Howard: It is just a huge honor for me today to be podcast interviewing Cindy Day Hauk BSHA of Global Team Solutions. Her website is gtsgurus.com. But I love her phone number the most, her phone numbers 844 OH MY GOD. It's 844 OMG for GTS. I think that is the most hilarious phone number on earth. 844 OH MY GOD for GTS. Which stands for global team solutions. Cindy always knew she wanted a profession where she can help people.
As a young receptionist at a dental practice in Branson, Missouri she found her dentist to be willing to mentor and the job just clicked. She quickly learned about the many aspects of working in a practice and her training in clinical and clerical skills provided all the tools she needed to embark on a lifelong career. Along the way Cindy has served as a certified dental assistant an office administrator. In addition to earning a Bachelor of Science degree in health administration.
She loved getting to know her patients and used her quick sense of humor to make their appointments and her work fun and rewarding. Just ask the Branson entertainer who sat down for x-rays one day and asked what the lead from apron was for. Cindy said it was in case he blew up, then proceeds to go around the corner and flinch as she pressed the button. When she said they'd gotten lucky because he was still there, he laughed so hard the plastic x-ray device out of his mouth. Today Cindy is passionate about training and consulting for dental practices.
She's a former field training manager for a practice management software with more than seventeen years of training experience and over thirty years in dentistry. She excels as a large group presenter at workshops and seminars. She's excited to be a part of the GTS team and share her know how and knack for practice security, paperless processes, staff management productivity. One of the things Cindy loves best about working with practices is helping dentists and staff to let go of their fear of change.
Sticking to the norm can hold practices back from discovering true productivity and delivering the stellar patient care practice want to be known for. She is an expert at helping to turn that fear around, and giving practices the ability to work at more efficient and exciting levels. In her downtime Cindy is a swimmer, a singer, and a movie buff. She has two grown sons and lives outside of Springfield, Missouri with her husband Mike and multi-poo Casper.
She can be reached at Cindy at gtsgurus.com, or just call her at 844 OH MY GOD for GTS. So Cindy, I think the issue is dentists are loners. So you look at the these traffic jams, the reason there's so much traffic is because every car only has one person in it.
Howard: So right now everybody listening to the show, it's about eighty-five percent have an hour commute to work. That's why we do an hour show, and fifteen percent are on a treadmill but they're all alone. I've told them for eight hundred episodes that the number one return on investment is a practice management consultant. That's why I called you, you didn't call me. This isn't an infomercial. When I called you, you probably didn't know who the hell even was. Who's this bald guy from Phoenix bothering me?
But the reason I want practice management consultants is because my homies, they think that when their dental office is failing that they need to add like Invisalign, or sleep apnea, or learn how to place dental implants. For me in my thirty years, the number one return on investment a dentist can do is get their damn house in order.
Howard: If a restaurant can't make money on hamburgers, fries and cokes then going off and adding corn dogs is not going to save their restaurant. I mean if you can't make money on hamburgers, fries and cokes your house isn't in order.
Cindy: That’s right.
Howard: But they're driving to work right now Cindy, and you see hundreds of offices, they only see their office.
Howard: What are red flags? Paint some descriptions of red flags, that might make them think they could benefit from a consultant. I mean I know they could benefit from a consultant.
Howard: In fact everybody I know that's doing two to four million dollars a year in collection, and taken home six fifty or more. Not only have they have been doing it thirty years, they've had every consultant they could ever find. I mean every year, every other year, because they figure 'well hell if I brought in Cindy and she only gave us one great idea, it'll pay for itself.
Howard: Then the dentists who are the most miserable, and stressed, and hate their office, and burned out, and all that stuff like that. They've never had a consultant one time to come in and help them. I don't know anybody who ever got a gold medal who didn't have a coach.
Cindy: Right. Right.
Howard: So paint some flags. What problems do people call you up with that you say 'oh, I can go in and help you fix that'?
Cindy: Well usually their production is down, or their collections are down, or maybe they're having issues with their staff. They don't know quite what's wrong. So usually they don't call us until there is a problem, which I think sometimes is the problem. I think anybody that's starting out in dentistry should hire a consultant right away, because needless to say we've gone through all of the the criteria of learning the mistakes along the way. I mean I've been in dentistry for over thirty-one years, so I've learned by my mistakes and now I can help those new dentists learn by my mistakes.
So I think with dentists generally, they don't really know how to run the business end. So that is also questions that we get is 'I don't know what to do with this, all I want to do is just dentistry'. So we help them in that manner, help them set up policies, and just generally guide them along and teach them how to run the business. So that's basically what we do, and I really feel like new dentists that are just coming out of school, get hold of a consultant like me, or Janice, or Denise, or Chris, that's part of our team. To be able to get you set up to learn what mistakes that we've come across so that they won’t come across those.
Howard: The first time I ever told my dad I want to go golf with him, he's gone off to golf. I said that 'dad, can I can I golf with you?' I don't know how old I was, must have been ten, eleven, twelve or something like that. He said 'sure', and I had no idea. But on the way there I thought I was going to call golf with my dad, and my dad walked into the deal and he was signed in, and he said 'you got a pro free?' The guy said says 'yeah, I've got two of them right here.
He turns to me, he goes 'Howie, rule number one in golf you the first ten times you play, you play with a pro. You don't want to develop a bunch of bad habits'. He goes 'if you go out there and play with me today, and develop a bad habit, it'll take the rest of your life to get rid of that damn habit'.
Cindy: That's right.
Howard: When I opened up my dental office, I graduated on May 11, and it only took me a hundred and thirty-three days to open September 21st. The first time my front desk asked me a question, and I didn't know what the answer was. I thought back of to that golf, and back in the day, in 1987, the big bomb practice management consultant was Sally McKenzie.
