Listen on iTunes
Stream Audio here
AUDIO - DUwHF #300 - Kerry Straine
Watch Video here
VIDEO - DUwHF #300 - Kerry Straine
Kerry K. Straine, Certified Professional Behavioral & Values Analyst, holds a Bachelor of Science in Business Administration with a concentration in Accounting and has been in business and financial management for more than thirty years. It was Kerry’s education and experience in accounting that led to the development of The Straine Management System™, the premier platform that provides strategic planning, leadership and team development, policy and management system design, training, monitoring and coaching for dental professionals throughout the United States and Canada.
Kerry’s contribution to the dental industry earned him the award for Best Practice Management Consultant in the nation in 2012. The mission of Straine is to advance the understanding, practice, and development of leadership for the benefit of all professionals in the dental industry.
As a Certified Professional Behavioral & Values Analyst, Kerry understands that behavior and attitude can help or hinder the strategic process and because of that knowledge he is able to assist dental professionals gain a better understanding of the complexity of strategic leadership.
Kerry says about personal strategic leadership effectiveness, “Thinking strategically, acting decisively and in alignment with the practice’s strategy, and influencing others’ commitment to short- and long-range objectives is the essence of effective leadership. The Straine Management System™ provides the essential systems and processes that can improve the strategic functioning of a dental team.”
Kerry has also contributed to the dental industry with innovations such as the Straine Practice Analysis™, a window into the day-to-day operations of a dental practice that illuminates the effectiveness or ineffectiveness of existing strategies and systems. As an administrative reformer, Kerry recognizes the significance of each dentist’s unique clinical vision and standard of care, but says that “without a well-defined philosophy and sound management system, the business will fail to deliver on its owner’s promise or stand the test of time.”
Howard : It is a huge, huge honor to be interviewing my longtime buddy Kerry Straine. My god it seems like yesterday you were in my front room watching my boys. I think they must have been 1, 2, 3 and 4.
Kerry: I remember the wagon at the airport when you picked me up and you had all 4 boys in it. That was an amazing experience.
Howard : That green wagon, that was the biggest wagon I could find to put four boys in there, but man I have loved you for so long. Let me read your bio just in case there's some kid living under a rock in Asia that's never heard of you. Kerry Straine, certified professional and behavioral values analyst holds a Bachelor of Science in business administration with a concentration in accounting and has been in business and financial management for more than 30 years. See, I've only been in it 28 years. I'm much younger than Kerry.
Howard : Much, much, much, much younger. I could be his kid. It was Kerry's education and experience in accounting that led to the development of the Straine Management System. The premiere platform that provides for strategic planning, leadership and team development, policy and management system design, training, monitoring, coaching for dental professionals throughout the United States and Canada. Sorry I'm breathing hard. I just did a 8 mile run and I walked through my front door, literally Ryan had you on the screen when I walked in the door. Kerry's contribution to the dental industry earned him the award for best practice management consultant in the nation in 2012. Congratulations on that Kerry.
Kerry: Thank you very much.
Howard : The mission of Straine ... By the way, you never told me what strain of bacteria you are. Are you Streptococcus mutans causing decay or P. gingivalis causing gum disease? Which one are you Kerry?
Kerry: That's under lock and key.
Howard : That's right next to Colonel Sanders secret recipe.
Kerry: And the Coca-Cola recipe?????
Howard : The mission of Straine is to advance the understanding, practice and development of leadership for the benefit of all professionals in the dental industry. As a Certified Professional Behavioral and Values Analyst, Kerry understands that behavior and attitude can help or hinder the strategic process and because of that knowledge he is able to assist dental professionals gain a better understanding of the complexity of strategic leadership. Kerry says about personal strategic leadership effectiveness, “Thinking strategically, acting decisively and in alignment with the practice strategy, and influencing others’ commitment to short- and long-range objectives is the essence of effective leadership. The Straine Management System provides the essential systems and processes that can improve the strategic functioning of a dental team.”
Kerry has also contributed to the dental industry with innovations such as the Straine Practice Analysis, a window into the day-to-day operations of a dental practice that illuminates the effectiveness or ineffectiveness of existing strategies and systems. As an administrative reformer, Kerry recognizes the significance of each dentist’s unique clinical vision and standard of care, but says that “without a well-defined philosophy and sound management system, the business will fail to deliver on its owner’s promise and stand the test of time.”
Kerry I want to open up with ... I've already had over half a million views on these podcasts and they're just being devoured. In fact, I got several e-mails over the weekend that over the holidays they were binge listening to them. You know, one kid told me he was listening to 12 a day. I just want to set the stage for you that the evidence I have, everybody that emails me about my podcast that heard it on dentaltown.com, most of them are the first 5 years out of school.
Howard : Where you and I have an advantage of being in this industry 3 decades, I want to ask you this. If your own kid, your own daughter, was walking out of dental school today this is what she's going to say to you is "Dad", and I want you to affectionately, fondly tell your daughter the truth. She's going to say, "Dad you got out 30 years ago in the glory days of dentistry. I'm getting out with a Heartland Dental and Pacific Dental, big box dentistry, on every corner. I got $350,000 of student loans. They're telling me I can't be a great dentist unless I double down with $150,000 Cerec, a $75,000 Biolase, a $100,000 Carestream 3D x-ray machine. Dad, should I double down on my debt or should I just go get a job for Heartland? Are the glory days behind us or does dentistry still have a future as opening up my own private dental office?" Now, if that ain't a loaded question.
Kerry: That is a loaded question and, again, I'm talking to my daughter and I only have one. That being said, $350,000 in debt, is that all? I'm talking to kids that are graduating from school that have a lot more than that. It's daunting to realize that they've got to make 90 to a $100,000 on top of the income that they need to fund their lives annually just to fund the debt instrument that they're going to be committed to to pay off the student loans. That being said, a lot depends on what they want. I think that the corporate dental world is a great learning ground working for someone like you that's owned a practice for 28 years, working for anybody who demonstrates tremendous leadership, not only clinically but building a great team. If you're going to put yourself in a position where you've got a job for the next 1 to 2 to 3 years, you want to work with someone who's modeling the leadership and behavior for you to learn from. Those are valuable years that you need to continue to be a student and commit to becoming the leader that you can be.
Leaving dental school with a $500,000 or a million dollar loan where you bought a practice or you're starting up from scratch with 5 or $600,000 just to open it up turnkey. Most of the students I meet aren't use to writing that check for more than $1,000 or $1,500 and that's rent. Then, to be faced with 20, 30, $40,000 a month worth of labor, $6,000 for rent, $10,000 on the debt instrument being funded. When you look at what the net cash flow is available after operations, then to fund the interest or the debt service, then there are taxes.
What's leftover to the bottom line they need to have a clear perspective of. They need to determine just what it is that they need to live on and if they can't make that model work through an acquisition or start-up then they're better to go to school on how to apply the dental lessons they've learned in school by working for a large group, as you say, Heartland or Pacific or one of the others. It doesn't have to be a big practice, it could be just a very successful baby boomer, like you and me, whose got more patients than they can manage who's thinking about bringing an associate on so that in there 50s or 60s they're not contemplating retirement, they're looking for an associate. If that young dental graduate can find a doctor to work for that has a quality patient-based staffed facility and economic model in place and is going to commit the time nurture them and mentor them, then I don't see that as a bad option for the dental graduate to consider as well.
