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AUDIO - HSP #144 - Marc Cooper
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VIDEO - HSP #144 - Marc Cooper
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How many dentists do you know who are not incorporated? Corporate dentistry is not unique. Group practices, however, can be.
Dr. Cooper's professional career includes private periodontist, academician, researcher, teacher, practice management consultant, corporate consultant, trainer, seminar director, board director, author, entrepreneur and inventor.
Dr. Cooper has studied with masters in many disciplines, participated in formal business educational programs, and worked as an independent contractor with top-flight consulting companies. In 2011, Dr. Cooper was selected as a coach for the prestigious TED Fellows Program.
The Mastery Company has been in existence since 1984. Dr. Cooper's client experience in dentistry includes solo private practice, small partnered practices, managed group practices and retail corporate enterprises. Dr. Cooper has worked with numbers of health care entities such as insurance companies, clearing houses, bio-technical companies and disease management companies, as well as the senior executives and boards of large hospitals and hospital systems and a number of their related physician groups. In addition, Dr. Cooper has worked with Silicon Valley start-ups and Fortune 500 companies.
The SUMMIT was launched by Dr. Cooper and several colleagues in Seattle Washington in 2013. The annual conference was developed to educate and support dentist-entrepreneurs interested in creating managed group practices. Due to considerable interest in this meeting, the Dental Entrepreneur Organization® was created for entrepreneurs in search of resources to assist them in growing their group practices.
Dr. Cooper is author of eight successful books; Mastering the Business of Practice, Partnerships in Dental Practice, Running on Empty, SOURCE, Valuocity, Valuocity II, Valuocity III and The Elder. His weekly electronic newsletter reaches thousands of subscribers in 31 countries.
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MasteryCompany.com
Contact Chris Creamer at (425) 806-8830
info@MasteryCompany.com
Howard: It is a huge, huge, huge honor for me to be interviewing the man and you are the man, Dr. Marc Cooper. I don’t know anybody who has … You graduated in ’66 so you’ve been around the block a few times.
Marc: Oh no, I went to dental school in ’66. I graduated in ’70, then went to perio school from ’70-’73. Then I was a Periodontist in the military from ’73-’75, purchased a practice in Beverly, Washington, Dr. Beverly Brayton and practiced there until 1985.
Howard: That’s a suburb of Seattle?
Marc: It is Seattle. Pre-Microsoft.
Howard: Pre-Microsoft?
Marc: Yeah, so it was [crosstalk 00:00:52]
Howard: Well, I want to ask you, I just want to start with the 4,000 million pound gorilla in the room and that is when I got out of school in ’87, there was Orthodontics Centers of America, the only one that made it on the New York Stock Exchange. At one time, it had a billion dollar evaluation with [inaudible 00:01:10] of New Orleans. There was a dozen on NASDAQ and they all fell apart and went away.
Then 10 years, there’s nothing and now they’re back. Now, you got Heart London, Pacific Dental Care and you’ve got a dozen corporate dentistry. I don’t know of anybody who has been around long enough to see the first roll out of corporate dentistry, then how they fell apart, then they’re back. I don’t know anybody who knows more about this than you, you have singular focus on this.
I just want to start with this question, is the corporate dentistry people like Rick Workman, he’s saying that in 10, 15, 20 years, half of all the dentists will be working for corporate dentistry. Are they here to stay? Is dentistry going the way of Walgreens? When I was a little kid, every single pharmacist owned their own pharmacy. Now, every single pharmacist I know works for Walgreens or CBC, just 2 people. Is dentistry going to follow pharmacy? How is that for a loaded intro?
Marc: Yes, [crosstalk 00:02:20].
Howard: I heard yes.
Marc: If you look at the overall scope of what is occurring and you hold that the ADA surveys are accurate, then the trim lines are pretty clear for many practices. The number of patient who visits [inaudible 00:02:45], per capita, expenditures [inaudible 00:02:50], per patient expenditures who visited them.
The rate time in a solo practice used to be around 5 days … About 10 days per new patient, only a couple of years ago. Now, it’s 5 days. There are trim lines occurring. That’s one aspect of it. Then there’s a second aspect of it is the economics of it.
Seven out of 10 patients have some form of dental plan. Nine out of 10 dentists take some form of dental plan. The only thing that’s growing is the government’s medicating state programs and insurances becoming more constricted in terms of dental practice and reimbursement, so you’ve got that piece filling on.
Then you’ve got another piece going on you have practices that are doing 1.2–2 million who can afford to buy them, but who are they going to sell them to? The volume of buyers is shrinking because you have kids who are coming out of school in $3-400,000. Then you have the patient mindset that which is electronic and they’re all [inaudible 00:04:05] economy and were driven by insurance.
When you look at all the trends that are occurring, they’re all lining up to say that solo practice cannot … Investing in solo practice costs a ton of money to run. You have you have to buy the new equipment, the new setup, the new laser, the new ... Whatever it is, I think a hundred grand a pop plus your staff is asking you for a raise, your revenues are going down and your expenses are going up, your margin is shrinking, your asset value is also decreasing, it all points to one thing which is manage group practice.
My money, if I’m putting my bets on the table, that’s where I’ll put in my bets. I think that there are many people who would like that not to happen. There’s lots of reasons for that, but I think it’s an inevitable future.
Howard: Okay, who does not want this to happen, the patient or the dentist?
Marc: The dentist, mostly. Howard, I think, when you really take a look at it, “Here I am, I’m 50 years old, I put 22 years into my practice. I made my living off of doing it this way. Now, I have a little corporate competitor showing up around me. I have group practices beginning to emerge. My revenue stream is going down. Do I want to make a drastic change? No, I’m habituated to this particular situation.”
If you take a look, they go to their state representatives and they say, “Listen, keep corporate dentistry out.” There’s a lot of laws trying to not have non-dental owners own a practice. There’s only 2 states that can do that, but [inaudible 00:05:48] done it, but I believe that will disappear as well over the next 5 years. The FTC will get involved.
One third to ½ of the population cannot see a dentist. That’s going to become a political issue. Once you get politics into this whole mess too, then group practices are going to be able to address that much more effectively than solo practice. They’ll be able to open up access because it costs less per patient delivery in a group than it does with a solo practice. This always comes down economics.
