Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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226 Ordinary VS. Extraordinary with Sara Fossen : Dentistry Uncensored with Howard Farran

226 Ordinary VS. Extraordinary with Sara Fossen : Dentistry Uncensored with Howard Farran

11/13/2015 2:00:00 AM   |   Comments: 0   |   Views: 383

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"All you dentists out there, if your schedule's not full, great!" There are always ways to serve people TODAY!

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AUDIO - HSP #226 - Sara Fossen

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VIDEO - HSP #226 - Sara Fossen

Sara Fossen discusses how to make your practice truly stand out, how to be a more effective leader, and how to make sure the solution doesn't sound worse than the problem when talking to patients!



Hi—I’m Sara Fossen. I am a practice management coach. I run and own a business which assists doctors with the overall effectiveness within their business. I’ve been in this field for 17 years. I’ve had the great fortune of working with practices all over the world. My background includes office from London, to Canada to small town USA. My degrees are in business and communication. But, what really gives me credibility is my talent or knack to relate with people.

What I do is assist doctor or business owners with their bottom line. I teach people how to “wow” their patients and simplify systems. 

All of my work is about getting patients and medical practices healthy, increasing profits, leading the team, and driving the bottom line. My work is all about effectiveness and implementation.

At the end of the day, what I REALLY offer people is sustainable results, accountability and a solid game plan.

It’s all about people and relationships.

I give people permission to WIN!

Sometimes, my work looks like creating yearly goals. Other times, it looks like refining systems and protocols. Ultimately, it’s all about leadership by the owner for the team and patients.

People usually come to me for results. But what they REALLY walk away with is Freedom and Balance in their work and professional lives!

How does that sound for YOU?



Howard: It is a huge honor for me to be interviewing a dental consultant in my backyard. I've known Sara for years. She has a stellar reputation. Thank you so much for coming by the house. It's always better to do it live than via Skype. How are you doing, Sara?

Sara: I'm excellent. How about yourself?

Howard: I am doing damn good. It's so fun when you get to work out of your house and have your own son. I feel the luckiest dad in the world because all four of my boys had moved out, gone to college, moved on, and then one by one, three of them moved back in. I know this is a rare golden chapter in my life and it could be gone tomorrow. I want to ask you, you've been consulting for years. You've seen, there's 3800 dentists in the Valley and you're in one of the tenth largest cities in Arizona, I mean, in the United States. What I wanted to ask you is what I think the biggest advantage of consultants is, is a dentist only sees their own office. That's all they see. They may think they're doing good when they're doing bad. A lot of dentists, especially the super achievers, think they're doing bad when they're doing really good. 

I have dentists all the time doing 600, 800, a million dollars and think they're doing so bad. I'm like, "Dude, the average doesn't even do 500." I had a dentist the other day. I thought he was going to cry, and he was doing a million five. I'm like, "Dude, you're doing 3 dental offices." I think a lot of dentists don't have any grasp of comparing their offices. You've been doing this for years so I just want to cut right to the chase. What do you think separates a dentist that's happy and healthy and successful, whatever that may mean to him, versus the ones that are not happy, not successful, whatever that means. What are best practices that you see that, you're talking to thousands of dentists out there. I'm not sure you're talking to any consultants or office managers. Everybody that sends me an email is always a dentist.

Sara: Okay.

Howard: Tell the dentists. What do you think they should think about?

Sara: Well, the biggest thing why I think people hire me, Howard, is really for balance. They don't always know that yet. When I first go in there, one of the things you always talk about, what's the question that keeps you awake at night, right? I ask the exact same thing. What is it that keeps you awake at night. Usually it's some version of, they don't have enough time. They don't have enough money. They don't have enough balance. How do you work that out so that they can have the freedom? Why you went to dental school is so that you didn't have to work. 

You're the exception. You work a million hours a week, right? So that they don't have to do that, and I think that's one of the most common complaints I hear. Doesn't matter if I'm in Canada, London, anywhere in the US. They want to know how to balance everything and be a good effective leader. That's the portion that's always missing. They always have somebody in their office that maybe you dentists out there listening today don't have this equation, but there's this great girl that works up front or somebody awesome in the back, but there's this one thing that I need to speak to them about. They're afraid to do so, for whatever reason. Good help is hard to find. I hear that a lot, right? How do you have those uncomfortable conversations? 

One of the things that I get to do if I'm hired into a practice is really look at, can I help facilitate those conversations and hopefully train the dentist and the office manager, so when I'm no longer there, they have the technique for having those kind of conversations and not letting it fester.

Howard: I see it with all humans, and I think all humans call it gossip when it's really not gossip, but they're venting and they're venting exactly negatively because if I complain to you about Frank, I feel better. Now the problem's worse because now I'm less likely to go back to Frank. If you're a social animal and we all have to work together to get along, having an uncomfortable conversation is against our hard wiring biology, and success is measured by how many uncomfortable conversations you're willing to have. 

Sara: That brings up a lot of points. One of the things that I do is facilitate those conversations, and sometimes I have to have them for the dentist or the office. The consultant has a bad rap, that you're going to come in, you're going to hire, fire, and then leave a notebook and then go away. I love saying I have this coaching component to me where I'm on the court with them. I understand dentistry. I started as a hygiene assistant. I was a dental assistant. I worked up front. I know what it feels like to fill slots, those big open holes on the schedule. If there were those, I was not allowed to go home at night without filling my hygiene schedule. It was one of the greatest gifts I ever learned was how to fill a hygiene schedule. That's one of the things I train people on that they still come back to me, all these years later, and like, "Thank you for teaching me that." What was my point? 

Howard: The coaching aspect of it.

Sara: The coaching aspect, thank you. It's really teaching them how to have those crucial conversations so that they have the freedom and they have the balance and they don't have the front hating the back and the back hating the front or being resentful for somebody. One of the things I've noticed is I have to sometimes have those crucial conversations with the doctors themselves. Like, "Listen, I see that you call in sick at least one time a week. You're really only working three days a week, not four days a week. Let's deal with the facts here." It's not emotional. It's not a personal attack, but how do you have it in a way that they feel left empowered as well? Sometimes the dentist is the problem as well. It could be that they're calling in sick, they've lost their passion and drive for dentistry. How do you re-motivate them? It's really getting everyone involved. 

I was listening to one of your podcasts recently about letting your team know what the bare minimum is or a bare bones minimum or a nut you have to crack. It's really important because most teams don't understand what that is, and then they're like, "Why is my dentist such a pain in the butt and why is he watching every pair of gloves I take off and throw into the trash can and picking them out and counting?" This and that and the other. They don't really understand how much money it takes to run the business. When I can coach the dentist to be effective leader, it trickles down into the practice. Who doesn't want to be led by an effective leader?

Howard: I think that's interesting when you're talking about balance and then these doctors calling in sick. There's a lot of data that shows that when a doctor goes in and works like 3 9 hour days, they'll produce more than any dentist who's working 5 and a half days a week, and that it's kind of like the difference between a 5K and a marathon. When you're just going to go in there and you know you're only going to do a 5K, you'll run as hard as you can. If you know you've got to go Monday through Friday and a half day on Saturday, you just go so slow. You pace yourself. When dentists work more hours like 5 days a week, they work Monday through Friday 8 to 5, they do far more watches. They'll go in there and there'll be a black sticky, and, "Oh, I'll just watch it." Emergencies instead of starting the root canal and they'll give them Pen VK and Vicodin. They'll call in sick. Those are red flags. Calling in sick, doing watches, treating an infection that nobody on the planet knows how to treat a tooth infection other than endo or an extraction. When doc's treating it with a script of antibiotics and Vicodin, they're burned out. They're fried. There's something else going on. 

Sara: Yeah. That's-

Howard: This balance you're talking about is everything. 

