Dr. Jonathan Cook is a cosmetic dentist who owns two successful practices in Fort Lauderdale Florida. He graduated from Nova Southeastern University in 2008 with honors and won awards in Prosthodontics, Implantology and was inducted as a member of Omicron Kappa Upsilon National Dental Honor Society. He is a fellow of the International Congress of Oral Implantologists and has completed hundreds of hours of continuing education from implantology to botox and fillers to occlusion. He has been practicing dentistry for just over 11 years and has built his practices reputation on integrity, passion, teamwork and empathy.
VIDEO - DUwHF #1176 - Jonathan Cook
AUDIO - DUwHF #1176 - Jonathan Cook
He has purchased 7 practices in the 9 years since his first practice acquisition in June of 2010, learning a ton along the way. Most notably, he has grown his business from $500K to $5 million in just 6 years. He attributes his exponential growth to the implementation of strong systems, keeping things simple, building a healthy culture with a stellar team, folding in old practices into his existing locations, marketing marketing marketing, and never letting his foot off the gas.
He is passionate about priming his team for success, keeping his mind, body, and soul in tip top shape, giving back to others through charity and coaching, and balancing work and life.
Howard: It's just a huge honor for me today to be podcast interviewing Dr. Jonathan Cook DMD he's a cosmetic dentist who owns two successful practices in Fort Lauderdale, Florida. He graduated from Nova Southeastern University in 2008 with honors and won awards and prosthodontics implantology and was inducted as a member of Omicron Kappa Upsilon National Dental Honor Society. He is a fellow of the International Congress for oral implantology and has completed hundreds of hours of CE from implantology to Botox to fillers to occlusion. He's been practicing dentistry for just over eleven years and has built his practices reputations on integrity passion teamwork and empathy. He has purchased seven practices in nine years since his first practice acquisition in 2010 learning a ton along the way. Most notably has grown his business from five hundred thousand to five million in six years. He attributes his exponential grow to the element ation of strong systems keeping things simple building a healthy culture with a stellar team folding in old practices into his existing locations marketing and never letting his foot off the gas, he is passionate about priming his team for success keeping his mind body and soul in tip-top shape giving back to others through charity and coaching and balancing work in life. Holy moly I'm so excited to have you on the show because you know that these graduates all believe I don't want to I don't want to own a practice it's too complicated and all the DSOs come in there and they offer free pizza lunch they all come in there and then they just scare them and scare them that pharmacist thought they were gonna have their own practice now they all work at Walgreens and CVS and you guys are all gonna work for us the DSOs are taken over. So they go for a miserable job too miserable job and finally the only reason they start their own practice cuz they're so sick of working for anyone else and here you have done it seven times in nine years. So kudos to you Jonathan and thanks for coming on the show and sharing your story.
Johnathan: Thank you so much, it's an honor.
Howard: So you think the DSOs are gonna take over in 20 years now everybody will be a dental associate at McDentals's?
Jonathan: I do not think so no, I mean they have their place and they're growing that percentage is growing certainly more than more than the solo practitioner that's for sure.
Howard: and you know you might have you might have a very interesting story to tell because you graduated at the worst time in the world 2008 right before Lehman's Brothers meltdown and everybody thinks is in the world but you know I had the end of the world in 1980 when I graduated high school interest rates 21 percent inflation and unemployment double-digit and then I graduated May of 87 October 87 Black Monday the market fell a quarter today and then you had the y2k bubble pop in March of 2000, Lehman's day another day. You you know I always felt when everybody starts talking about all this paranoia I'm like you know you know you're gonna live through this right. So what was it like graduating at an economic collapse?
Jonathan: Yeah that's a good question so you know 2008 was rough and then it kind of carried on until 2009 2010 you know banks were lending at all you know if you're if you're graduating dentist at that point and you didn't have mommy and daddy money that was gonna help you you know front the money for for purchase of a practice you're gonna have a really tough time getting financed. So that was a challenge and then just finding a job you know if it let's say you didn't want to go out and just start from scratch or buy a practice from somebody finding an associateship was really really hard I ended up with I know that three different Associatships throughout the week so I had like a Tuesday and Thursday job I had a Monday Wednesday Friday job and then I had a Saturday job and I kind of I kind of wanted to get the feelers out there and it actually helped me a lot in regards to figuring out first what I don't want and then also seeing how different practices work and don't work and really getting a feel and getting my speed up to of course. So but man if the first year or two to try to find a job at that time was was really tough.
Howard: So the filing for chapter 11 bankruptcy protection by a financial services firm Lehman Brothers on September 15 2008 remains the largest bankruptcy filing in US history with Lehman holding over 600 billion in assets and you walked out graduating from that did you ever think you'd be alive ten years later?
Jonathan: I mean I heard it from a lot of different perspectives I had a lot of friends who were in real estate and they got crushed I mean like most of them went bankrupt and then I had other friends who were in for DC where you know Obama came in and it was bigger government. So they didn't see that massive decline in housing prices and economy didn't feel as much there so I had a couple different perspectives but man it was yeah I mean that the global economy went into cardiac arrest and it was uh it wasn't it wasn't for maybe a couple more years before he people kind of could take a deep breath in a sigh of relief.
Howard: Well you know my favorite Nobel prize-winning economist Joseph Schumer who wrote the book business cycles I remember reading that book and I read the first page and I couldn't stop those over but basically humans are irrational they make irrational decisions and that's why you always have a business cycle and nobody knows everything we don't know what we don't know but man it happened in eighty eighty seven 2000 2008 and it smells like teen spirit again. I mean it totally smells like it's happening right now again but if anybody Warren Buffett won't tell you what to do now even he will stop short of making a prediction because nobody convicted the Berlin Wall the Arab uprising the no one predicts the outbreak of war one or two but I'm glad you're on the show because it does smell like teen spirit so if it does happen to do it again is there any advice you'd give to some kid walking down a school with $289,000 in debt?
Jonathan: Yeah it's I think it's kind of easy honestly we have a pretty darn good dentists and let's just say worst case scenario you can't manage to get a full-time job maybe you're maybe you've got a part-time job because let's be real I mean how many how many dentists are hiring associate if you're not only one of those big DSO is how many you know solo practitioner dentists or maybe you got a group practice who lost a guy who needs a position to fill but they're just there aren't that many full-time positions especially for guys that are right out of school so let's just say you do something similar to what I did where you're bouncing around from one office to the next or let's say you can only get one job and it's two days a week or three days a week we have it we have a nice. I mean that's you could you I can't see how you couldn't make eighty or a hundred thousand dollars doing that working two or three days a week as a dentist and you just you just weather the storm then you know but a couple years go down and go by and before you know it you're grinding again.
