Dentistry Uncensored with Howard Farran
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1293 Successful Multi-Practice Ownership with Dr. Syed Rehman : Dentistry Uncensored with Howard Farran

1293 Successful Multi-Practice Ownership with Dr. Syed Rehman : Dentistry Uncensored with Howard Farran

11/14/2019 6:00:00 AM   |   Comments: 0   |   Views: 115
Syed graduated with a Bachelors in Dental Surgery in India and decided to move to the United States for a better life. He and his gorgeous wife Ameena moved to Chicago and fell in love with it. After several struggles he got accepted into NYU Royal College of Surgeons' one year Oral Surgery certificate program for international Dentists. After completing that he joined University of Illinois at Chicago where he earned his DMD in the International Dentist Degree Program in 2015. After his graduation he associated for 4 different practices, figuring out different practice philosophies with his mentors and learning everything from building a practice to running a multi million dollar practice. He did his first practice in April 2016 in Chicago with 6 chairs and now is running 11 very successful practices hiring over 30 associates and 5 specialists. His goal is to make dentistry predictable, affordable, accessible and comfortable.


VIDEO - DUwHF #1293 - Syed Rehman



AUDIO - DUwHF #1293 - Syed Rehman


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Howard: It's just a huge honor for me today to be podcast interviewing Dr. Syed Rehman DMD graduate with bachelor's in dental surgery in India and decided for a better life and moved to the United States he and his wife Amina moved to Chicago and fell in love with it after several struggles he got accepted in NYU Royal College of Surgeons one year oral surgery certificate program for international dentists completing that he joined University of Illinois at Chicago where he earned his DMD in the International degree program in 2015 after his graduation he associated for four different practices figuring out different practice philosophies with his mentors learning everything from building a practice to running a multi-million dollar practice. He did his first practice in April 2016 in Chicago with six chairs and now is running 11 very successful practices with over 30 associates and five specialists. His goal is to make dentistry predictable affordable accessible and comfortable my gosh I'm so excited to have you come on the show I mean I look at dentist and they come out of school it will be basically it's a millennial thing they basically only work somewhere a year whether it's Facebook Amazon Hartland I mean most of the millennial researches I mean they go follow any of them on LinkedIn they have a different job every year until about five years out of dental school and then they they settle down and then they practice 30 years so when they come out of school talk to me I mean you started a dental office and now you have 11 locations I'm trying to get Karen just to open up one so I really want to know from the guy who opened up 11 practices across Milwaukee and Chicago what do you say to Karen who's 27 she gets a different associate job every year she hates them all and all she's ever wanted is to own her own office and then here you're sitting there with 11 of them so well talk to her.

Syed: Well I am a product of you yet I have listened to you since my first day in dental school I pretty much heard every podcast that you guys said and I just followed what you guys said and you know it's all about meeting different people having different mentors taking those calculated risks and just going for it I mean you know you need to go out there there's so many awesome dentists how their meet them talk to them not from them and you know it's it's an amazing profession.

Howard: They're the natural selection dentist shy introvert because you gotta get A's in calculus physics chemistry biology so that that's the kid who sat in the library that wasn't the guy in the frat house and all that stuff so so meeting people and getting out there and pressing the flesh and running for mayor and meeting all the dentistry that I mean my god they they'd rather go how do you get a shy introvert mathematician scientist to actually walk across the street and shake hands with the dentist?

Syed: Well you know they don't teach any of this in dental school but you know you need to you need to go out there you need to go to all these different meetings your district meetings or your city meetings and start socializing talking to all the different dentists are out there and just learn from them learn as much as you can gather up as much as knowledge as you can and you know I mean just just do it just to take some calculated risks and just go for it that's what I did and you know you have resources like you guys and Mark Costas and Guy who have all these three podcasts out there so there's just so much information that they can learn from and you know it's all free and build with it so that's what I did.

Howard: Man Arizona really is the hotbed for a podcast I mean you said Costas Takas Farran, that's a I wonder if our state has more podcasting annotate so if someone wants to follow you you you have 11 different dental offices do you do you have a website for you or what you do or...?

Syed: Right now I actually just hired two people to work with me on personal branding so we're going to try out something new with marketing with all my offices where we going to personal brand all my doctors so you know so she's working on creating personal BIOS and some personal video clips for all these doctors so you know so I'm working on something like that right now so hopefully I'll have it out in a few weeks.

Howard: and would you have 11 practices across Milwaukee in Chicago so is that a a do they all have a certain look and feel and and business model I mean do they all do everything the same?

Syed: Yes, no you know I was you know when I was in school I was really passionate about the whole access to care issue that we're having you know and and I I was working with all these different different doctors and mentors and everybody wanted to work 9:00 to 5:00 and you know or everybody wanted to work 9:00 to 4:00 and they only wanted to do what they like and what they did not like so I learned it from all of them and then when I started my practices I said okay these practices are going to be open from 9 o'clock in the morning to 8 o'clock in the evening we're going to be open seven days a week so a lot of my practice is closed we are open Monday through Sunday the only three days we closed this fourth of July Thanksgiving and Christmas and you know and I have some surgical background so I wanted to get associates and mentor them so you know the day associates join me they learn everything from surgical extractions to do orthodontics to you know everything that is possible so I invest a lot in my associates you know I sent them to courses in the Dominican to learn implants I've made them join the u.s. GI course where they learn ortho and then - not this who put me all across the board and you know the deal with them as hey listen you can work with my practices if you were to teach my general dentist how to do simple cases of ortho and then when we did these practices the look and feel up all these practices is different because there are different kinds of neighborhoods and they see different different patient demographics and different profiles so we didn't wanna I didn't want to create something which is you know one size fits all so what we did is is we create a different things different offices.

Howard: So you have 11 practices

Syed: Yes

Howard: Do you own a hundred percent 11 practices or...

Syed: So I own about four of them I owned a 100 percent okay and then the rest of them I have a partner.

Howard: Okay so...

Syed: 2/3 partners so in different practices.