Howard: Oh, yeah. In the United States or, actually, in the entire world, money is the answer, what’s the question? You can have all these fancy philosophies, but it always comes down to money. My question is, do you think this is a good thing, a bad thing?
Marc: I worked in hospital systems from ’91-2000. I was around when Manage Care rolled in. It took away all the independent, so most physicians. Did the quality of medical care go down? I think it got better. I think you’re able to do things as a group that you can’t do as an individual. We’ll see changes in delivery of care in dentistry that are parallel to what’s occurred to medicine in group, quality assurance.
I believe this is not meant to be funny, but I’ve talked in front of a lot of dental groups. I walk into a group of dentists and say, “Raise your hand if you do not do quality dentistry.” No one raises their hands. How could that possibly be? Yet, they blame the corporations for not doing quality dentistry, but corporations are measuring, they’re doing the quality assurance, [inaudible 00:07:38].
Then the dentists now begin to roll into the picture in which they can look at the best practices, results and all of that stuff. Who can afford to do that is not a solo practitioner, but members of the group. I think that group will actually enhance the quality of care.
There’s a wonderful book, Howard, that I’d love you to read, it’s called The Cleveland Clinic Way by Cosgrove. That’s what’s possible as a group practice. That is probably the most developed group practice in the world, although it’s a Cleveland clinic, how they go about their business, how they design their delivery of care, what they measure, how they do all of that, that’s all going to be, at some point, incorporated into the dental world as well.
Howard: I always think it’s funny that the dentist who badmouth corporate dentistry the most are always the ones saying you need a $150,000 CEREK machine, a $100,000 CBCT laser, a $75,000 Biolase laser, a CBCT, all these stuff, and that’s actually the types of stuff that’s going to force that place right into corporate dentistry because those machines need to be used by 2, 3 or 4 people, not by one person.
Marc: Let me entrust another aspect because you’re using the word corporate dentistry, how many, if you’re a dentist, do you know in dental town are not in corporate?
Howard: They’re all in corporate. They say, “I hate corporate dentistry” and they have a PC after their name.
Marc: I happen to work in that domain of the industry and they’re all different. Each one of them has their values, their mission, their vision, their purpose, their leadership, so they’re not all the same. You can’t put them all into one pile and say, “That’s corporate dentistry.” They’re working together. They’re doing a good job.
The first time I went to the Association of Dental Service Organizations, it was a board room. Now, I went to the last meeting and it was a ballroom. You have to imagine the growth, it’s exponentially. Why is it growing in such a rapid developmental capacity?
If the market didn’t allow it, it wouldn’t happen, so that market trends are antic solo practice and much more supportive of group practice. Also, the economics and now the political atmosphere is going to get that way as well. I don’t think this is a stock[ph], I don’t think you can stop this. I would rather be on the front end of it than on the tail end of it.
There’s a wonderful body of work from Harvard by [inaudible 00:10:33] about the change curved. The first time I started talking about this to dentists, it was anger and denial. I got threats, it was unbelievable. Now, I think dentists are at the level of acceptance going, “Hey, you know what, it’s going to happen.” My business is about developing dentists into group practices, and doing some consulting with existing group practices, but really converting dentists to think as a group as opposed to individual. That’s not an easy thing to do.
Howard: Well, it’s funny because if you ask a dentist, “Are you about the patient, are you patient-focused or are you dentist-focused?” Just like you’ll be asking, “Are you a quality dentist or are you a shitty dentist?” They all say, “I’m a quality. I’m the best and I work on all my family.” “Okay, so you’re a really good dentist, you’re not shitty or crappy?” “Oh, no.”
Then I say, “Well, are you focused on the patient or yourself? Do you go to the mirror every morning, look at the mirror and say, me, me, me, self, self, self, me, me, self, self, self, me, me, me, me, me?” I say, “Or do you care about the patient?” “I totally care about the patient.” “Okay, well the Federal Reserve says that 1/3 of all Americans, and I go to the doctor for treatment in Friday after 5, what are your hours?” “Monday through Thursday to 5.”
There’s 168 hours in a week, they’re open 32 hours, so that there are a whole rent, mortgage, equipment, [inaudible 00:12:02] computer, the insurance, laser, CBCT, CAD/CAM, it’s only running 19% of the week, then they get mad at this corporate people and they’re the one hiring the 5,000 dental graduates that are going to replace us when we get hit by a Mag truck.
It’s like, “Well, you don’t provide jobs, you don’t extend your hours, you’re not patient-friendly, you’re not consumer- friendly and this is America. America is the country, if you want a pizza delivered in 30 minutes, someone’s going to knock in your door.” You know what, a funny thing, I was hiking on South Mountain a few Sundays ago, some lady fell. She couldn’t get up, move or whatever and everybody’s on their cellphones, they called 911. There’s 2 fire trucks there in 3 minutes.
I told the firemen, I said, “Thank God, she didn’t break her tooth because there’s no chance she could find a dentist in Phoenix, Arizona today, but God dang, there’s the firemen, they’re right there. It doesn’t matter if it’s Christmas, Easter or Hanukkah, they’re right there.”
I think Americans, at the end of the day, are going to get everything they want. What they want is faster, easier, lower cost healthcare. A corporate dentistry delivers that better than the individual. I want to ask you this, when people say, “I don’t like corporate dentistry” and they’re an LLC or a PC, what is the correct term for … When I think of corporate dentistry, I think of multiple locations and multiple states.
Marc: Yeah, there’s a tier of them. You have the small ones that are 5-10 locations, more in the neighborhood, maybe with a central, larger entity that can do specialty services. A lot of them are 20-30, that’s the sweet range, regional practices, lots of control. Then you have the larger and larger units. I think Heartland’s going to surpass a thousand practices this year.
Howard: What is Heartland, yeah?
Marc: Yeah, I think their target is 150 more practices, I don’t know, accurately.
Howard: You think the sweet spot is 20-30 practices?
Marc: Well, for this time in the evolution of the industry, I would say 30 practices will give dentists a good stock, ROI, good collegial relationships, a strong presence in the community and they’ll feel that they’re writing their own story. That’s really important to dentists.
You have to understand, from my point of view, I have known dentists forever, that number one, is a little bit of this, what you just talked about, it’s a little bit of this entitlement streak in them, they think they’re entitled to not provide the kind of exceptional service, the hours that are needed to capture the market.
