Dr. Allington started working in his father’s dental office in Peterborough Ontario at the age of 14. After finishing his BSc and MSc at Queen’s University he did 1 year internship and Hoffmann La Roche in Basel Switzerland. In 2001 he entered McGill Dental School in Montreal Quebec graduating in 2005. Following a 1 year AEGD residency at the University of Connecticut, he returned to Montreal working in variety of practices in Ontario, Quebec and Vermont and teaching part time at McGill. His goal was to get as much experience as possible prior to moving to his ultimate destination Bermuda in 2008. He worked as an associate from 2008 until 2018 when he purchased the practice where he works full time. He has served as the President of the Bermuda Dental Association and is the current Chair of the Bermuda Dental Board. Dr. Allington is a Fellow of the Academy of General Dentistry, Fellow of the ICOI and has been an Invisalign gold plus provider. Recently, he has begun organizing dental continuing education bringing speakers to Bermuda to help educate his office and the rest of the Dental community.
VIDEO - DUwHF #1332 - Chris Allington
AUDIO - DUwHF #1332 - Chris Allington
Howard: it is just a huge honor for me today to be podcast interviewing Dr. Chris Allington: DMD AEG D which is an advanced education general dentistry which he got from UConn he started working with his father's dental office in Peterborough Ontario Canada at the age of 14 after finishing his Bachelor of Science and Masters of Science at the Queen's University he did a one-year internship at hoffman-laroche and bacillus whittlin in 2001 he entered McGill dental school in Montreal Quebec graduating in 2005 following a one-year a EGD residency he returned to Montreal working in a variety practices and all Theriault Quebec and Vermont and teaching part-time at McGill his goal was to get as much experience as possible prior to moving to his ultimate destination Bermuda in 2008 he worked as an associate from 2008 until 2018 when he purchased the practice where he works full-time he has served as the president of the Bermuda Dental Association and is the current chair of the Bermuda Dental Board dr. Ellington is a fellow of the Academy of general dentistry fellow of the i co i international congress soil hunt ology and has an Invisalign plus goal provider recently he began organizing dental continued education bringing speakers to Bermuda to help educate his office and the rest of the dental community when not working he enjoys traveling spending time with his wife and two daughters and keeping in shape while playing ball hockey with a bunch of Canadians stuck on the rock so my my gosh oh thanks so much for coming on the show well thank you for having me hard great great honor so what's the population of Bermuda and how many dentist are there
Dr. Chris Allington: well we are about 60,000 people it's always in a little bit of flux and there are between 25 and 30 dentists depending on what you define as a dentist specialist to part-time guy working part-time so so it's it's how many people 60,000 and between 25 and 30 dentists
Howard: Wow so the the first thing I want to talk about is when you go to these islands and they're like small towns but they're really defined margins so what is the what is the culture like of the twenty five thirty dentists I mean because you're with the Bermuda Dental Association and you're the chair of the Bermuda Dental Board yeah so you know all of those 25 dentist
Dr. Chris Allington: so yeah it's a good thing and a bad thing you had access to all the dentist but you also they all have access to you which is great but if there's ever a problem you know everybody so there's it's very different it's very difficult to be impartial you know it's interesting we if you look on the island there's basically three places people have trained Candida the US or the UK we have one or two that trained in the border the three places Canada the US and the United Kingdom so it's pretty close to a third I've never done that I've never counted but it's pretty close to a third a third a third a third trained in Canada a third training in the US and a third trained in the UK so it leads to an interesting culture and you know it's being so small here you'd think that it would be more you know streamlined people might do things more the same but I would dare to reckon that we have the same diversity of care and treatment as you would get in the United States the only thing we lack is some of the specialists but we've got we've got everything here we've got one of the guys here has been an educator at spheres we've got some exceptionally good dentists and then we've just got you know something you find in any small town any town in in the US or even in a big city so it's interesting when you get to a small community you realize it's kind of the same as a big community with a few different exceptions
Howard: so that's the that's a business to population ratio of 1 to 21 about 2,000 so that that's the same ratio as the United States
Dr. Chris Allington: it's quite similar yeah and it's always a debate here you know do we need more dentists do we not anymore dentist when I first came to Bermuda in 2008 there are a couple older guys just retiring and slowing down a couple guys that did retire and they literally had no one to give their practices to I mean you look at the dynamics that one major difference between Canada between North America and Bermuda is that we don't really advertise here so when I came down I'm like I'm able to do a little bit advertising try to get some people in it coming from Montreal which was hyper competitive and boss is like probably not needed we're I'm sort of overflowing when I first came in the practice was booking out for restorative appointments nine months ahead of time so I really had to pick up some of the stuff that was just lagging so I I was busy right away that's changed today substantially we've got a lot more dentist here a lot more a lot more people looking looking for work and the dentists calendars are starting to get a little bit patchy ER but when I do when I mentioned advertising to patients a few of them said if I ever saw you advertising there's no way I'd show up your office because it means you're bad dentist you got advertised so it's all word of mouth here small communities word gets around fast and it's worked well and and there's so many vanities and disadvantages to that and I was speaking to a guy like you who's always been on the cutting edge of advertising might seem might seem like it's a little horn but you know we we try to we try to do marketing but we don't track we don't do a lot of advertising
Howard: yeah so the so it's it's it's a British I'm gonna be independent country but it's a British we're a British dependent territory so so is that um so do you trade the British pound or the US dollar or the Canadian or all three and
Dr. Chris Allington: we're pegged to the u.s. dollar so the currency is the same we have our own dollar we have our own currency but it is pegged one to one to the US dollar and it's been able to maintain and do that because of all the international business here which started with tourism back in the 50s 60s and 70s and now is mostly international insurance and reinsurance businesses so there's a good chance that your that your insurance provider in the United States your malpractice provider is reinsured in Bermuda because there's really only there's three big centers in the and we're one of them
Howard: yeah that's kind of the UH that that's a whole yeah we could do a podcast just just on on on the need for all these people to go to these islands so so let's back up all the way how did you growing up in Canada decide you wanted to go live the rest of your life on an island in Bermuda which how far away is that from the I'm looking at it on the map that's how far is that from the mainland if you could so straight to North America from
Dr. Chris Allington: so the closest point of land is 600 miles off of North Carolina the quickest flight here is usually up to New York which is a about an hour and 15 minutes flight time and why I came down here I found I met a woman yeah I married in for median my father grew up I grew up I worked in my dad's office sweeping his floors when I was in high school and eventually found my way into dental school and it was never certainly that I was going back to Peterborough to work but it was always in the back of my mind but I moved back from Europe to start McGill and I had decided oh I didn't want to be in a relationship or date anyone I just said hey I just finished a long term relationship and the first day I was there I met my wife and that was that so within about three months it became pretty apparent that if we were together I was coming to Bermuda so I started looking at it and it looked to be a pretty good place to go
