Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1333 Bob Fontana of Aspen Dental on the Changing Dental Landscape : Dentistry Uncensored with Howard Farran

1333 Bob Fontana of Aspen Dental on the Changing Dental Landscape : Dentistry Uncensored with Howard Farran

1/15/2020 3:00:00 AM   |   Comments: 0   |   Views: 2646
Robert Fontana has served as ADMI’s Chief Executive Officer since the company’s inception in 1998. Under his leadership, ADMI has advanced from its Northeastern roots to become one of the largest and fastest-growing dental support organizations in the United States. With a unique grasp of the intersection between retail and healthcare, Bob has pioneered an operating model that breaks down barriers to care and puts patients at the center of everything Aspen Dental-branded practices say, do and promise. He has led Aspen Dental’s successful national expansion entirely through organic growth, with a new office opening every four days, giving patients more choice, greater value and better access to care. 

VIDEO - DUwHF #1333 - Bob Fontana

AUDIO - DUwHF #1333 - Bob Fontana

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Howard: it's just a huge honor for me today to be podcast interviewing Bob Fontana: he has served as the CEO of Aspen Dental Management admi since the company's inception in 1998 with a unique grasp of the intersection between retail and healthcare Bob has pioneered an operating model that breaks down barriers to care and puts patients at the center of everything ask for Dental branded practices say/do and promise with almost 700 Aspen dental practices across 38 states every practice is supported by Aspen dental management support organization that provides non clinical business support services to license independent dentists admi provides a full range of practice support services from marketing scheduling billing payroll IT and other business related tasks this model allows dentists with Aspen dental to have the freedom to focus on their patients and provide high quality dental care while enjoying a secure income a healthy work-life balance and a clear path to practice ownership Aspen Dental branded practices or independently owned and operated by dental licenses the great thing I can say about Bob is that man he has been present and persistent over a very long period of time Aspen has grown and been extremely successful I always respect that because business is not easy I respect that bob is quite transparent about Aspen's mission and market segments I got to listen to you lecture in a Chandler Arizona right up the street from here when you open up your Kohl Center let me tell you how big a fan I am of yours I am i but I didn't stalk you I was at a dentist's house no I was at a dentist's house I was lecturing for IVA Claire and I think I was with George Tate Kowski or one of the dentists areas and we were driving to his house he goes yeah that's where Bob Fontana lives i go stop the car I'm gonna run over there I want to meet the guy and he's like well well I mean do you have an appointment or did you call him I go no I'm just gonna knock on the door he goes dude are you sure that's cool I thought he probably won't mind but right it's not cool so Bob I spared you from knocking on your front door while going to another dentists house but I mean but man thank you so much for going to show a quarter of our listeners are still in dental school and when they're looking at job opportunities because in my day when I got an 87 the only people that offered you a job you got out of school was the Army Navy Air Force Marines and now you're providing jobs to dental graduates that all the old people like me aren't doing so thank you for providing jobs to the dental school graduate but how are you doing doing great 

Bob Fontana: doing great and great to be on your show I appreciate you have me on for sure 

Howard: you know what I what I tell kids all the time is that even even the older guys who don't like the fact that dentistry is being consolidated by going from a cottage industry to amateur industrial I say well regardless of what you think I mean Bob's running 700 offices and you're having a hard time running your own office don't  you think there's anything Bob Fontana might know that you don't know like like when I went to hear you speak I mean you're opening up your third call center what do you think of your competition of the the old guard how do you think they handle the phones versus Aspen Dental 

Bob Fontana: we've learned some things along the way there's no doubt about it I'm not sure if we give you one of the things we need to learn is give you an updated actually 800 over 800 office is now in 43 states so you know we continue to grow we open up a practice and you practice every four days so that way that's why that number is a little fluid but listen the call centers the call centers the first experience the patient has with the with the organization so it has to be right and calls are important people are making choices so you want to make sure that they have the right experience right from the start for sure 

Howard: yeah I mean if you call any dental office I mean the  practice management consultants tell me that when they call their own clients at 36 to 39 percent of all incoming call during opening hours goes to voicemail and that's not a problem with Aspen Dental is it

Bob Fontana: it's not it's one of the reasons why we removed it from the practice to a call center today we handle 15,000 calls a day for new patients fifth think about that 15,000 calls and so our choice is pretty simple we say listen we want to have a very consistent delivery and how we handle the calls for those practices and so typically at least with our organization the front desk physician turns over the highest and yet those were the people who used to take the calls so for us it made sense to consolidate those into a call center and is that because the front desk person has the highest turnover because Dennis have eight years of college I just have four years of college all my assistants went to a year college do you think it's because a degree slows down employee turnover or why do you think the front desk has the highest turnover I don't know I mean it's an hourly position it's a lot of work obviously I think in some practices where they see they have an opportunity to grow they don't turnover as much you know but it is it's a junior role within the office so you're if one rolls in turnover the most that's probably the role is going to turn over the most and and when I saw you you said the Chandler was your third call center so is that what 

Bob Fontana: so all the incoming new patient calls go to your three call centers they do we have one here in Syracuse we had a small operations in Florida we actually consolidated all of that now into Chandler I think now we have almost 450 associates in Chandler every day answering those Falls phone call so Chandler's your only call center right now we consolidate all in the Chandler that's right that was the whole purpose of Chandler from the beginning oh Syracuse and Florida and every everything yeah we wanted the move it all over Arizona I don't know if you know us Arizona I think Phoenix is the call sound call center capital of the country so it was it made sense for us yeah I have a ton of AME America merican Express is like something like 4,000 call center just on their travel agency yeah it wouldn't surprise