Howard : I would consider it a post-graduate degree just like a periodontist will go get a masters and science degree in perio. Kerry, the most bizarre email that I get the most from these dental students is they always come back and say, "I'm going to go back to where I was born in Tulsa, Oklahoma and there's 2 guys looking for a dentist and one will pay me 35% and I pay half the lab bill. The other pay me 30% and I don't have to pay the lab bill." I'm like, "Dude. I mean, that's not even what you should be looking for." Between those two dental offices he should be looking for what? He wants to go learn how a dentist is a leader. Tell them what type of job they should be looking for. It's the same thing with the big boxes, like there's 450 DSOs. We always say Heartland or Pacific or Aspen, but there's 450. What qualities should they be ... What would be the most things you'd want to learn from this associate job for 2 or 3 years? What should they be looking for?
Kerry: Well, they should be looking for an experience to learn that's more than just dentistry. If they had a checklist to go through to determine whether or not they should take that position, the first thing they want to look at is how productive is the practice and profitable is the practice, because they're wasting they're time if this doctor's going to bogart every case that comes in the door, the original dentist, and not provide this person with anything more than a 1 or 2 surface filling procedure. If there's not an abundance of patient flow, a committed team that loves their dentist, enough operatories and, again, committed to mentoring that individual. I wouldn't go there.
I've broken it down to what I call the 5 success strategies. Strategy number 1, there needs to be enough patients in the practice. The first 1,500 patients in the practice are going to be seen by the owner dentist, 1,500 maybe even 1,800. Every practice has a maximum patient base capacity, Howard, and it's equal to how many people they can fit into their continuing care program if they're general dentists or pediatric dentists. Look at that number. In our Straine survey that's the first statistics we gather; how many patients of record do you have? Then, we look at is how many patients have walked in the door the last two years. Prior to that and you're hunting for your high school girlfriend on Facebook, you're not going to find them. If you look at the number of patients that have walked in that door the last 2 years, that's your body count, number 1. Number 2, you want to ask this question; how many of them have made it into hygiene in the last 6 months and number 3, how many have a scheduled hygiene appointment? There's got to be enough sources of dental procedures for that associate to earn a living otherwise, Howard, 30% of 0 is what?
Howard : Nothing.
Kerry: Nothing. That gets back to negotiating a base salary. These larger groups are telling and I have clients that are large group practices. Over the next 2 weeks I have 4 large MSOs, DSOs coming in to meet with me beginning tomorrow from all over the country through now and the 16th of January here on the coast of California, just planning out where we're going to be over the next 3 years each one of them different. These people have a plan to not only provide dentists with the opportunity to do dentistry, to be fairly compensated and to train them on communication, leadership, teamwork. That's not saying individual dentists can't do that as well, but before you sign the agreement to go to work for someone you want to make sure that A the patient flow litmus test has been analzyed, so back to the numbers. How many people have walked in the practice at least 1 time the past 2 years? What percentage of them made it into hygiene? Just that statistic alone Howard ... I've conducted over 22,000 practice analysis just looking at that statistic over the last 25 plus years. The percentage is 48 to 52% of the patients seen, from my data, in the last 2 years are participating in continuing care. Maybe that's all the doctor had room to see.
Howard : 48 to 52?
Kerry: 48 to 52%. I've got the statistics to back it up. We conduct in our office 4 to 800 practice analysis complimentary to doctors annually. We want them to see exactly what's there. Now, the good thing about that, Howard, is if the practice is seeing 2,500 patients in the last few years and they've got 13, 1,400 of them they made it into hygiene the last 6 months, my god, there's an untapped potential if the owner doctor has a plan to sweep more of those patients into continuing care to feed the associate. I think that could be done because we see it all day long with our clients. The third statistic is what percent of them are reappointing for their next hygiene appointment? We find that a high percentage of the continuing care patients are reappointing, but obviously not all 2,500 of them. These numbers are well within the range of what we see to be the statistics of practices we're looking at. That to me is the number 1 statistic an associate needs to find out about. That is an issue once they've negotiated their compensation plan.
Howard : When you said you don't want the owner dentist bogarting the patients, my god the last time I heard that word, bogart, I was in college and someone said, "Howie quit bogarting that joint."
Howard : Who should be rescheduling the hygiene appointment? Do you think the hygienist should be scheduling that back in the operatory because that puts the burden on her? You've been back there an hour, get her done, as opposed to the hygienist just walks up front and says, "Mary Ann will check you out." Did you see any difference in strategies to get a higher percent?
Kerry: I see practices doing it every different way. The key though is to make sure it gets done. Whether or not the assistants are reappointing the patients the doctor sees or the hygienists are reappointing the patients they see or administrators are reappointing the patients, at the end of the day that doctor wants in their inbox, they want the following statistics; how many people did we see today and how many of them left with their next continuing care appointment scheduled? If it's not scheduled then we got to go do some work either electronically through our sweeping program and emailing them out, but the fact of the matter is we didn't underscore the importance of being in our continuing care program because we want to take care of you for god sakes.
The dentist can talk about the oral systemic relationship, blah, blah, blah, blah. I'm not a clinician as you know, but I know that we've got to manage body count. I know my clients that have more and more paitents able to capitalize on that goodwill and the leverage because there at an inflection point where they're going to have to make a decision, "Where do I go next? Do I bring on that associate? Maybe. Maybe I don't have room. Maybe I don't want to. Maybe I don't trust anybody else. Maybe I've got so many patients I can move out of network." There's so many options when demand is far greater than supply and I know you know what that means because you have your MBA.
Howard : Speaking of MBA, the American Dental Association has a PhD economist and he wrote an article last year, 2015 that said ... It was called Dentist Lawyers and Lattes. "The data is very clear that after the 2008 meltdown the only people who have not rebounded to 2008 numbers were dentists, lawyers and lattes, Starbucks, coffee shops." My next question to you is, Kerry this dentist is out there in the middle of Ohio and he says, "Kerry, come on, dude I've been doing this 15 years. I'm just flat. I'm flat. I'm not even back to 2008. I was doing 750 a year, now I'm at like 700 and for basically a decade. It's almost a lost decade. Kerry, I'm sitting out there in the middle of Ohio, I'm doing 2008 numbers and it's 2016. What could Kerry Straine at Straine.com, S-T-R-A-I-N-E dot com, if I called you up what can you do because I'm out here in a city it ain't doing nothing. There's no new factories. There's no cranes in my city. It's just flat Kerry. It's a decade of nothing, just flat." What would Straine tell this guy? What are his options?
Kerry: The first thing that weigh his options are to get on the phone and have a conversation with me. Just reach out and send me an email and say, "Kerry, I want to sit down and talk to you about where we are-
Howard : Okay. Then, what's your phone and what's your email?
Kerry: Kerry, K-E-R-R-Y, at Straine, S-T-R-A-I-N-E, dot com or call us 800-568-7200. We're glad to schedule a 1 hour consultation with anybody and during that one hour consultation wer-
Howard : And how much is a 1 hour consultation?
Kerry: What's that?
Howard : How much is a 1 hour consultation?
Howard : Okay.
Kerry: Free. Anybody who's listening to this podcast, it's free.
Howard : What are you going to do in that 1 hour? Go over some case studies, I mean, what magic bullets are you finding for a flat doctor whose lost a decade of growth?
Kerry: Well, first of all is to figure out what he's got so we have to collect a Straine survey. I need to know how many patients have walked in the practice in the last 2 years. You know, there's only 3 sources of production for a dentist; new patients, continuing care patients and patients in the practice who are not in continuing care. Those are hard to find so that's what I mentioned earlier when I said it's important that a dentist to have a minimum of 2 full-time hygienist containing 1,200 to 1,500 patients of record. Howard, this is an interesting statistic. The first thing I would look at is what is that doctor's annual revenue per patient in continuing care? I don't know if you have ever looked at this number, but I have. When you look at 2015 let's say you did 700,000 and you've got 1 hygienist, she probably got 700 patients in continuing care. If you look at the annual revenue per patient in continuing care it's about a $1,000. That's not high today. When you look at exams, cleanings, fluoride, radiographs, a few of this, a little bit of that, that's nothing advanced. If you're lower than that, that's what we call a clue. There's something going on clinically that needs to be addressed as well. Maybe, the production by ADO code report would say there's no perio being done, there's no scaling, root planing There's no peri-
Howard : You're talking about a $1,000 a year just for what the hygienist is billing per patient per year or for the whole office?
