Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard: It is just a huge honor for me today to be podcast interviewing Dr. Oleg Drut on the right wave your hand, so the right and on his left is Dr. Martin Rabinovich, did I say that right?

Martin: You got it.

Howard: All right so Dr. Oleg Drut is an orthodontist clinical care expert and diamond plus Invisalign provider recognized the top 1% of the most experienced orthodontist in the u.s. he is passionate about his clients overall health and well-being and has 20 years of experience straightening and brightening the smiles of people of all ages of backgrounds. His expertise clear aligner therapy and customer centric care inspired by the impact of healthy smiles on perception and self-confidence Dr. Drut founded diamond braces to provide accessible and affordable orthodontic care that is delivered achievable results to all. As CEO he rapidly grew diamond braces into an office chain spanning the tri-state area of New York, New Jersey and Connecticut his network of top orthodontists focused not just on helping clients to enhance smiles but also on improving their overall health and quality of living under his leadership his company has serviced over 100,000 clients since 2000 and is continuing to expand along the east coast believing that orthodontic care shouldn't be a luxury for few but instead be a basic essential for many Dr. Drut's unique approach was to bring traditional healthcare practices into modern retailing people shouldn't fear the orthodontist he believed and so he mainstream orthodontic care with a client centric basic model to deliver expert treatments with personalized experience. He believed that seeing an orthodontist could be a commonplace is going to a hair appointment or a coffee shop it just needed a process reinvention. His network of doctors is a testament to his commitment to provide easier more affordable and more enjoyable experiences for everyone regardless of financial insurance status. He's a graduate of the New York College of Dentistry running a full-time practice and mentoring other doctors. He still finds time to be a devoted dad to five children plays various sports collects war memorabilia and trains dogs.On the left Martin Rabinovich attended Rutgers University in New Brunswick New Jersey where he earned his Bachelors of Arts majoring in the biological sciences he then went on to earn his doctoral Dental Medicine degree from Rutgers School of Dental Medicine after graduating dental school he travelled to Denver Colorado obtaining a specialty training in orthodontics and dental facial orthopedics and earning a Masters of Science in dentistry at the University of Colorado he's an active member of the American Dental, Association New Jersey Dental Association, American Association of orthodontists while in residency he represented the rocky mountain society of orthodontists on the AAO Council on new and young members he loves to travel stays active hiking skiing playing ice hockey and spends time with his friends and family. Well thank you gentlemen for coming on the show today my gosh congratulations III mean your company diamondbraces.com I mean you guys are just crushing it tell us about diamondbracelets.com.

Oleg: So we started Batman braces in about 2000 really and it was a traditional approach like everybody else is doing orthodontics and when we grew over the years we changed directions many times we started all over again all over again and last time we start all over against about two years ago taking all those healthcare traditional locations towards the retail spaces removing the front desk from offices and my goal is to eliminate waiting room I think the waiting room concept is absolute oliet okay and it has to be are absolutely patient-centered practice with a doctor as a core okay because that's our expertise we're doctors we have to exercise our right to be doctors okay especially in today's world when you have a direct-to-consumer companies sending their aligners okay and we have to be bad simple like that so about two years ago we reinvented the company and then we started just moving to the towards the retail spaces right that's how we did it and still gone and now we're getting a couple of locations with pediatric so in other words they also under our brand because orthodontics I believe in prevention okay it's all about preventive care right and pedo is a part of us so and I tell many people our new graduates and orthodontist pediatric dentists they have to be a base to ortho okay we don't work for them they work for us to prepare the patients for for proper education home care fluoride treatment and then we have a final stage in a in a preventive after ortho it should be no dentistry really except the pile of understand pedo's genetics to give or take but but we transform lives I truly believe in this quality of life we improve quality of life okay.

Howard: Well you know when I get our school in eighty seven people were Omar Reed was talking about front desk lessness you just said that you just started this new model two years ago you're trying to get rid of the front desk why what does that mean to you getting rid of the front desk?

Oleg: Well we have open formats so people check in on what they have all application they check in from the car they come in we measured the waiting period okay waiting time so our average waiting time and consultation about less than three minutes they they see that right away and adjustments people with appliances already the waiting time is a little more but we're fighting this to reduce it I think the whole concept of waiting confirm test it should not be there everything has to be online so when the patient makes a future patient or a client they call them makes appointment online we check absolutely everything they already processed which has the insurance which should be the the history we informed them what to expect and then they come in they're ready now and of course and then they see the doctor basically paperwork. So front desk is not meeting we have a check in their ass that's it but offering that no traditional front desk when you have a front desk we have a concierge staying there okay and greeting the patients and then that's how it works and eventually in waiting rooms should be a that's the whole thing absolutely yes.

Howard: Does your patient download an app or as they are they doing all this on Diamondbraces.com?

Oleg: No they download the app which called Diamond braces.

Howard: So or are you do you know of anyone else who's using an app like this for an office?

Oleg: I'm not sure if anyone else is doing it or not but I think it's convenient for that not everybody by the way not every patient using it but still they they have a ability to do that but when they come in they just check in and they they proceed right away but again we as we grow we change it's always it's nonstop learning experience we're learning our own mistakes obviously but I truly believe in the retail approaches with the Healthcare Compliance I believe ok that's what it is that's what people have to know that it has to be convenient okay that's number one and not expensive number two and it has to be given right for every single individual to have a straight case okay I mean we don't question think about this we don't question somebody who has a nice haircut right that it's ok it's a given right you don't see me in that old man walking the streets right how it's possible stealing in the civilized world like you had a sense if I'm a people still have a lack of access to care I mean that's it blows my mind in some areas of New York City they have issues accessing the care ok that's what we are trying to reorganize the whole approach and make it accessible affordable with amazing customer care that's important it's without compromising the customer care and of course the quality of care because we are doctors.

