Dr. Jill Tanzi, a graduate of the University of Maryland School of Dentistry, has over 19 years of private practice experience. Dr. Tanzi started The Dentist at Hopkinton in Hopkinton, MA (www.hopdent.com) 15 years ago near the starting line of the Boston Marathon. Passionate about issues facing dentists and private practice, she is also a founding member of the MA Dentists Alliance for Quality Care which advocates for independent dentistry, patients, and quality care (www.madentists.org). She can be reached at info@madentists.org.
VIDEO - DUwHF #1363 - Jill Tanzi
AUDIO - DUwHF #1363 - Jill Tanzi
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Howard: it is just a huge honor for me today to be podcast interviewing Dr. Jill Tanzi DDS she's a graduate from the first dental school ever University of Maryland School of Dentistry has almost 20 years of private practice experience she started the dentist at Huffington in Hobbiton Massachusetts 15 years ago near the starting line of the Boston Marathon passionate about issues facing dentists and private practice she's also a founding member of the Massachusetts dentist Alliance for quality care which advocates for independent dentistry patients and quality care the Massachusetts Alliance for quality care is a group of dentists committed to providing high quality care to all patients in Massachusetts dent Alliance is making dental student and resident mentorship a top priority they urge all students and residents that are interested in private practice and small business ownership to join their group or sign up for a private practice mentor she also keeps a database at private practice opportunities please get in touch with her for more information for her database founded by Jill Tanzi in 2003 the Dennis at Hopkins provides the most up-to-date dental care and a comfortable and relaxing setting provides complete oral health care to patients of all ages she has enjoyed developing long-term relationships for their patients over the years and loves welcoming new patients as well in addition to utilizing the best technology available to patients her staff regularly attends continuing education courses to keep abreast of all current information and techniques in dentistry you will notice that our staff goes above and beyond to ensure your comfort needs are met not only does her office offers superior don't care but she also understands the complexities of dental insurance and guides our patients on maximizing their dental benefits our their staff is eager to help you navigate your insurance plan and other options to complete your recommended treatment my gosh you're um very passionate about owner-operated dentists how do you believe after two decades of performing dentistry that when a patient goes to the dentist that a owner-operated dentist would be different than an employee Dentist with no skin in the game
Dr. Jill Tanzi: yeah so there's definitely some great dentists that aren't owners but I feel strongly that our profession needs to get its act together and kind of preserve our doctor-patient relationships and doctor ownership not private equity ownership like we need to hold on dermatologists are getting swallowed up and the medical field has been getting swallowed up for a while now and people don't love going to the doctor anymore they're losing their relationship with their primary care physician so I think we have something great and I think we should try to preserve it
Howard: yeah I mean I you know as you get older and you know and by old I mean anybody one nano second older than me I mean I got my four kids turned into five grandkids I don't want to pass on and have my grandkids go to a dentist and some cheerleader with an MBA is saying oh today you're gonna see 20 people with an MOT amalgam those are all opportunities to be upgraded to a crown and the doctors on Commission and doing that it's like well if everybody works for Wall Street where are my grandchildren gonna go when they need a dentist
Dr. Jill Tanzi: right and I actually had the unique experience when I got out of school I did work for a DSO and I work for DSO that had just been sold by to private practice dentists I mean they regretted it they I just saw the whole downward spiral I was witnessing it firsthand so I knew I'm gonna go and start my own practice and do it the right way but
Howard: specifically what did the DSOs do that made the two sellers regret it um
Dr. Jill Tanzi: I think the first thing that happened is that they lost a lot of good staff so I think they were really trying to save money on staff um which is really hard to do now in this economy I'm having trouble finding people to work for even a good salary so I'm back then I don't know what the economy was like so much but they were losing staff that were trained so we ended up having staff that weren't trained and it was a complete disaster so I ended up learning a lot about how to do things in the dental office myself because we didn't have the support there
Howard: what we need to do and then we started losing a lot of patients they always they always used to buy offices and the labor of the selling doctor you know they would give him a raise every time the earth went around the Sun they give him another dollar because you know the the raises were based on I guess astrology and so they would go in there nay by these offices and it was common for labor to be anywhere from 25 to 35 percent of a selling doctor so they would have to go in there and fire all those people and go back to the the entry-level wages because when the young dentist hires them they don't give them a range like if you go get a job McDonald's I say okay if you're gonna work in the drive-through this is the range that you can make and it starts out as say 12 then it maxes out of 15 or 18 or whatever but everybody knows going in when they reach the max it's the max but Industry they don't know where the max is then every year they asked for another raise so the doctor just throws them another buck but that's why that's why DSOs of all switch to de novo and just solve that problem so they that they tell they've said on this podcast I'm Mel you know 20 30 different up DSO guys that they'd rather started new office from scratch with new staff then go in there and do what you just talked about where you going there and you hire all the old expensive ones because if you go in there and say well you know you're making $25 an hour but we're gonna move you to 15 well now you're dealing with the toxic a day I mean humans don't don't like the that one step backwards so it would be
Dr. Jill Tanzi: it's probably harder to do that in an existing practice though because you have such needs and you have the patient base but when you start a new practice from scratch you're a little bit slow in the beginning it's not like you're getting bombarded with this so you can train staff but so it makes sense that they would go in and start people pretty low and train the staff and get them to where they need to be and they create a lot of loyalty by coming in and buying an existing practice you can't start out with entry-level workers it's really difficult
Howard: I know a lot of the DSO stuff you being a female and I can't speak on matters of expertise with being a female even though I did grow up with five sisters I feel like I I should be a be able to be an expert in sisters a lot of them are saying that the Essos are being fueled since two out of three of their employees or women dentists that need change in demographics doing that and then you have another set of people that are saying we'll look at Millennials they're telling you they don't want to work like their parents they don't want to wear all these hats and they don't want to do that they're having less kids you know so talk about since you're a girl talk about