Kerry: For the entire office's practice, the practice's revenue, 700 grand. Divided by the number of patients she saw in the last 12 months in continuing care, so at there you've got to take the number of adult prophys Divided by 2 assuming everybody came twice. Same thing with child prophys and your periomaintainence this time's 4. Determine your body count. I would want for the appointment, a production by ADA code report for the last 12 months and I would want a Straine survey which is going to tell me how many patients they've seen, how many have an appointment, how many operatories they've got, how many hygiene appointments a week, what did we produce, what did we collect last year, what was December production and what was my accounts receivable balance?
I'm looking at many different factors when I have a meeting with a client and I'm looking at what they've accomplished. What they've accomplished is based on what they know. What I often find Howard, is that the average annual revenue per patient in continuing care is around $900 to $1,100 a year. My first strategy is why don't we double the number of patients in continuing care? For god sakes, you've got a fourth operatory, you're paying rent on it, you invested in it for god sakes, why don't we start reappointing patients. As we look forward 3, 4 weeks in advance and we realize we're filling up the schedule yet we're getting 20, 25 new patients a month, and if we're not that's a clue, and we're reactivating and reappointing the patients the doctor's seeing that aren't in continuing care we start to grow that number. If we can grow that number to a 1,000 patients over the course of 2016, Howard we're going to go to a million bucks. We get it to 1,200 we're going to go to a million 2.
I know that sounds simplistic folks, but I've been doing this for over 25 years and that's how I started. Once I get full and my doctor can't keep up with either the exams or the dentistry, then we've got to look at financial options, in-network options, expansion options, technology options, but too often what's associated with a $700,000 a year practice in production is a $600,000 collection level, especially in Ohio. I have staff that live in Ohio. We see that the in-network participation at that level of production is high, we're reacting instead of being proacting. We look proactive with our plan and what's not happening at the 208 rate Howard, is overhead. Overhead is happening at the 2016 rate, so the net cash flow or what you might want to call profitability for the sole practitioner is diminishing. As this guy gets to be over the age of 50 and he doesn't have a lot of money saved up for retirement, he's going to end up hating to go to work and if he doesn't put a line in the sand and call today amnesty day and make a decision to move towards a new vision, based on a new set of values, with a new set of strategies driven by the passion within his mission, we're never going to get anywhere different than where we are today.
Howard : Kerry, I'm a detail guy I think. Most of my viewers, probably 90% of them, commute to work. That's why we did an hour because the average guy has an hour commute to work and the ones that only have half hour they just listen to half and back. They're driving in the car, they can remember in their minds Straine.com, S-T-R-A-I-N-E, but when you're talking about this survey I know what my homies are thinking, "Do I run those reports and FedEx them to you or do you dial in to my computer and I give you some password if I got Dentrix, Eaglesoft, Softden, Practice Works, Open Dental? How do I get these numbers to you and should I get these numbers to you before I talk to you so you can see what you're looking at?"
Kerry: Yeah. Step 1 Howard would be to contact me and I will either or one of my team members will send them an email where we'll have a Straine survey and what we call a business discovery questionnaire. We want to find out what they've got, what they want, what they like, what they're concerned about, and if they'd like to increase their profitability. We get that back plus we'll get a copy of their production by ADA code report. If they do not know how to run these numbers, my staff will dial in and they will access the software as they do with every client that we serve and we have 400 active clients at any given time. My team knows how to pull all this data out in the period of a couple of minutes, so the appointment in my schedule is populated with data and I prepare the night before and I'm ready for the call so we can end up at that hour with an action plan. We can have an agreed upon set of goals, we can discuss strategies that they're willing to implement, and every one of my clients is different. There's no cookie cutter approach to consulting. Is there a cookie cutter approach to treatment planning? No. Is there a cookie cutter approach to taking radiographs? Yes. You certainly collect records in a standard way, but every treatment plan's different. The same in consulting it should be.
We have to look at the economic component, the facility component, the team, the leadership and the patient base component. Once I have that information, I can sit down with that doctor and give them recommendations as if they were my daughter, as if they were one of my sons and I want them to be successful without the risk of having to be baited to become a consulting client.
Howard : Kerry, what I've always loved about you is you're so data driven. I mean, you believe in gravity. I've listened to your 3 hour lectures so many times the last 30 years, I mean, you can rattle off numbers. A lot of questions I get is these young kids, "I'm going to set up my own practice. I just work with Heartland. They're on Dentrix. I'm setting up my own office, management information said there's Dentrix, Eaglesoft, Softden, Practice Works, Open Dental. Are you agnostic to any of those or any of them better than the others? Do you think anybody can get better data from one of those than the others?"
Kerry: Well, I mean w-
Howard : And just disclosure, I've been on Softden for 28 years but I'm actually thinking about switching to Open Dental. I haven't pulled the trigger. Are they all the same I mean?
Kerry: Well, they're not all the same. I mean, the size is different and I've had a relationship in the 90s with Patterson Dental. They're a phenomenal company. I have had a relationship with Henry Schein since 2001 as an educator in their continuing education program called Core Development. I lecture for them. You spoke about Tulsa, interestingly enough I'm lecturing on January 22nd I think in Tulsa. Whoever was out there in Tulsa you were thinking about, and I'm sure it was somebody, I'll be there. You know, you look at whose got the best track record and whose all the resources necessary to commit and you can't argue with Dentrix. I love the reports. I love the ability to get the data. I love the commitment that they've made to technology. The other ones are certainly quality as well. I don't spend my time researching them, but I must say I do have a relationship with Henry Schein and they're a great company. I think you need to check them all out and find out what's best for you.
Howard : Okay. Kerry, a lot of dentists it seems like the first thing they think when they're not growing, "The magic bullet is I just got to get more new patients." You said ... I'm sorry. What were the 3 things you said? New patients was one of them.
Kerry: The sources of production for the doctor are new patients, continuing care and unscheduled existing patients of a practice.
Howard : Yeah. Okay. Let's go through them. New patients, number 2 was continuing care ...
Howard : Number 3 was ...
Kerry: Patients of record who are not in continuing care.
Howard : Okay. Let's go through those one by one. A lot of dentists, you can just tell the way they're talking on dentaltown that they think, "You know what my problem is Kerry? I need marketing. I just need more new patients." How often is not enough new patients the issue and are there any silver bullets? I mean, if someone told you, "I just need a lot more new patients." Is that going to be internal marketing, external marketing? Is that external marketing going to be flyers? Is it going to be Facebook? Talk about that. Talk about new patients.
Kerry: Yes, yes, yes and yes. Having conducted over 22,000 consultations, having worked with over 6,000 practices and actively having 400 in our cue and more in the pipeline the number of times I've had to tell the doctors, Howard, to go out and hire a marketing company to get new patients because you need that lifeline filled or you need to acquire a practice, it's fewer than 15 times. Not 15%, 15 times. If you don't have enough patients of record to begin with, then of course you're going to have to look at developing a marketing strategy. I'll never forget a young man I met probably 12 years ago in the Philadelphia area, graduated from Temple and hired us and he wanted to grow. I asked him how big he wanted to become and he says, "I want to hit 5 million dollars in production." He asked me, "How long will it take me to get there?" I said, "Probably 5 years." He goes, "Well, we made it in 3." I just saw him the other day. He was committed to new patient flow. In the case if you don't have enough existing patients, you can only get so much blood out of a turnip. You're only going to get so many patients to refer their family and a friends and if you don't have a large enough patient base to begin with you're going to either have to commit to an external marketing strategy.
