Dentistry Uncensored with Howard Farran

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Howard: It is just a huge honor for me today to be podcast interviewing Pat Carter IIDA which stands for international interior design association sitting next to that man with all that gorgeous hair is Dr. Jeff Carter DDS. Pat attended Clemson University and graduated with a degree in interior architecture from the University of Tennessee in 75. Practicing as an interior designer, she started her career with hospital and hotel design projects for several architectural firms. Pat was VP of the design Inc for 20 years prior to forming her own company the practice design group with Dr. Jeff Carter in 2002 who I assume is her husband?

Pat: He is, yes

Howard: You're still renewing his lease. Pat has written numerous articles on dental office design in dental economics and other publications and is a frequent speaker at many national and state dental meetings including the ADA annual meeting Henman Texas Greater New York Chicago midwinter Southwest Dental conference how was at the forefront of the evolution of dental office design that utilizes architecture and interior design to elevate dental facilities from the realm of generic office space. Since 79 she has participated in the design and construction of over 3,000 dental facilities and is considered a leading expert on the provision of dental office design services nationwide. The man sitting next to her Frankie Valli Dr. Jeff Carter DDS it's a wig guy he's don't even think it's all wrong dr. Jeff Carter DDS graduated from Colorado State University with a BS in biological sciences in 76 in 1980 receiver's DDS degree from the University of Colorado School of Dentistry where my radiology instructor Denise Kassebaum is now the dean.

Pat: That's right

Howard: Yeah she's just the most she was the most amazing intense person from UMKC that I remember. In his nerves as a practicing dentist Jeff practiced as a young associate dentist a group practitioner and a large clinic setting and as a solo practitioner in his own practice. In 1997 Jeff was hired by the Design Inc of Austin Texas during tenure at the designing Jeff implemented technology integration services a much needed adjunct to the dental office design services. In 2000 Jeff developed the workstation and pendulum mounts to effectively integrate dual monitor systems of the dental operatory and other medical settings. Since 1997 Jeff has been involved in the design and construction of over 500 dental facilities so he's about one sixth of his wife Wow including dental school and has published over 75 articles on office design and equipment and technology integration. Jeff is also a frequent speaker teaming with Pat to present over 300 si courses on dental office design nationwide. Jeff's multifaceted career also includes working as a Seri sevens license investment broker writer stuntman and b-movie actor. In 2002 Pat and Jeff formed the practice design group in response to dentists seeking a more collaborative and innovative design resource that was available through the dental supply house and other formula driven dental designs. The reason I am so excited to get them on the show is because I for 32 years I watch dentists come out of school and some supply house rep or something will say hey I can design your floor plan for you and go do some quick $5.00 you know what are the minute dimensions of your space Oh mine's 40 wide and 60 deep no problem I can do that in a minute and then they don't realize that from age 25 to 65 a third of your life here asleep a third of your life here at home and a third of life your dental office in this cramped condition that you don't like you know on people and then the other thing that's just really bizarre is your dental office is a business and when you rent a thousand square-foot crappy location but you live in a 3000 foot home that you own the land and building and you want to leave your office because you want to go home and you're tired and you want to you know your dental you know rich people their business they own the land and building and it's bigger than their consumption but a lot of dentists have more debt in the consumption of their home I mean when I have patients come in I'm Equestria from the Guadalupe Guadalupe Indian reservation for 32 years you know some boy will come out here and he'll want me want to take me outside to show me his new car and it'll be some lowrider or hot thing and I'm like buddy look I said that is consumption I know you got it because the chicks are gonna love it but you know what Maria really wants you to have is not a fancy lowrider she wants you have dental benefits and you should have spent the money on this car to go to some tech school to get a good job at Intel to have dental benefits. So what would you say to somebody who lives in a 3,000 square foot home and owns the land a building they rent in a thousand square foot dental officer burned out their cramped up they don't have a break room if they don't feel good they can't sit down anywhere they can't lay down it and then they wonder why they want to leave their dental office and go home my home. My home was my dental office was 4,000 square feet and my home was on you know slightly less than that so I've ranted enough what are your thoughts on well burn out too big you know what are your thoughts on that the actual dental office might be taking the smile off your face?

Jeff: Let me get my hair first so I didn't fly off in the middle of this description okay so you know really that's why we're in this that's really our passion about dental office design and yeah you're absolutely right and we've had so many experiences I blame it on a spouse but you have a doctor that's burned out tired they're in a cramped office they're not happy they dragged home every night to this fabulous palatial mansion you know and sometimes sometimes especially you don't need to spend that at a dental office you know that's fine you know it's worth it like I said they're there a third of their life a half of their life so I tell Pat, Pat doesn't know a lot of the kind of average dentists out there you know we've through her career through our career we've worked with a really kind of select group of doctors and it's really people that are sensitive to the environment of the dental office they've perceived that at some point in their career and I actually in retrospect perceived that in my career that I realized what the impact of the facility was and a lot of the things that discouraged me a lot of the things that that you know took my energy winsome we're actually facility related they had nothing to do with the dentistry they had everything to do with a poorly designed facility where it was small I was cramped I was claustrophobic people were on top of each other there was no privacy and you would come home at the end of the day and you were just like mush no I thought man that dentistry is really hard you know and I just as I got into design I learned more and more about design principles and a thing called zoning and things like that but it could actually alleviate some of those issues. So you know we we've been lucky like said we've worked with a lot of great practitioners but people with the vision for what a dental office could be and I think what really separates those people from people not as sensitive to that is they're in tune with what the experience is in the facility what does it feel like what does the experience I have in the facility and they're you know you have to be focused on the clinical dentistry but they're you know that's a big part of it they're very sensitive that I hate it'll sound sexist you know we've worked with a lot of women you know female dentist if they're actually in a lot of respects more in tune with that they're more into a sort of a nurturing supportive environment, oh I wanted to be nice and comforting and welcoming I want people to feel relaxed here I don't want them to feel like either you know everybody hears every word they say if they have an issue or something they can tell me in private you know in a private conversation I have a nice consultation room or something like that. So I would say you're absolutely right on that hair that's really what motivates us to do what we do and how you how you get to doctors to explain that to them and you know is an interesting challenge and part of part of what prompted our Podcast was with you was a mid-market nails were starting for 2020 another we're doing an impact design series for mid-market sassy course on dental office design but he gives us a chance to get in front of hundreds of doctors a year hundreds of doctors manufacturer up some dental reps and really just talk about the impact of the facility on their office and get people to open up you know it's an interactive thing and it's just it's a it's a real pleasure for us to feel like maybe we're in impacting people to give them a sense just like you said you know just you can't spend a third of your life and this thing that drags you down and makes you you know makes you exhaust at the end of the day, Pat?

Pat: I think to add to that I think there's a bit of mindset for the longest time but you're you're prompting a thought that I think it's changing if not already changed is the dentist actually believing that they deserve a good space to work in I think the dental facility for the longest time has been and I wouldn't say it's a blame of the dental suppliers but the limited thought process put into what that environment is like how it works your interest specific in what you need as far as clearances and that kind of thing but there's also that added I'll blame Starbucks for that the expectation of patients for an experience the expectations of what the quality is that they're going to receive by what they see you know I hate to say that to dentists. I I tell Jeff I know that hurts your feelings but the reality is as patients we can't fully appreciate the skill sets that you have to do what you do as far as we're concerned you're as good as the guy down the street so the way we discern the quality of your dentistry is oftentimes going to be what that facility looks like how it works how it accommodates my needs how it accommodates my sense of quality if you will because I take those cues from what I see and I think that is a big shift hopefully that we're having an impact on.

