In addition to her 17 years of clinical experience, Monica is an Executive Coach for Fortune Management, where she coaches teams on implementing tools and strategies customized to meet the individual needs of the practice. This includes customized programs targeted on excellent communication, scheduling for increased production, financial policies, accountability, and building a strong hygiene department. As a former client of Fortune Management, she believes in the teachings and that it is crucial for a practice to build a strong relationship with their patients by being extraordinary. Monica received her Bachelor of Science in Dental Hygiene from the College of Southern Nevada. She began her career with a leading Periodontal Practice, which specialized in state of the art dental technologies. She extended her hygiene career into sales, Brand Management, and a public speaker, focusing on preventive and esthetic procedures. This avenue inspired her to have a true passion for the business side of dentistry, thus leading her to obtain an MBA, . A past Global speaker and educational consultant, Monica has presented a wide range of topics to audiences throughout the world. She presents a variety of educational programs, while initiating and maintaining collaborative working relationships with dental and dental hygiene key opinion leaders and professional associations. Monica continues her clinical practice in Utah, volunteering with the Northern Component of the Utah Dental Hygiene Association. Outside of her career aspirations, she enjoys spending time with her family and friends, cooking, traveling, and staying active through hiking, mountain biking, kickboxing, water sports, and snowboarding
AUDIO-DUwHF #1095 Monica Murray, RDH, MBA
VIDEO-DUwHF #1095 Monica Murray, RDH, MBA
Howard: It's just a huge honor for me today to be podcast interviewing Monica Murray RDH MBA in addition to her 17 years of clinical experience Monica is an executive coach for Fortune Magazine where she coaches teams on implementing tools and strategies customized to meet the individual needs of the practice this includes customized programs targeted on excellent communication, scheduling for increase production, financial policies, accountability and building a strong hygiene department. As a former client of Fortune Management she believes of the teachings and that is crucial for a practice to build a strong relationship with their patients by being extraordinary. Monica received her Bachelors of Science in dental hygiene from the College of Southern Nevada, she began her career as a leading periodontal practice which specialized in state of the art dental technologies. She extended her hygiene career in sales brand management and a public speaker focusing on repetitive and aesthetic procedures, this avenue inspired her to have a true passion for the business side in dentistry thus leaving her to obtain an MBA. A past global speaker and educational consultant Monica has presented a wide range of topics to audiences throughout the world cheaper presents a variety of educational programs while initiating and maintaining collaborative working relationships with dental and dental hygiene key opinion leaders and professional associations. She continues her clinical practice in Utah volunteering with the northern component of the you thought that hygiene Association. Outside of her career aspirations she enjoyed spending time with her family and friends cooking traveling and staying active through hiking mountain biking kickboxing water sports and snowboarding. It is a honor to have you on the show today.
Monica: Thank You Howard it's an honor to be here
Howard: Oh you're too kind. So do you know do you really think I get this all the time did you know I'm 56 I've been out 31 years a lot of these Millennials they come out of school and they go Howard you don't realize it's a different world today I graduated 30 years ago it was the golden age dentistry was great now their coming out with 350 thousand dollars in student loans DSO is popping up everywhere do you think the opportunity to have a successful dental office as this is the same today in 2018 as it was in 1987?
Monica: Absolutely not I do think that exactly what you just said there's a competitive market out there with the DSOs and I not I'm personally not a super big fan of how they set it up for these dentists coming out, it sounds beautiful and you know unicorns and rainbows and I don't think that it helps them be successful as business owners slash entrepreneurs if you will.
Howard: So what advice would you give to them if they're coming out your daughter just graduated from dental school, not saying you're old enough to have a daughter who is graduating from dental school but if you did and you just had her graduate today and her name was Monica Murray ii what advice would you give her?
Monica: I really am a firm believer in vision and that's part of what we teach at Fortune if you don't know where you want to go how are you going to get there it's just like a vacation if you don't have some idea of what you want it's really hard to obtain that and I think many dentists if it were Monica Marie junior it's the second I truly believe that if she were to say I just want to practice dentistry great then go work for a company but if you truly want to have that entrepreneurial spirit and be a small business owner and or a large business owner or multiple offices at some point be very clear on where you want to go because that will set you up for success and or could set you up for failure from the get-go.
Howard: Well that's a great point do you think more dentists 30 years ago had a business entrepreneurial wanted to own their own practice than 30 years later today?