Howard: so just from that on that was sort of the goal it's a pretty rare behavior only three according to the UN only 3% of the world's seven and a half billion people live currently in a country they weren't born in and it's always because of work or love I mean that that's that's the whole the whole deal so you went there and then met your wife
Dr. Chris Allington: no she I met her at McGill actually she's she's a physician oh and McGill was one of the one of the first school they think Harvard might have been the first one but basically maybe they ran out of money and they needed to amalgamate some some of the courses for medicine and dentistry so I think most schools will have some overlap but what McGill did was they actually enrolled the dental students in the first two year curriculum of medicine so we didn't do much on teeth at all for the first year in a year and a half two years at McGill because we were studying with the medical faculty which my wife was in so that's how we met they didn't distinguish between doctor dentists and physicians so that just went from there
Dr. Chris Allington: well it's the better system and when people always talk about how great their country is it's like well come on dude there's 200 countries can you tell me what's better or worse in all the other countries and the the Soviet Union did the best I mean the dentistry was a branch medicine and it was called stomatology and what I and it was so great because I'm undergrads the same the first two years is the same when I was in dental school all of our teachers for the first two years taught at the med school but what I like about it is when you're an older dentist and something happens and you can't do surgery all day you can just go back and do a residency and dermatology and then now you're a dermatologists or go back to the hospital so yes I mean it makes no sense that every part of the body is integrated with an MD except the DDS and the podiatrists you know and I like the reason why the US Congress covered the chiropractor's and their Medicare and Medicaid because they said you know if you have a lower back problem you go to an MD they're gonna spend fifty thousand dollars and do some surgery fusions spine thing and then five years later you still have a problem and you go to the chiropractor he's gonna do it for fifteen hundred and five years later you're still gonna have the problem so neither of you fix the problem so we'd rather not fix it for fifteen hundred than fifty grand but it all needs to go back to integration and I'm sure it will sometime so when you're on an island like that does the internet become more important because your substitutes in the marketplace are all going to be digital as opposed to yeah so
Dr. Chris Allington: yes and no I mean Bermuda the Internet is important here we were a little bit behind the times in terms of getting up to speed and the cost is a lot more than in Canada States but you know in terms of communication with our with our labs and our colleagues certainly the internet is important if you're looking at in your education we've always provided some on the island but never enough to get all the credits you want and never all the advanced advancements so with all the CE on mine now it's a super great facilitator and we've had dentists all the way from one year out of school to this year actually I signed a guy up in his 80s for dental town and CD on demand vive learning because he hadn't got a C credit in years and we just instituted a mandatory Cu requirement so he didn't take in CDs he called me and said oh can I can you just pass me without the C E and I say well not really it's for a whole bunch of reasons but he just didn't want to fly over in his mind he was getting on a plane and flying over the state he didn't realize all these things were available online so I literally signed him up sent him an email with his with his log on to dental town and - and - vive learning and he banged off his credits in a couple of months
Howard: so and that's the me because in a community like that you have a human relationship where's like a big city with a million people you know you wouldn't even have known who you were talking to and you know you know it's probably what did you said if you don't I'll take your license away you know it's just yeah I love that so what did you end up going with your Bermuda requirement you said the Bermuda Dental Board just instituted at continued education requirements what were they
Dr. Chris Allington: so at first we've got them fairly loose first first year we did it it was just 40 hours over two years then we changed it to 40 hours of which 24 had to be clinical because a lot of you know a lot of ours are on in practice managed management which is great but we do want to have some basic clinical on there there's the mandatory CPR requirement you know moving forward it would be nice to you know to look at the core things that we figure everyone should have every year oral medicine pathology radiology infection control that sort of thing and with the way the internet is now it'd be pretty easy to do we could assign courses on dental town assign courses on Viva or there's there's tons of yeah I'm sure you're aware of all the online courses that are available for free so what is the main ones for free for you now well the ones that I use are you know with you guys you've got the platform where internationally that you don't charge people so the middle student or a piano student so if I'm if I'm on if I'm on a VPN in the US I got to pay for it try to figure out what's going on but it's because I'm in Bermuda I put them on online first for four for free Viva learning is another good resource I subscribe to Frank Spears which is a monthly fee but you've got access to all sorts of stuff there you know I really share that on the island know there's a few offices that have it I do and if I was to use that as a public forum I'd have to call them and find out yeah under the table but not how you want to organize something but no we've got our own our own office subscription then - no - Beals was a good one I realized I was getting all my education from North America and realize they do things a little bit differently in Europe and you know I think we do have this bias of the way we do things is the best way to do things and I think that maybe in part because in North America so much of our of our see he is funded by the companies which is great I mean it's so much for that providing us but sometimes we may or may not follow the science as well as different places in the world and if you look at things picking up like using a piece of glass ionomer I just heard one of your talks this week with silver diamond fluoride you know we've always you know we're behind the ball a little bit with that and when I say we I'm talking about North America whereas in Europe you know they think differently they do things differently and you need to replace that first or second molar with an implant they have a different opinion than we do or at least I've heard that over there so it's interesting to hear what they say and look at the research done in both places so the you know curves got a free learning site Glidewell has got a huge free learning site very good really good courses on them and I would think that most of the big suppliers do have continuing education so you can find it everywhere whether it's credited or not Colgate's got a massive it got a huge one yeah all those places when we sent out our list to our dentist there is at least eight places on there we could get I seen you for free online
Howard: that is awesome yeah Colgate was in the news day what did they do yeah they oh they just released their Colgate plaque less Pro tells you how to clean your teeth in real time they just launched their artificial intelligence high-end plaques pro smart electric toothbrush that connects to your phone on bluetooth do you really think that's gonna be a thing I mean I mean you can hardly get anybody to brush and floss now other than wanting to be sexier and and all that not for decay but you really think they're gonna wake up and take an electric toothbrush and turn on their Bluetooth and fired up
Dr. Chris Allington: well I know sonic Ayres had that available for a while and you know we've gone through different stages of providing retail items in our office which is a challenge and review just because getting things in can be difficult so we've got several patients on sonic air that that have used it and they all say the apps of pain in the ass maybe because we're here but most people don't use it I think the best thing the best thing is a timer and unless your parents unless you're a parent watching your kids on it on the app I don't know how often people are going to be logging in to check out their brushin for two minutes