Dr. Jill Tanzi: the girl issue okay the girl issue and I think we have to be careful as women we have to make sure that we're actually negotiating contracts don't just take the first contract someone gives you right like say I it's happened to me before and I say no I can't sign that I need you know more money you know I want this I want that and and then they do come back they'll negotiate with you so we need to do that as women we need to negotiate more but you said something else that was interesting about the Millennials and the Millennials are their generation just below me but I can assure you the generation that's in school now they want to be owners and I know firsthand I was at a vendor Fair I think I met maybe two dentists all day or dental students that actually did not want to own their own practice so I think a lot of the information that's out there may not be fully correct it may be an agenda that's being propagated that's not the real truth I think people do want to own their own dental practices
Howard: okay boomer they're saying so generation Z students have replaced Millennials on college campuses and you're saying that you're in touch with generation Z students and yours you're sensing that they want to be owner-operators
Dr. Jill Tanzi: yes they do by far for sure by far for sure now
Howard: do you think the Millennials were we're different do you think Millennials that were between boomers and Generation Z do you think they were more likely to be employees I don't know because you know they're just below me and I'm pretty much out of touch with that age range
Dr. Jill Tanzi: I've hired employees that are Millennials but I I don't know a lot of dentists that are Millennials I'm meeting more of the students now and of course my age and boomer age I'm under the bloomers so you're under the Boomers you're not alone I think I'm I think I'm Generation X or Z I know is everybody that works today which is I was from the Silent Generation but anyway um so when you negotiate more let's talk about that just a second
Howard: so the job market is incredibly fully employed I mean you're down to 2 to 3% unemployment I mean and anybody who thinks anybody who can go to the mall and doesn't think at least 5% of Americans should not have a job is not going to the same mall I'm going to so it's fully employed and we always were always bizarre like in Phoenix so when I started there was no fluoride in the water and there were no dental schools now there's two dental schools fluoride in the water and the class come out they all whine about how much debt they are and so you put out ad and say I'd like I'd like a dentist to do evenings and a Friday Saturday Sunday and it's crickets not now one person and then and then you get even more personal with them you're like dude you're in a lot of debt I know your dad just go back and move in with your mom and dad and pay this off and next thing you hear they're buying a $400,000 house and what the hell was all this about the dental student loans you just bought a house and anymore society to have you know 14 kids in a shoe so but when you negotiate when you negotiate that's what I'm trying to tell you the point is it's a fully employed market and I can tell you that you only have to be on LinkedIn for about four minutes to find out that about half the people on LinkedIn our recruiters trying to find Dennis to work for DSOs I mean so that that's a Grove number two the first thing you complained about when that DSO when your friends sold that practice is that um the staff turnover and when you look at staff associates turning over in DSO is the number one thing they've told me and on this podcast is they're sick of going into work every day and not knowing who their assistant is and then you have this big splurge and temp agencies and I've had this with my own staff where I just told them you know they'll say hey can you work Thursday and I'll say who's my assistant and it's crickets well your favorite is she's I go to see her grandkids and the other one you know and it's like no you know if I tell my office manager I say well do you want to work how about I do this I'll come and work that day with the temp and then I'll send home your receptionist who will place them with a temp so you're gonna be the office manager all day with two people you've never met before and I'm gonna be the dentist all day with two people I've never met before doesn't that sound like fun I'm calling in sick now so you can negotiate right so in your contract you got to sit there and say I want a lead dental assistant who's with me at all times and you know blah blah blah blah blah and and then temp agencies could do a much better job of sending you back someone you've worked with they don't even attempt to do that because sometimes when I get the same workers here oh yeah and and that so so that so number two I know what you're thinking about negotiated you always think money money money money in the air they're gonna pay 25% you won 26 27 hey this is the thing gets on your skin more freedom to pick your own lab it's the hugest thing in a DSO where they have to send it to the only publicly traded lab there's no publicly traded dental offices on on the Nasdaq which is melting as we speak or the New York Stock Exchange but there is a publicly traded dental lab and the reason you haven't talked to the CEO of that on this podcast is because it's actually owned by China Chinese people and it's um and I have a great relationship with them but coming on a podcast is not their Forte I mean I wouldn't be on a Chinese podcast where I'd to speak Mandarin or Cantonese so the bottom line is I'm the some of these labs are not known for the type of lab you might be used to up the street from you that you've been working with for twenty thirty years you do this great case and and then I'm also wondering what the corona virus is gonna do to shipping cuz planes planes and ships I mean it's it's a serious issue I mean some of those cities have been locked down for a month and so I wonder how that is gonna play out but negotiate for elite dental assistant choose your own lab and you should be able to choose your own lab under most state laws the dentist is supposed to be the one choosing their lab it's the nature of our job and our license like
Dr. Jill Tanzi: we can't be forced to choose use a lab I mean I know that DSO is do it but it's your license you need to use the lab you need to use and this is this the continuing downward spiral of dentistry where it's just like a race to the bottom with reimbursement and so lower reimbursement offshore labs you know I don't want to go in that direction so you
Howard: I love your website hop dent the dentist at Hopkinton Hopkins yeah popke so hop dentist um what I like about it is every study I've seen done at a major university on the dental market it says half is afraid of the dentist and a half is afraid of cost and that's basically how you've been able to break down 331 million Americans the whole time I've been a dentist looking at data and when you look at that fear of dentist its beautyrx biology I raised four boys that I'm dad and I'm all that in the baggage ships till they fall down and get Ally and started crying and then they run all the way around me to mom right and you have three four three dentists all women we know that patients are afraid of masking questions they don't want to raise their hand do you think having in a fear-based industry like dentistry did you go after all women associates because it just as a softer safer feel mom can ask questions and you're not gonna hurt me
Dr. Jill Tanzi: I don't think we were necessarily like going for women in the beginning but a lot of patients have mentioned that they say I come here because it's all women and we actually do have one man we have a periodontist but it's just turned out that way that patients really like it they like seeing a woman dentist every time they come but you know I wouldn't say I definitely was looking for women in the beginning but it turned out that way
Howard: well your lawyers schooled you great on that answer are you reading a flash card from your attorney or is that just or did you have to memorize it I mean I mean I look at those three girls and it's like my god how pleasant and fun and you're just less scary and this is so cynical but it's factually true University of Chicago which I think has 18 of the 72 Nobel prize-winning economist I mean it's crazy but they did undercover studies where a man and a woman would go to a car lot and they always sold the car cheaper to the man and so when I see a man with a tie on I mean I immediately hide my wallet and you know like you know you just like and you just get good boys even this morning you know like you know cells of a knock on door what are you selling you know just just be honest what do you what are you selling make it quick and he said CenturyLink and so I think that if those three girls I'm looking at on your website told me that I had two cavities I would just believe these three people more than I believe three men wearing a tie