Martin: So bottom line I mean coming out of school and going to practice and being an associate at Diamond Braces you realize that it's a customer service business and really seeing how for example not having a waiting room concept and and really developing a system like that it really gives a more personal approach to the whole process and it puts a unique culture into the practice too and patients realize that from you know having no waiting room to have an apps which literally explain every little detail from before getting the braces to how to probably take care of them two different videos of how to properly take care of aligners I mean it's amazing.

Howard: You mentioned Oleg when you started about pediatric dentists I know over the years there has been some source of friction between pediatric dentists doing a type one interventions with RPE things like that and then later on when they go to the orthodontist there's been a little you know talk back and forth what do you think of phase one at the pediatric dentist office and phase two when they get older at the orthodontist?

Oleg: I have absolutely nothing against it as long as the dentist understand what he or she is doing I mean you don't question a general dentist doing endo if he knows what he is doing right same thing here it really doesn't matter what your specialty is look if you look at the Europe European model 80% of specialty work is done by general dentists here in this United States my advice is reversed which is fine as long as it is under stance and properly diagnosed the case and properly executed the treatment why should be an issue I don't really see it at all okay as long as it's not over utilized okay that's all that's my opinion to it.

Howard: So why do you think in your general dentists to 80% of specially work and the United States specialist to 80% of their work, why do you think that is?

Oleg: Its educational system first of all educational system is slightly different residency programs are slightly different but a good experienced general dentist why he or she cannot do endo or perio or surgery if they don't understand what they're doing and they don't have more practice issues I mean I we trained many orthodontists and when you can't asked dr. rabinaw he is working recently with us we had to offer specialty programs we have to retrain them there is boarding period and we have a mentorship programs and so on so educational system gives you a baseline but if you if your doctor gets in the right position the right office then they better learn the ins and outs of specialty that's what it is so for us even if you take a general dentist under our wing in a week and they can do orthodontics on that Atlantic's again specialize in one service they can excel it's not the issue I really don't see a specialty is mean it gives you a lot but we have to retrain anywhere in a jobsite okay and I this is my job as clinical director I trained the orthodontist that's what they do we're systems in place and mentorship programs and so on everybody has to be trained regardless of their background or the school okay they went to that's my opinion but I really don't see the issue why if a GP or pediatric dentist does some limited ortho why not make Invisalign and Jenny ladies can do Invisalign some are really good I met some general dentists were really good in with Invisalign you know appliances and Invisalign it's a very complex process it's not easy okay it's not six hours course what Invisalign pushing right and again I've done over ten thousand cases with Invisalign and I don't have any financial you know stake in the company by the way, Invisalign so I'm not like educating one over the other but it's a learning curve and it's a big learning curve okay.

Howard: So you have a passion for making orthodontics more available and affordable is that what smiles direct Club was trying to do yet its IPO seems to have been a disaster what are your views on that?

Oleg: Well first of all you have to understand smile direct Club it's like comparing apples oranges small delay Club is is a marketing company it has nothing to it's a beauty shop it has nothing to do with medical medical space okay I mean they have they found an issue which is tella dentistry really that's what they do and they exploit it now they do have doctors nobody knows the credentials of those doctors who check the cases really. I am not advocating small direct report or any other companies now on the market I truly believe in a doctor centered approach the doctor should meet the patient okay the luck that should speak with the patient the doctor should guarantee the quality of care of course that being said the patient has to comply with doctor recommendations but tella dentistry can be done when you can solve the patient but doing the approach remotely is just failing it cannot be done I mean I that model will never survive you know that's my opinion about smile direct club or any other companies doing direct to consumers shipment okay well those aligners I it's a complex process it has to be doctor centered and doctor has to be responsible for the quality of care. Now you go to taxi right for example I mean you take a taxi you see the license of the taxi driver right on and dashboard same thing has to enable dental office consumer comes to old and those have my less than a wall right so the consumer can see my license number complains if I do II can place if I do something right or wrong wrong right so with it's not the red clap or a company that it's no such a thing people don't know they sign the release form I don't think there is a future for that model really but the good thing about them they spend so much money for advertisement they increase awareness so much and we as dentist that is the benefit from this to that's how you look at it.

Howard: So you don't really even see any form of salvation of the smiles direct model you don't see that it could be tweaked and I kept alive you see it basically as doesn't work end of story over?

Oleg: In my opinion what's going to happen to the state regulations or federal regulations will put the day will force them to put a dentist on the sites okay and they're gonna go in the GSO model when they go to year so model it's all different month they're gonna fail again this is a marketing company they don't have nothing to do with with medicine with dental I mean they're great DSO so in this country like Pacific dental like Austin but that's a different model small direct lab when they will be forced to put a dangerous on the side and eventually that does not happen I really don't see the future for that model at all okay. Consultation yes, you can do consultation online I mean without x-ray even you can but again you have to take x-rays obviously to diagnose the case properly but remote treatment with aligners it's a very complex process even limited cases listen every case you need first we have to speak to the patient right I've seen patients coming into the office with a very limited cases that it takes us two years to fix because people aren't happy right and at the end the successes the doctor successes how many people happy with their services okay I forget about class one occlusion here its class one occlusion we do for ourselves now the rest is for the patient right so even mild cases sometimes transverse in a difficult major cases because of so unrealistic expectations a dentist can patient can have or something else right so even limited cases it needs direct in consumer interaction with a doctor to understand chief complaint right treatment plan execution of the treatment and then retention so if all this three part something is music is just gonna fail with a smile direct club tella dentistry platform there is missing major parts here so how can it work it's impossible.

