Dentistry Uncensored with Howard Farran

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

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Howard: It is just a huge honor for me today to be podcast interviewing Dr. Agatha Bis, she is a practicing dentist in Oakville Ontario Canada and the founder of UPB Dental Academy which is an online learning platform for dentist looking to improve grow or change something about their practice. She has been in practice for 23 years currently working four days a week with no weekends or evenings, her practice has five full-time hygienists and completely fee for service. She created UPB Dental Academy to share with other dentists the systems that have been extremely successful for her and growing her business because she is passionate about elevating Dentistry and eyes of all the patients creating successful happy dentists around the world and helping others achieve their ultimate level of success doing what they dreamed of when they first got into dental school and this was all born out of necessity years ago when her dental practice was failing she was forced examined her situation in a very different way she was forced to look at what she could change immediately in order to turn things around. She settled on five key insights that formed the basis for the ultimate hygiene program from there she employed first principles thinking approach to solve a bigger problem. She's a board-certified doctor dental surgery from the University of Toronto in 1992 with an honours and bachelor in science in the film of chemistry. I assume she went into chemistry because her name is Bis

Agatha: Just Bis

Howard: Were you named after a bonding agent you have to go into chemistry if you're named after a bonding agent and but you know I just love him she went on to the prestigious Las Vegas Institute to learn cosmetic makeovers full-arch mouth rehabilitation the treatment of TMJ disorders and migraines she currently as a practice in Oakville Canada that focus on cosmetic and holistic dentistry. I mean I could go on and on about your bio I was so excited your job but I wanted to start with something completely off topic that you're not prepared for and back then that is I see all these grant me because what I loved about your story the most is when you started out it didn't it didn't start out too well right?

Agatha: Yeah at the beginning it did and then it went downhill for sure.

Howard: So this is the dilemma so I'm in Phoenix and we have two dental schools that have been here a decade every week or month some big DSO comes with free pizza gets them all in there and says if you don't work for me you're gonna go bankrupt and we're gonna be like Walgreens and we're taking over and better get in on the ground. So they buy into this stuff and the teachers agree and of course the teachers agree because those who can do and those who can't teach so they're in a mental institution with a bunch of people that couldn't run a dental office and you put a gun to their head so then they join these dsos and I tell them I say look I'm a lot older than you I could be your dad and I watch this for ten years and you'll come out of school you'll get a job as an associate it doesn't matter if it's DSO or private because Heartland and Aspen it doesn't matter most of them go to it doesn't matter they they all quit after a year then they get another one quit after a year. So they have to they have to get five different jobs in five years until they're so miserable they don't even care if they start a dental office and go bankrupt because at that point they're standing on the ledge thinking about jumping so I just want to know why do you think like when I got out of school I got out May 11th had in my office open by September 21st four months it was a hundred and thirty three days, why do they have to go job hopping for five years because you would think they'd get an Excel spreadsheet they'd go to the class that graduated and on school five years ago call them all up and say hey how's that associate job working and they're like it was a really bad idea. So why do they not see this is just not working I mean it's some fairy tale that the cow jumped over the moon?

Agatha: I think it's fear I think dentistry has changed and I think a lot of dentists are afraid to go off on their own. You know I talk to a lot of dentists when we do different summers and it's just like this ongoing fear of what if it doesn't work or you know if I can't get you know payroll met or rent met things like that they're just money fears issues. A lot of you grads just don't really know what to do they don't know where to set up they don't know how to set up thanks for different now I mean you know when I graduated banks gave me money to set up easily now there's a little bit more struggle in terms of financing...

Howard: Just for the record that was Canadian money now that's not money money that's monopoly my anyway but the banks the banks will loan them because the banks don't even have a half percent default rate so when you're out of school you can get seven hundred fifty thousand dollars just by signing the application.

Agatha: Not so easily here anyways but a lot of the dentists I talked to that are associating right now what a lot of them do now in terms of setting up their own practice they'll associate somewhere else right and then they'll open up their own and grow it slowly which is a kind of a safe idea right because you still have income coming in and you're able to grow yours the problem the only problem with that I have is that you're not focusing a hundred percent of your time and energy in your building of your own business you're still one foot in one foot out right so in any kind of entrepreneurial situation if you don't dive in a hundred percent fully then you're kind of cutting corners are missing out on the opportunity to really be different in your area. So a lot of them are I think well I mean I

Howard: I disagree with that because when most people get married they keep their girlfriend on the side for at least a year or two just in case it doesn't work out right it's the same thing isn't it?

Agatha: I never thought of that but you're so right I mean you're a hundred percent in when you get married and it's the same thing in business right why do businesses succeed in some fail because you know 100 percent in.

Howard: and they'll go work for somebody else for some $500 a day guarantee it's like okay so if one person called you up with a broken tooth and needed a crown one crown what would what would the revenue on that be more than you're guaranteed a rate for someone else but you answer the phone and just I mean getting married keeping your girlfriend aside or starting your own dental office while be still being an employee somewhere else I mean at what point you just like hit him over the head with a hammer and hope they'll snap and when they wake up they won't have that thought anymore.

Agatha: Yeah but I think it is a lot of dentists are afraid now certainly a lot more than when I first graduated it probably when you graduated for sure.

Howard: Yeah so podcasts are definitely younger people so a quarter so email me Howard@dentaltown.com tell me how old you are all that kind of stuff but about a quarter of the emails they're still in school and the rest are all under 30 what would you tell that person who says I am scared what did she just admit that I'm scared.

Agatha: Well the first thing is is that I mean you can be scared of a lot of things you can be scared of flying we're gonna get on a plane if you're going in a trip right so you have to take the fear aside because fear is basically an emotion that you're having about something that hasn't happened yet so it's kind of a wasted emotion right because you have spent all your time worrying about what if instead of just doing so number one is you gotta kind of get over that and jump and do it the other thing is is that and I tell this to a lot on you grads when we're speaking at seminars you've got to start your business with the end in mind right like the typical what does the Stephen Covey that said that where you're kind of setting up your office instead of doing what other people tell you to do or what the staff you hired did in the previous office you've got to create the practice that you want to finish with and then work backwards so that's kind of like where I'm seeing a lot of people that I speak to you know they take insurance because other people take insurance in the area you know they they do certain things because their staff did things that way in their previous office so they're kind of taking on a bunch of other people's garbage and creating this kind of semi average practice and then they're unhappy because they're not doing what they've always wanted to do.