I flew my team all the way to her in Florida, and I flew her all the way to my office. But here it is thirty years later, and I still have staff members saying 'well Sally McKenzie said this'. 'Well Sally Mackenzie said that'. That was three decades ago. When would be the best time to set up the best systems. Day one?
Howard: Or day twelve hundred, or day two thousand, or day I'm burned out, and now I'm drinking Listerine in between my patients because I'm so stressed. But dentists don't get that. But they'll go buy an $85000 buy a place Biolase. They'll say 'well I need chairside milling at $125,000 or I need a CBCT at $100,000’. ‘Like dude, your how your house is not in order, get your house in order and then buy all the boy toys’.
Cindy: Right. Right. So day one, absolutely. Just like you said you want to learn that from the beginning, instead of going backwards and then going to try to fix things. So you get people set in their ways, and it's very difficult for them to learn new stuff, new things, new policies, when they've been doing something for years and years and years. So it's day one for me, I honestly, truly believe it's day one.
I learned the hard way, I did everything on my own, I did everything paper. So I was one of those people that swore I'd never get on a computer, or get rid of my ledger cards, or my pegboard. But you'll learn...
Howard: Now you've all given away your age, when you say pegboard, you just gave given away your age.
Cindy: I know. I know.
Howard: You can't be under thirty-nine if you know what a peg board is. There’s just no way it can happen. But for you millennials out there, when I left dental school I still hadn't used a computer and my first accounting was a pegboard system. It was a big old notebook that was when you opened up is about what? Three feet wide.
Cindy: Yeah. Yeah.
Howard: It was really small, and it was a number two pencil and you were always sharpening your number two pencil and it was all was all paper. But I think the difference in a great leader and a poor manager is, a leader will say we've got to reduce our cancellations and no shows and the teams like 'yeah we need to reduce our cancellations or and no shows', and say 'we need to do our recall better', and they're like 'yeah we should recall better’. But then they're all standing you're like 'okay, but show us how'. You just can't go sit there and say 'okay, I want you to hit a hole in one'. It's like 'well are you going to show me how to hold the club.
Howard: The dentists, they give them these audacious goals like 'well we need to do four thousand today. That's our goal for four thousand today. 'Okay, but how do we do that? They don't show them how, they just say 'at five o'clock we should be in Los Angeles'. 'Okay, but how?’
Howard: Do you agree that there great leadership is providing the tools necessary, and if this dentist doesn't know those tools, then they need to get a consultant to come in there and show them how.
Cindy: Absolutely, and I feel like where did this a dentist go wrong in the beginning is they don't invest in the training part of it, of learning the jobs, the different duties that they do. So you just throw somebody in and they're like 'I don't know what to do'. So can you tell me what to do? Well usually the dentist doesn't know the business end, so they've got to have somebody that has that experience to come in and teach them that.
Howard: Well if anybody in the dental school knew how to run a dental office they wouldn't be working in a dental school.
Cindy: That's true.
Howard: Getting a job in the dental school was plan B. Well are you going to open up a million dollar practice, and be the most successful dentist your city? Well I can't do that. What's option B? Well option B is teaching. What's option three? Prison dentist. So working at the dental school is only because they didn't want to work at the penitentiary. So they could learn that. I always thought it was funny when I went to Catholic school, and I was taught sex education by a priest, and I thought that was even strange. Okay, I'm being taught about sex by a virgin. Okay, does that even make sense?
Howard: So the dentists they come out of school, day one they set up their office. I mean they don’t even know how to set up a recall, and then they get on DentalTown and everybody has a different idea on a recall. What advice would you give them on a recall?
Cindy: Well for me as far as recall is concerned. It depends on their area as well, but I especially recall to me, I think that is probably the most important thing in a dental practice, because that to me is your lifeblood that keeps people coming back in, keeps your patients coming back in. If you don't have somebody on top of that on that recall system then people just get lost in the system. Now you're spending all this money trying to get new patients in, when you're not utilizing the ones that have already walked through your door.
So, to me, setting up that recall system is imperative in the beginning. How are we going to handle this? What protocol are we going to use? So as far as recall is concerned. Are you scheduling before they leave the office? I absolutely believe in that. Is scheduling them before they leave the office, and making sure that you're running lists out of your practice management system, to make sure that you're keeping up with those people that haven't scheduled yet. So, yes, I totally believe that the recall system is imperative for a dental office. If you don't have that a good system in place, you're just going to keep spending more money trying to get that new patient in.
Howard: So you recommend scheduling them before they leave and who should schedule the hygienist or the front desk?
Cindy: I prefer the hygienist.
Howard: I agree, because then now she has to own the problem.
Cindy: Absolutely, and she's going to better know her patient, and when she's talking to her patient, it comes better from her than it does that front desk person. So the receptionist hasn't given him that education or that one on one that the hygienist has. That way they can talk them and say 'hey we really need to get this schedule, we need to keep you on a maintenance level'. I totally believe it's the hygienist.
Howard: Yeah, because if the hygienist just takes the chart up front job and drops that and says a 'schedule recall', while well hell, I maybe checking someone in, I may be checking someone out, and I maybe having some lady on the phone that's all concerned, because her two year old just fell on the coffee table, and got a bloodied lip. If the hygienist is going to be measured by how many she pre-appoints, and the whole hour she's talking about her husband, and her kids, and her dog, and her cat. The patients aren't getting any value, and they don't even want to come back.
Howard: She owns it. If you see eight people a day for a cleaning, and no one want's to schedule to come back and see you. It's you, it's the man in the mirror.
Howard: It's not the receptionist.
Howard: It's not my office manager, it's not the dentist, is not corporate, it's you.
Howard: So I agree with that. Do you do any reminder six months later? So I clean your teeth today and I schedule Cindy Day Hauk, six months from today. Do I do anything to remind you half a year from now?
