Dr. Mark Tholen is the former CEO of the nation’s premier dental office design firm, which created over 3,000 offices in virtually every State of the Union, Europe, and Australia. His career in dentistry spans over 30 years including clinical practice before obtaining his MBA from the University of Texas. He is the author of three dental textbooks published by Lea & Febiger, the most recent of which is a comprehensive book on all aspects of dental office design with over 7,500 copies sold. Dr. Tholen has lectured extensively in the U.S., Europe, Australia, and Asia and is a former consulting editor to the parent corporation of Dental Economics. Currently, he is the principal instructor of the extremely popular dental office design seminar, "Inspiring Success", sponsored by A-dec of Newberg, Oregon.
VIDEO - DUwHF #1296 - Mark Tholen
AUDIO - DUwHF #1296 - Mark Tholen
Having launched 1,275 (and counting) Dentistry Uncensored with Howard Farran podcasts, Farran Media is proud to open its recording studio to the public. Reaching a new audience and potential patients has never been easier as you partner with a sound engineer and professional equipment to create, host and launch your very own podcast and video content. Farran Media offers hourly studio rental, remote recording, podcast launch packages with custom logos and intros and so much more. We’ll guide you throughout the entire process to ensure your podcast is a success–click here to learn more or give us a call at 480-445-9699.
Howard: It is just a huge honor for me today to be podcast interviewing Dr. Mark Tholen DDS MBA he is the CEO of Tolan Healthcare Environments Design, you probably notice the design T capital T period H design. Dr. Tholen earned his dental degree and an MBA from the University of Texas he is the former CEO of the nation's premier dental office design firm which created over 3,000 offices in virtually every State of the Union, Europe and Australia. His career in dentistry spans over 30 years including clinical practice before obtaining his MBA from the University of Texas. He is the author of three dental textbooks published by Lea & Febiger, the most recent of which is a conference a book on all aspects of dental office design with over 7,500 copies sold that's amazing dr. Tolin has lectured extensively in the US, Europe, Australia, Asia and is a former consulting editor to the parent corporation of dental economics which is pen well that was on there first magazine was Pennsylvania oil and wells and then a hundred magazines later they were at dental economics. Currently he is the principal instructor of the extremely popular dental office design seminar inspiring success sponsored by A-dec of Newberg Oregon he consulted with Pelton and crane conducting three-day cells training programs for their dealer equipment and sells representatives and a 2-day office design conference for doctors audiences averaging over 350 dentists per show. He is just the man I'm so excited he came on the show but before we start the show I want you to say something about the passing of Ken and Joanne Austin of A-dec they were they were legends in dentistry and I know your your great friends of them what did you think of them and how did they contribute to your career?
Mark: Well I just working actually with a 2,000 see so Ken Austin, Joanna already passed away but Ken was still alive still coming to the facility but no longer actively involved with day-to-day activities but very very much what I had called an Imagineer you know almost like a Disney Imagineer first did here was a tremendous capacity to conceive of new ideas and be an entrepreneur so I thank goodness they lived in America we created a fantastic company and I'll have to say it really is a top-drawer operation from beginning to end and if anybody ever has the opportunity to go out to Newburgh I mean just a physical plant alone looks great and in fact I've always said I would like to just be a gardener at the at the facility it's beautiful.
Howard: Yeah it is a 1 any kind and I just love that guy I mean my four boys were blown away I mean you go in one the entrance door they're dropping off pallets of wood and metal beads and leather planks and at the other end of the building a football field down the line is rolling off A-dec chairs and it's just a story where the whole thing could have only been done by those two lovebirds just with a dream to do it because there's someone made you and me do it I don't think we could have done it, I mean it's just an amazing man an amazing story just crazy amazing and then the same at Pelton and Crane you go out to you got to Pelton and Crane.
Mark: I used to work with Pelton and Crane for over many many years over 12 years I went out to Charlotte and did conducted dental office design conferences with and for them so we had hundreds and hundreds of what I thought alumni doctors who would come out there listening to the 2-day event and then consulted with me on a variety of issues surrounding their office design.
Howard: Okay so going into going into today's discussion the office design first of all tell everybody what is your business and what is it that you do?
Mark: Okay that's interesting when my son was a little boy he's now 34 and on Wall Street but when he was a little boy he was always a little confused on what I did and he's well when he was asked what I do he said well my father would get on he works at home for a while then he gets on an airplane he goes solve some problems and he comes home and he starts working again so that's pretty much sums it up but what I do every day is be involved with the design and the financing of dental offices and really Howard we create kind of a ritz-carlton level a dental office but all the offices has one doctor put it move like a Swiss watch because our objective is to drive production and to minimize the physical stress of the staff inside the inside a facility and so our objective is to yes design great offices but at the end of the day we're there to help doctors optimize their production and minimize their physical stress.
Howard: So do you go more by the design capital T period catalase period Cavallini Perry the design or Tolan healthcare environments design?
Mark: No THE Design
Howard: THE Design, so you don't ever so you know most people don't know what it means, I mean they don't use Tolan healthcare environments design?
Mark: No no no I mean if they wanted to know what the acronym stood for.
Howard: Are you the founder of that or the CEO?
Mark: No I am the founder too.
so you're the founder and CEO?
Howard: Wow congratulations and how old’s the company?