Just think about all the points of distinction that you want to communicate to the community. If you look at you being the greatest dentist since sliced bread or you're going to offer a free new patient exam with radiographs, I mean, there are many companies, many practices that do that today. You just need to be clear that in order to get to the number of targeting patients you want to have in continuing care, 1,200, 1,500, 2,000 you're probably going to have to see 3 times that in new patient exams because not everybody's going to want to make a commitment to a going steady relationship with you just because they came in the the door the first time. It's not like it was when you started years and years ago and you didn't have to focus on this.
You need to figure out as a new dentisty, what is my BAM? What's my bare ass minimum amount of cash flow that I need to have and do anything and everything legal, ethical and moral to achieve it on a monthly basis. Otherwise, you're going in the hole and you're already in the hole to begin with so the new patient flow may be needed. The internal marketing strategies are every point of contact. It's a key phrase we use at Straine. Every point of contact with a patient is an opportunity to delight them or disappoint them. You remember that Jerry Maguire movie where Renee Zellweger said, "Jerry, you had me at hello." Do you have your patients at hello? When they come in the door do you greet them? Do you thank them for walking in the door? Does somebody walking down the hallway see an assistant who turns the other way? That's a negative point of influence when they could have stopped and said, "Hi Howard. Welcome to the practice. How are you?"
When's the last time your hygienist saw a patient who wasn't in continuing care very frequently and said, "I want to talk to you about making your next hygiene appointment." The patient starts to balk and the hygienist has got to own that relationship and at that moment she's got to look at you and say, "Howard, I just got to tell you something. I love being your hygienist. Do you love being my patient?" Howard, to be honest with you, that's the message that turned me around. I never use to commit to continuing care. I'm Kerry Straine for god sakes. I fly the second highest number of miles in dentistry, only to you, every year. When that hygienist whose name is Kitty in Davis, California looked at me and said, "Kerry, I want to reschedule you.", and I balked and she said, she moved the monitor away, she just looked at me. It wasn't about technology, it was about love. She said, "I love being your hygienist. Do you love being my patient?" She goes, "I want to take care of you." If you want to have better relationships with anybody, but more specifically in your practice, there's 2 things you got to put in it, the relationship, to have it; energy and empathy.
We talk about a culture of yes at Straine. Yes is an acronym for you. E is ethos. Your love, your culture these are things owners have got to spend years developing and sharing with their team. If you're not having huddles you're not sharing anything. If you're not having staff meetings what are you sharing? If you're not having training sessions, I mean, my god read the book "Outliers". Malcolm will make it very clear. Last is systems, I mean heavens, from a marketing system to an onboarding of patients system to an onboarding of employees system, to a leadership system, to a team talent development system, to operating policies, to the management system of planning, doing and reviewing, to financial systems, to your comp plan. All of these come together when a committed leader commits to engagement with everybody on the team. You know, you as a parent and I as a parent, we love our children unconditionally, correct?
Howard : Yes.
Kerry: You take a bullet for them?
Howard : Yup.
Kerry: As an employer you have all of the responsibilities. You have no rights anymore, just like being a parent. When an owner commits to this, internal marketing can begin. Patients feel the love, they feel the message. It's not just insurance assignment or being in-network with the lowest paying price, it's that we make eye contact, we care about them, we go to where they are and we let them know why we're taking care of them. Internal marketing strategies, I'm going to give you a couple right now that your listeners can take home with them. You ready?
Howard : Absolutely.
Kerry: When a new patient calls in and you're working so hard to get that new patient call, right? There's so many marketing companies out there that help you inreasee that traffic. At the end of that call when you tell the patient, "Howard, we're looking forward to seeing you next Wednesday at 3 o'clock.", right?
Howard : Right.
Kerry: Why don't we also finish the statement by saying, "And by the way Howard, is there anyone else in your household who'd like to schedule an appointment with Dr. Farran at this time as well?" Sweep. Right? Just sweep it. When you have your morning huddle and you look at the routing slip no matter if it's on Dentrix or Eaglesoft or Softden or Open Dental and you you look at that routing slip and at the bottom it says here's are all these family members and they're unscheduled. Why aren't we leading our teams to make sure that, not only is this patient, but the family members leaving with their next appointment. If you got somebody whose emergency contact person ... You know, you probably have a form that has the emergency contact identified, right Howard?
Howard : Right.
Kerry: For me, it'd be my wife Olivia. Her last name's McCloud. We've been married for 23 years. Olivia is amazing. She runs our company, truly, but if she was my emergency contact and I'm going to go in and see your practice today and it says, "Kerry Straine's coming in. I don't know if he's single or married, it should have been documented, but his emergency contact's Olivia McCloud." Before the huddle, your team ought to be doing a search looking up Olivia Straine, Olivia McCloud and if she's not a patient of the practice my friend we have an opportunity. Somebody's going to take that health history information and say, "Kerry has your health changed?" I said, "No, I'm going to be 60 next month." I can't believe that Howard. Then, they g-
Howard : You look good buddy. You look good. Not as pretty as Olivia, but you look good.
Kerry: I'm telling you, I feel good. I'm happy.
Howard : Tell Olivia I said hello, by the way. She's adorable.
Kerry: I will. You come over to Carmel, Pebble Beach spend time with us anytime or I'll see you in an airport. That being said, when somebody's talking to me and they say, "We just want to confirm if there've been any changes in your health." I mean, offices are saying that all day long. Then, they should confirm "By the way, is Olivia still your emergency contact in case of an emergency?" "Well, yeah." "And is her phone number still 1234567?" "Yes, it is." Then your team's got to be trained. This is information ... These strategies got to be housed in your policies. This is what we talk about at Farran university. This is where your department leaders train the people within it and are coaches throughout the day so you and your administrator, your manager, can administrate learning and implementing and succeeding. Sombebody's going to say, "Kerry, I don't know if you know this, but I don't think I've ever had the privilege of meeting Olivia. I was just kind of curios how's she connected to you?" I said, "Well, she's my wife." "Really?" Then, you can go on from there and invite her to become a patient of the practice. There's technique that we need to define in the policy and customize the strategy but Howard those two ways, phone call sweeping, reappointing all existing family members including the emergency contact and making sure ... I'm a nut about this. Any one of my clients who's l-
Howard : Phone call sweeping, what was the second?
Kerry: Number 1 was the sweeping of the phone call. Number 2 was to make sure in the morning huddle that unscheduled family members that are patients of the practice are given an invitation to reschedule for the continuing care. Let's get them back in the cycle man. Number 3 would be going after emergency contacts, whether they're a friend, family or whatever and letting them know that "We love you so much we want to make sure that everybody that's connected to you or in your family is taken care of as well."
Howard : Okay. Well, do you care if I interrupt you with a question because my job in these podcasts is to try to guesstimate what thousands of dentists are thinking by themselves. I'm the guesstimator and here's how they think. They think, "Well, Kerry, my labor's too high. I can't hire people to do all this stuff because I hear my labor should be 20% or 22%. My labor's already 25% and you're telling ... This is going to raise my labor bill." What should labor be and talk a- ... That's how they're thinking. You know they're thinking that. You've talked to more than I have.