Howard: yeah I just eat all my patients say look look you know I I don't think they're gonna use an app I don't think that they're gonna do it for three minutes so what I just tell them dude it's all in your mind when they do research when you take a shower if they film you take your shower a hundred times you wash everything the same order when you put your shoes on a a hundred times you always put the same Shaun first so I said all you have to do is get a habit that when you start brushing your teeth you do a chore - that takes two or three minutes so you know maybe you go pull out your socks and underwear and lay out late get out of your clothes or something so I always um I always start brushing and then as I'm brushing I go to my next task you know yeah so so that's so yeah the the dentinal tubules I really like that guy yeah and even on there oh yeah it was a my podcast man on your podcast oh that's awesome yeah and I love him and his wife is a class act she's uh she's so neat he's a periodontist I forgot what um I I think him and his wife for both periodontics right yeah yeah yeah but but England England is a different country and and I I like I've learned so I've learned more from visiting and speaking and fifty different dental tribes around the world than I ever did I mean last week before Christmas I was a week in Israel and I mean the little nuances in dentistry and and patient care and technology it's just so amazing so so what's the DMF T like a Bermuda I mean M is it water fluoridation is a rampant decay is it what does it remind you of uh so we don't have great stats about it but it's
Dr. Chris Allington: if I had to guess I'd say it's pretty high our water we're actually cistern based so basically we catch our water on a roof that goes but either I was this so we don't have we don't have fluoridated water but we don't have a central system to put it into there's a water fluoridation program in the school which you need to opt-out of so we do see I perceive we see a bit of chlorosis and I know that's from the school or from from other sources but fluoride is available here and the the government clinics have done a good job of providing it to kids we've debated going to ionized into salt fluoridation but that hasn't happened and there's logistical problems with that but I would say the DMF tea is is on the higher side of north america i've seen the last thing that came from here said we were we were lower meaning we had less decay but it's also how they're doing it is they're going into schools and just looking with flashlights they were looking with flashlights i think at the last time so they weren't they weren't geared up to do it as well as one could in a dental office so when you look at the FMT you also got a look at how they got gained got the research was it public health people going out with a flashlight or where they come into your office with the big overhead light inderal loops and looking so yeah it's i would say are carries rates pretty high
Howard: and your doctor David as Samuels he he did he retire on the island
Dr. Chris Allington: no he David Samuels is he was significant involved with the mass dental society here and Yankee for a couple of years periodontist who in his late 40s early 50s just sort of wound his practice down his kids had grown up and he wanted to he wanted to work as an associate so he was familiar with the island he came down met a few of us and ended up coming down here two weeks a month and works he was with a group called smiles Inc with dr. Stephen card well and and our and our only oral surgeon on the island dr. Akbar Lightbourne and he provides periodontal services here that weren't there weren't really available before so he's been a great asset to the community he's such a good guy in terms of what he's done for dentistry and really involved and and and thrilled about about everything what you
Howard: brought him up well I brought him up because he wrote an article said gum disease islands hidden epidemic and he says while most bermuda ins are aware of the disproportionate high prevalence of diabetes route the population very few understand there's an inkling obvious infection disease more people parried on us um so i'm why is do you think well first of all do you agree that there's a disproportionately high prevalence of diabetes throughout the population
Dr. Chris Allington: yeah so i mean it's interesting right now we're actually going through healthcare reform here and one of the things is we're looking at trying to decrease the cost of healthcare and dentistry is getting involved with this because that you know the model that they're trying to use may or may not involve dental care to either a very basic level or up to a complete comprehensive level so our when you look at the numbers of our of our annual spending for health care where we're similar to the US i think the u.s. is 17 percent we're closer to 14 or 15 and they like to say we have the highest health care in the world but they put a little asterisk beside it after the united states so the United States has the highest cost of health care in the world and Bermudas number two but I you know when you look at that you got to figure out why it's happening and is it the cost of care here is it over prescription of services is it that the population is unhealthy and it has been stated and I'm not positive the truth in this but that we have that we have the highest diabetes and heart disease rate in the world that wouldn't surprise me but I don't know it to be factual stays very high
Howard: so why why do you think if it is hide what would you say that you think it's from
Dr. Chris Allington: well I mean there's three sources basically I think there's genetics there is activity and then there's the care that you received and if I had to guess it would probably be a combination of everything for me is a temperate climate but it's not the easiest place to exercise our roads are really smaller speed limits only 20 miles an hour but people go a lot faster and when you've got these winding roads like you might see in in rural England it's hard to get out and just go for a walk so there's that you know just looking at us statistics you it's well documented that the African American population has a higher rate of diabetes and obesity than the Caucasian population and there's a whole bunch of reasons why that may or may not happen but the same thing happens here I think it's in arguable that there's a genetic component involved in it and then the care that you receive you know both the care that you're actually getting and the care that you're actually seeking and it's you know it's a possibility that people just aren't seeking care when things are in the early stages and people don't tend to go to the doctor if they if they need to and that can be financial or that could just be they don't they don't feel it's important or or they're scared of going to the to the physician and or dentist
Howard: but it is neat that you're thinking about tying the more dental part into the the medical part with the diabetes and talking about the game
Dr. Chris Allington: yeah definitely connection I mean the oral systemic link I think is something that is I don't say it's a hot topic in dentistry because now it's pretty obvious that it that it exists the question is is what do we do about it how do we inform patients that's scaring them too much how do we set up programs to look at it how do we join with our colleagues and and in medicine and try to and try to tackle it you know you've got these great groups like bailed uh Nina that's included dentistry now but you know that's still the minority I think you've talked to Bradley Bale and what's the donee nutritionist you familiar with them mm-hmm yeah the sale Bell Donnell the Bell d'Alene Bale Dineen I think is the is it so basically that we got him on the show yeah so you know that what they talk about is instead of heart disease you know being an issue traditionally thought really I think it more of a they think of it as more of a skier ologist said leave is what he calls it so you're looking at the vessels in the physiology of how if how plaques develops and more importantly how plaques become unstable but they certainly recognize that dentistry than a major part of it and there's been a lot of cases where they've had where patients have been doing everything to to get back healthy and maybe eating well and they followed all the steps but the one thing they missed was a dentist and then when they go get pareo treatment which could be anything from scaling and root planing to extractions and an implants they get better so definitely a connection there
