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: We are here today it's a huge honor to have Richard Dawson thank you so much for coming by the studio today. Richard Dawson is the founder of dental school digest he's a d4 student at Mid Western University College of Dental Medicine right here in Arizona I'm in Phoenix Arizona he's right next door in Glendale Arizona. The other dental school AT Stills in Mesa Arizona so Phoenix is right in the middle of those two dental schools. Richard earned his bachelor's degree in solo performance from the University of Utah in 2010 while working full-time at an asphalt plant near Salt Lake City before dental school Richard work at an asphalt plant as a musician a web developer and was training to become a pilot. Once he discovered dentistry he never looked back so his he started a I asked him to come on the show because I'm a big fan of what he started with Dental School Digest on his website says applying to dental school wants to know what to expect join our community of current and future dental students for insights in a dental school dental school digest is a community website for current dental students and anyone interested in dental school, he says hi I'm Richard the founder of dental school digest I created this website with a vision that it'll someday serve as a community hub for current and future dental students his aim is to make dental school Digest a one-stop shop for everything related to dental school. I mean I just think it's a really cool deal well first of all you're a D4 yes sir yeah and you're studying for your boards and you just add your first baby?

Richard: Yeah about 14 months ago yes she's just over a year.

Howard: So you got a a you got your first baby and ready to get out of dental school.

Richard: and I want to say thank you for having me on the show today Howard it's a huge honor for me to be here so

Howard: Oh, it's an honor to have you come on this show. So now that you have this dental school digest now that you know applying to dental school I want to know what to expect well now you're just about to finish dental school

Richard: Yeah

Richard: Was it what you expected looking back?

Richard: Was school what I expected?

Howard: yeah?

Richard: You know in a lot of ways it was and actually it was a lot more than I expected, I mean we learned so many more things than I would have ever thought we would learn it's just been such an amazing experience and I really love my school I can't speak to other schools but I just feel like what we've done so far these last four years I've been really well trained and learned a lot of really great stuff.

Howard: Well you have the best endo Department in the United States Brad Getlemen the number one selling endo book in the history of endo.

Richard: Yup

Howard: Was pathways to the pole by stephen cohen Brad wrote chapter 8 of that book.

Richard: Yup

Howard: and the number one selling implant book was Carl Misch, those are the two top selling books of all time right and so how did you get the man who wrote chapter 8 I mean and a lot of even local dentists and they didn't don't need no Brad lectures because in Brad lectures that's they ended on us all go, he lectures on endodontist.

Richard: Right yeah you'd have to ask Dr. Smith on that those I'll tell you our school really they do an amazing job of just getting some really incredible talent in there to teach us I don't know how they do it but they work their magic somehow so.

Howard: So I'm what when you get out of school what is your plan I mean to you is the one thing the old people like us always wonder, Harvard Business Review is doing all these studies about if you see that meme, that meem hey boomer?

Richard: Yeah oh yeah

Howard: So there's a lot of there's a lot of this stuff about you know boomers are different than this so whenever you see that the researchers aren't going okay maybe there's a lot of smoke Landers fire right in Harvard revision review they just keep publishing study after study that we can't find any difference in fact they find more variance within boomers are within Millennials than from Millennials the Boomers but were but when I get out of school I got to May 11 it took me 133 days don't my dental office September 21st I see kids coming out of school and they get an associate job for a year here then here then here then here and after five years and five associate jobs they finally open their own but I don't know is that a millennial thing versus a Boomer thing and you don't look like you're afraid of much you look like you can slap a grizzly to death are you gonna walk out of school and start your own practice or do you want to be an associate?

Richard: Yeah I haven't really decided yet so I think you know speaking to what you're asking though there's a lot of animosity from generation to generation I don't think that's a new I think that's kind of that's always happened but what makes me sad is to see it in dentistry you'll see comments on social media from you know older doctors to younger doctors and vice versa and a lot of times I think it's because the older doctors have sort of forgotten what it's like to come out of school and have to establish yourself and the younger doctors sometimes are a little impatient about things they think I should just get out of school and be making the living and doing the lifestyle that I've seen these older doctors do but that takes time and patience and you have to build up your skill set you know you have to build up your patient base. So I think dentistry like anything you have to have patience and be willing to sort of work towards something I'm so for me personally you know I kind of want to like find the right opportunity and then have enough patience to try and work that opportunity and make it you know happen.

Howard: Well you know there's a hundred and eight billion humans that are lived and died where we'll never even know their name but you do have 5,000 years of recorded history and you're absolutely right, everyone thought the next generation was just taking the whole species off a cliff. I remember when I bought my first album it was flat as a pancake by Hedy so I was so excited about it and I wanted to turn on for my mom and dad and all they said is turn that down you know and I couldn't even play it in my room I had to go down in the basement with my five sisters and shut the door so yeah I don't think they ba and what were they after listening to the Glenn Miller Orchestra so I go figure. So yeah, do you think that girls are more likely to want to be in a DSO like your wife is a doctor.

Richard: Yes yeah

Howard: Do you think that I don't think I'm qualified to speak on what girls think or what I do but a lot of people that are my age saying well those girls they want to stay home and make babies they just want they want to do an 8 to 5 dental job because they got to go home and be mom and say well she's got a husband yeah I mean so do you think the girls are more likely to want to be employees versus owners or do you think that's boomer millennial stupidity?

Richard: No I'm glad you asked that question because I actually been thinking about this recently I think I think what it is and you know I've kind of seen this with my wife she's a physician and she had many opportunities coming out here to Phoenix to work but because we wanted to have children I can't have babies only she can do that right so yeah.

Howard: Not with that attitude.

