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Dentistry Uncensored with Howard Farran
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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1315 Startup Practice Tips with Dr. Andrew Sarpotdar & Dr. Jenny Sun : Dentistry Uncensored with Howard Farran

1315 Startup Practice Tips with Dr. Andrew Sarpotdar & Dr. Jenny Sun : Dentistry Uncensored with Howard Farran

12/18/2019 6:00:00 AM   |   Comments: 0   |   Views: 337
Dr. Andrew Sarpotdar is a board-certified orthodontist in private practice with his wife, Dr Jenny Sun, in the greater Phoenix area. He attended dental school at UCLA before earning his Masters degree in orthodontics from Columbia University in 2013. Dr Sarpotdar is a co-founder of the Orthodontics Pearls Facebook group, along with its corresponding annual meeting, the Mother of Pearls Conference, and is a strong advocate for collegiality and shared learning within the profession. In his free time, he enjoys traveling the world with his wife, working out, and spending time with his twin puggles, Chief and Lexi. Dr. Jenny Sun is an orthodontist in private practice with her husband, Dr. Andrew Sarpotdar.  Dr. Sun was born in Beijing, China but moved to Gilbert Arizona at 13 years old, where she lived throughout her tenure at Arizona State University.  Upon graduation, she attended Columbia University in New York City where she took an interest in orthodontics.  After receiving her DDS, she moved on to Tufts University to complete her specialty training in orthodontics.  Today she lives in Peoria, AZ with her husband and puggles.  In her spare time she enjoys travelling, drawing, and watching the Bachelor.  She is one year into her startup practice that she manages with Dr. Sarpotdar.
VIDEO - DUwHF #1315 - Andrew Sarpotdar
AUDIO - DUwHF #1315 - Andrew Sarpotdar

It is just a huge, huge honor to be sitting in the studio with Andrew, so you say Sarpadar, so Sarpadar. It'll take a few times, Sarpadar. I mean, my, um, Spanish teacher, uh, Martin San Martin told my mom in a high school that I was linguistically challenged and my piano teacher, um, fired me as a student. And Jenny, Sun, and I can say Jenny Sun because that's not your real name; you made up a name like that for us Americans who can't say 'say' say your real name. Okay, I'm just gonna agree with that. These guys, um, are legends, uh, and Andrew is a board-certified orthodontist in private practice with his wife Jenny in the greater Phoenix area.

He attended dental school at ucla before earning his master's degree in orthodontics from columbia university in 2013 he's the co-founder of the orthodontics pearls facebook group along with its corresponding annual meeting the mother of pearls conference and is a strong advocate for collegiality and shared learning within the profession in his free time he enjoys traveling the world with his wife working out and spending time with his twin puggles puggles chief and lexi that's right is that after the kansas city chiefs doctor at the Kentucky Doctrine and dugu that going real confused to change it up no actually uh he was Chief Resident at UM Columbia for the program and um I had some friends in dental school who got into the habit of climbing, someone ironically, Yahoo, and uh we always talked about it when we met.

It premier call me 'She' for a while, real recognition that I'd im but then I said, you know if it's not going to stick for me, we should at least collaborate Chief so that's the long story before that comes from the Doctor's Journey student is an orthodontist some private practice with her husband, Andrew. Dr. Sun was born in Beijing, China, but moved to Gilbert, Arizona at 13 years old, where she lived throughout her tenure at Arizona State University. That's where I went. The Sun Devils. Upon graduation, she attended Columbia University in New York City, where she took an interest in orthodontics. Is that where you guys met? That's right. Yeah, he was in residency. I was in dental school. After receiving her DDS, she moved on to Tufts University to complete her specialty training in orthodontics.

Today, she lives in Peoria, Arizona with her husbands and puggles. In her spare time, she enjoys traveling, drawing, and watching The Bachelor. That's right. She is one year into her startup practice that she manages with her husband. And they met in 2012, both with a passion in orthodontics. They wish one day to build a family in Arizona and a career transforming the smiles of young kids and adults. Their mission is to help people feel more confident and empowered. Icon Orthodontics was born in 2014 with their vision to provide excellent clinical care, outstanding customer service, and a nurturing environment for their patients and their team members. So I think everybody wants to know the most obvious, who got a better orthodontic training program with Dr. Jamie Chen in Columbia or Dr.

Carol Ann Trautman at Tufts? I'm not touching this one. I feel like that's a constant debate in our household. Do you guys sit there and say, well, Dr. Jing said this. And the other says, well, Carol said this. Yeah. Do you get that a lot? Well, luckily, most of our diagnosis and treatment plan have been fairly similar. And when he and I talk about our training, we always jokingly put each other down and say that Tufts is better. He would always say Columbia is better. So Columbia is in New York City and Tufts in Boston. That's the two coolest cities. I mean, I think Boston's the coolest city. I mean, I remember one time lecturing up, and I was walking into a restaurant and you realize the street's higher than the door because the door is made in the 1600s and all the meteorites and dust falling into the earth.

Now the street is three, four feet higher than when the door was. So you get to see how the earth is growing. But when you walk into a restaurant where the door says built in 1640, you're like, wow, for America, that's, I mean, this town. So I call it dentistry and sensory because I don't like talking about it. I don't like talking about anything that everybody agrees on. I like to go right for the heart, but you can pass on any question. It seems like of the 10 specialties, orthodontics with this recent IPO on Wall Street, Smiles Direct Club, I mean, nothing like that's ever happened in pediatric dentistry or endo. Sure. So what's happening to your specialty and what do you make of all this?

Well, I think that's something that has been on all of our minds since 2013 when this said company first made its way. It's debut. There's been a lot of controversy throughout the dental profession, I think. I think that our knee-jerk reactions have been some of, I mean, I think some people see it almost as a form of disrespect or slighting the education that we've got to see like everything that we've done is now packaged into this at-home aligner kit. I mean, it's actually insulting on an emotional level for a lot of people. But once we get over that, I think we just need to look at what this is showing us about the industry, showing us about the demand for our services.

And I think the ones who are going to thrive in whatever new environment comes our way are the ones who are going to recognize what is this telling us? You know, there's clearly a demand for something that we haven't been offering in the past, whether that be convenience, whether that be lower prices, whether that's just clear aligners in general. I think there's many ways to sort of surf this wave and it's going to be up to us to figure out where we fit in with that. I do think that, one of the mistakes that a lot of people do is trying to compete head-to-head with this new thing. I see it as a bit short-sighted, probably a little bit lacking in understanding of the economics behind it.

For example, I mean, this is a company who, to my knowledge, I don't believe they've turned a profit yet. I believe they're still hemorrhaging money in the tens of millions of dollars every year. And I think I've seen copycats crop up. You've seen this in Phoenix. You know, we've seen the mall kiosks and we've seen, I mean, certain businesses try to go direct to consumer, eliminate or greatly reduce the doctor's influence there. And as we watch these things, most of them are closing down at this point. And we've seen this happen. I'm sure you've seen those in the malls even. I think there might've been one in the Chandler Mall, if I'm not mistaken. So I think that if we can get past the emotional aspect of this thing, there is opportunity in what this is making us aware of.

As well as the awareness that it's bringing to the public about what we do. I mean, we have such low market penetration right now. And I think a lot of that comes down to us failing as an industry to effectively market our services. Now that, in a sense, it's almost like these companies are doing the work for us. And as you've seen what's happened to their IPO, this is not, it's my prediction, this is not going to last as it has to this point. I'm sure it's going to evolve. It's going to change. And they'll find some way around the new regulations that are going to be coming out. But it's not going away entirely. And I think that there's opportunity for those of us who are willing and able to take advantage of that to ride this wave that's coming.