Howard: You know one of the things I've always thought was bizarre about dentistry is when you go over to wall street you know tracking mergers and acquisitions I mean it's a growth pattern for so many companies and in dentistry it's just so underutilized but I've met so many dentists last thirty years that you know went to some small town at ten thousand it had like ten dentist but every time old man McGregor retired they would just buy the practice and fold it into theirs and think about that an old 65 year old dude retires and I buy his practice fold it into mine murders acquisition as opposed to that guy sells it say I'm 56 and he sells it to some young Wooper snapper named Jonathan cook who's got all this energy and marketing and just gonna crush it I mean you're eliminating competition you're buying patience which you have to compare to your acquisition cost of a new patient. So I want you to talk about how did you have the genius insight of M&A; activity coming out of dental school, I mean you just don't see that in dental school.
Johnathan: I definitely it was not I can't I can't take claim for that I actually my first partnership was a tremendous I had some tremendous lessons there the guy who I went into partnership with was a 60 or 65 year old guy of out of New York and he's really like kind of family he was my brother-in-law's brother-in-law if you can follow that and he's an orthodontist and a general dentist he's got a daughter who's a general dentist up there so you know at family functions we'd see each other and he'd always say oh yeah you know I mean you're gonna be my guy in Florida I've got these ten practices in New York and I want to open up in Florida and I eventually want to retire there and you're gonna be my guy and I always kind of roll it off my shoulders and say it sounds nice you know Here I am as a sophomore junior senior in dental school and that wasn't even even remotely on my on my radar but I think you know I kind of kept it in the back of my mind and then you know I graduate I do the kind of bouncing around thing from one associateship to another gained a lot of a lot of experience there and a couple of those practices and you know just with my speed in general and then you know he was always in touch with me and finally called me one day and some just clicked you know I was like you know what what do I have to lose you know and so I went into partnership with him and it was his practice model to a degree up in New York to to buy these kind of under underutilized practices and so I got the idea and I saw it come to play when we started buying practices down in Miami which was my original practice that I purchased with him in that case I was fifty one person was forty nine percent he was 51 percent. I learned something big things there and so you know not to mention with the contract that we signed with the dentist's who we purchased the practice from this is an old-timer he's 72 years old and we stupidly we agreed to sign him on for a five-year employment contract. Now that would have put him at the age of 78 at the end of his contract and you can imagine you know you're walking into somebody's you're really working in somebody else's house I mean it was his business that he built over that amount of time and I'm not saying that it can't work it can work but you have to really play it play it wisely and the fact that that that 5-year contract really came back to haunt us down the road but with that said you know in year one we went from I mean this guy was historically doing $750,000 a year you know last three tax returns were pretty consistent no real uptrend no downtrend was really kind of had plateaued and and you know in year one I think we took it to 1.2 and that was literally just a matter of me doing now the endo here if it was referring it or everything out endo implants Invisalign implementing some really basic systems I mean it's a collection policies or practices were pretty pretty abysmal and that was it you know overnight you know you go from 750,000 to 1.2 and then and then in year two we go to 2 million I mean we had some really exponential growth so I kind of got a feel for and understood the value in taking in folding in a practice where you're just taking in really some minor overhead but some incredible upside especially if you're gonna buy it for the price at which they're currently running it at you're not buying it at a premium for what you know that you can take it to. So you know how I and I known that I could take it from $750,000 to to 1.2 million in the first year I wasn't you know it's not like you buy the practice based on what you know the potential is so that really benefits you hugely when it comes to you know economies of scale, getting patients in, that it's just you know exponentially growing the patient base and what do you take on you know maybe the doctor that's that's a yes or no it depends on the scenario. Generally I like to take on the hygienist because that's usually the person in the practice who has the most interaction with patients consistently and you decide on the front desk you decide on the assistance and you go from there but uh you know there's a course a small uptick in your in your dental supplies small up tick in your labs but outside of that you're not paying for the for the other physical location of you know just that that massive overhead that typically comes with with a dental practice if you're if you're buying the physical location.
Howard: So you primarily have two dental offices you have downtown Fort Lauderdale lauderdale-by-the-sea so you have two offices do you own the land and building and how many offices have you rolled into those two locations?
Jonathan: Great questions so the main location is the Fort Lauderdale one that one we've rolled two separate practices into it.
Howard: Is that downtown Fort Lauderdale?
Jonathan: Correct yep downtown Fort Lauderdale.
Howard: That's the main practice originally.
Johnathan: That's the main initial practice that we purchased in 2012 when I was still partners with my partner back down in Miami which is a whole nother story that I can get into if you care to. So in 2012 we purchased my partner and I but my other partner and I John DeStefen partnered in that practice in downtown at the time that practice was doing five hundred and fifty five hundred thousand dollars maybe five hundred fifty thousand dollars a year and since that time in 2012 we've merged in or folded in two additional practices.
Howard: and then lauderdale-by-the-sea?
Jonathan: lauderdale-by-the-sea is one practice that we purchased in 2016 and then have since folded in another practice as well. So essentially the downtown one is one in three practices if you want to call it that in that lauderdale-by-the-sea practice is a one in two practice, so we've got one practice that folded into another existing practice.
Howard: So you called out um you taught letter nobody might see one in two and then the downtown Fort Lauderdale one in three?
Jonathan: One and three exactly.
Howard: Yeah that is uh so so now your new partner you learn the first one you were four he was 51 and now in this John DeStefan you're you fix out you're 51 he's 49 talk about what that means.
Jonathan: Well so you know when it comes to any strategic decision you want to feel like your voice is heard and I'm not saying that you can't have a nice working partnership where both voices are heard regardless of the shares break down but when you have one majority partner it's it can become challenging when you when you start to see you have different visions for the practice. You know when I when I started that practice down in Miami I was on my I had an exponential learning curve just based on how quickly things grew and how young I was so I was taking a lot on but you can imagine just you know if I'm living in that practice and working that practice in my partner who's the 51% shareholder is essentially a silent partner it can be challenging. You know how do you really voice yourself to your partner and have him really understand what's going on. I mean I had I had a mess on my hands at times that was that made it very difficult for me to manage you know you can imagine me trying at 29 years of age trying to manage a seven 72 73 year old guy who whose house I was living in you know it didn't it wasn't easy and not to mention the staff that we retained and a lot of these a lot of these ideas and decisions were made kind of by default that my partner made and I was okay doing that because I'm like okay you're 65 years old you got your ten practices and in New York like of course you know what's you know what to do but the message that was being missed was the fact that he wasn't living in my practice and so he really as much as I as much of a voice as I felt like I had I mean how many how many conversations can you possibly have with somebody telling them the same thing over and over and it just doesn't it's not real until that person is living it and so that wasn't gonna happen you know he was up in New York and I was down in Florida.
Howard: Well you know there's nothing more beautiful than an org chart and you know like you look at that major religions there's one God if you have multiple religions there's a god of thunder and a god of lightning you know what what happens and and a 51/49 just reduces so much legal battles at because you have an org chart if you own 51 you might as well own 100 so the other guy is the minority partner but a lot of a lot of guys don't want to be the alpha male they want to be an owner but they don't want to be the alpha male because they think someone else does it better. So how many dentists associates do you have in those two locations that are employees?
Jonathan: So we've got myself my partner a periodontist and as of last mid last year we had three associates all of which and this is a again another lesson for you know the youngsters out there as to how to manage and scale back your efforts and to kind of get things more simplified. So you may ask yourself well how do you go from having three associates to only two again assuming my partner's an associate in my in our periodontist as an associate.
