Howard: We are live at the Townie meeting in Scottsdale and we have four Canadian dentists who all went to school with each other who have been out ten years introduce yourselves.
Angela: Hi I'm Dr. Angela Snider I'm originally from Emmington and I practice in Ontario and we all went to the University of Saskatchewan.
Nicole: I'm Nicole Adams and I currently practice in Calgary, Alberta.
Krista: I'm Krista Maedel and I'm from a small town Saskatchewan Kindersley and I currently practicing Kindersley as well as Rosetown, Saskatchewan.
Lindsay: I'm Lindsay Yaworsky and I practice in a small town like Krista in Yorkton Saskatchewan.
Howard: You know I've been out 30 years and you guys have been out ten years and I think if I was in dental kindergarten school right now I'd rather listen to what's it like from someone who's been out ten years as opposed to someone about 30. A Lot of times they see some somebody came out thirty years ago they think well that was so long ago everything's different so let's aim this at the people that are still in dental school because you guys are ten years out. If you could go back and know what you know now as you did when you're in dental school what would you be telling yourself in dental school, what advice would you give them?
Angela: All sorts of things probably, I think the thing that's probably helped us the most is our class was very very close we made really good relationships clearly we're doing CE together ten years later and we have each other to bounce ideas off of take CE together, when we don't know something like yes there's dentaltown we can set it all up but I have three great people on text message that I can send and get it instantly to know what's going on.
Nicole: Having worked in a well small center big center and rural don't be afraid to go rural it's like the best place to practice, you're gonna learn the most and then get on I tell friends family who are in dental school get on dentaltown like read whatever you can yeah.
Krista: Same thing with Nicole I think rural has been huge for me I spent five years in a really small town kind of thought I was just gonna go there for a couple years and just the experience I gained and being able to do you know all sorts of things that I probably wouldn't have got to do and just be so busy to get the experience was really critical and I had a hard time leaving it. I left to go to the city and I was back a couple years later to rural just cuz it's just such a such a great place to practice, the patients are very kind genuine and supportive.
Howard: I want to stop you there because you know business is supply and demand go where their not, go where they ain't and I see two dental schools right here in the Phoenix Valley one's an AT Still Mesa ones in Midwestern in Glendale and where does every kid want to go and they graduate Scottsdale. So why do you why do every what does everybody hate rural and why do you like it?
Angela: The best thing so the town that I live in working right now is Deepriver, Ontario so it's building hour and a half outside of Ottawa veneers specialists is bare minimum 90 minutes away a lot of our population are kind of older people that when it's snowy they're not gonna go so they're not gonna go see a specialist in the winter. So the option is okay you need this tooth oh you need to root canal yes you know you can go see the specialist like we'd be great if you go see the specialist especially for this you know upper molar and they say no I don't want to like okay well the alternative is we take the tooth out or I do it yeah if you don't if you'd say no I'd rather take the tooth well let me do it and I get to do all these things that I would not get to do if I was living in a city where the specialist was across the street. So the patient is happy to be like oh yeah I don't have to go I can get this done if it doesn't they're like well I was gonna have it taken out anyway so it's not a big deal to get to do all these crazy awesome things that you would not get to do if you're practicing in the city. So you get better at everything I mean it allows you to then pick and choose what you actually want to do and choose to do because you still can decline and say no you have to go to the city but you got to do a lot more.
Lindsay: and can I add to that a little bit, I'm in a small town too and I think that people don't realize that you can you've said this on your podcast you can work three or four days in a week in a small town and you can fly wherever you want after drive the two hours to the airport and go wherever for the weekend whereas if you're in a city you're gonna have to work five six yeah weekend's evenings I don't work evenings or weekends and it's great I work three or four days a week it's awesome.
Howard: and then you go to like some LA place where you meet some dentists who had to live on near the beach and you say well how often do you actually go to the beach, he's like well I didn't go last year. So you made this horrible economic decision to go where there's a dentist for every 300 people so you can live by the beach and now you're poor and broke as a dentist and you still don't go to the beach.
Lindsay: Exactly exactly so yeah I would I think that's huge like if you're willing to go rural if you're willing to just step outside of your comfort zone a little bit you can gain like a ton of experience and like have a great opportunity and a great lifestyle.
Howard: So I want to ask another question I want to take advantage of as a demographic thing, a lot of women in dental school are emailing me and asking me and they're posting on dentaltown they're saying I'm so torn because I want to be a mom and I'm gonna be a dentist and their questions very succinct they say well should I go work for Aspen so I just work Monday to Friday 8:00 to 5:00 and then I don't don't worry about the business of it at five o'clock I can go home and be Mrs. mom because the truth is I know this sounds bad but if you're a woman dentist married to a male dentist you're still gonna do more of the child-raising do you agree with that or absolutely so I don't know if that's biology or we're stupid it just I don't know about what is woulda, shoulda, coulda it just is. So the succinct question is if I really want to be a great mom would I be a better mom as an employee for Aspen, Heartland or a DSO or owning my own business?
Angela: So fun fact about us I work as associate I have two kids.
Nicole: I'm an associate.
Krista: and I own two practices and have one kid and I 100% think you should own your own practice and yeah instead of working for a corporation do it on your own if you have the team to support you have the system in place it's very very doable to be a mom and a business owner I think it's...
Howard: So are you the only business owner here?
Lindsay: I'm a practice too.
Howard: Okay so we have two associates and two practice...
Nicole: We follow our husband's careers around a little bit.
Angela: Alot a bit
Howard: What does that mean you follow your husbands career around?
Angela: My husband’s in the Military.
