Dentistry Uncensored with Howard Farran
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1136 Dr. Renato Viegas Cremonese, Founder of SABER Intelligent Dentistry, Porto Alegre, Brazil : Dentistry Uncensored with Howard Farran

1136 Dr. Renato Viegas Cremonese, Founder of SABER Intelligent Dentistry, Porto Alegre, Brazil : Dentistry Uncensored with Howard Farran

2/8/2019 2:46:00 PM   |   Comments: 0   |   Views: 52

Graduated in 2003 from Rio Grande do Sul University at age 22. Took his MBA on Strategic HR Management at Getulio Vargas Foundation when he figured out that dealing with people was the most important skill to develop. Renato is a natural entrepreneur.  Creative and restless leader. Currently Rena-to leads a team of 30 people (14 doctors). 


VIDEO - DUwHF #1136 - Renato Cremonese



AUDIO - DUwHF #1136 - Renato Cremonese



He has started in a small clinic of 2 operatories in 2006 and now have 3 locations that sums up to 12 chairs including his own emax lab. His last and greatest achievement was a brand new location where his partner (Dr Samantha) and him invested 1.5 million reals (more than 400000 us dollars) to build a inspiring practice with many ideas from Dentistry Uncensored interviews. He´s passionate about sales and dentistry. Renato is a talented clinician that goes from basic restorative to full mouth veneers and implants. His crew is highly trained in delivering a special environment  for the dental treatment, being able to flourish in times of economical recession. Founder of Smiles on Saturdays, a social initiative where a school was adopted by Saber Dentistry in 2006 having already treated for free more than 100 children. Some of them being Renato´s patients for more than 10 years. And of 101 Smiles a social business inspired on TOMS´ (Tomorrow Shoes) idea, a dental clinic for people with poor financial resources where for every 100 treated people, one person receives full treatment for free. (link para video da primeira 101) Father of two lovelly children (Pedro, 3 and Cecília, 1), adores surfing, running, biking and playing tennis. Married to a psychologist to keep himself in balance and rolling!

Howard: It is just a huge honor for me today to be podcast interviewing Dr. Renato Viegas Cremonese, founder of Sabre Intelligent Dentistry in Porto Alegre Brazil. Now I'm sure I butchered all those names and sounds so will you introduce yourself first then I'll read your bio.

Renato: Okay so I am Renato Cremonese from the Dentist of saber. Saber comes from the tooth saber, from the tiger and I'm here in South Brazil I'm talking from Gravataí actually is a city close to Porto Alegre it's about 10 miles 20 miles from porto alegre. We are this southern capital from Brazil the southern state from brazil we're close to Argentina here.

Howard: That's right it's a beautiful place, I love Brazil I've lectured Anna inside do you know the largest lecture I ever gave in my life was in San Paulo Brazil to 4,000 people at the Aesthetica 2000 conference, Larry Rosenthal was there. I mean that was now I feel like a rockstar for a whole day 400,000 dentists it was just amazing. Let me read your bio he graduated in 2003 from Rio Grande University at age 22 took his MBA on strategic HR management at Getulio Vargas Foundation when he figured out that dealing with people was the most important skill to develop. Renato is a natural entrepreneur, creative and restless leader. Currently he leads a team of 30 people 14 of which are dentists. He has started in a small clinic at 2 operatories in 2006 and now has 3 locations at total 12 dental chairs including an Emax lab. His last and greatest achievement was a brand new location where his partner Dr. Samantha and him invested over 400 thousand US dollars to build an inspiring practice with many ideas from Dentistry Uncensored interviews. He's passionate about sales and dentistry. He's a talented clinician that goes from base restorative the full-mouth veneers implants his crew is highly trained in delivering a special environment for the dental treatment being able to flourish and times of economic recession. Founders of Smiles on Saturdays a social initiative where a school was adopted by sabre dentistry in 2006, having already treated for free more than a hundred children some of them being Renato's patients for more than ten years and a 101 Smiles a social business inspired on Tom's Tomorrow shoes idea, a dental clinic for people with poor financial resources where for every 100 people treated one person receives full treatment for free. That's amazing. He's the father of two lovely children Pedro and Cecilia, adores surfing, running, biking and playing tennis. Married to a psychologist to keep himself in balance and rolling. That is amazing deal, So how and your five hours at its 12:00 noon here on a Tuesday and it's 5:00 p.m. because if you look at north and south america, south america is way over to the east and most people don't realize that miami if you went straight down miami you'd actually be on the ocean you'd be in the pacific ocean. So south america is way out into the Atlantic Ocean and and you say it takes you 24 hour drive south of Rio de Janeiro, which is a two-hour plane flight.

Renato: Yes

Howard: Love Rio, that's got to be everyone's favorite city on earth.

Renato: My wife is from Rio actually

Howard:  Is that right

Renato: Yes

Howard: I just I don't I don't feel like life is fair because I didn't get to see Carlos Santana play in Rio de Janeiro that that probably had to be the best day on earth in human existence how did you see that concert?

Renato: No I didn't

Howard: I think yeah I think it was over a million people watch that thing I mean it was just crazy.

Renato: Was he in Rock in Rio?

