Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1453 Drs. Katie Heald & Ashley Keen of Aspen Share a Day in the Life at a DSO : Dentistry Uncensored with Howard Farran

1453 Drs. Katie Heald & Ashley Keen of Aspen Share a Day in the Life at a DSO : Dentistry Uncensored with Howard Farran

9/4/2020 3:00:00 AM   |   Comments: 0   |   Views: 90
Dr. Katie Heald completed her undergraduate degree at Virginia Tech and went to dental school at Virginia Commonwealth University in Richmond, Virginia. After dental school, Dr. Heald completed a General Practice Residency at the VA Hospital, in conjunction with the University of Florida in Gainesville.  She has a strong background in medically compromised and geriatric patients and owns four offices where Dr. Heald and her care teams actively treat thousands of patients in need. Ashley Keen-Ramirez, DDS, is the Dentist Partner of the Ruskin, FL - Sun City location. She graduated from Louisiana State University School of Dentistry in 2013. Dr. Keen earned a Bachelor of Science degree from the University of Miami.

VIDEO - DUwHF #1453 - Katie Heald & Ashley Keen

AUDIO - DUwHF #1453 - Katie Heald & Ashley Keen

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It is just a huge honor for me today to be podcast interviewing two amazing young dentists first we'll go with Dr Katie Heald DDS completed her undergraduate degree at Virginia tech and went to dental school at Virginia commonwealth university in Richmond Virginia after dental school she completed a general practice residency at the VA hospital in conjunction with the university of Florida in Gainesville she has a strong background in medically compromised and geriatric patients and owns four offices where dry Heald and her care team actively treat thousands of patients in need and she must be a damn good dentist because before dental school she was Katie heel and now she's Katie healed she was successful in healing all of her patients the next one is Dr Ashley Keen-Ramirez DDS is the dentist partner of the Ruskin Florida sun city location she graduated from Louisiana state university with years of experience she and the rest of the aspen team are proud to offer professional compassionate care she was born in Philadelphia relocated at Northport Florida where she when she was 10 years old and quickly became a Florida girl loving the beach and sunshine she subsequently moved to coral gables Florida where she attended the university of Miami and met her husband andrew her next move was in New Orléans where she earned her DDS degree from lsu she moved back to Florida after dental school and joined aspen dental in their sun city location and my god I could read on and on and on I just uh thank you so much for coming on the show today I wanted you guys to come on because um you can only you only want to listen to a 58 year old grandpa so much I mean my journey in dental school was in 1987 and so a quarter of our viewers are still in dental school and the rest are all under 30. I think I’m the only I think I’m the oldest guy that's ever listened to my podcast uh so I wanted to hear from you two young ones um how long have you each been out of school um I graduated in 2012 and joined aspen in 2013. so you've been out eight years yeah and how about Ashley I graduated in 2013. so seven years eight and seven yeah I took algebra so I could do that in my head uh so what it what is it like I just want to get right to the basement what is it like um what do you think it would be like if you were the unfortunate unlucky class of graduating the class of 2020 um covid 2020 class I mean I’m here in phoenix we got two dental schools we got at still in mesa we got midwestern over here in Glendale and uh god what would you say to those people they're probably wondering what the hell is going on so I would say just I’m sorry what a horrible year to try middle school but it's going to test your perseverance and your determination and it's only going to make you a stronger clinician better for your patients and your teams I can't imagine the stress going through that right now with boards and trying to get requirements and seeing patients so more power to you and I can't even imagine what you're going through well that that's amazingly optimistic I always thought I was so lucky to graduate in high school in 1980 because 81 was the worst economy I’ve ever seen um the interest rates were 21 double-digit inflation unemployment in fact the federal reserve and chairman um had to have armed security uh taking them to work and back I mean it was just horrible but it made you realize that good things can come to an end and then I graduated from dental school in 87 may 1187 and September was black Monday uh where the market did it again so right when I opened I just hired my team I can still remember like it was yesterday having a team meeting in our waiting room and all my staff was scared they're like do you think we're going to have a job and uh I mean just crazy uh Katie what do you what would you tell them um I think if they can get through this they can get through a lot if they can figure out a way to navigate through boards and getting a job and um you know staying in practice I think they can really make it through a lot and I think it's going to teach them a lot about the sustainability of dentistry and that if they can make it through this they can make it through a lot well you know I was I felt very fortunate to have bob Fontana the founder of aspen come on the show he was episode uh 1333 1333 and you know when I got out of school in 87 the only people that would offer jobs to a new graduate was the uh about 20 of the class when mom and dad was already a dentist so you know you kind of had to end with your mom and dad um or was the army navy air force marines public health Indian public health and I am um so thankful of all the jobs that the dsos are providing to the new graduates and I mean there's so many there's 168 hours in a week and so many of the dentists my age they only have their office open 32 hours a week and they could have an associate in extended hours and provide jobs and all that but who's really getting it done um is the dsos and you work for uh bob Fontana aspen dental one of the biggest uh dsos um how was how was that like talk about your journey um how did you end up on bob fontana's doorway um you know I really wasn't sure what I wanted to do after my residency I wasn't sure if I wanted to specialize or what I really needed um and so I needed to find jobs and I wanted I originally started in Florida so I wanted to stay in Florida I wasn't ready to move back to north Carolina so I found aspen and um started with aspen not really knowing if I was going to stay or not but figured out I could develop my skills and practice really how I wanted I was given a lot of autonomy to um hone my skills her surgical skills and just really be on my own but had a lot of support I had a lot of direction a lot of um guidance from the business side and also from a clinical side I had tremendous mentorship and support and decided to stick around um group practice is more fulfilling than solo practice would you agree I completely agree I you know even if I was only the only provider in the office I would knew I was never alone I was never on an island I had um plenty of people to reach out to um even I had people that I know would answer the phone if I had an issue yeah I hired my first associate uh bob savage uh straight dental school same age as me just because you go from dental school to 120 classmates now being the only dentist in the building and it just it just wasn't fun and it was just far more fun and exciting to always be able to talk dentistry with another dentist um so you you've um you decided you when you got a job there you didn't know uh how long you'd stay and now you've stayed uh eight years and you own four offices with aspen yes four in north Carolina four in north Carolina so um so many people in fact there's even a threat on dental town what does that mean um so are you up uh so if you own four offices is it a franchise a partnership I mean is it like owning a mcdonald's franchise or how would you describe um your ownership so aspen is really the management firm