Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356
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1490 Carrie Gauntt, Phoenix College EFDA Coordinator, on the Value an EFDA Brings to your Practice : Dentistry Uncensored with Howard Farran

1490 Carrie Gauntt, Phoenix College EFDA Coordinator, on the Value an EFDA Brings to your Practice : Dentistry Uncensored with Howard Farran

10/30/2020 3:00:00 AM   |   Comments: 0   |   Views: 49
Carrie started her dental career in Orange County California at the age of 17. She was hired as a dental assistant for a new doctor straight out of dental school and fell in love with the dental field. In 1998 she graduated from Sinclair College's EFDA course in Dayton Ohio, completing her state boards later that year. After settling in Arizona, her dental focus shifted to education.  She worked for over 12 years with Maricopa Community College District dental programs, and in 2017 accepted the newly formed position “Coordinator for Expanded Function Dental Auxiliaries." Carrie was the first Certified EFDA in the State of Arizona. She helped lead the first graduating class of EFDA students and under her guidance, Phoenix College accounts for the most Certified EFDAs in the State of Arizona. 

VIDEO - DUwHF #1490 - Carrie Gauntt


AUDIO - DUwHF #1490 - Carrie Gauntt


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*Please excuse any typos as this was digitally transcribed

It is just a huge honor for me today to be podcast interviewing Carrie Gaunt cda crfda cpfda efda aze fdarf and cdhc if you want to know what that all means cda is certified dental assistant crfda is certified restorative function dental assistant cpfda is certified preventative function dental assistant efda is expanded function dental assistant and then the azfda rf is Arizona expanded function dental assistant restorative function and last but not least cdhc is community dental health coordinator and she started her dental career in orange county California does that mean you're a valley girl for sure for sure yeah no surfer heading beach that's the old frank zappa song as a dentist is age 17 hired as a dental assistant for a new doctor straight out of dental school she fell in love with the dental field after moving to Ohio she was able to see the value of eftas within a dental practice in 1998 she graduated from Sinclair college after course in Dayton Ohio later that year completing her state boards her employer and mentor encouraged her love of lifelong learning challenged her excel in her clinical skills and helped to shape the ethical standards she has set for herself in the dental field after settling in Arizona her dental focus shifted to education working over 12 years with Maricopa community college district dental programs and in 2017 accepted the newly formed position coordinator for expanded function dental auxiliaries uh which got my dental assistants all excited and that's why i graciously asked you to come on the show and thanks Carrie for coming um Carrie was the first certified after in the state of Arizona she helped lead the first graduating class after students and under her guidance pc phoenix college accounts for the most certified eftas in the state of Arizona she serves on the dental assisting advisory board for the west mac which provides career and technical education programs to high school students in Maricopa county and continues advocating on the benefits of maximizing a dental auxiliary scope of practice in all states um my gosh you know um lecturing around the world um well I’ll never you know intel out here right right and i don't know if hip i can say that but the two founders uh were my patients and they're from Iowa and I’m seeing this monster company just two good old brothers from Iowa and I’m from Kansas and this going back before dental town they coached me on how to do dental town and i was so lucky for their coaching and i said to him one time i said no offense but you're just two regular homies from Iowa how the hell did you do this and he goes man it's because we were military brats and me and my brother you know every three years we woke up in bed in a different country and we're all looking around like well the people are all the same everything's the same why is the outcome so vastly difference between poverty and rich and this and that he said you know by time we were in high school we understood macroeconomics and we didn't even know what macroeconomics meant and um my gosh um it's just um um but when I’m lecturing in these other countries like i remember like Germany and japan you know we make Chrysler Germany makes Mercedes Benz and you go to dental companies there and i mean you could eat off the floor and if you ask where's the bathroom well that's not an original question so look down on the floor the blue line goes to the boys bathroom the red line goes the girls you know i mean every every switch that you turn on and off would have the full instructions of when to turn on or off the light and um and i noticed in their their college they start very young in high school saying Billy what do you want to be and if he says he wants to be a welder you know start teaching them geometry and algebra and trig and i think these uh i I’ve been in Arizona for 32 years and the people that graduate with 35 000 of student loans at asu with a uh degree in underwater basket weaving are unemployed and then the people who go to like a one-year tech school like what's that um the electronics da vinci or um devry's they're both and devry's will go over to intel motorola and say what are you looking for and they say well we actually need somebody to run this machine and we just got a new one we'll give you the old one so these kids come out of high school they're working on the machine for a year or two and when they get a diploma they get a job one hour later at who's ever you know working with them and i just think the 200 000 people at maricopa are real world and i think half the degrees at asu and u of a i don't even know what they're there for but um I’m sorry to have asked you to come on the show today because you're talking about expanded duty assistance so i assume you're a communist a socialist um you're trying to take away my dental license and uh how could you be an American and what an expanded duty dental assistant i mean how how crazy is that yeah i think it's funny because um i i was researching a few weeks ago and you know 50 of our states have expanded functions that can place direct restorations this is not new um it's newer for the western part of the country um but not new um across the entire country so i find it funny when i hear feedback um often from doctors who um or the dentist who feel that we you know we shouldn't have this type of scope of practice or i don't want my auxiliaries doing this type of treatment or they shouldn't be allowed to do this type of treatment it's been around forever i think in Ohio i think the year was 1976 that it came out with expanded functions so again many states have had it for many years um again it's more of the western states that we sometimes get a little bit of pushback but because of our small scope of practice the expanded functions it's no different than um hygienics are great at their job at what they do and expanded functions are great at our job at what we do and you know history always repeats itself it's just always the same story and i remember when bob Barkley was flying around the country trying to get dentists to hire a hygienist two things happened you know the the knee-jerk reaction from you know the the top leaders was like uh uh you're taking away our sovereign duty and and um they were just against it for sovereign rights but the dentists were like i ain't got time for this I’m so busy doing full mouth extraction inserting dentures who's got time for this hygiene thing and and and it and they fought that tooth and nail and then when they started with the um the dental therapist oh let's go back to independent hygiene practice practices first of all if you're an American and you think someone graduates from four years of college with a hygiene degree and can't set up our own business you're not an American and you're not a friend of democracy you're not afraid of free enterprise and and when you donate money to the ada political action committee to take the rights away i mean it's hard for me to like you i mean i love my homies but i mean you got to call them on their and i i wish everyone who voted for the hygienist not to have the right to have their own practice had tomorrow lost their right to have their own dental office and had to call up heartland dental and say sorry rick i can only be someone's employer i mean it's just so completely un-american but i did find the seven hygienists who had independent practices lecturing uh on and off in Colorado and every one of them was in a small town that didn't even have availability affordability they're in town like a thousand they didn't have room for rent mortgage equipment all that stuff so when you walked in their front door where there used to be a dining room table and that china closet where you put dishes in that have never been used it's like a museum to the skill set you don't have whoever has a china closet if you want to hide something from them um just put it in the oven and they'll never find it and they converted that to an operatory and they wouldn't got an old used chair and they put in there and then they they just clean teeth cash it's usually you know 60 80 100 bucks cash and if they find something wrong they write a note and then she'll drive an hour down the highway into town and that dennis loves her i mean she's already had her teeth cleaned obviously there's something wrong with the tooth they just love it and and then um you know and then even this um expanded duty uh the dental therapist which is the new hygienist debate um again I’m in Minnesota and and the only dentist I’ve ever seen that had us said oh my god uh you know i got two hygienists in room one and two and i you know i hate operative and now i just go in there and um rooms three and four they seat the patient they numb them up they do the mod composite the whole thing's done i mean while