Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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883 Purchasing & Growing a Practice with Dr. Chad Hines : Dentistry Uncensored with Howard Farran

883 Purchasing & Growing a Practice with Dr. Chad Hines : Dentistry Uncensored with Howard Farran

11/15/2017 8:34:27 AM   |   Comments: 1   |   Views: 393

883 Purchasing & Growing a Practice with Dr. Chad Hines : Dentistry Uncensored with Howard Farran

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883 Purchasing & Growing a Practice with Dr. Chad Hines : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #883 - Chad Hines

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AUDIO - DUwHF #883 - Chad Hines

Dr. Hines was born and raised in a small community in Iowa. He attended University of Iowa for his undergraduate degree in Integrative Physiology and is a graduate of the University of Iowa College of Dentistry, class of 2010. Upon graduation, Dr. Hines became an associate at a large private practice in Toledo, OH. Dr. Hines associated at this practice for 5 years while he refined his skills and learned how to manage a large private practice. 

When Dr. Hines felt he was ready to purchase a practice of his own, he set his sights on Phoenix, AZ where he patiently waited and analyzed available practices. In October 2015, he purchased Dental Care at Moon Valley, a 9-operatory, 3,300 sq ft practice in North central Phoenix. In the short 1 1/2 years of ownership, Dr. Hines has increased collections over 20%, with 2017 projections over 2.1 million. Dr. Hines looks forward to continued growth of his practice and potentially expanding to other parts of the valley. 

Dr. Hines has a passion learning dentistry. He can often be found in study clubs, CE’s across the country, interacting on dentaltown message boards or even at the Townie Meetings!

Howard: It is a huge honor to be sitting here on a Friday with Chad Hines. Thank you so much for coming by today.

Chad: Appreciate you having me.

Howard: Dr. Chad Hines was born and raised in a small community in Iowa. He attended University of Iowa for his undergraduate degree in Integrative Physiology and is a graduate of the University of Iowa College of Dentistry, class of 2010. Upon graduation Dr. Hines became an associate at a large private practice in Toledo, Ohio. Did you work with Klinger?

Chad: Klinger? Oh, from M.A.S.H.

Howard: From M.A.S.H.

Chad: Yeah, he is a thing there.

Howard: Dr. Hines associated at this practice for five years while he refined his skills and learned how to manage a large private practice. When Dr. Hines felt he was ready to purchase a practice of his own, he set his sights on Phoenix, Arizona, where he patiently waited and analyzed available practices. In October 2015, he purchased Dental Care at Moon Valley, a nine-operatory, thirty-three hundred square foot practice in North Central Phoenix. In the short one and a half years of ownership, Dr. Hines has increased collections over twenty percent, with 2017 projections over two point one million. Dr. Hines looks forward to continued growth of his practice and potentially expanding to other parts of the Valley. Dr. Hines has a passion for learning dentistry. He can often be found in study clubs, CEs across the country, interacting on Dentaltown message boards or even at the Townie meeting. A big fan of your four hundred and some post. I thought it would really be cool to get some, you know, instead of a fifty-four year old guy talking to a bunch of grandpas. I'm sure a lot of the Millennials commuting to work right now want to hear your story and it's an interesting story.

Chad: Yeah, well, you know, started in Iowa, did all my undergrad at dental school in Iowa.

Howard: Do you know why I love Iowa the most?

Chad: Why's that?

Howard: I went to Creighton and it was in Omaha, Nebraska, and you had to be twenty-one to buy beer in Omaha. So, we crossed that river into - what was the river into Des Moines? No, Council Bluffs.

Chad: Oh, see, I'm from the east side of the States, so.

Howard: So, we just had to cross that river into Council Bluffs, Iowa, and they sold to you at eighteen.

Chad: Okay.

Howard: And, so, if you're an alcoholic, you had to drive across that river, and, but ...

Chad: I like Iowa. I mean, I think I got all my values from Iowa. Unfortunately, my wife is from Ohio and so that's where we headed to after dental school. I found a great practice in Ohio to practice in. Got a ton of great experience. And that's, kind of, really shaped me. From there, you know, as an associate, shaped me where I'm at now. It got me ready to purchase a practice and really, kind of, like I said, refined my skills in terms of a dentist.

