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VIDEO - DUwHF #874 - Nicole Foster
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AUDIO - DUwHF #874 - Nicole Foster
Prior to her lifelong dream of starting a business, Nicole Foster spent 14 years in medical sales, most recently selling Invisalign for Align Technology. Before that, she pursued her M.B.A. from Santa Clara University – a life-changing experience that changed her outlook on everything. While she was there, she was President of the Women in Business network and organized a groundbreaking conference with 13 renowned speakers and funded it through sponsorship. She also completed her Bachelor of Arts from UCLA.
Nicole has a passion for helping small businesses thrive, and loves working in the dental and orthodontic industry. She created ClearEdge Innovation to offer the best marketing solutions to dental practices to help them grow their business and stay current in the modern business landscape.
Howard: It is just a huge honor for me today to be podcast interviewing Nicole Foster, with clearedgeinnovation.com. Prior to her lifelong dream of starting a business, Nicole Foster spent 14 years in medical sales, most recently selling Invisalign for Align Technology. Before that, she pursued her MBA from Santa Clara University, a life changing experience that changed her outlook on everything. While she was there she was president of the Women in Business Network and organized a groundbreaking conference with 13 renowned speakers and funded it through sponsorship. She also completed her bachelor of arts from UCLA.Nicole has a passion for helping small businesses thrive and loves working in the dental and orthodontic industry. She created ClearEdge Innovation to offer the best marketing solutions to dental practices to help them grow their business and stay current in the modern business landscape.
I'm a big fan of yours and the reason I wanted you to get on this show is because when you go around the world, whether it's United States, where so many dentists are on PPOs; where they're given their fees so they have to work back from those fees. You go to three of the greatest civilizations on Earth: Tokyo, Paris, London, the government only gives them a hundred dollars for a molar root canal. I mean, a lot of these places -- you know, in Cambodia, Malaysia -- a lot of these places you almost break even or lose money on cleanings, exams, x-rays, fillings. But that's why the two massive growth sectors are dental implants and Invisalign, because their fee is not set by a third party.
I mean, like, you go around in Phoenix, the average hygienist in Phoenix makes $40 an hour, but the average dental insurance PPO gives them $55 for a cleaning. How do you pay someone $40 to give a $55 service? So Invisalign is just amazing, and you have a deep, long history with Invisalign. And I agree with you, you said when you got your MBA it was a life changing experience. I don't think anybody ever gets their MBA -- I got mine from Arizona State University -- no one gets an MBA and sees the world the same again. I mean, you just totally see things as --
Nicole: You look at a chair differently, because you think of where it came from: from the raw materials and the supply chain and the thousands of people involved in getting it into your home or your office. You know, something as simple as that, you just look at all of the different facets of it.
Howard: Yeah, Adam Smith described it in his book '1776: The Wealth of Nations,' describing with a number two pencil, he called it ‘the invisible hand’ because the person making the graphite, the person wood-making the pencil, the rubber trees in Vietnam -- I mean, all these people are working to make one product and neither of them -- nobody even knows that they're making a number two pencil, and a number two pencil comes out of it, it is clearly amazing.
So, what do you think of the current state of Invisalign? How is Invisalign doing? You actually know the CEO, what's his name? Joe Hogan?
Nicole: Joe Hogan, yeah. I knew Tom Prescott really well for most of the years that I was there. I mean, it's doing fantastically if you look at their stock, at any rate. And it's just grown by leaps and bounds even since I was there. You know, it's so rare that you get to work with a disruptive technology that's truly a proof of concept type of product. It's very different than say, selling an implant which is: well, mine's incrementally better than yours, but there's a lot of similarities and overlap and things like that. But with Invisalign, it really, truly changed an industry, changed a market, expanded a market. And the neatest part about it was that it really has provided better preventative dental care for people, ultimately.
Howard: How's that?
Nicole: Well, these studies have come to show that periodontal disease has links to all kinds of different systemic disorders in the body, and crowded teeth contribute to periodontal disease. The other big area is abnormal wear and trauma on the teeth. So if you can protect the teeth from banging into each other at odd angles all day, you're not going to get chipping and broken teeth and different abnormal forces on the teeth. So it's really changed that. I think prior to that, even though people knew orthodontics was beneficial for your health, it just wasn't feasible, for adults especially, to get braces. And this now creates a whole new different feasible solution for people. So it is really, really an exciting company to work for and get to be part of that.
Howard: You know what I like the most about Invisalign? Humans: 99.99999 percent of all their strengths and weaknesses live between their ears. And I've noticed the human condition is that you either haven't been bowling in 10 years or you are the opposite extreme and own your own bowling ball; you haven't been boating in 10 years or you either own your own boat. And what I've seen for 30 years is that when somebody doesn't like their teeth, they don't brush, floss, so they don't take care of it. And then you straighten them out with braces, Invisalign, some bleaching, some bonding, whatever, and they fall in love with their teeth. And then every time they're walking by a mirror, doing a selfie, they're looking at their teeth. Then they're 10 times more likely to brush them, floss them, come in for the regular cleanings. I mean, you just don't want a human to not like their teeth, because then they're not going to take care of it. But if they love their teeth, they're going to take care of them.
Nicole: Well, 50 years ago, even 20 years ago, it was totally acceptable to have all your teeth ripped out at a certain age and get dentures put in. And that doesn't need to be the reality for people anymore. And especially with something like Invisalign, it really fits into the model of preventative dentistry. Now, interestingly enough, where I come in, in my current role right now, is really helping offices convey different things to patients and market this to patients as well, whether it's Invisalign or dental implants or just their practice services overall. Because I think if you don't market it effectively to patients and you don't communicate it in a way that promotes case acceptance on their part despite the cost, then it's all a moot point, essentially, and the patient is not going to get the preventative care that they need. So it's all an interesting ecosystem when you look at it again from that business standpoint. You need all these factors working together to ultimately get the patient to a better place, where they do love their teeth and they keep them for the rest of their life.