Howard: So when they come out of school let's just start for example um how so let's see she um she graduated two years ago she's been working at Aspen or a heartland or Pacific for two or three years and she's she's getting frustrated I mean that the turnover and all the so she got again in private practice is they're averaging about a year and when you look and some people think it's just Millennials or whatever because you see the same thing in Wall Street where they'll get the best job at Goldman Sachs and a year later they switch to another job I mean they're jumping job to job, I mean I think the FANG stocks Facebook Apple Netflix Amazon all these I'm their average millennial only stays with them a year or two. So she's job hopping because she the grass is greener on the other side of the hill so where does she start does she start with demographics to do demographics matter?

Agatha: Well let's go back for a second because you said something that I think is really important as Millennials are a different bunch right I mean you mentioned Millennials and I do I work with a lot of Millennials in my own office, I mean more than half my staff is Millennials and I feel like the difference with them is they want to make an impact they want to grow in the business they want to do something bigger than just you know a job come in do their thing and leave so our generation was different because we just you know we worked really hard and then we went home and then we did it all over again tomorrow whether we agree with it or not. Millennials do want to make a bigger impact beyond their job and that's the one thing that I find when we're talking about you know the culture in the office and training your staff they I think you can get a ton of reward with working with Millennials but it's a different approach they have to feel like they're contributing to something bigger but going back to your dentist that you're talking about it all depends on the area right I mean there's offices popping up all over the place so it's a matter of knowing you know in my area my area is growing like crazy so you literally poppin office in the middle of a new suburb and start marketing advertising and on and on and on I moved my office from a different location into where I am now and this location was completely filled with dentists like I mean the competition was crazy so it's about positioning yourself in a unique way right like what are you good at what are you special at what do you shine it what do you want to be known for and really focusing on one thing in your marketing and your online presence so that when people are looking for that they can find you easily based on that, like I don't get people you know searching online and saying how much is a crown and getting my website that's not the kind of searches I'm gonna get because that's not what I'm you know promoting so really whatever you want to be known for that's what you want to focus on in all your marketing and when you first start up so that you get the kind of patients that you want to work with.

Howard: So you started a blog this is a pretty interesting whyIhatebeingadentist.com yeah you can find it on your you UPB which is the what is upp ultimate practice... what is it?

Agatha: Ultimate practice breakthroughs

Hward: So if you go to UPB for ultimate practice breakthrough UPB Dental Academy under blogs she has why I hate being a dentist so that is kind of that's so ironic here you are a very successful dentist did you get this approved by Bill Dickerson did he did he after you graduated from lvi did he allow you to have a blog why hate being a dentist where does that come from?

Agatha: It's a joke it's actually it started out of frustration you know I mean I was having some really bad days here and then I started writing about my bad days and started writing about you know whether it was a patient or a team member or just whatever was going on and a couple of my friends saw and they thought it was funny and they related to it because they are struggling with the same issues in their practice and as I built UPB Dental Academy we started solving some of those problems that I was faced with in those days and so it we decided well I decided to put it into a blog forum if anybody ever wants to kind of like connect relate look for what I did to fix the things that I was struggling with yeah I was kind of like a funny it started as a joke but it was kind of a funny blog that talks about common dental challenges and sort of what I did to fix them.

Howard: So I'm sorry but you said and the UPB was ultimate?

Agatha: So UPB stands for ultimate practice breakthroughs but it's a short form on the website.

Howard: and so going back to your journey when you you weren't happy it wasn't as successful as you thought you had a series of these ultimate practice breakthroughs that led to your UPB Dental Academy, what was the first big mental breakthrough that you had?

Agatha: So the whole thing really started with the market changing in 2008 so when the economy changed a lot of my patients that had coverage at the time lost their jobs and since they had no coverage so I mean my practice went down and numbers like crazy overnight and between that and I had some personal issues and struggles at home I just started looking for I started hating it and I mean I wasn't like meeting payroll I wasn't meeting rent I was like struggling with my team and I just decided that I was gonna look and do something other than dentistry I was gonna get out and do something else and the problem is I have no other skills right I don't know what else to do so I couldn't really figure out what to do with myself and at the same time I got a letter from the bank saying they were calling my loan meaning they were giving me basically 30 days and that was it so I had to figure out a way to turn my practice around really fast in order to show them that I can continue building this and it was out of that where I just locked myself in a room for two weeks and just went to work on every single thing that we do and tweaked it and improved it and basically went back to my team and said okay here's five things we're gonna change immediately and it's one of the things I talked about in the UPB program and then how do we grow from here so that I can not only take my practice back but love it and enjoy and make proper money so I don't have to stress like this anymore. So you know making small changes initially made a difference you know daily like if you see a difference today and you see a difference tomorrow and you see a difference the next day it motivates you to keep going and then taking bigger things like improving customer service that's a big thing right or how to do proper case presentation that's a big thing because you're training your staff to communicate differently so all those things we tracked later on as we got better and over a year kind of cleaned up the entire practice so that we could you know triple and quadruple the business and then show the bank said hey we're good and kind of go from there and that's when I started to love what I was doing.

Howard: So you know you said 2008 everything was going bad well that when Lehman's brother filed for bankruptcy me not that I mean that was that was actually a 1929 depression but in 1929 the Federal Reserve thought they should save the currency so they lost a third of the banks and one out of four Americans was unemployed for about three to four years it happened again September 15 2008 this time they realized no we are not gonna save the US dollar and they printed eight trillion dollars that night and because it was just in ones and zeros they could just electronically cover all the spreads it in it to print anything or move gold bars around but my question is this that was it's 2019 do you smell does it kind of smell like Lehman's day again today versus back then did you see it comin when I went on when Lehman's file for bankruptcy really yeah I kind of expected this whole thing to start contracting and does that have any impact on how you would coach a young girl who's a senior in dental school today?