Monica: No I think it's actually the opposite more people want to own it today and they understand that they're not just a dentist they're also a small business owner but that's what it was 30 plus years ago you went to school you came out you started a business but nobody considered themselves a small business owner.
Howard: Yeah so so typical client I mean who's calling you at Fortune what kind of offices are you going into what is your common you know like a dentist does a root canal putting in a crown. What are like two top three reasons people are calling you to come into their office and what are you doing for them?
Monica: I think there's really two, obviously the common thread is I want to work less and make more don't we all I think in addition to that if you look at the structure of how dental school is set up they he or she coming out of dental school is very successful at like you said prepping a crown placing an implant whatever that might be the dental side of things are very clear and the clinical excellence is there the business side of things are not discussed and if they are they're discussed and very minut measures. So you come out and you're wearing multiple hats not only are you the performing practicing dentist but you're also the HR manager hiring and firing you're also the accountant that's trying to run your QuickBooks you're the guy that's ordering or the girl that's ordering. You're wearing all these hats and you're not set up for success there's no company out there that you wear all of those hats and you do really well.
Howard: Like you say you're a working manager(inaudible 5:37-61:13) Would you recommend that they start a denovo, start from scratch, by an existing, do demographics matter?
Monica: Yeah I think again going back to the vision and if you have no vision talk to somebody that can help pull one out of you because if you come out of dental school and you say take over a transitory dentist that's wanting to you know he'll be your associate for a few years you buy into it you get as patient base you find out that you don't know anything about the business you know do your homework what kind of patient base do you want what is your target audience do you want an older crowd a younger crowd a mix of people. I think when you go into a specialty like Peto for example you know exactly who your target audience is most people coming out of school aren't in a specialty situation so they're taking what they can get and I think it's really important to understand what is it that you want to provide and don't live in that scarcity mode just because you're coming out be clear.
Howard: and that's probably sums up the last numbers I saw were for 2016 that the average dentist in America in 2016 netted at a hundred eighty seven thousand but this average specialist was over three hundred thousand and a big part of that is just because they have a target market.
Monica: They do they absolutely do, it's very specific to what they want to do I want to work on kids and I'm not doing molar endo you know or whatever that might be.
Howard: Yeah and with such a fast changing world I never I think the general dentist is under severe pressure just to be like in the fact that in 1900 health care is only 1% of GDP and there were no specialties and a century later mm it was 14% of GDP the MD's had 58 specialties and the dentist had nine and now we're at 2018 the healthcare 70% I couldn't imagine trying to keep up on endo, perio, pedo I mean it's just so massively overwhelming if you look at this century long trend it is trying to specialize and it seems to me that so many dentists when their practice overhead is out of control when their staff has high turnover they always think they need to go learn another clinical dentistry thing like the go add sleep apnea or they want to go add Invisalign or they think maybe I should be placing implants and it's like well her restaurant was failing with with anyone smart saying well maybe if you added lasagna to the menu everything would work its way out I mean what would you they always want to do political and when they come to me they say they want to add implants I say well what are you gonna take away and they say well I just want to do anything. Do you think being a general dentist that can do every single procedure do you think that's a big element of success or not really?
Monica: I think it can add to it for sure and maybe this comes from my background of being a hygienist I focus on their hygiene Department first because prevention is absolutely key to everything you do it's like building a home on poor foundation and I'm gonna say 99% of the time I walk into an office and their hygiene is at 30% or lower meaning for every ten patients that are coming in only three are returning twice a year for preventive measures and that to me is where we're missing the boat because that's where the restorative treatment planning comes out of. So you can offer all these you know A to Z procedures that you want to do in the restorative side if you're not nailing down your prevention you're missing a big part of it.
Howard: I agree because if I said a hundred practices that I know there's let's a million dollars and the dentist takes home 250 300 whatever they don't even do molar endo, place implants, sleep apnea, Invisalign, they just had two or three rock-solid agent is going all the time and then out of that they pulled enough fillings and crowns and that an emergency maybe some anterior endo or a simple extraction and they're just crushing it and then you go across the street to the guy who knows how to do every single procedure and has one hygienist three days a week that they don't have a successful practice.
Monica: Yeah what is the saying a master of all trades an expert of none.
Howard: Yeah absolutely, so do you think a lot of dentists have a hard time getting motivated about your hygiene department because they're down here in Phoenix saying well if I pay my hygienist $40 an hour and the insurance company gives me $55 for cleaning I mean you know that I mean my hygiene Department rented loss what percent of hygiene departments today in the United States you think run at a break-even our loss?