Cindy: Well I know I'm one of those older people, but I put mine on my phone. So if I'm going to be sending a reminder, because everybody's using their phone now. Some will say 'oh I've got it. I've got it on my phone'. There are so many different entities out there now, the electronic reminders. I love those, because now we're in a world where we're getting texts and we look at those texts before we do e-mails or postcards. So I love the electronic part of it and I feel like we would usually send something out like maybe a month before, and then maybe two weeks before and then if you're texting, then you probably want to sent one like an hour before their appointment as well.
Howard: You said one month, two days, one hour.
Howard: One month, two days, one hour.
Howard: What I'm reading on email reminders that fifty percent of emails go to spam.
Howard: Unless I send you an email, then it's a hundred percent.
Cindy: But they're getting texts, they like their text messages.
Cindy: Yeah, so they're getting those, and for those that don't have text messaging. Then you want to ask them, do you check your email regularly? If they don't, then that's somebody that you're either going to send a card to or are you're going to get give a call to.
Howard: You say you like some of these digital companies that do that. Any of them you want to give a shout out to? Any of them you prefer, or like the most, or recommend?
Cindy: I think so many of them have so many good features like Demandforce, or Solution Reach, or Lighthouse. They all do great of what they do. There's particular ones that work better with some softwares and than others. Just depending on what you have in your office, and what you're looking for? What are the criteria that you need?
Howard: Let's go one step back. Okay, she's listening to you now, she graduated last year from dental school. She's been working in at Aspen for a year, and she wants to build a Denovo practice in Branson, Missouri. What practice management software system would you recommend first?
Cindy: Well I truly would probably recommend Dentrix first there, and honestly it depends on the office as well. So what are their needs? If it's an office that has multiple practices, then you want to find a dental software that is going to be able to handle that. Do they need a cloud software? So every need is different in offices and not every one particular software is a cookie cutter for all. So it really depends on their needs and how big the office is, where they're at, and what they're used to.
Howard: Now you're in Branson, Missouri right?
Cindy: I'm in Springfield, right outside of Springfield.
Howard: But how far are you from Branson?
Cindy: Probably about thirty minutes.
Howard: Yeah. So my sister, when she joined the nunnery it was in Springfield, Missouri on highway M.
Howard: Right next to that golf course.
Cindy: Yes. Yes.
Howard: There's a cloistered Carmelite monastery there. You'd really probably thought they were all penguins from Antarctica. You probably thought at the zoo. But those aren't penguins. It's actually my sister is one of them penguins. But Branson, Missouri was the biggest sore spot for my father because he had two brothers, Mike and Jerry. If anybody asked me who my favorite comedian in life was, it's my dad and his two brothers. I mean those three guys start talking. My sisters and I, we couldn't breathe our sites hurt so much. Funniest people in the world.
But anyway, his two brothers said they found, like this is way back in the 60s when I was just a little kid, they saw this like ten acres off the side of the road off of Branson, and they said ‘let's all go in on this, because Branson is going to take off. So our whole family drove down and my dad's looking at these weeds, and this tall grass and he’s like ‘you guys are out of your mind. No one's ever going to do anything in Branson, Missouri’. So he said ‘no you guys are crazy’. Well guess what happened to the value of that land?
Cindy: Surprise. Yeah.
Howard: Oh my God. It went off the charts, because nobody believed in the vision that Branson was going to be like the entertainment capital of the entire Midwest.
Cindy: That’s right.
Howard: Have Marie and Donny Osmond and all that. I mean really it's the coolest area Lake of the Ozarks. It's on the Lake of the Ozarks right? Or near it.
Cindy: Lake of the Ozarks is more north, it’s at Table Rock.
Howard: Oh Table Rock.
Howard: But anyway, it's just God's country. I mean it's the most beautiful country.
Howard: It's a great get away. So my dad he gnashed his teeth all the way to the grave that he made out on that.
Howard: But anyway, so Dentrix. But it depends on the person, depends on what you're getting.
Howard: There's not one size fits all.
Cindy: The needs of the practice.
Howard: Yeah. Okay, so you like the (inaudible 21:24). So what I like the most about the recall is simply that I've seen so much evidence and data that suggests that if your best friend says ‘oh yeah go to Doctor Howard Farran, he's really good. I've been going there for ten years I trust him. the girls have been there forever. I trust him’. You will come in. You are three times more likely to buy than if you come in off a flier, or a groupon. You come in and you don't know me from Adam, and then I walk out there and tell you ‘Cindy, you have three cavities and they're $250 each’. You're sitting there thinking ‘I just wanted my teeth clean, I don't have any problems. How can I have a cavity? I haven’t had a cavity in ten years. I don't even believe you’. Just like when you take your car in for oil change and they say ‘oh you need to pay $20 more to get your transmission fluid flushed’, you're like ‘I don't even believe you. I just think you want 20 more dollars’.
So if I was going to have anybody come back to my office, it’d be someone who's been in my office and met us all and started building a relationship. What would throw my homies under a bridge is that, in any other business if someone falls off, like say they were scheduled for a cleaning and they cancel a week before, they fall off the list. Those are your leads and they would call that outbound sales, outbound telemarketer and they would hire the best telemarketing phone skilled people they could find. Not only would they pay them, in Phoenix eighteen to twenty bucks an hour, but every time you got a sell it would be a $10 bonus a $20 bonus.
I mean those outbound telemarketers they say ‘okay, well we’ll pay you a minimum of $12, $15, $17 an hour. But every time you set up an appointment for whatever you're selling there'll be a $20, $40 bonus, $50 bonus. These guys might make three sells a day and make a hundred and fifty bucks on top of their $18. So then you have a dental office and the dentist got eight years of college, a hygienist got four years of college. But the front desk, they'll just hire anybody they name your career after a piece of furniture they just say ‘well we're going to name you after the front desk, because the chair and the door was already taken. So you're the front desk’. No training.