Howard: I think so

Renato: The festival yeah

Howard: So tell us about your journey I'm one thing I want to point out first since there's so many Americans listening this is that one of the most interesting things about dentistry outside the United States like you have 30 total employees in your company but 14 are dentists Oh 14 and 14 be 28. It's almost like one assistant for every two dentist and it's amazing how when you go around the world you can find a two operatory clinic and two operatory dental office and four dentists work out of there and expanded hours whereas the Americans they they don't realize that one dental chair, there's 168 hours in a week one dental chair open 168 hours a week is the same as five dental chairs open just 32 hours a week and so most dental offices in the United States are closed 81% of the time and every time they get a little busy they think they need more chairs and I just think it's amazing how Asia and Europe and Africa and South America they really utilize their chairs more than any American as they are even dreamed of. How does that work what are your how do you use how do you 14 doctors work out of 12 chairs?

Renato: I think your idea is correct of what we do. Until last year we had only four chairs here in the city where I live and we had the scheduler some dentists they would work from 8:00 in the morning to 2:00 p.m. and some dentists would work from there on. So the chair is never empty you know and also in Brazil many dentists they are okay to work long journeys, like from 8:00 in the morning and to 8:00 or 9:00 in the night. They don't bother working many hours in the same day actually we try to make six-hour shifts here in the clinic and people they don't prefer that they prefer longer hours.

Howard: and how many days a week?

Renato: That's that I also listen to telling that there should be open seven days a week but in Brazil is difficult to to make people work during the weekends. We reopen Saturday mornings but it's difficult to find dances that wants to work Saturdays. We normally save Saturdays for big pieces for example if we we do an exam on during the week and we don't have any available hours we schedule it for Saturday. We don't do professor reviews on Saturdays.

Howard: Well that that's a lot of that probably is from the Portuguese ancestry I know 19 out of 20 people who speak Portuguese live in Brazil but yeah it's true when you go to Portugal Spain France they're a lot more into the work-life balance that they're very very their weekends are sacred the it's I think it's a more moderate nice lifestyle.

Renato: The patients miss a lot of appointments on Saturdays too.

Howard: Yeah

Renato: Unless it's something that they are really willing to do like a big treatment that we have a case then they come more easily on Saturdays.

Howard: and you know I really love that lifestyle down there because when you go to Korea, Japan, New York City, the hustle bustle that the speed at which everything's going seven days a week I I don't think in fact I think the happiest people I ever found in my life was in Kathmandu Nepal. I mean you just couldn't find more laid-back people you know they just didn't need the the 24-hour day hustle. So talk about your journey dentistry is very competitive in Brazil, there's a lot of dentists.

Renato: Actually I think we have the country for more dentists in the worlds do you know about that we'll have three hundred twelve thousand dentists here

Howard: Three hundred and twelve thousand dentists and what's the population of Brazil

Renato: Two hundred median I think now around that

Howard: Yeah so you have three hundred and twelve thousand for 200 million people and the United States has two hundred eleven thousand dentist for three hundred and twenty three million people so you guys have a hundred thousand extra dentist for a hundred and thirty million less people. So what percent of the dentist only do dentistry versus what percent have to have that part-time job in another income source?

Renato: It's not very common to have a part-time job I think it's more common that people just they they make a change in their career and they just give up dentistry and go for another thing you know that's a lot I've heard that 50% of women that graduating dentistry in Brazil they change to another job after a few years.

Howard: So of those three hundred and twelve thousand dentists how many of them do you think are fully employed as a dentist versus how many of them have gone on to other careers?

Renato: I don't know about that I know most of my classmates from college they are still working as dentists

Howard: Yeah

Renato: but is there is very common in Brazil to talk to a dentist and he is not very happy with his financial results

Howard: Yeah so how have you been able to be successful with your financial results in a country that has so many dentists what has been your competitive advantage

Renato:I think we did well, I think one of the main reasons that we did well I think you stated a lot in your podcast is about going to your see your hometown which is Gravataí is not a very big city and my family is well known here I'm from here so the network is good here. Also the competition is not the same as in Porto Alegre where you have the schools the biggest dental schools here are in Porto Alegre. So you have the best dentists there and a lot of dentists with big tradition many years in the in the work and also we have a location in portal angle which is struggles more than the one we have here in Gravataí.

Howard: Now so now would you consider that a rural location as opposed to an urban location?

Renato: It's not rural but Gravataí has four hundred four four hundred thousand people where Porto Alegre has almost a million and a half people it's very urban but the competition is not so big here.

Howard: Yeah

Renato: When we start when we started in 2006 it was quite easy to gather new patients that the population here in the city was not very happy with the dentist that were here before. So we started with a different way of treating people we try to make people very comfortable in our first first year work in my partner and I we used to do some kind of spa treatment where the patient would come for Monday in the dentist and he would do all the perio or the endo and try to do things faster also we would give massages as a present as a gift in the end of the consultation. So this way of treating people I think was the the big difference for us.

Howard: The customer experience always at the end that's everything the customer experience.

Renato: If you check on our Facebook we have a lot of reviews they are a spontaneous reviews people they were to go there and they were to write a big text about their experience here. I think that's our advantage.

Howard: and talk more about that what what is it like to have the new patient experience in your office

Renato: One of the things that we changed last year and made a lot of a lot of difference was that the first appointment experience. This idea came from one of your interviews I can't remember which episode was with that but the patient he comes and the first thing he gets is a gift from the the practice. Where he gets a ice pack of mine or something like this he gets a gift card with a partnership in a place that he can go and have a coffee and eat a cake or he gets a gift card for a massage he gets a whole bunch of things as gifts to make the reciprocity thing you know

Howard: Yes

Renato: This thing is is doing very well for us I think that the first appointment also we got from another episode from the Dentistry Uncensored routine of questions to ask the person, when we are talking to them for the first time we avoid we avoid talking about dentistry up front to try to establish a connection and and see what he really wants even when he calls the clinic he's asked what would you like to do. He is not forced to go to a routine first appointment with all the examinations,  if he says I want to do a restoration he goes for a restoration if he wants to make an appointment with the orthodontist he goes for the orthodontist. We tried to make the patient choose whatever he wants he and the experience he is gonna have. We will take care of this Mel of the clinic we take care of the sound we have massage in all the chairs we have Netflix on the roof, we we try to do something really special for them.