Howard: Your periodontist is an associate not a partner?
Jonathan: Not a partner no you know what was happening was I made a purchase my partner and I made a purchase our most recent merger if you want to call it that and this is something I wanted to touch on which is a little bit in depth but essentially you know I go through a template or a checklist when I'm looking into purchasing a practice and that checklist is really exhaustive. What I you know as I've done this many times I tend to just you know add a few more things to the checklist of things that I think are important to key to and so I this is one thing and particularly that I I don't have to learn the lesson twice. Essentially this guy was, a patient come in they'd run their credit it could approve for ten thousand dollars with a care credit, Lending Club, green sky, you name it and the amount of work that actually needed to be done when it was all treatment plan was let's call it seven thousand dollars so there's a difference of three thousand dollars he'd run it all so what happened when I went to buy that practice when I go through all those checklists and I've got that template everything's checking off oh my god this is great you know the guy was two blocks away from us similar practice similar patient base some with similar demographics you know ready retire okay with a you know staying long for a year to kind of help that transition occur is genis was ok was fine staying on so everything kind of was aligned to make sense where we could take his practice that was historically doing $700,000 and I'm thinking I'm like okay at minimum we're gonna do eight nine ten like that you know a million what do we what can we make of a $700,000 practice just based on history you know what we've done in the past and so you can imagine those numbers were inflated because of what he was doing it was I mean really arguably criminal you know your billing you're running a credit for for for an amount that the treatment plan doesn't you know match up to so where he was doing seven hundred what was he really doing what were those true numbers and so I mean after seeing it for long enough I figured I really felt like forty two thirty percent was that was the difference if you can imagine you're buying you think you're buying a practice that's doing seven hundred thousand we were going to continue to do the whole scheme that he had going on obviously. So that went from you know a practice that we not only do we have to deal with the revenue that we weren't gonna take on but we also deal with ramifications of what you know all these patients that were calling us I mean almost on week one we had patients calling us saying oh you owe me money and this and that and you know you can imagine what sort of a like an energy drain that was and trying to manage him and the hygienist that we retained on and so you know we ultimately parted ways amicably luckily and you know he had a one year employment contract. So we got things on her ass as soon as we started to see these things that you know were happening you know this is the first time he came into my office manager it was like oh yeah you know you know just run it we were like what are you talking about he can't just do that. So you know it was patient number one that we kind of you know our ears or were perked and and you know it was a bit of a red flag and so so I was poised to take on this this this this million-dollar pop I'm thinking okay we're at three and a half four million here we're gonna we're gonna be at five million by the end of the year reasonable to assume based on history, not even close. So because of that I hired two more associates again they were kind of staggered but I there was a there was an absolute upswing in our patient numbers. I knew that based on his numbers that there would be a natural overflow at the downtown office because that's where we merged that practice into so any overflow if we were just too jam-packed whose lauderdale-by-the-sea would take on those patients and boom it's a happy beautiful thing it obviously wasn't the case. So what happened well we kind of in a way got lucky because one of the associates unfortunately two of his payer parents came had cancer and he had to go back to New York so in a way I was like I was happy because I was like you know what you know I can't really us pay him 500 dollars a day I couldn't justify keeping him on based on the what ended up happening with this practice that I was so poised to assume was going to have plenty of patients to go around. So that's that that associate another associate retired you I love him he was amazing that was our our first practice that we rolled into our original practice. He stayed with us for three years two years more than he was expecting to stay home but he just loved it and he his he loved his dental life once he came on because of what he was because of how things were set up and honestly he was actually making more money with us after selling his practice than he did when he was running his own practice literally just by implementing some simple systems. His collection practices weren't great either and but man oh man was that that was a great they should all be that way but unfortunately they're not. So you know I've seen him I've seen him go sideways I've been I've dealt with lawsuits and you know like I said I just had a very fast learning curve with that original practice that I bought in Miami merging two practices into that one if you want to get into details there I got plenty of great stories but...
Howard: Well to avoid those issues what dental law firm do use for mergers and acquisitions and do they do any forensic accounting and auditing responsible for those numbers?
Jonathan: Good question I don't have a dental law firm that I do with I have a law firm that's down the street from us old friend he's done plenty of dental accurate mergers and acquisitions over the years it's not he's not strictly doesn't strictly do dental mergers acquisitions. I had a law firm up and uh up in Del Rey for a little bit but I just felt like there wasn't there wasn't a whole lot of knowledge base that came from that and as far as forensics go I just don't feel like anybody would look at it the same way I did and I really thought that I was doing everything right and I had a great template to work from I was able to you know dig deep into the patient charts see what kind of pending treatment look at all the x-rays. I mean I was going through I was looking at x-rays on a viewfinder crying out loud for some of these offices because they just didn't have digital dentistry so you can imagine a tedious that would be and I've said no to some practices over the years to you know I think some of those those are some of my my best decision where the times in which I said no you know it doesn't make sense for XYZ reasons but you know to answer your question I you got to dig deep into those charts you got it you got to ask if you can ask you know get some sort of insight inside information with the staff and I've done that over the years a great way to go about it is to have a dental supply rep I mean they get big a lot of these guys know that world better than anybody and you know they walk into an office they know one that's successful one that's not just by the energy when they walk through the door. So you know we've got a guy that we rely heavily on for that so you put all those things together and usually it's a recipe for success.
Howard: What supply company is he with?
Jonathan: Sorry sorry he's with his with Henry Schein no he was with Patterson.
Jonathan: Now he's with Henry Schein.
Howard: Yeah my rep in 31 years has worked for I think three of them Schine, Benko, Patterson but kudos to you I mean you're looking deep inside these practice numbers and a lot of my homies listen to you right now they got to look deep into their soul listen to what this business guy saying how he looks into the numbers. I mean I you're people working as an associate it doesn't matter if they're a DSO or bright practice and then you know they they're talking crap about it and all this stuff and it's like okay well what's what's the code for a crown how many percent they don't know any numbers they know no numbers and then they just want to you know they just want to go from occlusion camp they want to go from Koise to Spear to Pankey or Ross so all these things like okay you know you're you're you love your art I love that but you don't know any of your numbers how do you look compare mergers and acquisitions rolling them into your existing office versus just spending that money on marketing and advertising how do you know which would be lower cost to get a per capita head into your practice marketing or mergers and acquisitions?
