Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1507 Dr. Abhishek Nagaraj & Dr. Anushka Gaglani on Multi-Practice Ownership & Expansion : Dentistry Uncensored with Howard Farran

1507 Dr. Abhishek Nagaraj & Dr. Anushka Gaglani on Multi-Practice Ownership & Expansion : Dentistry Uncensored with Howard Farran

11/24/2020 4:00:00 AM   |   Comments: 0   |   Views: 448
Abhishek graduated with a DDS degree from NYU college of dentistry as an international dentist. His passion lies in buying practices and scaling them up to 1 to 1.5 million dollars by using tools of patient education, empowering team members and by putting the patient first. His core focus is to enhance dental experiences by providing same day comprehensive dental care to patients and education. In his spare time, he loves watching thrillers, playing with his dog Pumpkin and connecting with people of different business backgrounds.  Anushka graduated from the University of Illinois at Chicago College of Dentistry in 2011. She is passionate about combining the business of dentistry with quality dentistry and believes both can be achieved. Her goal is to provide stellar dental experiences through same day comprehensive care. In her free time, Anushka loves to read and spend time with her dog, Pumpkin.

VIDEO - DUwHF #1507 - Abishek Nagaraj

AUDIO - DUwHF #1507 - Abishek Nagaraj

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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 Dr Abhishek Nagaraj who i will call Dr Raj and his lovely wife Dr Anushka Gaglani they are founders of True Blue Dentistry smiles and blue island smiles in Burbank and Chicago Illinois with state-of-the-art dental offices serving a wide demographic and providing comprehensive dental care for all ages they focus on painless dentistry with a completely digital practice renowned for superior care expertise and outcomes dr raj graduated with a DDS from nyu college which is where uh my gosh what is it seven percent of all u.s dentists graduated from there uh with a DDS degree um as an international dentist in 2014 his passion lies in buying practices and scaling them up to one to 1.5 million dollars by using tools of patient education empowering team members and by putting the patient first his core focus is to enhance dental experiences by providing same-day comprehensive dental care to patients and education in his spare time he loves watching thrillers playing with his dog pumpkin and connecting with people of different business backgrounds he is a member of the ada the agd the Illinois state the Chicago society dr g graduated from the university of Illinois at Chicago college of dentistry she is passionate about combining the business of dentistry with quality dentistry and believes both can be achieved her goal is to provide stellar dental experiences through same-day comprehensive care and she too likes your dog pumpkin did you go did you bring him to the show i mean is he is he gonna come up and uh uh come on the show i got four dogs and you can have all five of them oh my god every morning i wake up i'm like what what what the hell do they do now um thank you so much for um coming on the show because um it's in it seems like the business model of uh healthcare is really rapidly changing i mean um i cut my teeth in fast food which didn't start until the interstates were developed after uh Dwight Eisenhower built all these interstates for the first time in America people start going further than 50 miles away from home i read a stat that before the interstate 90 of Americans were born lived died without ever going 100 miles from home and then they built these interstates and when they got to the next city they wanted to see something familiar there was the franchise but it's been pretty steady i mean it really has been steady um you know McDonald’s was number one burger king number two Wendy’s number three um the founder of Wendy’s died and his daughter um finally made all these uh about a hundred little changes that her stubborn dad would never do and actually finally um um passed burger king for the first time and they didn't even she didn't even hold that spot for an hour and then chick-fil-a comes out of nowhere and beats everyone and they're not even open on Sunday and i really really believe that with all the uh talk about dsos and everything it's probably gonna be another 20 30 years before the business model kind of stabilizes and you guys are really really different you're thinking outside the box uh who's the brains behind the operation which one of you is it him or her so we actually follow the eof model um and he is the integrator so he handles a lot of business and i'm the visionary those are the roles they've been assigned so um so you say that you're uh so dr g is the visionary and you say raj is more the ceo of the operations i think right now we're probably both we're both about the eo level uh you're both level we've just differentiated our goals um entrepreneur operating system lets us do that where we can put our structure before our vision we have a 10-year target and we we're building our accountability chart uh where i sit in the integrators role where i integrate our meetings uh to where I’m the glue and i kind of you know oversee uh all the practices she's the visionary where she comes up with the creative ideas she's working on our culture and um and really kind of seeing where the company you know what other things the company could be doing along the way first i want to get where does this come from i mean most dentists i mean they're like a chef they want to go in the kitchen and make lasagna and they want a new recipe and they just love working with their hands i mean for me the dream is a patient comes in and they're in so much pain they can sleep and they're holding their face i love it uh when you say comprehensive same-day dentistry because so many dentists they they're they don't work they don't hustle i mean they're like oh i can't do that today because they're taking because lunch is coming in 30 minutes and they're going to subway some guy couldn't go to sleep last night and you're putting them off for a subway sandwich i mean my god could you imagine me that pace sorry the doctor cares more about a foot long sandwich than you um they just don't hustle i mean um um but so I’m wondering where does this come from from you guys i mean why most dentists do that then here you are and and you know you've already got three offices and you have all this um intense vision what's driving this were your parents entrepreneurs or is it or is it going to come back to the dog pumpkin she has a lot to do with that we have to give her a good one no so we have the the five practices um well and we have a six the six that's coming uh kind of coming along right now um one of the things that i guess that drives us is my my parents are not entrepreneurs and neither is it um actually one of my partners are actually entrepreneurs in the medical field my mother is a physical therapist and she has her own practice to a smaller level still she's just been a great role model i think to me i got exposed to dentists here in the us when i was uh 2010 when i was still trying to get into a program in the states i kind of went and shadowed a doctor who was entrepreneurial and he was actually the first guy who hired my uh how he hired me for my first job when i graduated in 2014. i think he played a big role in shaping how i think about group group dentistry and group practice dr mirza one of my first mentors and then of course i've had other associate docs who work for him who've gone on to do the multi-practice model i what really drives us is the fact that we us being dentists are really you know driving that bus and um that's that's kind of how we we'd like to keep it so um are you when you um talk about multi-practice so do you have a cookie cutter um approach i mean like is it like a 12 operatory that are they all the same or are you doing mergers and acquisitions where you just buy different practices and and so to talk about your talk about your business model um sure i uh so typically one of the things that we do is we usually buy practices that are doing anywhere from 100 to 300k in revenues and ramped them up to about a million million two in year one and million and a half and maybe year two or year three so typically we're looking at um you know practices that are kind of uh dated and where the dentist is kind of on their way out and really they have no motivation to do any more dentistry that's kind of the offices that we've we've uh bought and acquired so you can call them acquisitions but they're really small acquisitions essentially like startups and we really have to kind of put in all the groundwork to update the office put in bring in all new equipment and all this stuff and then ramp them up that way so there it's a combination it's a hybrid model is what i would like i'd like to put it so so let me get this right I’m a slow uh note tape uh typer um so you buy practices between 100 000 to 150 000 to 300 000 a year in revenue that is correct yep and ramp them up to one point ramp them up to what to about a million million two um in in year one or one and a half so um i didn't even know there were practices doing 150 000 year i mean um what what is um what what is a practice that's doing 150 000 i mean is it just someone who works one day a week or two days a week or are 80 years old or what what what's going on it's it's much older a retiring dentist uh for example one of the practices he was doing probably eight days a month oh okay they're not working every day uh for some of them yeah i can uh i can um okay that makes more sense and when you buy a practice um for 150 to 300 000 do you are you is there a minimum size well first of all do you want the real estate too are you looking for land and building or do you just want retail uh rental typically yes real estate typically we want to uh i think we like to be landlords it's just not wanting to pay rent um or deal with or deal or deal with landlords some crazy stories say what yes what'd you say i said ordeal with uh landlords we've heard some some crazy stories uh yeah i mean it um well you know so many different people have so many different opinions that are legend like a good friend of mine growing up in wichita dan carney um was the founder of pizza hut he hated real estate he he just wanted to rent but he said he had to buy real estate and then there was sam walton just uh six hours down the street in bentonville and um him and helen were renting to save uh cash but then one of his landlords uh screwed him out of a