Howard: So even though you make more money than your husband you feel the need to follow his career?
Angela: So complex, this career has been very fortunate for me because we for him to do his job he can only be in certain places in the country and I'm fortunate to have a job that I can take anywhere with me so yes in the grand scheme of things would we make more money if I owned a practice and we stayed in one place absolutely but we've had like a ton of life experience we've got to I practice in the UK because we were in the UK for a few years I did all my licensing to practice there so I practiced in England and I've been able to move around and still you know get to do all these things and see all these things and yes.
Howard: Well I remember a case where that comes from we're in Phoenix there was a woman dentist back in like 89 and she was bawling hysterical because she got out she opened up her office in Phoenix and very very successful and then her son her husband was with that copper company and they transferred him to another copper mine and he said come on let's go and at the time he was making like sixty thousand a year and she's making like 120 but she owned her own practice so the move set to sell her practice and and it was very troublesome and I said well what are you gonna do and she goes well I don't want to blow up the family I'm we got two kids and she goes he should get another job but he's not so I'm forced with either blow up the family or do it so she sold and went but she did tell me that then that you know looking at him she was not gonna own again she was gonna be an associate because she wanted the liquidity of movement.
Angela: There's benefits to it.
Nicole: Yeah and like I mean my spouse I mean that's important to have a good family life and he's got great job satisfaction so we kind of compromise there but I've been fortunate to be mentored in my associateships by phenomenal dentists so I'm lucky enough.
Nicole: Her uncle in Alberta and it's been like if I was still in the first practice that I was in and we hadn't moved like I don't think I would have grown as much as a dentist so it's been great to be an associate that way learning from others seasoned dentists and I'm at a stage now where I'm pretty comfortable with how I'm working and my lifestyle three days a week, life is good.
Howard: Now let's hear from the practice owners.
Krista: I guess with I was associate for five years before I bought my practice so I have seen both sides of it definitely the associateship is nice when four o'clock comes along you do leave and you go about your life. I don't have that now I mean there's a lot of evenings I'm spending at the kitchen table on my laptop doing work but I'm hoping I'm fairly new into ownership when one practice I've had for three years and then the other for just a year and a half so things I would say are getting better every month and able to kind of step away from some things it's not as consuming I guess as it was initially and I think yeah once you have the support and the systems and I'm hoping that I will have maybe that associate kind of at the like be able to walk away I guess.
Lindsay: I'm an owner as well and I think I was an associate for a year before I went to the practice I'm currently at and then I bought in after a year and I think yes it's very hard at times but it's also very rewarding and if I need to change my schedule I can change it, which I'm sure you guys can do in your associateships but I don't necessarily think that about maybe corporate dentistry but I think although we have all had different paths we're all like fantastic mothers and friends right and it's just whatever works for your family.
Howard: Now do you know your owners do you have partners or are you a sole owner?
Lindsay: I have one partner
Howard: and it's another dentist, is it your spouse or?
Lindsay: No my husband is a teacher, so I am the breadwinner so for me I don't really have to follow him he kind of follows me which works for us yeah my business partner is great and he's probably seven years out from retirement so it works well for us yeah.
Howard: Now do you have a partner?
Krista: No I don't.
Howard: So I want to go in with you because you have a spouse and a partner and they're both men right?
Lindsay: They are.
Howard: So a lot of people you know when you do get a partnership when the obvious numbers you look at is when you get married you have family, children you have all these things all these social glues that hold you together love companion children and it fails half the time so now you have another marriage of the man where you don't you know there's no all these social glues of children and family vacations which how are the partners different and how would you how would you line up the risk of a marriage failing and a business partner failing because the data is pretty much shows about half. So what do you how do you look at that?
Lindsay: I think communication is key in both marriage and business but I think if we focus on the business you have to communicate and you have to be willing to have different opinions on things but respect the other person's opinion and yeah I think it's all about being open and just being able to communicate well.
Howard: Yeah and I one of the things I see with dentists is you know there's a natural selection of dentists I mean you can't get into dental school unless you get A's and biology chemistry math physics so you go back to undergrad they weren't the heavy drinkers the frat boys but I think one of the cardinal signs of communication is like when you when you see someone erupt it's like instead of you know it's like you're sitting within five minutes late instead of just like hey what's up you know or just instead of the communicating little little little I think our introvert brothers hold it in until it pops and and it's all about communication and I look at. I tell dentists it's so bizarre you know they always want to learn more about bone grafting an endo and all this stuff art and if they don't get an A in HR they're gonna be miserable and I'd rather you get an A in HR and be a lousy dentist because if you're the best dentist in the world and you have staff turnover your patients don't come back your family doesn't come back your wife leaves you, you know they're just miserable or whole life and almost every consultant that I've ever known in dentistry will tell me off the record that all these dentists would have been so much better off they just what I got a psychologist or a therapist or you know just to get their own mental house in order so they can attract and retain a quality key staff. So it's all HR so that leads into my next question I remember I'm using all of you because I'm a man in your girl's so I'm gonna ask well I do I want to get all that other way because a lot of women dentists say that if 98 percent of the employees in health care are women you know all the employees are women in hostels in dentistry. Well if I'm a man you're a woman some say that it takes a different style of leadership that a man can come in and say hey give me a cup of coffee assistant will jump he sells the office to this lady man she says give me a cup of coffee and she's like what about your slave so my question is: is that true or is that false do you do you think it's different if all the employees are girls do you think it's a different floor management if the owner is a boy dentist verses a girl dentist?
Angela: A constant struggle with that I think.