If you look deeply at this, Howard, there’s something like, “Well, why … I’ve done it for 50 years like this or 100 years, now, you’re going to ask me to open up on Thursday nights, Fridays and Saturdays, I don’t want to do that because that’s going to require more staff, other doctors, more management.”
There’s a kind of entitlement about it, “It should be this way. It should be, our focus is this way, not this way,” but the market demands, particularly now that all the social media and all the stuff that’s going on, people want to go when they can go.
The second thing that I see is just that corporate dentistry is beginning to whet that need, it’s beginning to open up access, it’s beginning to have evening hours, it’s beginning to adjust themselves to the third parties that will pay them. They’re meeting the market need. Solo practice, because of the way it’s configured, has a very difficult time doing that.
Howard: Well, I think the single, biggest market failure in dentistry is the fact that the Center for Disease Control keeps telling us that about 8% of the emergency room visits are tooth related and America deserves a 24 hour dentist. When I literally Marc … You can’t make this stuff up. When I tell you this, you’re not going to believe the story, I had an emergency patient come from the emergency room and the doctor gave him his x-ray.
He took a 2 ft. by 2 ft. x-ray of the side of his head, gave him penicillin and Percocet and I thought … Marc, you go in there, an emergency room and fix a broken leg, they can fix your heart, they can’t take a PA of a molar, they can’t pull a tooth, they can’t start a root canal.
Marc: I believe that there’s an incredible business opportunity for someone who wants to do urgent dental care service. If you look at about 20% of all emergency care visits to hospitals are tooth related and they do exactly what you say, they don’t have a place to offload them.
[Inaudible 00:17:07] has a dental clinic, [inaudible 00:17:10] hospitals I’m talking to have dental clinics. I think they’re seeing the [inaudible 00:17:14]or the interrelationship with systemic disease and the chronic diseases in terms of lowering cost, but they’re also seeing, “My God, I spend so much money with dental.” It’s just occupying a space in an emergency room is a couple of hundred bucks. Even seeing your doc and taking away from patients who really need it.
Howard: What percent of emergency room visits do you think are dental related? What data are you seeing or have you seen?
Marc: I can’t be accurately quote it, but if you went to the Health Resource Institute, that’ll be ADA, Marco has measured that pretty closely. He has some graphs on that that I don’t have instant recall of.
Howard: What’s his name?
Marc: If I’m going to mispronounce his last name, so please, you’re going to have to …
Howard: He works for the ADA?
Marc: Yeah. The ADA has … Marco, I’m going to say it poorly, Witziak[ph], has taken on the leadership of the Health Resource Institute. If any of your folks are members of the ADA, they ought to go visit that. He has the most remarkable data that I’ve seen about industry trends, what is occurring …
Howard: Can you spell his name?
Marc: Oh, I have to look it up on …
Howard: It’s okay, it’s okay. ADA Health Resource Institute has data on this, okay.
Marc: Brilliant body of work, the guy is just brilliant.
Howard: I have an MBA from Arizona State University and I love economics as much as dentistry. In my mind, I totally see how if you went into a small city and had a location, northwest [inaudible 00:18:53] and south, you’d have scales of economy, so you get someone totally focused on finance, HR, marketing and you could just have scales of economy because in dentistry, you have too many unsophisticated people wearing way too many hats. As you get just a little bigger, you’d get specialization.
I have lectured around so many smaller markets where a group has 3, 4, 6, 8 locations. They’re not in sexy areas, they might be South Dakota and Nebraska or out in the middle of Timbuktu and they’re very well-run and efficient. What I don’t see is skills of economy of the next layer up where there’s a headquarter location and you got to pay for all that overhead.
Then they have the regional location which is the most efficient, then you have the office location. I totally do see regional group practice within office. I hired my first associate the day I opened. I thought, “Well, I’m going to work 7-7, Monday, Tuesday, 7-1, Wednesday, Thursday, bring in someone else, 1-7, Wednesday, Thursday, 7-7, Friday, Saturday.”
I did that in 1987 and it was a complete competitive advantage to every other dentist in the neighborhood. We were [inaudible 00:20:09]. We had early morning, evenings. In fact, what’s funny is the older guys, they would leave my dental office [inaudible 00:20:17] emergency room, they say, “We’ve got emergency after and we’re closed. [Inaudible 00:20:21] today’s dental.” It was amazing that they didn’t even care.
What advice would you give to the dentists, 40-50 years old, that are seeing this change pop-up around their office and they still want to stay in this game. You’re still [inaudible 00:20:40], that they want to do another 10, 20, 30 years, what advice would you give them? Would you tell them to get big or go home?
Marc: No, I’ll first tell them to get smart. I do an educational program, if you’re a dentist, called, “Okay, you’re here, the future’s here, get smart about it. What is an MSO? What is a DSO? What is a group practice? How do they work? How do they operate? How do they administrate? What is the leadership like? How are decisions made?”
I have created an educational program to take those dentists who understand that the future is coming at them point blank, that something has got to occur for them in order for them to have their asset values increase and their talents used and educate them about what the hell is going on so they understand the landscape and can make better choices for themselves.
Some will sell their group, some will form a group, some try to stick it out if they’re in a small enough region, they’re doing the margins and they can hold on. Yeah, they may be able to make it 5-10 more years. They’ll have choices, but the choice always comes after consideration. Consideration is a matter of understanding. I need to understand what the hell is going on.
When you look over there, when they look at group practice or corporate practice as you call it, they don’t know what the hell is going on. Once you have understanding, then you can begin to serve the appropriate moves for your assets, your values, where should I put them? I’ve had groups developed, I’ve had people sell them to groups.
I’ve had all of that occurring, which at first what I would do is get educated. Then the second is just make a choice that you feel you can … That honors your values, that honors your ethic because there are a lot of good people and good groups around or form your own group.
Now, that’s a whole other story, but you can form your own group, you just have to learn how to go through a particular process, invest your money and time, but it can be done. I don’t know if that fully answered you question. Those are the things that I’m doing forward, at this point.
