental and Q and M out of Singapore and you know what they all three have in common? I mean about finances. All their marketing will do everything for $98 a week because people are afraid of the costs, but they're not afraid of $98 a week because they just spent $98 last night taking their kids to eat Mexican food.
Then back to the fear of the cost their mouth is all a disaster. They might think, well, this might be a five, ten, twenty, and thirty. I just, I am too emotional to go into it. Back to where we got off on that tangent is, you need a strategy? There have got to be decisions; you can’t just be a cheerleader. That is what they are that is what those lecturers are, they are cheerleaders saying, “Go team Go!” Well, I need to know is this going to be a pass or a run should we run right or left? Who do I throw the ball to?
Kenyon: Not only that, do you need the cheerleader every day?
Patrice: So the interesting thing is that team is going to come home and they are very pumped up and they are excited to implement these things. Who knows how to do it?
Shelley: And each of them has their own opinion of how to do it.
Patrice: Then how do you know when it is working and when it is not, you know, you were even saying before about you go to a website and people are visual. People make decisions visually and so if you've got a picture of yourself in a clinical white jacket, they are going to swipe right and go to the next one. .
Howard: Ryan on Tinder, do you swipe right or swipe left?
Patrice: Is it right or left?
Shelley: There is some confusion in this area.
Patrice: Is it swipe left or swipe right?
Ryan: There seems to be some confusion.
Howard: Should I get on Tinder and say my name is Dr. Swipe Right?
Patrice: Delete that last part right there.
Shelley: No we are live Patrice we are deleting nothing.
Howard: I mean, it's so obvious I mean name one person who got a gold medal, that didn't have a coach.
Patrice: Every Fortune 500 you have to have – Here is the thing, and you know this, you cannot be an expert in everything. So you want to bring in another set of eyes to help you see your blind spots and to help advance you what you might be good in, or just okay in and gets you awesome. Make you extraordinary in it. You need another set of eyes to look in to see what you are not seeing, to make the changes that you want, not that you need, but that you want.
Kenyon: It has got to go beyond the systems because like, you remember watching that show, TV show, ‘The Biggest Loser’. I just came across an article I don't know if you saw it; it was a bunch of the winners, like what they look like a year or so later after the show and all of them had put on almost as much or more than the weight that they lost.
What happened was, what they were doing was they were following a health system that didn't become part of who they were. They didn't integrate it into their life to become a healthy person. They were just like doing it kind of for the moment, right? And so when you are training your team and working with them, you want them just to, not to learn a system, right? The systems are important, you have got to have the system, but you want them to be the type of person that no matter if you are there or not, that the system is important and it matters to them. So that when doctor is gone, when you know, when consultants a year later or whatever are less in the picture, then they are still following those systems because they made it important.
Howard: And as far as consultancy goes, not only have I used them and used them for 30 years, I remember when we installed -- I am so old I got out before the computer, when I got out of dental school, I had never touched a computer and we thought we were so lucky because they were installed and the freshman were going to get them and we like high fived each other, we were like “Nice we don’t have to deal with that bullshit.” Then three years later on then my dental office and comes [inaudible 00:57:25] we got SoftDent --
Patrice: You mean you got rid of the big scheduling book?
Shelley: The “Week-at-a-glance?”
Howard: Oh yeah, big scheduling book and the accounting was all done pegboard accounting those big old ledgers.
Patrice: I was in the industry at that time, yes.
Howard: Were you? I mean oh my god that was back when a pencil sharpener was so critical to write in those little squares.
Patrice: Those tiny little ones
Howard: Then we got SoftDent and I said “Who is the number one SoftDent trainer in Arizona?” It was this lady I shouldn’t say her name, it was Sandy Wilkinson and she came in and she said, “Yeah, I'll train your staff” and I said “No, I'm going to hire you” and she says “No, you can't afford me” She goes, “I do this all day long.” Then she told me how much she was making and I said “Well that’s what I will pay you then.” Then she goes, “Seriously?” And I said, “Seriously, because I don't want a one hour lesson or a five hour lesson.” If you are the number one it is like if I had a basketball team and you came up to me and said, I'm the number one dunker in Arizona. I would be like, well, I'm not going to win if I don't have the number one dunker forward guard or center or hockey player.