Howard: But, talk about why if you're born in Iowa, why did you not want to stay in Iowa? If your wife's from Ohio, why did you not want to stay there? What made you come, literally, a thousand miles to the Phoenix desert?

Chad: Well, a couple things. It was, really, we love Phoenix. We wanted a bigger city that wasn't, you know, traffic-congested, you know, Chicago, New York. However, I wanted a good opportunity, you know. I think that some of the issues some people face is they want to go where it's popular, where it's, you know, you're not going to find a lot of gigs there that, you know, are profitable. And so, I just set my sights on Phoenix. We loved it there. I just waited and waited. Actually, we were looking at a lot of places, but the right opportunity came up here and that's, you know, brought us here.

Howard: And, so, when you came out to school in - what year was that?

Chad: 2010, from dental school.

Howard: 2010. Did you have student loans?

Chad: Yeah. I came from a not a wealthy family, so, I took out pretty much the student loans, you know, for living and tuition, the whole works. So, yeah, I came out with not as sizable as I hear some people are now, but came out with student loans. You know, after about a year as an associate, I started really tackling those, just to get that under control, and obviously that has allowed me to get where I'm at now in terms of paying those down and purchasing a practice, but, yeah, I came out with sizeable student loans.

Howard: So, you came out on in 2010 and you were an associate till 2015.

Chad: Yup, yup.

Howard: And, so, you ... would that be a lot of advice before someone ...

Chad: Oh, absolutely.

Howard: And what were you trying to learn? Your basic dentistry? Basic business?

Chad: Well, there's ... I mean, dentistry is, I mean, it's loaded. I mean, there's so many things to learn. I mean, from, you know, the business aspect to the dentistry aspect. And I always say, you know, I've given a few talks to, you know, some younger dentists and I always say you got to learn to your dentistry first. Don't try to tackle the business end of dentistry at the same time. Oh, you're going to learn business stuff at the same time, but to tackle them both I think would be, in my opinion, a nightmare. I mean, I did an associateship for five years and ...

Howard: In the same place?

Chad: I was in the same ... we had two locations, so I was kind of between two locations, but it's the same owner, same ... basically the same place.

Howard: So, it seems like when you look at ... a lot of people throw corporate dentistry under a bus because of their high associate turnover, but you see the same thing in private practice.

Chad: Yeah, yeah. I mean ...

Howard: Why did ... why do you think you stayed there five ... well, first of all, when you look at your classmates from class of 2010, did most of them get an associateship job and stay there for five years, or are they turning and churning and burning in associateships?

Chad: Yeah, I think it was a mix. There was a couple that went owned in small towns in Iowa which, I think, ownership in a smaller town would be more manageable than in a bigger city. But a lot of them had a few different associateships, you know, usually you hear one to three years is kind of the max associateship. But, you know, I had a pretty good associateship where, you know, I was learning a lot. But after five years I felt I was pretty much ready.

Howard: But why do you think the average associateship ...

Chad: Oh, why?

Howard: I mean, the reason I'm asking is because you're a lot closer, I mean, I'm a grandpa. Do you have any children?

Chad: No, I do not.

Howard: You have no children. I have two grandchildren. Why do you think the average associate is one to three years? Why is private practice and corporate not keeping associates?

Chad: I think there's a variety of reasons. I would probably, you know, say number one is the communication between the owner and the associate. I think they want two different things, you know, and I think they don't communicate those things. I mean, sometimes you'll see owners just want someone to fill the odd hours, Fridays, Saturdays, you name it, and to fill in for vacations. And there are some owners that will want someone there, you know, to produce, you know, and take care of the patients. But, and, I think that a lot of associates, they want to come in and they want to be busy from day one. But a lot of associates don't realize that you've got to earn the trust of the patients. You got ... it is a slow process and some people just, I feel that some people just can't handle that slow process to gain and bill. So, and I think it all comes back to communication and seeing each other eye-to-eye, you know, to know where each other's at in terms of how to get there.

Howard: So, you didn't ... it's kind of funny, you did not buy a little office.

Chad: No.

Howard: You bought a big dog ...

Chad: Yeah, yeah.