Howard: Yes I'm that a lot of people and have study that persuasion and in fact the guy who wrote persuasion now is a new book pre suasion a revolutionary way to influence and persuade by - Robert Cialdini, who actually lives up the street for me and taught at Arizona State University and my MBA program, he has a PHD but it's amazing the way humans are what the condition of the human being is that if you give them a gift they biologically want to give you back a gift that's why everybody's selling you insurance or whatever that's why everybody wants to take you to lunch because if they take you to lunch your biological Homo Sapien self wants to return the favor and trade with this person. So you're saying a new patient gift has been very effective in your office.

Renato: Yes that's also when we did this new location last year we planned a special office the office I'm here now you can see back there on the wall we call it the ... office. It was planned for people who are afraid of going to the dentist and we are trying to make it as a brand here inside the clinic. So some people go to the Internet and they they they look for fear of dentists and they find this special office here. We all used we don't use the high-speed drill to make it not noisy we have a bigger screen on the roof but the patient can use the the earphone during the appointment so he he can watch the Siri or the the film that he wants to watch. We try to make a special experience for people who are afraid of Dentistry.

Howard: Now whenever you're talking about business you know price is always the most elastic effect on demand, in the United States about half of the 325 million people have some form of dental insurance all the way from Medicaid government to private like Delta Dental. Is dental insurance a big issue in Brazil?

Renato: Yes, yes it is we actually started the clinic with about 8% of our income coming from the delta insurance and 20% was privates is less when you started a pre start of it 8% was coming from insurance.

Howard: Okay

Renato: We actually one of my my teachers in university he invited me to to plan a practice to improve the quality of service of insurance service. The customers were they weren't happy with dentists in their insurance so they planned that beyond the insurance they plan to open their own clinic with high quality service to make all the the chain better you know. So the other dentists they would either get better or give away the insurance to stop working for that insurance. So we started very focused on insurance but we knew that the margin the profit was not very good so we had a plan to year by year change the game and improve the private practice. So nowadays we have 60% come in 61 % coming in privates and 39 percent is coming either from insurance or some kind of agreement that we have with some companies here in the city.

Howard: So you started off with dental insurance to get going but as soon as you you got up and going in cash flowing you've been trying to wean yourself off of dental insurance

Renato: Yes and also we still use the Delta insurance patient we find an opportunity to upgrade up sale it because the insurance in Brazil doesn't cover implants crowns veneer art oh so you can upsell the patients.

Howard: Yes that's a recurring theme I've seen all around the world I'll go to a country like say Malaysia or Cambodia and they'll say well the dental insurance covers cleaning exams, root canals, fillings and you can't make any money off that but if I just place one implant per week out of my patient base or I do one Invisalign case per week then they have an extremely successful doctor dental business. So they're using government insurance or private insurance for a base and then they're trying to pull out high perceived high value procedures like implants or veneers. Is Invisalign a big thing in Brazil?

Renato: It is becoming a big thing it is not a big thing for us yet but we are working hard to make it a big thing here in Saber too.

Howard: Now would you use these would you use the brand name Invisalign or would you just use or find another lower-cost clear tray alternative, is the brand name important or is it just clear aligner therapy?

Renato: No we are using Invisalign here the brand name is important to us but we are also talking to the guys from Straumann that are launching the clear correct here in Brazil now.

Howard: Yeah and straumann is very very big in Brazil because they bought the biggest implant company Biodent down there.

Renato: No Neodent

Howard: I mean Neodent sorry my brains starting to implode at age 56 but so Neodent is that still the largest dental implant company in Brazil?

Renato: Yes 55% market share

Howard: Now they're bringing clearcorrect clear aligners?

Renato: Yes

Howard: and how is that going

Renato: Their really starting it now we just got a visit from their sales guys and they were trained last week so there there are a little bit lost in the what they're gonna do to to gather some part of the market share from bit Invisalign but they have some things that are interesting they have true plans for clear correct one is a aligner by aligner. So you plan the case and the patient pay a line of eyeliner and the other one is unlimited. So you can you can use clear correct for small pieces like free pre rehabilitation cases are going to be you good to be done with clear correct I think.

Howard: So you're saying they have two they have two models clear correct owned by straumann in Brazil one is aligner by aligner and what was the other one?

Renato: Unlimited

 Howard: Unlimited

Renato: Yes

Howard: Okay and would they be would you be oral scanning the the impression and emailing it to the lab or would you be taking a vinyl polysiloxane impression how would the impression work?

Renato: Here in the clinic we would take an impression but there are some images imaging services here in the city that they can scan it for you if you don't want to take the impression.

Howard: So you would call the imaging surface and company and they would come by your office and scan for you?

Renato: They can do that or you can tell your patient to go there and do that on their location.

Howard: That's an interesting low-cost way to enter, a lot of people they decide they want to start placing implants they think they got to buy $100,000 CBCT or they want to start getting into Invisalign and they need to buy an iTero scanner and you're saving a lot of capital investment by not buying that and having the patient go to the scanning center or the scanning center come to you.