Lindsay: Well yes I think it is different between being a male leader and a female leader and I think it's about laying I've worked with a coach a business coach for a while now and I think it's about laying expectations clear expectations out to your staff and maybe just managing in a different way than a man I feel like I'm maybe gonna say their own thing here but I feel like a man can just say things without a reason behind it and the staff will just follow it maybe a little bit more so then if a woman comes in and wants to change something there's a little bit more resistance to it so you have to lay out clear expectations.
Howard: So your saying a man will say something I'll just do it but if the woman says some they'll actually question why.
Lindsay: Well that's what I've found.
Howard: and I see I think that's absolutely true but I think it's a sincere compliment because with the men a lot of them just rule and just like fear or just ultimatums and there the staff doesn't have empathy or sympathy with them and there's no communication. I think it speaks very highly of you for one of your employees to say but why because if you if I say go to your room and the four kids all run in their rooms they're doing out of fear but a mom said go to your room and all for my boy stops at but why I think well god they got a better relationship with mom. I mean I wouldn't I don't want all my employees or family or friends doing something out of fear I'd rather be leading them I'd rather be leading ducks to water because I explained to the Ducks how they're better off in water than in the deserts and so I always thought that was that so is the complaint I hear a lot from women leaders but I said man that's not complain that's a compliment thank you they actually have faith they don't fear that they actually have enough faith in you that they can question that's communication the first thing you said is you know more communication and I think a lot like I've been in rooms where my friends we're the assist that would ask them a question on an x-ray and my own friend would say well you know if you want to learn that go to dental school. You're an ass and then and then if you can't explain to your assistant what this is well how is the patient ever gonna buy it because as soon as you leave the room they're gonna turn to the assistant and say what do you think and what do you want your assistant to say... well then go to dental school. So what other issues are there of women leadership versus male leadership?
Krista: I think for me initially as a leader I was more concerned about hurting the staff feelings yeah being liked by the team every decision I had to justify instead of you know taking ownership and this is my practice and you know being really confident with my decisions I felt like it's been a growing process for me to learn to follow my gut and this is my practice and this is what I want instead of trying to always please and be everyone's friend and everyone like you.
Howard: So when you're an old guy and we're sitting around drinking a beer talking about the young generation one of the things that always confuses us is we always kept a distance between friend and employee. I mean because I you can't be my friend because I reserve the right to fire you so there's just a clear moat around us and then we see the younger your age going drink you're holding your ponytail while your hygienist is puking in the toilet and we're like that might be just a little so so how do you define do you agree with that assessment that maybe you're closer with employees.
Nicole: I can make a comment like I'm Lakes I mean we're all kind of outgoing friendly people the four of us and when I've been at work like I'm not an owner but I find I'm friendly at work but it's not like I socialize out of work with you know the staff but I would almost call everybody a friend I don't know how to explain it, it's like a dental family but I but there is that line where maybe you're not...
Howard: Do you see that line being crossed by some people that really...
Howard: Well explain what that line is because they're in dental kindergarten and they might not really know what that line is what would it what is the line between friend and employee how do you how do you really like someone and then reserve the right to fire them?
Nicole: Good question I don't know I think like in my situation I like knowing about everybody that I work with I like asking them about their personal life that kind of stuff but it's not like I go to the zoo with them or go out for drinks with them or you know we don't socialize outside of work but I think I'm still well liked at work, I think that's the line.
Howard: Yeah and here's what...
Krista: I use too, I'm really good friends with one of the assistants and hygienists and I think that dynamic definitely changed once I was the owner and I think it needed to because there is that like employee relationship.
Howard: and every case that I ran into in the years about embezzling it wasn't the amount of money the receptionist took maybe up 50 usually about 50 to $100,000 it was the fact that she was the godmother of his baby that she was you know so and and then the people that do that for business say well that that's part of the whole scheme I want to get in real close. Like a lot of them a lot of them will start having a relationship with the doctor because then if he gives caught you say well you want me tell your wife that were lovers cuz that divorce that'll cost you a million I only sold a hundred thousand are we good are we good how about I just leave no it's a common it's a common trill deal but another another way to get in really close is their spending extracurricular time they're going to the cabin she's the godmother and then the next thing you know she's depositing the checks paying the bills depositing checks paying the bills you not you're the only way you can ever stop embezzlement is you have to you have to make sure two people are involved in it and then what's the next thing oh the mother hires her daughter as the assistant then next thing you know they move her up toward the recall now you got your mother and your daughter and the daughters were in the recall it goes back to the embezzling. So there's only a few ways to do it I mean either one person had does all the functions which is really bad and the way you get away from you break up the function so it takes two or three or more people but if you get too close to a sociopath that's what a sociopath tries to do. This is why you don't want to live in a country where you speak English is the second language there's like if I moved to Brazil they always think about 2 or 3 or 4 percent of a population as a sociopath. Well if I moved to Brazil and I don't speak Portuguese all the surprises are going to be looking at me I mean it's a lot easier it's like a tiger when he's going hunting he see he watches him run it looks to a guy with the limp and so that's the one. So getting too close is just can be can come back to bite you.
Lindsay: I think so I think there has to be some limits like I agree with Nicole and Krista you can be friendly and friends at work and you can do other work functions outside of work hours but you can't get too close there has to be those limits and those lines.
Howard: Yeah so 10 years out of school they're in dental school they what do you think when some kids come out dental school night they think they know it all and you when you come out of dental school you think you're the best dentist in the world because no matter what you do works.