Howard:  ya you know you know the other thing I've really admired about you is all the DSO Chieftains out there their guys leading the assessment you you're the only one who ever talked about you had a specific segment in mind I think I think a lot of dentists come out of school and I say well what market segment are you and they go oh I I want to make a great car for everyone I'm like okay so you're gonna sell a Cadillac to everyone but you're signing up for a price of a Ford Taurus or a Chevy I mean what-what are you doing and you would always say that you you had a target market Aspen ever was meant to be all things to all people but you had a specific target in mind will you talk about that

Bob Fontana: yeah for sure I mean listen I think all great brands understand who their consumer is understanding that customer is our case understand who the patient is and so from us from the very beginning it really was trying to understand who this patient is and what their needs are and so that leads really the way to the kind of the foundation are of our organization and for us it's been pretty simple it's been our North Star you know helping patients get the care that they need and you know you're touching on something I think is near and dear to our heart which is you know there's lots of great practices out there's lots of great DSOs the question is really do they really understand deeply understand what their patients needs are and we recognize for us our that people have choices and you got to earn those choices you got to earn the right for that to be able to see them and so I like to think in our best days that's why we get a fifteen thousand calls a day that's why we see 25 thousand patients a day that's the reason why I think that we've opened more de novo offices more new practices and literally anybody else branded prices than anybody else in the country probably the world awesome 

Howard: yeah and one of those I knew patients actually stole my uncle so thanks all Bob and you know why you stole him from my practice where my price is free and you know how you stole him whether I pay money because whenever he came to me I had to take an impression and then send it to the removable lab yeah and he had to go without it you know he got to come in at 8:00 and then do this and then come back at 5:00 and pick it up and he goes no way so I can go right down the street from where I live at Aspen and they got the lab in-house and when I go on there Howie you should do that how he says when I go in there they do it all right there and and it's it's all done on services and I think what's interesting about you is when I was at 10 years old about half the dentists had that lab guy in their office in Wichita Kansas and my they had a one guy making gold crowns and P FM's and a removable guy and then everybody kind of quit doing the in-office lab thing and then here comes Bob not even a dentist say sowe're putting the blab back in and then you still my own uncle from me so so how did you how did you see the importance of the lab and is that still a part of your secret sauce today 

Bob Fontana: yeah if you just go back a little bit so when we founded the business I mean I was thinking about going to school to be a dentist actually dentist talked me out of it was I was pretty I was pretty intrigued by Lenz crackers and if you go back you know 20 30 years ago LensCrafters forever change the eye care industry and if you if you remember they've moved along since then but if you remember the original kind of brand promise and  how they position themselves in the market was glasses and frames in about an hour on-site labs so we start to think about what the consumer what the consumers choices were and you think about a very fragmented you know marketplace your mom-and-pop dentists all over the country really not competing we thought geez can we really get people a different choice and understand they have real needs and real choices and that was really just again the kind of the springboard to Aspen Dental 

Howard: well you know and that brings back one of my sad summers growing up I think I was about 10 years old in Wichita Kansas my buddy David Horne Brooke his glasses we were playing around and they fell off and got broken and he couldn't see without him but then he cut a couple weeks to get into the eye doctor then he got a prescription then he sent it somewhere else it took six weeks to make his glasses and there we were horsing around and now my buddy you basically couldn't see all summer and I just thought how terrible this but fast forward that's a 20/20 did that happen to and said he wasn't a little Davey Hornburg today he did all that he'd be back on his feet a couple of hours

Bob Fontana: that's exactly right and we like we hope the same thing happens for us me listen at the end of the day Howard consumerism is everywhere and you understand anything you think about your daily life when do you want something you make you right when you make your mind up and you want something you want it out and I don't think dentistry should be any different than that right so when you think about these patients who are you know maybe pushing things off pushing things off and they finally make that decision to come in the office we call those our moments of truth we want to be in that consideration set we want to earn their their right to come see our practice their ability to see our offices 

Howard: yeah when I pull into McDonald's if there's more than three cars in front of me I just go across street to Burger King I mean I'm not waiting three cars for a Big Mac and I really love the fact that McDonald's now has more cow calories and their coffee with creamer than a Big Mac so you don't have to chew anymore you can just drink all those calories that's right I want to talk some specifics with you  have a branded Aspen in the age of Yelp and Google is it really smart to have all eight hundred dental offices linked to Aspen or Yelp or Google like like some DSOs they don't if they buy a dental office they leave your name up there and you roll them all into one brand so what are your thoughts on branding versus non branded

Bob Fontana: well listen I mean you broke up a little bit there but I think I know you're getting that I mean obviously we believe in the brand for a lot of reasons I mean first and foremost we look at the major jobs that we have is putting new patients through the doors for our doctors I mean it's this it's key to the practice obviously when you think about what the efficiency is of a brand across 43 states going you know obviously completely across the country you know we'll spend more in marketing and advertising for the brand than most than the revenue of most dsos I think next year we'll spend about 125 million dollars in marketing and there's a fair amount of efficiencies you can imagine in that and so for us we believe in the brand listen we understand that there are a challenge just everything rotates to the brand that's no different than any other brand out there and we work hard every day to make sure that we have great patient satisfaction but at the end of the day we believe wholeheartedly and having and having one brand you know we consider ourselves operators not necessarily consolidators there's an operations model to the brand there's a brand promise a set of values and a culture all that's wrapped up under the brand and so that's again foundational to kind of who we are at Aspen Dental