Agatha: So I heard a quote was that says you know when you're doing great when you party you ignore things and when things are crap you ponder and in reality I think I didn't see it coming because my practice was really good at the time so I didn't see the depression coming I didn't see any of the issues coming and then when they came they came like a truck hit you right because it came overnight because of the systems we've built I don't see it happening again but that's also because of the way we structure the way we do things in my office so I'm still getting patients that are paying for things out-of-pocket completely like I'm not dependent on insurance the way we deliver our service is just a little bit different so you know I don't know when the next depressions coming I don't know if the next thing is coming having said that having some proper systems so that you don't lose anything when you're you know it's a you have only 100 patients to work with making sure they're getting in on time making sure that you're not delaying their treatment by a month or two or three because that's where the revenue gets lost and the treatment doesn't get delivered properly so having a lot of proper systems in place so that you maximize every opportunity for me made all the difference in the world for sure.

Howard: So the first thing I gotta address is you're saying something totally not mainstream with not taking you do not take insurance

Agatha: I do not.

Howard: Okay you're gonna talk about that what percent of dentists in Canada in the United States do you think do not take dental insurance?

Agatha: I have no idea probably not that many.

Howard: Yeah I mean I am it's got to be well under two or three percent so so how do you how where does that come from how do you get there I'm talking about that because most people if you went in there and said I came and business consultant and we're gonna quit taking insurance there's no way they bar the door shut.

Agatha: Yeah exactly you know you can't do something like this overnight this is a, I mean it took me ten years to do it right you have to go slow so we did it I did it in baby steps when I first tweaked my practice and we were kind of rolling along properly I started to change little tiny things so in terms of how we communicate with patients how we communicate with new patients on the phone how we present our policies or philosophy so I did it really really slowly and I did it in six-month increments so I would sit down with my team and say okay now we're going to say this to new patients when they call we're a fee-for-service office and if you have insurance and whatever you're covered for that's what you're gonna get reimbursed but we're not gonna take what the insurance covers we have our own fee guide and so on so kind of like getting around the wording around that six months later we implemented something else six months later we implemented something else they're like baby steps in terms of shifting the practice to where it is now. Now we still get calls every now and then you know from new patients saying you know will you take my insurance or will you do this or will you take my fees and it sorry my fee guide and I told my reception team a long time ago I don't want to hear about those phone calls because I feel like we're missing out on some of the patients that are calling our office and I think that's a lot of the struggles with new dentist they want everybody to come in the door right you want every new patient that calls your office just so you can be busy but the problem with that is then you become or you end up doing what you're told to do as opposed to doing what you've always wanted to create so you know out of all the phone calls that come into the office we'll probably only see maybe 10% of those patients in reality because a lot of people are not willing to come in and pay out of pocket and pay above the fee guide and so on but the ones we do our quality patients plus they believe in what I really plus they refer their friends plus they tell their neighbors it's just like it's it's grown slowly but I'd rather have slow growth consistently the massive growth right away and then suffer with what I've created.

Howard: Interesting by the way you said I mean you know if that business cycle would be back Joseph shooting there's got to be my favorite economist of all time and his book is business cycles and the bottom line of the book it's not just that economic progress in capitalism means turmoil but there's a business cycle because guess who's making all the decisions a bunch of crazy monkeys and if you think these crazy monkeys are as smart as ever well then you'll be surprised by the next business cycle even Warren Buffett you're sitting on a hundred and forty seven billion in cash says that's why you have recessions and when the tide rolls out you'll get to see who's swimming with a bathing suit on and who's swimming naked and so yeah so if someone told you they could predict the future you would have to say they are completely insane because you can't predict the future but my gosh you can't I graduated high school 1980 economic contraction twenty one percent interest rates I graduated dental school may 11 and the following October was Black Monday the markets contracted a quarter then there was the y2k bubble March of 2000 then there was Lehman's brother and I have been and we're coming up on one of the longest economic expansions that I've ever lived through and they're always followed by a contraction because human beings are wild animals who make malfeasance investments. You're in the country of the smartest man in the world mr. wonderful that why is it that the smartest Canadians are always bald why do you love Mr. wonderful, is he your favorite Canadian?

Agatha: He is pretty entertaining, I know a lot of people don't he's pretty funny.

Howard: Yeah and he and you know why he's pretty funny it's pretty interesting what he believes he believes I was taught this formally in Catholic school I went from Catholic school from kindergarten to the end of Creighton and they always said that in the I was talking about stories and parables cuz you can remember a story you can remember a parable and they pass it on and he always talks about how the greatest communicators always talk in stories and parables and what's funny is that last Sunday we had a the grandkids over and sure enough one of the grandpas set all the grandkids down in the corner and he sat in a chair and he was telling them stories and he even said that he says you know they'll remember a lesson in a story you just tell them to be good or don't kick the dog or you know what or whatever they're not gonna remember it. So I want you to tell me a story you survived life with five hygienists are you on medication do you drink at work how do you you cohabitate in a house with is it five hygienists?

Agatha: Yes, five hygienists.

Howard: Wow so these people are coming in paying for a cleaning less like a girl going to a salon and paying for a hairstylist without insurance?

Agatha: If they have insurance they'll be covered for whatever their insurance will cover but not what they're getting done so whatever we do is independent of what their coverage is.

Howard: So they pay you and then the insurance will pay them?

Agatha: That's right

Howard: Wow

Agatha: Usually a portion of what happened in the appointment right in most cases anyways.

Howard: Give an example

Agatha: So I come in to you I get my teeth clean what happens so first of all I have a very specific system and we teach that I teach that on the UBP Dental Academy but it's basically it's seven screenings which is like little things that we do and a lot of dentists do this I mean like we all do oral cancer screening and we all do occlusal screenings and things like that but it's not properly communicated right I don't know who does your teeth but most of the time you probably just go in and they clean your teeth and off you go but nobody really spends the time to explain to you the value of doing certain things and what what your what looking for and consistently kind of show you what's happened in the last five years right so show you where you were five years ago and where you are now kind of thing to motivate people to do things but there's a number of little things that we do a little bit differently that has grown my practice tremendously the other thing my hygienists do is they see the new patients they see any whitening cases they do help me a lot in terms of emergencies and things like that so they're not just doing cleanings they're doing a lot of things that are very important in terms of building value in that appointment but the new patient exams are by far my favorite there are two hour exams we spend a crazy amount of time getting into a lot of detail kind of find out what the patient wants how they want to deliver it we have a questionnaire about specific things like you know what did you not like about your previous dentist how do you want things presented to you there's a lot of communication learning in terms of what they want how they want it and then kind of finding out like I have a lot of patients we even asked me for specific materials I'll get people coming in and say I only want this so I only want that so again just kind of getting into the information of what they're looking for and giving that back to them that's really all we ever want in any kind of business scenario right.