MOnica: Oh honestly like I said 98%of them yeah I mean that honestly that there's a there's a one percent that's sitting out there that's doing really well and that's kind of who we like to work with or the people that want to improve themselves constantly and be willing to say you know maybe I could do this a little bit better I'm great but I could be better and this is irrelevant kind of relevant the very first job that I had for the perio office hired me with no experience and I want to say I beat 300 other people out and I said why I literally asked the doctor why me and he said honestly you can train a monkey to do anything but you can't give them personality and I think it's the same to be said in any hygiene or dental department or any job anywhere you have to be able to connect with people and want to grow and want to better yourself and not sit yourself behind a title or fear of mentioning something to somebody, you have to be passionate you have to love what you do and you have to continue to grow.
Howard: What percent of dentist do you think does not have enough personality to become an accountant?
Monica: Almost all
Howard: Yeah so like wants to be with like so they decided the library play here if you think the librarian is the hottest rock star in the world so you surround yourself with a bunch of introvert geeks who and even openly admit that they dealing with the patient is the hardest part that when the staff is the second part they just want to go in and do their work and and they look you in the eyes and say they don't like to sell dentistry and you're like you like maybe with all those characteristics maybe you should be working for someone else.
Monica: Yes exactly and sometimes that is the recommendation you shouldn't probably own your own business you want to show up do your stuff and go home you'd make a great associate.
Howard: Yeah and then when they and then I've been telling them you one of the biggest messages I've done on my podcast is that again when it restaurants failing you don't sit there and say well maybe we should get a brick oven and start doing brick oven pizzas alongside of our steak. They want to go out by a hundred and thirty thousand dollars LANAP machine or a hundred thousand dollar CBCT or a hundred thousand dollar Cad Cam you know I always tell them I've told them probably a couple hundred times on a thousand shows, that the number one return on investment is practice management and everybody I know doing two to four million dollars a year you say well what consultant did you use they can name half-a-dozen consultants they use and I don't know why the dentists don't get that either stressed again I overhead they have staff morale drones they have turnover problems and they think that laser is going to fix it.
Monica: Well I'm a super big fan of any kind of technology that's going to better your practice and provide better patient care I will say that however if it's gonna be a coat rack or collecting dust in the back you're right don't invest in it learn how to use it learn how to implement it learn how to sell it quote-unquote because that's what we are is we're selling we're selling lies like we're you know we're selling smiles. So I guess I agree with you at the same token learn how to make it work.
Howard: So look at a program if you offer I mean what is your bread and butter programs? Is it something you go in once a month for a couple of days or is it online how do you actually coach your office's?
Monica: It's a hundred percent in person that's the nice part is so we don't fly to other areas we're right here in your backyard depending on where you are Fortunes National including Canada so it depends it varies I can't give you an actual cookie cutter what we do or how it works but it's very much consulting versus coaching. There's three main aspects of what we do first and foremost were a coach and I always think of I'm a football kind of girl so the coach coaches the team to run the plays and do the systems and go through the tackles so we coach majority of the time every now and then yeah I'm gonna have to put on a consultant hats just do this because it works and trust the process and then in addition to that when you look at mergers, acquisitions, transitions, retirement, bringing in an associate whatever that might be looking at your finance engines were key business strategist and I think that's where we can provide a really mass amount of education and help to the dentist that like you said doesn't know the accounting side of things.
Howard: So you're in Salt Lake City?
Howard: So are all your clients then basically Utah is that your territory?
Monica: Yes majority I do venture out a little bit I've got a favorite client out in I shouldn't say that but out in Green River Wyoming so there's a few outlying areas that we work with people as well.
Howard: Yeah I just lectures in Wyoming oh my god that was
Howard: I couldn't believe it and I'll tell you the story because maybe you could believe it because I don't think anyone will, from the airport to the lodge the taxi guy slowed down and stopped on the side of the road I said what are you doing and he goes by that tree and there are three bears and Ryan and It was just so funny you guys watch since I stopped I'll draw a commotion and he goes because it won't even take five minutes for some idiot to pull over and then get out of this car to take the picture and sure enough within five minutes not five or six cars were pulled over and some Idiot gets out of his driver's side walks around in the passenger side and is taking a picture of these bears which would be like across the street from you and the taxi drivers like this guy I mean can you imagine being that dumb but I guess the things that the Bears name was Winnie the Pooh. So Utah the data I see Utah is the most competitive market and has the lowest median average income for a general dentist because so many dentists just want to practice. They're Mormon they want to go back to their mother country and that is so valuable to them they just keep flaking back and a lot of demographic people just say no don't go there you know go there go somewhere else. So my question is you demographics matter?
