Throw money back into your practice…the right way!
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AUDIO - HSP #251 - Emily Letran
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VIDEO - HSP #251 - Emily Letran
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Dr. Emily Letran shares details about Why and How to invest in:
• Your Practice
• Your Team
• Yourself
Emily Letran, DDS:
• Came to US as a refugee (Vietnamese boat people) at 13 years old, no English (learned some in refugee camp)
• Finished undergrad UC Riverside 3 years
• Finished UCLA in 4 years with 2 degrees: DDS and MS, Oral Biology
• Currently has 2 multi-specialty group practices in Southern California: mix HMO, PPO, DentiCal, cash
• Author, "From Refugee to Renaissance Woman"
• Upcoming books:
1. "Commit! Embracing Your Big Life, Celebrating the Entrepreneur's Family, Business, Passion, and Fun", foreword by Sharon Lechter
2."How to Train Your Patients": comical e-book to remind professionals they have to train themselves and their team FIRST before asking their patients/ clients to do what they want
Exceptional Leverage Coaching for business professionals to win back time from work: ACTION formula: Appreciation, Communication, Trust, Investment (in self growth/education, in practice - taking care of patients and RE for dental office, in team members), Open-mindedness, Never give up
Emily Letran Foundation: I am ALWAYS driven by gratitude and appreciation. This foundation is set up to raise funds for mobile dentistry to serve outreach communities and senior centers. It will also give scholarships to minority/under privileged business owners to access my coaching program
http://smilechampions.org
http://exceptionalleverage.com/ebook/
http://www.cosmeticdentistmonrovia.com
http://www.myelmontedentist.com
emilyletrandds@verizon.net
Email: coachemilyletran@gmail.com
http://www.facebook.com/coachemilyletran
Dr. Farran: It is a huge honor today to be interviewing an idol and a role model of mine, Emily Letran. Emily, you just have the most amazing story. Your whole life story is just amazing. You came to US as a refugee from Vietnam when you were 13 years old, no English learned. You learned a little bit in a refugee camp. You finished undergrad at UC Riverside in three years. You went on to get two degrees, a DDS, a dental degree and an MS Masters in Science in Oral Biology. Currently have two multi-specialty group practices in Southern California with a mix of HMO, PPO, Denti-Cal Cash.
You're the author of the book. That's why I called you, your book. I called you. You did not call me. Author From Refugee to Renaissance Woman. You have some upcoming books, Commit, Embracing Your Big Life, Celebrating the Entrepreneur's Family, Passion and Fun with a foreword by Sharon Lector. That's very impressive. Sharon is in Phoenix, isn't she?
Dr. Letran: Yes, she's in Phoenix.
Dr. Farran: Yeah, I'm trying to meet her and see if she would do a podcast. How To Train Your Patients, a comical eBook to remind professionals they have to train themselves and their team first before asking their patients, clients to do what they want. You're just an amazing, amazing woman. What a wild story. How are you doing today?
Dr. Letran: I'm doing good thank you and how are you?
Dr. Farran: I'm doing great. Tell us about your book, From Refugee To Renaissance Woman. When did that come out?
Dr. Letran: That book came out toward the end of last year and I was inspired in a group Mastermind to tell my story. I told my story from when I was in Vietnam. I lost my mom at the age of eight to cancer and then the Communists took over in the country, so six years later we left the country. I left with my aunt and my brother and a couple of cousins.
We came through the Malaysian refugee camp and then from there we were blessed to come to the US. I first came to Louisiana. I was there for six months in New Orleans. Not in Ne Orleans, but in Harvey which is a suburb. Then we moved to California and I've been in California ever since. I went through a lot of challenges like any refugee or immigrant would go through, financial challenges.
The family couldn't really support that much because I'm supposed to be the best one in the family to go to a professional school. Then I finished professional school. Now I'm lucky to have two thriving practices. I really think I listened to the right people. Somebody like you and hang out with the right people to learn more and to excel.
Dr. Farran: It's funny how when so many people get the smallest of challenges they just stop. They always have an excuse. I'll say well, did you do that? Well, I did this and this happened and this is why I no longer ... Then there's other people like you who just have enormous challenges and you just climb every mountain they put in front of you. I just think that is just mind boggling.
Dr. Letran: Well, thank you for saying that. I think there are a lot of professionals, dental professionals, who also overcome challenges. We may or may not know their story. I was just blessed. People inspire me to write that story and that's why I want to share. At the end of the book I say I'm writing this story hoping that you will share your story to the world.
Because sometimes we live our story and we don't realize that our story can inspire a lot of other people who may be stuck in a position or they may be going through some challenges. If they see that somebody like me can do it, then they suddenly can try to do it. There's just certain strategies that you work through to get to where you want.
Dr. Farran: What is your lifelong strategy?
Dr. Letran: My life long strategy, my goal is to become a world famous philanthropist. I want to live my life, a life of appreciation and gratitude because along the way a lot of people helped me from my first ESL teacher to whoever lent me money in dental school to fix my car to the bank that lent me the money to buy my practice when I have no experience, two three years as an associate. I want to give back.
A lot of the goals in the life has to do with charity, so I started a foundation. That one will, part of it will be to raise funds to have mobile dentistry to serve specifically senior centers or outreach communities. Where I practice there are quite a few seniors. Sometimes they don't have the means to come to the office. They take a dollar ride. It takes them forty-five minutes to get to my office to do an adjustment for 15 minutes and then they have to wait and catch another ride, forty-five minutes.
Those are things that I see in my practice. I feel there is a need so I want to fill in that gap. Above and beyond that I also see kids coming from underprivileged background. I like to use the foundation to fund dental treatment for children who may not be able to afford it. Those are part of the goals in life.
Dr. Farran: What is the website for your foundation?
Dr. Letran: We actually are working on that. I barely got approved for the tax exempt status.
Dr. Farran: 501(c)?
