Howard: It is just a huge honor for me today to be podcast interviewing Dr. Guy Gross, DDS, FAGD, MICOI, all the way from Salina, Kansas. He earned his doctorate dental degree in 2002, graduating with honors from the University of Missouri, Kansas City School of Dentistry. Since then he has become both a Fellow and a Master of the International Congress of Oral Implantology, a Fellow in the Academy of General Dentistry and a lifetime qualified member of the Crown Council. In his private practice his main focus is on dental implants and reconstructive dentistry with the emphasis on sedation procedures and cosmetic dentistry. He also owns and operates a dental practice management company that operates and manages a large group of dental practices across the state of Kansas and Oklahoma. His biggest role in the management company is the mentoring of doctors and dental teams on clinical excellence and leadership. He has lectured both nationally and internationally on topics such as dental implants, case planning, practice management, cosmetic artistry and 3D imaging. He has been a faculty member of OsteoReady, teaching live patient surgical courses to doctors from many parts of the world since 2014. In his spare time he enjoys coaching football, basketball and baseball for his two boys ages eleven and ten, and attending dance recitals and softball games for his daughter who is eight. He and his wife, Dr. Kate Gross, enjoy serving on dental mission trips and have done for humanitarian trips to foreign countries to date with their most recent one being to the Dominican Republic last November. They also served as co-Chairmen of the Kansas Mission of Mercy, leading the projects to doing over $1.2 million in free dentistry over the course of two and a half days. Their practice has also been named to the Smiles for Life Hall of Fame after raising over a $100000 for children's charities through their whitening programs. My gosh, you make every graduate from UMKC a proud man, how are you doing today?
Guy: I'm great thanks, great to be with you here today.
Howard: Well, you're living up to your name Guy Gross, Gross means a dozen, dozens, right? Gross means a hundred and forty four, so you're about worth a hundred and forty four dentists doing all this stuff.
Guy: I don't know about that.
Howard: So, when you're mentoring young docs, when you look at Dentaltown, quarter million dentists have registered on that site, and when we came out with the app fifty thousand downloaded the app and those were mostly kids born after 1980, so you can basically say the millennials are all on Dentaltown on the app and the baby boomers are on the desktop. Your... these podcasts are on the app and pretty much everyone that emails me about the podcast is really a millennial, in fact, if you're listening to this e-mail me email@example.com and tell me how old you are, tell me if you're a Millennial or a boomer. But when you're mentoring young Docs, what do you think they need coming out of school these days with a $quarter million in debt, some of them are $four hundred thousand in debt, what do you think they didn't get out of dental school that you find really helps in mentoring them?
Guy: Well, I think that's a great question. I always distill it down with the Docs that I work with that there are really four key things that I think are critical to be part of their their way of thinking, I guess, as they graduate and it has absolutely nothing to do with specific dental skills. The first thing I always talk about is being willing to come in and work hard. I think they're... I find with some of the young Docs there's a little bit of disillusionment at times when they come out and it's like, I'm not instantly rich, it's almost like we walk across the stage and instead of getting a diploma we expected that we were handed some money or something. And I try to help people understand that the work of dentistry is challenging, physically and mentally, and you've got to get in shape for that, you've got to be ready to really be productive. And you've got to engage your mind in the idea that it's a process and it's not going to be something that is an overnight success story, it's going to take time. And then... so, that dovetails into the second thing which is being a lifelong learner and being coachable. I love forums like Dentaltown, I love forums like our OsteoReady forum where doctors can continue to learn on a daily basis, they can continue to add to their armamentarium, their experience, their expertise even gaining the experience through somebody else whether, learning from other's mistakes but being willing to be coachable, be a lifelong learner. Then the third thing is come in and treat your team and your patients with respect and that will go a long ways. Truly learn to be a great communicator learn to find ways to make people feel better for having spent time with you and you'll do well with that. And then the fourth thing I always say is, start to think like the owner of a dental practice even if you don't own it, and that to me helps doctors to understand, and I always define that with the docs that I work with, but I want them to understand that you cannot sacrifice long term important investments for short term gain and your relationship with patients are always long term investments, everything you do if you think of it as an owner would being a good steward of resources things like that will help you be a more effective dentist.
Howard: It all starts with... you said, your first one was learn how to hustle, this person ask on a thread, advice for temporizing a toothache, what's a fast way to temporize a toothache. He goes on to say, sometimes, like, at four thirty someone'll walk in with a toothache and they want her to temporize it, and I replied, well, why are you temporizing? Why don't you do your damn job, I mean, if the tooth needs a root canal, build up and a crown, it's four thirty, Why don't you do your damn job? Could you imagine if the fire department showed up at your house on fire and said, well, we all leave in 30 minutes, I think... how do we, what are we going to do? I mean... but you're saying, number one, work hard, hustle and they have an entitlement, and when you tell them that they're also entitled to not having their feelings hurt, have you noticed that? All these universities they don't want any speaker to come in and tell them something they don't want to hear, they don't want to hear a debate about any of the sacred truths. But yeah, working hard and hustling just goes a hell of a long way, doesn't it? Working through lunch, staying at the end of the day.
Guy: It sure does, yeah. I always say I consider that to be well more than half the battle is if you're just willing to work hard and keep going when other people are thinking about quitting. And then the feelings hurt thing, I mean hey, I'm not here to have anybody have their feelings hurt, but I'm also here to tell people the truth. And the truth means, if you're willing to accept the truth that works for me as being coachable, and a coachable person is going to continue to learn and that's the key. I tell young docs something, listen, I've probably made mistakes yesterday, probably earlier today already I've made those mistakes but I learn. And if somebody needs to tell me a hard truth I'll listen and I'll hear it and learn from it and keep moving. I think when we... if we have somebody that's willing to tell us the truth and help us to be better, I think we should not resent them, we should consider them to be a great friend.
Howard: Another thing on these young kids, when you look at associates in private practice and corporate, their turnover is off the charts, it doesn't matter if... a lot of people say, there's thirty five corporate dental chains that have over fifty locations and some of them, their average associate only stays with them one year and it's considered, the better one, the average is two years. They change jobs a lot, but it's not just corporate, it's private practice too. In my thirty years, for every one that I had stay with me a decade someone else stayed a year or two. You know what I mean? Why do you think their turnover is so high?