Sara: It's huge because it really allows them to do what they say they want to do. Here's the thing. If you're an effective leader, meaning a boss, to many people are counting on your livelihood as a dentist. You own a dental practice. You know if you're not there, the automatic thing, or if you have a limp or a bad back or a bad arm, the whole team, you can almost see it, if you really pay attention to it. They get nervous, because they're like, "Uh-oh, my doctor, my leader, the dentist, is not as well as he could be. Now what? What's going to happen to my livelihood," if I'm the dental assistant or the hygienist. If he's not here, it's an awesome responsibility and somewhat of a burden. You're responsible for lots of people's livelihoods. You have a lot of people on your team that have been there for ages, and they know that they can count on you and their checks aren't going to bounce, and even if you're not there, you're going to be accountable and responsible and have somebody else do your job. They get nervous, and they tell me these things behind closed doors. They're like, "Uh-oh, he's calling in sick," or "Oh, my gosh, he has a backache," or "I noticed he's not going to his therapy sessions for his arm, back whatever it might be." That's just a reality in dentistry. You're hunched over a lot.

Howard: There is a huge study. It was done with a million chiropractic, big two foot by two foot x-rays, lower back, and I think it was the National Institute of Research or the NIDA or some big national. This came out five years ago, that basically they proved with this study that all lower back pain was psychosomatic. When you're stressed, you have migraines, TMJ, irritable bowel, lower back, and heart arrhythmias and issues. When you go around every country, this country says, "Oh, I get my migraine from gluten, or this one I forgot my [inaudible 00:09:35]." They have all these little tribal voodoo things. When you look at the data across countries, it's like, "No, it's probably stress reaction."

Sara: Yeah.

Howard: When doctor's lower back is going out and he has to call in sick and all that, it's stress. I'll get to this. What other things do you think that stresses out a doctor to where they have to call in sick, they've got lower back pain, they get migraines, irritable bowel?

Sara: I think there's some reality on it. There's some physicalities that just happen, but then also the stress of managing their team. There's usually-

Howard: People. 

Sara: People is a big component, right? Any time you have stress or you resist something, whatever you resist, persists. Have you ever noticed that?

Howard: I like that. I'm going to write that down. Whatever you resist, persists.

Sara: Persists. It just continues to percolate. Have you ever noticed if you have a backache or a toothache or anything like that, and the more you're touching it and feeling it and rubbing it and all of that, and not dealing with it, it just continues to persist. Dentists, in my opinion, I love them. I love dentistry. I've been doing this for many, many years, thank goodness, and one of the things they don't like to do is be confrontational. Whether that's even just dealing with their wallet or their budget or their team, and it's not right or wrong. They keep resisting it and they're not dealing with it, and that coincides with a backache. They say a backache, what I've learned about that, too. Lower back is all about money. If you're stressed out about money or you're concerned about it, your lower back will hurt. I don't know if there's truth to that or not, but-

Howard: The three divorce issues. A third money, a third over sex and a third over substance abuse, and I think that substance abuse is self-treating for the stress over money, and the stress over sex goes back to they're afraid to have an uncomfortable conversation. 

Sara: Yeah.

Howard: The same thing with money. A successful dentist feels like a loser to go home and tell his or her spouse, "I know I'm a successful cosmetic dentist in Manhattan, but I don't have that much money."

Sara: Yeah. Correct.

Howard: It lowers their ego to sit there. Who wants to go home and tell your spouse you've got to be on a budget? That's an uncomfortable conversation that you have to have with your spouse, your kids. You're big into monitoring and measuring.

Sara: Yes.

Howard: Before we go into monitoring and measuring, I've always thought the best consultants at the end of the day, they're all armchair consultants, they're all Dr. Phils. When someone says to me, "I paid this consultant $50,000 and I loved it and in fact, I had her back 5 years later," and this and that and this. When I start saying, "Well, what did it do?" They almost never, ever talk about production, collection, money. They always talk about they're happier and healthier and their gain came together. Then you look at these Olympic coaches. If some little girl's been doing gymnastics from 5 years old to 20, you're not really out there coaching her on how to do a back flip. You're basically trying to keep her head on task. She's burned out, she's fried, she's got injuries, she's not happy. The Olympics is still 12 months away. 

In fact, I always thought if you were ever going to go to school to be a dental consultant, you should be Dr. Phil first. The reason I set you up for that is, you're going to to into what you should monitor and measure and all that stuff, but my problem that I see is that humans don't like to be transparent. They don't like to show their staff their numbers and everything's a secret in their closet. I have lunch this week with two different dentists and when I go in there, I always ask the same routine questions and [staff 00:13:14]. No one knows their break even point for the day. No one knows their bare-ass minimum. No one knows at what time of the day do they enter the profit zone. I can ask them, "By the way, are your supplies 4% or 8%?" Even the girl ordering them doesn't know.

Sara: I know. It's scary. 

Howard: When you're talking about all this measuring, I want you to first back up and put on your Dr. Phil hat and say, "Why does a talking money not want to show his report card and get all the staff on the same team so that the work just goes away?" Once you're transparent with the numbers, and I say, "Okay, you're in charge of supplies. Supplies should be 6% and if it's 7%, that's cool. Next month I want it 5, but at the end of the year, if it's not 6%, then you and your little supply lady friend are both fired." THat's what I tell Val. That's what I tell Jan. "If you can't do it, you got the whole year, but if you can't do it, then I'm going to let someone else try it for next year." 

Here's the number. Those two work on it, but Val is very incentivized because she doesn't want to lose the account. Today's dental orders a lot of supplies. The problem with the assistants like Jan is every time you go to a convention, you want to come home and buy every new toy known to man, but then she's sitting there thinking, "But he did say-" and I tell Jan. She's been with me 20 years. I said, "You go to a convention and get crazy," kind of like when you go on a cruise, you go to Jamaica and you see all this weird neat shit, so you buy it all. Then you get home and you're trying to, "Well, where should this go?" Probably back to Jamaica. How do you get a dentist to be transparent?

Sara: That's awesome. I'm so glad you asked me this question. I just had this conversation. One of my best friends is in dentistry as well and we're weird. We go to coffee and talk about dentistry instead of other things. She was telling me she just saw a study recently that said 70% of Fortune 500 companies hire a coach or have a mentorship program in it. They understand the value of mentoring your people, that they're more productive when they're at work, and not working more, because who wants to ever sign up for working more. 

No one, when I go to a dental office, says, "Sara, I want to work more and get paid less." Ever. They never tell me that. They want to work less and get paid more. What's the difference between therapy, consulting, and coaching? There was a great breakdown on it. I'm like, "Wow, this is really great." When you go to a consultant, you're asking for an expert opinion. What should my number be? As a consultant, I can tell you that, but if I don't get to the philosophy that's going on in between these two ears on a dentist, the leader, or the owner, it doesn't matter. I can give them all the best tools in the world and none of this stuff's going to matter. They're not going to implement it. 

I always start with, "Where do you want to be next year at this time? Where do you want to be? December 31, 2016, we're standing on the finish line. "Where do we want to be?" I have to get what their goal is. Otherwise, I'm never going to get them there. I can give them all the tools in the world. I can train their team up, and what's predictable and likely is the minute I walk out and I'm not keeping them account, no one's going to- What you just said about your two people on your team is awesome because most doctors don't know those numbers or they won't hold them to account. They want to be nice, like nice nice. Meanwhile there's a fire going on and our house is burning down and your spouse is cheating with your best friend and no one is talking about it. That's that transparency you're talking about, correct? You're right. You have to get into the coaching realm, and there's a fine line between coaching, therapy, and consulting. I don't want to be a therapist. I don't want to be Dr. Phil. 

Howard: How's that working for you?

Sara: Yeah. That question. I'm like, "How's that working for you?"

Howard: How's that working for you?