deal because they he didn't tell him he wasn't gonna renew his lease to like the last minute and then that guy opened up his version of walmart across the street and sam was so pissed he uh he owned all of his land ever since uh but um so you like to buy uh dental practices land and building and uh and that's McDonald’s i mean McDonald’s is a real estate company i mean if you really look at their balance sheet every month 38 000 McDonald’s pay rent to McDonald’s and I’m not going to say they don't care about the hamburgers and fries but that is not their top priority i mean their top priorities are real estate business that's what rick uh kerster does rick workman and effingham is the billionaire with uh heartland but the other one is rick kershner with comfort dental and uh he owns i think 300 offices but he owns landon building then he sells it to the dentist and then he leases it back so every month he has 300 dentists paying him a rent check off of 300 paid off properties because just like McDonald’s he buys the land and building fixed up the dental office sells that as a um to dennis as a comfort dental but he retains the property and he's got uh i mean when he he's one of my friends where he once have lunch he sends his jet to pick me up and uh and I’m not that impressed because he flies his dog around too so I’m just uh I’m just another dog uh but so so when you buy the land and so you always want to land in buildings so you have uh three open uh uh we have five open and a sixth one about to go open correct yeah that is correct and you own the landing building on all so on four of them um you know it's not always possible to to buy the building or land sometimes it's more about the location but four of them we do and um so so i always say to the kids in dental school is that the primary thing is the um um the dentistry if you're a dentist but a real estate model is very very nice so dr raj and dr g by prax is doing 150 000 if they get to land and they prefer the land and building is there a particular size uh some some dsos want a certain number of operatories what what's your uh what do you have any requirements yeah i think i think we're not a cookie cutter model i think whatever fits into that demographics and whatever we think that practice is worth uh so typically we will we we obviously want at least six to be able to have six to eight ops in that um and we've heard of stories where they have 12 15 20 ops but i don't think that's our model um i think we are okay with six to eight ops with having one to two quality dentists in there uh with with one to two quality hygienists um i think that's our model and that um where quality can can actually be controlled as opposed to we're not just a mill and churning out a ton of dentistry where we can't oversee any of that and again this is what i call a uh rich world american problem because uh when you go to tokyo where land is a million dollars a square meter you will find a three operatory dental practice that um is owned by seven dentists and they'll work you know six to noon noon to six six i mean they just they all get their hours in but it's spread out over 168 hours singapore is almost as insane as tokyo and then you go to america and they tell you well i don't have space for another operator and it's like doc's private office is like half the size of a japanese office and it's like really well if you were japanese I’m really sure you could figure this out uh but being an american uh maybe that's why they invented the sony walkman i mean i can still remember buying my first sony walkman it was uh how they got that all that stuff into something so small but i do notice it's an american thing and a canadian thing where it looks like when you walk into a dental office the first goal was how do we waste the most number of space and then and then even in my in my little neck of the woods of phoenix and all watuki if you just say to me show me a four operatory practice i can show you that for operatory practice and anything from 800 square feet 2 000 square feet 2 800 square feet and then once like 3 000 square feet it's like 3 000 why didn't you just rent the new york empire state building i mean you know because just put one chair every 100 floors or something i mean it's crazy so so but you do like six you you like to get in uh six off stories yeah i think at the minimum moving forward i think we're looking at six to eight operatories and what is your model with the dentist is it a partnership is an employee for life what what is the what is the um what is the the business model there so right now uh you know until now we've had employees but we are looking at a partnership model moving forward uh we kind of want our dentist to have some skin in the game and and feel like they're part of something important yeah and it's a balance i mean if they um i i i look at the turnover in dso so um i figure everybody working the dsos i mean there's so many really really smart people in there so i said um they can't figure it out i went to other industries and i noticed when i talked to um big you know people that employ people with doctors you know eight years of college that's a different mindset than uh running a company with a bunch of people that didn't finish high school or uh in the army or something like that but i talked to law firms and um boston um boston consulting and price waterhouse and that that that's what they said to they say you know they they um they tell them you know if you if you come in here and you hustle you do same day dentistry you work through your lunch you get some clients you get the word of mouth um maybe in four or five years you'll get partnership but if they didn't have that light at the end of the tunnel they think that the aces would uh be off uh and somewhere else and um and then you get stuck with all the people that aren't even trying to make partnership they're not hustling they're not working through life so then you kind of get bogged down with a bunch of entitled people obviously um when you're gonna be a partner and get married i mean that that that's a serious job interview you know what i mean i mean we they take that so serious but it seems like dentists buy into groups and they don't they don't take um becoming a partner with frank over here one-tenth as serious as they did when they got married and uh dennis my gosh again dennis lawyers physicians they're so over educated they read so much every one of them is so brilliant that um it's hard for them to get along they don't play nicely together because they're just not gonna shut up and take it they're like well in fact i read a book on that and you're wrong in fact i went there on an airplane i went you know they're just how do you um how do you try to get dentists to play nicely in the sandbox well first of all have you been listening to us uh no it's uh we we uh i think we have different strengths i think that's a big positive um with us and we both kind of like different things so we play off each other's strengths is the main thing as far as other dentists other dentists i think so a part of eos I’m going to go back to that when we came up with eos we we run on a you know a set of core values we have five core values that we hire and fire people on those core values one of our core values is humility it's super important for a dentist to be humble and if they're not we just want to hire them and i think so far our doctors in the group are amazing and they're very humble and they they have a growth mindset which is also another core value for us uh and and pursuit of excellence um so now when you say core values is that would that be the the true blue dentistry core values or stegger smiles or what is the parent what is it uh the parent company or it's called area dental so how do you spell that a-r-e-o a-r-e-o one word or two just two words so so ariel dental is the parent company and then it has the brands of true blue dentistry stagger smiles all that okay so aerial dental um core valve five core values are um humility i agree did you say it was a-r-e-o or a-e-r-o a-r-e-o a-r-e-o mm-hmm okay area ariel okay so humility great one i agree with that a million percent i mean you saw that you you see that right now before the pandemic i i never knew there were so many phd epidemiologists and virologists living around here i mean i mean god you just go home and it's like you're listening to this person you're like i had no idea you know more than the 12 epidemiologists that i issue unbelievable and they don't even blink they they're they believe their own more than anyone so humility what was the uh what's the worst uh team oriented and growth mindset yeah pursuit of excellence and the last one was committed yep committed commitment commitment which which includes being professional to reliable to consistent we combined all those words into commitment nice nice nice nice so so you go get this office if it's only doing 150 to three hundred thousand because doc's old and decrepit and um you know he's in as bad as shape as i am um then how do you how do you ramp that up to a mill or a million and a half i mean the average dental office doing 7.50 so you you pass them or double them in in a year so what are you doing uh to do that i i think um well i think we get the right team in place i think the right dentist will play up plays a huge role in that when we hire based on these core values we know that this dentist can ramp it up to about a million dollars right off the bat and hiring team members on these core values um we can we can do that and of course choosing the right location i think going into it picking the right demographics choosing the right location how much visibility does it have and of course throw in some dollars at marketing and you know ramp it up with direct mail and um some paper uh paid clicks google ads and um that that combination really helps us ramp it up to a million bucks that is amazing um and you're in Chicago which um you know that that's how many dental schools are in the Chicago area so there's uic and then there's midwestern uic and midfield um yeah and um but it seems like a pretty saturated place for dentistry i mean i don't know if that maybe that's the ada building i mean it's really i kind of think of it as uh the the capital of dentistry in america i mean the capital of the country is washington d.c but the capital of dentistry i mean every major organization is right down there in Chicago i mean i don't care i don't care what the name of the society is they they're down there in Chicago um so um uic midwestern so when you buy these dentists um when you