Renato: Yes we actually received place here in our location we made that a special room to put the CBCT machine do you think it's not a good idea?

Howard: Well I mean it just comes down to volume I mean you know some kid comes out of dental school I mean you put four hundred thousand dollars into your new Clinic a lot of American kids come out of school $400,000 just in student loans. I mean the two schools in Phoenix each costs 100,000 a year for four years so if you've already spent $400,000 on dental school do you really have a hundred thousand dollars for a CBCT and a hundred thousand dollars for a hard tissue laser and a hundred thousand dollars for a CAD CAM. I mean I love the way that so many countries around the world they go in very low cost with just one chair. I was surprised in Singapore almost every dentist that I podcasted in Singapore on location in Singapore most all of them only had one chair to their name and a bigger office had two and it's just amazing how they would they were so low cost, like their office phone was their own Apple iPhone or Android they just had one chair and they wouldn't do nearly as much of the volume but they would net so much of their income. I mean they were just they were dentists there I met all day long that might only do three hundred thousand dollars a year us but they would take home two hundred thousand and it just seemed like a lower stress lower volume and a lot of dentists and I say it's I make $200,000 a year their roller-skating around five different operatories all day long from 8:00 to 5:00 at the end of the day they look like they've been hit by a car and it's just it's a matter it's just a there's so many different business models in dentistry but I think you got the key, one is that the human experience I mean that's what you know Robert named Robert BC and Aldi in his book influenced the science and practice of influence. I mean that you know if you get to cut the new patient experience the customer experience they every day. If they connect with you and they bond with you they're gonna do business with you and it seems like your big competitive advantage is just having a really nice happy place to go to the dentist.

Renato: Yeah I think so but we also think if the patient can do the whole 360 experience here it would be better to them. Nobody wants to come here get the prescription for the exam go to another place have to park again in another place that's not convenient you know. Parking here is not an easy thing to do.

Howard: Yeah I agree I mean you gotta go to Kathmandu Nepal that city was built when the roads were not even wide enough for a horse and buggy I mean you're talking about a 500 year old city there I mean it was amazing. By the way the CEO of a straumann we podcast interviewed him on 839 with Marco Dola. Now are you placing implants yes.

 Renato: Yes we are and after this podcast we taught our clinics here how to place implants the civilian cases you know. So I listened to this podcast and I saw that if the the clinic's the general practice they they have the knowledge for implants, they they can see more opportunities to treat. So we change that and this year we did 400 implants here in our dental group there are three locations.

Howard:  and were those all Neodent implants or what type of implant?

Renato: They were a 126 were straumann and the other the other ones they were Titanium fix which is another Brazilian company

Howard: What's the name of it titanium fix

Renato: Yes

Howard: and why and why do you what makes you use a straw man and what makes you use a titanium fix

Renato: We used Strauman as the premium brand that the one with the most value for the patient and we used Titanium fix for the low cost option. In our low cost bread the 101 smiles we use only Titanium Fix and the commercial agreement with them was amazing they gave all the surgical teams and they gave a lot of support their salesperson gives a lot of support for us.

Howard: Well it's a pretty good sized company because on LinkedIn they have a hundred and twenty three employees. So must be doing good. So your sounds like you're placing a lot of implants and you're starting to increase on clear aligner therapy.

Renato: Yeah that's the plan

Howard: Now do you charge more so is the patient being offered a higher cost implant through a brand-name Strauman and then a lower cost implant at a titanium fix is that how you do it price segmentation

Renato: Yes we actually talk to the patient and try to figure out what kind of patient needs what kind of buyer he is and then we explain the advantages of Strauman and if the person is looking for something cheaper we then offer the the option of Titanium fix.

Howard: and what is the price difference?

Renato: It would be $300 for this surgery and $300 for the crown $600 for one went to the difference to them.

Howard: Now you know when when you're leading a big team I mean you have three offices with 30 employees 14 in which are dentists. Now when I look at dentists coming out of school you know the only way you can get into dental school is got to be a bookworm you got to get a's and calculus physics all this stuff i got they just really don't come out with the skills to be a leader and build a team and how do you get 14 dentists to work for you? One of the biggest problems with associate dentist in the United States whether it be private practice or that big DSOs is employee turnover of associates most associates only stay in their job a year or two and it's the same it's even to the same in high tech. I mean you take companies like Amazon their average employee only sees about a year Facebook it's only two years. How do you were you born a natural entrepreneur or how do you get the skills in order to lead a team like that?

Renato: Well I always liked that part of the business but also I went to the MBA to learn about it and since we I think we were one year old the company was one year old when I was I went to study the human resources things. So about that time we tried to create a career plan for our dentists here so the person who comes as a junior dentists and at this time I think we retain them giving knowledge to them, trying to give as much knowledge as we can. Try to help them to do big cases trying to teach them how to place an implant how to make veneers. I believe you're right and the way you think about it because I think dentists they want to do the complex stuff you know they keep they come out of school and they want to do big cases, we have kids most of them. So we give a lot of knowledge in the years they are started here and after that when they start to get better and their financial results are good we try to make them partner of the business. So they start knowing that if they go well they can become partner in the business.

Howard: So you started in 2006 and this is 2019 so how many of them are partners now 13 years later how many of those 14 are partners?

Renato: Three of them they are partner and they run the the location we have in Porto Alegre.

Howard: So you own the business and three locations and you have a partner in each location?

