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The NHS Lately with Dr. Dev Patel : Howard Speaks Podcast #127

The NHS Lately with Dr. Dev Patel : Howard Speaks Podcast #127

8/25/2015 2:00:00 AM   |   Comments: 0   |   Views: 504

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"I've got a few plans of how we can change the NHS…but the dentistry system in the UK is run by 10 or 20 very old school dentists. I've got a vision of a new system that's fully private; no government backing, patients pay a low fee. To change a whole country, it's going to take a lot."

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AUDIO - Dev Patel - HSP #127

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VIDEO - Dev Patel - HSP #127


Regardless of how you feel about the UK's National Health Service, it causes problems for some. Established dentists are having trouble and new dentists are struggling more. Dr. Dev Patel, BDS shares his network solution to getting the kind of work that you love.

Dr. Dev Patel BDS PGDip has a special interest in cosmetic and restorative dentistry, in particular direct composite resin artistry and minimally invasive all ceramic restorations.

He graduated from the University of Manchester 2012, he then completed a post graduate diploma in primary care dentistry and is currently enrolled on a masters course in implantology at the University of Sheffield. He was awarded 'highly commended' in the category for 'Best Young Dentist South' at the prestigious 'Dental Awards 2015'. Dev is also the co-founder of the UK's largest Dental Professional Network - Dental Circle (

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Howard: It is a huge honor today to be podcasting, Dev Patel from the United Kingdom, and your in Kent, United Kingdom. Now, where is that in relation to London?

Dev Patel: It is about half an hour outside of London in the suburbs.

Howard: So it is basically a suburb of London?

Dev Patel: Yes.

Howard: Your a townee, and thank you for sharing an hour with me today. What did you want to talk about to the dentists today? You have five thousand dentists listening to you right now, from around the world. What's new with you?

Dev Patel: My partner Ana and I have created a network called It is UK's largest and first professional network, where people can showcase their work. Show pictures of their work. They can also connect to professionals in the area, all over the UK. They can get help and advise are the main tools. They can also connect with potential employers to get jobs. They become more employable because they are showing off more of their work, and actual highlights of their career on our network. Which in the UK is very unheard of. We are bridging the gap from [inaudible 00:01:23] so the young guys out there can get more exposure online. Through our websites and they can start to network in the UK.

Howard: No how is that different, there is another big social network in the United Kingdom by a periodontist...his name is lost, what is is name?

Dev Patel: Oh its called [name? 00:01:45] by Drew Shaw.

Howard: Yeah, [00:01:47] by Drew Shaw. Awesome, Awesome guy. So how are you different than Drew Shaw?

Dev Patel: That is a video, educational website. They put out videos of work, of procedures or educational CPD. They show people in their network that. Ours is more of a networking website, where you actually network with people. We have a profile for each member, and each profile has a lot of information about that person, so you may see someone that you might want to hire, or you may want to work for in the future. You have all that information in that profile. From the picture to their portfolio of their work, before and after photographs. You have their CPD log, so you can see courses they have been on. You can see where they graduated from, what years they worked or will have worked. Which is completely different from an educational style like [inaudible 00:02:41] which is bizerk.

Howard: How long has it been up and how is it going?

Dev Patel: It has been up for about seven months. We are having a party tomorrow actually, for our kind of summer party so, its our first party. We have about three thousand members in the UK, which are all GC registered. We are completely focused on just the UK, and they have to have a GC number which is a number you get when you graduate, to go on the website. It is a secured network. So if you are going talk about cases, rather than talking about it on Facebook and saying "hey look at this new crown I just did on this patient." And you get a hundred comments from all those colleagues, which is all of a sudden in the public eye and unprofessional we are doing it on a network which is secure. Only the dental profession can look at it and discuss cases together. It is a bit more secure that way.

Howard: I have listeners from every country around the world that listen to these things. If you are from another country is it closed off to them? Can someone join...

Dev Patel: Yeah, at the moment it is closed off but we are going to go international hopefully in a couple of years time. At that time we will have a separate network per country. The next one is America...

Howard: So, you said it is like LinkedIn. I imagine most of your members are on LinkedIn. Most dentists are on Facebook, they are not really on LinkedIn. Describe what LinkedIn is, and what its like and how yours is like LinkedIn. 

Dev Patel: Facebook is a social. network, It is a social network where you can go put up your weekends out your night's out whatever, your holidays. That is your social life. We want to direct all of our network, which is all of our network that is just physical dentistry, professional network. You can talk about cases, job, or new things going on in the dental industry. So you have two different networks. Whereas LinkedIn is a network, which is really good but it is more for people who are in the city. People who want to start headhunting. It is not really somewhere you can use for dentistry because, if you are hiring someone in dentistry what do you look at? Their portfolio of their work. 

You see their before and after photographs, what degrees they have. That kind of stuff. You don't really get that same kind of feel from LinkedIn. No one is on LinkedIn anyway in the UK in dentistry. Because there is no real benefit from it. So, we created a network that is just a very tight professional network, only professional discuss stuff and network with each other.  

Howard: Is it successful? Is it meeting your expectations? Is it going like you thought it would?

Dev Patel: Yeah, Ana and I are both full time dentists. We both work six days a week, so fitting this in as well as working six days a week is difficult. We have other things as well. We have similar cases for award shows, we are doing Masters degrees, so there are other things as well. It is a lot of time, we are not doing it full time. We are doing it as much as we can after work, for six hours every day after work. 