Okay, that was the Columbia take on everything. Now let's go over to Tufts. Do you agree with Columbia? Does Boston weigh in with New York? I definitely agree with everything that Andy had said. I feel like, the thing is, we cannot – Smile Direct Club has said that they are a dental service organization. They're not doctors. They're providing accounting, maybe the insurance billing, the marketing, they're a DSO. So, but we need to get down to where the doctors who are actually doing these ClinChecks, they're, I think they're getting paid $50 a click to approve these ClinChecks. And, most of them, actually, the ClinChecks I've heard that they get approved. It doesn't, I would assume that not everybody is class one mild crowding or spacing.

The ones that get approved, I've seen people like through the office where they had severe, severe crowding, severe bite issues, and they've also been approved. They've also gone through SCC. And in those cases, I mean, it's the doctors who approve those that are, you know, under, they're legal and ethical obligation to not serve these patients with the at-home aligners. You know, I find it interesting because, you know, when I got out of school in 87, and please don't tell me neither of you were born at that time, were you? I was four. You were four? I was four, yeah. Right on, right on. Were you alive? I was two. Okay. Okay. So I'm not that old. But, you know, the big brands of Colgate, Crest, Listerine, they all already existed.

The only brand I've seen that big in my lifetime out of nowhere was Invisalign. I mean, you, if you walk into a restaurant in Cambodia, the minute they find out you're a dentist, you're like, oh, do you know, they started asking about Invisalign. I mean, I've, my boys, I mean, they, just because they're sitting there with me, I remember in Ryan, in Somalia, they were asking Ryan about Invisalign, you know, because he was with me and I was at, I mean, it's a huge brand. So it goes, when you look at over the world, dentistry last year in the United States was, you know, there's 211 dentists. There's 7,000 Americans alive with a license to practice dentistry. And they built out $109 billion. There's 2 million dentists around the world.

And last year they did half a trillion. And when you look out at dentistry, everything's just creeping along one and a half, two and a half percent growth for cleanings, fillings, exams. The only double-digit growth is implants and clear aligners. Those are clearly the hottest thing at any meeting. I mean, if you're going to have a big dental meeting, you want to have someone showing you how to place implants and someone doing clear aligners, because seven and a half billion people want to look better because the number one goal of a species is to reproduce that offspring. You're not going to do that missing your front tooth, you know, and they just want to look more beautiful.

So, but I do see how the main difference I see is Invisalign tried to come forward with the business model that incorporated you two, Smiles Direct Club said, I don't know, I don't need you. And that was and that's why one is growing rapidly and one is contracting to what I think will be eventually a fatality. Well, I would tend to agree with that. I mean, fatality, I'm not sure. I mean, we've seen their stock plummet ever since the IPO. I mean, it dropped what, like 20, 30 percent the first day, enough so that they opened up a class-action suit on behalf of the investors for for fraud. And we see this in. You. Look at the at the breadcrumbs.

I mean, I'm not an expert on this, but I from the articles I've read, I understand one of the founding members selling his plane to the to the company for seven hundred fifty million dollars. I mean, they're under strict laws that prevent them from cashing out, but it seems like they're making every or they did make every effort to cash out within the bounds of legality and possibly even outside of those bounds. We'll find that out soon enough. So it's; it seems to me like they they have to know on some level. That there's that they're advertising essentially a technology that does not exist yet, and whether that's possible in the future remains to be seen. But I keep coming back to the Theranos example, a Theranos analogy. Are you familiar with Theranos?

Have you seen that? Yeah. That document. There is the blood. Sure. Yeah. Elizabeth Holmes. This became really well known when HBO made the documentary. I think it's called 'The Inventor' or 'The Founder' or something like that. I can't, I can never recall the exact name. But it's interesting to see how one of her idols was... was it Bell? I'm trying to remember now. It wasn't Bell. Thomas Edison. Thomas Edison. Mm hmm. And his model was just keep the funding going. Even if you don't have a product, convince people that you do and get that funding coming in and eventually you figure it out. And the story of his... I think it was telephone or light bulb. I'm horrible with these with these details. You'll have to excuse me. But it's interesting.

One of those inventions, a telephone light bulb. It was down to the wire as the story goes, and it was the night before he was basically had to cash out. And that's the day that he figured it out. And then now he's a hero by American standards. And I think Elizabeth Holmes was going down that route. She knew she didn't have a viable product. She knew that this was a technology that everyone said was impossible, which is the same thing they would say about the light bulb. And she just kept going in spite of that. And eventually she just she never quite tipped. I, you know, one speculation of mine is perhaps that's what's going on with with Smile Direct is that maybe they think if we can get this funding going, if we can get the funding based on the idea of something that sounds amazing, I mean, it almost sounds too good to be true.

And we're kind of finding out that it probably is. Then they can make it happen if they get that funding and get the research going. Maybe AI saves them. Who knows? But as we're seeing, the check is coming due and I don't think they have anything. Well, then. And the neat thing about Edison and and what later would be GE and versus Westinghouse is the winners always had a flair for marketing. I mean, when he came when they were working electricity, the first thing he did is the electric chair. He knew everybody would show up to see that. And then he did the World's Fair, I think that year was in Chicago, if you say so. And you know, at nighttime, the whole city's dark. So he lit up that whole Chicago fair, the World Fair.

But they all had a massive flair. I mean, it was a huge flair for marketing. But by the way, in that Smalls Drug Club, did you see that podcast I did with the that attorney Rick Stone? I missed that one. Yeah. I'll have to check that out. So Rick Stone, lawyer on lawsuits against Smalls Drug Club. This is the guy that that this is the guy that's going to take them down. And and I knew he wouldn't come on the show because he's a lawyer. And and I knew that I, you know, I had to contact him and ask anyway, and he immediately said, absolutely. And I thought, why would he do that? Well, why do you see all these television commercials? Have you been on television?

Have you been injured by, you know, multiple myeloma, you know, call the law firm and he just wanted leads. So we I interviewed him and just on YouTube, it had five hundred and eighty five views. But if you you should push this around with the orthodontist because what he's telling me is, he says, I need injured patients. And most of these orthodontists have seen one guy that had gum disease, somebody who got their fifty dollars for a claim check, but would not have been approved by anybody who sat down. And he's looking at him, sweating, that deal. Look at him like that. Can you see that? Look at this. I mean, this guy, he was burned in the midnight hours. This was this was crazy, but yeah, it's going to be a big fight.

And where where they're going to get in trouble is that fifty-dollar claim check where somebody clearly shouldn't have this treatment and they're getting it. So, you should push that around with more if you want to, if you want to kick, you know, dirt in the or make their problem worse, then more orthodontists should contact. Actually, there's there actually this actually has been a big push in the orthodontic community. And as you know, I'm co-admin on a Facebook group for orthodontists. It's fifty-five hundred and counting. Mothers of Pearl. Mother of Pearl. That's the conference. That's the name of the conference. The actual Facebook group is called Orthodontic Pearls. Orthodontic Pearls. And what's the deal with Pearls? You have to explain Mother of Pearls. Right. What's the group on Facebook if they want to go there?

It's called Orthodontic Pearls. Facebook.com/OOrthodontic Pearls. Orthodontic Pearls. And did you know, did you know the founder of Facebook? Did you know his dad's a dentist? I did know that. Yes. Ed comes on the show once a year to tell everybody what to do on Facebook, and I am we email a lot. Yeah, Ed helps me so much. So Facebook group Orthodontic Pearls, and then your conference is Mother of Pearls. Mother of Pearls. So explain the Pearl connection. What does that mean? Just white pearly teeth? So Orthodontic Pearls it was it was founded as a group to share your pearls. You know, just basically, your little ideas of how to treat cases better or like you know tie in this way and you get this much rotation or you know here use this sort of intrusion arch for for this type of occlusion.