Howard: Now I just -- my homies, probably 85 percent of them right now are driving to work commuting, so I always -- so they can find you when they get to work. I just reach -- they just go to my Twitter @howardfarran. I just retweeted you @clearedgeinv, for ClearEdge Innovation.Your last tweet ‘What are your goals for your dental practice marketing plan? Learn about setting marketing goals in your blog.’ What is -- what do you like to do? Explain to my homies what ClearEdge Innovation.com, what it is you do and why they should go to your website: clearedgeinnovation.com.
Nicole: So we've really decided to focus on the marketing aspects of dentistry. And when I originally started this business I thought about doing a little bit more of the general consulting, internal trainings and things like that. I turned away from that more and really, really honed the focus onto marketing activities. So a lot of external, a lot of online marketing. But what's great is I can also combine that with some internal strategies, because they really do work together. So some element of team training, patient communication and things like that. What I'm not doing is going in and managing a team for a dentist. At some point down the road I would love to empower dentists to be better leaders and manage their teams more effectively themselves and communicate more effectively. But right now I'm really focusing on the marketing aspects.
Howard: Is it marketing aspects of Invisalign mostly?
Nicole: No, not at all, it's across the board in the practice. Whatever the practice’s goals are, whatever procedures they're focusing on, that's what we focus on pushing out to the community at large around them.
Howard: It's really, really changed. I remember in 1987, when I got out of school 30 years ago, I took out a full-page ad in the Yellow Pages. And back then there were only like three or four of us doing it, so it was just a cash cow. And I actually got a free lunch from the director of the Arizona Dental Association to come take me to lunch to tell me how many complaints he'd had about my Yellow Page ad. Not anything wrong with the ad, just that it was cheapening the profession of dentistry. And he asked me, “If I had prostate cancer, would I pick an oncologist out of the Yellow Pages?” And it was just so controversial back then.And now, do you even recommend the Yellow Pages now? Thirty years later is the Yellow Pages alive or what? If you found some old guy, as old as me, 54 with three grandkids, had a Yellow Page ad, what would you say to that dentist? Would you just take them to a vet and put them down? “You're too old to be occupying space and breathing oxygen.” Or what would you tell an old man with a Yellow Page ad?
Nicole: Oh, I would probably give a response that said something along the lines of, "You're just wasting your money." I haven't kept a Yellow Pages in my house for years, I still get them delivered to my doorstep and they go straight in the recycle bin unfortunately. I think, for better or worse, across generations people are searching for businesses online and they're doing Google searches, they're looking at online reviews. I think even in a case where a practice has a really effective internal marketing strategy: where they're asking for referrals, where people are doing those internal referrals, nearly everyone is still going to go online and see what their online reputation is. If you get a great recommendation from a coworker or family member and you go on the doctors Yelp review and it's two stars, you're going to think twice about actually picking up the phone and calling and scheduling.So I think that it's the world that we live in today. It's changed very quickly, in terms of how much we rely on the internet to direct our commerce these days. So I think that the profession of dentistry is no different. I think that in many ways it might be slower to catch up, but it's no less necessary.
So back to the Yellow Page guy, I would say to him, "All that money that you're spending on the Yellow Pages and invest it in an online strategy instead.”
Howard: If you talk to every single practice management consultant on earth, they will tell you that when you go into a dental office and observe, they've never seen anyone in the office ever ask for a referral. So it's almost like, and you're a consultant, you have to do the stuff they can buy because they'd rather buy advertising than ask for a referral. Why do you think they're embarrassed to ask for a referral? Do you think it's because they're too proud? Do you think it's pride and arrogance, or do you think -- well what do you think it is?
Nicole: I think a lot of times it's really the back-office team that needs to engage the patient in that type of conversation, and I think the personality type that you get who are assistants, hygienists, doctors, they're not naturally that sales or marketing type of personality. To me, asking for a referral is the most natural thing in the world. And I really appreciate when people ask me for referrals. Even though I'm in the business of it, it doesn't always occur to me to send a referral until they ask me for it. My personal dentist has actually asked me for referrals in a very, very convincing, effective way that didn't put me off in the slightest. And I think that the other thing you have to really think about as well, is that when you ask for a referral, you're not necessarily asking every stranger that comes into your practice. The ecosystem of referrals needs to be: are all your team member's family members coming to your practice? Is the woman sitting in the chair, is her husband and are her children coming to the practice as well? So, I think that people need to think about it in almost a little bit of a smaller circle, because that's how it starts to expand outwards. I think it's a critical part of any business. I look at the incredibly successful business that you've built and you're constantly asking people for referrals, to sign up for your podcast, to sign up for your newsletters, to get engaged on your boards, to be on your podcast. Those are all asking for referrals and that's why you have such an incredibly wide reach in this industry.
So anyways, back to your question of why it's so hard. I think it's a personality type, I think it's out of their wheel house. I think that is something that -- I think the team members often don't feel as invested in the small business as we might hope that they would be. I don't think that they necessarily appreciate how incredibly challenging it is to run a dental practice with the astronomical overhead, with the competition, with being tasked with wearing so many hats, and having to be the leader, be the business owner, be the manager, be the financial person, be the marketer, and be the dentist on top of that. So sometimes what I try to impress on my teams when I'm having that conversation about referrals, and I do combine it with asking for online reviews, is just explaining how difficult it is to run a business and explaining that when the business is running well everybody does better, everybody's happier. And I'm a huge fan of dentists incentivizing their team based on production for a lot of those reasons.
Howard: I know how my homies think, and they're all thinking, "Look, Dr. Jack Kevorkian put all of his patients to death. They couldn't have referred him any patients and he's still successful." So how did Kevorkian do it? He couldn't ask for referrals.
Nicole: He got a lot of free press. All press is good press.