Almost every consultant I ever had that ever came in my office the first thing I did is watch them do their stuff. Then I tried to hire them and some of the –
Patrice: We get that a lot we get offered a job pretty much every single time.
Howard: Well you were just talking to one right now. Because it is all the team and I get dentists because I'm a dentist. I get it I would rather pull four wisdom teeth; I don't know what else is more fun than that. I mean, it sure as shit wouldn't be golf, it wouldn’t be watching the ‘Cardinals’ get their butt kicked. I get it, I mean when you started talking about bone grafting to a dentist, he starts drooling all over his shirt slobbering on himself. So if you are not interested in something, they are never going to be good at it. I remember in school people would always say “Oh, I'm horrible at math”, and I would stop and say, “When was the last time you did a math problem?”
“Nah, I haven't done one for a year.” Well, if you loved math, you would have been doing math problems. You would not have done the math wrong yesterday. You are not bad at math. You don't like math. It's like chess; some people just love chess and play it every day. Other people haven't played chess since they were in a dorm room, so if they are not interested in how the front best works and treatment planning and overhead, if they're not interested in all this stuff, they are going to suck at it.
I'm telling you, everybody who reaches the top has a coach that does what you are not interested in. It's not that she's smarter than you; it's that she is passionate about figuring out this stuff while you want to learn bone grafting.
Patrice: They don't teach you in dental school, you are going to come out like a boss coming out of dental school when it comes to dentistry, what they are not teaching you is how to be influential. If you don't know how to be influential with people, you are not going to shift your team. You are not going to get your patients to stay; you are going to stay stuck in that 20, 25% case acceptance. You are going to diagnose a million and only have two hundred, two hundred fifty thousand show up. So you have got to learn how to be influential because that you learn, once you get it, you get it and you know it and you use it everywhere, not just in the practice. You use it with yourself, with your family, with your friends, and then it becomes who you are to where you are not teaching it. You are actually just being it and you are teaching by being.
Howard: You said influence were you referring to the book by Robert Cialdini.
Patrice: Yeah, I love that.
Howard: You know he was my teacher at ASU MBA program and he is friends with one of my dentists. He lives right here, I tried to get him on the show like four times and he's always like, “Oh dude I am working on my next book”. And he said, after his last book, he would come on the show, so I need to write that down. Ryan shoot me an email to email Robert C –
Kenyon: C-I-A-L-D-I-N-I
Howard: That must be Italian but anyway,
Kenyon: Yeah it’s got to be
Patrice: Any INI
Howard: What is it?
Patrice: Any INI is Italian.
Howard: Any INI is Italian.
Patrice: You can be a phenomenal dentist, but if you can't speak, even if you are introverted and being influential, you have got to have that foundation down. Otherwise you are going to hire people just like you because you are comfortable with people just like you. And now you have a whole team of people who are people who don't speak, and as soon as they get an objection from a patient or a complaint or anything, they are there going okay, we will discount everything. Instead of --
Shelley: They go back to the money thing.
Kenyon: They go back to the money thing or if you are at 25% case acceptance, what they do is, I am just saying whatever it is, 30% or whatever your number is. If you are 30% case acceptance, a lot of times they will just say, let us just get more patients coming in rather than, you know, how do we get from thirty to thirty-two, how do we get from thirty-two to thirty-five?
Howard: A lot of them get tripped on case acceptance, how you measure it. That's a good question to dive deep. Never trust a number always dive deep. Some people say, well, my case acceptance is so low because I full mouth, I diagnose the whole thing and they always get stuck on how do you measure cases like that? Like when you go into an office and you ask them, what do you think your case acceptance is? And they say 70% and you figure out it is 25%. How do you figure case acceptance?