Then the hygienist like ‘well you schedule the recall’, and people are checking in and they're checking out and if you have four operatories. Well everybody has an appointment at twelve o’clock, at eight o'clock to nine. So four people are coming in and four people are leaving at the same damn time. How does that logistically work? If they would take their front desk more seriously, and they would treat people who fell off the schedule as outbound telemarketing, and put some seriously trained people on the outbound marketing telemarketing. Then the incoming calls inbound sales, Do you know the outbound sales in all the call centers is twice the level of training than the inbound sales. So the phones ringing and then you look at inbound sales in dentistry, and the data shows that fifty percent of inbound sales calls to dental offices go to voicemail.
Cindy: Yeah. That's true. That's true. Yeah. That's crazy.
Howard: But the dentist thinks he needs a laser. It's like half your incoming calls go to voicemail and your answer is a laser. Are you out of your mind.
Cindy: Yeah, I truly believe you've got to have somebody up front who knows their stuff, and you can talk the talk. Anybody that sits at that receptionist desk, or that front desk, I kind of have that pet peeve too. I never like to be called a front piece of furniture. So I totally get that. But you have to be a multi-tasker to do that. If you can only focus on one thing at a time then you're not meant to sit at that front desk. As you said, you've got to be able to check people and check people out.
You may be entering in insurance in as well at the same time. Then you may be having to put a treatment plan together at the last minute. So there's all kinds of things that that person up front needs to do and handle and handle well. So I truly believe in that training and making sure that whoever you put in that position is selling your practice, because they are that first impression. When they walk to the door, or when they answer the phone, they're the first impression of that office. So I strongly believe that you want to make sure you have that right person up there.
Howard: Now I want to talk about the second nightmare, and I just heard this. I just heard this twice last week from I think the one dentist was twenty-seven, the other was twenty-eight. They open up their office, they think they're doing great because they're doing all this dentistry, and they don't realize it's all go into their account receivables. I was having dinner with this one dentist and she was so sad, because she did her first full mouth rehab and she's into seating the upper arch, and she's already impressed the lower arch, and he still hasn't paid a dollar yet.
I'm just like ‘oh my God’. I was formally trained that the most businesses that go bankrupt every year are profitable businesses, they just ran out of cash. What that means to you young kids in dental school, probably twenty percent of the listeners to this show right now are actually in dental school. Is that let's say that I do a dollar worth of dentistry on you. Okay, well I had to pay my rent, mortgage, equipment, (inaudible 27:29), computer, insurance, I had to pay all my bills.
But let's just say I bill you, and you don't give me that dollar for ninety days. Well that means I have three dollars in savings to pay my dollar bills one month, my dollar bills month two, my dollar bill month three, because I incurred the cost of this dollar today when I fix your tooth. If you didn't pay me for ninety days, three months, I need $3 in the savings account. So that's why most businesses that go bankrupt were profitable, because you were going to give me that dollar. But I didn't have three dollars to live off of until you gave me that dollar.
Howard: Then some of these offices that are ten, twenty years old, they still are not getting the collection policy right. So I want you to give us a rant on the collection policy. Is it important? Is it a problem? When you're out in the field is a collection policy still a problem? Or is that something that you don't really see a problem with?
Cindy: Yes. Collections are a big issue, and if you don't have something set in place then it's insane to me that people don't have a policy set in place. I went into an office at one point and the gal says to the patient and she look down and ‘well can you pay that today?’ You got to have somebody is going to look at you straight in the face and say ‘that'll be $500. Will that be cash, check, or charge?’ You also may have to set up financial arrangements, having that policy set in place for when that person does come up front, or even when you're making the appointment, it needs to be clear of what your financial policy is.
Somebody does a crown and they do half of it by the time they prep it, if they're doing two day crowns. Then I want at least half of that, and then when they come to get it seated, I usually ask for that money before they get in the chair because once they sit down and they get it seated, there's no taking it back out. So you want to make sure that there is a solid policy in place. Have that ahead of time when you're talking to them about their treatment plan. You want to get those financial arrangements set in place, make sure you're following that guideline for everybody. It's ‘oh, we'll let that one go because they're a friend of the family’, or ‘they're a friend of a friend of a friend’. It just keeps snowballing. So you've got to have that in place and you got to have somebody that's going to look at him straight in the eye and ask for that money.
Howard: So do you think it's a personality trait. Is that something you're born with? Some people love sales and they love asking for money, and some people hate sells and hate asking for money. Can I take someone who hates sales and hates asking for money and make them love sales and love asking for money, or do I just have the wrong person. Like you obviously have all those guitars hanging behind you, your husband plays in church, you sing in church. If your church said ‘no we don't want Cindy to sing anymore, we want Howard to sing’.
You would learn in about four minutes that I should not be your singer, and I don't think you could send me to singing lessons schools and say ‘well give Howard a chance, we're sending them to some singing lessons and he'll be fine next week’. I ain't ever going to be your singer. But do you think if Shirley’s up front and she can't ask for money, do you think I can make Shirley a singer who loves singing for money. Or do I need to replace Shirley and find someone who can ask for money?
Cindy: You either have those qualities or you don't. What I consider is if they are trainable then that's maybe somebody I could train to do that. But if I'm going to have somebody up front, they need to be comfortable with asking for money. That is usually the first thing I would ask if I was hiring somebody is ‘how comfortable do you feel. Asking me for that balance?’ I like to do a lot of role play. So when there is somebody new that is going to be in that reception position. Those are some of the questions I’m going to ask. I'm going to do a roleplay ‘okay, I just had a crown done. I want you to ask me for money’. I go through that process, if I don't feel like they can feel comfortable doing that. Then they're not that person that should be at that front desk.