It is time consuming. We are doing as much as we can and we are doing really well with it, because our target for the first year was two thousand five hundred members. We are only three quarters of the year, and we have got three thousand members. We have already hit our targets, our sponsors are loving the site. It is the first of its kind. We are aiming for young dentists. So, if you are a company in the UK and you are in the market for a dentist. Or if you want to network with other dentists there is no where else but where we are. We have found a complete niche there. It is the first of it's kind. I think most countries in the world, I don't think there are that many out there. 

Howard: Of your three thousand dentists, the UK has what twenty two thousand dentists?

Dev Patel: Yeah.

Howard: Twenty two thousand dentists... do you think that younger dentists.... I mean, how old are you?

Dev Patel: I am twenty six.

Howard: I am fifty two, do you think that a twenty six year old is more likely to do this than a fifty two year old?

Dev Patel: Oh definitely.

Howard: Definitely...

Dev Patel: We are not aiming at the older market. We want to get the young dentists on there. The main benefits of our site are the networking to get jobs, so if you are young you want to get jobs. Getting advise from mentors. Courses to advance your career, that's for young dentists, you know learning. Also to find out which events to go to and what courses to go to. We are aiming our site toward young dentists. We are doing a jobs board, which is going to be a unique kind of jobs board because in the UK there is only one jobs board. That would be, the J jobs board. 

It is very bland, in terms that it only has a couple of lines about the job. On a very bland old website. We are going to have a jobs board where you can see who you are working for before you even go there. You can see their profile, where they have worked, what degrees they have got. Everything about them, so you can be more interactive. We are mainly targeted under thirty five year olds. That is our key market. 72% of our users are under the age of thirty five so that is working quite well. 

Howard: Let me ask you a question. Obviously, everybody living in every country is living in changing times. I graduated in 1987 and in 1987 when I got out of school I think there were about fourteen thousand dentists in the UK. They were all NHA dentists and everything was good. The whining, complaining and bitching about it has been growing more and more. More and more people are dropping out of being NH dentists. I would say that the majority of NH dentists are doing some NHS, some private, some cash. 

For you young guys walking out, in your twenties what do you think of NHS dentistry from when it started and now? Where do you think it is going over the next ten or twenty years? What is your prediction for the past UK dental market over the last two decades? What do you think is in store for the next two decades in your career?

Dev Patel: That's a good question Howard. My problem as a dentist is, I have family dentists I know how it has been for the last twenty years...

Howard: Your father is a dentist?

Dev Patel: No my brother is...

Howard: Your brother?

Dev Patel: Yeah and I have an uncle as well. 

Howard: So it is a genetic gene in your family and you are passing it...

Dev Patel: If you are a Patel, you have three options in life you become a dentist a pharmacist or a doctor that's it. You choose one of the three. That's why so many of your friends are dentists. 

Howard: I can't even count how many friends I have who are a dentist with the last name Patel. I couldn't even count them all. 

Dev Patel: What I have seen over the years is, your right the reason why more people are worrying is that it is getting more and more difficult to get good quality jobs. The UK had almost the same thing as America. The recession, five or six years ago. When it happened it really hit NHS hard. The government didn't want to put any more money into the NHS. They didn't have any money to give anyway. What ended up happening was they said "no more funding for you guys for the next twenty odd years." So for the last five years, everyone is competing for the only contracts out there. Which are only a handful. If you have a contract you can have a practice under the NHS if you don't have a contract you can not. 

Howard: Be more specific. You are saying in the 2008 Leemans day financial collapse that the British government... Do you call it the British government or the United Kingdom government? What do you actually call it?

Dev Patel: British...

Howard: British or United Kingdom, same thing. They just said we are not going to fund any new providers for the NHS or they cut existing funding for existing NHS providers?

Dev Patel: New providers. 

Howard: Really? So they just said "If you got a contract keep it" but no new ones?

Dev Patel: No, that's why good will value for the contracts have gone up ridiculously. I know in America you guys pay 60-70% good will. In the UK it is about 200-250%. So we are paying two and a half times that good will value for a contract which is just doing amalgums and crowns and stuff on the NHS which is not amazing dentistry even. So, in the UK we are really really struggling to get good jobs. These days, as an associate you become a self employed associate. When you come out of university you have got to complete your training year. Then you can work under the NHS.

Now in that same year, that amount that you get as an associate is going down and down. The way it works in the NHS is you get paid per UDA. Which is a unit of dental activity. Say for example, you do one crown. You get twelve UDA's, if you do one filling you get three UDA's.

Howard: Three?

Dev Patel: Three, so you get roughly around ten pound per UDA as an associate. Every year its going from ten pounds, to nine pound to seven pound to six pound. It is getting to the point where you are working less than [inaudible 00:11:59] people. 

Howard: So, tell us the fee of a crown and a filling. On NHS

Dev Patel: For the patient or the dentist?

Howard: For both... What do you charge a patient in the NHS?

Dev Patel: There are fixed fees. There are bands. Band one is just for your exams, hygiene cleaning and x-rays. That is 18 pound 90. 

Howard: What is 18 pounds 90? 18 pounds?

Dev Patel: That is for a band one, yes they will do any exams or any x-rays it all comes in one band. You get paid 18 pound 90. That is what the patient pays. 

Howard: Okay, so you are saying 18.90 pounds?

Dev Patel: Yes. 18-19 pounds. 

Howard: Okay, well lets say 18 pounds for an exam or x-ray. Is that also a cleaning?