Mark: 27 years old
Howard: 27 years old I'm going to start just for my bizarre thoughts about this whole industry is that you're gonna spend a third of your life asleep well get a get a damn good bed and don't have a TV on the wall and don't have alarm clocks in blue light I mean my bedroom is a cave I mean you know that I mean because we're dentists we've studied sleep apnea I mean you know if your best idea is to sleep every night with a st. Bernard dog and leave the TV on you should give someone your dental degree they can use it and then so you sleep a 30 or life so you're awake the other two-thirds and one-third of that is in your dental office and their best idea is that they're gonna live in a thousand square foot shoe box in operatory that's 10 by 8 and that's how they want to spend 1/3 of their life and I just thought to myself and then and then you look at them when you know you look at rich people make fun of when poor people own a car that's worth more than their house or you know they put all their money in consumption and so then this dentist I see oh they own a 3,000 square foot home that's nice to visit and fun but then they live in a rented thousand square foot shoebox and then they're always surprised because they're burned out they want to win the lottery they don't want to go to work I mean the first thing I figured out when I walked in my office is you know first I had to rent cuz I was a kid out of school you know I said to everyday and think I walked in your dark and left that dark I didn't even see the light I wanted a window in each operatory I want what's the favorite what is the favorite room of every house it's wherever the refrigerator is I want a refrigerator or break room god if an assistance got a migraine you don't even have a couch so put your dad hat on and tell talk to this 25 year old kid that thinks to save the most money he's gonna live in a shoe and that'll be the best life I mean do you think that's ridiculous or what?
Mark: Yeah my comment would be don't deceive corn don't go wild and take your money and start using it to buy fancy cars and to build big expensive houses the very first thing you want to do is create an environment that is consistent and congruent with the level of care you propose to your patients and if you have an office that looks the part it sounds the part of what you want to be then going to be able to be able to be successful and be able to communicate with your patients about the quality of the care that you're delivering to them and then it becomes all about it becomes all about delivering the care not about being able to get the patient to say yes.
Howard: and I just want to beat up this one point again that I see all around the difference if you ask me what's the difference between rich people and poor people I would say you can find out in a second just just hand a poor person a hundred dollar bill and it'll like burn his hand and they'll have it spent before sundown they cannot hang on to money they spent as fast they can so if you're still using you borrowed other people's money you complain about your dental student loans but I don't see you deciding it's a good idea to work at McDonald's for $15 an hour for ten years to save up to go to dental school and count in cash I see that yours you understand enough logic of financial leverage geometry leverage Newton give me a lever long enough I can lift the earth and that it's better to go borrow someone else's money go to dental school and when I started dental school I'm making $10 an hour when I graduate I'm making $100 an hour that's a smart decision but some dentists at 50 years old they're still barring other people's money for cars and houses and you don't get it and if you own your land and building under your home which is consumption before you own your dental office you're a peasant and I guarantee you when you're 65 you'll still be using other people's may so your whole life every time you use a dollar for a year you'll pay a dime interest to someone else instead of having a dollar in a stock where they'll pay you a nickel a year for the you seer money so you're either gonna loan poor people your money to make a nickel a year the rest for eternity I mean the Rockefellers are dead but they had so much money those big trust funds are still cashed in hundreds of millions of dollars a year so when you get a dollar you could put it in a bank and make a nickel a year until the end of time or whenever the next Big Bang is but you can't do that I give you a dollar you just instantly have to spend it because that's why you're poor. So I can't say enough the difference between using other people's money to build a dental office and you're saying build a dental office that creates an environment that conveys the level of care, explain that to the kids you know most of our viewers are under 30 right that might seem obvious to you and maybe not them what do you mean by that?
Mark: Let's use Starbucks the Starbucks is a fantastic kind of almost morality lesson for us in being able to match the product with the environment. There are coffee shops all over the world and if you just think about this for a second in 1975 Howard Schultz had to pitch the idea of coffee shops he's got this new idea called Starbucks he wants to get a bunch of investors together they're all going to become rich because he is he's going to have a very very unique coffee shop and then he says but wait a minute it's not his coffee shops it's going to be expensive coffee we're going to charge three and four and five dollars for a cup of coffee and not only that is only one cup of coffee where in America in 1975 everything is a bottomless cup of coffee they mean it sounds like there's no way this is going to work but it does in the reason it does the secret to Starbucks is they match the environment with the product they put a high quality product with the beautiful environment and people want to come into Starbucks and they want to have a superior experience in Starbucks and that's just a great example of period. So we want to have an office that says who we are we want to know we want to be an office it says exactly we are in the quality the care that we deliver and we had to speak to people in a language they understand they don't understand dentistry but they understand nice environments and they understand exactly what you're doing when they walk into a beautiful facility where everything has been thought out and that's a constant comment patients have they say oh my gosh the doctors thought of everything in here ergo therefore the doctor will think of everything about my particular situation. So that's what I'm talking about when I say we want to have an office they matches the quality of care.
Howard: and Starbucks was confusing to me because I'm from Kansas I mean I knew it was gonna be successful because the CEOs name was Howard I mean that was a dead giveaway but in Kansas you didn't ever have to pay for coffee every filling station in Kansas had a coffee pot the little white styrofoam cup you can have the little pink sugar the cubes the stick I mean you didn't even pay for coffee then this guy says oh I'm gonna sell it for five bucks a cup and you're like are you out of your mind and he was the next billionaire. So when you're saying well dentistry is a commodity dentistry is come on dude dude coffee was free my entire childhood no one ever walked into a filling station and paid for a cup of coffee and Howard Schultz turns into a five-dollar cup so that is something. So would you say is it over simplistic to say that you're a dental office design and construction company?
Mark: I would say we redesigned the dental office we build the office on paper we create the office virtually but we do not construct it we will interview general contractors with the doctor and generally with the dealer representative and will come to a consensus as to which the general contractors most qualified then we Shepherd the general contractors through the construction process to be sure that they build exactly what we designed.