Howard: Well what percent of staff do you think are only comfortable asking for money when it's a raise because the Earth went around the sun, and every time the Earth goes around the sun they want another dollar from me. What percent of staff only can ask for money from the dentist and not the patients? Would you guess, in your experience.
Cindy: That's fairly high I would say. Yeah.
Cindy: Fairly high. Absolutely. We want to be paid, but sometimes we don't want to do the job for that money.
Howard: Okay. I want to hold your feet to fire though because she's driving to work right now and she's thinking to herself ‘well I think we do a great job on collections’. You said you recommend Dentrix. When she gets to the office, if she's on Dentrix, which is the number one selling practice management software in America. How could she get on her computer and give her office a grade on her collection policy? How would you grade her collection policy? What would the specific number be? What should her over thirty, sixty, ninety be?
Cindy: Well you always want to make sure that you have more in that current and the thirty and you're sixty to ninety, because I honestly believe once it gets past a forty-five day span you'd hit that ninety, and your percentage will drop less and less and less to be able to collect it. So that's why those policies or those protocols for that financial policy that is set in place be followed, because you don't want that accounts receivable to be up there. I’ve walked in to where they've got like two hundred thousand in the over ninety. Well how did that happen? So you want to run the reports…
Howard: That’s an entire student loan debt.
Cindy: Yeah. So how did this happen and why is it so high? Is anybody working? I think that is the biggest issue, is there's nobody really working the system. They might only have one person up front, so they're expecting that one person to do everything, keep up with all the maintenance. When you start to get bigger and bigger and bigger, it's almost impossible to handle all of that. So you've got to make sure that you set up a flow of when am I going to do this? When am I going to run my reports? When am I going to call on accounts receivable? So keep that set in place, and it just becomes part of your world, what you do. I actually spoke with a doctor who said ‘well that one person should be able to do everything’. Okay. Have you ever trade places with her?
You'll be able to see that maybe it’d be more productive if you had somebody up there to help. So that way they can actually pull reports that can fill that schedule, and be more productive, and keep that accounts receivable down. Make sure that those people that you set in place upfront are collecting, so that it doesn't get up to that ninety day. For me I want a hundred percent collection of course, but if you've got eighty-five to ninety percent collection, that is pretty good. We want to make sure that we're at least that point, you don't want your ninety to exceed more than maybe five to seven percent.
Howard: So if you collect a hundred dollars a month, then your over ninety should be $5 a month or less.
Cindy: Well let's hope it's absolutely zero.
Howard: Over zero about five percent would be the max.
Howard: So if you collect $100 a month, what would be a normal healthy B plus A minus over thirty, over sixty, over ninety for $100 a month production?
Cindy: Well if I've got $100 a month I’d be probably breaking down my practice.
Howard: Well I just use a hundred for the percentile.
Cindy: Yeah, yeah. So I’d probably have at least, in the current I would want at least maybe $80 in the over thirty, maybe fifteen and then anything past that would be that $5. So I want to keep my current in my over thirty at a fairly decent rate.
Howard: It's really the number one deal on overhead because let's say that you collected eighty-five percent. Okay, well that fifteen percent that you didn't collect, you paid to have that done. I mean you had a facility of rent mortgage, (inaudible 37:16), computer insurance, malpractice, you had labor lab supplies. You paid for that dentistry and you're still in business, so that fifteen percent you didn't collect was totally profit dollars that would have dropped to the bottom line.
Howard: I’ve always said that when you see high overhead, there’s only two things I would look at, is labor and the collection policy.
Cindy: Right. Right.
Howard: So I want to switch to the next uncomfortable conversation, is that there's a lot of dentists that are my age that have what we call legacy dental practice problems. Where they opened up in the ‘70s and the ‘80s when you submitted your own fees to Delta, and they just paid a percent. So when I got out of school in ‘87 my fee for a crown was a thousand, my fee for a root canal was a thousand. Now thirty years later, Delta has given me the fee, they don't care what I charge. They said ‘here's the fee’. Ninety-five percent of American general dentist take Delta. Which means ninety-five percent of the dentist in America take a PPO because when they sign up for Delta, Delta’s given them the fee and the fee is about forty percent less than it was three decades ago.
Howard: But you still have your best friend, reception assuredly and you've given her a raise every time the earth went around the sun. Now there's dentists in their fifties and sixties where their labor should be total labor, vika matching, health insurance, 401k, everything. Twenty-eight percent would be the max, and they’re at thirty-eight percent.
Howard: They're ten percent over. Do you see this problem in the field or am I out of my mind?
Cindy: Oh yes, absolutely and there's a lot of areas that they feel like they're almost forced to take every PPO available. In some states, like Illinois, the state actually pays Delta. So it doesn't even get released unless that money is sitting in the state bank account. So they could be waiting forever to get paid from Delta claims. So it's a matter of that choice, do I take Delta? Or do I take Aetna? Or do I take Metlife? What are you willing to lose, because some insurance companies that are PPO’s may be almost half of what you normally charge. So do you want to take that much of a hit? It's really what I'm seeing is totally in the area. I know one practice that I used to work in, we accepted PPO’s and then we eventually started to drop all of them and went fee for service. It was so free to go fee for service.
Howard: In agriculture they call that selective pruning. I had a patient one day school me and I love the correlation between agriculture and dentistry, where when she would go do like the site of interstate or a big government building. They would plant three times as many trees because they don't know which ones are going to take off.
Howard: Then five, ten years into it they start selectively pruning. So you're saying that when a office builds up and gets going whatever, they should start looking at their PPO’s and start selectively pruning and trying to reduce the amount. Is that what you're saying?