I’m over here in room five doing a molar root canal or placing an implant or a denture or partial and i have to admit after 32 years my rock bottom is when i look at the schedule and and the next hour i have to do four mod composites on two three four and five i mean really i'd rather be pushing a lawnmower or a weed eater at least you could be looking around i mean it's just there's no shortcuts it's one hour of just really intense work and and i i don't um it was really challenging the first thousand fillings you did but four mod composites if i could hire you to come in and do every one of them the rest of my life I’m halfway died and gone to heaven and who's fighting this my homies you know it's like dude so so where are we at where are we at with this in Arizona so Arizona it passed in 2015 it took two years to develop curriculum so in 2017 is when we started the first class and in 2000 beginning in 2018 is when we had the first graduating class there's uh three schools that have it now in Arizona so midwestern university has a course rio salado has a course and then of course phoenix college where I’m at um we have uh the last data i got from dental assisting national board because uh our Arizona dental board contracts with dan b dental assistant national board dash issue the credentials and does the testing um so the last that i had in june from danby was uh we have over 105 now um expanded functions in the state and there's a wide range of where they're practicing um we do see quite a bit of probably the doctors that are on board the most right now are probably peds and pedo and then the next would be general and then probably the third is public health um you know when it comes to sort of a demographic of those uh the students that we have i again it's been around in other states forever and i know that it's new here it's new and new in California newer in Oregon and Washington um Colorado it's been around forever Colorado is actually the one that um i i just showed up first in pediatric dentistry second was what probably general it was probably general for that oh okay general dentist yeah i think third was um public health okay yeah sure and that's a general you know looking at the the demographic of my students i don't know what midwestern's getting or um rio salado and then when i was saying with the university of Colorado the ada did a study with them in 2009 which any any of the any other dentists who you know our ada members can pull up the study and it talks a lot about the benefits it talks about the increased production it talks about the lower stress it talks about how staff members will usually stay longer they feel more vested in the practice i mean it's a win-win so to hear sometimes pushback from you know dennis and again more pushback with the western states i don't usually get that from uh or hear about it from midwest or east coast at all they're usually on board just because it's been around in those states forever they're used to it um and when when you get pushed back um what what is it really i mean what what what is the argument against pushback that they just love um doing dental fillings the rest their life that you cannot you know what is the pushback they feel that the quality of care won't be there i think it's the same pushback that you heard what 100 years ago from from you know people pushing back with dr phones with hygiene um you know and and newman who was the first hygienist that you know they can't possibly do that that scope of care and that's just not the case we actually um when i talked to my doctors again that i know back in Ohio they say that they actually the ethics do better quality and usually faster than what they can do that's all they do all day long if that's the only thing you do all day long you become very skilled at it i know personally i don't want a dentist doing my trophy i want a hygienist doing it that's what they're skilled at so um it's the same type of quality care you do need to have a mentor i think it's no different than dennis graduating from dental school um i think it took you a bit you know to to feel super confident in the direct restorations you're doing and they definitely need it and that's one of the questions we ask with our program do you have a supportive doctor do you have somebody who will come in there and critique afterwards not necessarily in front of the patient but um you know critique or give you feedback on how you can and you know improve your skill set and that's what we want i did i mean it i would say for me it probably took easily um six months to a year before i completely felt comfortable with everything my doctor would come in as what law states you they the patients have to be checked before they're dismissed um my doctor would come in and maybe it was a small rounding of the marginal rich maybe it was something tiny but i was learning each time um on how to improve my skills and and let me i got a um comment on the um they're always I’m talking about the the skill won't be as good um okay well what's the quality of a cleaning that's never done um you know they they say oh you know back in the 50s only a dentist could do a cleaning okay dude well there's a town of a thousand and it doesn't have a hygienist and nobody gets a cleaning so you're saying better is the enemy of best right and and it is the same in in political voting i mean i have always i don't want to talk about religion sex uh politics or violence but i have always thought since the first time i voted for a president um that um it was like deciding if you want your leg amputated above or below the knee it's like deciding would you like to die of a heart attack or cancer i mean i always thought you know with 330 million people you think we'd be voting between like batman and superwoman and it's always like you know the two craziest hillbillies they can find under a rock but one of them might be slightly better than the other one but what you're thinking of is like like I’m a registered libertarian so I’m thinking this guy that just shuts down all the government agencies and deregulates everything opens back up ellis island and go to what you know how this country how humans lived the last one million years without any government I’m totally fine with that um but that's not gonna happen so what do i do say well since nobody's exactly as crazy as i am I’m not going to vote for anybody i assume um that you know that you know so um i see that in Arizona so guadalupe doesn't have any dentists in there I’m a crosstalk I’m in all watuki uh where are you at uh well my home is in surprise and then i practice well i practice once in a while at the peds offices around the valley um my sister's in good years she's a hygienist now she your sister your sister is the only one true to the dental faith good year because i mean this go let's go all the way back to goodyear so goodyear everybody thinks he's associated with tires i mean come on he was a chemist and he was uh working with rubber and um just like ben johnson in tulsa oklahoma where he found some old gutta-percha and a jar and realized that it aged and it was no longer the same gutta-percha and that observation not only made him a gazillion million dollars and he started tulsa dental products and he started the thermophile on the stick or whatever but mr goodyear noticed um um the problem with rubber it was all flaky and cracky and all this stuff and he finally made this contraption under um what would he call it vulcanized rubber and he added a carbon atom to the rubber and vulcanize it and it's the rubber we know today and his first application of applied science um was you bring in your old denture your wooden denture george washington had several made while he was the president and he would vulcanize his rubber pour it in there not too hot to burn you do you remember that goldilocks story where one one was uh the bed was too small and one was too big and one was just right and he made it just right and then he would seat that and then he'd cool and it was the it's considered the first ultimate adventure where people said oh my god um yeah re-lighting a wooden denture made with rhinoceros teeth and so he set up these little franchises and we're talking way back in the day the guy became a multi-millionaire because dr goodyear's vulcanized rubber franchise was the only thing on earth delivering high quality dentures where people said god i love it people were flying from france i mean i mean read the deal on it and then just about as he's ready to die he got another call from someone you probably never ever heard of henry ford said uh hey we're gonna make 10 million model t's can you put four rubber tires on them and then everybody knows them as goodyear and when i got here i called the mayor and i was telling her about this and she's like i said you know i wanted to go see the museum just like when i landed in Australia the first time the first thing i want to see was the bee gees museum and there wasn't anything for the bee gees I’m like okay let me let me tell you guys something your country's greatest achievement of all time was the bee gees and you don't have a bg's music and i said are you serious goodyear doesn't have a museum and we and then when ebay came out we got on the internet and she found one of the contraptions and in the mayor's office she got like an old desk and she set up a nice little neat display that um mr goodyear did more for dentistry uh I’m sure you can make an argument did more for cars but i mean he was an amazing guy for dentistry and um and so um so here we are I’m across from guadalupe there's not one dentist in there and a good mexican dentist that i know come up from mexico and they'll set up in guadalupe and they'll start doing you know they can speak spanish they know the language they're in a low overhead deal they're in someone's home and they're doing 20 fillings and what does the Arizona state board of dental examiners do that's not how the mob works you didn't have your proper paperwork in line we're going to send out the mob which is the police and they're gonna rough you up kidnap you and arrest you and then we're gonna deport you to the border and then the dentist doing it they're always rich