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VIDEO - HSP #173 - Scott Leune - 1
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Dr. Scott Leune shares specifics about begin, evaluate, manage, and grow dental startups.
Dr. Scott Leune has owned 11 startup practices, has helped build over 60 other startups for dentists across the country, helps manage over 130 practices through his powerful outsourcing services, has built a lucrative exit path for dentists selling their practices, and provides intense dental business training seminars to dentists and staff throughout the year. He is one of the most subscribed-to people on Dentaltown.
www.BreakawayPractice.com
8000 Interstate 10 Frontage Rd, suite 300
San Antonio, TX 78230
210-899-4500
Info@breakawaypractice.com
Howard: It is just an unbelievable huge honor to be doing a podcast today with the man, the legend, Scott Leune. How are you doing?
Scott: Hey, I'm doing good. Thanks for having me.
Howard: My God, I feel like I'm your father. I really ... I'm 53, how old are you?
Scott: I am 36.
Howard: Well, I guess I could be your father. What's 53 from 36? What is that? How old would I have been?
Scott: Yeah.
Howard: 3 from, 6 from 13, my God my brain is like freezing. No but ...
Scott: You'd be 17.
Howard: I'd be 17. My God I paid for your college, you said 23? I want a refund for my son's college over here. Yes 17, I could be your father. The reason I said that is because, I saw you when you'd just graduated dental school, on Dental Town. When was your first post? 2005?
Scott: Yeah, 2005 is when I graduated and actually as a dental student I saw you in a lecture at the dental school and that was the first time I was exposed to you in Dental Town ...
Howard: Is that right? I lectured at your dental school, University ... San Antonio?
Scott: Yeah, yeah I went to San Antonio.
Howard: I lectured there?
Scott: You did.
Howard: Who was that guy that was in charge of the speaking there?
Scott: Bill Butler maybe.
Howard: Bill Butler, is he still there?
Scott: He is still there, yeah.
Howard: Oh my God I'm going to send him an email today. That guy had more spunk and charisma and was totally hitting it trying to get rocking hot speakers to come into your school, the alumni. He was just a dream and he was so charismatic and all that stuff. Just an amazing guy. You graduated in 2005, that's when you joined Dental Town. You started focusing on the business of dentistry and opening up your practices. I think it's one of the single, it's one of the top ten largest threads on Dental Town of all time, wouldn't you say?
Scott: Yeah you know I had no, I just in my spare time was just telling people the story of our practice. I was letting them know what we're doing, the successes, the failures. I was looking for advice. I was doing what everyone else does on Dental Town and just try to get better. That's what happened and the thread just blew up, just a very long thread with a lot of value in it. That kind of started our relationship with Dental Town.
Howard: Well I tell you, success is so counter-intuitive. I mean the world's greatest investor Warren Buffet, second or third richest guy in the world, there's 1645 millionaires and he said forget Wall Street, I'm sayinng Omaha, Nebraska, he figured all of that out that let's [inaudible 00:02:52]. Don't read all the 10 pages of the 10 and all that stuff. He says, "Now, if there's a restaurant chain stock where normal people in your town go to there because they liked it [inaudible 00:03:05] like. What your counter-intuitive success is, and I've seen it a half dozen times in Dental Town, is [speak 00:03:11] social pack animal monkey, ape, humans throw their cards themselves.
Every year or so, there's some dentist that comes to a fork in the road and just feels humbled and transparent and honest and posts their articulate decision with the name of their service, their email, website whatever it says, "Should I do this or do that?" Then all these loving, caring people, most of which are anonymous, go in there and tell them the greatest advice in the world. Then you got big old national many brand consultants like Sammy [Pardue 00:03:43] and all that giving him all this great advice. I've watched those kids over the years and they always go the highest and the fastest and the farthest. [Samir Curry 00:03:52] was one of those. [Tarut Ageral 00:03:54] was one of those. August [Oliviar 00:03:56][inaudible 00:03:59] August, how do you pronounce the word, August Oliviar?
Scott: Yeah, I think so.
Howard: You. Most people, when they have a decision, it's all private. I get all these private messages. [inaudible 00:04:12] I was thinking, it's not even the spirit of Dental Town. Why are you asking me privately, why are you sending me a private email? Why don't we post it [inaudible 00:04:21] and let everybody chime in? You were transparent with your journey and then at first you were the student and then after a couple years and a couple of practices then you became the master teacher. That's exactly why because of the decision making process. Starting out, "I don't know. I'm a young grasshopper, help me," and everybody helped you and next thing you know, you're the 4th degree black belt in the business of [uninaudible 00:04:49]. You just crushed it. What did you want to start talking about today? What did you want this session to focus on?
Scott: Yeah. I think start ups would be a great topic. We get just a whole lot of dentists every year coming to our seminars to learn about start ups. The industry's really changed in the last 10 years. Start ups are bringing a lot of dentists a lot of success if they're done probably. I think we could maybe focus this session on talking about start ups, what's happening across the nation and what are some of the best performers doing and how do people go about evaluating that model?
Howard: In the technical world of MBA, that would be a de nouveau practice. On these [teams 00:05:39], de nouveau ... That's d-e space n-o-u-v-e-a-u, meaning starting again from the beginning. It's a late century French word, luckily the French [brought 00:05:51] new. Do you see, a lot of these corporate empires don't do de nouveau starting practical. A lot of them just do mergers and acquisitions. Do you see the big corporate expanse in more buying or start up de nouveau practices from scratch?
Scott: Well on the corporate side, you actually see both. Some of the corporate chains, the DSOs, they focus on a de nouveau model because if done well, if you can do a start up practice well, it brings a higher return for that corporate dental practice. Other corporate models of the DSOs focus on acquisitions. Then you've got the larger ones that are doing both. You'll see, for example, Hartland. They might go start 40 or 50 de nouveaus within a year or two and then of course they are also acquiring practices. For the private dentist, it's getting harder and harder to find practices that are worth buying in areas that have growth.
A lot of the great practices for sale are being sold to corporations early on. You've got young dentists coming out and they don't want to work for corporations anymore. They want to have their own thing and they can't find something to buy. A lot of them fall into a trap of buying a small practice, buying a practice that's not successful and then hoping they can turn this thing around in an area that maybe doesn't need them or will not support that kind of growth. You know once we ...
Howard: I'm going to get you started, I think you started 11 yourself. You helped 60 others and then your breakawaypractice.com website, you help manage right now 130 other practices. Did I say that correctly?