Howard: You know, I actually get mad at my homies when they say that they don't like to sell dentistry. I'm like, “Dude, you should not be working in a company that you don't want to promote.” I mean, I know women that have -- I don't know them personally -- but I've heard stories from other dentists that a lady lost all of her teeth and got a denture and then they found out later that she killed herself a few months later. If I went to any woman in California and said, "How much cash would I have to give you to pull your front tooth?" What do you think the average woman in California would tell me? They'd say, "All the money in the world, I'm not pulling my front tooth." They feel so strongly about their teeth.
In fact, I don't even like the word ‘oral health,’ because I think the only thing oral health does is promotes mental health. And when a woman gets her teeth knocked out from her abusive husband her self-esteem goes to the floor. When they lose their teeth it's so stressful for them. And then this is your sovereign profession and you say you don't like to sell dentistry? Well, what do you like to sell? I mean, if it's iPhones, iPads, if it's music, go work at a music store. You should work for something that you're proud enough to promote, ask for referrals. I mean it's all a head game. All your self-limiting beliefs live between your ears. They're not -- none of them are real.
So how do you coach an introvert scientist, engineer, physicist, dentist, to sit there and start feeling jovial and selling dentistry and asking for referrals and asking for reviews. How do you get in his head and make her think differently?
Nicole: Well, one thing that comes to mind is you have to sell anything that someone has to pay for. So it's really, really different if you’re a family practice doctor and you're telling a patient they need a diagnostic test or a blood test and the patient pays nothing out of pocket for it. And unfortunately, the overall medical system has trained a lot of patients that they don't have to pay for medical care. Of course, we know that dentistry is totally different. Dental insurance doesn't cover much, patients have to pay for a lot out of pocket. That's why you have to sell the procedures, because you have to get them to open their wallet and see a need and a reason to pay you for the services. And it may be fortunate, not fortunate, whatever, it depends on how you look at it. I think the upside for dentistry is that you get a lot more cash-pay patients, which is better for a business overall than dealing with insurance all day long. So if you can look at some of the positives it's not so bad. As far as the introvert, scientific dentist, that is a tough thing to change people's personalities, it really is. What I really try to focus on is getting away from the dirty word of 'sales.' And truly excellent sales is meeting someone's need and maybe meeting a need that they didn't even know that they had but it's going to make their life so much better for it. And I think when you get away from that used car salesman type of mentality and say, "You know what? I am bringing confidence to a patient; I am bringing longevity to a patient; I am bringing the ability to have proper nutrition to a patient."
When you really, truly believe in those things, and you believe in what you're recommending to them, it's lot easier to be passionate about it.
Howard: So what is your proper nutrition, because you're Irish and your last name's Foster. Would you just say Foster's beer? I think that's the going nutrition in Ireland these days. You know, I'm a big fan of your blogs and I wish you would repost them on the Dental Town blog, because we've started a new feature five or six months ago where I would say the greatest compliment a homie can give, reading an article online or on the app or a blog, is we put up the share button so you can share it to your social media: like Facebook, Twitter, LinkedIn, and the shares have gone from zero to stratospheric. It's really great, you put a blog on there and these dentists like what they read, they'll hit their share button and they'll share to their hundreds of friends on Facebook and Twitter and LinkedIn and all that stuff.
But I like your blog: 'Best social media tips for dentists.' What are your tips for social media for dentist? Because I know what my dentists like to post. It's always some bloody, gory picture of like, some gum surgery or some cosmetic gum lift or all this stuff. And I just look at so many of those pictures, I'm like, "Okay, well half of America is afraid of the dentist, don't show too much pink bloody stuff." It may really impress the hell out of you --
Nicole: Not unless your patients are only other dentists, then you might be covered.
Howard: Right? Because they like to show real close-up pictures to show off to their dental homies like, "Look how well this matched. And look how the gums, and look how awesome this is."
I'm like, "Dude, the people seeing this want to be on nitrous and knocked out when they go to the dentist. You just can't show pink bloody stuff on your blogs and websites."
And another big thing -- someone asked me, "What's the biggest mistake dentists do online?" -- is they get all caught up in the current political stuff and you go to their Facebook page and they're talking about dentistry, they're talking about bleaching, bonding, Invisalign, and then they're weighing in on all this political stuff. And it's like, America is so divisive, why would you want to put on your Facebook page what your political and religious thoughts are. I mean, is that just insanity?
Nicole: Absolute, complete and total insanity. And something I actually recommend to my clients, and I helped Joe Field set up when I started working with him is, if you're going to have a personal Facebook page, keep it completely and totally private. And then start a separate person page for your professional contacts. It's really easy to do, there's no issue.
Howard: But when a patient searches your name -- you know, if they just search your name, Facebook will prompt them -- it'll show them both, and so they might go to your dental office page, but then they'll go to the personal page and see what your thoughts are on everything from ISIS to Afghanistan and then end up hating you.
Nicole: Well that's what I mean. So a couple of different things: number one, you can completely privatize your person page so that it never even comes up in searches and only your personal friends and family can see it. But that's what I was saying --
Howard: But then your ex-girlfriend from high school will never find you and want to hit up again.
Nicole: Oh no! That's exactly what I'm saying, and I actually finally bit the bullet and did it for myself as well; where you have two person Facebook profiles, and your second person Facebook profile is just all your professional contacts. So when a dentist goes to a conference and wants to connect with his buddies and things like that, he adds them to the professional person Facebook page.
Now in addition to that, you still have your business Facebook page. But it's really a way that you can keep your personal and your professional circle of friends and family and stuff just completely separated and out of the public view. So that's something that I strongly recommend.