Martin: To pick it back on that I think what you know a big part that's missing is that when you're dealing with dentistry as a whole it's different because it's one of the most personalized services in the human experience so I mean the mouth and a person's smile is a very intimate area of our bodies so I think that's where it's different we're coming to an office where there is a you know a formal consultation where you're personally taking care of a patient I think that's I think it's huge and I think that's what tella dentistry is I think it's missing I think it's missing that that personalized factor.

Oleg: Tella medicine and it exists in many major hospitals there you know a patient can contact a doctor so the lesion doctor will diagnose and this diagnosis I am again I'm not criticized to smile direct club or any other companies doing tella dentistry the execution itself it's complex and challenge challenging you have to see the patient that's why you know we have to build the locations and offices to see the patient listen if it was possible not to see the patient I mean I would I mean look at Amazon for Amazon I mean I hate to do shopping I use Amazon all the time I just don't go there and it's possibly deliver it in two three days see if I don't like it I return it here is just not possible you know I wish it was possible but we have to see the patients every four weeks every eight weeks every 12 weeks depending on a case to make sure that the treatment goes on track okay otherwise how else can we deliver the results it's impossible I mean is my mind.

Howard: So do you think California was another death nail into smalls direct club when they signed that bill and when the governor signed a bill into law this week?

Martin: That was recent the x-rays right?

Howard: mmmhh

Oleg: I think smile direct club has a very strong legal team probably the strongest in the country I don't think I mean the stock went down honest after that but I think they're gonna exist there now and they have a lot of money to fight this so I'm sure with timie agian and I don't have I'm not you know Messiah to see the future bread but I don't really think they have a lot of complaints from consumers okay and we have a lot of patients from them too we see and then they come in those by by the way those patients they don't like to do anything with aligners they want fixed appliances because they lost their belief in does a lot of those patients so if they cannot deliver the results good predictably it just model doesn't work same with ortho listen and I see in many forms though the dentist says all put polity or work put pals work we can just say quality of work because I've seen a lot of cases with a bad quality coming from ortho office a store it's not about quality here it's about delivery model delivery system okay and that's simple like that state regulations obviously okay but we cannot just say Oh smile direct doesn't work or they work right again I can show you hundreds of cases transfer cases that we see that after where they did something wrong I mean it happens that's why we had that we have human beings will do mistakes right so we can really judge an equality okay this is an invalid point and I think we have to educate the consumers or patients why it's important to go to the doctor we have to be better simple like that and welcome in today's residency programs and I this is my routine question and an interview when I interview a doctor right newly graduate or recent graduate I said what do you know about Invisalign your creature so the usual answer yes I know a lot so I show them clean checks tell me the mistakes none of them can understand I mean because education is not there they take six hours course they do 20 cases and then they come out of the residency program and they really don't have a knowledge to treat complex cases so they become in the same level with a smile direct club or any align your companies right and they cannot compete against them simple like that they cannot they will not be those are monkeys and company they spend a lot of many millions of dollars every month on advertisement. So what I'm saying we have to increase educational levels of our doctors that can help to for the consumers to understand why it's important to go to the doctor not to to get the aligners at home you know that's all that's my opinion.

Howard: So you're saying kudos to Joseph M Hogan the CEO of wine technology who built that Invisalign company centered around the orthodontist?

Oleg: Well not just at the orthodontist but you know but the general dentists can do it as well obviously but definitely I like to work with Invisalign for a few reasons they have a lot of a lot of tools in their toolbox that can deliver the results better than any other companies out there that print clear aligners okay and it's really not about the price per case it's about delivering Invisalign a tool correct is a tool or if I put printers in my office it's a tool okay I have to deliver for me and I've tried many different options really for me Invisalign gives much more tools to deliver the results okay and it's a great company i like them i think they grow in tremendously but and I told Joe this I know I spoke with him you know in this year and I said listen the biggest danger have to invest in education of the doctors if you don't invest in education it's gonna be a problem I know and I truly believe that if a doctor understand their plan they will use only Invisalign not something else because it's less headaches faster and it's just better okay for us and we deliver the results for the consumer consumers that's all.

Howard: Well now that would you agree that most of the patents for clear aligners are now expired it seems like clear aligner companies are popping up everywhere I mean I yeah I think there's over 40 companies now offering clear aligners is that going to be is that you think that will harm align technology as so much more competition there's like a Cambrian explosion of new species that clear aligners do you think Invisalign will be able to hold against all those forces?

Oleg: Yeah I think you know only last meeting we were on tour on the Lazy is not printing the liners or in the lazy I mean look but the quality is not not the cool plastic is different they listen Invisalign invested five hundred million dollars and a smart track acknowledged it it's just a different they have they have a huge support listen they have I went to Costa Rica they have two thousand people 24/7 operation in Costa Rica but plus they have centers like this and in China Europe they have about 400 people development team in Russia I mean PhD it's just different some different plastic they invest money in this other companies their Neanderthals okay so even though it looks the same but it's not the same but it's like heaven after if I played in your backyard you have to know how to fly the thing otherwise it's useless it's business junk right I truly believe it's a learning experience and if they invest in education in dental schools I like if knowledge I'm talking about then they will not go out of business now that the world is very open now with the technology listen they go to China the billions of people that India and it's I think this is gonna be everyday product okay and straight teeth it's a given like a good haircut it's a given right for every individual same to the straight teeth simple and that the price is gonna go down more and efficiency can go up let's simple like that and the benefits to the society to the consumers okay but I truly believe Invisalign as a company it's gonna be there it's gonna be there for a long time regardless the patents they invest a lot of money and you practice are coming out by the way I'm talking with plastic you watch it just say no time.