Scott: Yeah, that's correct. I myself have owned 11 start up practices and then we've now are part of building, I think we've got 68 or 69 offices across the country on top of the 11 that I've owned. Then we also manage 140 or 150 practices through our company that are not startups necessarily.
Howard: Okay but what's the difference between the 60, helped build 60 other start ups and 130 that you manage, that you helped build, you helped 60, you had 11 start ups of your own. Then you helped 60 other start ups and then you helped manage 130. You helped 60, so you're telling me as a consultant service to just start the start up process?
Scott: That's right. Dentists come to us saying, "I want to build a high growth, highly successful practice. We have a program that's a 5 year program to take them from the very first step of finding an awesome location to 4 years after they open to help them grow, design, oversee construction, manage, have huge group discounts, have all kinds of training support and coaching, so that by the end of their 4th year being open from scratch they're hopefully just a massive success story.
Howard: I'm sorry to keep interrupting. You say a 5 year plan, so it's basically a year say, to contact you to open a practice. Then you manage it for the 4 years after that. That's where you come up with the 5 years?
Scott: Yeah. It's around 5 years. These practices are owned by the dentists. They make every decision. What we do is we give them the answers, we give them the path, we scream out the solutions and we do most of the work for them if they want us to. It's like having a personal trainer and a personal chef all in one to try ad get you healthier. We do all the work and we hold them accountable to doing the things they should be doing as much as they want but they own the practice. They get to use all of our systems and our proven methods to build highly successful start ups, yet they maintain autonomy. They maintain control.
It allows us also to see across the country what works well, what does not. We've now done this, you could almost make the argument that we've been part of 80 start up practices. We know the space very well. We know how to find awesome locations. We know how to market them properly. We know how to staff them, how to deal with hygiene, how to deal with training and compliance and how to design them and save a bunch of money while doing all of that because we've just got a large sample size that we've been helping.
Howard: Everybody's probably wondering, what's the fee for this 5 year service plan [inaudible 00:10:31]? We're settig up revenues and we're setting [inaudible 00:10:34], is it just a big [inaudible 00:10:36]? How does that work?
Scott: Yeah. It's a formula. While I'd love to pitch our services for an hour, I'd rather just give a bunch of value. We do have a formula on how we charge dentists based on how large they get. We get paid more if they get large and we get paid a lot less if they don't get large. For every $1.00 they have to pay us, we save them about $2.50 in discounts. You can make the argument we're free because they're getting discounts and services we've negotiated that only the large corporate groups get right now.
Howard: I assume you're talking about labs and [subduties 00:11:17]?
Scott: Yes, labs and supplies but marketing, it's sign design and installation, it's software. It's just about every item on the PNL we have gone in and found smarter ways and cheaper ways to do them and negotiated directly with vendors to get big discounts that they only give us and they're not even allowed to give those discounts to anyone else.
Howard: I want to ask you right out of the gate. Let's start, obviously if you open up a practice in America it would do better than if you opened it up in Ethiopia, do you have any ...
Scott: I'm sorry you said, say that one more time, you ...
Howard: It's obvious that if you opened up a dental office in the United States versus Paraguay, you would do better in America.
Scott: Yeah America offers just an awesome opportunity for start ups and entrepreneurs. There's other countries that would do well but ...
Howard: The point I'm making though is, [inaudible 00:12:17]] when you set out to help this dentist, is picking the right demographic, location probably the most important decision?
Scott: It is one of the most important decisions to the early success of the start up. You can look at it as if you have the great demographics, then you've got a safety net to failure. You're going to have a higher natural patient flow come in. You're going to have better response to your marketing. You're going to get a boost when you get out of the gates, you're going to have a head start.
There's a lot of things though that can counteract that. If you don't have a great location, you can still do well in other ways but having a great location is one of the easiest ways to get a head start right out of the gate. If you don't have a great location, if you can't get the patient flow-in, you are having stunted growth in a start up that might last a year or 2 or 3 years because of a slow start.
Howard: Walmart was in 32 States before it went into one of the 117 towns in America that house half [inaudible 00:13:24] Americans. [Inaudible 00:13:26], I think he was [inaudible 00:13:28], he went to all those small towns where there wasn't even a dentist. He was a multi billionaire before he went [inaudible 00:13:37]. Do you believe the rural is still the goldmine as opposed to LA, San Fran, [inaudible 00:13:45] Dallas or do you, how important is that to you, rural versus [inaudible 00:13:52]?
Scott: It's more complicated than that. We have the ability to scan the country and pluck out all the pockets of high demand, where we could do a start up practice. A lot of rural areas might need a dentist but that doesn't necessarily mean that's better or easier than going right into a major metropolitan area like Houston. The key is to be able to find those pockets of high demand. If you think, most dental practices need about 30,000 people around them to start marketing properly to drive up patient flow, we're really looking at pockets of 30,000 people.
In a rural area, that might be a very large radius and in Houston that might be a 3 mile radius. The goal is to find those pockets that need a dentist. We've got 7 or 8 offices in California, for example, that are just booming. Yet people would argue, "Well, California's saturated." Well, only if you look at it as a state but if you look at it as a pocket of 30,000 people here and there, you find pockets that need a dentist. One key is to find that.
The downside to a rural area is it's harder to get population density. What's just as important to the dentist population ratio is population density, meaning how many people live within a drivable distance from your practice. If I don't have a lot of people living close to my practice, it's harder for me to pull out specialty procedures, for example, from the population. Versus if people are living on top of each other, my marketing can be more powerful and more predictable.
Now, I'm not saying rural areas you can't be successful. You can. There's benefits and drawbacks to both. We haven't even talked about is this going to be an associate driven practice or an owner driven practice? The more rural we get then we have to recognize it might be harder to staff, it might be more expensive to staff a dentist there. Which is why you see most of the large corporate groups starting in metropolitan areas, I think. It's easier to market to a higher population density. It's easier to staff that office. The reality is we dentists, the goldmine in dentistry, I think being a dentist, was about 10 years ago.
Howard: Say that , in the what?
Scott: I think the golden age of being a dentist might have been 10 years ago, where all you had to have was a Yellow Pages ad, send out a post card, maybe you had a website, patients believed us. Today, it's getting a lot harder. Most dentists aren't running their practices properly, if you think about it. If dentists, if we had to compete like the restaurant industry has to compete, we sure would run our businesses a lot differently.
