Noted as a key risk management and compliance expert in dentistry, Cary has provided training programs for dental schools, ASDA, private practices, dental groups, Texas Dental Association, American Association of Dental Office Managers, and Seattle Study Club.
VIDEO - DUwHF #1264 - Cary Smith
AUDIO - DUwHF #1264 - Cary Smith
Cary is a Certified Professional in Healthcare Risk Management from the American Hospital Association and the American Society for Healthcare Risk Management. And a Certified Insurance Counselor from the National Alliance.
His professional background includes 15 years of risk management experience in dentistry and 11 years of corporate HR leadership at Motorola, CIGNA Healthcare, and The Hartford Insurance Company.
Cary is the founder of Dentist Secure, Dentist Secure Labs, Done Desk, and High Trust Practice.
Howard: it's just a huge honor for me today to be podcasting Cary Smith his initials behind his name CP HRM stands for certified professional health care risk management and that's a certification from the American Hospital Association and then followed by CIC certified insurance counselor Kari is a certified professional and health care risk management for the American Hospital Association and the American Society for healthcare risk management and a certified insurance counselor from the National Alliance through his experience working with dentists about 95 percent of his business is all in dentistry I'm Kerry founded done desk dentistry's first online platform designed to help the dental entrepreneur manage risk in addition to his role at done desk Kerry has provided training programs for dental schools as the private practices dental groups Texas Dental Association American Association of dental office managers and the Seattle study club his professional background includes 15 years of risk management experience in dentistry and 11 years of corporate HR leadership at Motorola Cigna health care The Hartford Insurance Company Cary is also the founder of dentists secure dentists secure labs and high trust practice my gosh we have so many things to talk about first of all let's start the beginning how did you end up in dentistry
Cary Smith: well partly because my brother's an oral surgeon in Austin yeah so going know that how did I miss well I didn't tell you Mark Smith Mark Smith now see when I went to college if you walked in a liquor store and said your name was Mark Smith they wouldn't believe you so mark Smith and he's an oral surgeon in Austin Texas yep sure is Wow and so um was his father or in dentistry or nope it was the first person the family to go into dentistry yep not the first entrepreneur though that's my family's full of entrepreneurs and so that was within his his track you know just to learn a technical skill and then go sell it so is he your older brother younger brother by a year younger brother oral sir that is so darn cool does he like it I think so he's been doing it while yeah so your brother mark becomes an oral surgeon and what did you do well it he called me regarding some insurance related questions and now it happened to be in the insurance field at the time and we worked through a number of things and I said you know do you know what this all means he's insurance policies and he goes no I'm spending about 15 grand a year on insurance I don't know any this stuff means and I said how big of a problem is this for you and how many of your friends think the same way and we just started getting phone calls after that and then Providence led me to start my own brokerage and that's where we just started going talking to Dennis hey I wouldn't
Howard: I gotta start at the very beginning because my my homies quarter em are still in dental school and the rest are all under 30 and what was the your brother an oral surgeon was paying $15,000 here which they think is a huge chunk of change what was you spending fifteen thousand a year on their one in what what what would a normal surgeon spend fifteen thousand here what kind of risk are we talking about
Cary Smith: well I mean there's there's different segments there there was his malpractice insurance policy obviously for a surgeon because it's more invasive you're gonna pay more insurance for that than a general dentist would so there's a key differentiator there do you know those prices offhand I don't I don't recall Howard yeah exactly I mean today for today so his business insurance through covering his practice probably in the neighborhood of two thousand dollars a year and covering his practice not for oral surgery malpractice no sir no so this would just be for the business insurance liability liability there in a practice once your equipment you know if place catches fire for car comes through the front door or what have you that and then workers compensation that you need in most states except for in Texas it's not a required policy well the the thing about the work comp that's scary though is people here I don't have to buy work comp in Texas but then the state holds you unlimitedly responsible for injuries to your employees and your health insurance doesn't cover workers comp related injuries or work-related injuries so your internet you end up in a pretty big hole financially
Howard: which should really motivate you not to really injure your employees yeah yes yeah well
Cary Smith: yeah create a safer work environment would be what I would say is a risk management technique to avoid you from needing to use workers comp insurance that's you know when I one of my jobs
Howard: I used to work at at tweak Oh which made copper handles for Coleman heaters and above every cutting machine they had a glass jar with a severed finger or thumb and it looked like that's real and it was so cool because every time I walked up to that machine you it's kinda like a pilot's checklist if I don't but anyway I'm so general liability which is about 2,000 just for general I've never bought yep sure so general liability is just for your your office facility someone falls down and fire all that stuff yep yep and then the other one was workers comp workers comp for work-related injuries workers comp from one of the four pillars of socialism I know that's a cuss word and all that kind of stuff but the four pillars of socialism go all the way back and to Roosevelt he kept saying that the people had four major complaints and the four major complaints were age-related retirement so um you worked the world road until you couldn't work and then he went and crawled under a tree and died so the people wanted to have an age-related income and that was the Social Security program and then the other one was um workers comp and so workers comp and Social Security they're not I mean these are legal statutory laws they're not I mean they're federal laws and then the what was the other one on workers comp one was health care that's the one he never got unemployment I mean that the railroad workers I know I know you have strong feelings on this stuff but the railroad workers they would have when they connected to two railroads coming from San Fran from the East Coast when they connect them it was in a Provo not Provo Utah somewhere in Utah with the Golden Spike yeah when they were done the row of he was just left home and they left like 5,000 Chinese people in the middle of nowhere and they were like um when you fire us can we have just a little cash flow to get another job so unemployment insurance is mandatory statutory workers comp mandatory statutory Social Security's mandatory statutory and now a century later twenty countries out of 220 have the the healthcare and it'll be an American debate for a long long time it's but so three of the four pillars of socialism have already been enacted in the United States so so you're talking about malpractice for all certain general liability workers comp what was the other one
Cary Smith: well those are the three you really need to get into business relative to your lease agreement contracts maybe bank requirements the rest of them that he was spending a lot of money on were relative to disability and life insurance and in in his particular case he had a life insurance policy that was a whole life policy that was costing him around eight thousand bucks a year and we looked at it and said look man I mean you why are you spending eight grand on something you could spend maybe eight hundred dollars a year on for a term life policy which is cheaper than a whole life she's like I didn't know that so we cancelled that policy
Howard: I got my MBA 20 years ago well the thing that the thing I've seen with whole life is that there's this an investment component to it that seems attractive that you can borrow money against the value to expand your practice or
Cary Smith: whatever money's cheap right now you don't need to borrow life insurance against your life insurance so so you don't see any reason for a whole life policy well there is a there is a reason if you if you die you need it your family feud's i yeah well you don't but your family does but the the whole life I think there's better ways to handle either the money that you'd spend on a whole life policy and really trying to understand the riskier your insurance so for example like myself I bought a 30-year term when I was 40 years old so that gets me to seventy and that's by a factor cheaper than buying a whole life policy that would pay when I'd actually died so I figured you know look I'm my earning years I'm done when I'm 70 earning years why's that if I died that would have replaced those earnings or financial obligations so there's a dental students and new dentists whole life policies as an investment vehicle and a potential borrowing source it's no bueno there's there's better ways to do that
Howard: okay my homies know if you go to McDonald's they sell up Big Mac for Hanako your Big Mac Franco is malpractice general liability workers come disability and life insurance policy is that way cuz you have two websites you have dentists secure comm and den desk yep so do you want to talk about both of those websites or do you just want to focus on you well let's start you want to start with dentists secure comm or dent done desk well let's