Howard: So you know that's the big debate by you know you have guys like Rick Kirchner Rick Kirchner owns 350 Comfort dentals and he doesn't want any associates he wants everybody have skin in the game then you got Rick Workman who does it all with employees so what have you learned you have four offices were you and a hundred percent out of eleven so that means you have nine offices where you have a partner where someone else is a dentist in there with skin in the game.

Syed: Everybody who is my friend so it's basically the associate who's either working there or the owner that I took the practice room and then we book or we've structured have something where you know I'm going to go help them I'm gonna bring it my systems and the way I do things and then you know transition them.

Howard: Okay so again in four offices you own a hundred percent nine offices you have a partner

Syed: Yes

Howard: Are there lessons learned in that I mean what's the difference between owning a dental office a hundred percent where all the dentists and there are employees yes versus the having skin in the game because I know and I believe a lot of people believe that if you own your office and you got a mortgage well you're gonna try to do that molar root canal if you don't you're an employee I'll send it to an endodontist. You know there's a whole different mindset when you're an owner operator have you noticed any of that or not really?

Syed: Well that was my biggest forte when I take on associates it's all about comprehensive treatment planning you know and you know I sit with them every day and I teach them how to do those molar root canals and so far I've been lucky enough yes there are some times where there is you know conflicts in practice philosophies but I've chosen my partner's very wisely so you know before I took over their offices you know it was really made very clear to them that listen I'll be running the shop so you know that's the only way I'll be a part of it so so far it has worked out so I haven't run into any major conflicts.

Howard: That is great so is dental implants a big part of your formula?

Syed: Dental implants is a powerful but how it is comprehensive dentistry it's partials and dentures and root canals and crowns and bridges yes dental implants do add to the do the menu but you know they are not envy all of me our practices we do everything from from from prophy to sealant to and all of plan fully comprehensive orthodontics but a major portion of our practices are still bread and butter dentistry and that's what we focus on.

Howard: and when you see bread-and-butter dentistry fillings, basic endo, crowns?

Syed: Yes Basic endo and you know crowns bridges dentures and then we upgrade to over dentures or you know talked about in all our course so anything goes.

Howard: Do you consider orthodontics and clear aligners basic dentistry or is not really?

Syed: We do consider simple orthodontics so we are almost all my associates can do a class 1 mild occlusion case using straight wire technique we don't do that many clear aligners ok there are only few practices where the pro patient profile can afford the clear aligners so that's where we use Invisalign and correct but otherwise we do full comprehensive you know braces.

Howard: What do you think of general dentist learning comprehensive orthodontics?

Syed: I think it is really important for general dentists to learn orthodontics and practice orthodontics at the basic level because what it does is it gives them this Arsenal where they can diagnose better and treat the patient better you know so I have learned that you know my relationship with my specialists has improved after I or any of my associates have started doing simple orthodontics and and the new generation orthodontics that are coming out now realize that and it has to be coexistence with them and this is working out for us it just helps us diagnose better.

Howard: A lot of kids they're getting mixed signals they get out of school and they see something like the Scottsdale Center and Frank Spear and it's basically all wrapped up in a CEREC machine so they're think well if I want to be a great dentist like that I need a CEREC machine and then there's old guys there's old guys like me that's like man I'd rather have it 30-year relationship Don Vanhook up the street with Vanhook labs than a machine and is your 11 locations 11 practices across Milwaukee in Chicago do they all have chairside cad/cam milling machines?

Syed: No we absolutely don't have any cad/cam we still use PBS impressions and I don't think anybody needs to buy again I'm gonna get a lot of heat for this property but you don't need a CAD CAM machine to run a successful practice I mean a successful practice is a practice where the dentist is doing good diagnoses talking to the patient's just doing comprehensive dentistry you know there is there is needed dentistry and there is wanted dentistry do all the needed dentistry educate the patient on water dentistry and and then give them a nice clear a nice treatment plan give them a nice treatment plan and they will they will fall through I mean they'll come through so but no I haven't upgraded to any cad cams I don't believe in them yeah maybe later. We do have two machines I have two offices but that's for orthodontic purposes we use that for clear aligners but not for CAD cam so no.

Howard: So what technology do you feel is vital for comprehensive dentistry?

Syed: CT scan maybe you know so it's going to help you diagnose do a root canal better place an implant better extract better I think you know I mean I am looking for a good course in incomplete dentures or partials I mean if I can find someone who can really again teach me how to do a really nice complete denture or nice you know a metal based partial or flexi partial I close my eyes go myself send all my associates for it.

Howard: Yeah you know the biggest partial lab in America is right down the street from me in Nogales Arizona and they're all shipped to Nogales USA then they're driven in a car across the street to Nogales Mexico and they get about a thousand partials a day and it was amazing to see how 90% of the thousand incoming partials a day the lab script is just lower partial didn't cut a rusty didn't say anything about designing it and I'm like dude all you had to do is pick up a football burr and you could have done something better than this nine out of ten just lower impression lower partial.

Syed: There's so many people out there who will you be happy with a partial or or or a complete denture everybody wants to jump into this exotic stuff I mean yes the exotic stuff comes in later but you know I mean do do like harder dentures and then jump into implants in and do a lot of partials if you can do a good partial or a good complete denture then you can place an implant better you know you can treatment plan better so I really focus on this with my associates I mean it's all about just how can we do this this class 2 better or how can we just do a simple root canal and make it you know as you used to say it you know make it fast make it cheap make it affordable make it convenient so with us it's that's what it's all about.

Howard: So you're mostly in Chicago in Milwaukee

Syed: Yes

Howard: How did you get a Chicago in Milwaukee how do those two things go together?

Syed: I started off in in Chicago and then a friend of mine talked to me about the opportunity in Milwaukee and you know it's it's it's funny you know when you when you live in the suburbs of Chicago Milwaukee is just a heartbeat away from you it actually takes you more time to commute to downtown Chicago from the suburbs of Chicago then it takes to commute to Milwaukee so when I started putting this all together and you know I well you know you have this land of opportunity which is just sitting right next to this is this major city and then everybody wants to be in the city of Chicago so I took that opportunity you know and and then found some very good locations and it worked out so.