Right now, there's this huge opportunity for dentists and corporate groups alike to come into dentistry, run businesses the way they should be run, build locations in areas that need a dentist and market properly and they don't just have to be that amazing to make it work and do well because the rest of us have been lazy when it comes to running a business. We haven't been tracking metrics properly.
Howard: The average grocery store chain in America has a 1% margin and dentists, if you look at their [inaudible 00:17:15] last month it was 6%, next month it's 8% and then the month after it's 5%. Their supplies variance from month to month is 3 times bigger than the entire margin at Kroger, Dylan's, Safeway, Fry's ... It's literally, dentists have no idea how good they have it.
Scott: On top of that there's the law that says to be a dentist or to own a practice, you've got to jump through all these hoops. We have some monopolistic effect as well that prevents us from having to be amazing, business ...
Howard: Yeah. There's so many economic barriers of entry in the trade of medicine dentistry law and pharmaceutical and that's why they have ...
Scott: Wall Street moving in, now they see all this opportunity, they see the broken systems of the average practice, the bad locations a lot of dentists are in, the poor marketing, the poor phone skills and they're able to fix those things and do well even with high dentist turnover. Even with commoditizing and competing on price, those corporate groups are still able to do okay. We dentists, if we just have the right knowledge, the right systems, we can go build start up practices and do amazing. We can go run highly profitable practices that we don't have to worry so much about that corporate chain trying to compete.
Howard: I would say to my peers here or someone who's listening says, "Well, I'm not starting a practice, I'm going to, this isn't the thing for me." Dude, I know several dentists who have made billions in States like Nebraska, South Dakota that just has [inaudible 00:18:46] when starting a couple of practices and then sold them to big corporate America. I know dentists who have made billions, this is a very good reveal. As far as not being able to find an associate in the rural area, how come the navy has no problem finding a guy to leave his wife and the babies and go sit out in a boat for 6 months doing circles in the middle of the Pacific for half a year and might want to go to [inaudible 00:19:11] Oklahoma. Are you kidding me? The army, I know dentists that went to Iraq and Afghanistan [inaudible 00:19:20] and North Korea. You're telling me you can't find one for Des Moines or Arizona? Come on.
This might be ... If you're a young dentist out of school, Scott Leune, I'm going to deliver you several servings of this man. If you're an older dentist like me, this might be some psychic [inaudible 00:19:37] can make a million on the side for your underfunded [401k 00:19:43] I want to ask you the most important benchmark, what does the average dental office collect and what does the average dentist make versus [your 00:19:56] 60 other [guest 00:19:59] startups and your 130 practices? Are you getting these guys to beat the average too? Are the below average, are they above average? [inaudible 00:20:06] what's your benchmark?
Scott: According to the national data on start up practices in dentistry, the average startup collects about $305,000 their first year open from scratch. That's the national average. On that 305, they've lost about $15,000 for the year. There's no cash flow there, there's no profit and the dentist did not get a salary. That's a very depressing average. The practices we work with, granted we don't control them, we don't make the decisions. The dentist makes the decisions whether they're the right ones or the wrong ones. I feel like a lot of our dentists could do better but our average dentist, by month 12, is collecting about 85,000 and they've made, by month 12, they're making about 35 to 40,000 per month cash flow.
Howard: Say it again. What was your dentist year one, I didn't hear that.
Scott: If you take a snapshot of month 12, because that's the data I've got available to me here for you. If you take a snapshot at month 12. Month 12, opened from scratch, they've collected 85,000 and they've taken home about 37,000 of that 85,000. If you look at the national average, the month 12 national average is they're collecting around 35,000. At month 12 they might be taking home about 5. AT month 12. We're about almost 3 times the national average and maybe 7 times the national average for profit. We have some dentists that, last month we had a start up dentist, he took home $85,000 last month. It was his 11th month opened from scratch. His take home was 85,000.
You have some people that take the systems of proper start up and business management and they take that and they just explode. Then you've got the other dentists who are scared, who are timid, who are doing this the first time. They want help and they end up doing well but the guys that are aggressive, that are growers, that have always done well in life and in school and they want to just conquer, you take good business systems, good marketing, good location, good design and you put that behind those guys and they just blow it out of the water.
Howard: Okay, now do these practices take [inaudible 00:22:34], do they take a year, do they take [inaudible 00:22:37]] or are they all different depending on where they're at [inaudible 00:22:40]?
Scott: The practices we work with, they're all different. I think a better way to talk about this is what should a practice do? In an area where a practice is in high demand, there's going to be a lot less pressure to be in network with insurance plans. What we've found in measuring and listening to phone calls and measuring conversion rates on the phone, we know that being in network with an insurance plan in most parts of the country does not produce more phone calls. What it does is it raises the conversion rate of a phone call. Meaning if a hundred patients called to schedule an appointment, if you're in network more of them will schedule. You won't get more phone calls by being in network in most parts of the country.
Then you have to ask yourself, "Okay, if I've got a start up practice, is my schedule wide open? Do I have a capacity problem where I just, I have too much capacity and not enough demand?" We would want to consider being in network after proving that we can't get the patient flowing if we have a conversion rate problem over the phone. Whereas you got the opposite practice that's slammed with patients, that doesn't have a whole lot of room, going in network with them doesn't make sense.
If I were to sum this up, being in network doesn't necessarily bring in more phone calls. It just gets more phone calls to say yes to scheduling. There's other things you can do to get people to say yes to scheduling besides being in network. I think a lot of people think that I am an insurance dentist. That's not necessarily true. I'm an insurance dentist when it makes sense to be an insurance dentist but I don't want to be an insurance dentist. I'd rather be a higher profit margin dentist but it's not just that simple.
Someone saying that you should start out being in network with a start up, I think has not experienced enough, you shouldn't really listen to that advice. It's much more complicated than that. It has to do with the demand of the area, the success of your marketing, what your success is over the phone, how much extra capacity you have in your schedule. All those things have to be looked at to determine whether or not you should be taking insurance.
Of course, I didn't even mention insurance negotiations. What we're able to negotiate for pricing in different parts of the country on different insurance plans. It's all part of the conversation.
Howard: Are you negotiating higher rates for your then offices that you're managing for [inaudible 00:25:17]?
Scott: Yes. Not all insurance companies do negotiate that but a lot of them do. Every time we open an office, we're trying to negotiate them up.
Howard: Who won't do it and who will listen to your phone call?
Scott: I'm sorry, say that one more time?