Dr. Letran: Yeah, 501(c)3 last month. We're working on that webpage. I'm very, very excited about that.
Dr. Farran: Well, when that gets done whenever you need me or Dentaltown website or magazine or whatever to do, you just let me know.
Dr. Letran: Thank you so much.
Dr. Farran: You have two websites. What is the difference between www.cosmeticdentistmonrovia and versus myelmontedentist?
Dr. Letran: Those are my office websites.
Dr. Farran: What is my El Monte? El Monte is the city?
Dr. Letran: Yes, El Monte.
Dr. Farran: You have two offices. One is in Monrovia, California and one is in El Monte?
Dr. Letran: Yes.
Dr. Farran: California?
Dr. Letran: Yes, there's two offices.
Dr. Farran: What city is that near? When you grow up in Kansas and yo learn geography California only has three cities, San Diego, LA and San Fran. Then the rest of your life you never meet anyone from those three cities.
Dr. Letran: Okay. Well, I guess the closest you would call would be to LA.
Dr. Farran: Okay, so it's LA.
Dr. Letran: Yes. I'm actually close to Pasadena.
Dr. Farran: Okay.
Dr. Letran: Yes, I'm about forty-five minutes east of LA.
Dr. Farran: Forty-five minutes east of LA, okay.
Dr. Letran: Yes.
Dr. Farran: Is that near Redlands?
Dr. Letran: No, to go to Redlands it would take another 90 minutes going east.
Dr. Farran: What's the dentist school in Redlands? Loma Linda.
Dr. Letran: Yes. I think it's in Loma Linda, not in Redlands.
Dr. Farran: Not to get too off topic, but have you been reading that wildly successful book The Blue Zones about how there's nine cities on earth where they have ten times as many people living to be a hundred. The only one in North America is Loma Linda where I took my dental school boards because they're a specific religion. They were, what were they?
Dr. Letran: Seven Day Adventists.
Dr. Farran: Seven Day Adventists, so they basically have a plant-based diet and a lot of beans. Anyway, this science book, they've really been focusing on this that they really really think there's something going on in their diet. I think there's two cities in Japan and a couple in South America. It's amazing how a plant-based, bean-based diet is a game changer. What was also interesting, they don't exercise, but they have a lifestyle where they're always moving. They're not sedentary. These ... Go ahead.
Dr. Letran: Yeah, well the Seven Day Adventists is also like a no medication, no drug kind of practice.
Dr. Farran: Really?
Dr. Letran: Yes, so I believe, because I got accepted to Loma Linda University but I didn't go because I also got into UCLA so I decided to go to UCLA. They from what I understand they don't even have coffee or coke there because caffeine is a drug. They don't have it at the dental school.
Dr. Farran: Now Mormons don't use caffeine either, correct?
Dr. Letran: I don't know about the Mormons.
Dr. Farran: Yeah, because Gordon Christian is a Mormon and when you go to his courses for years he didn't serve coffee. I just thought it was just comical because it was the only dental meeting on earth that didn't have coffee out there in the front. He stuck to his guns and I love him for that. What did you want to talk about today? What's RE for dental practice? Invest in your practice gives the best return on investment. What's RE for dental practice?
Dr. Letran: Real estate.
Dr. Farran: Oh, real estate, okay.
Dr. Letran: Yes.
Dr. Farran: My walnut brain did not pick up on that. What do you think about real estate for dental practice?
Dr. Letran: Well, I think it's very, very important to invest in the real estate for your dental practice and I'm sure I hear about that years ago from you and from Dr. Woody Oakes back when I bought your DVD set for the 30 Day MBA.
Dr. Farran: Don't say that or you're going to give away your age. Everybody's looking at you thinking you're twenty-eight or twenty-nine, but when you say that, now you just put yourself into your 40s.
Dr. Letran: That's when I first learned it's a good idea to have real estate so you don't have to keep paying rent because rent, you're just basically giving money away. I bought my first practice in 1997 and in 1999 I bought my second one. It was because it has a building, it was single standing building. Then whatever money you invest in basically is for your own building, whether you're fixing the roof or you're upgrading the building.
I throughout the years I've owned three buildings. Right now just two, but it housed my dental practice. The rent from the building goes into the LLC that owns the real estate. Then the LLC makes that mortgage payment. Same amount of money so two purposes. I can also do what I like to do with the building. Whether I want to plant something, I want to trim something, I want to put a bigger sign, I have the control of all that.
I think that gives the dentist the freedom to be themselves rather than being in a professional building or sometimes you may be in a strip mall, but all the signs are supposed to look the same.
Dr. Farran: Well yeah, 80% of American millionaires, 80%, eight out of ten millionaires in the United States made their money in real estate. Then Forbes in fact of the Forbes 400 richest people in America, two hundred seventy-three out of 400 made it in real estate. I got that lesson actually from Sam Walton of Walmart where he had leased his first location and then his landlord messed around with him on renewing the lease. He wouldn't renew it.
Sam almost went bankrupt at Walmart because his first building was a lease. Sam, in his book Made in the USA went into long details about how you have to have control. The other thing I like about the real estate is people are always saying the real estate is stocks and they're 401K. You've got to have a diversified portfolio to have ...
Dr. Letran: Right, right.
Dr. Farran: ... all your money in stocks and bonds and not something. Then these people who like gold. A lot of these crazy people like gold because they think gold is real and paper is fake. Well, Warren Buffet said that all the gold in the world would be about the cubic size of a cubic football field. It's totally useless except for jewelry and dental fillings. It is. A building, you know, a building is just real. For a business, for living. Yeah, I love real estate.
Dr. Letran: Yes. You own your real estate also. You've been talking about your building at the corner of that big shopping center.
Dr. Farran: Yeah.
Dr. Letran: For your dental office. It's been there forever really.
Dr. Farran: Yeah, I bought that in '87. When I tell people what I paid for it in 2015 they think it's ... They don't even believe me. It's 30 years later. What about technology?