Howard: You know you've made the example of a haircut three times and I'm bald and then he said you said these other companies are Neanderthals and I just had 23andme done and I'm like four percent Neanderthal I'm like a bald Neanderthal just eating all these rotten tomatoes you're throwing. When you talk about standardization of the clinical process I mean it's so it's so hard to get to dentists or anything I generally feel sorry for my dental assistants because there's just three of us in one dental office we can't even agree on the same burrs for a filling or a crown prep and I swear if I told my assistant several times if you take away that burr from my crown prep I won't quit how do you get orthodontist that just came out of school to get him to all agree on a process when doctors they're just they each have their own mind they each want to go their own direction how do you herding doctors is like herding cats how are you able to herd these cats into one system ?

Oleg: I guess Dr. Rabinovich knows better this because he went through the experience.

Martin: I mean the thing is in recipe programs you you really learn the fundamentals of orthodontics and then coming into private practice into whole it's a complete 180 I mean so being an associate at Diamond Braces really seeing Invisalign you really appreciate how like you said it really makes everything a lot more standardized because it's it's a matter of virtually programming the treatment properly and then you train between your staff so the beauty with orthotics you can train your staff as as good as you want so the staff can do a lot when you're busy and with Invisalign you can really minimize doctor time and expedite the process of seeing more patients by with aligners.

Oleg: Well not talking just with our aligners again a lot of this is a part of our treatment approaches but we still do a lot of fixed appliances and the fixed appliances braces will not go anywhere they will say they're not gonna be absolute okay it's a great tool and a lesson we do a lot but what would the way we train the doctor sooner the way I we have manuals okay we have case studies right and then if the doctor has any questions and want to try any other approaches doctor we'll take in certainly do if it makes sense but if the treatment plan issue with a treatment plan we can always I can always show them I also show them similar cases that we've done with the certain treatment plan that it was successful because listen cases malocclusions is malocclusion okay so have as many variations not much so that's what makes help standardization and and as a result outcome is much better outcome of the of the treatments but it's all about standardization we can't deviate and we have to really remove that what's called Abell of the doctor opinion okay it's like think about Starbucks right I love this model you go to Starbucks you don't say I want but it's the to to Jon to do my cappuccino right you expect the same quality no matter where you go right so in that it is much much challenge and obviously because of the human factors and variables but it's possible still okay.

Howard: So I love the Starbucks model too. What percent are you clear aligner versus fixed at Diamond braces?

Oleg: Well about thirty percent clear aligners that's fixed.

Howard: and it's in what percent of your clear aligners is Invisalign?

Oleg: A hundred percent

Howard: and is Invisalign I mean invisaligns of brand clear aligners the generic but you're really seeing Invisalign the brand significantly different than clear a night clear aligner the generic you it seems like you're really I'm sold on the Invisalign advantage?

Oleg: Well I'm sold on a quality and easiness for me to a separator I want to flawless seamless process that's all I care I don't care what to use I can use Mickey Mouse if you call it right but that's not as it delivers the results today in today's world Invisalign gives much more than any other companies okay simple like that that's why I'm using Invisalign if tomorrow another company comes with a comparable product with ease in the separation listen I I said I'm not sign a non-compete or anything I with any of the companies I want to do what's better for our clients that said today Invisalign is better and they work people happy and we trump knows yeah we travel day satisfaction level so people listen people are happy again thirty percent we still have about seventy percent fixed appliances it depends on the location because many multiple occasions but an average about 30% 35% give or take I mean it will never be a hundred percent I'm not looking for a hundred percent okay sometimes we start with fixed appliances finish with the liner so sometimes we do aligners then finish with fixed appliances or some sometimes into one harsh with fixed we are to dine this we have to think outside of the mind of the Box that's all okay.

Martin: I think it comes down to what works in the hands of the doctor so I'm in this case without the Drude I mean Invisalign is the way to go I had experience with an office that I work at we do we print our own aligners completely is completely different definitely a whole different learning curve so I think it just it's a matter of what works in the hands of doctor what you see is being successful and then just go with it.

Howard: So you say that you've redone your business model on you started from scratch and just redone it did you does any of your business model incorporate anything that I'm Dr. Gasper Lazzara when he started working on my Centers of America in 1994 but was there anything in his model I mean he may he was the only one that made it to the New York Stock Exchange and all that did any of his ideas hold through the history of time or not really?

Oleg: Not really no I think that that model failed because of issues with it was not patient centric model really we creating patients sent a client centric model okay and in the urban in a high density population okay highly competitive model all locations really that's what we are doing so it has nothing to do with the OCA model n.

Howard: So how do you how do you why do you think is the OC model was not patient centric what about it struck you is not patient centric?

Oleg: There was no mentorship programs there was no I mean they were no doctor basically was doing whatever they want there was no control over over the locations I mean if we set up my office we take a control over marketing over over in a proper education okay compliance all the stuff we have to make sure that everything is standardized really okay but we are not going to just put a dentist or anybody doctor tool tool because it's a challenging world out there it's not simple just to set up office and then people will line up now it's much more involved it's a complex model in order then tell us you know any DSO when they are on it's not easy so we really have to standardize it and it's it's it's educational education centric model mentorship model and most importantly the benefits will be dust down patients will benefits really that's what it is.