Cary Smith: let's do both but I'll start off with why do those exist and the nature of we have this philosophy I have it is that risk is infinite and the benefit you get out of dentistry is finite and some people in figure out ways to treat risk in singular way so insurance is one risk management technique it's like as a dentist you don't treat pathology with extraction only right there's other well he does but there but before it gets to that point the general dentist doesn't say well you know you have pareo so let's extract right there's risk and there's different ways to treat that risk and insurance an insurance policy is one way to treat risk for a dentist oftentimes a dentist is only presented that opportunity and they don't they know nothing else and the reason why I started done desk and are there compliance training programs and even hydros practice was that the one I wanted to provide more to dentists more comprehensive way to manage risk and to offer different techniques so you mentioned workers come the best way to have high work comp bills is to injure your employees through bad work practices the best way to have low worker's comp premiums is to not hurt people and the way you do that is through training education so you would think as far as sharps injuries go in a practice the the more frequent injury a person would face in a practice little practice relative to sharps would be what what would you imagine that calls out the item that would cause the injury what would you think that would be well the actual the actual implement that would cause the injury a sharps injury and or dental practice what do you think that yeah it could be could be a needle right the most people say a syringe or a needle irrigation needle whatever it actually ends up being a burr burr burr - yeah so you know the docs aren't taking the burrs off after the prep they're not taking the burr out of the handpiece and therefore when someone comes in to clean because we're trying to turn it over in a hurry they're catching them in their arms we've had a lady break a burr tip off in her hip and so the the treatment there is education and awareness of the employees and connecting with them so they understand that but Dentist secure the work we do there is the insurance piece but we're also because of the risk management training I've had and we've developed a whole program around keeping you from needing your insurance and that's the difference and that's where when we deal with malpractice cases or State Board challenges the connection is usually sometimes the patients are hurt right that's definitely a thing patients do get hurt but then the other causality is general patient of dissatisfaction like you've missed an expectation and you go back and look at how did that patient have that X missed expectation and it comes down to how they were treated and sometimes the employees just didn't know how to treat the situation they weren't prepared correctly
Howard: and I read a lot of research on this um on this valve right the first thing the malpractice people figured out long you know you worry because when the world went from paper charts and paper all the lawyers had books and carrying and stuff and now it's all digital you got big data that they're mining it turns out that a very small percentage of the doctors keep getting sued over and over and over and the first thing they correlated to is toxic personalities and so the you're not communicating with this person and so they feel helpless so what's next a lawyer called the State Board and just I see it on dental town all the time because I this this letter they post letter they thought about it should I call should I call my malpractice first or so I called her hey why don't you call the person who's upset in that the shortest distance between two points I would call those people and I mean I mean you know you do a denture she's all upset she wishes she had her money back and never did it okay I give your money back and then she's crazy cuz she wants her money back and she wants to keep the denture but you're like my god this is 1987 I don't want you living five blocks away from me hating me till you drop dead it's just or worse yet
Cary Smith: walk out the door with an unanswered complaint and posting it on the Internet now which is ubiquitous and you're now having you can't really respond when they post things on the Internet right so for Yelp or whatever social media platform doctors are really challenged with being able to respond and you want to respond you know the facts aren't all known or posted as the as the patient presents but you can't respond because I bet you other situation
Howard: but you already know that because your mama told you are a little don't stir makes it stage just it's done I have two really bad reviews of someone that's never been in our office no never yeah I don't care and also a lot of people say that if all your reviews are five-star there you know humans are very cynical andd so yeah it's easier it's
Cary Smith: you're more motivated opposed to negative review than you are positive review it takes more energy actually to post an positive review because you're not motivated in that way you know people I think psychology as humans are oriented as to be social animals and to warn each other away danger and it's just it's in our nature it's and so people on it almost everything it's easier to get someone to read an email that's in a negative light than it is in a positive life
Howard: you know I always had a problem whenever they call social animal because you know Newton says for every force there's an equal and opposite force yeah we're social animals but Luke wrote they all know they need each other to survive yes but look how they live I mean I just reading this this morning 76% of Americans drive alone to work every day only 9% carpool and they social security they all want more money but all those grandmas live alone so we cut your costs in half once you move in with the widow next door they so they they're a social animal but they really like to belie mean most people are alone in your car only a couple of people in the house and we're from you know a third like one a couple you know two points or whatever so they they they're a social animal but they like their safety net space yeah they like their so he said their spaces walls lock doors they get in their car they roll their window they lock their car when they leave so there are social animals who they need you but they're afraid of you yeah there's a lot of fear there so um I love that risk is infinite benefits are finite satisfaction equals expect satisfaction equals your experience - what you expected and we see that in dentistry all the time like like you'll break a burr off in a or you'll break a file in endo and the only reason I became a nightmares because you just didn't tell him I mean that that patient knows your car breaks down they know their transmissions I don't think they know all everything humans ever made breaks down but they just don't communicate and that
Cary Smith: that's the key if that's the key point there is the patient if you're if you're working with patients and you're thinking about okay Myra please people that are conducting this what we call a team task right all these people individually are contributing to this team task what is our optimum output for the patient what is the patient ultimately going to get and then we say hopefully positive treatment outcomes and no pain and all this but but in in dentistry I've seen as dental entrepreneurs we don't really upfront tell them what to expect from us from the process and maybe practices do so I don't I don't know all of them yet but the one thing is when you look at board reviews or board cases you sit through those conversations or you look at my practice cases you or even look at Yelp reviews look at one-star yelp reviews as an exercise and you can clearly see an undertone of the patient's expectations weren't managed upfront as to what they could expect the other thing you have to that and this is called an informed consent right you you want to lead the patient down a professional pathway that says this is what we professionally say is what we expect the outcome to be and in most state boards if not all hold the doctor accountable to present the negative outcomes as well and this is a this and if we're not presenting the negative outcomes with the treatment plan and the negative outcome occurs would be it's like you said it's an unknown that's now unfathomable and we end up with financial situation and when we talk about risk in general it always ends up coming out of the doctors pocket in terms of either value of the practice or actual money so when we talk about building a practice all you have in your business is trust in this relationship with your patients and if you lose patients because you've lost trust you end up losing value because you know that's what the practices valuation is built on its revenue and if component of revenue isn't is repeat business it's not just a singular visit that the patient comes in there's no value in that there's revenue there but having explaining these things to the patient upfront pros and cons and letting them walk out with an expectation of okay if it does go wrong it was known and I'm not going to be upset as upset potentially if if had I'd just been caught out of the blue
Howard: you know I'm the old saying is so true money is the answer what's the question and what so when we you know this because you know what in other areas you're like but your own appliance administered I kin or they don't want you leading the witness well you're always leading the witness well you're missing that tooth error I think we should we could do an implant they're put on a crack you start explaining all this next thing you know you talk them into some you know 2500 other treatment then something goes south and then when the lawyers and the boards look at this the first thing I say is well well what was the problem I had no problems and then and then the other mama thing is that you know you you think all your patients are victims I mean they I mean the first hundred and eight billion humans that and they think pretty much all the humans lived in our modern form in the last fifty thousand years the first hundred and eight billion humans didn't have dentistry and when they come over the to think I don't leave the witness well you know the easiest thing to do and the lowest costs just pull the tooth and I mean by age sixty for ten percent of Americans don't have one tooth so I'm sure you're gonna live without one tooth and by 74 twenty percent of Americans don't have one tooth so the easiest fastest quickest things to do and let's just pull the tooth because what does that do now instead of them coming I'm a victim when my employer pay for it is our government programs like let's just pull it let's just pull it and then all of a sudden they're like well I don't want to pull the tooth I want to keep it so now they're buying into this said they want to say they're too well that's a luxury item I'm sure there's a for there's eight billion people on the planet and if we reduce that to three one has a cellphone on the internet that Steve Jobs started in 2007 one-third just has a cell phone and one-third ain't got anything so you're not entitled to a root canal bullwhip and crown and and and you're not a victim and all this stuff like that so how will you handle people your employees your patients their satisfaction equals the perception what's happening - what I expected well I expected just to not take care of my teeth live off dr. pepper and Cheetos and then when I need a root canal that obviously the President or the my employer should pay for it and you're just like you're your scientist okay you got a toothache you know the cheapest fact that fascist is cheapest best thing to do let's just pull the tooth yeah and then they changed their card game wow I don't want that because I know that health is wealth and I want to I want to luxury item and then the second thing they do wrong is when I tell you need a room job but you gonna make donald's in order a hamburger what's the next process the sixteen-year-old kid demands the money payment in full and then she hinges a hamburger then these guys know they they sell you this big dentistry then they do it and then the patient doesn't pay now they're incentivized to not pay by going to the board or an attorney so it's just I always tell everyone that you know life is so much easier if you understand people I mean I'd rather you get an A in people and a C or D and time and money yeah they get an A and time and money and well here's