Sara: They wouldn't hire me if it was working. I want to go in and be able to coach them up. Even the best practices I've ever worked with, no matter what, always have some fine tweaking, and it's usually in the leadership portion of it. It's not the numbers. Of course, those things help. We have to have systems in place, no doubt about it. Dr. Costas, my [inaudible 00:17:24] name, he's a big fan of operation manuals. I used to always call them the how-to manual or the bible in the office. You have to have the rules put in place so that there's always exceptions to the rules, however- usually there's an exception- but you've got to have the rules in place so your team knows what it is. It's no different than your kids. You're talking about your four great boys. When they were 10 and 15 and 18, you didn't say, "Well, go out and come back whenever you want." Hopefully you didn't. You're like, "Your curfew is x, y, z, and when you break it, there's a consequence." For some reason, we don't want to do that in our dental practices. We just want to hope and pray that it all turns out. 

All that's based in fear. When you're going back to saying the coaching aspect of it, fear. That's what's driving all of it. Fear that if I tell everyone my numbers, what if they go out and get drunk tonight at the bowling alley in a small town and tell everyone what my numbers are? It's neither here nor there. Who even knows how to really break those numbers down, anyone else? I was in a practice recently in Scottsdale an we had a big team meeting and we always do them off site. We go off site so that it feels like a CE course and we're learning and the doctors are paying their team and they're paying me. I want them to get their biggest bang for their buck. I said, "Hey, team," and I'm looking at them, "What do you think it costs to run a dental office?" A lot of them had been there 3 years, 5 years, 10 years. They had no idea. They were like, "$30,000 a month?" "$30,000 a week?" They really didn't know. I turned to the doctors and I'm like, "Is it fine if I share with your team what it costs?" They said, "Yeah." It was $115,000 a month. That was their nut they had to crack. 

The team was floored. All of a sudden this revelation, and they were coming up to the doctors afterwards and hugging them and thanking me for just allowing them to know what that number was, because now it made more sense to them. We'll use a football analogy. You and I go to a football game tonight, and we're not really watching the game, we're just hanging out, chit chatting, and then you go home and Ryan says to you, "Hey, dad, who won the game?" You're like, "I don't know." Who scored the winning touchdown, or who kicked in the field goal? You're like, "I don't know." That's how it is in some dental practices if we're not sharing those numbers with them. We're just running really fast on the treadmill and we have no idea. That's why going back to things to measure, that's why we do a morning huddle. Why wouldn't you do a morning huddle? It's ridiculous. Why wouldn't you want to start your day like, "Hey, how did we do yesterday? How's it looking for today and how are we looking for tomorrow?" If we're not talking about it and we're not having the communication and we're not sharing with our team, we're just doing okay work. They can be the best dentists out there. 

Howard: Two big fears I hear is, "Well, I don't want the staff learning how much money I can make." It's like, "Dude, there's 56 dental schools. If they look at your numbers and say, 'Damn, I want to be like Dr. Sara. I'm going to dental school.'" Awesome. I've had two assistants go to dental school, Elaina in Florida and Kelly Bradley in Bullhead City. Go for it. You know why both those assistant, I told them they had to go to dental school? They're the only two assistants in my life where when they were assisting you, and I have a bald head. I don't have any hair. They were always bumping their head. They were bulldogging their head. 

Sara: Oh, to get in there.

Howard: I've got to see, and they're like, knocking my head over. I just saw the passion. They always begged to do all the expanded functions, and so we broke every law known to man. "Yeah, do it. Knock yourself out." The other one is that they don't want their staff to know, in a small town, they don't want their- and it's funny how exactly wrong that is. I'll never forget. I met an Iranian cardiovascular surgeon in Wichita, Kansas, where I was born and raised. He came in there and he said, everybody else was a legend. They were all from Kansas. He was an outsider. He was an Iranian coming into this farm town. You know what he did? 

Sara: What?

Howard: He went out and bought himself like $180,000 red Ferrari, Lamborghini, I forget. I think it was Ferrari or Lamborghini. I forgot what it was.

Sara: Really stick out.

Howard: And put "Heart Doctor" on the back. Ask anybody in Kansas, "Who do you want to do your bypass?" The guy driving the Chevy truck, or the guy driving the only $100,000 red sports car. He told me that was the single biggest- I think his name was Dr. Fara- he said that was the single biggest- he said he never had to market because everybody wanted the heart doctor that's so successful that he owns a red Ferrari or Lamborghini or whatever the hell it was. 

Sara: Isn't that great?

Howard: Who cares if your staff knows? That's what I think it come downs to. I think it comes down to, if the staff finds out you make a bunch of money, that there's somebody wrong with that. Well, they all want to work for a successful business. Nobody wants to work for a dying dental office and nobody wants to have their body fixed by someone who's so unsuccessful at it, they're about to lose their business and they have to drive a Dodge Dart to work every day.

Sara: Right. It's the perfect analogy is a sport. Who wants to be on a losing team? No one does, right? You want to have a door that everyone's knocking on it because they want to work for you because you're the best dentist around and you treat your team well. One of the things I learned many years ago from a consultant I worked with, and I'm stealing this from him and I'll give him props, and it's Gary Katy, that he really coined the term triple win. Not just a win-win, but the triple win. What that meant is how do you have the business win, the patients win, and the team win? For me, I'm a visual learner, so I always envision as a three-legged stool. If one of those three legs were off, you wouldn't want to sit on it and you sure in the heck aren't going to jump on it or stand on it. How do you ensure that the team wins, the practice wins, and the patients win? 

When you make every decision as a leader based on that triple win, you're not going to lose. It doesn't matter whether it's rolling out bonus structures. You've got to look at from your business, too. Are you about price, quality, or service? You can't be all three. You know this. I'm not telling you anything you don't know, and I teach my offices that. Which one are you? Which two are you? Are you price, quality, or service? That goes along with that triple win. You can't be everything to everyone. When you really hone in on those two, that's your leadership portion, and now you're sharing that with your team. Now you're sharing your bare-butt minimum with them. You're sharing the number that you want. 

It's just a number that we pick based on where they want to end up at the end of the year. I'm working with a practice right now with two doctors and they want to do $2.1 million next year. Why? Why not? That's the number they want. We break it down for them, how many days do you have to work per year? All of that, so that they can have the results turn out. If you're not sharing that with your team, your team has no idea what your goal is, and they're just coming in and working. There's nothing wrong with that. It's just that if you want to be world class customer service, you want to go to the Super Bowl or the World Series, you've got to have a game plan. That's really what I do is create the game plan. 

Howard: The dentists can't even do that, just that simple deal. If you want to be all things to all people- I don't know the secret to success, but I know the secret to failure is to be all things to all people. They can't do it. They'll sign up on these PPO fee schedules and you'll say, "Okay, on that fee schedule, you've got to place amalgams and use a low cost lab like Glidewell." "Oh, no, no, I'm doing direct composites and I'm using the lab up the street that's 140 bucks a unit." You're like, "Okay." Then they'll sign up for all these PPOs and go out and buy a $75,000 Biolase, $150,000 arcad cam, $100,000 CBCP, and you're like, so basically, you're getting paid for a Chevy and you want to build a Mercedes Benz. 

Sara: Yes. 

Howard: To a patient that's just coming in there just because your PPO, they already came to you on price. They ordered a hamburger, and when you serve them a Ruth Chris steak, they don't even say, "Thank you." I've never ever had a patient say, same thing with the fee schedule. You'll go into a medical dental building, right here in this zip code, right here in Ahwatukee, Chandler, and Mesa, and there'll be 8 dentists in the building and they're all charging $1,000 for a molar root canal. There'll be endodontist next door charging 1500. If I say to you, you're a woman, so I'll ask you, how much is prostate surgery?

Sara: No idea. 