dentists living in suburbs they're saying well I’m concerned about the quality okay so you're saying the quality of nothing is better than a man who went through dental school in mexico and traveled on his feet and came up to so the only reason you dentists make 150 000 a year to 200 to 300 is because you're in bed with the mob and they keep out all the competition and it's kind of like the free trade deal and they'll say oh you know we passed a free trade event okay free trade means um um pretty simple uh Carrie you're free to go to the store and buy what you want so where's the six-year contract because it's not free trade it's manipulated it's all this stuff like that so when they spend six years on a free trade agreement they name it free because it's any it's the opposite of free and dentists always talk about truth liberty and justice the American way and the first ones to take away your license to own your own hygiene office they're the first one that if anybody comes from another country and sets up a dental office they're the first one that wants them kidnapped arrested put in a cage and go to jail or ship back um and and what i do have some foreign trained dentists too in our program because they aren't able to get uh their general licenses out out in the states now are they also communist you know i mean i mean yeah we all are right in the program we all are right yeah and I’m not what i what i think in in the real world is that I’m going to the dentist and howie was trained at university of Missouri Kansas city and Larry was trained at the university of Antarctica with three other penguins it's my freedom to choose where i want to go and I’m sure the Antarctica penguin Dennis would cost less than the American dentist just like i could go buy a Mercedes-Benzes but um i i bought a lexus i could have bought a toyota i could have bought a dodge dart i could have bought a go-cart i knew i was buying a lexus and um and i knew it was way too much money but it was in 2004 and i still have it with 180 000 miles on it didn't your office bring it to you didn't your office or something yeah yeah yeah i remember i remember listening oh it was Sam Dominic because i would do dentistry up to last minute jump in my car and drive 80 miles down to the airport and barely make the plane and they're like dude one breakdown and it's a disaster and i said i saw on time and Sam Dominic said well if i get online order and have it delivered here are you good with that and i said sure i went down molar root canal came out and had a new car thank you Sam Dominic for that um so you know i I’m a I’m a true hard um um capitalist and i i think that um we should um we should work hard uh for the um consumer who not just votes for a president united states votes with their dollar that i want to go and and I’m sure some dentists some patients they'll go there and they don't like the fact that the dental assistant did the certified um expanded duty fund well fine don't go back don't go back go somewhere else and and i i had that problem when i started in 87 was um i did all my cleanings for a while until i got a hygienist and then we had about you know a couple of uh crazy ones that would only have me so i made a decision i said well you know I’m the eighth dentist on this corner there's seven other ones tell them to walk across the street and find someone else because i knew whenever you're specialized on one thing you do a better job right in the year 1900 there were no dental specialties by 2000 or eight now there's 12. i mean a hygienist is eat living breathing dying cleaning what she's doing and I’m sitting up there um you know waking up all night thinking how you're going to get a broken file out of a root canal too our minds are different and expanded functions are no different it's no different than we have that small scope of practice and i know there are dentists out there who don't you know plus i i don't know how they can afford to necessarily do direct restorations all day long i i mean it's not as beneficial financially i mean usually the rule of thumb is thirty percent of the time is the doctors when you're doing a direct restoration and 70 percent of the time is the efda we know that that mod is super time consuming for you if you are a dentist doing it why not let us do it why not you know take that burden off and you can go focus on something that you enjoy um much more than doing direct restorations we happen to love doing them so let us do them you know it makes no sense and i know that you have always you said with with your staff you know many times on the pod different podcasts that you want to maximize their um your auxiliary's um duties there's no reason they can't do certain things and i think you had Gordon Christensen one time you interviewed him too and he said the same thing he was you were asking him specifically about um something about just all the dentists just being you know the half a million dollars in debt and things like that and you're asking him which they purchased first what should they do first and i i think one of his top three things where you need to maximize your auxiliaries maximize what your auxiliaries can do by the state law in order to be profitable and that's just basic economic sense i mean how how can you how can you not understand this at economics i mean if I’m only getting you know when i got out in 87 i had my own fee schedule and delta just told me what percent they're gonna pay was a hundred percent whatever i submitted for cleaning time and x rate they paid um fillings and root canals eighty percent uh root canals crowns dentures are crowns dungeon partials 50 and then after about 10 years they stopped doing that and said we're going to send you the fee which is what 95 are and that's been drifting down so let's just say for easy mass say they're only gonna give you a hundred bucks for a filling if i can be doing a thousand dollar root canal why am i doing a hundred dollar filling and uh what was the going weight uh rate wage rate of your graduating class and I’ll just say in Arizona um dental assistants usually start at 20 and hygienists start at 40. so that the easy math obviously in san fran um you know they'll start at 50 and in uh lafayette louisiana they might start you know you know it's they say same with the price of ortho ortho costs between 4 500 and 6 500 and it depends exactly on what zip code you're in you know what i mean right but if you're in san fran you're not going to get Invisalign for 4 500 bucks but you can in saline Kansas yeah so i can only track what i did with my students again because we were this is so new we had no idea everybody was coming to me and especially the doctors asking about fees and um or excuse me salaries and things like that um i can say on average they're at about 25 an hour in Arizona um i have a little bit different philosophy on some of that and maybe it goes back to my parents owning their own businesses i happen to think um no different than hygiene so i see like my sister's hygiene schedule if her high teens go there i have three hygienists in the practice often you know at different times and if um the schedule falls apart usually patients are transferred over and maybe a hygienist has to go home because again it doesn't make a whole lot of business sense necessarily to have your hygienist there for eight hours and you don't have patience so i know with my expanded functions i get that the curve of dentistry has gone a little bit different we're doing a lot more um indirect dentistry than we were even you know 30 40 years ago and you don't necessarily as uh after i was i this is what i say to my students do you um want to be paid a straight um amount per hour um and if there is you walk in on a Monday morning and the entire schedule is filled with indirect care or dentures or this and that um is your doctor going to send you home are they going to keep you on staff it really sort of depends on the office i think for my students i recommend that they take a base salary and they take a percentage of what they're helping to produce i think that if it's a straight amount that you settle on per hour i think that that's fair for the doctor as a business person again staff needs to remember it as a business and um if you are doing indirect all day long you are still helping your doctor do those indirects all day long um and if you happen to have a day where you're doing a bunch of direct restorations maybe you're paid a percentage of that that's my personal feeling on it um i think that's fair for both the fda and i think it's also fair for the office but I’ve had offices right now that are paying a base amount i would say maybe around the one office is about 24 and then they pay two dollars a restoration for every restoration completed by the expanded function so there's a wide range when it comes to different um you know salary amounts so um let's get to basics um first of all what website what is your website at phoenix college is there an extension that goes right to the after program uh i think i sent you the link but yeah um no the easiest way really um because it's such a long link we don't have a small one just because again i don't get to control this website um is to really search the fda in there um yeah feeds phoenixcollege.edu right slash program slash center continuing dental education slash expanded function dental auxiliary so the first question is what does that bad boy cost and how long is it what what's it what's the tuition on something like that so the tuition for our school is three thousand dollars it's a 12-week course you come every Saturday so um cost is um three thousand dollars for 12 weeks and that's every Saturday all day eight to four thirty just one day a week one day a week uh for three months one day a week uh uh on Saturdays from when to win like eight to four thirty or so four or four thirty and then if the the teacher starts drinking you get out a little early that's right we have parties to go to or anything like that we're out earlier and and does does the um does the doc i know i know how my homies think the doc's thinking well this is something she's gonna get and carry it on the rest of her life who pays for it usually so so far