Howard: Dentistry is changing in another area. When I was in dental school, all dentists were males. The senior class had one girl in the class. My class had a dozen. Now, 45% of the classes are women. A lot of women are telling me that one of the things they love about group practice is that they have a baby, they might want to take off 3-6 months, they might want to only come back 2 or 3 days a week.
They love the flexibility of group partner and they don’t want to be married to a husband, married to children and married to a dental business. Do you think the change of all males like us to now 45 in the graduating class are women, do you think that’s had an effect on the demographics for corporate dentistry?
Marc: Absolutely. I think you also have the millenials coming in, your generation x or y, I’m a post baby boomer, whatever you want to call us. Millennial see the world differently and that’s just coming out of schools. You have the women who, exactly what you’re saying, who are looking for a good job. Great, because of the availability of practice …
Howard: What would you say to all these dentists who don’t hire them and they’re closed Fridays, Saturdays and Sundays that I say to them, “Do you have a digital phone recorder?” They have an answering machine, so they think the 1 and 12 people are leaving messages, they’re going to a call I say, “Do you have a digital answering machine? Do you know how many people called your office?” “No.”
Just like, “Why are you mad at Hartlan[ph] for applying these jobs?” Then these people join the military, they have to go sit in an aircraft carrier for 6 months in the middle of the Pacific Ocean. It’s like, “Why couldn’t they go to Parsons, Kansas and why didn’t you provide a job?” You forced corporate industry’s hands because you don’t provide jobs.
Marc: It’s not like me, Howard.
Howard: Yeah. What you and I do is when we talk, because I’m a big fan of yours for decades. A couple of my friends went to your [inaudible 00:25:04]. You know Sarah? She went to your class in Scottsdale, but I think what you and I have done is we made a living just telling us what we truly believe where a lot of people are politically panhandling.
So many people in dentistry are telling you what you want to hear. People like us, they don’t like our message, they can call us an asshole, but the bottom line is you and I are smart people, we believe what we say. You can’t buy our thoughts, we’re not promoting an argument.
I want to ask you another thing about group practice, that’s the another 4,000 pound elephant[ph], dentists all agree that when you marry a woman, you make love, have children, holidays and she’s beautiful, that fills half the time. Now, you’re telling me to form a group practice and marry a male dentist that I don’t have sex with, I don’t sleep with, we have no children, no holidays, none of all the glues that hold a relationship together. Quite frankly, dentists are complicated people. That’s not the easiest person you get along with.
The reason why is the normal people in college, they went out, they had girlfriends, they had joined frats, they made As, Bs and Cs, so they never got in med school, dental school or law school. It’s the freaks like us. I closed down the library at midnight. Every night, I was at Creighton and got accepted a year early. We’re not well-rounded people. We’re freaks. Marc, are you suggesting on the Howard Speaks Podcast that I should marry another male dentist?
Marc: I’m suggesting that if the leadership is there, from my viewpoint, Howard, I’m just going to go through this quickly, there are 4 aspects that I look for in leaders is authenticity, integrity, responsibility and the willingness to make a difference to leave a legacy.
Howard: Authenticity …
Marc: Authenticity, integrity, responsibility and a commitment to something bigger than yourself.
Howard: That’s awesome, well said.
Marc: If the leadership … You talked, we mentioned this …
Howard: Have you named the 4, that authenticity, integrity, responsibility and how do you say the fourth one?
Marc: A commitment to something bigger than yourself.
Howard: What would that be in one word?
Marc: Legacy.
Howard: Legacy, okay.
Marc: You take a look at [inaudible 00:27:25], any of the player who have owned this large entities, they have all of that. Now, it may not look that way to dentists [inaudible 00:27:36], he wanted to make a difference. He wanted to make a difference for dentists, make a difference for the patients that were treated and he wanted to give dentists a management structure that allowed them to be able to be more successful in life and in their practices.
When you’re up to something big, when you’re up to really doing something beyond taking just your focuses on I, your focuses out here, then partnership works, the marriage works. If a marriage doesn’t share the same future, it dissolves.
I think that partnerships are very possible in dentistry when the criteria is meant for leadership. Let’s change the way we deliver care, let’s change the way we … Let’s do the best work we can for patients. Let’s actually measure something in terms of quality. Let’s be the best we can be.
Howard: My job is to ask the questions. About 7,000 people are downloading this show, so my job is to ask these questions. I’m trying to predict questions. I don’t always ask questions I don’t know the answer, but what do you think is better though, if I’m one of the 5,000 graduates, the dental recent grads are devouring this podcast, they’re huge for them.
If I’m going to go get a job, will it be better to work for the man like you and you are the sole owner, you have this, you’re older, leadership, authenticity, integrity, responsibility, commitment to leave a legacy and there’ll be less drama, we’re all associates or do you think they should be looking for a buy-in and say, “No, I want to work for a group where there’s going to be 8 dentists and we all own the 8. Is that going to be a lot of drama and stress?
Marc: It depends how it’s setup. Most of these things are setup for survival and not for making a difference, how do I protect my interest? It’s playing defense, not offense. I like offense to win the game. You can play as much defense as you like, “No, I’m not going to let corporate dentistry in, I’m going to get a small practice, I’m going to try to kill off all my competition, I’m going to talk to my state representatives to kick [inaudible 00:29:59] out of non-dental hands.” All the things you’re doing is toward their own survival of what they’ve already got, but you cannot stop this.
When I talk to young graduates, which I do from time to time, I say, “Look at your values, because that, ultimately, is the decider. What are your values, what are your core values? Where do you see yourself in 5, 10 years? What do want to achieve with your life? What is that all about for you, then find the place that that can be expressed.”
There are a lot of good groups out there that he can or she can start to look at. We just talked about young, women dentists coming out. What are values? The values will be family and children, [inaudible 00:30:54], “Well, where can I do that?” Where to get a young kid out, so he just wants a job, pick up his 200 grand a year. They don’t need much money as dentists did in the past, so they’ll be dentists in the future.
Howard: Marc, when I was telling a lot of my friends that I was so excited about having you, some of them are your biggest fans and some of them weren’t aware of who you were. You have 8 successful books, Mastering The Business of Practice, Partnerships in Dental Practice, Running On Empty, Source, Valuocity, Valuocity 2, Valuocity 3 and the Elder.