Howard: What do you do when a kid gets out of school and they got 285,000 our student loans let's say they want to buy a practice that's 750 so they're looking at my god I'm gonna be a million dollars in debt I really want this to work do demographics matter I mean you've opened up 11 offices demographics matter?

Syed: I do a lot of research on demographics but my thing has been I've been going after these legacy practices you know you have these practices sitting in these inner cities which are 50 years old and 60 years old and you know all these awesome dentists who work there for for 40 years 50 years they're about to die they're sitting on 20,000 patients or 30,000 patients I mean you know everybody wants to put out this really nice shiny 5 star building out there but you know I'm going after these legacy practices where I don't have to spend half a million dollars or a million dollars you know I go in there I at least a really nice retirement plan for the dentist you know can some good technology some good upgrades you already have the patient base it's it's easy.

Howard: Yeah and it just makes so much sense a so-so are you I'm not really finding a big difference between the the business of Dentistry success in Chicago versus in Milwaukee if you picked up a great legacy location it doesn't matter?

Syed: I think again you know the dentist is good can create a good treatment plan you know be nice to the patient and and be accessible to the patient and the treatment plan is presented nicely I really don't think it makes a difference.

Howard: So you have 30 Associate dentist and five specialists,  what kind of specialist are those five specialists? 

Syed: They're all orthodontists

Howard: They're all orthodontists  wow and talk about that so are these full-time orthodontists?

Syed: Yes office we go to different offices so they rotate between different offices so

Howard: and do they all get paid the same way?

Syed: You know Chicago is a little bit cheaper Milwaukee is a little bit more expensive so you know I am really all about taking care of my dentist again I'm gonna get heat for this but when I come to Milwaukee I pay for the car I pay for the hotel I really take care of my associates so that's why that's one of the reasons I think a little bit successful as well I'm paying them more than whatever the market pays I'm investing $10,000 per associate just of the CE's every year you know but when I do that I'm seeing that you know when they have that knowledge they are going and just join it killing it.

Howard: I know I never understood this infatuation with 20% labor and these and these misusing all the people who have their labor at 20% they don't pay they don't pay health insurance and then you say oh so do you believe in like the government should pay for it like Medicare for all oh no oh so you're a doctor and you just don't believe that anybody said health insurance and then you see the high employee turnover I mean when you take care of your employees they stay with you 20 30 40 years that's kind of priceless.

Syed: I have about 33 or 34 I lose count how many associates I have only two associates that have quit on me okay that do because they wanted to move to a different state I have almost 200 to 250 support staff that work in all the clinics I can literally count on fingers on people who have actually quit on me no one and I'm affording to give them health insurance and I'm not just gonna start giving them you know what she was saying disability insurance and life insurance and all that stuff I mean we're making it happen with what we're doing.

Howard: So everybody reports high associate turnover I mean I just lectured to a hundred people in Scottdale at a big DSO convention the number one issue with DSOs is associate turnover why do you think and it's in private so why are you not having this problem and they are?

Syed: Because I am with my associate from day one I'm teaching them how to surgically section it to okay I'm teaching them how to do a root canal in a very efficient way I'm teaching them how to do orthodontics I'm teaching them how to do implants I'm teaching them everything and there is always someone behind them protecting them guiding them and then holding their hand they just love it and when I do this and then obviously you know teaching them treatment planning I mean you know my associates are making north of 25, 30 and when you are making money why would you keep in and try to reinvent the wheel and and open up a new business the way I tell my associates is listen you know I'm going to give you three chairs in my practice I'm going to give you two assistants one treatment coordinator one hygienist you know like you running a practice so this will be your practice within my practice. So you know I've created such awesome setup so then they just don't need to quit.

Howard: So now all that young associate will they ever have a chance to buy in and be a partner or they become an employee?

Syed: Yes yes that's how I'm expanding you know and that's what my next thing is listen if you think you're good you want to take it to the next step let's go out let's explore some more areas let's look for these legacy practices and and you know you and me let's do together.

Howard: So you're saying that you think what the young dentist is looking for the most is a mentor?

Syed: Yes yes 100% not one three or four vendors because when they come out of school they don't know who they are they don't know what they like they don't know what they enjoy so they need to worry about how much is minimum they're gonna make or what the contract looks like or all that crap and then to just focus on learning dentistry from the best or who they think is the best and learn how to take out a tooth learn how to do a root canal at six o'clock in the evening to learn how to make a complete denture which doesn't need you know whatever the blue thing is you know they need to focus they first year or second year or at least two years on that and then after that I mean this profession is an awesome, awesome profession.

Howard: That is a yeah that is so you think they're looking for several mentors that they come out they're not quite sure who they are they're looking for mentors they need mentors and what legal root canals implants that's why when you're posting on social media that you're you know you're going back to Parsons Kansas and there's two different people and you got two job offers and one's paying 25% but he'll pay your lab bill and the other ones paying 30% but you got to pay half your lab bill you're asking which one's better I mean that's a cry for help there you have no idea what you're looking for that's no idea what are you looking for where do you want to be five 10 20 years.

Syed: Exactly yes not worry about how am I going to do this or who's going to teach me how to look up well you know what production is what collection is or who's gonna teach me how to do this root canal as quickly as as efficiently as possible or who can teach me how to do a bone graft or how to surgically remove this teeth I mean who can teach me how to be confident and how to talk to my patient and then you know how to convince them that this is what they need so you know I understand the contracts and all this legal stuff is important but I think for the first year or two either they should join a good GPR program or an AGD program and or or come to the city don't be afraid to go to these practices where they see while you patients but you know see if there's a good mentor in that practice who will teach you how to do things we teach you how to do things fast and just focus on developing speed and your treating time skills.