Richard: That's true yeah technology but yeah that's true

Howard: Bad attitude for a man but anyway

Richard: but you know currently like you know the only person that can have the babies at this point is the female in the relationship so she kind of her options were more limited she couldn't take an opportunity where she would have been a partner because the way that typically works is they advance you alone and then you're in the red and you stay in the red until you've paid back the loan and you're not gonna make partner as long as you stay in the red so if you go out and you're gone for three months on maternity leave then you're paying the overhead costs for three months which is expensive and you still have a loan that you're still paying on towards the practice and then by the time you get back you're so far in the red you can't get out from under it. So for my wife it was a better opportunity for her to go work at more of a corporate style physician group and I think that's probably true in dentistry like a lot of times these women don't have the ability to start a practice right out of school because if they're gonna have children who's gonna pay the bills when they're on maternity leave that can be very difficult.

Howard: So how big is your class?

Richard: So we have a hundred and forty two I think.

Howard: and this is about half girls?

Richard: No our school is a little more towards the male's I know their schools out there where there's actually more female to graduate than males and I think on the whole in the country it's about 50/50 or close to 50/50 now.

Howard: Did you ever know big Becky Cecil or was she already...

Richard: She left right before I got to the clinic.

Howard: Yes she was a classmate me Brad and Becky she's been on the show an amazing person but I look back to my class and the the 20 women in the class yeah they had a higher percent of owning your own practice and having more successful dental offices than the males and I always thought it was because I'm what are the two biggest things associated dentistry I'm afraid well if I'm afraid that you're gonna hurt me I mean you look like you're gonna hurt me a lot more than Becky Cecil right my four boys.

Richard: I hope my patients don't think that would they see me.

Howard: I mean my four boys I was all dad and that and a bag of chips till he fell down and got an owie start crying and then they'd run around me but you know they they wanted to see mom and I I've seen I've heard so many times people saying to me that yeah you know I'm going to treat summer fee up the street um you know I bet but she's more gentle I mean how do you argue with that so I always thought women dentistry would have a big advantage and so that might explain some of the advantage maybe they're afraid of getting hurt they're afraid of getting shot women are more likely to ask other women questions whereas if you say you need a crown they just fight like okay you know they eat it but a woman and that's why a lot of women managers they had their whine to me and they don't realize they're what they're whining about is a comment they'll say you know I don't get it when I worked for Sam you know he'd say give me a coffee and there's everybody would jump and I worked for him to two years I bought his practice I say the same thing and they're like well can you get it because I got to go set up room three and I like right and I say well that's a compliment they they lived in fear of that man.

Richard: Yes

Howard: and they don't fear you because they think you're a human it's a compliment when people engage you and raise their hand and talk and and so the old man would say yeah you need two fillings and the patient just leave and wouldn't schedule but they trusted you enough to start arguing about the treatment plan or they're against amalgams or composites or vaccines or whatever their issue is so I think I'm just all my doctors are women and I mean if that's just trial and error it's kind of like all alcoholics end up on vodka.

Richard: Yeah

Howard: because when you you know be an alcoholic with say Jack Daniels at 300 parts per million impurities you feel really bad but the clear vodkas are like 50 and under so to a trial and error they end all up on the clear stuff to have less and in my trial and error I mean if you if you know dentist can be kind of high maintenance about tests and this and that like I'm like this close to suing Walgreens cuz they won't give me the HPV vaccine and they said no, it's only approved for 45 I said I don't care I'm an American it's made in America I'm a doctor I don't care if it's good or bad I want the vaccine.

Richard: I'd actually heard that before.

Howard: and she's like well I can't do it and I'm like okay I'm gonna see if I have enough time on my hands just to sue you for the sake of that this is not right I mean the lady I bought my house from had to sell her how born and raised in Phoenix had to sell her house moved to scanty because she had a brain tumor and the American pharmaceutical company that made the drug you know was trying to get FDA approval she couldn't get on the FDAtests they only had a limited like a thousand people but they were selling it in Denmark so here's the American had to sell her house and go to Denmark and say I hate stuff like that the government is not my mom and dad.

Richard:Right

Howard: and if I'm a dentist I can't give my patients a flu shot yeah but the tech at Walgreens can break I got eight year college degree and a two-year MBA from ASU I can't give you a flu shot in my office but some 19 year old Walgreens tech can.

Richard: I think it Oregan they just passed a law saying dentists can so maybe that'll change.

Howard: Yeah

Richard: I think that's something that's up there going back to something you said though I wanted to get back to the two women I'm in their role in in health care and how you feel like sometimes women almost have an easier time with patients because they see more motherly or more trustworthy and I think there's sort of a flip side to that too I read an article I'm gonna say this maybe a month ago I'm about the emotional toll on women in the health professions because patients are more likely to unload emotionally on their female practitioners so dentists doctors so you said like with me if I tell somebody they need a crown they're just gonna accept that maybe whereas a female practitioner you may say you need a crown and the patient may then go on about some other thing in their life that's affecting them and now she's running behind she's having to take this emotional baggage that she wasn't anticipating walking into the room and I've certainly seen that with my wife she just patient because she's very sweet and so patients are constantly unloading on her and she's always running behind and she's always kind of emotionally just drained by the end of the day. So it's a very different experience sometimes I think between males and females in that way.

Howard: Yeah and my two sisters that are nuns they always talk like my oldest sister Mary Kay is a Catholic nun I think she's a nun for 35 years and people treat priests and nuns completely different completely different jobs skill sets I bet you're right when they when they just can't take it anymore, they go to the common cry all night.

Richard: Yeah

Howard: They don't react to father McGloin who probably would how do you think father McGloin would stay at the door as you start breaking down and with everything. So student loan debt and cost tuition there's the student loan and they're saying that the average students coming out about two hundred eighty five thousand dollars in student loan debt but you're in a private school.

Richard: Yeah

Howard: Your Midwestern and AT Still, do you think it's higher out in Midwestern?

Richard: Oh yeah it's much higher I think my school my classes average was anticipated at almost five hundred thousand in total loans so pretty heavy heavy debt burden and so when you were asking about DSOs and do i think that you know females are gonna go work at a DSO I think it's more likely that recent grads are gonna work at DSOs because we just have to go somewhere and make money right away to pay off those student loans so I think thats so oftentimes you know why DSO is how we're running a successful business model where it's easy to pick up new grads who are you know heavily encumbered by debt.

