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AUDIO - HSP #160 - Bill Busch
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VIDEO - HSP #160 - Bill Busch
Bill Busch, DMD shares a horrifying story of when he first adopted adopted practice management software, and why he's still ever-optimistic about tech in the future.
Dr. Bill Busch graduated from Fairleigh Dickinson University College of Dental Medicine in 1989. Followed by a General Practice Residency at The VA Hospital in Topeka, KS. After completing his residency he started as an associate in a group practice in Kansas City, MO for one year and then started his own practice in 1991, North Kansas City Dental. In 2009 he received his Mastership Award from the Academy of General Dentistry MAGD. The practice is a multi-specialty family practice focusing on providing the best patient care and experience. The practice employs every facet of technology available to dentistry today. Dr. Busch has a relentless passion for dentistry and giving back. He is married to his wife Natalie and has four children. He is presently the Team Dentist for the NFL Kansas City Chiefs.
Dr. Busch has written many publications, including technology articles, book chapters in the Computerized Dentist, his own book “Digital Technology Integration for Efficient Clinical Workflow” and has his own blog the Dentrix dentist. He has lectured extensively on the paperless dental office, CAD/CAM technology, digital dentistry integration, implantology, Cone Beam technology, imaging, and practice management software. He has given many training courses on new technologies in his office for over 25 years and continues to educate, motivate, and inspire his colleagues. His office is completely digital. His current project is to make is dental lab digital and plaster free.
He is presently on 3M’s prestigious Council for Innovative dentistry, board member of TeamSmile dental outreach for children which he created and co-founded in 2006-2007 with his best friend Jason Krause of Henry Schein Dental. Helping over 25,000 underserved children across the country get the dentistry and oral health education they need to be pain free and successful in school. With the help of over 40 professional sports franchises and Henry Schein Dental, TeamSmile is the leader in giving back to local communities through dentistry and sports.
Howard: It is an honor and a privilege to be interviewing a man from Kansas City where I went to dental school. I graduated in '87, you got out of Fairleigh Dickinson in '89. Bill Busch, DMD and congratulations on earning your MAGD and everyone's dying to know did your grandfather own Anheuser Busch? Are you sitting there drinking a cold one right now?
Bill: Drinking a cold one but I'm sad that there's no relation there.
Howard: That was a wild family the Auggie Busch. If you grew up in Missouri, listening to Auggie Busch stories were just riveting, they were so hilarious. I guess there were several of them and one of them was extra wild more than the other ones, right?
Howard: Thank you for joining me today. First of all start with MAGD and how did you get so into technology? When I think of you I think of an MAGD guy who just crushes it on all levels of technology. How did you get into that? Were you always a high tech guy because you got out of school in '89 when there wasn't high tech.
Bill: Computers were coming out and I remember the event distinctly, this was before I got into dental school. Sitting home in New York, graduated college and saw a commercial on the TV for Crazy Eddie's Audio and Video in New York were selling computers and come on down to Crazy Eddie's and buy this 512k computer with 5 megabytes of memory. I started looking at that and I had no clue what any of that was. I knew it was important and I knew I had to learn it, so from that point on I thought I better learn this stuff because it's going to impact my career and possibly where I go. I started to learn about that and then got very intrigued about how I could apply that to dentistry and got really excited about dentistry and where it's going.
Howard: Was that a Tandy or Radio Shack that was selling those?
Bill: Yes, it was exactly that.
Howard: I have to admit I heard Warren Buffet speak in college and I thought that guy was crazy because he didn't invest in any of the nifty fifty. Nothing with Xerox or Kodak and he says if you don't understand the business he won't buy into it and his list of things that he had bought I thought he was an old crazy guy. I was in Omaha, Nebraska and then my neighbor down the hallway, David Heilman, came over freshman year in the dorm room and showed me the new Tandy and he was all excited about it. As soon as he left the room me and my other roommate looked at each other and rolled our eyes like that is the stupidest idea I've ever heard.
When I saw the first cell phone, this suitcase opens up and you pull out a brick and it's hooked to a battery and there are wires going into the car's actual battery and I thought why wouldn't you just pull up to a gas station and drop a dime in a gosh darn payphone. I missed every technology wave there was except for the internet with Dentaltown and that was because I only wanted it for me. At night I was just dying to talk to anyone else who was a dentist about a case. If it wasn't for selfish motives for me I wouldn't have even got that one. Was was your first love of technology and where have you seen it go from '89 to now and the big question is what technologies do you see as a clinician too? You're a MAGD, what technologies do you see where you're looking at your peers listening to you right now on the way to work or home from work and saying if you adopted this technology you'd be a better dentist.
Bill: It started back in '89 when I got out and I knew that the infrastructure was really important to your practice and sharing information between yourself and your patients and your staff to give the patient the best possible result. I thought a practice management system was key. Back in '89 when I graduated there was a company out of California called ICS or I forgot what it was spelled by it was a Unnix system and they had pictures of, I think it was called Tiger View and they had the imaging and they had digital x-ray and they had all the thing that were in the paper chart. I got really excited about it but unfortunately I put $10,000 down for my practice management system and they went bankrupt about a year later.
It discouraged me from trying to create a completely digital record at that point, I didn't think it was possible. I mean how was it going to be possible for somebody to create some technology where we could take an x-ray with our existing x-ray machine and make a sensor and that still is a miracle to me how we can get x-rays into a computer from a small plastic sensor. That was really our first purchase after the practice management system was digital radiography back in '91, '92 and at that point it was Trophy was the only system in town. I thought well this is great, I used it for emergencies and checking for cement and checking fits for bridges but I didn't incorporate it completely. I used that alongside the traditional, it was the AT2000, remember that one?
Bill: Went from that then to Phosphor Plates and I thought I needed a sensor in Phosphor Plates, so I used that for a while then finally went to the DEXIS system where I just had one sensor fits all like Southwest Airline, one airplane fits all 727. Got really good at that and then continued to add on the technologies from there, the intraoral camera slowly and then periodontal voice charting with Victor Voice, you probably remember that way back in the day.
Howard: This is a walk down memory lane for me, this is a romantic podcast. I feel like I'm reliving my entire 28 year career.
Bill: Oral Vision, remember that with the start with the Sony intraoral camera and way back then it was $50,000 to get an intraoral camera. I always thought-
Howard: It was the size of a refrigerator.