Guy: Well, that's a great question. I don't... as you're developing that question I'm thinking of examples of people that I can see both sides of that same thing happening. The people that I see that I really have enjoyed working with for a long time have been the folks that really embraced the opportunity to have the power that comes from working with a group of people, being able to share ideas on a regular basis, being able to share some of the economies of scale of the higher technology equipment, like the 3D imaging and on and on, maybe CAD/CAM, things of that nature. In addition to that just the support that comes from, a lot of times... we chose dentistry, I think dentistry is chosen as a profession more recently because of lifestyle reasons. Maybe there are a lot of people that could have gone to medical school or whatever that sort of thing, and maybe they chose dentistry due to lifestyle reasons. Again, that sometimes can lead to disillusionment that it should be really easy or, that whole four thirty analogy, like, well, I chose dentistry so I didn't have to work past five o'clock, well, sorry that's not exact, it's not a perfect science when you're dealing with humans and pain and emergencies and things like that. Yet, having the ability to maybe take a maternity leave without it cost you an arm and a leg, or having the ability to have somebody support you when you're on, rather than being on call all the time, somebody to help you with all the things that quite frankly we dentists most commonly don't like to do, whether it's payroll, accounting, hiring, firing, training, dealing with all the compliance and [00:10:37] [inaudible], and blah blah blah the list goes on. I think the people that appreciate that are the ones that really can fit well in a group practice model, I think it really fits well. If they're a person that's such a lone eagle and they literally cannot work with other people and that sort of thing, that gets to me where it's some of the only times it really makes sense for a doctor to go on their own these days.
Howard: When I talk to the associates and the young kids and the CEOs of some of these deals, I think the ones that keep the longest, like, Heartland, actually has the most robust continued education. And seems like they stay the longest if they're learning something. like, say they come out of school and they want to learn implants, and they know, and they go work for... most private practice associates, the older dentist steals all the big cases and then abuses the kid and just gives them all the fillings and stuff, and single units. And the ones that keep them say, you want the big case? Go for the big case and I'll help you do the big case. So, it looks like they stay the longest because they feel like they're being mentored and are learning something, and you're big into mentoring implants so... and you're a teacher, instructor for OsteoReady, now, did Brady Frank out of Seattle, did he sell that to someone on the East Coast?
Guy: No, well he, Brady still is I believe, the majority owner of the company but Brady has passed on the operational aspects of it to a company that's managing it I guess you could say, doing the operations side of it.
Howard: What company is that?
Guy: It's called Channel Traction out of the Boston.
Howard: It was Channel Traction out of Boston. What's that other implant company out of Boston? The conical shaped one, Bio, what is it Bio...?
Guy: Great question, there's a number of implant companies I believe, around the Boston area, but I apologize I'm not well versed on where they're all out of.
Howard: So, Channel Traction out of Boston is the one managing OsteoReady?
Guy: Yeah. But it's I mean, it's OsteoReady, I think, I probably misspoke on that a little bit, I think Channel Traction does some of the services for them relative to marketing and.
Howard: So, is that the implant system that you use, OsteoReady?
Guy: I do. Yes.
Howard: So, talk about that because you're talking to a lot of millennials, and they come out of school and they see there's anywhere between two hundred and four hundred dental implant companies around the world, and they're just, like... why did you go with OsteoReady?
Guy: Well, it was the first... to me, I had placed implants with a lot of different companies or several different companies over the course of my career, and I saw that OsteoReady had a unique position in that it was really the first implant company built for GPs, which I'm one of, and it's made so that it fits well in a general practice. Even though I do lots of procedures, grafting, sinus lifts, connective tissue grafts, you name it, I do all of that sort of thing. Over the course of my career as I had learned all of those things I had... so, I have kits for vertical approach sinus lifts, lateral approach sinus lifts, I've got all the different grafting kits and several different implant kits including even a mini implant kit that I had utilized, and I utilize on rare occasion now. But the thing was, as I had increased the complexity and sophistication of my practice to where, like, every procedure my assistant's, like, so which kits do you want, what do you want, what you want with this, do you want the...? And which implant do you want to place and all these different things. And what I realized is that I had created a lot of complexity and a lot of confusion quite frankly. And then, God forbid, if your main assistants aren't there one day and you've got to try to explain that to somebody else. So, what I started realizing is that simplicity is the ultimate complexity, and I think Steve Jobs actually is the one that said that, so please don't think I can take credit for that. But the idea that a two year old can pick up an iPad and know how to use it if you can make it, if you can choose an implant system to where it's intuitive and an assistant could pick it up and you can literally use it for virtually any case, to me that was attractive. So, that was that was piece one of the equation. Second thing is that it's really all built around minimally invasive concepts, so to me that means the less amount of times we're doing incisions, having to place sutures the less amount of times that we're having to graft or do sinus lift things like that, to me that's a benefit to the patient, much the same as if I'm doing a veneer case, I don't prep the teeth unless I have to, or unless the teeth are already damaged, I try to be minimally invasive there. I've just been that way with everything I do in my career. And so, for patients, I find they heal faster, implants integrate faster, they have less postoperative pain and for my business it's a huge win because I get tons of referrals from patients going, I can't believe that I had implants done and it didn't hurt, it I didn't... I literally thought I was going to have to take pain meds for, like, three days and I didn't even take one, and that's a common story with these types of cases. So, I've endeavored over the last several years to teach people how to do that and it's been... well, people have traveled either to my my courses in Salina, Kansas, which isn't the easiest place in the world to get to, or I have courses in Kansas City, in fact I teach another one here in less than a month in Kansas City. And the people have traveled from all over to learn how to do minimally invasive concepts because I think it resonates with GPs. The other thing that's great about minimally invasive is that it doesn't take half a day to do an implant it takes, oftentimes we can do those procedures where my time is less than 10 minutes.
Howard: Nice. Associates, they stay the longest when someone's mentoring them, they stay the longest when the senior doc isn't stealing all the big cases and giving them fillings and single unit crowns. But my gosh, I've heard when associates literally walk off the job at these corporates is because the assistant turnover. So, they have a big day scheduled and now they have some temporary assistant, they're, like, where's my assistant? I mean, I couldn't imagine going in there and doing a big case without one of your assistants who's been with you for thirty years or ten years or twelve years. I mean, now that is tough. So, you like the... And you mention Steve Jobs, I heard him say in one of his endless YouTube videos that what he was most proud of was not actually what Apple, the things that he... the features that he did, it was that 95% of the features that he killed from his programmers that were always adding complexity to it and he again... I mean, we grew up in the age of Microsoft where Bill Gates would release a software, it would be riddled with bugs, he knew it, everyone knew it, all your... you'd pay $250 for a piece of software and then you have to pay a $1000 to some IT guy to come in there and get it to work because of all the bugs that are in it, you agree or disagree?
Guy: Yeah, that's true.
Howard: And here was Steve Jobs, he wouldn't release it till it was bug free, simplified, and he said, when I come out with this iPad, or the iPod with music, he says, I want a six year old granddaughter to be able to figure this out with a 60 year old grandmother with no instructions. Whereas Microsoft spun up this whole industry of people trying to teach you how to use Word and PowerPoint and Excel because it was so unbelievably complex that no one even knew how to use it. So yeah, Jobs was an amazing business man.