Howard: You the vp of the design inc is that now called desert go desert co?

Pat: No we were THC design is how we pronounce it is stood for total health environment and it is in no longer as I understand it shortly after we left or a while after we left they closed their doors.

Howard: Sounds like you were the the ingredient keeping it all together but my point was gonna be for that has it since you were with a total health environment a long time ago you've been in this a long time has it is it changing?

Pat: I mean yes we had through a gentleman by the name of Dr. Jim Pride that you may or may not recall gentlemen out there but one of the things that I would give him full credit for is creating for the dentist an appreciation for the ergonomics of the dental laboratory and I was trained by him you know this is before I married a dentist before I knew dentistry.

Howard: So you knew better not to date a dentist

Pat: That was a long time ago Howard.

Howard: I want to go back to that comment you made about Jim Pride what because this Dentistry Uncensored I don't want to talk about anything everybody agrees with you said Jim pride love-hate controversial why, what was controversy about Jim Pride.

Pat: He is controversial because he simplified he expelling did two things I think he is simplifying the equipment is driving the dentistry and he expanded the view of the facility itself as accommodating equipment and I think what was being missed there and that's his point and what he was looking at at the time with an architect partner he said it doesn't work it's not the equipment failing it's the facility that's failing he also felt that dare I say the dental suppliers were driving the design and they weren't sensitive to the clearances of ergonomics of some of the things that we talk about fairly regularly today and dentists appreciate today especially those that are practicing like yourself for many years you understand the physical challenge of performing dentistry and so if you have a facility that's in your way or stands in the way of you being effective and efficient it just adds to the stress and the stress it adds to the stress.

Howard: So I can vouch that Jim Pride I'd the first time I heard him was right when I graduated in 1987 he was lecturing here at the Arizona Dental Society and the big hot thing was intraoral cameras and everybody was saying we had to have an intraoral camera and he said you know what he goes when you talk to physicians they don't talk about their equipment their MRI and all this technology stuff it's it's a relationship and eye-to-eye contact is shaking your hand and architecture and then when you went out to visit him what I couldn't figure out about Jim fright is I mean he had a beautiful winery it was like it was like dentistry was this side gig and winery and they you know the whole because wine is all about marketing I mean it's all about branding but yeah he was he was an amazing thinker right up there with the Omar Reid and others but so some people the diss towards everything Jim Pride or you guys are doing is that um you can't build a million-dollar Taj Mahal I mean it's just too high overhead you don't want to Taj Mahal so

Jeff: It's not a million anymore Howard it's not a million anymore what is it two million okay so since this is uncensored and we did this stuff nobody gets into what's ice I think this is interesting so Jim pride was a trailblazer and so is here in memory but they create a lot of principles that actually hold today most of those principles in terms of flow and patient interactions are still really valid but what there was there was sort of a schism I would say so you talked about you know well I go to a dental equipment supplier and I get a $5 floor plan I'm off and running and then you know that's it well there was the the dental design people there Jim Pride Harry Demaree my con thanks split off the design ergonomics is David Ahern was actually part of the design at one point I showed up years later but all those people kind of went off in their separate ways and for many many years they were at odds with the dental you know the dental distributors are dealers so the shine of the been cuz the Pattersons they were odds with them because they were selling against what the dealer was offering in a design package and actually part of the way they were doing it was within undercutting sort of equipment costs and cabinetry and custom designing things and knocking off things so you know you know work for many many years well around when technology showed up at tweaked a lot of things. So part of what Pat and I in the last several years we we take a lot of you know a lot of pride that we sort of formed a relationship we worked really hard to form a relationship with manufacturing we've worked you know we've had interactions with all those people schein patterson Ben Co Burkhart all the independence and we've actually come back towards them to try to combine good equipment integration you know good equipment support through the people that we don't sell equipment we're designers but to help support them in that but then mix it you know merge it with great design bring the two together to where we're not you know picking at each other we're not trying to undercut each other and really I think the main things that were contentious were especially in the operatories so you know no typical kind of a GP op where you have a 12 o'clock dental cabinet behind the head of the chair and that in a typical kind of dual head entry concept well that thing is just as a complete difficult I won't cuss on a podcast it's a very difficult thing to custom-built it's really a hybrid of cabinetry and equipment so we love you know we love the midmark version we love the ADAC version we love the pill and creme version of a 12 o'clock cabinet that's fully integrated with delivery units nitrous oxide timers storage all of that stuff sterilization there's some great sterilization cabinetry systems midmark makes one out of metal that's a tough thing to do you get some crummy you know custom mom-and-pop shop cabinetry as sterile as the sterilization process will eat that in about a year. So we're very supportive of their of their interaction the project and their specific products I think because of the advancements of technology are just essentials in a well-designed office, so design ergonomics has their own little kind of delivery unit system they may sell my gun thing is somewhat gone away from that but Pat and I are you know we take all those great design principles but we want to merge them with state-of-the-art good quality equipment that is sold and installed and serviced and maintained by you know our dealers are people that know how to you know how to take care of that stuff. So I think we're actually we're actually better designers because we have a good collegial relationship with those people we learn every time we do a course it's full of reps everywhere doctors right we learn something every darn project from that and the stuff of all's I mean the equipment evolves and so I would say you know if anything is controversial we've come at you know we've kind of come back to the center with a lot of those people and like you said Herod the the $5 floor plan we try to go back and hey you guys just don't throw this thing in a box you know let's help the doctor let's consult you know what are you doing with this what are you know what is your vision for this thousand square foot space you're gonna cram in five ops and everybody's gonna be miserable you know let's take a step back and see you know how we can better assist the doctor to advance his vision.

Howard: You said the three troubles were Jim Pratt you said Hary Demaree, spell Demaree.

Jeff: Demaree

Howard: and the other one you said was a David Hearn

Jeff: David Hearn as the design ergonomics guy there in the Northeast it's alright and then my gun think was another t-h-e so we're kind of what's left of the dental specialty people.

Howard: Yeah and you mention adec and we lost them we lost Ken and his wife this year I can still remember taking my four boys there for vacation and at one end pallets of leather and plastic and metal beads her and there was a deck chairs and Ken and Joanne took my four boy I mean they were like four six eight and ten and they spent about two hours with them walking down the assembly line they were so amazing but again the you know I said for this deal was I don't want to spend a million dollar Taj Mahal a lot of people say well you know the patient can't tell the difference in adec chair and a chair half the price imported from who knows where do you what would you say to a kid who wants to save money on a chair I mean I know what I would say but what would you say to them?