Kerry: Well, let's break your question down into 2 parts. What do we say about the labor and then what would their labor be? Remind me to come back to that last question. Number 1 when you look at ope-
Howard : Because labor is their highest cost.
Kerry: Well, no doubt about it.
Howard : No doubt about it.
Kerry: It's the least 10 to 2 investment. Imagine you have a new landscaping after the snowstorms of the winter and you put $40,000 in your yard and don't hire a landscaper to take care of it. What's going to happen to the yard? Weeds, right?
Howard : Right.
Kerry: It's going to die out. Same thing happens with team members. They're only reflection of the energy given to them by the owner.
Howard : That's a profound quote. I'm going to quote you on that. Write me up a meme for Kerry's picture, labor is ... What'd you say? Labor is your number 1 cost and least invested in in dentistry.
Kerry: Correct. What your team's doing is a direct reflection of the energy of the owner. The energy and engagement of the owner ... If I have an owner who shows up late for work, ducks out for lunch, leaves early at the end of the day, doesn't spend any time and thinks somebody else is going to tend to their family, it's a very unique practice that can accomplish that. If I see one out there, I'd like to talk with that owner and I'd like to look at the facts. You can have your own opinion, but you can't have your own facts. You've heard that one before.
Labor as a percentage, what should your percentage be? The first thing we have to do is assess what's your production going to be for the year Howard? The first thing I have to do is look at last year, 2015, and I have to assess what was your average hourly or daily production for any given month? I always use the denomination of a month, not a week it's too narrow of a period. I'm going to set my production goals. I'm going to set my collection percentage and I'm going to know how many days you're going to work and how many days my hygienists are going to work. From there, I can forecast out what 2016's going to be if achieve our production goal. You've heard of the acronym smart. Our goals need to be specific, measurable, attainable, realistic and timely. I just can't arbitrarily set a number as a goal-
Howard : Smart is S is specific, M is what?
Kerry: Measurable, attainable, realistic and timely.
Howard : By the way dude, I've listened to your 3 hour lectures so many times and you've never graced ... I got 205,000 dentists on dentaltown. I put up 350 courses. They've been viewed over half a million times. When are you going to give me a digital copy to put that on dentaltown so they can be listening? You mostly lecture in the U.S. and Canada and 20% of my audience is in Asia, Africa and Latin America. I want to digitize you.
Kerry: Well, let's make that a plan by the end of January.
Howard : Okay, I'm Howard at dentaltown.com. We have another Howard that runs our CEC, Howard Golstein, so he's Hogo at dentaltown. Man, I can remember listening to you in 87 and just loving it. I think I listened to you in 87, 91, 93. I mean, you're a great guy. You need to digitize this.
Kerry: The last time was down in San Diego.
Howard : Is that right?
Kerry: Yeah. We were at some retreat together, a big outing on the marina a couple of years ago and you stayed at the back of the room. You were incredible. Back to this labor percentage, once I know what your production's going to be then that becomes my denominator. If I look back over 2015 and with this existing staff I have some months where you've average $6,000 a day versus other months where it's $2,000 a day. Imagine what could happen if every month you averaged what was your peak performance, 6 grand a day, and if we put in place that as a vision and strategies to make sure we fill the body count in the schedule we're going to end up with a result that gets us closer to that vision than ever before. Before I commit to a set of goals and strategies for 2016, I need to know what your production goals are going to be and that's got to be accurately accessed, not just guessing pin the tail on the donkey. That doesn't cut it.
There's a science to this and I know how to do it. What is your collection rate? Then, I can apply your overhead. I look at all your operating expenses and I get to profit before debt service and doctor comp, then I can understand whether or not you got a model that you can economically commit to. Too many dental practice owners are committing to the future without knowing what that model's going to provide for them. As I talk to a dentist there's 2 things I want to know for 2016 Howard, how many hours do you want to work and how much money do you want to make? I'm not saying gross production, I mean what does your net profit need to be? What do you need to live on? How much do you need to put the kids through college? How much do you need to fund for retirement? What about life insurance, disability, long-term care? What do your working capital reserves have to be and how much you going to pay in taxes? If we don't have that determined before we commit to a plan, we're going in the wrong direction. Wouldn't you agree?
Howard : Yeah. Kerry, I want to ask you another question. I mean, obviously, you got a bachelor of science in accounting and you're a numbers man, totally a numbers man, but I always coined you as a guy who understood the workings of the human mind. I mean, you understand how a monkey thinks. Dentists, physicians and lawyers always attract 400 pound gorillas. 400 pound gorillas are control freaks and don't like to delegate, so my question to you is in your 30 years of doing this does the dentist doing all this himself, does he or she seem to be better or do you like one who delegates to an office manager? I see the AADOM, the American Academy of Dental Offices Mangers, in your 30 years experience does people who delegate and really build up a strong office manager to do everything, is it better if I'm listening in the car and I say "Hell, I'm just going to have my office manager call Kerry and I'm going to let you guys do this because what I want to do is I want to get a microscope and find every MB2 in a molar. I don't understand this shit. I'm not interested in it. I just want to delegate it." Or, is that a cop out and this dentist needs to own it?
Kerry: Well, first of all the American Academy of Dental Office Managers is a great organization and they are committed to educating people so they can become contributors to the vision, the mission, the strategy and the culture of a practice. That being said, an owner can not abdicate what they don't know by definition. It's up to the business owner, whether it's the president of the company, chairman of the board of directors, the present CEO, to understand what is our vision, what is our mission, what are our strategies for this year. That owner's got to sign off on it whether they're hiring an office manager to do the job or it's a smaller practice where they just have 3 department leaders, or we call them department facilitators. In my seminars ... I recently spoke in Sacramento and Dallas and San Antonio, just all over the place, all over the east coast. When I talk to office managers I ask them, "What is it you're managing?" You've heard about a business should be systems driven versus of people driven. How many times you heard that Howard?
Howard : Yup.
Kerry: In dentistry, without a vision with strategies that are documented in operating policies, and these are tangible items, without a management system to make people fit knowledgeable for the position, leading them and then coaching them with performance management strategies we're never going to achieve these numbers we calculate. Numbers are just numbers. What is our dream? If it's not something that the owner spent time defining, they can't expect that office manager to make sure it's executed. At one of my most recent seminars I gave a couple of months ago in northern California, there was probably 150 office managers in the room. I asked everybody who was an office manager stand up, they all stood up. I said, "How many of you have an end of month planning meeting with your doctor to make sure that you know what's coming up in the future and that the performance we've achieved over the last month and year to date is on track?" 80% of them sat down. 20% said yes.
I said, "Everybody stand up again. How many of you have written operating policies which are the curriculum of what we want people to do, about the what's in support of the why, the mission, to accomplish the vision?" I said, "How many of you written operating policies? Stand up if you have written operating policies that are being updated to reflect changes in technology, strategy, the dental practice act, new goals." Again Howard, out of whatever the audience was, maybe 15 people stood up. Then I said to myself and I said to them, "My god, what are you managing? All you're doing all day is putting out fires." God bless them. They're the fireman. They're just putting out fires all day long and they're doing the best they can so that owner cannot blame them for putting forth 100% effort, as they're doing, if the owner hasn't given them the direction and the clarity, the coaching and the positive reinforcement or redirection when they look at the results to say, "My god, are we not accomplishing this because people aren't doing it or was it a bad strategy?"
You know, I have 26 employees and when it comes to goals of my organization my employees are not responsible for the attainment of my goals. You want to know why?
Howard : Why?