interview these dentists um what are you um what have you noticed anything between the ones that worked out and were successful and the ones that weren't i mean uh um and i'll give you example of things that um um might shock some people but like with student loans if you owe less than 25 000 in student loans you're like 10 times more likely to default than if you own oh 500 000 um because you know the the person 10 20 30 they really weren't into school and they were you know they were just killing time and going to parties on but the person is a half million dollars in debt they absolutely wanted to be something and they got it and uh and i kind of wonder with that dennis sometimes i mean um you know you're not supposed to talk about these things but that's what i call dentistry and senses like i've always noticed you hire a mormon kid out of school and he's he already had like two kids in school and he's gonna have like 20 or 30 more that guy will work he'll work 12 hours a day seven days a week and think he's part i'll say you're working a lot hours she's like no actually I’m only working a half time i just work 12 hours a day and i take off the other 12 just half a day every day seven days a week um i've noticed that some of the single kids with no student loans are infinitely more likely to be lazy than the kid with five hundred thousand dollars too long as he was married with a kid in the ground i even saw that with my four boys i mean three of my four boys now have uh dropped a frog and their work ethic just doubled when they had a baby at home i mean you got to be that bird and bring home the worm and drop it in the mouth and and uh three of my four boys i mean it was a measurable increase in productivity and work and all that stuff when they had a baby have you noticed any trends like that yeah i mean definitely you know uh our most successful dentists are the ones with the growth mindset um they kind of go in every day and you know it's funny earlier you mentioned the dentist who's like oh i need to have my foot long sub you know we we've we've gone through that um you know the one that wants to go out to party and and uh is patient comes second and that's just not the way that that we believe it should be done so um i i do agree with you i think that the dentists who come out you know they're hungry they want to learn they want to grow they want to see patients those are definitely the more successful ones and they like you said they have they have loans to pay off so they are very very motivated to get get things done so you would say that a uh debt is correlated with a growth mindset uh you know that they they owe a bunch of student loans or they're gonna work harder somewhat i think i think so at least i can i can experience share for for me and for her we came out with a bunch of debt and i think that was a motivating factor for me um but but after after a certain point it just becomes a means to an end um where you're able to pay your debt but live and do much uh much more with with all the money that you can make um if you have that mindset right mindset and if you're humble about uh what you want out of dentistry so what's the opposite of a growth mindset dentist what would you call that dentist what's the opposite of a growth mindset i don't want to say lazy yeah what would you say fixed my fixed mindset a fix of my uh okay fix this is what i was expecting this is what i thought um have you noticed anything um anything I’m trying to find things that help dentists during an interview and by the way every time i've ever seen a dentist interview someone i mean you can't make this stuff up i mean it's like the the appointment's an hour and the whole hour he's talking about himself he's selling his practice he's talking about everything and then it just said they're smiling and at the the end of the interview I’m like you didn't even ask them a question i don't even you know you're talking to a wall you're not trying to sell yourself you're at you're trying to hire someone for a job and I’m trying to help these guys what should they be looking for uh to help them figure out a growth mindset dentist because it just blows my mind how um when dentists tell me they're patient focused i mean it just boggles my mind that they they you know they believe it and and there's just like no evidence for it you know their hours are monday through thursday eight to five i mean uh you know um all that kind of stuff and the and the emergency rooms prove it eight and a half percent of emergency room visits are odontogenic in origin and then the dentists say you know they don't even treat us like a real doctor you're not a real doctor no one can find you third friday saturday Sunday you're unlisted your patients all end up in emergency rooms where real doctors take it from there um so I’m just trying to help him um find that growth mindset have you noticed any difference um in correlation between dentists born um not in the united states are they more or less likely to be growth or fixed minded i don't think necessarily no no i think we have uh we've dennis um who who grew up here and who have fixed like extreme growth mindsets uh american dentists who went to you know school here um they've great i mean the great personality is super humble and they they really know what they want you know in 10 years or five years and i think that's a part of the the whole interview process is really getting down to what they really want out of dentistry and life and if we can do that spend more time on the front end i i we truly believe that we'll spend less time with them on the back end trying to make them better because we don't believe that you can necessarily make people better or change them it's they're either wired to have a growth mindset or they're not correct yeah absolutely that's what you do when you're young you argue with people trying to change their mind and then by the time you're 60 you realize that person's been thinking like that since they were five years old and if they lived to be 500 there you still think that way in fact i really think i've called my six grandchildren i mean you know you grew up with your five sisters and i had my four kids and now my grandkids i mean the oldest one is uh now 13 and I’m pretty much calling them at five i mean at five years old you know who this little kid is you know i mean yeah and you don't you don't have to wait till they're 50 to find out i mean people right people are born and they um you know they they are what they are um so you have uh five offices with a six one coming and you own the land of billy in four and what is the average number of operatories uh average would be about five five and which with which the first thing i think of here's what i do when i take that in my mind i take um i'll take the 168 hours in a week and then i'll time to times five and now i know i have 840 hours of operatory available now if you're an american um you know you just say well we're only open 32 hours a week so you knock off 80 of that and and then you say oh well Chicago is crowded there's not room for another dentist of course you couldn't find a dentist open on Sunday you'd find a mermaid riding a unicorn three times uh before you found a dentist open on Sunday um so it's really operatory hours and then and then in your model um of that five or six ops um how many dentists would be in each of those locations how many would work there typically typically we're one dentist model so far but we are adding part-time dentists so we you could say one and a half uh dentists um on on six days on a six-day work week and let me tell you um you know i don't like to come off and say you know this is right and this wrong you know i i say everything has a trade-off so what i've seen is when um and lots of people that own hundreds of offices we've talked about this for a long time where when you have one office and it's four to six chairs whatever the whole staff only has one 400 pound girl to look at and the staff problems are just non-existent and if you do have any it's got to be the doctor or the house manager i mean it's you know it's the doctor is the leader of the culture and when you have two doctor offices now half the assistants are looking at this one that one and there's all this confusion and i mean every dso captain kingpin has told me that my gosh you want to um utilize your operatory hours more you'd like to for the patient if you're a patient focused like the only three publicly traded dental offices in the world two in australia one in singapore they're all open seven to seven seven days a week well in doing that you're gonna have to have a a bunch of doctors so then your your um your grade from the patient with convenience and availability goes real sky high but then your management problems go sky high too yeah and if you don't like to manage people and drama and all that crap then you just keep one doctor offices but once you try to increase that utilization and keep them open longer now you're gonna have management issues of uh and it'll be more and more important to hr to get people that can play nicely in the sandbox which one of the values is that you said a team oriented and that's the uh the team player uh that just yeah okay um so so you're one doctor now but you're thinking a one and a half doctor or what what are you yep so we're heading to the one and a half doctor model and um you know eventually the two doctor model i think her office with one to two hygienists and are you brandi i notice you're not um calling them all aspen i mean aspen everyone you drive by you see aspen and they're building this big national brand and again the trade-off was that was i couldn't believe it is back in 2012 when pbs did a documentary on aspen and all that stuff and i mean uh so that's the um the negative side of that is you're just one big target to be shot whereas heartland they wouldn't even know where heartland offices in fact today bizarre i've had two different linkedin messages and texts asking me if they can have a zip code breakdown of a certain uh dso of where their offices are and everything and i don't i don't play with them because um you know i don't know who they are or whatever but again it goes to show that they don't know where these offices are because they all have different names so where are you with that are you thinking you'd rather have one big brand dr rajee pumpkin dental iii or are you gonna go with true blue stegger blue island what is what is your strategic approach you you just gave me a great idea for a name pumpkin dental pumpkin dental yeah so you know the first three we