Dr. Letran: Well, one of the thing I believe the dentist should be doing investments. I wasn't talking about investments in stocks and bonds like what you mentioned. The specific investments that I think help us as a dentist, so for example number one is the real estate. Number two, the technology. Things like digital x-rays, the intraoral camera. I know some offices invest in 3D technology. I can't believe I still have assistants who come through my office that they work in offices that still use regular x-rays.
Dr. Farran: You mean film?
Dr. Letran: Right, right, films. I would have an assistant come in and she would say she doesn't know how to do the digital x-ray. It takes longer, it's more radiation and it's not keeping up with technology because that is one way our patients are viewing us is how we take care of our offices. Whether we have nice furnitures or we're keeping up with the technology or we have nice waiting area for patients, for the kids. It's like they're coming into your house and you want to take care of them. One way to take care of the patients is to keep up your house and keep up the equipment in there, all the modern technology.
Dr. Farran: I like to call that heuristics where I'm always talking to the patients. When they would ever tell me that an office, they were afraid of it from infection control and didn't think it was clean and sterile, then you would talk to them and try to pin them down why, it was from the dust on the baseboards, leaning back in the chair and seeing the water stains on the ceiling, the dust on the ceiling fans.
Dr. Letran: Right, right.
Dr. Farran: They don't know what an autoclave is. They don't know what a [inaudible 15:46], so if you go into the dentist's bathroom and it's not clean, then they think they're going to catch hepatitis. I always thought that the other heuristic with technology is that when they see a digital x-ray and they see the laser DIAGNOdent reading the surface, they see these little low cost technologies and then they heuristically say, "Oh, Emily Letran must be a very high tech doctor. She must be very good."
Dr. Letran: Right. Yes, sometimes they come in and the first question is, "What other new toy did you get?" Because when I get something then I put it in my email, blast it out to the patients so they know we have this new technology in the office. Come in and share the experience with us. Then I put it on Facebook. Try getting the words out.
We have a mix HMO, PPO practice. Sometimes people talk about HMO as being you don't spend a lot of money because you're trying to keep costs down. For me it's all about the patient, so I spend the money for the patient because all patients are the same. They're all people. I treat them that way and they all get the same technology that I invest in the office.
Sometimes when I talk to people they're kind of surprised, oh you have HMO patients and you have this and that and some other investments. For me that's the way that I would grow and that's how I serve people.
Dr. Farran: Emily, a lot of our listeners, you're talking to thousands of dentists and a lot of them are young and don't even know the difference of HMO to PPO. Can you explain what the difference is between an HMO and a PPO and why you take them and how they work for you?
Dr. Letran: Well, an HMO is what we call capitation and so the office get a certain amount of money per head every month. Then you are assigned a certain number of patients. The PPO are the insurances where you sign up and you have a discounted fee. You have a contract with the insurance and you have a discounted fee.
I happen to be based in Southern California. It's pretty competitive. There are a lot of offices that take HMO. When I took over the office that was already the setting of it. As I grow the office all the segments grow, you know? For example we have around 30% HMO and 40% PPO and the rest are cash and mixed Denti-Cal.
When you grow everything grow, but the percentage remains about the same. I'm comfortable with that because I do have to work a little harder sometime and I have to watch my margin, but anybody come in I present ideal treatment to the patient. It's up to the patient to choose, so to me it doesn't make a whole lot of difference as far as how I treat the patient. I just need to watch my bottom line because the margin is smaller.
Dr. Farran: Just because I still think a lot of kids don't exactly understand the HMO and PPO. The HMO, which you're calling capitation, they pay you a certain amount, capita is Latin for head, like capital.
Dr. Letran: Right.
Dr. Farran: They pay you a certain amount per month, per head, per capital, per person, capitation.
Dr. Letran: Yes.
Dr. Farran: Is it multiple different plans or is it mainly one plan? Is it about the same amount of money per head, per person from the HMOs?
Dr. Letran: No, it actually varies. It actually varies so even each insurance, for example Delta Dental has an HMO part to it and in that HMO part, I don't know, there could be fifty, one hundred plans, different plans. Each plan has a different fee. There's a lot more paperwork that you have to look at when you treat an HMO patient because when the patient come in you don't just check their eligibility. You have to check their plan. Then for each code there's a different fee.
Dr. Farran: They pay you, what is the range of how much money they give you per month whether you see them or not?
Dr. Letran: It depends on how many patients they assign to you. The reason I was comfortable taking the HMOs for example with my first office, when I come in I know there is a certain amount of income. I think back then it was maybe $5,000 a month. That amount would pay for my loan, so I took over the office. I know I have the money to pay my loan.
I don't have to worry about that. Then I just have to worry about managing the office and making sure that we are making money. A lot of offices that take HMO, it only makes sense if there is a volume. Your capitation check take care of a certain expense for you and that takes over the worry of that.
Dr. Farran: When those patients come in with an HMO do they usually have co-payments for fillings, root canals, crowns, extractions?
Dr. Letran: Yes, they do have co-payments. The co-payments, the way I look at the plans that I take, the way I do it is if it's like as low as a Denti-Cal fee which is very low, but that's also another insurance that I take. Then I'm comfortable because then I consider that similar to the Denti-Cal patients.
Dr. Farran: Denti-Cal is the California state Medicaid plan for dentists?
Dr. Letran: Yes. Yes.
Dr. Farran: For the international viewers, in the United States Medicare is a national program for the elderly, old people over sixty-five. Then Medicaid is for low income poor people, but it's at the state level. America has 50 different state level Medicaid plans for the poor. Then it has one national system for social security and health insurance for the elderly over sixty-five.