Angela: I came out terrified that I didn't know as much as I actually did that was like the biggest surprise coming out of dental school. I graduated thinking that I knew nothing and how was I gonna do this and then after the first few weeks practicing I was a oh wait a second my dental education was really quite good I dunno what's going on not the best I don't know everything by any stretch of the imagination but I was like surprisingly prepared to work. I guess I got my money's worth.
Howard: What would you tell him on the supply-demand what would you tell them to learn what would what skills, cuz they come out in there I mean they got 20 things they could learn. I mean there's people saying come learn occlusion and or neuro-linguistic this or snore guards or Invisalign root canals implant. I mean literally they're coming out of school they only got so much time they got some little money they got all this student loans and there's a hundred people saying come learn this what how should they process?
Angela: My advice which is not glorious would just be to get good at restorative, restorative made all of my money for the first many years and only once I got good at that can I actually expand to be doing other things and I learned a lot by making mistakes figuring out how just like simple restorative functioned and worked and when it failed and how people were biting that affected it and it was very beneficial and granted you can't go and really learn CE nobody's really teaching you well let's go learn how to do a filling everybody knows how to do a filling but that's that's what both do dentistry is it's 90% more not 90% of what I do but a huge part of what I do I don't know
Lindsay: When I think you maybe need to gain some experience and decide what you want to focus on with CE before you make a jump like go to dental school and just get your hands wet for a little while before you decide you want to get into implants you want to get into whatever, you can listen to a lot of podcasts and get a lot of information on that's free right out of dental school.
Nicole: On your advice I just spend time with specialists to right and go ahead like they're more than welcome me to have you come look over their shoulder and then you got a good kind of...
Howard: but they're always afraid that the specialist is gonna close the door in their face what was your experience when you?
Nicole: No way and they're like open to me just even just sending a quick email with a radiograph be like here's what you need to do like I don't know maybe it's just don't be scared to go and talk to the specialist because they're gonna be in there so helpful when you get into trouble too.
Howard: I can never figure that out I mean I know people in Phoenix and to learn like pareo though they'll fly all the way to Clearwater, Florida drop three thousand on a weekend listen to a periodontist like dude there's like six of them just in our neighborhood why would you go to Clearwater, Florida instead of just I mean they're in walking distance to your office and you're flying to Clearwater they're like well and they always say well why would he want to help me cuz you're cool and your a dentist and you live in the same town and maybe he wants to eat a cheeseburger with you and watch a hockey game I mean I don't know. So you found them not in fear and scarcity but in hope growth abundance?
Nicole: Totally, yeah.
Angela: and everybody likes to talk about what they do like you're a specialist you obviously like what you're doing somebody's willing to listen to you talk about it absolutely like I'll talk to anybody to teach.
Howard: and what periodontist would think that if we have lunch or you watch them observe that you're gonna learn every single thing I know about perio and never need me again. I mean you must be you must know almost nothing if you think that because most people they well if I've been in periodontist for ten years and you've never been a periodontist ever obviously there's some trade here I mean and then the other thing that periodontist don't realize that like when a dentist starts when once the dentist learns how to do ortho and does like five cases his average diagnosing ortho doubles out of the gate because he didn't see a before didn't see it and when a dentist places their first implant they like never see a bridge again or partials or you know. They take the whole cannon classification personal system throw it out the window so the evidence is that the more a specialist teaches you about their specialty the more you'll see it so then the pie gets twice as big and even if you take half the pie well the other half of the pie is bigger than the little mini pizza that it was started you know. I remember the best thing for me was when I am did my first sinus lift and I can't say who it was on because it was on my mother-in-law and that might come back to haunt me and but the deal is I actually believed in my heart that it was a bad idea and didn't work and then when I was I'm taking a course of Misch and he was talking about that I I just told him I said I would never do that I sighs I think yeah a bridge would be better and he didn't belittle me and marginalized me he just like well why do you think that and then he takes me back there and I'm this three days the University of Pittsburgh seven three-day weekends I mean every time he's doing his sinus cavities like we're where's that little kid at again yeah I was like 25 we say hey you know come over here right here and almost like had me on his lap showing me this and it was, that made me realize okay this does work. So just by showing me a sinus lift I mean I would have never diagnosed one before until somebody showed me and then I believed in it and now how many have I diagnosis and treatment plan the 30 years following that a gazillion yeah. So I want to ask the other thing about pediatric dentistry, so when I was little all the OBGYNs were men now they're all women when you look at some of the racist terms or sexist terms like hysterical, hysterical is the Greek word for historist so when someone says you're being hysterical that's saying you're being a uterus and the old OBGYNs would always sell the women including my mom and says all in your head and now it looks like all the men that were saying that have all lost their jobs and it's all women and I'm seeing the same thing in pediatric dentistry when I go to any University they say yeah we have six students it's six girls and then you say well how many your program is two, where's next class and I'll say those six so there's like five girls in one boy do you think pediatric dentistry is following OBGYN and is turning into a male or a female professional?
Angela: I would say yes probably no no maybe that's general it, you know, especially because you know women relate better to kids I think mothers maybe feel more confident with a woman treating their child which maybe isn't true but...
Howard: but is it true? This is dentistry uncensored, do you think a mom would prefer to talk to a mom?
Angela: Yes, we were talking about this last night actually about like we got better treating kids and once we became mothers because you can relate better you know what the mother's feeling no mother wants to hear that their kid has cavities because they feel like they've done something wrong and they're so upset that their kid has any problems. So then like a mother can kind of more so relate to that not to say that men can't either there's a lot of really great male pediodontist out there but there's just yeah I still think that mothers probably prefer it.