did brand the same we branded them through blue dentistry but then we kind of decided we wanted to be within the community um right so we're probably we're kind of trending away from that now and we're gonna name it whatever the community is um with the smiles at the back yeah so typically we if we're in the town of blue island so we've just simplified it to blue island smiles we are just simplifying our life and our business model as we kind of go further um and ultimately there isn't that much to a name but as you rightly said howard is they can you know one negative experience in one dental office can then relate to another dental office with the same name i think that's much easier in today's world but especially with so much social media out there i think we we're gonna brand differently as we go along so we're more personalized to that town or that city that we go to well today was a day i learned there's a blue island Illinois i was not aware of that and that is that is one great thing with a brand so if everybody lives in blue island and it's blue island dental at least the name gives you the location uh so it comes to the brand why why is it named blue island it's inland it's real far and it's in Illinois i wonder great question but our logo has an island with a palm tree coming out of it so you know go figure ah that is uh that is wild and um what what about dentist um dentist experience i mean um the these kids that graduated in the in the 2020 pandemic i mean my heart goes out to him i've been doing everything i can to help them um interviewing uh the dsos that are like out here uh a big hiring was mb2 and a lot of the kids were saying well who owns that why don't you podcast him i did man i had it out in a couple of days you know um but um so but i i feel bad because the old dentists around here that are pushing 60 i mean we've we've tried these young kids out of school and uh my god you better have patience i mean they they need like four and a half hours for a occlusal composite and and then you know i mean um so do you what's the minimum requirement well you take a kid straight out of midwestern yeah as long as they fit into our core values i think that doesn't matter i think if somebody with the right growth mindset and you know team oriented and humility will adapt maybe we will not vamp up as fast as we like to with somebody with a little more experience but somebody with a little more experience who doesn't fit those core values will also not make us ramp up as quickly so yes we have no reservations and who we can have as long as they fit our core values wow and uh so you um you talk about that uh well if you take a kid and and you know when um when i dennis says you know why do you say you practice dentistry if you know if you've been practicing 20 30 40 years and i said I’m I’m practicing sleep i didn't even know what sleep apnea was and all that i mean we practice everything we do and uh and um so help most Americans sleep every single night and a lot of them need to practice sleep i mean it's just crazy i love it around holidays when you get to see um your other family but i mean how many of my family members go to bed they got a big screen tv in their room their phone's exploding and they got a 80 pound dog jumping up and down out of the bed and it's like and you're like you can't sleep like that you need a cold room we need to get rid of the tv the phone and the dog and they they wouldn't even consider it i mean it's like asking them to go live on the moon and and but you're sitting there realizing that the amygdala is going to be freaked out all night long and they're not going to get the profound sleep but if you do take these young kids out of school um man the ce's got to be real important is ce a big part of your culture and organization absolutely i mean we stress that's one of our biggest things is stressing on education you know i think we've seen some people come out of school and they're like well I’m a dentist now now i know everything and you know i think you know that that's definitely far from the truth you have to continue to improve yourself and keep up with you know new studies technology etc so one of the things we do is we actually um use spear online and we enroll every single one of our dentists in spear and everything it kind of standardizes our care um so every bi-weekly we're having we have a call with our doctors where we're discussing two to three hours of ces with them and we're all talking about and then we the next two weeks we go out and execute that and that's worked out really well and uh oh my god um frank spear was lined up for a podcast i was we were all set up that was the the pandemic that was my first casualty of war during the pandemic i just almost cried when i uh got the text from mts oh you know we can't do this huh uh but um i need to figure out how so you do frank spear online and um how much does that cost uh for it's about a it's a couple i think it's about 20 2100 per doctor per year for per year 2100 per year per year and what subjects does that uh cover um everything literally it's got 900 hours of ces uh but and doctors can 900 hours of education they can get 400 out 400 ce's just off of sphere frank spear online yeah and um that is um that is the number one correlating thing i've seen in my 32 years is um why you know when people say um what what's definitive success well it's got to be your own personal definition i mean it's you got to be happy you can't live in someone else's life but when i see happy dentists that um at the end of their journey it seemed like they were having fun they they they seem like they liked it they told you they liked it the number one thing i correlated with was a hundred hours of ce a year i mean that's the only thing no matter if they went into cosmetic or tmj or medicaid or not or high end or low end it doesn't matter because it's not so much just the information um but it's the people you're running with so if you if you left dental school and your five best friends were the five best drinkers in school and they they hated dentistry and they hated it they hated everything and they just drank and and got out they'll drag you down i mean you absolutely are it's not a pun it's not a it's true you're a some of the five people you spend all your time with and when you they what i remember the most from all of these institutions like i spent you know five weeks at panky and i had done all these um things is not the five or six weeks of pinky it's the the fringe you made uh the the people the friends that you made that were going for and um what i and that's why i i started online c with dentaltown in 2004. we put up 400 courses they've been viewed a million times um I’m looking at these sphere courses they're amazing composite versus ceramic uh creating meaningful connections uh what we now know um implementing spear patient education what's the difference between regular night guard factors and maximum inter customization i mean um if you just if you spend 100 hours a year thinking about your craft instead of 100 hours a year wondering who kim kardashian's going to marry next week i mean uh you're going to end up in two different places and uh yeah um my gosh that that is just so cool so um but back to the online ce the the one thing that is missing is that you know when i when i went to um watch carl mesh seven three day weekends at university of pittsburgh again carl was amazing great uh um but some of the lifelong friends i met there so on online ce um how how was this pandemic um affecting um that that the culture of uh running with other successful fun dentists to get you fired up actually um we are our dentists um because I’m gonna go back to that because we hired them on a set of core values they are super motivated to do better than um any other year yeah and and the fact that we can sit down and talk about how we're going to standardize our care and not just doing things at them for example not just telling them to do things because that's going to make us more money i think they understand that this is something we all need to do as a as a team and that's got them really motivated and they have complete autonomy right each each dentist runs one practice we have a director of operations who helps them hire they absolutely are part of the hiring and firing process so they are completely involved in the day-to-day and i think that gives them that empowerment to go out and actually do better because now they know that our other dentists at the other practice is able to do ramp up the practice to a million bucks they feel like they can do it too um the um one of the biggest issues period in dentistry is um patient communication because we we sell the invisible i mean you guys don't run a flower shop where i can come in and say well those flowers look wilted and those look good give me those um it's not uh packaged goods where you know the brands you know um i mean when i walk into your office and you tell me i have four cavities and i mean it's like when i go do them i you know i always go to the same uh dealer i bought my car because when they say to me uh you know well you know um did you want uh you're you know are you hearing those lifters i don't know what lifters are i grew up with five sisters i played barbie dolls until i was 12. I’m the poster child uh for what happens when you're you raised with five sisters i mean um i mean they have to trust you and so how do you um in fact there was a great book on it um um um what is it uh trust at the speed of light um by uh stephen covey um how do you get dentists who only got to the party because they could sit in the library and knock out aids and trig and calculus and physics and biochem and they still know how many atp come out of the glucose in the krebs cycle how do you convert that librarian physics guy to communicating trust uh that um you have four cavities and and be able to communicate that to where the patient trusts you and believes you how do you pull that off yeah so i think the main thing um you know which i think a lot of guys have gotten on board with is intra oral photos uh we stress a lot on patient communication and you know if you're if you're putting up an x-ray on a screen a patient's not going to be able to read that so we definitely we're very much every new patient gets photos every time you're showing a patient or explain to them why they need a filling or a crown or whatever it may be they see a photo of their tooth so they understand uh what exactly we're planning and why and then you sprinkle in a lot of autonomy to the dentist and along with that and