Patrice: We have an analytics program that will actually go in and do it for us and you are right, it does --
Howard: Where did you get that?
Patrice: We work with a group called ‘Practice Analytics’. They are one of our strategic partners.
Howard: And who is the CEO of that?
Shelley: We work with Jeff Clark; I believe that he is one of the writers on it.
Patrice: Jeff Clark, yes
Howard: Is that out of Lehi, Utah?
Shelly: I believe so, great guy, great to work with.
Howard: Okay, so you use ‘Practice Analytics’.
Shelley: It is wonderful.
Patrice: It is very user-friendly
Shelley: Yes and I like it because I like to involve the team in using those analytics, not just the doctor. The team needs to know what their case acceptance is in terms of even how many phone calls did I convert? How well am I doing over here for a treatment planner, did I go ahead and sell, did I collect over the counter? There are so many fine tune areas of being able to look at it when you have those analytics going on.
Howard: So you like ‘Practice Analytics’?
Patrice: We do, I mean we have worked with Dental Intel and so many other groups. We specifically, with our clients, we like to have them use ‘Practice Analytics’ because it's very user friendly and we train the teams to look at their analytics every day and it breaks it down by back-office, hygiene, front office, collections so that everyone on the team, it's not so number crazy that people can't read it, they don’t understand it. They don't have to be this huge mathematician. It's very simplistic and it helps each team member own what it is that they are doing because they can go in and see the real time numbers and they use it in their morning huddles. They use it in their team meetings.
Howard: Well, whoever owns this thing would never do online dating because he won’t put his name, his picture.
Kenyon: He is scary
Howard: Is he really ugly?
Patrice: Jeff you are going to need to reach out to Howard.
Shelley: Jeff we are plugging you here.
Howard: I just -- oh and his last twitter was 2014?
Kenyon: Wow.
Shelley: You are stalking.
Howard: Well you know why you have to take Twitter seriously? Are you guys on twitter?
Patrice: I am not.
Howard: you know why you have to take Twitter seriously?
Patrice: Tell me.
Howard: Who is your last president? Trump shows you that if you have five million followers. I mean CNN at nighttime, there are hundred million. There are three hundred and twenty million people living in one hundred million homes. There are only a million watching CNN and only three million watching Fox. Trump can tweet five million of them ten times a day. I have got twenty two thousand Twitter followers and if I send them a tweet, they all get it, instantly. You make a post on Facebook their algorithms might not show it to any of your friends or followers.
Patrice: You are schooling me right now I have to get Twitter?
Howard: I have got one hundred and eighty five thousand Facebook followers. If I post this podcast on my page, which we will, only a thousand or three thousand will see it. If I want all of them to see it it’s about $300 per hundred thousand. So if I post your podcast and I boosted the post for one thousand, two hundred thousand views, but on Twitter when I upload that video and tweet it out everybody gets it.
Patrice: These two get to check what is on social media so I am not allowed.
Howard: The deeper you go with Facebook the more you are going to pay. When you transfer like Trump love him or hate him the guy knows one thing. Mark Cuban spent a gazillion dollars building up his Facebook page to a million followers having no idea that when he posts something no one will see it unless he keeps giving them money.
So all the smart people are going to Twitter and Linkedin, your video will get more views on Twitter sending a tweet out to twenty two thousand Twitter followers than posting on Facebook to 287,456 followers. Facebook is about taking your money, taking your money and the algorithms are only going to show you sponsored ads are serving you up is all pay to play. And YouTube is now the same way, when you pull up YouTube what they are serving you up is all pay to play. So when people still talk about the video that’s gone viral.
Patrice: Which one?
Howard: Well you know back in the day when like the cat videos or something funny happened and next thing you know it has twelve million views. That died several years ago there are no videos that go viral because Facebook and YouTube wouldn't allow a video to go viral. They are serving up videos that are boosted and paid for. There is no more videos gone viral, it is all pay to play on YouTube and Facebook. And I'm sure since Twitter has gone public their stock is trading at half of what it was Snapchat is half of what it was. I'm sure Twitter they are there trying to figure out how to do this too but right now Twitter and Linkedin. I’ve got thirty three thousand followers on Linkedin. So I'll post this video they will serve up to thirty three thousand. I'll tweet it out it will go to twenty two thousand, but Facebook, I will have to give them money.