Dev Patel: Yeah, mm-hmm (affirmative) 

Howard: Okay, so 18 pounds for an exam, cleaning and x-ray.

Dev Patel: Yeah. 

Howard: Okay, I am sorry I am so ignorant. What is a pound to U.S. dollar? Probably 80% of our listeners are Americans.

Dev Patel: Okay, one pound is probably equivalent to $1.70-$1.60 dollars. 

Howard: Okay

Dev Patel: So one pond is one dollar and sixty cents. 

Howard: Okay, so that was band one. What is band two?

Dev Patel: Band two is... you don't get paid per treatment you get paid for the whole band. So if I do one filling... what I am telling you now is what the patient pays. The patient will pay 50.00 pounds for band two and they will pay 219 for band three. Do you follow me?

Howard: Mm-hmm (affirmative)

Dev Patel: Yeah? That is what the patient pays. We get paid by the government by the contract. The government will pay whatever the fee in the contract is. Each place has different contracts. Each place will have different amount of money per UDA. For example, in band one you get one UDA, for that one UDA the government may give that practice 25 pounds. Of that 25 pounds an associate will take home 9 pounds. Does that make sense?

Howard: Mm-hmm (affirmative)

Dev Patel: So, its roughly 40% of it. If I was doing a filling which is 15.50 pounds for a patient paying it. The government would give me three UDA's. It is always three UDA's. If it is three UDA's I will get three times nine so I will get 21 pounds. That is what I will take home, for one filling. If I do twenty fillings, I get paid the same amount of money anyway. If someone comes in with twenty fillings, I will get paid 21 pounds. That's it. You see? 

There are a lot of problems in the UK where people are saying..."Why would I want to do twenty fillings? I will do one filling for now, and another the year after and get paid each time." That's what happens. Unfortunately the government has put in, root canals and extractions in band two which is the same amount of money.

If you have the choice, someone coming in with an upper eight or an upper seven, needs a root canal. What are you going to do? A root canal for one and a half to two hours or are you going to do an extraction? They are the same amount of money. It is a very bad delimma. 

Unfortunately, because it is so busy and patients do not know better. A lot of times they will take the teeth out rather than doing the root canal. They figure, its the same amount of money, same band two. Why would I want to waste two hours when I can take the tooth out? And if it is band three, you have to do four crowns you only get paid twelve times nine pounds. Which is just over 100 pounds for one, two, three four however many crowns you need. Because of that people are doing what is best financially and what is minimal to the patient. 

Howard: Okay, so you and I are dentists. We know that the way that NHS is compensating dentistry is just not a good system. Do you think that amount of craziness effects the other physicians that are doing the rest of the body? Heart, lung, brain, the rest of the body. Do you think their system is equally kind of...? Do you think their system is kind of...

Dev Patel: Um, no because with other systems there is, when it comes to medical stuff there is a whole team of doctors doing each stage by stage. You kind of see someone for your scans, and someone for your treatments and they will get paid way less to do what they do. Then there are specialists or consultants that do what they do. In the UK dentistry, because there are so many dentists out there. Basically the government doesn't have enough money to fund what we want financially. 

It is a triangle, you have the patient, the funding from the government and what we do. Unfortunately there is no win, win for all of them. The patient wants, white crowns, white fillings the best of everything. You know specialists, periodontist. Then you have the dentist who wants to do the best work but they want to get paid for it. 

The government says, "We can't pay you for it." So there is no win, win for anybody I am afraid. Everyone knows that is the way it is. We do the best we can for the system we are given. They are changing the system in two years time to a new contract. Which will be even more difficult for dentists. 

It is going to be a traffic light system, if you come in to the practice as a patient you get assigned a color it goes red, amber and green. If you have bad mouth, bad perio, lots of holes you are red. If you have amber or green you can't get any fillings or any kind of long term preventative treatment. 

Dentists will have to spend an extra six to eight weeks doing expensive treatments, and hygiene stuff before they get paid for anything even. So, on top of what you are doing now you are getting paid over three months, and you are getting paid less for what we do anyway. So, it is actually making it hard for us to make any kind of living. It is getting more and more tuff actually. 

The government wants high quality, we want more money. They are not giving any more money, so they are trying to squeeze more out of us you know? People are trying to do more [inaudible 00:18:56]

As a new dentist when you are coming out of university you don't have a portfolio you haven't gone to any courses. Who is going to hire you privately? No one. So how do you get hired? You have got to network. You have to get a portfolio of your work, before and after photographs. The whole point of our circle is to get networking right?

That is the whole idea behind it. 

Howard: So being a young, bright eyed, bushy tailed, energetic, handsome. Look at all that hair you look like Elvis Presley with that hair. Are you bullish on your future in dentistry in the United Kingdom? What other dental reimbursement systems around the world? The one thing I would say about London...[inaudible 00:19:37] If you go to Vietnam they are all Vietnamese if you go to Korea they are all Korean, you go to Japan they are all Japanese. If you go to London, My God every person is from a different place around the world. You could be sitting at a restaurant and hear five different languages going on.

Someone said to me, what is the most international city in the world? It has to be London. How the British Empire used to have sixty eight countries flying its flag. What other systems around the world do you think are better? Do you see any systems in another country, whether it be in Europe or Asia, what systems do you think are better?