i think when we have our monthly conversations with them it's never a conversation of you could have done this much dollars on this patient it's it's always would it be misdiagnosing or that we could have diagnosed better and how how could we present it better and i think our director does a great job of breaking that down so it's always putting the patient first and when we put when we all have a common goal of putting the patient first that unifies us and that's the vision and that that core focus immediately translates translates across the company right and with our dentists we do teach them you know once you kind of go over everything with patient you're not you're not sitting here trying to pressure them do anything all we're doing is educating them and consequences consequences consequences that's it and you have the option to do all of it some of it none of it i think every dentist in our company kind of you know says the same thing to our patients so um how um has this pandemic affected you i mean you weren't uh my gosh were you hoping i you wish you two just would have had your own office and one little place to worry about and on that now you've um you're starting to expand and leverage and you've got five offices then bam out of nowhere corona welcome to 2020. man this year was dead on arrival um marco uh economist the ada saying that um um first he thought uh the industry would contract uh 30 for the year and now he's revised his numbers to 38 for 2020 38 i mean hell we were close two months so you know two divided by 12 i mean they're they're 16 right there and um so how did you survive that what um how did you uh adjust to that yeah you know like you said we were closed two months um we actually still went in for emergencies but it was stressful because a couple of our dentists were not um comfortable they were kind of very nervous with coronavirus which was okay we understand that but we kept going in for emergencies and as soon as we were ready to open we just had an influx as I’m sure many dusted of patients with you know pending treatment who just really wanted to come in i think it was the first time i told my patients i was like i think it's the first time people actually want to come to the dentist it was it's people couldn't wait to get their teeth cleaned and the pent up demand was was really good for two to three months and that seems to have carried over um of course uh it's been six months exactly down to when chronovirus happened so it things did slow down a little bit but it seems like it's ramping back up again now you know how we were talking about you know how can you find a growth mindset dentist versus a uh uh you were nice and uh saying fixed mindset i was the guy saying lazy bastard mindset uh you know i mean i i i truly i i don't get it i mean i've seen this for 32 years well we can't do it now we're going to lunch and I’m like you're going to taco bell i mean uh you know i mean um but anyway um these patients that's come back i mean i don't know Chicago I’m here in arizona where i mean we just had an election and um i don't want to talk about religion sex politics violence but clearly um the the country is very divided i mean there's two camps and just because one slightly won this time and another one slightly or less i mean i've been watching this uh i was born in 62. and and you look at the numbers when people say it's more polarized now than ever well you don't have any data to suggest i mean look at the registered voters republican government it's always been the these these two different divisions but in arizona we're kind of the florida of the west and uh most of the people just think that it's the flu and uh and they think my four boys even think well yeah dad you're worried hell you're grandpa i ain't worried i you know it that the so what we i've noticed out here is the 40 and under market hasn't even changed i mean i mean the lowest the traffic during the height of the newness and the the shocking off at all traffic in phoenix only decreased 20 percent and uh and you tell them to wear you know so have you but the older people like me you know um the 60 and over you know they're they're scared well those are the ones that need all the implants and you know they they need a lot of major dentistry so have you seen that where a lot of the old people are staying out that need all the work and you're getting a bunch of young healthy kids in that need occlusals and buckle pits or yeah so you know initially i think when we when we first reopened a lot of the older people were staying away and then they started slowing slowly trickling in um now I’m seeing you know the numbers have spiked a little bit so they're still a little bit nervous and you know it's interesting you mentioned florida that's where i grew up and uh my parents are there and I’m sorry I’m sorry you can't i was joking I’m sorry where in florida did you grow up uh melbourne beach it's called it's east of orlando um on the atlantic yep yep uh on that and it's got that barrier reef thing going all the way down that's exactly it yep wild my gosh that would be cool to live on but anyway um but anyway until there's a hurricane then you're between a river and an ocean that's not fun yeah well actually i should ask you this question because the old people laugh at all but young dennis um especially down in florida keep wondering here's a great practice down there on that barrier reef but you know you read all the global the climate change stuff and they're like um is this thing going to be underwater when uh I’m as old as howie i mean you know things look very different 32 years later um you're a smart person and you live down there do you think buying real estate on that um ocean level is going to be a bad investment when they're 65 and trying to sell it that's a constant debate within our family because my parents live very close to the ocean um i i think there are definite changes that we're seeing but i i i can't speak to that I’m not i i don't know if within you know the next 40 years that'll all be gone or if it'll still be incrementally uh changing yeah but but um but it is spiking now it's it's kind of spiking big i mean it's not a little spike i mean if you go back to march they told us you know humans are an interesting uh species i mean 90 of them ended up on the northern hemisphere not the southern hemisphere and most of them live between the 20 and the 40th parallel and they say in that region these viruses die out in the summer and they're strong in the spring in the fall and they were telling us my virologist friends at asu where i got my mba were saying oh yeah it's going to come back in the fall with a vengeance do you believe it's coming back right now i mean it is november 11th and it is dead winter i mean uh in arizona we have to wear long um sweatpants now and i got long sleeves on now i mean i was wearing shorts up until halloween but um so it's it's full-blown winter do you think it's coming back with the vengeance or just trending upwards i think i i personally think it is coming back with a vengeance you know it is flu season so that does not help things and i think with people having been cooped up for so long they're maybe being a little more relaxed um than they necessarily wore back in in march april uh may yeah i think the numbers are going to go up pretty drastically but but i think people are tired of staying in and and the numbers are just going to keep going up but i don't think people are that's going to stop people yeah it's it's just killing my mom and but it makes you see everything differently like um i i really thought all my mom's church activities were about church and now i've been thinking about i saw my brother last the other night i mean she doesn't ever talk about you know any scripture this or canon law you know she didn't talk about any details and we start realizing it's just a big social thing i mean you know she goes there i mean her whole life all of her friends are at her church and they and it's killing her i mean the social isolation and um we've taught her zoom but you know you just can't replace uh going out with your girlfriends with a zoom call um so so what technology what did you have to do on your protocol i mean you had to think this out because you weren't just buying one thing you had to buy five and what i noticed with the um the first uh viral epidemic that i lived through with the hiv uh that killed 36 million people is that we made a lot of changes that never went away went to gloves got rid of custards bottled water in the op instead of a street line i mean just a lot of stuff with the same issues i can still remember like it was yesterday those old kansas dentists when they were told that they had to wear gloves they were ready to just start shooting ya i mean they were ready to get their gun and come on we're gonna you know they were they were very very upset so none of this is surprising to me about the mask thing i mean i lived through it with dentists and gloves in fact one dentist he thought um he was so against sit-down dentistry i mean he thought that was the end of dentistry i mean when he saw some dentists sitting down on the job he thought that was the the sure mark of the sign of the decline of dentistry but what did you purchase um and make changes because of this that you think you'll still be doing 10 years after the epidemic when people won't even remember it you know one thing of course face shields i think everybody incorporated that uh medical grade air purifiers and then you know me personally i would use level one masks and now we've gone to level threes with face shield or n95 so i think that's not going anywhere i think the level three masks are going to are going to stay yeah you do it and that's just a funny change but i mean it's just a different mask but it's not something we've used before so do you do you think um um my the people listening right now if they wanted to get to know about more about you which website would they go i mean you got and trueblue is uh not even spelled true it's t are you oh my god it's uh and blue island smile is there one for your parent company your arrow or yeah we're in the process of building out a website right now for aerial dental yeah um that's where they would go maybe in the next couple months or three months that's where they would go if they wanted to find some information so so where are you adding your journey now you're you're building your sixth office now yes and so um so that means you've already uh found a location land building uh so it's just going through the uh the paperwork or the finance