Howard: I don't know what he was on a personal level, I don't know if I'd want him to be my dad, but he was a complex dude to say the least. So, you like OsteoReady because of the simplicity and you can have one system that's intuitive for the whole staff, is that right?
Guy: That's right.
Howard: Is that it, in a nutshell?
Guy: Yeah, there's little to no question what we're going to be doing when it comes to implant and grafting cases, my assistants know exactly what they need. So, I've got a lot of old systems sitting on shelves in my office that I had utilized for various things and whether or not they actually ever cash flowed for themselves is debatable. But my OsteoReady system... I had probably placed somewhere between a thousand and two thousand implants before I got into OsteoReady, and then I have literally, even in just the last couple of years I have done more like six hundred some a year and it just has exploded quite nicely in all... I mean, almost all of it has been with that one system. I mean, anteriors, posteriors, doing short wide implants under the sinuses, doing narrow implants in narrow ridges, things like that we can do it all. And I've really embraced it, and worked to find what it can and can't do, and so far I haven't found too many things it can't do, and I really like that. And so it makes it fun for me to teach, because I really have seen some doctors transform their practices in a huge way. In fact tomorrow I'm headed to our practice in, one of our practices in the Kansas City area and I'm working with a doctor there, back to sort of, the mentorship thing, but we're going to treat I believe eight patients tomorrow and it'll only take probably about six hours by the time we start to finish on all that. And I think we will have placed maybe eleven implants. It's one of her first days doing it, I'll be there to help her, we'll go through it. She's taken my course at least once if not twice, and then she's come and observed me doing surgeries and then I've gone to her practice we've done some surgeries together. And now, tomorrow is the day she gets to jump in and really get her hands on it, and so I'm excited for her to do that. And that's been a process that we've done, that I've done with my doctors. You're absolutely right, I saw so many, even from my classmates, class of 2002, I saw the doctor that hired them cherry picking their cases, turning them into glorified hygienists almost. And then basically they stagnated, they weren't learning and in fact a lot of those people almost seemed like they never did recover back to where they were really doing great as dentists, they just got off to such a bad start in their careers. So, my objective has been to help doctors really accelerate their potential, do cases. One of my associates that joined me a year ago, a little over a year ago, within her first month she had a patient enlisted to do an $18000 treatment plan and you know what? I... our hygienist's lovely, experienced enough to help her get through it, she got it all treatment planned up and I helped her figure out how to do it, and I did none of it. I just coached her through the process even to some extent sitting there, being in the room on certain technical parts and she took it from there, but [00:23:03] [inaudible].
Howard: So, how many offices...? So, you're the owner of New Horizons Dental?
Howard: Are you the sole owner?
Howard: And how many locations do you have now?
Guy: I have ten doctors in eight locations.
Howard: You have ten dentists and eight locations? And do you... and are they all named the same is it branded, like, or are they all different names?
Guy: They actually all have different names, we utilize the names of more location based names so that it... for specific reasons of primarily for a little bit of risk management and a lot of marketing reasons for that.
Howard: Yeah. So, do you prefer one doctor per location versus two? A lot of people who manage a lot of offices say that when you add doctors to a location the HR, it's almost like, logarithmic, like, when you have one doctor and six [00:24:05] [inaudible] and two hygienists and two assistants and two front there's almost no H.R. management. But as soon as you get two doctors, humans are very tribal, they're programmed at birth to follow the four hundred pound gorilla. And when you have two four hundred pound gorillas in there it's more confusing to all the other humans in the room. And by the time... and then... what I saw, I'll never forget. Kaiser Permanente had nine dental offices, they went from one was seven chair, one was nine chair went to twelve, fifteen, went all the way to I think it was like eighty chairs, by the time they got to eighty chairs... and they had a complaint department, and I was standing there at the complaint department watching this lady slap her hand on the deal wanting to know where her damn crown was. The director of that told me the same thing, he says... But anyway, do you find single doctor locations easier? Your motto is: happy docs, happy teams, happy patients. Do you think it's easier to have happy docs, happy teams, happy patients, with one doctor in a location versus two or three or four?
Guy: That's a great question. I think doctors, you're right, some doctors are wired to work on their own and it works better that way. Others would prefer to work in a group. Most of our practices, in fact all but one at this point, are all solo doctor practices. My main location has four doctors.
Howard: That's in Salina, Kansas?
Guy: Yeah. And I work there, as does my wife, and so I think it works well because of our relative roles in that practice. We've, sort of, treated it like a super GP practice where each doc, sort of, has carved out their own niche, if you will, with mine be in the implant aspects and the reconstructive things. My wife's niche is more specifically in orthodontics and sedation procedures. So, we each, kind of, have our things that we do there and it works out pretty well, so we take care of each other. If you get docs that are that are ultra competitive and they're in the same practice and it's a competition, some people thrive in that environment and some people just go to war with each other and it doesn't work well. So, I'm very, very careful about that, and I think the solo doctor practice in our smaller locations works really well.
Howard: Yeah, that's why... all the comedians who Saturday Night Live over the years said the same thing, it's just an all out war to try to get your skit approved and get time on the show. And some people thrive in that environment and other comedians just felt ran over and didn't like it. So, when you... so, go back to UMKC, you graduated in 2002, I graduated there in '87 you're from Salina, Kansas, I'm from Wichita, Kansas. Do you think when I got out of school thirty years ago all the docs wanted to own their own practice and it's different today in 2017? Do you think the percent of millennials coming out of UMKC at 2017 the same percentage want to work alone? Or do you think that what you're doing, taking away the business aspect of it so they can just do clinical dentistry, do you think that there's more people who want to do that and be an employee their whole career? Or what do you think is... has the mindset changed in thirty years?