Cindy: Well what I'm saying is it really depends on what area you're in. You may be in an area where the huge employer that area has MetLife or Aetna, and you almost need to take that to be able to get those patients in the door. So it's just matter a philosophy for the doctor, some will say ‘I absolutely don't want to do any PPO’s’. That's fine because what I do find as well is let's say, okay we've quit one of these PPO’s, we're no longer taking it. So your patient says ‘well then I can't come any more. I'm going to have to go somewhere that accepts my insurance’. What I do find in some instances, because they’ve been going to that dentist for so long and have trusted that dentist, trusted their hygienist, the person up front.
They go and the grass isn't always greener on the other side and they say ‘you know what? Yeah, they take my insurance but they don't do the work that you did’. Some of them end up coming back anyway. If you are starting to want to take down, not using PPO’s. You want to make sure you start with the ones that you don't have as many patients, and you don't want to just say ‘as of today I'm no longer taking this’. You've got to gradually take care of that and say ‘next time you come in we're no longer going to be a provider, and what that means for you is…’, and then it might be just a small higher percentage. We still will file that for you as a courtesy, but we will no longer be at that percentage. I'm finding it more area driven as far as PPO’s and HMO’s, things like that. Specialty offices as well. Just really dependent on…
Howard: So you're saying if you're a legacy dental office and you’ve been out there thirty, forty years. What do you think total labor should be in a dental office?
Cindy: Oh, total labor. Depends on how big the office is. As far as your front, or your hygienist, your assistant, that's all going to be based on experience as well too. So I'm feeling that maybe if you're looking for a percentage that's hard to pull out, because it really depends on the experience of that dental practice. You certainly don't want it to go over maybe ten, fifteen percent. I mean you've got a large salary for maybe the front desk person, she's been there for thirty years and, as you said, you just keep giving her a raise and giving her a raise but still you're still at the same prices. Your production level, collection level, is definitely not going to be where you want to be if you continue to raise that and not raise your prices.
Howard: So there’s what four of you guys at Global Team Solutions?
Howard: At gtsgurus.com?
Cindy: That’s right.
Howard: So there’s four guru’s.
Howard: There's this one chick named Cindy Day Hauk.
Howard: That would be you. Then there's Chris Ciardello.
Cindy: It’s Ciardello.
Howard: It's what?
Howard: Ciardello, but it's spelt C-I-A-R-D-E-L-L-O. That's got to be Italian.
Cindy: Right. Yes. Yeah.
Howard: Chris Ciardello.
Howard: Denise Ciardello.
Cindy: That’s his mother.
Howard: Then Janice Janssen, so are Denise and Chris sisters?
Cindy: No. Chris is Denise's son.
Howard: Oh Okay. Well that is damn cool. Denise is a consultant and her son followed her into consulting.
Cindy: Yes, that's right.
Howard: That is so cool. God, you ought to have them both come on the show.
Cindy: Oh, they’re awesome.
Howard: Yeah, have them both come on. I don't think I've ever seen that before. I don't know of any consultant, I can't think of a single consultant that had a child follow them. Oh, Blatchford, Christina Blatchford followed her dad Bill Blatchford. Yeah, have Denise and Chris… what’s that?
Cindy: Yes, I said they are unique.
Howard: Then there's Janice Janssen now. Now do you guys consult anywhere in the US and Canada? Or are you more regional?
Cindy: Anywhere in the US. Yes, absolutely. Yes.
Howard: If someone called you from say on the other side of the country, California or New Jersey. Do you do it all online? Do you fly to location? How does your consulting actually work?
Cindy: Well we've got different programs. There are clients in California, as a matter of fact I just came back from there. So yes, we do have clients in California. We go all over the place. We do have different programs to where we can do it online or we will have different programs to where we may come in there once a month so we'll do either or.
Howard: Is your system like a contract.
Howard: Is like a yearlong program, a two year program? How long does it take a contract and how long is the program?
Cindy: It just depends on the program that you choose, we do have some that are a year. We have some that are six months. We have some that extend further because they want to renew. We're not so much a cookie cutter as we're going to base it on that practice. Somebody needs a year then we'll set up for that contract.
Howard: I just decided I don't want Chris, is it Ciardello? That's how you pronounce that Ciardello? So the I is silent. Is that common in Italian, the I is silent?
Cindy: I'm not Italian so I don't know.
Howard: Well anyway he's got just way too damn good a hair to come on my show.
Cindy: He's better than the rest of us. Yeah.
Howard: My God he's got good hair. I'm only going to do him if it's on iTunes only. It's just audio only, we won't film it and put it on video. But I want to ask you another question and this is dentistry uncensored. If I'm ever talking to a dentist and I say ‘man what is the worst thing about being a dentist? I mean what do you hate the most? What gives you nightmares and puts a knot in your stomach?’ It's always staff issues.
Howard: It just drives dentists crazy.
Howard: They're so confused because the patients all love the hygienist. But the hygienists and the assistant fight like cats and dogs, and the dentist can have a meeting with the hygienist and explain to her that the overhead should be sixty-five percent. Now it's seventy-eight percent at the end of the conversation she just says ‘oh that's interesting. By the way I'm due for a raise’. It’s like ‘did you just hear a single word I said?’ When I meet dentists who say ‘I just want to burn down my dental office and get a job at Taco Bell’. It's always because of staff.
Cindy: The staff.
Howard: Do you see that in the field too or not, really?
Cindy: Yes, absolutely and dentists don't like confrontations. So they want to just come in and do their dentistry, and they want everybody to just do their job and do what they're supposed to do. So that's part of our services as well, as we come in and help those conflicts within the staff. Find out what's going on, guide them and start putting protocols in place, and that's what we're for. So we really help in that manner of helping those conflicts, because the dentists they don't want to approach that or confront those.
Howard: What percent of the time do you go in there is the main problem staff or a staff issue?