Howard: Yeah. You don't have a prostate and you probably are never going to be told the financial arrangement on a prostate. You go into the eighth dental office and not one person's ever had a molar root canal and said, checks out and says, "Oh, my gosh, it was only 1000? Wow, that's low cost. Thank you so much." They all say, "Wow, that's expensive." They go to the endodontist, 1500. "Wow, that's expensive." The endodontist has 40% overhead. The general dentist will have 65% overhead, and nobody thanks the dentist for being lower price. They sign up for these PPOs and they still give them direct heliomolar tetric flow, high cost composites with rubber dam, average barrel of bonding agent, a barrel of oil is 100 bucks. It was a year ago, now it's about half that. A barrel of bonding agent is a million five. You say, "Well, let's not buy a barrel of bonding agent. Let's place some amalgams in the back. At least [on boys 00:26:47]." Nope. Not going to do it. "Well, let's at least use a low cost lab like Glidewell. Let's get an oral scanner. They'll give you a $20 discount on your crown." No, not going to do it. Then they'll come back to you and say, "Well, why is my overhead so high?" It's like, "Because you're trying to be all things to all people."

Sara: Yeah. That's a great thing. One of the very first offsite team meetings I do, hopefully in the first 30 days of when I'm hired with a client, is we want the whole team to have the same methodology. That's the other part. It makes no sense to them if you and I, you're the dentist and I'm the, I don't know, I'm the dentist too and we own it together, but we're not sharing that information with our team. They need to know where we stand. Are we price driven? Are we quality driven? Are we service driven? Then you can only be two of those three and do it really well. 

I always give them the analogy of going to Costco. We go to Costco to save money on our toilet paper and paper towel, and we buy it in bulk, and there's no one in the aisles helping us. No one's going to help us push it out or load all that stuff into our car. Then we go to Starbucks and we drive through the drive-through and spend $5 on a cup of coffee. You've got to look at- and there's nothing wrong with any of those models, but they're not trying to be everything to everyone. You don't go to Costco for the service. They're good when you return things, but you're going there for price and quality. That's my take on it. When you're going to Starbucks, you're not going there for price. They're all quality and service. They know your name, they write your name on the cup, they put a little smiley on there. It's so overpriced but we still do it. 

You're exactly head-on on the dental offices, and I let the teams decide that, because if I go in there and try to be a dictator to them and be a consultant and be like, "You're going to be this," it's not going to work out. I'm like, "How many of you like to be told what to do?" Same thing on me, and they're like- Some will 50% of the room will say, "I like being told what to do." Okay, so where do you want to be. Do you want to be price, quality, or service driven? Then you've got to pick those two and then that's where we're going to stand for the whole year. Going back to what you were saying a few minutes ago, how do you start off? You've got to really start off with that leadership portion of it and you've got to get the team engaged in it and buy into whatever it is the doctor or owner wants. Otherwise, all the systems, they don't matter. They do and they don't. 

Howard: I'm in Ahwatukee and you live in Chandler?

Sara: I live in Chandler, yeah.

Howard: Chandler. In Chandler, how much does a bypass cost?

Sara: No idea.

Howard: The average in Chandler is right at 100 grand.

Sara: For a bypass?

Howard: Yeah. It's a cabbage, CABGA. Coronary artery bypass grout. They take the coronary clogged arteries. They cut them out. They go into leg veins, and replumb it. I should have had you guess. I'll take another price. How much does it cost to get a colon cancer resection? You go in there, you've got colon cancer and they've got to go in there and cut out a foot of your pipe, and sew it back together.

Sara: Colon cancer resection. I'm going to say it's less than the heart surgery, maybe, because it's not a, I don't know. Let's go 75. 

Howard: Because an asshole's worth less than a heart. 

Sara: I wasn't going to say that. 

Howard: That's what you're saying. What were you going to say?

Sara: I'll say 75.

Howard: Wow. It was 70. The point I was making was that all these dentists out here, they'll go learn how to do ortho in their medical dental building, in their zip code, and orthodontists charges $6,000 and then they'll just price it at $4500. They'll say, the orthodontist has 50% overhead, so you just lowered your fee 1500. Then you're going to come back to me and say, "Why is my overhead high?" None of the patients go, "Wow, that was really low cost ortho." Every dentist listening to this podcast could call all the specialists and ask for what they charge for a pulpotomy, a chrome steel crown, what do you charge for ortho? Call the oral surgeon, "What do you call for an extraction, wisdom teeth?" Set their fees tomorrow, and not one person in their zip code would know because all those fees are already clearing in their marketplace. If they say, "Well, Howard, you don't understand. I'm in Clay City, Kansas." Well, so is that oral surgeon, endodontist, periodontist, pedontist. All those prices are clearing in Clay City, Kansas right now. 

You're not going to find anyone in Kansas who knows the price of anything in dentistry above a cleaning, maybe. They just won't do it. It's silly. Then when they go to their state board, are the lawyers going to say, "Well, I'm not going to hold you to the level of the endodontist, because he was getting 1500 bucks. You only got 1000, so that's only two thirds, so that's why you only got two thirds of the way towards the apex. The root canal failed, but they didn't give you enough money to go all the way down."

Sara: Oh, geez.

Howard: They're not going to do that. The endodontist getting 1500's going to come in and grade your $1000 root canal. The orthodontist getting 6500 is going to come in and grade your $4500 short term ortho or whatever the heck you're doing. The specialists are always going to be sitting there as the judge, the jury and the executioner, so why not charge their fees, because the 9 specialties by the ADA, their overhead's between 40 and 50. Then 150,000 general, their overhead's north of 64%. 

Sara: You bring up lots of valuable points. One of the things, if I could tell all the dentists out there right now, and they're all going to not like this comment, Howard. Most of them aren't. If you could really focus on something, focus on those people who don't have dental insurance. We're so insurance driven, so all to your point, when I go into practices, they're always telling me about their fees and the numbers and the last time they, blah, blah, but what about all those people when only 30% of the population has dental insurance, why are we so driven by that? Why aren't we tapping more into all those people who don't have it so we can serve those people? Going back to price, quality and service, not to beat a dead horse, but if you're about quality and service, why don't you really feed into all of those patients without dental insurance. Do you have dental insurance?

Howard: I don't.

Sara: Yeah. Do your kids?

Howard: No. 

Sara: Now granted, you're in a different-

Howard: Neither does my cat.

Sara: Your cat doesn't either?

Howard: My cat doesn't either.

Sara: She doesn't have Care Credit or anything. Most people don't have dental insurance unless they're working for a big corporation. I hear you speak on your podcast all the time. How do small dentists stay apart or stick out compared to these big corporations? What are the big corporations really good at? They're marketing to dental insurance. Are they trying to capture those people that don't?

Howard: You know what I like the most about corporate dentistry in Phoenix, Arizona? 

Sara: What's that?

Howard: It's the best place to steal talent. Those chains, some of those chains have-

Sara: They learn a lot.

Howard: -100, 200, 500 offices. Now when I have an opening, I only want somebody that's been in a chain of at least 25 because they're so- When you have 1 office, you can be so inefficient. Basically, this is what I think how management works in a small office. With their PPOs prices so low, with them trying to do such high quality dentistry with all Ivoclar and 3M products and [inaudible 00:33:52] gauze, it doesn't matter because everyone, a $1000 crown is half margin. Half of the dentists don't do $1000 root canal, which is 80% margin, but if they just do 3 or 4 crowns a day, it covers up for all the inefficiencies and they make bank and they just go on forever and ever and ever. If that office expanded to 2 or 3 or 4 locations, all those little problems that could be buried by just doing 4 crowns a day, those little Doberman Pinschers have now turned into a T-rex, and you go bankrupt. 

The most highly percentaged chance that a dental office could go bankrupt is between the 2 to 3 million mark. You can cover so much shit under the rug at half a million a year. But between 2 and 3 million, you are so big. You are such a beast. These problems are insurmountable. When you have a chain that gets to 5, 10, 20, 50, 500 locations- The last team member I picked up came from a chain that has over 100 locations. They're so highly edumacated in all the little details that they're the best. Their turnover, too, with patients and doctors, so I think the chains are best educating dentists. I'm going to go back to it. You're known for, so what do you monitor and measure, and then the three things I want you to talk about is, what do you monitor and measure? When everybody says morning huddle, morning huddle, what do they do? Do they just sit there and show up and bring donuts and-

Sara: No. 