Howard: ... and some of these kids coming out of school, I mean, you know, I compare it to a house. So, if I buy a hundred thousand Dollar house, it's gonna be three-bedroom, two-bath, and then when I go to sell it, I'm selling a hundred thousand Dollar house. You could just as easily have bought a two hundred thousand Dollar house, maybe four-bedroom, three-car-garage, you could have ... but I see some of these kids and they'll say, “You know, I don't want to spend a lot of money on a practice. I only want to buy, you know, I'd like to get one for like six fifty.” I mean, dude, you're Mormon, you have three kids at home, you have a stay-at-home wife. You need a lot of money.

Chad: Yeah, you need cash.

Howard: And you're four hundred thousand Dollars in debt. You need to buy a one and a half million Dollar ...

Chad: Absolutely.

Howard: ... big business to ... and, the bigger that office is, the more cash you'll make, the faster you'll pay down your student loans.

Chad: Yeah, yeah.

Howard: And it's kind of like, they go three hundred and fifty Dollars into student loans and they say, “I don't want any more debt”, and now they go get a job at Aspen and then they go buy a house and a car and they start eating out dinners and living, kind of, a nice life and it's like, “Okay, so, now you're going to work at Aspen for twenty years to pay off your student loans.”

Chad: Yeah.

Howard: So, it's kind of like ... so, the question I have is, you bought a big office. That's rare for a kid five years out of school ...

Chad: Yeah, yeah.

Howard: ... to buy a nine-operatory, thirty-three hundred square foot practice. What were your thoughts there?

Chad: Well, I was in a bigger practice, you know, in Ohio and that kind of trained me, you know, how to own and manage that kind of practice and handle that kind of workflow. Obviously, a new grad can't do that. I mean maybe there's a few out there but by and large I don't think a new grad can do that and that's why, you know, I'll be on Dentaltown and I'll hear people talking about the whole debt thing, like, I'm already four hundred thousand Dollars in student loans, I don't want to pick up another, you know, one point four or five million Dollars in practice debt. But I think you need to ... a lot of people need to realize that a practice debt really isn't ... it's a debt, yes, but it's almost kind of a needed debt to get your cashflow to get you where you want to go. Obviously, you have to do your cashflow analysis on these practices to make sure that makes sense, but my ... the other advice I have for people is that you've got to be an associate, you've got to learn this stuff. You know, like, if you go out and buy this five hundred thousand Dollar collection practice, that's not enough cashflow to pay off your student loans, especially from what I see people are coming out now with. That's why you do your time, do your DSO, your large private practice, whatever, get your experience in, make a little money, pay down the student loans and then actually get a bank to loan you. You know, you show you can produce, the bank could even loan you that money, as opposed to coming right out of school - it's not going to happen, you know, you'll just never get there. And, so, you see people end up just being ... they get used to that lifestyle of working for Aspen - making a lot of money, but they just have to crank that out for twenty years, like you say.

Howard: Did you have problems getting financing for ...

Chad: No.

Howard: ... a practice that big?

Chad: No. I actually had banks competing at that point.

Howard: Who were competing? Which banks?

Chad: I had Bank of America and it was ... the other one that was competing was ... it was a smart bank here in Phoenix. It was First something? I forget the name now because it's been so long, but, yeah, they were going back and forth fighting with rates, you know.

Howard: And then what kind of rates and how long was the loan? Was it ...?

Chad: I got a ten-year loan at four point two nine. That's what I ended up with and this was ...

Howard: Ten-year at four point two nine?

Chad: Yeah, yeah.

Howard: And, you know, it's so relative. When I got to school in '87, the mortgage ... the going rate for a mortgage on a house was fourteen percent.

Chad: Wow! Student loans were that high too, right?

Howard: And, so, [...]. Oh, it was crazy. I mean, when ... so I got out of high school in 1980 and that was when the New York Fed chairman - oh, what was his name? Oh, Paul Volcker! How ... Paul Adolph Volcker born, he was an American economist, he was Chairman of the Federal Reserve under Presidents Jimmy Carter and Ronald Reagan, from August '79 to '87. He's widely credited with ending the high levels of inflation seen in the United States during the '70s, '80s. It was an amazing story. He was appointed by Jimmy Carter - and Jimmy Carter didn't get any credit for this - but Jimmy Carter was a very smart man. He said, “Why is the economy so boom-and-bust, boom-and-bust, boom-and-bust?” And they said, “Well, the presidents want a robust economy going into their four-year election. So, they make money real cheap and they throw out a lot of cheap money to fuel up for the election. Then after the election, they clamp back down.” And Carter said, “Well, that's insane.” And Paul Volcker said, “You need to stamp out this inflation.” And so, Jimmy Carter appointed him. All of his Democrats voted against him, because they knew what was going to happen.