As far as other best social media tips. I think that where I see dentists missing the boat so often -- you're absolutely right, the clinical pictures are terrible to be patient facing, they just scare them if anything. They get the dentists really excited, but that's not your target audience. The other thing I see over and over and over, and I feel like a lot of the bigger dental online marketing companies are really guilty of this, is: you'll just have a really generic picture or meme with a little saying over it, like a little tooth saying, "Remember to floss." Well, you put that out there and it doesn't engage with anybody. Nobody clicks on it, nobody likes it, nobody comments on it and it's just kind of a waste of your time and money. So that's one of my big pet peeves is these lifeless non-engaging posts.
And I think that you have to get really customized with your content and really personalized, so it has to reflect the brand and the personality of the office. So that's what I feel like our competitive advantage is at ClearEdge, is creating highly customized and highly engaging content. So what I like to do is draw the content from the office in a very efficient way, by interviewing the team members extensively, and the doctor. Spending a day in practice, talking to everyone, getting their thoughts and everything, and then turning that into these really engaging posts that directly reflect the brand and the personality of the office.
It was interesting, I just started working with a new client in the last couple of months and she had had one of these larger companies doing her posts and you'd be lucky to get even one like on them. And as soon as I took over, one of the initial posts that I did to celebrate the doctor’s work anniversary got, I think, up to about 60 likes on it and several comments. So it just goes to show that people want to connect with that human element of the practice and they also want to connect with things that are relevant to them as well.
So if you do have any sort of general advice, dental advice, things like that for patients, make it relatable, make it interesting. There are very few dental and ortho offices -- and there's some that are phenomenal -- but there's very few that have this engaged following. And the ones that do, every single post is personalized and fun and full of energy.
Howard: Yeah. What I think is interesting is I'll say, "How is your social media doing?" And they'll say, "Great!" And you'll say, "Dude, there's a reason in college they make you take a test. So let's scroll back for your year." And you just scroll back and you say, "Okay, you almost got -- you had zero comments. Two out of three pictures didn't have a like. So, when you're telling me it's great, what is that based on?" I mean, if you're not getting likes, comments, or the most coveted, the share, then it's not working. Or they'll have a Twitter account but they've never had a retweet. It's like, if you don't have a retweet on Twitter or a share on Facebook or a comment or a like so -- there needs to be a scorecard.
Nicole: Yeah. And there is. I mean, in all your Facebook analytics, and any company that a dentist works with should be providing them that on a monthly basis to show what the ROI is, and show progression over time. You know, the client I mentioned that I just started working with, I got her more new page likes in the first month of working with her than she had gotten in the previous 17 months with the previous company.
So I think that's another really good social media tip too is: you always need to be building your following in a variety of ways. Everything from: the hygienist is cleaning someone's teeth in the chair and they are on Facebook for the entire 45 minutes that they're in there, the hygienist simply saying, "Hey, looks like you're on Facebook, you want to give us a like? We're there, you can follow us, get some great dental tips." Things like that. And that does go back to the challenge of getting the whole team on board with marketing the practice verbally every day to patients, and that's really a mindset, in my mind.
Howard: I believe that one of the self -- I think one of the issues that you face as a dental marketer is that when you talk to older guys like me, they don't use Yelp. Almost all my dental friends that I went to school with, they're not on Facebook. I mean, I've got four boys, three of them are on Facebook. So then you've got the millennials, who, they hate direct mail. So they think direct mail is stupid, but I know all these dentists who do direct mail, especially for implants. Well, who's most likely implant patient? Grandma. Well, is Grandma more likely to be on Yelp and Facebook, or walking out to her mailbox and getting the mail every single day? And so I imagine it's hard to get older people to go online, and I imagine it's very hard, if not impossible, to get young millennial dentists to do any direct mail, which would be very important if you're doing dental implants and dentures and over dentures on grandma.
Nicole: Yeah. Now it definitely has to be a mix. Although one thing that I've been curious about with the dental implants is how much they might rely on their adult children to recommend a dentist to them, and maybe even get them to the dentist and things like that to get their implants. Or how much they're looking on their own. So that's why sometimes with dental implants, I think it can be helpful to target people in their 40s and 50s and things like that, possibly for their parents as well.
I think sometimes with those older generations there can be other types of marketing that can work very well. Anything from a well-placed commercial, infomercial, possibly radio ad, things like that. The challenge, of course, in that, along with direct mail, is that they're extremely expensive. And depending on how you're targeting, it can sometimes be hard to see ROI from it. But I also think every dental practice has a little bit of a different target market too.
Howard: But here's another dilemma you have in helping that market, a dental practice, is that if you ask a dentist, "Hey, how's your website?" And they go, "It's good." And I say, "Okay, give me a scorecard. How many people have to land on your Web site before converts one to call?" They have no idea. "How many people have to call your receptionist before one converts to come in as a patient?" They have no idea. "How many patients do you have to come in with a cavity before you convert one to get a filling?" They have no idea. And I say, "Well, here's what I see: ten people have to land on your lame website before one calls your front desk. Three people have to call your front desk before she gets one to come in. Three people have to come in with a cavity before you do a filling."
So when you're looking at a dentist doing $750,000 in revenue, taking home $175, to do that filling, three had to call, to have three call -- I mean, three had to come in with a cavity, to have three come in with a cavity, nine had to call your front desk, to have nine call your front desk, 90 had to land on your website. So I mean, my God, if you do all this online marketing, you have to drive 90 people to my website before I do one filling. How do you fix any of that funnel? You know what I mean? It's almost like, I'd rather fix that. I mean, how do you convert people? You're driving people to doc's website, how do you advise his website to drive people to actually call the office, as opposed to just look at it and then go back to their Google search? All they got to do is hit that triangle thing, back page, and go to the next dentist online.