Howard:  so you're spending a hundred and twenty-five million a year in advertising which translates the 15,000 incoming calls a day and scheduling 25,000 patients today well 

Bob Fontana: we see 25,000 patients of the 15,000 calls per day we schedule approximately 55 or 60 percent of those calls every single day 55 so you convert about 55 to 60 percent are converted to schedules that's right that's right and we only take the new patient calls at the call center the call centers really just meant for the new patient if you're an existing patients those calls because they've already established a relationship at the office so if you're an existing patient you go back to the office

Howard:  hah that is a man you must have so much data to work with on that that's just that is amazing so um a lot of people say okay when I was in high school all the pharmacists all they all work for themselves and now they were all consolidated into CVS and Walgreens and so some dentists are wondering how big is the DSO market today and where do you think the top end rate I mean that what 10 20 years from now what percent of dentists will work for a DSO

Bob Fontana: I don't know that's a tough one I think if you use I care as a proxy I think there's a fair amount to go for sure I think maybe the market it's a little definitional like what is a DSO so I think that's part of it but I think if you believe in the market right now maybe is 20 percent DSO 80 percent maybe more traditional and I think I cares maybe more 50/50 in the way it delivers I care so that would suggest again if that model was a proxy for the dental category would suggested there's still a fair amount of growth for dsos

Howard:  so you think dentistry right now is 20 percent DSO and I care is 50 percent

Bob Fontana: I think the delivery model is priest is split you know we think about kind of what I'll call more corporate more branded retail delivery models in eye care versus traditional practice so a Warby Parker or a LensCrafters versus a traditional practice I think I hear it's about 50% and so again don't know if that's the right proxy for dental care but when you think about the consolidation and the movement in the DSO space it's gone pretty it's gone pretty dramatically over the last few years and and I think generally new dentist coming out I almost say they like the model but I mean even for us I mean we'll hire four or five hundred new graduates this year I mean that's probably about 10% of the class and 

Howard: so you'll you'll hire how many how many we'll hire four or five hundred new graduates this year and how long does the average graduate stay with you oh that's a good question 

Bob Fontana: average graduate well certainly the more junior they generally join us associate Dentist and generally they will turn it over faster but many of those new graduates will get into our ownership program they'll stay they'll make a career out of I mean that's the goal really at the end of the day we want to we want to establish a long-term relationship with them and eventually transition them into our ownership grammar 

Howard: so um I've had the luxury of lecturing around the world since 1990 and I've only been able to talk to three guys like you who were actually publicly traded and two of them were in Australia and one of them was in Singapore so I my question was on let me uh let me get their names right here so in so the only three publicly traded dental companies or one three hundred smiles in Australia Pacific smiles group in Australia and then QM so there are amazing podcast one three hundred smiles was Darrell Holmes and Pacific smiles groups my favorite Alex Abrams and dr. Raymond Eng out of Singapore who's rapidly expanding across China I want to ask you comparing Aspen to those three first of all those three do not have hygienists they they in fact they all have the same business model they're um seven two seven seven days a week they hire new kids straight out of school and the average dentist stays with him about five years but I was wondering a couple question on that why are none of the big dsos like you or heartland or Pacific why are you not on NASDAQ these guys are publicly traded and why do they not have hygiene and what's your thoughts on the hygiene Department 

Bob Fontana: so for us I don't want to speak for Heartland or Pacific to those guys made for us we don't feel the need to access the public markets for capital and it's really that simple we have you know we have a business that cash flows pretty quickly we like the returns and in the de novo model that's why we built 800 of them that's why we open up a new one every four days so we think the returns that kind of cash on cash returns for that model is compelling and fairly predictable so there's really not a great reason at least this point to access the public markets maybe at some point there will be I don't know but my view of the world is this grow and operate a great company everything else will take care of itself if we want to go public will go public we want to bring more private equity whatever we want to do first thing is go grow it and manage a great company's lead a great company so on the hygiene question we love our hygienist we can we have the practices have great there's a great IG practice it's led by two wonderful individuals who would do a great job focusing on  supporting the hygienist day in and day out and I can't imagine having a healthy practice without having hygena true I mean it's just it's a part of what we do in this country I think it should be a part of the dental practice it is for us and I don't see it going anywhere

Howard:  so do you have a model I mean like is this average Aspen you you have 800 locations is

Bob Fontana:  the average one have two dentists 2 hygienists to us deserve a model for the averaged Aspen number very square feet standard model 3,500 square feet generally 78 operatories as it matures usually has two full-time dentists it'll have a hygienist and a half it'll have oral surgery and Adonis coming in and out of it kind of the itinerant model they all have on-site labs is we've noted before and so when you look across the country really at the end of the day they all operate generally speaking on the same model so when using our same labs is on-site one word ons IG HT it is a - in it is there