Howard: Okay tell me what I'm wrong, I mean I know it's my show but you just call me no you're wrong. My 32-year takeaways is that I don't care what you're designing in five years you outgrew it and you're you always regret not being better you know some kid I always say I'm written a thousand square foot and putting four ops I'm like okay but before your lease expires you'd give away your car to have a fifth or six op. So it's never big enough they never have the money because they they put it in their home and vacation or car so I'm always saying own your dental office rent your house and if you think it needs to be a square foot make it two square foot now is that just wrong dumb what do you think are the most common mistakes that dentists make in designing and constructing a new office?
Howard: The first and biggest mistake so many doctors make is they don't build an office with enough operatories and and the office is not appropriately sized to support the operatories. So we very carefully assess what the doctor is going to need and then you know a little bit of crystal ball looking twenty years into the future the average doctor will be in their office for seventeen and a half years before they move or retire and so we want to be able to have enough ops you know if I tell a doctor for many times I'll be talking with the doctor who's coming out of five ops I listen to what their story is how many active patients they have what their plans for the future in many times I'll say okay you need eight not you need nine eighty ten and the my gosh that's crazy talk but if you actually break down the financing on this the big issue is being too short of ops if you're short ops you're losing a minimum of ten thousand dollars a month because most doctors have been even qualified for a loan to build a new facility it takes their new generating about ten thousand dollars a month per operatory minimal. When we go on to 50 and 20 and many doctors days are doing 25 and the ones who are not going to debt are doing 25 plus forty forty five thousand dollars...
Howard: Your saying they're building 25 operatory dental offices?
Mark: We've actually done that and we do probably 120 to 225 office every year one but on average what I'm gonna say is most of the offices that we're going to build are going to be probably a minimum of 8 ops but go up from there you know but for a single doctor what we're needing to do is make sure they are not short operatories for the entire time that they're in their office because if they're short ops they're losing a minimum of $10,000 a month for up that they're short so that that's our big danger the average incremental cost of an additional operatory this fully-equipped when I'm talking about debt service is about $700 a month so you're betting the $700 a month against the 10,000 a month or the 20,000 for the $30,000 a month and so it's a foolish bet and if you take the equipment out of the key question if you're just using if you're just building an empty operatory and holding on to it in the event you may need it then you end up having a debt service of around $300 a month for storing so to speak that empty operatory but if you just go through the numbers for say bring on once you bring on that operatori mean in one to two months you've paid for that off even if it's been empty for five years so it's a foolish thought to build an office that doesn't have enough ops. In fact what I would encourage doctors you will be successful at the end of your seventeen and a half years or twenty years whatever it is before you move if you have an operatory you never use that was a good thing because you never lost money.
Howard: Yeah know and the other thing they don't think about when they're 25 is liquidity maybe someday they'll want to sell and dsos are major purchasers and they have a minimum like they don't even want to buy an office I collect 750 well what do you what do you think the minimum that the big boys will come in and buy you vs. no you're too small we're not even interested in looking at your place? Do you see do you see them having minimum size purchases?
Mark: I don't really see that what I see is they're always looking at outside potential they're also here what do we turn this into because obviously they have to earn more in order to buy handle the disservice as a paid a doctor for the fur they had for that practice so it's more about what kind of upside can they develop how the the office spread and then just the physical size of the facility.
Howard: So on your book you put it was a guide to designing the elegant dental office you should have named it size does matter a guide to designing the dental, by the way you have two amazing books on on Amazon you have a guide to designing the elegant dental office the largest marketing tool of your career addition by yours truly on Amazon the step-by-step guide reveals the fact-based decision process by which you're able to decide whether to build lease remodel or buy a condominium. The proven principles of dental office design are revealed that have been developed over three decades and three thousand offices these principles are focused on driving productivity and reducing the physical stress of daily practice, every room of the office is examined to optimize its functionality and efficiency that's a hook and then your other one is giving form to your future 100 award-winning dental office floor plans the floor plan is the architectural foundation of your new office a properly designed floor plan yields optimal productivity and minimal stress but a poorly designed plan will impede your practice and minimal stress objectives daily and hourly this book clearly describes how to approach designing the single best floor plan. I guess so I was born in Wichita and when I was 10 my dad bought a sonic drive-in franchise every year from 10 to 20 and so you live in Dallas that's where I met Ray Kroc because he lectured at the he was the big speaker in the hamburger conventions and that guy was a genius when he reading your book giving of do you know his secret was when he picked up McDonald's they had 10 locations and from like oak location 11 to 30 he would first lay the foundation have the architect's chalk out what it looks like get all the employees there and then he started talking about what's going on well every time I make a mold turnaround and then this mark guy knocks me down mark what were you doing I was trying to bring the French frys over and it was that's how they did it from 10 to 20 mean it's everything and when I started to build my office and that architect said I'm well what how do you envision this thing looking like and I'm like I think I have the wrong guy I mean I'm real little and young and isn't this what you so I went and got this guy in and it was amazing what he did for me and I didn't even appreciate half of what he did for me so this ensuing 10 years so uh you know but I but my dentist you know I always tell them to stay in their Lane they don't know a damn thing about designing a dental office. So a lot of people say things like well they wouldn't know the difference in A-dec chair and an Ikea chair they don't they don't know that is that true I mean you yeah we're talking about size matters you need more operatories but those name-brand equipment Pelton and Crane A-dec versus IKEA does it even matter?