Howard: Well it's funny how history always repeats itself and this is just the reinvention of the indentured servant it?

Richard: Yeah I don't know I you know I think the thing about dentistry it's expensive to get into but it's also a protected profession and so what if we can go out there and we have sort of a classroom protection that I can't really think of too many other professions that are afforded that luxury of you you just not anybody can be a dentist not anybody can just go out and open a dental practice in most states I know Arizona is an exception and so that actually makes it so that in again in most states you as a dentist are sort of privileged in that you know the competition is a little more limited than if just anybody could go out there hang their shingle and say I pull teeth for a living come to me you know what I mean so I think that yeah it's expensive but you know dentists also make a decent income and and you know I think that if you're careful and if you're smart about it you should be able to pay back the student loan debt.

Howard: Well an indentured servant was someone who typically worked four to seven years in exchange for passage room and board coming from one country to another country but yeah I mean you look at if you open up a restaurant anywhere in the United States first year twenty to forty percent bankruptcy, in dentistry if I loan you seven hundred and fifty thousand dollars for a dental office you have about a point four percent bankruptcy so it is so non-competitive um it's just so non-competitive. I mean when people tell me dentistry is competitive I always ask compared to what yeah you know talking about restaurants dry cleaners I mean

Richard: It's competitive to get into but once you're in where you've gone through the filter I mean...

Howard: Right

Richard: and that's the beauty of the profession and that's kind of why we you know go out there and spend so much money on the education because of that.

Howard: So what would percent of the class is dad paying for it all?

Richard: I don't know actually more than I had anticipated though I'm surprised at the number of students who tell me that their parents are paying for their education so

Howard: and when their parents pay for their education are they almost always a dentist?

Richard: Oftentimes they are there's been a couple who parents were like executives for big companies but yeah usually...

Howard: So your wife's a hand surgeon so you didn't meet her in dental school?

Richard: No we actually met about two years before I went to dental school.

Howard: Okay two year before

Richard: Yep

Howard: So what percent of the class do you think was planning when they leave to go do they want to be in corporate dentistry versus private practice Associate I mean do they prefer Heartland, Aspen, Bob Fontana Stephen Thorn's Pacific Dental do they / for the big chains or would they rather do the solo private small deal are there advantages to the big chains versus the small-town guy?

Richard: That's a great question, I think that overall most of the students in my class would like to associate with an existing established dentist it's just that there's not a lot of opportunities out there relative to how many people are graduating, there's just not a lot of dentists that are looking for an associate or can it can even sort of fill the schedule of an associate so I think that's part of the issue and that's part of the reason that so many of my classmates will end up at corporate you know dsos because they end up not having the options to find doctors out there. If there was an awesome program in place to match graduates with doctors looking for associates that'd be awesome you know and I know you have classifieds and things like that on dentaltown but I think that a lot of Doc's just the opportunities nobody ever finds out about them.

Howard: So in 1980 there were more than 6,000 graduates a year

Richard: In dentistry?

Howard: Yeah I'm trying to find that number how many new dentists graduates each year...

Richard: Now it's about probably about that or a little bit...

Howard: About 6,200 yeah and so you think they're having a hard time finding associate jobs?

Richard: Yeah I think so, you know, I think a lot of times there are doctors out there who may want an associate and maybe don't they don't really think about it they're they're busy doing their job they're busy you kind of being a dentist they don't necessarily want to think about you know do I want to hire an associate on right now because I've talked to a couple dentists now who when I sort of floated the idea by them they were like oh yeah that's an interesting idea I hadn't really thought of that why don't we, why don't we talk about that but they weren't actively thinking about doing it so.

 Howard: Yeah and when you do the kids feel like they know how to do clinical does family and do they come out with confidence they think okay I can do what I want to do molar endo what it whatever they want to do they have confidence are they scared or how does it, it's been so long yeah since I was a senior in dental school it really is hard.

Richard: Sure

Howard: I mean it's hard for me to remember this picture when my poor babies now those four babies have five grandkids but so it's hard to remember what it was what you were thinking when yeah when I was your age but confident scared where's the class mentality?

Richard: I think our class is really confident you know I mean there's always going to be a segment of the population that is more hesitant or reluctant to do things but I think that you know we're graduating some of the best young dentists in the country I'm really proud of my class, I think they're doing awesome stuff they're coming out doing everything implants you know we've got students who have done you know lateral or a lot of sorry lateral approach sinus lifts and things like that but the oral surgeons downstairs you know just really incredible things that you don't usually see people in dental school doing it and we do it every day at the school.

Howard: So talk about your website.

Richard: Yeah sure

Howard: What was going on your life that brought that along?

Richard: Well I was a I was a computer programmer at the time like a web developer in Chicago and just kind of my downtime I was like you know I'll just make a website

Howard: Downtime, you mean when you're watching the Cubs?

Richard: Yeah right yeah because nobody likes the soxs. Yeah know when I went ahead sometime I would just kind of work on this this project which was dental school digest the idea was that I would try to blog about my journey through dental school but then get having a baby and then also just how busy you are in dental school it's been hard to kind of keep up with that as consistently as I would have liked the big thing that I've been trying to work on is actually the school pages which is my idea is I want to reply the a lot of the information that you get out of the ADEA guidebook you have to buy that and it's it's like 20 bucks or something or 30 bucks I can't remember how much it costs but to me I feel like that that information should be free so I'm trying to try and put as much information out there on the internet as I can in terms of like what what's the tuition costs of the school how many students were accepted how many males two females what are the GPA requirements things like that so.

Howard: It's called dental school digests dental school digest I love it what would is your market more pre dentist or during dental school?

Richard: It's kind of both I mean the idea was that you know my grand vision was that what would happen is that I would have students going to different schools writing about their experiences at those schools so that pre dense and people at other schools could kind of see well what's it like at Marquette what's it like at USC you know what kinds of procedures are they doing you know what school do I want to go to that matches sort of my philosophy and how I want to practice dentistry I thought that would be great but dental students are busy and you know they're about as busy as I as I was and I realized that people don't have time to write about their experiences so much so.