Howard: I agree what you're saying DSO's have gone from you know they're they're the talk of the town they like to take credit for being the biggest drivers of the u.s. dental economy do you see any patient centric models of the DSOs where you're thinking they're really onto something here and I am going to add a lot of value or do you see most of the big modern dsos in your backyard as being the same as Orthodontic Centers of America?

Oleg: Absolutely not I think there are great DSOs all patient centric DSO and the india saw some dsr great deer sauce and they have really great mentorship programs for the doctors is really good I think this misconception in a dental world DSO on incorporating absolutely not you know doctor has autonomy to do the triple platinum in this is what it is but DSO has to take on the responsibilities of of training of the staff training of supplying stuff you know many many factors their compliance.

Howard: I mean what DSO models do you think or more or better more page patient-centric more better and onboarding their doctors with training which ones do you like more?

Oleg: I like Pacific Dental I mean I like them a lot how they do again I'm not talking about ortho services here I'm talking about for general okay I like Austin they're not bad okay they don't write things for the for the doctors again Heartland I think so too but again I don't have many details for the Heartland small brand certain brands are okay again that's my opinion I'm not criticizing DSO's here but I think there's something to learn from dear sir absolutely okay.

Howard: Unlike OCA so OC nothing really from their business model from 95 to now really proved its history in time but you do see promising aspects from Aspen and Pacific dental of being patient centric and better at onboarding doctors?

Oleg: Yes absolutely

Howard: Nice and so what would you say what would you say to Martin of someone who's thinking about their in dental school we know on this from her feedback from everybody that emails me, howard@dentaltown.com or makes a comment on the YouTube section if they were in dental school today and they were thinking about being an orthodontist what would you tell them?

Martin: Well first you have to really do your research and I would start off shadowing orthodontist at that you might have had people from or talking to a faculty of dental school and really getting a perspective on what it's like seeing if it's something that that you really may have a passion for and and then applying to resume programs.

Howard: and what would you recommend one residency or another or was kind of like if you can get in anywhere just get in and go?

Martin: I think that honestly when you're applying and then when you get in it I don't think it matters what ready program you go to you can be in the best most world-renowned residence program the country it's what you make of it as a resident so it's how much time you put in it's what you do to really I mean you only have you know two or three years of residency that's it so it's how much you make the most of it and that's that's what's gonna really season you in terms of when you're when you come out and what kind of orthodontist you are.

Oleg: I can I get add if you don't mind and I interview as I said many doctors the last time the last thing I look where they come from as a residency it does okay I get my advice to the data to the attend students get something that pays you okay because I see doctors coming in with $800,000 debts it's crazy I don't understand how how it's possible now after dental school or older all those residences try to stay with a minimal debt that's really important now you know life is what you put put into this right so it doesn't you have to love the profession it's a hard work okay it doesn't matter what you choose it's a hard work or talent is a hard work but you have to love it that's primary the most important part when you choose this profession but in terms of the residency with type of residency get something that pays you if you get into this right I mean that's my advice the rest is the same okay doesn't really matter you know you gotta learn you gotta learn you have to experiment you have to work hard you have to try and then you find and right you find the right office for you and that's where your education begins I call it freedom diamond braces I call it residences on steroids I mean that's what it is.

Howard: It was a year ago this month when the Wall Street Journal had that article on Mike Meru a 37 year old orthodontist who graduated with over 1 million dollars in student loans

Oleg: Crazy crazy crazy mind-blowing

Howard: I mean they started GoFundMe campaign for a doctor Meru?

Oleg: I had people come in for me to be with six hundred thousand dollars eight hundred thousand owes debt after those expensive dental schools I just don't understand how they can make it because they have a burden so much burden to begin with.

Martin: Also for ortho you have to pay for residency so it's on top of dental school you have to pay for residency after that so it's again a pretty staggering number.

Oleg: but not some businesses will pay you right so I imagine advice get something less at least expensive or whoever new whatever pay get in starting good work hard yeah and two three years will pass by fast and love what you do and then work hard.

Howard: So let's talk practice management software do you do you have special you just what type of software using cloud 9 software what are you using to run all these dental offices how many offices do you have?

Oleg: We could have only have about 23 but we adding about 10 more as we speak so probably first what up next year we're gonna have about 30 to 35 locations but what we are using now I mean we try them all those software's unfortunately ortho market is very small okay so there is not a blood of choices okay to use dental is much bigger market that's why I have more choices but in order and we even try to write our own and we failed so we use it now ortho to edge ok and it's one database it's not the best software okay it's not the best but it's probably better than what I have seen okay out there we have we're probably the biggest client for them now and we advise them on the development of the software really and certain parts that you were missing okay I mean that's what it is but eventually we will have to write our own software ok in fact big year so they have owned their own softwares and I think it's coming to that point that we have to have our own software our own other way but it's a challenge it is a challenge.

Howard: So what are they missing that makes you gonna have to write your own I mean it seems like such a waste it's what are they missing?

Oleg: Well billing you know they're all those software's were built and a notion that it's a fee for service practice that people come they have a balance they pay it's just different worked out there people change in students is all the time for example in New York people change the job change insurances and so on so it doesn't have those capabilities to track properly okay and it's plus you know think that the people is very human if a human there is a human error prone okay so if the report is if the status is wrongly placed by an associate the whole report is gonna be off so it's just a lot of and not necessary work or too much work for kids for user okay there is no flaw proper flaw let's put it this way or compromise flaw even though it has certain benefits obviously it's one database we can access any patients from anywhere but it could be improved and we are working with them constantly to improve the operation of the software itself okay.