Dr. Jill Tanzi: my least favorite activity I just said my husband I'm like just go find me a car
Howard: yeah my last car I I had the staff delivered I didn't even pick out dr. Dominic deliver the whole thing I walked out and there there was my car but yeah I just think my god women have so many advantages you're not gonna hurt me I trust you I think you're gonna do better in my kids by the way when I was little all the gynecologists were men and now all the women I know their gains are girls and I've seen the same thing in pediatric dentistry I was at a pediatric I was in some dental school and they had six grad students in Ped treat all women and then I was and two more were all women and then I was with one were just one guy out of like four so um and I think that's because who would mom feel safer and more trusting to ask a bunch of question about their two kids stream of land some man in a tie or some woman who also had a baby yeah you have to be like a nice cute looking guy that might work oh that was rude to say to some old fat bald guy my god just rub it in don't tell me about your journey um what was going on in your world to start the Massachusetts and you're it's ia ma dentists org the Massachusetts on what tell us about what that is and why did you feel all motivated to go down that road
Dr. Jill Tanzi: so back in 2017 we received contracts from Delta they were pretty bad I think it was going to be 30% off all of our fees it was really bad and they were taking all their non profit business and putting it into a for-profit part of their company so um you know we were advised like dentists can't talk about this you have to just decide if you're gonna sign the contract or not and so we actually contacted an attorney a group of us and we found out like what we could and couldn't do as a group you can totally petition the government that's one thing you can do as a group there's no antitrust problems with doing that so we formed a group and it wasn't just me there were about eight or nine of us and we got together and we said we're gonna have found this nonprofit so we can actually advocate for other independent dentists along with our patients because a lot of times what's actually good for us is good for our patients you know being reimbursed properly lets us give patients the best quality treatment and being reimbursed very load that we're just barely covering expensive that's not good for anybody
Howard: so you you're seeing this more you have in Kansas they started the United dentist of Kansas org United dentists of Kansas org you and Massachusetts have ma dentist org the mask uses dentists lines for quality care then there's the concerned dentists of Washington Square shirt have their shirt on o reread your shirt that's gonna be hard so disa dentists a” dentist who opposes official policy especially that of an authoritarian state” so that's kind of just a definition of dissident but in Washington state judges were at some hearing and the executive from Delta called them dissidents so they just made oh that's right our group so I thought I would wear the shirt in support of them today so so we're we're do so where do you think Delta's going with all this I mean where where do you think they're at in their mind journey
Dr. Jill Tanzi: I think we could have predicted this five years ago that they want to stop premiere in all the states and I think it's pretty well known fact it's a higher reimbursed plan and in Massachusetts it's in a special category of nonprofit and it's just you know I think it's just corporate greed in that and they're sitting on a mat in Massachusetts over a half a billion dollars in assets and you know that could be used for patient care and but you know it's all political and it's very complicated and the more complicated they make it the more profit is there for them
Howard: so when I have lunch and dinner with the Delta boys they always say the same thing they always say okay this Denis is complaining about a lower reimbursement fee and here's the long letter they send all this stuff and but the dentist is signed up with six other PPOs and those are all lower fees than that and then when they're out in Arizona and they're trying to get company a by2 by the interns they're looking to these other plans and lower fees so to be competitive to get the sell they lower the fee and then they get a hate letter from the dentist saying well you lowered your fee and and they'll tell you off the record they will not come on this podcast I mean I almost got another couple times but they're just shy public speaking I get it they're their friends but public speaking is terrible but they sit there and say hey this is killing us to our overheads going up I mean we keep lowering the fee we're on a percentage our overhead is going up by chasing these lower fees and they say it's like a snake swallowing its own tail that the whole industry is going down because the dentist's how many how many PPOs would you say the average dentist is signed up on
Dr. Jill Tanzi: I have no idea half a dozen half a dozen am I sure in Massachusetts there's a pretty wide range I don't take any PPOs in my office although I would kind of consider Delta more like a PPO at this point even though they call it premier I it is the lowest reimbursed plant and now in my office now that they've dropped it it was eight point eight percent this year so that's a fee eight point eight percent yes yeah yeah and it was they were shooting for ten but they actually got thanks to our group it went down to eight point eight percent we went to all the hearings and we actually held them off for a year but I understand what they're saying but the problem with Delta at least in Massachusetts is we've been recommending this plan to our patients for years when patients would say to us Oh like what plan should I get we'd say Delta because they reimburse very well so I'm you know we kind of screwed ourselves in a way because now it's just getting cut over and over again and it's it's not good it's I don't think it's good for their business model either I think new things are gonna come out and it's gonna be replaced by something else I don't think this model is gonna work that much longer in the future
Howard: and now you have a you know you're supposed talk about religion sex politics or violence but on it's very interesting in this election that the Democratic Party started and that blowout winner for the first three is the one endorsing Medicare for all a national medicine how does that sit with you
Dr. Jill Tanzi: not very well and I'm not a Republican or a Democrat I'm an independent builder I'm a registered libertarian I just think Medicare for all is gonna be really hard in the United States and I've seen different plans in other countries um I think in England there's there's a range of like what they'll pay a physician but we all know I mean I do tons of see I'm not gonna want to be compensated at a lower rate like I think everyone in America has this work ethic that we're gonna you know work really hard and get a good pay or we're going to kind of just lay back and you know so you make your choices here I think it's going to be really hard to have the best doctors in the world if we're we're in a medicare-for-all but I do think we should have some kind of public health for all option like I think there should be one or you can pick you can pick insurance or you can pick Medicare for all but I don't think it's the way to go like to have it give you our complete system