Jeff: So you know it's the chair it's the function of the chair it's the ergonomics of the chair so you know this is uncensored you know we've had all kinds I've had that exact question posed to me by several clients so for example I hate to use names but you know they were comparing the top of that you know top tier chair so midmark adec reign top tier chairs there's a whole middle tier so he goes well you know let's talk here chairs there Tanel up and you know thousand dollars why don't you know it looks the same to me so he looked at a mid to your chair and said okay to examine that chair you know tell me what do you see well I got there exposed bolts and nuts and stuff that rust so they're sharp things how well is it crafted you know it's like anything how do you start breaking again well you know it well yeah doesn't you know now that you said that it doesn't quite you know it doesn't quite look the same when I look at some of the finer detail you know well don't you know how high does it elevate does it have you know the headrests have multi positioning so you know I would say some people can do fine with a mid tier chair other people you know they're just if they take the time to examine it they see the bonuses it's like you know it's like a high-end car versus a mid to your car I mean where you get you get something you start planning to go okay well now I see what this is more oh yeah I see why this is more so I wouldn't say everybody's gonna buy into that but a lot of people that would pursue you know kind of a more of a state-of-the-art office that's very in tune with how the patient experience they're gonna be sensitive to even the chair they're gonna look at the chip you know that shared looks better it feels better it's more comfortable has more options has better ergonomic positioning maybe it has a massage action in it and it looks cooler you know what you went through the adec thing I mean they they put a lot of care into that chair there's that thing where the chairs getting beat up on the assembly line where they show you you know the chair folds up and reposition like a thousand times a day and it's still going after many many years yes anything with mid Markman they're they're very proud of that plant who are in the craftsmanship that goes into their products so it's a you know so you know it's a the chairs just part you know it's another piece of the puzzle of this of this office that you know either works for you and works greater or it's you know it's a detriment to the advancement of your career.

Pat: I'll put another spin on it Howard and I guess I'll come from a design standpoint one of the things I say over my career is really about design following dentistry not dentistry following design by that what I mean is the procedures and modalities that you do and perform as a dentist especially seasoned dentists nowadays is so far beyond what we were what was happening in dentistry you know 15 20 years ago design was simple because dentistry was more simplified as we've gotten more complicated we've got more technology we've got more requirement for procedures that are longer for patient sitting in the chair longer periods of time with higher expectations of what that dentistry is going to that dentists total outcome is going to be the expectations that are going to be higher for the equipment so I think the equipment knee as a start-up practitioner might be more simplified dare I say but as a seasoned practitioner more the practitioners that we work with that practicing for 15 plus years their expectations are a different level and the expectation for the equipment is at a different level the expectation of the facility is at a different level as far as making a statement of quality I would say that's the biggest thing on our side of the fence as far as design to speak to that chasm that schism that Jeff was talking about that was in dentistry the approach I think that Dell suppliers were often taking whereas if I'm spending if there's spending money on the facility they're not spending it on equipment and that was not the equation they were looking for and I think that's what Jim Pride was creating out there in the shake-up about balancing equipment with the facility that there are needs the facility had that were not being delivered to the dentist and awakening if you will the marketplace to how dentists should deserve and should benefit from something that is very thoughtful and deliberate in design on the design side as well as the equipment side all kinds of conversations about equipment but no conversations about the design of the facility and unless no chair in this room. So I would say over time and say history has become more complicated the expectation of equipment does but I would also dare to say that the the dental facility does as well and I would agree with you there's a line that you can step over if you were to say Beverly Hills and we've had an experience and a Beverly Hills facility expectations and how that's supposed to look they're shiny lots of bling if that's the expectation of that community of dentists and so that's what design delivers but it's very different I think in most other locations in the United States as far as what the facility will do to deliver to the dental expectations to the community expectations that kind of thing but I think there definitely is a balance beyond which you don't go in design there's I think there's a loss if you will be on in your investment that you don't really Derner from the patient's experience by spending all kinds of money beyond the need if I can say that way.

Jeff: So Howard just look at look at your set I'm staring at your well Pat's talking so you say you're right behind us barn what is that barnwood pad recycled recycled wood looks that looks like a place I'd go and have a beer and be really comfortable and relaxed so you could be you know you could be positioned in front of a stark white sheetrock wall but see you chose that so you chose that and that has an impact on us you know watching you personally there's some how we perceive you so yeah that was a conscious choice by you I think that was a good call you know for a backdrop.

Howard: I just gotta say one thing you brought up Harold L Demaree DDS he passed away April 28 2009 just an amazing man University of Nebraska College of Dentistry graduating 61 I was born in 62 this guy was a while back but I'm an amazing in my class I you know we always I always say that the smartest guy in my class was Bryan Neuwirth I mean he was just he was just an amazingly brilliant man and when I visited his office and Hickory North Carolina the first thing I noticed is the opatories were twice the size and some of them had couches and things that he goes he goes man I was gonna be an oral surgeon in here for 40 years I don't want people coming in and stumbling over the edge of the chair and trying to sit in a chair to watch their daughter you know hold her hand while she gets her wisdom teeth pulled out or whatever he goes you know so she could just walk in hang up your jacket in the opatory sit on a couch or a sofa or a chair I mean and I just thought oh my god I mean so hit the average op is about 10 by 10 so he built his 20 by 20 it's

Jeff: but see he's thinking through the experience of what it's like to have your wisdom teeth removed and be accompanied by an adult so he didn't even he didn't show up with that ID he fed that to somebody and they they designed around it you know so if you have a rationale if you have a rationale how you want to do something design as your tool to deliver that and if it's well grounded and sort of you know in clinical procedure and how we treat people usually it turns out fine I mean I want to waste a bunch of space but you know yet he had a specific reason for doing that if that's how he practices you know that supports him people are that's a reflection of how he perceives hey patients gonna be more comfortable I don't want you know I want that I don't want that like you said I don't want to tripping over the J box at the toe of the chair at the end of the procedure and moms you know get wrapped up in an umbilical cord you can't get out of the op at all there's a lot of that so so yeah that's a great example.

Howard: So who really is your target market is is that the young kid coming out of school that's been an associate for some dentists or worked at Aspen for five years gonna start their own practice or is that really you know getting to first base a second and you're really more the person who's been around the block a few times and is ready to expand into something bigger?

Pat: I would say you know to that question and Jeff can add to this which I'm sure he will but I would just say we seem to attract who we are attracting now are the practitioners that are more seasoned that are looking for actually are building buildings they're wanting to invest in that equity he talked about that earlier on why dentists don't own their practice their facility when a lot of professionals do out there that I think is a shift that at least we're seeing and we seem to attract that dentist who is wanting to no longer put out those lease payments and wants to invest and put equity into his own practice or their own practice so that's the other side of the equation is group practices or multiple doctors building a single facility that kind of thing but I will also say and I'm going to say this to the benefit of those that have called and talked to Dr. Jeff Carter on the phone we've had startup practitioners knowing nothing about design knowing nothing about the process where he'll talk to them for an hour or so on the phone just coaching them whether we design the office or not which oftentimes their dollars are just not there for them to invest to the level that they will further into their career but just the counsel that we can offer someone about how to find a space what they're looking for in guidelines of square footage setting up at least the tone of what they are trying to do to balance what they are otherwise requiring an equipment obviously to start up a practice and then what that facility will require in square footage to accommodate that so I mean what would you add to that?

Jeff: We don't do a lot of startups hard we have on anybody why she didn't start up for a guy who is in his senior year of residency and a pediatric residency at Ohio State I thought this guy had two or three little kids was finishing up his residency and we were helping him design an office he was moving to Texas I thought god this guy's you know gotta be ten times smarter than me to juggle all this stuff at one time he actually had a lot of good thoughts and I just but it's a challenge for the startups because of the lending no just you know Howard so I don't know I know this is your show but what if we liked it a little hypothetical because you said hey you don't need to build a million dollar Taj Mahal how about if you give us an opatory let's say you're you're finally Arden let's say your admit you're 35 you're gonna do your ultimate office dental office and you come to us and you're asking for advice just give us some give us some like a hypothetical and start with how many ops you want.