Chad: Yeah.

Howard: And all Republicans were like, “Oh, my g*d, this stupid Democrat President Jimmy Carter is going to swallow a poison pill. He's going to take one for the team, be best for the country.” But nobody, especially not the Republicans, they wouldn't touch it. Paul Volcker went in there and, to stop inflation, he raised the interest rates to twenty one percent, and he killed it to this day. But, I mean, it was 1980. So, I had close friends who, you know, their dads were farmers and they had these big loans and the interest rates were floating and they went in the barn and blew their head off because they were going to lose ...

Chad: I can imagine.

Howard: ... the fifth-generation family farm. And how would you like to be the great-great-grandson of a wheat farmer in Kansas and you lose it. And Paul Volcker was escorted from his house to the Fed every day in armed security. So many people wanted that guy killed.

Chad: Wow.

Howard: But to this day we really don't know what inflation is.

Chad: Yeah.

Howard: And, so, all the ... but, anyway ...

Chad: But, yeah, I'm happy, I mean, with four point two nine.

Howard: Yeah, so, four point two percent! Well, back to debt, I think people use the term wrong. I mean, like these people come out of school and they'll say, “Well, I have three hundred thousand Dollars of student loans”, and they'll throw a pity party like they're some victim ...

Chad: Yeah.

Howard: ... and it's like, and the next thing you hear them, you know, they're working at Aspen, then the next thing you hear from them, you say, “Well, what are you doing?” “Oh, we just bought a house in Chandler!” “Well, how much was your house? Three hundred fifty, huh? So, three hundred thousand Dollars of student loans you thought, everyone was a pity party. And why did you buy a three hundred and fifty thousand Dollar house while you're an employee? Shouldn't that three hundred and fifty have gone to ...”

Chad: Student loan.

Howard: “... a student loan or a big dental office?”

Chad: Yeah, yeah.

Howard: You know, or dental office? So, and, yes, so you'll see them. They ... three hundred and fifty thousand Dollars of student loans, within two or three years they buy a three hundred and fifty thousand Dollar house, they're driving to sixty thousand Dollar sports car, and then they want me to feel sorry for them ...

Chad: Yeah, yeah.

Howard: ... because of their student loan debt. So, debt for going to dental school and becoming a doctor or buying a dental office business, that is leverage.

Chad: I look at it that way.

Howard: Debt for a house, a car, a jet ski and a cruise - that's just raw, naked consumption.

Chad: Yeah, yeah. I a hundred percent agree. I mean, I look at all debt differently. You know, a car loan is a lot different than a student loan, it's a lot different than a, you know, practice loan. You know, there are some that are generating income and some that are just costing you, you know. And I think that's ... I see even on, you know, Dentaltown, there's a mindset out there that some people are just debt is debt, you know, and I think that the sooner you can feel that practice debt is, you know, it's overwhelming but you got to just look at the cashflow standpoint.

Howard: Yeah, well, it is purely leverage. I mean, you could have gotten a job at McDonald's in Iowa for ten years at ten Dollars an hour, and saved up and gone to dental school but you said, “I'm going to use leverage, I'm going to use other people's money and I'm going to come out of school a hundred thousand Dollars in debt but then I'm going to pay it back, not making ten Dollars an hour but making a hundred Dollars an hour.”

Chad: That's right.

Howard: So, it was a 10x leverage to say, I want other people's money. Same thing with that dental office. If you come out of school and you open a scratch dental office, it might take years to build it up and get it going.

Chad: Yeah, yeah.

Howard: And you don't know, I mean, you can ... you still have risk. I mean, you might not build it up and get it really going. Maybe there's too many dentists in the area. Maybe a 2008 will hit and contraction.

Chad: Yeah.

Howard: But when you go buy an existing practice, how ... this practice you bought, how old of a practice was it?