who's paid for it uh i would say 80 of my students the doctor or offices if it's corporate it's the offices uh private obviously the doctor the other 20 are assistants who uh or hygienists are paying on their own because hygienists are legally allowed to take the course too so um either or so that's only 250 a day divided by eight hours that's a 31 an hour course and by the way the asu um to get an mba they also do that where you can just meet every Saturday for two years um i couldn't do what i was getting at is you know it's impossible to leave the to work to go to school and so um they had um um Mondays and Wednesdays from six to ten for two years or Tuesdays and Thursdays six ten two years or just every Saturday for two years and um and and the people who took up money to Friday’s five those were all the kids under 20 or under 25 and and even the teachers said that um that was the part they didn't like because this older students who had already been in the real world the teachers found so much more interesting uh than some kid who's um and only had a job at the ihop so and the assistant's when you you have to remember that yeah every state's different of course so here in Arizona uh they did set up parameters you have to be an assistant for uh at least two years your doctor has to sign off on that um you already have to have your radiology and you already have to have your coronal polish in order to take the written exams once you finish the course and i also want to say one thing to you know another thing i'd like i'd love all the dentists to go on social media and declare that they are completely against expanded duty dental assistants and then go then go um bring in all their past assistance and swear them and under oath did your doctor ever tell you because i'd be doing i mean a lot of times i just hold the tissue together and i didn't have another arm i'd say okay now put a stitch in there and you know the first time they say well are we allowed to do that I’m like shut up and suture that right there and then when you then i was at truman medical center east in dental school they we had to do a hospital rotation and I’m looking at some of these major surgeries i mean we saw feet being die you know amputated for diabetes but the other nurses i mean you either helped with the surgery physically and then i asked some of the doctors now can they legally do that and they just say do you want him to die on the table so there's so much um expanded apprenticeship where you're my assistant for 10 years and over 10 years of training you do a lot of procedures that if it was on the front page of the new york times I’m sure would not um be legal right right we do agree with doctors oh yeah and i also think that i hear um the other pushback i hear not very often but the other pushback i hear is that they are afraid that these that the dentist will pay for this education and their assistance will leave well we know that normally those that are going to this course want to further their education and they are more vested in their practices in general a little bit more loyalty to the practice but also how long do you think they really have to work in order to get a return on your investment i mean your roi is not going to be that far off it's not that expensive of a course that within a few months you would not see a return on investment so even if that staff member should leave a year down the road you've definitely made your money back do you know what i mean on that particular staff member um it's definitely an investment in your practice i think it's definitely an investment in your patients um it increases the access to care i just again i don't understand some of the pushback you know um for it and they when i hear it i just i just again i i go back to dr funds and all the pushback he must have had from a dental hygienist it just makes no sense and now dennis couldn't possibly think of doing their profies in general do you know what i mean they don't want to do that they want to do other things why not let us do the other things let us do the direct restorations or in this state we can also um cement pre-formed crowns and that usually means impedo stainless steel crowns so we can cement those um and i think that is a large reason why we see a higher percentage of pitot offices getting on board specifically because of the stainless steel grounds so that's the driver in pediatric dentists is the crumbs still crowns i think i think so and uh you know um first of all thank god for pediatric dentists i don't know what went wrong in their life for that i don't want to do it i want to do it but i mean someone's got to pick up trash someone's got to be a fireman i mean I’ll never forget um in Wichita Kansas one time the um the golf course country club went up in flames and i lived i happened to be walking by with my dad and we walked up there and we were actually there when the fire truck pulled up and then they you know they're just all calm no one's running and they put on their suit and then they go to the country club and they actually open the door and they just walk into an inferno and then they came out like 20 minutes later I’m like man that's a weird job you know um but thank god people love to do it um yeah the chrome still crowns i mean you know how many times um I’ve uh tried to get try it in a different shape and then knock you know a hundred aluminum chrome still crowns on the floor the funniest one i ever had though was when the mother came in and um she was all upset because she went to this dentist and they did this and um she said you know he didn't tell him it was going to be all metal and you could see it across the street and and why does it have to say d4 on it and i thought oh my god so i just polished off the d4 and that already made it at least half better yeah um well and also they also put into our laws with uh um with the fdos is that of course we have the itrs so the intermediate you know restorations which could be like a glass ionomer or things like that um and that gets a little bit um in a gray area when we talk about that but also we have the fluorite varnish so we can do the sdf it's a fluoride varnish so that is something that is beneficial especially for the older population and the younger population again these are things that we can take that burden off the doctor and why not let us do those types of um procedures and help with those procedures you still have to check it by law um the doctor still has to come back in and see that patient so i think it's just a win-win and i think anybody who's not on board or those who want to complain and i understand their complaint um so i don't want to sound rude about that i understand the half million dollars in debt from dental school i think that's huge and tremendous and what a burden for them to have but why aren't you again bringing in something that can produce more for you um studies show it produces more not my study even though i can see i can tell you what my doctors are saying or feedback from doctors you know within the community but um the ada study shows you know the amount of production for high delegation offices range anywhere from 60 to 36 percent per month that's huge that's a huge amount yeah i can see why you train after and they leave because when you look at research on um why employees quit um a dentist or an alien always thinks it's just money money money money they think people do everything for money i mean I’m telling you um you know um no one wants to live embarrassed and shamed and and all that stuff but the number one is lack of trust and autonomy um your micromanagement and now you know I’m doing an mod in this room and you're freaking out uh number two not being appreciated or recognized number three lack of respect uh number four little to no opportunity for growth and development enhancement um I’ll just keep feeling underutilized uh six bad manager uh seven poor management eight poor communication nine feeling overstressed or overworked uh 10 lack of support 11 lack of work-life balance 12 uns uninspiring or unhealthy work environment or company culture and uh and then you don't want your employees to get bored right i mean you don't i mean you don't want them to get bored invest in them they will stay with you for loyalty i know for me um when i decided to go to expanded function school um the doctor i was actually living north and i was living in the cleveland area and the doctor i'd worked for before i i had to have a mentor by the rules of that particular school and so i moved back i had to ask you know for uh um basically my old job back which he graciously did and then he mentored me through it that was huge and so i stayed with him until i moved to Arizona you know um the the loyalty is a big thing with me i think education was a big thing with me he was taking courses through the ada um and um even lvi was a really it was just sort of getting started at the time so we were taking more courses like we did a hands-on course at the university of kentucky for um indirect restorations even though i was in the field of direct restorations i still got to go and i still got to learn i think that makes a huge difference um when it comes to expanded functions when you talk about hygienists that maybe want to take the course um why wouldn't you why why are we rescheduling patients and not doing the same daycare if they have come in to see the hygienist and they have a small class one or a small class two or a class five um maybe it's a 16 year old that needs a couple you know occlusal fills that hygienist can easily numb up that patient normally right then the doctor once the prophy is done the doctor comes in it takes them two seconds to prep that and your ester comes in and fills that patient didn't have to be rescheduled the parents are happy patient's happy they don't have to come back it's all done the same day so that's a big driving for some of the doctors that are sending their hygienist is they want to be able to do that same day care for their patients especially because you don't want to miss school if it's younger patients older patients it's hard to get them there sometimes it's a son or daughter having to bring their parent in which