Bill: Yes, like the cell phones.
Howard: It was $36,000 that Patterson sold it, what was it called?
Bill: It was a Sony system but I forgot what the exact one was. I always laughed with my patients because I told them if you could see what I see your mouths would be healthier and they'd laugh and I said well now you can.
Howard: The funniest thing is when that came out it was $39,000 and this is back in the 90s when $39,000 was worth twice as much. Everybody laughed to the people that spent that much money, but everyone who bought one not one person regretted it because it sold so much more dentistry. Now those things are down to couple thousand and what percent of the dentists would you say don't even have an intraoral camera turned on in every operatory every morning when they turn on the lights?
Bill: Oh gosh, I mean we do in our practice. I would say probably not that many.
Howard: I want to go back to guys like you and me, we both have our MAGD, we both have a love for technologies that the average dentist has a 38% close rate. I always say in business you make something, you sell something, watch numbers. All the dentists that get a MAGD they just think well I'm a good dentist. Well yeah you're making something, but sell something. If the national average is 38% and you can double yours to say 80%, you're twice as good a dentist and I always tell my staff, I have 8 operatories, everyone has intraoral camera. I say when you're talking into your ear make sure their eye is looking at the intraoral camera. They see it, they get it, they understand her and I think an intraoral camera and digital x-rays made me a better dentist because it massively increased my case closure and if I tell you you've got a cavity and you just walk out the front door, don't schedule for it, you're not a very good dentist.
Bill: I agree and I think it transfers the power to the patient. You don't have to sell the patient a thing, they sell themselves and that's the best kind of sale ever.
Howard: A dentist wants to talk about what's the best bonding agent until the cows come home but they don't even remove the decay 62% of the time. I'd rather you remove the decay and filled it with IRM, that would be a better dentist then debating bonding agents. That intraoral camera digital it's everything. I thought intraoral camera was the bomb until digital x-rays come out and now I almost think digital x-rays is a substitute for intraoral cameras as far as a close rate. When we took that one inch by one inch film off a view box where you look at the view box and all that light, all it would do is constrict your retinas, so the patient just looked at the box and the only thing they could see is nothing, they just went like a deer looking in a headlight. To move that to a computer monitor where they totally see the tooth, the nerve, the bone, the cavity, that's an amazing ... I'd hate to say what's more important if you could ... I'll ask you, if you could only pick one digital x-rays or intraoral cameras, which one would you pick and why?
Bill: Definitely intraoral camera because it's for the patient, it's an education device for the patient. They can see things in full color. I've never had a patient tell me to get an x-ray off the screen, they can't bear to look at anymore. When I've showed them a picture of their tooth and it looks horrible they tell me get that off the screen as quickly as possible, I want to get this tooth fixed or these teeth fixed. Again it's all about the patient, we know our diagnostics and our clinical and I agree with you, like you said a picture's worth a thousand words and probably more in the case of dentistry but absolutely intraoral camera number one.
Howard: What percent of the dentists, do you think, have an intraoral camera in every room? Labor averages about 24%, by the time you cost, all inclusive costs of medical insurance and 401K and uniforms and all those ills, it's about 28%. Then any office I go into the doctors say oh we need the intraoral camera and we have one that we share between 5 operatories so expensive labor 28% of the total cost of this filling. Will you go down the hall, 5 operatories, get the camera, wheel it back and then forget it. When you go into my operatories they're turned on first thing in the morning and then they turn off and go home. I want you to be able to seamlessly ... What percent of dentists do you think seamlessly have an intraoral camera in each operatory?
Bill: I'm going to guess 25%.
Howard: How much is an intraoral camera? If someone was asking you, Bill I'm all alone, Dentaltown promised me that with dentaltown.com no dentist would ever have to practice solo again. What would you buy and how much would I have to spend on that?
Bill: The simple intraoral cameras range from $3,000 to $5,000. The $5,000 range is probably your best picture and color, but what I've done in my own practice because I mean I'm just like everybody else that's listening is ... I mean we budget and we save and we save for the practice and we save for our families but I added the intraoral cameras one at a time so every year I would buy a new intraoral camera and that I did the same for my sensors. I agree with you, I don't send people down the hallway. I take the workload off all the equipment because if you think about it and I'm sharing it between rooms, the less times I use it, the less likelihood for breakdown so it just goes on and on and on. I would say the intraoral camera is indispensable in that sense. You can get a $3,000 intraoral camera. I've tried the $700 intraoral cameras, it's not worth really your time but in the $3,000 range you're going to be okay.
Howard: Can you name any brands? Dentists always complain to me that they're waffling on a brand. So many people want to know a specific, could you give them a name?
Bill: Sure, I love the DEXIS brand. They just launched their newest camera, I would recommend that one highly. It's the DEXcam 4. We use AcuCam in our practice and one of my favorites is the Digital Doc because the Digital Doc has an extra oral lens and an intraoral lens so I don't have to use my 35mm Canon to take extra oral pictures anymore for new patients. Every new patient gets the 7 traditional pictures that Invisalign expects, so I have those pictures just in case in the future patients want to do Invisalign. If not I've got a baseline pictures of their teeth so I can show them 5 years of being in my practice that their teeth are getting either healthier or if they're not doing the things they recommend, it's getting unhealthier.
If you said which one would you pick I'd probably stick with the DEXIS for the lower end and then the Digital Doc for the higher end version. The higher end again $5,000 or more and then the DEXcam is in the $4,000 range.
Howard: You're saying you like the Digital Doc for the extra oral photography too?
Howard: You're saying you need that for Invisalign cases?
Howard: One Invisalign is going to be how much money?
Bill: In our practice $6,000, $7,000.
Howard: Yes, so there's your answer. You got to get what you need to get to do the cases you need to do. You can't sell a product if it's not sitting on the shelf.
Bill: Sure, and the beauty of the Digital Doc is that there's no little SD card or memory card you have to take out of the camera, walk over to a computer. Goes instantly into the practice management image panel, whatever practice management system you're using. It saves you time, it's going right into their record immediately.
Howard: You're a big Dentrix fan.
Howard: I need to back you, I'm just curious, how old are you?
Howard: We're the same age, now I'm wondering why you look 10 years younger than me. We both have 4 children.
Howard: Theoretically one of the 2 of us should be dead by now if we're 52 with 4 kids. What do you think is going to be a bigger stress on your life, the 4 kids or the dental office?