Shelley: Yes for- profit
Howard: Yes, exactly. So gosh, I can't believe we have been rambling for -- God dang we are in over time. We are an hour – ten they are sitting in the parking lot at work saying “Hurry up and shut up, guys we want to go in”
All I want to say is -- by the way DMI stands for Dental Management Innovations and you guys, I love my homies bad. The only reason I'm hard on you is just because I love you. I mean I think you are doing great. I went every time I go to the physician, all my physicians office I go to, you go in there and they have a glass wall, you know, that slides
Patrice: The window witch.
Howard: Window what?
Patrice: Witch. That’s what they call them. You have heard that term.
Howard: I've never heard of a window witch, damn.
Patrice: What?!
Howard: Can I steal that term?
Shelley: Never?! Where you stand there and they turn the glass and they don’t open it up until they are ready and you are just standing there like “Should I sit down, what should I do?”…the window witch.
Howard: But see they are sweet ladies window witch, you know it's window bitch. So I go to all my doctors, they have got some window bitch sitting there, they hand me a form and then you go in the room, then you sit there till kingdom come and then the doctor comes in and doesn’t even say, I'm sorry, you know, I'm forty eight minutes late for your ten o'clock appointment and the only people I see crushing it are my dentist homies, vets and chiropractors.
I mean they are on a level of Montessori Pre -schools. I mean they are crushing it, so you are doing damn good. Damn good but here is what really rubs me wrong is your $350,000 student loans. You bought a practice for seven fifty, so now you are a million under. I watch you, you post twenty nine thousand times a day on ‘Dental Town’ and they are just flying around to all these courses Kois, Spear right here in the back yard, Dawson, Pankey I get all those. And I get it, I get it, but that's not how you get rich in dentistry.
It is getting a consultant. I cannot name a single dentist that I drink with that got to 2 to $4,000,000 a year without using five different consultants by 50. It's not about whether you are going to use these people. It's like you are going to call these people, you are going to use them, they are going to cost a dollar and you are going to get a buck fifty back and then you are going to call your coach again. Then some day may change where that is not the consultant you need, maybe you need some other type of consultant.
I know a lot of them are asking we just changed after 30 years of SoftDent we just changed to Open Dental. A lot of these young ones are asking, what software do you recommend?
Patrice: Open Dental is fantastic; Dentrix fantastic, I think Open Dental is leading the way right now. I really do and so many doctors just aren't familiar with it.
Howard: You know how I can prove Open Dental is number one, besides the fact that I switched to it?
Kenyon: That is what took them over the edge.
Patrice: Can he go there?
Howard: I have a dental magazine, people advertise. Open Dental is the only one I saw that won’t advertise because they are growing so fast they don't even need it. When I tried to get the CEO to come on the show he goes “Howard the last thing I need is exposure, the last thing I need is work.” So then you go to Dentaltown where we have a search bar which I want you to use because that box costs me fifty grand and every time I want to update my server box I got to give Google, you have to buy the appliance.
So Dentaltown is at five million posts but it has got the Google search engine. You search Dentrix, Eaglesoft any one of them. It is a hundred threads of bitching, moaning, whining, crying, complaining. You search Open Dental, it's all raving fans. Open Dental and YAPI. YAPI stands for ‘Yet Another Practice Management Information System. Like, we needed one. If they said you pick one, you can only pick one, which one would you pick?
Patrice: Probably Open Dental and they are moving where technology is moving.
Howard: But you know what that guy told me on Open Dental, he told me and I mean I’ll get down and dirty with you. He told me, he goes “Look you are connected to all these practice management people.” He said, you know, “Hook them up with me tell us what to do” Because his brother the dentist Jordan started it, but then he interest in it, you know, he was a dentist, he started it then went on to other things.