Howard: So what would you say to now so let's just say you're going to finish yep you're gonna pass your boards you're you don't know what you want to do it you don't want to be associate or start your own?

Richard: No yeah I haven't decided yet exactly what I'm gonna do there's a possibility of doing a residency just there's one that I think is really interesting that I might try to do so.

Howard: Talk about that.

Richard: So it's actually at implant pathway here in Tempe

Howard: With Justin Moody?

Richard: Yeah Justin, so they've got an AEGD they're opening up and

Howard: They have an AEGD they're opening up?

Richard: Yeah they just opened it so I was interested in trying that.

Howard: A 1-year AEGD program?

Richard: Yep

Howard: With implant pathways?

Richard: Yes sir

Howard: and is it gonna be working on like is it involved with homeless I know he was part of that

Ricahrd: I think so yeah most shelters and yeah so I don't think it's like expressly for the homeless population I think what it is is that it's more like word-of-mouth people coming in who can't afford implants usually and they come in because I think it's a 501 C organizations so I think they can place implants for free in these folks that come in so I don't yeah I don't know there's an income requirement or anything though.

Howard: Yeah so so if you join that AEGD would you would it cost money or would he pay you to work there?

Richard: It's through NYU so they have a stipend.

Howard: NYU, New York University?

Richard: Yeah that's the Llangollen program so they run AEGD's all over the country so there's actually already five here.

Howard: So there's already five NYU programs in the city?

Richard: Yeah so there's the one at St. Vincent DePaul there's the brighter way there's there's like I think there's one at native health and these are all different different places you can go...

Howard: Chris Vogual at Brighter Way?

Richard: Yeah

Howard: You know who funded that whole brighter way?

Richard: No actually don't

Howard: The wife of the founder of GoDaddy

Richard: Interesting

Howard: You know Go daddy's right here in Phoenix and of course he made a gazillion dollars and his wife's got a real soft spot for the poor and I went to a fundraiser night the other night and almost everybody I talked to in their deal got most of their money from Go Daddy's founders wife so she's a special lady here in the Valley.

Richard: That's really cool.

Howard: So NYU has five AEGD deals?

Ricahrd: Yeah I'm not exactly yeah it's four or five.

Howard: So for the International people in the United States obviously New York City is the biggest city it's the largest city and their dental school NYU I think graduated seven percent of all the dentists in America NYU so and and they have five AEG it's AEGD?

Richard: Yes advanced education in general dentistry

Howard: Wow and so when I look out at um global dentistry you know there's 200,000 dentists and the Ice Age there's two millionaire on the world the dental GDP in United States last year is about a hundred and seventeen billion but for around the globe is about half at five hundred billion half a trillion it shows you that seven and a half billion people really I mean the only true health is the only true wealth is health and if you won the lottery had twenty million dollars and that little girl you showed me what a priceless little girl she's almost as cute as my granddaughter and but if something but it doesn't say her eyeball fell out you would give your entire inheritance to get it fixed.

Richard: Oh yeah absolutely

Howard: I mean you would even blame the only wealth is health and when seven point eight billion humans say man we're gonna we're gonna pay these two million dentists half a trillion bucks a year and then you say that people don't value their teeth I mean what are you looking at when people tell me that humans don't value their teeth I'm like now are you talking about Martians vena's Pluto you're not talking about sapiens I mean they they're totally into this or whole thing but when I look across the deal a lot of its mature fillings cleanings exams x-rays basically dentistry it's only growing it one and a half to three and a half percent a year except for two areas double-digit growth clear aligners implants and I noticed you picked AEGD for implants and they notice a lot of the kids they come out of school they're you could I could separate the herd in in one way not not boy girl it's and I want bleaching bonding veneers fluffy white fun stuff sleep apnea you know they and then there's the blood and guts people that's what I am you even see in their root canals.

Richard: Right

Howard: The wimpy ones you know they want to stop a half a millimeter from the apex and preserve the apical seal not me I'm a freakin toughest healer out the apex I'm an apical barbarian I'd rather pull a tooth then do a MOD composite I'd rather I'd rather do an endo retreat then I mean when you when you sit there and say it's a root canal number eight I mean I'm still like well can't the assistant do that I mean do we do we need the height it's one canal so you're so you're either blood and guts implants like Justin Moody implant pathways or you're white and fluffy not really doctor stuff you know bleaching bonding veneers, do you see your classmates kind of one or the other or do you see people that are both?

Richard: Well I don't know about my classmates you know once once we're kind of sequestered into our Suites we don't see as much of each other anymore so I couldn't say but what I do see is a lot of the faculty sort of fall into sort of those two categories that you describe like you've got your more blood-and-guts faculty and then you've got more of your like protect the tooth structure faculty so there's definitely a difference in philosophies there and us students I think that we sort of have allegiances as well so but I couldn't tell you how many of our class does what.

Howard: Well it but it shows up economically I mean okay you know the average net income for does dental specialist 320 general practice 197 so my first question is you know if you stayed and become a specialist you'd make 320 instead of 197 so you make a hundred thousand dollars a year or more if you're a specialist did that cross your mind did you think about specialty when you look at your classmates what are their thoughts when they're looking at like being a specialist like a pediatric dentist and endodontist periodontist versus Family Practice?

Richard: Yeah no I actually wanted to go into oral surgery that was my first plan and it's funny because I went to Washington DC for for ASDA and Dr. Clemmensen was there and he's now the AD president-elect and I was talking to him about it he's an oral surgeon and he says to me you know if I could do it all over again I'd probably not not do this I would just do a GPR and do the same stuff I'm doing now but with less schooling you know so and then I talked to a friend of mine who was a resident in OS and he said I kind of regret it I kind of wish that I hadn't done that so you know like I think it's awesome that people still go into that but I kind of decided for me it wasn't really the right thing just based on what what these guys told me and our conversations. So the money thing notwithstanding yeah I don't think it's for everybody and I don't think that that necessarily you're going to make a whole lot less money just because you're you know quote-unquote a general dentist.