I wish you would consider making a dental time online CE course for each one of those books. We just passed 200,000 registered dentists on Dentaltown, it’d be amazing [inaudible 00:31:47] or this Dentaltown, the app, is everything because people carry it with them all the time.
We just passed 35,000 downloads on the app. Most of my podcast views are actually through the app, but we’re starting an audio book section. You could read those books on audio file because what the millennials are doing … What you and I did, the real deal is we sat down and we read books while all the elders are running around, yelling all at you, “You need to read more, turn off the TV” and no one wanted to do it, but now reading is audio and it’s multitasking.
These kids are ADD and they’re listening to an audio book or a podcast while they’re doing the dishes, the laundry and cleaning their car, they’re on a treadmill and all these kinds of stuff. I was hoping, could I get at least 1 online CE course out of you and at least 1 audio book?
Marc: Well, this is going to be a good conversation. I opened up this morning my email and I saw a program that’s being promoted on Dentaltown, in your Dentaltown, whatever, someone sent it to me. I don’t want to mention the name because I think I might get in trouble, but it was igniting your practice to be successful and making sure that you can [inaudible 00:33:06]. My impression, and I could be off about this Howard, is Dentaltown represents the mass that’s trying to restrain group practice from emerging as the leading deliver of care.
Howard: My comeback to that is when you’re at 200,000 members, you basically have every American dentist that owns an internet connection, then about another 40,000 Australia [inaudible 00:33:35] around the world. I can’t find any single area that we have more or less been the general population.
When you have them all, you have them all, 200,000 is huge. The reason it’s huge it’s because if you go ask a question on Dentaltown, the main value of dental time is why I create it was that no dentist has to practice solo again. In 1998, I thought that was priceless to me.
When I put my 4 boys to bed so many nights, I just so desperately want to show, “Here’s a root canal, here’s the final, they swelled up. Should I have not one stepped in. I put them on [inaudible 00:34:16], should I add it …” I was just sitting and everyone who loved me, my 2 older sisters are nuns, my dad and mom went to church every day, 7 days a week until my dad died. They would just say, “Well, I’ll say a rosary” or “I’ll dedicate mass tomorrow morning.” I didn’t want another rosary, a candle or someone to kill a cat, I just wanted to talk to a dentist.
The think about Dentaltown that’s first in classes, yes, if you ask a question on Dentaltown and you go to the bathroom and come back, 5 people have answered it. That’s what’s priceless. By the way, this should seduce you to put up a course, we put up 327 courses and they’ve been viewed 550,000 times, half a million views.
I like to go out … That’s why I was chasing you down because you weren’t chasing me down for this, I’ve been chasing you for a long time. I want you to go out there because there’s very few people that … I’ve been in this business for … How many years have you been a dentist?
Marc: I started dental school in ’66, it’s 40, 50 years.
Howard: Yeah, there’s so many young minds in there and they need to see what you have to say. I think it would be … It’s about your legacy, I think you’d have the biggest reach and impact. By the way, they’re going through the same questions in England, Australia and [crosstalk 00:35:42]
Marc: I have clients in all those places as well as Singapore, as well as Hong Kong, as well as Dubai, Abu Dhabi. It’s a global phenomenon.
Howard: I know, you’re the man, so you build me an online CE course and talk about this. It’ll be a huge exposure and enlightenment for so many minds.
Marc: Let’s talk about the structure of your CE courses then before I commit to anything. I want to be clear, what does it take to design a CE course and help people who don’t need to contribute?
Howard: No, everybody does it different. Most people just upload their slide … Howard Goldstein is the dentist in Bethlehem, Pennsylvania that’s in-charge of it. He’s [inaudible 00:36:24] with 3,000 [inaudible 00:36:25]. Most people just upload their slides, then call on the phone and do a voice-over.
Marc: Okay, we have a program ready to go. It’s called Future Strategies. It’s about here it comes, here comes the future, what are you going to do about it? It’s got a voice-over. We recorded with a professional studio. It’s got all the stats, it’s [inaudible 00:36:48]. Let me send that into Dentaltown, however you recommend.
Howard: You may send it to howard@dentaltown.com.
Marc: Okay. Then go see the response rate to that.
Howard: Awesome.
Marc: Okay, so we’ll do it … In Silicon Valley, they call it proof of concept. Let’s see, because I am of the particular view that the trends are going into a certain way and it gets to be … I get a lot of responses from my blogs, from people who just really want to read me a new one because what I’m saying about the future of dentistry. They want to protect it.
About 3 years ago, I got engaged, I want Dentaltown in the conversation, and I got blessed, by the way. People were really upset with me. In fact, people called me names, but it was pretty close to that, they’re saying, “You’re going to ruin the future of dentistry, you’re talking about [inaudible 00:37:52]” like I’m talking to a communist country, like I’m talking to North Korea or something.
Howard: Well, the problem … The only thing I ever said about you is when the Sea Hawks beat the Arizona Cardinals, other than that, that’s the only strike you have against me. You’re going to do it again this year, I know you’re going to beat us again this year.
Marc: I don’t know now, [crosstalk 00:38:13]
Howard: You’re the only team standing in our way this year, but I want to say this that the problem with communities, this has been researched, and the communities, they might be programmers, engineers, lawyers, it doesn’t matter, the standard deviation, 1, I mean, 3, and the standard deviation, now you’re 3, those are the 5% of the 200,000 members do 80% of the posting and they’re all the extremists.
What you have to realize is … That’s why do it on media like when you watch the McLaughlin Show, Fox News or CNN, those are the freak on the right and the freak on the left to show the extremes knowing that they’re going to define the parameters of the debate and all the normal standard deviation, 160 and a half percent, they’re lurkers and they’re never going to say anything.
That’s why in statistics, in my 501 statistic course, all those call-in numbers when they say, “Call in 1-900 then vote yes or no,” that data is never statistically significant because all it is is freaks. Every normal person isn’t going to spend 50 cents to get their vote in to the television station. It’s just nut head.
When you’re posting, what I tell everybody to do is keep your eye on the 200,000 members that are normal, moderates and that are never going to enter the phone conversation because they’re not a freak. If you’re listening to this and you’re a big poster, yes, Howard just called you a freak. Some people call me a freak.