Okay. So since then it's kind of grown. We just we let it evolve and it definitely has gone into more of a business focus in certain aspects. A lot of it actually has to do with social aspects as well. I mean, one of the things that we recognize most practitioners suffer through is the sense of loneliness being on our own island here. Anyone who's graduated and tried to start up a practice can certainly understand that. And, in a huge way, this alleviates some of that loneliness. Yeah. It helps to have multiple people across the country, across the world, really, that you can commiserate with and talk about your your universal struggles and just recognize that what we're going through is not anything unique. It feels that way in the beginning.

But for every problem there's someone else who has been through it and who has come out victorious on the other end. And this is a way of connecting us to all of those people. It's really been an amazing experience. And you know, it's really weird. It's really weird because, like, two dentists across the street are saying I'm competing with you. I'm you know I'll stay away, you know. And but if you're on the other side of the country then they're they open up. And and I remember when I got out of dental school I opened up got out May 11 went straight to Ahwatukee was open by September 21 '87 just one month in time for the the Black Monday where the stock market collapsed a quarter, and the phone didn't ring, one ring, for like three days.

But when I did that you know, you just left you know 120 classmates. So you just left this drunken, alcoholic, you know party. And so I'm banging on all the doors and half of them are like you shouldn't have been here. We don't need another dentist. And they were they like I like I was a germ or a bug and the other half were like come on in and you know we charcoal a burger had a beer. Now 32 years later guess which ones I think had a much more. Fun, exciting, rewarding career, I mean when I go out of town and I rolled over emergencies, I mean they don't want to drive to Glendale right? I I tell them to call Tom Madden, across the street, down by Jungle Roots, you know, down there.

It's like it's like these are your buddies, and and I mean for 30 years I'm so many times someone comes in and they're like, 'I'm gonna sue that guy because of this.' As I say, 'I'll tell you what, I'll just fix it for free if you knock off this lawsuit.' So he's a great guy. He's a great guy. He's a great man. Great family. It didn't turn out; I'll fix it for free, but you gotta knock off that deal because I'm sure if I went in your life, you've made mistakes too. But you know, it's just but so they they're they're always still friends with their four buddies from dental school, but they don't become that for friends with the guy across the street.

So, I want you to talk about that because that's what you're doing outstandingly, trying to get orthodontists to be colleagues and of course, colloquial, come on we're on the same team. You know what I like the most about the Smiles Direct Club? You don't like about it when Invisalign came out that the first orthodontic reaction I felt was that, well, you general dentists better not... you know, we were the bad guys! That we were trying to do Invisalign right now with Smiles Direct Club. Not now, we're their friend; yeah, your enemies enemy is your friend. So now the orthodontist are like you know I kind of like general dentists because that Smiles Direct is so bad that now the general dentist is not my enemy and it's like we've been on the same team the whole time and I almost think it took a Smiles Direct Club to get everybody on the same on the same team.

There's there's so much to unpack there but just to address your first statement there of uniting the we'll start with the orthodontic profession this has always been one of our goals and like you said Smile Direct Club is presenting sort of a common enemy I it's I don't know of an or well okay I'm not I'm not gonna say that but I there's you would have to search. Few and far between to find an orthodontist or a dentist who actually supports what they're what they're doing, and in the face of that common enemy, we do find a lot of common ground even within the orthodontic profession. We are so fragmented, and never has that been more clear than running a Facebook group.

Because most of the Facebook groups out there, they do have a very specific agenda, either this one is you know about pushing Invisalign or this one's about you know very financing a certain way. Whatever it is, no matter your niche, you're gonna find a Facebook group for it. Orthodontic Pearls we really are trying to remain neutral in all of this because we see it as it's it, we want to be an organic animal that should evolve with the profession and we don't that happens if we're shutting one voice out here or there. So we really founded ourselves on the idea of protecting the conversation, you know, keeping things from getting personal. You don't want to have any sort of derogatory language, sarcasm anything that really shuts down communication. Okay.

And then let's just have at it, you know, similar to what you're doing with this podcast, let's get into these controversial issues but discuss them like adults and come out with hopefully a richer understanding all the way around. That requires an open mind, it requires a level of professionalism that may not be for everyone, but I think that that's. I do see the effect that that's had in my own life as well as the those who are members of the forum. So when we started Dentaltown, so I started Dentaltown five years before Facebook because I was too stupid to think of the 2000s. I was impatient with every dentist. I was just being a dentist, thinking of dentists, of course, and it was very hard before emojis.

Because when you're talking to someone, you have, you know, a hundred million years of evolution with all these smiles and muscles and, you know, the nonverbal cues of being relaxed and non-threatened and non-aggressive. And I remember when Dentaltown started in 99, there were no emojis. So, you know, you would say something that was the funniest joke in the world. But you thought I was dead serious. And then your reply was profanity. And so they invented 'lol' before they invented an emoji. Yes, and when you're talking face-to-face, and I have a lot of problems even running a company. I mean, you know, I'll see a thread going, and finally, I intervene, say come on, you guys are eight feet from each other; get off the email; someone walk over there.

Because clearly, you don't understand what the other person's saying. But it's come a long way. You said something in the beginning I can't quit thinking about you said that the orthodontic talked about the orthodontic market penetration was low. Oh right. What what what what figure or number what are you thinking when you think that I'm not much of a numbers guy Howard but I do know that I believe that I may be misquoting myself on here we're at like one to three percent market penetration something like that into the number of potential patients who are actually undergoing orthodontic treatment. Yeah. The best place to read about that was in the smiles drug club when

in the IPO and that's what I tell people if the fastest way to learn economics is own one share of every publicly traded dental company like like Danaher just spun off Invista well they they have to by SEC send you a 10 quarterly report and then a 10k annual report and if they lie they go to jail and you can do that with Patterson and shine and all these companies and I love it because they're writing. To the Wall Street people who are the most analytical, and I love reading their 10-Ks; so many dentists they'll be saying something, I'm like well that's just not true because if this guy's at that company if that's a lie they're gonna go to jail for five years; they're not lying on a 10-K annual report.

But yeah the orthodontic market pen, so so when I was little I grew up in I was born in '62 it was just the most messed-up child would get ortho. And everybody was about five and a half kids per family, and then with with birth control technology as the family's got down to two now; I've seen a switch to it's an entitlement. I mean, I got two kids though, I mean I see people getting braces, I'm like well what's wrong? Well that teeth a little bit in the '60s you got braces because you couldn't eat corn on the cob to a chain-link fence; you know it was like it was like okay no one's gonna reproduce with this person; it'll have to be a nun or a priest if you want this kid to ever be a priest.

If they ever make you a grandchild, you're gonna have to fix them up before you put them on the market. So, and now it seems like you see the big orthodontic push in grammar school, and then you see it again after the first divorce they're going back on the market, and they need to get fixed up and touched up. Then, you know a second marriage is just it's the triumph of optimism over experience. And then they'll get it a third time. Right when they don't wear the retainers, and it all goes back. So, so in trying to get these dentists, you got this big group, you said there's 55,000 people on Facebook.com, Orthodontic Pearls correct. How do you... What is your goal? I mean let me back up and you know everybody wants to be more successful.

What I'm sure you're at the end of the day, your goal is you want these orthodontics to be more successful. What is your definition of success? What are you trying to achieve? So, that's that's a really good question now if you're asking us what are we trying to achieve on the forum itself, what is our definition of success? We mean, I think that evolves over time you have to be continually moving your goalpost. In the beginning, our original goal was, 'We just want to grow as fast as possible', which most startups would resonate with, that's so you know we were just we were recruiting people getting the biggest names that captured an audience, you know, posting on there and really drive our influence, and as we as we started to grow.