Howard: Which insurance companies just do not do that for anyone [inaudible 00:25:37]?
Scott: There's some insurance companies in some areas that won't negotiate and in others they will. It's not just about negotiating with them, there's also, you can sign onto smaller insurance providers that lock you into a higher fee schedule with the bigger providers. There's 2 different paths. You can sign on to the right insurance companies in the right order or also you can negotiate with the insurance companies in that area. In one area they may negotiate, in another they won't. I can't really give you a rule of thumb on who will and who won't. It's different in every part of the country.
Howard: How many parts of the country are you in? How many States are you working with?
Scott: On the insurance negotiation side, we're probably in 30 or 40 States. On the outsourcing services and managing supplies and coaching and all the other things we do, we're probably in 40 something States. I'd have to look that up to give you ...
Howard: Yeah [inaudible 00:26:46] amazing. When I said these demographics are the most important was that well, it's one of the most [inaudible 00:26:53], is to have steps steps of where to go [inaudible 00:26:58]? What are you looking at here? When a dentist says, "I want to start a practice" what are you looking at?
Scott: You're talking about what are we looking at demographically? Yeah. We're looking at of course dense population ratio but we're also doing a complete competition analysis, calling every single office in the area. We have a whole list of information that we get to tell. Are they, do they have too much demand or not enough demand? What are some of their weaknesses and what are some of their advantages so that we get a good idea of a specific area. What's going on with the dental practices in that area?
We do a lot of undercover work. We look at population density, how many people live within drivable distance. We also look at future population growth. We look at income levels, dental expenditures per population. We look at how many employees are employed in that area during the day. We connect all of that information with what the dentist is trying to do, what their vision is. Are they wanting to be one of the few high end cosmetic offices or are they wanting to be PPO mom kind of practice? Are they trying to do multiple locations where the owner does all the implants in all 4 locations? All of those practice models would have a different demographic make up that would be ideal.
It's like, I hate what dentists do. Dentists say, "I want to live in this spot. That building's pretty, there's windows there. Let me call the landlord and see what the rent is." That's their formula for success. Can you imagine if Starbucks had that as their formula for success? "Let's go to pretty buildings with windows near our manager's home." That doesn't make any sense.
Dentists have to learn the information they need to know to have a formula for success. That's part of the problem is we're very slow as an industry to say, "Here are [inaudible 00:29:00] practices. Here's the different types of models in dentistry and demographically, here's what we want to see for each one for a start up practice."
Howard: When I got out of dental school in '87 and I was trying to decide where to go, I worked at [inaudible 00:29:14] the population had been 285,000 for 10, 20 years [inaudible 00:29:27]. Hea said that they thought from '85 to 2000 [inaudible 00:29:34]. It was like Tampa, Boston [inaudible 00:29:42]. When I was living [inaudible 00:29:44] Orange County, within a mile of the ocean, there was a dentist [inaudible 00:29:49]. By the time you drove an hour inland to Redwood, I mean to Palmdale, back in '87, it was 1 dentist for every 6,000. What is the national dentist population ratio and what would you like to see it at?
Scott: I don't know the national average ...
Howard: We hear 1 to 1850, I hear that number thrown around all the time, 1850 Americans for every dentist. What would you like to see?
Scott: I get asked that question all the time. I think that it's like asking a cook, "In this dish, what, makes it taste so good? What's the one thing?" It's not, it's everything.
Howard: [inaudible 00:30:29] fat with sugar.
Scott: If I were to come up with a number, it'd be a lie. I think people that come up with that number are either ignorant in the process, not understanding how all of the numbers play into account to that process or they're trying to sell us something. They're the ones saying, "Hey, hire me to find you that number because all you need is 2,000:1 ratio and you can do a start up so hire me to find you that number." They're either trying to sell us the number, the report or they just haven't built offices themselves and truly understand that it's not just that number. Its a weighted thing.
Howard: One of my viewers is sitting here in Spokane, Washington, he's a city an hour away. Can he just call you? Can he just e-mail you, is there a [inaudible 00:31:22]?. What if one of my listeners, you're probably talking about 7,000 dentists, probably 5% of our community work. What if some guy [inaudible 00:31:29] there was this [scenario 00:31:33] of a year and he just, he email you [inaudible 00:31:36] Your website, breakawaypractice.com and send you the zipcode. Well how much would it cost them for you to look at that or answer that question, if someone just wants to talk to you?
Scott: Yeah, well there's a couple different ways. If they go to our seminar on start ups, in a very short amount of time they will learn all the ins and out that they would need to get started. They'd also learn to save $2-300,000 on building an office. That's one way to contact us. That's the way ...
Howard: How often is your seminar? Is that a 2 day, 3 day? How long is that seminar?
Scott: That seminar we give 8 times per year. Right now, in 2015, it's a 1 day seminar. In 2016, it will actually be expanded to a 2 day seminar that will cover not just how to find the ideal location and design a practice and save a couple hundred grand, but also the management side of a start up practice. When to hire a hygienist, how to market properly, how to manage staff and train them. It's an intense seminar. Right now, in a seminar weekend, between the 2 seminars we offer, it's 700 pages of content. It's just all value, it's a very intense ...
Howard: Sorry, so in 2015 right now, you said you have 2 different seminars, they're each one day?
Scott: Yeah. 2015, we've got a 1 day seminar on how to find an ideal location and save a ton of money building it. Then the other seminar we have is 2 1/2 days. It's called Our Business Masters Seminar. That is 500 pages of content that the ins and outs on how to build and manage a high growth, high profit practice. It's not for startups necessarily. It's for any dental practice ...
Howard: Is it always in the same city or even out of the country?
Scott: It's in San Antonio, in our home office where I've got 130 or 140 staff that are answering 30,000 phone calls a month and billing insurance and managing AR and marketing and doing auditing. We give this seminar in our facility and people can walk around and hear these systems being used and see what kind of results they get first hand.
Howard: Now I want to go. I would love to. You've already got my mind racing. I would love to go. I've always only had one practice. I did some start ups and sold them down here. I started 3 others and sold them but then I had started [inaudible 00:34:08] and I started a magazine and a website [inaudible 00:34:12]. Now I'm a grandpa but I'd still be interested in this, I really would.
Scott: Dentistry's changed. It's a new face of dentistry. Find the things that practices don't necessarily do well and have someone else do them better. Take a large sample size of practices and find all the things that the best performers do and create systems around them and teach that to all the rest of the dentists. It's all of us joining together in an alliance to learn all of the things we need to learn to do better.