Howard:  so it's on-site labs 3500 square feet you said seven to eight ops yeah seven to eight ops and matures at two full-time dentists so you start with one and then you try to grow into two yeah and some you know listen some will have three and one not but for the most part of you take a cut at at the mature offices generally have two full-time dogs okay and then 1.5 hygienist yo is the 0.51 she'll is she like alright she's okay she's arm and left leg sorry on-site lab what's Alban site lab is that one removable guy does that use the unemployed it's usually it's usually staffed by one some times in busier offices could be two technicians yeah but it's mostly for removal it's not crown and bridge or CAD cam or Sarah oculus it's mostly removable night guards you know that type of stuff but yeah mostly they're mostly acrylic so so so you kids listen this guy I mean I mean do you know you know you  know anybody who has built 800 practices from scratch and got them all up and running without the need to go public but they're 3,500 square foot offices seven to eight ops you say generally speaking yeah and they mature you start at one dentist go to two full-time Dentist one-and-a-half hygienists and on-site lab for removable and what were you say about specialists which specialist do you usually will have an oral surgeon and endontist coming in you know kind of rotating through territory oral surgeon and endodontist yeah um I can vouch for that a lot of my friends and when I say friends I mean I myself included when young kids come in and work for you and they t start wanting to learn how to place implants so they place four or five implants that first year and they do a dozen molar endows and then you have turnover and then over the next two or three or four years you get a pay a periodontist to redo every one of those implants and redo those root canals and so now some of my friends that have three or four locations they  are only letting endodontists do the Moller endows and periodontist place implants because of the failure rate of the  general dentistry yet did you did you do that for those same reasons were you having those same issues 

Bob Fontana: it's a little bit it's a little bit of that it's also just a little bit of listen you're gonna have people who are different comfortable at different things so the owner doctors you know some of their practices may be pretty adept at them others may not be mean we're going to support them either way we're going to we have all sorts of programs continuing education programs clinical support programs I mean we just enrolled rolled out Invisalign last year for example and so forth it was not a part of the practice up until last year but we went out and hired would we think some pretty talented folks who one one person in particular came from Invisalign and another person who was one of the leading Invisalign producers and doctors across the country we said listen if we're gonna go support the doctors let's go support them the best we can and give them the right tools to be successful so witless at the end of the day that we want we want our one of the doctors to do what they're comfortable with but we also want to help them in their journey to continue to be a better dentist 

Howard: so who you gotta tell us the names who who's your Aspen Invisalign thought leader so 

Bob Fontana: we have Dr. David Geller who runs who really supports the Invisalign initiative he still does a lot of lecture and actually for Invisalign so he's been really instrumental in rolling that out we were the fastest ramp in invisaligns history last year and so we're pretty proud of that still a long way to go but we're pretty proud of where we've been and then dr. Rowe wall actually just joined us in deeper wall who's gonna now lead and support our implant initiative across across the country as 

Howard:  well I love David Galler he's a neat guy please tell him to come on the show and tell us what he's he'd be happy to I'm sure yeah yeah tell him I um I really would love to hear his thoughts on that so who is the other guy you said us in deeper wall how do you spell that son deep and in are a Wal fell son deep what say the last thing we are a Wal I believe RA yeah yeah and so

Bob Fontana:  he works the clinical leadership team to develop the programs to really help both on the restorative side on the surgical son the placement side so he works really pretty deep with the clinical team will support the doctors to continue to enhance enhance their skills well talk about is cerebral is that the the prosthodontist out of florida that's right 

Howard: Wow yeah I'm on the show that guy is amazingly smart so why is a prosthodontist helping you with your Invisalign

Bob Fontana:  no he's helping with our implant initiatives so oh okay what you were asking this how do you get doctors better what I'm saying is what we typically do is go out and find great leaders who've been are really strong at certain areas of the practice and say let's go leverage them to really help the general dentist population across the 800 locations yeah okay now that makes sense

Howard:  so um let's talk about I'm still back on your model so you have oral surgeons and like say I am I I give you so much credit hiring five hundred kids out of school I mean really Bob I I tip my hat because when I was little that only the Army Navy Air Force Marines would do that I know guys my age do not want these kids and I have to say on my own show I don't want them either because I let them do 20 implants and 20 molar root canals and then I got to pay for the periodontist up the street or you know to redo all that stuff and so if you keep if you could ramp these graduates up you know my power to you but  on that model what butter with the expensive stuff CAD cams CBC T's lasers I mean those are a hundred thousand dollars a pop do you what is your high technology expense needs on your de novo new Aspen dental office model right

Bob Fontana:  well back up for a little bit on the new grads we love them we absolutely love them there they're hungry they want to continue to learn I mean there's a lot more than dentistry than just teeth and so if when you come into our programs it's really about wanting to hopefully make that progression into a lead dog into an owner dog thinking about how to lead people and manage people really supporting them along the journey and so all I really care about is that they come in open minded and they're willing to learn and they'll have a great love a great journey here and we've got programs got a 130 130 mentor doctors across the country and we understand we will be as good as our learning and development programs and that is really kind of central that investment is really central to their success so we're excited to have them we love we love them and  you'll be surprised on how fast that they ramped up so on the technology side listen we have as I mentioned Invisalign I think we weren't big on CAD cam we had you know we had I would say maybe eight to ten machines I don't know with limited success to be honest with you we just didn't get the traction we poured some time and money into it and I'd say that half of them maybe you probably aren't even getting used today but I would say the I taro from a technology standpoint has been very positive it's easy to use it supports new patient you know just the acceptance and the treatment planning obviously it's critical to Invisalign helps with crown and bridge a lot of efficiency there we think there's  a better image more efficient for the lab kind of all that stuff and now that we're doing implants we're going to do a CBC T across the country and so we believe it's the right a CBC t1 for every location across the country which one are you gonna go with I believe we chose Carestream because we have a care stream ecosystem today we put it up and they have there's some really good things about about their system including that I'm not familiar with all the moving pieces but particularly the treatment planning software we like a lot but we just we believe in terms of the standard of care doing that type of work is really important to us so we're going to make the investment I think this year alone will probably put in four or five hundred CBTs and offices this year alone good lord