isn't easy because they've already had to miss work for that particular day so so things like that you know they're they're it's just a huge benefit to every practice yeah well well said um and and again i always remind the dentist as I’m you know when you take your point of view versus the assistance the hygienist a dental therapist uh the insurance companies all the stuff those are all numerators divided by the denominator and the denominator is the patient and um just keep one eye on the patient and one eye on cost and if you can't hold up your hand and each finger stands for better faster easier cheaper smaller if you if you if you're not making something better faster easier cheaper smaller than for everyone for everyone yeah you're taking away people's practice i mean even that study states that uh the doctors who employ after this feel less stress in the practice um which is huge i i mean of course they do they're not happy to do maybe direct restorations all day long or something that they don't want to do you know and they can focus on things that are a little bit more fun to them whether that be cosmetic or whether that be implants or whatever that might be um maybe it's extractions all day long but i know let's talk about the the uh the the um the 400 000 pound elephant in the room and that is um the pandemic um my gosh um you know injured my insurance ceo friends tell me that they think 40 million Americans lost their job with dental benefits um everybody in dental insurance knows everyone in economics knows that if you want more of something make it cheaper faster easier you know higher quality lowers cost subsidize it deregulate it don't tax it but if you want less of something um you know raise the price regulate it taxes all these things so if so the um the people that end up going to the dentist usually had a subsidy from their employer or the government so now that 40 million people have lost that subsidy do you think a lot of dentists do you think this is a tough time for fda's where a lot of dentists are going to say well now I’m so slow i might I’ll just do it myself versus right nothing at all i think i think what i see is um again i think we've seen a change in dentistry that there's a lot of indirect being done but we're also the changes that that might be flying over the head of some of our uh um just a lot more crown and bridge a lot more um inlay online so a lot more of that type of treatment and i think they're forgetting a lot of the autonomy for the patient i think that if you are diagnosing right now with patients who are worried about the economy and you are saying they need an inlay or an online whatever it is on tooth number 30 and not giving them the option maybe you don't feel it's the best option but it is an option to maybe buy some time for them to do a direct restoration on that number 30 instead you either either the patient's too embarrassed to say they can't afford it they walk out or they schedule for an appointment and they walk out of your office and you never see them again or they cancel that next appointment because they're not gonna come back they can't afford that thousand or fifteen hundred dollar charge or whatever it may be for that um and instead you could have given them the opportunity for 200 direct or you know a filling on that too the 200 direct restoration um and they're going to be appreciative they're probably going to refer friends because they were able to do this treatment and they could afford that at this time they couldn't maybe afford the other and again i get if a tooth is completely broken down that's a whole other story but if we can buy some time for that patient or like what i always hear you say in your podcast that bread and butter type of dentistry why are we not giving that patient autonomy and because i do hear it i heard from my neighbors and my friends that this was the treatment plan and this was the only treatment plan given to them and they they can't afford it at this particular time are we really going to just let them sit there and have decay in their tooth are we really going to wait until they're in pain or until they have an infection that makes absolutely no sense i understand that maybe that direct restoration wasn't what the dentist feels is maybe ideal for that particular patient but in my opinion it's ideal at that particular time for that patient we don't want to leave disease and necessarily inside the mouth so why can't we give a patient a different option instead of them walking out the door you just lost a thousand or fifteen hundred dollars you let them walk out the door to reschedule for two days from now to do an inlay on and crown or whatever it may be and they're not coming back and you could have kept them in the office by just helping them that particular day or even the next day of just doing a filling um you know i I’ve always said that you know the i i can with these two dental schools in our backyard we got at still masonry midwestern I’ve been predicting the successful ones since day one um because you you you could you can just tell that they they'll hustle like they'll come by your dental office and just like want to shake your hand or this they're networking um I’ll go to the lab and and um I’ll go to the lab and there's like uh you know a thousand kids in dental school between the two schools right now and I’ll go visit a lab guy and there's a dental student there and he's like yeah you know what probably only like one guy every six months will come from that school but I’ll watch him 10 years later and they're you know they're they hustle and same day dentistry is about the hustle and and my gosh um consumers you know they they know the research that probably about 40 of the stuff you bought was impulsive like when i go through the drive-thru at McDonald’s i mean they'll say well do you want fries like that well of course uh would you like an apple pie I’d sit there all day i mean i don't know what they could say where I’d say indeed i do not want to eat that extra cookie um you know and so someone will come in and they'll say oh well we break for lunch in 10 minutes dude you got 400 000 student loans it's called a fireman misses a lunch a policeman misses the lunch soldiers aren't getting lunch and and this person is here they're in your office and you're gonna reschedule so you can go to subway i mean i don't even understand that logic and then the other thing they don't understand their cost um so the hygienists are always doing this the the hygienists are are probably one of the worst at this where um they'll say well i got another patient coming in ten minutes okay well we'll have the assistant go start that patient in the uh emergency room and we'll get the and they're like no no no this is my room this is my and it's like in the minute they tell me that then when that patient's done and they finally get the room cleaned up they want that person transferred to their room i will ground them from their room for 30 days I’ll say i don't know what happened but you're having an extra marital love affair on your husband with room number one and i don't unders i mean could you imagine getting on southwest airlines and you're getting ready to debark and the pilot says oh my gosh i just realized this isn't my plane so I’m gonna have everybody get off right see that plane out the window that's my i mean it's just it's the customer comes first or it doesn't you're either patient centered or you're not but I’m gonna get some details for my walnut brain um what exactly are you teaching like um do you is it just posterior composites is there do you teach amalgam or glasionomer direct indirect what are you actually teaching them to do all of those materials so we only uh focus on amalgam for a week that's usually in the beginning i happen to like amalgam but i get that a lot of people aren't using it anymore i didn't really use it in Ohio um but i like it because it's antimicrobial i think it's a good restoration for certain cases so we do teach that i also think that it helps learn to carve and get anatomy we also teach the majority is composite and then there's also a weak on glass ionomers more so with the ietrs um so the intermediate therapeutic restorations that we talk about that it's a hybrid course so it's online and Saturdays is mostly clinical or pre-clinical so we work in a simulation lab they fill during those 12 weeks i would say they probably place anywhere from 60 to 80 um direct restorations in the sim lab and then they once they pass their written exam through danby they are required by Arizona dental board to also fill out another form their dentist has to fill out the form that they place 20 direct restorations on live patients in their offices and five reform crowns and that signed off and once that signed off and you said that and then you actually get your afta certificate our course we pride ourselves on the fact that we have an extremely low um ratio when it comes to the amount of staff that we have we try to keep it a one to three ratio which i know is um well above what coda is for credentialing so dental schools as you know and dental hygiene schools and and some dental assisting are coda accredited um through the ada so i think their labs or their stem labs are maybe like a one to nine one to eight somewhere around there and we try to keep a one to three the goal is to give them a great foundation and i think our students leave with a great foundation they still need to have that mentor they still need to have someone who supports them and can help guide them maybe a little bit and learn a little bit more about materials and things like that but it's about a partnership um between the dentist and the dentist needs to um feel safe with that after um and they need to feel that that after can give the same quality of care with their restorations as the dentist would do remember that the dentist is the one deciding what materials to use the afterthought doesn't come in and go oh this is what I’m going to do i decide what I’m going to do that is has no control that's not what happens the dentist is in full control of what is being placed in that patient's mouth there is one thing um that you that i really wish you would