Jonathan: That's a really good question I like the idea of having multiple funnels you know what can go wrong let's say you're ramping up your marketing efforts and you're seeing good return on your investment, if you buy a new practice let's say and let's say you're doing a million million dollars a year you buy a practice that's doing four hundred thousand let's just say and you know that you can take that 400 to 600 now you have a 1.6 million dollar practice. How can how can you go wrong by increasing your your bottom line what you're taking home and now shuffling that money towards marketing efforts as well it's like a it's like a steamroller that just keeps generating steam. So I don't I have to say I feel like on both fronts I'm gonna always attack the marketing and I'm also gonna always have the feelers out because you never know when that next practice comes up so you know I don't weigh the two against each other I just know based on history just how profitable they can they can be and so most often it's how comfortable I do I feel with a bank account you know how much profit we had over the last six months over the last year you know we practiced we purchased two practices in 2016 two in 2017 one in 2017 happened in that last one being the one that we had all those troubles with you can imagine I was like I 2018 we're just we're gonna hold up here we're gonna you know take a deep breath get things back into into gear get that negative energy out of the office and and start rolling again and so we've really ramped up our marketing over the last year because we weren't acquiring practices. So look I mean you know it all depends on what's on the plate you know if there's a practice that I'm really that I've been you know if I've been courting a dentist for a number of months or years you know I got some guys that are on for three I've been calling and in touch with him for three four years you just never know when that's going to come but you know you speak of the 22 the 2008 and how everything you know took it took a mess blow a lot of these old timers that were that were they were set up to retire they were like okay I'm good in 2008 2009 2010 whatever right around that time frame and then what happened a lot of them lost massive massive amounts of wealth in that downturn and so now those guys that were poised to retire in two thousand eight nine ten even even eleven twelve you name it now they're dirt not only are they having to scale back and say wait a second I gotta change what my expectations were of retiring but now they're even more afraid to sell at you know at three or four or five years down the line because they're like we'll wait a second all this money that I'm putting into stocks or real estate whatever it might be what if there's another downturn. So you got all these scary turkeys out there that are that are also way up there in their years and and and it's it's kind of like a recipe for for to have a lot of really good quality offices out there that you can merge into yours because they're hanging on for dear life and they should have retired back in 2008 nine or ten but they're they're still plugging along because they're afraid and they lost so much wealth. So you know it's kind of like this perfect storm then of these guys that are I mean they're in eighty years old eighty-five and you're like what are they why are they still hanging on you know and for a lot of them that's the reason.
Howard: So to have two locations what management information software to use to have to is a cloud-based or you have two separate IT systems hardware what do you do?
Jonathan: You know the beautiful thing now look every program has its pros and cons but I'm really loving how you just get if you got Wi-Fi you got a or you know Internet your on it's a it's not opened it's it's Dentrix Ascent it's the new Dentrix. I don't know they named did it they named Ascent I don't know for whatever reason but it's a cloud-based Dentrix essentially but it's very very different from Dentrix. I mean nothing nothing about it looks similar to Dentrix that you know the old traditional Dentrix but I love it because you can be anywhere. Sorry you're gonna say...
Howard: That's what Heartland Dental uses Rick Workman at Effingham he's got 900 locations, he uses Dentrix.
Jonathan: Okay well that makes you feel a little bit better yes both practices or anywhere that I might happen to be I just jump online and I can access both locations no problems.
Howard: So you know there's a lot of really big businesses coming in dentistry that find dentist associates because there's all these DSO's and you know they can put hundreds of dentists to work on any given day you bounced around you said from associate to another what why do you think associates bounce around what percent of associates can look in the mirror like you and I do and say I'm gonna do I want to do the business of Dentistry and the art versus what percent of these dentists, do you think if they took an honest look in the mirror they'd say look you're not committed to owning your own practice you'd be a better employee. I know that's a lot of questions.
Jonathan: No that's okay I mean I can tell you that it can't be more than five or ten percent of like when you know I immediately think of my class my graduating class how many of those kids at the time had a real business sense and it can't be more than five or ten percent so they gotta be honest with them.
Howard: So do you think that or are you saying that when they graduated from dental school that ninety percent of them probably want to just be employees or whole life and only 10% want to be owners or you saying they're not ready for it and someday they will?
Jonathan: Great great question I think that definitely a larger percentage of them think that they can be owners but are not don't have business sense and either are willing to learn it because let's be honest I mean it's learnable or aren't willing to learn it or they just start chasing their tail kind of like you always say which is you know they try to throw everything at their practice by you know getting continuing education there we go but if I only buy this laser then then and only then will I be successful or you know then I can market to a different type of patients or whatever they just they're so clinic we minded they don't open the door for business and I just think that they kind of, it's natural for us as clinicians to go in that direction to always be kind of pulled in the direction of continuing education and oh let me learn a little bit of laser let me learn some implants and implement that in my practice and now all the sudden I'll be successful. Well if you're spending all this money on all these implant courses and you're you're getting just as little return on the patients that are coming through the door as you are with your current patients not having that information and knowledge base then you're really ruining yourself and setting yourself up for disaster because now you've purchased all that implant supplies and materials and all that and you're ready to go and you've got you've got Sally at the front desk who's not answering the phone you know you've got a you've got so-and-so trying to close the case and she's got a 10% closure rate. So you're just losing all these patients all these opportunities to actually make a buck and so I think that's the vast vast majority of dentists. So five to ten percent may have like a real business sense another maybe ten or twenty percent get out there open their own practice don't really have much of a business sense but know how to figure it out for themselves and then the rest are just you know then there's probably another twenty or thirty percent who go out there don't learn it open the prevalent practice think that there are things that they're a dentist and don't realize that they're actually a business owner and so you know the remainder are just those that are perfectly suited to be associates.
Howard: and that's why I always tell them to get your house in order get your house in order and they're always in a failing restaurant and they think if we just add lasagna or beef stroganoff we're gonna be successful like well you weren't successful with steaks and salads and baked potatoes but beef stroganoff is gonna do it huh and they don't want to face HR accounting legal marketing phones treatment plan presentations knowing their numbers. When you're doing a merger and acquisition how far away do you think that in a Fort Lauderdale area before the patients say you know what this is a good excuse to find a new dentist I'm tired of driving that far, how close do they need to be?
Jonathan: Great question, five miles that's where I've kind of set the radius. You know anything outside of that it if somebody more people are gonna get drawn to your practice nowadays and I'm not saying this is 100 percent across-the-board but nowadays more people are gonna be drawn to your practice because they are searching for your practice for searching for a practice online and they're getting drawn into your practice because they see great online reviews, they like the way that your their website looks, they like what they see on social media. All these things are gonna get them convinced that you're the place for them before they even decide to make the phone call. So if it happens that they're 5 you're 5 miles away okay you get in the car and yes traffic can be terrible around Ft. Lauderdale but worst-case scenario 5 miles can't be more than 20 25 minutes so which is not a big deal.
Howard: and you know it's just so cool like these these dentists want to learn something simple like placing an implant they feel they gotta get an airplane fly across the country drop three thousand dollars somewhere when they could have rode their big will across the street to a periodontist who's a lonely introvert who's dying for a friend and just sort of just love to have a friend and then you feel good when you help another human or a dog or a cat and knowing every dentist within a five-mile radius and popping the question like hey I'm young Jonathan and you're an old fart I got to say my old fart joke. So I was teasing my grandpa my one of my grandkids this weekend a Sunday and I said ah hey why are you doing your hair why don't you shave your head and look just like grandpa and she said I don't want to be old. She associated bald with old but you know when you go to that young those older dentist by you that they got to look at you differently now you're this friend they're sitting there thinking dude I'm 60 years old in this Jonathan guy's five miles up the street and he's already popping the question we should get married someday and sell me your practice you'd have to have better relationships more likely he'd leave his emergencies on call with you I mean just not talking crap about you.