His brother, Nathan has been running it forever and Nathan was like, “Tell us what you want”. He really wants a relationship. So if you are going in there and you need smart stuff, you need to strike up a relationship with Nathan at Open Dental.
Shelley: That is a great idea.
Howard: Because he has an open ad for programmers nonstop. Every time I talk to him he says “We just added two more programmers last week” and they just moved to a bigger building, but it's all about the quality product. So if you sit there and say, gosh darn, I wish it did this or that, tell him what you need.
Patrice: They are on it, it is not two years down the road, they are on it now.
Howard: It's like Dentaltown, we are a year behind. So we have had five programmers since 1998 and our to-do list is always about one year. So for twenty years they have been telling us what they wanted on Dentaltown, whereas Facebook goes the other way. I mean like Instagram, if you have an oral cancer walk and you post a link and say here is the link. The link is not even activated they don’t want you to leave Instagram and go to the oral cancer website; the links don't work because they want more sponsored ads.
I saw this with My space, I saw with Friendster now I'm seeing it with Facebook and Instagram where their programmers are taking away the things that you want and are asking to put them back, taking you down the rabbit hole so they can send you more sponsored ads.
And Dentrix I believe is like that too and, and my team gets so mad because I have ruined so many advertising opportunities for Dentaltown than I can even count. They ask me “How are we supposed to sell ads on Dentaltown? I asked this guy for an ad and he sent me your podcast, telling me that your company is a piece of shit.
You know how Open Dental started? The dentist, Jordan Sparks, Jordan Sparks he had Dentrix and he wanted to export all of his patients names and addresses to make labels to do [inaudible 01:15:12] and he realized he couldn't export it, but he is a really, really smart guy. So he started digging into it, so he realize not only could he not export but their programmers went in there and programmed it extra so you couldn't do it. So he called them up and he said “You know what, that is my data and Dentrix said, “No, it's our software.” and he goes, “Are you shitting me?
That was their corporate deal, so that is why he calls it Open Dental because Open Dental believes that it is your data and you buy Open Dental and you decide you don't want to use it anymore, you still have Open Dental, you still have it and it's open. So like my five programmers, they are looking at Open Dental just salivating because no practice management software is hooked up to accounting.
So they get one, like you are talking about dental intelligence. My programmers could start hooking bridges to my own accounting team and because we are in Peachtree, I know dentists like used Quicken, but Quicken isn't going to run Facebook, Google, Instagram, I mean General Motors can’t run on fricking Quicken. If you get an MBA, you are going to need at least Peachtree, Microsoft Great Plains also called Microsoft GP that sophisticated software, the Fortune 500 all use the German SAP.
I couldn't do what I do on Quicken, but my programmers are looking at our Peachtree data and we are looking to Open Dental and they can bridge any gap. So it is yours and it is the future. It is the same thing in software, you will buy an oral scanner and you can't export the file, Sirona is famously known for that. When you have an open software, you could have a chairside milling machine, half the price from Curry over here, a scanner, half the price over here. You can start mixing and matching as opposed to a lockdown closed system.
Patrice: Yeah, that is so true, we just ran across that with a client's office. They were dealing with all of that and it does, it just makes it a mess. So much time is now being spent on trying to figure that out and how to get this to talk to this. And the patients are just sitting here being ignored.
Howard: That is a great segue into their $350,000 student loans, he has bought a $750,000 practice and now all the –
Patrice: Don't forget marketing. You have got to add marketing into that
Howard: The speakers are telling them they got to get a $135,000 chairside milling machine, [inaudible 01:18:27] or CEREC. What are your thoughts on switching from suddenly a $14 Impregum impression to your lab man who has made ten thousand crowns to buying a $135,000 chairside milling machine to have your dental assistant start milling crowns and she has never made one?
Patrice: What has been your experience with it?
Howard: My experience is that you schedule thirty minutes for a crown, you go in there and [inaudible 01:18:56]. You set a timer four minutes, you tip the shade, unless it was a man over sixty-five with liver spots and then it is just an eighty three five.