Howard: so you've um you've worked in so many different practice environments countries Canada the u.s. Bermuda you've worked for DSO is associate being the owner my gosh so many of these kids a fourth everyone listen to use right now is in dental school the rest are all under 30 email me Howard at dental time.com and tell me who you are and where you're at in life but do you think looking at the the UK the Canadian the Bermuda what would you tell a young kiddies in dental school right now what they should be thinking of had and and what what what do you think that young kid listening to you today what woody thinks a part of their constitution that would make him do better in each different environment and how they should think about rolling out their journey
Dr. Chris Allington: well I mean I think you really got a at least have some concept of beginning with the end in mind you got to figure out where you want to be what you want to do what kind of practice you want to have and then you've got to you know tailor yourself towards towards that and you know that's probably gonna change some when you start - when you - when you actually reach the end of your career but it's always good to think about the future and not not about exactly what's best in front of you right right when you graduate you know I don't think it's wise to graduate some down school and go get the job that pays the most or that you know percentage-wise you look at it being an associate or you might be able to take on a practice and generate a lot of revenue but not have any mentor there so I would encourage the students to to think about you know where they want to be in ten years over from practice or five years out from practice and then work towards work towards that role you know I think it's important and I think most most students even recognize it when you finish dental school you don't really know a lot most dental students you know they finish with maybe ten crown preparations that they're lucky they're lucky to do a molar endo so you got to do something to get yourself educated whether that's GPR and a GED like a general general residency working with working with idea so we're going to associate with someone who's you know not treating at a factory not not just wanting you to do the crap left over or have you sit in the back and just see emergencies but you know all those things what they have in common is you need to find a mentor you need to find somebody who can help you grow and help you know talk about your frustrations and help bail you out when you've got a problem and more importantly help you learn when you bail yourself out
Howard: so you have one oral surgeon on the on the island is that a yes to bail out everyone
Dr. Chris Allington: well there's a few of us that will that that get called when there's problems there's a few dentists on the island that are pretty good in surgery and I've gone to a couple offices to finish some extractions or had the patient sent over the oral surgeons done it with he does it he does it a lot more than I do will actually drive to the office I don't know if he'll drive to an office but I know he'll see pains in his office halfway through a procedure I've Drive driven to a couple couple dentist office that refer to me when they've had problems doing something and finish what they started I'm just easier that way yeah I was so lucky and I'm I
Howard: I had to drive at least half a dozen people do dr. dawn gas oral surgeon in Chandler and he was always a just a sweetheart about it and then I had another one Bob Sundberg Dennis a general Dennis I'm up down the street two miles and same thing with him it was just was so cool so you could try all these things and not to worry about if you got stuck yeah
Dr. Chris Allington: well I the same thing in my office I mean the guy worked for it now he works for me is dr. Ian Campbell who may be the world's greatest single tooth dentist this guy's work is just immaculate and exceptional and he really thinks about everything in terms of how he's at how he's working and it was really good whenever I get so I can it could be it could be anything not being able to get an impression or difficult extraction he'd come in help me out and and and bail me bail me out and and you also get you also learned real quick how to do all that stuff yourselves right um one of the one of the advantages of being you often don't have anybody to call so and you don't have anybody refer your tough cases to you so you just end up doing them all
Howard: yeah and that's uh that's uh it's good what other challenges do you think that you have living on an island how many miles by how many miles I know I know I should be asking that in kilometres but I am a we only use metric when we're buying our 9-millimeter shells on their way to go buy drugs that's the only time we do metric so how many miles is it
Dr. Chris Allington: we are 21 miles long and one-mile-wide
Howard: oh my gosh that's crazy so so is that a is that a psychological issue that what do they call it island fever island fever yeah it can be I mean it's pretty diverse here in terms of the topography and first town the size there's a lot of things to do but yes people definitely suffer from Island fever yeah and then
Howard: you're then you're always running into your patients I mean you can't be a beach drinking beer of fish and tuna you know underwear and then how your implant patient walked by yeah it happens all the time having two doctors happens two dentists yeah you can't get away from them so yeah number of cavities in Phoenix right look at the the percentage or they say you know half the people said they saw a dentist last year I'm like yeah but they saw him at Safeway they didn't see him at a dental office you know they thought about buying beer at midnight they didn't see him for a cleaning but is that a is that harder for introvert dentists I mean I want to think of a dentist they're always a mathematician introvert and introverts are drained by people whereas extroverts or fueled by him is that draining for the introvert dentist on the island
Dr. Chris Allington: yeah it is I know a lot of people are getting quite stressed when they you know going out in public and talking to people who may or may not want to do things like I'll see my patient there and and it's just not a not a comfortable setting for them so it definitely does it does it does play a role hear me I'm fine with it but a lot of people aren't so well it's gonna injury because
Howard: if you look through the animal kingdom I mean most I mean a bird wants to be alone in its nest I mean the animals in their caves I mean most all animals they they want to be with the tribe but they also want to be alone so that that's a tough deal so um how do you like the state you're at now of owning your own office because you were an associate with that guy for what a decade
Dr. Chris Allington: yeah a full decade as an associate you know you've had ask me when I came along I'd have been associated wouldn't have been that long I thought I was ready to go after about as soon as out here but it just worked out well actually I was treated well and finances weren't an issue so it worked well for me the stage I'm at now you know I'm still learning you know part of what I've decided to do this is the first full year I wanted I've owned the office for since I guess June of eighteen and it's the first full year and what I've done is I've tried to make a lot of changes and some of them have gone well and some of them haven't and I'm going back and saying okay now what work and what didn't so I'm still a work in progress so