Dev Patel: I think America and Australia have a good system going on. It is about insurance, the patients get fine dentistry. Which means that they are going to get, better materials. They are going to get more time spent on them. They are going to get a system where there are no limits. In terms of who you can refer to and when you can refer to them. What treatments you can do, you have more control yourself and you get reimbursed so the patient doesn't pay the whole thing themselves. They pay for [inaudible 00:20:43] what they pay for it, and dentists get paid what they want. It is kind of a win win. You get quality, patients are used to paying a lot of money so they only pay what they have to pay and not an excess amount. 

From what I have seen, I have cousins in California and all over the U.S. If you look at their overall patient base, everyone has white fillings, soft crowns, good perio. It is all stable. In the UK, if you came here you would be like "Whoa". Everyone has amalgums everywhere, chipping all over the place. Things like four or five retained roots. It is because everyone is staging treatments according to what works for the dentist. So they get one extraction a year, they really only get one go. 

There are a lot of unhealthy mouths out there. Don't get me wrong, it is just amazing, its the only system in the world where you can pretty much get treatment free of charge. Or seen as soon as possible and it is government paid. However the limit, there is always a limit right? Unless the government is printing money, you are never going to get the best of all three in the world.. 

That is why I think it has to be private around the world and it has to be, reimbursed by insurance companies to a level where patients can afford it, but the dentists get paid enough that they are happy and can do the work they want to do and they enjoy it.

Howard: Are you familiar with any other, you said United States and Australia. What about your own continent Europe? Do you understand any of those systems? Whether it be Italy, France, Switzerland, Sweden? 

Dev Patel: There are some good ones. I Sweden, and Switzerland especially have a good government system going on. They get paid a lot of money for the treatments so there is a good level of health care. Obviously it is good for taxes as well. I haven't studied any other systems apart from Italy, Sweden and Spain but the problem with those systems as well is that, they are not as well... it is hard to say they are not just as good because in the NHS there are specialists that you can refer to and you can do a lot of good courses in the UK.

Obviously there are a lot of good learning dental schools here. There are schools that aren't as good but from what I understand, everybody that understand everyone that comes from a UK university they end up coming out at a very good level. Almost above the rest of Europe. That is quite generalized however, everyone that I have spoken to around the country says "Ah you know UK dentistry is really good, the teaching is really good." 

Obviously it is because, the consulting in the UK are really good and they teach in the U.S. Then again you go to America and you are here and we are there. We are still really far behind.

Howard: And you believe that, why is that? Do you think it is true? Is that perception? Is that reality?

Dev Patel: I think that it is true as a whole. If you put the whole of America against the whole of the UK. The level of dentistry and what has been going on in terms of how advanced you are to [inaudible 00:24:05]. 

I do a lot of private dentistry and cosmetic work here, what we find out is that, five years after America finds out and it comes over here afterwards. Like a set will come out there and five years later it will come over here. We always get the second hand stuff from America. 

Everyone knows that America is the prime market to start off in. You go there, make a big bang and you come to UK afterwards. Just generally though, in America because it is all private, people have that time to spend with patients. They have their own dentists to do the best they can without financial constraints. The UK is opposite. 

Howard: What are the biggest dental manufacturers out of the United Kingdom? What products do they make? What are the biggest names over there? 

Dev Patel: We have Henry Shine over here, which is obviously an American company...

Howard: That is a distributor, I mean as far as making a product. What are the most famous products made in the United Kingdom? Any come to mind?

Dev Patel: Most of them are from other countries. Like implant systems like [strauman?... 00:25:11] from Germany. [Halaous? 00:25:15] They are not made in the UK. There is not many UK developed products. They are all distributors from American companies, the majority of them. It is not like anything is made here...

Howard: You said that you have other dentists in your family. You said brothers, uncles and cousins. You said some of them live in California?

Dev Patel: Yeah.

Howard: I want to pin down that. We keep hearing that the way bleaching is sold in the United States. Some say that it is not that way in the United Kingdom. Explain the bleaching dilemma. 

Dev Patel: Three years ago the EU made a new law saying that you can't sell or use any bleaching products above 6% hydrogen peroxide. If it contains anything more than 6% hydrogen peroxide, you can't use it, you can't sell it you can't do anything with it. You can't even buy it here. I know you guys use bleach a lot so its completely different over here. 

Because of that in house whitening has gone down the drain here, everyone is doing home whitening. Which is not bad, it doesn't get as good results. 

Howard: I am confused because you said the EU, but the United Kingdom is not part of the EU. 

Dev Patel: The EU limitations still apply to the UK legislation as well. 

Howard: To health care?

Dev Patel: Yeah.

Howard: You aren't on the EU currency are you?

Dev Patel: Correct, we are not on the currency but legislation in the EU counts all countries including the UK.

Howard: The United Kingdom has signed on to the EU? They will adopt some of legislation...

Dev Patel: I am not sure if the rest account but this one definitely one of them. I think the very core directives is one that they have set up to. Which is the whole of the EU including the UK. They all have to follow by those rules. 

Howard: Not to get too off topic, are you kind of glad that your country stayed with the British pound and didn't join the Euro? Every time Greece threatens to default the Euros going crazy. A lot of Americans are scared, the whole 2008 financial crisis was caused in Manhattan by the Leeman brothers. They were crazy leveraged and out of control and it really hurt the country. 

Now it looks like in 2015, here we are seven years later and the whole damn thing can unravel again because of Greece. What is your prediction living in that continent? I am sure you get better news and information than we do.  