Howard: So a lot of people are gonna ask well if you got 11 offices now that's a beast to feed with new patients how do you feed 11 offices of new patients?

Syed: So I'm really big into good systems Howard so we use networks all across the board I'm a big fan I'm upgrading to ascend in a few days but we have partnered up with dental in town which really gives us a good break down of you know where the patients are and then what I've done this as I said I have two people who are constantly working on digital marketing I'm doing a lot of these big companies who are into SEOs I personally don't think any of that works you know and creating original content and posting on Facebook and posting on Instagram and promoting all that stuff so I have two wonderful you know staff or team members who are constantly doing that constantly updating that and the biggest thing is word of mouth Howard  word of mouth I mean if you extract a person's tooth when they're in pain they've got about ten people and if you did a root canal at seven o'clock in the evening and you know that's our biggest biggest referral source just good work and being there for patients.

Howard: So you said how do you where the young kids and I guys go there yeah they need several mentors I still don't really know who they are?

Syed: Yeah

Howard: Yeah you said you didn't really know who they are the old u2 song I still haven't found what I'm looking for what do you think you're looking for and they come out of school?

Syed: Just figure out what your niche is you know what you're going to be happy do you know figure out work with different people and and and once you figured that out you know make some plans you know okay will you see yourself one year or five years or ten years or you know two years three years you know everybody is all confused they're just running behind you know what the minimum amount that I'm gonna get or you know what the contract says and this and that but instead of that, let's take some time and focus on you know what am I gonna learn you know how much am I gonna learn and you know how will you know how will I develop myself six months if I associate myself with this practice or this doctor so a lot of emphasis should be made on that.

Howard: Do you when you're looking at yourself are you do you have an exit strategy do you see ten years you'll be up to 50 offices and partners and then load the whole thing to Hartland or what is your exit strategy?

Syed: I don't have and he you know a lot of people asked me that and they said do you have like a private equity that is investing and you know I have never been approached well I mean I had a private equity that approached me but I didn't want to talk to that I'm just doing this because because I love it and you know I don't have an exit strategy I'm four years old you know I'm gonna be 40 and I wanna do this still have at least 60 at least 60 65 you know I wanna grow this as much as I can and you know when it burns me out I'm just gonna stop that's it so I'm not doing this Wow for what other for a lot of other reasons why people are doing this you know to build 20 locations and then just relax no I'm gonna be in this game for a long time again as I said to me this is all about access to care and you know making dentistry yes you used to say you know or you still say you know making it a four making it accessible and and and and you know for everyone she whatever you know so just everyone should have access to good good good dentistry at any time.

Howard: I got to ask this question and I'm already regretting cuz I know my home is can't talk about it there so why is healthcare so emotional in this country and it's just not in almost every country I've been to I mean like I'm lecturing on next weekend I in Israel I mean Canada Israel Australia I mean healthcare is just not it's just not it's available it's affordable they got a government plan you can do your own plan no no one even cares or really talks about it then you come to this country and it's like you got it you got to put your stake in the ground and tell me what side of the line your are and ready to I mean why what is that I mean you live, how many countries have you lived in?

Syed: I've lived in India and the United States so I have not lives in England.

Howard: Okay but what why is it why is health care just such an emotional issue?

Syed: I have no idea Howard I mean it is so simple but yet it is so complicated you know I mean you have all these groups of dentists who are talking about oh we can take insurance and this and that or you know I become a bad person if I start accepting insurance but if I am in this for the people Howard I'm in this for the patients you know so you know not everybody can afford $25,000 all on four case you know there are a lot of people who needs filling Stan you know they can't afford to pay and I'm just out there to help them and I believe in karma you go to good stuff good stuff will happen to you, you know and and that's what I'm doing I'm just going out trying to help out all these associates who join me I'm trying to help out all these employees who work with me I'm trying to help out all these patients who show up at my practice then it doesn't matter they have or MetLife or for the Mac estate insurance I'm just gonna treat them right and I'm gonna treat them as if I would treat my wife or my kid or my father or my brother or my friend and I'm not going to listen to the crooks who say you know don't do this don't do that I'm just gonna do it my way and if it works out works out good if it doesn't work out I'll come crashing and burning down so far it's working you know I mean in in in three years you know we build this thing everybody loves working for us everybody enjoys working for us we have absolutely no turnover rate it's you know it's just working out you know all my dentists are happy they're paying off the student loans really really quick I mean you know so it's...

Howard: So how did you get involved how did it become part of your out of access to health care what does that just health care mean to you and why is that part of your...?

Syed: because Howard everybody talks about access to health care in the boonies you know so there are no dentist you know hundred miles from this city I understand that but even in the city I think there is a big issue you know that dentist don't want to open up after five o'clock what they do even in the city of Chicago try finding an orthodontist or endodontist you can't and I'll think that is still a big access to care issue so that's why you know when I was a dentist where I moved here and - personally I wasn't licensed and and you know we didn't have insurance I mean we have the state plan or whatever you know working hard at that time and I couldn't find any dentist or I couldn't even find someone who could write a proper prescription we had to work emergency room just to get a prescription and I saw her suffer through that and I took it listen I'm gonna change this you know I mean nobody deserves to be in pain at 6 o'clock 7 o'clock in the night when it doesn't matter what how much money they have what kind of insurance we have I mean patient is a patient you have to take care of the patient you know stop thinking about the patient's pocket just think about the patient's disease clearly treatment time treat the patient do whatever you can do and then just leave the rest everything falls into place.

Howard: Yeah it is amazing in Phoenix Arizona is the 4 million Metro yeah on Sunday if you had a toothache I tell people you have you a better chance robbing 4 banks in a row without getting caught the 90 a dental office that will see you.

Syed: Take a flight out to Chicago or Milwakie we'll do it.