Howard: -talk about last night's World Series victory by the Royals? Then the treatment tracker. Go more into, let's start with monitor and measure. What do you think you should monitor and measure and why?

Sara: The biggest thing for me when I see practices are really successful, even to what you're speaking on, big corporate dentistry, what do they do well is they monitor things, they measure and they make it go right. I like saying that. Monitor, measure, make things go right. Whatever that means. When you're monitoring and you're measuring, the first thing that we want to talk about is morning huddle. Let's use the football analogy. I know we're coming off the heels of the game last night, and you're probably a huge Royals fan, right?

Howard: I went to UMKC Dental School and it almost made me fall out of my chair last night when they said it was 30 years ago. I don't feel like I'm that old. I was in Kansas City Dental School when they won the last World Series. 

Sara: Oh, really? Okay. 

Howard: I just cannot comprehend that that was 30 years ago. I remember walking in dental school and thinking, "There's no way I can do this for 4 years. Just 4 years seems so long." Now, that was 30 years ago. What's 60, 30 years divided by 4. I've gone through dental school that many times. It's just crazy. 

Sara: Yeah. Going back to the sports analogy, when we go in the morning huddle, what we always want to do is look at where, how did we do yesterday? I'm always wanting the office manager to print out the morning huddle sheet in the morning, have it on her desktop, or his, and write down something that worked really well today. Why? Because we always hear all the negatives. We could sit there all day long and have a morning huddle about everything that didn't go well yesterday or how the schedule looks today or how it's looking for tomorrow. Who wants to hear all that nonsense first thing in the morning? We want to start on a positive note. What did we do right yesterday? Now, what didn't we do well, and that we could of course correct immediately. We don't need to go into the story about it. "And then she came in at 8:02 and her appointment was at 8 and she didn't have her paperwork." No one cares about all that. Excuses are just well-planned lies. That's a Sara Fossen little thing.

Howard: I like that. Excuses are just well-planned lies.

Sara: They are. No one wants to hear your reasons-

Howard: You're much sweeter than me.

Sara: -and your excuses. 

Howard: I always say, "Everyone has an asshole and an excuse."

Sara: Yes. Reasons and excuses are well-planned lies. We want to have our morning huddle sheet and say, "What did we do yesterday that, how many new patients did we see? How much did each doctor produce? How much did the hygienists produce? What was our closing ratio?" No one ever knows their closing ratio. Everyone will tell me, "I close 90, 100%." I'm like, "Great, are you measuring that? Let me see the facts on it." If you deal with facts and you're not dealing with the emotion, it cuts all the drama out. Have you ever noticed that? When you're just dealing with facts, you're like, "Oh, what are the facts, what are your numbers?" When we do that each morning, it can be short and quick. It doesn't have to be a long, lengthy thing, but we want to talk about that. How did we do yesterday? Where did we end up? What was our pre-appoint number on each hygienist? 

I'm working with a practice right now in Casa Grande. They have 3 hygienists and I want to know their pre-appoint number every single morning. Why? Why is that important? We want to see, are people rescheduling for their next cleaning? Are they doing it in the back? Are the hygienists doing it? The hygienist is the number one patient educator on the team. Number one patient educator. They're number two most trusted. There's something very magical about your hygienist booking your next appointment, and your patient sitting in the chair knows that the hygienist did it, and she wrote it in her handwriting on the appointment card, or if you're still doing the old cards where you're having them do their own card and filling it out. Whichever way you do it, doesn't really matter, as long as you're having a system in place. I want to go to them the next morning and say, "What was the pre-appoint number?" Why? First of all, create some healthy competition amongst the hygienists. Who's getting 10 out of 10 or 8 out of 8, or who's the one that didn't schedule and is that somebody we can call right now today? They slipped through the cracks, and get them pre-appointed right now. 

The stat is- and you probably know better than I do, for sure, Howard- is 70% of what a dentist does comes out of hygiene. If that number is true, 70%, that means our hygiene schedule needs to be just jam packed and we need to have a short notice list, because it's missed opportunity every time there's a hygiene appointment available or open. If it's open today, it's going to be open 6 months from today. We want to know what that pre-appoint number is. In the huddle, we're talking just briefly about yesterday. What were the facts? What were the numbers? What did we produce? What did we collect? What was our pre-appoint number? How many new patients did we see? What did we do well, for goodness sakes? Let's start with that. What did you guys, high-five? You want to talk about sitting around a table and eating donuts, that's fine, but we're still going through the numbers, and then what is something that we maybe didn't do quite as well as we'd like to. We want to, of course, correct it right here without the story of it. That's first.

Second of all, we want to look at where are we for today. Dentists get crazy. That's my experience. I'm not saying it's the truth, anything I say. When they walk in and their schedule's not full, they're like, "Oh, my gosh, my schedule's not full." I'm like, "That's great news." That's like opportunity everywhere. That means anyone that's in the hygiene schedule today, you're doing an exam on them, how great would it be to service that patient today when they have a tiny little filling that you might not want to shove into your schedule today, but now you have an opening. You don't need to tell them that. You get to look like a rock star for once. You get to go in there as a dentist and go, "You know what? I need to get a filling on this upper right hand side. Let's do it for you right now so you don't have to come back." Then they don't have to think about it again. They're not making a buying decision again.

Who loves going to the dentist? No offense, all you dentists out there. I never hear patients or my friends or I'm not, at a dinner party, when I say I'm in dentistry, what's the first thing that people do? They cover their mouth. They don't want me to see their teeth. They're embarrassed, or they're like, "How do you work in dentistry, blah, blah, blah." We want to change that stereotype. How do we change? It's by warding things off. You know in dentistry the smaller something is, it's usually easier to take care of today, and it's less expensive. All you dentists out there, take something away today. If you're schedule's all full, great. Good news. Let's find things that we can do today and serve people today. 

Howard: By the way, these people listening, do you mostly like to consult in Arizona, or do you travel?

Sara: I traveled. I was on the road for about 12 years, and so now I really love being in Arizona because I have a house in Ocotillo and I love giving back to my state. I went to school at ASU, nice job, yes. My mom did, both my brothers, so big ASU family, but absolutely I'll travel somewhere. 

Howard: How do these dentists get in contact with you, because I guarantee you, Sara crushes it with your staff. How do they go to

Sara: Yep, it's just my name. 

Howard: Sara Fossen. I know from your young sprightly age that you are named after Sara in the Sara, the Hall and Oates song, or the Jefferson Starship. Every Sara I know is named after, their mom and dad loved Hall and Oates, Sara, or Jefferson Starship. 

Sara: I'm a little bit older, but yes. 

Howard: Were you named after one of those?

Sara: No, I wasn't. My mom and dad wanted me named- My middle name is Jolie, it's French. It means the word 'pretty.' My mom's a French teacher. She teaches in the high school in Casa Grande and she did not-

Howard: Your middle name's what?

Sara: Jolie. That's the-

Howard: Jolie is French for-

Sara: Pretty.

Howard: Pretty. Well. 

Sara: It's similar. In Spanish it'd be bonita. 

Howard: Howard is Latin for ass. 

Sara: Ha! 

Howard: I did not know that. 

Sara: You're the only boy in your family.

Howard: How do they contact you? What's your email address?

Sara: My email address is my name, so it's My dad didn't want my first name to be that because he's like, "Everyone will call you Julie, Jolie," and so they compromised with Sara, was a biblical name, and dropped the 'h' because my dad said no one pronounces it, so he dropped it. I know the two songs you're speaking of. 

Howard: I'm going to go back to the-

Sara: The huddle?