Cary Smith: here's I got a statistic that'll back up that commentary is that 80% of all malpractice cases at least according to one of our insurance companies that looked at 5,000 cases 80% of them yielded zero payment to the plaintiff the patient so then they dug into why what was happening in those 80% and a lot much of it was a dispute over money or patient dissatisfaction so there's that's the causality of it so because we're in Phoenix and I told you before we were sitting down I worked at Motorola and one of the big thing training's at Motorola when you're when you're making anything in a repetitive nature you have a process and to measure that process you use some sort of methodology and Motorola adopted this thing called Six Sigma which was from the Japanese Kaizen approach of manufacturing and Six Sigma popped out and it was basically for a layman's perspective every time you do something there's a chance for an error and the way to have effect that error improve your outcomes is to statistically manage your process more closely so the outcome is good so that every time you hand up a time you're not latent Lee building up risk through the process and so how do you apply that to dentistry right a service business a medical business with you're not dealing with chips you're with people and it comes down to process and that's why we built done desk and the reason why we started that software company was in my office's I was in 200 in walked into 200 offices working with them and I just kept seeing the same thing over and over that the the practices lacked systemic process that would yield success they were accident in a lot of cases they were accidentally having success meaning they were avoiding failure just because the failure had to come yet and I'm a big believer in putting process in place so when a patient comes in you're gonna have this experience and they're gonna be able to understand how you practice dentistry and your people are also gonna understand how you want them to practice dentistry an example of that would be I like to ask my practices how drunk is too drunk when a patient comes in how drunk that's the one question I should be able to just nail well the other the other one make it make it a little less make it easier is how young is too young you know there's a habit of patients drop parents dropping kids off for treatment in the practice and you know do does the practice have a stance on how young is too young and and if not what risk you're you're accepting by allowing minors to be in your practice what could be alleged and what do we do if we have an emergency event also with respect to process are we trained and prepared and ready to handle emergency events or are we just gonna wing it and go down the process so that's what done desk is designed to do is to help the doctor manage these things in various ways in a singular way online is the online platform but it allows the doctor to build their compliance program in process programs
Howard: so anyway your video stop struggling to manage your dental business done dusk is the dentistry practice manager software that provides a suite of resources that automate the admin operations to your dental practice risk management dental compliance better HR practices so um so let's and I like that design because the easiest thing to understand it is with because it's so easy to count it's the your like money and drugs because those really wants to use metric yeah the only Americans that know what a kilo is or dealing huge volumes of drugs but with you know you look account receivables and they're always working their account receivables for forty years they have an account receivables from it's like you could just change the process and this be done I want filling give me two hundred we give filling you know yeah so you're saying Six Sigma is looking at the processes that keep having reoccurring problems and change the process instead of dealing with the outcome yeah and you
Cary Smith: know what your outcome won't needs to be what's your ideal outcome is I mean if you're a dentist driving to work or if you're a dental student going to school right now you know you're you're kind of sometimes gonna show up and you don't know how your day is gonna end and that's partly because you didn't may have not this may say you may have not determined what that individual delivery process for your patients look like what the quality is how you wanted your your people to interface with those patients and what the patient should feel and believe when they leave and and to have that level of sophistication in the practice requires you know identify what that is and then also train your people and develop your process so it's repeatable that's the other thing with Six Sigma is you should be able to take a process pull it out of where it came from stick it in someplace else and with the same level of discipline get the same result and this is really important for that because we would test product in Austin develop the product and the testing process as we're manufacturing things then able to bubble-wrap that whole thing and ship it over and Indonesia and plug it in and off it would go all the bugs would be worked out in one place and they would develop all that process and push it out that's the theory behind done desk and the actual practicality of it is as a dentist you can develop your process train your people on it with nothing more than a phone you can record it load your phone video up into the system assign it to everybody and make sure they've read it and actually even retest people it'll some of the trainings can expire during the years of people have to retrain so things like setting up trays or how do we do our front desk phone calls how do we greet people how do we build all these processes you can upload into done desk and out it's
Howard: funny because you work for Motorola and and I've lived out here so I lived through the whole deal where I had patients coming in that worked for there were engineers for Motorola and they were very very frustrated because they were talking about you know I mean I'm humans looked at silent movies while having a phonograph for 40 years before dawned on anybody to put the peanut butter on the chocolate and it'll be better and the what Steve Jobs did of just taking I mean it was a peanut butter chocolate let's just add the Internet to the phone and I remember when I got here the whole phone industry was half Motorola and half nokia yeah Nokia and they're dead and right now you see all these dentists having a lot of emotional problems with the changes but you just got to get a top of it so Six Sigma describes the term Six Sigma is used as it describes a target of 3.4 defects per million opportunities which is considered to be world class Sigma is a term given to a measure of deviation and a dataset and so the other so how that applies to healthcare in my mind is that 300,000 Americans die each year from an iatrogenic hospital issue they didn't have a problem they went to the hospital and 300,000 died and you go to the hospitals in Phoenix Arizona and the surgeon pulls up in his pores she's wearing Nikes he walks across the parking lot goes in the elevator and he religiously washes his hands for 10 minutes like it's some weird thing and then filets you open and then there's all this infection then you drive across the street to Motorola or Intel which is very hard to get in you gotta have a patient for security and all that someone's got to let you in there and you walk in you take off all your clothes you shower you redress you have a mask on you breathe the air the air is filtered at one part per because of one little dandruff or a hair or something fellow class 10 cleanroom a class 10 cleaner so America it's so embarrassing that we have a class 10 cleanroom for my iPhone and then your mama's gonna go into the hospital and gonna be one of those 300,000 that dies so she
Cary Smith: she almost did my stepmother went in for a broken hip and she came out six months later after surviving a staph infection in the hospital yeah and that took years of her life off and so hospital contracted infections is a major financial problem and this is why when you go to a hospital you'll see gel bottles every six feet on the wall Foam bottles antiseptic foam but
Howard: but if you took the nicest Hospital anywhere found on the world would it pass Motorola for a chip room
Cary Smith: well it's a different level it's a different standard I mean yeah it's a different standard but I'd like to be the higher standard than the iPhone well that's you wish right so like okay so OSHA let's say this OSHA says you cannot take personal protective equipment I have an operatory that's been used in a procedure right but yet every day dental employees are taking home lab coats that were used in procedures to wash at their house right against the law and it's just a training it's a training ignorant it's an ignorance thing right people just don't know the law so therefore they just react and now you legally can't wear your scrubs oh well if it's the outer layer that's presented to the patient as you're working then that cannot go home that cannot leave the operatory field and it has to be long-sleeve well yeah you can't have an underlying clothing or skin visible or not visible but a veil Johanna definitely old I am
Howard: when I open up my practice for the first five years we all wore shorts because it's the desert it's a hundred and eighteen degrees outside and the hygienist used to always say the assistants you know I loved most about working here it's fun and we get it wear shorts and they know she came along and said no and they were very upset
Cary Smith: well you know the this really hit home and my daughter was diagnosed with tuberculosis when - and the infectious disease doctor while we were getting tested ourselves to see if we were infectious said that if we're determined to be infectious we would have to notify everyone we've previously come into contact with the last day or so to have them tested as well and I tell that story in front of dental practices and occasionally I'll have employees say you know what I've received that letter from my primary care physician that they recommend we be tested because a patient came in the day we were there which was diagnosed with tuberculosis so that is not something you want on your letterhead as a practicing dentist right like hey I receive hand out letters of potential infection to my to my patients right and all of this the reason why my stepmother got sick plainly is somebody just did not do their job somehow Staphylococcus bacteria made it from someone else to her through a contact situation but come on