Howard: so what um what after your first year what did you try that backfired and what did you try that worked well did you use a dental consultant or yeah so I've done done a couple of things in this started while I was an associate as well you know I went to initial the first consulting we had in was transitions group out of Canada Lisa Phillips is running that and founded a her fan of her because of her she came out here to talk a couple of times she's an exceptional speaker I encourage anyone who could Phelps Lisa Phelps yeah and if transitions at Canada they have a big US presence as well mostly in the Northeast but she'd be a great person for you to podcast is it Phelps pH think it's Phillips yeah okay and so she's I does transitions but yes she also is practicing or was she doing or what she do new transition to buy that practice no she's so transitions is the name of the company doesn't mean they do transition on offices ownership that's not their main thing their main thing is as a practice consultant just like Levine group and productive dentists Academy same idea just their philosophy as they all do their philosophy is a little different she came in did an initial evaluation probably after I've been office for about four or five years we you know we took the consultation we didn't up using them as consultants but I was back and forth there a fair bit and then I went to Scott Lewis group break away again their system is set up not necessarily to act as consultants but to have courses on practice management and sort of do-it-yourself with some guidelines from them and then who I ended up working with was productive dentist Academy and that's a really unfortunate name because it implies to everyone that it's all about production but it's really about you know providing the best care to patients in the best manner possible for them so I was weird that's Bruce Baird yeah and you thought didn't you thought that was the best one you know that's what I that's who we utilized and that's who we use and we use them for two or three years again I started out with watching his lecture on dental town and that lecture changed my mindset and changed my production overnight my production jumped I bet it jumped $200 an hour overnight from watching that podcast well I decrease the cost of my patients and did better care and that was a confluence of the way our insurance system works and the environment of practice that I was in but just thinking about you know how to do things best for patients and make win wins at everything it really it really changed the way I thought about caring and I would encourage anybody to watch that lecture and see if it's something that would make sense for them about three years later we ended up hiring them as consultants after I went to their weekend seminar in Texas in Texas yes oh I went and you know dr. Campbell was nice enough to sort of let me make some changes in the office and you know it really you know it really helped look at what we were doing and why we were doing and the focused on you know comprehensive care that we had maybe been missing for three years it it really helped develop that and you know helped us take on some of these bigger cases and really present them to patients and make it so that there were things that that they wanted you don't want to sell what you're doing about when someone comes in with you know worn down dictation doesn't like the way it looks and they require $50,000 for the dentistry because everything broken you know you got to have a plan for them to do it and they just they made it easier to do that
Howard: so um what about Bruce beard did that I mean you just said some powerful things I mean it really rocked your world as saintly what do you think Bruce beard woke you –
Dr. Chris Allington: well it was about you know part of it is somewhat take money out of the equation but to me what it was and I didn't you know I sort of adapted what Bruce said his big thing is is to you know see patients do all the treatment you can in one visit and then he finances them out they've got a part of the part of the arm of that company is comprehensive or compassionate finance that facilitates patient lending it's another Avenue like Care Credit so his big thing is to get all the work done in as little time as possible and for me the insurance here was quite good and you know how it worked was if I was seeing a patient for one crown if I did the next crown at a substantial discount which would have the patient's pay very little when it came and we look at what they were occurred from their insurance I can do - and it took me an extra 10 or 15 minutes so it was a no-brainer it was a win-win for everybody so that's what I started to do and I didn't even tell patients I was really doing it I just our office you know as always had sort of a floating fee schedule we we've we you know every dentist on earth decreases their fees but when something's harder sometimes the fees need to increase cuz it takes you a lot longer and what we did was we I just saw these patients and I said you know what if we do - it's gonna be you know for one crown it's gonna be 1,500 and for two crowns it's going to be you know twenty to twenty-five hundred whatever the number was and it worked really well for them so it just got me doing more things that were needed that we were going to do anyways at the same appointment at the same visiting got me just structurally plan out my treatment planning better with patients
Howard: so that that's that's um whatever one says but they don't want to do they the dentist says well I I don't want to sell dentistry and it's like guys the diagnosis the treatment plan and the presentation determines if you ever get dentistry if you can't diagnose you know they start off diagnosing a tooth and then after five years they move up to a quadrant and at the end of the decade it should be full mouth and they they don't want to do that they would have u12 dentistry and blame it on the insurance company only pays a max of a thousand and then they they don't their model and their mind doesn't account for the fact that five billion Earthlings don't have dental insurance so how does it affect them differently and presenting the whole case so so how did you would change your psyche of not wanting to quote sell dentistry to now wanting to do a complete diagnosis and exam present the whole thing including finance
Dr. Chris Allington: well I mean for the first step you trying to take money out of the equation you need to show the patients what's going on you need to you need to have them become aware of it and a lot of times they're coming in asking you asking you for it and it's you know I was really lucky because a lot of the patients I inherited were from dentists that sort of hung on a little bit too long working because they had to and the patients came in knowing it so yes um you know how do you think things are like they're telling me a lot of work that I'm not getting done in a while or you new patient that comes in who has been identified six years so those are ones that are easier to you even have to sell them you have to tell them what they need and then you worry about the finances later so you can't start talking about money until you start talking about what stage they're at how they got there what needs to be done money's always gonna come it's important but the need to do the work and the amount that it costs are two different things and you got to tackle the the work that's needed first and then you can tackle the money issues and you know Bruce always says like I don't care if we do this in four hours or four years it's up to you and that's one of his lines that he that he or one of the one of his phrases he says the patience you know it's it's up to your mouth you do it at your speed but it's it's it's easier and better for you if we do it all at once
Howard: well they do it with their cars I'm in to do their houses I mean one of the most interesting things about a poor underdeveloped country which I've been to a gazillion of versus the you know the twenty really rich countries were you know median incomes fifty sixty thousand dollars is you'll see them build their houses over years instead of getting the money and build the house they save up and they get the land and they save up and they bit of foundation basically the houses are never finished there they're always under construction some of that status code because once you declare your house is done then the stupid mob will come out there and see how much they can shake you down for for their taxation that's what houses he greased that rebar sticking through their rooms right right yeah and it's all it's all part of the the mobs sixty thousand page tax code but patients want their house now and paid over thirty years they want their car now and pay over five years they want there a smile makeover done now and paid off a couple years I mean that's what they all want and the most resistance to that obvious decision is lives in between the ears of dentist I mean these I mean it's so and and I'm like what what did you see in your life that makes you think that's that that's not the way it is I mean they want instant gratification and pay for tomorrow
Dr. Chris Allington: yeah and it was hard for me coming from Canada where you know the system that we have there is is medicine is it's government-run and it's it is paid for through taxes and dentistry isn't so one of the reasons why I ended up working in the states while I was living in Montreal was because I was running into a lot of well if it costs me anything I'm not going to get it done and when I was working in Montreal and near Ottawa when I went to the state's I did find that in the US people were much more receptive to it was it when you went to the doctor you would you hadn't expected copay and my experience in small-town Canada was that patients were quite resistant to paying for dental treatments so I sort of brought that with me and maybe that just existed because that was in my head and not theirs but I did find it a little bit easier working in in the u.s. doing just I'm talking about single crowns I wasn't doing full rehabs or anything down there but even doing single crowns the American system seemed to be a lot more receptive than in Canada but that could have been just my percentage