or where's that now that is correct we're in the um like the lease uh negotiation process right now but it is pretty much a done deal um and then we will immediately start building out and then our target would be probably q2 of 2022 2021 2021 sorry get started on the practice 2 20 21 man you you just i can tell you guys you're so organized i mean uh you didn't say yeah we'll get up in the spring you get over on 2 2 20 21. um so this one you least you didn't get the landing building sounds like right you leased you got released yeah and that's why i was saying earlier you know the main business is the business and the secondary business real estate and i've had grant cardone on the show twice trying to make this point whereas uh you know the reason dsos um do well is because they start with just a group practice i mean first you got to get a group practice you got to learn how to run two doctors and then you got to learn a second location and these are the baby steps that have that will determine all your success you got to remember that the McDonald’s brothers uh richard mcdonald when he sold it to uh um uh the boys in Chicago um he had nine locations and he couldn't get it working and um you know and i i um so you know these are absolutely tough times but um grant cardone says that you need you need a full-time employee if you're going to make money on real estate you need a full-time employee and that's why he always recommended uh to my boys that they start with a uh a 12 unit or a 16 unit duplex because you could live in one and then you could uh work the other ones but you need a full-time person and so when a dentist owns their own land and building i mean it's um i mean i can see it as an investment but i can't really no one would say he's in the real estate business i mean he just owns he owns uh land of billing and i do think it's a mark of a much greater intelligence when you meet a dentist you find out that they rent their 1 000 square foot office and they own their 4 000 square foot home uh they they laugh at people who buy an intro camera but then they get a boat they tease this guy because he got a laser and then they he got a cabin i mean um so if you sleep eight hours a day you're down to two eights and i say you know they should be very similar and your toys should be evenly spread because if you're living in a hell hole and you just can't wait to get out and go to some place that's nice and you can breathe and has the the things you like i mean make your dental office like that in fact the the best dental office i ever saw in my life was in uh south carolina i was at a oral surgeon's office brian neuworth and i said damn why are your operatory so big he goes you know I’m an oral surgeon and people come in here and they're squeezing around the chair and they're they're they're you know they're bringing in some little chair he goes I’m gonna be in this room for 40 years okay i wanted it big enough for a couch i wanted it big enough where you could just relax and he says why would you spend from 25 to 65 in a 10 foot by 10 foot room when you get to spend it in a 20 by 20. you know what i mean that was actually the smartest guy in our graduating class at umkc by a mile and a half uh but um again you you could never do that in japan when you're starting with a framework of ground at a million dollars a square meter you can't do that but you can in south carolina Chicago seems like very high overhead real estate to me yeah well we actually that's why we've chosen to go out closer like to the suburbs and and uh closer to uh indiana actually which you know has has really been beneficial the real estate prices are not they don't break your bank but they're just it's the sweet spot where if you're gonna pay four grand in monthly rent you you might as well own yeah and be your own landlord and you know ultimately the way we look at it is you build every business to be able to sell one day and when you do sell you do have that real estate uh to kind of fall back on that all this rent that you you wouldn't have paid for 30 something years which which amounts to i think millions of dollars that you you could have saved yes you you're going to pay property taxes but it's nowhere nowhere near comparable to how much you would have paid in rent and plus you get to sell a chunk of that in 25 or 30 years or whenever you want to do that and the other thing that um you know i don't like to talk about it because people think you're a conspiracy nut or you're crazy or whatever but people get so settled you know it's that boiled frog deal where if you put a frog in boiling water he jumps right out but if you put him in cold water and slowly bring it to a boil he never registers the change in delta his nerves don't fire and he sits in there and he boils and um um the uh the debt situation is just out of control i mean um they got you know they were adding about a trillion year they added 3 trillion this year um you know you got um the debt is insane and everybody's banking on that the united states will always be the reserve currency and you just can't always bank on things like that and there's a lot of really big countries that are sick of having the us dollar being the reserve currency because to put it in perspective if you're if you're argentina and you borrow a bunch of uh money in u.s dollars um but you have the argentina peso i mean you have to buy us dollars if america has a bunch of debt they have the printing press they can just print it and it's not so much that obviously major competition in china russia you know they would like to get off this us dollar i i don't think it's gonna be um china russia it's gonna be digital currency and it's not gonna be the bitcoin crazy stuff but i have seen with my own eyes like in china there's already a system where you store your money on your phone it's a digital dollar and you go to the store and you scan and it pays for it it scans that dollar uh it makes a trade it didn't even go through a bank and right now they're all banking on that you know well the you know like when i write you a check it's got to go to the bank then it's got to go to the federal reserve clearing house and it goes through all these processes they're not even thinking maybe someday i can just give you a dollar like that used to be when they had a gold coin and if there ever was a crack in the u.s dollar um all these people have all their money in their 401k and all their money's in paper and then here you have money in bricks and mortar and buildings and that's why i also um i I’m very concerned about dentists who don't own their means of production because every time there's been a great catastrophe in economics for any country and in the last five thousand years you have 500 examples to look at i mean it's clear as a bell that can go south well if you own your own dental office you can just you know if inflation's running away you can you have the power to raise your prices um you have if you're really broke you have the power to live in your dental office and work 24 hours a day pulling t whatever but if you're just an employee you're just going to be you're just a wage slave and this is going to fire you and um so it's nice to have a diversified basket i like kevin bacon i mean i was listening to the story where you know he lost all his money in the bernie mado deal well why the hell did you have all your money with bernie maddow why why would anybody have all their money with bernie anybody i mean you know i mean i mean i don't care what your name is why would you have all your money with someone what kind of diversification is that but not just diversification and paper but diversification and something real like a land a building and a job and i'll tell you what um during the great depression uh the people that could work with their hands and could weld and hammer nails and milk cows and farm and all that that they survived fine but the people who don't own their house they don't own their car they don't own their dental office that don't own anything well in the in the um 25 unemployment for four years it was them they were just let go you know demand went down so you let go of all the wage slaves and so it's kind of it scares me to see so many kids not own their means of production i wish more dentists would think like you um so again ramping that thing up so you go by old man um so you go by dr you go by his practice so he can spend more time with the diabetes clinic and um so how do you how do you ramp it up specifically um like let's talk marketing um when you're buying a new patient head is it digital is it facebook is it direct mail radio how do you ramp that up i think it's a combination of the three that you just said uh pay-per-clicks google i think is huge um focusing on at the minute you open your doors focusing on getting great reviews it's a review driven world where we have to focus and that reviews those reviews will then drive organic traffic to you to your site um the the idea is to get patients to land on your um landing page which is your website so so you said that the main thing the first major deal was pay-per-click google google okay so you're talking about it pay-per-click google ads for when they're doing a search yeah correct yeah because when someone breaks their tooth they're not gonna go start scrolling through facebook until they see your tooth meme that you posted they're gonna they're gonna search and what are you um what what search words how much do you pay like what is your budget for something like that a budget depends on the the what we're trying to accomplish if you're if you're trying to get the office to a million bucks i think your year one um you probably want to spend a good eight to ten percent in marketing in year one so which means 80 to 100 grand really needs to go into getting that practice to a million dollars it should it should normalize to about five percent in your your two or year three and get that under five thousand but if you're going to grant that practice from a million to two million then you're going to wrap up that marketing effort again so you you so when you're ramping full speed it's eight percent or do you say eight to ten eight to ten percent damn that is thinking outside the box that wow and and um the orthodontists were smarter on this because of just the reality that um you know the average you know united states is a big country so when people say ortho in america is six grand i mean really in persons kansas you think parsons kansas is the same as san francisco but it's about 4 500 to 7 500 depending on if you live in san fran or kansas um but