Howard: Well I actually I can do that but I want to spin it back the other way I'm you're go out to Ohio I just lectured at the Ohio State Dental meeting that's where midmark is and John Q Baumann is there you do a really great if you go to their website again this is not a commercial John Q Baumann and I've asked him to be on the show for years I don't know I think he knows I haven't got a return email so that's definitely not a commercial but he has a deal called the midmark dental design center impact design and so my question is: you're a big hit out there who is showing up for these design seminars and what are they asking?

Pat: They're coming from all over the country and even out of the country.

Howard: What I like about Ohio is you know a lot of times you know I'm like I'm lecturing in Israel next week when I when you go lecture in a lot of countries they think that New York City and Beverly Hills and Key Biscayne those are for rich people but they know Ohio is just country Kansas in the middle so you know things can work in Beverly Hills, Key Biscayne and Manhattan that do not work in Dayton Ohio so when I see a bunch of so it's listing international folks when they see something working in the heartland they know they got a better shot out of the attic in Cambodia and Vietnam and Indonesia then like say then Beverly Hills 9110 where your hair belongs, first of all how many shows do you do a year at midmark?

Jeff: Well so we've an average in tan anywhere from 10 to 12 so

Howard: How many people show up?

Jeff: Well it's so it's a mix of doctors and raps and and so that we just did two we had I think 45 and 50 made one in Las Vegas seems to bring out people's interest we had one in Bellagio which sparks dental office design interest and then one in actually Newport Rhode Island would be great so but they're they're poor it's an interesting process out so they're doctors that are interested in design but they're brought there by their dealers so some are Schein, presentations summer Patterson some early and some of the independents and then they're working a partnership with midmark reps but we've over that we've done this for seven or eight years we have a reputation as we can help doctors that are stuck so doctors are pursuing a new office but if the dealer perception is they're stuck so maybe the dealer maybe Henry Schein has done 15 floor plans and they can't get off you know they can't get past there and the don't I don't know I just I don't know what you know I look at the plan I don't think that's going to work I just I'm not sure that's what they want I'm not sure that's what I want so they come to the course well the course is very interactive so we we'll bring kind of like you try to do on this or are doing on this will bring stuff out of doctors that you know in a group setting although they'll express their frustration we had a guy oh my current ops he goes I hate I have my fate you know one of my office is right by the front desk yeah he goes so I don't want to go back by the front desk because Mrs. Smith is checking out I just had kind of a you know a tough go around in the off with her I don't want to run into her so he'll go hide in the bathroom next to the front desk and wait for her to leave the front desk before he goes in the op it's right next to the front desk that he hates so he'll waste you know 5-10 minutes of 20 minutes a day hiding in the bathroom by the front desk so the people at the front desk check out and get out of there citizens and have to run into him again I mean what's that and money you know and the guy that you know this was like a forty five-year-old very successful guy admitted in a group of like forty people that he was hiding in one of the bathrooms to dodge people at the front desk.

Pat: We also have young people that are coming they're just getting ready or they know in a year or two that they want to start a project but they don't know anything about design they don't know anything about the construction process and so they come to the course to learn more about that just to kind of get a handle on what it is they're about to venture into some of them are coming as associates some of them are coming and having been an associate and now ready to start their own practice so I mean we cover a range of individuals that come to that course.

Jeff: and usually their you know I can liken spot kind of a designee doctor you know within a sentence or two they ask tough like well you know I was envisioning that's kind of warm and inviting but I need some privacy but you know where I have now has no natural light I need more light I just feel like it's claustrophobic they don't go how much is this cost you know what you know what do you guys charge to design an office they have a whole vision thing it's not everybody but it is a significant you know number of doctors have that sort of sensibility so it's driven by dealers that are out there that the equipment specialist that would have come the field sales consultants those kinds of people or doctors doing a new office they start the normal process with the dealer but then they get stuck or it's more complicated than the typical project then right so they come a lot of them are ground up some za remodels get really tough there's a lot of remodels where you're in the office and you add on it you add additional space you don't add any space but you tear up the office while you're in there trying to practice those are very difficult it's very complicated very difficult there's a thing called phasing how you kind of work through things like that but one of the things we feel that we like to be able to do is you know we do a handful of projects every year maybe 10 to 15 but there's so many doctors out there example pursuing things that they're actually never gonna pull off because the parameters are so far off so you'll have people looking at property thinking so they're maybe their vision I want to build a ground-up ten operatory office so and they're pursuing a lot that's maybe less than half an acre they think you're gonna spend a million dollars they have no chance of pulling that off but nobody will tell them that because they don't want to they don't want to discourage them, they may talk to a contractor hell yeah you know we could probably do it you know show me some plans someday when you get there they may have a commercial broker selling a piece of property with big setback so utility easement running across it and not enough space to cite this building but they don't know they don't know the specifics of dental so we like to head off things are we think there's just no way you know you're not your whatever vision you have is not gonna fit on this piece of property and it's not gonna fit within the budget you that you have. So that's what I said just hypothetically there's there's rules of thumb where we can coach people in a few minutes if we have project specifics and at least give them a fighting chance of you know pulling off whatever it is they're envisioning and not spending years to get to the end of the road and find out oh my god I did you know I just spent a hundred thousand on design and my building won't fit on this piece of property that I bought five years ago you know I should have done some due diligence I should have had somebody with dental specially design expertise look at that site plan layout a building layout parking show me access from the street all that but all of those kinds of things does that make any sense Howard?

Pat: I mean the biggest thing is giving them tools to assess the best project for themselves and some time and the reality as many of them don't have familiarity with why would they you haven't built an office ever or they haven't built an office in many years so we're there to provide updated information so that they've stepped into this project eyes wide was it wide well open very informed about the project that they're doing and they have a realistic budget they have a realistic concept for the project they're endeavoring to do and there's a lot of relief I think that comes to them about going through this course and feeling like okay I'm on the right track or the track I was on wasn't going to get me where I needed to go but now I know what I need to do to make this thing happen.

Howard: So do you, I want to go back earlier um the last you know when you look at franchises like McDonald's where they have 40,000 locations they have a budget where they intentionally redesign all their locations every seven years so 7 times 12 is what it was at, 84 so they put away a little money every month and then at 7 years they they redo it so when you walk into any McDonald's in the world it's anywhere from looking brand new at the best to 7 years old to worse and you go into dental offices where some guy will put in this rockin hot dental offices in 20 years later you're like dude the paneling and the foglight and the you know is just not blending in and for my office I couldn't get everybody had been with me 10 20 30 years to agree so we actually all flew out to San Diego to the the Benco facility and by having everybody in that room at the same time what was most important to me was just that we got the decision done you know three hours in that building where we were done whereas before you know we kept getting that the decision couldn't get made because that's so getting your team all in one place you're doing it you know you're doing it in Ohio and Vegas?

Jeff: Well no we're all over the country just every year they picked different venues so about a third or in actually Versailles Ohio and then the others are out in the field and I just feel they've done Canada we've done we did one in New York City that's why it's interesting that the Northeast is sort of...