Howard: Now now before we go further that not only do not take insurance you have the word holistic on your website which on dental town is a trigger word on dental town when a dentist reads holistic he immediately needs to swish his mouth with scope and swallow they run out of the room what I've noticed is some bizarre things like when in California dentists I know put solar panels on the roof and advertises off the grid well there's you know that that's a big thing in California so he has people driving their car one hour across town burning gasoline to go to the dentist off the grid. I've noticed that if a dentist writes holistic on his website that the patients love it now all the conservative rednecks on dental town they just like freaks so where does the word holistic come from and what does it mean to you?

Agatha: So what it means to me is basically looking at the whole patient like as a whole so it's not about the I'm not an extremist whatsoever but I had my own personal medical issues that my doctor kept blowing me off for for seven years and nobody would listen and so I experienced the holistic approach with somebody else and basically looking at all my symptoms all the problems and going you know what could be triggering this and so we do look at our patients a lot in terms of what else is going on in their lives now I'm not saying I solved their medical issues what I'm saying is we communicate with them in terms of what's going on beyond their teeth beyond their mouth and then a lot of the times sometimes it does tie in a lot of the times people just need to sort of express to you what it is they want so some people just simply don't want fluoride I mean that's a simple thing other people want to discuss their nutritional supplements of their taking other people have like a whole host of illnesses that nobody's been able to diagnose them with and they think that you know if you take out that one root canal treated tooth that's gonna solve all the problems and I mean that's obviously not the situation but a lot of patients will think that you know holistic means that we have some magic pill. For me it just means really really going into detail in terms of what the patient is experiencing medically and dentally and some of their challenges and then sort of finding out where they want us to help them and how and giving that back to them if it's feasible.

Howard: I think you know when when people are really conservative and they don't like holistic or natural paths or things like that and they they talk about you know you should only go to the Mayo I always remind him I say now you know the longest anyone ever lived was 122 years right so you know all you all their patients are gonna die and then what I also think is bizarre is when you hear MDs talk about how they just know everything about something and they can say that's something else doesn't work and I say okay so then you can cure this disease oh no there's no cure for oh oh so you know everything about it but you can't cure it does that make sense you, I would think if I know everything about a car engine I could fix it so if you bring me your broken car and I can't fix that I'd have to be humble enough to just say wow I don't know what's wrong with it but a MD doesn't able to say that can they they're just like no you have to take this and you have to take this prescription you have to take this pill and you say okay but okay so we know everyone's gonna die and we know grandma's been following your advice for three years and just no benefits can I go to a naturopath oh no those guys are qucack and can I tell you something else I you know this podcast we're doing...

Agatha: Yeah

Howard: I started I did it started out way back and a this was Ahwatukee Uncensored for my practice B to C and I am called all the healthcare people to do the podcast with not one MD had the time they were too busy because if you sign up for Medicaid and Medicare you book three months in advance so so so who came they're all a does all dozen chiropractors all dozen naturopaths all everybody like you who wants people that aren't getting the help they need that are willing to pay their own cash and I did I'm 88 podcast and the other thing the marketing thing is guess what they did with that podcast they put on their website so you start going around where I live in all what Suki and there's all these people that have an hour interview and I did it for free yeah and I did the podcast so this holistic deal I mean and I think it's neat people are complicated I think a quarter of all humans are completely crazy disconnected from reality and I love him like like I always tell people my favorite patient at today's dental is that when I go there she's sitting outside out the front door on her little electric wheelchair taking the last puff of her cigarette not knowing when I open the door she's gonna exhale smoke all the way there but I mean obviously she knows when you're in a wheelchair with an auction you probably shouldn't smoke but you gotta love people play in know it so the people and she's gonna die one day and so am i and I'm not gonna ruin her life because she's not caring the yoga instructor eating yogurt and you know so people are crazy and you just gotta love them and I think that's very neat but do you would you agree that saying holistic on your website is a marketing advantage?

Agatha: I think both, it's an advantage and disadvantage it does open you up to obviously more potential exposure having said that it actually brings people in that are sometimes dangerous to a dental practice right because I've had some patients that come in and 100% believe and I'll give you an example that you can cure them and I had a lady bringing her son in a wheelchair he was probably in his 40s mentally incapacitated physically a lot of issues and she swore up and down that if I remove her mercury fill that his mercury filling that one filling that will cure his disease and I mean you have to be really careful with patients like that right because you can't do this and then have them think you're gonna fix them and because their going to hold you to it right so essentially as long as a spicy this is why we spend so much time with our new patients as long as we see that there's that belief system attached to one thing in their mouth whether it's a root canal or you know a filling or whatever else was done I'll usually dismiss the patient from my practice I won't treat them if their expectations are that I'm gonna cure their diseases.

Howard: Well the Romans thought the Sun and the moon and the five largest people day they're they'll all planets right and mercury was the fastest one so that when people say they want all their mercury removed and you just they're the fastest patient out your front door. So I want you to go back to the big issue the hygiene Department I mean is the dog wagging the tail or the tail wagging the dog everybody that knows that ever had a dental office answer the phone I'd like to call and just get my teeth cleaned and whether or not you do new patient cleanings or not is the first division between complete dentistry and wham bam thank you ma'am dentistry so tell my homies which I know they all do first appointment cleanings what are your thoughts on first appointment cleanings?

Agatha: I have no problem with that I think whatever gets a patient in the door so they can experience your services he's key so I wouldn't turn down somebody who calls the office and says I just want to cleaning because it still gives me an opportunity to sell myself and what I mean by selling obviously I don't mean it in a cheap way I mean like explain to them and show them how good we are and what we can do for them a long time but I don't have a problem with us how you are I think a lot of patients when they don't know what stay on the phone they'll call for cleaning right not everybody's gonna call and say I would like a comprehensive oral exam right a lot of people just say you know I'm due for cleaning can we do a cleaning so go for it absolutely I totally think it's a great way to build your practice.