Bill: Definitely the 4 kids.
Howard: Mine are all boys, what were yours?
Bill: I've got a boy in college and I've got 3 girls. One 11 year old and then twin identical girls that are 8.
Howard: Wow, good for you. I grew up with 5 sisters so I'm just going to shut up now. I grew up with 5 sisters and then I raised 4 boys and all I can say is they're slightly different. There's a lot of kids listening to this, the podcasts are huge with recent new grads. They love the fact that they can turn on their smartphone and listen to older guys like us. You started out saying Unix and then you got to tell them the Dentrix story because number one they don't even know what Unix was. Tell them what that was but I think you ... Let me guess if I'm right. I think you picked Dentrix, which is owned by Henry Schein, right?
Howard: Because that was the first pure play on the Microsoft back in the day, before Dentrix everything was DOS code and then the people in Dentrix, which are right up the street from Gordon Christian in Provo, Utah, they saw this Windows come out and they saw the vision that, you know what, it's really going to go Windows driven. They were the first one that started writing their code from scratch in Windows and then the other ones were in DOS and then when Windows was obviously the market leader they tried to make their DOS look like Windows but it just didn't act and behave like Windows. Is that a fair assessment, did I describe it fairly?
Bill: Yes, 1990 they were the first dental practice management system for a Windows based system. Whenever I talk about Dentrix I always say it's about evolution and they've always had a leg up on the competition because they've been in the horse race from the very beginning. Created it and now they're delving into the Apple part of the Apple world for the younger dentists, a lot of whom do like the Apple platform with their Vibe product, which is doing very well with Dentrix also.
Howard: You consult with them or you're on their-
Bill: I'm on their customer-
Bill: Yes, advisory panel.
Howard: Advisory panel.
Bill: Between you and me that's the guys that create enough tension for them that they say come on and join us. If you want a solution to your problem you've got to create some answers, so some of the things that I've recommended over the years they finally have put in there. That's always an uphill battle but you got to fight for what you want.
Howard: I love CEO Henry Schein, and the reason I love him so much seriously is he's done 2 things that got my heart. Number one he's in 36 mergers and acquisitions where he's bought 36 companies and it's kind of like the stock chambers, Cisco. Cisco doesn't have an R&D department, they just see something pop up and they go buy it. When they buy a company the founders always stay on and pretty much everybody, the 36 companies that Henry Schein bought, they all love him, they all love staying, they all do that but deep in my heart I have crawled into jungles doing dentistry on orphans in the middle of Timbuktu and all of a sudden out of nowhere is a fully equipped dental office with 6 operatories with this little bitty sign that says brought to you by Henry Schein. You're just like oh my God, you know what I mean?
Bill: You're unbelievable.
Howard: He's an unbelievable guy, but my beef with him and I have gotten on an airplane and flown all the way to New York City and drove to his office and told him in person in Melville is that I cannot believe they don't integrate an accounting package. Why don't they hit that up to Quickbooks Pro online? That would solve so many problems. That would solve half the financial problems in dentistry if this dentist could generate his own payroll and then he signs up on his PPO plan and they say, hey Bill Busch, we noticed you signed up for Connecticut General and you do an MOD composite for $250 and since you pay all the bills on Quicken online we realize that operatory costs you $275. Are you aware that you throw away $25 every time you do an MOD composite on this PPO plan?
If every dentist had that measurement they'd say holy moly, I've got to either raise my fee or drop that plan or do it in 30 minutes instead of 45.
Bill: Completely agree and I've heard you speak about that before and there used to be a DOS program, it's not around anymore called Cashpro that did that. It would give you those but not as in depth as far as what procedures we perform but would give you real time information. I'm trying to get in Henry Schein's ear too to try to get that information.
There's a new product out called Thrive MBI and it integrates with all the practice management systems that gives you the kind of information you just spoke about and they're on the march to continue that to give you real time production, collections, new patients, who's walking in the door, who's walking out the door, your turn rate about your practice all in real time. Actually I have it running on a little Surface tablet in my office next to me and it's syncing with Dentrix everything 5 minutes. Henry Schein may be planning to do something like the Quickbooks integration or they may be relying on other third parties to enter their marketplace like the Apple marketplace, the app store for a third party company to create that. Thrive MBI is the closest thing to what you're speaking about now.
Howard: Thrive, Thrive what?
Bill: M as in Mary, B as in Bill, I as in iris.
Howard: Is it just thrivembi.com?
Howard: What city is that in and who's the founder?
Bill: These guys are from Henry Schein, they work for Henry Schein and they live in California.
Howard: Is this Jason Krause?
Bill: No it's not Jason Krause, it's ... I forgot his name but I'm pretty sure it's Andy. That doesn't help anybody but if you go to that thrivembi.com I think it's really up your alley what you just said. I use it everyday because I don't have time to push buttons to generate reports. I just need to look at a dashboard.
Howard: Fix me up with this guy, can you email me email@example.com and cc Andy at Thrive MBI?
Howard: Right on, you just made my entire day. Bill this is what I want to say, we're both in our 50s, these kids are coming out of school and they're saying dude, I'm $250,000 in student loans and everything you talk about like CAD/CAM's $150, CVCTs $100, some of these lasers are $75,000, $80,000, digital x-rays, intraoral cameras. Go through the technology of what you think is worth the return on investment.
Bill: The first key is to get a practice management system that you enjoy and like and that has the best open architecture with all the different peripherals that you can add to it. Like you just said intraoral camera, digital x-ray, cone beam and you start to add these technologies. Digital impression taking, things that accept everything into the practice management system because it's your electronic file cabinet for everything that you do in your practice, you remote in from your home. The biggest purchase is buying the practice management system and Dentrix is the one that I've used since '98 and has a leg up on the competition. Then secondly add your digital x-ray and speaking to the younger graduates that seems to be the pathway that they are taking is to get a robust practice management system that they're comfortable with, getting the digital x-ray and that seems to be the standard. They're willing to borrow the money to get it, so I think that's the platform that most graduates are getting, followed by the intraoral camera.