Mark: This is matter to the patient or I mean obviously it matters today to the doctor because of the ergonomic symbolic because we want to be able to employ certain principles Bergen Onyx especially inside the operatory sea without getting into the weeds right now because it takes a little bit of time to sling but we want to we want to engage in very very specific motion inside the operatory in order to do that you have equipment with the very specific design and very specific motion capabilities so yeah it doesn't makes a huge difference about what kind of equipment you put into a facility. Now if we just talk about delivery systems so for just to say I would say that the delivery systems that are offer the greatest opportunity to create the least amount of motion among the doctor as well as the assistant is here to be a flexible rear delivery system or a continentalsystem those two systems will allow the doctor and it will be entire dental team to participate in forehand passes and that's what I'm really try to dispose in during the conference because the forehand and passes drive down your treatment time by almost 25% they reduce all the repetitive motion in the operatory and it and it creates a superior experience for the patient because the you know who enjoys having somebody's hands in their mouths and so and you keep your mouth open and so if the dental team is able to infect the treatment very quickly this is a win-win for the patient and for the dental team. So yeah I think the equipment does make a big difference in delivery systems make a big difference hecl lighting makes a big difference ending up in the operatory Howard I mean you you've been there for many years I was in it for many years you you get fatigued eyesight later in the day and your eyes see a glare at 3:00 or 4:00 in the afternoon they never saw in the morning and so we've gotta have a very specific ratio of ambient lighting to operating light and the operating light has to have very specific physics also so yeah I think all kinds of things inside the operatory matter and they greatly impact the ergonomic health were used to the musculoskeletal health of the dental team.
Howard: You said a new term to me you said continental delivery system I've always heard of side delivery rear delivery over the patient delivery did you that continental delivery?
Mark: Yeah continental delivery is a form of over the patients that allows the assistant complete and total access to the system using a class three motion or just rotating the shoulder and he ratted them rather than having to rotate a trunk at all.
Howard: So do you agree with me and will you sign my petition that dental schools will never accept any left-handed people ever again. I mean we're already 90 percent of the winners I mean we just need to get because you can't you have to do rear delivery or something because if what I mean it's like these DSO tell me the hardest thing they have is finding an associate dentist an associate turnover so they finally got a great dentist and he shows up and then they find out he's a lefty, how do you solve the lefty problem?
Mark: and exactly with either the flexible rear delivery system that allows the left or right-handed doctor to work with equal facility or with continental system as a continental system can be flipped the entire can be flipped so you've got a you've got a rear delivery workstation from the assistant along with the continental or over the patient delivery system or you just have flexible rear delivery and the Handy's delivery head and the assistant delivery Jets are on the assistance workstation and she is handy everything to the doctor.
Howard: So the only one you can't have is a side delivery system?
Mark: Right side delivery is you know work you know what I'm called the old-style transthoracic or over the patient system really doesn't work either if you're trying to do for an efficient four handed passes.
Howard: but do you agree that my idea is better just to not never accept a lefty to dental school again?
Mark: Would solve the problem.
Howard: because that is a huge huge problem. So the other thing so you say matters and another thing what I look for is there's two million dentists on earth no matter where you going out there in the top 1% years education top five they're always the smartest people around in a country and so when I see big discrepancies like why do all these smart dentists with the same brain over here do this and why do they do it different over here and what are those is electric handpieces there's countries where the whole country's electric and then you go to another country and there's no electric so how what's your views on looking at that? I mean people always have their handpiece break down they're having to autoclave them I mean there's it's so multifactorial what we're where would you recommend a new dentist coming down on that?
Mark: You know I mean to me again it's all proactivity and so I'm going to have backups on top of backups if if I land electric because of the because of the torque and the cutting ability in the efficiency then I'm just at plenty of them and so many doctors cut the onion to thin in terms of well we were just talking about with being able to have an environment that drives productivity I want the office to always work every day therefore I may have a great office I'm going to have an office with the highest quality materials in it because I always wanted working well and so I maybe give I am buying electrics I'm buying top of the lines if I'm buying air turbines I'm buying top of the line I'm just not I'm not going to tolerate downtime because if you actually do a little bit of calculation the ADA says that to the average office has 300 dollars an hour overhead hey that's your the clock is running so every minute we've got five dollars a minute to just keep the door open so I want to be sure that I've always got the equipment I need so I would say electric or air turbines are fine it just depends upon what your preference is but whatever you whatever you do have plenty of it they even have a system for my vacuum and compressor I do not want to go down.
Howard: and another I'm just good all the things that I have that I thought were crazy that I watched dentists to their whole life so I go into your office and you and I get a cleaning done and you come in and you check my cleaning and you say oh you have this little bitty cavity hey Howard would you want to do it now and I say yeah can you just knock this out on me I'm right here come on Mark you're a dentist you got an MBA can you do it right now and the first thing out of your mouth is well we're gonna have to move yeah it's like wait a minute I'm in a dental office I'm in a room I'm in a chair I mean I'm looking at the light what's wrong oh well we don't have we don't have one thing so we're gonna move you because we don't have one thing and then I look at the genius the greatest businessman in my lifetime was in your backyard Herb Kelleher where he said look at look at Southwest Airlines the last thing we're gonna do is have five different kinds of planes we're only gonna fly a 737 every pilot can fly it every flight attendant you know and then so I go in and dentist I said well every operation should be a 737 fight them in there and I wanted a filling why would you build a $25,000 operatory and then stop and not put a drill in there or now amalgamator or I mean what so so do you think Southwest Airline do you think Herb Kelleher would want every dental operatory to be a Boeing 737 identical?