Howard: Now you just said a word you just said Pediodontist that word is this still a word in Canada? Someone just told me why they stopped using pedioontist.
Nicole: That advertisement that just said pedo?
Howard: Well I'm just a a big believer that girls and boys are different by just looking like economic data, Ill give you an example my brother is gay well if it was a gay it was an economist that showed me this years I was an MBA school I saw my communist and gay came up and he goes oh man have you ever looked at occupation data she said if you just look at their occupations you would think they're girls you know Airlines cooking music all this stuff like that and he goes so here's evidence that the brain has to be different because they all chose a different occupation. I mean what's the correlation that I choose same sex and also decide to be a chef or a cook or a flight attendant you know what I mean and I just think that um I just think girls and boys are different and I think if I was afraid I would think you would hurt me less than a man. So if I'm afraid of the dentist I think you would be nicer to me than a man and I have four kids I have four kids and five grandchildren and I wouldn't I would want to take my grandchildren to a girl I mean I just I don't know so it just it's illogical is that it may sound it doesn't matter what Theologica is just that's how I feel.
Angela: It's interesting to see the rise in females in dentistry in general or class again was a little bit different there small class sizes of where we are our class was twenty eight and only eight of us were female and every class after that there's been a lot more females but dentistry is an excellent profession for women it's you think of how much compassion you need how much kind of hand-holding for the nervous people like it again not that women always are better at that than men there's a lot of very compassionate men but the gentleness a lot of people really appreciate the gentleness of a female versus male.
Howard: So your marketing is a competitive advantage I mean if you come out and there's far more male dentist in Canada than in the United State and females do you put that your marketing come to us gentle touch?
Krista: In Saskatchewan or Canada or advertising we can't advertise anything like that.
Angela: Anything that makes you different, you can't.
Howard: You can't say you're a girl?
Krista: No no all we can say is...
Howard: So this is kind of funny...
Krista: New patients, that's the only thing you can put on your advertising.
Howard: You know when the thing that's surprising to me is that I think the craziest word is United States of America because I don't know what that is, I mean you can compare Anchorage to San Fran or Louisiana to Chicago. I mean people call Arizona the Florida the West that might be the closest closest similarity. Canada I mean the difference between French Quebec and Toronto and Vancouver it's multiple different countries but a vast part of Canada is as conservative as the conservative Midwest. I mean like advertising I mean I think a lot of people it's so funny because a lot of people think Canada is so liberal it's like wow they're liberal and some things like immigration or liberal and some things but dental advertising there is old-school as they're old school, where does that come just conservative farmers conservative small grains farmers?
Angela: A lot of it though is like keeping they want to keep the like a level playing field so they don't really want anybody to be like it's not like so like okay not to get into politics but American like political ads are all like the other person's terrible the other person is terrible the other person is terrible it's never like I'm great it's the other person is bad and then like the dental advertising you can't do that you can't call down the other people by trying to make yourself look better they want everybody to be let everybody have a fair chance not is that wrong?
Howard: So do you guys consider Canada conservative or liberal?
Krista: Depends, marijuana...
Howard: Did you guys just legalize the whole country? Is it with the license or just completely?
Lindsay: Anyone over 19.
Howard: and that's the one thing I want to remind the kids because a lot of kids here really really frusturated like when I was in high school in college I knew my gay brothers gonna have a very hard life and if you get and when my boys uncle was ran over and killed by a drunk driver he just got a he didn't get a ticket it was an accident and now and when I was in high school if you got caught with weed it was go to jail stuff and you were a druggie and I never even thought in the wildest no that someday my brother can get legal and we'd be legal you know I mean and now if you run over someone drunk you're going to jail. So when you're young and you see these great big obstacles remember they they get fixed via generations you know and and humans are a generation about 20 years of generation but you're so many people in the United States have to die before a lot of these things are gonna change because everybody like everybody 65 to 85 who thinks this they're not gonna change your mind but their kids or their grandkids. Well so it's a very like when I got it when I went into dental school it was a man's profession and now it's more than half girls I mean do you guys feel 10 years out you're kind of in the middle do you feel it's a man's profession women's profession or if it or equal?
Angela: I think they're still mostly still male-dominated I think I think it's very much becoming equal though.
Lindsay: Yeah I think it's on its way but I would I would agree with you Ange I think it's still male-dominated.
Nicole: I work with like three other female dentists and two male dentists so like we're a group practice and I don't know all of our patients are just as comfortable with a female dentist or a male so it's kind of where the opposite that's I talk to more female dentists in my little world than male dentists.
Angela: Now there's some patients that prefer the male absolutely like definitely some people that self prefer the male absolutely.
Howard: Like older people?
Angela: Yeah usually I think they still think the man knows best yeah but...
Howard: There was one thing I learned really quick so my first associate Theresa Murphy from Oklahoma from OU and we were babies I mean I was 24, 25 when I think I graduated 24 but the time I opened my office I was 25, my birthday was August 29th and I opened up September 21 and she went to give a shot and the guy grabbed her wrist and said shouldn't the doctor do that and I realize well that's my fault because you we all looked the same. So like in one week we corrected all the doctors were a lab coat all the so we were color-coordinated you should be able to tell you're a dentist you're a hygienist you're an assistant you're business administration. So I saw that because my analogy was imagine you're in the hospital and a guy comes in with a tool belt with a drill and a hammer and a deal and wants to start an IV when you say well well aren't you're the electrician shouldn't a phlebotomist start the IAB I mean anything if he said well I actually am a phlebotomist well you shouldn't be dressed like an electrician I thought you were here install fix the Internet so we did that but yeah I you see I just kind of...