Howard: I'm gonna be hard on you this is dentistry uncensored the research is now I'm showing that that's apps actually not true when they go in there because these as these cases got real big they started saying come on we do 23andme she had this infection let's go find where it came from and it turns out there's ten trillion organisms living in your gut and watch.watch grandpa on the couch he's sticking his finger in his ear he's rubbing his eyes he's going to the bathroom and and the ones ice I read up here today were like four were like tracked down like a crime scene and all four staff all for infections came from her own gut microbiome so you she's laying in bed and you're cleaning the counters and autoclave and everything while she's scratching her nose and grandpa's scratching his rear end andfact you look at that and you're like okay be an open wound and they're a human it's scratching themselves maybe it's time to put mittens on him and but anyway so I think that I think that model or that um that is it's gonna turn out sure because the hospital is scratching her head yeah I could if you do all this stuff and she still got it there was a
Cary Smith: there was a research report and I'll have to pull it up for my studies that they looked at 98th Hospital and I can't exactly recall the exact study I can get it for you but it's they took tivity hospitals and they studied students medical students that were there and they said the medical students on average touched their face something like a hundred times a day and they also noted that the medical staff there only washed their hands effectively 50 percent of the time and which just points to the illustration of that research report was that if Hospital contracted infectious diseases are a big problem then the process something in your process is causing this and you have to identify what those processes are and that's what risk management is is identifying what the potential causes of risk are and manage them manage them managing them willfully and with a certain amount of consciousness so
Howard: so and so if you go to done descon it's three things it's risk management dental compliance better a charge so risk management done desk helps you manage your business with expert resources that manage risk yes sir and how long and summarize that for the best example well for the
Cary Smith: HR piece the question I know I just on the wrist man over the risk management piece so a1 you can develop your own training courses that reflect how you want to run your business and effectively train your people in a repeatable way so they're not left to do what I told my doctor still let your employees run your business meaning give them clear instruction sets on how you want them to operate so they're not winging it or bringing in training that they have had previously okay your election Amarth a it's a it's it's for a dental supply company there and it was Midwest and oyster and what would are you
Howard: what are you talking about tomorrow so I'm doing a there's a three-hour set so the first hour is OSHA the second hour is HIPAA and the third hour is emergency preparedness OSHA are those all so done does three things risk management dental compliance better HR practices would you say those are all with covered yes those classes are in there yes sir so for an ounce of prevention is worth a pound of cure so you're saying that I'm a big lion's share what you're observing year 15 years is us that you need to prevent more risk by better staff training on on three main subjects of OSHA HIPPA and emergency preparedness
Cary Smith: well I that's not all done desk dies I mean there's the bigger risk like for example New York State New York City launched a requirement for employers to provide sexual harassment training the city and the state have two different actually signed a waiver and gave it all to my staff so so that's in Dunn desk so we picked up the laws called the Attorney General studied what they wanted us to teach doctors and we put that in there did a class and put that in and now fifteen years have you seen sexual harassment claims an issue in dentistry I mean is that a highly it can be in a situation where it has been yes I mean you're in close proximity you spend a lot of time and things could be said or done or if you go to an off-site event even though your ought not in the work you're still at work and those allegations have been made I wouldn't say it's III don't have a ranking of top ten I think the number one issue doctors do face or employment related issues I mean that's certainly within the top one or two day-to-day if you talk about entrepreneurial satisfaction with the job the if you say hey Doc what satisfies you about entrepreneurship the number one reason is not employees it's the something else the employment related issues seem to be the number one phone call I received just because my HR background doctors tap into that and it'll oftentimes the answer comes down to well why isn't that in your handbook well what's a handbook you know why is it why was it processor expectations established just like we let in when you say employment related issues is the main risk I would say for an entrepreneur yes and how we used to sink we say that employment related issues are the main I think the top one of the top risks for dental entrepreneurs is employment practices liabilities the liabilities associated with employee people and that could be things like discrimination or sexual harassment failure to promote breach of contract some sort of contract so sex promotion discrimination and does that be and what does that usually based on well your race race racer or in some other characteristic that has been Mardan you know perceived to be marginalized within a practice
Howard: so sexual what they call it sexual harassment sexual harassment
Cary Smith: yep failure to promote there's another one in order to promote that would be if if you've made a promise of promotion or you've made some sort of agreement that if you did these things we would move you and then you did those things and
Howard: okay let's just time the I loved my go-to thing during college and you know when you couldn't study anymore physics or math was auto buyers I don't like biographies I don't really care what you think of that guy I want to read what he thought and so many of them had this ironclad rules sex like if you wanted to go to lunch with me I mean I got 50 employees we're not going Billy Graham we're not going alone so if you're not gonna go alone me somewhere if we go to a convention I stay on a different floor if we have to meet even though you're a guy and we're just doing shots at the bar you can't meet in my room because if I let you in my room and it's determination against everyone who's a girl so you know so and because this yeah so just jput down some ironclad rules that you won't do and everybody's making fun of Mike Pence for that maybe he carried a little extreme but um probably don't have any sexual harassment claims so then promotion which position is this usually is a dentist
Cary Smith: well it's just in the definition of an Employment Practices Liability who's calling a lawyer because they thought they were gonna get a promotion and well I don't think that that what I that would be just one of the pieces of the definition and I think one of the ones what I'll give you the one that recently popped up was I'm having a performance issue with a protected class which would be an older woman let's say that would be considered a protected class and the doctor had made promises to her but then the doctor is consolidating his businesses because he's preparing it to sell he lays her off and she alleges wrongful termination which is another piece of Employment Practices Liability so the doctor then has to defend himself against this wrongful termination and other allegations were made the discrimination and wrongful termination yeah and let me on
Howard: let me just say something up minorities are really r quick hmm this is a much less weighted issue in my mind what I see the biggest problem with minorities is I go into an office in Phoenix you think you just landed in New Delhi yeah I've lectured in New Delhi and they're in an area that's like a hundred percent Hispanic and it's like you know it's the just you your staff should reflect the people and I see dental offices that are in an area right here in my back yard all the time they're like they're an area where the five mile radius is 25% speak Spanish as a primary language and so you know when I think of race in business humans are so complex my gosh I am I can't tell you just yet I mean patients Monday and Tuesday I mean half the time this conversation switch to Spanish I don't know what she asked what's all right I don't know what's going on do my molar work you know but if everybody in there is not reflect your customers I think it's a bad business yeah
Cary Smith: I don't know I don't have a comment on the race aspect but when I hear that I hear communication issue right so you're trying to communicate complex perhaps complex medical terminology or a situation and you don't speak the language or culturally you're not sensitive to the way people receive medical advice or perhaps someone moves
Howard: oh it can't be done it can't be done like when I lecture internationally I know you're not gonna believe this but I humor drops completely because it just doesn't work you don't realize how complex a pun is and that's not gonna be picked up by English as a Second Language and humans are so complex and language and syntax and expression and oh yeah you just you want I couldn't even imagine what would they call it if you only know what one language if you know two languages what are you called I'd have no idea okay if you know one language what he called unilingual an American an American yeah I mean I've had so many people that they did this podcast yeah I couldn't imagine if you told me tomorrow gave you a podcast and I go do it in Japanese or Spanish I don't know how they do it
Cary Smith: well you can't you can't indict Americans on that just because we didn't they didn't have that as a force for curriculum in our school there was an elect usually an elective I mean there's certain class I got to expand it right I used to travel in Mexico and I understand in Spanish as far as I can get a bad in the beer right I mean that's about as good as I am Abed in a beer yeah so the but if they would have forced me as part of mathematics like the same discipline as mathematics or reading to have that track I would speak Spanish if it was part of my community but it's not part of my commitment I live in San Antonio and it is but I don't even my neighbors who are from Acapulco next door they choose to speak English and I try to get them to speak Spanish with me but I'm terrible at it so they don't yeah I am