Howard:  so I do get free tickets to Atlanta season tickets to the Braves games or

Bob Fontana:  listen care streams been a great care streams been a great partner of ours and and I would say this so we went through I mean well it's one of the advantages the docs get for joining us is we will run a pretty tight process RFP process and it enables us we think to get best-in-class pricing and support and service and so we're happy with the way care stream responded we're excited to continue to roll this technology out across the offices and doing it with them my gosh

Howard:  is this gonna be Lisa Ashby is this gonna be her greatest year ever which Aspen Dental 500 I don't know you know actually you're making me feel better because that's the one I went with and I was a caring CB CT and I also want to say that I'm I never it's amazing how a business of mine like you didn't see the value in the CAD cam either I mean it just just didn't didn't make sense but but when you see Invisalign that brings up a something else interesting um so in orthodontist is it's sixty five hundred bucks and Invisalign rolled out clear aligners and they worked with the orthodontist and but it's still you know high dollar sixty-five hundred dollars and then the American Way is that you have some innovation technology so here comes smile direct Club out of Nashville and they say you know what we're gonna use that oral scanner and we're gonna have a I designed the deals and we're gonna we're gonna squeeze costs out of this which is mostly labor and we're gonna go direct to the consumer and we're gonna deliver him a lower cost or for $2,500 and when I got out of school a big-screen TV was $5,000 and it was it was a yard deep now there are $500 and you can hang it on a nail on the wall so why the difference why did why does it work for big-screen TVs and not orthodontist because smile direct Club I mean it was it was one of the most it was it was a crazy event for orthodontists their roll out I mean it's just been a lot of stress so um what was your assessment of that why so different for high technology low-cost option good for big screen TV bad for clear aligners 

Bob Fontana: well I don't know that it is bad for clear liners I think a couple things technology is going to continue to evolve it's going to continue to change there's no doubt about it and you know what I'll tell you what we believe we believe that people deserve value they're going to want to go where value is and if smile direct club did one thing they showed I think the world that people need more ortho than what you think and they've democratized it and for $2000 they understand that price is a big deal it's an issue for people and so when people can't afford it they don't get it done and so I listen I don't I think we believe that we want to blend the right technology but also have the doctor involved you're moving teeth inside bone I think it's critical and so listen technologies gotta continue to evolve consumers are going to make choices and it's our jobs to make sure that we do have the right technology the right price for offering it also do the right thing for the patient and blending those things together I think is really critical 

Howard: so yeah I mean money is the answer what's the question if you move braces from 6,500 to 2500 I imagine four to five times as many people would be getting braces if it's one third to cost yeah real thing 

Bob Fontana: yeah if you do it but you have to do it right and again at all I'm not I don't I'm not familiar enough with SDC's process to opine on whether they're doing it right you're doing it wrong we believe our doctors believe it should be done the dentist's involvement should be it's consistent with state regulation they should be involved but at the same token we also understand valued price convenience is really important it's the backbone of our brand and we're gonna work hard to continue to provide that level of value to the patients

Howard:  so do Joe Don Howard for sure

Bob Fontana:  price will come down yeah it's going to there's no doubt about it I mean it's it's gonna happen so so so basically what he saying you kids are a little younger to understand is Invisalign aligned technology the CEO is Joe 

Howard: Joe Hogan who I've been trying to get on the show as long as you so I next time you see Joe say well Howard got one of the two but he owns a owns a line technology any owns I taro there you have two products and what some of the dentists want to know and what I want to ask you is such a big sample sizes some say that when the dentists are old like me and take their impressions with em for gum and send it to the lab that there's more remakes than when you take it with an oral scanner and I Tarot and send it in and do you you should have date on that I mean do you think an emperor gum has more remakes than oral scan or what is your we're compiling the data now 

Bob Fontana: I don't have the exact numbers in front of me but anecdotally I would tell you that the team believes that the digital scan is more accurate it's more efficient it's more accurate particularly one you become efficient with that machine so it's unlike CAD cam it's pretty easy to use as you know and I think I Tarot I think three shape those organizations continue to evolve that product in a way that I think is going to continue to help both the dentist and the patient so and interestingly what you'll see for us pretty soon is we'll be going towards digital dentures and we believe the scanning that that technology exists it's a better fit there's less remakes there's a lot there's a lot happening in that world and so you know again we're going to continue to push hard to leverage technology where we think it makes sense and where it's ready for our organization and then deploy it 

Howard: digital desert dentistry is big here out in Phoenix yeah there's some major players out here yeah um so but did you um I mean you could have gone three shape their trio scanner 3m has true deaf did you like did you want to go with the oral scanner from I Tarot because you're rolling out Invisalign and they're both owned together and that's a 

Bob Fontana: more simple closed system working together was that a big part of this lines got a great product Joan the team do a great job and [Music] you know we just we like that closed loop system and where we were happy going we listened with like three shape to don't get me wrong I think it's a great product but we came down to we just felt like the ecosystem in around a line made sense for us so if we're gonna use Invisalign then we should use I Tarot