Howard: Right it's mostly related you're a businessman.

Richard: Well yeah exactly that's the thing right so and we were just talking earlier about there's people that are going to have children there's people that are gonna work part-time there's people that will associate for their entire careers those people always going to make less right it you know specialists are always gonna make more because they don't seem to have those many that way it doesn't seem like it works that way for them.

Howard: and I also to be clear about financial planning I mean every I mean you could go to 20 courses in dentistry on financial planning and they'll never even they'll never even discuss financial planning and they think their talking about it but you know you graduate 285,000 our student loans the average divorce in dentistry is well over a million so if you think your student loans are a lot of money wait till your divorce my divorce was 3.8 million my student loan debt was 87,000 so my divorce costs forty seven times more than my student loan. So you want to be a millionaire don't get married you already violated that rule don't have any kids you violated at once did you say a second one on the way?

Richard: No not one now

Howard: So was the one you get so like right when I got married in dental school and had four kids I mean that's not financial planning I mean is I'm sure glad I did it's the best move I ever made but and then the other thing I want to tell you about dental specialists I mean weak people they you know they they find one thing wrong and that they stop and they're like oh I wanted to be an orthodontist so I didn't get accepted you didn't get accepted to the only ortho school you applied to in the country you were born into when I let you down in Central and South America my god I was in the Bahamas and Caribbean these people said they didn't get in Indo school they went you you can buy your way into any medical school dental school anywhere in the world and then when you come back to America and you're an endodontist for 20 years how many people say well did you go to where did you go to endo school.

Richard: Right

Howard: No one cares where you went into school I've been a dentist for 32 years and only about ten times just someone asked where I went to dental school and then when I tell him I went to the University of missouri-kansas city they're like my sister's roommates brother lived in Kansas City I mean that's the whole extent of the Kansas City thing. So if you want to be an endodontist or an oral surgeon you can't get in well go to the Bahamas go to go to Grenada go to anywhere so the next question I want to ask is dentists who owned your own practice they average 244 dentist who are employees average 147 so you make a hundred thousand more if you're a specialist and you make a hundred thousand more if you own your own practice do you after your GP are I'm just curious how far down the road are you thinking like do you think someday you'll own your own practice?

Richard: Yeah no absolutely I mean my goal my goals within two years

Howard: Within two

Richard: Yeah I think that's that's pretty reasonable so there's a guy that went to our school at Georgia he runs here at practices podcast I'm sure you've heard of it yeah and and Richard Lowe and

Howard: Richard Lowe

Richard: Richard Lowe, yes

Howard: No work for me while he was in dental school.

Richard: Really I had no idea

Howard: Guess what he was incharge of

Richard: The podcast

Howard: My podcast yeah so that's where I got the idea well I got more from Richard Lowe then he got from me but he's in Texas now right?

Richard: Yeah I actually don't know I know George is still here in he's working in an arrowhead actually so.

Howard: For the shared podcast?

Richard: Yeah so he runs this year practice this podcast and I think they've brought somebody else on to even so.

Howard: So you think but what were you saying?

Richard: Yeah so they're gonna advocate that you know within two years if you're gonna own you should try and own within those those first two years you know get out there get some experience under your belt and then buy a practice because you're never gonna pay back your student loans as quickly as you can if you want to practice you just said it you make a hundred thousand on average more per year owning than you do as an associate and in this country I think you know 70% of dentists own sole one practice so I mean it's a high rate of ownership the fail roots are super low 0.4 percent I think you said there's really no reason not to yeah.

Howard: Yeah when you borrow other people's money, first of all when people complain that they have 285 students I always remind him okay well there's over 200 countries and I'm pretty sure you only have access to other people's money in about 20 of those countries, I am pretty sure that people don't wake up in Bolivia this morning applying for student loans you know I mean so it's an honor to live in a civil society where people let you have access to other people's money and so and everybody that's in Midwestern who's whining about their student loans completely could have got a job at McDonald's at 16 for $10 an hour worked 100 hours a week for 10 years they saved up all their money to go to Midwestern in cash but they thought it was a wiser financial leverage movement to borrow other people's money go become a dentist and then it's easier to pay it back you know you're earning $100 an hour.

Richard: Exactly

Howard: Then saving up for for $10 an hour the only time other people's money is a nightmare and it turns into a disease is when it's for consumption when you're borrowing other people's money for your house your car your clothes your vacations now you're just being silly and it's silly for the same reason you don't want to try what's the New Deal meth were on it have you seen that...

Richard: Yes

Howard: Yes it's meth we're on it well you know what you know what's worse than math other people's money because when you see people borrow other people's money so they can have a car for five years the minute they make their last payment they go get other people's money and upgrade their car for another five years.

Richard: Right right

Howard: and then now they're 40 and they do it again I mean I'm 57 and I know fifty seven-year-old dentists that are buying their their new houses on 30-year mortgages I'm like dude so you're so you're gonna do this to your 87 have you met a 87 year old I'm pretty damn sure they don't want to work in a dental office 40 hours a week. So and this sounds so racist and so bad but it's Dentistry Uncensored I'm gonna say it but you know who's the only people who get off other people's money not born in the United States go to California if they're born in America they graduated student loans the minute they graduate think you'll buy a $30,000 car though if it was money they'd go buy a house with other people's money they go buy dental office with other people's money and then you come back and you meet him 45 they still have debt on there house or they paid their house down a third but then bought a bigger house and they paid off their $30,000 car but now they're at $100,000 Porsche there's still just other people's money.