Chad: Well, it was two practices that merged in 2011. The guy that owned that building and probably the bigger of the two practices, he had passed away fairly suddenly.

Howard: How old was he?

Chad: I think he was around forty or fifty.

Howard: Damn, that's young! What did he pass away with?

Chad: Cancer.

Howard: Which kind?

Chad: I think it was ... I'm going to say pancreatic cancer. I can't recall exactly. I never knew, or never met him, but I hear great things about him just about every day. It was the two practices combined, and so it was a bigger practice. Then over the last few years, the guy I bought it from, you know, just got a little more lax and sort of ran out of energy for it. So, that's why I came in. It was a great opportunity, you know, just to pick it up and, you know, take it from there.

Howard: So, first of all, let's talk about that. So, in Wall Street, M&A, mergers and acquisitions, is huge.

Chad: Yeah.

Howard: And if you track merger and acquisition activity, it's very predictive and correlative of where the economy's going. And dentists, I mean, you see it all the time, there'll be a small town, there will be six practices, some old guy puts his practice up for sale. Wall Street would say, “Oh, my g*d, I'm going to buy that, and roll that into my office because there are six offices. I could buy that and roll it into mine.” Now we've gone from six to five, and then you take the purchase price of that practice, divide it by the number of active patients, and you're usually buying patients cheaper than you could buy them through advertising.

Chad: Yeah.

Howard: And advertising, you're going to pay at least one hundred and fifty Dollars per head, and they don't know you. But when the guy selling the practice says, “You know, what I'm going to retire, and I think the best guy to see my patients is Chad Hines.” Now they come in with all this stuff like that, and then the dentists don't do that and then some young guy like you, I mean, you don't ... you have no idea how much more energy you have than me. You're twenty years younger, I mean.

Chad: Yeah.

Howard: And, so, now they're in this small town and some young thirty-five year old, full piss and vinegar Chad Hines, who's ready to see a thousand patients and work through lunch and even ... and now you've got to compete against that. And it's like where, why ...? So, that was interesting, they got to a nine office by merging ... a nine operatory, by merging two practices together.

Chad: Yeah.

Howard: So, now, are you doing all of those patients yourself or do you have an associate?

Chad: I have. When I came on board it was the current owner and another associate. And he had left within a few months, and so it was me and his old associate, and then I just added a third ... well, second associate, third doctor, to the practice, just because the work for me was just getting too much.

Howard: And what are your hours?

Chad: We're seven to five, Monday through Thursday, and then seven to noon on Friday, and then I come in on weekends as needed, but it's not too often.

Howard: Yeah. And how many hygienists?

Chad: We have four full time hygienists.

Howard: So, and nine operatories?

Chad: Mm-hm.

Howard: Operatories 1, 2, 3 and 4 are always hygiene?

Chad: Yeah. Well, then, yeah, 1, 2, 3 are hygiene and then 8 is hygiene, yeah.

Howard: But four out of nine chairs ...

Chad: Four out of nine chairs are hygiene, yeah.

Howard: ... are doing hygiene?

Chad: Yeah.

Howard: Wow.

Chad: And the rest are the doctor chairs.

Howard: So, now, what is your mix of dentistry? What type of dentistry do you like to do?

Chad: I like ... personally, I like the surgical aspect of it. Yeah, I love placing implants, love extractions, you know, kind of the bloody stuff. It is kind of my favorite. I like, you know, I like more complex cases, you know, it keeps life interesting. Worn dentition, those are always fun. Implants. I would say, you know, my favorite part of day would be, you know, placing implants, extracting teeth. And then either two associates, they don't do a whole lot of that, and, so, but, you know, it's ... part of the problem is, I came into the practice and, you know, you put your game face on for the first year and a half because, you know, that's your baby and you've got to milk that, you know, you've got to treat these patients well just to retain them. But, now the problem is they all want to see me for everything. And so, now I'm trying to just get, sort of, focused on more implant, surgical stuff, and then some of the other associates are taking care of the other stuff.

Howard: So, when they come out of school it looks like, you know, an endo we, you know, if you're like me where you want patency at the bottom of the apex.

Chad: Yeah.

Howard: And when you operate that thing you want to puff a sealer at the ... and you're an ape-ical  barbarian. And if you read too many endodontic textbooks and you want to be a half millimeter short of the apex and all that, and make it all clean and pretty, you're a pulp lover.