Jonathan: It's a beautiful world.
Howard: So do you is it fair to say that if you're an urban dentist you should consider acquiring every selling dental practice within a five-mile radius of you?
Howard: and what would you say for rural?
Jonathan: I'd say that jokingly but there are some limitations as you could imagine I think look I don't take Medicaid I don't take HMOs those are ruled out and but the most important thing that I'm looking for now when I am one of the things that I added to my lengthy list of you know my due diligence list is personality you know if you don't mesh you can arguably get by for a year which can work because now you've got this dentist who you pulled into your practice and he kind of passes the baton over the course of a year but most importantly you have light at the end of the tunnel. So even if you don't click he doesn't mesh with some staff members or what you know whatever the case I mean it's two recare points away you know it's 12 months it's not the end of the world. So I find that that's that's a pretty nice happy medium where you can you know get by and have everybody part ways amicably.
Howard: I love it how you are specific on the criteria you don't take Medicaid you don't take HMOs. Another one is on which I'm sure you're aware of is a culture there are just probably they think somewhere around two to four percent of humans or sociopaths and they're just dentists selling their practice where you can just tell they're either not right they're either not right in the head or evil or they're broken mentally a sociopath but the culture you never want to do M&A; activity or a partnership with someone as a different culture rant on the hard lessons you've learned on culture.
Jonathan: Great question so I had a bipolar dentist legitimately bipolar and you know I'm from one day to the next you just never knew what you were gonna get and screaming and yelling at staff members that was the original practice that I bought down in Miami and it is a an absolute killer. You know I mentioned that you know in when I purchased the practice he was doing seven or fifty thousand dollars and we took it in year one to 1.2 but it's what if it could have been 1.5 but we lost the $300,000 because of the energy that was being sucked out of that business and if the negative effect that it had on the staff and just the cancer spreads. So culture is so so huge in my practice you know we talked about it and almost every morning huddle we talk about it at every monthly meeting whether it's a management meeting or a team meeting you know for both teams both offices. We talk about about it at our team our quarterly team-building events so it's repeated and repeated and repeated you know if you don't stick to your guns and look before you know it you've got you got you look around and you see everybody kind of almost mimicking each other. You know they get why it is that we do what we do and they understand the culture and they understand why the culture is so important and so like I said you know you birds of a feather flock together before you know it you've got everybody rolling in the same you know rowing in the same direction and believing in something bigger than themselves. So culture for us is right there at the very top and and it's mostly look I think it wouldn't naturally came regardless but a lot of it has to do with my past experience of being in these I mean I was in the Lion's Den I really was and it wasn't just with one it was with two and you know these are these are guys that you take on and you try to try to make it work and you try to you try to keep them bay and but you know there's only so much you can do.
Howard: So yeah I agree that untreated bipolar people that are maybe everyday they're they're so height they're so toxic and you know they can be so nice four five six days and they can just tear someone a new one then people start fall in love with them and they make excuses for him well you know she's having a bad day and it's like it's like you got to get that fixed or you can't be here but yeah but toxic staff moody staff it just can't do it and then with a criminal activity or and you think the only criminal activity do you think they're totally smart dentists that know they're criminals or do you think they're mentally broken sociopath so you can't really distinguish like like all given we're examples like a lot of dentists got mad at me because I posted on dentaltown the dentist that was had a hidden camera and his bathroom was filming it and I thought well if there's two hundred eleven thousand Americans alive with a dental degree and one guy gets arrested for doing this someone else is doing this and some dumbass will say you know I better take that down. Everybody got mad at me why are you talking shit about dentists it wasn't even four months and another dentist was arrested for it and I'm sitting here thinking I'm started thinking you have a hidden camera in your bathroom are you completely broken insane and weren't born right or a normal dentist and just that that weird. I always have a hard time and but I did I did listen to a long lecture on and they said when you look at some of these massive criminal empires like Nazi Germany or you know many of these regimes they said there was no history of mental illness among you know ninety percent of the leaders they were just doing purely evil stuff. Do you think when you're dealing with criminal activity with dentists do you do you think they're more mentally broken or are they a sociopath are they just evil or or does it not even matter I got to deal with him the same anyway.
Jonathan: I mean you got to deal with him on the same either way but I think that they just they're humans they they convince themselves that they either convince themselves that what they're doing is OK they kind of justified in their own mind and before you know it you know they're doing it on such a repetitive basis maybe it started maybe it's initiated because a guy's having a bad month and he's like well man if I just do this one time I can make payroll and then all of a sudden he does it again and it just each time they do it it gets easier and easier so that has to have been the case at least with this guy that came in with us and so you know sure could it could have been a sociopath and just not even at all in tune with what's going on and how that's wrong or they just turn a blind eye and they're like man I think they justify it in their head.
Howard: So the associate turnover is so high what advice would you give to dentists who have an associate to be better employers, is it picking them at HR can you just kind of tell the people they're gonna bounce around is it an HR pick? Like the NFL Draft is next week and I mean you know they these guys take HR I think more serious than any business I've ever seen I mean I just take the church.
Jonathan: I would agree.
Howard: So how is so if your goal is a reduced dentist associate turnover what advice would you give?
Jonathan: Well it's coming from the owner dentist perspective I mean start teaching them it doesn't cost you any money it's a way to justify them not making as much money as you hoped that they would. A lot of these dentists when they take on associates they're you know that they they have all these grand ideas that that you know everybody's gonna ride off into the sunset and a lot of times that's just not the case you know if a dentist comes on in there and they in the in their own mind they're like man I just $150,000 of what I need and I know that I'm worth that. So then when they're turning out dentistry and they're maybe making $100,000 a year there's gonna be some bitterness and some resentment there that breeds but if the owner dentist is there and is able to give them something more than just money then now all of a sudden they've got they've got a you know they're just less likely to get disgruntled and upset and look who knows maybe in year one you made a hundred but in year two everything but every with everything's humming and you're making 125 and you see this this uptick and you know when everybody's happy and the patients pick up on that everyone benefits and so you know there's nothing worse than having an associate that's not happy and it almost always comes down to money you know they're not making enough money. So I would just say you know take it under their shoulders in every free minute that they have bring them in and and teach them not just clinical stuff but also business stuff you know maybe they want to learn not to buy I took one under my wing and I taught him a lot about the business a lot a lot of people would call me stupid for they say that why you teaching this associate all your tricks and insights and I'm like I don't care about that you know I'm not worried about that I just want to teach and help this guy learn and he's he's asking the questions from assume he's a you know he's interested in the subject so clinical stuff I'm talking a lot about business and and you know if a day came or we came and he's like he has a crappy paycheck you know it's just it's not as bad as it would be if you didn't like you.