Of course the trend is, and I know they'll achieve it within Obamacare, to just expand one national Medicare over to the entire country like they have already done in Canada, Australia, New Zealand, all of Europe, Scandinavia, Hong Kong, Thailand, Singapore. That's the long game plan. Then on PPO, so the difference in PPO is that they don't give you a monthly fee per person.
Dr. Letran: Correct.
Dr. Farran: They just give you a discount fee. I don't like the term discounted fee. I think it's more accurate to say it's a volume discount. The reason Walmart can sell things so low is because if I go and buy one Barbie doll I'll pay ten bucks, but if Walmart orders a million Barbie dolls, they might only have to pay five bucks a piece.
When you sign up for a PPO and they give you a hundred patients, the trade is you're getting the volume discount and I don't really know what that volume discount is because if I go back and look at a dental office and I look at their marketing costs for new patients, 1-800-dentist, which I've been a member of since 1987, I pay $100 for a new patient, per patient from 1-800-dentist.
A lot of my new patients from Google Ads, Google AdWords are $100 per patient. Direct mail is costing me $250 for a new patient. Yellow pages is costing me $500 a new patient. I'm trying to think of what other ... If you sign up for a PPO and they give you a hundred patients and you say okay, well then the fee schedule is going to be a volume discount, then I go back in and add the marketing cost that costs me to buy another new patient, a lot of times that PPO fee schedule is actually a rocking hot deal. It's usually a very good deal.
What would you say to a dentist? A lot of these consultants they go out there and they just say blanket statements like, "Well, your goal should be to get off all your HMOs and PPOs and go to all cash patients." What would you say? You're a savvy business person. How long have you been practicing dentistry by the way? From '93?
Dr. Letran: Twenty-two years, twenty-two-plus years.
Dr. Farran: Yeah, so you've got two decades in this game and you're out there in California where it's very saturated. You have six dental schools. You have 30,000 dentists in California. California, New York is the jump in point form Europe which is kind of flat. Miami is the jump in point from Central and South America which is really exploding.
California, you're the jump in point from Asia. The whole world lives in Indian, Asia, China, Vietnam. You have lots of immigrants, lots of foreign dentists, six dental schools. What would you say to someone who said to you, "Oh Emily, you should try to get off all your HMOs and try to increase your marketing and just go to V patients or PPOs." What do you think of that as a business? Is that realistic or do you think that's not a good idea?
Dr. Letran: Thank you for asking me that question, Dr. Farran. Actually a lot of time I do hear that conversation saying you shouldn't treat HMO patients because they don't pay you enough, et cetera, et cetera. To me first of all, somebody, the dentist should have clarity in knowing what he or she wants. Do you want a boutique practice? Do you want a Walmart kind of practice? Do you want to do volume? Do you want to have a clinic?
The way I treat the patients is all the patients are the same. The ones that are coming from the PPO or the HMO, you don't have to spend the marketing dollar and the trade off of that is the percentage of the fee discount. However you want to say it. Once a patient is in the chair you still present ideal treatments, so a lot of my ideal treatment patients like six veneers in the front, multiple implants, they are HMO patients.
Sometime I have a PPO patient who come in and they start with, "I have $1,500. My treatment should be based on that $1,500." They don't want to spend more money to invest in their health. That has been my experience. I think when the patient is in the chair you want to work on your referral skills. You encourage the patient to bring in their family and friends. You present the ideal treatment, so if you're looking at the amount of dentistry you diagnose for the patient, there's not a lot of difference except for the very basic one, for example fillings, simple fillings.
If you're talking about crowns, let's say the HMO fee is low. Let's say it's $300 for a PFG. Then I explain to them that's not your only choice. You can do a lava crown and then that becomes what we call an optional treatment. The patient pay closer to UCR. I think it's viable. I've been doing this for more than twenty-two years. I do treatment in my office.
I can't please everybody. Whoever come in and like us and trust us and will give us their business, so insurance I think is only part of the equation. Anybody who want to think about signing up for PPO or dropping the PPO, I think they should take a close look at different offices. How different offices model. They should learn from mentors. For example if you were on Dentaltown reading up at all, that kind of discussion or I'm also in [inaudible 28:34] Waters Dental Marketing Project Group. We have those discussions all the time too.
Everybody take a different viewpoint and you learn how everyone is running their practice. For me I'm comfortable having the model that I have right now because I've been successful with it. I've got the real estate with it. I'm raising my three kids. I can do a foundation. I go do dental mission trips. I'm pretty happy with what I can do with what I have.
Dr. Farran: You are amazing and your dental mission trips, are those to Vietnam?
Dr. Letran: No, last year I went to Costa Rica for a week. I brought my two team members and my three kids.
Dr. Farran: How old are your kids?
Dr. Letran: I have a thirteen years old, a boy and another boy fifteen years old. He knows everything. My nineteen year old is at UC [inaudible 29:35], her second year.
Dr. Farran: Your daughter is nineteen and your boy is 15 and where is the third one?
Dr. Letran: The third one is thirteen.
Dr. Farran: Oh, thirteen.
Dr. Letran: Yes.
Dr. Farran: A girl, then two boys?
Dr. Letran: Yes, a girl and two boys.
Dr. Farran: That is amazing. I want to switch to that. One of my biggest complaints that I always get on the online CE and on the podcast is that it's all men. If it's a dentist it's a man and if it ever is a woman it's a dental consultant or a hygienist. I wish you would do an online CE course and do it with your book. Maybe you could do the deal where they buy your course on Dentaltown and you'll send them a copy of your book.
We need more women role models out there. I'm always telling all the women my age that basically 99% of the people that email me and say I want to be on the podcast, just all men.
Dr. Letran: I see.
Dr. Farran: Then you go to the dental schools and they're half women. They want women role models. I can't think of a more amazing woman role model than you. I want to go into some woman role model questions. Most men don't have to worry about their three kids like a mom does. I don't know if that's ...
Dr. Letran: Yes.
Dr. Farran: .. sexist. Is that true or false, just even that statement?