Monica: Absolutely not if you look at our Hawaii demographic now that would be a very difficult place to do anything because you're stuck on an island you're you know there's a dentist on every four corners I mean it's it's very saturated so I don't believe that in any way shape or form. I believe it's a limiting belief and a belief system of what you want to provide because again the guy across the street may be doing subpar dentistry or not even meeting the standard of care and you got to focus on yourself. It's absolutely what you want to provide providing you know having that vision if you will moving toward that and what kind of dentists do you want to be, now the challenge I will say out here is we have probably the nicest people on the planet I will say that and they love to give dentistry away for free oh that's okay you can pay me later so it's it's not a quality it's not a skill level it is just being a good wearing that business hat and saying I'm providing you a value and this is what it costs and I'm okay saying that.
Howard: Yeah you're free I mean oh my gosh my assistants have gotten so mad at me over the years my biggest problem is when someone fails financial policy for an extraction especially if it's four wisdom teeth it's like I don't care I'll do for free, I mean I'd rather pull four wisdom teeth then go to Hawaii if I had those two options it's like well she doesn't have any money so let's just and always having five minutes let's just do it yeah I totally get that. So when so you're saying that fortune management does better when with elite clients people who or that top 1% is that who your target market is?
Monica: Oh no I didn't mean to imply it that way I'm saying we end up working with those people that become the top 1% because of their drive to look at systems and outsource things to their team like create a middle layer of management if you will to where the dentist can focus on dentistry and then the office runs smoothly so it's just I mean our average growth is 30% year over year and that's what I'm saying is when you take a $500,000 practice and turn the next year into an $800,000 practice or more we had one right here in Salt Lake that grew 64% which almost equated to a million in one year but that's because they did it they followed it they believed it they lived it they breathed it and it worked.
Howard: but there's been so much better hundred thousand cad/cam.
Monica: Well they did because they needed to spend money to offset their taxes.
Howard: Yeah there you go if your business is for growth I know boys love to waste buy a laser buy them you know if you want to play with something that makes you run 20 red lights on the way work do it but don't buy that way because you think that's gonna make your office business a place for growth that's a toy and nd I and I've set there many many times buying insane toys that can well you know I can turn out and buy a sports car I don't have I don't have a two-seater sports car or you can say I do with a boat or a cabin but that's how you should look at this stuff because if your business is you're poised for growth in your business in order you should be able to buy those things for fun but you don't buy them as the hail mary pass to fix a sinking ship.
Monica: Absolutely and one of my favorite sayings ever is culture eats strategy for breakfast so again that goes with what you're saying you can have all the latest greatest neatest brand-new toys the nicest office if you don't have the right people the right systems the right organization and the greatest monitoring it can fail you and probably will.
Howard: Who's the lady in the that psycho show or she was the nurse the guy ran off the road cabbies I say you know in real life Kathy Bates really isn't an urge to find the stranded passengers in snow banks and drags them back to their house and these races she's Hollywood she's pretending. So I know you're introverted I know you don't like to live leave staff meetings I know I told them 100 times that you know successful people are the ones willing to have the most the highest number of uncomfortable conversations and they always tell me they say well I don't like I don't like that I mean on dentaltown you know how many threads their are what should I say to my hygienist and then they're posting all this up and just reading the thread basically just tell he's more afraid of his hygienist than King Kong and it's like why but I was so you know you can just pretend I mean you could show up to work and say look there's a hundred and sixteen hours a week and all the 32 of them I can be an introvert and geek afraid of the world but now I'm going to walk through that office I'm going to be a leader and I'm going to lead the staff I'm going to have uncomfortable conversations and I'm gonna have staff meetings. How do you how do you coach a dentist to be something they're not?
Monica: I think it's I like people to be who they are and I believe in not necessarily profiling somebody but understanding what their natural state is like say a color code or a personality or an astrology or whatever that might be people have their natural adaptation of states that they go back into or their automatics but I believe that you can have an uncomfortable quote-on-quote conversation and not have it be something that's threatening or rude it's matter-of-fact and so that's your business hat and I think when you when somebody says I want to be a better leader and I want to do better things they're open to the coaching and they're willing to step out of that comfort zone and stretch to be uncomfortable and do great things and then when they see the results come from it it's almost eye opening like oh I could have done this years ago so instead of having this belief that it's going to cause confrontation it's gonna help create a solution it always ends up working out.