Dev Patel: It could all fall out tomorrow, you never know what will happen. I personally can't see Greece defaulting. I don't think that the EU would let them default because they know what would happen. Everyone knows that everything would just completely collapse again. So, I think that the EU will just buckle down eventually and be like "Look we have to buckle down and bail them out again you know".

Howard: You are buying into the "Too big to fail" problem? It is too big of a problem to let it happen. 

Dev Patel: Well, I was also one that thought that Leeman Brothers was too big to fail. After what happened the first time around, I don't think that they will let it happen again. Its not like it is a bank or anything. It is a big country. If that goes down its going to be a huge uphill fight.

Howard: I wanted to ask you, another cultural dental question. When you watch movies and media, things like that. We kind of hear a lot of countries outside of the United States think that Americans kind of look like a clown. With their too white teeth, too big of breast enhancements. Do europeans in general think that the white bright bleached American look is just silly? Do they like it? Do they think it looks like a clown? Talk about the cultural differences between...

Dev Patel: Every time I see a patient coming in that literally says to me "I don't want to be like Hollywood white smile, I just want to have a natural white smile." So there are two celebrities that are linked to Los Angeles, and America because they are celebrities. Who, both have that bright white, gleaming, shinning Hollywood smile beyond A1, B1. So, A1 or B1 is what we are looking for. 

Howard: A1 or B1?

Dev Patel: Yeah...

Howard: So, you say that the UK in general would rather go with an A1 or a B1. What would you say the Americans in Hollywood are going for?

Dev Patel: Do you guys use a fancy shade count right? [laughs] The bleach shade count is the one that you guys look at right?

Howard: Yeah. 

Dev Patel: BX1 or BL whatever its called...

Howard: So the UK in general says, that's too much? They kind of want to tone down from that. 

Dev Patel: Yeah

Howard: Would you say that is the rest of Europe too? Is anyone going for that Hollywood bleached out look?

Dev Patel: Not really, even in Italy and places that are a bit more in to their looks There aren't many, like "bleached" white looking teeth. We are looking a bit more natural B1/A1 shades. For my age anyway. That is generally what I have seen. I haven't been in the whole of Europe to know for certain. 

Howard: I think it is funny when you are in Asia, well East Asia, when you are in like China. In that region the good looking movie Hollywood stars are the Koreans. When you are in China and you are wearing something fancy people will say "ah, you are looking Korean." If you think about it, if you think about the musicians out of Korea you think about the big hair, the big glasses, the dances. 

Being on both sides of the pond, and with Social Media. What other differences do you think there are on different sides of the pond that you perceive. You have family, dentists in California. You are younger, brighter on social media and all that stuff. What do you think are the major differences?

Dev Patel: I think obviously, everyone is on Facebook, and they are all on some sort of Twitter or some sort of social media in both countries. That's good, however I think the one thing that you guys have a lot more of, and you have to have a lot more of is, marketing, you have more websites for practices. 

In the UK, I think only 20% practices have a website. Or even less than 20% have practice websites even. 

Howard: Wow, less than 20%? 

Dev Patel: Have a website for the practice. 

Howard: Wow, and why do you think that is?

Dev Patel: Well, you have got to remember 8 out of 10 dentists, or 1/8th of dentists are interest dentists,[inaudible 00:32:09]. If you are an interest dentist from contract which I said before is a gold mine. You have got a list of people coming in, as many as you want as much as you want whenever you want. Because of the plans of the NHS. There is no need to market anything. You can literally have a sign on the door this big saying "Interest Dentist". 

There are so many people in the country that want to be seen and there are so many that have them. Whereas in America where everybody is private practice, you have to have a website. You have to market yourself. To show your work and the way you are or how to find you. 

Even if you are an interest dentist it makes sense to have a website because it is common sense you know? How are you going to find the place otherwise or how are you going to tell people about your open hours or whatever else. They don't however because they don't need to. They are so old school most of them are still using hand written notes and that kind of stuff. 

There are some that are moving to websites now, but the need for it really isn't there. So people aren't really going out and spending a thousand pound doing it. That's why, when we did our website we thought, we want to start a new generation of dentists. Which will be under the age of 35 dentists that everyone will start being online. Being more socially active. Being more physically aware. That will start marketing themselves throughout their own portfolios, through their own work. 

Howard: So you have to be under 35 to get on your website?

Dev Patel: You don't have to but...

Howard: That's what you are targeting?

Dev Patel: We both know that, who goes on Facebook eight times a day and who goes to Facebook once a week. Its the age range right? 

Howard: I used to be fifty two, but I got on eBay and bought me a birth certificate and now I am only twenty eight. 

Dev Patel: Well, go to our website and try it out. 

Howard: I was able to buy a birth certificate and save twenty years off my life. I think one of the times I felt bad the most, that ever made me feel the saddest about anything I have ever done in dentistry was, a kid listened to my 30-day dental DDA and my Virtues of probable dentistry, my 1-day MDA and he got all jazzed up and built a website, did this huge marketing campagin in Hong Kong. He didn't know, and I didn't know that it was all illegal. As soon as he did a direct mail piece, my God they came after him like... it was all illegal. 

I know that in the United Kingdom doing bleaching over 6% is illegal, is it illegal to do direct mail to houses? Or a billboard newspaper ad? Is all that stuff legal?

Dev Patel: Yeah, that is a good question actually. I suppose China is similar to Australia as well there is very limited things that you can do for marketing. You can only do very limited things, like have a little plaque outside your door. There is no like, marketing online is very very tight. 