Chad: Yeah.

Howard: But I take that on more than dentistry. Some many of these kids come out of dental school and they don't like blood, and they just like the white, pretty stuff. They want to do bleaching, bonding ...

Chad: Yeah, cosmetics.

Howard: ... veneers, cosmetics, sleep apnea, Invisalign. And then there's these bloody barbarians like you and me who just, I mean, like, one of the reasons I pull wisdom teeth so fast, I mean, I can pull all four wisdom teeth in under ten minutes ninety nine percent of the time that there's nothing that tooth can do to hang on to that jaw. But when I lay a flap, I mean, I peel it like a banana, I see white mandible. When I erase buccal bone, it's like one time, it's like gone, boom. But to me it seems like the people that like blood and guts, whether it be extractions, root canals, implants, it just seems like it's an easier path to success, than if you just don't like blood and guts.

Chad: Well, I think, you know, especially ...

Howard: And one last thing, but the average general dentist makes one seventy-four take home, but endodontists are three fifty-four, oral surgeons are four eleven. I mean, if you just look at the nine specialties, the endodontists and the oral surgeons and the periodontists are making two and a half times a general dentist. So, the white, pretty stuff doesn't really show up in the numbers.

Chad: You know, a hundred percent. The biggest thing I see too is that there's a lot of big cases that hinge on implants, endos, extractions. You know, if you say to a patient, “Well, I’m going to refer you to this guy for this, this guy for this, this guy for this.” They kind of go, “Oh, okay.” And they just, kind of, never. Or you just say, “We're going to do all this. This is how we're going to sequence it. We're going to do it like this.” They say, “Where do I sign up”, you know, and that's ... especially in probably the last eight to ten months, I don't know if it's an economy thing or just, you know, I'm getting more comfortable, you know, doing this stuff, just left and right, you know, these big cases where they need two implants, you know, three root canals, a bunch of crowns, opening the bite, the whole works, you know. So, I think even just from the fact of doing the procedure, you know, and the profitability from the procedure, it's just the whole case in general, case acceptance.

Howard: Yeah, and I ... now, are you born after 1980? Are you a Millennial?

Chad: I was born in '81.

Howard: So, you're a Millennial then, so ...?

Chad: I guess so.

Howard: Yeah, 1980 is the beginning of the Millennials. '45 to '64 is a Baby Boomer - I was born in '62, so I'm a Baby Boomer. But it seems like the Millennials are the first generation in the history of humanity where they're obsessers. Well, do I like my job? Does it have meaning and purpose? I mean, for the last two million years a hundred billion sapiens have come and gone. How many of the hundred billion sapiens have said, “You know, I like eating Mastodon shit in a cave. I like finding ... coming across a rotting, four-day old animal and chewing the cart.” I mean, there's a shit load of humans in the last two million years that didn't love their job and they'll say things, “Well, I don't really like endo.” Well, I don't give a shit if you like endo. You have three hundred and fifty thousand Dollars of student loans. This person's in pain. They didn't go to sleep last night. You're a doctor. They took time off work. They show up in your office and you're like, “Well, I don't like endo.” Well, maybe you won't like the first hundred, but you'll like the second hundred more and by the time you do your third hundred, you're just sitting there saying, you know, you like what you're good at and how can you get good at it if you never do it because you say you don't like it and maybe you should just do your damn job and learn to like it.

Chad: Yeah. Yeah.

Howard: You know what I mean?

Chad: Yeah, I mean, obviously, you know, there's a competence level there that, but, yeah, I mean.

Howard: But how do you get competent if ...

Chad: Yeah, if you don't do it.

Howard: They'll say like, “Well, I refer out second molar.” “Why?” “Well, I'm not good at second molar.” “Well, how many second molars have you done?” “Well, I don't do them because I'm not good at them.” Well, maybe you should do the next hundred.

Chad: Yeah.

Howard: And I'm sure after the next hundred, you'll be twice as good at second molars. And the thing I don't like about ... can you imagine breaking your leg and going to the hospital and the doctor says, “Well, you know what? We don't do legs. Yeah, we just do arms and fingers and ears, but you need ... here's a referral and I know you came in an ambulance and you're in pain but, you know, go make an appointment across town.” I mean.