that deals with a lot of the front office management hiring payroll insurance negotiations [Music] fees for supplies and so they really handle a lot of that and they're employed by me to take care of those things so that I can really focus on patient care so can you share the numbers that when you say they're employed by you like what percent overhead or what percent cost or it differs from state to state on what the percentages are based on state regulations and guidelines yeah and that is a um that is a mess and uh some things in the united states you can say well having a big country 325 million you have all these advantages of scale but when it comes to healthcare each of the individual states have micromanaged it to where it's just not you know you can't say oh we get this big market the united states like you can in shoes and you know so many other uh cars and all that kind of stuff but uh the regulations in health care are absurd um so you have four offices um eight years out of school that that's crazy is eighth the lucky number uh or um you already have more uh are you going I mean um you have four offices in eight years um are you gonna shoot for more or what's your goal I don't really have a goal it's really what I feel like I can you know emotionally handle if I feel like I’ve taken on plenty then you know i'll stop there but I have a fifth one coming in October and aspen really helps with a lot of the management so I can take on some offices um hire associates and really get the offices up and going and running efficiently and effectively now is that are your offices all together in one city in north Carolina are they spread out throughout the state or I have three within about 30 minutes of each other um in central north Carolina and I have one office in western north Carolina and Morganton and how long does it take you to get there and about an hour and 45 minutes okay learn one lesson from my father will you please learn one lesson so my dad was Howard Eugene Farran and it was a horrible idea he named me Howard Eugene Fran the second so it was so confusing that uh before I was 10 everybody was referring to my dad as his middle name gene and they referred to me as a mistake and uh he had five sonic drive-ins in Wichita but he wanted to go national that was you know that was the extent of it so he went to Abilene Kansas and Kearney Nebraska north and then south he went to children's Texas and east he went to Louisville those four offices nearly killed him because when you have five offices five locations in Wichita your management team handled that like it was smooth but man when you have an office that has a problem and you have to go to Louisville Kentucky or children's Texas or I mean it was just crazy so um my gosh um why would you leave north Carolina i mean what's the population in north Carolina no I have no idea off the top that's why that's why god made google so let's see what uh let's see what the north Carolina population uh 2020 is um 10 million people holy moly so 10 million and you need a dentist for every 2 000. I hope when you're as old and fat and bold as I am that you're still in north Carolina uh because um it just means so much to be able to be uh so close um so um so ashley um which what are you at now you're one office one location what are you doing yeah so I’m at one office one location I’m actually a little bit different than uh dr heald I’m a partner on an office so myself and one other dentist owned the office together um so how aspen works is like dr hield she owns multiple offices and as you grow and continue to add offices you also will add partners in your practices so that the workload is shared you have growth opportunities for your doctors that are working in your offices and that's kind of where I’m at the Florida market's a little bit different than north Carolina it's a little bit more established there's not as many new practices that are opening with availability to own them myself so I’m my family's here my I’m comfortable here I don't really want to relocate so this is kind of my spot where I’m going to be for a while so you're saying you like your family on some days my goodness gracious ah it's uh but it's fun getting old by my five sisters they always argued forever and ever but now that they're all you know between 50 and 60 now they're just uh it's funny I’m the only guy that when they're getting too lovey-dovey I always remind them of their crazy pass and now they're in denial they're like oh Howard that I don't remember that and I’m like okay wow you're so old you don't remember that uh so um a lot of people are saying and I again I feel um I don't want to be the man expert on the difference in men and women dentists because I’m just a boy uh but a lot of people say that um it's tough being a female dentist because um you know we just you know man um you know we just donated gammite you have to incubate it for nine months and there's a lot of issues with um child rearing and all that do you think um if for all the girls in dental school um they're you know they have professional goals I want to be a dentist I’m going to own my own practice I want to do all these things but for a lot of biology saying I want to be a mom and if you ask me you know I always say family first business second I mean i'd rather be a better dad than a better dentist I mean I don't want a bunch of um alphabet soup after my name I want to have a good positive relationship with my four boys and I’m glad I never killed any of them because they made me six grandkids that's so if you're ever thinking about killing your children remember it'll be worth it when you get the grandchildren but if someone was asking you in dental school say katie ashley I really want to be a great dentist but I really want to be a great mom do you think there's advantages at aspen if you have two goals of family hood and dentistry hood a hundred percent absolutely yeah being with aspen dental provides you a network of support on so many different levels so like dr heald was already saying she was saying that you know we can focus more on the dentistry and aspen dental or admi is focusing on helping us with the business side that's already a headache off of your plate you're able to do your dentistry at work and leave it at work and go home and enjoy your families the other advantage is we're a huge network of doctors and providers and we're truly a family and we're here to help each other so if something happens we're able to extend help to other offices whether we help take care of their patients or send an associate to cover their office there's always a network of people there to support you and it allows you the freedom to not have to worry and not have to stress about what's going to happen in my office if I need to stay home for a day or if my daughter gets sick or if I’m sick there's always someone there to be there for you now do either of you already have children yes how many each I have a daughter you have a daughter yeah and katie a five-year-old son and the two and a half-year-old daughter so katie having a five and a half year old son and two nap and how old ashley how old's your child he's two and a half um do you guys um do you guys think it's easier to be moms and dentists with aspen than if you would have just built your own office like I got a school may 11 had my own office on september 21st do you think you're in a situation that's easier for your job now than um than if you just had your own uh solo office absolutely yeah absolutely why um so my husband also travels for work so if something's going on in the office it's something an emergency happens after hours and I have to go meet somebody in the office if I had my own private practice get the kids out of bed call them to the office wait for somebody to come to the office um but with aspen we'd pick up the phone call regional manager they handle it for me I don't have to i'll have to leave my house i'd say you need to handle it and somebody will be in the office to fix whatever issue I have um and just from you know if I’m on maternity leave with my two children I know the doctor who's coming into cover I know my office isn't gonna burn down I can take six weeks or more to spend time