Then when the timer goes down and you pack the zero cord, the one cord, then you prop and then make the temporary to your assistant and when you make the temporary and you got loops on and you can't find the margin on your temporary, you learn all about your prop at the temporary, you go back in there and I throw that away and start again.
So then you make the second one and then when you are reducing inclusion, sometimes you go through the temporary, so you have got enough reduction. If you get one reduction coping in your life, you should learn, never, ever take a final impression before you have made the temporary. It is a logistics error it’s not only dumb, you are in the wrong order.
So then the, the temporary is all great so that I can take an Impregum impression I have used it for 30 years and then I go do a hygiene check or two, come back, look at the impressions seal it on the temporary, done in thirty minutes. They have got a CEREC machine, do it ourselves? That is a two to three hour appointment.
Shelley: If it goes well.
Howard: So what have you seen? You have seen those appointments take longer?
Patrice: Yes
Howard: Then the lecture circuit says it is all done in an hour. What percent of the time is three hours?
Patrice: We have seen it up to three hours. It just depends on the skill of the doctor as well and how confident they are in their craft. I mean we have got doctors who have the machine in their office but it's taking three hours and the patient's sitting there.
Howard: Would you even want to see a three hour movie?
Patrice: I just saw a two hour and twenty minute movie two weekends ago and after about an hour and a half has done.
Howard: What was it called?
Patrice: It was the superhero … what was it called?
Kenyon: Thor -Ragnarok
Patrice: I think maybe it was Thor, that one.
Howard: There are only like five guys alive that have lived and made like sixty movies, and Oliver Stone said “Dude, Homo Sapien can't pay attention for a hundred and ten minutes, hire a freaking editor.” Now that patient's sitting there in a chair for three damn hours.
Patrice: Listening to the drill, anxiety ridden, wondering what's going to happen next. I mean, it's horrible.
Howard: And your lab man has made ten thousand crowns and Doc hasn’t. Yeah we have just lost another advertiser on Dentaltown, thank you for that.
Patrice: Thank you for encouraging Howard.
Howard: You are the one that brought it up.
Patrice: If your doctor, if your doctor is solid in the craft, then absolutely you want to have it.
Howard: I say I will take you to the other side. Here is why I like CEREC, dentists 14% of them in their career will go to Outpatient. Alcohol rehab, it's about 85% alcohol, 50% opiates. You are doing a repetitive task. My dad owned restaurants when people came to [inaudible 01:21:49] they were so happy, you couldn't beat the smile off their face with a crowbar. When you are ordering a foot-long chili cheese dog and tater tots.
Now you are in dentistry, everybody is coming in scared, I hate the dentist, am I going to get a shot? And even though they have five earrings, a bar through their nose, a bar through their tongue and they have sleeves and you have to deal with the window bitch. So there is a lot of burnout in dentistry. So if buying a CEREC machine makes you run twenty red lights on the way to work? You have got to have it.
You are buying a laser a laser doesn't stand for Light Amplification Stimulation Emission of Radiation; it stands for Losing All Savings, Equal Reality. But if that's what turns you on and you are like, “I want to go to work and play with my laser.” God then get a laser because you are going to make so much more money if you stay in this game past sixty-five, seventy-five. The guy that inspired me and inspired me to be a dentist, Kenny Anderson last month I celebrated my thirtieth anniversary and he celebrated his 50th anniversary.
Howard: And you know what he told me last time I talked to him, “I'm so lucky because all my friends, they went into forced retirement at sixty-five.” From Boeing, Cessna and here he is seventy-five and he still gets to go play and do you really think that when you are sixty-five that your wife wants you to retire and stay home with her at all times a hundred and sixty hours a week.
She is going to be an alcoholic a year after you retire. The funniest retirement story of any dentist of all time was, remember Bob Ibsen, he started DenMat. So he finally sold it all to Proctor and Gamble and unbeknownst to him, like just a quarter or two later Gillette gobbled it up for a 40% premium. The guy was sitting on a quarter billion in cash after tax and he is a catholic boy, married to Marcia for fifty years and Marcia said, “Hey, you are still going somewhere.”