Like I said, we want this to be an organic thing; we're not trying to necessarily influence one way or another because we're it's all founded by people like me, you know we're about five to ten years out in practice, we're still learning and I'm I firmly believe in continual learning, I don't believe that the opinions I have today are going to be the ones I have five years, ten years from now; I certainly hope they're not the same, and I recognized that for me the growth is what's important. And I wanted to create. A form we wanted to create a form that is conducive to that growth to that change so, really our goal

is for first of all to sort of lighten the communication a little bit open facilitate that communication because what we notice is that there's just there's such tribalism even within specialties right now and I don't think that's ever going to go away that's just a part of human nature but if we can do something to sort of at least break down that wall in some way. And open communication and influence someone in a positive way, that's really our current goal for this. I think that. I don't know where I would be today if I hadn't found the online forums to discuss these sorts of things and I want to protect that for others well you know they all know it they just don't think about I mean they've been told since they're just all it's not what you know it's what you know and who you know.

Get out there and network, you know. You know when I open up my dental office, you know. Back then we you didn't have Facebook and you know all these things that are but. I open up my dental office and it was Monday through Friday 7 to 7, and then Saturday morning I got up and I got a big map of Ahwatukee. And back then it was Ahwatukee, it wasn't Phoenix Arizona, it got annexed, but. I went door-to-door; it took me half a year to walk down every street. When I walked down the street, I'd take a magic marker; I had this big old map in the back of my car. And I would knock on the door and say, 'Hey, I was 24. I said hey, I'm Howard, and I just opened up my dental office there.

And I'm gonna be there till I'm 65, and I just want to get out and meet the neighborhood, and if you need a dentist, I'm right there. About two out of three people it's like, 'Okay, you're a dentist.' Two out of three people like this is just weird, and I thought, well, there's eight other dentists on the corner, and they go back there, and the third guy would be out there it is you know, wife-beater shirt, and his underwear thing. Oh, I got it. I got your shirt. And then I put down my backpack, and I pull out my mirror and a flashlight, and we talk about it, and then I then I pull out my deal, and I said, 'Well, I have an opening 7 a.m.

to 7 p.m., till the end of time, does any of those hours work for you? And I wouldn't quit on Sunday until my next Monday through Friday every hour and a half I had a patient, but I got every one of them door-to-door. Now here it is, 32 years later, and I mean, last week in the office, someone said.' I can remember when you came to my door back in 1987, and there I mean I still have patients; I mean Mary Jo is one of my patients, and and she just passed away, but she every time she came in, she had to laugh and said, 'I can remember when you had hair and were knocking on my door.' So it's just like you just get out there and press the flush; they're just they're just humans; they want a relationship.

And the problem with dentistry is that when I took my, my favorite business that I try to reflect on the most is I'm Gruelix Automotive across the street. Love Gruelix; that's where we take our cars. You know what? To me. Oh, actually we live in Peoria. Because I grew up with five sisters, I played Barbie dolls till I was 12, so when I go to the mechanic and he says, 'You know, it's not your battery, it's your alternator, it's your lifters,' I don't know what a lifter is; I've never changed oil in a car. So I'm looking at him and I'm trying to say, 'Do I trust this guy? Remember in Peanuts cartoons whenever the adults talked it was wah wah wah wah' and when you start telling someone about you know their class 2 overbite and then they're all 'they hear wah wah wah wah' and you're just like, 'Do I trust this guy?' And when I tell you you have for an M.O.

a D.O. and a M.O.D. I mean, right where are you supposed to bounce that off your right where what lecture did you miss in high school to not know. So at the end of the day it's just like: is do I trust him or not exactly and it's a game of trust. I completely agree with that, and I believe that we're anywhere in the teeth business and most importantly we're in the people business, and I think that that that has to do with our patients of course it has to do with our team of doctors that we choose to work with, really every aspect even your landlord you know. And. And one of the advantages that the networking has provided me is the opportunity to visit some of the guys who I consider monumental successes, and see how they do things.

There's a lot to be said for actually visiting and observing; you can talk to someone online, they might give you their reasons for why they think they're successful, but half the time they don't even really understand it themselves, and they don't know your area or they might practice in this one very specific niche. But getting out there and observing it from from a third-person perspective. You can pick up on these things and really identify what is it that will work in my area, what is it that I want to test in my area, and maybe even come up with a new hypothesis for what is making this person successful, so you know, with by observing these people, you start to pick up on very subtle cues, and a lot of this has to do with emotional intelligence; the more I read, the more I recognize these are principles that have been written about before, you know how to win friends and influence people, all this stuff.

It's nothing really new, but we're so many of us are so used to being very technical about the details and that's how we've gotten to this point we're always focused on you know this millimeter or so off in the in the tooth or the prep or whatever you're doing there, that we tend to discount those people skills. And then once we graduate, the smart ones figure out pretty quickly that well from here on out, you have the skills already to over serve your patients in terms of what they need with dentistry. You can choose to use those or not, but really what's going to get you ahead at this point is like you said before, you know how are you marketing those amazing skills? How did Edison market that electricity?

That's the part that makes someone who's technically very good monumentally successful, and unfortunately we also see that it makes some people who are not that great, you know they find success too. But the principle there is, you have to, you have to understand and you have to embrace the fact that this is all about people and trust. Yeah, I mean definitely. In dental school, pretty much all we learned are the technical things. We didn't learn that much about business - how to run a business, how to successfully be a good boss, or how to manage staff. There are just so many things that are kind of running my life right now, but very little is about ortho and later on, I mean being out of school, out of residency for four years now, I do feel like it's too patient-centric.

It's not really about what you tell them; it's about how you made them feel. They won't remember I would say 95 percent of the things I tell them, but they will remember if they felt welcomed in the office, if everybody smiled at them, remembered their names, and if they felt special. So I feel like that's one thing for private practice to be very successful at, even DSOs you know, those dental corporations. Their turnover rate is very high, and I think that's part of the bigger problem. If somebody's number of clients is so high, they're not going to be able to provide that kind of service. And I'm hoping that's going to be what you know keeps private practice in for a long period of time.

Right, I think it's so funny how people are so afraid of the DSOs. My god, I mean the DSOs! I mean they're going to come in there and say, 'Well, I went in there and she said I had 10 cavities.' So I went in there to do the first two; she didn't work there anymore, and it's like, okay, so they can't even. You know what I'm afraid of? I'm afraid of the guy across the room talking about you know... It's fine. I'm going to train you. Yeah, the street that's had the same two hygienists for 25 years, and people recognize them at Safeway and Fry's! I mean, it's the relationships. Um, I want to, I want to... um ask you a question... a totally different question...

So when I got my MBA at ASU and um, and if you get a degree at ASU, you can really say U of A, because If you just go to Tucson, drive by U of A with your windows down, they'll throw a diploma in your back seat. So I should say ASU and U of A um but they um you know the only business model of retail has been um one-stop shop bigger for 200 years. So you go back to Manhattan in the 1800s and you had the little you know shop, maybe 100 square feet, and then they were put out of business because the next generation rented two shops and had twice as and it just kept going going going till they all maxed out at about 250,000 square feet for Walmart, Ikea, Costco all the big ones and then they realized Walmart released that study saying they got two shops.

That's not too big, people are now saying it's too big. I don't want to hassle with that, so they backed down, but $250,000 is the max. You see, you take your kid to a pediatric dentist, and the first thing mom's gonna say is, 'You think he's gonna need braces.' And her answer is, 'Oh well, here's a slip. I want you to get back in your car and drive down the road.' Like when I started lecturing in Australia in 1990, they didn't have a grocery store that sold meat, bread, vegetables. So back in Australia, 1990, you'd go to the butcher and then you go to the bread guy, and it's like, 'Where's the grocery store?' And it wasn't there yet. Now it's here, but now it seems like um the fastest growing business model is to combine pedo and ortho.