Renato: Yes the location in Portal Alegre is ran by these three guys actually two guys and a girl. One of them is also partner for the whole group for that for the comfortable company and the new location there were 101 Smiles they are in the process of becoming partners. So they received a project a administration project, so they have the year of the 19, 2019 to give results and they get the opportunity with the shares they do in this year this they can buy some shares of the company. Also there's another dentist that was invited now to replace one of our Partners important leg that is moving to Australia.

Howard: Wow that is amazing why is he moving to Australia was it love?

Renato: His family is all family went to Australia so he's going to his brothers are there already his parents want to go also and he did the first part of the validation of the degree there. So it's probably going to be a dentist there too.

Howard: Wow it is amazing I there's seven and a half billion people on earth and less than 1% live in a country they weren't born in and they mostly leave for family for love for Economic Opportunity and that's a yeah that's a rare behavior. So I'm I you said something very profound that I want to repeat and that is I'm you say that you're keeping your associates because you know what they want and they want knowledge and when you look at all the DSOs in the United States the DSO that keeps them the longest from my interview knowledge is a Heartland dental and that's what they do they put them on all these curriculums, they say well if you stay with us for five years you'll get your FAGD and you might get in the Academy of General Dentistry you might get your diplomat and implantology or whatever but the reason they're keeping their doctors is because of their intense continued education and then the opposite of that when I go into the private sector and all me I was lecturing the other night and I met a lady she's been out of school five years she's already had five different jobs and her complaint with everyone she worked for is that the older Dr. stole all the complex cases and was just given her fillings and single crowns and she thought my god I'm wasting my time I'm already out of some line. So it's counterintuitive if you're an older doctor and you have a young associate they want to do the big cases that yes and it's just counterintuitive for you to think that you don't want to do that so in fact some of the most successful older doctors I know they just do hygiene checks, case presentations sell all the big cases keep the you know this guy has been in this small town for twenty thirty years he's pressing the flesh running for mayor, you know walking out in the waiting room all that kind of stuff and is really good at case presentation and presenting these treatments but then when the big treatment comes they're pushing it off to their associate and I and I also think about this partnership interesting is that. In law I think the lawyers are at least two rowdy

Renato: Yeah we copied the law style

Howard: Exactly I mean you're you're an amazing mind because the law firms about half of the lawyers and there's a million attorneys in America about half them or private practice and half are in these big firms but the one thing they have in these big firms is they come in as a junior but if they work hard attract some clientele win a few big cases they make him partner and I just don't think that the, I don't think the final business model of DSOs dental services organizations in the United States. I think III don't think the final business model has yet been implemented. I think it's one of the reasons they haven't gone public, I think it's one of the reasons you know they this self but but like Price Waterhouse I mean what an amazing partnership strategy for their partners that they keep a Price Waterhouse for a long time, law firms the same thing. So talk us about you journey so you you modeled your partnership off of lawyers tell us what you did and how you learned that and and what that actually means

Renato: Yes this idea actually came from the net Netflix series suits have you seen it?

Howard: Netflix fairy suits?

 Renato: Suits yes

 Howard: No I have not seen it.

Renato: It's a law firm in New York and my partner and I we were watching this series and we first was a good idea to try to copy that to the company. So the the company so we hired the accountant that had some experience in that and he had already done for another health company. So he designed a special contract for us that a special document that we use for our dentists to become the parenter and stuff.

Howard: Wow I wish you any chance you could post that contract on Dentaltown?

Renato: I think so we'd have to translate it to English so

Howard: Well you know that the Google translation I just cop I just hit ctrl a and then ctrl C and drop the whole thing into Google Translate and it's amazing how good Google Translate is. I mean just just five years ago it was pretty choppy but I don't know what they've done in their research or algorithms or what-have-you but they're they're Google translation is amazing. So what is the basis of the deal you make so many total shares of the whole company and then how do you value that then how do you

Renato: The document has the evaluation formula there for the entrance of a new partner and also for the exit of the partner and always the entrance valuations bigger than the exit valuation. So the company stays protected to to stay stronger you know.

Howard: So it's more expensive to buy in and less money to sell and some

Renato: and also their are some rules that must be fall apart must be still working in the company you cannot be a partner and leave the company no, because it's not big enough to support someone that sits at home just waiting for the optimum shares, profit.

Howard: that is amazing you know a lot of dentists tell me they're very stressed cuz they graduated four hundred thousand dollars in student loans and I tell them that's really only the price of one child I mean it costs four hundred thousand dollars to make a baby and graduate from college. So if you graduate $400,000 student loans you're gonna have three kids just have two and you're even-steven but when you do get married half the marriages fail and you always tell them this to get a prenuptial agreement, you know but they never do and then they'll go in and they'll go become a partner and sometimes with a family member like their dad or whatever they buy in but they don't have an exit strategy and when you get a divorce with a dentist it's brutal and you go to court and the judge is just sitting there saying all I can do is look at what you guys agreed on and say this is legal and you got to agree but if but if there's nothing in writing and then there's no penalties and what you know they're like what do you want me to do I'll give you an example a dentist worked for another dentist he told them he can't when he leaves he can't steal any patients bla bla bla the dentist leaves five years later. Prints out a list of all the patients emails and contacts them all and says we've moved and so it made it look like you know that the the office moved and and then it goes to court and then the lady says and then the judge says well yeah you said you can't do that but you didn't put up penalty in there if they did that.