Howard:  the Japanese have a very interesting saying they say successful man fall down seven times get up eight you've been you've been in this game a long time and so where did you fall down along the way and what did you learn from it and they say if you learn a lesson it's not a mistake what have you what have you learned along the way that you could tell some young kid not to do that don't uh you've already stuck your finger in that electrical socket and you don't advise it what have you learned along the way a lot the bruises to prove it listen I mean 

Bob Fontana:  what we knew to beginning for we're pretty I think we were pretty along far along the curb we understood we had an operating model that works you know a lot LensCrafters we knew that I knew that in rolling that out and when the organization was small you know you could get your arms around the organization you could communicate you knew everybody in the organization and all of a sudden we turn around we look or huh 150 locations and I'll never forget it I mean I I went to the organization in 2011-2012 I remember saying jeez you know we have some cracks in our armor and the reality was for me Howard there was a learning lesson for me was people matter and people matter a lot in this business and every dentist every leader every manager I mean this is we have 800 locations they're all branded Aspen dental they all look the same they're all built the same until you open the door at the end of the day we understand that people matter the most and we have 12,000 people going into the offices every single day team members and having clarity on who we are what our values are what our purpose is what is the lie of this organization and so all I would say is for you know younger dsos or group starting out there yeah it took me a little while we had to have some bumps in the road but I thought values culture that was just an HR thing you know and it was just kind of soft stuff but this the reality is if you have a successful enduring organization and they are the foundation of what we do and in particular the doctors and how we support them I think you know for us we understand for a long time ago we understood that we want to build this business with our doctors and that was critically important we don't want them just as employees we want them as true partners and again if you think about the people component to this business it starts with them and so we make big investments in that all day long we believe that the patient experience will never exceed that of the team experience and it starts with the team so when you never want to capable people across the organization 12,000 of them if they come in with a great deal of clarity who is this patient what are we trying to do for them how do we help them and they understand what our brand promise is then we have a bright future if we stumble on that then we'll have to reset and

Howard: that's kind of the difference between Joseph Hogan the CEO of align technology rolling out Invisalign with the orthodontist versus smiles drug club trying to go trying to eliminate them there were nothing I mean they want to eliminate him to lower the cost like I get that but do you think that was a big part they're a big part of their dilemma I mean they're trying to reduce cost by eliminate the orthodontist

Bob Fontana:  yeah I mean listen Joe yeah I'd say Joe and the line have a great product I think one of the challenges when you have outside people impacting your brand every day that's hard because they can't control things related to their brand they can't control price they can't control service they can't control all these other things related to the brand that's hard and so I think in us in our case and smile direct clubs case in other cases when it's your organization you control the brand promise and let's know figure it out don't get me wrong but that's that's a tough position to be in 

Howard: yeah I wonder and of course everyone's know also because the it the stock is like it's almost like a daily movie on dental town I remember everybody is talking they follow that start crazy who do you think you know who your customer is you've been very focused on your customer who's your competition is it more other large skilled DSOs or is it the or is it the fact that the older dentists are gonna do the status quo and not change who's your competition the status quo of the old guys are the up-and-coming des those who are following your lead

Bob Fontana:  I don't know I mean we have competition for sure so this is always a funny question I actually believe though the competitions ourself honestly I really truly mean that like we'll go into any market we don't care about the supply ratio of Dentist and population and all that stuff because we understand our we think we understand our patient better than any other group that's out there I mean I just got a call I really I got a call quite a second one I've had this one right before the holidays from a CEO of a DSO said how do you open up so many de novo locations I push back on they will tell me like who do you focus on he said what do you mean when you open up a de novo who do you focus on what do you do what do you stand for he's like well we do family dentistry family dentistry what kind of target is that it doesn't make sense to us if you're in my shoes that doesn't make sense we see the world like Starbucks and Dunkin Donuts everything that they do everything that Starbucks does they do with purpose based on the customer that they want to draw through the store the color of their stores their environment their pricing strategy their hours if you maker with the barista everything is in ten today if they think of the world you have home you have worked in there the third place and that's very different than Dunkin Donuts that one's right or wrong but when you when I get asked the question for us going to mark it and understand it really starts with the end user in mind who is the patient what are their needs and how do we help them in a way because we listen we understand that they have choices so yes we have competition but the end of the day we had to understand that the worlds that they continue to change that's why I get frustrated sometimes by the traditional practice because yes a we get sometimes we get arrows slung at us and all that stuff but the world's gonna change technology's gonna change consumers are gonna demand it no different than you I mean think about it I mean how many years ago you you you would never have thought to take in an uber who would've thought that we would need a new taxi service but all of a sudden ubers everywhere lyft and we weren't because it's a platform that consumers and decide to use so we can bury our heads in the sand or we could say what do the consumers want in health care unfortunately for maybe fortunately for us unfortunately has been more about the doctors rules than the consumers rules and the consumer now says that I'm not sure about that anymore in fact I don't know if you know this we have a small Urgent Care business as well we bought an urgent care business at six locations we're now at 45 locations we'll be close to a hundred locations by the end of the year it's the same thing it starts with the consumer in mind and so for us again we have competition but at the end of the day it's do we have do we have people every day coming into our offices understanding our values our purpose our brand promise and executing on that every day that's what's critical 

Howard: so Aspen bought an urgent business that's right yeah in 2016 well and tell us Aspen Medical Center is that what you're calling it or

Bob Fontana:  no it's called well now Well Now Urgent Care and we build them out in some cases right next to the office well now yeah well now HT retail dot-com let's see what it says Horvath and Trimble sells Aspen Dental and well now urgent care in Lakewood New York 