Do you think that? Do you agree or disagree? Or is that a more successful retail business model than having to go to the butcher, the baker, and the candlestick maker? Yeah, so, um, I actually do associate for a pedo ortho office, um, I'm the only orthodontist there and they have uh three to four pediatric dentists. It definitely makes the lives of our patients a lot easier - patients' parents they don't have to pick one up, untie the wire, drop them off, uh, get the cleaning and take them back up back to the orthodontist, put the wire in and then they're done for that visit uh with the at the pediatric dental office. I work out of um, I think that's a very very um main component of why they pick up pick us is because of the convenience.

However, you know because it's um one pedo office one orthodontist so I'm not there every day so that can you know cause some issues because with emergencies like bracket breaks um appliance falls off I'm not there all the time um so if we can have a full-time pedo, full-time ortho, full-time oral surgery all in one building that would be ideal for our patients where they can just you know walk across the hallway and get their other service. Um but with DSOs, yes they advertise that they have you know five different specialties there but one specialty is only there one day a week or one two days a month so that's peak I mean I've worked in a couple different uh DSOs uh Andy has worked in a couple different DSOs each office can only support an orthodontist you know four days a month.

Right. So that I think that's that's something that's uh that's important there is that the uh the ratios of practitioners have to be just right um I do see sometimes I mean we we notice this in in corporate you know and like she said I I started out working for um a few different corporations which is pretty much what everyone does nowadays and the uh what you what you gain in convenience of having it all under one roof sometimes you do lose in the convenience of accessibility um for example there's offices that I work out of where they had maybe three three GPs um and then like a handful of doctors and then like a handful of doctors and then like a

handful of specialists and each of the specialists were there maybe two days a month and um for that demographic it works because we were the cheapest in town and that works for people who are looking for cheap but I don't think that the biggest pull there Was convenience maybe in the sense that you know they're at the dentist and the dentist says, 'Hey, get your braces and it removes that barrier having to go to a different office, you know. Because I happen to be there that day, and we convert them, um. But it's, I don't think that anyone has mastered this group practice model yet, um. I've seen some, some come pretty close, but I would predict that in the future, we're going to see a lot more group practices, um.

I think that the strongest business model is getting the ratios, the proportions of practitioners just right, uh. But have everyone having some sort of skin in the game because what We notice is that in a DSO or even in most associate positions, the doctor does tend to turn over very frequently, and as you mentioned Howard, that can really lead to some dissatisfaction with the patients. It harms the continuity of care, especially in something like orthodontics where it goes on 12-18-24 months. Sometimes, if you're turning over your your doctor every 6-12 months, you're very rarely finishing those cases with the same guy. Oftentimes, that leads to increased treatment time because what we do is as much an art as a science, and if someone isn't doing the art exactly the same way, usually those first few Months when they're in that that new office, they're undoing what the previous guy did, and they're not doing the same thing and they're redoing it the way they did or they just continue to retie.

I've seen that too, and they're just sort of apathetic towards it. Um, I've definitely seen and inherited some cases from uh doctors who were kind of biding their time waiting for the next thing to open up. Um, and I think until these challenges get addressed that group practice model is always going to be sort of a second-tier, second-tier model. But I do believe it's the future, and what for those who can master it well. I always thought it. was fun that you learned something from every model like like you said um the first thing I thought is when you said um you know I mean how many I I do this all the time

but they they come into us and we um you know you you send them to us they take everything off then they come to us they clean and they go back well there was an orthodontist um Benjamin um Benjamin Burris Benjamin Gray Burris who was on the show um episode 439 and of course now he's actually um indicted um but one of the first things he got in trouble for is having hygienist right and I one of my listeners says you know Google says first do no evil and then all they do is Evil and, um, so the dentists always tell me: 'I always say, are you patient-focused? Are you dentist-focused?' Oh, I'm totally dentist-focused. What are your hours? Uh, Monday through Thursday, eight to five. Okay.

The Federal Reserve has more, um, PhD economists than any place on earth; I think like 3,200 and they've done a gazillion studies showing that one-third of America can't go to the hospital. So, what are your hours again? Uh, well, we got rid of Friday; we're just Monday through Thursday, eight to five. Well, you can't look at me with a straight face and say you're patient-focused if 32,000 doctors said that one-third of America can't go to you during those hours. And so here is Ben Burris, who I I always love because I know he's a rebel, rouser; he's a hell raiser. I mean, I know when you when you ever talked to an orthodontist about Ben Burris, you know what I'm talking about. Oh, of course, he's one of the most controversial figures in the dental community in general.

So I already want to go to Arkansas and drink with him; I'm just on on that referral. He's in Orlando now, well, yeah. When you start when you get caught for bribing an Arkansas senator, I'm sure no lawyer said 'Can you get out of Arkansas'... for now, but um, but the thing is... um, what did you... what what did you just on that? deal what's wrong with an orthodontist having a hygienist I mean just to address that because I've learned something for orthodontics from um back um when I was in the hospital I was in the hospital I was in the hospital I was in the gas for Lazara did orthodontic centers of America

I I think he he he was the only one that made it to the New York Stock Exchange had a billion dollar valuation and he he shot taught me something that I never even thought about imagine going to get your nails done and let's just say for easy man to get a mani pedi was a hundred dollars a month uh say you got it done every two weeks do you get a mani pedi Or not really, not really. Do you know? Okay, um, my um, I do, but it's only uh when my gay brother, uh, you know, wants to go get a mani pedi and I, so I get a mani pedi with my brother Paul; they even I, um.

But anyway, um, so I do that, but let's say it was fifty dollars to get a mani pedi and you got done twice a month, say it's a hundred a month. Well, if you walked in there and she said, 'Well, you know how hard to get a mani pedi?' It's a hundred dollars a month, and uh, so for a two-year treatment, it'd be twenty-four hundred dollars. I need one thousand down, and then we're gonna finance you for the remaining fourteen hundred if you approve a care credit. I'd be like, 'Whoa.' Whoa, whoa, what's going on? Well, that's what Gaspar said about orthodontics. He came out and he said, 'I got a pano and stuff.' The rest is my time.

Um, if I finance a sixty-five hundred dollar ortho case and I need a third down, am I gonna prepay one-third of my rent, mortgage, equipment, build that computer, insurance, staff, malpractice, nothing? So he came out and he said, 'Look, orthodontic centers in America: zero dollars down, zero percent financing. No one's denied; $1.99 a month, um, for two years.' And all these Americans said, 'Oh my god!' Because I wanted to go to you too, but it was sixty-five hundred. I need two thousand down, hell there's Dentists listening to this podcast, I don't have two thousand dollars right, and um, so and then in economics ASU they said well if you got a big economic barrier to entry demolish it, so I thought my gosh now, um, you know no one really talks about that business model but they look at every furniture ad no money down right, nobody denied, and now you're gonna they're gonna finance something you know for this share but anyway.

And then on Smiles Direct Club the first thing I thought is, 'Well do you need to see them every month for 24 months because these guys are saying we're gonna see you one time in and instead of 24 months, we're gonna get rid of 10. We're gonna see you one time here's 14 trays so my first thing is, well maybe you could see him every other tray so there you know there's so, you can't be orthodontic centers of America without some something unique, you can't be Smiles Direct Club without something unique, so I always looked at these as opportunities. It's about somebody tried something really big, it failed. Orthodontic centers of America Smiles Direct Club will fail and I'm sure they're they don't even know it yet.