Nicole: Yeah, it's tricky. And I think -- what is the statistic that a patient has to have, or a consumer we should say, has to have about seven hits on a product or service before they actually make the call. The concept of the conversion funnel is fascinating to me. And I think that when it comes to dentistry you can hit at any particular point in the funnel. And I think the first thing you really have to do is identify where the funnel is leaking, so to speak. So, if you have a crap website to start with and patients are just totally turned off and bouncing off of that, really high rates of people leaving the site, that might be a good place to start. If you have the most beautiful website in the world, and the surliest receptionist in the world that just turns patients off when they call in, that's the point where you start; by training him or her to answer the phone properly, be nice to patients, smile, things like that. Maybe you're getting tons of patients in the door but they are just not converting to the treatment that you're recommending. Well again, that's a communication strategy in my mind, so you might have the website right, the receptionist right, they come in, they like the office, but you're just not convincing them to get the treatment that they need.
So I think the first and most important part in starting this process is really diagnosing where the issues are. And that way you can spend your resources and your time improving that part of the conversion funnel that's leaking.
Howard: But they always run this whole paradigm, from the conversion funnel to getting to one filling except a treatment, to the leaky bucket of why, by the time we get to 5000 patients charged, 4000 of them have never come back.
So there's a huge conversion funnel before someone comes in and gets a filling, and then 80 percent of their patients are lost over a five-year period. I mean, it's just like, my god, that's so big of a problem. And the dentist has no measurements.
So when you sit there and say, "How many active patients do you have?" They'll say, "Oh, about 1850." "Okay, what is that number based on?" He's like, "Just a gut feeling." My guts are filled with fecal matter, that's just -- you might believe there's a parallel universe with a pink Tooth Fairy, right? And a unicorn.
So how do you get them to go to -- like Google talks about management by numbers, and when you're in Google management, if you go to a meeting and you say, "I think we should do this." They say, "Oh that's a great idea, show us your data. How did you arrive at this conclusion?" And you say, "Well I don't have any data." They're like, "Okay, we need you to leave the room." You know what I mean? Because they have all your history, all your searches, all your search words, how long you were on each site. So they got a gazillion trillion quadzillion data points. So why are you using a gut feeling and not looking at the data? How does a dentist get data driven on this mess?
Nicole: You'd think with dentists being so scientific and kind of into the really nerdy aspects of dentistry, you'd think that data would be a really paramount thing to running their business. But in my experience, especially seeing hundreds of customers at Align, it was just not. It was frightening, in a way how little these business owners knew about their business.
And I couldn't agree more, I think you have to be so on top of the numbers and have a really deep understanding, like I said, of all aspects of: how many people are calling, how many people are coming through the door, how many people are converting, how many people are going out the back door once you've seen them a couple of times?
And again, it goes back to the fact that, like I said, the diagnostics, if you don't have a pulse on where the issues are, you can't fix it and you're just throwing stuff at the wall and hoping it sticks. And I think that every little part of the process that is problematic, you can focus on that and make a meaningful change. So if you're finding that you have patients but you can't retain them, there's something going on in your office that's turning them off. There's something that they are not liking. Maybe it's even just as simple as their whole family isn't going there so why are they going to keep going there? Whereas if you had locked in some of those referrals and gotten the whole family into your practice they might be more likely to stay in there. Or maybe your office smells and you don't realize it and they're really turned off when they come in there.
Howard: They all smell. No, I've been in as many dental offices as anybody. I don't know how -- I've been in a lot of dental offices in the last three years. When you lecture all this stuff and you open the front door and you just get knocked over by Eugenol. And then you read people, like the Howard CEO of Starbucks, where he talks about how the smell of everything is everything. You go read about Kroger and they run these bakeries in every department because they know if women walk in and they smell stuff baked, they buy much more stuff. And there's all this research on smell and color and dentists they think, "Ahh, if you're going to talk about aromatherapy and all that witchcraft stuff you're out of your mind.”
And it's like, well, the people that don't think it's crazy, they do billions of dollars a year and they're publicly traded.
And when you walk in -- I'm embarrassed to walk into my own dental office because when it's 118 degrees outside in Phoenix, you can't crack a door, open a window, you can barely -- it's hard to keep an air conditioner on max, really can't keep it 30 degrees cooler. So when you're at 118, that's almost 120. You're talking about 30 degrees cooler is 90. So a lot of times when I walk into my office, it's going to be 85 degrees so -- but it smells like a damn Eugenol -- it smells horrible.
Nicole: Well, it's interesting, I think that more dentists and even team members, need to put themselves in a position of a consumer for all the things out there that they buy, or all the restaurants and hairdressers that they go to, and any time they're making a consumer choice. And we need to remember how fickle consumers are every step of the way and just the tiniest little thing can throw them off and cause them to completely turn away from your business.
And it's not to put so much pressure on a business owner that every little single thing has to be perfect, but I think you have to really have a mindfulness towards every aspect of your practice, and how is the customer experiencing that part of your practice? And is it something that could potentially turn them off and either get them to not walk through the door, not convert to treatment, not keep coming back to your office? And really, just be mindful of all of those little things that may not seem like a big deal because you're in the practice every day. But putting yourself in the mind of that consumer.
And again, thinking about all of the things that you choose to consume and how you choose one business over another, and the businesses or services they get you really jazzed up, versus the ones that you say, "Gosh, I'm never going back there again because they did X Y and Z."
Howard: You know, half of the market, as determined by studies done in universities -- that half the market in dentistry is afraid of the dentist and the other half is afraid of the fear of the price and cost of a dentist. And I think when you walk in there and you smell all those chemicals, it triggers a lot of fear. And then the patients don't understand autoclaves and spore testing. And you just had another case blasted all over social media last week about some dental office in Canada; three locations where the government's asking all their patients to be tested for Hepatitis C and HIV. I mean, that's got to scare the hell out of the public. But they don't know an autoclave and spore testing, but when they go into the dental office and they see dust on the baseboards and they see a dirty bathroom, then they're thinking, "Oh my god am I going to get Hepatitis C?" And then when patients -- when's the last time a dentist even laid back in his own chair and looked at his drop ceiling with water leaks and all this? I asked my patient the other day, I said, "When you look at my ceiling, do you think it's good?" And she said, "Well it's really up there.