Renato: Yeah after after I heard about the no compete in one of your episodes we added the non compete agreement they are also. The dentist also knows by the time he is entering the company he knows exactly what he can do to become a partner because I have some friends here that work for law firms in Brazil they have the promise of becoming a partner sometime but they don't know what to do to become a partner then they work hard and the invitation never comes you know. So we tried to make it all clear also many people want to leave abroad and have an international experience sometimes so we added that too if you want to stay one year out and studying dentistry or not it makes a difference for the document know. If you want to stay two years out you can do that too and that is the a special rule for what happens with your profits if you are out of the business for a while.

Howard: Yeah and another way to make it really simple also is you can be in the deal that if if this employee if you if you violate the terms this condition like you know the no compete clause and you set up a dental office down the street or you contact patients or whatever you have to give me you know say it was a hundred thousand dollars u.s. or something like that. I mean just put it in writing then the judge can say yes you did violate the terms of this agreement on these three areas and you signed that if you did any this you owe this person $100,000 US and do that. When dentists in Brazil studied dentistry abroad what are the top like three countries that they like to go to?

Renato: I think the United States is one of the countries they like to go I have some friends that been to UK to I me and my partner we went to UK in 2003. Just after graduation we went to one month internship in Wales. Many people watch Australia too they normally choose English english-speaking countries because we study English in the school here so it's easier

Howard: It's easier for you to learn in English than it is in Portuguese

Renato: No Portuguese is there but I don't I don't listen about people going to study dentistry in Portuguese speaking countries abroad from Brazil I don't know anybody that did they went too far to go to study dentistry

Howard: That is amazing where do you most Brazilians in America live seems like all the Brazilians I know are mostly in Miami is there a favorite where is the largest Brazilian population in the United States?

Renato: I think the largest is in Orlando, isn't it?

Howard: Is it Orlando,

Renato: Yeah

Howard: Yeah that was what am I agree too. So what is the Brazilian what is the really famous dentist in Lisbon, Brazil? Paulo Malo

Renato: Paulo Malo

Howard: Yeah he invented the all-on-four and he has very very large. He was a podcast number 571. I mean that he might be the smartest living man in implantology, I mean obviously you had you know a lot of a lot of famous people but I think he might be the smartest guy in implants have you ever did you watch his podcast on

Renato: Yeah

Howard: Yeah he was amazing and then who's the the other one Miguel Stanley he was podcast guy he was early he was number 87 but he's got a really big Learning Institute called, you go to MiguelStanley.com or white life design have you heard of him?

Renato: No I haven't listened to that episode, I was trying to remember how did I found I find the Dentistry Uncensored where I can't I can't really I'm not really sure I think I was just searching on Apple podcasts and I must have written something like dentists podcasts or something like that. I'm not sure how how did I found you, but it was about two or three years ago and I think if you run your analytics on podcast download for Dentistry Uncensored you gonna see that here in our city everybody's listening to it now.

Howard: That's so cool I just love technology I love that iphone are you on an iPhone or an Android?

Renato: iPhone

Howard: You're on iPhone, yeah it's really weird because Android is so much more popular around the world but dentists just love iPhone. I mean when people log on to dental town we can tell if they're logging on from an iPhone or an Android and I mean gosh dentists just loved iPhones. That Dr. Miguel Stanley in Lisbon Portugal he has a hundred thousand followers on his Instagram page. I mean I only have like 15,000 I that guy is a legend you should you should look into his courses on if Portuguese. Now when you do what percent of your time do you speak Portuguese versus English?

Renato: No I only speak Portuguese no I was really afraid of being interviewed in English because I listen a lot to English listening to the podcast and listening to movies series English.

Howard: Yeah and that is amazing I I what do they call someone who speaks two languages bilingual what do they call someone who speaks one language American that's the joke but yeah I and a lot of people are just afraid like I have a lot of really good friends who are amazing dentist and some of them even lecture but they won't come on the podcast because when they they're afraid of public speaking and when they do public speak it's a very controlled slide program and they might practice it ten times at home for an hour presentation to a study club. I'm like dude let's just let's just meet on a podcast like we're having a beer and then just fright and in fact what am I almost convinced them I said how about we go to the bar and you get you get wasted and then you come on my show and they almost consider that. So yeah

Renato:When I was living in London so after I went to Wales I lived in London for six months and I was working in a bar there and it was much easier to speak tough after a few beers you know.

Howard: Well you know that's that's a very interesting thing where the case presentation the bonding is everything and I always tell Dennis you know you should you should join a Dale Carnegie study club do to learn how to talk to people get up front a Toastmasters club like if you're too afraid to come on this this show how are you presenting dentistry, you should do a Toastmasters to learn the public speaking and they even went through the comedy club in Tempe because I think stand-up comedy is the most brutal because you only have one minute to win them over and if you do if you drop two bombs you're your booed off the stage. Another another great class is improv where three or four people come out there and they just tell you what what the situation is the next thing you know you know you're some you know some existing character person or whatever but communication is everything and

Renato: It's something that we use here in our business model that you might like have you ever heard of the book Strengths Finder?

Howard: Strengths finder

Renato: Strengths Finder from there Gallup Institute's

 Howard: No Strength Finder from the Gallup Institute. What is that about?

Renato: That's a book that they've researched their their research on managing and leading people is very impressive they have like three million people investigated already and they figured out that if the person is working on his strengths he is way much more productive. So they developed this test that can show you which are the five talent natural talent areas for every person. So everyone that enters the company here is given a book and he takes the test and we try to develop the place for this person aligned with his strengths. So if someone is strong in charisma and communication he's gonna he's gonna take the first appointments if he's not you don't want to put this person to have a first appointment no he's gonna drain his energy instead of getting fuelled if energy after a first appointment. So there are some dentists here they work only their specialty they just received the patients after the treatment is sold

Howard: That is amazing so the book talks about them basically this this book StrengthsFinder says that a strength finder 2.0 argues that we should forget about fixing our weakness and go all-in on our strengths instead by showing the...