Kerry: They didn't choose the strategy. What they're responsible for is implementing strategy, performing the tasks, the behaviors associated with all of my policies. What am I responsible for? Training them. They're amazing people. I am so blessed to have such a great team at Straine Consulting. I have my consultants, they're supported by their coaches. Then, we have our onboarding team, our admitting team, we have our accounting department and then we have our director of operations. I have a director of training. Everybody puts forth phenomenal effort. They're resilient. They're optimistic. They're willing to do what I guide them to do. That's what I can hold them accountable to doing. Whether that gets us to the goal, who knows. That's subject to my design, correct?
Howard : Mm-hmm (affirmative)
Kerry: They show up and they're ready to play every day. I have an amazing team and I hope the listeners get that concept that employee who's measured by the attainment of goal versus the performance of the policies may do whatever's necessary to obtain the goal even though it may be out of alignment with the owner's philosophy. Tha-
Howard : I just want to say one thing for my word. I've known this dude since 1987. He's just a good guy. I mean, you're just an adorable teddy bear. I mean, you're adorable. I saw so many dentists with ... There's a thread about new years resolutions Kerry so I want you to address this. Tell me if I'm seeing this wrong but when you talked about silver bullets a lot them think, "I'm going to solve all my problems by blitzkrieg marketing and I'm just going to get a gazillion new patients. That's going to solve all my problems." The second silver bullet I want you to address and that is, "My new year's resolution in 2016, I know I'm going to break out if I buy a big, shiny toy like a CAD cam, a laser, a CBCT or I'm going to go to the Scottsdale Center and learn how to restore the worn dentition or go to the Pankey Institute. I'm going to learn how to place implants. I'm going to fix my problems by starting to do something new."
It's my impression that if I got back over my 28 years and I look at all the dentists who are collecting a million and take home 350, all they do is restorative dentistry. They place implants. They even do molar endo. They don't do ortho. They don't do anything. They just check hygiene and do fillings and crowns and they're millionaires, but it seems like the impression on dentaltown and in the media is that, "Oh, no. The successful ones are milling their own crowns, they're doing sinus lifts, they're placing implants, they're retreating failed root canals. They are just amazing clinicians." Again, my question to you specifically. "I've been flat for a decade. I'm going to solve all my problems by buying a shiny new firetruck and learn how to put out a different kind of fire." True or false?
Kerry: Maybe, but it's really not going to happen. I've seen, going back into the 80s when the [Interoff 00:47:09] camera first came out, what were they $35,000?
Howard : They were $30,000 as [crosstalk 00:47:13]
Kerry: God almighty. I can't tell you how many of them just ...
Howard : What was that thing called? I was from Patterson.
Kerry: Reveal Welch Allyn.
Howard : No, that was the second lower cost version. The first one [crosstalk 00:47:22]
Kerry: [crosstalk 00:47:23] ... spent a $150,000 to equip 6 operatories in Newport City, California.
Howard : Yeah.
Kerry: Unbelievable, but these tools great innovations that's what they are. They're great innovations, CAD cam technology. I can't tell you how many people I meet, probably 90% of them that buy the intraoral cameras, the lasers, the CAD cam technology, put computers in every room. You know, that's higher th-
Howard : That's me I have ever-
Kerry: [crosstalk 00:47:47] ... marketing company and they never use it.
Howard : Oh. Oh, okay.
Kerry: I mean, Howard, I belong to 4 gyms. At some point in time, you got to go. I'm going to run this afternoon. I've got a half-marathon I'm going to run in November Howard. I want you to come to Big Sur and do it with me.
Howard : Where was it at?
Kerry: Big Sur, California, Monterey November 13th.
Howard : Oh my god, Monterey. That's got to be the prettiest spot in america.
Kerry: You know my daughter-in-law and daughter came out this November to run the half-marathon and my wife, having never run one, registers. She ran it right with them on Sunday. I didn't necessarily want to join in, but as I've said before all these new innovations, I belong to 4 gyms at some point in time if you want to get healthy you got to go. That being said, why is it that your laser sitting in the corner, your interoral camera over the corner, why is your software whether it's Dentrix, Eaglesoft, doesn't matter, why is it that your only using it for scheduling and billing and collection instead of a management tool? It's because you haven't incorporated the use of this tool, because that's what they are, into your policies to describe to your team member for their position how they're to use it and so that they're trained on it number 1. Now, they're fit because you've trained them on it. Number 2 you're not leading them in the morning huddle to be aware of how to apply it [inaudible 00:49:06] Number 3 you haven't given them immediate positive reinforcement.
I mean, there's 3 ways to get people to do more of what you want. Number 1 is money. Everybody's throwing money at people, reward, but the problem with money is that's really not a motivator. It's not something that is going to create satisfaction. It's part of the hygiene of the relationship between you and your employees. You got to have a certain pay package, you got to have coffee in the Keurig machine, you got to have the room stocked with supplies and you got to cover vacation, sick pay and the governments going to make us cover health care soon, right? It's like jacks or better to get in the game, money is part of it, but what's going to inspire them is not the reward it's the positive reinforcement and Howard there's 3 ways to give positive reinforcement and they all begin with A; attention, approval and appreciation. You've got that hygienist whose never used an intraoral camera, you tell them in the hudd-
Howard : Attention, approval and what?
Kerry: Attention, approval and appreciation.
Howard : Appreciation.
Kerry: Yeah, the third way to get people to vi-
Howard : Unless, it's a woman and then you got to add shoes for number 4.
Kerry: Well, we don't want to go there. That being said, in the morning huddle when you tell your hygienist, "Listen, when I walk in I want a photograph of the post probing bleeding, or if they don't bleed, I want that information up on the monitor. I want to see bloody gums or I want to see healthy gums. Either one. I'm going to talk to the patient about our continuing care program. Number 2 there's a crown on number 3 that we've talked about, take a pa of it, get a photograph of it and number 3 anything else that want to talk about you put up on the monitor." That's how you set the stage. The huddle is an antecedent. It's setting the stage for the behavior to occur.
Howard : What percent of the dental offices do you think have a morning huddle, because I want this guy driving to work I wan-
Howard : Yeah. What would you say, you're talking to 1,000s of dentists and 80% of them don't have a morning huddle. What would you tell them?
Kerry: Don't have an expectation of your team to do anything different. Manage your expectations, don't get angry, be grateful that they're at least showing up. For god sakes, you can't expect them to be fired up and excited unless you've cast a vision of what we're going to be fired up and excited about.
Howard : What percent of the NFL teams have a morning huddle?
Kerry: Well, probably a high percentage. I mean, think about it. If we're not helping the team members understand what our promise is all about, how are we going to get them to be ignited with passion about caring for people? Howard, when I ask people what they do for a living most of them will either say, "Well, I'm an administrator.", "I'm a hygienist.", or "I'm an assistant." This gets into talking about engagement and back in 2010 Gallup did a whole study on engagement in the workforce. Guess what percentage of american employees were engaged with the employers vision and mission; 13.
Howard : 13%?
Kerry: You have people waiting to be led. Waiting to be inspired. Waiting to make their job a career instead of a paycheck. When a NASA janitor was asked what he did for a living, you know what his response was?
Howard : What?
Kerry: "I help put people on the moon." Now, that's an engaged team member. When I'm talking to team members of dentists, I know the leader is leading when I ask them what they do they say, "We help people have healthier and happier lives." That's when you're getting to the heart of it. That's when people are passionate because you represent what we should be passionate about owner and without it, well, you got 1 or 2 choices. Either learn about it and start to implement it and watch what emerges around you as something similar or do nothing different. Then, what's going to happen is your overhead percentage for labor will rise because the revenue will never rise but the cost to hiring people is going to rise.