But a lot of them are sitting there, they'll have patients for the last two years that when they lean back in the chair, they see some water leak stain on their drop ceiling and it's like: how are you going to be a cosmetic dentist and not give them hepatitis C when you got a cobweb in the corner and a big old dirty deal? Because they don't see it from the patient perspective.
Nicole: Yeah. I mean, you really almost need every dentist and team member to go through a full procedure in their office at a minimum of once a year and walk in like they were a new or existing patient and be taken through the entire process.
Howard: Yeah. And it's also a red flag when your staff doesn't have you do their dentistry. I mean, how come none of your staff wants your hygienist to clean their teeth? That's a red flag. How come none of the staff want you to work on them or their babies or their loved ones? That's a red flag. And when your team is getting worked on, maybe that's when they notice the ceiling and the baseboards.
I also believe that dental staff should not be cleaning the office. I think you have to have professional cleaners, because I think a cleaning service sees a dental office facility completely different than your assistant hygienist and dentist picking up and taking out the trash. I mean, I just don't think they see it.
But look at the specifics. When you talk about online marketing, what does that really mean? Is that just all like Google ad words? Some dentists say, "Well, you know what? Everyone's on Google and you can't make it to the top. I'm going to go to Bing."
Or is online marketing your Facebook? And then Facebook just bought Instagram and then people say, "Well, what about Twitter?” Snapchat just went public. Some people think LinkedIn is good because those are all professionals and everybody on LinkedIn probably has dental insurance.
So I know I just asked you 47 questions, were any of them good enough to answer?
Nicole: Yeah, definitely. And you know, I really like to keep this online marketing thing as simple as possible. I think there is way too much smoke and mirrors in the industry and way too much mystery and voodoo. People really do try to make it sound too complicated, and it's not. It boils down to a few things: can the patients find you online for common search terms that they're looking for? When they look at your whole online ecosystem, is there a positive presence for your practice online?
So again, it kind of goes back to: put yourself in the position of a patient who might be seeking a dentist in your area. So maybe they ask a coworker for a referral. The coworker says, "I go to this dentist, I really like him." So they're going to go and they're going to Google search you, maybe by name. They're going to pull up your website. If your website is totally outdated and crappy, things like that, they might bounce off and go back to their insurance list and look for another dentist. If the website kind of passes the test, they might say, "Okay, well, let's look at their Yelp and their Google reviews. My gosh, two stars, three stars, I don't know about that, maybe I'll go back to the drawing board." Two, three stars looks pretty good they might click on some of your social media, see how engaged you are with patients, things like that. And all of this might only take 20 minutes or so at most, but they're going to do their due diligence, and then hopefully pick up the phone and call.
So, getting back to what are the different facets of online marketing. There's, in my mind, two big categories. There's the organic type of search results, which is more based on blogging and social media and online reviews. And that is content that you're putting out there that's telling Google what you're all about and how patients can find you. Then on the other side we have the, essentially paying for leads: the pay per click, the Google ads, the Facebook ads, are the two big areas for that. So, depending on what you're trying to do and what your goals are, you may focus on both or one or the other.
So, for example, kind of going back to that blog post that you just retweeted, which, thank you very much for that. An office really needs to identify what they want to do. So I find, for instance, in the orthodontic world, it's much more about connecting with the community, connecting with your patients. It's a little less about “I want to push this particular procedure or grow in this particular area.” It's more, “I want a presence out there so people know that I'm the gold standard in this area for stellar orthodontic treatment.” With general dentists, it can run the gamut.
You know, a more family practice oriented dentist might want that kind of community type presence, involvement, being the go-to practice that most patients in their neighborhood think of. A heavily cosmetic dentistry practice, for instance, might be much more about pushing a particular product or service and becoming the standard for that particular product or service.
So, for example, what we focus on with the work that I do with Joe Field, is all about implants; everything we do is about implants. So instead of the more touchy feely, “this is my assistant's work anniversary and her best tip for patients,” it's all about: do implants hurt? How much do they cost? What supplemental procedures do I need? That sort of thing. So really, your goals can dictate what types of online marketing you do.
So going back to those two categories: when it comes to organic search it boils down to a few things. Number one, you want to make sure that you have good copy on your website. One of my biggest pet peeves in the online marketing world, and especially with larger companies that manage sites, is they use the same copy for a hundred different websites. Well, Google really doesn't like that. It's duplicate content, it means that you can take a paragraph off the website, put it into your Google search engine and find it on a ton of different websites, and it kind of renders it worthless. So, making sure that you have original copy on your website is important.
I have found that very few dentists and orthodontist have really, truly gotten into blogging. And so partly because of that, I'm a huge fan of it, because I don't think the market is oversaturated with dental blogs. And so many of them, very much like the website copy, can be very generic. So adding a blog to your website is one of the best ways to get solid, organic search results, which can have really, really long term benefits to your website when you're searching. So, Joe Field as well, we've started a fantastic blog for him. It's been running for just short of a year. And now just because of that, without any Google ad words at all, he is ranking on page one in an extremely competitive market for many, many different dental implant search terms. So that's going to be something that really helps your organic search.
Social media does play into that as well. Because Google picks up a lot of those different posts and things like that in searches. It increases your page authority. The online reviews also really play into this as well. And the interesting thing about online reviews is, it goes back to what we were talking about, where the manifestation is a better online marketing presence, but it all has to be done from internal marketing. So, you have to be asking patients for reviews. But they are so powerful when you get them to do them, and they really help with that organic search strategy.