they're going to realize that money in two years whereas a dentist that patient they're going to realize the same amount but it's going to be like more over five years so the orthodontist since it was coming in in two years they could observe that and they they got it much quicker and i remember um in the early 90s when most of the dentists were still debating to advertise or not some of the orthodontists had already passed the 5 mark and they were just crushing it and and i i remember the shock on people's face they found out that someone was spending five percent of their collection on marketing and it really comes down to what is the cost of acquisition of this patient how much does this average patient spend what is your overhead and what is in that so if i spend a dollar and i get two dollars of net income back i mean you you just would never stop it in a million years so what is your average cost per head would you say uh on a google pay-per-click to get a human in there and then what would the new patient um revenue be and um and uh what would be the ri on that yeah google i think google clicks right now based on the demographics we're in go anywhere from three to ten twelve dollars i think the practice that we've closer to the city is more expensive per click uh but that one click can give us a patient so roughly out of all the markets spread across the marketing when we track our dollar i think we're spending about 130 bucks to acquire a new patient and and that alone you can go i used to play with my boys you know every time a new business opened in all water we'd go there and we'd park the car and we'd just sit out there on the hood and talk about it and i'll never forget my little zach who now is a child i can't believe it he was only like four years old and this this new yogurt shop went up and it was kind of tucked away it wasn't seen from the intersection where there's a dairy queen sitting there and zach's like four years old throwing his hand up like what were they thinking they that you can't see him from the four-lane intersection and there's a dairy queen right on the corner you know and and man we could call but one thing as we get older because restaurants are the best example to do with your kids like like when you buy them a stock buy them a fun sock like they like to go to disney um they they might like nike shoes so don't buy them a stock of something they don't understand buy him a stock of something um they they they play with and love nintendo you know whatever and then restaurants are the best examples because they got about a 40 to 60 percent one two year mortality rate and i my boys they learned very early i said zach you sit down on table the manager comes by and you ask him you know any of his numbers like how much does it cost in advertising to get a new customer in this restaurant if he doesn't know he's gone in one year just gone and the ones that know their costs like i'll never forget this one there's only three restaurants that's been as long as my dental office in onwatsuki all the others just burned and churned it's uh you know cks it's um i mean just unbelievable i'll never forget when i went into uh um the the one um the italian one and uh i said hey what happened to your tablecloths and and the owner's wife said to me uh you know what i just got tired of paying that bill i mean my we we were spending 55 cents on every table just for the damn cloth i said no no more cloths and i thought oh my god she'll be here she'll die in this restaurant i mean when you know your numbers like that you're gonna win you just gotta know your numbers so you're spending a hundred and thirty dollars uh per uh new patient and then um and so do you think that is a um um that you make 130 of net income profit off that patient to pay for the ad oh absolutely absolutely 100 we so the way we look at it is if a patient comes in and spends we spend 130 bucks and we can make 150 bucks that's a win right but ultimately i think if you're going to operate it at a 20 margin on each of these practices that justifies the cost because we are coming out ahead at the end of the day wow and um so um back to uh so it so that's pay per click of your marketing what percent would you say of your marketing is spent on that strategy google pay-per-click um i think about um 40 is on google okay and then the the remaining um 40 to 50 percent is on direct mail uh kind of drives us insane just oh yeah wait wait wait work it it seems to help with brand recognition so so 40 with pay-per-click and and um 40 40 to 50 on direct mail correct and then the rest on facebook ads and what do you what do you think about well first of all um my gosh i i love it because the um the millennials you know they they have their different cultures and they they hate direct mail they call it junk mail uh they're they're on their phones at all times so they they um they don't ever look at or see direct mail and they forget there's a bunch of old people out there and i i i don't know but i when i when i I’m on the ground i hell i've podcasted 1500 people and direct mail kills especially for older people dentistry like implants and uh my gosh um when people just say direct mail is dead i don't know what to talk about in fact i was talking to my uh postman today because every time i see him i'd say uh i pretend like i was taking this picture and i go here he is throwing away election ballots in phoenix arizona you know and he just starts laughing but he said he said he's um this campaign that every single house has been getting seven different ads per political opponent uh political person per day per house seven ads those people are the best marketers in the world i mean they would never waste a dollar anywhere i mean they know what they're doing um gosh they know what they're doing those they they do their um political opposition research and all that but anyway when they're all done they are sending seven pieces per day per house during this last campaign and then you'll hear some 30 year old man i'll say yeah direct my homework it's dead it died a long time it's alive and well so so google first pay-per-click and facebook was last and why what is up your thoughts on facebook and their strategy and and um well first of all why is it last but why is it still even on your list um i think facebook i mean just because it's one of the most uh visited social media sites in the world i think it's good for brand recognition so if ultimately you want somebody to go look at you on google and then also look at you through a direct mail also look at you on facebook that's what ultimately gets people to land on your site which is what you want and then pick up the phone and call you which is what every dental practice out there wants so it's mainly name recognition i think facebook paper uh the clicks the cost per click is cheaper than google yeah um it doesn't mean it's more effective i think google is still number one so that's one of the reasons we also do it and i always the way we think about it is we put another five percent just to exp experiment and see what could work can we throw it into instagram ads can we throw it throw it into church bulletin billboards or billboards maybe that's the other five percent so to speak that we play around with but we need like a proven proven strategy that kind of works and this seems to generally work for us well i'll tell you what i think of your ad um i mean my gosh um i i do it i mean your websites when i do it in my seminar i'll just point to any person i'll say stand up and come here and they stand up and they come here i said what did you just do you just stood up and come here i mean i just said stand up and compare i had no reason for this time here and i like it you go to your page you land on and the first thing i see is a button says book your appointment and you're you're asking you're trying to close the deal and when you talk to um dennis i even called dental offices with the doc with me in the car you know and you could have a 20-minute conversation with their adorable rece and she never once asked you for your name trying to schedule you i mean she she just talked for an hour i mean uh you know it sounds like you know it's like uh it's unbelievable they don't go for the clothes and then i like the fact that um you got your pictures right up front so they they i mean you guys are adorable you're beautiful um that they see who it is uh but when you say but you said but here's the killer uh when you say learn more um and you clunk into uh one of the two doctors it's a youtube video and the guy at the holiday inn at the dental convention is telling you he understands search engine optimization but funny how um everyone at microsoft doesn't know what google's doing but the guy at the holiday inn does the guy speaking at the dental convention he knows what microsoft doesn't know and uh microsoft doesn't isn't going to tell anybody how that works but they do um but it is obvious that a big part of that search um is um video and um experts that look at these um what they can find is that the majority of it set up for video well google and youtube are owned by alphabet and then i go to your doc website and you got an uh email why why would the why would sergey burn and larry page be trying to promote you with a microsoft outlook email um you know and they're the um the data is clear that half the people are afraid of the dentist and the other half are afraid of the cost so when they see your gorgeous smiles look like okay they don't look like they're gonna hurt me and then i click in the video and it's a youtube and so so jeff bezos said it nicely said you know amazon we um when we started it could have been called but we only went with books it was the only thing you could sell with text because the pipes are so small but we knew the pipes were getting bigger and eventually we wanted pictures jpegs and then eventually we wanted video well you know i remember buying that stock in 94. now it's 20 20. that was 25 years ago and and um if i sent you a text like my boys you know they'll text me sup sup sup all right you know and uh that's probably just a few ones and zeros with your computer if you sent me a picture of what you're eating that might be a block long but you do like like this podcast you do an hour-long podcast i mean that's ones and zeros to the moon back so people who have all google stuff all google gmails um youtube videos uh google is gonna support their own and uh that's uh you know that's amazing so i love your website um thank you very very nice um so um direct mail um the big question on that is uh do you have