add to your program and um since uh you're a uh wife mother to four boys grandma and I’m a husband daddy to four boys and grandpa um since we're both equally um probably is equally insane um when we go back to that amalgam um you know let's be honest um um fillings fail for microbiological purposes they get eaten by um single cell you know microbiology eukaryotes prokaryotes i was blew my mind last year when they realized that the yeast were involved with this the yeast set up like a Canadian barrier and they're hiding behind that barrier i always thought it was plaque and tartar and that's all true but the fungi these you know these uh um you know i always liked mushroom on my supreme pizza and now I’m almost this close to not ever ordering mushrooms on my cheese sweets anymore uh those dirty bastard mushrooms and there's just not much room for that get it yeah there's do you like amalgam then let me finish my rant so we're eight billion people and I’ve been to very poor countries in central and south America Africa Asia where they don't have high-speed suction they don't have rubber dams and and then they they're on YouTube hearing all these rich dentists from rich countries from new Zealand to Scandinavia saying how bad amalgam is like shut up dude you you have a you have a car and um you know amalgam is um antibacterial it's half mercury the other half silver's in copper so it's all that stuff but there is the the concern about mercury so now we got to be non-emotional and say what does that really mean and when it's in an amalgam it forms an insoluble salt you can't get that mercury away it's when it's bind to copper zinc silver tan i mean come on and look at all those ingredients hygienist stannis fluoride pediatric dentist um silver diamine fluoride i mean it's but but where is the problem with the amalgam which you could solve here in Arizona and that is it's the cremation it's responsible for six percent of the atmospheric mercury because when someone dies in Arizona they cremate them and someone has to go in there with the pair of forceps on your dead grandpa and pull out those amalgams they can't be incinerated and i don't know um they're already starting to do that now and so in the countries where they've banned amalgam um they they're well aware that they still have a century-long program problem of cremating them and drilling out the ones that exist right well why can't the expanded function dental assistant um go down to the morgue with a pair of 150s and 151s and even if she breaks off the the two she doesn't need to get the root out we need to get the amalgam out and you really don't want to section it because drilling and all that stuff but i if it's six percent of atmospheric mercury it could be stopped like that if no one can cremate a human with amalgams in their mouth and the um the the crematory guy probably doesn't know the difference in a partial on the flipper and all this stuff like that but an expanded function dental assistant could go in there without x-rays look in the mouth and say i need to pull these a teeth and that that needs to start like 10 years ago i mean they really issued for 20 years yeah so you you just don't an amalgam is a horrible idea if you're gonna heat it up uh to uh to the whole body turn test but i wish um we would add that do you think there's any uh chance of that or um how how does something like that even start does that start i don't know if you might have to add it with with the the scope of care for either fda's or dental therapist you know or even the ap maybe some of the ap hygienists are also asked us um because we do have a couple um of those out there i think again it goes back to do we really does the dentist really want to go do that skill if they don't want to do that skill he or she doesn't want to do it why is that not an option for us for those of us that want to um take on more responsibility it's just getting everybody on board and not um uh i don't know conspiracy theories and things like that of what they think that afters can do again i think that there are doctors out there who have had assistance with them for a very long time and trust them 100 why aren't you sending your your staff member why aren't you helping them elevate their career why aren't you um expanding their knowledge you know and working together with that isn't that what we do don't we want it for 3 000 bucks think of all the stupid things you've spent three thousand dollars on your life i bet you personally there's a purse involved a month ago yeah yeah yeah i mean i mean when people i i love it the devil is a 250 but i don't have insurance I’m like how much are those shoes just just tell me how much those shoes are cost you know how many times they cover their face and go yeah these shoes were more than 250. yeah um and uh so they needed to do it i mean we want it there is an excellent return on investment they need to start thinking about again the autonomy of their patients access to care same day treatment you don't have to do same day if you have a fda but i do it makes it an option for you to do it if you have a full schedule um of whatever it is whatever your full day is and you're going in there doing a hygiene exam it takes two seconds to say yes let's let's put them in another room and let's go ahead and do a couple class ones on that patient um the patient's happier again how many if they actually did their their studies and looked at how many patients were scheduled for treatment and then cancelled um instead of actually doing the carrier when they had a commitment that day um i think they might be surprised I’d be very surprised so here's how i did it for the first two decades um and this probably isn't politically correct or fair or whatever but if if you're married with children and you and you got it and and they're they they think mom's leaving a five that's solid if you're single and you don't or you don't have any kids and you got a dog um you know it is is it gonna like poop in the house or something happen so what I’d always do is I’d say the married with kids um had to be willing to lose their lunch and then the uh no kids or no one waiting on my home had to be willing to stay late and then here's the other thing i did i mean like so we'd be closing at um like six o'clock or seven o'clock and say six o'clock some guy comes in he's got a toothache and i have the skill i can do um i always do the final restoration first to make sure it's restorable that makes the endo so much easier so i would um you know prepare the two for the crown and get the cord back and all that then i do the root canal and then uh do the build up and by the way endodontist should not give general dennis the option uh well did you want to do the build up dude it's leaking saliva um the smallest thing your eye sees is 50 microns or saliva carrying five micron bugs in there and while you're doing this because he wants to build the insurance code does anybody care about the patient the build-up needs to be done right then and then and do i want to make a temporary or do i want to scan it and make the final restoration and so that six o'clock patient i mean that you're talking about a two two and a half three hour deal so six so seven eight so now she's leaving at nine but i was able to bill out another twenty five hundred dollars so what i do and I’ll show you right here um let me find my uh wallet i mean it comes from retail you sit there and you go back to your wallet it's not cash it's not overtime and you sit there and say you know what i just made 2500 bucks and you go hang your dental assistant three Benjamin’s and say i mean she's already on the clock she's already getting paid but it's the same thing at a restaurant when you have a great waiter and he had six great tables and he's like man tonight I’m going to walk home with a thousand dollars well no he's not he's going to sit there and say it was that bartender and it was that bus boy and he's going to go tip out the staff and you create a culture and it's not that you're doing it for money it's an emergency room i don't want to show up at the emergency room say well unfortunately you are in a car wreck right before lunchtime and we're all going to lunch right now or the firemen of the policemen so you know um just it doesn't make sense i mean again you want to be able to give the best care to your patients and i think that if you have an expanded functions on staff it does that it gives you that option and that more flexibility i guess in your schedule and that lessens your stress level right i mean as dentists and what are they what are they being employed for in the real world i mean i know you teach them all these things with directs and directs all these different things but you've had you've had two class graduates now right two classes just six we've had six classes you've had six classes so how many percent we we have over 100 graduates okay so those hundred graduates what is their 80 20 rule what are they doing 80 percent of the time i uh 80 um posterior direct composites yeah so they're doing direct composites um i would say it's more of like a 60 40. so they're probably doing direct composites probably 60 of the time the other 40 percent of the time they're working as a regular dental assistant in the practice oh okay okay you know yeah so we don't use uh assistance for us as fds of course um everybody you know wants to complain about the rubber dam but we happen to like it we can't work alone without it honestly because we have to isolate we don't have somebody there so we get very good at it usually gets put on in about 15 seconds and i know for me and i know from most of my students what we do is we're actually in the op while that doctor's prepping so that patient all i do is move from the dental assistant um position over to the operator position when the dentist leaves the room so I’m usually there with the patient while we're prepping it's um you might be in a public health or you might be in a pedo a little bit higher you know um a little bit higher amount of patients you might go from room to room as a nafta but like in a general practice we're pretty much the assistant we're prepping and then the doctor just gets up and leaves and i