So then, like I said, on the other hand we have a more pay per click strategy, and that can be used in conjunction with an organic strategy or separate from it, and you can have one being a little bit more dominant than the other, totally based on what your goals are. So pay per click is buying Google AdWords, having your practice show up higher for different Google AdWords. It depends; sometimes people don't click on ads at all, sometimes they do. It can have mixed results, it can be expensive, it can be inexpensive. I'm a fan of Facebook ads as well. The one downside is for people who are not on Facebook, but the upside is that they can do really, really specific targeting and they're not very expensive, so I like that too. So it's a very long answer to your 47 questions.
Howard: Well you just made the richest man in America, Bill Gates, cry because you didn't mention Bing.
Nicole: I know.
Howard: But it is a smart thought. Some dentists say -- well, you know success is counterintuitive. Warren Buffett is the greatest investor in America and he's the only one that doesn't live in Wall Street and listen to all the daily hype. And some dentists tell me, and they post it on Facebook, they say, "Well, if everybody's on Google, I'm going to go after the Bing." Do you think that's insane or do you think it's good?
Nicole: I don't think it's insane at all, especially if it's working. I mean, it's a different segment of people that you're capturing. So, yeah.
Howard: And Facebook, I've seen this rodeo three times. I remember when Myspace was all that and a bag of chips. Do you think Facebook is going to have any -- do you think it's still just -- would you buy that stock or do you think it might have fatigue some day and could go the way of Myspace? Or do you think it's SMP, Dow Jones, 30 industrial type company that won't blink for a decade.
Nicole: Well, I mean --
Howard: I know you don't have a crystal ball and you can't predict the future, but you've seen this rodeo before with Myspace.
Nicole: Well, but I do think that it's very, very different. Myspace had nowhere near the level of users that Facebook has. It has nowhere near the level of, just sort of, industry clout, I guess, and reach around the globe and things like that. That being said, I think there's a very good chance people will get fatigued on it and move on to something else. However, that doesn't necessarily mean you can't use Facebook ads right now while everybody is on it. I mean if it starts --
Howard: Another question I have about Facebook --
Nicole: You go to the next platform and put your ads on there.
Howard: Well let's talk about that next platform, because a lot of dentists asking on Dental Town: when you buy a Facebook ad it has a check box: ‘do you want this to include Instagram?’ So, Facebook bought Instagram for a billion bucks, what's the difference between Facebook advertising for a dental office or Invisalign? What's the difference between Facebook and Instagram? And when they boost a post or create an ad, should they check Instagram box? Is that a different market than Facebook? Are those different people? What are your thoughts on Facebook versus Instagram?
Nicole: You know, I think that they're both valuable and I think it's actually a real benefit to the customer who's buying the ads that you can just, with the check of a box, have it on both. And I think it's absolutely important to have it on both. I found, just non-scientifically, in my own circle of people, that a lot of people are abandoning Facebook and spending more time on Instagram and it's a mix. I notice people are kind of on one or the other. So there's absolutely no downside to clicking both. And I think it's very smart. Snapchat? Not a fan of that. I think that they are on a downward spiral so I personally wouldn't spend much time and energy there.
And my overarching feeling too, on social media, is that: only do it if you can really sustain it and if you feel like it's working for you. So you could be on Facebook, Instagram, Twitter, Pinterest, Snapchat, Linked-In. But if you have five followers on each of those, it's really not going to do you much good. You're much better off picking your top two platforms and really going all out on those. So I think you should only keep platforms alive that you can really put some effort into it and create engagement around.
Howard: You know, you can almost look at their stock price. I mean, Twitter's went public at 40, it's down to 20. Snapchat went out at 27, down to 14. Does that kind of reinforce not spending your time on Twitter or Snapchat, or not really?
Nicole: I'm a much bigger fan of Twitter than I am of Snapchat. I think Twitter is still trying to find their way and define themselves, but there is a certain segment of people who use them and for a dental practice attracting patients, I don't know that it's the best thing. For a dentist who wants to get his name and his brand out there as a speaker, as a key opinion leader, I think Twitter can be really valuable.
I think also a dental practice really needs to look at their target audience and look at where they're spending their time. If their target age range is, let's say primarily between people in their 20s and their 50s, probably something like Facebook and Instagram would be your best bet. If you have 100 percent a patient population that's over the age of 50, you might not want to be spending your time on that. So I think it really depends on where your patient population is spending their time and where you want to draw patients from.
Howard: A lot of other dentists on Dental Town are saying -- a lot of times they feel this, they'll chime in when people are talking about online marketing, they'll say, "Yea, but you guys are all general dentists. It's different for me because I'm an endodontist or I'm an orthodontist." Do you buy that or is it the same old -- is it really the same if your general dentist endodontist, orthodontist? Or are those specialties really, really unique and different?
Nicole: No, I think it's totally the same. I mean, my question back to them would be, "Well, do you have any competition?" I mean, if you're in a really rural area and you're the only guy, the only endodontist for 60 miles around, maybe you don't really need it. But outside of that situation, if you're in any sort of metropolitan area, any sort of competitive area, absolutely. And that also brings up the specialist generalist relationship too and how you can leverage these -- especially social media to connect with your general dentists as well and have them follow you and have them be thinking about you every time they pop online.
Howard: Yeah, my only pet peeve advice for a lot of these specialists, like endodontists, they don't like the term root canal so they call it endodontic therapy. I guarantee you there's not three people in America that aren't working in dentistry that know what endodontic therapy is. And the headache people do the same thing, they say, "Well it's not TMJ, that's the temporomandibular joint, it's the termporomandibular disorder. Dude, it doesn't matter. If everybody in America calls it TMJ, it's TMJ. If everybody calls it a root canal, it's a root canal. Just because you don't like the negative terms -- I want to switch gears completely. By the way, Joe Field is amazing.
Nicole: I adore him. I'm so blessed to be working with him. I worked with him for many years at Align; took him from a very small provider to one of the biggest providers in the Lower Peninsula area where he is and he is just, he's like the full package for a dentist. He's got all of the clinical skills, he gets marketing, he gets the sales aspect and he's just so kind and compassionate. His patients adore him, so he's really an inspiration. He's great.