Mark: Absolutely and that's what we always suggest that the opportunity be exactly the same in design and in the the small equipment so every you can't tell the difference between operatory to and p[eratory five and there is no hygiene op there's no oral surgery op there's no laser op or crown and bridge job every of the same so idiotic can be used for any procedure at any time by anybody and that is to eliminate the scenario you just mentioned which is oh we have to move you because every time you move somebody it costs a minimum of $32 to turn the operatory over.
Howard: Yeah I mean that is that that is just so uh okay. So I there's so many things I mean there's dental office design there's design flaws there's organ --om --ax there's location and property dynamics there's office decorating there's dental demographic, theirs when should I relocate my practice ORS lease terms and negotiations there's landlord tenant occupancy there's so many things so I'm just trying to boil down in my head most questions asked via email per day at Howard@dentaltown.com the biggest one's should I rent or should I own, that's a big one how would after three decades of looking at this do you think it's better to rent her own?
Mark: Hands down and I think the optimal ownership modality is a condo in other words you do not have to maintain all four exterior walls you know you've got to maintain essentially two walls and I think that that is the optimal ownership methodology today but absolutely ownership ownership ownership when the when a doctor sells their practice there to enjoy about a 30% premium if they own the practice actually and own the building as opposed to or on the condo as opposed to leasing the building ha that is that that is amazing some people are afraid I mean the reason they run a thousand square foot and try to put four offs in there and the reason they avoid your entire career is he there was your some guys calling it the Taj Mahal oh you don't want to build the Taj Mahal it always the Taj Mahal I've been to the Taj know I've lectured a connection but its money is the answer what's the question do you cringe sometime when you see somebody building the proverbial Taj Mahal and you think he's shouldn't have done that?
Mark: I think that first of all you want an office that is consistent and congruent with the level of care you propose to your babies they period paragraph end of story and you said that you also want to have a facility that matches the locale that you're in so you wanted a statement of quality of aftercare but at the same time if you're in when you use the term you you see a job with you of Kansas if you're in Kanzi world chances they we don't want to have something that's gilded we want to have something that's quietly elegant we have want to have something that conveys the level of care that's being offered to the patients in that locale but you don't want to be out stripping the locales than the decor.
Howard: because they don't look like it'll be too expensive?
Mark: That could be part of it but I'll tell you and this was just an unbelievable experience that I had a few years ago we built in a dental office which was truly the Taj Mahal in what I would call a town in which the last picture show was shot it was just desperately poor town and the doctor did not just well he did fantastically well was so well in fact that what he had a partner that now they had to that they had to actually create another facility in another adjacent town and the same doctor moved to the other facility because they had outgrown the first facility. I'm going to say that there's always money in and I think it's so many times there's always money in different socio-economic environments and doctors consistently underestimate the ability of the patients base too want a higher level of care and and I'm also going to say for that the vast majority of of the patients that we encounter are looking for a better level of care. So I think yeah I would never be apologetic for creating an environment that allows allows the doctors to practice at the level they were trained to practice at.
Howard: You know on dentaltown there always posting their floor plan and saying what do you think about it when you see more floor plans than anybody would what is the most obvious design flaws when someone says hey Mark well you look at my floor plan what are the things that you're like oh my god I can't believe I'm still seeing this?
Mark: Their trying to stuff 10 pounds of cotton into a 5 pound bag, they're putting way too much in the space that's available and they can't you know if you think of the the operatories as fighter jets and they have a very specific mission to accomplish you have to have the support structure to keep those fighter jets in the air and you've got to have a support structure for the operatories and so much at the time but doctors are trying to create too many ops in too little space and in fact this creates more and more stress for the entire team so I haven't say that the biggest mistake the other one is the so many doctors said that the elegance and the beauty of the office is to be coming from the exterior footprint of a building and and so they want to have these odd-looking perimeters you know make it almost look like being a medieval castle in terms of the projections and recessions of footprints and we're sending lunar footprints for a L-shaped flip print in the building and you know hidden thing the aliens and the beauty of the buildings actually come from the roofline it comes from the roofing materials and it comes from the materials that you put on the on the walls of building and on the window the window frames and then the lighting if you use also so no I'm going to say that yeah those are probably the two base mistakes I see one is size and the other one is the shape of the footprint.
Howard: What about light I always hear companies talking about oh this light has the full spectrum of the Sun so you're taking a shade you would need these types of light bulbs some cosmetic dentists say no you have to have windows in your room, you hear at all where do you come down on windows and lighting?
Mark: Okay the purpose of windows and especially in the operatory is to distract the patient period paragraph end of story. There's no other reason for a window the way we're going to take an accurate shade is to have an ambient lighting system in the in the operatory and in the office that committed natural light and there are some very specific parameters to that I cover in the conference and in my book but to go into that now's almost getting in the weeds but there's a very specific configuration of langley system also inside the inside the operatory over the over the head of the chair and at the foot of the chair and the side valances on the over the side cabinets and it creates a very specific intensity of light at a very specific wavelength and that's going to allow the doctor to take very accurate shades. So that in this Howard what I can see this one other thing about laning there's no bigger bang for the buck in a dental office in terms of the design of the facilities than creating a great lighting plan a great lighting plan can be done for about eight dollars a square foot in the new office and that includes the design as well as the installation of the lights and it create magnificent environment and if you just go back to that comment about starbucks if you walk you through with starbucks you'll see a 110 to 50 lights on the ceiling 1,500 to 2,000 square feet Starbucks I mean it looks like a one way up there and so that is a that's a fantastic example of how you use alliance to create beautiful environments.