Dr. Letran: Well, if he has a strong woman behind him he doesn't have to worry.
Dr. Farran: Women dentists tell me things like if a man wants to just go take some dental continue education course, he'll just fly off and go do it because his stay at home wife will take care of the kids. They have more balls to juggle. I know that depends on the relationship, but what advice would you give to women dentists who are in dental school that say I want to own my own business like Dr. Letran, but I also want to start a family. What should I be thinking about if I want to have three kids like Dr. Letran, but I want to own my own business? How hard is that to juggle? Was your husband a stay at home dad? Did he take all this three children off your hands during the day? How did that work?
Dr. Letran: No. No, actually I get all of them. I'll tell you a little background. As far as somebody who is new, like a new [inaudible 32:03] coming out I want to emphasize on getting clear, getting the clarity and the vision of what you want. If you want your business first then you work for a couple years, you get the experience so you can learn the business part of it. The clinical part usually will come with time. You got trained in school, but dentistry is a lot of practicing to get better.
Learn the business part. You need to know what you want. For example, when I was working, when I got out of dental school I was working in three different offices. I'm trying to learn all the different ways to run business. Once I bought my practice that was kind of the first priority. I've got to get this thing running. Then when I became pregnant with my first child ...
Dr. Farran: What year did you get pregnant? You got out of school in '93. What year did you get pregnant with your daughter?
Dr. Letran: I have Jennifer in 1996.
Dr. Farran: '96, so it was three years out of school.
Dr. Letran: Yeah.
Dr. Farran: That's what I did. I graduated when I was twenty-four and I waited until I was twenty-seven to have Eric.
Dr. Letran: Yes. When I have the child I make arrangement for babysitting. My husband is an engineer and he actually, he takes off in the morning because of the traffic situation in California, so if he starts the day he takes off at 6. Then he come back home at 6 or 7. I get up early. I take my child to the babysitter. Then I go to work.
Then when I get out of work either he will pick up the child or I will. Then I go home and cook dinner. We have our family time. Same thing repeated when I have the next two boys. The only time I'm out of the office, the thirty days. I usually take one month after pregnancy to stay home with the child and then I take them to the babysitter.
I'm one of those people that I go volunteer at school because I believe it's very important for your kids to see you at school. I go to all their functions. At one point when they were younger I took them to work with me. I go pick them up from school, they come to work. They go sit in the kitchen or in the little doctor's office. They do their homework.
A lot of the patients know my children. My daughter Jennifer, she hates it when she comes to the office and everybody is telling her, "Oh, I remember you when you were about this high." Now she's 19, but it's because she's been coming to the office. I think that's because I made the choice, because I'm clear in what I want. I want to have my family and I want to have a practice.
I have friends who when they were pregnant they decided to sell their practice. Then they decide to stay at home for a while. Then now they're getting back, either they're getting back to the job market or they're trying to buy another practice. I raised three kids and I think all of them are good. When I went on the dental mission trip my kids, I think I was yelling at them for something and they told me, "You know what Mom? All the people who we're working with, they're willing to adopt us."
I'm very proud. I think I raised them the right way. One of the reason I'm actually starting a coaching program called Exceptional Leverage and the reason for the name is you just have to leverage everything. For example, when you're in the office you leverage the staff, time and effort. You delegate things so they can do things for you so you don't have to do everything.
Difficult cases, I bring in specialists to my office so they can take care of all that so the patient don't have to go anywhere. I can just concentrate on doing what I like and what I'm really strong at. Again, leveraging that. I go to business conferences, I learn from mentors like you. Right now I'm coaching with Chad Lector. I'm leveraging on the people who have already paved the way. I leverage on their knowledge so I can learn faster and I can short cut that path to success. Just like you say, there's not a lot of women leaders or however you want to call them. I go to these Mastermind groups and I'm the only woman.
Dr. Farran: Exactly.
Dr. Letran: I get really frustrated. I talk to some other female dentists and they say they're too busy and sometimes they have fewer kids than me and they have a smaller office than me, but I don't think they make the decision to commit to having a big life when they can have the practice and they can have their family. My kids are very happy that I'm always in their life. I go to all of their performances. When it's time to go check out school I'm the one driving them around.
My husband, he works from Monday through Friday, so I basically run the whole show with the kids and the practice. I think I'm able to do that because I leverage and I made a decision I'm going to commit to that. I don't give up.
Dr. Farran: You have someone come in and place your implants. Is that an oral surgeon, periodontist or implantologist? How does that work?
Dr. Letran: The periodontist, right now the periodontist is placing the implants. At some point a previous oral surgeon also placed the implant.
Dr. Farran: Now there is a big, what is the big implant chain where they do all on four? They have them out there in California. Anyway, what is the going pay for something like that? What do you have to pay them of the procedures? Is it a percentage? Is it 30%, 40%, 50%? How does that usually work?
Dr. Letran: Well, for my particular practice with periodontist, he place the implant and the fee is $1,800.
Dr. Farran: Is it a he or a she?
Dr. Letran: It's a he.
Dr. Farran: He charges $1,800 to place the implant?
Dr. Letran: Well, that's the fee that the patient pays.
Dr. Farran: Oh.
Dr. Letran: My arrangement with him is I pay him $1,000 and I provide all the material.
Dr. Farran: You pay him $1,000. You buy the parts and the pieces and the fixtures.
Dr. Letran: Oh, no, no, no. He brings the ... I should back track. I pay for the abutment. He pay for the implant, the implant itself. He place the implant, he does the surgery, he gets $1,000 flat. I've had other periodontists that have come through the office and we work on a percentage, like 45 to 50%.
Dr. Farran: 45 to 50?
Dr. Letran: Yes.