One of the most profitable things past that is to get into digital impression taking starting with just the scanner and then being able to scale up to the in-office CAD/CAM just makes a whole lot of sense. We've been using CEREC and also the Planmeca product plan scan over the years and I've never looked back with that. It just makes sense return on investment wise and time savings and all that. I would go in those steps towards that to get the base of your practice built, the infrastructure, the trading of electronic information from room to room. I look at each treatment room as it's own little business office, so I reproduce each treatment room as it's got a printer, it's got everything that I need so I can answer emails, I can get the patient numb, I can answer questions about a patient in another room.
When an assistant comes in obviously keeping the HIPAA stuff secure, not mentioning their name but I'd say go to room 5 and explain a root canal treatment and show CE education or one of the patient education software's to the patient, present the treatment and pretty much we don't discourage anybody from going away. If there's an emergency we're going to treat them that day and over the years it has turned out to be a big plus for our days to be technology savvy allows us to do single visit dentistry and people talk about cosmetic dentistry, implant dentistry, sleep dentistry but I think the cry from the public is going to be single visit dentistry. Although albeit it's a hard goal to attain but they have busy lifestyles, you've got to adapt technologies that are going to get the patients in and out in an efficient manner with high quality dentistry.
Howard: When are you going to turn your book, Digital Technology Integration for Efficient Clinical Workflow into an online CE course on Dentaltown?
Bill: I'd love to do that. I was excited to put that together but I'd love to do that. I love the stuff.
Howard: Tell them about your book and where can they get it?
Bill: It's on the Henry Schein download, it's an e-book so most of you can download it to your phones or your iPads and it's a free download and basically it's just a little handbook. It's 14 to 15 pages that goes over adding technology in a sensible, logical manner in an order that you can feel like you can do it at a pace that feels comfortable to you. All the elements that are in this handbook are things that are essential for the success of, I have to say a modern dental practice, the digital dental practice.
Howard: That would be a rocking hot article for Dentaltown Magazine and a rocking hot dental online CE course for an hour. Do you realize we put up 327 courses and they've been viewed 550,000 times.
Bill: Wow, that's amazing.
Howard: Back in the day if we wanted to go to course, 9 times out of 10 we'd have to get in an airplane, fly to another city, stay in a hotel, get up and listen all day and now dentists online CE they can just come home from work, they only got to commit 1 hour and they can watch someone like you for an hour. Doesn't cost them any money, they just love that, I mean they absolutely love it.
Bill: What we need from you Howard is we need you to have an Apple TV app or called it Howard TV. I know it might have been taken before but Dentaltown TV so this way when I'm folding the laundry on my couch in my bedroom I can watch CE courses. That's what I do now with all these smart TVs that are out there, they're all loaded up with the apps, so I just go to the app, open up YouTube and watch videos while I'm doing something else relaxing. Be great if we could have all those on the AppleTV platform.
Howard: Will you send me an email at firstname.lastname@example.org saying that and I'll forward it to my 5 programmers and we'll get it done.
Bill: That sounds great.
Howard: It would be an app for AppleTV?
Howard: Huh, that's interesting.
Bill: It could be a Dentaltown app which it'd be the hottest thing there because they think they've got 30 apps right now on the AppleTV product. Hooks in right into your HDMI on the back of your TV set. You connect it to your wireless and you're off and running.
Howard: I have AppleTV, I absolutely love it. I love it because you can be watching a YouTube video and on your iPhone and then throw up on your big screen.
Bill: I know, I mean you know it's all about multi-tasking these days and anything that helps us in our dental practice or in our lifestyle and you're seeing too, all those 2 things are merging together. Your home lifestyle and your practice lifestyle, which is exciting to me, gives me goosebumps because it allows you to be more effective and more profitable.
Howard: Also the research is showing that when kids go to school they don't retain any information before 10am. They're waking up, they're not paying attention and then when you talk to a child in middle school and high school the longest period they could actually look in your eyes and listen to what you're saying is 12 minutes. Dentist's love little hour segments as opposed to going to a course on Friday, closing down your office, flying to a different city, staying in a hotel and then listening for 8 hours when their mind is exhausted after lunch.
Then when you get old and fat like me and when you go to a CE course, when you go eat the lunch, after lunch the only thing you want to do is take a nap. The last thing you want to do is go back for more information for 4 more hours. You want to go crawl up and lay down on a couch for half an hour.
Bill: I completely agree. Everything has to be in short segments that are manageable. The on-demand products that you're furnishing are awesome and that's what people want, they crave that.
Howard: I'm going to hold your feet to the fire, I'm going to hold you down and ask the uncomfortable questions. You said optical scanning impressions, there's a lot of people out there that say Dr. Busch, I know you got your MAGD but that's bleeding edge technology, that's not leading edge technology. How does a guy like you wrap your mind around it and say ... You and I have seen a lot of bleeding edge technology come and go, I mean every dentist our age has a museum of stuff they bought in the back room. Optical scanning, what would you say to a guy who said Bill, that's bleeding edge, that's not leading edge. How do you know if it's bleeding or leading?
Bill: We've been exposed to it since 2001, I had been watching that technology forever and it was DOS like we had spoken to earlier, wasn't that sophisticated but when CEREC went to Windows in 2001, it was a game changer because most people can just move a mouse and work the program efficiently. It wasn't all that good back then but now it's become so predictable that laboratories are using this technology themselves and enjoying all the efficiencies that it provides. When I go and speak about it and lecture about it I talk about that's the gold standard because the cop out would be well the lab does them so much better work and it's more accurate and I trust the lab. Guess what? The labs are making your crowns with CAD/CAM milling machines and optical scanners now, so if you're not a do it yourselfer it's something to consider being a do it yourselfer because of the, and you know this, the time savings, the reputation you build in your local dental community with your patients. They want single visit dentistry and that's what the digital optical scanners furnish.
Then like you said, the doubters. I compare it to GPS. Remember when you got your first GPS? You couldn't believe it, it could get you from point A to point B and you'd miss your turn because it just told you 500 feet and you go there's no way and you go right past that street sign and you go gosh darnit it was right. Although albeit when they were first coming out you may take a little longer but the technology there has improved so much you pick the shortest route, the fastest route, it gets you there every single time, you don't doubt it. That's what I say the same thing with the optical scanners. It used to be that way but it's so precise now that it gets you from A to B predictably every single time.