Krista: When we first out of dental school we all talked about that oh are you gonna wear scrubs to practice are you gonna wear a dress clothes and I think all of us prefer dress clothes cuz it does I guess identify you as the dentist.
Howard: Well the only you know when I said you go back to yourself and tell you what to do differently oh my god the thing I would tell you to go back and do differently is you know I I trashed my neck leaning over like that so many times and I just specially during surgery I just loved to take my head and twist it around lay it back on their teeth and now at 56 I mean if it finally it was a dentist wife that saw me and so much thing that said you got to do hot Bikram yoga it took like a year of hot Bikram yoga like every other day for a year just before it finally all the pain went away and if you talk to any of your male podiatrists friends any foot surgeons they'll all tell you that all their clients 80% of are women who were those those crazy shoes oh and he's and he's on him that you because you're standing there and you're trying to get leverage you know that but my god don't look straight use a mirror in loops and don't wear those because when you're 65 you're gonna sit there yeah. I think I think you really should I think all women should really talk to a podiatrist right when they graduate dental school because you just don't realize that you know 25 to 35 to 45 to 65 you know running around with your foot at that angle yeah a podiatrist can tell you in five minutes what's gonna happen and so yeah so get loops.
Nicole: Head lights
Howard: and the other thing about the mirror I did for 10 years I looked through this little three-quarter inch mirror before I realize god they make you been full inch inch and a half two inch and you know you're looking at your preps and I mean that's another thing you can't see here's your damn mirror so small. So start getting a variety of size mirrors. I mean I like to I'm doing the whole case just a guy yeah like a one in three-quarter inch mirror I don't know what they'd be in Canadian you guys are on that funny metric system and just and just look but you know but they keep your head up look at bigger mirrors don't you don't just fight the temptation to twist your neck around and stop with the high heels.
Krista: I think they do really stress in dental schools now ergonomics but the headlight that was a game-changer for me.
Howard: So I want to go back to the big money they're coming out you know two hundred eighty three hundred thousand dollars in debt they sometimes have doubts they're laying there in bed and they're a junior senior and i was gonna say man was this a bad idea what would you say to her who's wondering one night a little sad like I'm gonna walk out of here three hundred thousand dollars and that was that a bad idea?
Angela: The career choice or being in debt?
Howard: To spend $300k to get a dental degree.
Angela: I don't think so, you contemplated a bit more right whether or not you made the right?
Krista: Well I contemplated career wise not I guess financial wise I just considered medicine as well but no I think the debt load at least for all of us it was reasonable and manageable to pay it back within probably all of us paid it back less than five years.
Angela: Yes for sure
Krista: We all went to rural practices where we were busy we had the cash flow to pay it back but maybe I guess if you were practicing in a bigger Center where you didn't have the patient flow to support that debt load it would be scary but I think you do have to be more open to and willing to work and willing to work hard.
Angela: I think all of us were working five days off the get-go like working there we liked actually putting in the time working the hours and yeah working hard to pay it off so that then when you have kids you can work less than all that.
Howard: Marketing observations that like say just a clock on a deal like I'm when I'm with the kids grandma's I feel so sorry for meters are eighty and the microwaves got like 300 functions and she just wants to turn it on to warm a bowl of soup and she has to literally be a calc major like I'm a doctor and I'm on my app is like this how does this make sense to anyone and I tell and I was looking at I just feel so sorry for 89 year old people they just want to microwave that has an on/off and they just want to say they just want to hit on and wait a minute but you're never gonna find it and I was looking at the last time I was at Walgreens or Walmart I was looking at microwaves and I looked through the cheapest one and it actually had 18 buttons. So the simplest she could get it would be eight there wheezing the chances that 85 year old woman's gonna get a magnifying glass and readers and try to figure out how to warm up her bowl of soup. So I'm trying to find out how much time we have and it looks like we got about ten more minutes but anyway but the other thing is so she comes out three hundred thousand dollars in debt and I asked this a lot because she thinks if I'm gonna be a good dentist and I start up my own price I need $100,000 CBCT $100,000 CAD CAM and $100,000 laser so three purchases later she just doubled her student loan debt. So I want you to talk about technology and does she need $300,000 technology could be good?
Angela: Need versus want I think we all want that do we all need it I don't know the comb beam too tough one I work an associate it's not up to me as to whether or not we get one we're not getting one the person I work for places a ton of implants and has never used one so it doesn't feel that it's necessary whereas I think I'd probably more beneficial. We were talking earlier with the milling machine is it again this is stuff we've gotten from you is it worth you know fifty plus grand to get a machine that makes you do more work and have a patient in your chair for twice as long when you can just send it to the lab is it worth it probably not. We have an iTero which I think was a good, I like that like that that one was a good investments I think but what do you guys think?
Lindsay: I think good I think coming out of school like your new grad you have so much other stuff to learn like focus on the basics focus on the basics and once you get your motor.
Howard: and what are the basics?
Lindsay: Just learning how to do yeah exactly there you go exactly all those things just learning how to get your speed up with basic procedures.
Howard: and did you say that was important?
Angela: What did I say restorative, simple crown and bridge, taking out a tooth, good injection that was kinda mentioned in the beginning, my uncle's a dentist he's a very very good dentist and one of the things that he told me she likes straight out is like learn how to give a good injection. They don't know if your work is that your patient doesn't know if your work is good they know if you're gentle caring if you can made that part which is what everybody fears the most if you could be good at that it's gonna do wonders for your practice.