Howard: You know you keep saying the word environment and I'll never forget I'm listening to the founder of Hilton what was his name randolph Hilton or something like that yeah and he I'll never forget a story told and that he'd always asked his customers what was the big complaint well when they started building high-rises the complaint was always waiting on elevator waiting you know so the next one would have instead of an elevator she had to and the next one's have three and then and then he had four and he said this one has twice as much elevator as they need and we never and we solved it and it was still the complaint. So then an industrial psychologist said well yeah because when they push that button they're just staring at it and then you put the numbers above the door so they're watching where it is he goes take those numbers away so they don't know where it is put a window there so they can look outside or a mirror so you look at themselves and now they will miss the elevator when it comes to their floor and the smartest people in the world always know how people work and do you think so right now someone probably listen to this right now and they got out of school that they've done there were three to five years working for someone else they want to build their dental office they're gonna try to do it on the cheap they're gonna try to put ten pounds of corn in a five-pound bag and do the whole thing in one operatory and we're saying slow down Spanky you're gonna practice for three four decades have a break room have a damn window but do you think the person in the better environment will have less burnout disease and dysfunction at the end then someone who likes their environment did you see the YouTube video called the rat cage?
Mark: Oh absolutely and I can say this from experience that I will run into so many doctors for who we've designed in office at different Dell meetings and they'll say Mark you have absolutely rejuvenated me I love the way to work every day I enjoy being in the office now the office is a pleasant non stressful environment for me is it's changed my life and that's a comment they frequently will make it's changed my life and I thought well this is this is fantastic because they like dentistry again and it renews the excitement for the profession and my daughter said something recently that she's an emergency room physician in a hospital and she said you know she said I call all kinds of specialists to come in for one reason or another and she said invariably I don't care what the specialty is sometimes they can't fix it sometimes all the king's horses and all the king's men can't care for this patient it's over but she said I have never ever never called an oral surgeon and the oral surgery comes in and says we can't fix it she said dad she said dentistry is the only profession of medicine that can fix everything and it's feild and I've thought about that for a second I thought this is unbelievable she's right she's right you know there is nothing we can't address now and that I mean so we want you know so my admonition to the profession for heaven's sakes let's look the part let's look the part I mean if we can fix everything let's have an office that actually looks the part whether it's small medium or large.
Howard: So your daughter is an emergency room physician?
Howard: Wow, wasn't it Hippocrates said the best physicians were trained in war I mean in the emergency room that that's the war zone of the hospital is it not?
Mark: Yeah it is yes
Howard: Does she like it?
Mark: Yes but now he is almost the oldest person there they're not easy to get it Howard they're not very old before they all end up leaving because when she when she first joined the chief of the service was 38 and now she's at that point and so yeah I think she's probably kind the end of her what I would call the rough-and-tumble part of that world.
Howard: Yeah that is okay so we talked about dental office design as far as construction you said you would work with the people we talked about design flaws ergonomics what comes your mind when you think of building a dental office in ergonomics. What's the low hanging fruit on ergonomics that you've picked up?
Mark: Okay two big things is telling you a very very short story and as when we began actually developing the principles of design we said you know what's the objective and I said well I'd want to earn more money if I were investing a million to two million to 3 million I want to return on the investment I said but the other thing I want to do is remove my physical stress in this environment in dentistry is just physically difficult so one of the things that we started doing the architects interior designers and myself we would count the number of times a an assistant walk from the from an operatory into sterilization every day and we found that the average assistant walks into sterilization almost 100 times a day so that's a clinical assistant. So we have to create a sterilization area it's very close to the ops so we began developing principle that put different rooms in relation to other rooms and the highest frequency rooms became closer and closer together so we started grouping different rooms of the office based upon frequency of use and so that's one of the really low hanging fruits the development of architectural zones so we developed a clinical zone a public zone and a staff zone. The other thing low-hanging fruit was being able to minimize the repetitive movement inside the operatory and with that it just means that we wanted to employ a very specific type of delivery system and we wanted to have it in a very specific dimension and so the dimension that we really keyed on was the reach of an average dental assistant the average female in North America we found out that was 27 inches from the axilla down to the knuckles 27 inches and so we put the dental chair in the middle of the operatory and the side cabinet each side cabinet was 27 inches from the side of the dental chair. So now we could be seated we could be treated treating the patients in a seated position and we are not using any kind of extended motion.
Howard: Wow that is a very good and all I want to say to young kids if I can go back you know if I can go back and do one thing differently oh my god I trashed my entire neck with that direct vision and when you and I were little when we when you and I graduated from dental school at least more than half of the oral surgeons were all doing it standing up at least 20% of the general dentists and they told us when we sat down that would trash our back and neck who was right do you think stand up dentists were smarter I mean I don't think looking at all the baby boomers sitting down leaning over I don't I don't know if I can say that was a good idea what do you think?
Mark: Hey it's not the standing up for the sitting down it's about three things keeping your head over your shoulders being able to keep your arms and your elbows down at your side and keeping your back straight those three elements and if you have the right dental stool and you have the right in dental chair and you've got the right delivery system you can be seated and you can keep your back straight you can keep the elbows down on the side and you can keep your head over your shoulders and here's the key without using any muscle okay we're not going to hold our back up straight using muscle we're going to use physics if we have the right dental the doctors operating stool we've got the right stool at the right height and we have a positive pelvic tilt to that stool we're gonna be able to sit there using physics to hold the back up straight keep the elbows down in we keep the elbows down the side by positioning the patient up or down and so obviously dental chairs go up and they go down the back can recline as well as go up and what we want to do is make sure that that patients had basically as are the level of our belly button because they're you're able to drop your elbows to your side and now you're just using a rotation of the shoulder like this rather than reaching which is a class-four movement and so there are five classes of movement we want to engage in one which is a class three movement and that's why I highly encourage the doctors to use a dental assistant and employee for four handed passes because then you're able to engage in only this one movement which is the class free movement and I would really recommend that whole idea of yes indirect vision getting tremendously you've got to use direct vision to see everything you're gonna be in a world of hurt ten years into practice.