In the past, you'd have consultants come in and try to train us how to do one thing here or there. Now, we build a whole system and we have a process where you come in for a very short amount of time and you're given all the answers. Then you decide which one of those things do you want to do yourself and which one of those things might you want someone else to help you with. We give all the answers right up front in a very intense training seminar and in an environment where they get to see this large sample size of highly successful practices being managed.
Howard: Scott, we have a unique opportunity here. There's 2 real dentists that really know how to root canals, implants and [inaudible 00:35:30] and all that stuff. Probably all of our listeners are dentists. I have never gotten an email from the, Well, I've gotten a couple emails from [inaudible 00:35:38] dentists but I've never had one from [inaudible 00:35:40]. Dentists are, they think it's all about them [inaudible 00:35:44]. They're just all this and if I just go to [inaudible 00:35:48] there's 100 dentists on every corner and I open it up. I go to the [inaudible 00:35:52] the Point Center and I'm just the best damn dentist [inaudible 00:35:56] and it's so far from the truth.
I think the opposite. I think the most important person in the office is the lady answering the phone [inaudible 00:36:04] but the [inaudible 00:36:05] but the person answering the phone in my office, I have 4 people [inaudible 00:36:09]. Do you think, you were talking earlier about the conversion rate that you're getting at work [inaudible 00:36:17] portholes but you get more conversive [inaudible 00:36:20] appointments. What are your thoughts on the importance of the person answering the phone and what can you tell the dentists listening to this now that it's really not their [inaudible 00:36:32] skills and the [inaudible 00:36:33] but what's really more important are [inaudible 00:36:36] phone upfront and how they're answered. What are your thoughts on phone [inaudible 00:36:39]?
Scott: I think anyone listening to this has been to one of our seminars is probably smiling right now because I think phones are one of the most important things but before I tell you how important I think they are, I want you to understand our philosophy. There's about a dozen of these things that when you improve them, it causes exponential growth from the practice. For example, I could double the new patient flo9w, I could double the conversion rate on the phones or answer twice as many calls. I could double the case acceptance, I could diagnose twice as much dentistry. There's all these things where you have a lever that you could pull that would increase the success of the practice.
The phones is one of the earliest levers you can pull, so it has a dramatic effect and it's one of the easiest things to fix. The national average right now on the miss-call rate. Most practices, I ask them, "How many calls do you miss?" They say, "Oh, we answer just about every call. We probably miss maybe 5 or 10%." National average is 38%. They have no clue that they're missing calls because 5 calls are trying to come in to their 3 lines, 2 of which are being tied up by someone verifying insurance or someone confirming appointments. They don't know they even miss those calls trying to come in.
Then you look at the conversion rate, when a call is actually answered, what percent of those result in appointments? You look at new patient calls, the national average from conversion rate is 43% meaning 100 new patients call to schedule, 43 you give an appointment. That leaves a whole lot of potential. We think we're missing 1/3 of our calls and of the ones we answer we're only converting 43%. It's very easy to see how a lot of our practices are getting 150 or 200 new patients a month because we've fixed the phones where another practice might be getting 40 new patients a month. They could get more if they could answer more calls and if they can convert more appointments.
Back to startups because that's what we're talking about here in this podcast is startups, they've got a big disadvantage. They might only be open 2 or 3 days a week. They might only have 1 front office person so they're going to miss a bunch of calls. That 1 front office person hasn't been through training, this new dentist maybe with his new practice is just trying to get the x-rays to work. They're not focused on training and listening and recording an auditing their front office phone calls. Unfortunately, a startup practice is going to live and die by that new patient flow, of which marketing and phone performance are determining how successful that practice becomes.
A startup practice to ignore phones, to not have proper auditing, to not have training and to not have the marketing to drive in the phone calls, that startup practice is going to be that stunted national average of 300 grand collections in the first year and the dentist made no money.
Howard: I really love what you were [talking to Brad 00:39:48] about [inaudible 00:39:49] leverage and said there are so many leverages, you said there's a dozen [inaudible 00:39:53] flow of the market, increase incoming call [inaudible 00:39:57] conversion rates. You said [you can 00:40:00] increase diagnosing. What other levers are there? That was 3.
Scott: Yeah well just, and each one has its own levers. You look at for example, conversion rate. Let's just look at that 1 lever, what are the little levers inside of the conversion rate? We know that if dentists have high initial up-front fees to come in for the first appointment, that hurts the conversion rate. If they don't have a lot of prime-time appointments available, that could be after-hours or it could be just enough ops. They've expanded their hygiene departments so they can see more patients after 3. If they don't do that, that hurts the conversion rate. If they've got poor phone skills, the receptionist might still sound nice. She might be saying truthful things but what she's not following is a system for conversion, that can hurt it. Not outsourcing all the calls you miss.
It's a no-brainer to have someone else answer a phone call you missed. That hurts conversion rate. There's all kind of things that will affect the phone performance. Besides that you've got things I didn't mention, other big levers are internal referrals. Once a patient makes it through, let's say we did get them to call, they made it through that wall, then we did answer the phone, then we did convert them to appointment then we did have them show, that's another one, no-show rate. Then they showed, we did diagnose plenty of dentistry, that's a lever and then they did say yes, that's case acceptance. Then they did follow up through and show up for the work. Then after they showed up, they got all the work done, the full treatment plan and then they referred us other people.
All of those things are little walls that we build up that we can break down. There's systems, there's the lists of things we can do, some of them are very easy, some of them are more complicated that will give us an added boost in each one of those things. A startup practice typically doesn't know any of them. They will die if they don't do those things well. A startup practice has more pressure to be great than a mature practice that's built up 20 years of good will in thi8s area where they've treated generations and people show up because you're the doc and they say yes because they've always said yews even if you're terrible.
Startup practice does not have that luxury. They've got to be great, they've got to do it well.
Howard: I [inaudible 00:42:33] kids move back to town, their parents living there, they're an hour away, you remember coming to see me when they were 5. Okay so we're [inaudible 00:42:53] startup practice. The startup practice infrastructure, do you [inaudible 00:42:59] when you start is it [inaudible 00:43:05] one system, one dentist? Talk about the actual physical startup practice and I'm [inaudible 00:43:11], is there a formula? I love the [inaudible 00:43:14] that we scream the answer to that, I just love that. It's like I almost want to name this podcast, 'Scott Leune is screaming the answer to success.'