Howard: The huddle. After we leave the huddle, we all, not me, the dentists, all the non-dentists wire up on two way radio, walkie-talkies, and now I notice, when I go to any organization that's doing a million a year, you go up to, you check in at a restaurant, they're wearing them. Back 20 years ago, when you took your kids to Disneyland, you could always see 2 or 3 Disney employees in a full sprint across the park. 

Sara: Yeah.

Howard: Now everybody's just comment like, "Yeah, we got a lost kid, blah, blah, blah." You go in and you ask a special request at the maitre d' at a restaurant, every one, they're 16 years old and they're like- everyone uses them. Lifetime fitness. Every workout trainer in that place is on one. In my dental office, I couldn't live without it. When I'm lecturing to a group, there's not even one office out of 100 on two way radios. Then you go in their office, and there's Sara walking around her whole life looking for a lost chart. There's a lady, "Well, can I squeeze in?" "Well, let me put you on hold." Then they go back and they're standing there waiting for the assistant to look. What are your thoughts about two way radios?

Sara: I love them. I have-

Howard: Why did they not take off in dentistry?

Sara: I think that the dentists are fearful. This is just, again, not the truth. This is just my perspective of, they think that they're taking away from their patient when they're talking into their caller or into the earbug, and really it's not. It's so effective. I was working with a practice up in Dewey, Arizona. One dentist, he had two hygienists and he ran out of three rooms himself. He had 3 operatories at all times, two hygienists, and those radios were a lifesaver. I remember implementing that with them, and as well as black scrubs. 

I'm a huge fan of black scrubs. I think it's classy. Everyone matches. They should have their name embroidered on there. They should have your logo on there so when they're going out to lunch, it's marketing and branding for you. Just going back to what you said about even being in a really nice restaurant, what do they always wear? Solid black. You know who's in the back. I hate scrubs in the front. I think it's tacky. I think people up front who are dealing with money need to dress appropriately. We don't go to the bank and try to deposit our check or get something corrected and somebody that's wearing scrubs. You want them to be a professional and look in a professional appearance. I think the headsets, they just get scared. They're afraid that they're taking away their time. That's just my opinion. I don't know that that's a fact, but when we did that in Dewey, it was so effective. You saw the level of stress go down.

Howard: It makes so much money because you'll have two receptionists on the phone, and I'm talking to Mark, and you're talking to Amy, and Mark calls me up to cancel, and I don't have time to put him on hold and go tell the whole damn office he canceled. I'll just go up there and push PTT, push to talk, "Howard, your 10 o'clock just cancelled." Then my other receptionist has just heard that in her ear and she's talking to a lady with an emergency, and she hears that, one second, "Well, can you come down right now?" Then all the hygienists are hearing that saying, "Well, Sara, do you want to stay and do your filling?" Then one of the hygienists thinking, "Well, I'm doing a quad [inaudible 00:47:12]. You want to stay for another quad? Well, here, take my cleaning. I'll just-" 

Sara: So efficient.

Howard: I don't know how we could do our break even point without that. 

Sara: I think-

Howard: I don't know how we would do that. What would be the alternative? Write a post it note and go stick one in eight operatories that Howard's 10 o'clock canceled? It's just, I don't get it.

Sara: It's either the fear of just looking too technical, or taking away from the patient, or the other thing I always hear dentists say is they don't want to hear all the jabber that goes on on it. 

Howard: Well, then, that's you just tell them not to jabber. That's not for jokes. It's not for-

Sara: Yeah, you have to just-

Howard: It's kind of like LinkedIn versus Facebook. Facebook, you can put a picture of, "I'm eating a tuna sandwich." LinkedIn is just-

Sara: Unacceptable. 

Howard: Yeah. I want to ask you another thing because I'm 53. Bill Blatchford I think is 73, is that right? He's the grandfather of practice management and everything. When I get out of school, his big message out there, a lot of the old guys like my age believe is that you want to do a dollar to the dentistry? You're going to diagnose 3. Then there's these other more new age consultants are saying, "Well, if you present it right, you can have a 90% treatment plan acceptance." As far as what are the facts, when we look at the facts for the US industry, the dentist close rate for the country is 38%. If they diagnose 100 cavities, they drill, fill and bill 38. The fact that they talk about all this clinical dentistry bullshit when they only do 1 out of 3 cavities, they should only talk about why you're not doing the other 2 out of 3 cavities? What went wrong in your treatment plan, your presentation, your financing? Imagine if the fireman only put out 1 in 3 fires. Imagine if the police department only caught 1 in 3 bad guys. 

Back to this deal. This is something that really it's hard for me to grasp. If you want to do a million dollar practice, should you just start diagnosing 3 million a year and if you throw 3 million of diagnosed treatment against the wall, a million of it's going to fall down in the chair, or do you just diagnose a million and try to get the million done? 

Sara: The rule of thumb that I always go by is that you're going to close about 66%. A third are always going to say yes. There's a third of the population that when you share with them that they have active decay in their mouth, and they need to have it filled, drilled, they're going to say yes to you. Your patient that's been coming to you for forever or whatever. We could create scenarios all day long, but a third are always going to say yes. A third are always going to say no. They say no everywhere in their life. Let them go. They're just going to say no to you. They're not going to believe it. I just had my teeth cleaned a couple weeks ago. The hygienist is like, "Oh, you really should get a skin graft on this tooth number 14." I'm like, "No. The solution sounds worse than the problem. It sounds disgusting. I'm never going to have skin taken off the roof of my mouth." I'm in dentistry. It sounds awful. You have to sell me on what the consequences if I don't do it. 

Howard: Yeah.

Sara: Coming back to that point. A third will say yes, a third will say no, and then it's our job to get the other third over the fence. We're only going to close 66% of all the patients we see. Where you really want to go to work, and my opinion is what I see that dentists are really good at telling you what the problem is, and really good at the solution, but the solution, lots of times, sounds worse than the problem. When you say to me I need a root canal, I'm like, "That doesn't sound fun. That sounds worse than the toothache I have." Root planing and scaling. I love when hygienists say that. I'm like, "No, stop saying that to patients." First of all, that's our terminology and our school and our backyard, not theirs. The solution sounds worse than problem. 

What we have to get really good at if we want to close 66% is that what the consequence is if we don't take any action. Here's a problem patient. Here's the consequence if you don't take any action, and here's the solution to the problem. Then that's going to be tied with whatever personally motivates them to go to the dentist in the first place. Lots of people get their teeth cleaned every single six months because their mamma's mamma's mamma told them to get their teeth cleaned, or because the ADA says you can have your teeth cleaned, or they have dental insurance that says you can have your teeth cleaned every six months. They come and we want to get really good at having them come on a regular basis so we can close that 66%. That's all I'm looking for.

Howard: It's kind of interesting because the insurance companies confirm that it's a 38% close rate. What Bill Blatchford's saying, the 38% is a third. He's saying, "Yeah, you close a third, so if you want a million bucks, you're going to have to diagnose 3 million. So he's there going- but what you're saying is a third will say no to anybody, a third will say yes to everything, but if you work on that third in the middle, you can swing them over from an- and I like that model because as a dentist, I think a fireman should put out all the fires. I think the police department needs to catch all the bad guys, and I would rather send my four boys to a dentist who had a two thirds close rate, and I don't care what materials he used, whether it was amalgam or IRM and butter, versus the dentist who's a [panky 00:52:29] grad and married John [Coyse 00:52:31] and has 9 point inclusion. Who cares? You don't do anything two out of three times. Two out of three times you're not doing anything. 

Then my question is, I know two assistants, and they're busy and they're shy and they're married and they've got kids, but basically they work for dentists that we know, and they hired them at a dental office at a half million a year. They hired them and as a dental assistant, they said, "Well, let me just be your treatment plan presenter." They went to a million and a half, and after 5 years asked for a raise from, they were getting 14 and went in there one day and said, "I want 21 an hour." They said no and gave her 15, so she quit and went to another office in Glendale. We both know, she said, "I'll take you." She went from a half million to a million and a half, and the last office that did a million and a half went back down to a half million. 