In the UK it is the opposite, You can do anything you want pretty much. You can have your own commercial, you can have your own advertisement. You can have, flyer drops you can do anything that you want. The problem is that in the UK no one has realized how good it is and how beneficial these things can be for a business. 

Why would you want to market yourself if you already have two people at the front door anyway?

Howard: Yeah, I always think it is funny how everyone wants freedom for themselves but they always want to take away the freedoms of every guy around them, do you know what I mean? It is like, when they say "I want prayer in school"... no, no you want your religions prayer in school. You don't want anybody else's religion praying in your school. How can a free society tell a dentist that they can't talk, and market and advertise what it is that they do....

Dev Patel: I don't know...It is rediculous I know. 

Howard: It is crazy ridiculous I know. And some of the countries... Oh, go ahead you were going to say something.

Dev Patel: I was going to say, the one thing about that though is you guys do take it quite far. Do you know... I am not going to mention names but I know some dentists that come over here and do marketing talks and stuff.. They will do actual commercials about how bad other offices in the area are and how  good they are. It gets to the point where you are actually going "oh don't go to those guys, come to my practice down the road, we are much better." 

Howard: They do that in the United Kingdom?

Dev Patel: No, in America apparently.

Howard: Oh in America. Oh in Texas.

Dev Patel: I have seen advertisements, you know cheesy ones "come get a teeth whitening, come see us" you know, it goes a bit too far.

Howard: You know what I can say that I believe is the biggest misconception of the United States? Cause I have lectured dentists in fifty countries. You know what I think the biggest misconception is of America abroad? It is that when America thinks of Europe, they don't mix up England, versus Portugual or Spain or Greece or Germany. They just see all these all these different countries under the EU. America is the same thing, its like twenty different countries. You just can't compare Alaska to L.A. You can't compare New Orleans to Witchataw. You can't compare Miami to New York city. When I go around the United States it is literally a dozen different countries. 

In fact, I have an MBA from ASU and one of the biggest red flags that I quite listening to someones business knowledge is when they start talking about the US economy. They start naming all these figures for 330million people. The really elite information they will break it down by regions. 

Dev Patel: That was very ambigious. Obviously they are completely different in different areas. I was talking about Dallas I think, but you know what you are right. It is completely different ball game. New York is obviously at least what I have seen is high end makeovers and cosmetic stuff. I am sure in Alaska its not that kind of stuff. Its basic dentistry I am sure. I can't really say. You are the expert on America anyway. 

Howard: The United States is just like Europe. It is a huge region, very very broad. Very diverse. I actually was born in the middle of the country in Kansas. Now I am out here in the Southwest dessert. I spent half my life in the Midwest Kansas and half in the west, Phoenix. Just between those two places is literally two different countries. 

I wanted to ask you about the NHS, do they cover dental implants?

Dev Patel: It is only basic dentistry. 

Howard: So, what if someone comes in... what I am thinking is like a bait and switch so, you are an NHS provider and you are doing all of that fee schedule. However you might be able to make a lot of money by converting a lot of those people to like, high end implants instead of a three bridge or veneers... is there a lot of that going on?

Dev Patel: Yeah, definitely that's where a huge market has really exploded in the last couple of years. So, this contract that we are in now, works on band 1, band 2 and band 3. Seven or eight years ago it was different for ten years. It used to be that you got paid for what you did. So, you would do one filling you got paid for it. You got paid for each filling. Back then it used to be all NHS this NHS that. Everyone loved it. You could do a filling get paid, do a filling get paid. 

Now, because it is the system that we discussed. Now people are playing board games. People are starting to do a lot more private options, offering it to the patients. Because they can't do implants on NHS but they can offer it privately but are being seen as an NHS patient there. Its like you cant get a layered filling in the back of your mouth, but you can get it privately. Or if you want to get an Emex Highland anterior crown, you get it done privately. 

So there are options, you can get it done privately, and you can get anything done under NHS really apart from implants. You can't really ruin the dentist if it doesn't turn out all right so you have to be very careful about what you say. Essentially anything clinically necessary is available on NHS. Any cosmetic, isn't. That is how you differ between the two. 

Howard: One thing this reminds me of is talking about the American system of private insurance versus the UK system government. I just want to say, if you are looking for intellectual banter or thought, or data points. It is interesting, America is very old world private health care insurance system. Which is very expensive by the way for the country as a whole. I mean we spend a lot of dollars there. 

After World War II, probably twenty five countries started insurance. But what most of the experts I listen to say is that the smartest systems are the newest, youngest systems that are only like ten years old. Like Taiwan and Singapore. They got to see what everyone else is doing, study the bejesus out of it, and most people Fred Zakari. Have you ever seen him on CNN? He is just a really sharp journalist. He actually thinks that those systems are the best ever simply because they are the youngest newest systems. So they got to learn from all the countries that are... 

Dev Patel: Definitely, yeah. Its like any country though Howard. You go to, Australia for example and you look at the infrastructure, the way things are set up. The size of the roads, tiny little things. They have learned from the UK or from other countries, they learned from the mistakes of them, and they have the modern technology now to make it better. Its like a flat canvas, is like starting fresh. You can do anything....

Howard: That might be one thing that you do with your dental circle. You might be able to get Singapore and Taiwan. Go back and say, on behalf of the dentistry we are going to be practicing next years, we have a system that dates back from 1980. The people who studied every system in the world, this is what they have come up with. Maybe you can put that in front of their noses and maybe the decision making groups would look that over. 