You know that because there's so many of these companies popping up now. GC America, I was speaking with them, they're going to come out with their intraoral optical scanner and they call them IOS and told them you shouldn't be using IOS because the Apple people will think it's an Apple product. You'll see that in articles IOS intraoral optical scanner, but they're popping up all over the place and as Gordon Christiansen has said, it's going to be mainstay in the next 5 to 6 years and I really, really believe him because the accuracy and the precision and the time savings and the efficiencies are there.
Howard: When I got out of school a lab would have to hire a person and it would take about a year to really train this person how to pour up a model, trim the dye, wax it up, cast that, get it back on the dye, stack porcelain, get eclusion contacts, it'd take about a year of training before somebody was good at this. Then when they were good at that they could do 5 a day and they'd average 6% remakes. Now with optical scanning they say now I can take someone off the street, it only takes me 1 week to train them and they can make 50 a day with 1% remakes.
Now what's amazing and I can't share too many sources on this, I don't want to get in trouble, but now a lot of the labs that we're sending to China, China's all labor. Now some of those China labs, which you know who I'm talking about are actually sending them back to other labs in America that are CAD/CAMing 50 a day per person with 1% remakes, sending them back to China, who then sends them back to the lab in America and the lab in America thinks it was made in China and the lab in America doesn't know it was made in American lab. It's almost comical, it's almost crazy. I mean wow.
Bill: Explaining it to patients, you've probably got a closet full of VCR tapes with bunch of educational things and I used to show it and it was kind of funny. It was called the Crowned Jewel and it showed the 231 steps to a patient of how 1 crown is made. Goes through the plaster and the humidity and the mixing and the waxing and all that stuff. Now, and I dumb it down for the patients, I said instead of doing it that way, with the click of 1 mouse and 1 step think about all the sources of error that go away with the 1 mouse click. You go from 231 to a handful.
Howard: I like to pin you down for names. One of the biggest companies in Finland, Planmeca, who you said you had their x-ray machine right?
Bill: And their scanner too.
Howard: Same here, and I had been [inaudible 00:33:57] for it. They just bought the American company in Dallas, E4D. Now Planmeca's E4D and then there's also the other big German company Sirona that has the CEREC. What do you say to dentist's entering the market? It is CAD/CAM and CAD/CAM and CAD/CAM, do you think there's much difference?
Bill: At this point the accuracy is there across the board so you have to go with a company that you trust and that you're used to working with. What you're seeing is companies like Planmeca and Danaher, who owns all the DEXIS, so many companies, huge, is that they're collecting all the peripheral devices that we use in the office and integrating those and making those seamless. If you're bound for being a completely digital office, you need to consider companies that completely integrate the peripherals and then integrate the peripherals with your practice management system. Planmeca, in my opinion, has the strongest digital workflow of all the peripheral digital devices together at this point.
Howard: Explain that, a lot of dentists ... I've always tried to get dentists, I say just buy one share of all these publicly traded dental companies and by law they have to mail you the 10Q quarterly reports, the [inaudible 00:35:15] report and that little 6 page report is so much information. Most of the viewers never heard of Danaher which is the largest dental holding company in the world. Go through Danaher's portfolio, re-explain what you're talking about. It's a holding company in Washington, D.C. and list the companies they've bought.
Bill: The most famous is their Craftman tool brand from Sears. They still own that but they're like the evil Yankees in New York. They tend to buy all the AAA companies. They own Kerr, they own Sybron, they own DEXIS, they own i-CAT.
Bill: KaVo, they own Ormco, the orthodontic company. KaVo too, oh they bought Implant Direct.
Howard: And Nobel Biocare which was interesting.
Bill: Oh that's right.
Howard: They brought the highest end, the $500 implant and one of the lowest ends, the $150 implant, which I thought was interesting. They're like GM, they wanted to have a Cadillac and Buick and a Pontiac and a Chevy, different price points.
Bill: I love the Danaher products, I love what they do, I love that they get the best of the best. It's a company that's very well respected and trusted and like you said, not many dentists know that Danaher owns them but they run them so efficiently and well it really benefits our profession.
Howard: You think they're trying to do a grand master technological integration system?
Howard: What would be their central management information system? Would it be Dentrix, would it be Eaglesoft, would it be both?
Bill: I had thought a couple years that it would be Dentrix but they're really opening, as you're seeing, they're opening the platforms to a lot of different companies and people are finally realizing that if they want to be in this sector or this arena of digital dentistry that they're going to have to allow choice amongst the dentist professionals. Right now Danaher closes things off and as you've seen Sirona has a market to keep things closed. On a whole I think Danaher is starting to open up the field. You can by the DEXIS digital x-ray but it integrates with over 20 or 25 intraoral camera systems out there. It does allow you the freedom to integrate other peripherals into it. I always say you got to choose the company that's going to take care of your service and a company that's going to stand behind their product with their warranty and a company that you're most comfortable with that makes you the best dentist.
Howard: I actually feel sorry for Danaher because they bought the Nobel Biocare, which is still the top brand for really oral surgeons and periodontists and people who place a lot and then they bought the low Implants Direct where the business model is you would buy them direct and online and they wouldn't have to have this huge expensive sales force. What are the dentists doing? They're buying the low cost Implants Direct and then they're screaming and yelling that some rep's not in there holding their hand through all this. Dude, does the Amazon.com rep come by your house when you get a book delivered? I mean there's a reason there's savings on online. They don't have to build a Barnes and Noble bookstore and all that overhead. It's funny how the dentist wants to pay for the low cost but then wants the full-service rep and if you want the full-service rep, the one that's waiting on all the specialists, go to Nobel Biocare and pay for the rep.
Bill: Oh you know dentists, we try to penny pinch and take the best angle on things. I can completely see the business model there and I've explained it to other doctors too is when you're first starting out with implants, you don't know a whole lot. You take some courses but you need the hand holding, you need a company like Nobel where your rep is coming in. Then you get some notches on your belt and you know this, you get some notches on your belt 5 or 6 years in and then hah, I can save a little bit of money if I use these clones over at Implant Direct, so I see they're hedging their bet. They're getting the experienced dentist and they're also getting the dentists that are just starting out, which is pretty much all of us.
Howard: Are you placing implants?
Howard: What system did you go with and what cone beam did you go with and what was your technological integration there?