You dropped 2 terms and I always have to be in-charge of answering the questions. You dropped a couple of terms so you got to define them. You said, get smart, know the difference between MSO, a DSO. Can you explain that and then follow that into how do you start a group practice?
Marc: Okay. Well, it’s very complex. The more developed you become as a company, the more complexity occurs. In some areas, what you have is you have a dental component which basically a DSO, a Dental Service Organization. It’s [inaudible 00:40:25] … By the way, I should say this, if people want a lot of information, they should go to my website and go to the multimedia section. I have audios, I have videos, I have blogs, all on materials and information [crosstalk 00:40:43] about today.
Howard: How long are those audios?
Marc: Usually, 20-30 minutes.
Howard: On the Dentaltown app, do you realize that on the Dentaltown app, we have a podcast section and about a dozen different dentists like us upload their podcasts. They all say they get far more views happening on the Dentaltown than they do on YouTube, iTunes, whatever. You could upload every one of those for free.
Marc: I will do that.
Howard: That would be awesome. I would listen to them.
Marc: I would ask my … I have an incredible partner, administrator who … He’ll need to figure out and work with somebody in your company [inaudible 00:41:23] all our stuff.
Howard: That’ll be so nice. Like this morning, like every other day, I bike around South Mountain, it’s a 44 mile bike. I don’t want to tell you how long it takes, because then you’d know how old, fat and piggy I am, but it’s about a 3 hour bike ride. It’s so fun. You could do half an audio book. Then at the podcast, when it’s done, it rolls over to the next one. Three hours around the mountain, then you get to the office, you just have all these ideas racing through your head and all these things. It’s amazing.
Marc: We have enough material, at least to not create something for about 2 years at Dentaltown, the materials we developed. The Get Smart Program, it comes , “You’re old enough to remember to get smart” televisions how, that’s what I’m talking about, get smart about this. It’s an unalterable future that’s going to happen. You cannot stop it. Economics is always the driver.
[Inaudible 00:42:30], for example, much of it is standalone, but by the end of the decade, I think it’s going to be embedded into medical insurance. I don’t think you can avoid that. That’s going to change things as well. There are so many things that are occurring. I trained with [inaudible 00:42:47] back in the day, he always said, “You only see what you know.”
What this course is about is knowing things so that you can see things out there occurring, make decisions that are going to be consistent with what you really need in terms of your values. If you’re blind, if you got your head in the sand, all you’re doing is resisting this thing occurring, that’s really dumb. Kids today are digital natives. They grow up with all this stuff. For you and me, running and having all this computer crap, it’s effortful.
Howard: Do you want to hear the most embarrassing technology story? I was trying to get my Apple TV to work and I was cussing at the TV saying how the damn thing never works, shut it down. My granddaughter, Taylor, is 3. I don’t know what she did, she walked over to the center, she was literally in the TV and she was mumbling something and it she got it to work. I said, “Oh my God, she’s 3, how did she … What did she …” I don’t even know what she did.
Marc: She’s growing up in another context, context is the [inaudible 00:43:58]. We go into that and we don’t know what they [inaudible 00:44:02] intuitively know. We don’t have that intuitive sense of how to deal with electronic interface. We have to struggle. It’s the same thing with dentists that if they are coming into a new context, we have to understand the context of dentistry has changed. It isn’t going to go back to the way it was. Get clear about that. Cellphones displaced payphones. When was the last time you saw a payphone?
Howard: Well, I had to use one when I changed into my super menu.
Marc: Usually, other than that …
Howard: Other than that, I don’t …
Marc: All I’m saying is that when context changes, everything changes within it. When [inaudible 00:44:44] 3 years ago got funded for $1.3 billion, you have equity partners calling me … I have one coming up this afternoon actually after [inaudible 00:44:53], he’s flying up to meet with me so he can figure out where to put his $50 million into dentistry.
It’s amazing when you have $125 billion industry which is greater than the GP. Of course, national product with the numbers of countries and it’s growing. Interestingly enough, the access is decreasing. You take a look at the family structures and schedules, people see it as a retail business, they do not see it as a service business. That changes everything.
Howard: Marc, is there any chance I can get you to go through your 8 books? We’re 45 minutes in this, 4 we’re 3 quarters down, 15 to go, any chance you could go through the 8 titles of your book and give the most important takeaway from each one of those books?
Marc: Yeah, I think I can do that. Mastering a Business of Practice is not about what to do, it’s who you need to be to be able to do that. If I put Babe Ruth’s bat in your hands and sent you to the Arizona Cardinals and got in that batter's box. This babe Ruth bat, you know how to swing it, but you wouldn’t hit the damn ball because you’re not a baseball player.
Somehow, most dentists, when you look at them, are not the owner, they’re not a leader, they’re not a manager. This is what’s looking at yourself through those lenses, like who you need to be, not what you need to do. That book, I think, is fundamental for anybody to understand whether they’ll be a solo practice or a group practice. Most partnership, as you know, in dentistry fails. When you …
Howard: Since you used a Babe Ruth, I got to ask you a Babe Ruth question.
Marc: Okay.
Howard: Who should have to give back their prestige more, Babe Ruth who played when all African-Americans were not allowed to play or Barry Bonds who played on steroids? Which was a greater advantage, Babe Ruth, having no African-American to play against or Barry Bonds on steroids?
Marc: Context is decisive. The era of Babe Ruth was the era of Babe Ruth and the era of Barry Bonds is Barry Bonds. Today, most performance enhancing drugs, they’re unable to be detected so they’re probably … You’re a professional athlete, so of course you’re going to do to try to get the edge. Do I blame him? No. Should it be regulated and part of the game? More than likely, yes, because it’s not going to go away. When the context changes, everything changes within it. This is another example.
Let me just go through these books and then we’ll take a couple of minutes. The Partnerships in Dental Practice, the subtitle is Why They Succeed and Why They Fail. The Partnership for… Back in the day, remember, Howard, that not too long ago, everyone was promoting, “Get an associate, sell them half the practice, work in the practice for 5 years, sell them the other half, then become an associate until you walk out the door. That was the classic way of looking at this, but most of them failed.
When you really take a look, who do associated fail, why do partnerships fail? I looked at that pretty deeply and this is what this book is all about is how to have a successful partnership.
Howard: Why do they fail? Why did most of them fail?