Howard: Wow I now have you rolled that out in Phoenix marching from New York going across Ohio into Illinois that is genius because in Arizona eight and a half percent of emergency room visits are odontogenic in origin is that the kind of the guts of why this happened yeah you have that you just have the overall kind if you think about our core capabilities in understanding kind of the consumerism in healthcare 

Bob Fontana: we think that is really core to what we do not to mention how we work with insurance plans revenue cycle management marketing site selection team development leadership and development so dentistry is obviously really important to us the Aspen Dental is the hundred pound gorilla in our universe but we also know there's a lot more that we can do within healthcare and now that we have kind of the the infrastructure we believe we can we can develop other platforms and brands as well 

Howard: Wow that is amazing because I always have said if I was going to start my own DSO it would be I would I would be inside the emergency room of every major hospital in America because when I go to those emergency rooms um that's what they always tell me the data I see it's about you know eight and a half percent for Arizona and they can't do anything it's a hospital you said that health care has been more about the rules of the doctor than the consumer well no but nobody explains that better than a hospital they can remove a brain tumor give me a bypass amputate my foot for diabetes but they can't touch a hot tooth hay right or

Bob Fontana:  they can't even figure out how to bill you and so I mean I really don't really understand again not to disparage anybody but at the end of the day we just again fundamental to what we do is is really trying to understand the consumer by the way the doctors our consumer - and how we help them how we support them is just as critical because at the end of the day when you think about obviously when you think about Aspen Dental open a new location every four days it has to be done in partnership with our doctors and so you know we think about the business support services that we provide them those are really  critical and paying attention to their needs is just as important for us and so we go to market the way we think about our strategy is not just you know the patient but it's also the doctor and how we can continue to support the doctor to be great at the roles that they're in

Howard:  I'm trying to look at what would be the best summary of your well now Urgent Care what would it what is the business model of your well now Urgent Care 

Bob Fontana: well it's seeing a patient immediately it's all walk-ins and we see that patient for roughly I think the average tickets 125 dollars compared to the emergency room at $900 and doing it with five-star service I mean I mean we really try to make sure that that patient would think about it you know your son gets hurt in a sports game or your daughter gets hurt in a sports game or you got sick now you're running your family doing all that you can't get ahold of your primary care physician you don't want to go to the emergency room so that's where we intersect and so we think about that business almost as a portal we're gonna help you out we're gonna get you stabilized you we're gonna help you out and then if you need to go back to your primary care or you go back to your own physician or whatever it may be your specialist then we'll do it but but that's a great little platform work cited we're excited to continue to roll that out across the country I 

Howard: you're so generous with your time I'm rapping I'm coming down to two more questions but when we look at dental dentists income it's no doubt that you know the average American specialist makes three twenty year the general only makes one ninety seven for general Dentist family Dentist if you own your own practice you make two forty four if you're an employee you make one forty seven well a lot of that is because of our amazing insane US government sixty thousand page tax code which you probably can go your whole life without ever meeting anyone who's read all sixty thousand pages that tax code you have owner operated practices do you see just the fact that you're an owner operator in Aspen that the change in tax code is a big part of this material difference of why the average employee dentist makes one forty seven and the average owner operator Dentistmakes two forty four is a lot of that tax code and as they're a chance if someone works for Aspen that they would be an owner operator and that tax code would benefit them

Bob Fontana: yeah I mean I think there's probably some some benefit I think it's de minimis in the scheme of things let me let me walk you through so we hope we call it dating we want you to come in we want you to love the organization we want you to be passionate about what we do every single day and we want you to learn and we want you to become a lead dentist eventually we want to get married we want to become an we want you to become an order doctor within our system our average owner doctor makes roughly a half a million average a half a million dollars a year on average our top guys are making in excess of four million and let me let me let me make sure you understand I think what's critical for me cuz I talk to a lot of young doctors over time dentistry is great obviously it's a great it's a great category and and we're blessed to be in it but dentistry is also physically demanding and it's hard when you're sitting there and you know you've been practicing for a lot of years so what we try to do is we try to encourage that just to think more than just about the mouth more than just about the tooth what they can do to monetize their license how to become an effective leader an effective manager and leverage the out of us in our infrastructure and our organization in a way that allows them to have multiple offices and a practice they never thought possible to me at the end of the day and that's the dream that we're trying to say listen you don't need to be a mechanic for 54 40 years and sell that practice for maybe less than you put into it or the less you bought into it thirty five forty years from now we're trying to say listen go into it with the best in my opinion obviously I'm biased the best group the group that's open up more practices successfully than anybody else in the world and let us partner with you in a way that can change your life in a very meaningful way and those are the people we want to go on the journey with us that's what's critical here and so for my part listen we're going to help them with all their clinical stuff for sure we're going to develop them but we there's so much more to Dentistry than that and for those who are open minded and want to continue to learn we're were completely invested in them because we know our business can't grow without them and so that's been a great partnership for us over the years and it's allowed us to be who we are today 