with my children um and not feel pressured that I need to come back immediately after having a baby that is uh now do you see um some people report you know I’ve seen reports that that's why dsos um over 60 of all their dentists are female do you see that do you agree with that number or do you know what that number is for aspen what percent of their dentist are female versus male 1 I don't know for aspen in general but I know that we have a lot of female dentists because I have lots of and before me that helps set the groundwork and I mentor several that are younger than myself as well so in my specific region we're more female than male but company-wide I can't really speak to that yeah I’m I’ve seen um several reports um that you know more than more than 60 percent of all the dentists that um go be in a dso or an association or whatever um are female and I think it's a uh I just think it's obvious um another thing I’ve noticed is that when I was little um you know I had five sisters I’m very sensitive of all those issues because they always affected me like whatever girls couldn't do back then in the 60s meant all my playmates couldn't do so then Howie couldn't do it you know what I mean so if my sisters couldn't swim in the river but I could why then I’m swimming alone in the river that's no fun you know you want to go fishing and swimming with your sisters so it was very weird but I noticed at the time all the ob gyns were males and now I notice they're almost all females and I’m seeing that shift in pediatric dentistry um moms um you know you could get the number from your own calling center I went and met bob at his calling center over here in chandler and fielding all the incoming calls and that guy was telling me I thought he said 85 percent of the incoming calls to schedule were female have you ever heard a number like that not surprising I haven't but I’m not surprised yeah and um and so you know if moms are making the appointments and she's got two people to pick from and she's got a two-year-old and an eight-year-old and she's looking at you and then she's looking at this 58 year old grandpa me I mean does he just didn't it just feel more natural plus if you look back at some of the terms like in ob gyn um they call it a hysterectomy hyster hysteress is greek for crazy I mean you know I mean just rude names that you like only a man could call that procedure you know that it was it was crazy times and I now I see um now I see the same thing happen to pediatric dentistry when I go to residencies in uh dental schools and say they have six people in their pediatric residence class it's five ladies and one man and so I I’ve always said and in fact the first person I told this was to was theresa murphy back in 1989 I said well I really believe since everybody's afraid of the dentist and I know some of my four boys when they got hurt they wanted mom not dad and you and I just think the whole world thinks that women are more gentle and they're all afraid of pain at the dentist I told her that when she got an associate uh to even make sure that's a female just brand a female dental office and I think that's a massive competitive advantage do you think being a woman dentist is a competitive advantage to the us dental market I think it can be I think it definitely can be you know I had when I first started aspen as an associate I um worked with a male doctor and so if somebody was particularly afraid or really was not feeling the male um mailed in that's in the office they would say send in the angel and so they would send me in to kind of move things over and make people feel a little bit better and if they were having a rough time so I definitely think it can have some advantages what do you think ashley I think it can as well I’ve had patients that specifically said they've come to me or to my office because we are a female staff I’m a female dentist I also think you get the opposite as well though especially with the older population they expect something when you picture a dentist you don't always picture a younger female dentist and so I think sometimes there's some misconceptions there but our goal is always to make the patients comfortable and to make them feel at home and at ease and win them over that way so you know that exact experience happened in my office back you know back in 87 89 and uh where my female associate went to give a shot and a man that was actually older than me at the time um grabbed her arm and said shouldn't the doctor do that and she was upset with him and I’m like well him just is I mean you know it just some things are is what it is I mean if you don't like uh the next galaxy uh andrew media is moving in and gonna crash with uh our galaxy and then you know within a billion years uh the milky way and andrew media are gonna crash uh well I don't like that but it just is so I said so it's our fault and I was looking at the uh the staff and you couldn't tell anybody was different I said if I was in the hospital and a guy came in my office wearing a tool belt and he had drills and pliers and all that and started to start an iv I would have said no you know so we immediately went to doctors looked like this hygienist looked like this assistance so we got four uniforms for four different um positions in the office and I think that was clarity you knew if someone had on this uniform you knew what they did in the office uh so do you guys do that or do the doctors wear totally different looking scrubs or outfits than assistance hygienists and admin I’ve started to where I always wear a white coat so that it's and the rest of the staff isn't wearing one and now with kovid things are a little bit different everyone kind of looks the same again but you know that is what it is it's one of those things yeah um so um a big problem with millennials is um and I don't want to be that old guy you know um yeah look how bad we left the country for uh you guys so you know um old people like me have nothing to complain about millennials but it is obvious that they change jobs frequently like if you go to the fang stocks which is fam facebook apple alphabet netflix uh microsoft all those their average employee only lasts one to two years um amazon's the shortest if you work for jeff bezos you're gone in a year and facebook has the best perks the best everything amazing and they only keep their employees two years because you know you could be working on facebook for two years and some guy from uber walk up to you or meet you at a bar and say ah you got to get into driverless cars and bang like my uncle that lives um up the street here he got a job with mobile oil when he was 16 and he retired at 66. he had one job one job so um and it but it's not just dsos it's private practice whenever you meet a dentist five years out of school they've had five different jobs and it doesn't matter if it's private practice indian public health whatever they just job hop a lot are um do you see that and where you're at in uh aspen and what you uh do to try to retain people but most importantly why did you guys stay I mean you guys been there what one in seven years so but both of you have been there seven to eight years how come you haven't had seven to eight different jobs in seven to eight different years like everybody that works for you know apple and facebook and google I think the biggest thing for me is security you know what you're doing every day you know what you're getting into every day you have the support you need to do it and you have the autonomy to decide what this career can look like for you can be an owner of multiple practices you could own one practice you could partner you could stay as just an associate there's so many different options and pathways that provide you with the decision for yourself no one's making that decision for you as for our staff I mean just like anywhere else you've got to treat them like family I’ve gotten to the point where I do all my own hiring and I hire off of personality if everyone in the office gets along well and they're happy to come to work every day and they work great together they're more likely to stay with you I think most of my staff have been with me for three or four years now at this point and we're happy