Bill: Going to the cone beam I went with the i-CAT flex because I use Dentrix and I use DEXIS. DEXIS is the only imaging system that allows you to put all of your images in one panel. I like to see everything in one spot. I like to see my pictures, I like to see my x-rays, I like to see my cone beam. Then what'll you'll see here in the future as doctors come on board and add digital impression taking, those are part of your dental record so you're going to, just like a stone model you have to say it in different states from 5 to 7 years you're going to want to save that digital impression so you can at least look at it or print it or go back to it. I see imaging companies adding that to the image panel. Going back I like DEXIS because it allows all of the imaging in one spot for me to look at. I don't have to read notes to know whether I had a cone beam, I can see the little thumbnail of it there.
I went with the cone beam and then implant systems I use the Nobel, I use CAMLOG from Henry Schein and then we use Bicon because I like to not have to do sinus lifts and it's a great company out of Boston. Then finally we use ASTRA, and you say Bill why do you use so many different systems? It intrigued me that if you have one system, and you know this, that it's either a 1, a 3, a 5 or a 7 well what if the patient needs a 2? You make the 3 fit or you make the 1 fit, so I always thought different systems allow you to provide the patient with an exact fit as far as diameter and length because they all have their proprietary diameters and lengths.
You say Bill you're crazy and you're right. I learned a lot but I'm starting to narrow it down to 1 or 2 systems at this point.
Howard: What would you say to a kid who's saying how do I learn how to place an implant? Where would you point him to go? There's 275 different implant systems and I think you and I both agree that you want a relationship, if you're in Kansas City it'd be really nice if there was a human there in Kansas City that could help you, hold your hand. Where would you go for training? Would you pick the rep first that you like in your geographical area, then look at that implant and then see what hands on training they have or would you work it that way or how would you work it?
Bill: That would be the exact way that I started. I'd do exactly that way. The Nobel Biocare rep came in, I formed a relationship, I told him implants were on my goal list to do someday. He said I'm going to take you through the journey. I started with them and again you get your notches on your belt and then I ventured out a little bit and came back and I'm at that stage that I'd be interested in trying an Implant Direct implant just for trying. Just to see what's out there, but I would say find your rep first to develop that relationship because, you know what, he's going to be there or she will be there in your surgery, just like they do in the hospital for the MDs and guide you through that until you're comfortable.
Howard: It's so nice to be able to sit there and ... I have one in my zip code and something came up, you need something whatever, whatever and she literally lives in my zip code and that's so nice. It's funny how so many dentists step over $100 bills to save a penny and they never get it going. Every time I find a dentist who has the surgical implant thing going and their crushing it and they're doing it well they always have a buddy who's their implant rep in their city.
Bill: That's great too because they get real comfortable and you've been with them, the other thing too that you forget is what if you're out an implant or you need an implant part? Guess what? Your buddy's going to be bringing it over to you, you don't have to order it overnight. He'll lend it to you for a day or 2. That's the other part of the relationship, so if thought you had something and your dental assistant forgot to order it, they're going to come through for you.
Howard: I've had a traumatic relationship with the dental supply house because I used one big name, went to the next big name and then went to the next big name, so you can figure out it's all 3 of the big names. Every time I would leave they'd say what happened, what happened, what happened? I was following the rep. I can't help that the rep left your company but I love this rep and I really don't care who does the back end operation. I have a relationship with this rep and my assistant Jan loves her to death and that's sorry. You'd be with me if you kept that person. It's relationship driven, we're social animals, we're pack animals like monkeys, dogs, cats and horses and we work best when we have a friend in the flesh to help us get er done. If you're trying to save a lot of money that's a great idea, but if you're not getting it done you're not saving any money.
Bill: Surgery is so critical too, it's surgery so you got to be prepared and you've got to have everything locked and loaded for it. It's not like doing an occlusal filling.
Howard: There's a lot of hands on surgical courses out there. Is there any you like or any you can throw your name behind to recommend?
Bill: When I started I started with Nobel so I really love their courses, but there's so many good courses to go out. I'd start with a course from CAMLOG or go on Dentaltown and look up the CE or go to the Henry Schein website, they have a great site for continuing education now. Another great and maybe it exists, maybe there's a website for dental education that you just type in the topic, it tells you everything that's in the geographic area and the dates and times and you can just go. I think they're all equally as good. I would recommend a weekend course to get your feet wet and then I'd amp it up to do some of those symposiums that go over a couple months where you go for 3 or 4 days then come back couple weeks later or a month or 2 later and then go for the third session. Any of the hands on courses that you can get, hands on I'd highly recommend as a second step.
Going to a good 2 or 3 day course with some of the bigger names like DENTSPLY, the ANKYLOS or the ASTRA system. Their courses, usually you can get them to do it for free. Most of these introductory courses are for free, so Nobel but most of them they're interested in helping you and getting you interested in it because it benefits them and our patients.
Howard: Also don't ever forget about all the available research you can do on apes and I'm talking about your entire family tree. Your cousin Eddie, I mean they're coming in for free dentistry, so you're like you're a research monkey now. You're coming in for free dentistry, I've never done this, I don't want to say you want to be my first sinus lift on because it might piss off my mother-in-law but I mean charity. I mean you'll have a charity case and they wanted to save the tooth or whatever, whatever and you sit there and say I'll tell you what, I'm going to do it for free. You know what I'm going to do? You just tell them I've never done this before and I'm going to do an implant.
Bill: Your patients are asking for implants now and we worry about ... I'm trying to think of the implant company that you see all the commercials for but I'm sure you've seen dental commercials for implants all over TV. That's good for dentistry, I'm not worried about the people who are doing that I'm going to lose business to a company that places it. It creates awareness just like Invisalign has done. I have patients asking more and more about implants lately. The insurance companies are off the hook adding implants as a service. I don't know if you've noticed, I mean we work with dental insurance but more and more of them are having a benefit for them. It's something definitely everybody should have on their radar to learn and find their buddy, find their resource, get on YouTube, watch some videos on how they're placed, find the family member that needs the implant and most of these companies will front you a couple of implants for you just to try for free.
Howard: Absolutely, you also talked about your next step is to make your own dental lab digital and plaster free. You want to make your own lab?
Bill: Yes, I want to maybe not have a lab technician because I do like my lab for that but I want to do away with plaster. We want to buy a 3D printer from I think it's Stratasys and Henry Schein has their ... Not a lot of dentists think of it but they have their Zahn division of Henry Schein which is all laboratory based but you get talking to that rep too to help you and we're going to store all of our digital impressions on the cloud and we're going to scan them in and we're going to get rid of all that. I'm going to march them out to the dumpster and I'm going to recover a lot of space and I'm not going to have water in a spatula anymore. Anytime we do need a model we can just 3D print it.