Howard: but right now you the best one in your opinion is ortho to makers of edge cloud six?

Oleg: Yes that's correct we tried all of them dolphins we try it or to track I mean it just thought price structure was wrong or something else support was different those guys I mean they have about what 50 or 70 people in support plus Schine bottom being a 50% of them now it's probably better than the rest again in my opinion you might disagree but there is no perfect software for orthodontics in at least from what you've seen we wish there was something better now they build in the pita platform so we're gonna we're gonna be testing that pita platform because we're going in the pita space we'll see what can I say.

Howard: So Henry Schein owns a big chunk of ortho cloud too?

Oleg: That's correct

Howard: and do you think that's a plus or a minus I mean when Henry Schein buys a company when Stan Berkman part of his internet one strategy of buying a lot of the digital companies to kind of get away from a sundries selling supplies but more a digital company as he buys you know I'm Henry Schein one got a on WebMD ortho two do you think it's a big plus or not really?

Oleg: Hard to say I know that this pretty smart people running Henry Schein they have a great experience and understand the dangerous of online services like Amazon they will go in the medical space as smiling little space I'm sure they won't diversify now and that's what they do in but this is successful or not and it's hard to say for now I didn't see any benefits of of them haven't have or that ortho two model I mean I have not noticed.

Howard: and what are you doing I'm for accounting I mean you have so many locations what are you what software are using for accounting?

Oleg: Well we do what the name nothing special I mean have we have bookkeepers that drannit

Howard: Quickin, Quickbook Pro?

Oleg: Quickbook Pro we have what else again I'm not accounting he's hard for me to speak with in our statements and so all this stuff but quickbook pro and now we switch to the company payroll company Ulti pro yeah Ulti pro which supposed to be good and I will see with just our integration with them but that's a lot it but...

Howard: Ulti pro payroll?

Oleg: Yes payroll but they have a lots of and they have a huge platform it's not just a payroll. We used to have ADP but they fell sale ADP we used to run with ADP but it was not a successful model ok ADP doesn't have capabilities were UltiPro does.

Howard: So ADP does the payroll for one in six Americans and you tried that and it wasn't good for you so you switch to Ulti pro?

Oleg: Yeah but you have for example labor an allocation okay so for us I systems can travel from all of this or not we have to have an exact level allocation they don't have to trackable system okay so they even have a lot of stuff even though it's a big company but means nothing really big company sometimes they don't deliver to know so that's why you gotta choose what's better for you for your company it's very customizable listen but we just started with UltiPro I'm not demo expensive by the way than ADP.

Howard: So when you're saying Ulti pro its but that does it does that include accounting?

Oleg: No no so we use something else.

Howard: Right but are you are you sure your accounting is on QuickBooks Pro is you don't need anything more sophisticated than that to run thirty forty dental offices?

Oleg: I mean I cannot answer this question really that don't I don't want to make a mistake ask for something that I'm not I know that my bookkeeping account receivable payable they use quick book pro but what my CPA is using I mean it's hard for me to say.

Howard: Yeah it's just I've been I've been screaming at my colleagues since 1987 you know why doesn't my why doesn't my practice management software hook up to accounting and it's still and then when you go talk to the big boys like Stephen Thorne over to Aspen I'm like yeah we yeah we had to do our own and then when I literally beg Stan Bergman I mean I literally flew to his office begged him to hook up dendrix to accounting and he listened I love Stan he total listen guy but he he sent a questionnaire to a thousand of my colleagues dentists just saying you know is this important to you and they said no and stay he looks at me like sorry dude so you know that I loved it us but man their dentistry has gotten so far ahead of their business skills I just wonder if it will ever catch up or even if it can catch up. What do you find the most challenging of managing 20 30 offices how many offices you say you'll have this time next year or how many three now

Oleg: We have 23 now we're adding about 10 more so it's gonna be about 35 40 locations and next time next year this time again we're in the process of building the old anova locations I mean you that's our motto we will the offices with the biggest challenges is staff training ok staff training those making them follow those KPIs that we put them in them and the following that's that the challenge that we think that that's not easy to overcome but we are trying and with today's online capabilities we really can utilize all these tools in our toolbox to control the situations in every location ok that's what I believe and we're working on this every day and listen I think we're gonna succeed we'll see.

Howard: and do you do you have private equity behind you do you have partners is this all Dr. Oleg Drut how do you how does that look?

Oleg: For now it's only Dr. Oleg Drut but we trying to change this model too it has to be really employee employee owned model because it doesn't really work otherwise so we're gonna start selling equities to the doctors and that's how we're gonna do it it has to be Dr. owned model really oh it's not just doctors.

Howard: So that will you do that with an esop or...?

Oleg: I don't know I don't think so I don't think so but we still trying to figure out the best approach I mean I'm sure the best approach there's multiple approaches to this but we have to find what works for us I mean there is no quick answer to this really that's that's a challenge to make sure that but it has to be Dr. owned model and we're gonna you're gonna do it this year this was next next year.

Howard: There was there was an orthodontist in Arkansas who decided he was gonna start having a hygienist cleaning his patients teeth did you guys hear about that and what were your thoughts on that?

Oleg: I know this I think we don't do this, let's put it this way, I don't want to take general dentist business okay I don't want to in we still depend a lot on the referral from a general dentist okay we're in the city and man we work with many general dentists so I'm not we don't even do bleaching let's put it this way, the only thing I'm gonna do we're gonna get in the space in some limited location speed of space again better limited P the hygiene profi sealants nothing nothing crazy like surgical stuff now that's about it but we're not doing any cleanings for we do a hygienist as a system but they don't do cleanings let's put it this way.