we're a good family we work great together we're here to take care of patients and we all get to go home at the end of the day and have our own family time okay so you obviously um are a leader I mean you're attracting and retaining and keeping employees um there's a lot of dentists who um can't attract them I can't retain them and um where did where does this leadership in you come from where I mean where was it sports was it was it girl scouts what where does this leadership skills um come from I grew up playing sports I have two younger brothers um so I was always the oldest in the family I think that has part of it from growing up my parents always instilled into us that you know we need to take ownership for our actions and be kind to people and I grew up playing soccer my entire life um and I think that's a big part of it and it's just something inside you it's a desire and a will to be around people and grow and mentor people as well so your big sport was soccer yes that is a amazing I am um one of the neatest gifts of uh lecturing around the world it was I was uh lecturing in Africa and their that country's team was in the world cup and I always thought Americans you know they had serious fans you don't even know what fans are until you've been in Africa during a world cup and the only people who came close to that was I got to watch another game in the world cup years later in Paris France and those guys were so crazy the police had to come I mean I literally thought they were gonna have to bring water cannons to a soccer game so uh when uh because I’m i remember when the Arizona cardinals came to town the newspaper the big issue for the first five years is a lot of proper people didn't think they should serve alcohol because the fans were drinking alcohol and being too rowdy and I’m like they look like a church service compared to Paris France and Africa I mean you think you're at a wedding not a sports game but uh so um do you think um you know it's everything I mean your number one thing is uh and is you know my book people time and money uncomplicate business you only manage three things people time and money and if you get an a on people you can get a d on time and money and still be rich and successful and live a happily life you look at the sports teams I mean the only thing that matters is you have the right players on the team it doesn't matter if the stadium has a retractable roof or artificial turf or real turf it's the people and um I’m always telling dennis I’ve laughed a lot of staff turnover that I say well who's picking these people and you know I have and I said okay buddy you've been picking people for 10 years and it looks like you're really bad at it so you know let's uh let's get someone else to do it or do you think if someone was young and they were afraid of the responsibility they're like okay I’m 25 I just got out of dental kindergarten I don't know if I can lead a team I don't know um why they'd follow me all this stuff like that do you think you were born this way or do you think they can learn that is there things they can read what would you what would you suggest to young uh dentists um do you mind me asking how old you are have you hit the big 3-0 I’m 33 33 okay just barely katie what about you 34. 34. um did you guys have this skills at um when you're still in your 20s at 29 did you have these skills or is this something that being thrown you know if your uh family you know if your brother's pushed in the swimming pool you just got to learn how to swim do you feel like you went in and didn't have these skills and after you're thrown in the office you just had to learn them on the spot and what helped you learn them or what I think there's definitely a learning that goes along with running an office um I think aspen lays really good groundwork from starting you as an associate and you don't have all of the responsibilities you maybe manage you know a dental assistant tell them what you want what you need and then as you feel more comfortable having more challenging conversations telling people what you want then also your skills develop you can become a managing clinical director and then you have additional responsibilities to running the office and then eventually a partner or an owner but having those little pathways to build foundations of leadership and having a team of um people behind you with aspen and admi who have a lot of leadership experience who have managed a lot of people to give you some guidance is really very helpful um so I think being a female and being a little bossy and definitely helps get what I want what I need but um I think that aspen really lays a very good foundation to developing people into very effective leaders um I also want to switch to um you know um we're really supposed to be dented I mean patient focused and when I talk to uh dentists they believe their dental focus but they're just not they want to believe it but like the federal reserve has um the most phd economist of anywhere in the world I think they have like 3 200. and they've come out with reports that said you know america's got 325 million people and a hundred million of them can't go to any doctor Monday through Friday eight to five and then i'll say uh to the dentist so what are your hours and they say uh Monday through Thursday eight to four and I’m like okay well Friday Saturday and Sunday your dental office just laser idle all your assets all your fixed costs rent mortgage equipment build out computer insurance updates professional dues it's all sitting there idle why patients are calling your practice and they have pain and we see it in the emergency room data here in Arizona eight percent of emergency room visits are odontogenic in origin and if you go back in time the lowest it ever was six percent um so um do you feel that being in a group practice and having partners and having a larger entity that you're able to become more patient focused instead of dentist focused absolutely it allows you to extend your office hours offer Saturday appointments offer late in the evening appointments because you have additional doctors and additional support so that you're not burning out one provider you can't ask one person to work 60 70 hours a week and not get burned out it's not possible so when you have a support network and multiple providers you're able to extend those hours and offer times to patients that's more convenient to them access to care is important especially in dentistry and I think being in part of aspen dental allows that to be not as big of an issue um another thing is when you go back in time you know um in retail you go back to the 300 years you know we got good data around the world of retail and it started out you know 300 years ago with uh a little bitty business about the size of a one-car garage and then you lived upstairs above it and they called it a shop house and the strategic advantage that won for three centuries in a row is that the next generation always made it bigger um because you had more selection you had more convenience and so one shop house was replaced by people who bought two and then it went to four to eight and it maxed out at about 250 000 square feet for your walmarts and ikeas and costcos and sam clubs and then and then walmart said we actually um we got too big we hit our max we went over the wall now we have a lot of push back like people like me I mean I would rather buy all my groceries at 7-eleven uh than go to safeway um the thought of going into walmart you know I mean my guy it's like going to a cardinals football game uh which means you have to be drinking on the way there um so um so I’ve noticed that um the new most outstanding business models that I’ve seen in the last 10 years um it was happening 20 years ago and I wasn't smart enough to recognize it but it's surely now the last decade was like pediatric dentist plus orthodontist one plus one equals three or periodontist plus prosthodontist is getting huge um look at clear choice they took the oral surgeon with the prosthodontist with the lab tech and came out with clear choice I mean and people don't track their customers like when you call a dental office and you ask them you say like are you open on Saturday it would