Pat: San Diego's, Las Vegas

Jeff: Florida

Howard: So you work with all the dealers a Benco, Patterson, Schein, Burkhardt?

Jeff: So we've done not as much with Benco we better listen over the years we've had interactions with everybody we spent a lot of time with Chuck Cohen at Benco he's actually been in this office right here and came and visited this but so then the midmark impact design is mostly Schein in some Patterson and then on occasion of Burkhardt.

Pat: Yeah the independence that kind of thing It's their choice as far as how they participated to what degree they participant.

Jeff: Actually the former head of the dental division of midmark is now the president of Patterson I've ever met Eric Shirley he actually is...

Howard: He's from Effingham isn't he?

Jeff: He's from actually from El Segundo naxi Manhattan Beach California he started there and he was a catcher and he played for Long Beach State he was a catcher so he was at Midmart many years he's had a lengthy dental career but yeah he just like within the last year came on as president of Patterson yeah so we're hoping to to an advanced at relationship.

Howard: Well that I love that Chuck Cohen at Benco I mean he says he's been such a mentor but my original mentor was actually Pete Frechette Patterson because my older sister is a she in her nun or she's a Catholic nun in Lake Elmo so every time I go to visit her I need to do some business for four hours in one minute so I either go to Patterson and sit next to Peter Frechette or I'd go to 3m and so I bother him but man when I go to Patterson I'd walk her there I say Peter I gotta kill four hours or a minute he was good just just follow me around go to my meetings because it'll be good to have a young dentist perspective and these meetings just right now he was he was so so such so incredible of a man anyway so now Eric Shirley's down there well all I could say the Eric Shirley is man with Pete Frechette you got some big shoes though but anyway so what would advice would you give right now to someone who's like I hate my facility but I might take a lot of PPOs I mean you know what advice would you give them who's your ideal customer who's listening to you right now on that they're our commute to work I hope your on your commute or I hope you're not one of them poor guys on the treadmill or the Stairmaster but if you're on that stairmaster just just get off and go have a beer yeah you're not gonna live any longer but who's listening to you right now that needs to take it next step who's your ideal dentist listening to you right now?

Jeff: Well we hope it's a dentist with the vision to change the circumstance that they're in their current facility something about their facility doesn't work many things probably don't work for them and it's driving them to do something else but they're not sure what to do so that that's really who we want you know so something that has had some experience you know it's that maybe they're starting to build up a practice but they're seeing the limitations of the facility so we want to know well what is that vision so like you said that maybe it's okay well my production is plateaued at the end of the day we're exhausted my productions plateaued but we can't bring it any more patients cuz we're maxed out we got four chairs you know a hygiene is booked eight or nine months out people get there you know there's a new op a lot of times what motivates us there's a new office down the street it's just you know the kids right out of school it makes our office look bad we got to do something to compete this it's actually a lot of times it's that more than anything, the peer pressure of knowing that you're not keeping up but just like you said Howard people will invest twenty years ago to grade dental office and not touch it I mean they won't even flip the pillow around in the waiting room in 20 years you know.

Pat: I don't really understand that but I think yeah definitely because I would say the number one thing we hear often is it doesn't look like the dentistry I'm doing today my office doesn't look like the dentistry I'm doing today I go in there and I even challenge dentists when they leave the course I said go back the first thing you do is you walk in that front door and put your patient hat on and you start looking at it if you've got clutter if it looks tired and old get rid of it or fix it because all of those things are cues about what you're doing as a dentist whether you choose to believe that or not and then I would also just say we find that we're a lot of dentists who think oh I can't do this there's no way I can do this I can't change I can't remodel I can't do a new building I can't you would be surprised at the abilities thanks to the lending environment especially now be surprised how many dentists are actually in a position if they would take a look to do something about it.

Jeff: We're encouraging

Howard: My pet peeve is you know I I don't you know I'm only known for a few things one is I'm the only person on earth you listen to all 1,300 of the Howard of the Dentistry Uncensored podcast no one else is and I think I've had I drink more beer with more dentists in Arizona than anyone I don't know who has I had more but but the thing is every single time I've ever walked into a dental office I mean I use write it down and and when I'm talking to my team they're like okay tell me what happened you got there but every time you go to a dental office the dentist is in their private office waiting because surely is dismissing a patient then she's got to clean up the room and set the next and I'm like okay doc you know the ADA says average and all 65% overhead so you're 35 percent of the cost what you're one-third of the cost what what are you doing I'm waiting on a chair after after you at 35 percent Labor's 20 to 25 labs 8 to 10 so plays 4 to 6 I mean we don't even get down to operatories until we are after the electric bill and they're like well I don't have room for an operatory well where you're sitting is an operatory. I mean Superman we're out of a damn phone booth why do you if you work in if Superman only needs a phone booth and I can put an operatory in your chair or they'll say well I don't have room to expand oh yeah because you're renting so you're letting a landlord's key concerns Trump your entire existence and purpose because you decided to be a renter for 40 years in the same location as opposed to be an owner oh but you decide to own your own 3,000 square foot home I mean you don't lease your car you even own your car but you rent your dogs. Do all I can say is this when I look at the income that people make a lot of people shortchange the the specialist and they say oh well oral surgeons and endodontists you know they get more money for their procedure you know it's multivariate but when we look at the fact that oral surgeons make the most money at 448 periodontist necks at 330 endodontists nexts at 307 the one thing the specialist all have in common is about 80% of their referrals comes from about five offices and 20% of the referrals come from about another 20 offices and when they're one or five referrals calls up and says hey dude I got a patient with a toothache can you squeeze them in that endodontists is not gonna say no because they don't want you to find another endodontist because he knows you don't do any molar endows and there are thousand bucks apiece so every endodontist, periodontist, oral surgeon I know they all have one or two extra operatories that are never scheduled and then you go into any dental office and you say well what is your big problem on income well you know I've plateaued I've been collecting the same amount of money every month last ten years yeah that's because if I call your office right now and say hey I broke my tooth can I come in the first thing you do is is start looking for a chair you're constraint is a stupid chair and this specialist that's not the constraint the constraint is when can you come down here to catch the fish I might not do the root canal now but I'll give you some antibiotics or get out of pain have you vicodin or just straight heroin or whatever it is you need and then every dental office the dentist is sitting in there operatory all day long waiting on a chair the receptionist can't get anybody to come in right now when people come in to us and say you know I got a toothache well we're at the corner of 40th and Elliot right next to Safeway when can you be here, we don't start looking for that so is so if you don't have an operatory that was not empty never used at least every other day then you need another operatory another constraint in your life that you need to go to the pinky and soon learn TMJ or you need to buy a laser can't can't look I'm on the phone my tooth broke I need a crown and you're looking for a chair you should never be looking for a chair you should have so many damn chairs that if the homeless guy came by and say can I just live in that room you say yeah because I haven't had a patient in there in a year so you add operatories until they're never used again they that's my rant so my whole deal is I don't care what the design is I just want to come sit in a chair I don't care if it's a lawn chair and you're holding a lava lamp you know I need a chair.

Jeff: Yeah that's why we want you to have a flex op you know we want everybody to have an overflow op so they're not just crazy trying to get people.