Howard: That was the orthodontist on Benjamin Grayhairs orthodontists in Fort Smith Fayetteville who I always stay and rest up because my sister Kelly lives in Fort Smith Arkansas but so but so you don't think that's really part of the duties of an orthodontist is to also clean their teeth for convenience easy?

Martin: I think you're just stepping on you know on other dogs just turf which may you know definitely open up some controversy.

Oleg: Yeah that's true I think we have to be professional and we work with other professionals I mean that's my philosophy and we sold very small world out there right then just have to respect each other you know we never criticize dental work when they come in, I mean this is not how we work I believe in respect and I'm not going to take business where another I take business from other professionals if a patient needs the clinic I'll refer them out to the dentist okay II don't have a dentist we'll give them some suggestions okay that's not us but we are not I disagree with the concept just to do general dentistry in the side even the cleanings even a bleaching test matter of fact we don't do it we give patients the syringes but we're gonna charge for them let's put it this way.

Howard: So another big question dentists an orthodontist always get really focused when the decision involves a lot of money obviously and switching from a pano to a CBCT is a lot of money some radiologists do not like some oral radiologists have come on this program do not like the routine use of a CBCT on a child on all your locations is it all CBCT is at any two-dimensional pano what are your thoughts on someone wanting to upgrade from a Pano to a CBCT?

Oleg: I don't think it's necessary I think especially not semantics companies that produce certain stuff they start to push on the doctors I have experience you don't need any CBCT here I mean take a pan and you and look at the patient you know where the powerful impaction you know what impaction will I mean I get I sometimes really feel for that but it's so seldom that I don't feel that we have to invest in that technology it's thrilling about the expanse here I mean the prices will go down I'm sure but I never found that you need to have it okay.

Martin: I think it depends on the type of practices for example we when I was in residency at Colorado we had a CBCT so definitely for a residency program is convenient because it takes everything in one shot and you can use it for research capabilities and things like that so I just I just think it depends on the type of practice setting.

Howard: but right now you have no CBCT's you don't have any of them?

Oleg: None zero

Howard: and you're they we have our gist Invisalign provider in the tri-state area?

Oleg: Yeah I mean probably from us meet market we're number one in North America you know meet market spaces.

Howard: So see kids that's what I'm telling you, you know you always feel good when you make a big purchase there's no doubt about it and that's what draws you into all this deficit spending but I mean you can do this without a CBCT so you're listening to the guy these guys are the number one Invisalign providers probably North America and they don't have a CB CT and then you will sit there with all the student loans $750,000 mortgage on your practice you just bought a house your wife is pregnant and all you can do is come up with three reasons of why you need a CBCT. I mean, I mean if the only thing your brain can do is to convince you to get into more debt then you should just start you should just make all your decisions and then do the opposite what why do you think dentist just get into so much said like like how did that guy get a million dollars in student loan debt I mean how does this happen?

Oleg: I think they get they get influenced by by big companies who sell those items high ticket items you know you cannot man plus the peer pressure I have never seen a patients who would come to in and say do you have a CBCT I mean nobody nobody cares about this they have to have a screen office good civilization good Pleasant doctors good Pleasant staff that's what people look and good location obviously okay but do this they care what type of chair you put in there okay is it Italian for $20,000 you know Castellini chair or some I mean this is nonsense it's a nonsense okay so it's not gonna give you better edge through the command to competition you have CBCT or not I mean it's just as I said we don't have it we never owned one single unit really I don't feel the need of it and I'm asked this question many times I mean we've done I've done ten thousand aligner of cases okay full comprehensive I'm talking about right ten thousand patients over and my count I mean absolutely no need for that.

Howard: Mike bar who's known as the dental warrior he has a very large footprint in dentistry he wrote an article one time they said why are orthodontists so hostile to GPS doing ortho do you think that's a a general assessment or do you think that's a rare event?

Oleg: I mean it's tough to say I when I look at the forums with people respond and they some of the doctors they read you kill those GP so I had order case from a GP look what they did I don't think it's appropriate to comment on something like that okay without understanding the roots of what happened to know why it happened I think I've seen great GPS by the way and great Invisalign providers with a great quality of care that GPS okay so and I've seen very poor orthodontist or there are that is they do terrible job so I mean I think it's about personality not about your profession I mean you GP orthodontist so we have to be respectful to each other we're in a small world out there okay we are all dangerous we have to allegation to do good for the community now if you know if you agree and you take in every case if you're not if you don't you don't get training or certifications that's your issue should get sued for that right but if you know if you take a course CE credits you you try slow you have advisor mentors why not why as you peeking at the water I mean I don't think it's appropriate to comment on that really.

Howard: Well I mean in your tri-state area like save the Greater New York mean it's it's the biggest thing in North America do they ever have classes by orthodontists that are teaching general dentists how to do Invisalign?

Oleg: Of course

Howard: During the meeting?

Oleg: Yeah

Howard: By board certified orthodontist teaching general dentists how to do Invisalign?

Oleg: Yes I mean the same and that is the teacher how to do endo or perio the I mean what why ortho is different than endo area or extraction of the tooth I mean this is the same thing it's a procedure.

Howard: I mean Martin do you agree that the Greater New York Dental meeting has lectures by board-certified orthodontist aimed at general dentists how to do Invisalign?

Martin: That I don't know that I don't know I've only been to that meeting once but I don't know.