Dr. Farran: I love the way your business mind thinks because people who go out and learn how to place implants, by the time you figure how much they've paid for the surgical kit, the training, flying to different cities, the hands-on, I think a lot of dentists have 30 to $50,000 invested before they place their first implant. Then to sit there and say, "I'm not going to spend 30 to $50,000 learning how to do this. I'm just going to split it with someone and then have them come in and we'll split it 50/50." That's what you've done.
Dr. Letran: Right, because I don't think you can be an expert in everything.
Dr. Farran: Oh, you can't. There's no way.
Dr. Letran: Yes, and I think there are a lot of dentists out there, some of them are my friends, who want to do everything. They want to do [inaudible 40:27] which is great if you're really good at it, but if it's going to take you a couple visits and you're going to struggle, I don't see the point. Just leverage that. Bring somebody in to do that or refer the patient out.
It really is for the patient so you don't want to be practicing your skill on the patient per se. Let an expert. Let a specialist serve your patient so they get the best care. That's one other thing also, I try to when I mentor my associates I tell them try to learn as fast as you can where your limit is because I don't want you to go in there, try to take out a tooth and then break the tooth. Then two weeks later you're going to repeat that on another patient. You need to learn your limits and either you go get more training, but you have to practice more to practice at that higher level or just don't do the case.
Dr. Farran: What other specialists do you bring in?
Dr. Letran: I have a periodontist, an oral surgeon and an orthodontist.
Dr. Farran: Wow.
Dr. Letran: I have three.
Dr. Farran: How often do they come in?
Dr. Letran: The two surgeons, they come in once a month. The orthodontists comes in twice a month.
Dr. Farran: I want to get a state of the industry in California. Again, California, you swim across that pond and you're in China, Asia. Two-fifths of all the people on the planet so you have lots of immigration of dentists, you've got six dental schools. Going back to when you walked out of school in '93, twenty-two years ago to today, is the dental economy about the same or do you think it's gotten a lot more competitive? How would you describe the changes in the competition? How hard it is to make a living or how easy it is? What's changed in twenty-two years?
Dr. Letran: Well, there's definitely more competition. In the little town where I'm at in Monrovia it's not as big. I think we used to have seven dentists there with about thirty-five, forty thousand when we started out. Now I think we have eleven, but two of them are big corporations. One is Pacific Dental and one is West Coast Dental. West Coast Dental is more on the west end.
What you do as a private practitioner is you're competing with those places where they really just try to get the business by cutting prices, cutting the fees. I used to work for West Coast Dental when I in my first three years. I worked there for about two months trying to learn the business. You don't see a lot of returning patients because when the patient come in they try to do as much as they can. Whether or not it works out in the long term it doesn't matter because by the time the next patient come in you probably have another associate in those big corporations.
It really comes down to the dentist himself or herself, how you treat your patient, how you take care of your patient. That's how you compete with those places. You have your own way of competing. You're not going to compete on their terms. Their terms is on price. My term is more on patient appreciation. For example I have a movie night for my patients. I rent out a theater and I invite my patients to come.
One year I got talked into dress up as Iron Man because we were watching Iron Man. I have patient appreciation events. I invite my patients that want to invest a lot in the office, I invite them to dinner. We just show up, we just talk. We've done it at Mexican restaurant, we've done it at Dave and Buster's where they can go and play games. We've done it at bowling alleys.
On Valentine's Day we have cookies and cupcakes and we send out an email inviting people to come by and just say hi. We have raffles so they can pick out a gift. It could be a wine kit, it could be one of my books. All of those things, that's how I compete with those places. That's my term. I'm not going to go out and try to do free exams where everybody can come in. I'm not going to cut my fees. I already have a very diverse fee because of the HMO.
I don't compete on those terms and I think anybody who is in California need to figure out a way on how to differentiate themselves and stay in their own bubble, treat their own patients, work on referrals so the patient base will refer more patients to you and kind of ignore all the other competitions from all the corporations.
Dr. Farran: Going back twenty-two years ago to 1993 to now, how extensive was corporate dentistry in 1993 versus in 2015?
Dr. Letran: Well, I think back then the main one was Western Dental and then through the years I believe they got bought by Newport Dental. Some of the offices because you know how Western Dental always owned, they have their own building? It's always in the best location kind of like a McDonald's location.
Dr. Farran: Did they own their buildings or did they rent them?
Dr. Letran: I don't know if they owned the building. I just know that they usually have the best real estate as far as exposure. I know some of their big offices got sold to Newport Dental. Right now in California Coast Dental started moving in. I believe Coast Dental is more from the east coast.
Dr. Farran: Florida. Yeah, they started in Florida.
Dr. Letran: Yes, yes. They opened some offices there in Southern California. That's where I'm at so that's where I can speak about. Pacific Dental is very big. Kind of the same model as Western Dental. I have friends who work there and basically they push for production from how I understand it. Put a bridge on number one through six or something like that.
They put a bridge in and how long it lasts it doesn't really matter because by the time the patient comes back the doctor may not be there. Again, I think it all has to do with the doctor's ethics and training. If you think you're doing the right thing for the patient or not. That's the stories that I hear from the corporate dental world.
Dr. Farran: You've been on the planet a long time and you've been doing dentistry twenty-two years. What percent would you say of just humans in general in California on the planet earth ... No, let's stick to Monrovia. How many people live in Monrovia?
Dr. Letran: Well, the last time I checked which was several years ago probably about forty thousand.
Dr. Farran: Okay, so ...
Dr. Letran: It's probably gone up now.
Dr. Farran: When you're looking at a market of forty thousand, what percent of the people in Monrovia, California today would simply only want to buy dentistry on price like a commodity like a bushel of corn or a gallon gas versus a differentiated product based on I want, I trust Dr. Emily Letran? I want her to be my doctor. I don't want to go to a corporate chain where it's a different dentist every time.
I trust you. Percentage-wise the reality of life, elderly, poor, rich, middle class, high educated, low educated, but just of the forty thousand people where would you divide the market today in Monrovia? What percent would just want just price, wham bam, whatever and the other half no, I want to pay extra value added? I want Dr. Letran only to treat me.