Back to that percentage again, there's no standard percentage. I've heard consultants tell me wages should be 20%, wages should be this, it all depends on what your revenue's going to be. I can take 2 equally staffed practices ... For example, I have a client with CAD cam technology. We didn't hire an associate until he couldn't keep up with the exams. We got him to 4 hygienists. You can get to managing 3 to 4 hygienists a day if you move out of a prophy palace, Howard, where everybody's a prophy.
Then, you've got a certain percentage of your patients in periomantainence and you minimize the number of periodic exams every day, number 1, and number 2 if your periodic exams are taking more than 5,6,7 minutes then you didn't instruct your hygienist on what data to gather to have up on the monitor so when you walk in you can look at the monitor and say, "Wow, she got all that data for me." You can look at the hygienist and say, "Hygienist, my god, it looks like you two have had quite a conversation." You say, "Hello, Freddy.", to the patient. Say, "Hygienist, tell me what is it you two have been talking about?", and let her talk. Let her show it and when she gets done with it, you look at the patient and say, "Gosh, isn't she incredible? I don't know if you know this, but I am so fortunate to have the greatest team on earth and with the work she's doing it just enables me to ask you one question patient. What do you think about that?" The guy says, "I'm in." Case is [inaudible 00:54:32].
My clients that are highly producing where their average daily production is north of $15,000 a day, are not doing major full mouth restorations Howard. They're doing a lot of single unit dentistry. Now, with the patient flow, with the committed team, with using assistance to the extent we can legally in that state, wheter they're assistants that can place fillings or they're just making and seating temporaries or permanent crowns. Whatever the laws are you have to adhere to them, but I can now manage the flow with an owner who's grown a team. I mean, honestly if you live in a state where a hygienist can give anesthesia, Howard you can cut 2 crowns a day for having 1 hygienist give all your anesthesia. There's a lot of ways to, as my granddad said, a lot of ways to skin that cat. We just got to figure out where you want to go, what you believe in, what you're comfortable with and, thankfully Howard, I've never met an industry where I've seen it so rich with existing patients of record who get so many things for free that we allow go neglected annually because we have unclaimed benefits because the patients didn't get the message of how that practice wanted to take care of them.
Howard : Yeah. I want to ask you another specific question. In your 30 years experience, do you see ... Okay, so you're talking about silver bullets, new patients, then continuing care, then who's not on continuing care, getting on continuing care but as far as general dentistry, true or false, yes or no. In your 3 decades at this, do you think dentists who have a treatment plan presenter presenting the treatment do more clinical dentistry per patient as opposed to the dentist presenting the treatment plan to the patient himself?
Kerry: Yeah, I do. Once the doctor's developed the treatment plan and outlined it to the patient clinically, and they've done a very thorough job explaining all the problems that exist and what the solutions are, the next team member should be the one to make the financial arrangements and get the appointment scheduled. The doctor who tri-
Howard : Is that lady just presenting the finance? The treatment planning coordinator, is she presenting the finance or is she actually also explaining the clinical dentistry?
Kerry: I think she certainly needs to be equipped to answer any questions that come up after the doctor's explained the treatment plan. Certainly, I don't expect her to explain the science behind it like the doctor would. Again, think about it, even my clients that are lecturers from cosmetic dental lecturers will tell you the majority of their production is single tooth dentistry. The number of patients that are doing full mouth constructions just isn't there like it was before 2008. People don't have the equity's in their home to have the lines of credit. They can't borrow on this or that, they're finally turning older. I'm, you know, they're getting in their late 50s they're realizing, "My god, I've got to start putting some money away for retirement." There's a lot of single tooth dentistry, but whether it's an implant, whether it's crown and bridge, whether it's fillings, whatever it is that person should be able to present it. Again, let's get back to it. What is a patient of record? A patient of record is someone who's got a comprehensive exam, right Howard?
Howard : Right.
Kerry: Comprehensive exam and been presented with a comprehensive treatment plan. Let's back up. What's a comprehensive exam include? Full set of films, right?
Howard : Right.
Kerry: Charting of all missing teeth, all existing restorations and a full or partial periocharting Howard?
Howard : Full.
Kerry: Okay, well why isn't that done? I've looked at a lot of charts and I think the listeners of this need to ask themselves are we blocking and tackling with that? That's number 1 because once you gather the information, now you can give that informed opinion soft tissue to hard tissue, function, occlusion, the whole thing.
Howard : Kerry. Kerry, come on dude. These homies 90% of them are doing first appointment prophys. They come in, the hygienist snaps bite wings and they go in there and start doing the cleaning.
Kerry: You're reaping what you sow because until you change the way you approach your relationship with your patient and the way you want to take care of them, you're going to continue to get what you get. A new patient goes through the comprehensive exam, but a patient of record is someone who's had a comprehensive exam and been presented with a comprehensive treatment plan. That doesn't mean they're going to say yes or no to all of it at this time and, quite frankly, I don't think most of them can say yes to much of it at all if you look at the statistics of the average american household's ability to add money to their credit card balance. They're stuck, but at least you've onboarded them accurately and you at least let them know that they can make the determination at the pace they want to move forward. It's up to them, but you're going to have a higher probability of getting that treatment plan completed if you get them into the continuing care program. Not only is it good for you, but it should be much healthier for them in the long run and that's going to meant something to your patients.
Howard : Specifically, new patients first visit, cleanings yes or no?
Kerry: Not until there's been an exam done.
Howard : A new patient comprehensive exam.
Kerry: What kind of cleaning would you do?
Howard : I know. I know.
Kerry: I mean, it would be like back when I had my accounting firm it'd be like you giving me your general ledger and me preparing a tax return without reconciling the bank accounts and all the balance sheet accounts. I mean really, what is your income statement but a change in the balance sheet from the beginning to the end of the period? If you have no assets, liabilities and equity at the beginning of the period and at the end of the year you got 200 grand in cash and you didn't put up any money, you must have had a profit of 200 grand. I mean, there's science to this and there's science to that relationship and if you start promoting cleanings first without a comprehensive exam, it's no wonder your patients think that there wasn't really a big commitment to get entered and you really are confusing them. You're confusing them.
I would take a step back and ask how's it working for you know? Look at how many patients you've seen in the practice the last 2 years? What's your hit rate? How many did you get to make it into continuing care? Here's another great stat, Howard. Let's say during the course of the year you saw 500 patients, right? That'd be 2,000 quads, right? 4 quads a patient. Go look at how many SRPs you did last year. Oh, we had 2,000 quads and we did 80. Oh my god, there's something missed in the new patient exam. It's not missed in the periodic oral evaluation, it's missed at the get go and until you get clear clinically I can't help you administratively.
Howard : This is dentistry uncensored so I'm going to get crass and crude, how much is Straine consulting? My homies listening, I mean, if they commit to you how much is it? Is it a year contract? Is it a monthly fee? What's the nut on this?
Kerry: Our relationship is a month-to-month relationship with all of our practices with a 30 day cancellation probation. All of our clients go through the first phase called initial services where we discover what they want, discover what they've got. Besides looking at the number, we want to find out the opinions of the team members as well. What are their goals? What are they looking for from this career experience? We want to know what the owner's personal budget requirements are. We have a very comprehensive analysis of the patient base, the facility, the economics, the management systems, the policies and team development. Then, a consultant comes on site for 2 1/2 days.
Consultant flies in day 1, they're going to have dinner with you doctor friend. They're going to get to know you. They've got to get to know you. They've got to review the comprehensive practice analysis which is a huge 3 ring binder of stuff. It's information about you. Next day is a full day in the office. They're going to observe all morning, see how you start the day, see how you lead your team, see how they respond to you. These team members are a bit nervous Howard. All of a sudden you're bringing in a consultant.