Richard: Right

Howard: but you meet that dentist since she was born anywhere not in the United States I mean just that's the only criteria were you born in the United States if you're born on the United States you're entitled to other people's money and that instant gratification higher standard living and you are a financial disaster and then if they were born not in the United States usually three four years out of dental school you see their moves right out of the gate they go buy a practice and they live in it they don't have a house or a car they live in their private office I mean I've seen this so many times and when we talk about demographics that's when I would ask you next that the only american-born dentist think about demographics non-american born dentist own because they know all the American borns are gonna work Monday through Thursday 8:00 to 5:00 they know what six o'clock there ain't gonna be no american-born dentist open like in San Francisco they'll tell me they go well you know none of the Americans work Saturday and Sunday so I'm just sitting here by myself I have no overhead and about every three hours it's a broken tooth or a toothache I get out my isolate do a root canal built-in crown for two and a half hours they put it on twenty five hundred bucks on their chase Visa Card and then I'll go back in my room and I'll get a little bit of break and then my iPhone will ring again and and I deposit you know fifteen thousand dollars every Saturday and another fifteen thousand every Sunday because the Americans won't work on Saturday or Sunday so that's that's amazing so my all that segue rant was do demographics matter?

Richard: Do demographics matter in what sense?

Howard: Like you want to own your own practice I mean you and trying to get a feel for your classmates I mean like okay so I remember when I was out here in 87 and a young kid walked up to me and he was thinking about going to Scotts and I said dude Maricopa in Florence and Eloy don't have a dentist and 90% of dentists would say really they jump their car they come back there and say oh well that's a crap hole in the middle of nowhere well it's a lot of people and there's no dentist and where did they drive to North Scottsdale sat up and struggled and struggled but all my homies that took my advice went to Maricopa Florence Eloy I mean there's entire cities at the Pew foundation always talks about income inequality they always talk about dental shortages other ones that promote dental therapists and I don't care if you're for or against all turbines that's not the point the point is they got awesome demographics and they can show you where all the dental shortages are. So it's like I look at that map this is Arizona I live here and I'm like yeah I know that's it he doesn't even have a dentist and so but then a lot of people say well the Millennials you know they want to live with theirs restaurants and shopping and sports and all I said in your classmate in your class do you feel that demographics mattered where yeah they don't want if there's if there's not at least 2,000 people for each dentist they're not gonna open up an office and if that means the like the richest dentist I know found about 11 percent of the cities in the northern Midwest don't even have a dentist so the this one dentist a big fan of the show he found a County in Iowa 6,200 people in the county the big town had like 2000 there was the dentist in the county so I mean when he says I've you know he charges 1,500 for root canal 1500 for a crown he doesn't take any insurance I mean he has like 40 percent overhead people in that town a $10 an hour job is is a great job. You know in San Francisco you know an assistant with what 30 an hour so my question is would you your wife and baby would you go to some town two hours away from an airport for a better economic advantage or do you say I'm not that desperate for money?

Richard: I'd well so yeah, my wife and I are kind of a unique situation because she's a subspecialist so she has to be in a populous area to support her specialist.

Howard: Explain what a subspecialist is.

Richard: So she's an orthopedic surgeon but then she's a hand surgeon with in orthopedic surgery so like she has to have a huge catchment area to have enough of a patient base to sustain herself right.

Howard: Did you call it a huge cash...?

Richard: Catchment area so sort of generic catchment like you know like the catcher's mitt

Howard: I've never heard it describe it in half how do you spell it?

Richard: I think CATCHMENT

Howard: Okay

Richard: Yeah so I think it's you know...

Howard: So she needs a big volumes

Richard: She needs a lot of people coming you know she needs basically probably a city or small city to be able to have enough patient base to be able to treat.

Howard: So you're saying you'd have to get a new wife

Richard: So yeah pretty much so that's the only way that would happen so you know I know I have to I have to kind of stay where she where she can have a job which means I have to kind of stick to an area like Phoenix Valley but I think that in my class there's people that want to do all sorts of stuff there's people from you know Virginia like from from even like close to West Virginia that want to go back home, I've got a good friend of mine who's from Connecticut in the community where I think the dentist to patient ratio was was like 1 to 700 and he said you know what the dentist I work for was doing great I want to go back there, he told me he had a job for me and that's his plan. So you know it's kind of like the whole gamut I've seen with my classmates and to be honest with you, I think going back to the corporation's thing I think that this is where corporations fill in need because you know wherever you stand on the dental therapy thing the corporations are going to be able to operate at lower margins than your typical sole proprietorship can...

Howard: So you said the corporate dentist can operate at a lower overhead than private dentists can?

Richard: Well yeah you said yeah I think if you're talking about like a large DSO.

Howard: Like Heartland?

Richard: Like a Heartland yeah exactly a Heartland to be a perfect example these guys can go into a community and they can underpriced a dentist which is not good for for the sole practicing dentist but if they're going to a community where there isn't the dentist then they're actually fulfilling a need that's not being met and 50% of Americans I think is is how many are not seeing dentists regularly.

Howard: Right

Richard: So you know if you do have corporations kind of going into these communities that could actually be a good that could be a positive.

Howard: So why do you think her Heartland can go into a community and do dentistry cheaper?

Richard: Well first of all they can negotiate much better rates on supplies and things like that because they're negotiating with a thousand practices as opposed to a you know single doctor trying to negotiate their prices they can also negotiate better insurance rates because an insurance company is gonna listen to them when they have a thousand practices or when they can when they're the main player in an entire region and they can go to the insurance company and say pay us more we're gonna drop you that doesn't matter so much if a single dentist says I'm gonna drop your insurance but when they're gonna lose four practices that's that's a big problem for them.

Howard: You know what story I wish you would do on your website yes I do I am because when I look at dental school digests my first thought is obviously if one of my four boys wanted to go to medical school dental school law school I would have wrote a check yeah but I think before I would have wrote someone like in white what is NYU cost out 110 thousand a year?

Richard: Yeah I think they're I think they're about what we cost probably five hundred thousand or so.

Howard: Yeah the weather in New York City it's like I would cost of living if I would say son if I'm gonna pay you know so why don't you go live in the Caribbean but why don't we do this for half the price and you can catch tuna on the beach so my question is I know obviously when you're a lawyer the pedigree matters I mean the difference in a law school from Yale or I you know it your pedigree always matters in law school sure but it doesn't in dental school or med school

Richard: See I disagree on that

Howard: Maybe that's an old school thing.