Howard: we'll talk about that system because you're from Canada and the countries part of England and they have socialized medicine or nationally paid for medicine the United States doesn't they got they start on two different journeys it's very bizarre how at the end of World War two healthcare was not was paid completely different after before war two is a very private enterprise and then because of the World War Two effort they passed wage controls because they thought that was a good idea to build up for the war but when they put wage controls built there's the lawyer mob you can't raise their wages so the muscle man the unions the mobsters they said okay well we want something and they argued for medical benefits and dental benefits and all the economists at I was saying why would the government or your employer get involved with your health care they're not gonna buy your house you're car your groceries but nothing less that's how it took off 70 years ago so here we are at 20 20 70 years after the war what do you think the pros and cons is of the UK in Canada paying for the health care almost nothing out of pocket versus the American system or the other systems
Dr. Chris Allington: well there's a few differences between Canada and the states and I'm not as familiar with the UK but you know in Canada there is this perception that health care is all covered by the government and your basic health care is but you know if you want to get physio it's not covered the dentist isn't covered Chiropractic is incredible physiotherapy physical okay physical therapists okay you know a lot of the rehabilitation isn't covered you know if you look if you take dentistry out of it one-third of the money that goes in the cane healthcare system comes from private private funding and it's interesting here right now because we're actually looking at doing a new revamping our healthcare system and I was racking my brain trying to think of an intervention change in health care that made it better for patients and better for the providers and I couldn't think of one until finally what I thought about was when Canada introduced their national health care plan I think it was in the 50s it could be the 40s but you know you had people showing up at the emergency room with livestock in the back trying to trade it for an emergency room visit and the doctors weren't being compensated and patients you know weren't getting care they're only going for emergencies so the Canadian government said yeah we're going to nationalize this healthcare system and I don't know where the money came from it was increased taxes I'm sure it was or it was just a surplus in taxes I'm however it came from I think that did improve healthcare the the good thing about you know Canada is is that everyone's got a base level of care and maybe because of the size of us we've only got 15 or 20 medical schools I think if you show up at a hospital in Canada you're gonna get more consistent care then you may in a country with a lot more facilities in in the state it's in arguable that the high end care is better in the States than in Canada I should say it's an arguable it's probably better in u.s. than in Canada but in Canada what we find is that things are very restrictive if you want a hip replacement you're waiting over a year for it heck if you want a CT scan unless you're in the hospital in the emergency department you're gonna wait six months for a CT scan and all the provinces in Canada so things go really slow in Canada whether that's better or worse is to be debated in the States and in Bermuda you need an MRI or CT you can get it in a couple in a week or two so you know the big difference I think is that and the UK kind of has this hybridized version of it the big difference is is that in Canada we tie your basic health care to your citizenship or your status in the States and in Bermuda right now we tie to your job as long as you tie health care to a job and there's no there's no back fall of some form a government-sponsored agency you're gonna have people that don't have health care and you know my view of health care is is that basic health care is a human right like you need to have we need it we need to provide health care for everybody no matter what but you know not everyone can jump on a plane and fly to Johns Hopkins when they want to which is sort of what happens here right now we've got this elite level of health care on the island that everybody wants but we don't ask ourselves why are our expenses are so high well maybe maybe that's maybe that's the reason and you know although basic health cares are right you know the top-end health care being able to you know not have lines and everything that's a huge huge privilege and with those privileges and responsibilities and also comes you know someone's got to pay for it
Howard: well I mean I don't you're the the oh okay first of all when you say health care is a human right I mean dude what about food I mean what about water well I mean I mean what would isn't a human right if you needed it for survival what about that need to reproduce but here's ears might be for they because I've seen you know like say I just left out Israel and the most unique thing about their dental situation is um it's more there's a lot of people that live there from Russia so there there are three major DSOs are all connected with the hospital which is I just love the details but the bottom line is like look at government housing you know if the government really wanted to help the poor housing they should have said okay all these people we're gonna give this much money each month here's four hundred bucks maybe you'll want to go live with your mom maybe you'll want to live with your sister maybe you'll innovate and figure it out but oh no it's never that it's about their bureaucracy and control so they build the government housing then you're not an owner and you look at them or all the people there and they're you know it's just horrible government public housing is the worst same thing with health care if they really cared about your health care they'd say hey we think more people should need health care so we're gonna give you you know this much money every month or every year for you to go to health care and you said that in Canada one third of the health care is private so they might have more innovations more services they might take those dollars and go there but the government's like well no we're not gonna do that what if they just take the money and go buy Cheetos oh so they want it so it's always they want to help you it's kind of like they come up to you they take a baseball bat they break your knees and then they want to help you buy a wheelchair it's like if you want to help someone do it like your mom you know when your mom needs help you give her five hundred dollars you don't go tell her exactly what she can do with it or not do with it and public housing if they would have taken that same trillion dollars that Johnson and those guys in their greater society if they just would have given those people that money they would have left those cities they would have bought trailer homes land small houses moved rural they would have reinvented themselves but that's never what the government wants to do they want to control the entire situation until it's completely unaffordable then say see you guys can't do it now we need to take over the whole thing I mean yeah you know and it's always gonna come down to checks and balances yeah and they're just not into checks and balances and that's why I told Dennis in America do not do Medicaid because when your receptionist is under train because you don't take her to CE and she starts miss screwing up all the Medicaid billing yeah I've indicated Fighting's out about it they're gonna kidnap you and put you in a cage if you did that with for enterprise they're gonna sue you and 99% of lawsuits never go to court because you're business people so you settled out but you just can't get in bed with the government because they're just I mean they got three million people in jail and you want to do business with those guys why don't you go do business with the mob yeah yeah