Krista: and I think learning how to talk with patients and putting the yeah the time in to build relationships with patients I don't yeah those all that technology is nice but at the end of the day if you can't talk to the patient there not.
Angela: One other piece of advice that I found really helpful when I graduated is I work with somebody who was so again as an associate a very good practitioner who is he's phenomenal at explaining things and the first few years that we worked together his op was right beside mine and I could listen to how he presented things to patients and it was it was amazing. Like listening to how somebody else can explain it sell it for lack of a better word but I found out extremely beneficial and I learned a lot just from that case acceptance and whatnot.
Howard: I thought it was interesting I'm so Glidewell, Glidewell that man makes does 12,000 cases a day so a lot of people say they know probably they make five percent of all cons I'd say so it's a great databank to see what's going on I mean you see Glidewell's data kinda know what's going on twelve thousand you say but they came out with their own CAD cam and they only have it work with iTero and they have no relation with iTero. Itero is owned by align technology which owns Invisalign and they have no contracts or they're nothing like that but they only support iTero because they noticed that their impressions that came in with a tarot they only have a 1% remake and it comes in with impression it's 5 percent or higher and then all the other scanners are in between and they can take any impression but they love iTero so but that's that's a low-cost technology versus a CB because you gotta remember on the CBCT I guarantee that everyone who's ever placed 30,000 implants or more they didn't even have CBCTS back then. So you take a guy like Carl Misch you probably I mean so many of those guys had turned they did them all because they were surgeons so the pano was one thing but when they put your head at 12 o'clock and felt your mandible and jaw they they knew the width they saw the pan you know they they were surgeons and they all knew that the ultimate CBCT was just say we're gonna lay a big flap open the thing up. Like I remember the first time I asked him I was asking the surgeon know so I was so young and dumb I said well are you worried about the mental foramen he looks me goes well of course I'm worried about well first damn thing I'm gonna do is find the son of a bitch so he laid a flap peel it out and and there was and I can still remember asking him if I could touch it because I know there's gonna be like a soft piece of pasta that would break but it was a tenacious hard rubber thing and I was good I think it was the first time I ever saw the metal framing on a live person. So are you guys have any of you oral scanning impression materials are you all doing polyvinyl or poly ether?
Angel: We are you scanning yep we stand we stand pretty much everything you still have the PBS I still like it but yeah we have iTero.
Nicole: PBS but our lab scans and they got a five axis mill for some of the restorations.
Howard: So they scan the impression?
Krista: One of my clinics I'm still doing traditional PBS's and then I have an iTero scanner and the other practice so a little bit of both.
Lindsay: We use PBS so yeah.
Howard: So our is are any of you doing clear aligner therapy?
Angela: Yeah we do, I do Invisalign.
Howard: So what do you think about clear aligners?
Angela: Yeah I like it's patients like it which goes a long way we use Invisalign. Smile Direct just recently opened up one of their stores in Ottawa which again is a few hours out so I'm interested to see where that's gonna go but ya know we use Invisalign.
Lindsay: We have orthodontists that come into our office now.
Howard: so you have an orthodontist that comes into your office?
Lindsay: Yeah once a month.
Howard: Is that the only specialist that comes in your office?
Howard: and is it a fee where you just rent space or is it...?
Lindsay: Yeah we just rent space to them and they come in on a weekend so we're not losing chair time so we're more than happy to just rent the space out.
Howard: Yeah very good yeah I don't know where the clear aligner therapy going because clear aligner well align technology there Invisalign and iTero and then they had a big lawsuit with 3Shape because they don't want to take they only they want you to only use guy taro and then smiles direct club I don't understand that because they originally owned 19% of smiles direct Club and invisalign makes all their trays but they just Invisalign just opened up started opening up their own stores and smiles direct Club sued them and they had to shut them down which is weird because could you imagine I'm suing you you have to shut down your stores but you make all my trays and that contract I think what beside on the mix portion big alignment support I thought they made them all yeah well it's hard to say but it's wall streets a complicated game but I think but you two do clear aligner therapy and you both use Invisalign?
Krista: Yeah, you betcha
Howard: Well I think the US market is still 80% fixed only 20% clear aligner
Angela: It works.
Howard: Yeah and the other thing is back to sexism is when you see a boy when his hair is matted up he's wearing the same shirt for three days in a row is he really going to wear his aligners and I never asked the boy I always turned to his mom I mean you're paying for this I mean I can glue this stuff on and I don't have to worry about Billy. So you have more faith in me or Billy yeah. You know they say that you know successful dentist add like a new specialty every five years well if you guys what's the next thing in your brain that you think you're gonna add some day?
Angela: Sleep that would be amazing it was more recently getting into the clear aligners and more recently getting into implants oh I feel like I took a big leap very very recently and I'm still gaining the experience in that before I take my next leap I'm not there yet for the next one.
Howard: So you added clear aligners and implants and which one was a lot harder to add?
Angela: Implants, clear aligners I thought there was there's a lot of resources there was a lot of like even with working with Invisalign I'm like doing like they have like the i-pro and I'm same thing down here but so there's a lot of kind of mentorship with that and implants there is but it just implies a lot more stressful a lot more a lot more stressful.
Howard: So what specialty are you girls adding next?
Krista: You know what I'm interested in sleep medicine yeah sleep dentistry alliances.
Howard: So why are you interested in sleep?
Nicole: I don't maybe it's something we didn't learn in school and there seems to be a lot of like interesting courses out there also like sleep airway kind of stuff for children screening as a parent that's kind of a good Avenue for us to kind of branch into and learn more about. So I'm more interested in it from a growth child perspective rather than maybe snoring for adults and doing sleep appliances at this point but maybe you're thinking more appliances for adults.