an economic incentive some people like those some say it cheapens dentistry on your direct mail do you have some closed deal like 99 complete exam or any economic incentive or what's your strategy on direct mail yeah it kind of changes uh you know it kind of depends on what we're running at that time but one of our standard ones is you know a new patient special um kind of have them come in for a complimentary consult etc uh i think that's that's been pretty standard for us but you know as you rightly said a lot of the older people are the ones that they work with direct mail i once asked a patient uh you know can he write us a review and we kind of text them to write us a review and he says i have an older style like a flip self when i said well what if i emailed it to you he says i don't have email i was like he's like i don't even have internet at home I’m like all right we're out of luck i guess this is why we're doing direct mail but yeah it does and actually in dentistry um it's got a much higher conversion rate than any other industry and is there anything you're aiming for like do you aim for um like a lot of dsos um it seems like the major strategy for dsos is aiming at their their minimum neighborhood is sixty thousand dollar medium household year income except for aspen i really like bob fontana and his aspen model because he has a denture removable partial lab in the location and he his strategy is go where they ain't and he's going in the area where everybody needs medicaid and i raise my hand i won't do business with medicaid because they're mobster thugs that if i screw it up i'll i'll go to jail i mean i i don't do business with with those type of people but um um are you targeting like in your six locations would it be standard dso 60 000 median household income higher or are you looking for demographics you're going where they ain't where there's you know maybe a dentist population ratio that's greater than one to two thousand anything specifically you're looking at in the demographics um yeah we definitely want to be where incomes are sixty to eighty thousand dollars i think that's our sweet spot too blue collard uh people with with uh with good insurances uh who can come in and use their benefits and whatnot we're making it easy for them to use that insurance um that's that's generally the sweet spot yeah i mean we this this is Chicago and it's really hard to get one in 2000 although we do have practices where we're the only dentist in town and that's such a rarity it's really hard to be able to do that here but you then you know overcome that with the solid marketing strategy nice um and um and was there i mean i can't believe we went uh well over an hour was there anything else that um that you were thinking we'd talk about that i wouldn't um didn't ask about i think you're very comprehensive you're very comprehensive you product you know one more follow-up um is there any high-tech equipment i mean some um dentists are strange they a lot of them think um when they think that they're gonna really uh invest it's time to invest in their office they'll they'll buy a laser they'll buy a chairside milling or they'll buy a cbct and um you know it's it's a lot of cash when you're setting up an office do you have any high-tech purchases that you spend a lot of money on that you that you uh think is worth it i mean every one of our offices of course digital is is we have to have digital and in every office um we usually get a panoramic um and you know a couple of offices have a ct uh those are the ones where we do implants um anything else that I’m so would you say it's a digital office you mean like um like instead of impression instead of vinyl poly stock saying you're digital scanning your impressions or are you talking about digital computers or what what do you mean digital altitude like all software pretty much paperless um digital x-rays x-rays texas or digital x-rays and intro cameras with um and what practice is the standard what practice management system did you go with dendrites and do you like it yeah yeah runs great reports that's the same so and and what digital x-ray did you go with um we have i mean we use dexa exercises and then we have some gendex as well and uh what about oral scanning for impression you're doing pressure material oral scanning we do impression material but we are looking at getting um scanners as well and which scanner do you think you go with i think uh we're a fan of um trios and of course there's the medic scanner now that's that seems to be pretty price competitive uh we might do one of those but again it's hard for us to just do it in one practice and not do it in the other because i think all our doctors that we all have similar uh ways of practicing so that it would be an investment for us yeah the only thing i've noticed on scanners without a doubt is if you have any intention of building a an invisalign practice of course invisalign is owned by a line technology and they bought um they own their scanner and they don't play nicely in the sandbox and it doesn't it doesn't uh go with three shape and all the other ones uh but if you're just only uh doing implants it would matter but is is invisalign a big part of your um practice or is that a big growth thing it's not a very big part of our practice i think ortho would be say less than ten percent of our practice at this point i agree well i've noticed it's either it's either one i mean it's either one or the other i mean the the dentistry's flat around the world for a long time because we've had dennis for 200 years uh so you know it's not a new growth industry and uh but the only parts of it growing uh more more than twice the rate of inflation is only implants and clear aligners from kansas to kathmandu to if you live in a canoe and it seems like you're either this soft and pretty um bleaching bonding invisalign or your blood and guts extractions root canals and implants and uh which one of those are you probably the second the blood guts yeah and and that is far more in the profit zone and i don't want to uh take up any more of your time than that but i'll just i'll just end on uh i'll just i always say these numbers um because uh no one wants to hear them um and that is um income for dentists i mean my gosh it's uh here it is are you ready drum roll please number one highest paid oral surgeons 448 number two periodontist 333 endodontist 307 pediatric dentist god bless him 304 000 i hope they spend it all on uh alcohol and but ortho ortho is where you fall under 300 and you start the 289's i mean there's just the the dentistry i mean you may think about it whatever you want but dentistry started as barber surges remember pierre fouchard in paris france was the first one that thought it should go from a barber surgeon to drop the barber and then um over here a century later was uh gv black and then when i was in dental school i'll never forget a conversation i had with george ruiz 92 year old dennis and saint joe missouri we're sitting there having a beer fishing uh some lake in uh st joe and i and he says to me i said well you're graduating you said 27 oh my god wow that was just uh two years before 1929 what was that like and he said um and he said to me he said that the great depression was the greatest thing for dentistry and i said why he said well we were all outside and no one could afford to go inside and then everything collapsed and got boarded up and went bankrupt and it finally got so cheap that we could we could move our barber chair inside and when we moved inside a saint joe dennis decided that we were gonna give up the barber thing now that's a hundred years after pierre fischard takes a long time for it to go around the world like i grew up in kansas and i noticed that whatever happened on california and florida within 10 or 20 centuries it gets kansas and uh you know just you know it slows and i thought to myself wow I’m sitting with the guy that practice outside and uh i mean that just puts everything in perspective and uh so we start as bloody surgeons and what that means folks is that um you have to sell me veneers if you said to me um you know hey howard you should you know bleach your teeth like oh well okay i'll write that down but if you're in pain and you can't sleep and you need to do an extraction or you want to save the tooth and do a root canal and then you tell me that you can't pull a tooth or do a root canal and then every economic contraction whether it was lehman's day or the y2k the cosmetic dentist who could only do bleaching bonding veneers those were both times what made up the 80 to 100 practices that went out of business in the y2k and the lehman's day but the old man that could sit there and say well you know i yeah i can pull a tooth yeah i can do a root canal and a lot of a lot of people tell me things like uh well they don't like endo well welcome to earth wow it must be pretty cool to be an animal living on earth that discovered something they don't like my gosh our ancestors i mean think of how they lived the last just yeah go back 5 000 years could you imagine living 5 000 years ago and then and then your your complaint is you don't like endo well if it um if it if it hurts they are going to buy and you're going to be busy and you're going to make a lot of money and if it's if it's if it's um extra they're not going to buy it in a downturn so stick with blood and guts and uh none of this um pulp lover stuff that you do in a root canal and you try to stop a half a millimeter from the apex because you're all you're all a cosmetic dentist be an apical barbarian throw a puff of sealer at the apex extract teeth get people out of pain so they don't be the eight and a half percent that end up at the emergency room uh with an ontogenic origin and that's where all the money is but uh congratulations uh any little kids or you think any babies no the dog is their daughter is the baby yeah that and uh what what i love about that last thing too is that student loan in debt just remember that when you come out 440 thousand dollars or 400 000 student loans to raise a kid from birth to 17 is about is about 200. so if you have 400 000 student loans just take two kids out of the picture and uh you had no uh no issues but uh thank you so much uh for coming on the show it was an honor to podcast you and uh good luck with uh your mission thank you dr fred it was our honor we really appreciate everything that you do it was an honor dr fran it was a pleasure talking to you and thank you so much for everything you do all right tell pumpkin hello from me

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