Howard: we got into this with dental town back in 1999 about the foreign languages we make foreign language websites on it and so I went down to issue that suppose you're always trying to find who's the smartest kindest so I went down to ASU I won the language for Ana and I found one guy that spoke my language and he basically said look how there's eight billion people on the planet if you wake up you're born you got 50 million people to talk to so when you go to someone like huh Brazil's got 200 million people they speak Portuguese China you know but when you go to like little Denmark and they just got five million people well they got a comedians the French the Russians English so those people know like five languages so bottom line is use it or lose if you don't need it you're not gonna spend a lot of time on and in fact if you don't need something you're spending a lot of time on it most people would say you don't have very good time management yeah
Cary Smith: but I think that the point the point that you that that we both were trying to drive at is you know within the practice well at least the point I would like to make as far as you think about this is the implications of your team being prepared to have these conversations with people that would come in and that's a purposeful thing right I mean just driving back to making sure your people understand the situation and how to communicate with them it's not every day you meet an Amish person right and they're that person may come into your practice and there's not going to be a routine you've practiced on that particular situation but you might meet someone who's let's say anxious or has anxiety which is a communication barrier and have your team be under understand how to handle that situation effectively so it doesn't drive unnecessary problems into your practice preoperatively
Howard: yeah the Amish on amazing the Amish have settled in as many as 31 states in Canada in Central America though about 63 percent are located in Pennsylvania Ohio and Indiana the greatest concentration Amish is in homes and join counties well I hear actually big Amish community there and the last time I was visiting mom I saw the most adorable thing I'd ever seen in my life you know there's the buggy going down the street dad's up there there's horses and the girls are in dresses and they're so adorable and she's sitting on the back of that buggy looking at her phone well times got a change man a little bit yeah so um so which is bigger than I'm an issue dental malpractice or you said that the biggest risk is um for entrepreneurs is staff issues so what's the bigger issue is that um is it dental malpractice or is it staff
Cary Smith: well if we had if we had to stack the two staff out by a large measure really yes by a large measure the average is gonna pay more coin settling staff issues than perform dentistry malpractice ultimately not in terms of not in terms of maybe policy premiums or outright payments but in terms of time that investment and frustration that's a huge component that's definitely way outside of that I mean most doctors from my experience will have a serious malpractice case once maybe twice in their career right that's the average you know and I'm gonna happen
Howard: that's why you have car insurance like when you wreck your car when my boys call me and say you know I wrecked my car my first question is are you okay is anybody heard do they call an ambulance is you know not money cuz you have insurance yeah
Cary Smith: so on but in the spectrum of risk you know there's financial risk there's environmental risk there's people risk there's malpractice risk there's governmental regulate regulatory risk there's all kinds of different categories of risk that you can face what I want to try to help doctors avoid is just accepting all that risk without any sort of contemplation and one of those ways so we developed done desk and it's been it's been great it's been really good everybody loves it and they see it as necessary and useful but what I've also seen is that you can't out software bad leadership people people buying done desk thinking it's gonna solve their problems within their practice and it does create some efficiencies it does create a lot of efficiencies but the underlying issue of why all these inefficiency inefficiencies exists is the lack of leadership skills on the part of the dentist or the dental owner the other thing is you have DSOs these big DSO meetings and these group meetings going on and you look at all the agendas the a DSO and is one of the major guys there's a bunch of them out there nobody's talking about risk management everyone's talking about the upside not the downside or the potential downsides and I think that's a disservice and I think it's opening up these guys and gals who want to do group practices or multi locations to unnecessary risk in the end they're not may be made aware up for and the other you know the
Howard: some people just get a lot of satisfaction of saving money and some people just they never have their iron cost and they their whole life they need more raises and they want more return from suam it's like you got a spinning drum like though they want to learn something on occlusion so they get an airplane fly here to Phoenix Seattle whatever dropped three thousand dollars plane ticket and then I get back and I said well okay um tell me exactly didn't know before you left that you know now and then I'm like my god I mean these online courses how much is an online course on
Howard: Dunn desk oh well it seemed free it's included in the fee in the monthly fee if you bought it all a car what's the monthly fee and well it depends on the size of the practice most practices are a hundred and forty nine bucks a month for Dundas for done desk so ridiculously cheap most practices
Cary Smith: so Dundas cost one hundred and forty nine dollars a month is that a contract no month month month a month that's a huge red flag I mean can you imagine um you're moving into college and you meet your dorm room and he makes you sign a contract that you have to be my roommate all year I kicked my first roommate out I think like the third day so so you don't have a contract that's great so one hundred and forty nine dollars a month what if it's a DSL yeah we usually price that based on the location so negotiate it as we go the last several ones we did was around 75 bucks a location so it's still ridiculously cheap for those guys Dee and how long has it done now well we lost it last year we had a hundred offices sign on last year's our closed beta learned a bunch of stuff it's cool when you develop software you get to see how people use it and then we spent the spring this year implementing a new functionality that our doctors wanted and what was that functional so they wanted internal chat so we have a chat feature now within the software they wanted the ability to have a resource library so we built a resource library we have most 300 practice management documents we've created everything from emergency preparedness infection control operations HR we even have an employment handbook template we worked with a law firm we put in there as a resource library but then the doctors wanted a place to store their own stuff as well so we created a library where they can put their own standard operating procedures and other marketing documents patient facing documents in the system so they have a singular place to keep all this operational activity
Howard: nice so how's your two going
Cary Smith: it's very good I'm tired of driving I've driven a lot of miles yeah I'm on the road a lot and I think it's important to not phone it in a lot of service a lot of software companies try to do this virtually and and I think it's really important to know the day to day experience of the doctors I mean that's the real key thing is that the doctor pulled me into the room off to the side and go hey this is what's going on and then I can diagnose how can we help what what is the solution and is this solution applicable to a lot of practices that's been good that's been the hardest part it's just being away but it's also been the best part of it this is
Howard: why I started podcasting I'm August 4th 1990 I gave my first lecture at the Sheraton Manhattan so this August for 2020 be 30 years of this and I just love right now when you get an email from like when I get an email from India I'm like dude you really set to go talk to you I used to have to fly five hours from Phoenix to New York 15 hours New Delhi which is exactly on the other side of Phoenix so you know 12:00 noon here is 12:00 midnight there talked to 200 people for a day and then turn around 15 hours back I mean I live like a cockroach and now I'm sitting here you know so digital it's scalable you know all the work you put into one move the decimal place over to ten not much more work you just learn more so it's amazing you did you did touch on something about cost right and
Cary Smith: so you said some doctors are cost super cost conscious and some are have spending problems and we have something in the middle you know the old adage stepping over dollars to pick up dimes and what I do when people ask me how much does this stuff cost that you do and whatever it is whatever program we have I always tell them we'll the cost of inaction first of all no the cost of inaction if you have a penalty or a fine here's what that number is right I'm not fear-mongering but I just want you to put that into balance right so informed consent is really what we're driving for and so I think that's with with your patients you want to tell the DA you want to make sure in an informed rejection conversation we're presenting treatment here and if you choose not to do this here the negative outcomes and here are some of those costs associated with the negative outcomes a bone loss and you know whatever
Howard:
Cary Smith: whatever you guys put a little always when you got an employee handbook yeah comes with it okay and then the next is new talent acquisition there's some issues in an HR hiring people access Canada screening templates interview guidelines other essential tools any summaries of that well one thing it does so our software does that nobody else has is it's a checklist of all the documents you need to get from your employees and so the employees get an account and they can log in and load in all the documents that you need to collect from them on an initial basis and an ongoing basis so there's CPR cards licensing you know if it's a bunch of independent contra or associate dentists you know the other DEA licenses if they have their own individual malpractice policies and you can put time dates on all those documents and every Friday for the first time in dentistry every Friday the employees receive an email that says these are all the documents that are expiring this is what you owe us and here all the training courses you need to take to be in compliance with our practice
Howard: so it's amazing so all this regulation which you know everybody always talks about taxes but government regulation is more drowning in taxes and and so the the DSO is they have departments for this like I feel lucky I mean with 50 people I got five people in management it's not like when you own a McDonald's franchise there's the McDonald's franchise that never makes a hammer they're just working on your processes and with dsos I mean ground zero for DSOs 18% of the dentists Arizona affiliate with the DSO that's number one app here's all the way out to none so these DSOs this is easy for them to do because they got an error management so if you're gonna save independent dentistry you're gonna have to you're wearing too many hats so you're trying to digitally condense their hats faster easier or better