Dr. Letran: I would estimate maybe around 30% of people will choose the dentist or choose a product by price. Part of the reason is I think the insurance companies do an excellent job selling the insurance whether it's HMO or the discounted fee. There's also some smaller companies that they have their little small HMO. They're just selling it to a very small community base.
They thrive on the membership of those people paying the fee to you. They do a very good job explaining that to the patient, that the patient think they have a good plan and they don't have to pay a lot. A lot of people will look at it from that perspective first, so they call your office and they say, do you take whatever plan it is under the HMO.
It is up to the dental office to explain to the patients the comprehensive treatment plan, have them come in so they can have that chance where we chat with them, we check out their teeth and we present the ideal treatment plan to them. Once you do that and they understand that is in the best interest of their health, they don't decide on price anymore.
Like I mentioned earlier, a lot of my patients that do big treatment, they are the HMO. The HMO, you can think of them sort of as a price shopper kind of patient, but sometimes they have the HMO because of where they work. It has nothing to do with their lifestyle, what they want to do. They work in company A and company A only has that particular choice.
I think a lot of people look at the price because big corporations or certain doctors may advertise just based on price. I'm sure you've seen the big billboards. We have one close to where I live, implants for $399. The patient will come in and ask me why would I pay you $1,800 and I don't go there and pay $399? I explain to them I have the periodontist. He is trained at USC. He's placed a lot of implants. He has a lot of experience. You've been my patient for so many years. You've just lost your first adult tooth or whatever and now you need an implant.
You already know us, the service, the way we treat you. If you like to go over there and check them out, certainly do that. I tell them because I've heard stories from those places also, I say just check out all the stories first before you make that decision to go over there. Every week I have people who come in and say, "I want you to double check this because I went to so and so. I just want to know what your opinion is."
I always ask them, "Well, why did you even go over there?" "Well, you know they sent a flier and it's $19.99 for a cleaning, checkup so I decided to try them out." At the same time I have patients who come in to check me out because I may have sent out a postcard and they come in just to see how I am and then they stay.
Dr. Farran: Some words are negative and some are scientifically, like a religious person will say, "You're being selfish." Whereas the economist will say, "Well, that person is following their own self-interest." A negative person will say, "That business is bait and switch." Then an economist will say, "Well, this person is very great at up-selling."
I see that a lot of these $399 implants and that just means a little mini implant. Then the patient comes in there for the $399 and then they up-sell to you want a root form or you might want two root forms and a Hader bar or casings. Denture clinics do it all the time. They advertise a $399 denture. Then you get there and they show you four dentures. The $399 one looks like you wouldn't give it to your hamster. Then they have the up-sell with the ...
What's amazing with the up-selling is that usually humans don't want the cheapest or the most expensive. I notice when I was little and got out of school, usually the middle is what everybody would get, but it was just the middle. Now I see a lot of people putting two middle sin there. They'll say okay, here's the low cost answer for $399. Here's the full eight implants, lower eight implants and upper and two twelve unit bridges for $50 and then they have an all on four that might be $30. Then a four denture, four implants and a removable denture.
[inaudible 53:57] price points, but I think what I hear several times in talking to you is that through your confidence, your communication, your building of trust that people will come in for a low price HMO or PPO, but you're able to up-sell them to higher quality dentistry. I think that's amazing. You're basically saying about 30% probably just by on price, but you're able to up-sell 70% into getting more ideal dentistry.
Dr. Letran: Up-sell is one word that describe how you present the treatment. For me I always give them all the options. For example, if you have nineteen missing, let's say nineteen and thirty, the best choice would be to place two implants or you can do two bridges where you have to shave down both of the abutments. Or you can do a partial denture. I give them all those choices.
I think if you give the patients all the facts and what the quality of life would be if they choose let's say two implants with just a partial denture, once they understand that they can make a decision based on what they want to pay for that. Now, there are always patients that they may not be financially ready, so they'll go with the lowest cost alternative. I have already planted the seed that the best way is the implant. A lot of times those patients will come back and do the more ideal treatment.
Dr. Farran: Emily, what are your thoughts on an associate? Do you have an associate? You bring in specialists, but you do have an associate too?
Dr. Letran: Yes, I do have associate doctors. Yes.
Dr. Farran: How many associates do you have?
Dr. Letran: Right now I have three. Between the two offices we just have one doctor working per day. It's not all four of us in at the same time. For example if one associate is in one office I am in the other one. Both offices can run at the same time. Occasionally when I have a real young associate I will come in to "babysit" and try to help that doctor learn the business part of the business and the clinical part. Tips on how to cut down your time on prepping a crown. How to run three chairs at the same time. How not to get all freaked out if you're backed up because there's an emergency walk-in.
I love to have associates. Again, that goes back to my belief of leveraging the time. Other people's time, money and effort because I'm only one person, but if I want to grow I need a team. Whether it's the dentists or the assistant or the front desk staff or the CPA or a mentor. All of that, I consider that leverage.
Dr. Farran: Emily, would you ever consider these associates, selling them a percentage and having a partner or would you not like giving up the control?
Dr. Letran: At this point I don't think I would want to give up the control. I think for me from what I see with my friends, partnership is difficult because you have to have the exact same philosophy about your values and what you want to do. Secondly is when I was younger, absolutely you've got to be very similar in your lifestyle.
Meaning if I have three kids and I'm partnering with you and you don't have any kids, I may be the one calling in because my kid is sick or I've got to go to this function. You don't have those same "excuses", so sometimes people don't get along in the partnership because of that. They're not similar. If we both have children and we both agree that we're going to spend time with our family we may change our office hours to accommodate the family. Anything like that. If you're similar it's just easier to work with.