Guy: Yeah, I mean, I know you can relate to the idea that there is a mindset thing in dentistry where it seems to be, sort of, a noble pursuit to hang your own shingle and have your own place and all of that. That certainly has been the traditional mindset in our profession, and I don't necessarily have any problem with that. Yet, at the same time I do realize that there's economic drivers here that that don't make sense as much as they used to. I mean, the... one, the amount of student debt load is just crazy for young doctors and in many cases. Couple that with the pressures to start a family, buy a house, whatever, hopefully they aren't going to go ahead and buy their Ferrari on their first year, but some of them do of course and that doesn't help them with their practice at all. But the mindset being that I can get more access to technology, better cost drivers on all of my supplies, equipment, lab, things of that nature reduce the workload in terms of all the extra stuff that I would be required to do, and so I think a lot of doctors are getting back to choosing the lifestyle aspect of the profession. It's not terribly dissimilar to what you're seeing in medicine, in that I've seen a lot of practices being sold to the hospital in our community, in our area, where the doctors are saying, I just want to do medicine and come in and do my work and then go home. And I think that makes a lot of sense, and the way that I sort of, explain this is, I know doctors, optometrists, chiropractors, I see them, I know people that are doing their own payroll, they're doing their own accounting, they're attempting to anyway, they're even mowing the lawn at their practice and stuff like that. Whatever it is they're doing it themselves with the idea that they're saving money. And I look at it differently, I look at it with the concept of leverage, in that the more I can do dentistry and be great at dentistry I'm going to budget a specific amount of time to make sure I'm either doing or learning dentistry, and now, to a large extent, teaching dentistry, which is learning in my opinion. I have a certain amount of time that come hell or high water I'm going to do that every week, and so then the rest of my time is, sort of, an arbitrage spin between, does it make more sense to pay somebody to do this relative to the value that it would bring to my life. So, now I choose things like coaching football and baseball and basketball and things like that, over doing all this extra work myself and every doctor is going to be forced to choose there's always a cost, it's either going to cost you cash or it's going to... if you're saying yes, just like Steve Jobs said, I mean, all the things he said no to are a big part of his success. So, I say no to a lot of things so that I can say yes to my family, I can say yes to teaching, I can say yes to a continuing ed course, things like that.
Howard: So, when you're managing ten dentists and eight locations are they all on the same practice management software?
Howard: And which one did you go with?
Guy: We use Dentrix at this point with all of our practices.
Howard: Just Dentrix regular or Dentrix Enterprise?
Howard: Regular? Do you use anything else like some of these dashboard companies?
Howard: Which ones do you use?
Guy: We've worked with Practice Analytics for several years, I know there are competing products out there but that one has done a great job for us, they do well.
Howard: And tell us about practice analytics.
Guy: So, it's a company that basically pulls all the data out of each practice on a daily basis, allows us to look at metrics down to, I mean, down to the very, even down to patient by patient metrics per provider in every practice. So, you can look at your key performance indicators of how a practice is doing certainly in production collections, booked treatment for the month, things like that. You can project and forecast how your operations are going to go and where your cash flow needs are going to be and things like that very well with this software. It's all online...
Howard: Does it only work with Dentrix?
Guy: I don't believe so. I believe they could work with multiple software and they have an app where you can pull it right up on your phone, so I could be anywhere where I'm connected and look at what's going on in every practice.
Howard: And who's the CEO of that?
Guy: Geoff Clark I believe is his name.
Howard: And do you ever speak with Geoff Clark in trying to...? I mean, I'm sure since you have eight locations you probably need a higher degree of sophistication than a solo practitioner person, does he work with...?
Howard: Do you ever talk to him?
Guy: Yeah, and they, to my knowledge they continue to evolve their product, even developing some custom solutions. But I'd be remiss if I didn't mention my Operations Director, Scott that works with me and has helped me build this company. He really is the point man with Geoff, and they talk on a routine basis.
Howard: What's your point guys name?
Guy: Scott Guest.
Howard: And is he like an accountant or a CPA or what is his background to help you manage eight locations?
Guy: He's neither. Scott is... Scott spent ten years in basically helping build the personnel and product side of a marketing company, and it was a database company. So, Scott spent ten years working in the trenches building another company. So, he came in, started working with us and... anyway, he's helped us from the time where I had a two practice operation at the time and we've grown it from there together.
Howard: So, UMKC is a public school, when we're looking at student loan debt the debts are higher when they're coming out of private schools. What do you think the average debt is that you see walking out of UMKC? Which is a public dental school in Kansas City.
Guy: Yeah, I think it's still pushing... I think they're spending somewhere in the range of $60000 a year just on tuition, so they're a quarter of a million, three hundred thousand, depending if they have to get to finance their living expenses as well.
Howard: But a lot of that is simply access to capital. So, I mean, I raised four boys and yours are eleven, ten and eight, so right now you think you're the greatest father in the world because all your children are perfect and I'm just telling you that one by one you're going to give him a set of car keys and you'll get into more trouble from age sixteen to eighteen than you could even... Yeah, so I call your time the calm before the storm, talk to me after all three of your kids have a set of car keys and tell me how perfect they are, no, I'm just kidding. But they started mailing my four boys credit card applications when they were like, ten years old, twelve years old. If I would have given each one of my four boys when they were sixteen a credit card with a $300000 line of credit, what do you think they would have done with that at sixteen?
Guy: Spent it all.
Howard: They would have gone out and bought four wheel drives and boats and jet skis, and I look at these kids and I mean, they're complaining about their debt but my god they on spring break say, they fly and go on vacations and take cruises, they come out of school. I just met a guy the other day, on graduating dental school he has an $85000 BMW, like, an $85000, I didn't have a car... undergrad at Creighton University, and I didn't have a car in dental school at UMKC when I lived eight blocks away from the dental school in Kansas City, the first three years. I only got a car senior year because I thought when I graduated I'd need to have a car, I can't be a dentist and walk to work every day. And I never would have... when we were a little a spring break was you went back home to live with mom and dad for free and ate free at mom and dad's kitchen table for a week. I mean, I don't understand, there are a lot... what I'm saying is this, their student loan debt is because they've had too much access to capital. I mean, some of them decide they're going to get married in school and have two kids. Well, could you get married in school and have two kids if you didn't have access to putting a $150000 a year on a credit card? If you just went in there and say, well no, you have no access to capital, then they would have said, okay, well we have no access, we're not having a child. So, a lot of that is just because they were extended too much capital. But on that note, since they were very young, and they did have way too much capital than they should have had, and the schools I think are seriously taking advantage of them. I mean, I think there's not a single dental school I know that has sympathy for the student loan and debt mess, and saying, how can we teach these kids faster, easier or higher quality for a lower fee, I don't see any discussion about that. But when they do come out of school what are smart investments for young Dentists? You talked about, I mean, do you think... What do you think? You talked about 3D imaging some of the high ticket items are 3D imaging, chair-side milling, laser, CBCTs, what do you think for your ten doctors, eight locations, what do you think is a smart investment for a young Dentist?
Guy: So, my perspective on that is, if I was a young dentist, which is hard for me to think I'm not anymore.
Howard: Ah, you're a baby, you're forty one, I'm fifty five next week dude.