She said, “That is my time. I need forty hours a week of my time. I can't deal with Bob Ibsen one hundred and sixty hours a week.” But he had too much money. Dentistry is a glorious thing you can do dentistry. So he set up a dental office for battered women who got their teeth knocked out because he loved cosmetics the most. That's why he started doing that.
So when I did his last podcast, I did his last anything before he passed away and he does have this big old smile and he just, he just went there and played and he loved it. You know that when your husband knocks out your teeth, that kills your self esteem trying to get back on your feet when your lover knocked out eight and nine.
He just loved it and he just played, I talked to Marcia one time and he always came home late from the office. They stopped at five and he wouldn't get home till 5:30 5:45 late for dinner and the guy had a quarter million. How many of the dentists that you consult with, if they had two hundred and fifty million of cash in their savings account would burn down their dental office.
So make your dental office the tour bus. I raised four boys, I put them in the bathtub, with nothing in there they would all fly out, if I put in a bunch of boats and planes and trucks and same thing in the sandbox. The more Tonka trucks you could throw in there, you know, I love toys. If CEREC is your toy, if the laser is your toy, it places implants, I get that.
But first you need to get that you need to get a dental consultant. If you are going to get gold in the Olympics, you are going to need a coach. You need someone, you play. Like a dentist told me, he said, “I'd rather be beat with a stick, then do a root canal.”
Howard: Then freaking don't do root canals they are called endodontists, there are four thousand of them. Google it!
Patrice: Do what you are passionate about otherwise that is why you see all the alcoholism, that is why you see all the drug addiction because they are having to put so much energy into something they don't want to do and then they come home and they have got nothing.
Howard: When you do things you don't like to do for money, it's always going to lead to disease. I mean, they say that like 95% of prostitutes are heroin addicts. They hate their job, don't hate your job. Google, one of the most fun Ted Talks ever was Rat cage and we will just end on that note, right? Rat cage did you see Rat cage?
Patrice: No
Howard: Rat cage was a deal because all the studies on addiction came out that if you put rats in a cage –
Patrice: Yes I did see that one.
Howard: Or monkeys in a cage and you gave them a choice between water or cocaine induced water or alcohol, whatever. They will drink the drug water until they die. So everybody said that drugs have got to be illegal and they are really bad because when any of these animals choose between water or drugs, they choose drugs till they die and it took like 30 until some guy said “Dude they are in a freaking cage.”
So he redid the study. He put the rats in a rat park that had other rats to play with and things to run on and everything rats like and then the other guy in a cage. The guy in the cage drank the drug water until he died and the guy in Rat Park didn't drink the drug water, he drank water. So all these things that they say about addiction and all these things like that, you know a hundred years from now they are going to know a thousand times more, a thousand years from now they will have a million times more. But a lot of it starts with, you hate your wife, you hate your dental hygienist, you hate doing endo, you have all these things you hate. Get rid of what you hate, turn your life into rat park. You had to write an article for Dentaltown (inaudible: 01.27.40) and write Dentalpark instead of Rat Park, Dentalpark.
Shelly: That’s a great idea.
Howard: Have you guys met [Tom Jacoby inaudible 01:27:50]
Patrice: How Howard inspired us.
Shelly: Absolutely.
Patrice: In the Rat Park.
Howard: And that's another big killer thing. Don't stay with someone you hate just because you don't want to tell your parents you are going to get a divorce or for the kids or things like that and never pay an employee money that you can't stand to be with. When I'm driving to work, I mean I have to go early, like if it is Dentaltown, a Dentaltown meeting, I have to go early because I know I'm going to stop and talk to Stacey and then Ken and then Laurie and then Stan, they are your buddies.
Kenyon: They are family
Howard: You shouldn't be walking into your dental office and see your hygienist and say “God I hate that girl” I freakin hate her.