Howard: 8 and a half percent of emergency room visits are in the United States of America or odontogenic in origin because the dentist not only are they not open they don't answer their cell phone there now I have an answering service and then if you say they're not a real doctor they'll go insane but you know a real doctor they're open 24 hours a day seven days a week and you're and then they say oh I know we have bankers hours I'm like dude no the bank is open 24 hours a day seven days a week too I don't even know where you get bankers hours from it's lonely it's only dentist you work Monday through Thursday 8:00 to 5:00 who else does that...

Syed: Well what's the difference between us and physicians were doctors of the month so you know I mean so why should we be treated differently and I mean we're held to the same standards as a regular doctor.

Howard: My physician friends when they get off work on the way home they'll stop by one or two hospitals to make rounds.

Syed: Yes yes and what I'm doing is I'm opening my practices from 8:00 in the morning to 8:00 in the night I'm taking these dentists and I'm giving them listen you work the 8:00 to 2 shift or 2:00 to 8:00 shift and they love it, it's a six hour shift you know they see their patients they are not burnt out and you know sometimes they say okay doctor I'll just work you know the whole 12-hour shift and they work three days the food is out it works it works wonders it works great.

Howard: Okay so let's go through that because you talked about that is very similar so let's go through your business model okay so what are the hours?

Syed: So clinics are open from 8 a.m. to 8 p.m. we do two chests from 8 to 2 and 2 to 8 so mostly all the clinics we see about 60 to 70 patients per clinic in the clinics that I own a little bit smaller you know so you know our business model is again you know one dentist is with two assistants one hygienist is the ratio and then one...

Howard: What is the ratio?

Syed: One dentist two assistants

Howard: One dentist two assistants one hygienist

Syed: One hygienist

Howard: So your ratio is one dentist

Syed: Yes because my dentist like to do so we use the hygienists only for very limited things.

Howard: So your ratios one dentist one hygienist two assistants yes and then the dentist their shifts are six hours eight to two or two to eight and that's Monday through...

Syed: Every day

Howard: The seven days a week?

Syed: Yeah yeah they work five days to keep repeating so Saturdays and Sundays were open from nine to three.

Howard: So Saturdays and Sundays 9-3?

Syed: Yes that's right

Howard: So and why did you go 9 to 3 on Saturdays and Sundays?

Syed: It was difficult to keep them after three.

Howard: So it was the labor, the employees?

Syed: Yes yes

Howard: So here so your 8:00 to 8:00 Monday through Friday

Syed: Yes

Howard: and 9 to 3 Saturday and Sunday

Syed: Yes

Howard: Your ratio as a dentist one dentist one hygienist two assistants yes so do your dentists do cleanings?

Syed: They do SRP

Howard: Okay I'm sorry so dentists do their own scaling and root planing

Syed: Yes

Howard: but not their own Profis?

Syed: Sometimes they will you know give the scaling and root planing to the hygienist but we are moving away from the hygienist model.

Howard: So let's talk about that because there's only three publicly traded dental offices on earth in three four three two in Australia one in Singapore they all got rid of the hygienist.

Syed: Yes we're moving towards that as well.

Howard: Okay talk about that.

Syed: The dentist like to treat their patients the way I trained them is I trained that listen this is your patient this patient is your responsibility and the patient appreciates it more if the dentist pulls in that effort and puts in that care so I know it's gonna involve you know spending 20-25 minutes for a profee but we've seen that that builds a much better relationship with the patient the patient gets more that the dentist is putting in all the effort be a 800 or $900 crown versus $75 cleaning or $100 cleaning to an SRP or whatever and so we are moving away from the whole hygienist model.

Howard: Do you see that as a trend also in Chicago, do you see other people trending away from hygienists?

Syed: Yes yes I see that a lot.

Howard: Yeah and I just want to tell you they again the only three play and I podcast the owner of one 300 dentistry one 301 302 I long story short he said well first of all he goes how do you have a hygienist your paying her $40 an hour to do a $50 cleaning and then everybody and then I just love it when people say oh yeah our hygiene department is so profitable I know I could walk in there with a gun put it to their head and say show me the accounting on quicken and that shows me you made one penny on this and then they couldn't do it no they'd never seen the return on asset return equity they would know a profit margin from a crown margin.

Syed: They are absolutely not making any business sense Howard so you know it's just not working out for us.

Howard: Well it's not our fault I mean all the hygienists could all go down to the insurance companies and start talking to them when the earth goes around the Sun and my $40 hygienist says well the earth went around the Sun one rotation will you give me another dollar dude I've got another dollar for a dental clanging for a decade so who killed the hygienist that was song who killed the radiostar what was the name of that song Oh video killed the radio star.

Syed: Yeah video killed the radio star.

Howard: and Delta Dental killed the hygienist

Syed: and the problem is people ask $60 bucks or $30 bucks for an x ray.

Howard: and I told the Delta Dental guys I'm going all the way back to Ed Judd in 1987 I said dude I don't need a thousand dollars to pull for wisdom teeth yeah but I can't pay her this is clear back in the day I can't pay her twenty dollars to do a twenty dollar cleaning and so I think I get too much money off molar endo dentures partial I mean I got all these things for yet big chunk of change molar endo you know for wisdom teeth you know that's all I got but the cleaning fee the cleaning fee killed it and they need to but the other reason is this this is what they tell me down under is that if I have a hygienist she's gonna spend ten minutes of that hour just waiting for the dentist to come and give the check yeah so here's how they explained to me all the time they say okay so you pay this hygienist $40 an hour to set up a room that a $20 assistant can do and then she goes out there and gets the patient that your receptionist could have done and then they bring her back and they take x-rays that your assistant could have done yes and and then the the hygienists likes to probe but so now she gets a $20 our assistant with a $40 our hygienist to measure the probing and then when that's done then she's gonna be a hygienist and scale but when she's unscalable or that the assistant could have done that but anyway so here's what they do they say okay we're just gonna have a $20 assistants seat up the room go get the patient take the x-rays yes and she's gonna go get the doctor you're gonna probe they're gonna record and then you're gonna just do the scaling done you're gonna hide gist but when the dentist sees a new patient he's spending about 15 minutes with that new patient and the treatment plan acceptance rate is this big of dollars and then when he does the 4-minute hyejung check the the the treatment plan conversion is almost zero so they take out the hygienist and then the dentist is actually now he's in the room too if that dentist is in the room for 15 minutes the treatment plan conversion goes real high if you have to probe every tooth and scale every tooth you're gonna be in there for 10-15 minutes and you're gonna bond hey how's the wife how's the dog how's the kids you know how's the Cubs how's the bears how the White Sox and then you get around to that tooth really needs to be fixed and and all the own old three four three publicly-traded dental offices say that if I put the hygiene in there they dental treatment plant acceptance rate plummets and my overhead skyrockets.