Howard; it's funny how when people talk about the system they'll talk about Canada which it's got like you know thirty million people and it's like California is more than that and they you know there's 331 million people and they always start showing you countries with like 30 million or Denmark or Scandinavia and it's like okay but we're in the league with Indonesia is number four we're number three it's China billion three India billion one US 331 million Indonesia two hundred or show me a country that's doing this with a hundred million people and they're like do you mean dead mark and it's like Denmark has less people than Arizona I mean so the problem and then they can't even tell how many people live in this country the range I mean I mean Arizona I'm the border state with Mexico that the range for how many illegal aliens in here is between 10 and 30 million people well just the range is another okay so the Devils in the details but speaking of that in the details the insurances are definitely used playing their cards like if they don't if I'm not a provider of Delta and I do the work they're gonna send the check to the patient and I've had this I have this burning problem cuz it's even a couple of times has gone to family and friends or whatever not not family not blood family but friends a family and they cash the check what and they just said oh oh my god so my car died right and I had to take it in and I needed $800 and I got that check and it was $900 if I wouldn't can't you know and it's like so so they know that when they send the check to the patient you're not getting you know you get the money but they do that on purpose so my question to you is um when you talk about a state government you know you got to be heard you got to be your voice heard do you think the local state Dental Society of Massachusetts and the American Dental Association for the country out of Chicago do you think they're aggressively fighting for independent owner-operated dentists or do you think they have to play the field in the middle with DSOs and trying to make everyone happy
Dr. Jill Tanzi: I think they have to represent all done and there's a lot of dentists right there's academics there's dentists that even work for insurance companies there's DSO dentists but a lot of things that are good for private practice are also good for DSO is like reimbursement is one of them like I don't think yes always want to be reimbursed poorly either I've spoken to some owners of DSOs and you know they've given me a high five thanks for helping us to you know um but yeah so I I think that the ad a mass Dental Society they're there for all dentists I don't think they're aggressively pushing our agenda I think that we should support each other when it works out and we're working for the same things but we are just focused on independent dentists independent dentistry and you know helping the students we want them to keep continuing with private practice because I think that's in the best interest of patients and doctors oh
Howard: so do you feel that when you you know in any other industry it's just business I mean they'll just tell you you know nothing personal just business I mean you know yeah and everybody's good with that but independent it but I noticed that in my sisters that are nuns you know religion is a not you can't just say well it's business and business can't but in health care it seems more like religion and politics than it does business when you're working when you're talking to the Delta people you're the leaders in the Massachusetts Dental Society this is seem like a genuine conversation or does
Dr. Jill Tanzi: it feel more like partisan politics I feel like there's definitely some politics but I am NOT in on those conversations with them they they have their own meetings you know we're pretty much just going up with our legislators and going to hearings going to stand up or dentist where we can and but yeah I've been in very few meetings with Mass Dental Society or the Delta not none with Delta
Howard: so what's the status so you're so go to her website ma dentist dot org you talked about the the some bills assignment of benefits is agreement between patients and dentist specifying that the insurance company will pay the dentist directly without the patient to pay for the treatment upfront entirely out-of-pocket how's that going
Dr. Jill Tanzi: I mean it's very slow I think what's going to happen with that bill is hopefully Mass Dental Society will come out and help us with that we're trying to pass a bill in Massachusetts delta's lobbying hard against it and you know I think it's great for patients they should have the choice to go where they want to go like and get the insurance company to pay they shouldn't have to get a check after the fact and I think this bill has been passed in 23 states so it'd be great if the ad everyone can support assignment of benefits here in Massachusetts and any other state that doesn't have it
Howard: to me they're just falling into I mean we have 5,000 years of history of what the top is gonna do to the individual and I believe that was for the first time reversed when jobs came out that plugging the internet and the smartphone and now the average humans walking around with a it's his first arrival on earth I mean Neil Armstrong landed on the moon with a computer in 69 and it's until 2007 before homo sapien landed on earth with the same playing field and I think it's gonna be our finest century but they don't they don't realize that for five thousand years the top is always trying to control you like if you come in to the dentist and they say going back 30 years ago say okay and amalgam is a hundred bucks but if you want the tooth colored one it's 200 bucks but Delta you know going back to the beginning they'd say oh no we only pay for this one and you can't assign your benefit and pay extra out-of-pocket you got to lock in it's just one filling and it started out as the amalgam fee and you can't pay well that's controlling and then they try to do with services they didn't even cover they'd say okay well we don't we don't pay any reimbursement from bleaching but but if the doctor agrees to this they can only charge you know this much money for bleaching it's like dude dude so I mean just go to other cars like on the Bernie Sanders deal I just always go first like that well why did you negotiate free health care why didn't you add negotiate for free housing why didn't you know for free cars I mean who the hell wants a free root canal and a mammogram when you could have had a house in a car and then why don't you go for restaurants and bitters I mean what is it that when I sit down and work with my hands that you want that my stuff's valued at free but when but when a carpenter and a cabinet maker build you a house my god it's $300,000 it's a 30-year mortgage that question I think that dentists and doctors physicians we're kind of altruistic and we want to help people and we're
Dr. Jill Tanzi: yeah well we're easy targets to where we're like head-in-the-sand a lot of us were introverts I'm this is totally stressing me out doing this podcast but I know I have to do this for my profession I have to stand up and talk about it because everyone needs to do it and then we maybe won't be taken advantage of so much it's like these business bullies coming out and you know this is our labor and our you know we studied for a long time this is this is our profession and they're just trying to advantage of us yeah
Howard; I mean I think everybody on the way home tonight should stop at a construction site and just walk in there I say hey all you guys carrying sheetrock and hammering nails and doing toilets electrical I'm from now on we're gonna cut your wages in half because these houses should be free and what and why you're saying that they'd be taking the tires off your car and you know and I mean it'd just be I always tell people um you know on the way to the you know the rally why don't why don't you call your plumber and tell them next time that your toilets clogged though you want them to come fix it for free I mean they and they say well health care is different because you know if you got cancer it's very expensive well the average cancer treatment is far less than the price your house and it's about the price of a car you have no problem buying 13 cars in your lifetime but when you get pancreatic cancer now your neighbors should pay for so and even if you wanted to do that let's let's do the insurance let's do the insurance we'll do that but but health care that the the flood is 30% of its paperwork and Delta doesn't have an app when they come in there they go you still got to cut down a tree have a piece of paper they took off work then you came in here and you find out they don't know the form so now you have a human calling another human and it's like okay so that's one-third of the cost why did you not even touch that not to mention the assignment of benefits is cruel oh I'm in medicine it's so complicated