Cindy: I would say most of them.
Howard: Most of them.
Cindy: It’s always somebody.
Howard: What percent of the time when you go in there. Is there a staff member that really needs to go?
Cindy: Oh boy. That's kind of a hard question to answer as far as percentage wise. But I will say that if there is somebody that is driving the practice and to me I feel like the whole practice needs to work as a wheel. One of those spokes are continually breaking off, and it's because of that person who continually adds that drama, or that confrontation, or everybody else just dreads coming in. If it is not something that can be taken care of, then yes that person would probably need to go, because you don't want that person driving the office. Everybody else doesn't want to come in because they never know how they're going to react, or how they're going to be that day, are they going to be Jekyll or Hyde that day? So it really depends on the person, if they can be sat down and discussed, and they don't want to conform to what we feel like they need to do with everybody else, then they will probably be the one that would that would be gone. So yeah.
Howard: Then I want to ask you another toxic question. What percent of the time when you go into a dental office, do you actually find out the end of the day someone is embezzling from the doctor? Do you think employee embezzlement is hype in dentistry or do you think it's real and really occurs. How how reoccurring is this issue?
Cindy: It is real and it is really reoccurring, it’s too bad that it is such a high percentage. We have Janice Janssen, who is one of our co-owners of Global Team Solutions, is a certified fraud examiner. So we do find that you look for those little details of, is that person just continually only wanting to do that part of their job, and nobody else can be a part of that. There's different little tricks or tips that we see red flag so to speak, of when we're looking at somebody who possibly is embezzling and it's not just monetary.
As far as money wise is concerned, it could be products in the office, or it could be they're fudging on their time card. Or using maybe some of the offices stamps, letters, things like that. Anything considered taking from the office. Yeah, it’s pretty high and we do have some tips and tricks that we look for. Somebody might call us and say ‘hey, we think something’s going on’, so we’ll probably go in there and do an audit and check and see what we find. We also want to look to see if they’re on passwords, that’s a big deal.
Howard: Talk more about that. What do you mean if they’re on passwords?
Cindy: So if I were to come in to audit an office, probably the first thing that I’m going to ask the doctor is ‘are you all on passwords? Do you have a password policy?’ What I mean by that is certain people are restricted from doing certain things in the software. So if they tell me ‘yes’. Now does everybody know each other’s password? Is that ever shared? That’s something I would ask as well. If it’s not shared or they have a policy set in place to where if you walk away from your computer, you’re going to log off. So those kind of things we’re looking at or else we can’t go in, and see if that person who they think is embezzling is actually doing that.
Howard: Well tell me this though, because she’s driving to work right now and she doesn’t want to believe it. Is there any red flags that she’s embezzling? Is it more likely be lutherans instead of baptists? Is it more likely to be single mothers versus married? Can you paint a picture of what this chick looks like that’s embezzling from me?
Cindy: No you can’t, because they could be your best friend, they could be the person that’s worked for you for thirty years. They could be somebody who comes in and takes care of your kids. There is no set person embezzler that looks the same.
Howard: I’ll never forget a dentist told me, I was out there lecturing, and he started crying. She was the godmother of his baby and they went to church together every Sunday.
Howard: He would’ve considered her family, best friend, everything. I mean just the greatest gal on Earth, and she stole like a quarter million dollars from him over the last five years. But you know what was the very worst? He knew something’s wrong, he couldn’t figure it out and finally brought in a consultant. It was his wife, and she had been embezzling a lot of money for years and moving it to Sydney, Australia. Then when he finally caught her, she says ‘oh, no worries’. She just filed for divorce the next day. She goes ‘the only reason I’ve been hanging in on this marriage for this long, because I’ve been stealing you blind. Then the minute I realised I was going to divorce you I thought well I don’t know how the divorce will go, but I know I can steal you blind until we find out how much I’m going to get from the divorce’. So he found out that his wife had actually mentally divorced him like four years ago, had moved off a ton of money out of the United States, and then filed for divorce, and then took him to the cleaners on top of it.
Cindy: I have run into one that was actually the wife of the dentist. Yeah.
Howard: So you’ve seen this too.
Cindy: I’ve seen it, yeah. I only saw one as the wife.
Howard: What was her story? Was she doing this in lieu of divorce? Or did she have like a gambling, drug problem or something?
Cindy: I don’t know what her situation was, but it happened before I came into that office. I found out about it later, so yeah, as she went each day she put a little bit aside and took it out. So, yeah. But they’re all just normal people, your normal joes that are out there. You never know who it is.
Howard: But you agree though, it’s definitely more protestants than catholics. You could at least say that. This is dentistry uncensored you can tell the truth.
Cindy: Since you’re a catholic I’m going to say yes absolutely. How’s that?
Howard: It’ll never happen, an Irish catholic man will never embezzle. You can say that, right?
Cindy: Well now you have to understand that my father’s a retired warden from the federal prison system, they all are out there no matter what.
Howard: I’m not a big movie watcher because I just don’t have enough time, one of my top ten favorite movies of all time was that prison movie. Who was that prison movie Shawshank Redemption?
Cindy: That is my favorite. Yes, absolutely.
Howard: So your dad was a prison warden, did he like that movie?
Cindy: Yeah. Yeah.
Howard: So I had dinner with that guy, did you know that?
Howard: Yeah, they had me speak at the Memphis State Dental Association meeting and then after my lecture the president, and the president elect, and the past president, and the treasurer. We all went to dinner and Morgan Freeman.
Howard: At his restaurant, which is about a two hour drive South of Memphis, and you go to this small town where he was born and raised and he’s got the restaurant in there. That was the big treat, we were going to have dinner with him and it was just amazing. I couldn’t believe we all got to eat there, the restaurant was amazing. There’s probably a town of about five thousand, and I turned to him and they were talking about all these movies that he’d been in like Driving Miss Daisy, and I hadn’t seen any of them. He was asking me something, I said ‘I’m sorry to admit this but I don’t really watch a lot of movies, but I have to tell you your movie Shawshank is one of my top ten favorite movies of all time’.