Chad: Yeah.

Howard: You know, there's nine specialties. One of them is public health dentist, and, you know, everybody wants to talk about ortho, periodontist, pediatric dentist, but you're a public health dentist. When someone shows up in your office and they're in pain and you have a dental degree, maybe you should fix it.

Chad: Yeah, absolutely. And not only that, it's from even, you know, learning it from a diagnosis standpoint, you know. I mean if you're great at, you know, endodontics, you're pretty good diagnosing it too, and I even think that goes into implants as well to where, you know, how do you diagnose and send to a periodontist or oral surgeon for an implant if you don't know if that needs grafting, you don't know what's it all involve and you don't even know how to restore it, you know, when it comes back with the implant. So, I mean, you got to learn, you got to learn this stuff, you know.

Howard: And that's what I've always told the orthodontists. Every general dentist who ever went and learned how to do their own ortho, usually within two years they stop doing it, because the orthodontist is flipping these patients every fifteen minutes.

Chad: Yeah.

Howard: And all [...] and all that stuff. But after they quit doing it, they diagnose two to three times as much ortho.

Chad: Oh, yeah.

Howard: Because they didn't see it before they learned how to do it. Now they see it. So, when you came out of school, how many implants have placed at Iowa?

Chad: We didn't place any in our program.

Howard: So, how do you go from, I graduated dental school in 2010, I've never placed an implant, and now you're doing these implant cases with a CBCT?

Chad: Yeah, well, obviously, CE. You know, a lot, a boat load of CE. You know, I basically for ... it was about a year there I just tackled every CE I possibly could, you know, that sounded interesting and that'd get you a good experience. And then, as you take one, you just, you advance to the next level and to the next level and, you know, the last one I took recently was at the Brighter Way Clinic here in downtown, where you did a lot of edentulous implants.

Howard: Was that with ... who was that?

Chad: Joe, Dr. Joe Mehranfar.

Howard: Right.

Chad: Yeah, yeah.

Howard: And he teaches at the ...

Chad: He does a lot of things.

Howard: ... at Midwestern.

Chad: Yeah, he's a little everywhere doing stuff.

Howard: Is he a friend of yours?

Chad: No, I just know from the course.

Howard: Yeah. I need to get him.

Chad: I got ...

Howard: Well, who were your standouts in your implant training? Dr. Mehranfar?

Chad: I took a course with Leo Malin up in Las Vegas. He's based out of Wisconsin.

Howard: What was his name?

Chad: Malin, Leo. M-A-L-I-N.

Howard: M ... Leo, L-E-O, then?

Chad: M-A-L-I-N.

Howard: Leo Malin. And is he an orthodontist or an oral surgeon?

Chad: He's a general dentist.

Howard: And he teaches implant surgery?

Chad: Yeah, yeah.

Howard: In where?

Chad: I think, well, he's based out of Wisconsin, but the course I took was at the LVI. That's the only course I've taken at the LVI, was their implant course.

Howard: Huh, Leo Malin.

Chad: And, you know, a lot of the stuff is Dentaltown, you know, learn a lot on Dentaltown, and then just obviously research and, you know, you get in a little ... few, little, small complications, you start with ...

Howard: When did you start Dentaltown? Was that in dental school or after you graduated?

Chad: You know, I think I browsed it a ton before I created a login and started get active with it. The more I wanted to learn, like, that's when I started to become active, and more converse with people and ask questions and throw things out there and respond to things.

Howard: You know, what is it about the posters? I mean, most of my emails are asking me questions and I say, “Well, you know, you should ask this on Dentaltown.”

Chad: Yeah, yeah.

Howard: And they're always the same thing, they're scared, they're shy ...

Chad: They're behind a keyboard!

Howard: I mean, there's people that have been on Dentaltown since 1998 to 2017, they come on three times a week for an hour and they've never made a post. And I'll say, “Well, why don't you ask that question on Dentaltown?” And they're just scared. Why? Why do you ... I mean, you've made four hundred posts.

Chad: Yeah.

Howard: Why are you not afraid to ask a question? And ninety percent of your comments are.