Dr. Jill Tanzi: I had a patient that got hit in the face and and maybe we were charging $3,000 for whatever treatments we did it took us a year to get paid for medical and it's not because we can't feel that the claim is wrong either are like they say oh if you don't submit a clean claim it's got to take longer no our claim was fine we had to send it in like three or four times before you got paid so that's medical dentistry he's still relatively simple and straightforward we can give you a quote we can give you an estimate and we get paid relatively quickly usually in a month and so when people talk about let's let's add medicine to done it let's have a dentistry to medicine I'm like why don't you fix medicine first like I think adding all the dentistry to medicine is gonna make it even more expensive because we're gonna have to now still add more administrators we already have enough I mean we're on the phone with Delta and Blue Cross all day like we don't we don't need the hassle of being under medicine that's just going to make everything way more complicated and add cost and then enough I think these will go up for patients
Howard: so that's what the government does that you know they pass HIPAA and ocean all these laws and slow everything down with this massive paperwork and then when the people screamed this is getting slow and expensive and cumbersome then the camera says oh well now you need us the free-enterprise people can't do it look how they're letting you down so we need to go so they they come up to you they take out a baseball bat they break your leg take your wallet take half your cash and then say you know maybe I should help you buy a wheelchair and you know it's just crazy so I'm so how is your movement going you spent a lot of time on this I mean this is a big hobby do you have children –
Dr. Jill Tanzi: yeah I have almost 14 year old in an 11 year old 14 year 11 year old yeah
Howard: so that's the time where parents I just want to tell you kids I'm that that's where you think you're a genius you look at your 1411 euro and say my kids are perfect I think I think I should write a book on raising children because my entire upper and they're all perfect until you hand them a pair of car keys and then they drive on the other side of town and meet some Irishman drinking beer and all hell breaks loose oh enjoy enjoy these next three years but for all the time that you've put in this Massachusetts dent Alliance for quality care MDA which is ma Dennis org do you feel like it's been worth your while are you glad you did that
Dr. Jill Tanzi: I think so even if we don't pass a bill or change much of anything ourselves we're hoping we can influence the industry and even our Delta Dental Society is the a da to stand up for independent dentists I mean where most of the members we are we are they say that a lot of dentists are in dsos but we are still private practice where most of the dentists I mean probably at least 80% are still private practice so I think everyone needs to kind of take another look and stand up for us and yeah we've spent a lot of time on this but I think we're actually I mean we held Delta offer a year and instead of 10% we got eight point eight percent but you know just talking over and over to legislators and letting them know what's going on for patients and our profession it's worth it because the next time they come around and they want to slash us 20% they're gonna be like hey you just did it wait kid you need to stop
Howard: yeah but the it's their mindset though because I'm by the way I get any of kudos to you you are you are one smart cookie you even got the help of CK strategies when you started your website you thought okay I'm a dentist I take see and root canals and implants and all this stuff I'm gonna get a political firm how has CK strategies first of all how did you how did you think of that you know you usually refer to orthodontist and end it on its how did you know that you should pass his football and political organization
Dr. Jill Tanzi: That's not me that's one of our members he had a contact organization and we started working with them they're not cheap but they gave us a huge break and they've been very helpful there on Beacon Hill every day so they can actually spread our message along because we can't be there we go there but we can't be there all the time but it's amazing like I think every dentist should have a relationship with their legislators and just let them know what's going on because you really have to educate them they're not really thinking about this situation they're thinking about health care which is good so you can tie it into that because I know health care is like one of the their biggest issues right now so if you can explain it and
Howard: what I think is great is is when you go press the flesh of them and you meet them and you're done and you're walking out to their car and then you look at their car and say wow that is a nice car now see all my crowns are gold and dentists don't like filing down on the teeth so when you pay for an MOT composite for 250 why don't you just say hey that's all we're gonna pay but if the patient wants to pay out-of-pocket and chip in another 250 and get a gold crown like this nice car you're driving you worried that you're the guy that says no and I'm just wondering where is that coming from because I noticed you don't eat at the Waffle House you eat at a nice restaurant I noticed that you know that when you come out of school with $400,000 student loans you can only eat at restaurants that have pictures of the food and your past that you go to restaurants that the menu doesn't have any pictures of the food and you're driving a $60,000 car and you're not living in west side of Phoenix you're living in Scottsdale so why do you um you know at first it was like I'm gonna help you pay for filling basic care but where's the the block that says but you can't chip in your own money and upgrade that's just control I mean five thousand years of history it's always about the elites trying to control us and it always ends up with violence and you know they they you know you you when you don't agree with their law I mean not even paying a parking ticket they can pull you over now you've given him permission to kidnap you and put you in a cage I'm serious and take you before a judge that can leave you in the cage I was reading another deal from New York there's like 10,000 people in jail on any given day simply because they didn't have the hundred dollars or less money that it took to pay to go home so they go put him in a cage I mean they just don't realize how their actions lead to very dire consequences so yeah but when you talk to them and you're standing at their $60,000 BMW car $90,000 car coming back from a hundred dollar lunch what do they say to you well I don't know it's necessarily my legislator lives though I'm talking about the interns voice Delta Dental
Dr. Jill Tanzi: I don't talk to them I mean they're they're not talking to me if anyone they'll talk to math Dental Society but I'm not a big enough player to talk to you I'm Delta dentals well how can my homies listen to you right now make you a bigger player I mean come on you're talking to a lot of dentists for members I mean we need members I mean we we're all Massachusetts dentists but I'm sure there's a way we could get even more members nationally we would like people to start groups in their states and we can help you do that because we've done it so I think starting a group in your state would be great all this stuff's local I don't think we're gonna change it on a national level it's gonna be really hard politics is local so I feel like we got to get a group in every state it's not super hard to do it does take some time so if you are looking at you know you have some free time or you're retiring or I do this when my kids are doing their homework I have to sit with them at the table and I'm just working on