Cary Smith: I asked the lady who air in Phoenix oddly enough she I said there's no ladies and things well she she she was lady and and I said give me the list of the top ten things you do day to day as the operations manager done dusted seven of them and so I emailed the doctor and I said you know this can be all this can be consolidated into the system and she said well that'll drive her out of my business I won't need her anymore and I said no what it does is allow her to take what she knows and focus that time on bigger issues not where is the CPR card for Jenny at location two like that that's not where you want you just be spending your dollars from a person perspective and that's where the DSOs and these group practices allege they can save you some time and I say a Ledge because from my experience it doesn't it I heard it takes thirty thousand bucks to start a DSO right there's no barrier to entry as far as the ability to manage business effectively I'm not saying they're all bad I'm not saying they're all good I'm just saying there's effectiveness levels in in all of them and dentists are biting on that I think they're biting on that promise that all this will be handle also administrative stuff will be handled for you but you still have to give up a piece of your business or your future for us to get that and I think Dundas sits in that spot where you don't have to do that it helps that practice get some of this discipline and when these kids come out of school how long you're talking about onboarding an employee
Howard: I'm always on last Saturday was my third September 21st it was my 32 year anniversary and I made a post on I am I graduated May 11 to me 133 days to open and then I got it open September 21 1987 and 20 days later was Black Monday largest single-day stock job how gratulations how long is the but I see this onboarding they come out of school you know the type of person that goes eight years of college doesn't want to be your employee and I mean everybody I talked to this it seems like the office manager is ground zero for problems when she starts talking about dentistry and you know is this acceptable or you needed and and they're just sitting there thinking first of all you're not even a dentist why are we having this conversation I mean yeah and things like that but I'm how long are you seeing in your experience between graduation and they
Cary Smith: finally are opening up their own practice to be interested in some light dumbbells well they're they're always retro actively interested I think when you graduate dentistry you're in a deferred risk management mode until something bad happens to you and what I mean by that is I had a call yesterday with a gentleman who got the bank loan million bucks bought the practice moved in calls me hey Kerry what do I need to know about compliance right he's already spent the money he's already obligated and the and you know this no dental school has a risk management program or a business program or anything like that maybe there's a topical class in your your three before clinic you know that some guy comes in and talks but it's not part of the program just like we talked about our language right language isn't part of our schooling and at Cary Smith: first management isn't part of Dentistry in dental school people just don't know what it is and they inadvertently assume risk and it usually pops out when they start the practice or they buy a practice and they start getting run over by problems they realize wow I don't have the answers here and that's what we want to try to fix and part of that fix is high trust practice partnered with max Kerr dr. max Kerr in Austin and we have a training program that's now is that so that's on that's on been desks calm well that's a separate it's a high trust practice calm is that but to get another website yeah I didn't mean to bleed into that but but what's it called it sky high trust practice calm yep dub dub dub high trust practice. Com and what this is with dr. dr. Carr's client and we got to talking about challenges as a matter of fact he was probably one of the originators of why done desk exists he says hey I have all these employees what are what does the state require me to have as far as all these documents and ice that's what started us building done desk and through that relationship we started having these discussions on leadership and talent and management and marketing and how do you build a practice that you can trust yourself and then allow your people to trust it and then allow your patients to trust it so it's a process that we've developed and we've done something like 16 hours of recording and we have these training courses we launched our beta we have 15 offices in the beta right now we're in our last week that a class comes out every week for a seria period of time and the were having a final our final Conclave this weekend - with all of our doctors talk about what they learned and how it worked and any innovations they developed and who's dr. max Curry's Vista Ridge ma x ma x ke RR and he is Vista Ridge it's he's in Cedar Park Texas right there mr. Ridge Vista Ridge ok and he had about a he does 3 million bucks in production out of a six off practice there it was pretty good and he also owns a sleep dentistry business with another dentist that does about a million in bucks in production there and he shares that number all the time so my aunt somaek started this and asked you to join him or who started hi trusts I started it in terms of the trademark and all that good stuff websites all that but max max and I we just started talking about these business problems and it led into hydros practice that's the formulation of it
Howard: I just checking my email you know I recently that guy he sent me an email in 2007 I recently attended your lecture at the Rocky Mountain dental convention I was the red-bearded dental student I was entertainment formative but uh so what was max trying to do what why did max need this was it for his office or he just learned everything the hard way and thought he could scale this to help others or what what was he what would drove this innovation
Cary Smith: end suffering and suffering that's a good one that's it plainly I'd like I said you can't out software a bad leadership you can't out process dissatisfaction with your career we you know they both of us reached a point in our careers where we were driving to work and dreading what was about to happen to us mostly because we didn't set our own path of what was going to happen to us we didn't have the right people we did another eye vision we didn't have the right process and we didn't have the right help or colleagues or fellowship with the right people to help us think straight we were just buried in our own stuff and I broke out and he broke out and then we got together and we realized that how we did it individually we brought we bring different perspectives to the table and how a dentist can achieve success and avoid failure in dentistry and gain a really nice I think engagement in their career get their people on board and make sure the dentist trusts their business and then therefore instead of throwing their hands up and saying I don't I don't like going to work so I'm gonna sell out or I'm gonna what one dentist one dentist told me I said hey man I have a really good idea to help you get good people and he said I'd rather keep my mediocre people than trying to go recruit new ones and I just thought to myself that is the crappiest way to live your life because there are good people out there and just because you can't or don't know how to do it is limiting his amount of satisfaction he has in his career so we presented this to our dentist and we had 15 sign up as the beta and it's been going really good people really like it and the format is a podcast similar to this where we just discuss issues and then you get a side lesson with how to implement this topic the first lab we developed is talent lab which seems to be we were going to do leadership first but we found out we thought or thought about it's like leading terrible people is not a good thing being a good leader being terrible people leading a terrible team is not a good thing I'm always aware of
Howard: where you know we all got the same brain there's only one species all were the last remaining homo there's no more Homo neanderthalensis they're all dead but us no breeds one species and we all got the same brain and they know the answer in like five different areas but they don't apply to this one like they knew in sports when they're watching their team they're like we need to fire a player and get a better one yeah exactly how can you backseat drive the Arizona Cardinals without looking at surely or
Cary Smith: let's recruit the best first baseman and all not our heads when they sign a ten million dollar three-year contract but we want to pay our front desk person seven dollars an hour and not invest in the first impression of our practice you know those sorts of things right and that's the cycle so we said let's get the right talent first let's chase that dragon first let's get that guy out of the room and then we'll focus on leadership so our five-part series on talent labs was developing your vision values what are you about what are you really about you get three or five items there then how do you attract and recruit the right people look what's that process how does it work how do you do that how do you onboard them which is the really key in getting them productive quickly and into your process and then how do you performance manage them in a positive way and then how do you develop them and developing is key and this is another thing I see unfortunately in the industry is you've seen this I'm sure is people go to CE classes for no purpose there's no business reason why you're going to that class other than hey it's in Scottsdale let's go to play some golfing or I'm gonna send all my people down to the TDA the Texas Dental Association meeting and guess what they're walking around with margaritas and getting their hair blow-dried in the in the Convention Center and they're not there for a purpose that supports your practice right so that's the part about and having all that system in place and oddly enough people didn't really know how to do that
Howard: I'll tell you my favorite little stories my idol and mentor Jared Pope back in the day he wanted to learn how to place implants so every night when he came home from work yeah and just watching an hour every night figured it all out but most we were like oh no I I gotta spend $3,000 a weekend and I need to be what do you call why are humans always getting there they need validated yeah so they guys say well I went to pinky or cuase or spear and I got a trophy and a certificate and a piece of know you you're validating yourself can you place an implant on because if you just want to know the information information has become a commodity they just deny they overpay for information that's the most distinct way to say it dentists pay way too much money for information but