Syed: I've even train my doctors to press a treatment plan so I mean most of my doctors actually love presenting treatment plan to the patients obviously they don't discuss the financials the financials are discussed at the end but I mean you know 89% of my doctors actually present treatment plan to the patients as well so you know and that's our biggest thing you know we train them on how to use this whole dentrix treatment planning module and this whole technology to work in our favor and and and I mean our treatment plan acceptance is pretty high because you know I mean you've connected with that dentist you know he's explaining all the treatment to you and all you have to do at the end is just discuss the financials and if any person can do that.

Howard: and when you talked about the hours I mean I this is Dentistry Uncensored this sounds racist and all this stuff but the bottom line is if you're born in America and you come out of dental school you're only gonna work Monday through Friday Monday through Thursday 8:00 to 5:00 and you're always gonna use other people's money your whole life I mean you use it for dental school then they'll use it for a house even when they have their student loans paid off and you see them they'll go buy a Range Rover and I'll say did you know it's on it's on a five year loan oh so you're so you're 40 and you're still using other people's money oh you're 50 so I met a dentist Saturday 62 years old just bought a brand new killer mansion on a 30-year mortgage I'm like oh so you're gonna practice till you're 92 do something but when they come out of dental school and they were not born in the Ice Age they're just born anywhere other than the United States they're not entitled and they'll come a school like like I go to San Francisco and they say well you know when you get our dental school man San Francisco it's got to do it's got six schools in California two of them are in San Fran Monday through Friday 8:00 to 5:00 it's brutal but you know at five o'clock every lazy American boy dentist is at home and who's still at the office the Vietnamese the Koreans the Chinese anybody from Africa Asia South America and and then I'll go talk to those people and they'll say yeah I got out of school three hundred and fifty thousand dollars in debt I bought this office and and I don't have a car because I moved in here I mean there is an opera Tori that's I live in operatory for and you come back in three years and they have no student loans they paid off their practice their iPhone is their office conversation deal and they just they just do they just work all day every day and they just crush it but if you're born in America by the time you got a dental school you're like well I'm a doctor so I already deserve a BMW and of course I don't want to work weekends or evenings I mean I'm it you know so it's so my question to you is when your staffing your 15 locations do you go out of your way to make sure that you don't hire American boys I mean I can I have been asked to quit saying this and so all quit saying it but some of my very wealthiest friends will not run any ads for dentists in English they're out there and I don't want to say what state there are cuz it's right next to Arizona and it touches it and all that but they want to run the ads in non-english speaking magazines because they just know well this dentist shows up and he wasn't morning I say it's already a home run are you sensing that is that part of your strategy?

Syed: No actually most of the dentists to work for me are you know working boys and gals you know over here you know and what I see is \they're very smart and they're very sensible did you see some guidance I think you know if you can sit with them and teach them listen you know this is why this makes sense this is why this makes sense you know they they understand and you know actually how actually have bad luck with typically dentist American boys and girls you know it's I mean the newer generation that is the new dentists is coming out there I think they're all coming out listening to you guys every day I mean I think you guys are playing a huge huge part in changing the way they think so the next the next two three waves of dentists that are gonna come out I mean we'll be all schooled by Howard Farran or the guys from the bottom I'm blacking out now so the other podcast Jason and you know listening to Mike Kostas and you and Gary so I think a change in the next 2-3 years.

Howard: Do you know why they like my podcast

Syed: I like your podcast

Howard: but do you know why?

Syed: Why?

Howard: because it's free

Syed: Oh yes

H9oward: because I get guys on like you I mean that that's my only singer magic is that I can it I price it free and I can get guests like you to come on the show you know another question: how do you know if something's real or fat like there's a lot of people and sleep management to say you know look I'm a dentist sleep the you know asleep management is how do you what do you do to go through to decide no doctors are dental surgeries should be doing this or no someone else should be doing that or is your offices into sleep?

Syed: No Howard I'm noticing right now is this just so much general dentistry that is out there to be performed you know instead of worrying about you know what kind of the sleep appliance let's just focus on on the basic stuff and maybe I haven't come to the point where I need to start looking into all this stuff but I'm still playing around with just basic general stuff you know and and they've been extremely successful I mean you know couple of my practices are doing north of a half million dollars here so you know and we we don't need to go out and we haven't even entered all the stuff so so you know I don't have any plans to get into it right now and and and I haven't really yes I believe that data should be able to diagnose that because you know it just creates more avenues for the patient to live a better life and if we can give that to the patient nice but as I said you know I haven't really mentioned into that area at all I haven't ventured much into sleep and and and and Botox and fillers and any of that stuff because we just you know we're just so busy with just dentistry that we didn't even get time to do that.

Howard: What about labs I am I'm going back to what makes associates quit and turnover and you're saying you know they're looking for mentor and all the sorry that it seems like a lot of places they work for you have to use this lab this is you work for me we use ABC lab and and they get all upset that that is they do not like that lab how do you handle that?

Syed: I opened at three of my practices have already opened my own local maps so what I did is I found out in Milwaukee there was the lab which used to work for us and he was facing out I told the time is to take all your equipment I have this face I'm going to give you and even the work exclusively for two of my practices so I am I that's my next thing in 2020 I want all my clinics to have their own labs so you know that just cuts down the time and you know we use only local labs and the lab and us we have a very good relationship so the lab guy is this an art clinic you know at least two or three times he's really good friends I think your your luck I should be your best friend you know I personally think that and you know so so we have tie ups with two different labs in Chicago and there are local and the really good friends with all our doctors they're really accessible and couple of our clinics we have our own lab.