Howard: what technology could make this easier I mean you know III think the smartphone scaled landing on the moon I mean I think I think Neil Armstrong that was that was the warm-up picture the warm-up better
Dr. Jill Tanzi: I mean you can start a Facebook group and definitely do that that can you can grab a lot of members and then you can start getting organized yeah definitely a Facebook group there's saw where you can use to have a nonprofit that will keep track of all your members so I don't do all that it's all automated on one where's it all automated it's called wild apricot it's just a it's the software so like when you get members they can go in and pay for their membership and it's called what www.abracadabrasuperstore.com or so wild apricot okay yep okay so you'll you would end up going there to pay and it keeps track of if you have a membership when your membership expires like we don't manually have to do any of that it's all how much how much does the membership to join $250
Howard: $250 for a one-time or yearly and then does automatically renew um no you have to renew it the reason Netflix was that the same value of Disney and Disney has all these theme parks and cruises all that stuff because designer would put a hundred million into a movie but you didn't know if it's gonna do two hundred or three hundred million or be a blockbuster so the whole trick of this is you pay your bills monthly so you need your revenue monthly so charge them a monthly fee like Spotify or Netflix and then have it go into perpetuity because the whole the only reason you have so big selection of gems to go work out in is because the person joins a gym they pay for eight months but it takes thirty eight months to cancel their membership so you got thirty months worth of people not in there so if you and Procter & Gamble that that's how they became the first billionaires you know people would make soap they'd make a they'd spend a month in their ranch making all this soap they'd load up the wagon they'd go sell everybody a gunny sack full of soap and then no one needed soap for two or three years they go bankrupt so P&G said what we have to do for cash flow purposes and remember I'm talking to Dentists who only get a P&L sheet from their CPA they don't you know what a statement of cash flow is let alone a balance sheet your assets equal to liabilities equity but on the cash flow sheet you pay your money coming in money coming out it's a monthly deal so if you change that deal to just whatever $10 or 15 or whatever $100 but it's a monthly deal you know people get excited and then you'll start building building building get leverage
Dr. Jill Tanzi: yeah that's a good idea and we actually had it on auto-renew for a little while and somebody said I don't do anything that way like I don't want to do an otter or any
Howard: oh but is the smart person and that's about 8 out of 38 people that is that person actually he's probably married to a CPA but but the I'd rather lose that guy yeah I'd rather lose those 8 and get the other 30 yeah so so how much is it a year 250 so I'm sorry my my brain so 250 divided by 12 so that's $20 a month no no it's $20 in 833 so why don't you just change it what what does that flex cost you a month I have no idea what does the Hulu ESPN thing why did you start a deal for $20 a month well the 19.99 doesn't um there's no research right you know the you know where that came from no so when they started with the cash register they had to they wanted to know if you were gonna steal and one of the things they were gonna monitor you you still the cash but they want to know how many transactions they had because you know most things were a dollar so they charge everything so they go in the morning they dump a hundred pennies in and then they charge 99 cents for everything so everybody to give a dollar you have to give a penny change so now I'm the store owner I come back to the end of day and I started with 100 pennies and there's only thirty pennies I now have 70 transactions then I look at the fee and then so so that was an actuarial risk analysis for control over internal peculation it was not a sub but a lot of people think it was a psychological thing that you'll buy it for $9.99 but not ten so that's just an actuary thing I think I'm I think you just say 20 bucks a month would you pay 20 bucks a month to save your profession and not not to trash anybody I'm members of everybody trying to help but how would you compare the value of the $20 a month to you which would be to 40 a year to the Massachusetts your organization versus they're already paying $1,000 a year for the ad a tripartite system which includes the Massachusetts state and local how would you compare the value are you or were you on par with I mean they they do other things that we don't do
Dr. Jill Tanzi: I mean we're not gonna do like CPR classes and you know updates about everything they have other meetings they do Yankee dental every year so you know we're totally different in a way but yeah they're not gonna join that they should definitely join us because we're we're fighting for their profession and it's a lot cheaper for sure
Howard: well why don't you boil on that thread so we got that thread um on dental town what that's talking about you and we're actually making some progress with and and it's about all those different states doing that why don't you go on there and I bet you'll get people to join Matthew I know I will when you get dentists from all over to sign up for the monthly annuity because once you say i I've gone from 100 how many members you have now can you say 300 members yeah but if you had 300 members in 3000 well 300 let's see so where is that where is that and all the app things they all look alike so 300 times $20 that's $6,000 a month cash flow and how much a month cash flow would it be 10,000 20,000 30,000 to actually have one letter management have your CK strategies guy and a full time we do need a full-time person
Dr. Jill Tanzi: that would be nice because it's me doing whatever I'm and some other people too so then we wouldn't have less to do we could focus more on lobbying and I think if we had about I think 10,000 a month would be good well
Howard: you're you're you're over halfway there yeah so so you need to get to you know you need to switch from early non-renewal yearly non-renewal to spot a fly you know that you ought to go on that thread and tell them that and tell them that you have this much and you're looking for this much more and see if I
Dr. Jill Tanzi: I bet you I bet you'd fill that mount with this podcast I think that it's not a hard sell and we talked to dentists individually but just trying to do this over social media is very difficult to get members but when we go to any meetings people join right away they totally get what we're doing and they want someone that stands up for them in the government
Howard: so back to Facebook I mean if you read their I I don't post on Facebook right I don't have a Facebook account anymore I'm think about it you the screen time is the same but every year they double the ads and right now all the people analyze this say when you make a post or a comment only six percent of your followers are gonna see it because every year you're still on that phone the same amount of time but to grow revenue they got to raise the price ads or double the number of ads you're selling so you just said that whenever you do it on social media doesn't work but whenever you're in the flesh they sign up right and left it's because it's the same people they're just not seeing on social media so when you're posting your way on Facebook you're basically in your bathroom taking a selfie of yourself texting it to yourself and so whatever your pucker fish kiss of the day is or whatever nobody's gonna see that or your tuna fish sandwich lunch that you're you know everybody shares their food so so that's that's why dental town still continues to grow a thousand new members a month because if you post something every single person that gets on dental town sees the damn post and we had up private groups it's the same thing so you don't have somebody again it's always the top down command and control controlling you manipulating you and if you don't go along with their game it always resorts in violence but man you're doing good do you