go to the operator position and i start placing my restorations okay first of all i just want to say that i have always worked under a rubber dam because i the first time i bought one i tacked it on the ceiling right above my head and I’ve been under it for 30 years you hate it huh but um no no i i love the rubber band but i know how my homies think um i mean it um they're gonna be wondering what about isolite rubber dam versus isolate what what's your thought on that um well my personal opinion i think isolite is actually great um but there is still some moisture that gets in with isolite so rubber dam is considered a standard of care but if you don't want to use a rubber dam or you don't think your patients will like it very much i think isolite is great i think those are probably the only two things i would use as an expanded function everything else you just can't isolate correctly it will fail we already know read the studies we already know that if moisture comes in contact with any type of composite material or bonding um bonded restorations they are 100 percent going to fail and so and most of most of asian and african south America there's no dental assistant and they're spitting in a in a pickle bucket and in between these bonding steps the patient's sitting up taking a dixie cup of water swishing and spitting out and then and then they go put the second layer of composite on i mean i mean so so yeah remember it's kind of like um it's kind of like one thing i always remind myself and i said it before on the show um you know the the two biggest characters on sesame street the whole time was big bird and oscar the grouch and one guy did both of those and then he lost out to elmo which kind of worked out perfectly because he was getting up and is 70 years old but it literally scared me when i thought why us to the grouch i mean he's this grouchy man in trashcan and the kids love him because they it reminds him of their grandpa it's an old guy yelling at the tv and and i always remind my boys uh that you know when we're um crazy talking about you know politics or economics or whatever the hell um you know when you got a a one-year-old gunner and a two-year-old mason looking up at you concerned um i always tell him I’m not gonna be I’m not gonna be oscar the grouch um so uh you know you don't wanna be talking from your grandkids and be scaring them out of scratch and dentists are always talking on social media and facebook as if Asia where four out of seven dentists live uh didn't exist and when you're sitting there just bad-mouthing amalgam four out of seven people listening to this are in Asia and this makes no sense so then they start believing you because you landed on the moon and you have a lot of wall street money and all this kind of stuff and it ends up that somebody's getting a bonding agent who's swished five times who could have had an amalgam done once in the last 30 40 years but through your um inconsiderate YouTube views the same thing with the grandchildren i mean you know there's things that you don't talk about and don't talk about dentistry on social media if you're not talking to 8 billion human beings from the same species not that the kings and queens and the people the richest 20 countries we shall have our bomb bombs dipped in chocolate when the other people are like it's kind of like Marie Antoinette whenever he's like well let them eat cake i mean she's so disconnected from reality that her head got disconnected so um so so i get started i think the biggest thing is like materials are the biggest thing i think i i have found with most of the assistants not so much the hygienist but the assistants have sort of been um not given maybe the encouragement to critically think or encourage them to have their own opinion of certain things and [Music] we ask them to bring in for example we ask them to bring in the instructions from their bonding that they're using at their office just because we want them to learn about it is it you know what do they think an all-in-one really is do they really think that that you know um is your doctor really scrubbing for the 20 seconds and should you be scrubbing for that 20 seconds if that's what the manufacturer's instructions are we encourage them to make sure they're testing their lights they don't under they have never heard of that besides the bulb just completely going out that they wear down and they're going to have a harder time with curing which then um creates sensitivity for the patient so all of these things that they've never had to think about when it comes to the chairside milling that's something usually they learn um from the cerec reps um it's not something that we focus on here um i know with the scanning they're talking about that um I’m sure i know it's listed in other general boards and other states it's not listed yeton our laws um do i think that fda's and assistance trained properly can do a scan yes our particular laws in Arizona state that no final impressions can be done so then you have this thing if uh does the doctor think that that's a final impression you know a lot of them are doing it um i know the board wants it and i know that they're going to vote on it but then covet happen so hopefully it will get put back on and actually have it added to our laws um and that um my gosh i would never wish any ill will on one of my homie dentists but i mean my god um i hope someday they're getting a bypass and the doctor says well we could put in this suture but it might take like a minute but we got this new all-in-one suture it only it only lasts half as long i mean i mean come on really i mean you're a doctor and it just scares me because when they're saying well i want the bonding agent all in one well is that how you want your prostate treated to well we have this one this one treatment for your prostate cancer but it's two steps and we've got uh another treatment where it's one seven it's like um um yeah and and the other reason um hygienists do higher quality is because they know what they're gonna do and they schedule the time that they need to do dentists we're always running behind we're always doing problems and when you got a dentist and he's got to go knock out this mod composite and he's only going to get 17 minutes to do it he's going to do a 17-minute posterior mod composite because the schedule's falling apart where if you put that with with your new efta i mean um and you know i i had this uh i just lost one of my great assistants after 20 years um her husband got transferred to houston and i i told her I’d pay for the divorce I’d put her up in an apartment across the street from the dental office and she's not having it she's uh gonna go with her husband and um and it's tough because um um you know these 20 years i mean they're just so good with the patients you trust them but when you get a a world where it can be scheduled you have time for quality and you can't do a quality posterior restoration when you're running 30 minutes late and um you know so 30 minutes late and also what you're getting reimbursed from the insurance company i mean think about that i mean it's very um it's really not a good return on investment you know um for that because you're not getting paid very much and we're much less per hour expanded functions than what the doctor's salary is going to be we have a smaller scope of practice you're right we usually do it better um i was talking to one of the doctors who flew in from Ohio that i know uh just this past friday and he said that you know I’ve placed maybe a handful of direct restorations uh since graduating from dental school and he goes and why would i they do it better they do it faster and it and the patients are happier having that have to do that particular procedure they just like it they like having the assistant and again let's go to the quality so you do a hygiene exam and the person needs a filling and you and they're in your office and you're the same dentist has to be well how do you get rid of uh cancellations and no shows dude she's standing in your office and when you say would you like to do that now because and here here's right just same point blank i just say um they say well i don't have time now and i say well look the number one predictor of future behavior is past behavior so um you have not been in here for four years you have a filling it's 250. you won't be back in the next four years and when you do it'll be a toothache that cavity will go into the nerve and it'll go from a 250 dollar filling to a 2500 root canal belt crown you just told me you don't have 250 and you don't have insurance well you're not going to have 2500 and you still won't have insurance but you're going to be in so much pain you're going to find that 250 and you're going to give it to me and I’m going to pull it and I’m going to keep the tooth so either way I’m going to get 250. so give it to me now you keep the tooth walk out that door you're still going to give it to me but I’m going to keep the tooth i don't care either way it's your life it's your journey what do you want to do but my homies are like well i i don't have an extra room i don't have a an operatory i don't have a fda it's like what do you mean your number one cost is you charge a thousand dollars for a crown you signed up with insurance company they're going to give you a 650. so 35 of your cost is insurance adjusted production right next is going to be labor 25 next is going to be lab 10 supply 6 facility 5 operatory room doesn't even show up so you're telling me that the doctor which is 35 percent of cost if you look at the fact that um the ada says the average overhead is 65 percent um 65 but that's not really true because the doctor value of being a doctor is 25 and 10 of that is from having capital employed in a dental office as opposed to buying stock in a or a bond or gold or or what have you so you got um so so chairs don't add up and you say well i don't have room for a chair your private office is a room you're i mean and if you get to the point where you can't squeeze in a operatory then you just need to go to japan because japan you know where tokyo the land in tokyo i know people complain about uh scottsdale but land in tokyo is a million dollars