If you can start to think about with digital dentistry there's a lot of things you don't need a plaster model for and there are things that you are. 3Shape from TRIOS we have one of those on order, it's such a phenomenal intraoral scanner. They're getting to the point, well you can do partial dentures now and immediate dentures with it but they're getting to the point where you can do everything with it. That's where we want to head to, where we can get rid of all those things and store everything digitally.
Howard: Dude, you have to start making online CE for Dentaltown. Like I said we put up 327 courses, they've been viewed 550,000 times and I want to watch your course more than ... I can't think of another online CE course I'd rather be watching.
Bill: Count me in Howard, thank you so much.
Howard: That would be so cool. Now you're in Kansas City, wasn't that one of the cities that Google decided to pioneer one of their cable, fiber optic cable network?
Bill: Yes, we've got Google Fiber here so it's a gigabit speed and I'm telling you, once you get it in your town you got to have it for your dental office because your claims are flying electronically so quick before your eyes blink you get a lot of the things that you see patient education software is now cloud based, so that streaming video is instantaneous. As the cloud based practice management systems come online it makes it very doable at that speed, it's unbelievable.
Howard: You had cable internet that came with your TV and then you switched to the Google-
Bill: Fiber, yes.
Howard: The Google Fiber and the difference was noticeable?
Bill: More, you would never want to go back.
Howard: Really, it was just that big of a difference?
Howard: Everybody in Phoenix want to know is Google glad they went into ... I think they went into what, San Antonio and Kansas City?
Howard: Or was it Austin and Kansas City?
Bill: Everybody's got a waiting list to every town around that doesn't have it.
Howard: Is Google happy with it? Are they glad they did it? Are they saying this is a good test and we want to do it to other cities?
Bill: Absolutely, yes that's what they're on the march to do.
Howard: Man, that's going to be a game changer for those cable monopolies. I get so upset with the cable companies every time I pick up ... You go to someone's house and they pick up the remote and there's 47 buttons and they got 5 different remotes and nobody in the house knows how they work and I just think to myself why are there 40 buttons on a remote and could you imagine Apple coming out with something that stupid and complicated and dumb? I hope Google's system just takes out all these cable monopolies because they're just horrendously horrible.
Bill: I agree, you're going to laugh at me but back in '93 I got the Gateway Destination which was the first inkling of merging the computer with the television set. It was a computer TV and it had a tuner card it in and I'd have the patients in there doing presentations with the computer in the background and then also using the video assets from ... What were they called? The interactive CDs which were the earlier version of a DVD and being able to put those 2 things up on the screen, showing the patient their problems with their big tooth and the crack and then the solution right up on the screen. Yes, I agree with you, Google's definitely headed for merging those together and really taking out the cable companies.
Howard: Well the remote control is a classic example. I mean are you dentist focused on yourself? I mean just look in the mirror and think about yourself all day or do you think about your patient? In the case of the remote control, every division of that company wanted their buttons for their little part of the cable TV on the deal. You have this remote with 45 buttons on there because there's no one representing the consumer. Every little department had to get all of their functional buttons on there and no one just sat there and thought, you know what? I'm representing the patient and I'm representing the consumer and this is a total train wreck and we're going to strip out all these things down to 5, 6 easy to use buttons. It's about putting the patient first, not the dentist first.
It makes me cringe when the federal reserve, every 3 or 4 years, they'll update a study showing that 1/3 of Americans cannot seek healthcare from a doctor between Monday through Friday, 8:00 to 5:00. Then you go ask all your colleagues, what are your hours? Monday through Thursday 8:00 to 5:00. Really? You just went to a dental school and you decided you weren't going to treat 1/3 of America and you tell me you're consumer friendly? What do you think? Do you think this technology, you're a technology wiz kid and you're an MAGD coalition, but do you think all this technology is for you or do you think at the end of the day it really makes you patient centered?
Bill: I think it really makes me patient centered because all the time savings that I have through the technology and the digital workflow allows me to sit relaxed in the chair and to really educate the patient. They really feel tuned in, most of us are looking at either a computer screen or a TV screen sometime during the day so you're presenting things that they need in a format that they're used to seeing, a computer screen or a tablet or those kind of things. They relate, you get that instantaneous relationship building because you're presenting it in a format that they're used to. Their smartphones, their tablets and by using that technology you can cut to the chase and build instant rapport very quickly because they get to see their problem up close and personal and then you let them make the decision on what they would like to do.
Howard: Not only are you placing implants but you're doing Invisalign?
Howard: What do you think of Invisalign and I know there's some other companies started up too and what would you say to a dentist who's never done Invisalign? How would that dentist learn how to do Invisalign because that's a very high end cosmetic procedure that people ask for and if you're struggling with PPOs and student loans and whatever. I mean what would you say to a dentist who's never done an Invisalign case?
Bill: It's one of the easiest things that ... Some things like services and technology and certain disciplines are for certain people. I think Invisalign can be done by every general practitioner and every general practitioner can offer it. If you said Bill pick one service, you asked me about one technology I can do without, one service that everybody could do and would benefit the patient and the doctor monetarily, profitability wise and improve the patient's health Invisalign would be it. You can go to an Invisalign course in a weekend and then be up and running with the case on Monday. It's all based on the cloud so you can either digitally scan your case like we do in our office, we use the iTero product but there are more products coming online that Invisalign will start taking intraoral scans so the patient doesn't have to take a goopey impression. That'll-
Howard: Who did Invisalign buy? They bought an optical scanner.
Bill: They bought the iTero system.
Howard: Which is owned by Danaher?
Bill: Which is owned by Danaher.
Howard: Danaher doesn't own Invisalign?
Bill: I'm sorry, no iTero was owned by Invisalign and I'm not sure if Invisalign is now owned by Danaher or not.
Howard: No they're not, so you're using Invisalign's iTero to scan the arch.
Howard: You don't have to take any impressions?
Bill: No impressions and it comes back a week earlier.
Howard: Bill, how about a man to man talk because these dentists are saying I got out of dental school, I did a pulpotomy, I did a root canal, I might have even placed an implant but I didn't have any ortho training and that's the big fear factor.