Howard: That's because a lot of dentists always sit through me well if you're not gonna take x-rays you know I'm going to dismiss them as a patient I'm pretty sure everyone needs a dentist if you go to if you go to all the prisons in Arizona, they even have a dentist for the prisoners and I think it's completely not doctor like to find all these legal reasons to keep patients out and you just document in the chart and you don't live your whole life being feared of getting sued I mean you have car insurance in case you crash the only person that should worry about Howard Farran getting sued by a patient is my dental malpractice carrier I'm not worried about it I'm tree I'm trying to treat that patient like I would myself after crazy I treat him like I do when I treat my mom I mean you know they're just you know and obviously I take after my dad since I'm the most normal person ever. So that's pretty neat that they want a new patient cleaning and you're not an extremist like okay come on in because you know if they come into your practice see you meet your staff that they'll probably come back.

Agatha: and half of them you know once they come into the office and we explain to them that eventually you know we'd like to see for a comprehensive full exam a lot of them will book it right away and if time allows we'll do it that day like a lot of the patients will convert automatically on that cleaning to an existing patient to a comprehensive exam so I don't have a lot of issues with that I think anybody who you know says you shouldn't do that I'm sure they have really good reasons but I think it just kind of limits you in terms of who you allow into your practice.

Howard: Yeah I'm gonna next subject is probably the most taboo subject members heard a song the sweetest taboo?

Agatha: Yeah

Howard: Yeah you know you know what the taboo was ?

Agatha: No I don't

Howard: It was a dentist selling dentistry and it was just it just rocked her world yeah sure day and she almost left America and went back to France I mean so they tell you I hate selling dentistry I didn't go to school eight years to sell I don't like to sell dentistry and then their patient leaves with 11 cavities and when you're as old as I am and your four kids turn into five grandkids you're thinking you're sitting there think of the transition when my five grandkids go to a dentist someday when I'm not no longer in the present I don't want them to go to some lame dentist it just says well you have fake cavities but unfortunately your you don't have dental insurance so there's no way you could do anything because you're a victim and I mean I would you know case presentation is more important than clinical dentistry like would you rather my grandkids go to a dentist who said well look all I can do is numb up the teeth and remove all the decay and pack it with butter it'll be real butter it won't be margin versus another dentist who leaves all the decay in because he can't sell the case would you rather have your grandchildren have all their decay removed and packed with butter or go to a dentist who leaves all the decay and because they don't like to sell dentistry. I mean if you can't convince my little Taylor to get a filling done you're not a good dentist and there's so many dentists who have the alphabet soup behind their name that think they're the greatest dentists on earth I'm like dude you can't convince anybody with an f-150 pickup truck and a big Green TV who's been to Disneyland twice to save one tooth you're not a good dentist you're a legend in your own mind and until you can convince another human to part with their cash to get their teeth fixed you're not a good dentist do you believe that or is that not true?

Agatha: 100% I mean the word sell I think what people misunderstand is selling isn't like I'm trying to get you to do something that isn't in your best interest selling is like what we do with our kids we sell our kids on stuff all the time right when we're trying to motivate them to do something like brush their teeth at night we teachers should be selling their kids on learning and you know growing so selling is basically influencing another human being on to do something that is in their best interest so whenever we talk about selling or case presentation it's about making sure that we influence the patient to do the right thing for them so if that means that they need a bunch of crowns or they need a bunch of fillings or they need even whitening because their teeth are super yellow and I mean they can't even smile properly that's not manipulative that's helping them to me that's that feels like I'm a true professional because I can able I'm able to convince them to do something that is in their best interest so the case presentation is number one but the ability to truly believe in what you're delivering is so important a lot of dentists can like what you said where they shy away from it and they hide and they go oh I'm sorry I have to deliver this news to you no I mean you didn't create the problem you didn't put the cavities in their mouth you're trying to help them fix it so the solution what you what we're trying to deliver every day is in their best interest so it's not selling it's helping and it's my job to convince the patient to influence the patient to go ahead with treatment and to go ahead with treatment sooner than later so it doesn't end up being a root canal or an extraction or something bigger so I think that's our job as dentists as dental professionals to do exactly that to sell our patients on the dentistry that they need.

Howard: You talk about customer service which I think I mean every time you see a patient you know movements of your face I say Oh congratulations did you just move here a lot of times is from Canada about 10% did you know that 10% of the homes and Phoenix are owned by Canadians?

Agatha: I believe that yeah

Howard: Yeah I mean it's just really this is like a little Canada and you always don't you know how you can tell who the Canadian is?

Agatha: How?

Howard: I'm serious I mean this isn't even a joke.

Agatha: I thought it was

Howard: No I mean it'll get down to like you know like 58 degrees they walk down the street and shorts and thongs when you see someone it's like okay either you're drunk out of your mind or your from Canada and so one day this is the worst thing ever there was a dentist he's at my house and he was swimming and it was like January and I just thought okay it's all in your head look there's a real human in there he's swimming it's all in your head so I told my boys on there like dad go do it do it I don't know he's in the pool it was John Lyons do you know John Lyons?

Agatha: No

Howard: and he and so I put on my bathing suit I jumped in I thought I was gonna die have a heart attack my teeth were chattering I might turn purple there's just you you guys are you you've been frozen for so long and you're just used to it and and when you come out here in the heat you quickly get unused to it and I read a study about um hair and if you go up to people who live in like on the northern above the Arctic Circle each one of their hair stands perfectly straight up because the smooth muscle tonicity is so strong and then when you get close to the equator that hair lays on its side and then they showed they show a deal where he's an infrared deal and the above the Arctic Circle person you don't see any heat coming out and then the person from the equator just flowing heat so we can't do it but but when when they say they let they say no I I've lived here in Phoenix for five years you say wow you haven't been to the dentist in five years no I went to does your go okay why did you leave it's almost never clinical dentistry and it's almost not to be rude but it's usually not even the dentist yeah somebody somebody hurt their feelings said something rolled their eyes, some somebody made them feel bad so how would you explain how how do you convince these people that customer service is more important than the Pankey Institute?