Dr. Farran: Yeah. A dentist partnership is just exactly the same thing as marriage except you don't have any sex or children or holidays or vacations, so good luck with that. Then do you ever see a day to where you will go to full leverage and just be a business owner and not do clinical dentistry like Rick Workman of Heartland Dental hasn't seen a patient in twenty years? Rick Kirschner of Comfort Dental hasn't seen a patient in twenty years.
Steve Thorn of Pacific Dental Services, his dad is a dentist and he said hell, why go to school for eight years and be a dentist. I can hire one in five minutes. He never even went to dental school and he has [inaudible 58:59]. Do you think Emily will ever make the transition to just pure leverage? Just pure leverage and just work off of your mind and cell phone?
Dr. Letran: I don't think that will ever happen. I think at least I would have to work one day. I love the connection with my patients. The dentistry part, on certain days it can get challenging. If you've got a difficult case it can get challenging, but what I really value about this profession is the connection and the relationship with the patient.
I'll tell you two quick stories. I have a lady come in and she's sitting there and she said, "Do you remember me?" She was in the waiting room. I said, "I'm sorry, I don't remember." She started telling me about her mom. It's an older lady several years back have a, well, she call it the snaggle tooth. It's kind of turned, it's kind of crooked. I think it was number nine.
I told her let's do Invisalign to straighten out the front teeth and then I can put a veneer or cap on that tooth and you will look fine. She told me that her mom, they had moved out of state and her mom got a stroke, couldn't really talk very well, but she is super excited about her smile because Dr. Emily fixed her snaggle tooth. That was several years back and this is the daughter who is an all grown lady in her 50s telling me about her mom.
The other story is I have an older patient, I think she was in her 80s, she always come in fully made up. She does all that just to go to a dental appointment. I remember one day I told her, "Can I take a picture of you because you always look great?" She has red hair. She was sitting in the front and all of a sudden she told me, "Wait, wait, wait." Then she put her hand under her chin like a model. I noticed this because she was sitting next tot he Invisalign poster that they have that model. She wanted to look like that model. She did the same pose.
I took the picture, developed it, mailed it to her. Several years later somebody called and they said so and so wants to talk to you. He said that I am the son of Mrs. So and So and I'm just calling to let you know my mom passed away. I said, "I'm really sorry to hear that." He said, "Actually the real reason I called you is because we were going through her things and she has a list of favorite things and people and Dr. Emily was on there."
Dr. Farran: That is so sweet. You are adorable. I love you so much, Emily. I want you to be a role model. Half the dental school classes are women and they don't want to see a bunch of old, fat, bald guys as mentors. They need to see women who came out of those schools two decades ago and blazed amazing trails like you. I hope that you build an online CE course on Dentaltown. I hope you package it with your book.
I think that would be a great thing, because if I was going to point a little girl in dental school and say when you grow up you need to be just like this role model, I would say I want her to be just like Emily Letran.
Dr. Letran: Thank you for saying that. You're so sweet. You're so generous. I like to extend a gift to the listeners of your program. I have a webpage called Exception Leverage. If they want to go to www.ExceptionalLeverage.com/eBook, there is an eBook version of the book that I had sent to you, the book Commit.
Dr. Farran: From Refugee to Renaissance Woman?
Dr. Letran: No, this is the one that is the eBook version of the newest book that is coming out, Commit.
Dr. Farran: Commit.
Dr. Letran: Commit, yes. It's www.ExceptionalLeverage.com/eBook and get an E version of that book. It tells about my story. It tells about my struggle. It gives advice for young professionals to make sure that they have the clarity, the dedication and the commitment to run their office, have a wonderful family, have a big life.
Dr. Farran: I'm on the website now. You have Five Secrets to Growing Your Business. You have a lot of books, right?
Dr. Letran: Yes, I have a couple of books.
Dr. Farran: Also Emily, Dentaltown, you know we've had half a dozen programmers since 1998 and one of the next features, so we have the website and then we came with the app on the iPhone and forty thousand dentists have downloaded the app. When we do this podcast a lot of them see it on the podcast section. The next section is eBooks. I think that section is due first quarter in two or three months. I can't think of a greater honor that when we come out with the eBook section you might consider putting your book on the Dentaltown app.
Dr. Letran: Oh absolutely. Absolutely.
Dr. Farran: I think we're going to try to do it, I think we're looking at three models, so you can do an audio book because that's the most popular because the reason podcasts are crushing radio is because they're multi-tasking. They're basically commuting to work for an hour, like your husband. Your husband has an hour commute each way and they're tired of radio. They're listening to podcasts. I think the audio books are just amazing.
I notice all my dentist friends, it will be a book and it will take six to eight hours to listen to the book. They just don't have the time to do it, but in one week of commuting to work they'll go through a whole book. Hey Emily, we're out of time, we're five minutes over time, but thank you for all that you do. You're just an amazing person. You're my idol, mentor and role model. Thank you for all you do and I can't wait to see you again some day.
Dr. Letran: Thank you so much for inviting me on the podcast, Dr. Farran. You're my great role model. You don't know but I follow what you say. I read what you write and I think you're great because you telling people the story like it is, that dentistry is not a hobby. You don't just go and practice and just enjoy it. There's a business side to it.
You have to work at it just like you spend four years working your skills up at the dental school. Just because I know you have Dentaltown all over the world and you create also the Spanish, right? The Spanish part of it, the book about my story From Refugee to Renaissance Woman is on Amazon, I translated it into Spanish.
Dr. Farran: Oh, you're amazing.
Dr. Letran: Because I want to share the story with a lot of people and if it just gets somebody pumped up and go through the day, that's the least thing that I can do.
Dr. Farran: You know what's amazing? Back to English, so the United States is a third of the billions, three hundred thirty million, but North and South America combined is a billion. Just like Africa is a billion, India is a billion two, China is a billion three. There will be more Spanish speaking people than English speaking people very soon. All right, we've got to go. Thank you very much.
Dr. Letran: Thank you doctor.