Bill: The fun part is with Invisalign you can go about it ... Once you take your weekend course, you can take traditional impressions, just PVS impressions, photographs and x-rays, send the case in and if you need help they have a help section by licensed orthodontists to do the treatment plan for you. When I started I had my first 10 cases, treatment plan by an orthodontist online that I talked to back and forth, came to the result that I had 10 perfect cases and then after that I weaned myself off. The other thing you can do is just easy cases with it too that most doctors got the training in dental school with some minor ortho so you can pick and choose the cases you want. My patients are always asking for Invisalign. They want straight, white teeth, that's what they want if you ask them.
Howard: You're saying that if you had to recommend one new technology to increase your production you'd pick Invisalign?
Howard: Why Invisalign and not other knockoffs, ClearCorrect, other ones you hear?
Bill: I've tried the other knockoffs over the years to venture out and see if I could save on the lab bill and so forth, but they've just been in the market so long and I get predictable results. It's pretty much auxiliary driven in my practice. I see the patient for the first impressions and I do the treatment plan and then I might see them once every 3 months and the assistants are delivering the aligners. It depends upon your level of participation but I've been very successful making that an auxiliary driven service for the patients and they love it.
Howard: The bottom line that I keep saying is are you getting it done? My bias in continuing education for 20 years has always been a rep will come in and they'll say well you should try this or that and I would say well right now I'm not having any problems with that, it's all working perfect. I want to spend my next 100 hours of CE on this area where I'm having problems. You know what I mean and guys like you who say well I'm paying extra for Nobel Biocare, I'm paying extra for Invisalign, but I'm getting it done. It's consistent, it's implementing and then other people trying to save money and they're not getting into the technology, they haven't learned it, they're not getting it done and they're telling me how much money they're saving over the last 5 years and they still haven't placed an implant or done an Invisalign case.
Bill: It's not how much you make, it's how much you keep.
Howard: You're just a class act of getting it done. I want you to end, I've only got you and your amazing mind, the hour's gone but tell them about your best friend Jason Krause from Henry Schein and all that you're doing. I think that's amazing.
Bill: Jason Krause worked for Henry Schein. I had a dream when I got out of school about the digital dental office back in 1989 and I also wanted to take some of my skills and give back to the community. I wanted to do it in a way that would help youngsters and help insure their smiles for a lifetime and I knew I wanted to do it but I didn't know what to do. Then back in 2006 I saw that Brian Williams story about Deamonte Driver that passed away in Maryland from not being able to get a primary tooth extracted. I never watched the news and I just happened to be home that night and it was a big epiphany for me that when I heard that that happened that I had to do something. I thought well how do you get people excited about dentistry? I thought well people get excited about their sports teams, you can walk down the street and see the Kansas City Royals or the Arizona Diamondbacks, people are excited about their sports teams because that's the fabric of their community.
I thought how can we twist dentistry around that and we came up with the Team Smile concept with Jason Krause so I had this concept unformed in my head and I knew at that point back in 2006 he was running the Tomorrow's Dental Office of Today project for Henry Schein which was a high tech trailer that traveled all over the country to show dentists the high tech tools and get on board and try things out. I persuaded him to take the trailer to Arrowhead Stadium in Kansas City. We took the trailer out there, we served 125 children that were underserved. We had half the football team drive up in their cars, sign autographs, hold their hands while they were getting shots or teeth filled or primary teeth extracted, cheerleaders there, mascot there and I looked at Jason, I said we got to keep going with this.
Since 2006 we started with one team in Kansas City with the Chiefs, which spread to the Royals, which spread to the Chicago Bears that went down to New Orleans with the Saints and it went from the Saints to the Miami Dolphins and we have over 45 professional sports teams joining us, the dentists, the dental volunteers, the hygienists, the assistants, the dental community and really an uplifting thing. Creating smiles and education for children across America.
Howard: That's the coolest damn story I've ever heard in dentistry in my entire 28 years in dentistry. That is cool, that almost made me verklempt and well up with tears. That is amazing. We got to get that message out in Dentaltown. We should write that up or I'm sure so many dentists listening to this are thinking I wish you would do that with my sports town. I'm sure none of the Raiders fans are thinking that but all the others, I'm just kidding.
Bill: They need the implants.
Howard: A lot of these listeners are probably thinking God I want to do that with my local sports team. You should write that up or start a thread on Dentaltown or put it in the magazine or something.
Bill: I definitely will. We want to get the message out because not only does it uplift the community, but it really brings dentistry, which was I think one of the toughest professions in the world to be and I'm honored to be in it and anybody that's in this great fraternity of people that change people's lives, the rest of the community needs to know about it. By helping children those kids are going to grow up and we won't here the old ratio of 50% of the patients, people in the country go to the dentist. We want to have 100% of the people coming to us and by using sports to motivate people and tap into it's energy I think we can do a lot of good.
Howard: Do you think we should do an entire other podcast on this and bring Jason Krause in too?
Bill: I would love it and I know he'd be all over that.
Howard: Should I just interview him on it or should I bring you back both because you're so high tech, I've never had 2 guests because you're in different cities right or is he in Kansas City?
Bill: No, he's in Milwaukee.
Howard: Yes, so I've never done a split screen where we brought in someone from Milwaukee and someone from Kansas City to me in Phoenix but I bet the 3 of us could figure it out.
Bill: Oh yeah, I'd love to do that, he'd like it too. We've talked about it before.
Howard: Bring it back. You figure it out with my son Ryan, my son Ryan is my technology guru who thinks his old man takes a horse and buggy to work everyday. Send an email email@example.com, send it to Jason Krause and then my son Ryan and we'll figure out, we'll do the first dual guest, a 3-way Skype.
Bill: That sounds awesome. Thank you so much for having me on, I'm thrilled and honored to speak with you. I'm a big fan.
Howard: Well and I'm a huge fan of yours and if you've got that 14 page e-book that's free you ought to put that together in an online CE course and they could download the e-book and then you could go over it visually on online CE and that'd be a killer course.
Bill: I've got it all written down, I'm on it.
Howard: Let's do it buddy. Thank you so much for your time and my last statement I decided to go is I really like the way you decorated the dollhouse behind you.
Bill: I knew you were going to say that.
Howard: I think the pink bed is just rocking hot with the canopy and my hats off to your dollhouse.
Bill: Thank you.