Guy: Fifteen years under my belt right here, I used to think fifteen was like, a whole lifetime. I think as a young dentist the key is not to fall in the trap of trying to act rich, look rich, all of that. I mean, you certainly want to be... you don't want to act poor necessarily, but you... my investment advice would be, steer clear of the fancy cars, the boats, the houses. I personally, I don't know why, maybe it's how I was raised, but I still don't drive the $85000 BMW even if I could go pay cash and whatever. I mean, I'm not trying to say... I'm just saying I don't do it just out of principle, I still... heck, I like to buy, I currently drive a 2011 Infiniti QX60 or something like that, I've had it for several years because I just think I found one that was, like, spanking new and somebody had taken great care of it, didn't drive it very much and I'm like, hey that's just a lot smarter investment for me, so. But either way I don't think that cars are anything to do with something for a dentist. So, I... really the three things that you want to invest in, in my opinion, are one, your education, okay? I could show you ROI calculations on taking my dental implant course for instance, and courses that I've done over the years. I took courses on learning how to do functional anterior veneers with David Hornbrook back when I first started doing hands on patient treatment things like that, that has paid for itself over and over and over again throughout my career. It's like I built an annuity, granted I had to work, I mean, there was no, I had to show up and work, same thing for implant courses, grafting courses. Even if you just spend your time getting great at crowns, getting great at [00:40:32] [inaudible].
Howard: Do you know David Hornbrook's oldest son is named Phoenix?
Guy: Yeah, I know Phoenix.
Howard: And you know why?
Guy: Is it because.
Howard: Because I'm the father. He doesn't like to tell people that but that's... he didn't want to name him Howard, that was too obvious, so he named him Phoenix, where Howard lives.
Guy: I get that, I totally get that. Yeah, so I spent a lot of money and time, it was like, I'd literally just got out of dental school and I started, kind of, doubling down on my education thereafter. I had enough hours to become a Fellow of the Academy of General Dentistry within almost three years of graduating. And I found that to be the most... I mean, I could look at my investment portfolio, real estate, all this junk that I've accumulated over the years whatever it is, nothing pays like the continuing education that I invested in, there is nothing close. So, I think you learn enough to go learn more once you get done with dental school. And unfortunately it costs you a lot of money now, and it cost... I mean, my wife and I were, we both went through at the same time, we came out like $265000 in debt, but thankfully there were two of us.
Howard: Combined or each?
Howard: Two sixty?
Guy: Yeah. So we started pounding away at that debt.
Howard: I've been reading today, One of the girls in your class that her father was paying... your wife's dad was a dentist, didn't you date all the girls who would have no student loan debt first before you started dating Katie?
Guy: Yeah, I just wasn't smart enough.
Howard: Do you think that was a bad move?
Guy: Yeah well, I think it's been okay. She's been pretty solid on her performance on the back half of the [00:42:19] [inaudible].
Howard: Where does her dad practice?
Guy: He practiced in Salina, Kansas actually as well and so he retired...
Howard: Does he still practice?
Guy: No, he retired, he graduated UNKC in '78, and that was after a four year stint in the Navy as well, so he's I think seventy now.
Howard: What year did he graduate?
Howard: So, do you tell your three children that someone's got to be the third generation dentist?
Guy: Yeah. Well, they got the idea, we'll see what happens.
Howard: Grandpa, mom, dad.
Guy: Yeah, there's a lot of dentists in our family that's for sure, and.
Howard: Seriously, how many?
Guy: Well, between... on this side there's the three of us, and then my brother in law, so, my wife's brother married a girl who has four dentists in her family and we... between all of us there's a bunch of us out there, yeah.
Howard: So, I completely agree, I mean, watching dentists for... the number one thing you said was education, and in my thirty years trying to track who was successful. Number one, they hustle, number two, they were humble. And the education... it was about... the people who did a hundred hours a year their whole career, got so many great ideas, they always [00:43:39] [inaudible]. And the ones who were complaining that they had to have twenty hours to get their license renewed, they didn't seem happy, they seemed burned out, they didn't seem to like dentistry or enjoy it. But my specific question is, you and I both were members of the AGD, you got your Fellowship in the AGD, so did I, do you think just getting the hundred hours a year is enough, or do you think there was something special or magical about joining the AGD, and did that help your journey?
Guy: Well, it did help my journey in terms of accumulating hours and having a track that I was on. It, sort of, just happened though, I'm, I guess, a guy, I refuse to be the guy that was constantly referring every case out. And so I really attacked into education even while I was in dental school and then I started really doing the same thing with implants while I was in dental school so then I continued on that track. Well, then I started realizing that I obviously needed to be great at crowns and fillings and I was going to continue to work on that, but I wanted to be able to do the restorative cases, not just like the, I call it dump truck dentistry, where you see a cavity you fill it, you see a cracked tooth you crown it whatever, I try to do it as, hey, let's look at this full mouth, why is there all this wear and tear, why... are they interested in improving their smile? And we started looking at ways to ask the questions more comprehensively about how to take care of patients. So, the big cases started happening only when I was really ready for them and I had the confidence to present them and recommend them, and the patients could tell that I knew what I was doing and I could deliver the care. So, that was a huge thing, the education, I can't underscore that enough. And I totally agree with what you said, the doctors who have invested and continue to invest in themselves and their education are most fulfilled and happy as dentists, the doctors who have stagnated and are trying to just get their hours by showing up at the local dental society every month or whatever and that's all they do, tend to be the least happy doctors I meet. And so that's something I said. The second investment I would encourage doctors to make is in their own leadership capabilities and their communication skills which parlays into building a great team around them. If you can understand how to build your team I feel like... I read a stat the other day that it's something like 33% of the workforce is actually engaged in what they do nowadays, and it said, even in Germany it's as low as 12% now, and it's on the decline everywhere, people are disengaged, they're not... and the interesting thing is, being happy at work, like, smiling and laughing and all the time, isn't necessarily a criteria for being engaged, because you can be happy sitting still doing nothing. The key to engagement is to have a team that understands the commitment to what we're trying to accomplish, and I've felt like this, I've felt this way for years, that the success of my organization has been directly correlated to my ability to build the people in the organization around a consistent vision and a consistent culture that is a culture of success, I guess, if you will.
Howard: So, when someone's trying to learn leadership, and of course these kids, they know what they know, they don't know what they don't know, navigating all the other seven and a half billion humans on Earth, hell, just navigating through a family reunion or Thanksgiving dinner I mean, that's the number one skill set you need. Is there any book or course on leadership? Looking back was there anything you'd recommend on leadership the most? I mean, for clinical you recommend Hornbrook, and implants, but on leadership anything ring a bell?