Howard: That's the same thing the sales I mean almost every dentist says to me I don't like sales I still like it how do you coach someone who just tells you I mean it's like telling the kids eat their broccoli I mean you just make him eat it till they cry or what do you tell some dentist that says I don't like that?
Monica: Well I think it comes down to the power of good questions and understanding the why behind that why what you know what is it that why did you get into dentistry in the first place what is it that you love what is it that you value how do you express this through communication to your patients or your team members and I think when people really go back it's like the five-year-old thing why why why why why, once you really get to the why all of a sudden they realize what their vision is and I keep going back to this vision statement but I truly believe if I said I want to go on vacation and I get in the car and have no idea where I'm going how do I even know when I got there. You've got to start out with some kind of vision and if your vision is to create beautiful smiles life lasting you know changing people's lives saving their lives then that changes the conversation that you have with them and you're not fearful to bring things up you don't feel like you're selling your feel like you're giving.
Howard: Do you think DSOs are going to continue your growth unbridled growth you think they're gonna like double in the next ten years or do you think they're there's some holes in their strategy and they're not going to be as successful as they think they are?
Monica: I hate to guessestimate but what I what I do believe is that if they continue down the path of quote-unquote being cattle prodding you know patients the more we educate patients the better they understand the quality that they receive and I think DSOs can be a great place and I think if they run it correctly and they run it based on the patient and not on numbers and yeah I mean they could be around and they could double but if it continues the way that I personally witnessed it I'm not sure that it meets the needs of the clinician or the patients and we get better and smarter year after year after year. I mean look at a hundred years ago what we were doing versus now and I think if we are aware of that and in tune with that and we educate our patients more than a commercial saying brushed your teeth twice a day go to the dentist once a year whatever it might be I think then absolutely the general dentist which we call a dying breed still has a chance.
Howard: You know you just sing the song for Amos and Andy up Pepsodent and it's funny it was to show you how powerful marketing is they ran that commercial so many times made Pepsodent the number one brand even though it didn't even have fluoride in there that was up that was that crest and Colgate secret ingredient is pressed with MFP what's MFP? Maximum fluoride protection but the insurance company saw that commercials so many times they just covered cleanings twice a year it shows you the power of advertising. When you go into your clients office is lack of advertising and new patient flow usually a major problem that needs to be correct or is it more or is that usually not the big issue?
Monica: Actually it's the opposite and I don't know if this is an area type thing I know on average dentists get about 20 new patients a year or sorry a month excuse me that's the national average I have I have multiple offices out here getting over a hundred. The additional challenge that is that's great I mean that's wonderful but there's a revolving back door they're not sticking around and you're not maintaining the people that already love you and call you their dentist. So again going back to hygiene and just focusing on what everybody wants to have new patients and more patients well if you can't even focus on the ones that you have then maybe we need to look at a different strategy.
Howard: Now since your from Utah are you biased towards Dentrix so you just going to tell everyone to buy Dentrix because they're your homies?
Monica: Well I have to I have to just put out a disclaimer I'm from California and that will never change. I'm not biased to any product per se if it works well and you utilize it to its best advantage I personally as a dental hygienist egle soft fan just because I've used it for years I started out on softdent and that's how long I've been in this and I love them all but you have to use them there's there's something to be said it's like having an iPhone and using two apps on it what's the point why don't you just have an older phone.
Howard: Now I'm so old after 31 years we just finally got off Softdent mainly just because it was crashing all the time and my tech support guy was just look at me saying I'm pretty sure there's something wrong with this and so we got on dentaltown and we went with Open Dental. Do you have any thoughts on Open Dental?
Monica: I think it's great I don't have one person out here in Utah utilizing it but I've heard great things I want to say it's a complimentary service so there's no fee that has to be a nice thing again I'm not biased against any system as long as you're using it, you have to utilize the features otherwise it's not serving you.
Howard: So when you go into an office you know when the patient comes in as a hygenist you want x-rays exam what kind of metrics are you looking at when dentist called you up and you go there and look at their office you jump on their practice run your system what works these metrics are you looking at that could be a cheat you know form your opinion on what you've got going on?