Cary Smith: but it's the investment if the investment is acts right the return should be why not why and like why like why are we here but the X the value why and understanding if I go do that my business needs implantology it needs it to survive and we're gonna do implantology so I'm gonna go take these classes to develop my skill verses I think I'm gonna go learn a little bit about implantology and put my toes in there and spend all this money when you could have spent the 3,000 bucks say on teaching your people some other aspects of Dentistry that could lift your business in other ways but you have to have a plan otherwise you're just gonna throw money to the wind and your people aren't gonna end up getting this connection
Howard: I know I know we're ten minutes over but you flew all the way in on from where Austin around San Antonio from San Antonio Southwest Airlines yes earner bird my gosh I Herb Kelleher passed away this year what a legend I flew so much three times I saw them at that guy really what a legend man he is so he was so damn cool you talk about not being toxic you talk about HR s everybody loved him I mean he just stand there this cigarette in one hand and a drink in the other and just just an adorable guy just a legend love that guy
Cary Smith: well so so the brand the brand values you're contributing to him and to Southwest Airlines right that's all by design dental offices dental entrepreneurs don't have that don't have that approach to how they deliver the brand experience within their practice for their patients right so and if you're good at it if you're really good at it patients refer you by word of mouth but that's that's a key key point we also make in our in our hydros practices you know are your patients walking out wanting to give you word-of-mouth referrals and that's the reflection of your brand just like that was unsolicited as far as feedback around herb Keller yeah
Howard: and he didn't even design the Southwest Airlines business model he saw it the whole thing was rolled out in California and it was working great but then they started expanding international and him and his lawyer drinking buddy thought they do that for they went under hers a lawyer just saw a business opportunity that they weren't pilots and what I love most about the herb Keller is every time a dental office is on fire they think that they should just get another validation and take more training go to more courses and implants TMJ all this stuff Herb Kelleher founded and ran Southwest Airlines his whole life died he never even got a pilot's license if any of my homies out there decided they were gonna start a pilot business oh my god they'd have to get they get certified Boeing all the hours and hours then they would spend their whole life taking pilot classes it is like Rick workman Rick workman is gonna be the first dentist that owns a thousand dental offices and he hasn't seen a patient in 25 years Rick work but I work Kershner owns three you know has three hundred come for dentals he and see a patient for five years so they peanut-butter-and-jelly the dentistry in the business I mean ray kroc is dead and 40,000 McDonald's open this morning and it wasn't cooked by a ghost yeah so so business but was it food that's the thing that's you close food you know we're back in the day when I was little my gosh it was the biggest treat in the world oh yeah and dad take you to meet God's by a sack amber I don't think anybody design when they designed dr. pepper they never thought that you'd wake up and drink 64 ounces of it on the way to work so yeah so there's a little responsibility for that but um so what do you have most passionate about on this um on this some done desk right now
Cary Smith: really it's for multi office locations for people that have multi offices they can consolidate the operational routines that are just in notebooks and folders laying around and that's been the really big lift if practices that have we have a seven to seven dental in San Antonio its friend of mine Justin Koch five locations shout out Justin and he bought a used on desk to a great degree and if sometimes if you don't take the training they've built in done desk you don't get a paycheck like you don't get hours and that's just a discipline that that I think is really cool about the software and it's working as intended that's why we built it and
Howard: I flew all the way from San Antonio I don't want to cut you off too rapidly though cause we're probably just gonna pull the plug on me any second now but I mean what would since since the majority of our viewer a quarter of the viewers are still in school and the rest are all under thirty and I know and thanks for I do read all the comments in the YouTube section I know I'm with two bald guys if you're listening to this on iTunes it's it's you just got to go to youtube right now what would advice would you give to those kids coming out of school
Cary Smith: oh well it's yeah it's stuff we're doing right now get advice on understanding out creating a risk management mindset I it sounds boring to a dental student like why would I need to study this stuff and I'm not saying get into the details like I did with this certification that I launched into I'm saying just go into it with eyes wide open that there is what you're about to do is fabulously amazing you're an entrepreneur and I come from a long line of entrepreneurs you'll be able to rely on yourself to earn a living and that is absolutely the most beautiful thing in the world to me and in my family but don't expect that it's going to be easy and it's what it's without challenge and risk and sure your skill your technical skills up as much as you shore up your entrepreneur skills those two things go together and they cannot be separated in the future last you just want to be an employee dentist and fall into you know an employee employer relationship model or you don't have to worry about all this stuff are you seeing that though what percent of the market is that
Howard: I mean how many of those six thousand graduates here in the United States now when they come out that's just what they want a real good job they do not want to be an entrepreneur well you know in debts motivating you
Cary Smith: you know you have to pay down the debt and I think that's the self or for the group practices corporate dentistry is you know you can come in will help you with your debt by by a steady income and here's a location and it's great because you got this big debt
Howard: and they pay you just enough to stay with them just long enough to kill all your dreams and it looks like it's about five years so about 20% a year dropships so it's about five years and but what what percent do you think have the mindset that they do not want to be an entrepreneur very oh not be an entrepreneur just flat out
Cary Smith: I would say just anecdotally like 20 percent I think yeah and the other 80 the 80 goes well I'm gonna go work corporate and then eventually bounce out and a few like maybe five percent will say I'm coming in buying right out of school if they're in a residency program right I mean the bank's usually don't find a fresh out of dental school but if you're in a red GT residency and you want to come out they usually get some money there that that's how I just anecdotally see it I try to help my when I work with dental students I try to connect them with my my companies my dentist because I know they need help so we try to make connections and that just seems to be the way it falls out yeah
Howard: and some of them are perfect like I got a good friend in the valley here and she she works at PDF she works for a Steve thorn she singles she's got a kid she she's got single with a kid and that that's a big commitment it's a big source of her joy and then she you know had a couple dogs and she loves the fact that and it may change you got to remember when people say what's the bigger market and mistake house or McDonald's is it Taco Bell or sit down my sister it's actually both for the same person depending on your age yeah where you're at in life it's like when you're in college all your friends are very different as soon as you get married you find out a year later now all your friends have changed now they're all married then when you start having kids you no longer hang out with the married kids people the smart ones that don't want any kids that want to be millionaires so you know you just you're constantly evolving they there was a
Cary Smith: I did a lecture for the Asda district 9 as the leadership team near off they had a Conclave everybody got together from the states and they said Kerry effort did my little my little pitch they said Kerry what would you do if you were coming out as a dentist and there were probably 40 kids in the room when I call them kids right they're all younger than me and I said well if I were you as you sit in this room as much as you if you like them or not y'all all of you get together and form a trust that can help each other build each other's businesses and find funding and grow each other up and group tackle entrepreneurship within this community that would be how I would do it and you could go to rural America you rural towns and start this up and rather than pop out on your own and be an individual and then you know go through that process on your own be a group as graduating class of whatever and then get 10 people together and work it that way that's how I would do it same again
Howard: I'm not falling you say that your advice the young kids is to start a group of like-minded people I think you
Cary Smith: well here's the thing with entrepreneurship and dentistry you're on an island and the risk you face is sometimes unbearable to be on an island so you perceive safety in numbers and you go work for a group practice right so you're just transferring the risk to the group practice in that regard I told the students if it were me because I'm an entrepreneur and I like risk in that way I said there are 40 people in this room you should all group up and form a trust or a corporation where you're all equal partners in it and there's terms and conditions and what have you and then group fund crowdsource developing and starting practices that way you can spread the risk out but you're going to individually benefit with this little community here and it would just be like a crowdfunding situation but you're spreading the risk out but you're also helping each other learn as you go that's how I would set it up yeah