if you have to say no we track that I mean I want to know like dennis will call me and say Howard do you think I should say this blue cross and blue shield ppm like what do you think I am a palm reader I mean this isn't you know um I mean it's crazy I mean how many people have asked you do you take blue cross blue shield ppo and they don't they don't track anything and we've been doing that since 1987 I made little prescription pads called getting to yes track all the no's and you have to wonder what a pediatric dentist saying I mean how what percent of moms that take their baby to a pediatric dentist will ask this question do you think boo is going to need braces one day I mean I mean that I mean that's probably the majority of them so now and then what did the pediatric dentist do it's all about me and so me I always said the national anthem for dentistry was me self me self me self me oh you want an orthodontic um opinion well here you're gonna have to leave my office and make an appointment and drive down the street and I know you had to leave work and pick your kid up from school and all that but you know it's all about me and I’m a pediatric dentist and I don't really understand why everybody keeps asking me orthodontic questions it's kind of irritating me and well other people just embrace like god I mean I mean look at walmart if what first of all what percent of moms do you think going to take their five-year-old to a pediatric dentist would ask about their bite and their future orthodontic needs what would you what would you two say that's pretty high it's probably at least four out of five yeah four out of five I mean four out of five if four out of five people that went to walmart wanted something I don't know you think they'd carry it I mean my god that I mean walmart won't carry anything the space it takes by the way someone sent me this uh dentistry uncensored with Howard fran joy comes in the morning oh thank you whoever sent this thank you but in walmart whatever the volume of space this takes up it has to turn 12 times a month or they don't even carry it I mean they know what they're doing so um so there's a lot of specialists out there and um I wanted to um you know there's uh my gosh there was nine when I got out of school now there's 12 there's oral surgery endodontics periodontics pediatric dentistry orthodontics prosthodontics dental anesthesiology oral facial pain oral med oral path oral radiology and dental public health how many of those 12 do you have do you have any of those come into your office or do you have to refer them somewhere else we haven't come into the office we have an endodontist and an oral surgeon come into the office and yeah and those are the top two you always see is oral surgeons and endodontists um but you have only had two do you think you'll ever do any of the any more periopedo ortho et cetera et cetera I think probably two for a little while um aston's expanding its ortho but as from a as a gp on a gp level but um I think perry on oral or oral surgery and endo really still a lot of the needs that we have for right now and um and what about you ashley yeah we're the same we have an oral surgeon and an endodontist that come in um once or twice a month each and we I get all the time well can I do this here well can I do this here and it's really helpful to say yeah sure you can absolutely and it's not just that it's um like even when you write an antibiotic you know that sometimes they're not gonna fill it or whatever and when I was worried about um lugwoods angina or you know and they're and they're young and it's always young boys you know they're fearless they're not gonna die they can you know climb up a palm tree and saw off a branch they're never gonna fall and um I got um I got really unlucky with a kid who uh didn't take his antibiotics and end up three days later had to be hospitalized somewhere so I started having antibiotics in my office to where I did not want you to be in charge of this part of the treatment you know what I mean it's like it's like I’m scared you're gonna take this you know two grams right now in front of me here's the prescription to go get a fill but I want to make sure uh you get this dose or whatever it just really um increases treatment plan acceptance when it's faster easier higher in quality lower in cost and smaller so convenience means you're gonna happen I mean everybody in retail knows about impulsive shopping I mean why are all the candy bars two feet off the ground I mean I take my grandkids any grocery store and I mean of course they're gonna reach for all these bright colored packages red and yellow and orange at their eye level two feet off the ground and if you and if you say um yeah you can do it right here come back and the specialists will come here and do it it's more likely they're going to get treatment would you agree or disagree I completely agree yeah that's why we also stress same day starts get the patient started that same day if you can that's everything same day starts and a lot of the dentists they can't do that because they don't have any um capacity when you look at their cost their cost is they charge the number one cost is your insurance ppo reduction that you agreed to in contract for a volume discount so you charge a thousand dollars for a crown but if you sign up with this ppo they're going to pay you 650. so that 35 percent nationally across america it's about 42 and that is the number one overhead costs in dentistry that didn't exist when I got out of school and then the second would be labor you know that's uh 20 to or 25 percent you routinely see it uh all the way to 30 labs 10 supplies six operatories they don't even show up on the breakout and your accountant doesn't even break out the opportunity costs and they call up the office they say I have an emergency and they're looking if they have a chair and it's like why don't you have an emergency chair or two and the two that you just mentioned that come in your office oral surgery or endodontist um they are the most likely to have two emergency rooms an emergency room is a room that no one's scheduled in like a lot of dentists say well yeah my hygiene's room one I work mainly at a room two sometimes three but room four is for emergencies I’m like dude there's three appointments in that room every day as far as I can go back in the schedule that's not an emergency so when someone calls with an emergency and you're looking for a chair and you don't have a chair I mean for some reason you think chairs are your constraint your cost and they're not and then the funny thing is dennis I say well what's your complaint what's one of your big complaints no shows and cancellations okay well that if emergency came down and you thought you were just going to get a pa and exam and write a prescription and get a diagnosis and then they tell you oh your 10 o'clock didn't show or just canceled or whatever now you realize oh my god this now I got a whole hour to spend with this emergency and I can do same-day treatment I think same when dentists don't know their treatment plan acceptance rates and by the way I don't like people sharing treatment plan acceptance rates when a lot of it includes botox and veneers and bleaching and bonding I mean let's be a doctor first uh nobody ever needed a facelift uh or any of that stuff um and I can't sell I mean for me to tell you two ladies huh katie ashley I think you two should bleach your teeth you're looking at me saying yeah you should lose 30 pounds get a tan and wear a wig you know you want to you want to go uh for round two so I but for doctor stuff um things that you need for epidemiological reasons to lower the disease missing and filled teeth of your community um my gosh the more accessible and available it is the more the treatment's going to get accepted and then you're going to be a better dentist absolutely it's helpful to have aspen kind of um give you guidelines with your scheduling and suggestions on how to effectively schedule so that you have the ability to work in those same day starts and it's something that as an organization we want to be a yes organization and help and have be able to say yes to these patients getting to yes is everything so here's