Guy: Well, one of the things that I've done over the years has been, I'm an avid reader and so I have spent a lot of time investing in time of my own. I go to the library a lot, I go to bookstores a lot, I'm kind of, a geek like that. And so, I've discovered that it's a, leadership is a moving target, and I fully believe that leaders are made, not necessarily born. I believe that you can learn skill sets that are going to move you in the direction of being a leader, but it starts by having an understanding what are you really trying to accomplish in your practice, as a as a person, as a dentist, as a human being on this planet, whatever you're really trying to accomplish. And then setting out by... really leadership starts with knowing what that is and then living that daily and encouraging other people to follow you and helping them understand why that's important. I mean, I think it can be distilled down to fairly simple things, but I bet if I took you over to the library here in my house where I'd put all my books and obviously it doesn't have all my downloaded books that I've read, I bet there's a thousand over there that I've read, and I continue to do so because I don't know that there's like, a course you could take on leadership. Now, there are certainly systems that you can follow, and one of the best people I've ever seen at teaching people how to lead a practice, how to build a culture of success in their practice and things like that is Steve Anderson, who has an organization called Tops, I feel like he does a great job with that.
Howard: Well, my advice on that would be, you're heavily involved in coaching your boys football and sporting events, things like that, and I always say you're a special person, you're a snowflake. Who was your great leader? Go back in your life, who touched you, who motivated you, who connected with you? Try to be that guy. And I bet a lot of these kids that are eleven and ten years old that you're coaching when they grow up, they're going to be great leaders because you're going to rub off on them and and every one of these little ten and eleven year old boys that you connect with, when they grow up they're going to want to be like you, and they're going to use what you're saying. Like you said on the beginning of the show, when you're with people try to make them feel good, try to make them, the time spent with you as special. So, I say, who totally connected with you, be that person. But back to the... I'm going to hold your feet to the fire, what about all these expensive things the return on investments, small investments for young dental students, what about all these are high tech things. What are... for your eight locations, how many of them have lasers, CBCTs, chair-side milling, all this expensive stuff where you can have as little as three purchases and then double your student loan indebtedness?
Guy: Yeah, yeah. I'm like, I do own some equipment that costs more than my first house, and that's not bragging rights, that's just the reality of how it is. My first i-Cat, I'm like, holy smokes. But here's my rationale, and there's a lot of garbage junk that I believe the salesmen try to get us to buy into, like, all the wonderful benefits of your Section 179 deduction and blah blah blah, and how an i-Cat will pay for itself because you get to charge this much more every time you use it, and I think most of that is a load. My consideration is what investments, the first investments I would make in a practice, start with things that you can do to make a patient more comfortable, things that you can do to generate more referrals, things that you can do to make raving fans out of your patients. If you wanted to build your practice start there. And guess what, a lot of that stuff's pretty darned inexpensive. The second thing is then to look at what else you can accomplish based on, if it's a technology investment, I mean, if you're going to buy a chair-side milling or CAD/CAM or things like that you have to understand that that's only going to be as effective as you implement it. So, every time I make a budget to buy a new piece of equipment the first thing I do is I also build a budget for implementation and that budget includes both time and money. And if you don't do that I feel like most investments dentist make actually fizzle out, and a lot of times they buy really expensive dust collectors. And so, implementation is the more critical element of the investments that you make. If you can avoid all that, the pitfalls of lack of implementation I think you'll go a long ways. So, I have no doubt in my practice that having CBCT imaging has accelerated my practice because I make it available to patients. I use it to show them things they can see that we're able to diagnose and treatment plan minimally invasive implants because of it. And there is absolutely zero question that I have accelerated my implant practice because I have that technology.
Howard: How many of your locations have a CBCT?
Guy: Three of them.
Guy: And which one, are they all three the same kind?
Guy: Yeah, we use i-Cat.
Howard: i-Cat in each one?
Guy: Yeah. My main practice that has the four doctors we have the, oh the i-Cat Flex. So, we upgraded that one and moved our next gen over to our Kansas City area locations and then we have the Wichita area covered with the same thing. So, it has been a tremendous thing for us, it really has. Yet, if you're not ready clinically to invest in implants some of that stuff doesn't make as much sense.
Howard: And why did you go with i-Cat? There's so many, help them understand your decision making process of why you went with i-Cat.
Guy: At the time I bought it, which I've had i-Cat since 2008 or 9, I think, no, no, no, that's not right, probably you're closer to 2011-12 is when I bought i-Cat for the first time. So, I had placed a lot of implants with 2D imaging, and keep in mind that anytime you're working in 2D most of your cases need to be you know flap implant cases to see the bone, so I look at it as the i-Cat helped me to start to do surgeries virtually before I started placing them surgically. But the decision at that time was one built around their software, I felt like their software, especially at that time, was superior to every other software. So, I was getting great image quality which allowed me to look at implant planning, we're doing Ceph tracings with it, we're doing airway evaluation, we're looking at skeletal things. So, we use it a lot and it really has been helpful to us in our practice for all of the doctors, not just me as an implant doctor. If all you're doing is implants and that's all you want to look at there may be better ones, there may be lower cost ones, for us it was the best. The other part of it was in my area the support I got through Henry Shine and my local rep and things like that was far superior with the iCat product, so I went with it. And that has, that's stood the test of time, they've done a great job for us.
Howard: Did you ever go visit them in Hatfield, Pennsylvania?
Guy: I didn't go to Hatfield but I attended 3D imaging conferences, actually in Dallas, a couple of times and even ended up lecturing at some of their conferences after that, because I was a fairly early adopter. The way I was using the cone beam technology was something they hadn't seen before, so they had me start speaking to that a little bit about implementing it into a general practice.
Howard: So, on the first one you said invest in the stuff that makes patients more comfortable and more likely to refer. What specific things were you talking about?
Guy: Well, I would make sure that you have invested in maybe spending a little bit to make the creature comforts in your office a little bit more robust, whether it's the nice memory foam pads for your chairs if you have long procedures, the ability to offer sedation procedures or even just nitrous. I think TVs in the ceilings go a long way, headphones, neck pillows some things that are really fairly low cost you can do to make patients way more comfortable. And I feel like again, I talked about my sedation aspects of our practice, I invested in sedation training somewhere around 2004-5 somewhere in there, and I'll tell you that has paid for itself a million times over. Again, not in the fees that I charge for the sedation, but in the cases that I can do for people that otherwise wouldn't get complex dentistry done, because they'll come in and they don't even have to know they were with me for a whole day and they can wake up, as far as they're concerned they wake up and realize that their dentistry is all done.
Howard: So, after CBCT, what other do you think, smart investments for young dentists? You said all these creature comforts that make patients more comfortable, more likely to refer, then you said a CBCT, you went with i-Cat in three of your locations. What about some of the other big... what about chair-side milling? Of your eight locations how many have chair-side milling?