Marc: Because they didn’t do … Well, if you take a look at, and I’ll use some, given yours, your family heritage, your church provides an incredible service called premarital counseling. Most of those marriages succeed because they went through the process of looking at their values and what to do when issues happen, how to communicate and how to structure their relationships so that when it hits the fan, they know how to deal with it.
I think that none of that is ever done in dentistry. What happens is you have somebody who says, “There’s the economics about how you’ll win. I’ll get an associate.” You get the associate in, we throw them to the water then you hope he wins, but you never communicated, you don’t have full partnership meetings, you have never gone through your values systems to see if they’re aligned. You don’t have a common future.
The work I do in partnerships is I take people through a whole series of things to make sure … Let me give you an example. Human beings operate the way they operate. We’re all kind of the same. We all have expectations. You have expectations. Expectations aren’t fulfilled, [inaudible 00:49:39].
When someone sits down with an associate and a senior doc, what does a senior doc expect from an associate? Behavior, marketing, dealing with staff, dealing with the patients, they never communicate that. Then he sees the guy walking out of the front of the clock, he says, “Damn, I’m here until 6:30 …” Expectations aren’t fulfilled, start to fracture a partnership.
Then there’s some things called concerns. When somebody doesn’t do it like you, you have a concern that they’re missing something. Where the greatest flaw in a partnership is is in the communications domain in which they fail to communicate their concerns and expectations and transact those so that they are handled and not getting in the way of the future of the practice. The book is about how to do that.
Howard: That sounds like an amazing book.
Marc: It’s an amazing book.
Howard: Now, when you put that audio book on Dentaltown, are you going to read it yourself for free or are you going to mail it to us or have one of our readers read it for you?
Marc: Actually, I tried that. When I lived in Ashton, I had a friend who did audio books. He actually [inaudible 00:50:51], you read it? I have dyslexia so I stumble in my reading. I prefer that you want to record it that I do with some of professional reader, I think it would be a little bit easier than listening to this voice.
Howard: When you were little, did you think everyone was praying to a dog?
Marc: Yes. The worst thing is [inaudible 00:51:12], they said, “No, I’m still on.” [Crosstalk 00:51:16]. Yeah. Then the Valuocity book is really about …
Howard: Did you make up that word?
Marc: Yes.
Howard: Awesome. I did that on my book, Uncomplicate Dentistry Business, Uncomplicate Business and uncomplicate is not a word.
Marc: Yeah, well it is now.
Howard: Yeah. I love the fact that I … Xerox wasn’t a word, they pulled that out of a hat just like many of the pharmaceutical names, always find a word with an x, y, z. That’s so creative and cool that you created it. Where did you get that word, valuocity?
Marc: Well, we knew that if you read the volume of books in the business state, Drucker[ph], Collins, [inaudible 00:52:00], then [inaudible 00:52:03] they all say the same thing that a value driven business can stand the temper of time. There’s a wonderful book out by Collins called How The Mighty Fall.
Howard: I love that book.
Marc: Exactly. Look at the index about the businesses that succeeded and got through 2008, they were all value-driven. If you look at Zappers[ph], if you look at Amazon, if you look at Starbucks, really, the great companies are value driven. Now, dentists usually hold values platitudes. They’ll do their little core values, then they’ll go on and do whatever they do, but what it does a value-driven business look like? Really, a dental practice look like or a group practice.
Valuocity 1 and 2 are about really dental practice because it was written during that time. Valuocity 3 is about how to develop group practice based on core values. To get the group together, where do you start? [Inaudible 00:53:02] about that.
Howard: Talk about that, how does a dental office … What are core values? Look at this, all research shows amalgams last longer than composites. Yet dentists, well, some believe that … Well, [inaudible 00:53:18] and said, “No, no, no, not if they’re done the way I do it. I’m special, I do it differently. My composites last forever.”
It’s like this, you ask a dentist, “What percent of your root canals fail?” “Well, knock on wood, I’ve never had one fail.” It’s like, dude, there’s 4,000 endodontist and they all tell me, all they do is retreat your failed root canals, but I can’t find any American dentist that’s had a root canal. Dentists are nuts. They never had a root canal failure. There’s 4,000 endodontists. I guess they just work on illegal immigrants coming into the country with failing root canals because no American never ever.
They believe composites lasts longer than amalgams when the research says, “Actually, the amalgams last twice as long.” When you’re saying ‘create values in a practice,’ isn’t that arbitrary? Are you grasping for [inaudible 00:54:06]? How do you put values in a dental practice when you can’t get 2 dentists to agree that today is Wednesday?
Marc: I don’t think that that’s an accurate assessment. I think that people are actually value-driven. What happens is they don’t have the courage to live their lives in accord with their values. There is a risk factor that one must … The difference between an entrepreneur and a dentist is a dentist builds a practice primarily to get themselves a good income, to be able to fund their retirement, then to go out happy. They do a fair amount of CE to train themselves become better at their vocation, but they are risk-adverse.
Their risk tolerance is not very high, they’re very conservative. I work with enough entrepreneurs where they’re willing to take that risk, where they’re willing to borrow a million bucks or 2 or 3 or 5 to put together a group, where they’re willing to make more bold mistakes and not be upset by the mistakes they make.
One of the reasons that group practices are accelerating in terms of their growth is they’re risk-takers and are able to manage the risk they take whereas dentists are so conservative trying to hold it back. You have kids, right?
Howard: Four kids, 20, 22, 24 and 26.
Marc: Okay, when you …
Howard: I’ve never done DNA studies, but at this point I still assume they’re mine.
Marc: Okay. When you corrected them as children, what guided your correction? When you saw them do something, you said, “Hey, don’t do that,” what guided your correction?
Howard: That they will be productive people when they grow up. That they would be productive citizens and that the playground will be better when they left it than when they entered it.
Marc: Right, those were your values because you look at it from your values system into the world. It determines the choices you make, oftentimes. When you don’t operate consistent with your values, your own integrity goes out. When your own integrity goes out, there’s usually some kind of suffering or justification, but when you live in accord with your values, your values make a major contribution to the dental community.
When you took … You have a lot of heart to be able to put together Dentaltown and take the risks you took, but you have … One of your values was contribution, that’s one of your values, that’s who you are. If I were to take you out of Dentaltown and I will put you in something else, that would drive you.