Howard: Yeah and listen to what John's insane I mean you know there's a you know a lot of dentists will post on dentaltown you know I got two associates which one should I take and it just accounting mechanism like really I mean I imagine a tinder was like that they had no pictures already is purely a bunch of numbers. You know being an associate at a DSO where there's nobody in that office that owns the place let's say you come out of school and you really love implants well getting an associate job with someone who's places you know 1 implant a week or more it's not something numerical. I always found it bizarre when you look at these dental lawyers who are in practice transition you know they show the office it's just all numbers but I can't tell by looking at it if this office has had the average staff has been there 7 to 12 years and this one there absolutely is turnover every year it tells me nothing about the culture and then they don't place a value on the culture but they sure have a place for the value of ten year old dental equipment and it's like a 10 year old dental equipment is more important than who the hell is answering the phone and the hygienist and and just everything that matters an accountant is really a glorified historian. So how do you incentivize your staff? You talk about you incentivize staff to build their own following on social media and how to get all staff on board creating content for social media, do you think social media is a big part of marketing or do you think it's more?
Howard: Do you think it's huge versus direct mail?
Jonathan: No direct mail look I mean this market just in general and Fort Lauderdale is really saturated but the direct mail look I did I did it for years and maybe if I were to go back at it maybe we get enough of a return on our investment I just doubt I doubt it because it's so... I mean I get my mail and I go to my mailbox and it's just it's five to ten different dental offices that are that are in there with direct mail I mean how do you choose I just it's too saturated. In fact I mean I was doing that in like 2011-2012 when I first started and it was there was a return on investment there but man oh man did things come on quick and no I wouldn't go there personally at least not in this market maybe other places in the country but social media is huge it is just huge.
Howard: and when you say social media what do you mean? Define social media.
Jonathan: Good question so really the big three players our Facebook, Instagram and LinkedIn and on LinkedIn I really feel like LinkedIn is like the Instagram of four or five years ago where there wasn't that many players in the game but you had incredible exposure and you know video online videos marketing testimonials all that sort of thing is going to grow exponentially and really you know if you're not in the game now you're gonna miss the boat.
Howard: Well what I don't understand about LinkedIn I mean on Instagram you think it more likely to be some kid you know sending selfies Instagram everyone has a job at a fortune 500 company and as dental insurance oh my god I love LinkedIn and everybody that it's almost like to be on LinkedIn, you have to be pre-screened to be intelligent whereas all of your own cousin can be on Instagram. I mean my gosh what percent of the people on LinkedIn do you think have dental insurance?
Jonathan: Oh my god I can say the largest percentage than Instagram and Facebook combined for sure.
Howard: Your the first person that's been on my show that talked LinkedIn.
Jonathan: So I'll give you one example of Instagram just so you can kind of wrap your head around how that's worked for us and yes maybe this is an anomaly but we have had really hundreds of thousands of dollars funneling into our practice from Instagram and this is just one particular example that I can recall in my mind. We brought a patient in it was what we would what you would define as a micro influencer so he had like maybe 50,000 followers he was really big into fitness I think he was even a model he comes into practice. So he comes into the practice he posts on his story on Instagram I just moved from Ohio I had to come see the best dentist in South Florida that's all he did he has like I said maybe 50,000 followers one of his followers sees the posts calls our office comes into the practice is a $25,000 case, done. So you know it is doable you kind of have to know and we're still working on it I mean we haven't figured it all out but you got to figure out what your what your market angle is and you know everybody's different but Instagram can work absolutely Facebook can work absolutely in all in different ways and that's why I really love the fact that you've got these three different social media platforms that you're really kind of taking chunks of different markets from each. I mean you said yourself you know Instagram can be a bunch of kids that are taking selfies and Linkedin is a bunch of professionals. So we just started to get an influx of patients coming in from LinkedIn as well again from our marketing efforts and we're just start I mean this is like in a matter of two months. Instagram we've been doing from more like a year or so where we've really started to ramp things up but.
Howard: You know Mark Zuckerberg dad is the dentist, Ed he's been on the show and Wall Street generally says that Mark Zuckerberg acquisition of Instagram for 1 billion was the best M&A; activity for ever and the one and the best one before that was going back in the day when Sergey Brin and Larry Page of Google bought YouTube for 1 billion and turned out to be awesome and you know and the immigration you know from telephone from telegraph to telephone to texts to email to an image to video I mean you just got to make the jump to video but our homies are so they're so introvert and it's like she doesn't want to maybe on a video on her but it's really hurt it's so much more powerful and you're so more likely to connect and make a relationship and have the other monkey secrete dopamine and serotonin and oxytocin and make up and bust a move and come in but they don't they don't want to be on a video what do you say though yeah should they just start drinking and then...
Jonathan: Hey I mean I'm one of those peopleI hate it, I really really I dislike it but I forced myself to do it I forced myself to do it because I know the power of it, it's so powerful and I mean like you said you yeah I don't care if you got a good personality shitty personality what if you're if you're on if you've got a video you tell me what's more impactful you walk up to somebody you hand them their business card out at dinner because you like you know they overhear a conversation that you're a dentist and they've got this they leave with like this little piece of paper that says your name and address and phone number on it or they get online or they pick up their phone I mean like it's like you know it's always in these things are people's asses all day long you know what do you what's more powerful they get on their phone and instantly they have videos that they're seeing you interacting either just with the camera or with other patients doing testimonials it's just it's not even in comparison.
Howard: You know not only are they afraid and I I've been telling them forever I wrote an article on it, you know when people tell me well that's not really me well then explain Hollywood I mean they give you those actors to play their actors murders and every despicable human and and no one walks away and says god I don't like that guy anymore he killed three people in that show. I mean I just saw him doing doc Hollywood it's the same thing with staffing they're like well I'm not a good leader well okay you're not a good leader but when you roll up to that office before you get out of your car you put on your Hollywood act and you're gonna walk in there and you're trying out for some lead part and today's lead part means you got to sit there and make a 60-second video why they should come into your office and I mean today is April Fool's Day how can you not why can't you sit there and say hey guess what did you know you don't have to brush and floss your teeth anymore April Fool's come on down right now. I mean...
Jonathan: What you just said is perfect, that's incredible.
Howard: I mean and the other reason they won't come on the podcast or do a video or give a lecture to their local study club is they're so afraid that someone not gonna like what they said or they're not fear of public speaking is because you're a social animal. So if you're a social animal it's so important that everybody likes you and you dress the same and follow them so what do you and when this dentist gets a negative online review I swear to god they're out there they're standing on the ledge of their window ready to jump talk them down from the bridge with the negative the online interview how do you handle that do you just think therapy?