Pat: We challenged dentists on the number the count if you will of operatories what are you in now what are you proposing to in this new change whether it's remodel or new building or whatever and what's the rationale for because what we're looking for is exactly what you're talking about is that flex op do you have a...

Howard: I haven't heard that term how am I the same ages you guys never heard of a flex operatory is that an Ohio word or is that?

Pat: Because we're brilliant and we work in this all the time, I don't know Howard.

Howard: You're from Buda Texas?

Pat: Yeah of all places just outside of Austin does that give us a little weight right there?

Howard: Four out of five of my grandchildren live in Beeville Texas.

Jeff: Where's that?

Howard: Beeville it's downward by refugio Texas by Corpus Christi.

Jeff: Okay three hours from here that way.

Howard: So you agree that if that operatory is your constraint then that's gonna blow out your overhead that's gonna ruin the efficiency of your staff I mean sometimes that what I love is you know you'll work through lunch squeeze an emergency and it's at the end of the day and the whole office looks like a tornado just made out with a hurricane and I can go home everybody was seen I mean I know I assumed the dental assistants were there till midnight yeah we got everything done so if someone goes to again I was super impressed by the the website midmark.com dental design center impact design they have design center they have architectural resources designed tools impact design seminar. So if someone's thinking about that next level can they go to that website didn't do that should they go to the course and what would be the next step for them?

Pat: Yeah you can go to the website and they have a registration capability there you can register your interest in that you can talk to your dental supply partner assuming that you've got a partnership with a wither down supplier just say hey I want to do this course tell me how I need to get registered so.

Howard: First you're saying it was their dealer now you're saying it's their dental supply rep?

Pat: Same thing

Jeff: Schine, Patterson, Benco, Burkhardt all of them.

Howard: Oh you mean not a dealer from college the new dental

Pat: Not that

Howard: You know what I wish you guys would do is we put up 401 our online CE courses in dental town and they've been viewed a million times I wish you would make a course an online CE course or dental town because it's kind of a you know if they saw you for an hour and met you and got your chemistry and all that that would make it easier to make the next move of going to Ohio or Las Vegas it kind of deconstructs the sales process because I really wanted to make a good decision and my my main purpose is that and this is another bias I've seen so my entire life whatever a dentist designs five years later they all regret it not being bigger I've never heard anyone say five years later I wish I would have made it smaller they always say God instead of four ops wish you gone six six eight eight says twelve is is that I wanted to make good high-quality decisions do you what would percent of dentists do you think at sixty months after a new office regret that it's too small?

Pat: You know we coached them into...

Howard: Not the ones that you coached just the industrious?

Jeff: I would say typically ours don't but you know part of it Howard is you know you give it your best shot so five years ago you give it your best shot number of obsolete and it's really they're all budget derivative some point a number is going to determine a lot of what you can do so we actually just had some guys in Abilene three got three doctors they slapped on an additional four ox we went from fourteen to eighteen because they started to get how she ready get in they're gonna be completely maxed out in like a year so they had enough foresight and also because there's three of them make it afford the budget lead going from fourteen to 18 but I would say we've never specifically got and gotten that feedback and anybody that was highly concerned you know well you know this is a big so here's it here's a typical scenario so it's a single doctor they want to build a table so they don't have an associate or a partner but they have you know they have a growing practice they have visions of bringing them on you know with them and that they there and it's a struggle for like a single doctor for example to build an eight ground up building so maybe they'll build complete four or five opps they'll dry box the other three they won't complete part of the inside and they'll get all that up and running and then in two or three years they may bring on an associate that may go great turn into a partner then also they may max out that a top facility so we have conversations about that so somebody's highly concern that goes back to picking the piece of property so let's say the original office okay I'm shooting for 8 ops but who knows you know I'm in my 30s it's you and we can tell we've worked with some great you know kind of high-profile practitioners we can usually tell who's gonna build up a big booming practice based on kind of their personality how they interact what their vision is well if they're highly concerned let's get a little bit bigger piece of property we're gonna master plan an 8 op building that if you ever outgrew it so we're gonna be able to add on four more ops it's gonna flow right into an additional four ops if you ever get to that point you know we can project now you know may cost us in five years we don't know it's going to be more but hypothetically you know you could expand this facility from eight to twelve ops so we want sort of a safety valve fallback position sometimes you're just landlocked sometimes a doctors on a piece of property for ten years five years doesn't matter what we do we're not gonna ever get more than a three thousand square foot building on there and we got to know that okay you know 3,000 square feet maybe we get a good six or seven op office you're never gonna go past so you can you know is that gonna work for you for the rest of your career and sometimes people have actually sold land and moved somewhere else but you know that that is a good point you've got it you know what are you envisioning now but what is your alt what is your ultimate vision in the future and many doctors it's a single doctor I'd love to have two or three associates that turn into partners where I'm spending a course of my time managing this practice or maybe I want to spin off another practice.

Pat: or I don't want a partner at all yeah I don't want to be on rollerskates I mean tell the truth about who you are as a dentist and that I think that is a lot of I mean back to your question earlier on knowing who you are as a dentist telling yourself the truth and then telling the designer here's Who I am as a dentist this is how I like to practice this is where I want to take my career I need a facility that supports me in that way you talked about that oral surgeon there was a reason why what he knew what he wanted as an oral surgeon what he wanted to provide his patients there was a rationale design should have a rationale and it should be backed by hopefully some level of experience and some level of truth-telling I call it as a dentist who are you I mean we have no judgment here about who you need to be there are dentists sometimes I think it's unfortunate that feel like they have to have a certain number of ops or somehow they haven't accomplished what they need to accomplish or I have to be a part of a group or I should be doing this or I should be doing that as a dentist, why I mean if you're really good and this is who you are and you can provide that service to patients beyond anybody else in the area I think that's I think that's the way...

Howard: Well said, always always be true to yourself I mean there's eight billion people on earth you weren't born to live someone else's life and to say that all, when people they say describe the average dentist well you can't describe the averageness hell you say is up my neighbor's house he has a full-grown Rottweiler and it's afraid of the cat I mean whoever I mean no one would ever say a Rottweiler is afraid of a cat I mean my gosh everyone's different just be true to yourself but I do got two more specifics because I can't believe we already went over an hour but two other questions what would you say to somebody says you know the only thing I'm really interested in is I want to fix this up for when I sell my practice some day and another and other people are saying well you know now that DSOs have through mergers and acquisitions have snapped up about 12% of the dental office the the the data I see on supplies DSOs are buying about 18 percent of supplies at twelve percent of the locations a lot of people are hearing things that DSOs aren't interested in you know they got to be at least a certain size for their business model so two questions that yeah what if what would make me what would help me fix up my office so I can sell it someday and number two what do I have to make in size and number of ops so that I have a liquidity play with DSOs?

Jeff: Spiffing up your office so you can you can sell it or and create some kind of transition strategy so it's like you said earlier in our we see doctors will come to us they've been their office 20-30 years you know it looks like it's from the 70s or the 80s wood paneling horrible you know old outdated well no really old outdated equipment you know.

Howard: Don't start making fun of the Brady Bunch scene.