a square meter and I’ve been into dental offices that have like um seven doctors and they use three operatories but there there's 168 hours in a week the average dentist is open on monday through friday to five that's 32 hours divided by 168 it's 19 percent of the week um their their entire office is closed 80 that we care not in japan so what they'll do is they'll say we only got three options but I’m starting at six to noon these three doctors will work three ops and then from noon to six pm these three die and you know um oh audio but the bottom line this is america where you got all this land and you put in an extra opportunity and by the way um i i think benco i i wish chuck and rick would do a new program that says if we can't fit an extra operatory in your room uh we'll it's for free kind of like dominoes will deliver in 30 minutes or it's free right because you can squeeze another operatory i mean I’ve seen so many um six operatory dental offices that are range in size from a thousand to five thousand square feet i mean there's just no efficiency but the deal is this here's a deal it's are you a good doctor or not and if you say i can't do it now you got to reschedule and the data already shows that half of them are never going to be back that's right and then so so so you know if you just remove the decay and filled it with butter that would be a scale infinitely better than the doctor who just let him go out to work with an active infection and and same day dentistry is not about oh yeah you're going to make a hell of a lot more money you're going to make a whole lot more product and you're going to get rich the bottom line is is you're a doctor are you a good doctor or are you a bad doctor and if you diagnose a hundred fillings and at the end of the day only half of them get done and the guy across the street diagnoses 100 and gets them all done he's twice as good as a doctor than you i don't care if you filled yours with i have eight restorations they're all gold cemented with zinc ox zinc phosphate cement but I’ve got alexis I’m a rich dentist uh but a composite amalgam i don't care i want the infection out and when you have a culture where we're going to reschedule that patient with a 50 chance they won't come back because our staff is entitled to lunch at subway every day i mean dentists are the most entitled people in the world i only work monday through thursday eight to five i get a guaranteed lunch at noon and at five o'clock we we turn the phones off well you're not a real doctor I’ve seen people on sunday you raised four boys how many times on a sunday did one of your boys get hurt and you had to lug him to the hospital and it was open yeah lots yeah those are real doctors those are real doctors and when someone says to you yeah i got a cavity yeah that'd be great to do it now oh i don't have an extra operatory and you know why and it's the hidden number in specialists everybody always wants to know why specialists make so much more numbers and they they go to things like um the insurance the fee you know blah blah blah but what they don't talk about is the fact that your average endodontist and oral surgeon has two emergency rooms each these are rooms that no one's scheduled in and doctor says room four's in our emergency room well you have a patient's schedule they're at nine and two and three so where's the emergency room an emergency and why because they're the 80 20 rule about 10 doctors give them 80 of their revenue and then about 25 doctors give them 20 and when you're one of those 80 20 and you're one of those guys who does not do endo and sends them all to you at a thousand bucks a piece and you say oh howie is there any way please can you get Carrie ganten today she's a toothache and you say no i can't today he's afraid you're gonna call the other endodontist and then he just lost her so they they and you gotta have the whole staff on board though too again it's the whole team it's not just the after trying to work again by themselves over in that room come on everybody let's everybody work together it's for the benefit of the patient it's for the benefit of the practice it's a benefit of you having a job in the future i mean you don't want the practice to go under either let's everybody work together let's get these patients in get them seen and get the treatment they need yeah and i mean and and again it's just like um what is the quality of dentistry that's never done and you're never going to get uh the mafia which is the us government uh basically all governments from the history of time they only care about two things shaking you down for money and uh it's money's the answer what's the question if you don't give them the money they'll arrest you they'll kidnap you they'll put you in a cage and all this stuff like that and the bottom line is this person has a cavity and you know humans um humans are wild animals and they don't like to be told that my mother gets so mad when i refer to humans as an animal i don't know what she wants me to call them uh but um my gosh um you know when they're here they'll get it done and when they leave they might not come back and if you can get a poor filling done now with just an amalgam I’ve only got time to throw an ammo d amalgam versa but i don't have time to do an indirect gold inlay cemented with zinc phosphate cement well i don't care she has a billion streptococcus mutans eating the tooth and she's kissing her husband and she's kissing her kids and she's spreading this around the family by the way when it when a child comes in and they need a pulpotomy and chrome still crown they live in a microbiological zoo and i can go out there and i have before and I’ve said to the city she goes well why does my child need you know four paul pottery and crimson crowns i said well i don't know you're the mom you're the dad guarantee you someone's kissing this kid with bombed out teeth i bet if i looked in your mouth dad's mouth or your mom or the baby sits whatever I’m gonna find huge open cavities and uh i can't believe they uh we went over we went an hour and a half you were so amazing um i just um my gosh i want to go back to just let real quick um it was a 1906 dr alfred c phones trained irene newman as his apprentice scaling and polishing teeth um and that would be the first dental hygienist uh from 1906. so shout out to dr alfred c phones uh for having the foresight to change dentistry and uh and to all the mental midgets uh fighting expanded duty dental function assistance uh love you but you're back crazy and then send your staff send your staff you know to any school it doesn't matter what state senator staff um it's going to be a benefit for you yeah uh how could it not be and imagine how much more exciting your career would be making something with your hands uh you know i mean dentists are all surgeons you realize that over one there's one million mds 90 percent of them don't do surgeries there's one million attorneys 97 percent never try a case in front of a judge and a jury like all the tv stuff only three percent do that but dennis are all surgeons you're all working with your hands in a operatory and watching isn't nearly going to be as much fun and rewarding as doing and i i applaud you uh for doing this uh Carrie gaunt cda see i mean there's the alf the whole alphabet soup is mine yeah and Carrie seriously uh good luck i will do anything um you can um to help get something started to where um um a nefta has to see the body before a crematory and this is scary stuff because like i can't believe on dental town you think they're all surgeons right so i posted this case of this uh guy getting shot at the dental office and i couldn't believe how many dentists were appalled that i posted this case like dude you're a surgeon you pull wisdom teeth you lay flaps you a gunshot wound i mean this is what police officers see every single day when they show up to work and all these freaking pansies on dental down oh my god you should have been safe for work should have put not safe for wussies i thought you were a doctor and i know that a lot of eftas aren't going to want to travel down to the morgue uh with a pair of uh 150s and i i i get that i get that but but you know some at the end of the day someone has to be a surgeon and we started off as barber surgeons and then it was 200 years ago in france uh where pierre fishard said let's kind of drop the barber stuff and let's do searches and then I’ll end on this one note this will blow your mind how old um you know you uh how old this stuff it but the oldest dentist that ever went to my seminar was on George rui out of st joe missouri 91 years old i went to his practice i watched him i mean just unbelievable and um we started talking he graduated two years before the great depression right and um there's a lot of corollaries to the economy right now kind of the depression like um the last time the u.s savings the u.s savings rate is always negative so if you earn a dollar with the use of credit cards and borrowed money you're probably gonna spend a dollar five uh you know you make you spend more than you earn and um and the savings right now has shot up to 15 and uh but anyway i said uh what was that like and he said it was the best thing to ever have to demonstrate and I’m like what how and he said all this dennis in 27 we practice outside and then during the depression everything was boarded up everything went bankrupt and the rates went so low that we were able to move our dental barber surgery chair inside and when we moved it inside that's when we all realized we've all been wanting to give up the barber the shining the boots and all that stuff but we all decided we went inside that that was it we would no longer shave and do beards and shine shoes and and that was only 1929. um and he said it took about 1932 1933 before every dentist was inside and uh my gosh we've come a long way baby remember that cigarette commercial yeah we've come a long way so uh thank you so much i know you're busier than a one-handed dentist so thank you so much for coming on the show today and i um thank you so much i appreciate it thanks so much for the time all right have a rocking hot day thanks
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