another thing I um an issue I want to talk I want to take advantage of talking to two younger doctors um in their 30s you know in 1900 there were no specialties and health care was one percent of the gdp by the end of the century 2000 it was 14 of the gdp 14 cents of every dollar spent was on health care and there were 58 medical specialties and nine in dentistry now it's 2020 dentistry has gone up to 12 specialties and the cost of health care is up to 17 yet you see all these kids coming out of school and they tell you right out of school oh I want to learn how to place implants I want to learn how to do clear aligners I’m going to do molar endo I want to do silver diamine fluoride I want to do prostho I want to I’m going to go get doc certified for anesthesiology I mean it's like so basically you think we're going back in time I mean what consumer I mean my eye doctor if you have a problem with glaucoma he sends you to a person he just specializes in diabetic glaucoma if it's a retin he's got a retina detached if you just want glasses he has the optician in the in the building I mean why do um so many millennials think they're going to master all 12 dental specialties um when there's just only 24 hours in a day I mean how where does this come from and what is your advice on someone who wants to place implants do invisalign molar endo and you name it I think they just don't know what they like yet they don't know what they really like and they don't know what they're good at and so once they get into practice they're going to figure out well I thought I liked indo but I don't want to work in another small dark hole and i'd rather focus my efforts on surgical skills so I think they need to get their feet wet figure out what they really like and they can start to hone their surgical skills on a couple of things rather than trying to master all of them yeah because if you're a master of everything you're I mean if you do jack of all trades is a mask for nothing what do you think ashley yeah I think that all the new grads that I um encounter I think they're very ambitious and driven and they want to learn and there's a thirst for knowledge which is super important in our field but the advice that I give them is let's work on our bread and butter dentistry first let's work on getting our hand skills learn the business side of dentistry a little bit and then we start piecing in those extra pieces over time you know it's not going to happen overnight and I agree with what katie said like we need to focus on what you're good at start there and then challenge yourself as we you know time goes on so what would you say is bread and butter dentistry well at aspen dental in particular you need to be good at extractions you need to be able to handle geriatric patients and medically compromised patients fillings crowns and bridges hygiene proper diagnosis comprehensive dentistry we don't want to do piecework dentistry that's not going to last for the patient and we want to make sure that their disease is controlled so start there then we move on to bigger things know your limits which is a hard thing for a lot of people to do but you've got to know your limits yeah and i I think that um I recommend that you learn one specially every five years not that you're going to be as good as an oral surgeon place implants do bone grafting and do a lefor fracture and do it all on four but just so that you stay motivated and cross-trained in the diagnosis and treatment plan because I remember when I came out of school I had a really bad attitude about uh sinus lifts and it wasn't until I went and got my fellowship and the uh the missions to with carl mitch where it was in pittsburgh three day weekend um seven weekends and it wasn't that I was gonna come back and do that master that but it certainly changed my knowledge my diagnosing my treatment planning and I realized a lot had changed since what I had learned in dental school and you don't know how old that is because some instructors are up to date and some instructors are talking about stuff 10 years ago so I and if you just do the same thing over and over and over you can learn how to burn out so I love the you know every five years I’m going to pick one of the 12 specialties and I’m going to chase it hard and try to learn everything I can about it and maybe do some of the simple procedures uh but uh not uh but you're not gonna be a master of all trades um there's a I wanna switch to uh something current um the pandemic I don't know if you guys have heard but there's uh evidently there's some severe asp respiratory virus going around um a lot of seniors um and I I’ve had them cry in front of me I mean real tears that have lost their self-esteem because they didn't get any clinic time and they say I only did root canals on typodonts I never did a canal on a live human and they just feel like um they don't even have enough self-esteem to knock on your door they're like well katie would laugh if she knew my skill what would you say to the pandemic class who probably got short changed a lot of clinic hours you know I think they shouldn't doubt themselves they are stronger than they think and skills can always be taught you can always still learn the skills whether you want to go into a residency program or come into a dso there's people that will mentor you and that will give you the opportunity to start and learn those skills and get your hands back working again ashley what do you say there's a lot of dentistry to be done and there's no need to feel any certain way it's not anything that you could have controlled by not being able to have clinic time there's factors that be it's just part of life so acknowledging the fact that you know your skills aren't where they could be is the first step and knowing that there's so many opportunities for learning out there there's so many programs of ce dso aspen dental is wonderful at mentorship we have doctors all around the country that love to help people learn um growing your hand skills and growing your patient interactions just takes time and you can do that in the workforce you just have to put yourself out there well will you go into that in more detail specifically for aspen like if she got a job for aspen now you say you have oral surgeons endodontics come in like when the oral surgeon comes in and is doing uh extracting wisdom teeth and implants um would she be allowed to assist and learn that way for oral surgery and endo um do you have online courses will you talk in more detail about how they could advance their training by working for aspen sure we have an online learning and development page where there's on-demand ce or webinars all the time weekly daily you also spend your first month with the company you are spent with an established training doctor a mentor doctor you spend an entire month with them and it's custom your training is custom fit to you so things in areas where you need to improve that's what we focus on I’m mentoring a doctor right now who just graduated and we spend that time learning the business and learning hand skills and working side by side together I can assist her she can assist me um before she even gets into her own office where she'll be practicing on her own and by the way I just I want to point out you know if you're wondering is how we doing a paid commercial for aspen no zero dollars um you can't buy someone this old um the thing I love about dsos again is um they're the only ones hiring my homies I mean I I’ve been to and to tell you how bad it is so dental town started on st patrick's day 99 and we've had free classified ads a very robust deal and there's always been about 1 000 dentists selling their practice for sale and about 5 000 jobs for associates and when the pandemic came it immediately went to 2000 selling and all my practice transition guys are saying dude if they're 60 years old and they've never been divorced this is the last straw you know if you've never been divorced and you're 60 year old doctor in america you can retire and they just said you know forget this I’m not gonna do all this ppe and all this crap they just put up for sale now if you got divorced one time uh you'll push back your retirement a decade and if you get divorced