Guy: All of them have chair-side acquisition units for like... and we utilize iTero. So, we use that to do acquisition of scans for Invisalign, for crowns, bridges, implant restorations and all of that. Every practice has that, and actually only one practice has the milling capabilities. We currently outsource a lot of our manufacturing and milling to labs still, but that's something that we've looked at in-sourcing, I just want to make sure that when we in-source that that again, back to Steve Jobs, I say yes to certain things, I say no to a lot of things and I don't want to end up with a distraction where we're spending a lot of money to get crowns that aren't even as good as what our lab can do for us. With the digital scanning we're getting great results with our lab technicians and so I'm very happy with that, the cost is something that fits in our budget, so as of now it works. We may eventually in-source our milling and manufacturing of the crowns and bridges though.
Howard: So, on the bread and butter, a single unit, most crown and bridge is done on a first molar. Most crown and bridges are sent to the lab one unit at a time. On your average [01:00:23] [inaudible] molar single unit crown are you guys sending in an iTero scan or a triple tray impression with vinyl [01:00:32] [inaudible] or a polyether like Impregum?
Guy: That has transitioned, where we used to utilize polyvinyl exclusively we now do probably 80% or more of them with a digital scan.
Howard: 80% of them digital scan. And those all go to one lab?
Guy: Yes, I would say we have it down to about three total labs across the whole group of practices.
Howard: And any, want to give any names? Dentists are always looking for a lab.
Guy: Yeah, well, I utilize... we've worked some with... our main lab that I've utilized for twenty some years is actually Sunflower Dental Studios in Topeka, Kansas. They do great with the digital technology.
Howard: Sunflower Dental Studios? And do they give you a discount since you're sending in a scan versus an impression since... some labs say well if you send me Impregum and a quadrant tray I've got to pay a human to pour it up in stone, trim the die, some give discount... do they give a discount for scans, or not really?
Guy: Currently with iTero you send the scan initially to them. They trim, they basically do the model work virtually, trace the margins, do all that and then send it off to the lab. And so I believe the lab picks up the fee that iTero pays, so instead of it necessarily being that it costs you less it'll just pass through, in effect it saves us mostly on time and shipping and re-makes, I mean, we see super duper nice quality with those restorations. So, we use them use the company, we've used Arrowhead Dental Labs, use another company called Albensi. There's been a number that have done a great job for us.
Howard: What was the third one?
Guy: Albensi, A-L-B-E-N-S-I.
Howard: Where are they at?
Guy: Texas, and I'm remiss to say where.
Howard: Did you ever meet... with Arrowhead, that's Dick Barnes out in, what is it, Fork, Utah, or what's the name of that city?
Guy: Yeah, they're in...
Howard: South fork, South bend, something like that?
Guy: Yes, I think that's right.
Howard: Did you ever meet Dick Barnes?
Guy: Not in person.
Howard: He was... maybe a little before your time, but everybody in my generation saw Dick Barnes and [01:03:00] [inaudible]. And when you got done seeing Dick Barnes you were barnesified, love that guy.
Guy: Yes, I know. I definitely know of Dick Barnes, there's no question about it. I know exactly who he is.
Howard: Just an intense man, just a really, really neat man. So, iTero, it seems like the two biggest growth sectors in dentistry around the world from Kansas to Kathmandu to Malaysia to Cambodia, is implants and Invisalign. iTero is actually owned by Invisalign, correct?
Guy: I believe, I know there's a relationship there, but I don't know.
Howard: Yeah, they bought them because... so, is your eight locations also doing a lot of Invisalign with the iTero scanner?
Howard: What percent of your doctors are doing Invisalign?
Guy: I would say at this moment in time probably 80% of them are doing it maybe more. We have a few, even in our main practice as of now, most of the work in orthodontic, anything orthodontic related is done by one doctor. But the other doctors have started taking the courses to learn, they've done the basics and maybe even the intermediary course, and we've done a lot of that. In fact I have a doctor study club two weeks from today, no I'm sorry, yeah, in two weeks or a week from Friday I should say, we have our group of doctors coming in for study club, Thursday night and Friday and we're spending four hours doing Invisalign training with them. So, we're continuing to allow them to learn Invisalign, we have a lot of great support around that. So, it's been a fun adjunct to a lot of our doctors to build and add Invisalign And when you can scan it, and they even have an outcome simulator built into the software that allows you to very quickly give the patient a pretty decent idea what their teeth might look like if they were straight. That has been a really cool thing and then having the training on Invisalign has allowed us to realize that there are a lot of things that we could do to improve outcomes of cases and get less of the having to go back and have new trays made or revision type corrections made mid course or late course ortho.
Howard: Yeah well, a lot of people love the orthodontics like Invisalign and the implants because so many countries the government controls the fees on root canals, fillings and crowns. Like in Tokyo, London, Paris you only get $100 for a molar root canal. So, the dentists there told me that if they did it like we do it in America it would cost them $300 or $400, so, how do you do a $400 molar root canal for $100? So.
Guy: Doesn't work to well.
Howard: So, guess what they do.
Guy: Pull teeth.
Howard: Well, I mean, would you pull the tooth and do an implant and try to stay in business or go bankrupt doing $400 root canals for a $100? And when you tell that to people... like, when people say that healthcare should be free what does that mean? Does that mean the government's going to show up to your house, arrest you and take you to a government facility and make you do free dentistry the rest of your life? I mean, people are out of their mind when they say that things are free. They're nothing free on earth, everything costs money and there's economic models that are more efficient than other economic models. So, besides CBCT, iTero scanning, any other... you like taking the scan and outsourcing your milling, any... what about lasers, of you're eight locations, what about lasers?
Guy: Yeah, most of the locations have at least diode lasers, soft tissue lasers. We do have a WaterLase that I've had for a number of years, and I'll be honest I don't use it a lot. There's a few indications where I need it here and there. But the diode still... I use it for gingival recontouring, gingival lift type procedures, use it occasionally for troughing, that sort of thing. My rule of thumb with lasers or with diode around crown preps, is I only use it if the tissue's unhealthy and thankfully we've built in such a healthy periodontal program in our practices that I don't work on unhealthy gums very often. So, I might just use like a zero cord real quick and put that in rather than taking away healthy tissue with a laser. So, just depends on the situation, but I like to have it available for when I need it.
Howard: Two more quick questions, you promised me an hour, I've gone way over. You're in Salina, you have offices... bottom line question, do you think these dental graduates have a better economic opportunity going rural, like, in cities like where you're at in Salina, versus staying in downtown Kansas City which has you UMKC Dental School? What's a graduating class these days at UMKC Dental, how big's their class size?
Guy: To my knowledge it's a hundred.