Dev Patel: Howard, you know what? I am completly with you, I have got a few plans on how we can change NHS. Its all good saying these plans and even showing evidence of other countries doing it but the NHS system in the UK is run by very old school dentist who have been here for thirty, forty years of dentistry. 

They don't want to change that much, and if they do want to change that much. It would have to have a lot of dates and evidence behind it. Right now, NHS is working on a system where they can clearly record each patients outcomes and treatments and therefore pay dentists accordingly. Which is in essence a good idea, but dentists aren't going to pay enough for it. 

I think in the next few years you are going to see people moving out from the NHS and into the private anyway, patients and dentists. So that is going to grow. Its growing now anyway, it is a five billion pound sector now, its going to keep growing and growing. The private sector grows by 70% every year anyway. It is going to keep growing. 

Unless government decided to fund contracts more, dentists more there aren't going to be enough anyway available. As the population grows there are a lot of people and not enough to see them anyway. Its public access. 

I think there is going to be a new system coming out in the next few years, it is in the making. It is going to be like an NHS system but fully private. No government backed, nothing. Patients pay a low fee for the work, dentists will have to do a little more volume for the work. At least that way there are no constraints. There is no limits. There is no "do this, do this" by the exact system of computer. 

You have eliminated that, but to change a whole country is going to take a lot. The UK is very stubborn. 

Howard: Right, but tell your young kids this, #1 there is no such thing as dental insurance because, like car insurance everybody pays a little and one person wrecks their car. That is insurance. Everybody pays a little and an actual insurance analysis says okay only one guy out of one hundred is going to stack their car, so everybody pays a little. That's insurance, spreading the risk around. Fire insurance on your house, everybody in Kent has fire insurance on their house but only one drunk Irish guy smoking in bed and catches his whisky on fire and catches the house on fire. Very, very rare. 

Dental insurance, how do spread the risk around? One hundred out of one hundred people need a cleaning, one hundred out of one hundred need an x-ray. One hundred out of one hundred people eat sugars and carbohydrates. One hundred out of one hundred don't brush two minutes every morning and every night, floss before bedtime and use mouthwash etc. 

There is no such thing as insurance. It is interesting, in health care insurance only applies to about 5-10% of the whole health care budget. You know, you get struck with colon cancer, your kid all of a sudden has Lukemia. 90% of the cost is people just going in with a sniffle, getting their blood pressure, getting all of these chronic disease. Because they are fat, they smoke, they don't excercise and at the end of the day we are all going to die anyway. 

It is easier to change a country than it is to change yourself. A dentist can walk in and they say well "what does the insurance pay?" I have a couple, one liners; I say what if you were done having kids and your insurance only paid for a castration. Would you pay for a vasectomy with cash? 

Someone else told me a good one the other day, if your company gives you a weeks vacation, they aren't paying for your plane fare and your trip to Hollywood and eating out and meals and everything. Its a benefit, a dental benefit. Whether it is private or government, gives a benefit that's nice. Where governments are abusive is when they say, okay Dev ill give you $18 to help this person get a filling but its against the law for them to chip in another dollar or two, or three dollars. That's just abuse. 

That is like saying, look at all the cars made in Europe and all the different price points. Well the government will pay $18 and give you a Chevy, but you can't take that $18 and apply it to a Mercedes or a Porsche or an Audi. Or something nicer. That is when they are abusive. If they would just get rid of that. 

We have that in America too. 

Dev Patel: Oh, okay

Howard: We have private insurance that says, yeah okay we will pay one half of a crown for a fee of $1000 but you can't charge $1001. That's abuse, because that is basically saying. You are going to drag the whole country down to the level of a Chevy. Some people value dentistry more than others. Look at my family. The whole pedigree can get free dentistry. Half of them don't even come up to get a free cleaning. I have uncles wearing dentures when they could have full implants, full everything. 

Everybody values cars differently, vacations, everything. You shouldn't drag an entire country to one market level. You should let people have the freedom to pursue happiness and maybe you want to spend all your time snorkeling and someone else wants to spend all their time at a dental office getting veneers and implants. Some people are totally into it. 

Tell the American Dentists something they don't know about dentistry in England. 

Dev Patel: There was a study done, a test in Scotland of childrens dentistry. They had 7-800 workers go to each school in Scotland twice a day, every single day for about two years. To make sure they brushed their teeth twice a day. Actually watching them brush their teeth. Do you know how much money they saved on the national health system in Scottland in those two years? 5 million pounds. Which is quite a lot. 

Howard: Oh my God, is there a study on that?

Dev Patel: Yes.

Howard: You have been on Dental Town for a couple of years, you never made a post. Is there any chance you would post that dental study on Dental Town? 

Dev Patel: Sure I will. 

Howard: And or email it to me I would love to read that!

Dev Patel: Another thing Howard, there is this new generation of smart brushes coming out now. I am sure you have Oral B doing an app. With their brush. There is one in UK called PlayBrush. I think it will change a lot in dentistry. Two reasons; if you can actually manage that for each patient. Adult or Child, how many times do they brush, how long and you get a report weekly or daily. You could actually start to say, "you deserve to be rewarded for your brushing every single day twice a day for the last six months, so I am going to give you a discount on your oral care. Whereas you mister have only been brushing once every single week. So its your fault you have caused this problem." I think it would be really really helpful. The data from that would help not only the UK but the whole world. If you started getting data per person on the the brushing. 