Jeff: Did you see the home and Garden television they redid the Brady Bunch house so you know you have to okay who are you gonna sell it to so somebody right out of school is gonna walk in there there's no way in the world they can ever envision themselves in that space I'm not gonna spend eight hours you know 40 hours a week in this space so you have to try to create something that has some appeal to knock see the the new end-user the person gonna sell or transition to so that could look a lot of different ways sometimes you know it's it's equipment sometimes you got to update the equipment and you just have old outdated stuff. What's interesting is beginning to delivery units and stuff like that but their organ except how people are trained in dental school now so almost all dental schools have what they call kind of splint delivery where the doctors module is in front of you I know what you got Howard, can be on a car it could be on a swing arm that attaches to the chair well some of it back in the 70s and 80s we did a lot of what they call dual function rear delivery where the doctors hand pieces in the assistance module were directly behind you and some of the even older units are there a hundred percent fix you can't move them around well they're just next to impossible if you're not used to working in that it's really difficult for you to adapt to that so one is look at the equipment don't have any technology do I have any kind of technology overlay over an office it was probably designed 20 or 30 years ago so has to be some level of technology because people right out of school are very tech savvy you know sometimes it translates you gotta have a few monitors and a couple of computers laying around doing something to entice somebody and then what does it look like you know like you said in retail every 7 years of McDonald's they spiff up something that could be finishes paint you know new new stuff on the exterior you've got to spiff up the finishes it can't be so dated looking that it just looks like you're moving in with their grandparents you know. So you have to take it to a level and it can be budget driven you can back in or something doctor said okay I want to transition I want to sell this in the next five years and I'm willing to spend $100,000 I'm going to spend $200,000 I'm going to spend $30,000 get realistic from what budget makes sense for you and then you can back into what's possible at that you don't need somebody tell you oh you need to do this and spend $500,000 you'll never sell it know you know you you you have every right to make a budget determination what makes sense to you to invest in that. So I would just say you've got to be sensitive and at most you know older dentists have children or you know nieces or nephews they understand kind of would you know a younger person is attracted to experience wise in a space and trying to translate that back to your office and at least bring it up to a level where they can get in there fill somewhat comfortable and then they could make it their own in a year - after they can make it their own they can pass their own money in it but you gotta you gotta have the bones or the core of a decent you know functioning office that can be developed over time.

Howard: Do you mostly do family practice general dental offices or do you do any of the specialists?

Jeff: We do everything

Howard: You do everything?

Jeff: Yeah, we've done yeah so we've done gosh we do a lot of specialty just because sometimes it's harder for the dealers that are the dealer design people they don't do as much of that so we've done a lot of oral surgery or ortho ton of origami we don't do a lot of endo for some reason and then now that there's simpler offices but of all the special do a lot of pediatric is really interesting because of them well actually when we're done with this we're driving to Odessa Texas to do a site visit on a 12 chair 6,000 square foot big smiles ranch it's really going to be something it's a pediatric specialty but...

Pat: You know that there's something new I would say when to your question that we're seeing the GPS bringing in or what a facility that will allow for an oral surgeon to come in or an orthodontist to come in or a periodontist to come in that may not otherwise be available in the area and now they get to be the one-stop shop I think it's sourced a little bit by a competition with the DSO that might provide all services to you know everybody this is version of that and so when they come to us or asking okay I'm gonna be the primary caregiver in this facility but I want to have an oral surgeon come in once a month or twice a month what do I need to provide to that all surgeon in this facility to attract them to this facility and so I think to say that as another thing we're starting to see in the marketplace which makes a lot of sense to us I mean it expands your availability to the community it expands the marketplace for the specialists who may not want to build a building and you know piquipsy Mississippi but I'll go there because it's 30 miles outside of where I live I'm willing to drive it I made that out but you get my drift so it is just to say that I think that's pretty smart for GPS as well.

Howard: Well you said something extremely profound and that is you know the retail the business model for over two centuries for all the Americas existence has been you go back to the early eighteen hundreds in New York City you know you had this small little shop and everybody lived above it and then the next generation they rented two shops put them together and put the one shoppers out of business and it kept getting bigger and bigger and bigger until it maxed all the way for Walgreens and Home Depot and IKEA there are all these 250 thousand square foot centers one stop shop before Walmart admitted they got too big and now that was scaring people away so they started closing down facilities and they're backing off from that size and that retail is not going to change you keep seeing where first you had pediatric dentists and orthodontists and then those two were like peanut butter and chocolate and they combined and now mom's like well I'm gonna go to this pediatric office because they have an orthodontist and the one-stop shop is going to rule dentistry for the next 100 years because it's ruled retail we've seen it completely play out retail I'm so old when I started lecturing down under in Sydney when I've gone down there every five years and done the tour of a Melbourne Sydney Adelaide Perth Gold Coast and jump over and do In Auckland New Zealand on the way back but when I started doing Sydney in 1990 I mean Here I am staying at a dentist's house and we had to go here for the meat at the butcher then here to the bread man then here to the veggie shop and I'm like well where is your grocery store that has all those departments in one place and at that time they didn't even have hygienist or hygiene school so you can literally go back in time when I went down there in 1990 you were going back in time in retail now now it's all caught up and how they have to publicly-traded DSOs that America doesn't have but the bottom line is mom and when I asked the dentist are you focus on the dentist is this all about you or you dentists centric are you customer patient center oh I'm I'm definitely patient centric oh really so your hours are Monday through Thursday 8:00 to 5:00 when the federal reserve has 3,200 full-time PhD economist and they say one third of America cannot see a healthcare provider Monday through Friday 8:00 to 5:00 so by intentional design you just told one-third of America you're not even interested when you have a question you always have to refer to another office. So you know these DSOs love them or hate them if they get the retail right if they get the one-stop shop right so l met an endodontist on Saturday coming out of school at half a million dollars in student loans because he went to a private dental school in a three-year deal and then he married some woman who was had the same thing so now combined they're like one and a half million dollars in debt you know combined and I said well why are you gonna go buy land and building and startup an endodontist why don't you go find the five biggest practices in town and go do all their endo and split it 50/50 you have no overhead no no you know I mean all that so so when you're talking about this flex op I do see the future being a a specialty operatory where specialists rotate through to provide one-stop shop do you do you agree with that?

Pat: Yeah that's exactly what we're saying but I'm and this has been burning in me since we started talking about the OP and adding the oppan one of the things I say and I and I mean it's very sincerely the way Dale offices have failed as a facility is the notion that I can just give up my doctor's office put in a chair give up my staff lounge put in a chair and all of that works on the production side but what was not happening was any consideration of what was happening in the waiting area the front desk area and then you started hearing all these upsets about the bottleneck at the front desk so I have more patients coming in because I've got more chairs and more availability but I didn't accommodate that increase in production in the front areas of the office so what we try to impress upon dentists and design is don't build such that the production can increase without understanding it's going to have an impact on the front part of the office so to your point it is to say breathing in the endodontist bringing in the periodontist the oral oral surgeon whoever they have some uniquenesses in even on the transaction side consultation rooms or exam with consultation that they may benefit from and so what are those other aspects besides an account of chairs that will facilitate that ability to bring in those kinds of patients on those days or or even expand your hours in the facility so that you can allow for that as well.