Richard: Yeah well yeah so I you know what other reason that shows my school was because of what we get to learn there I mean we're doing things at our school that that few if any other schools are doing and and I'm not saying that to brag I'm saying that because I wanted to if I was going to spend a lot of money on my education I wanted to come out of school being comfortable doing things like implant placements or hybrid supported over dentures things like that that you don't just get to do at any dental school that you go to and then when you can offer those procedures to your patients then you're going to run a practice that potentially you're gonna have more you know income and things like that that you wouldn't have had if you had to go take CE courses and spend money to be out of your office learning those things after you've graduated from dental school. So for me I think that if your dental school offers those kinds of thing you should definitely pursue that and medical schools I think it's important because it's a little it's a little different structure but where you do your residency is dependent on where you go to medical school so if you don't go to an Ivy League Medical School you're probably not gonna get into the best residency's and if you don't get into the best residency's you're probably not gonna get the best jobs so it's a little bit different than the dental world in that way.

Howard: Interesting and um so if someone said to you I can get into the inexpensive state school or should I go to the private whooty tooty expensive school and they're right now they're in high school right there they're pre done or no they're at ASU I they probably don't go to U of A anymore cuz no one goes you anymore cuz if you just drive by this University real slow with your windows down they'll throw a diploma in your backseat the real the real students are at ASU I think we could all agree on that but it's oh if they were in an issue right now and what would you say that she the lower cost state school or the expensive private school?

Richard: My rule of thumb is always if you can get into a cheap state but it has to be a cheap state school like it has to be cheap because their state schools that are not cheap out there then go there that's there's nothing wrong with doing that that's probably the best thing you could possibly do for your financial future but if you don't get into your state school or if your state schools not cheap then go to the best school you can find and that's to me that's just the best way to go.

Howard: So you know where the bet that cheapest best state schools are?

Richard: The cheapest best state schools no, tell me, do you do you have an answer to this?

Howard: Okay so when they form the Lone Star State you know if you Texas.

Richard: Texas yeah Texas has schools

Howard: You know Phoenix to El Paso so having patients in Phoenix for 30 years El Paso six hours away well if you live in El Paso Houston's 12 hours away so the regional managers for the El Paso like Walmart's and things like that are all from the Phoenix division so a lot of your Arizona companies their territory includes that a little paso thing because El Paso's twelve hours away from Houston that's how big Texas well when they form that state it was just so insanely huge as a big block and nothing in the middle so he said this is a trust land and whatever you do with that it can only go to education well 50 years later they found out it was all oil at 3,800 feet under the limestone so they just so if you look at the top the the top three libraries in the world that I have over five million books yeah they're all in Texas because they just they can't spend the money that specifically says you can only spend on education. So Texas like when I have gone into a Texas dental school watching them growing teeth and petri dishes and I mean the funding that they were get so so yeah so Texas is  a freak state.

Richard: No Texas...

Howard: So back to growth we talked about fillings crowns cleaning exams x-rays they're all growing globally one and a half three and a percent the only double-digit implants clear aligners do you feel like how was your education in orthodontics there are 10 specialties how was your orthodontic education? Do your classmates feel like they can go out and do a clear aligner Invisalign case?

Richard: So you know that's kind of one of the so one of the nice things in Midwestern is that our last two years are clinical so we're in the clinic all day pretty much every day seeing patients we set our own schedules we do our own treatment planning and so if you want to sort of you know pseudo specialize in meaning if you really want to do a lot of implants cases you can kind of design your curriculum to be I'm gonna do a lot of implants in those two years but you have to if you're gonna do something like that it's gonna come at the expense of something else right so there's people at the school who have done a lot more clear aligner therapies and probably not done so many endos or implants and then the opposite which is more where I fall into like done more of the Endo's and the implants and I haven't really done much of the clear aligner stuff so for me coming out of school the clear aligner thing I don't feel like I know enough to just get started doing that right away but there are people in my class who I think are totally ready to do so because they've seen a lot more cases than I have.

Howard: Did you feel like you know if you are in school if you ask an endodontist for help with endo

Richard: No problem

Howard: Oral surgeon for help

Richard: No problem

Howard: Orthodontists the same way?

Richard: Oh yeah absolutely

Howard: So if you're in school and you had an orthodontist and he would help you do the case?

Richard: Yeah so what we do is if so for example I've got a patient we're doing braces on he's in his jeez late 40s I think and we did the whole thing with the orthodontist downstairs you know mounted all the brackets and wires and everything like that with the orthodontist they kind of went over everything with us showed us how to bend the wires and all that stuff right but that's an N of one I've done one set of brackets and wires personally to me that's not enough to go out there and start doing that on a lot of patients right like you know doing something one time is not mastery whereas other people in my class I think have done seven eight you know complete brackets and wires.

Howard: You know when you look in the news for implants, implants doesn't really seem to make the news I mean I never really see implants news.

Richard: In a bad way or in a good way?

Howard: Either way I mean

Richard: That's a good thing.

Howard: Where a orthodontist I mean smiles direct close I mean it's like I feel like orthodontics in the media's like Beverly Hills housewives 911

Richard: Yeah

Howard: and implants is kind of it I just saw sitting there day about I'm from a political scientist eighty-nine percent of everything the US Congress and Senators talked about voted on everything like from nineteen eighty till now never discussed in the media they only like the firing range subjects I mean and in media my god smiles direct club and Invisalign and it's somewhere on social media every day but it but Straumann like I've never even seen Straumann in the news you know and then the number one seller of implants around the world mostly from mergers and acquisitions you know they bought Neodent out of Brazil they bought MIS out of Israel make it simple but I was just wondering um the smiles direct club was the biggest dental story of the year.

Richard: Yeah

Howard: Did your orthodontist or did the school the were they talking about that much and how did that go over?

Richard: So I think I think part of the reason that implants aren't quite as you know newsworthy is because they're not direct to consumer advertising in the same way that Smile direct club is going straight to the consumer and I think that's where there's a lot of contention is that you know dentists are saying wait a second we need to be involved in this process you can't just treat people's orthodontic issues and not evaluate their pareo health or whatever right so that's been a big part of the problem that's why it's controversial but it's also controversial because when doctors have spoken out against smile direct club they've been sued.