I know another amazing dental assistant who's done this three times in Indiana. Three times she's taken an office from a half million to a million and a half, can't get a raise, leaves, that one goes back from a million and a half to a half million. She's done this three times. My question is a two part question. You're a consultant, and you've seen so many offices for so many years. Do you think a dentist who can't run his office should just delegate that, to an office manager? If you have a one third close rate where you tell 3 people they each have a cavity and two walk out the door, should you just say, "Look, I'm a trained scientist, I know algebra and geometry. I'm just going to get a treatment plan presenter and just quit doing it."

Sara: Absolutely. 

Howard: That's what I've done for 28 years.

Sara: You have to.

Howard: People always say, "How do you do it?" You know what my answer is? They always say, "How do you have a dental office, a magazine, a web blog," and they always say, "How do you do it?" You know how I do it? I don't do anything. Ray Crock is dead and 40,000 McDonald's don't need him. Sam Walton is dead, and there's not one Wal-Mart today saying, "Where's Sam Walton?"

Sara: Exactly.

Howard: Nobody in my company has ever needed me once in 28 years because I got the best people, got the frick out of their way, and Jan's been presenting all my treatment for 28 years. I don't even like any of her explanations. I don't. I don't even get them. She still tells people that a root canal is when he blows the infection out. 

Sara: Oh.

Howard: I'm like-

Sara: Does it work?

Howard: I'm like, "Jan, we don't even use the air-water syringe." That's what I believe, but these people listen to me 80 million times.

Sara: I believe 100%. Some of the best treatment plan coordinators I've ever seen are people who don't have dental background. Surprisingly enough, I was working a practice in Stephenville, Texas, so many, many years ago, and awesome treatment coordinator, she came from the bank. It's just presenting what the facts are. Here's what you need to have done. Here's what's going to happen if you don't have it done, and here's the solution. They go in and they remove the decay. In the case of the root canal, worse-

Howard: You blow the infection.

Sara: If you're Jan, you say, "Blow." If Sara's teaching and I'm training, just remove it. Cleanings, it's ridiculous. Why are we talking to people about getting root planing, scaling. Sounds like you're going to wood shop or you're going to get cut up and sawed up or whatever. They don't know what that means. There's 3 levels of cleaning. One is the person who comes every six months and doesn't have a problem. There's level 2 when you've skipped a few years and level 3's like, "Yeah, you skipped more than a few years, but the good news is we're going to get you back on track and you're never going to have to have this done again, if you come back every 4 months from here on out." Even insurance knows that. They pay for replaning and scaling-

Howard: I love that. That's gold. That was worth the whole podcast.

Sara: Okay, good. Don't talk to patients about the solutions that we know as dental terminology, because they don't understand it. Most of them really don't want to know. You're going to have those types of patients, that one third, that always say yes and they're an A personality and want to know exactly what it is. Then you're going to have people like me who've been in dentistry forever and when you start telling me about taking skin off the roof of my mouth, I'm just like, "Gross, that sounds painful." I don't know, maybe there'll be a new cure for implants, or really simple- I don't know. You just have to speak to your listening, and I think sometimes we get caught up, meaning doctors, and I'm going to say that dentists, you guys are very smart people and it's technical for you, so stay out of the treatment planning. Stay out of prices. When they ask you, what's the price of something. 

Howard: The other reason I don't get it is sometimes when Jan starts presenting the treatment and Dawn comes in and starts showing the money, sometimes they're in there for an hour. 

Sara: Yeah.

Howard: I go into the next room and do a complete molar root canal and I come out and they're still talking. What dentist on earth has time to sit in there with Mrs. Jones, and then sometimes- We had one last Monday. You can't make this shit up. 

Sara: Tell me.

Howard: Two hours-

Sara: For a treatment plan.

Howard: Jan and Dawn, two hours, and she decided she didn't want to have any of it done, and left. We didn't even schedule [a nickel 00:57:36] for the chair. They were in there for two hours answering every question, going over every, and the dentist wants to do that himself? Are you kidding me?

Sara: No. It's not a good use of your time. It's not a good use of your hands, your drill, all of that stuff that you need to be working on. Let your team take care of you. Number one philosophy, and you're great at that. Let everyone else that's good at it, the assistant that you're talking about that's so great, I'd hire her in a heartbeat anywhere. They're the number one trusted person on the team. How many times-

Howard: The dentist is number one- You said the hygienist was number two.

Sara: No. That's the dental assistant. 

Howard: You said the hygienist was number two.

Sara: Yes.

Howard: I just assumed the dentist was number one.

Sara: No.

Howard: Was that a little self serving, or egotistic?

Sara: Yes. Yeah, a little bit.

Howard: Being a dentist. It was the assistant's number one.

Sara: The dental assistant is the number one most trusted person on the team.

Howard: Really. I believe it. 

Sara: If you ask a dental assistant, all you assistants out there, or you dentists listening, go ask your dental assistant how many times a day when I walk out of the room as the dentist, he or she, does the patient turn to the dental assistant, say, "Do I really need this root canal? Do I really need this extraction? Do I really need fill in the blank?"

Howard: What percent of the time do you think it is?

Sara: I don't want to guess, I don't know. I think it's higher than we think.

Howard: What blows my mind is I might do a root canal on someone and their eye will swell shut and there'll be blood leaking out of their ear and their left leg is numb, and they'll call the office and tell them all this. They'll say, "Well, is Jan there?" They're like, "Well, do you want to talk to the doctor?" "No. I want to talk to Jan."

Sara: Yeah, because she makes it feel good.

Howard: I'm like, "Really, your left leg is numb? Are you sure you don't want to talk to Howard?" "No. I'll talk to Jan." 

Sara: What's the old saying? You're going to forget 90% of what I say, but you're going to remember 10% of how I made you feel. That's why, even that lady that you're talking about that was in your practice last week that spent two hours talking with the gals in your office, she's still going to remember how they made her feel, even if she said no to her treatment. She might come back around. They say a patient has to hear it 5 times. For her, that patient, it might be 10. Who knows? At some point she'll say yes to something, maybe, or she'll say no and you've just got to let it go.

Howard: I want to go back to this bank thing. My best employees, receptionists, and all strangers always, were stolen from Chase Bank in my parking lot, which is what you said, and bookkeepers. You go to Arizona, and this is what I believe. If someone comes in and applies to work at the front desk [inaudible 01:00:09], and they say, "Well, I've got 5, 10 years of experience across the street." I'll say, "What software was he using? Dentrix? Okay, I'm just wondering, does Dentrix run 5 reports, 10 reports, 20 reports, 40 reports? How many reports does it do?" "You know, I don't know. He never really took us through training." I'm like, "You're a monkey and you sat-" Could you imagine if someone said, "I'm on Facebook 8 hours a day, 5 days a week, for 10 years, and I don't know how to poke someone?" 

Sara: Yeah.

Howard: You think, "You're not right in the head.'

Sara: Yeah, you're not paying attention.

Howard: If you hire a bookkeeper or someone from a bank and you give them no training and you put them on Soft and Dentrix, Eaglesoft, or whatever, in one week, they come back and they've gone through and they've checked every function on the website. They know how- They just have a different mind. The dentist will hire a receptionist who has 10 years of experience on Dentrix who can't even tell you almost anything about the Dentrix software, that she's been using for a decade, and then I'll just say to her, "Show me how you balance your own damn personal checkbook," and she'll say, "Well, I don't ever reconcile my bank statements." Then he wants to pay her like 15, 16, 17 bucks an hour. Then the bookkeeper chicks come in asking for 12. They don't need any training, and they are from Chase bank. It's a totally different breed of the mind. Some people are born to sing, and dance, and music, and some people just know the details. Detail oriented people come from bookkeeping and banking.