Howard: A hundred? And here, I'm in Phoenix, and when I got here thirty years ago there was no fluoride in the water and no dental schools. Now, there's fluoride in the water, two dental schools Midwestern is graduating a hundred and forty a year, A.T. Still and Mesa's a hundred a year, and there were no schools in Nevada, now Nevada has a dental school in Las Vegas. There were no dental schools in Utah, now there's two. So, the supply and demand ratio of dentistry in Phoenix has severely, severely changed. Which is a huge benefit for the consumer, the patient, and for the dental insurance companies but not for the earning powers of a dentist. Would you say with UMKC Dental School dumping a hundred dentists a year in Kansas City that you have better economic opportunity leaving Kansas City and going you know an hour or two hours out of town to rural?
Guy: Yeah, I do. In fact we've seen doctors be able to go in and literally be the... I mean, we have one practice for instance where you know we always joke that the doctor's pretty much been elected mayor already and he's only been there two years. They're so happy to have him, and he is the one show in the entire county. And so, for him economically, he came out of a private dental school $400000 in debt, and he's chipping away at it at a rapid pace. Meanwhile doctors in Kansas City, I heard a guy say, in Kansas City you can't swing a cat without hitting five dentists, whatever the heck that means. But it's, kind of, true, you go there and it's like there's a dentist on every corner and some multiples on the same block and whatever else. And I think a lot of people love Kansas City and they've gone there, they've lived there for four years, they want to stay... maybe they meet somebody from there so they decide to stay there. But let's just say it's not a good business decision in my opinion, compared to... I can drive to Kansas City in two hours and I'm completely fine doing that, and meanwhile I can be in an area where they need me and not be sitting there trying to... everybody's fighting for the same group of patients. It doesn't mean... I feel like every town has room for a good dentist, but it takes a while for them to know that you're a good dentist and so you better be ready to buckle down and [01:11:01] [inaudible].
Howard: I'd say in the... like, downtown Kansas City or Scottsdale there's always room for a great dentist. I would say there's no room for a good dentist in Scottsdale. I mean, you got to go from good to great to differentiate.
Guy: That's fair, I would say that's very fair.
Howard: You've got to be great. And I'll tell you what, it seems like every dental student I know that went two hours out of the city is crushing it. And like you say, this guy's in a small town and he's already ready to run for mayor. Last question, I'll let you go, last question. So, there's probably a lot of... when I ask these kids to email me firstname.lastname@example.org and tell me, who are you, why you listen to the show? Who do you want to hear? How old are you whatever. I was really surprised at how many emails I got that were from D two, D three, D four, I mean, my evidence it's greater than a quarter are still in dental school. What would you say to two kids dating right now, you married your wife out of your graduating class?
Guy: We were even smarter than that Howard, we got married before dental school and went all the way through and somehow survived.
Howard: That's amazing. What advice would you have two lovers right now who are listening to you in dental school and thinking about tying the knot? Do you work in the same office? How do you work in the same office together and then go home and raise three kids? How do you not kill each other if you're with each other twenty four hours a day? What have you learned going through dental school, being married, what? Fifteen years to your honey bunny, how many years you been married?
Guy: Nineteen years actually.
Howard: What advice would you give that love couple listening to you right now?
Guy: I think that it's good to develop interests that you have outside of dentistry. I think it's okay to be able to talk... we've dissected this a little bit over the years. I mean, we looked at... there are probably a lot more benefits than, or pros than cons in dental school going through it together, in that we both understood what each other was going through, we were doing a lot of the same thing, so when it was time to study, time to work in the lab, time to do whatever we didn't... it wasn't like we felt neglected, that certainly seemed to be a problem with some of the other marriages I think at times. But we... so, over the years, don't get me wrong, we've talked a lot of dentistry and we've had a lot of dentist dinners where we talk about our patients of the day and this and that. But we also, we both continue to explore our own educational interests so that we have unique perspectives on things. We both read a lot. We both invest a lot in trying to... in health and wellness and exercise and things like that. And so we make a lot of those kind of things our...
Howard: Let me throw you under the bus with the number one complaint from all hygienists, assistants and staff. They say that whenever the husband and wife are dentists in the office it's so confusing because the husband's always saying go right, and then the wife's saying go left, and the staff's like, well, if I ask the husband this he'll say no but the wife will say yes. And they always want to org chart, I mean, the Catholic Church only has one Pope, then Archbishops, the military's got one general, then captains, then infantry. How do you solve the problem that staff says, hey how do you like working for two Gods name lightning and thunder? And it's total confusion, how do you solve the org chart?
Guy: Okay well, I understand the question a little bit more clearly now and I think one, we've spent a lot... we sit down usually every six months and we plan our calendar over a year in advance and we... in the process of planning our calendar we put in the things that are most important which include the... well, we start with our personal things that we want to do. But we also set our, revisit our goals and our vision for our practice and that sort of thing. So, we've been very clearly communicating from the get go, about where we're trying to go with all this. And so then we, sort of, created a division of labor if you will. Kate oversees the ortho side of the practice, I oversee the implant, but when it comes to the overall practice I lead the practice. And then when it comes to the home, Kate leads the home. We still have a traditional approach, but we make sure we confer with each other so it isn't one of those deals where left hand doesn't know what right hand's doing. It starts with communication, in fact we've made it, over the course of our practice time frame we've made... communication is our numero uno core value of our business and every business we've built. And we've always planned, set time aside to plan for and revisit goals and check in on where we're at and make sure we're all tracking. I get together with my doctors every other week for at least a half hour to an hour, to check in on where we're at, how we're doing. And then we do the same thing with our whole team at least once or twice a month and it's on the calendar twelve months in advance.
Howard: And last thing I'll say is this, remember doc, even if you're not married to your spouse who works in your office, if you have an office manager and your office managers in charge of H.R. or whatever and they go to her and ask her a question and they don't like it and they go to you and they ask you the question, you have to... they're human, so you have to listen, show empathy, totally listen them out, and then you say, well, what did Lori say? So they know that you can't go around the org chart. And in the Pentagon, which has three million employees, the number one thing that will send you to Leavenworth, which is right up the street from you, is when you do not obey your commanding officer and you go around your commanding officer, and you go over his head, and that ends in tragedy or someone gets killed you will be in a cage in Leavenworth. The org chart is everything, and it's very confusing to the team if they don't know who their leader is, and they can't have two leaders. Every major religion is monotheistic. I mean, there needs to be an org chart. But man, gosh, I could listen to you for forty days and forty nights Guy. Thank you so much for coming on the show today and sharing your thoughts. You educated my homies so well today, thank you so much.
Guy: Thank you Howard, enjoyed the time and thanks for all you've done for dentistry, I appreciate you.
Howard: Well, I hope you have a rocking hot day in Salina, Kansas. I've been there so many times I grew up in Wichita, Salina, Topeka, Parsons, those are all, East Kansas, Kansas City, those are all my stomping grounds. I love that town.
Guy: Awesome. Hey, good to see you Howard. Have a great day.
Howard: All right, you too buddy.