Howard: Tell him that it's my birthday, is August 29. I'm going to turn 55 and for my birthday present -- his patient is Joe Hogan, the CEO of Invisalign. You know, you have contacts there. I want Joe Hogan on, because that's the biggest brand ever created in my lifetime. I mean, when I got out of dental school you already had Crest and Colgate and Oral-B and Listerine, like gosh darn man. I mean, you can be sitting at a bar in Cambodia and the bartender will say, "What do you do?" And you'll say, "I'm a dentist." Next thing out of his mouth asking about Invisalign. I mean, I've had those questions in Cambodia, Tokyo, Malaysia, Tanzania, Soweto. I mean, that brand is around the world. I haven't seen anybody in my lifetime build a brand as successfully as Invisalign. I think everybody could learn a lot from Invisalign.
Nicole: By far the most recognized, successful brand in dentistry.
Howard: And how much of that branding do they do on social media?
Nicole: You know, I think a lot of it -- I mean, there is an element of it -- but a lot of it is through other events that they do. And commercials and print advertising and overall branding. I mean, they do have an online and social media presence for sure. And their website is great with the Doc Locator and things like that, but they have the whole package with marketing and they made it a priority very, very early on and very controversially, as you started out by saying, where marketing was kind of a dirty word in dentistry for a long, long time and it was looked down upon. And I think Align really broke a lot of that mold and broke those rules and they're winning for it.
Howard: I want to switch gears completely. You promised me an hour of your valuable life and I'm down to three minutes and I don't like to talk about the subject, it is dentistry uncensored, and because I'm a man: when I was in dental school 30 years ago, most people say that being a dentist or a physician or a lawyer was a male profession. Now, you go into any dental school, half the class is women. You're a leader in women; you're the president of the Women in Business network; you had a groundbreaking conference with 13 renowned figures. I'm not an expert in women, ask my ex-wife. But do you have any -- is it different being a woman dentist than a man dentist? I would think it'd be an advantage, because I would just think if I was really afraid of the dentist, I would just think a woman would hurt me less than a man. If I was a woman dentist, I'd market the hell out of it that I was a caring, gentle, empathetic dentist. I tell women dentists, when you get an associate, I'd get another woman and brand that you're a caring, gentle dentist. I think there's clear research that people are more likely to ask a woman a question than a male priest, rabbi, politician. But do you think there's any differences in being a woman dentist or a male dentist, and is there any advantages that a woman could do advertising?
Or what are your thoughts about women in dentistry, women in business, women in leadership today?
Nicole: I think it's great and I think it's a nominal profession for women. You know, it's a profession that can allow a lot of different flexibility and iterations and you can be a business owner with it and create your practice around the type of life you want to have. It's lucrative -- well, in most cases it is, it should be if you're running it right. I think that both men and women have different types of advantages. I think patients connect with men and women differently. I don't know that one is going to be wildly more successful than another, because there's just so many factors that go into that in terms of personality, relatability, business savvy, ability to market, clinical skills, things like that. But I think it's wonderful that there’s so many women are in the profession. And yeah, absolutely, why not market yourself on it? Go for it. Any competitive advantage that you can get in such a challenging business and crowded market place, you got to run with it.
Howard: Yeah, I don't know. When I was little all the OBGYNs were men, now they're all women. And I have been predicting for years, I see the same thing happening to pediatric dentistry. I mean, whenever I'm in a dental school, you go to that pediatric residence, usually I think America graduates -- they graduate one pediatric dentist for a million, so they graduate about 325 pediatric dentists a year, and you go in those dental schools and they'll have like six students in there. They're all girls. I mean, you just rarely ever see males. And I think that speaks volumes.
And I was wondering if your favorite musician is Johnny Cash who did his Folsom Prison Blues. You're in there, you're right up the street from Folsom Prison. Did you ever serve time there?
Nicole: We sure are. No, no. But I would like to take a tour some day, actually. You know, the city of Folsom is a pretty great place to live. They take care of their people well and they just opened this fantastic Johnny Cash memorial trail tour thing you can do. It's a really nice walking and biking trail with some different monuments to him and things like that, so it's all good news here in Folsom.
Howard: I just love that guy. And I think his last album was actually better than his Folsom Prison Blues. I do. Did you hear his last album?
Nicole: I have it, yea --
Howard: It's what?
Nicole: I mean, it was just, some of the songs are just haunting, they gave me chills, you know?
Howard: Yeah, he was an amazing man and God I love that album, love that whole song. And I love you for coming on my show and talking to my homies today.
Nicole: Thank you. Thank you so much. It's really been a pleasure. And yeah, I definitely --
Howard: And repost all your blogs on Dental Town. And then if you're listening to her, go to Dental Town blogs, read her blogs, I'm a big fan of her blogs. I called Nicole, she did not call me. And if you like her blog and think your dental school classmates and friends and homies would like it too, hit the share button; share to your Facebook and Twitter. You know, these people spent a lot of time writing these blogs and articles. Like Dental Town magazine, we don't pay for any content. And these guys, a lot of times -- some of these dental cases, these guys will plan for a year. They might have to do 20 different cases before one gets photo documented right. And they write that stuff and you read it and you think, “man that that was awesome, I'm glad that dentist did all that.” Well reward him. The greatest gift a patient can give is a referral of a friend or a loved one. So the greatest gift a dentist can give another dentist is hit the damn share button on a Dental Town magazine article or a blog and help spread the word, because we're all in this together and it takes a village to raise a dentist, right?
But Nicole, thank you so much for coming on the show and I hope you never do anything where you'll be in Folsom Prison and I'll have to visit you. But if I do, I'll bring my iPhone and Johnny Cash songs and let you listen to him when I visit you. How's that?
Nicole: You'll be my first call.
Howard: All right I hope you have a rocking day. Thanks for coming on the show. Thank you so much.