Monica: There gosh there's so many I mean when we go in well we'll run a compliment if somebody's interested in bringing us in I say test drive us let's look at a 10,000 foot view of what's going on in your office and we'll do a complimentary practice analysis, it's basically a 15 to 20 page document of everything from the financials to the systems to the organization to the people everything I mean literally everything. Very going back to my hygiene roots once again a very simple very simple metric that I would tell anybody to follow is look at what your active patient count is and look at how many limited exams you've done in the past 12 months and if you're not you ideally you should be doubling that and if you're nowhere around the 70% mark you are missing the boat on your current patients, stop spending money on marketing stop trying to get new patients in and focus on the ones that already love you.
Howard: Okay I ask all of my patients they love me they all said no.
Monica: I doubt that.
Howard: So on what is your definition of an active patient so the two biggest systems are Dentrix and Eaglesoft how does someone listening to you right now when they get to work pull up their computer and find out how many active patients what would you definition is that just someone who was in one time in the last 12 months?
Monica: I would say anybody that has sat there rear in your chair in the past 18 months considers you their dentist.
Howard: Okay 18 months so you're going a year and a half?
Howard: and then and then you want them to run how many limited exams they had in the last 12 months or is that the last 18 months?
Monica: 12 months
Howard: Okay so give us some metrics so limited exams you want that to be...
Monica: DO120 right
Monica: So if you are I mean in every practice you should be doing an exam twice a year regardless what you believe in x-rays you should be doing an exam and if your patients if say you have a thousand patients that say you're my dentist and thousand patients have been in in the past 18 months but yet you're limited exam count is only at 500 you're missing a huge part of your practice and it's usually 30% it's usually 300 I'm giving it a little bit of better percentage.
Howard: It's usually what percent?
Monica: Thirty percent or lower I've seen as low as 12%
Howard: Wow I mean yeah I think the corporate cultures are like but you hear some of the biggest names in dentistry talk about the new patient experience I mean well Southwest Airlines wouldn't talk about the new patient range because everybody's flown Southwest at least once. Walmart Costco I mean I ain't even the high-end market I mean Chanel number five I mean wouldn't it be it except patient experience I mean and then they talk about marketing wanting new patients and it just looks like it's thirty-year-old metrics that you want a new patient with a awesome new patient experience when the fortune 500 blew past that a decade ago and they went they went on they don't do advertising for new patients they do loyalty programs they keep existing programs and they spend their money and increasing the experience while you're applying American Airlines not trying to find that one guy that's never flown American before looking for a new patient and then everybody treats them differently when he walks on the plane because it's brand new. I mean they really are behind I mean imagine retaining only 10 to 30% of your patients and really think that advertising for more new patient's is the key.
Monica: Yeah and I do think you need a mix you need old and new right it keeps you moving and shaking and all that good stuff and I think that you absolutely should have some kind of patient loyalty program here's my example and one of the offices I worked out for many years who did fantastic they did have a new patient experience per se because they're brand new and it's exciting and they've not been in an a they don't have that relationship or that rapport so there was a walk you through the office and introduced you to certain people and show you where the sterilization is and how clean we are but in the hygiene realm because we were pareo every single patient that kept that three-month appointment got a brand new sonic hairbrush head to go home they never had to buy another toothbrush it's kinda like the whole whitening for a life situation. You know have a program that meets your current patient needs something patient of the month.
Howard: and what about staff meetings and morning huddle's you know it's amazing I'm really surprised that how many million dollar practices say now we don't use their morning at all the other ones swear by it it seems like some say it's the the secret sauce and others say no we don't use it.
Monica: I am a 100% firm believer that you should be having some form of a huddle whether it be morning or evening or both ideally and a weekly meeting. If you're not talking about what's going on in your business then how are you focusing on what's not working and what is. I go to my local grocery store and they have Huddle's in the produce section for goodness sakes.
Howard: Yeah that's the one section I've never gone to there.
Monica: Well you live in Arizona.
Howard: I only go to the processed foods and then the liquor department.
Monica: We don't have those here.
Howard: but if I lined up a hundred dentists up against the wall and I said what makes you not want to go to work what does it makes your stomach just ah it's always that I mean it's always staff and they have to have turnover they I mean what would you how are you when you go into the office what percent of the time is the staff not happy harmonious and equilibrium?
Monica: Honest-to-goodness and this is where I have to give Utah plug they call it Happy Valley for a reason the turnover here is very low very very low, culture is definitely not the issue it tends to be my patients don't want to accept treatment and so I feel a bit deflated I'm not good at what I do. So here very low when I lived in Nevada really high I don't know maybe that is a territorial thing or a geographical thing.