Howard: but again Dr. Oleg Drut you are aware of you feel like there are courses at the Greater New York Meeting taught by board-certified American orthodontists teaching general dentists how to do Invisalign?

Oleg: I'm not sure about that particular meeting I'm just a way that courses offered in New York that taught by orthodontist I'm not sure about births certified or not I cannot comment on that and they teach general of the heart to do Invisalign yes I'm not sure about Greater New York meeting itself I mean it's been a while since I visited meeting but I just use the products I don't I don't attend the lectures there but even if it exists, I don't see the reason why not I mean what's wrong with that.

Howard: I know we come out to an hour can I hold you just for a couple more overtime questions oh is is moving teeth too fast and root resorption is that problem getting less the same more I mean that we've been seeing that for thirty years I was resorption an ortho look to you today versus ten twenty thirty years ago?

Oleg: Just based on my experience of hundred thousand patients here is a genetic mostly genetic okay certain areas of the world they have much more much and in New York you have a luxury to treat different populations really I mean you name it from all around the world I think root resorption is more genetic than then I understand it happens and some minor but it's not an issue at all even to speak about it even though we have informed consent but I've seen genetic root resorption that done in certain population that we can we can see pattern like social female population like Hispanic populations from certain areas of the world it's interesting I think it's much innately then and questions by ortho really now we always have in law forces anyway and then gradually build up the force and I really never had issues with root resorption caused by I mean I have not seen it.

Howard: Well there's a new order there's an orthodontist in Canada where they're they're basically starting a non-invasive therapeutic ultrasound orthodontic treatment the AVO system will facilitate faster tooth movement and decrease orthodontically induced tooth resorption says the founder/ceo smile sonica and he's got a couple of orthodontist on board with him Dr. Terry Carlyle in Canada I'm he's got another one Billy Withchild who's the anyway , do you think if it's more genetic do you think this ultrasonic non-invasive therapeutic ultrasonic returning treatment is what are your thoughts on that?

Oleg: I would be skeptical to this I can meet status and then good status not something random okay we need samples of population equal population to compare what is faster many companies claim faster but what is faster I mean we tried many modalities I don't think it's faster it's really depends on the doctor how he or she is doing mechanics well that's what it is but I would be skeptical to believe the claims without seeing actually status population samples and then comparison you know that that's what it is but I wouldn't just buy the product because somebody claims it is faster I know.

Howard: and you buy a lot of fixed braces are you brand loyal is there one brand of fixed braces that is faster easier better for you and your locations.

Oleg: Well use the standardized approach is basically 22 slab what we use and not self ligating not supplication I think it was a little matter what you use as long as you understand that bracket is a tool it doesn't matter if you know as long as you don't have a lot of breakage we track the breakage obviously and it has to have a good match but I'm not loyal to any I mean what are the best it has to be reasonably priced, obviously.

Howard: What brands are you using?

Oleg: We have different brands really I mean we don't but as I said bracket is a tool you can use whether I can make this with composite blocks as I'm concerned we can do it, it just takes longer you know that's it but brands are again we using just twin bracket 22 slot pretty large bracket that gives us better flexibility in rotations and that's it you know the regular stuff ceramic we use a belief don't even our core or GC now a clarity right in ceramics again invisalign and metal we use doesn't matter what I mean so they're all the same as long as it doesn't give you a lot of breakage because sometimes when you buy cheap brands they have a issues with the mesh so you have a lot of breakage that's what happens with those brackets so it has to have we trying to break it straight okay sometimes breakage because of it happens right so we try to basically emergency breakage and so on, I mean that's how we do that.

Howard: Last but not least and I'll let you gentlemen go back to work I'm there still I hear a lot of dentists saying don't get those braces off to the wisdom teeth are out you need a lingual retainer so you know do you what are your thoughts on the wisdom teeth, there's a lot of oral surgeons in Germany saying that they think Americans remove way too many wisdom teeth and then when you look at the wisdom tooth issue would you agree that the retention of an orthodontic case is more difficult than straightening the teeth to begin with?

Martin: I mean I think it depends I mean there's there's a lot of different scenarios sometimes you have to remove wisdom teeth during treatment at an early age because sometimes the wisdom tooth can be inhibiting for example a second molar from coming in so it there's a lot of scenarios that can arise as far as retention there studies where they've shown that wisdom teeth were removed and crowding still occurs so it's just there's a lot of variables.

Oleg: Yeah I don't think wisdom discuss anything to do with relapse okay it's a treatment plan crowding many genetic factors but wisdom teeth I mean I'm very conservative in nature, I'm not going to remove any wisdom teeth unless it interferes with my mechanics if the salary with second more is impacted on base time when I remove the wisdom tooth if there is a pathology I will remove the wisdom tooth otherwise no but the retention you are slot retention is one of the most important parts of the treatment if the retention is not properly done the whole treatment fails okay so that's why when we talk about the dentistry and they send those clear aligners retainers they usually fail people don't wear them away for a long time, so our approach is we put permanent retainer on lower unless the patient refuses okay and everyone and then we give the clear and then we supervise for about a year that's our approach but I don't think wisdom teeth have anything to do with with post treatment relapse.

Howard: So you're go to retainer is a bonded lingual bar?

Oleg: Yes

Howard: and is it is it a band on the canine or just cement it on the lingual?

Cemented on the lingual.

Howard: Okay well it was just an honor for you guys to come on today it's just it was just so fun to interview the largest Invisalign provider in the United States, talking to you guys have done a hundred thousand cases thank you so much for your time today. It was a real honor to podcast you.