Dr. Chris Allington: no you know I thought I thought that having a health care system that took away the right to really choose what level of care you got was problematic I looked at it from my father's point of view as a dentist he one of his mates needed a hip replacement and he couldn't go pay to get his hip replaced in Canada he couldn't have private insurance to do it so he had to wait just like everybody else did to go get his hip replaced which meant that you know if he couldn't work for three to six months and when that happened not only couldn't he not work you know his staff can't work so that's problematic you can't you can't really have that sort of system but then you move to a place where there's you know there there's no back fall with health care and you see people that are that are struggling and don't have any sort of sort of coverage it it becomes you start to look at it and think you know there's advantages and disadvantages each to each system yeah and that's the problem there's no perfect system right humans are incredibly complicated
Howard: so now that you're the owner as opposed to the associate do you see evaluating new purchases did you look at them differently and how do you and Vout like when you look at the big expense the cad/cam the CB CT the hard tissue lasers I mean those are $300,000 purchases how does your mind work those through those decisions
Dr. Chris Allington: so for me you know I looked at it and the first big piece of equipment that that we that that we bought it was tarot scanner and for us that was a no-brainer I had we had our criteria laid out we wanted it to be submitted we'll do Invisalign because we're doing a lot of Invisalign we wanted it to be video capture because you know the the initial the initial CAD cam where you know point-and-click eight different pictures you're 12 there and pictures had to be stitched together so I wanted to go to Invisalign we wanted it to be able to do restorative and we wanted it to be a video capture so as soon as the I kara elements came out it satisfied all those we said yeah forget it that's we're buying that and that worked out well so when you're thinking about buying something you got to figure out what's the what's the is it gonna make it faster easier and higher quality and for Invisalign the I Tarot was a no-brainer when you come to the restorative side it becomes a little bit different where I've sort of failed as an owners is that I've made some bigger purchases and haven't quite figured out how to integrate him into their practice ideally I do a lot of implants so the one thing that the first big-ticket item that I bought when I owned the practice was a Gumby machine and I knew that I wanted it I knew that I needed it I didn't have a good business plan in terms of how I was going to generate the revenue to pay for it but I generated enough revenue that I could buy it and I figured I would just increase my implants I was doing to make up the difference problem is you go from a pan to a CB CT and you get into this old insurance equation again insurance will pay for a pan but they won't pay for a CBC t which is hopefully a matter of time so I looked at that and that worked out worked out well but you know where I failed was thinking about you know how was I going to integrate things into the into the office because the I Tarot didn't doesn't do as good a job restorative ly as some of the other scanners do particularly when you when you want to start scanning things dentures and models and stuff I need a different scanner so I bought the medic 3000 which is a good scanner but I didn't think about the fact that I got at 7 operatory office and one of the great things with the I Tarot is that it's on this really nice stand it's easy to roll around I got no space for the minute I got nowhere to put it and it's become logistically a nightmare to move the thing around in the office same with a 3d printer I've got one sitting in my apartment at home that I use from time to time but I don't have any obviously I want the space for it so I bought it knowing I needed it or thinking that I needed it but I didn't know how I was gonna monetize it how I was gonna because I was paying cash I didn't not think what I was paying for it and then where it was gonna go and then how it was gonna integrate it with with my staff the CB CT I think I did a pretty good job one of the seahorse's a it actually Dale miles down here to give us a lecture he came and spoke to us right up the street for me yeah I know he said he said and he's done a few things on dental town which would be goodie I think series of lectures that he'd be interested in getting out to the public so he came down and again instead of instead of me flying 10 people have to go see him I flew him down here and then the rest of the island benefited as well we did a couple day talk with with him so back to purchases you got to figure out what's available locally how you're gonna use it and how you're gonna pay for it and then the third thing is like how you gonna integrate it into your practice integrate it into your workflow integrated into your physical space all that stuff's important and not everyone tells you about it before you buy them right
Howard: I can't believe we went over an hour man I'm trying to think of um what what were you on thinking I would talk about that we didn't talk about
Dr. Chris Allington: I think we got we got we got we got most of it you know we talked about consultants we talked about the island you know you know the practice and just hopefully people learn from my mistakes of how to how to really think about things before you before you go purchase them and
Howard: of those 25 to 30 dentist how many of them owned their own dental office owner-operators and how many mr employees there are about
Dr. Chris Allington: there's probably 15 owners and 10 to 15 employees I would think that is interesting 15 owners and 10 to 15 employees so that would that's a nice sample so 15 owner-operators yeah and how many employees probably 10 to 15 10 to 15 25 to 30
Howard: that is actually a really nice sample you have a finite island with people coming a third UK a third Candida third us they're all the same species sapien and they're in with 60,000 people and it was roughly 50/50 because this is what I've been saying forever when and when dentistry started to consolidate I said well let's look at the lawyers half of them work for a big firm and half of them are owner/operator it's a different cat some people like to work in teams and they like the org chart and there's all kinds of advantages for their unique situation life may they're married kids whatever they don't like marketing business they don't like the stress but it's about half and half for lawyers and it's half and half for burnt Bermuda yeah yeah I don't know what's the number in the u.s. well I mean you know the US is a big place but it's a you know Arizona 18% of the dentists are now affiliated with a DSO we're number one in Arizona because we if you're licensed anywhere in the state in any state and good standing in America for any professional nursing architect dentist in compare is onna and you're licensed so word 18% but there's five states that don't you have the the other end of the distribution five states don't even have one percent so yeah but you know talking uh you know every time I talk to Rick workman I mean that guy's got a thousand offices Bob Santana's got a thousand Stephen Thorne's you know these guys are all past or approaching a thousand but I I could see one or two generations from now half employees and a half owner operators I can totally see that and
Dr. Chris Allington: what do you think of the DSOs you think that that's a big deal so as a model that's going to continue or do you think it's more of a smaller model or bigger group practices that's going to be I'm going to be the norm moving forward
Howard: well money is the answer so what's the question I'm Wall Street won't take any of their stock and exchange it for equity that no no none of them could go public Heartland Aspen Pacific dental so Wall Street won't touch their money so that's a red flag and what and I think it's because what I to go public they're gonna need to take at least you know fourteen fifteen sixteen seventeen eighteen percent off the top and give it to Wall Street well yeah that means I sign up with a DSO and they're gonna take eighteen percent off the top hell my Mike total lab fee and supplies isn't that much money so what I continue to see is that the first layer of management you know when you're in it when you're in a town of a hundred thousand and you got one office when you go to one level of management and at a north-south-east-west where I could have a full-time person for accounting to know my numbers I can have a full-time HR to attract the retain the best employees and one person doing the marketing and I can scale the whole city man that 3/4 person operation takes a picture for average offices which do like 780 now they're all one point two one 31.4 the dentists in those places a lot of times they're partners which I don't recommend because you know I just don't want to marry a man dentist you know but yeah I so i think one layer of management dentistry is awesome III so I think that the group practice of five locations or less which is the 80% of the dsm market today is a better working model I just don't see how the second tier headquarters in bed with Wall Street giving them so much free cash flow off the top I don't see how that makes sense yeah