Jonathan: I mean first of all you can't please everybody we all know that but when these negative reviews do come depending on the form that they're posting on you can you can change it yeah I'm not saying that you know you pay the nation off but pick up the phone call the patient get to the bottom of it sometimes this has happened many many times for us in the past very often we will call a patient and it was a simple misunderstanding and now all of a sudden Oh two weeks ago two weeks ago he had a patient that wrote a one star review on us my partner called him he changed his a one star review to a five star review he said you know it's just a misunderstanding and I mean you have to be able to grow in your practice is great but if you've got just as many practice ants walking on the back door that are walking in the front door then it's a losing game. So you can't afford to lose these patients and if it's just a difference on the phone call or the next time they come in you say hey you know I know you weren't really pleased with your last appointment but what is it that I can do better how can we do better what is it that we what is it how is it that you felt like you were done wrong and most often now a sudden you just turned you've turned that patient into a patient for life and so you know they're don't just assume I wouldn't have just assumed that the negative review that's posted wherever it may be Yelp Google Facebook is therefore good you can make a difference and if not if I mean sometimes negative reviews come on and they're not even real reviews you know you can call Yelp Google and explain to them why it is that you feel like it's a fake review and we've had those over the years as well. So you guys you just have to keep you have to keep on top of and you have to be aware of what's have two dentists out there more than half the dentists out there don't even know what reviews they have online they don't even know what there are how many stars they have or whatever I mean it's crazy.
Howard: You know I love that quote from Timothy Ferriss of the 4-hour workweek he says a person's success and life can usually be measured by the number of uncomfortable conversations he or she is willing to have so you got a negative review you picked up the phone that's how I've avoided so many lawsuits over 31 years, some old man is telling me I remember my hydrogen I never even saw the patient he just came in and he would didn't want x-rays and then she looked around and told me that gum disease and he just lost it and the nice thing you know you know an attorney what's his right you know but it's just just a phone call and then he said to me he says you know I'd rather talk to you in person I said well it's at the end of the day I'm going home I'm at 48th and Elliot I live in the foothills if I'm going by your house is that on the way I can stop by your house you can come down here he goes you wanted to come by my house he goes I only live a half mile from me I said sure this is before cell phones and MapQuest get over to his house my god we sat on the porch she gave me a beer I mean it was just it's...
Jonathan: That's awesome.
Howard: They were able to learn how to place implants but they'd rather play pay four thousand dollars for a weekend course than have an uncomfortable conversation asking the periodontist across the street if they can be your body and it's always gonna be a win-win if you don't think it's fear and scarcity I mean if you learn how to do implants I'm sure for the first hundred you're gonna be placing you know upper second bicuspids maybe first molars you're not gonna be doing any all on fours and if you do anterior implants on a gorgeous woman you might as well just move to another foreign country today before you get smacked upside the head. I remember when I had a basketball game it was out of Suns game I had all four of my boys there and we ran into the periodontist I just given some front implant on number eight I did and the gums didn't turn out right and oh my gosh she wanted to shoot me and I told the boys this is the guy that fixes daddy's big mistakes and he was laughing his head off he goes you owed me a beer for that one so you know we bought him a beer. So kudos have uncomfortable conversing thing with staff you know staff come in Monday morning and everybody was what was your weekend like what did you do and that's all fun and games within what I do is I sigh Club and say okay let's get to work you know what what's on the day-to-day but tell me tell me what looks good on your schedule tell me what looks bad what did anything keep you up last night so you got to switch from that let's all be social animals and you know like five dogs get together they all want to start smelling each other well this is a business we're Homo sapiens let's have an uncomfortable conversation. So online reviews, have an uncomfortable conversation.
Jonathan: and not to mention I mean you have these reputation builders too I mean how much money do people pay for these reputation builders where they not only build your reputation so get you know five star four star reviews but also will you're paying them to try to attempt to remove negative reviews and I mean is is that more wise to hire some company that's going to do that or just pick up the phone you know I just feel like you know a lot of people are throwing all his money at and these reputation builders where they're missing the real picture here. The real picture is if you're getting negative reviews on a consistent basis or something you're doing wrong or your staff so you better get on top of it quick and remedy it otherwise you know it's just going to continue. So I feel like that's it's probably I just don't feel it at least for us it's not a wise thing to to put your money towards which is these these reputation builders where you'll pay somebody to like you know keep stay on top of your negative reviews you know I just we don't have that problem it's not not an issue because we tackle it before it bites us in the butt.
Howard: So have you ever used the consultant?
Jonathan: When I was in my original practice yes I used some consultants out of Denver I would go to I would go home he's Denver Colorado man what was the name a Marcus group or something the Marcus group Judy Marcus I don't know if that name rings a bell but they were out in Denver Colorado I made four trips up there there was like a weekend each of the four trips it was a weekend that we would spend there and learn some good things. I feel like I just you know I didn't use all of it I used very little of it but I did get some curls and but that was man that had to have been in like 2012 I want to say 2011 2012.
Howard: Judi Marcus with Vanguard.
Jonathan: Vanguard yeah that's it yeah.
Howard: So you made the trip up there four times?
Jonathan: Yeah and you know it was mostly you know sales it was a sales it was a how do you present treatment and I appreciate their approach it was it made sense I just you know we did it for a while I just I couldn't find a place for it but you know getting your org boards together I mean that I learned that from there though that's super important but mostly just sales and they also provided those mailers that we were talking about, that's part of their kind of package they'll provide the design and sending out all these letter leads.
Howard: Treatment plan presentations so many people think well to increase revenue I need to add lasagna or I need to start placing implants and you start asking well what is your treatment plan presentation what is your clothes rate they don't know and then they tell you I don't like sales. Well you know in a way that kind of makes me love you I mean you know you're not you know you're Dennis you went to eight years of college to help people and and do surgery with your hands and you don't want to sell I really respect that but your patients gonna walk out with a lot of disease if they don't accept the treatment plan. So if you don't learn how to present the treatment I love the fact that you don't look in the mirrors that you're you know some big salesman but my gosh I'm you know at my age my four boys have turned into five grandkids and when I pass on I want my grandkids to go to a dental office and it dentist and my gran kid had four cavities and he went to you and you could only and you couldn't convince him to do any and he went to someone else and they got him to do all four well the better does the one who did all four I don't care if it as amalgam composite he just remove the decay impact it with butter you know. So how do you get them to do that?
Jonathan: You hit the nail on the head. So many so many dentist... I think that that's probably the biggest problem that dentists have psychologically though they are constantly telling themselves that sales are bad you know closing cases they don't even like to say those words. You hit the nail on the head, you can't prove to these patients that you're a good bad or somewhere in the middle dentist unless you do the work and so you have to close the case in order to do the work. So you know I think that's probably the biggest thing that most dentists have to work against that natural feeling of well I just want to do the dentistry but I don't want to I hate to say oh they don't like I don't have like having to sell somebody well you better get to liking sales or have somebody in your office better yet who really enjoys and like sales so that you can do the dentistry and they do their sales part you know but at least then you get to prove to these people what kind of a dentist you are.
Howard: So who do you think should present the treatment do you think it should be the doctor do you think it should be treatment plan presenter who's whose job is that?
Jonathan: I think it's whoever's job is it's whoever's best at selling. I've had associates who were incredible at selling and they did it themselves so I'm happy you know by all means you go ahead and sell the treatment I also had you know office managers who are incredible at selling so it's you know I'm sure Heartland dental has has an answer for who it is that they have selling treatment and there's a whole system there right now or maybe a little bit too smaller I'd rather just how the sales happen then assign somebody who may not be as good as someone else in the office but I mean every practice is different, I can say for us I feel like the the office manager closing the cases is the best if she's incentivized correctly and most importantly if she or he is good at closing the case.