Uh, Ben Burris tried to have the IHS for a cleaning, he failed. But so do you ever look at these big emotional orthodontic earthquake disasters? Sure! But take away a pearl? Absolutely. And I think Ben Burris is a classic example of this. Ben was uh, he was fairly prominent when I first graduated from my residency in 2013. Um I I feel like I owe a lot of my thinking to to Ben because he does have some he's a brilliant guy, uh, brilliant businessman. Um, the financing that he advocated for, that you referenced, I think that that really helped me and helped a lot of practices um, weather a storm so to speak. I will

say one one hole that I'd poke in the uh, in the nail analogy though is that um, with a with a nail salon, you're you get a procedure done, it's done that day, you can come back or not but it's like the the procedure's finished that day with orthodontics dentistry in general um, you have to think about this is uh, you know a one to two year process there. I think uh, the analogy that I like to use is more that of a contractor building a house or building a dental practice um, once except that we actually do maintain liability over that patient's well-being uh, for example one of the things that is tough about orthodontics is if a patient falls delinquent and they're mid-treatment, extracted teeth on them, we're closing space, we don't have the option of just saying 'well, you're done'.

Paying with us, we're not going to see you anymore, and that's something that maybe not everyone knows, but you can't do harm; you can't leave a patient worse off than where they were okay. But a quarter of my viewers are still in dental kindergarten school, so sure they might not understand patient abandonment. So okay, so explain to the kids in school: okay, uh... So about the extractions, about patient abandonment patient abandonment because the nail salon lady can say, 'I know I'm never getting nails exactly exactly.' But you got someone in the middle of treatment; you can't just say, 'Well, let's look at this from your perspective.' Of uh, of a dentist, you know, and a crown prep, um, I know that Sarek has risen to prominence recently, but um, in the old days we had to do the crown prep sometimes, that would take one or two visits in itself, um, you take the impression, send it out to the lab, takes a couple weeks to get back, then you cement it.

That procedure is not done until you cemented that final prep. Now let's say that um, you decide to finance this because hey, I, I'm starting the prep now, it's not about time and the cost of a burn impression material so you know, I'll do, you know, I'll do zero dollars down for this and I'll take the hit if it doesn't come back well, if that Patient doesn't pay you by the time that you're ready to cement that crown, you have a dilemma on your hands, you know. Do you cement the crown anyway and accept that well maybe this patient doesn't pay me later or do you abandon your patient and you leave them with a hole in their mouth, a tooth that is now worse off than where it started?

Um, ethically legally we're not able to do that as doctors. I hope maybe that provides a little more clarity, but again, it's it's sort of like a contractor - if yes there is there is a time in which you can collect that money and I'm a big advocate for patient financing; one of the things that we that We base our practice on, but I think that it's important not to overlook the challenge of patient abandonment that can come with it. Also, understand that you are inheriting some risk, and there have been studies on this. I know Jamie Reynolds who runs OrthoFi. Are you familiar with OrthoFi? OrthoFi, yes, it's uh, it's basically a company that helps streamline the the financing process.

So, the advantage is they've collected tons of data on this subject, and they found that for example, a patient if they're going to fall delinquent; Jamie Reynolds, yeah, he's uh, of Splain and Reynolds orthodontics out in Detroit. And they found that if a patient is going to fall delinquent, they're going to fall delinquent, and they're going to fall delinquent; they're usually going to fall delinquent within the first three months. Um, so patient abandonment aside, if you can identify that, um, and perhaps avoid extracting or avoid doing something that's going to leave that patient worse off than where you started, you can kind of skirt around that issue while also it's sort of a soft internal credit monitoring, so to speak.

Um, so I I'm actually a huge advocate for that; but of course, patient abandonment makes the financing um, significant more challenging. and I will say that I have had to render quote-unquote free treatment to patients who I started with a with an incredibly generous financing plan um we extracted teeth on them early on and they didn't pay a single bill after that and now I've bought that case and I'm doing it for free um so I you know it's there's there's nuance to it there's uh there's definitely some risk that you inherit and I think that we should factor that into our financing decisions as well and sorry and I think with orthodontics it's a it's a it's a it's a it's a it's a it's a it's a it's a it's a orthodontics a lot of our um how our result turnout is how we Diagnose, treatment plan: How we place the brackets so a lot of what we've learned our knowledge is invested in that first visit.

I've had patients where we place brackets generously, financing, and then they continue their treatment in Mexico; um, they drive down to Mexico now to do their adjustments because you know the brackets are ours, the wires are ours, the bracket placement is which is I think one of the things in orthodontics that's ours. But now they can continue their treatment elsewhere because they feel like it's, um, maybe they can't afford the monthly payments or maybe they're just taking advantage of the low down payment because in Mexico I think that you do like um five hundred dollars to get it on and like a hundred dollars every time you go back kind of like what you were you're saying the nail salon comparison um but I I feel like as orthodontists we what we do a lot is the initial the treatment

planning and the bracket positioning and and then usually you know we see them back every six to eight weeks to um tie the wire change wires and sometimes yeah we can stretch it out a little bit longer but um I would say especially with like twin twin brackets the old ties uh wear out pretty pretty um they don't know what twin brackets are The ones that are traditional, see it when I was little, I asked for clear liners but he said, 'Dude, you're gonna end up so let's put your teeth behind bars for now to start getting used to living behind bars.' I haven't used that one; I'm gonna have to remember that. Um, I want to switch topics. Um, are you guys considered boomers or are millennials?

Millennials are you guys both a millennial? So, I think you're you're like well within the millennial; I'm more of like, I so I'm kind of a foot in both camps I'm like that 83, you know, in 1983. Um, we consider ourselves the zennial generation. I want to ask if this is um, you know, you've been in the business For a long time, and you've been in the business for a long time, and you don't know if this is real or just your perception. But my gosh, you know I graduated May 11th in Kansas City. I got my car, I drove straight to Phoenix, and signed my lease had it open September 21. I see

your generation; they come out, they get a job here for a year, and then they hate it, and they go get a job here for a year, and then in five years, they've had five different jobs, and and they're never happy until they finally just go open up their own practice right, and I tell these people I say you know when because we got two different dental schools here; we got Midwestern in Glendale, and we got an A.T. still right up the street and now Mesa, and I tell these people I said well if your idea is so great, well it's 2020, go back to 2015, get a list of all the graduates; they

should all be working for someone else happily ever after, and just loving it because I know my homies, and when you go to school eight years of college, you're not going to agree with anybody the rest of your life if if you want to have a bunch of people agree with you hire a bunch of 18-year-olds or high schoolers, and you're going to have multiple dropouts; but no dentist works for another dentist and says oh yeah I agree with everything he does. Right, and so why, why do they job hop, job hop, job until they're so usually they usually they don't open up their practice. Let's say you know I'm so miserable, I hate dentistry, so bad at this point, I don't care if a dump truck runs over me.

So I'm just going to open up my own office and I'm like, 'I told you that five years ago.' Do you think my generation? If we're going to learn how to swim, just walked out of the swimming pool and dove in, of course. And your generation walked around the pool more reading more books about swimming before it jumped in or or do you think it's the same delay? That's a really good question. I think that, um, it's I think a lot of that I'd like to think it has to do with external factors as well. I think that the dental market has more or less it's not fully matured but certainly more matured and I think that's a really good question and I think that's a really good question and I think that's a really good question and I think that's a really good question and I think that's a really good question.

And I, I only know what I've heard from more seasoned docs, I only know what I've read in books but I understand it, you know the market was quite different back then, we didn't have the competition that we have today from DSOs. other other doctors uh it was very traditional to start working in a practice maybe as an associate eventually partner in and take over the practice fairly amicably what we're noticing uh from the discussions that I see on on Facebook and just with other people in my generation is that you know you're you're you're you're you're you're you're you're you're you're you're you're one of the biggest challenges we face with getting our own practice is that there's not a whole lot of room to start up anymore.