think you can change that on the model to a Spotify Netflix monthly you could give options to see we were talking earlier about the the carpenters and the sheet walkers and the plumbers they just punch you and healthcare and religion they try to pray it away or hope it away or what it should have cut it away and these these Delta boys they're they're not kidding around they want to they want to upgrade from the IHOP to a nice restaurant they don't drive your standard you know emember that started a sour night live clip where Will Ferrell was saying night and I Drive a Buick remember that it deal where he was so proud of his uh but you you go in the Delta parking lots there there nobody taking the bus there's nobody taking the shuttle then they're all driving cars that are about twice the average of the median average price of a car they're not driving thirty three thousand dollar cars they're driving 60 thousand dollar cars so they understand that GM doesn't have and you know Andrew Ford sort of the model team have any color you want as long as black you can have any model you want as long it's the Model T and that assembly line closed down and went bankrupt for good and now you go to GM you can buy a low-cost Chevy more money Pontiac more money olds more money Buick more money Cadillac more money Mercedes more Ferrari hell you could own your own citation jet if you're Al Gore and out there preaching about the environment but but these boys want one market for all and we used to call that communism we used to call that you know you know in Russia you had plenty of money and nothing to buy and it just economically doesn't work so we either got to go back to Adam Smith 1776 and say okay we have 200 years of economic research and what do you say we just throw it away I mean I still think the the neatest most romantic thing and note that ever happened on earth was 1776 yet Adam Smith who wrote the first business book The Wealth of Nations that's free enterprise and then he had Thomas Jefferson another 32 year old Scott write the Declaration of Independence that's Free People and that was the first time free people met free markets and it created the largest economic boom ever and attracted people from everywhere around the world and made America and now what do you have oh well let's build a wall and keep out all the people for migrating air okay that's so so you're saying the last 200 years was backwards it made the greatest country in the world now you're sounds wrong and now you're saying that I'm that there should be no no market segmentation that price does not have an elastic effect on demand so you can't upgrade an amalgam to a composite to an inlay if I don't want my whole tooth drill down I mean look at the data on the tooth when you file a tooth down for a crown in five years one out of three needs a root canal so then you say well on this instead of a crown can I just do an inlay on light no no we don't peg every in a you have to file down the whole tooth okay so now you're a doctor you've gone from selling insurance to telling me I have to surgically reduce and remove all the scene ammo to get an economic Bear that's a practicing dentistry without a license and then one three and five years need a root canal so then you look at their own data from Delta if they do a hundred million root canals by an endodontist in five years five percent are extracted and if the general dentist says the molar root canal ten percent are extracted so so why don't you let me conserve to structure well I'm a practicing tennis license and we don't believe in pricey lies sissy we don't believe in market segmentation and you're just you're just gonna get an amalgam and that's what I'm gonna shove down your throat well that's that's just ugly and I know you don't believe that when I talk to him it's like I know you don't think like that so why are you doing that but you're not having a success with the the relationship thing well there there's dentists that work for insurance companies that actually making some of these decisions but they don't ever see the patient clinically so it's kind of like malpractice with a license
Dr. Jill Tanzi: I would say you can't you can't treat patients remotely and there's the whole tele-dentistry debate which you should probably have someone on to discuss I don't know much about it but I think smile direct club uses that method where they're not actually seeing the patient clinically so you know it could be a doctor in another state that's looking at your patient which should be illegal you can't you can't have a patient in Massachusetts see a patient dentist in another state which remotely and be responsible for the treatment there's no really easy recourse for the patient if it's not in the same state
Howard: so but actually if it doesn't work out with smiles direct club you go in there and it doesn't work out all you have to do is go show the problem to your dental therapist and she'll fix it by the way they're trying to pass that in Massachusetts right now so let's change some just completely dental therapist you know you know it's good
Dr. Jill Tanzi: yeah it's good until it's not but the dental therapist bill in Massachusetts was the compromise between some of our legislators and math Dental Society they want the dental therapists to have a master's degree here but our state has the most dentists per capita of any state in the country so we don't even need dental therapists here we have plenty of mass health providers we have all children covered under Medicaid so I really just think it's a way for corporate to get cheaper labor here and you know just to have a mid-level provider that they hire instead of a dentist and how what's the status of that now so yeah Massachusetts oh my gosh you are number one I thought okay she's exaggerating she is number one
Howard: well congratulations on being number one Jill you always wanted to be number one why don't you pick dental therapy for you're number one so so the dentist value they're putting the u.s. value 61 and Massachusetts is 82 and the least the best place to go would be Alabama number of practicing dentists per hundred thousand population 6061 per hundred thousand for the US eighty two per hundred thousand for Massachusetts forty-one so you have twice as many dentists per hundred thousand as Alabama why so talk about that
Dr. Jill Tanzi: why dental therapists in our state there's so many dentists there's three dental schools when these kids get out and they have six hundred thousand dollars in student loans and they can't find a job because that there's dental therapists being hired it's not really fair to them and I don't think dental therapists are gonna cost the consumer any less because someone's just going to take the profit it's it's it doesn't make any sense
Howard: yeah and they always I think it's funny how public health always complains about the dentist not going to the rural and you all the evidence
Dr. Jill Tanzi: we actually did a study we called every office in our most rural County on Berkshire County it's on our website and you can get in with a MassHealth dentist like you can get in in a very short amount of time so I don't know where this need is coming from
Howard: well this is an appointment this is a classic example of how the elites and education and government you know they always have their reasons for doing what they're doing but then they never address the the the the other side of the coin the inverse of what happened and I see in Arizona I've talked about it before where ASU will only accept you to their program if you have the highest marks and in great so they want the guy where the girl with a 4.0 and by the way you were the valedictorian of your high school class oh my god so were you like one of the original nerds were you like one of them did you know were you one of the earliest to get on did you have a AOL dial-up com do your Mars research paper congratulations on being a politic Torian that is damn cool oh I had to go to urban dictionary and look up the word to see what even meant and I was so but the bottom line is I'm so then you go to engineering places in like Bullhead City and you say well what is your biggest limit to growth they go man I I need three mechanical engineers but nobody that gets a degree in mechanical engineering and ASU lives and Scott sells gonna come live in Bullhead City and then when the bull had city kids apply to engineering school they don't have enough good enough grades to get in so and then and then the university doesn't care about Bullhead City he cares about US News and World Report they want to be ranked number one with the highest view they want to get the most Jill valedictorians in their class and say god we have a hundred jewels in our class and all the other school had was three Howard's and so you know it just doesn't work and then so it's just um the dental schools everybody