twice you'll actually die at the chair in the operatory um so but I have a lot of respect and right now the 5 000 associate jobs is down to 1 000 on dental town those 1 000 jobs they're all dsos and then the other thing I like about the dsos is how um I think it's sad you know doctor's always saying uh well you know people don't treat dentists like real doctors and I say well you're not a real doctor and they say what do you mean I said well go out on Sunday I raised four boys you fall down and hurt yourself and break a leg on a Sunday the ambulance man shows up he takes you to the hospital they're all staffed they're all the doctors are ready to go if you broke all your teeth out on Sunday in phoenix Arizona with 3.8 million people you would find two unicorns and a mermaid before you found a dental office open to see you and that's why when they have an emergency they go to the real doctors at the emergency room which is six to eight percent of all the emergencies because the dentist can't be found and I see far better consumer oriented behavior um with extended hours more available you know they just have better availability and availability and accessibility and affordability if you're you know you keep one eye on the patient and one eye on cost and if you don't use your brain to drive down cost then this human can afford the freedom to fix their teeth and anybody who and it's always weird dentists that um they always take their eye off costs and they tell me what they're doing i'll say well is that going to be faster easier higher quality lower cost smaller well actually it's going to take a lot longer instead of doing working on an hour it's going to take two hours and it costs twice as much and you gotta buy this fifty thousand dollar machine and a hundred and twenty dollars of disposables to rinse the tooth out and it's like okay so you're more interested in the 86 car companies before henry ford that no one ever remembers or talks about where they just made one car for a rich king but it was old henry that said I’m aiming for the middle class and my entire friend family tree in fact we were kicked out at 23andme they said you know they said what's going on here you know this is two uh too many uh mutants in there um my whole pedigree is middle class you know what I mean and if it's not affordable then it's not accessible then they're going to get their teeth pulled and too many people wear dentures because they couldn't afford the freedom to save their teeth so there's a lot of great things so this is not a commercial but I do uh think there's so much that they could all learn um so go back into that like right now like um are you guys hiring now from the covid class of 2020 yes absolutely and can I ask specific like um is you know what I want to ask this civic gap money because the american dental education association says the average debt for graduating dental school senior in 2017 was 287 331. I don't like that number because it's a median number I don't like media numbers i'll take mode any day because 17 of those kids didn't have any student loans because their mom and dad were dennis and paid for it so they're basically coming out of school a hundred thousand dollars a year in debt so if they four years old school four hundred thousand dollars in debt and by the way she thinks that's a lot of money and um basically the average cost of raising a child in america from birth to 17 not including college is 233 000 so my mom had seven kids um I had four so I already had three less kids so I could have gone to dental school three different times and been even with my mom and then I always have to remind people that um if you think your student loans uh is a lot of money my god I hope you call me first when you get divorced and see what that number is um so I don't know why I have to look at that but my divorce cost three million eight hundred thousand and my student loans were eighty seven thousand so my divorce was 43 times more expensive than my student loans but she doesn't know someday that she's gonna have to pay someone a million dollars to go away right now she thinks that student loan is a big number so she's thinking well if I get a job for you how much would I make so you're given to the daily rate so come play locus virus you show up to the office you get a daily rate and for a young graduate who has a tremendous amount of student loans that's a very secure feeling that you show up you try to do good work you see your patients and you're gonna get paid and what's the daily rate it varies from owner to owner and across the country um yeah and I I’m sorry I even asked that question because the most misleading term in the world is the united states of america I mean no one talks about the eu like they talk about america everybody would break out germany from greece everybody would break out spain from portugal to denmark but we include alaska to miami to parsons kansas to new york city so like on the price of ortho the true price of orthodontics in america from board certified orthodontist is four thousand to seven thousand dollars a case because it depends are you in celina kansas or are you in san francisco downtown so it does vary state to state um do you um so they got a guaranteed day rate is also um versus like 25 percent of production or any um anything like that to use the benefits of um and economics incentives matter and um it just drives me crazy when people from socialized healthcare systems say well you know I went in an operation and I didn't have a co-payment oh so you basically say that we should just throw away all economics then well that's great have you told all the universities that everything we've learned since adam smith doesn't apply to you because you're special I mean if the if the co-payment mattered everybody in medicaid medicare every hospital if they didn't have at least a five percent co-payment I think it should be ten percent because when you tell grandma oh yeah you need a new hip and you need two new knees and uh and she doesn't have any co-payments she just says okay you know you're the doctor but when you say that's actually fifty thousand dollars a knee and you'll need to give me 5 000 for that knee about half the time say are you kidding me I’m going to take buffering I’m not going to spend 5 000 on me okay so you won't spend 5 000 on your own knee but my taxes are supposed to pick up fifty thousand dollars for the whole knee I have seen where people need operations so many times doctors don't realize how influential they are I have seen this happen so many times where um the doctor go the band goes to the dentist and he says you know johnny I’m sorry I know you've been smoking a long time but you have to stop this is killing you I mean these gums are all rutted inflamed and forget the gums and losing all your teeth your heart's only a hand a hand away from these gums and dude that you're gonna die of a heart attack you've got to quit smoking and then the mom always comes in I’ve been telling him to quit for 20 years but old dr fran tells him one time one time and he stopped so maybe when you tell grandma she needs a new knee she's like you know um and you know why you need a knee because you're overweight and you don't exercise and maybe she'll say you know what I okay I’m finally gonna do it my doctor said I gotta lose weight and exercise or I’m gonna have to come up with five grand to get an e I mean they just they just have delirious thoughts about economics but a day rate is a guarantee um but uh production utilizes everything we've learned in two centuries of economic theory uh so what is the um what is the other incentive is that very uh location or is that a standard uh percent of production number so it's actually not a like a percentage of production which I actually really like the best thing about the way aspen doctors are incentivized is it's a team approach so in private practice you get paid a percent of production for what you do and I hear stories all the time about how people get the crap work right so they get to do the molar root canals or the modbl fillings and with insurance and they're not producing so how aspen dental's incentive program works is you get your daily rate but then you're based