It'd be like me going home tonight and seeing Olivia and she looks at me at the front door and she goes, "Honey, guess what I signed us up for tonight." I go, "What?" She goes, "Marriage counseling." What's the connotation? What an owner has to say to the team is, "You know, I've hired this group because I want to go to the next level and I don't know how to get there and I want your support to help me get there." On that first full day we're observing the morning, then that afternoon we're having a team planning session around the vision, the mission, our communication styles and preferences, the practices historical performance. We want the employees to feel at the end of that 4 hour first meeting, we want them to feel safe. Sounds like Abraham Maslow, right? Safety, belonging and mattering. If we don't have them feel safe, that they belong to this team and that they matter in accomplishing the mission and vision, then we're never going to be able to access the executive function of their brain and get them to contribute at their highest level because they're just afraid.
That night we have a goal setting conference with the client. We set all the benchmarks for the next year and we design the management system of how they should lead and coach their team and monitor. We're going to put that into play on the last day with a 4 hour team meeting again. Our initial fee to put that together is $7,950, very affordable. Then, on a month-to-month basis after that we're involved with what we call our continuing services. Our continuing services are the highest level on ongoing customization, consulting, coaching and support. On a daily basis our clients and their teams have unlimited telephone, email and text access to it. Call me. I've already been on the phone for the last 3 or 4 hours before I talked to you with clients all over the country.
We're here to be accessible. We are your chief strategy officer and in many cases, we're your virtual chief operations officer. On a daily basis, that management system we designed we're monitoring the implementation. On a weekly basis, we have training for 30 minutes. With who? Your department leaders, your department facilitators, so they can take it to the team. Checking your end of week performance and what occurred at your staff meeting, end of month review so your department leaders and you can see the future accurately for the next 7 months. We're constantly looking at the horizons, not just historically, that's not a horizon that's sunset. You can't change the past. We're looking at what's coming up today and tomorrow, what's coming up the next 4 weeks, what's coming up the next 7 months to identify when you can capitalize on all the great things you've accomplished so you can take the next take and increase your patient flow, production, collections, profitability and practice value and accomplish the practice of your dreams.
A client works with us on a month-to-month basis until they feel like they're capable of doing it on their own. We do go back on site for a day every 6 months, but with the advent of internet access we can access software all the time. We're working on a data sweeping program we hope to have out by April 1 with our partners there. We can bring 30 years of proven strategy of how to lead a team to grow to their potential and and be in control of their future instead of being a victim of their ignorance. That's what we want to bring to the marketplace. We do that all for $7,950 up front and then month-to-month $1,995. Cancel, but with 30 days notice. It's the most customizable suite of services available in the market. Most comprehensive for management system policy training monitoring and support with the most fair fee and the least amount of contractual invasiveness. I learned a long time ago if you can offer the best services for the most affordable solution with the least amount of contractual invasiveness you're going to stay in the game. We're blessed to have been in the game and we're going to be in the game for another 20 years at the very least.
Howard : We're 6 minutes in overtime, but I would just want you to one overtime question. My observation is that the problem with dental consultants, you're talking about $7,500 down $2,000 bucks a month, is all the people who are reach we always are using consultants. Jerome Smith probably has the greatest odds I've ever seen. He has a full consultant every year. Everybody who's rich always use consultants because when they're looking at $2,000 a month they know in our brain there's no way you won't take home more money. It's an absolute return on investment. Then, the 80% of the dentists who you would be a miracle for they'll never do a consultant and they'll always try to fix themselves. My question is do you believe that everybody that needs consultants the most that never use them and everybody who's rich already is the one who most all your clients are anyway?
Kerry: That's the case in over 98% of th-
Howard : I know. So how do we-
Kerry: Most of our clients that we start with are doing well over a million dollars when we meet them. In some cases, when you're working ... I mean, coming in over the next 2 weeks I have clients with over 40 practices, one with over 20 practices, one with 6 locations. I got one group coming in with 50 million that they want to invest in the dental market and they're trying to figure out how to do it. These are people that really want to own a business that's going to have traction for the next 20, 30 years and dentistry's in the perfect position. Baby boomer, millennials, I mean they've just got their own philosophies. It's not a very expensive value proposition and if you're educating the patients about all that's going on clinically within them and your role in their life. I mean, these people want a solution for health and a quality of life and dentists are the gatekeeper for that. When a dentist understands that they're going to be committed to leading and growing leaders around them to be able to get the endorsement of a qualified patient.
By the way, everybody goes "By god, all of your clients must be out of network." That's not the case. Most of my clients are in-network. They have missed appointments, they're just solving then differently. What we want to do Howard is take this bulk of patients each one of your listeners has, get them into continuing care and if we're producing and collecting at the desired level we just want to identify what's the normal attrition going to be annually because whatever that is we're going to need to that for new patient flow to fill in the schedule. If we want to grow, we'll fill in a strategy around there. I just want to know what do your listeners want? I want to see what they've got and I'm going to give them a 2 or 3 step plan that they can take an implement without the burden of having to think they're going to promoted to be a Straine client. We love to help those that want to put a plan in place that if all they want is to test the waters and find out what do I have and what should I be looking at? I think we're a very credible source due the number of clients we've had a chance to work with.
Howard : That's another reason you should do the online CE program because my beef with the consultants is we're always preaching to the choir. You just said 98% of your clients already do a million dollars a year and I'm out here in Phoenix where every year 1, 2 or 3 dentists actually kill themselves in the metro and every dentist who you would be Moses walking in with the 10 Commandments is going to save money and not use you and then everybody who can buy a shiny new Lexus is using you already. If you ever figure out how to get the ones who need you the most to call you, let me know how you did that.
Kerry: You know, my dad always said to me "Kerry, you know, where there's a will there's a way." You ever heard that Howard?
Howard : Yeah.
Kerry: Then, dad used to say "Well, Kerry, there's a way. The question is, is there a will?" You're either motivated to accomplish more gain or get out of paying and when somebody gets sick and tired of being sick and tired they're going to commit to a strategy. In the short term, if all you want to do is kind of talk about it we're here to help you. Call us 800-568-7200. We're just a phone call away. Look me up on straine.com as Howard said. Go to our Facebook page. Call the dentists whose pictures are on my Facebook page and say, "Is this real?"
Howard : You've already talked to 20,000 so all you got to do is go call the guy across the street and he's probably one of your clients. I just want to tell you seriously, personally, thank you for all you've done for me personally over the years. You were a big inspiration in helping me in the early days. You've even come to my front room, my office. Thank you for all that you've done for dentistry. Dude, you're a legend and I just am humbled that you spent an hour with me this morning.
Kerry: Howard, you're very welcome. It's a true pleasure. You've been a friend and a colleague for many years. As I've said to you before and I'll say it again, you're such a great individual to have pioneered the strategies to educate so many through your articles, through your magazines, through your seminars. I'm grateful to be able to spend the hour with you and I'll look forward to taking on a few more projects with you soon.
Howard : Well, I'm going to hold your feet to that fire. I want this Straine. You know, it's about a 3 hour lecture. You just rant for 3 hours and when you're done it's just brain overload. It's so awesome. I want to digitize because Kerry you're going to never lecture in Kathmandu and I got friends over there that want to hear you.
Kerry: Well, we do get to Canada but most of our work is in the United States. We have clients in about, actively I think about 46 states, anywhere from start-up to practices to large MSOs and we've worked with most all of them to some degree. [inaudible 01:11:38] what we want to do for you.
Howard : All right, buddy. Tell Olivia I said hello
Kerry: Thanks Howard. I will. You have a great day.