Dr. Jill Tanzi: yeah they'll go back and practice where they're from or a pretty local and I think that's proven that most especially starting up your own practice you'll go back to where you're from or close to it and so yeah be nice if some of these schools could accept people from a rural area right you are right you know but but in in some instances you know are we really responsible for f educating someone that doesn't want to live someplace you know they may not ever want to live there it may be like it's a really hard problem but in Massachusetts I don't think we really have this problem maybe in other states
Howard: yeah you're right cuz that you're you're in a very different state I mean that that northeast it's small yeah I mean the Northeast I mean the Northeast I mean out once you go west of Mississippi all the states are big squares and everybody knows the names of the states then you get into that northeast thing that's like my god there's so many states on top of each other so it might be a whole different deal but in these big square states I was born in a big square state Kansas now I live in a big square state you know these dentists will say why I'm in a small city and I can't get a hygienist so but I I found two girls in the local high school that want to be a hygienist and they've applied but their GPA wasn't high enough yes like okay so you're saying that there should not be any hygienist in this small town instead of having 2 hygienists that were not the valedictorian but indeed you know had bees or you know a 3.0 grade point average and and so they give the elite the elites never care they cause the problem and then they're shocked that you are having problems and then eir only solution is after they've broken and destroyed you that they should take it over and fix it and what a conservative is a conservative says I have more faith in the individual than I do in a government a thousand miles away making decisions because they're not here they're not talking to each other they don't see what's going on and what it really comes down to is people who have little faith in themselves want some big magical agency to solve all their problems and at all that it basically comes down because they don't have faith in themselves and I've got more faith in any individual human with a smartphone that I do with any of the 200 presidents ruling the world right now are they you know mean I mean I I have faith in you I mean look at your own data and make a damn decision I mean you know it's just so obvious
Dr. Jill Tanzi: yeah so we have a huge problem with staff in Massachusetts right now we don't have enough dental assistants and we don't have trained dental assistants we don't have enough hygienists so these are big problems that limit our practices but we're very focused on getting more mid-level providers but I feel like we already have them we have hygienists we need more we need more assistance we need these we need these before we need them l therapists for sure we need these employees and it's very hard to find right now
Howard: so have you gone to there's another website like yours it's called America's independent doctors are in critical condition the websites a ID - us org everyday hospitals and private equity groups are buying up medical practice turning independent doctors and employees that trend is not healthy for patients and there's a big article in The New York Times this weekend where when you work for these private equity hospitals that you're getting up to 300 text messages a day telling you about opportunities like well Margaret's do for her mammogram and Karen's do for this test and it's just she didn't refill her prescription can you call her and tell her she didn't refill her purse it's just money money money money money when you're interrupting an MD 300 times a day and then they looked at burnout the people who received the most text messages had reported on another study that they were more burned-out and the ones had reduced a little to none were more happy and you show them this data and the bottom line is when you die do you want your grandchildren to go to a medical practice that's owned by private equity when I was little I was born in a Catholic hospital I mean now it was st. Joseph's or st. Mary's and they were you know it's really gone from church to Wall Street hasn't it yeah definitely and where
Dr. Jill Tanzi: we're headed there dentistry is headed there but if we can do what we can to stop it I think it's worthwhile we we really need to organize and get many of groups like ours to start in each state and I think that's how I you can start changing things if we you just keep practicing and you're not looking at okay how much am i I'm actually am I even profiting from this procedure I'm doing I bet you will find that you're not you can look and see you know the time you're taking with your patients and what your reimbursement is sometimes you're probably not even it may be negative you really have to look at numbers and you have to figure out how you want to practice and treat your patients
Dr. Jill Tanzi: well I can't believe we went over our time but I still did you got you got a pace or they glaring at you right now my staff will be glaring at me in a minute because they'll want to go to lunch and I'm using the lunch er well just tell them that they don't overeat and up fat like how I am
Dr. Jill Tanzi: so I just go to clinical real quick
Howard: um you went to the Mid Western the Midwest implant Institute what type of Dentistry do you like doing I like doing a mix of a lot I really like crown and bridge a lot implant dentistry I just started placing implants so I'm doing more of the easier cases bone grafting extractions
Dr. Jill Tanzi: I always like surgery in school so I started getting more training and doing those procedures just because I'm I was getting a little bored and I wanted to you know do something new so you went to uh you went to Eric McNeeley alfred duke heller he was one of the original implantology yeah yeah i mean he is his son runs the institute now
Howard: Wow are you still friends with him yeah you what I just finished the program can you get Alfred and his son to come on the show oh maybe that would be awesome because I'm Alfred I'm you know he plays twenty thousand implants before there was a CBC T yeah and you know as people are saying you can't place an implant out a CBC I'm pretty sure Alfred and Carl mesh each place twenty thousand before there was such thing as the CBC team they were just better surgeons is there anything that you were hoping we talked about today that I didn't mention
Dr. Jill Tanzi: no I think we got to everything and I would just say just remember insurance dental insurance is not insurance it's it's just a plan that's like a discount plan and I think we forget to tell our patients that it's not an insurance like medical or homeowners insurance it's really almost a scam in a way yeah well done
Howard: well hey I'm really honored to have you on the show I'm so proud of you I mean you're so ambitious I mean I don't know you're valedictorian but here you are a owner/operator dentist you got kids family all this stuff and you know that's the old acumen business when when it absolutely has to get done give it to the busiest person that works for you because the person sitting there who has time to do it there's a reason they have time to do it because they've never got anything done in their life and you are one busy person you're so damn productive thanks for blocking out a lunch and coming on this show today it was an honor to podcast you thank you so much
Dr. Jill Tanzi: Howard all right have a great day you do