Everybody has a smart phone now, and its so easy. As soon as you pick up your play brush it goes on to your phone. The app comes up, its got a game on there so you can see the brush moving through the game. It makes it more fun. The game lasts for two minutes, when the game is finished you have brushed for two minutes. It even tells you how good you have done. That data is then sent to dentists that can work out imagine how many studies you could do by regions. Which ones have the worst hygiene which have the best. Kids are not brushing well enough in these areas. The number one reason for people going into A&E in the UK is because of kids tooth pain. Did you know that?

Howard: For the emergency room?

Dev Patel: A&E, highest reason for...

Howard: What is A&E stand for?

Dev Patel: Accident and emergency.

Howard: Okay in America we just call it E.R. emergency room, but your is A&E, accident and emergency?

Dev Patel: Yeah, so the highest reason for anyone to go into the A&E at any age is because of childrens tooth pain. Because they are not brushing enough. 

Howard: Okay, what was the name of that company?

Dev Patel: Playbrush.

Howard: Playbrush, now is that the one with the logo is silver with headphones on a ....

Dev Patel: I think so yeah.

Howard: Can you email me that at

Dev Patel: Sure. 

Howard: And to our five thousand listeners, is there any chance you would start a thread with that Scottish study?

Dev Patel: Sure.

Howard: And post this brush method? If you email me the notes I will put it in the notes of this podcast. What I like to do with my podcasts is, most people are multi tasking on the drive to work, they are on a treadmill. They don't want to stop and write something down. So, I always send off for a transcript and put it on Dental Town. I spoil my listeners so they don't have to take notes. It was called Play Brush.

Dev Patel: Yes.

Howard: Is that Play

Dev Patel: It is

Howard: What country is io?

Dev Patel: It is Germany.

Howard: IO is Germany?

Dev Patel: I think so, it is a German company. 

Howard: I thought Germany was DU? For Duechland?

Dev Patel: It might be Austria then.

Howard: Austria, huh! Well email me that. 

Dev Patel: Okay will do. 

Howard: I wanted to ask you something, because you are young you are fresh out of school. You went right to the importance of brushing two minutes in the morning and two at night. And now there is technology with the smart phone to monitor that two minute brushing. I was wondering why you didn't go to diet, because if you are a fifty two year old dude that has been on this rock for half a century. When we were little, you were drinking out of a garden hose and cool water was refreshing. It seems like now its all pop. It is all soda. 

Now, you said you are twenty eight?

Dev Patel: Twenty six. 

Howard: Okay, twenty six. When you talk to fifty or sixty year old dentists in the United Kingdom do they tell you that UK fifty years ago used to drink a lot less Coke and soda? Is soda on the rise? Do you see it more brushing or more diet?

Dev Patel: Well, it is a combination of both. We both know that the more sugar intake you have the more likely you are to get decay. At the same time if you don't brush well enough the sugar is left on your teeth for longer period of time it is likely to get decay. 

I know this is bad but you can have as much sugar as you want as long as you brush the teeth really well and don't leave it on over too long period of time. 

Howard: I am the perfect example of that, I mean I have five kids, I left all the sugar in food. 

Dev Patel: At the end of the day, no matter how hard we try. No matter how much we tell patients not to eat sweets and drink sugar drinks and give their kids that. They are going to do it anyway. It is so cheap, that's what happened. It has become so cheap for consumers to purchase a Coke, or a sweet from a shop. It is so easy and so cheap no matter what we say they are going to do it anyway. 

The only thing we can do is help them brush better to reduce the chance that sugar causes decay afterwards. You know? I think that the study in Scottland already shows how beneficial it can be for the whole government. 

I hope the government realizes how much they can save by investing in a brush like this. Or the dentist's do which I am trying to do at the moment. 

Howard: Do you know the owner of the Playbrush?

Dev Patel: I do very well.

Howard: Why don't you introduce us.

Dev Patel: I will.

Howard: Just send us an email, and CC him and I will get him on and maybe he is into that Scottish study too. 

Dev Patel: We are actually working together at the moment. They are getting ready to launch in a couple of months so I am hoping everybody will buy a lot. I will get you in touch with him, I will send you the other stuff for the study in Scottland. 

Howard: Okay, it was an honor to have you. It is 11:30 in the morning here and what is it there? Eight hours ahead of me. 

Dev Patel: Yeah, it is half past seven.

Howard: Is it Friday night over there? You are probably getting ready to go out to the clubs. You are probably thinking how do I get this old fat annoying guy off the phone. But seriously congratulations on entering dentistry. Congratulations on your new company If someone wants to reach you they can go to right? Do you want to give out any other information? Email or anything?

Dev Patel: That website is the best but the email is that is the website that I would recommend. For the Americans it will be difficult to get on to our site so my personal site will work that's it. 

Howard: I hope you post that dental study on Dental Town. Everybody needs to read that. 

Dev Patel: I will.

Howard: That would be your first post. 

Dev Patel: I haven't posted. Because I post on so many these days. 

Howard: People time and money. People ask me how I have time for Dental Town and I say cause I don't watch TV. We are both staring at a screen. Your staring at the TV I am staring at Dental Town. 

Dev Patel: I don't watch TV. I don't have Facebook even can you imagine that?

Howard: Well Dev, thank you so much. I have been staring at your for uh an hour. Mine is starting to grow back in. Okay, have a great day

Dev Patel: Bye Bye.

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