Howard: You know I really am you know you have those two books you should make those online CE courses on dentaltown where it takes the online course they could get the book you know they have it all there but because these are just lessons that I'm I mean you'll get a practice opening up a bunch of dental office you're probably only gonna do it one time and then you're stuck with your dental office your spouse your kids and what do we do to go back and change all of that so very very interesting. So the next thing that I see when I'm at picking up a dentist I visit a lot of dentists who have drinking problems and need to go out for restaurants afterwards and have beers and watch sports and I'm you'll see a mom they're jerking that overhead light they're always there pulling you know it's like on this train track rail or it's a pole I see a lot of people fighting their whole career with their light and and then some of these things are so dumb like you look at the overhead light you want to adjust the overhead light where where you grab the handle right where your thumb lands is where you turn the light off so every time you grab the light overhead you turn the light off and then on like even on mine my high speeds and slow speeds their quick connect friend when I grab my feet I grab it and lift up well guess what half the time it's now in my hand and I'm like well you can't have a quick disconnect in the same direction you pick up that you know so weigh in on that weigh in on first goal lights because some people are going with head gear and now there they've gone from a dentist to a minor there's poll lights there's overhead lights what's your thoughts on lights?
Mark: The very best like to use is a track mounted light and I recommend actually as you use to track modern lights much of what you know if we've all seen operating rooms and the operating rooms have a minimum of two operating lights no lanes coming in two different Corrections and then they never have to move the length and and that's what I would recommend that the doctor has a track mounted light and they have two lights on that track mount and now we've got light coming from two different directions you never have to move the light during the procedure even if you're rotating the patients have from right to left it doesn't matter it's still it's the light is still there for you. So that's that's one thing I would recommend and the other thing I'm just suggest is you absolutely want to have an ambient light that is of appropriate strength in most of the mostly illumination in our operatories is way too low and so ophthalmologists tell us and the way we design offices is we want to attend to one ratio between the ambient light and the operating light so if you're operating lights working at 5,000 lumens you want your ambient light working at 500 lumens and that way when you lift your eyes out of the operating feel the jump in the light intensity is not so great that the eye becomes fatigued throughout the day.
Howard: I always keep the light as low as possible just to enhance my appearance. Okay so you're gonna build a dental office and a lot of times I mean dentist I love them but they're like I like well why do you want to put it there were the Sleepy Hollow Creek comes down and I love that area and it's so beautiful and I'm like the Sleepy Hollow Creek, I don't know what what matters do you more the Sleepy Hollow Creek or demographics?
Mark: No they the absolutely is kind of boiled down to a combination of I want to be in an environment that is consistent and congruent with the level of caring approach so I want to be in a neighborhood that's like that or I want to be a business local that matches the quality of care that I propose to my patients the other thing is I do not want to spend a fortune on the site preparation so it's really important that I that I'm in an environment in a locale or a geography that you know it's not on this side of a mountain I mean as it as a in extreme paint because now we have to have a tremendous amount of sight preparation so it's a it's combination of looking at the economics of the situation as well as the matching in the low count with quality to care and then of course there's the issue of well how pretty or how nice is it but you know what we have we had a doctor \ who was in Colorado and he wanted to look out the Rocky Mountains and I said if you're looking out at the Rocky Mountains you're not earning any money so that's really not an issue for you maybe you'd like the patients to see it but they don't need to be inside your office looking out the mountain they need to be in the dental chair and you need to treating them so the only purpose of Windows as far as I'm concerned is to distract the patient when they walk into the operatory the patient walks into the OP they're distracted they look out the window they sit down they go past all the scary stuff and now they're seated and the reason we don't want to I guess visually frighten them is frightened patients don't buy things they frighten patients don't readily accept the care the trust between the doctor and the patient is eroded with the fear so let's take that that are still off the table let's distract the patients.
Howard: Okay that is I need I'm but when you said windows are for distracting do you think it's better that the patient is sitting there looking out the windows so they don't see the dentist's coming in the room up behind them or do you think it should be flipped around so that the patient is seeing the dentist come in I mean I've seen dental offices where it's the same office but the patient's facing exactly different ways which way do you think they should face?
Mark: I think the issue Howard is centers around the number of steps the doctor has to take in order to get to the head of the chair coming in to the operatory and the optimal way to get into the operatory with the minimal number of steps is two door or dual rear entry and so I mean again this all goes back to our concept of design principles when we're trying to minimize repetitive movement and this is a big issue repetitive movement is cumulative and it's damaging a repetitive movements a lot repetitive movement is a lot like radiation and so we really want to avoid that repetitive movement and so that dual rear entry allows that that happens at the same time the patient is facing either the window and looking out the window to a seen the Sleepy Hollow Creek or they're looking at a piece of art that's a lumen on the wall or they're looking at a sculpture they're looking at something that's interesting and or you have where you've got a flat screen on the wall and is displaying a lot of beautiful environmental seans.
Howard: Well I can't believe we went over an hour what does it cost if someone wants to talk to you or so your website is www.mynewdentaloffice.com
Howard: Okay so my homies listening to you and he wants to talk to you how much is a consultation or to talk to you or?