I mean, areas are fairly saturated. But most importantly, the senior docs – they’re not selling as much as they used to. Or by the time they’re selling, it’s 10 years past their expiration date. I know that when I first came out of school, I never wanted to start up. You know, my first thing, I wanted to buy a practice just like anyone else. I remember I started looking for practices to buy when I was still in residency because I knew that's the way I wanted to go. The practices that I did find just weren’t viable. They were declining practices. They were in areas that I just, I didn’t see a lot of growth. I didn’t see a lot of potential there. You’re basically buying a liability.

So the inventory, I think, is a huge factor for us. I think there's a lot of uncertainty about the future of the dental market. I think that that does factor into people's decisions. Like, am I going to, right now is actually around the world. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't really good time to be selling your practice. The DSO market has really driven up the prices of these practices right now. And we're looking at practices selling for well above 100% of collections, which didn't used to happen. Well, do I have a surprise for you?

One of the greatest advantages of being old, besides like diabetes and erectile dysfunction and all these other things, is that I have seen four economic economic expansions and contractions i got out of high school in 1980 that was the worst i'd ever seen ever interest rates were 21 unemployment and and inflation was double digit that was the worst i've ever seen i've seen nothing close to that and then it got better than 87 i graduated may 11 and september 21 was black monday the stock market dropped a quarter and then i saw the longest expansion 93 to 2000 the y2k bubble um march of 2000 you know as i went from 5800 to 1600

um and then 10 years ago lehman's day and um if you know you can't predict the future because the future doesn't exist anymore in the past there's only the present in the universe right according to albert and um so um but it smells like what's that nirvana song smells like teen spirit or it's smell it's the same smell and when you look at the public information of the available dso transactions their debt is all rated as you junk and they're it's all based on this cheap money where you know the interest rates have been negative one percent for a decade and but during a contraction you have to economically leverage so these dsos when um i talk To any DSO, and we've had the 100 largest DSO CEOs on the show; um, they're all the same - they're all about 30 offices and 10 are doing great, 10 are okay, and 10 are just dogs.

Taking them under and during that economic contraction, the next economic contraction which could be you never know, I mean it's like no one predicted the fall of the Berlin Wall; no one can predict the next uh um Black Monday. But when it happens, there's going to be so many DSO portfolio orthodontic practices there's going to be so much liquidity on the market because they don't they're they're not going to just keep giving them cheap free money right. And, that's the bottom line, and that's the bottom line, and that's the bottom line, and that's the bottom line of an of an economic cycle, you know. You can grow, grow, and grow when your banker just keeps throwing money.

We talked about that beginning with Theos where, where you know she probably knew she didn't have the product but if she got enough money, enough momentum, could cash flow, enough scientists she figured out at the end, well. The minute the bank calls your loan and says you're not getting any more free candy, then you have to sell your assets to stay afloat. So, um, I was just lecturing uh in Scottsdale last Week to a bunch of uh dental practice transition people and I was so impressed, they all knew that that wasn't news to any of them; they all they had more data on that than I did. They know of um all these DSO models that are um you know like say 10M are making money, 10M are kind of deal but 10M are almost going to take them under; they're all going to be for sale.

So you see the DS, you see the dental transition um organizations ramping up; they're hiring people right and left. But I was wondering: my lead under that is, are there any orthodontic DSOs out there that you think are um the the ones that are doing well and making money? Any out there where you're like, 'Yeah, that thing's going to be for sale the next downturn.' Yeah, you're talking DSOs specifically orthodontics. Uh, yes, on orthodontics I'd say, you know it's it's hard for me to say which ones are doing poorly; I don't have access to those numbers. I do know, um, you know Scott Law who owns Smile Docs is growing like crazy right so

um really that's the only one that I'm uh somewhat familiar with so but I, you know, I do know just from talking to people, Scott Law, law yeah Law with Smile Docs, Smile Docs, yes and you think that's the the um probably the best example of one to my knowledge; I know that that's One that has been growing a lot, um, some of my friends have ended up selling their practices to his, and these are people that I respect, who have had you know, incredible practices, incredible cultures. Scott speaks and speaks to him in person, and he's, um, he's going to be a force to be reckoned with, I think, in the future, specifically in the orthodontic DSO market.

What's incredible about what he's doing is that it is, he's running orthodontic offices; you don't see that a lot with with DSOs, usually the DSOs are more dentistry centric and then the specialists are more peripheral, and you bring in a specialist a couple Times a month just to get some extra income up your overhead, but he is his practices are all orthodontic specialist offices so um, to my knowledge, he's doing a really good job out there and I am, I'm curious to watch how they uh, how they continue to expand. Scott Law was oh, there it is, orthodontist, okay? And where's he headquartered out of it's in Texas, I want to say it's Austin, Texas that could be it Parker Heights, Texas, huh?

That that was uh, that's a new one for me, thank you for that, of course. And um, and then we, we're, I can't believe we already went over an hour, uh, but uh, don't worry, I've never stayed on time, and uh, I'm sure you got patience. but um back in dental one of the things we started this podcast was it's not just what you know it's it's who you know it's networking um i don't know i maybe is he that even if you want to be an orthodontist maybe that also involves pressing the flesh knowing names but it seems like my homies um you know they they got a's in calculus physics geometry they're

introverts i mean i mean i was at creighton university i mean every night you know every night we'd hear the same thing the library will be closing in 10 minutes i mean we were we're geeks so how do you get that introvert geek you got a in calculus physics geometry and it's probably the only guy in his city who knows the difference between cosine and tangent to actually go press the flesh and have lunch with another dentist because i remember when i okay i was in california and i opened up you know these specialists said you go back and then in the break room there'd be some cake or something from a cookies right

it's like i don't want cake and cookies i i want i want to meet you i i and and um i i want to um i want to meet my homie and it's like it seems like it was easier for them like well we just want to send a pound cake we don't actually want you to be able to pick me out of a police lineup so how do you coach young introvert scientists to be pressy yeah i mean i think um when he was starting up i was still in residency we would uh i would come up here and we would go out to dental offices and try to put our faces out

there so that way they know that we're we're people we're not just uh you know hiding behind a desk and um you know trying to get people to refer to us we want to be able to meet our general dentist to meet our pediatric dentist all the specialists and to know that we are here like you said we're here we're here for the next 50 years and uh you don't have to if you don't have time it's okay we'll come back um just to keep on keep on Going to not give up, you may not see any results for probably a couple years because people don't know who you are; they're busy, general dentists are busy. I mean, they don't like it when someone just stops by and messes up their schedule, so I understand.

Sometimes you try to coordinate with their marketing person to try to set up a lunch, try to bring their team lunch, and then you know the dentist may have some time to stop by during the lunch and say hi. It's just about uh, consistency; to just keep on going and um, trying our best to show our faces and uh, and you know, show up for their kids' performances like if you're if you're becoming um better friends to to show that you care and that we're not um we're we're not enemies we're we're trying to grow uh this profession together and we're trying to grow uh this profession together we're trying to make uh the

communication between uh dentists and specialists better like now a lot of times we can email these uh referrals or facebook these referrals sometimes like we can get a question answered in five minutes when patients still in the chair and that's what makes the patient experience much better too so if they're irish you bring them beer and sure yeah they don't want lunch they just want the Same thing, I notice um some differences like pediatric dentists and dentists and dentists and dentists and dentists and dentists, like 32 years ago the pediatric dentists were always trying to court the general dentist, and then they learned that no, no, no, court the obgyns and the pediatricians, you know, court them, and they get now, they their only focus is on pediatricians not general dentists and general dentists are the worst because you wait till that kid's six or seven, that has a bad experience, and then it goes shows that they don't even want that kid, um, so where do orthodontists get their most referrals?