Sara: You want that. When you're out hiring people, it's a question I get asked all the time, especially as a consultant. "Will you help us hire somebody?" Or if they need to fire somebody, they want to know that I'm going to help with the replacement. If they have dental experience, great, but what is their mindset on money? That's my biggest question. When you're a treatment plan coordinator, I need to know that you're not concerned about spending 25 cents on something or $25 or $2500. If you have that concern, it's going to leak through to your patients. That's why those people with those kind of backgrounds usually have no personal attachment to it, especially if they come to a bank. They see all kinds of walks of life and types of money, so those sometimes are your best treatment coordinators. 

Doesn't mean that somebody that has tons of experience can't, but I see the same thing with the software. They don't ever learn it and then they want to blame it on the doctor for not getting training. All right, well, did you ask for it? Did you ask for the training? Did you ask them to pay? Dentrix right now, there's tons of webinars on it. It's absolutely ridiculous. You're just not a self starter at all if you're not learning every minute detail of Dentrix. You can go in there. If I was going to train somebody, whether they're in the front or the back, it would be mandatory that they take those webinars and have to pass. 

Howard: These are webinars on [inaudible 01:03:14], Dentrix's own website?

Sara: On Dentrix. They're free. They go along with the program. I waited tables a few years ago. I went to work for one of my friends, owns a bar and restaurant downtown Chandler. I said, "Let me come work for you," because I was brand new from scratch. I go, "I know if I'm out on the floor, I will bring customers in, and they'll stay." I just know that because I have the confidence that I will serve them well. It's not about price. It was about customer service and quality. He's like, "You want to do this?" "Throw me in for six months. I'll work every Saturday and Sunday." 

To wait tables, I had to take a test and pass it and have a card on hand to even wait on tables. Here we are letting dental assistants clean things and be subjected to hepatitis. We could go on a tangent, right? Why don't we do the same thing for our team, going back to that 70% of Fortune 500 companies having mentorships, coaching programs. That's an important part, dentists out there. Get your team trained. The software is your bicycle. It's like riding a bicycle with one flat tire. If they don't know all the ins and outs of it. You're still going to get somewhere on the bicycle without handlebars or a seat or one flat tire, but you're not going to get there as efficiently. Your software, EMR, practice management software, whatever you call it, is your tool for your efficiency every single day. 

Howard: What's so sucky is you have to master it because they're so shitty to begin with. Dentrix and Eaglesoft and Softend are so horrible that the last thing you can do is just not even use their horribleness. When you're dealing with that shitty of a software that has no accounting, no costs, you can't enter your fee schedule, can't generate payroll, statement of income. When basically you'd been better served buying a Subway franchise or a Long John Silver's than buying Dentrix and becoming a dentist, but that's a whole other issue that I've been ranting about. I want to end with this, because we're in over time with you.

Sara: Oh, whoops. 

Howard: I want you to focus on this. I do these podcasts for free. I put them out there for free, because in my heart I want to help these dentists.

Sara: Me, too.

Howard: They're stressed. I want them to be happy and healthy, and I believe that a consultant, just like an Olympic coach, first they've got to understand this talking monkey. What makes this crazy person click? You've got to try to unwind and reframe. You're not firing Linda. Linda's miserable. She must hate her job. Look at her. If she was a monkey, she'd be throwing bananas and fecal matter at you. You're going to free her to go find something she likes to do. You have to crawl in their head and reframe all their problems. This data exists, but it's not fire. It's a freedom. You've got to reframe everything. My deal is all the successful dentists like myself on up, and I can think of a thousand dentists that have better offices than me, they've been on a diet of consultants for 30 years. They've all had a dozen. I've had a dozen. 

Then everybody who is just about ready to hang themselves on a ceiling fan and quit and burn out and start eating Vicodin and nitrous, they won't ever call for help. Everybody that needs you in this town- come on, we've been here forever. We have 1 to 3 suicides a year, right in the valley here. 1 to 3 every year that I've been here. Everybody that desperately needs you is never going to call, and everybody that hires you just wants to be even better. I want you to tell the dentists listening to, they're driving to work, tell them who is your perfect client? What do you like to go in and help? Try to connect with some dentists. They're all alone, each of them listening. Try to connect with that person on this podcast and say, "Hey, here's the red flags. If you have this scenario, I'm your chief."

Sara: If you're laying awake at night having the same conversation over and over, or, you know how you started this podcast, Howard, was talking about gossip. If you're going to your best friend or your spouse and you're having the same constant complaint over and over and over, but you're not getting a different result, I'm the person to come in and help you. If you're hovering around a million dollars and you want to go to 1.5, or you're at 1.5 and you want to go to 2 million, you're already successful. I want all those dentists out there to know they're successful. They really are. Whatever they measure themselves by. If they want to go to the next level, whatever that might be for them, whether they want to start weaning out of the practice or they just want to be more efficient, or they want to work less, anyone who's coachable is the ideal client for me. Anyone who's looking for help and says, "I know that I'm really good at being a dentist, and I might not know what else to do when my head's down. I need the people around me to protect my back when my head's down, when I'm drilling, filling, and billing." That's the perfect, ideal client for me is somebody who has the want, need, and desire. 

I can help you. I know I can, because I'm passionate about dentistry. I sucked my thumb. I had huge buckteeth. Thank God for Dr. Johnson and small town Detroit Lakes, Minnesota, the orthodontist who put braces on me, because if I hadn't had that and I didn't have parents that had the money and the know-how, I couldn't sit here and do a podcast in front of you with big buckteeth. I couldn't have been all over the world in dental practices. I understand the value of a smile. I understand what it does for people. I want to make a difference and how I can make a difference in this world is by dentists who will allow me to come in and make a difference with their business.

Howard: We both agree that people is probably 80% of it. It has to be 100% if Sam Walton is dead and all the Wal-Marts don't need him. Ray Crock's dead, no McDonalds need him. Back to that people issue, when you're talking to this dentist on the phone and she's telling you about everything right and wrong with all these employees, when you go in there, how often is she spot on with all the other relationships in her office, or how often is her favorite girl, Jo Friday, that she couldn't live without, usually a nightmare? When they're telling you on the phone, "Here's my staff problems and here's the strengths and weaknesses," how right are they? How often do you come in there and say, "You know that girl that you think you just can't live without and is the best thing in the world? Yeah, we need to take her to a vet and put her down. This girl over here that you think you want to fire, she's actually the heart." I'm trying to have a personal conversation because I don't know if they see their red flags to pick up the phone. 

Sara: Yeah. 

Howard: I'm trying to talk into this dentist's mind that, I'm just trying to get an outside idea of how right are they on their relationships and evaluating the relationships of their team?

Sara: It's really 50/50. Either they're spot on or they're so dead wrong, because they really don't know what's happening. It's not, they're not bad people. It's just that they're working on patients, doing what they went to school, and spending hundreds of thousands of dollars to do, and they don't see the other side of it. I'm their eyes and ears. I'm on their team. I'm on their side. It's not me against their team. I'm really looking to see, do we have the right people in the right place, doing the right thing, and if not, we have to fire them fast and start fresh, because one bad apple on the whole team can really bring it down. Most doctors don't like that. They don't like change. They're no different than people. People don't like change. I don't know what my stat would be. I'd say it's about right in the middle. They'll either know right dead on who's strong or weak, or they absolutely have no idea.

Howard: They're clueless.

Sara: They're clueless, and don't hear it like there's something wrong with them. They just don't really understand the dynamics of what's happening in the front of their building. 

Howard: Your email is

Sara: That is correct.

Howard: Sara, you've been my idol and role model for so many years. Thank you for all that you do for dentistry and thank you for all that you've done for me.

Sara: Thank you. Thanks for having me today. I appreciate it. It's been awesome.

Howard: All right.

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