Chad: I guess it all starts with, you know, the first post. If it goes successful, you keep posting, but you'll see a lot of, you know, obviously with any message board of any type or whatever forum, you'll see people with negative reactions, saying, “Oh, you're doing it all wrong!” You know, I think that's what people fear, if I had to guess. You know, you just ... people throwing each other under the bus and that happens, I think, in any forum. But, you know, by and large, you know, ninety five percent it's all positive stuff, they're there to help you. You know, I'm there to help people, you know, give them my feedback or I'll throw things out there, hoping the same.

Howard: Yeah, and, you know, even lecturers. So many of the lecturers, you know, they're used to ... they just lecture and give a presentation and they are literally shocked if someone disagrees with them. And where I come from, the camp of ... there's seven and a half billion humans on earth and ...

Chad: Oh, yeah, yeah, absolutely.

Howard: ... you can't get two of them to agree on anything.

Chad: Yeah.

Howard: I mean, even my two sisters that are nuns - Catholic nuns - disagree on half the issues in the Bible. Look at the Supreme Court. They're all reading the same constitution, they all went to law school and most of all the major decisions are five to four.

Chad: Yeah, interpret this differently.

Howard: So, it's like ... so, dentists, I mean, if you think you're going to get all the dentists to agree with you ...

Chad: Yeah.

Howard: ... you need to just start drinking heavily right now.

Chad: Yeah, yeah, absolutely.

Howard: 'Cause it's never going to happen!

Chad: I mean, dentistry, it's, you know, it's not black and white, that's for sure, you know, there's ... the majority of it's a gray area, in other words, you can, you know, do it eight different ways and probably get the same result, you know. It's just how someone might have a different experience doing one thing and the other guy has a different experience doing another, and usually, I think, we all end up with the same result, hopefully.

Howard: So, you ... so, what ... so, you said you went to the Straumann system.

Chad: Yeah, it was all Straumann.

Howard: All Straumann. So, Straumann is out of Switzerland, Novel Biocare is out of Sweden. What made you pick Straumann out of Switzerland?

Chad: You know, I was going ... you know, there's a lot of systems out there and I guess some of my experience restoring implants is that the parts and pieces are, you know, there's ... I'm sure you have, you open a drawer and there are just pieces everywhere, you know, and well, I wanted to focus in into one system, you know, place one system, restore one system, just to keep your inventory down and be good at one system. You know, every restore's different, you know, Nobel, whatever, and it's just a little different. You know, sometimes I'm like, okay, I'm not real familiar with this, but I like Straumann because it's probably not going to change and it's always going to be there. You know, my fear is, which I think is going to be an issue in dentistry in 2010 now, even in years, that we've got so many implants out there and there's so many small companies that when these guys go under, where's the parts, you know.

Howard: And how many have already gone under?

Chad: Yeah, yeah. And, so, like, when a guy comes in on Friday ... like, I had this guy came in on Friday at eleven thirty and we close at noon and he's got a loose implant on some system I've never heard of and I can't even find them on the Internet, you know. And, so, I know that Straumann is going to be around. I won't ... because if I'm going to practice for fifteen, thirty years, whatever it may be, their parts are going to be available, you know.

Howard: And here is the other thing. You know, it's one thing when you mess up on a single tooth, let's say it's a failed root canal. One of the reasons you're ... you can tell how much lawsuits are going on by your premium.

Chad: Yeah.

Howard: Like dentists say, “Well, there's so much lawsuits going on.” Then why is your premium so low?

Chad: Yeah.

Howard: I mean, an OB-GYN, their malpractice is over a hundred thousand Dollars a year, because when you screw up a baby ...

Chad: Yeah, it's not a tooth.

Howard: ... you know, when you screw up a newborn baby, you're in deep shit trouble ...

Chad: Yeah, yeah.

Howard: ... and the whole family wants to kill you. But with these implant cases, these are the bigger cases, and, my gosh, when a big implant case goes south and then you go to court and, you know, if Nobel Biocare or Straumann or Implants Direct or any of these major companies, they have tons of research that shows everything they did. And you're using some no name brand, some eighty-nine Dollar implant from Russia …

Chad: Exactly.

Howard: ... and it's not pretty.

Chad: Yeah, yeah. I mean, it's ... I mean, Straumann, obviously they got ... I think they're the number one selling brand too. Obviously, they have all the research behind them.