It from pediatric dentists or is it general dentist, I mean for the whole industry at large. I think that it really were seeing a lot of different models right now. I can speak from my own experience; I can speculate on others. Um, I'll say in the very beginning, um, the only patients that I was able to treat were the ones who were friends with my one employee, you know. And I remember sitting there thinking, 'I mean, I'd knock on the dentist doors, but like Dr. Sun alluded to, they're not going to take a chance on the new guy when there's five other guys who've been around 20 years. You know, it's like they know his work; there's nothing wrong with Him, why would they not be able to treat him?

You know it's like they know what's except for pity, you know what? What are they going to do to help? You know what's... really weird is... again, I've been out here 32 years and every conversation I've ever had um with a dentist about referrals is always comes down the same thing. This guy was the best endodontist in Tempe, this is the best orthodontist in Awatuki um, but the patients don't like him. And this guy, you know he's some of his root canals are short, some are long, but... um, um, but like like in um like in um Awatuki, the orthodontic community is crowded out by these two guys, they're both from Canada, who just has more personality than you can do, and it's never going to come down to quality; it comes down to mom coming back saying, 'Oh, I love him; he's so sweet, right?' And this one endodontist who um, I love him; he's one of my friends; he's the best, but my god, I don't think anybody likes him.

I mean, he would do a procedure and then schedule when the have the suture comes out, send him to my office, have me do it. I said, 'Why the hell am I doing your suture removal?' And he's just that kind of a freak; and um, but um, so it's just the um the patients don't know what a MO or DO is, and they they never remember what you said; they just remember how you Made them feel. And if you um um talk down to them and get them to disagree acetylcholine and epinephrine and norepinephrine they hate you and they never come back right. And if you make them secrete dopamine, serotonin, and oxytocin, they just love you and I. And I would say that um to you homies out there, I i know you, man.

You're an introvert geek, um, and that's why you always you know when they're hiring a receptionist, they hire the first person that reminds them of the librarian at dental school. And you can just walk in an office and smell the 750,000 collection. or less because you just walk in there and it smells like a library sounds like a library you're in a library and man you can smell the million dollar plus practices in one instant because you walk in there and you just feel something instantly and then you see these consultants going in there and they're they're writing scripts to your receptionist of what to say dude when you have to write a script

on how to talk to another human let's just find another human i mean you know i know um you know i mean you know i mean i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i got valerie answer at the front desk she could talk to a tree two hours and um it's it's it's tough because we're You know, we, we, we master the millimeters, but our customers don't, don't even know what a millimeter is. I mean, in America, you only know metric if you sell drugs, uh, grams, uh, kilos, you know, but no one cares about metric, no one cares about millimeters.

They just know 'I like you' and if I like you and you hear it with the deals they'll say, 'Oh, you should go to my doctor.' They never said they were board certified. You guys are both board certified. Yes, I've never heard of a person just a simple question: 'Oh, you should use my doctor' was he board certified? You know where he went to school? He ever had license taken away? Does he ever serve time in Florence? They don't know anything about them often, the ones who ask those questions, they're not the patients that you want anyway because they're going to make your lives miserable into those little kind of details usually. There's something, let's end on that question. Why did you go through the board-certified what does that mean to you?

Because that was a lot of work, of course. Well, I think that you know, board certification is definitely a a topic that comes up a lot on on the forums, it comes up, you know, is it a differentiator, is it um, you know, is it just an intrinsic sort of value for you and um, I'll say first, I don't see it especially. As a differentiator, maybe in some markets, maybe with some people, they like to see that I mean, I we, I keep the plaque on the wall and you know one out of a hundred consults will like make mention of that's that's cool, usually they don't know what it means, they're just as they're just as blown away by the diplomas.

Um, I think that within the orthodontic profession, you it's rare that you'll find someone nowadays who truly tries to use that as a differentiator. I think a lot of that has been debunked at this point; the value that I see in the board certification is more about the process to get there. Uh, I was lucky enough to finish my Cases in residency, so for me it was like you know, I'm not I mean, I actually even questioned should I go take this exam or not, you know, because it's still two thousand bucks, it's time away from the clinic, you know. I have no money when you graduate and it's a huge expense to fly to St. Louis and show your cases, you know.

It's and you have to study for it, it's another exam, I thought I was done with all this stuff, you know. But it came down to, you know, I have my exam and, you know, I'm in for a penny in for a pound, I want to go as far as I can with this, so I go out there and take it, and the the process of just re-studying all the cases that I had. completed in residency or even just identifying which cases are going to qualify for a board exam then reviewing all the material again and presenting it in front of people who will pick your cases apart, they will make you feel like the worst orthodontist ever, and that's when you still pass the exam, but the point is you learn to look for the minutiae of those details and you get a new perspective on the on what you're missing; more I mean, you can have great cases without that, but how do you get a new perspective on what you're missing more?

I mean, you know that they're great cases and I think that there's nothing that you get in the board certification process that you can't get from self-study but not all of us will take that time to study in that level of detail or seek out the kind of mentors that will pick apart your cases to that level of detail and to me i think that's the the biggest value of the of the certification process of course it's a source of intrinsic pride for me but it's um it's really it was really the learning experience that i that i got most value out of when you got your board certification did she start calling

you chief again oh man i tried i cannot i cannot get her to do that man just once on air can you call me chief oh my god um last last thing i just want to part one thing first of all thank you so much for coming out of your days to come down here of course but the one thing about i know about my homies is that um you're doing this big facebook group so when you um and ed zuckerberg who's you know fathered mark who owns facebook he can tell you 90 of people on on social media platforms of every kind they just lurk only 10 per only one percent so true or original content nine will engage 90 will say nothing but that's for the whole facebook in the world and twitter and linkedin all this stuff but i'm just talking about dentists that's my um that's my home Turf, when you have dentists on your Facebook group, um, nine out of ten are going to say nothing.

When you have your Mother of Pearls conference, they're all going to be in classroom style, but MTA's Manji, you know, Scott Stillman Center, he's come on the show and talked about this many times, but you have to be under seven or nine at the table before they'll do like this board certification where they'll pull out their cases engage and show you their worst nightmare. Right? But MTA says um, because his um, Scussell Center uh, is actually it's; they have more study clubs that people people always think about the center. But their real strength is the number of study clubs they have around, and MTA says you know um they all they just crush it at seven and under, particularly five.

So if you guys are ever setting up study clubs for orthodontists or say you want to have general dentists who want to learn more about Invisalign or something like that, um when you get it to a table like this I'll pull out my study models and show you the root canal that I perfomed and they got a purchase went out their nose and the patient almost died. But once it's seven or nine, they're going to be in the center, and they're going to be in the center nine, then at about seven. to nine they clam up they go into classroom style and they're on facebook and they're just taking it all in but they're

never going to show their cards so in the flesh press the flood that's why um that's why um you know press the flesh go go to lunch with them one-on-one and and that's why i like the reps because the reps that i use it's not whether benco burkhardt or whatever that the reps i use is because she's the one to say you know i'm going to say hey thursday at this bar you know three of us are going to go out there and and i'll just go for the beer and the next thing you know they're relaxed or loosen up and it's all the connections Like the implant I use is from the implant rep who can get the most people together in the small, intimate seven dentists. Or, because if you went to the bar and there were 20 dentists in the room, well then now you're on Facebook again, yep! But you go to that bar and there's only four people, and you're like, 'Oh my god, I'm going to go to that bar and there's only four people or five people.' You'll open up. But on that note, thank you so much, so much for coming on the show, it's been a pleasure, honor to thank you, yes! You both, chief! Finally, all right, some recognition.
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