Dr. Chris Allington: and then do you see the turnover as being a major limiting factor of these dsos over the long term and and do these smaller offices these smaller dsos are they better in terms of the turnover well it'
Howard: s it's clear that the turnover is multifactorial and and most tight to birth rate I mean go to Japan I know I've been there I've did several podcasts in Japan I mean that the lifestyle was so brutal that the women quit having babies are like I'm not gonna have a newborn kid and have it stress out through high school to get into the best college to get the best job didn't work 12 hours a day seven days a week til they drop dead so so they rebelled they said I'm not having a kid and I'm I'm you know I'm cutting back and so I think um I think there's a lot of people who are in dental school they look at their dad and their dad or mom was a dentist and they wore several hats they worked ten hours day five six day it was a total lifestyle that they don't want to have and I think I think it'll drift I can totally see this drifting to the median where half will be owner-operators and wear many hats and half will be independence dentistry is a job and yeah III think that'll probably be the equilibrium
Dr. Chris Allington: yeah you said something interesting there about watching your parents I find myself doing the same thing growing up with my dad as a dentist there's a lot of great things about it but the one thing that bugged me as a kid was he was always involved with work I said to myself oh I'm not gonna do that with my kids and now find myself just repeating the same thing that my father did you know 30 years ago with with with my kids you getting you know it is a dentist you get involved with your patients you're thinking about your day and you know it's hard to be present all the time
Howard: so what you should really look at the I mean I think this is the coolest thing Bermuda and third look just say 30 offices 15 own or 15 employee you should really drill that number down because it might be very profound I mean is there something statistically significant with the 15 owner-operators that are not that 15 employee dentist you know I I wish you you know you're in the Bermuda Dental Association you're with the Bermuda Dental Board I get the exact number anda and post it or write it up or put it on dental town because that that's a really unique data set because I mean it's the same humans they're from three different UK Canada in the United States yeah I think that's where it's gonna go numbers right there I can get it from the phone books and what was the last question yes yeah I think that's gonna go but uh any other last I'm sorry oh sorry my last question was just the dentist turnover is what I was wrong oh yeah the turnover um I was talking about that the the rappelling so the little girl in Japan her dad worked for a Honda or whole life and he got a job there 25 my uncle Pat got a job at Mobil Oil when he was 16 delivering mail and he retired there in 65 those days are gone and and if you go look at the same Facebook Apple Amazon Netflix Google they have the most money the most stock wage is the most any kid could ever imagine get out of school and and Amazon all their employees turnover in a year and Facebook does the best about two years when you look at the SOS heartland holds him the longest at two years everyone else is about a year and the the reason Heartland holds him is the the mentorship thing Rick is a dentist in Effingham and he knows the importance of mentorship so when you get a job at a heart and you know you're gonna if you want to learn Invisalign or place implants and they're gonna dump a ton of money because a lot of dentists they get it out on this program or I want to do I want to work at Heartland for five years to get my f AGD and this line certified in place implants or whatever but at the end of the day you you have the rise of the individual so it used to be I'm born and I have to conform to my father my tribe and the Queen and and that all changed I think it completely flipped when Steve Jobs stuck the internet in the individual cell phone I think that was the end of the first fight that from the pyramids - that was the first five thousand years all government tribe down and now this individual sitting there it's a stronger computer than Neil Armstrong had on the moon and now it's all about the rise of the individual liberty freedom and I think I think the next century is gonna be sapiens finest century ever when every damn sapien four-and-a-half billion humans are on the internet hold by their hand with their little opposing thumb and that's gonna be the biggest game-changer in the world and everybody got their roots to the last 5,000 years knowing that the people they lord it over 90% of them are illiterate and couldn't read or write so when this dentist comes out of school with eight years of college that's why I think the law firm that that's what I would try to do I would compare it to the the law firm on Bermuda because when you look at the United States that this you know four and a half percent of the world's population that's a huge sample size half the lawyers work in a form half are independent I I think this might be a psycho sapien dental lawyer observation that about half of these people are gonna want to be known or opera it's a lifestyle you got to be into it you're either into it or you're not like like anything yeah and I I think will you do that and post it on dental town yeah yeah demographics of owners and operators and you know it's pretty easy I think our biggest office has got four doctors in it and and the other ones are all one or two so yeah and of those employee dentists are just knowing in the back of mine or any of more likely to be single fathers raising kids without a wife or single mother most of them are sorry is that with it
Dr. Chris Allington: so one of them's father/daughter a couple of them are the retired dentist stayed on a couple of them are younger dentists just starting out so a couple of them have spouses working here on on on work for the company so the spouse came down and the the partner you need a job so so and we don't have trying to think we've only got one or two partnerships and as you've seen in the state's a lot of partnerships fail so yeah it's it's a sexless marriage yeah that's what a dental partnership is a sexless marriage how does that sound these days ever tiesm hey would you be insured in
Howard: a sexless marriage I know why well it's something yeah I you know they they get so much noise because there's so many people making a lot of money selling the partnerships and then they're gone and it's just and how do you have individual freedom when you're lost down on a contract in a partnership yeah you know yeah and that's why things work well in my situation that's one of the reasons why I say it as an associate so long because partnership I just there's potential problems and then you got a you know you're dealing with lawyers all the rest of it so just I think in both of our minds we it was always going to be a sale as opposed to a partnership but I could name 100 dentist
Dr. Chris Allington: yeah that sold the partnership for say five six hundred thousand dollars five newsletters a disaster they had to spend that five or six hundred thousand in legal fees for years in order to pay them the five hundred thousand back so they got five hundred thousand and it took them a million dollars to get it back
Howard: I mean humans are crazy you know yeah so all right well hey thank you so much for coming on the show and thank you it was just an honor and your day goes fantastic yeah and thank you for everything you do for dentistry Howard great all you do for all the young Dennis out there and all of us stuff on little islands like this right on man the biggest the greatest island store I ever heard I was lecturing in London and some guy came out to me he was on an island I'd never even heard of and he was the only Dennis on there and when he turned 65 retired but everyday people kept knock on his door because no one came to buy his practice and so here it was seven years later he's still retired but he has to go to his dental office every day to go see an emergency patient and he learned everything on dental town on the internet and he just told me the internet changed island dentistry forever yeah well it certainly it certainly made things interesting here and we can ever get you down here to talk Howard that'd be great whenever you want let's do it all right perfect all right have a great day