Scott: Okay, on a startup practice, most dentists are solo dentists doing this practice they're building, it's really their job they're building. They're building themselves a job. In that situation, what's very important is to have adequate working capital to pump up growth and to protect from stunted growth if things go wrong. To have adequate working capital, we need to spend the least amount of money possible in building these offices which means we need a small facility. We need to still have lots of ops but we need to cut out the fat, cut out stupid equipment, cut out stupid wasted space. We can have the smallest facility possible yet still have the number of ops we want.
By having a small facility, we have less upfront construction costs and we have less ongoing costs. Our break-even point is lower because we've got a smaller facility and less rent. Now how many ops? It depends on ...
Howard: Slow down, I mean how much space, a thousand square feet [inaudible 00:44:25] enough?
Scott: It depends on the deign philosophy you follow. If you follow some of the older design guys that made a lot of money 10 years ago on the golden age of dentistry, you'd be building huge offices with not a lot of ops. If you follow our system, you're building your office will be about 330sqft for every dental operatory you have. A 5 [inaudible 00:44:50] practice would be a 1650sqft footprint, but that gets you all the storage, all the private consultation room, video game room, big lobby, everything you'd want, private office, everything you'd want in that footprint.
Howard: Okay but what did you say, 5 op?
Scott: As an example, if someone wanted 5 ops but my answer to the question, how many ops should you want in a startup, it depends on how you schedule. I believe that with smart scheduling, you can fit a lot more dentistry in a smaller facility. I think that most dentists will want somewhere between 5 and 7 ops. A higher producing dentist will lean on a larger practice primarily because they will have more assistant driven production, [orifil 00:45:34] or sleep apnea therapy. They will be more efficient, they will have shorter appointment times. They will need more auxiliary staff to support their production.
Another dentist, let's say the average Joe, they may not need as many ops and so we have to really determine, is this an average Joe and how are they scheduling? Some schedulings require, excuse me, some scheduling systems require more ops whereas others don't. I could show you a scheduling system where you can have a 7 op practice and have 3 full time dentists and 6 1/2 full time hygienists working in 7 ops Monday through Friday. Yet I can show you another scheduling system where if you wanted 3 dentists, 6 1/2 hygienists, you might need 15 ops. You have to, to do it right, you have to really determine how productive are you, what type of assistant driven production are you doing and how are you scheduling yourself? Then you know how many ops you need but you want to have is, you want to have the smallest dental practice possible to achieve that goal so that you have much more money in your pocket on day one so you can push that growth.
Howard: Okay, and he said don't start with the rich and stupid equipment. Specifically what is unnecessary for the [inaudible 00:46:54]?
Scott: All right, there's, it depends. It depends on how you deliver dentistry. I'm going to use a dumb analogy for you but I think it'll make sense. Let's say you want a kitchen, you're going to fill it with a bunch of cabinets right? Why do we fill it with cabinets? Because we've got a bunch of plates we've got to store. If we got rid of plates we wouldn't need the cabinets. Let's say our dining table had little indentions and it was stainless steel and we never had plates any more, we just ate in the indention on the table and we cleaned it when we're done. Now we don't need plates, now we don't need cabinets.
Same thing in dentistry. How we deliver dentistry determines if we need the cabinets. Are we going to store things in all the ops or are we going to centralize storage? If we have centralized storage, we may not need all that storage in the ops. If we don't need the storage in the ops, we don't need the space for them. We save money on the stupid storage and we save money on the wasted space for that storage.
Howard: Sure, we can store things in the ops, or storage in the ops?
Scott: That's just an example but the national average, you'll spend about $45-50,000 on equipment pert operatory. I spend 12. I spend 12 grand per op on equipment. I can equip 4 ops on day 1 for just as money as the guy down the street that only equipped his one op in the old way. The old way of following what all the suppliers tell you, listening to what architects tell you and not really following more lean design philosophies.
Howard: What about your big [inaudible 00:48:31] there's [inaudible 00:48:34] 3 dimensional [inaudible 00:48:35] for 800 grand, there's [inaudible 00:48:36] cams 150,000, there's lasers [inaudible 00:48:39] 75,000. What about all that [inaudible 00:48:43]?
Scott: Yeah, so when I say 12 grand in op, it includes intro cameras in every single room and digital sensors, all the hand pieces, curing lights, diagnodents, a lot of TV screens, all the computers, everything you need. That figure, the 12 grand, does not include a cone beam or a CEREC. Those are additional things, but it does include the [vac 00:49:09], the compressors, the nitrous carts, the [modem tremor 00:49:12], the autoclave. Lasers, cone beams, CEREC, that would be on top of that.
Howard: Let me ask you this, when dentists [inaudible 00:49:21] the $100,000 for a CT I tell them, you have access to one, they're oral surgeons, they're periodontists, they're [inaudible 00:49:27]. In big towns like [inaudible 00:49:29] and LA there's actually, there are radiology centers and all that stuff. I would ask you, what do you think of the [inaudible 00:49:37] because it seems like a lot of offices were doing, like the first appointment they would [not 00:49:47] prepare [inaudible 00:49:47] for about an hour or [inaudible 00:49:49] later and they [inaudible 00:49:51] 30 minutes. Now that [inaudible 00:49:53] into the chair for 2-3 hours and the dentist is doing all that work.
Sometimes [inaudible 00:49:59] a lot of dentists need $150,000 to [denote 00:50:03] themselves [inaudible 00:50:03] dentist and for the lab-tech. There hasn't been a crunch time where, if you can't do the [inaudible 00:50:12] for a certain amount of time, you're not making money. I want to ask you, you're managing, you're managing a lot of practices. Do the practices that have [inaudible 00:50:21] not just CEREC or [inaudible 00:50:22] in there somehow for [inaudible 00:50:25]. Do you think that you can make more money or are you going to be there just playing lab-tech?
Scott: We've measured this, so I think you're going to love my answer here because we've got, everything in break-away is about measuring and finding facts. My opinion initially was a lot different than what we found out. Here's what we found out, first of all using CAD/CAM takes longer than not using CAD/CAM.
We know that there's more chair time for the dentist to use CAD/CAM on average than to send it out the old fashioned way and have 2 visits. Is that important or not? Well, if a dentist has a wide-open schedule, it doesn't matter if it takes him 10 or 20 minutes longer right? So capacity comes into it. Do we have a wide-open schedule or not? Now then you hear the argument, "Well CAD/CAM's cheaper." Well it depends. I spend 29 bucks a unit on labs because we've got negotiated pricing. Actually having a crown done by a lab is cheaper for me than CAD/CAM whereas another dentist might spend 150 or 200 bucks a unit.