Howard: You know it's just funny the greatest thing about getting old is you just see everything oh you don't see anything of the first time I mean the business cycle the consolidations like of the lab they even say clothing and miniskirts are a predictable cycle but you know when so when I got out of school there was a dental supply company in every city had one and then it starts the consolidation cycle war you know Stan Bergman at Schine and p4 shadow Patterson I got a big line of credit consolidated them all into one and now they're all deconsolidating and my god there's a dental supply company popping up on i mean i've i podcast that half a dozen these all kinds of POD can't have a dental supply companies the consolidation cycle is a big one when I was little my next-door neighbor Kenny Anderson they all had their own lab man they all had the guy was in about the size of an opatory it was all gold and PFM's and now...

Syed: We do a lot of PFM's still PFM's I think it's one of the best restorations it's cheap it's very biocompatible I mean it's yeah excellent success I mean I'm a big fan of you know the Michael Appa I follow him I mean that is doing still porcelain restorations I mean...

Howard: Michael Appa in New York?

Syed: Yes New York or Dubai you know so you know porcelain is an awesome restoration so you know we do a lot of pfm's especially in the posterior teeth I mean who cares you know the patients don't care you know that little that shows up I mean you know we want something that is comfortable they want something that is that quickly faster and it's working out for us I mean you know we use of our ceramic as well but a big chunk of our restorations are still pfm.

Howard: You know we podcast him Michael Appa, he was at number a 62 and Rosenthal was 754 that's what I love about dentistry you don't there's things you don't like to I do not like to do hi cosmetic cases on anterior on women because I just don't get their market you know maybe because I'm sitting they're saying well the last thing you want to do is file all your teeth down and do crowds of and ears and bridges your beautiful why don't you go home and you know just just just forget about it but they you know they you know I I'm just dont into that but I think it's amazing them I wouldn't spend a couple days and with Larry Rosenthal and what I thought was the most genius of Rosenthal is how he could handle expectations and I'll never forget him telling me satisfaction equals perception - expectations do not you know and dentists do it all the time they do it wrong and the patient will say well will this hurt no you won't feel a thing you don't feel a thing why don't you just set the bar so low that you're gonna trip over it on overtime you know when I when I get done with the root canal I say you know do you have a concealed weapon at home and about you know out here in Arizona at least have say or 2/3 yeah I do why well you're probably gonna want to shoot yourself when this wears off and you know and I'm lowering their expectations so this is embargo Howard you won't believe it I didn't even shoot myself after the root canal and the way these genius guys like Michael Appa and Rosenthal can handle expectations of crazy people who think they're gonna write you a check and looked over years younger is it's just amazing but I'll tell you another business cycle I've lived through do you realize that when I was little there were 70,000 micro breweries and then it consolidated all the way down to 70 and now it's back to the full 70,000 there's a micro brewery now and a dental supply company on every corner now and it'll consolidate as as soon as it's just like remember that game what was it game where you had the white ball in the tube it was like the first video game just the ball?

Syed: Pong, ping pong?

Howard: Yes just pong remember just bounced the ball back and forth that's what Joseph shooter won a Nobel Prize in Economics for the business cycle he goes just what they do man they it's a cycle it's a the agricultural cycle as toughest but I want to get back on that on the supplies we've seen the the business cycle we've seen it go from you know one in every corner to just the big four now there's one on every corner again how do you handle supplies what is your supply budget? When I talk to people from the deal with a big big organizations like yours they say my god he's got 30 different dentists and they all need different gloves and they all need different bonding agents and then the assistants don't know how to set up a room because everyday dentist needs a different bird so how do you handle all that?

Syed: Well no because we have systems in place you know as I said every dentist is trained on how it is done and supplies we basically I deal with Patterson I have a very good relationship with them we really negotiated the prices with them so and we stay at about 3.5 to 3.6 percent go to collection every month all our supplies and and and you know it's it's worked out so but again I think this is a lot of it is also you know when you get in your associate you know grooming them correctly you know teaching them that hey this is this is how it's done this is how we've done it successfully and you know we're gonna teach you this way and you know they're pretty accepting you know of all that so we haven't had any issues where you know a dentist wants to you know I mean we've had you know where assistant used to put the whole bond litter tray and like a bit more then but from there we moved on to now they have these bond tents so it really doesn't dispense a lot of bond so so the supply company has well Pattinson has worked with us very closely and you know we don't even go out looking anywhere else you know.

Howard: So you know you but you said earlier you like Dentrix and EagleSoft

Syed: Yes yes

Howard: So you like Henry Schein software it's like Patterson's supplies because Effingham where Dentirx or Eagle soft is there's only three hours down the street form you so why do you like why do you like Patterson supplies but Henry Schein management?

Syed: It wasn't it's more of a relationship you know Patterson gave us a very good deal where they provide us excellent technical support or on-site support for all our chairs and panoramic machines or CT scans we have CT scans in pretty much every clinic so it's just and the relationship they were there for us what they are more accessible to us when we need them compared to Harry Schine so we chose Patterson.

Howard: and basically what he just said this this might have flown over your head you're a social animal so you're patterson rep comes in he brings you doughnuts he tells your wonderful they always tell me that my hair looks wavy and thick and I'm thin and and and and the next thing you know your your State Farm man wants to buy you lunch because he knows from influence that if he buys you something or feed you you automatically want to buy him something feed him back and the most successful people are the ones that have the most uncomfortable conversations and we're standing there in the counter and you're Patterson ladies saying oh how's your grandkids I mean come on I mean come on really I mean what you're hearing is you're hearing a businessman he's saying it's all about relationships but he has a relationship of trust based on uncomfortable conversations where hey okay now let's go to work okay what do you know what you want to do you want to sell supplies I know what I want to do I don't I want to pay the lowest price so let's not talk about my dog my grandkids and frogs let's have an uncomfortable conversation and then if we take care of each other we trust that you will do business together.