Howard: Yeah

Richard: and so that made the news obviously because that's kind of a newsworthy story but yeah so my doctors at school they haven't really said a whole lot about it we don't do it at the school obviously we've seen cases that have come in that have had to be fixed so they've they've shown us some of those but yeah they try to be neutral as they can be.

Howard: I would really like to tell all the young kids and and all the international people that the what are the greatest books that ever sums up the rise and fall of the healthcare industry was the rise and fall of the healthcare industry by Paul Starr 1984 won a Pulitzer Prize winning deal basically just a real summary of the book so at 1900 all the doctors were quacks they're writing around all the medicines had opium cocaine morphine all the diplomas were from diploma mills you know you go to your deal and give you money and I was your graduate that I'd ride around on a horse back and it was it was insane and the richest man in the world was rockefeller and john d rockefeller I think when he died he had like 2.4 percent his wealth was equal like 2.4 percent of GDP whereas modern-day Bill Gates would he be 1.5  percent and he spent 50 million dollars of his own money on a political campaign to run ought to close down all the deals and and have each state open up a a state board of medical examiners and Dental Examiners where they became the judge during the execution so in literally one campaign season they denied all the medical schools all the medications they put everybody out of business and they started rebuilding it from from the ground up where know that medical school is not a medical school that's in your barn and you're just selling a diploma you got to have a curriculum and so it really changed the world but the one thing that the drawback from it is it went from zero one percent of the GDP in 1900 to fourteen percent by 2000 and now it's 17 percent as were at 1919 and I'm sure to look different at 2020 because we'll all have 20/20 vision in 2020 so everything will look better but the one thing that smiles direct Club it's like what planet is he from 50 state boards the the lawyers for 17 percent of the economy and your first idea is to start suing him. I mean when you go to the Phoenix Zoo when you see the lion cage you say I'm gonna get in there and teach these lines I mean you don't see me attacking a gorilla I mean when he started attacking the the dentist I'm like dude they're 17% of the guy they're the most entrenched class of people in the world and it's only gonna grow higher like all these Falls it's all end on this rant because I know you've been here an hour and you got better things didn't talk to me but my gosh I mean the health care is a luxury as you get more and more money you want to pay for luxuries and number one healthy luxury is you don't want to die of your disease you want to live another day and I love the fact that all the Millennials are into clean air and clean water not just because they're woke to it now they're there they just they just realize that this is important in the last century and so we're all so excited that everybody's woke but it's too a luxury you know I'll go make you an ugly brutal point like you have all these people that are talking about animal rights well yeah when you're rich and fat animals have rights but the economy went to depression and you hadn't eaten for a month you know what you would do with your dog and your horse and your cat you'd eat it. So you dogs only have rights when all the sapiens are fat and fat it's like I can put my hand in my dog's mouth because he's not gonna bite me because he's too fat he doesn't he doesn't need to bite the hand but I do love I do think you should read that Paul stars book because when I go lecture around the world I'm being Israel next time I say I've lectured in 50 countries when boys always say dad you say 50 it was 50 20 years ago you need to go back and work on your list but the funny thing is every country is different along that journey of where they're at and the United States is about 4.7 percent of the seven and a half billion heard about two hundred and thirty million here so four and a half percent that's a huge sample size I mean when you were doing your cellular research I mean how many times it was your sample size four and a half percent?

Richard: Yeah

Howard: You know I mean it's a huge sample size but and the one...

Richard: By the way I should actually correct you on that I was a cellist so I played the cello it wasn't like cell thing, it wasn't like a biology thing.

Howard: Oh it was a cello, sorry

Richard: No it's okay

Howard: I'm a low class from Kansas but yeah the health care healthcare is gonna be the ultimate all luxury and when you hear these politicians saying that we spend too much on health care I laugh do they not realize that in two hundred years from now at least a third of the economy is gonna be health care. I mean we finally got solar power we don't need anymore your cars last forever they've they figured out everything you and you and when you were born your daughter would have already inherited a great grandmother's house that was built to last and she has everything known to man and then she finds out she has lupus and she finds out that for $1,000,000 she can go get it fixed what is she gonna do?

Richard: Spend the million

Howard: Yeah so as they get richer and richer and richer they'll bid up the right dogs and cats they'll want all the oceans clean in the air fresh and they won't want to die from a disease so where do you give them back with we spend too much money on health care and I'll give you one last here's the parting shot I want you to think about the little blue pill so here we'll call it the little white pill cuz I got a little white cap right here to everybody who says we spend too much money on health care I'll give an example here what's your daughter's name?

Richard: Annabelle

Howard: Annabelle

Richard: Yeah

Howard: So here's your only choice because in when I got my MBA from ASU they said you know humans are humans are complicated you can't listen to their words you gotta listen to their actions because they'll say I mean even your own white how many times it's driving down the street and she says hey turn right and you're like okay you're looking left you're pointing right

Richard: Actually I'm more likely to do that.

Howard: You're more likely so look at the action so we spend too much money on health care, so here's the only choice with your babies she's got a disease she's gonna die tonight or you can buy this little pill and she won't die how much will you give me for this pill?

Richard: Everything I had.

Howard: Yeah people never say we spend too much money on houses they never say we spend too much money on cars never too much money on iPhones it's always grow the economy they they really want more sales they want but then health care always spend too much I only see that from politicians I never have heard that from a human every parent including myself, I mean I'd give it my granddaughter needed both of my kidneys and my liver and my brain yeah it's all I'm just parts you know I'm just parts and a paycheck for my grandkids at this point.

Richard: Yeah

Howard: and so when everybody says I'll give you everything I've got to keep booboo alive then you can't say we spent too much money on health care and that it's gonna start trending downwards it's been trending upwards for a century it's gone from 1 to 17 percent at 125 years and it's headed to the next stop is a quarter and next stop is a half and my gosh it's it's health as wealth and on that note, thank you so much for coming on the show.

Richard: Thank you for having me.