Getting dentists in touch with those values so that to clarify for them, you actually see them, they’re tangible, they can hold them, “Oh yeah, that’s my value.” Then the question becomes, how do you live a life or create a business that’s consistent with those values and to take a look at the interferences that [inaudible 00:57:12]. There are ways to do that, but values, they drive you
Howard: That’s why you said, and I hope the listeners caught that, you don’t call dentistry an occupation, guys like us say that it’s a vocation. My 2 older sisters are nuns. I think working your whole life so that people can keep their teeth is a noble profession and it’s a vocation.
Marc: I agree. The reason I left periodontics and I started to do all the business is exactly that. I couldn’t … We have 3 minutes, I’ll try to [crosstalk 00:57:49].
Howard: No, no, no, dude, we’re going into overtime with you. I would never ever …
Marc: All right, [crosstalk 00:57:54]
Howard: Stop a recording with Marc Cooper.
Marc: [Inaudible 00:57:58], let me do that. Let me come back to you. Can you hear me? Did I [crosstalk 00:58:05]
Howard: Oh yeah, I can hear you and see you.
Marc: Okay, great. I’m in my perio office, okay? Referral sends in a patient. The patient, her name was June, I can’t say her last name. An incredible, wonderful woman. She had been a patient of this doctor for 12 years. I put in my probe, 6, 7, 9, 7, 5, it’s like, “Whoa, manage neglect for 12 years. This woman is fabulous, she’s going to lose her teeth.” Implantology was not … I was using [inaudible 00:58:43], that’s how old I am.
Howard: That was very controversial back then.
Marc: Yes, probably … They didn’t work anyway, but anyway, so I’m looking at this, then as a peridontist, because my market, my customer is not the patient, it’s the GP. I can’t tell the patient the truth. I can’t say, “You have been screwed, lady. He’s probably screwing everybody else around you.” My integrity really was in question. What I said is, “I can’t stand this, I have to do something about it.”
Now, if I go become … If I didn’t take … One of the areas that I think is core for me is responsibility. My definition of that is I am causing the matter, I got to do something about it. What can I do? The first thing that I … Well, one of the things I discovered is the more economically viable people were, the better dentistry they would do, the less they would have it.
The more education they would get, the more experience, [inaudible 00:59:52], it doesn’t really matter, but they would improve their dentistry if they’re … The Maslow hierarchy thing, we keep on moving up. I saw that what I needed to do was generally more success for dentists, not try to make them wrong about the way they did their dentistry.
For years, I was a practice management consultant improving the performance of practices. Then it became obvious about 6, 7 years ago, “Hey, you know what, for dentists to really succeed in this new world, they’re going to have to figure out how to be in groups and how to work as a group, how to talk as a group and how to make decisions as a group or they’re going to be [inaudible 01:00:33] to the side.”
I’m for the dentists’ success. Oftentimes, because I’m a little bit more into the future working backwards, then the present working forward, I’m somewhat of an irritate to, “Hey, here comes the meteor, it’s going to hit.” Now, where are you going to be when it hits and what are you going to do about it?
I’m always for the dentists being successful because I think they do a tremendous job. Dentistry in this country has produced magical stuff. [Inaudible 01:01:11] for the pathways and it gets treated with the sealants and the things we do is remarkable, but we’re so limited in access that it’s going to become very problematic.
Howard: Valuocity must be your heart and soul because you have Valuocity 1, 2 and 3. I really, really hope that your friend that does the audio thing reads it for you or send it to us, [inaudible 01:01:37], but the other book, the Elder?
Marc: That’s another story. I have a great relationship with a Native American tribe. I was indoctrinated as an honorary elder. I also studied with an individual in [inaudible 01:01:57] University, Zalman Schachter, who had a program called, Age-Ing to Sage-Ing.
What I noted was is that what’s missing in our culture. It’s not a dental book, although it can be very applicable to dentistry. What I noticed in our culture is that where or how to start aged people and we don’t get any of their wisdom. We don’t have elders.
What we have is we have a [inaudible 01:02:27] and we believe what the hell is going on with our [inaudible 01:02:30], but you look at that original tribe, so you look at some European countries and you see the elders interacting with not the generation x, but the generation below that, intergenerationally and the wisdom that the can provide. It’s really very simple, if elders were in-charge of the world, there wouldn’t be war.
Howard: Last, but not least, how do they get a hold of you, www.masterycompany.com, M-A-S-T-E-R-Y company.com? Then how do they get a hold of your weekly electronic newsletter which goes to people in 31 countries?
Marc: They can do that just on … Our website is very robust, full of materials. It’s been accumulated for the last 6 years focused on the transition from solo to group practice. The can sign up for the newsletter on the website.
Howard: Well, buddy, all I want to say is when I got out of school, you were already a legend. Like I say, when I talk to anybody about corporate dentistry, where it came from, where it’s going ever, you’re always the authority, authoritative person.
I don’t know nobody who spent more time thinking about it or someone who is even smart enough to know the difference in Collins and Porter, 2 of my favorite business legends, but hey, we’re out of time, it’s an hour and 3 minutes. I hope we get that core sent to us, so our 7,000 listeners will be looking for it.
Marc: I’ll just send them. Maybe it will take us out a few hundred, I’ll just have Chris send you the material, is that [crosstalk 01:04:05]
Howard: Yeah.
Marc: Okay, great.
Howard: Then I want to get those audio books on because when I talk to people, they’ll do like a treadmill, 3 times a week for an hour. They’ll do 3 hours of audio book. You can only listen to the Rolling Stones so many times and you want something a little more stimulating, but dude, seriously, thank you so much. You have an annual seminar every year in my backyard, Scottsdale. When’s the next one?
Marc: End of May, I can’t give you the exact dates because [crosstalk 01:04:37]
Howard: May of next year, May of 2016?
Marc: Yes.
Howard: Well, I want to go that.
Marc: I’ll be glad to have you.
Howard: I’d like to go. Marc Cooper, thank you so much for everything you’ve done for dentistry, for your books, everything you’ve done for the profession. You’re seriously one of dentistry’s thousand points to light.
Marc: I appreciate that, thank you. Coming from you, that’s important.
Howard: Have a great day.
Marc: You too, buddy.