Renato: That's the positive psychology thing you know you you stop worrying about the gaps that everyone has because you won't get much developing in there and you start to worry about how good he can be in some area you know

Howard: One of the quotes says you cannot be anything you want to be but you can't be a whole lot more of who you already are. So exaggerate your strengths instead of fixing your flaws believers and futurists make for great co founders. I think that's an interesting deal, a believer is someone who can't separate motivation from belief. What is your thoughts on that?

Renato: Well you first you you asked me how did I manage to get a big team of dentists who willing to work for us here. I think I'm a big believer I can see things sometimes my partner even complains that I go too far away and then she needs to figure out how you're gonna do that and so we try to work out styles together because she is really different from me. She's not even practicing dentists anymore she's only managing the clinic now and sometimes I go too far with the ideas and she needs to figure out what are the steps to go there and so first I used to worry about that and try to be a big planner but I cannot plan it step-by-step. So I just accept that I'm like that and I I believe that things will do well will go right and I just try to follow that.

Howard: Follow I would say I can't believe we've almost come up an hour my gosh this has been so fun talking to you I'm talking about treatment plan presentation. I mean it seems like when they come out of school the patient comes in with 32 teeth and they just point to the one that's bothering them or broken or in pain and the dentist to fix that and it takes about five years to learn how to well heck if we're gonna numb of that tooth might as well do the whole quadrant and it takes another five you're talking about 10 years out of school before they just start diagnosing and presenting full mouth treatment plan but when I talk to dentists the things that stress about the most is their employees, presenting treatment they say things like well I don't want to be a businessman I'm not a Salesman I don't want to sell you dentistry. How do you coach a young child to realize that that patient has competitive force in the marketplace they might want to buy a thousand-dollar iPhone they might want to buy a $30,000 car they might want to go to Sydney Australia on vacation and you have to make them want to value dentistry and instead of just valuing one tooth or one quadrant, so how do you coach your how do you present treatment and how do you coach your 14 associates and partners on how to be better treatment plan presenters?

Renato: This is a big issue here too when I go out of school here we were trained not to sell the dentistry. Our teachers they they repeat time after time during school that selling this bad is not good. So we we start our training here giving a manual of sale, of selling treatment that's the first thing we will go on with our dentists here to try to change this idea you know. So we start making them figure out that they are gonna have to to get good results for them so they can be happy and reach their goals in life and they also wants to get the new iPhone. they also want to go to Australia. They want the same things that the patient wants in the end of the day but our our biggest ethical issue I think is to make patient know what he really can do with his health. So we don't try to sell anything to people we try to make him know exactly what he can do with dentistry nowadays. We try to show the great things that are available the technologies and stuff and another way that this sell process is in under interact you know they will ask for treatment after you show everything that can be done, because nowadays people wants to have a beautiful smile too. So instead of telling people you are to look ugly you can tell them do you like to take pictures do you like your selfies. So it's a whole change of the communication process that make people ask for treatment. I think it's episode 673 there's a guy and don't remember his name who tells a sequence of questions to ask your patients in the first appointment that sequence changed my conversion rates. I was naturally good selling treatment but when I when I started communicating with people trying to make questions and make the end of the conversation becomes the patient asking for something the whole conversion rate changes.

 Howard: That is amazing

Renato: We are not very successful coaching that I think there are two kinds of people that's not Strengths Finder tells you to we have we have two different teams here in the company. We are half of our team is good on that and if you coach it to them I you get good results but half of them don't like to do that so you need to stop coaching that, you just need to make these people help the people from sales and the thing that we are trying to do this year is that people who doesn't want to sell they can create the opportunity for one of the guys who likes to sell and he can get some part of the sell for him after the treatment is converted you know

Howard: When I got the Phoenix in 1987 one of the largest group practices I knew gosh I don't in fact he had a castle on the site at Camelback Mountain I forgot his name and I think he had like six or seven locations but that's what he did he got the best salesperson to do all the new patient exams all the recall exams and he said that this guy is a communicator he can sell he can present. I don't want to waste his time doing fillings and crowns and root canals whatever. So in every one of his locations he had an all-star diagnosing train bus so someone who likes that and that's what you're saying with that book, that in instead of trying to be something you're not trying to develop more of what you already have and you cannot be anything you want to be but you can be a whole lot more who you already are. So maybe that's something you can think about if you're in a group practice who's the best diagnosing treatment planner comprehensive dentistry takes digital photographs and roll cameras I still like the pano more than the CBCT for presentation because when a patient looks at a pan oh they get it when they look at a CBC tee it looks like they're staring at the Hubble Space Telescope.

Renato: Yeah we use more the DSDs, we have a person here who is not even a dentist she was trained to make a DSDs the computer and we take one picture and the first appointment a few minutes after the patient leave the clinic for the first appointment she receives he or she receives on the whatsapp the picture with the new smile that she can get here in the clinic. So we are using a lot a computer and pictures here to support the presentation.

Howard: When you talked about dental schools are they do they teach you shouldn't sell are dental schools more private or public in Brazil

Renato: but they are more private I've been to a public school who is very focused on training dentists for the public service. So they don't they don't even teach anything about administration or communication or sales.

Howard: and how long is dental school in Brazil?