Howard: Yeah well they never even mentioned it when I was in dental school I don't think I heard sleep apnea if ten years out but now I'm ruined because every time I met friends or family's house and you see that four-year-old kid taking a nap on the couch and you like - do you hear that oh yeah don't worry always it was like it was like oh sorry this grandmother day I said are you sure your dog can eat that and she said oh I don't matter if you don't like he'll just throw it up we just wait for the dog to throw it up I think we should stop but it is a whole new world because now it just Americans just waking up to the fact that a four-year-old kid shouldn't be grinding I mean it just it's just like it's like everybody...
Angela: Sleep issues lead to behavior issues and all of that.
Howard: Yeah it's funny because now that you study it you see it everywhere and before you study that I never saw it ever and now you just see everywhere.
Nicole: Well three of us did Rondo's course right out of school.
Howard: Why did you pick Brock?
Nicole: I don't use they were really
Angela: We got to go to cool places.
Nicole: We went to Edmonton, Chicago yep and he had like kind of a controversial reputation and was known to be in my circles to be like a really good educator teaching you stuff that you didn't learn in school so yeah.
where did you girls wanted to you were all buddies in school so like what's it what's it makes a great destination for you?
Nicole: I like online though like online is just as a mom limited time in the week I like being able to do it at 10:00 p.m..
Howard: Your a mom now?
Nicole: Yeah I got two.
Howard: and what are their ages?
Nicole: Seven and three
Howard: You all have kids, how old are yous?
Angela: Five and three six almost six and three.
Lindsay: I have two boys six and four.
Howard: Well I noticed you guys have learned a lot by not having four kids like me.
Angela: I'm pretty sure we learned from you this morning that each kid cost us what two hundred and seventy thousand dollars.
Krista: So done
Howard: and my oldest boy he does same disease as dad he has four too I said you know you that that's a big family he's like shut up you had four you know what do you tell me and I'm telling my next one he just had one and I said is that gonna do it and he goes of course not and I'm like okay. So Brock Rando I've always been I've always been a very big fan of Brock Rando and Richard Litt because what scares me is why don't want to say their names I'll probably end up in a lawsuit with six months ortho is that when you when you just when you take a short curriculum you just learn some anterior I'm not worried about you learning how to straighten teeth I'm worried about you get the wrong diagnosis and the wrong treatment plan and these people don't realize that you start getting some long faces some opened bites you can get you know over your head quick so why isn't your drinking beer buddy your orthodontist up the street and why don't you and why don't you do that 80/20 like smiles direct club which i think is gonna be a great IPO i'm excited about this IPO but what people never talk about is they only accept 20% of their scans. So and then I met all the organizers who are spending all their time trying to take their license away and make them go away and die which is not gonna happen because America if you haven't figured out the political system it's gonna get a bill passed you hand them a lot of bills and it's money's the answer what's the question. So you got some Wall Street tycoons greasing the US Senate you don't have a chance you know so but the bottom line is the smart orthodontists like hey where's those four if I did you don't want that's what we want so the smart orthodontists are getting into that connection that referral funnel and that's what I've been telling the general that's one time learn complete ortho go through a complete course like Brock Rando or Richard litt because if you just do that small one and you don't have a buddy you can show a case to oh my god cuz you know you only know what you know you certainly don't know what you don't know and the next thing you do is you open up some kids face and you know you get in over your head fast and then you find out you're not it worked on us and smiles direct love has the best feature because they're just taking the low-hanging fruit non growing class 1 molar class 1 k9 something where how do you really get into trouble with that but if I'm taking a step on you and I'm trying to predict at 12:00 what you're gonna look like at 17 10 years out that final question 10 years out what would be the next specialty thing you think you might be it should learning once you digest everything you started now. You said sleep would be next?
Nicole: Well we all hope we don't all do molar endo but
Krista: I think you know microscope though I think just really helpful.
Angela: Yeah we were talking about that.
Howard: and I'll tell you something's gonna come back final words on that microscope and everybody to use them is only about 8x most of them ever use them and adonis they just do it as a final right before they operate and they say you know every day they they find a little miss canal or whether the canal is still filled with sludge or whatever but you know i think history repeats itself you know my first introduction to a microscope was, back in the day it was called the key segment you would take that you know after you did the first little scrape deal you would just tap it on on the dish and you would show them and all these bacteria spirochetes and and because back then we I think a lot less people knew you know that there were stuff growing in your gums and when those people would see that in their gums it would scare the shit out and and we got away from that and I just think that needs to come back because I think you could probably do it a lot cheaper, probably somebody could buy an iPad some there's probably some optical thing you could buy where you wouldn't even need a big microscope but I really think it needs to come back and I just remember not I don't even know why I quit doing that it was so and the kids said that didn't come out of my mouth and I okay let's start from scratch yeah you do it this came from your mouth and then when they would see that and you'd see their eyes get that big and they need to there and say okay your gums are bleeding that's the area of your palm. So if you walked around the rest of your life and your whole palm was bleeding and you know why it's bleeding see those things and you gotta love the spirochetes they're jumping around you look like they're crackheads of the bacteria award while the cones and rods were just laying there and you know and they just put the whole thing together and I just thought to myself it was so great for kids it was so great for everyone that that's something I want to start working on cuz I bet you could do it a lot faster cheaper and easier today than you could be back in 87 but ladies thank you so much for coming on the show thank you so much for coming to Townie meeting and thanks for sharing with my homies your words wisdom thank you so much.