Howard: I think the break room is so important it's just in our office does something really neat we they play this game where they name food or something like I'll go in there and I'll be eating a ham sandwich I said Karen on it I game a game they play. One last trick question for you go when I get out of school in 87 the biggest guru in practice manager was Omar Reid and Jim Brown you mention but that Omar Reid used to always talk about front desk lessness he wanted a front desk listen yeah so and you just said bottleneck at the front so I know Omar I can hear his words thirty years ago saying I mean have a front desk so what would you say to someone who said hey what do you think about front desk lessness?

Jeff: So we lived through that time and we would do people you know person's a doctor after they're trying to get rid of the front desk and then we would we would talk through the rational case so how are we going to replace the front desk we're gonna do everything in the operatory okay we're gonna have credit card swipers in the ops attached to the charity you know and so it always broke down in conversation we probably 15, 20 times based on Omer reads saying that having doctors that went into design we started with no front desk and slowly over time we just put it all back in we just went right back there's the same kind of design principles you know and even today Howard well they're you know the hygienists they can reappoint their own rooms they never do it you know well it's you know I actually need to get out of there so we they have a hygiene assistant what's a break down the room clean it get another patient there it's more efficient the hygienist goes to a hygiene support niche and reports that the patient versus maybe go to the front turn over the room but it so it's all part of the experience with no we I mean we feel actually even more strongly about the front desk over time even with all the technology we're still and with I think the only thing that's maybe changed over time is we partitions sort of check out areas so there's more privacy so we would say in today's sort of environment you can't you can't introduce too much privacy you know back and maybe the 70s and the 80s everything was open a you know let's wear jeans and everybody hears everything a real jeans with bell-bottoms everybody hears everything everybody says well that you know people are just much more sensitive now and they they expect some level of privacy but yeah all of that that lasted for a while it just it never it never took hold I would guess.

Pat: Well you know like I said design follows dentistry, dentistry procedures are much more expansive it's not ten dollars at the front desk that I ran for I'm writing much bigger checks I'm investing much more dollar wise I need to have a lot more education understanding of what you're doing because I've never had a root canal I don't know what is what I don't know about veneers I need to understand more about that my gosh if I'm going to spend twenty twenty five thousand dollars I need an education experience I need to be able to do it in private I need to tell you why I'm afraid whether I can afford it or not etc etc so if we want to behave our patients commit to their dental health which we do and we have all these things that we can do beyond what we used to be able to do 15-20 years ago and there it'll be a pleasing outcome without a lot of pain we need a facility that will accommodate those adjustments if you will and I just emphasize the front area of the office helps feed production of those operatories so the operatories are a turnover if I can say and I don't mean like McDonald's hamburger but there's a turnover ratio that we want to see happening in those operatories and we don't want to have patients sitting there occupying a chair through a transaction process or through a lengthy education process or a lengthy diagnostic process there might be other spaces that can prove more beneficial to you what are those and so I think what I hope you're hearing in this it takes a lot of discussion with any practitioner what is it that you do how do you bring patients in what are you providing in service what do you wish you were providing in service to those patients and let's become let's create a facility that's gonna do that for you and it's not about spending money on Taj Mahal things it's about function and it's about delivering to the production or to the procedures and to the community that you're trying to serve.

Howard: So I know there's a hundred ways to do everything and but you've done I mean three thousand offices that the big question is should you have a treatment plan presentation room or case should you in the operatory where you have the radiographs pulled up and all the stuff what would you say all your experience doing this for 3,000 offices do they need a treatment plan presentation room or is that just as easily done chair side?

Pat: Well the answer is yes and yes so there's gonna be obviously when we say we definitely recommend a consultation room of some sort or treatment presentation room and then we have a conversation about what do you need in a treatment presentation room how many people would be at any one time in that treatment presentation room and we would design it as such but when we say that oftentimes dentists will go well I just I present treatment in the operatory of course you do that's where the opportunity presents itself obviously we're not eliminating that as anything that would go away because we have a consultation room but I want my teeth strained I want my teeth white I have things that are beyond a conversation that I might have in my hygiene appointment today and I'm really serious about that what's going to be involved with that you need to educate me I need to understand how I'm going to pay for it but I want to have it done and those are the situations where we say treatment opportunities that are more expansive can be presented very well in a treatment space it's planned that way. The other thing that we're seeing in GP practices is that room being users intake area I'm a new patient my best friend Veronica says I need to go see Howard and Here I am I'm your new patient and I've had some kind of history that you know nothing about but you can take me into that treatment area introduce yourself it could be the financial coordinator that does this or treatment coordinator does this just to explain this is what we are committing to here in this practice to you as a patient what are your goals what do you want to accomplish what are things that maybe you wanted to do that you haven't had the interest in or the opportunity to do let us see what we can do to facilitate those in your endeavor and a treatment presentation room can do that really well.

Jeff: Real quick idea so Howard so your highest producing per hour specialist is an oral surgeon correct?

Howard: Yes

Jeff: All oral surgeons have consult rooms they have exam consult rooms they have a concert room with a dental chair they would never bring somebody into their main surgical up and explain to them what an implant is or what you know extraction of four wisdom teeth so many GPS can take that as an example you know you present complex you know high costly treatment it's tough to do it in operatory you know it's much better it's much better and concentration room in a different setting.

Howard: Our one-hour interview is now at hour and a half and but I just want to say that I'm I still think first impressions are set in led they come in they see your facility for 32 years I've had you know they don't know what a statim sterilizer is you know many old ladies have told me well you know I'm in their waiting room and they got dust all over their dust boards they leave me back and there's water stains and I don't want to you know I don't even think that that place was filthy and then another thing is I what we've always done is when they come in it's their first impression well if you're I know guys don't do this but I know girls do if a girl goes over to some other girl's house for the first time that girl will always give him a tour of their house if I went over and visited Jeff I don't really want to see his closet at night really you know but I know it's a no thing but every single new patient when they come in for the first time they give them the walk through the deal and so there's a hygienist oh there's Amy there's Brandi there you know and then they bring them in that new patient caller the treatment plan presentation consultation or whatever and then I want to go in there and take out and go in there and look at him standing up shake their hand and then sit down in that first and perso so Jeff, Pat white why did you you know did you just move to Phoenix congratulations where'd you move from oh no I lived here ten years so you haven't been to the dentist for ten years or is that no I you know I'm changing and you you get that initial you know relationship and it's all about trust because if I tell you need four modo that they don't know if you need what a modo they don't know any of this stuff they have to see a team of facility and I also like name badges to say how long you've been here because when they see that the lady who shook their hand first dawn has been at the front desk for two decades and and and you know everybody's been there a decade plus then they start seeing trust and then and you're selling the invisible they need to see a facility they need to see long-term staff they need to see eye contact they need to see a dentist available and then I always give my card it's got my office number my cell phone number my personal email number and say hey you know you ever have a problem the book stops here and you know there's my cell phone number and only women never men will call me call that number while they're still in the office because they just know it's gonna be you know some it's not gonna be my cellphone and then all of a sudden you know your phone's ringing find out yeah she's sitting right there really you just gave me their cell phone number but hey on that note thank you so much for all that you guys do for dentistry and try to get try to get the John Q Baumann and put an hour, you know those kids they like that they like podcasts they like an hour online CE and they don't want to fly across the country before they exhausted you and see see at least seen what you're about on youtube or online CE but yeah I do an online CE course and get John on the show and thank you so much for all that you do for dentistry thank you so much for coming on the show today.

Jeff: Thanks for having us Howard, we really appreciate it.