Renato: Its five years

Howard: Five years five years out of high school

Renato: After high school yes

Howard: It's a five year straight program

Renato: Yes

Howard: Yeah they used to have that believe it or not when I tell you this no one's gonna believe it but back in the day when I was at I graduate high school 1980 University of Missouri Kansas City actually had a six year program for dentists and MD's and they were recruiting straight out of high school. I think they didn't like that program because a lot of kids at eighteen changed their mind when they were 19 or 20. I think the schools got away from it just because they wanted you to do your undergraduate degree to really find out what you want in life and usually the boys spend the first year thinking that what they want is beers and girls and it takes them a while to get settled down and...

Renato: I start dental school at 17

Howard: Wow that is amazing well I can't believe we went over an hour is there anything that you wanted to talk about that I didn't bring up?

Renato:  I think you would talk about the 101 Smiles

Howard: Okay talk about the 101 Smiles

Renato: That's a new idea that we started last year here. Brazil has a lot of adventurous people you know it's about 20 million people with no teeth at all and after 65 years of age at least one missing tooth is very very very common. So many of these people they don't have the financial situation to go to private practice like Sabre. So we decided to open a new brand with low costs because we also received a lot of patients coming from low-cost DSOs with treatments that were not very good so we need to do all the treatment again for a person who had difficulty to pay the first treatment was not very interesting. So we started this new project and we also made it a business with a social goal where every hundred patient we treat we give one treatment away totally free. We choose a person from a project that helps people with no money at all so we already treated four people we started last year we are close to to reach 500 people there and we already treated four people there for free.

Howard: That is amazing also when you talk about them ident are you or do you use ident.com?

Renato: No I don't use it

Howard: Is that is that very successful in Brazil?

Renato: If you search for dentist on google it might appear on ident too

Howard: So Ident  is the largest portal of dentistry in Brazil but that was kind of like the old AOL model where people thought that you were gonna enter the internet through a portal and that's why Time Warner gave away all of its money to buy that intern store to AOL and then it turned out that people enter the dinner the dental world through Google search.

Renato: Yes

Howard: So are you saying that idents kind of large the same thing it's kind of the AOL of dentistry in Brazil but most people are going on the Google.

Renato: Yeah they go they go to Google they find either your homepage or your Facebook page or an Instagram, Instagram is is really big here now bigger than Facebook.

Howard: and why do you think that is?

Renato: I'm not really sure I the social the social media and social network is good because people can they can find the reviews there the the reviews are very sincere they really translate what the person experienced here. So I figured works very well to support your brand.

Howard: You know so I'm giving away my age it was in the year 2000 how old were you in the year 2000?

Renato: 2000 I was nineteen

Howard: oh my god you're making me feel so old but it was in the year 2000 that American online agreed to purchase Time Warner for a hundred and sixty five billion dollars and what would be the biggest merger in history the company was renamed AOL Time Warner and my gosh that was the biggest disaster in the world not knowing that Google would come in and people would not enter the internet through a portal. Well hey um gosh I'm gonna be I'm allegedly lecturing in Bolivia this year. I don't know when it was this year and all I got to do is drive my car across Bolivia across Paraguay and then I'm right at your house and I'm gonna have to come see I might have to fly over you go to Bolivia much?

Renato: No never been to Bolivia.

Howard: You've never been to Bolivia what about Paraguay?

Renato: Never been too far, we go to Uruguay

Howard: So  you go to Uruguay

Renato:Uruguay yes, colonia these are beautiful cities to visit

Howard: and why Uruguay and but when you go to Uruguay do you ever go down to Buenos Aires?

Renato: I've never been to Buenos Aires  I've been to Colonia which is just across the river. My wife really wants to visit buenos aires some time but I've never been there.

Howard: My god I just love South America the people the culture and one last thing about Brazilian dentists kind of reminds me of India in the fact that almost every dentist you meet in Brazil or India is related to a dentist are you related to a dentist?

Renato: No Im not

Howard: but of your 14 dentists that work for you how many of them have another dentist and the family?

Renato: At Least one two three four if you consider divorce

Howard: Yes I do

Renato: Maybe half of them

Howard: Yeah it's funny because that's the way it's been all through human history like you know people in fact a lot of last names just come from your

Renato: I think also because during dental school is there's so many hours inside dental school and that's where they get me to meet each other and they don't don't get to know people from outside dental school and that's where they start you know. My partner she used to be my girlfriend during dental to school.

Howard: Oh now she's your partner

Renato: Yes

Howard: Yeah in India I think in India and send towel both of those times I went to a house and the family just the family between grandmas and grandpas and uncles and cousins that right. I think the one in India I think the one in Brazil had like 30 dentists in the family tree and the one in India had like 28 or something like that I mean it was just unbelievable how cool of a family business dentistry was but hey I want to thank you so much for having the guts I mean to come on to a podcast in English as a second language. I mean there's no way I could have done this port this podcast in Portuguese and you were amazing and smart and energetic and everybody listening to you learned a lot and I just want to thank you so much for coming on the show today.

Renato: I hope the english was not so bad I hope you can understand everything that I told you and it was a deep pleasure to be here. Like I told you in the beginning you're like an Idol to me I used to tell people here that you are my parent from another life you know because when I started listening to the podcast I was oh my god that guy he Phoenix like exactly like I think you know so I started reproducing your ideas here.

Howard: Wow that is just awesome and I'm old enough to be your dad it sounds like so so just say I could be your dental dad

Renato:Yes

Howard: Okay well hey thanks for all that you do for dentistry thanks for listening to the show and thanks for coming on and being on the show today

Renato: Thank you you do a good job for us 

 
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