Howard: Yeah I also think you know the term I hate the most of the United States of America because how could you compare Salt Lake City to Manhattan, how could you compare Anchorage Alaska to Detroit. I mean we really the Federal Reserve even says and it's published in really interesting papers how the United States really as nine different economic regions flying under the same flag and I think that transient societies are more related to transient staff turnover than when you go into a town of 5,000 and everybody was born there there's just massively less staff turnover.
Monica: I would agree I I was a sales rep in Las Vegas for about a whole year and I can't tell you how many times I was introducing myself every three weeks so yes absolutely.
Howard: I want to ask you another cultural thing about and see it's different Utah everyone knows when you get married that half of them fail and divorce and I know the divorce rates are coming down simply because as the average age marriage goes off divorce rates come down I mean if you get married between 16, 18 you're gonna have nearly as chance and to get married between 26 and 29 that's obvious but when half the marriages fail I've always seen dentists want to be partner with another dentist and I sit there and say really you really want to be married at home and married at work. What have you you been in this field a long time what do you what do you think about 2 dentists getting married and becoming partners at work they think you know the sum of the whole is bigger the whole is greater than sum of its parts and some of your really smart move good move most of the time are not so much?
Monica: I think it depends on the person honestly and are you are you too similar that you can't work together are your visions the same do you believe in the same philosophies, it's like raising children you know you've got to be on the same page and even if you aren't you have to be able to have that uncomfortable conversation if you will or corrective conversation to say look this is what we believe and this is what we're gonna do moving forward and I've seen very many many many successful married you know office relationships if you will work just because they're on the same page and they're talking about it people that stick their head in the sand are the ones that aren't making it work very well.
Howard: Okay now I want to ask you a selfish question for me just for Arizona I got to go we got two dental schools, AT Still in Mesa, Midwestern in Glendale. I don't know what percent it is but at least 20% of classes got to be LDS and they all want to go back to Salt Lake City. They're in dental school now the podcast is mostly consumed by almost everyone that emails at the hour in fact please email me Howard@dentaltown.com tell me who you are I would say almost all I want to go back to Salt Lake City. Talk to that person what should they do?
Monica: I actually taught at both of those schools when I worked for Phillips and it is not saturated here like people believe honestly and I'll tell you why if you want to come straight out of school and build a brand-new office and be the sole owner and the very new person there's still opportunity for that. There's even more opportunity for people to bring in associates when you're fresh off boat if you will you're coming right out of dental school you know everything but your speeds not there and you've got people that are willing to mentor you and bring you into their practice and have some kind of buy-in ownership, why in the heck wouldn't you take care or take advantage of that. So I think if you have that idea that it's saturated and I can't go back to my my homeland or hometown or be by my family then I would say you're not utilizing your resources and you're not reaching out to the right people. There's social media there's all kinds of there's you know dentalpost.Net there's all these different resources online utilize them.
Howard: You're a hygienist and an MBA let's talk hygiene compensation, some people say when you pick a hygienist $40 an hour that they're just like a vodka drinking Russian just you know communism other people say America was built on incentives and centers matter. So hygiene compensation were you more hourly more bonus are you straight production?
Monica: I'm both and I've worked all three to be honest with you I've been straight Commission I've been straight daily wage hourly wage whatever you want to call it and I'm a firm believer in some kind of bonus program that involves your entire team minus the producing doctors your producers should be part of it absolutely and it should be based on production because that gives them a good eye this is the business side of looking into if you're not bringing in 30 percent of the production into that practice then then you're not carrying your weight and you're just getting paid to be there and you're not you're actually missing a lot of things in my experience that they taught you in school to look for or do you're skipping a lot of things you're not talking about things you know people have bloody Profis and you're bringing them in every six months utilize the new hygiene code talk about different products that work like Oral care or varnishes or whatever that might be. I am a firm believer in incentivizing every team member as long as it goes back to the business and makes sense.
Howard: We have really good data about how dental office overhead has been drifting up for 30 years. I mean when I got out of school 30 years ago and was my patients were Barney Rubble and his wife Wilma it was just routine at 50% overhead now they say the average is 65% overhead. A lot of people a lot of people think 20% of dental offices have over 80 percent overhead when you talk to a dentist about overhead I mean staff salaries are just just every time the earth goes around the Sun everyone on your team wants a dollar an hour raise I mean it's just based on the zodiac I mean they they sit there in their astrology charts and they tell you in 20 days earth will pass. So what should staff salary be and is it often high overhead is that often a big problem that you see in dental offices?