Howard: but I'm Dentist are a little challenging there's a thread going on gentle town a day where these people are just just made about how you know I do dentists badmouth other dentists about I mean Ronald Reagan won by a landslide said that the 11th commandment never trashed another Republican and and dentists they they come out of school and they saw you know a lot of backstabbers they saw you know and they they anchor to that the toxic ones are the weird ones and so I think a lot of them have a lot of trust issues with their college when they get out of school and then we get out of school you walk across because you want to replace your buddies from dental school and your buddy across three then you find out that half of them thinking fear and scarcity in are all upset that there's another dentist out here it's like I had dinner Saturday with Jack dildora drove up to Jerome Arizona 5,000 feet they were so cool i dinner jack you wouldn't believe how viciously he was attacked trying to open up a dental school because all these innocent I'm like okay well didn't you go to dental school did your brother mark did he buy that oral surgery go online with a black belt and a and a Eagle Scout online at eBay no he you went to a dental school Jack's opening up a dental school like the one you went to and oh my god he was trying to be I mean it was just
Cary Smith: because there was a threatening threatening the establishment or says they want competition but not for them it's currently great the reason government is just not working is
Howard: because everybody says oh yeah freedom of speech right you do what you want except for this one thing you can't drink beer you can smoke pot but or you can drink beer but not smoke pot yeah are you marry a woman but not a man or would their every when you get a hundred people in a room and everybody says oh yeah I'm totally for freedom except for one thing laughter a hundred people take away one thing you have no rights and so they don't like any constant we're seeing that with SSD smiles direct Club there spawns is to go to attorneys who are in bed with the government to pass laws to restrain free trade and I'm like all the complaining I see on smiles direct clip I'm like you don't see any new innovation did did after the whole smiles direct Club did you change one thing in your office cuz I new award sadhana center sitting looking at like wow like I remember they first heard coming out they're like yeah why do I have to see him for every trade deal why don't I just give him a so a lot of my friends now then when they wouldn't give me a one tray they're giving me a three yep and instead of that I'm changing it once a month they're telling you to changer so you're saying that in a in a planet with eight billion people we're but a little over four percent live in America with 320 million that this big company goes public and all you can do is run to a lawyer and grab your shotgun in tritation really you didn't learn anything because I saw that with the original and then we'll wrap this up with with orthodontics Turner's of America um everybody has all these emotional things right overthrowing centers America and what Lazar Jasper Lazar just blew my mind open is why are you having to put a third down and finance the balance of something you haven't incurred any cost in I mean and the way he explained is like okay you go get your nails done imagine if the lady said well we're gonna sell you a two-year program we need one third down and we're gonna finance or us finance the rest for water you get a prepay your employees read more gonna do like your insurance all right you didn't curry cost and these were that honest I mean they got you know they got bands brackets whatever I'm clear aligners it's like an organized in America they just said let zero down zero percent financing 199 dollars a month for 24 months no contracts and ever you saw oh my god I've always wanted a as you go swipe the card at the door right I don't have $1500 for ortho so what in economics they call it an economic barrier to entry and after the rise and fall of OCA the only one that made on the earth change and now I'm a grandpa and 90% of that I still want an economic barrier to entry for orthodontics for a costs are not an anchor and and then smiles direct clubs likely they're either gonna go bankrupt American Airlines started matching the private fee schedule of salvatorians well the only secret lower bracelet cost so smiles direct Club is doing something a lot less money what's the secret well they they cherry pick the class ones they're not in certain class twos and class threes and they they cherry pick the easy cases and they give them trays without seeing them and all this kind of stuff and why don't you be proactive and say what can I learn from that instead of the old monkey thing go get a lawyer go to my dental society start suing everybody you know suing your way to success is is the opposite well you know that's yeah
Cary Smith: when you just smile direct Club mean from a malpractice perspective I just see that thing and I go you know I'm in braces now I was in misery and I was non-compliant and my my orthodontist said okay man we're just gonna put you in braces because you can't get away from those and I think that smile direct Club thing from a compliance angle they probably have their patients sign off that if you're not compliant we're not responsible I think that'll be the failure actual failure of the product in the end will be people being compliant well so today as we're speaking and then I can we're going to wrap this up rather
Howard: I'll wrap this up where is it no not there not there oh yeah here it is headline news the - ville post which is headquarters for smiles direct Club and doctors consumer filed class action against mild direct club downtown base orthodontic venture went public earlier this month a group of orthodontists and consumers on Wednesday filed a punitive a spelled wrong they said putative is that PETA a putative class action against local medical technology venture small dairy clubs in which the Plains lads that the company committed fraud amid less consumers the complaint filed in Nashville federal court makes a dual allegations against the maker of direct you know you know again it's all toxic it's all negative is all this might my interest is the one orthodontist in my town that actually just like this is enchantment will learn anything about everything about it and it's got them all motivated and he's changing the way he's doing things so ortho I said what have America's gone but why you solving I cannot bear it interest and whether smiles are club works or not has nothing to do what did they innovate something that might work for you so again it's is the is life is glass half-full or half-empty do you just go through your whole life thinking in fear and scarcity already lived your whole life and hope growth and abundance and I think as a leader in dentistry I think to be a leader you don't have to lead these guys to learn how to do dentistry I mean there chefs they want they wanna cook they spent eight years proving yeah I want to learn how to cook you don't have to motivate them to motivate them to go learn about how to work with their hands and do surgery and get people out of pain I love it but you do have to be a leader in trying to motivate them I'm to wear the hats they don't want to hat don't want to wear and you have to wear so many hats when you own your own business and the only ones I see are successful is if the dentist parents own their own business so if you're lucky enough that you're your mom was a dentist well you lived through so you you don't even realize how much you've taken in if your dad is a farmer if you owned a restaurant if you if you're self-employed you know all this at birth and don't even know you know it but my god if your mom worked and dad were employees and you came home and watch Netflix and fortnight and whatever I'm you and you go over dump your dental office wow you have no idea what's gonna hit you so my final advice is you need to walk at a school and dive in that swimming pool the first day because you're a really smart person I mean I mean most people don't know the difference between geometry and trig you know that trig is sine cosine and tangent you're a smart person so when you come out and you start analyzing all the risk you're smart so you become risk adverse you know when the best time I walked out of school opened up my office and made four boys in 16 months now I would have known that I would not sleep for a decade and and if I would have thought about it I might only have two kids or one kid or are you know so you're when you look at a point five percent failure rate you're not gonna fail you're not opening up a restaurant that's competition dentistry does not have companies you have but a half percent failure rate so and that's usually cuz your license taken away because you have a some substance abuse problem gambling problem you have some problem which you need to find the doctor that fixes that fix that they can come back and you're still square one just dive in and don't talk about whether or not you should have a kid or not you should have two or three before you start having those thoughts I mean do you have to - so you're twice as smart as I have I'm trying to talk Kyle and just stopping this now before it even gets started but but part –
Cary Smith: maybe how old are your kids we got a thirteen and a seven yeah so in 13 and seven you you you think you're a genius
Howard: you're ready to write a book I got two perfect kids I'm gonna write a book on how to raise a child and then they turned 16 they get a pair of car keys yeah yeah thank you hey thanks for helping my homies learn the stuff that they are not attracted to and when you own a restaurant I've been in awe to you for 32 years and only three restaurants have been at the same time and they're the ones who spend more time knowing what a table cause you know you walk in there one day what I don't do the tablecloth well you know when you realize that every damn table was a dollar and it's a dollar to launder and one you know and they just know their numbers know their numbers know the numbers so know your numbers you know you don't have to motivate your kid to go do what he wants to play with to be a leader for your child you got to sit there and try to sell them on the importance of why they need to learn this and you can get them excited about it and I like it when old people are trying to help my young the next generations of dentists that are going to replace us into okay you like you like reaching bonding veneers but now let's talk about malpractice and employee handbooks and all the things that you never that were not part of this Asian to become a dentist so thank you for that thank you for coming on the show and thank you for posting on dental town and yeah thank you sir
COMMERCIAL:as a dentist you know the drill a lot goes into running a successful practice from operations to HR Payroll admin training compliance and more we can see while you're literally drowning in admin what if you could run your practice more efficiently while enhancing the entire experience for your employees and your patients introducing done desk the dental software platform that automates your entire practice whether you're running one dental practice or many our state-of-the-art platform simplifies and digitally transforms your operation so long confusion and missing paperwork and because it works on multiple devices you increase employee access and minimize risk with done desk you can onboard new hires with ease and force compliance save hours a week tracking documents and easily into your timekeeping and off time tracking spend more time with your patients not your admin with done desk