What we also found out, the real value of CAD/CAM is not saving money and it's definitely not being faster. It's not faster. The real value is that patients go deeper into their treatment plan. Instead of having 1 or 2 crowns done, they'll just knock out all 4. When you look at the average size of completed treatment, how deep they go into the treatment plan, patients are, excuse me, dentists that have CEREC for example or any CAD/CAM unit are having patients go deeper into their treatment plan. That's where the real profit comes into play.
I'm not talking about dentists that are just diagnosing inlays on every single patient. I'm talking about looking at the procedures done before CAD/CAM and after CAD/CAM, those common procedures and how deep into a treatment plan a patient gets before and after. That's where the true value of CAD/CAM. Now, if you're a dentist with high lab fees, CAD/CAM will save you money. If you're a dentist that has a wide-open schedule then taking that doesn't matter. For me, when you have everything else right, when you have good lab fees, when you have a proper schedule, then the value comes into a deeper treatment plan being accepted.
You can make the argument that it's advanced technology, maybe there's some sort of marketing pitch to that, maybe there's more internal referrals from that. We haven't been able to see it. We haven't measured that. All we've measured, all we've been able to see is deeper treatment plans being accepted.
Howard: Well Scott, how come, I'm still bringing my friends into this sphere, I mean personal friends, when they take their [inaudible 00:53:16] and send it to a lab, somebody they, a lot of times they've never even met is making it [inaudible 00:53:23]. I have my assistant [inaudible 00:53:27] everything. I have insurance, I don't care because it's like they're controlling, they're like, "Well you have to stay here and you have to market to guys [inaudible 00:53:42] ..." Really? You're not doing that when you say [inaudible 00:53:45] to the lab. I basically only do what's irreversible, I [inaudible 00:53:51] and then I come back to this medic and I ... what are your thoughts on that?
Scott: Yeah, you're absolutely right. It's faster to do it the old way for most people. If you have a full schedule, you're slim, you just want to have faster crowns maybe, if you trying to measure the money. Some people don't have an open schedule and some people enjoy doing it, some people make the argument that it's higher quality, that they've got more control. There's a lot of benefits to it and I'm personally in the CAD/CAM fan but I don't kid myself based on our data, you're slower when you do CAD/CAM. Based on our data, you don't save money. I believe that by having more cases accepted, getting deeper into the treatment plan, we ultimately fill the practice faster and therefore have more control on do we keep expanding, do we raise our fees? We can have more control over our profitability in the long term by raising our demand.
Howard: I want to ask you another question since we're talking about startups, let's say, and maybe I'm being [inaudible 00:54:55] because [inaudible 00:54:57] startup for, to build it for a business that's on the side and not what's [inaudible 00:55:02]. I'm talking about building an investment on the side. I say I give that, I'm [inaudible 00:55:09] that was a long time ago, but some people say that if their, some of the [inaudible 00:55:23] but they [inaudible 00:55:27] one dentist. When they tried other models where they double that and went with 2 dentists, the minute they go from 1 dentist to 2 dentists [inaudible 00:55:43], have a HR problem, conflict, just to great lengths, more putting out HR fires. They just say that when there's 1 dentist, the assistants [inaudible 00:55:55]] looking at one leader and the minute you have to, like they [inaudible 00:56:00] religion like that's 1 god. Today it's Yahweh, Jesus all of, not many religions have 2 or more gods.
Do you think that if you're building this as de nouveau and you'd want to own this [inaudible 00:56:15] probably on the side and maybe something big [inaudible 00:56:17]. Do you see one dentist [inaudible 00:56:21] a lot easier to manage than [inaudible 00:56:24] or not?
Scott: I believe that the stories you're hearing are more the result of poor systems. A practice being successful with just one dentist, when you add a second dentist and it starts failing and you start having HR problems or patient problems or whatever it is, that's just a sign that there was no real good way of managing that in that practice to begin with. We're almost lucky it was doing okay because this one person was allowing it to be okay.
As you keep expanding to more dentists or multiple locations, all the weaknesses in running the business come into the spotlight and that can bring us down. If you look at the profitability of a practice, we're much more profitable with long term having multiple dentists pay the overhead of the small facility. Also having multiple dentists allows us to build a bigger patient base which then gives us more specialty procedures.
It's much more profitable to have multiple dentists. The real question is, well how do you run practices to have multiple dentists? That means you have to have your scheduling systems perfected, you have to have your HR side done, you have to be able to listen to the request and demands and concerns of dentists and act on them immediately. There's got to be a lot of things fixed. As you grow bigger, if those things aren't fixed, they eventually become problems and then I might be the dentist that says, 'Well, I only have 1 dentists per practice because the minute you have 2 it doesn't work." That's not really the case.
The most profitable practices and the corporations know that they need multiple dentists to that build a big specialty based patients, that has a lot of revenue to pay the over-head. It also gives them a lot more flexibility in-case you do have a problem with this patient or this dentist or this staff person. You've got a lot more resources and infrastructure to overcome that.
Howard: Scott, [scream 00:58:16] the answer, I've only got you for 2 more minutes in this [inaudible 00:58:18]. What you do is try to [inaudible 00:58:19] speak the answers [inaudible 00:58:22]. It seems like everybody in my neighborhood is [inaudible 00:58:25] does that really work for a startup?
Scott: Yeah so what we've done is we've measured conversion rates for practices that are open early and late on weekends and not. I can tell you, in most parts of the country, being opened early does nothing on the conversion rate, whether you're open at 6:30 or 8:00, the same amount of patient schedule. Being opened late, completely different story. If you're open after hours, you definitely have an increased conversion rate. Being open on Saturdays, same thing, and increased conversion rate.
Of course, if this is your job, if you're building your job, you also have to balance out your family, your personal life, the lifestyle that you envision leading here with your practice. I'll tell you that the later you're opened and if you're open on the weekend you have strengths, you have benefits that you don't have otherwise. You should be as opened late as you can, you should be [inaudible 00:59:23] on many weekends as you can and you will probably have more initial success that way.
Howard: When you say length, do I 7:00pm, 8:00pm, 9:00pm, [how long 00:59:34] are you talking about?