Howard: but so Wow when you see labor our team overhead 30 to 35% is that something where you grow your way out of it by increasing production treatment plan exceptions or do you sometimes have to go in there and say Monica we can't pay you $45 an hour we have to cut you down to 40?
Monica: Oh No the first question is oh gosh if my overheads high do I need to let people go or cut their wages and they say absolutely not you need to increase production / collections and so when we talk about our national average of growth is about 30 percent I immediately suggest they put some kind of incentive program in place and they say I can't afford it I can't do it and I say you're already paying them too much you know you're already your overheads already too high and they're not loving you for it so let's make this work for the business and let's make this work for your team and it works it turns itself around and the production goes up and they focus on the numbers and they start having those uncomfortable conversations and so nobody takes a pay cut that is not my recommendation.
Howard: So what so what are your plans but what type of bonuses do you recommend?
Monica: It is based 100 percent off of the net collections total and then the gross salaries
Howard: Okay so it's when the net collections they're in a biology class right now.
Monica: So net collections is the real money right so when you say you've produced a hundred thousand dollars but you only collected let's say 80 80 thousand of that 80 thousand is the real money you might have produced more but you didn't collect that that's not that's monopoly money at that point.
Howard: Yeah and they're but they had the money what's also sad is the money they didn't collect they still made behind us do the cleaning they think the dental materials they paid for this assistance to do all that. I mean all that money so if average oppa had a 65 percent and he produced 80 but produced 100 and collected 80 $20,000 a dentistry was done at 2/3 overhead. I mean I still think the number one cause of is the PPO fils guys I mean it doesn't tell you they turned $1,000 for a crown and then they sign up for all these PPOs and the average crowns pain them you know $600 well that means 40% of our overhead is just from PPO, number two would be team but the collection policy sometimes is one two or three.
Monica: Yes and I don't believe in being a victim to the insurance companies I will say that it's a benefit and we need to again better educate and not be run by the fees and if you're getting paid 40 cents on the dollar by an insurance company just to have patients come into your practice then you might want to look at negotiating those fees and increasing your fees. There's a lot of tactics out there obviously but I just don't believe in being a victim to that because that's not fair to the patient and it's not fair to the dentist.
Howard: Are you having any success with your clients in negotiating with the PPOs to pay higher fees?
Monica: I sure am.
Howard: Wow talk about that.
Monica: I don't have much to say about it because I don't handle that portion a company that I have worked with many a times is called Practice Quotient and they're out of New York and they work their magic in so many ways. I'll give you an example they've turned some you know like if you're on a poor paying plan they might turn you into a premier so again if you're 40 cents on the dollar now you're getting 65 cents on the dollar still not ideal but much better in some cases you were getting 52 cents on the dollar and they grouped it into this you know 7 different insurance carriers or PPO carriers now became this one plan it did nothing to change anything for the patients but now you're getting paid 85 cents on the dollar but again I can't I can't talk there magic I don't know what they do but I've had a lot of success.
Howard: So you like so you're recommending Practice Quotient?
Monica: I love them very much yes.
Howard: Who's the top dog down there?
Monica: Patrick O'Rourke is the CEO
Howard: Patrick O'Rourke, well you should email him and tell them to come on the show and talk about that and so many of you I know you only got two more minutes, if someone was starting up do you recommend they sign up for every PPO or you recommend that they you know to get going or do you recommend they avoid that?
Monica: I'm a huge fan of insurance for for a specific reason it is a form of marketing and if you look at it like that and you utilize it to the best that you have if you have no patience you have nowhere to go but up so yes I don't think that there's anything wrong as a brand new person out of school signing up with everything out there great as you get successful and you learn the traits and you increase your speed etc etc etc then you can be a little bit more picky. Somebody that's been in the industry 10 15 17 20 years absolutely not I think you should you should pick and choose a little bit of what you need and I'm a huge fan of in-office plans an absolute huge fan and that's where I think the future's heading.
Howard: and who do you recommend to set up in office plans?
Monica: You know Fortune actually has their own program that they offer and I you know so obviously I would recommend that plan for health. There's you can even handle it yourself internally as long as you have the right metrics and the right things put into place so it's just in order to be successful you've got to have your ducks in a row all I would say.
Howard: Your website is www.fortunemgmt.com fortune manager .com it was just an honor for you to come on the show today is there any question I was smart enough to ask?
Monica: No I've enjoyed my time and I appreciate it Howard thank you. I love your podcasts.
Howard: Oh thank you so much, I hope you have a rockin hot day.
Monica: Hey you too