He says ‘do you know why that is?’ I said ‘why?’ He said ‘it’s one of the rarest plots ever, it was a platonic love story between two men’. He goes ‘when I read the script and I realised that this is a love story between two men, platonic, no sex involved’. He says ‘this plot is so rare we are going to crush it’. That’s what it was, he said ‘you’ve seen a love story between a man and a woman a thousand times, what is so unique about that love story if it’s between a man and a woman?’ I mean how are you going to beat Romeo and Juliet or whatever? But he said ‘this is just a rare plot’. So he went with that movie on Scarcity.
Howard: That plot’s hardly ever done.
Cindy: I’ve probably seen it I can’t tell you how many times, but it is definitely one of my favorites. They were great in that movie.
Howard: Okay, well I can’t believe we went over an hour, we passed an hour. So you’re pulling up to work and all I want to end on is this. My God I love you guys, I love dentistry. I’m leaving right now, my lunch break is over. I’m headed to Today’s Dental right now, three point zero miles up the street. I love pulling wisdom teeth. I mean I love dentistry, I love seeing patients, I love it all, but gosh darn it you’ve got to realise that you’ve got to get your house in order.
Howard: Every time your house is not in order, your overheads too high, your collection policy’s off the chart, your staffs embezzling from you. You know what your best idea is? You say ‘I should learn sleep apnea, I keep reading that everybody’s getting into treating snoring and sleep apnea’. No, no, no, no, I’m going to learn how to do Invisalign. No, no, no, no, I’m going to go learn how to place implants. No. I know you’re a dentist but stop, get your damn house in order, get your business poised for growth.
I would never ever see, what’s that movie called The Prophet? I’ve never seen The Prophet go into a business and they have a pizzeria and he says ‘well the problem is we don’t have a pizza with grapefruit, and citrus, and whatever’. It’s not because you don’t have a certain pizza on the menu, if you can’t make money off just a cheese pizza, a pepperoni pizza, and a supreme pizza. Your business is not in order. You don’t need to add barbecue chicken pizza, if you can’t make money off cheese, and pepperoni, and supreme, something’s wrong with your business.
Then I tell these dentists, when I’m thrown under a bus. Chairside milling? I’ve got a Serac machine. When I’m thrown under a bus CBCT, I own a Carestream. Love it. I have every toy because boys have toys. But I could afford a cabin, or a jet ski, or a boat, or all these toys, because my business is in order. My staff are trained. The number one return on investment in dentistry is dental office consultants. I love the fact that you’re from Springfield, Missouri because a lot of these consultants my homies don’t believe them because they’re in Parsons, Kansas and these consultants are in Beverley Hills, or Manhattan, or Key Biscayne, Florida.
They’re like ‘they don’t get it, they don’t know what it’s like to be in Parsons, Kansas’. Which is only about three hours from you, right?
Cindy: About maybe a little bit longer than that but it’s pretty close. Yeah.
Howard: Yeah. How far are you from Nevada, Missouri?
Cindy: Probably about an hour.
Cindy: Maybe (inaudible 62:35)
Howard: Yeah. Shout out to my dad’s brother, Mike, who lives in Nevada, Missouri.
Howard: But I’m telling you, just get your damn house in order. Your other consultants, are they from Houston?
Cindy: There’s one in Houston.
Howard: Who’s that?
Cindy: That’s Chris. Christopher.
Howard: The long hair hippie?
Cindy: The one with the great hair. Yes. He’s in Houston, and then Denise is in Boerne, Texas outside of San Antonio. Janice is outside of St Louis.
Howard: Janice is your fraud.
Cindy: She’s our certified fraud examiner. Yes.
Howard: Well tell her if she wants to come on the show and do fraud, I’d love that. The mother/son, I’d love to do that too because I’ve done twenty-five of the greatest endodontists on Earth. I did the endodontist that wrote the textbook ‘Pathways to the Poll by Steven Cohen’, I did the endodontist who wrote chapters of his book like Brad Gillerman. I give them enough of root canals, fillings, crowns, implants, bone grafting, but as a leader I know what the young ones need more than they know what they need.
Howard: Sitting here thirty years into my game, they’re trying to learn all these procedures and they don’t have a collection policy, they don’t know they’re being embezzled. I want them to get their house in order so they make so much money that one day they sit around and think ‘should I get me a two seater fancy red porsche, or should I go get me a brand new laser?’ Get your house in order and buy toys in cash, the toy is not going to solve your upside down business that’s not poised for growth. You’re not going to buy a laser, a cadcam, a CBCT and magically have a collection policy, a trained front staff, and not being embezzled from. That’s not going to happen when you buy a laser, so get your house in order.
Cindy: You also want to make sure that your dentist is paying attention to the business as well, if you’re not paying attention to the business and you don’t know your practice management software. You need to learn, because if you’re just letting somebody else take care of it then you’re probably going to be embezzled. That is a good percentage that you might be.
Howard: Unless you hire all Irish catholics.
Cindy: Absolutely, there you go. Yeah.
Howard: But then they’ll all show up drunk, drinking Jameson whiskey. So then you’ll have a bunch of alcoholics who aren’t stealing from you. But on that note, Cindy thank you so much for coming on the show today and sharing an hour with my homies.
Cindy: Thank you.
Howard: We all greatly appreciate you coming on the show today.
Cindy: Thank you so much, I appreciate you having us and Global Team Solutions we thank you as well.
Howard: All right, now you go and have a rocking hot day, Cindy.
Cindy: You too, thank you.