Agatha: So I read an interesting study years ago by I don't know if you know who Dan Ariely is he's I think he works he's a basically does a lot of behavioral psychology studies and he took a bunch of people and took them through a mock drive-through and so you're going to get your sandwich and you know today it takes 30 seconds to get a sandwich tomorrow it's five minutes the next day is seven minutes and other day is a minute so it's always different times then they took another group and they ordered the same food and each and every time it was three minutes right so as always three minutes get your sandwich three minutes get your sandwich and they ask both groups to reach each drive-through and the one that was consistently delivered at three minutes had a much higher rating than the one that was inconsistent and what they found after talking to people is that the consistency was more important the quality of the food because when somebody's in a hurry or somebody wants a sandwich they want to know they're gonna be stuck there for a long time they want to know they know that they expect three minutes and they're gonna get it so it's the same thing kind of putting it into a dental practice which is something that I've utilized a lot as we move making changes in our office I said to everybody we can't go from here to here overnight right we have to tweak what we're doing right now and we need to tweak it and deliver it consistently so we started making sure that everything we do we do a cross board the same so whether it's hygienist number one or hygienist number four the same things get delivered each and every time at each and every appointment the same way and as we did that our ratings improved patient feedback improved drastically because people were getting the same thing over and over and so their expectations were always met and once we got that figured out then we elevated it right so then we improved to customer service again and again went to town to deliver it each and every time. So consistency is key in terms of kind of getting your patients to really appreciate what's happening at each appointment and have their needs met and as well it kind of makes it easy to because you don't have to be like you know super hero today you can just take your practice and as long as you deliver the treatment the same each and every time the patients feel safe in your hands.

Howard: That is a consistency is everything I mean McDonald's it's true but I mean it's just they want everything the same and what and I noticed that with hygienists I had the biggest problem with him hygienist to go on maternity leave or something and say she used a a the baking soda powder machine gun thing and then the person covering for doesn't use it they come up and say they didn't feel like their teeth I mean I don't care what it is and most people like their their their favorite food is what their mom cooked him and they they go to the grave not knowing their mom was the worst cook in North America and they craved it all the way at the end so yeah so you it's the same thing with employee turnover I mean you have you you fire an employee or they move it doesn't matter they they come in and they get their teeth clean like in my office they oh you know like Jamie and Brandi are the two hygienists and and you know one of them will say well she's gonna be gone that day you want to see Jamie nope and they say oh wait for Brandi and we'll say well Jamie's twice as smart as Brandi do you want to see Jamie they're like no I want to wait for Brandi and we say yeah you know you should go to Jamie I mean we you know they they just want the same. So really when you have patient turnover it's really got to be bad because everybody wants everything the same so when these people come to you and they're so upset that they're they're gonna look for a complete stranger I mean it's not just like I won't go back you know I'll just find no it takes a lot of effort to say I'm gonna get a whole new dentist I'm gonna get a whole new whatever but it couldn't have gone well.

Agatha: You know one of the things I do is every patient that comes into my practice gets surveyed right after so you know they get their automatic little survey and they can give feedback in terms of what happened and what they thought of it so any feedback that's below like 90% I'll contact them personally and I'll find out how we can improve next time and a lot of the times if something happened that they didn't like if you can resolve it and promise them to get it fixed by next time or you know talk to them in person it totally brings them right back and people will forgive you know an issue or a challenge or something they weren't expecting if the dentist themselves gets on the phone and says you know I'm sorry this happened how can I make it better next time so that's that's been real a lifesaver for us too right and when I first started kind of implementing some of these changes basically anytime a patient wasn't 100% happy me getting on the phone or me you know saying hey let's talk about this let me let me fix it let me make it better.

Howard: Yeah I sit on dental talent I'm people say oh this patient's obsessed I called my malpractice attorney or who should I call call the board like you're posting on dental town your first instinct should be same thing reviews they're trying to get lawyers to have reviews taken down and I've had reviews go up that were horrible and got them on the phone and it's a cry for help right and then when I talk to every dental malpractice attorney well did you see that big study with the MDS but you gotta remember there's 1 million MDS in America and there's only 200 11,000 dentists so there's five times the data for the MDS and the malpractice insurer started realizing that it's the same three or four percent of the MDS that get all the lawsuits and then when they went in there they found out that they will just have horrible personalities so the people can't get anything out of them they can't get any satisfaction so it's really out of vengeance like well I'll show you you little stomp us but I'm gonna go I'm gonna go file a complaint so you just call them and you be humble and you listen to them and and mine most of mine that one guy filed at the board it's always the same thing where the new patient they you tell them they have gum disease and they went to some other guy they loved and they saw him every six months since Adam and Eve and they and then you have to tell them they have gum disease severe gum disease and so it's all communication communication communication. I want to completely change gears now to a whole different subject in my walnut brain I if my bills cost a dollar a month I mean I can't go change the tax rate I can't call the the government utility SRP and negotiate a lower deal everybody pays their hygienist $40 an hour and their assistant $20 hour in Phoenix I can't lower my overhead by convincing my assistants to work for half of that I mean I don't know any single way to lower my overhead because everything is paid for in an efficient supply and demand marketplace so if my bills are a dollar a month I'm gonna have to pay a dollar a month and if I only do $1 of the dentistry my overheads on a percent but if I figure out how to do two dollars a Dentistry now my overheads 50% do you so is overhead more about saving nine cents on gauze by joining some dental supply club and getting volunteer dental assistance from the homeless shelter or is it just about doing more dentistry?

Agatha: Absolutely it's exactly that it's and tweaking how you do it right maximizing every opportunity I never care what we spend I don't look at how much I spend on dental supplies I don't look at my payroll costs I don't look at any of the expenditures what I look for is meeting and exceeding our targets because I can't week if I can even tweak one thing in my schedule each and every day it'll account for all the overhead discounts or whatever that you're gonna be looking for in those flyers and magazines so for me increasing revenue even slightly will be exponentially greater than save you know ten cents on gauze and 20 cents on resin or whatever it is for sure.