Howard: why don't you get do you have one in Arizona that would come down on my studio and share and go into detail about that yeah dr. song dr. mather the great owner doctors right in Arizona we love them there they're absolutely terrific where are they are they in the same office no those are two different owners in the brand Arizona we have multiple owners out there I got I got two chairs right here what would be they would do it I'm sure they would do in a heartbeat there they love their practice they love Aspen Dental they're great doctors they're great partners and we're blessed to have them on our team for sure what I love is that's why I call my show dentistry uncensored I don't want to talk about anything all the dentists agree on and that's that that's why I gotta say one thing about dental town like all social media you know the founder of Facebook Mark Zuckerberg you know his dad's a dentist and basically when you look at all social media 1% of the people or make all the original content about 9% engage but 90% say nothing so you get this very skewed confrontational kind of like when you watch the news and two people are arguing with each other so um I I don't like to talk about anything they all agree on I like to talk about what's new what's  a the change and so I I would love to have those two guys come on and talk about some hell I didn't even exist when I got out of school now the world is ever changing so uh my gosh I I'm trying to think of what else I would look smart I would have revisit one last question again but but you're you you still like the single branding versus each store have their own name because that's just a big part of your formula

Bob Fontana:  listen I just think I don't want to sound disparaging I come from I come from a place of we're one organization trying to do you know trying to execute on a set of values purpose and promise under this brand every single day I don't really understand the consolidator so again not that's not taking a shot but they have hundreds of locations maybe some of them they bought all these different micro cultures all these different you know different ways that they go to practice and they go to market and I just think that's  a little bit of a roll up and I look at our business completely different but we're in the business of putting doctors in business we're not thinking about it we're not buying anybody out we don't go out and we don't offer you know Howard a check to buy his practice and hope that you'll work there for two years that's not our model at all we're doing the opposite we're saying hey your ear a young doctor trying to figure out what your journey is come take that journey with us and let's go into business together right you own the clinical charts you on the clinical director you or not that's all the odds all the same you got a business partner who has all this data all this marketing horsepower all this information in a way that's going to make you successful make us successful let's do that together and so you know for us again that's just it's it's it's just it's just kind of who we are and I 

Howard: think that um the the well now Urgent Care I mean I've always said if I was gonna start a DSO it had been emergency room dentistry and I would have put it right in the parking lot of every major hospital in America and sure enough your how many locations of this you have I'm the urgent care side side now I were 

Bob Fontana: I think we're at 45 and those are all gonna be called well now urgent care they're all now yeah that's all well not all single branded same thing same branded Brant branding strategy yeah and why why did you know what when I call it am Aspen well now or you thought it'd confused dentistry and medicine where we're concerned we went through that we'd went through someone that worked believe me it was on the list it was a tough call but we like we like where we are with well now we think it's we like the name and and it works for I think that industry pretty well 

Howard: Wow and yeah I think that is amazing let's say do I have any more any more questions another thing I gotta tell the kids out there is that what I another thing I really really respect of Bob along with Rick workman and Steve Thorne is that you know you guys live in an aquarium with two hundred eleven thousand dentists all looking at every move and when some individual dentist does autoclave breaks down and he doesn't know it's not working and the next thing you know you know a bunch of people have hepatitis and Oklahoma and this and that and this of that and and all these tragedies that go wrong my god if you do the smallest littlest thing out of line your headline news and you just you guys have to operate a whole nother deal and I admire your innovation I admire your stamina I admire how many years have you been at this now Bob Fontana: founded the business 21 years ago so I've been doing it for 21 years 21 years

Bob Fontana:  my gosh right now I regret I should have knocked on your door when I had the chance I was it was George ty Kowski brachio Georgia house key I have a Claire and but anyway but Bob seriously and if you could deliver those two aspirin guys to come to the studio for sure that's no no they would I think they would love to do our 

Howard: dr. Geller this line I already had your Sunday guy and and I also want you to send me a picture of the prize that Lisa asked me the president care stream we negotiated pretty hard so she might let anybody to send her something I don't listen they're wonderful they're they've been wonderful partners SS Henry Schein 

Bob Fontana: we have long-term partners we believe that we believe in that strategy and and I appreciate your comments we are a little bit of fishbowl and I

Bob Fontana:  listen I always say we're going to be imperfect we're gonna make mistakes there's no question about it but we rely on like let's do good things for people right well if we rely on that across the 12,000 people we have we'll have we'll have a great business and a great practice and patience we'll have great results 

Howard: final question yeah for dentistry uncensored a tough question would what are your words to dental school deans who the price of their tuition just keeps going higher and higher and higher and now so many of them over $100,000 a year and a lot of us older guys are thinking you know you're supposed to have one eye on your customer that dental student and one eye on cost and you're supposed to use your brain to drive down cost so your customer can have the fordham to free what do you think of these dental school graduate what do you what do you think of these dental schools that just raised the price of their tuition and and by the time you get your hands on them they're they're almost indentured servant slaves 

Bob Fontana: yeah listen I don't know that model well enough I know and my daughter's going to go to dental school so I'm you know listen so we'll be I'll be writing that Chef pretty soon but as she picked the dental school yet she hasn't she's in the application process now so we got to write here I know and midwestern I know I know I know and she's talked about that she visited Midwestern when we're out the call center last year so she's been out there but listen I don't know I don't know enough about it to having a strong opinion about what tuition is I do know it creates a lot of hardship I do know for us maybe it creates some opportunity indirectly that's not a reason to keep tuition high but because you know it's harder for obviously doctors to go into practice on their own and so for us listen we could work closer with the deans I feel like we're kind of their customer if you will because I think it's a lot of information we can give we can give back to them so it's something I think we look forward to doing 

Howard:alright well Bob I know you're a busy man with 25,000 employees thank you so much for donating an hour to talk to my homies they I really enjoyed this conversation all right we'll see each other soon our time [Music] English (auto-generated)  

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