off of entire office production so your incentive is based off of what all of the doctors and the hygienists in the office are producing together which is really nice so it's a lower percentage than that 25 30 percent that you would hear but it's not just based off of what you're doing it's what the entire office is doing together so the team baseball what about you katie it's the same it's really nice because you can utilize if your schedule is full and you know you have an oral surgeon coming in you can utilize the oral surgeon's schedule put more surgeries on his schedule you're taking care of the patients you're getting them treatment in a timely manner but then the whole office benefits from maximizing the schedules of all of the providers so does the oral surgeon put patients to sleep too do they do iv sedation they do that you have dental anesthesiologists come in or just the oral surgeon does those for me it's been just the oral surgeon and same for you what if someone said I’m really phobic and I’m really scared and I want to be put to sleep the will the oral surgeon come in and do a sedation while you do the root canal or not really I haven't had that happen um I think it might be something that would need to be discussed for the specialist but it hasn't been a situation that I’ve had to encounter well um I can't believe I got two doctors to give me an hour out of their busy day on a Tuesday to come in and talk to me and I can't believe the hour already went by but um I just want you to um each share some final thoughts um about you know the young kids I mean they're scared they're unemployed um and it's really frightening some of the people I mean they're really scared um what would you what would you say to um the kids um you know right now that are unemployed dentists and don't know what to do I would tell them not that it's okay to be afraid it really is it's okay to be afraid and to um have some uncertainties but you know there are organizations like a dso or a gpr but a dso is a great environment for you to learn those hand skills be confident in who you are and kind of get back some of that lost time that you didn't get when you were in clinic and you were in school you're going to have a great host of mentors behind you and aspen's hiring so the demand is here for our patient population and we need the providers and if you want to work want to come in we're happy to have you so what would they do just go to aspen or what where they go what's that and uh okay and if they say how he sent you I get a case of a beer and a court of jameson since I’m irish is that uh is that fair um and what have she said to you specifically katie um would you recommend more that I go get a gpr or go get a job at a dso or aspen you know I did a gpr my gpr was wonderful but I think aspen has a lot of value that some gprs cannot give you um you're going to get the mentorship you're going to get the business education you're going to get time to figure out who you are and what you like so I think um I think aspen is a great option if the gpr route is something that they want to skip and katie I want to ask you a question because you're a neutral party um ashley is in Florida which is the absolute craziest state in the nation and now everybody calls Arizona the Florida of the west um would you recommend they go to crazy old Florida of the east or the crazy old Florida of the west in Arizona oh I am not a neutral party I say go to Florida that's where I started Florida all the way and ashley what's your final thoughts uh first of all who's more crazy the people of Florida or Arizona oh Florida for sure that is gotta be and you know why Florida is a crazy state do you know why it is why because something that all economists have said and all historians say the problem with humans is when they're not transparent you just gotta be transparent you can't be opaque and all of florida's um crime and police and all that stuff is transparent so the journalists have accessed all this stuff um you know so uh katie I know you got to go if you got to go um I know you're waiting for a patient but um your final thoughts ashley I would just say that it's okay to be scared and it's normal coming out of dental school yes the pandemic and covet has magnified those feelings but there are jobs out there there's a lot of dentistry to do there are great doctors all over the country that want to mentor you and need your help patients need us the demand is here we're back to pre-covered levels of demand and we need providers to give that care the student loans will go away your hand skills will come if you want to do it it's there for you to do it and don't be closed-minded I know when I was in dental school so many doctors were like oh don't look at dsos don't go to dsos many of the professors in the school were anti-dso and it had me nervous to start at aspen dental and I can't say that I made a better decision for myself this place has helped me grow into the doctor that I wanted to become a leader that I didn't even know that I was going to be and has afforded me so many opportunities and dentistry is a great profession there's job security you're going to be okay it's all going to be okay and do you have any um programs for student loans I mean if they stay with you a certain amount of time certain so high need areas where like in markets where they're having a hard time finding providers there are some student loan um incentives and then also aspen dental has program with sofi for student loan um refinancing and lower interest rates and things like that so there are definitely options out there yeah and I just want to end with one short succinct rant and that is it's market segmentation sometimes the markets are on price like um cadillac sells the least amount of cars lower the price pontiac olds buick but you sell the most chevy's and look at housing you could live anywhere from a van down by the river to an apartment a trailer one bedroom two bedroom three bedroom the person who decides who's good and bad is the consumer dentistry does not start until a consumer pulls out a dollar hands it to a dentist says will you help me so the consumer gave birth to dentistry it's not they're not our patients we're lucky to serve them and then as far as fear it's the same thing the best analogy is childbirth um so many dentists and lawyers and physicians are so smart they overanalyze everything and then they get blindsided in risk and they there's no good time to have a kid are you kidding me having a live human 24 hours a day seven days a week that'll walk out the middle of the street and take a nap crazy I knew that so I made my four boys in 60 months I mean I knew the best time to have my four boys was four years ago not four years from now I mean when I decided I wanted boys I or children um I came from a big family I wanted four and I wanted uh them all out of diapers when I decided I wanted four boys I wanted them all out of diapers today but that's not how it works so everyone else was delaying just quit living in fair it's like it's like when you want to learn how to swim you can walk around the swimming pool for five years dipping your toe in are you gonna me my two older sisters who are nuns just threw me in the deep end and I almost drowned so you know if you're thinking about having kids quit thinking about it have them right now just stop what you're doing make a kid and then and then it'll be done and then five years from now you're glad you're here so you're afraid of molar root canals you're unemployed go to get a job and of course you're afraid of a mueller root canal you've only done 10 or 100 I don't think you're even good at molar anything in dentistry until you've hit a thousand so you know the best way to hit a thousand is go work in a really busy place where you can do a thousand fillings and half the time as a slow place that'll take you know twice from a year so I know you guys got patience I know you're being pulled they're texting me saying they got patience shut up so thank you so much for coming on the show it was an honor to podcast you Katie and Ashley really thank you so much thank you so much it was an honor thank you.
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