Patrice: Yeah.
Shelly: You are not held hostage, ever.
Patrice: Is she going to be grumpy is she going to be ignoring everybody. What kind of mood is she coming down?
Kenyon: One of the reasons I was excited to partner up with Patrice and Shelley is because my brother is also a dentist up in Utah and about four or five years ago, he had been practicing for about six or seven years and he had hit that, where he wasn't turning to drugs and alcohol, but he was just turning to stress and it was showing up as this weird little heart thing. And they were monitoring his heart like at night with the machine because they didn't know what was going on.
He started to learn this mindset thing and he was working with a coach that mentored me and now he is getting ready to work with us. But he finally flipped that around and you are right, he was literally killing himself in his practice. Just forcing it, trying to make it work, going there, just like you said, frustrated and mad because you know, I got to fire this person today that which means I got to hire somebody. I'll have time for that because my schedule is filled. And you had all that going on and he finally did what you said. He finally just figured out what he wanted to do to make his practice more fun, make it exciting. So he sold it and moved to another part of Utah and is just doing some things totally different, but it started with changing some things up.
Howard: Does he ever come down to phoenix?
Kenyon: Yes he was just here a couple of days ago.
Howard: Well next time he comes down send him to my house.
Kenyon: Okay yes that would be great.
Howard: That would be a great deal and what you said at the very end is called the ‘Greater fool Theory”. A lot of times you have a practice and there is like a dentist for every five hundred people. It's all PPOs and Medicaid, you freaking hate it. Your wife is begging you to move back home because she wants to be next to mom and grandma and all that stuff. I don't care how shitty your dental office is, some idiot will buy it. It is called the greater fool theory. Get happy, when you are happy and healthy and you live in a house with. I mean there is so much love in this house, thank you Ryan for that.
I got fifty-five employees; I don't even have one employee I don't like. I don't have one employee I wouldn't want to go to dinner with. I don't have one employee that we are going to the ADA convention I cannot wait to hang out with him. I prefer drinkers, I admit with that. No I’m just kidding
Patrice: Debbie Downers go that way.
Howard: Just have fun; if you are happy and healthy, you are going to make money. But we are going to end the show because I can't believe how long we went over, my god hour and a half. Her phone number?
Patrice: They can text the text.
Kenyon: Text howard
Howard: Text Howard to six- zero- two- four – six – one- seven – six – one - three. And just get a damn coach, get a consultant get happy, make money and then go play. It is DMI for Dental Management Innovations and the website Ryan is –
Patrice: www.dmicoaching.com.
Howard: dmicoaching.com, alright.
Patrice: And you'll find our contact information.
Howard: Seriously, thank you so much for coming by and spending an hour and a half of your life
Patrice: Thank you Howard.
Shelley: Thank you
Kenyon: Appreciate it.
Howard: This shows it's just … I've gotten more love emails from the podcast than I did from my 30 day Dental MBA, from Dentaltown. I mean every single day dentists from all around the world are sending me email saying I got an hour commute to work or I'm on the Stairmaster, treadmill for an hour. And then some of them even make me cry. I get these emails from Tanzania, and Somalia, and Nepal and Vietnam, and they say, you know, it would be four months wages for me to fly to L.A to see you lecture for one day and fly back and you are just delivering me all these people for free on my Samsung.
Shelly: Do you know Howard the reason that is? You are real.
Patrice: Yes.
Howard: I’m real? Most people look at me and think I'm photoshopped but this is all natural and I have not had surgery.
Shelly: All of that.
Howard: But keeping it real.
Shelly: It is I am serious because how many people can get on here and be very polished and tell you what they think everybody else wants to hear that is not what it is.
Howard: That's why they don't trust politicians. They are all lying, everyone knows it and they are all in a suit and tie; you know why they wear a tie?
Patrice: Tell me.
Howard: It keeps the foreskin from coming up over their head.
Patrice: That is an important thing to know and I'm going to use that.
Howard: And I'm going to use the window bitch, thank you for giving me that.