Howard: Yeah they're back there on the internet trying to save 12 cents on gauze and little things like end of the day audit you'll find every dental kids I'll tell you at the end of the day they'll find at least $200 of Dentistry you did that didn't even get entered the hygienist said bitewings and do that yeah the hygienist took bite wings and no one entered it in the chart I'm you when you're doing that crown you said hey while you're here you wanna do that mo filling right behind it and that didn't get entered so so dental consultants tell me that that when they're in the office it's free they can get on the phone and start saying hey you have an overdue balance of two thousand dollars I could take that right now on your master jervie 'aa do you ever cry I mean I know dental consult doin in there and the dentist was so busy doing dentistry at a law so they just sat there and worked the over a 90 day account receivable and brought in ten twenty thousand dollars before he finally had time to start talking. System some people systems what what what what does that bring in your mind what how do you create systems?

Agatha: So for me systems create a relaxed environment meaning it takes nobody knows what to do when they come into a new office right so let's say I hire a new staff member and they're just gonna do whatever they did previously right there all they know is what they know so if I create a system even in terms of just like the hygiene appointment how is that appointment going to be dealt with from the beginning to the end and we implement and train specific ways of doing that and I'm not talking about scripting I'm not saying you know you have to say it this way each and every time I'm talking chunks of the appointment this is what you do here is what you do here this is what you do here this is what you do it with this is when you do it this is when you don't do it so kind of creating a very smooth appointment so that the team members all know what to do for me it takes the chaos out of the office and brings control because I know every single person in my office is doing what they're supposed to do with who they're supposed to do it with when they're supposed to do it and so that I don't have to stand over their heads and saying did you do this or did you do that or did you forget to bill for those white wings that we added or did you forget to deliver or talk about outstanding treatment you know things like that or I'll get into following a proper system but it takes training and it takes you know we do a lot of role play in the office we any new team member will come in and we'll go through learning and training and then role playing before they're able to do it with the patients but it does give me an incredible amount of control without me standing over their heads at all times.

Howard: So there's a guy posting on dental town I never heard it before Mark Gaylord and he says I'm curious about the active patient name with over 2,000 patients the price should be exploding do you know the percentage of hygiene revenue in the billing per hour he's on your team isn't he?

Agatha: Yeah

Howar: So tell us about Mark Gaylord

Agatha: Mark helps me a little bit with some of the UPP work and we've done some seminars together we just did a couple recently one was in Toronto for a group called Ever Smiles there can't member how many dentists were there maybe 300 or so and we did like a full day seminar together and basically just kind of talking about how to grow a business and he's like the interactive part of with the audience I tend to kind of like I'm a little shyer so I step back and just talk about what I know in terms of the dentistry in the systems he gets people kind of really involved in in the actual event and the seminar so um I want to change gears again when I ask any dentist what stresses you out the most no matter what comes out of their mouth has to do with a human it's either the patient complain or deal or the staff and you know a dentist in their fantasy bubble world they're just in a lab doing a scientific root canal on an extracted tooth and a molar I mean I know a dentist who opened his own lab and he said I said why did you do that he said to get rid of the patients and I said well how do you like it now and he says well I hate dealing with the other lab techs and now the dentists. I mean so at the bottom of the line they they don't want to be a leader and they wanted I'm dentists or introvert they got A's in geometry and trig and calculus and physics and they have they have fantasies about Niels Bohr and Albert Einstein how do you get them to be a leader and if they weren't do you think they were born that way do you think if they're they're not born that way if they're not born that way can they be trained that way talk about leadership.

Agatha: I think leadership is it's both I think some of us have it more NS than others and I think you can learn it I certainly learned it the hard way I did it I became a better leader by being a really crappy one to begin with I remember time when all I did was manipulate people to get them to do what I wanted them to do so like the stick right so like you know you have to do it this way or else and so that brings a lot of fear in the office right because everyone's afraid of losing their jobs and they'll do what you say in front of you but then behind your back you know you can see that things aren't exactly where they should be and I found that started kind of like reading a lot on leadership especially with people like Simon Sinek who's really well known for his leadership teachings and just really tried to incorporate what I learned in terms of you know being there for people helping people inspiring people to do what you want them to do and having people that believed and what you're trying to build people who believe in what you believe on your team. So that takes time you know people think people will probably listen to this and say oh that's easier said than done and it is because any time there's no trust in the office and you're trying to build trust you can't just say you know from now on I'm not gonna be this person it's kind of like when you're cheating on your spouse and then you say I'm not gonna cheat anymore there's a lag effect right so you have to show consistent behavior and consistent actions that support who you're trying to become and you know in my case it took a year for my team to go yeah you you know you are different now and you do have our backs and you do step up when things get tough and you do protect us versus yelling at us or getting mad at us or you know sending us home or whatever so that's took time but I think leadership has to do with protecting the people that are working with you that are working for you and making sure that you do the right thing even when it's really really hard to do it.

Howard: So his book 2009 start with why how great leaders inspire everyone to take action what is uh what is Simon saying to you what when you read that book?

Agatha: So I don't know how many people that are listening to this have heard him speak about it he basically kind of said you know we all know what we're doing we know we do dentistry we would do this we do that but we don't know why we're doing it and I think communicating with my team why I'm doing what I'm doing and why I'm implementing the changes that I'm implementing is key and getting them on board so for example if I you know I remember years ago where I said we have to stop taking insurance it's my biggest headache it's my biggest struggle and I want to shift from taking insurance to delivering a different type of service because we are all suffering when we do this we need to change and you know so building the belief systems around why I want to do what I want to do why am i changing the hours or why am i changing this or why am i you know introducing something as simple as like porcelain onlays why would I do a porcelain online over a filling it's not just about the money. So having my team understand the why behind my decisions get them on board right away.