Howard: I guess the same thing so you're saying who's ever best if doc is miserable at it than a treatment plan coordinator should I guess you say same thing about a marketing director some dentists have a natural flair for marketing and others just don't get it and they need to hire a marketing director what did you do? Do you have a marketing director or is that the hat you wear?
Jonathan: Good question, so yeah I've got a sales and marketing director. You know again it all depends on the size of your practice if we're gonna wear multiple hats as a dentist's don't get burnt out man because if you start wearing the marketing hat and the sales hat and the dentist hat and the manager hat and all these different hats you just can't it can't be good at all you can't be great at all and you can't you're not gonna have a long life of happiness and good health if you're gonna try to run all those different aspects of the practice of the business. So yeah I've got a sales and marketing director that was the first time I hired for that position was last literally exactly a year ago today so that was a huge move for us and it's worked out great and so he spear heads most of the marketing but of course we always have an open conversation and a lot of the stuff I'm driving you know if I come up with an idea I say I pitch it to him and he pitches me ideas and we go back and forth that way but it's it seemed to work so far.
Howard: So you're you know you're you're 30 years old I mean you're a baby I'm almost 57th again 20 years older what is your 5-year plan or do you even have an exit strategy yeah you have two big offices are you are you thinking five years I'm gonna do an you know sell this to a DSO or were you want to be in five years and do you or do not have an exit strategy?
Jonathan: So I had an exit strategy when I was still in dental school believe it or not I was thinking I was thinking about how I was gonna live my best life as an owner dentist and certainly as owning his having as many regardless of the number of locations having as many associate dentists working for me as possible where I've always said it where if I wake up in the morning and I say to myself you know I really want to do dentistry today I go and I do dentistry if I wake up in the morning I say no I just don't really feel like doing dentistry I don't have to do dentistry my doing the business doesn't rely on my two hands to produce that dentistry and that that income so that's where I've started I mean literally from the time I was in dental school and so to answer your question I think that exit strategy I'm gonna be in this game for life. I just take oh I'm not the type to retire you know to what degree will I you know how will my roles change over the years it's tough to say but I love what I do and you know five years from now that might change I might really feel like you know my role has warped or morphed into something different and you know five 10 20 years from now if 30 40 50 years from now I don't know if what will happen is I will have an exit strategy that allows me to do multiple have multiple different options you know so whether it's a big DSO that by snatches is up certainly that's a possibility and that seems to be that looks like the direction that things are headed you know there's no dental associate is coming out of school whether you've been out for a year or five years or ten years or saying oh I want that five million dollar practice down the road. So I think that DSO is probably the more likely direction but maybe I have kids that want to take it on or my partner has kids or you know somebody else comes in and they want to take you know they want to buy it to buy a share of the business so there's a lot of different avenues that we can go I just know that I do have options and I'm always gonna have my options open. I can't imagine a scenario where you know I'm one of these 65 70 75 year old dentists who are around the corner here who never thought of an exit strategy they don't even know what that is and they have no real direction or understanding for what they need to do to get themselves into a position to sell.
Howard: American Dental Education Association says the average dental students coming out to laity seven two hundred eighty seven thousand three hundred and thirty one dollars for 2017 what technology do they want to buy because some of them think well I need to do LANAP there's 125 thousand I need to do chair side milling with CEREC there's another one hundred forty thousand I need to do place implants the CBCT's a hundred thousand they can double the student loan debt in three purchases. So what would you tell all your the babies coming out of a nova right up the street from you. What would technology do you think is a return on investment and do you have to have?
Jonathan: None of them, when you're first getting out man that should not what should be on your radar is a maybe there's a dental practice of booming dental practice that you know of and you know the guys are guys or girls are cool they're down to earth they totally take me under their wing on they've got a bunch of associates working for them so me just you know poking my head in one day isn't much of a disturbance and those practices are gonna have a LANAP or CEREC machine you go there and you learn based on that but to come out of school with that kind of debt and then to just add to it hoping that you're gonna knock it out of the park because you bought some piece of technology man you better you better get your education with business and learning how to make money and drive growth in your practice before you even consider getting any sort of technology you know those are massive price points and they just eat up at the bottom line.
Howard: and the other thing is in my 56, 56 laps around the Sun when people are referring someone to their doctor like oh you should go to my doctor my OBGYN or my cardiologist, they never mention what kind of MRI machine he has or what sound they never mentioned any technology they only they only mentioned how that doctor made them feel and a lot of times if they compared to someone else well I had this OBGYN and he was just a complete Butthead and then I found this other lady and she's so nice you know what I mean. So would you rather have a doctor with a laser and a CAD CAM and an MRI and no personality or just a loving warming dentist that makes you feel good.
Jonathan: I mean the latter it's a no brainer.
Howard: So the same question but not technology but what they come out of Nova they barely know anything they've done you know 50 fillings fifteen crowns 15 canals of endo maybe ten units of removable, what dental specialties I have a higher return on asset I mean I look at you you do cosmetic dentistry veneers porcelain crowns implants teeth bleaching bridge work prosthetics. What would procedures like hold your feet on what would be a better return on investment learning how to do Invisalign or placing implants or what or where would you tell me go towards?
Jonathan: Well you know it kind of depends if you if you buy your own practice and when you graduate let's say and I just feel like you get more bang for your buck and you've got more peace of mind if you were to bring in these traveling periodontists are all over the place now and you know you get to know maybe it's a classmate of yours or somebody who is in a class of ahead of you but um I just feel like that's a better angle to to attack if you own your own practice and you're just kind of getting going once you get to a point where you're in total growth mode and you've got a bunch of money in the bank man my all means take the take the implant courses and maybe you can you know get rid of the periodontist if you feel that that's that that's necessary but if you're an associate Invisalign is got to be it's the easiest it's you know it's a great return on your investment. You're not dealing with surgery not having to worry about any sort of complications I mean what kind of complication couldn't go from moving into that little bit too far you know. I mean Invisalign has that technology that's built into it where you can't move the tooth too far too fast before you catch it right so you know there's just a very little downside to learning how to do Invisalign and a lot of upside so if I were to choose one or the other as an associate coming out you know I'm your one or you two out I'd take an Invisalign course.
Howard: and the other thing yet you gotta have a love for numbers. You know when dentist's ask me that I was having dinner with a couple dentists at night and I said well he's been in practice 30 years I said well how many root canals you refer out a month or it's it's basically we just finished the first quarter of 2019 so in the first quarter 2019 tell me units and dollars of what you referred, he has no idea and he's asked me if he should learn Invisalign or implants maybe it's business in three words is supply and demand maybe if you're referring out four molars a week then you know let's look at molar endo and we talked about so many things and we went so far over. Thanks for coming on the show and sharing what you know and hope growth an abundance instead of living in a cave and fear and scarcity, thanks so much Jonathan.
Jonathan: Thank you so much, thank you really.
Howard: Alright have a rockin hot day.