Scott: We measured practices that were opened till 7:00. I don't know what happens when you're open till 8:00 or 9:00. Maybe it's better, I know, but we, the only data we had is practices that are open till 7:00. I would also recommend that around 4:00 you really should change your schedule to make your schedule more open to new patients. You might go to a hygiene format for example and take a couple of ops to from the dentist so that you can have more seats in your restaurant during the lunch hour rush. That's what we're talking about at the end of the day, having more seats available for these ...
Howard: Scott, my job is to predict and to guess the questions for these guys that are listening to or calling in. There's a bunch of people screaming, "Oh, it's on Saturday, no one turns up. We always schedule the appointment and they never show up." True or false?
Scott: True sometimes, usually false. We know that if you're scheduling [ProFils 01:00:31] on a Saturday, high no-show rate. New patients on a Saturday don't have a different no-show rate than new patients on a Friday. That's what we know. We also know that there's a higher no-show rate for restorative work but you get high case acceptance so it's not that simple. I'll tell you though, I personally have never worked on a Saturday so I'm the guy that says, "I've got a family, I'm not working on Saturday." We've got a bunch at offices of dentists that want to work on Saturdays and they're slammed. They'll be booked out way in advance on Saturdays, they'll have a slightly higher no-show rate due to the restorative and the ProFils but they're some of their best days.
It's important to not focus on the no-shows and just assume, "Oh my god, it's not worth it." What's important is to actually look at the numbers, to see, "Okay, how much more money are we making because we made this decision?"
Howard: Scott, in regard to the numbers, what management information system are you recommending for us [inaudible 01:01:33]? I know Dentrix, Patterson and Eaglesoft, there's Carestream, PracticeWorks and [inaudible 01:01:42]. First, since you're just a total numbers guy, what management information systems do you like [inaudible 01:01:48]?
Scott: Here's the hard truth. None of them track the numbers we need them in the way we need them because all of them, the deepest [inaudible 01:02:00] is they'll give you a list of patients overdue for a re-call but they won't tell you what your reappointment rate is and why you're not scheduling patients.
Howard: They can't even payroll?
Scott: You've got to have a 3rd party program. My favorite one today, right now, is Dental Intel. They're my favorite. They're a 3rd party program that you layer on top of things like Open Dental or you layer them up on things like Dentrix or Eaglesoft. Now I do have my opinion on the practice management programs and I don't like most of them so I'd rather not speak too negatively about them. Most of them, most of them are way too expensive, the servers go down, customer support is horrible, the billing and insurance is messed up, there's way too much fat in the program, the scheduling is not set up properly. I just wonder who the heck was the consultant they hired when they built the programs because they're just not dentist friendly.
Howard: They're horrible.
Scott: Yeah, they're terrible.
Howard: If you have an MBA [inaudible 01:03:04] call it a management information system, they ought to call it a chaos system. They're just Bullshit with a capital B. They can't even generate a statement income and statement cash. You buy Dentrix and the damn thing can't even generate [inaudible 01:03:20]. How messed up is that? You [inaudible 01:03:25] when they come, when the [sideman 01:03:27] comes for their [inaudible 01:03:28] like to say, "Oh I'm [inaudible 01:03:30] Dentrix, that's the new payroll, sorry I can't pay you. Let the damn thing pay you." It's just crazy but if you have a good one, what are you recommending, straight to the answer [crosstalk 01:03:41]?
Scott: There's a handful of good ones. If I had to pick one today I'd look at Open Dental. Open Dental is like the Toyota that never breaks down. Dentrix and Eaglesoft in my opinion today might be like the BMW that always breaks down, you've got high maintenance cost, it sure is pretty though but it's a problem to deal with. Open Dental is like that Toyota that just doesn't break down, it gets you to work and back very predictably, very [inaudible 01:04:10] loss. It's awesome, but it's not the only good one but it's ...
Howard: I would say that Dentrix and Eaglesoft are a [Jaguar 01:04:15]. That's the ultimate luxury car that you have to hire [inaudible 01:04:21]. On Dentaltown, now that's the only one that has all [inaudible 01:04:24] fans that we know. Hey Scott we're [inaudible 01:04:27] you're an hour 4, you're just a rocking [inaudible 01:04:30] 4 minutes over time. I want to bring you back, what, tell them, will you come back?
Scott: Yeah, let' come back.
Howard: What do you want to talk about when you come back?
Scott: Let's talk about how outsourcing is completely changing the face of dentistry for startups all the way to big groups and everyone in between. It's making a dental practice much more profitable, much easier to manage.
Howard: Okay and when you email me, ca I come to your seminar, you 2 1/2 day one?
Scott: Yeah, you should come.
Howard: I want to come, I love San Antonio. San Antonio, that's the River Walk right?
Scott: Yeah River Walk, incredible Mexican food ...
Howard: Yeah I love San Antonio. If one of my listeners wants to ask you a question directly [inaudible 01:05:18] they go to breakawaypractice.com, can they call you, an they email you, is there any other contact information to give?
Scott: Yeah, breakawaypractice.com's a pretty big website, we're putting a bunch of videos on there as we speak. They can email us at info@breakawaypractice.com. That email, I've got 140 something staff, including myself and whoever's best to answer that question will hop on that email and answer it. It might be me, it might be some of my top people. Those are the 2 best ways to get a hold of us. You can call us as well but go to the website or shoot us over an email, we'd be happy to help if we can.
Howard: Okay, Scott. You're a legend, you're one of my idols. Like I said, I feel like I'm your father because I'm 17 years older than you but I feel like I saw you more [inaudible 01:06:02] and made it all the way to the NFL on Dentaltown. If you guys ever want to [inaudible 01:06:09] thread, what is your favorite thread about your knowledge on Dentaltown?
Scott: The biggest thread that everyone refers to is called 'not the average startup.' That's a very big thread we go step by step, just, I don't know how many hundreds of pages long it is. It's really long with lots of screenshots and how-to stuff in it. It's an awesome thread and there's a lot of people that jumped on that thread and gave a ton of great information.
Howard: Scott, when I go lecture, is this the number one, what we want to know is the number one thing that wanted to be, say a specific thread they'll come to me and say, oh my god, I discovered that and the next thing I knew it was 2:30 in the morning and I had 20 pages of notes. Okay, we're going to bring you back. Scott, thanks for all that you do for dentistry and thanks for all that you do for Dentaltown.
Scott: Yeah, you too Howard, thank you so much for having me.
Howard: All right buddy.