Howard: Are you a fan of Frederic Niche me you know I don't know if I said that right but uh Mitch he uh you know he says he who has a why to live for can bear almost any how to live is to suffer to survive is to find some meaning and the suffering that which does not kill us makes us stronger I think I love Simon and Frederic Niche and the fact that you see that people whine and whine and why but if they have to do that so their granddaughter doesn't drowned in the pond though they'll fight ten alligators and just get it done and with staff I again I believe that the the the culture the the fish rots from the head down and when someone's being a jerk you have to let them know that they wouldn't be a jerk if they were just entering Disneyland right now they wouldn't be a jerk if they're walking into a five-star restaurant about to eat a thousand calories of the deal you know what you know what just because this looks like a jerk it looks but you know what maybe he's scared maybe he doesn't want a shot maybe he's broke maybe he just had to put five thousand dollars into his dog at the vet but you know what word doctors and that guy needs a dental office and and okay he's pouting well when a teacher has a kindergarten a grammar school kid pouting do they quit do they burn out of teaching do they go home and say well if you saw my seven-year-old today you'd quit - no you wouldn't and and you know. My dad had sonic drive-ins and if you have ever seen an American before they eat a footlong chili cheese dog you couldn't beat the smile off their face with a crowbar and then I would go to work with my next-door neighbor and see that same guy the same guy that my dad's restaurant on the same Street West Street now walking into Kenny Anderson's office and he's having a big ole argument with receptionist and I'm like wow three days ago you were in the deal and you and my dad were laughing so hard they would cry one was about to give you an onion rings and the other one was about to perform a root canal. I mean just put on your big-boy hat and you just got to have compassion and but I yeah this I think the why in dentistry is easy is because you're a doctor they have infection they have bacteria they don't take care of their teeth you know it's it's all about love and compassion and all that kind of stuff. A lot of people today they're gonna solve all their problems yeah staff turnover there are employees don't their employees quit their patients don't come back and they're on wife number three so we're gonna fix all that on Facebook ads but in all honesty how do you promote your dental office market? Everybody thinks that I'm not gonna fix my customer service I'm not gonna keep my staff I'm not gonna train my staff what I'm gonna do it just flood my office with a ton of new patients so I'm just gonna ask how do you promote your office on social media?

Agatha: So there's a bunch of things that we do that I just started doing a few years ago and one of them is I just only focus on what I want to do what I want to become so I don't advertise you know how you see a lot of dentists talk about we do all these services I kind of hone in on a couple of things that I want to be doing more of and that's kind of what we promote but we also do a lot of stuff online that just engages patients like we do some crazy videos we just did a Halloween video with one of my hygienist Kiera walking down the hallway and like losing body parts and to like cavities you know getting bigger and things like that so we do some crazy wacky things we've got one coming up because we've been getting a lot of patients talking about how they've read that chewing on eggshells will cure cavities so you know we're getting a lot of this weird stuff so we're gonna do a funny video with eggshells and chickens and things like that so we just do like a really weird quirky stuff but it really engages our community and engages our patients and so as people see us doing stuff that's and this is what we do in the office anyway so it reflects who we are but as people see us you know as something other than just a dentist they share that information with their friends and so we're getting a lot of people going you know I saw your weird Halloween video like what was that we want to have an appointment in your office. So there's a lot of information being given out in terms of like what we do and why we do it but there's also a lot of quirkiness and weird stuff that we post on Instagram and different social media platforms.

Howard: So your website as talked about your online learning program what can they so if they go to UPBdentalacademy.com is this more lecture format is it more your courses more online how does this work?

Agatha: It's online and there's a video component and like a PDF worksheet component I've had somebody coded for me so it's like you literally just take modules and lessons and you follow through along and then implement certain parts in your practice there's a lot of things that I've always focused on in terms of delivering this to your team right so you could watch a video on something but then how do you take it and make sure that your people are doing what you want them to do right so there's workshops and you could present this at a group meeting and essentially just teach your team to do what we do in our office and implement these systems. So it's like baby steps to achieving the practice that you want to achieve so we don't tell you what to do we just tell you if you want to end up here, here's a system that you can utilize to achieve what it is that you're looking for.

Howard: Okay we talked earlier the the Greeks said you had two emotions fie fear and greed the biologists say that your every single living organism is a predator or prey so you're out there trying to kill a banana and while you know a tiger is trying to eat you so greed fear predator prey and they're afraid of making big purchases like $150,000 for a CAD CAM $100,000 for a CBCT $100,000 for a laser so is that are those good return on investments for you?

Agatha: Absolutely absolutely I'm just now actually working just finishing up another program that we're doing on a strategic plan which is basically like how to create a plan to achieve what you want in a year, so it's a really simple idea very low cost and very low investment but you'll see results right away, so we're just it's called the strategic plan video will be probably promoting that in the next month or so. So you know they can keep an eye out on that but our hygiene program online is the program that basically was built out of the frustrations that I was feeling a long time ago so that's the program that teaches everybody what we do in my practice to create that exponential growth right away.

Howard: The only thing I recommend and I really recommend you should do this is dentaltown we put up four hundred on one our online course they've been viewed a million times and the people like the paint Institute the the Dawson Academy a lot of these people like you have programs they put up a one-hour program about their online program and they all say it was the best marketing idea cuz you already have the content and they're you should take one of your hours and make it an online CE course on dentaltown because I'm sure once they they get to know you and see you and meet you they're gonna want to learn more yeah because I just think you're amazing I think what you're doing is amazing and I just wanna more role models for these young kids because I'm back to my all edawn Steven that you like sus simon Sinek well you know he's saying get your why you know what was your why in high school and you decided to it was to be a dentist was so you could go be somebody's associate at Heartland really is that why you can't you know kill know crushed it?

Agatha: My why has never changed my why has been the same since I was a young kid I had some really terrible experiences with my dentist when I was a child and I've always wanted to be the dentist that I've always wanted to have I wanted to be viewed differently by the public than all the dentist are and to this day it still hasn't changed. The way I got there has changed the way that I have grown is different than I would have anticipated but definitely it's still to this day my biggest passion is to change the way the public sees us not just me but all dentists I think that we have a bit of a negative connotation right now when I hear some people talking about dentists and my motivation my drive is to change that.

Howard: Well you're doing a phenomenal job tonight at dinner tell Mr. wonderful I said hello and my gosh I would love to get an online course out of you and any dentist helping other dentists is my friend and I love what you're doing and the mission is going to be large hell they they graduate 6,000 new dentist a year just in the United States so what you're doing it's all digital it's scalable you know it's not the old world where you have to do everything without scale but thank you so much Agatha this the founder of Bis GMA the inventor third-generation Bis GMA Agatha Bis, thank you so much for coming on the show today it was an absolute pleasure to podcast you.

Agatha: That was fun thanks Howard

Howard: Alright have a great day.

Agatha: Thanks you too