Syed: Tes that's how it is Howard I take the invoices I will have my manager called Schine get a price code I mean I used to do that they don't do that anymore because I trust them now so you know what we used to do is we used to just go in okay this is the invoice this is there anyway this is the invoice oh this is from dental health products this is from Schine this is from Patterson and Patterson always came through so it was a pure business decision based on whoever gave us the best deal for the for the best product that is available and you know and the best support in Patterson always came through so I couldn't change my business philosophy because it was completely based on Dentrix and I stick with shine for dentrix so that's the only thing I you Schine for everything else is Patterson it just it just works out every time I'm doing a new practice I will call the DHB lab I'll call the Chandra I'll compete after you all three voices listen guys this is it I mean you guys want my business fight for it and get it from me and Patterson always come to you you know they've given us the best offers and and the best deal I mean it could be different I mean it's really simple I mean you you you want to do this right call everybody let them fight for it and you just sit and watch the show that's it.

Howard: You know there's two hundred eleven thousand Americans who are living with an active license practice dentistry it's a big country to big market and i am i think Patterson would be I think their best market is just the relationship guy there's a ton of people who are never gonna know what the return asset return equity how many people land on their website last month how many converted to call the office if a hundred people came in with a cavity how many converted a tree I mean there's just a ton of my homies and friends and they make great dentists they're great people and they just want that relation they just say hey Susie you know she works for Paterson they want that relationship deal but if you're a little bit more MBA if you're a little bit more dentist just raise the professional standard and start don't have them walk in with doughnuts and schedule a time and go over the accounting and that was my next question how do you do the accounting for 11 offices when Dentrix from henry shined their best idea was that it shouldn't sync with QuickBooks Online?

Syed: Yes and that's the beef that my account has and my accountant has complete access to the to the bank he synchronizes the bank account with you know with our software and you know everything that we do all the purchasing that we do is through a specific business credit card for each clinic so it just makes it easy for him and then he comes up with profit loss statements...

Howard: but what do you think of an industry where Dentrix, I mean is it bipolar schizophrenic is it just bat shit crazy how does that happen?

Syed: This is the most screwed up thing in operation right now that everybody uses think into it for payroll and accounting and Dentrix its being such a small software I mean for God's sake it can figure out you know a dental core out of 20,000 patients what can they figure out how you just say you know how many problems will solve you know exactly how much time how much resources are going on this filling borrower on this cleaning but I it's just...

Howard: I'm going to try to find your name for you i'm going to show you how embarrassing this is I don't know let me see if I can find her name but anyway long story short so I flew down all the way I'm gonna find this girl where is she I got so mad I flew all the way down to Effingham talked to the Eagle Soft people telling them that I I don't know how to run a business with eagle soft not hooked up to quicken went down to New York and talked to Stan Bergman and you know he gave me his time and I told him my deal and he said oh okay said so he said this girl out and she's got an MBA and she worked for I don't know who was Spear Pankey someone like that and so she did a survey and she said okay Howard Farran you know you know he thinks that you want to know like Walmart what is your cells per square feet you know just just simple obvious stuff what how many hours use your facility when someone a hygienist guess I'm doing a cleaning exam and x-ray I want to know did I make nine dollars and 12 cents after taxes or and I lose 50 she had everything she can't ask you about my Comptroller Stacy Lauri we had this big old meeting she mailed out to 1,000 people came back show me results no one wanted it and when she said what do you want guess what that number the top two things were from her survey they wanted to change the font of the notes and the color that was that was the point when Stan got on the phony goes he goes Howie he says you know I know you love your homies but you know that they don't get this and that's when I realized oh my god I mean I love them for it they would rather fix your tooth perfectly yet not even know if they made money or not and this has or not.

Syed: You know I think it's gonna change pretty soon hopefully you know especially with you guys going out there and educating all these young dentists who are coming out and as I said again this all goes back to the new dentist who's graduated he has to find the right mentor who's going to teach them this you know who's going to teach them that hey you know this does matter and when they realize that this does matter you know the demand will increase and hopefully you know hopefully hopefully something.

Howard: Yeah I was trying to find the name of that girl that sampradaya but yeah but that goes to show you I'm you know it depends on just because you think something Israel just because you think all your dentists would on it you just never know but hey um is there anything you want to talk about that I wasn't smart enough to ask?

Syed: No I think you pretty much covered everything.

Howard: So if some young kid wants to work for you how do they how do they contact you?

Syed: You know they can text me or call me on my cell phone they can email me.

Howard: What do you want to give out?

Syed: My cell phone number is 847-915-2827

Howard: and what about your email?

Syed: It's my first name which is Syed and then my middle initial which is s last name rehman @gmail.com (syedsrehman@gmail.com)

Howard: So you're saying if right now they're at the bathroom is seven eleven right on the wall for a good time call Syedsrehman@gmail.com hey and man what passion think about your cell phone number on a podcast that's pretty committed dentistry hey Syed thank you so much it was an honor for a gentleman that has 11 offices in Chicago and Milwaukee to come on the show and share with my homies everything.

Syed: Howard and thank you so much I am Who I am because of guys thank you you know I've learned so much from you guys and I've implemented this so you know I mean thank you thank you thank you for doing what you're doing and doing this for free so you know the whole new cycle or the whole new generation of dentist that come out they come with a completely different philosophy come with a different understanding they're ready to work hard and and and I'm forever grateful to guys like you.

Howard: Well thanks man the only reason I do this show is because I firmly have seen for 32 years at the guys that come out of school and do a hundred hours of CE a year they're always happy on top of and having fun and this is you know when you're in Salina Kansas they're never gonna run into me and you and all we gotta do is commute to work on their iPhone they let's just us for an hour I think it's a beautiful thing thanks for coming on the show and doing it with me.

 
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