Mark: I charge $300 an hour for a if they only just wants to talk you know but yes if they want to come to the conference which I would really recommend because in that two-day conference they learn about the principles of design and they learned that design is not an artistic endeavor its highly scientific now we've broken this down into a into a very very methodical and orderly approach in science and so it's very very formulated Howard and so if people come to the conference and then they want to have a conversation with me that's free, that's because I for individual consultations immediately have an end of the conference and so the conferences are held at the A-dec facility in Newberg about 12 times a year so there are lots of opportunities probably know about once a month.
Howard: So how do, where do they get that it's at A-dec or Pelton & Crane in Ohio?
Mark: No no no I no longer do events at Pelton and Crane.
Howard: So it's all at A-dec Oregon?
Mark: I'll do it at A-dec for example I might do one for that Hawaiian dental Association or the Des Moines Dental Association something like that so I'll post though wherever I'm going to be I'll post that one on my website.
Howard: but you're at A-dec every once a month?
Mark: Once a month.
Howard: Oh man, so you should do the seminar, and it's a two day seminar?
Mark: Two-day event
Howard: Two day event and you came it right with the salmon run?
Mark: Yes yes it's always associated with Newberg.
Howard: Yeah man I love Oregon man I love I think that whole what is it?
Mark: Newberg, Oregon
Howard: Newberg, Oregon
Mark: It's about 45 minutes outside of Portland beautiful beautiful in the premiere pinot noir valley of the united states so mean fantastic vineyards and in this particular area of the country.
Howard: So you just catch a big old forty pound salmon get a bottle of wine and call it a day last but not least i want just one more question I don't like the term United States of America because I don't know how you compare Kansas to San Francisco or Florida to New Hampshire I mean the federal reserve even says this is nine different economies flying under one flag and I know that nobody in Europe uses the term EU no one compares germany to portugal or that but so regards to green dentistry I'm hearing dentists say that I advertise I was off the grid and the whole dental office ran solar and I have patients driving an hour to come to my dental office off the grid now I'm sure that's more popular in Oregon and Silicon Valley then Texas where you are I don't know but do you see green dentistry coming in and when you see because these kids making long-term bets do you think they should bet on solar off the grid? I know dentists who built a 5,000 square-foot dental office they can't even tell me how much electricity it uses and then I talked to people who convert buildings the solar and in Phoenix where you have more Sun than anywhere that I know of the United States most of the solar installers say well the problem with solar is let's say that Mark calls me and I go to his house and it costs a dollar to put it on solar well if Mark was gonna spend a dollar I would have him spend it below the roof he doesn't have his lights automatically turning off and so and leaves her so he did every single thing wrong under the roof and he wants me to get all that from his roof let's talk about finish up with solar and green, do you think that's going somewhere?
Mark: I think more of an ideological bent that the doctor might have rather than a financial decision and if we're talking about it so we're gonna separate those if we're talking about purely a financial decision I think that it will be very very questionable if you'll ever recoup the investment that you made in the in the energy saving component of your office even if you're there for seventeen and a half years I really think you're better off from a financial standpoint with a very conventional office that pays attention to exactly what you said you know about a smart environment that is connected to the Internet of Things and allows you to I have lights turn off in a room when you leave the room that the heater drops at night the air-conditioner goes up in the evening when the last person leaves but it doesn't go up so much that you have to turn it on for hours the next morning you know so everything is balanced out so I think that if you're going to if you're going to go green as they say it's ideological decision it's not a financial decision.
Howard: but it might be a marketing decision in some areas do you think not? Like I noticed like in Phoenix I can pay higher electricity bill if I only use electricity from the solar farm right but I don't do that because I'm not dumb but I I know dentists who do it and then they advertise I'm off the grid you know I'm totally all that and they claim that that's a marketing on that that works for marketing but are you not really seeing that?
Mark: Yeah I you know I would imagine in a place like Portland OR because people are much more attuned to that but I would have to say that I would much rather put my money my marketing money into the environment of my facility so that it matches the quality of the care and and that is if I had to leave one message with with your audience that would be it if you'll do that one thing you had any late Starbucks secret to success and it truly is a secret to success if people think it sounds so ridiculously simplistic but Einstein said simplicity executed well it's very difficult and indeed it can be but I think that easily that's the key to success and more than any other element more than the green issue you know anything like that.
Howard: Well it was an honor to get the 400-pound gorilla to come on the show today and talk about all things design and my gosh you're only until once even says when you do it you're gonna stay in there 17 and a half years I mean hell that's a long prison sentence right yeah I mean I wouldn't want to go to jail for seventeen and a half years so if you're gonna go to jail for seventeen and a half years it'll be nice and if you're if you can't if you're just it shouldn't get out of your house you can go home and sit in your favorite chair and turn on the big screen and open the refrigerator, have it in your dental office. My boys I had four boys what I like the most about when I built my dental office is I put a little play area out front for my four boys I put a bird box back there I basically never took my eye off my four boys I designed that no because I wanted him to have fun when they visitor daddy because when I was little when I visited my daddy hell he owned a sonic drive-in I can't compete with onion rings and tater tots and french fries but I tried hard I wanted it to be as close to a Tater Tot as I could but Mark thank you so much for sharing all your wisdom and coming in on the show today and if you ever want to combine those manuals and books you've written on Amazon to online CE courses I mean I really like what you've done on Amazon a guide to designing the elegant dental office just go to Amazon and type in Mark Tholen DDS MBA, Mark thank you so much for coming on the show today.
Mark: Howard thanks so much I really really enjoyed it.