Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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907 5-Star Service with Dr. Ann Marie Gorczyca : Dentistry Uncensored with Howard Farran

907 5-Star Service with Dr. Ann Marie Gorczyca : Dentistry Uncensored with Howard Farran

12/27/2017 8:15:37 AM   |   Comments: 0   |   Views: 356

907 5-Star Service with Dr. Ann Marie Gorczyca : Dentistry Uncensored with Howard Farran

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907 5-Star Service with Dr. Ann Marie Gorczyca : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #907 - Ann Marie Gorczyca

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AUDIO - DUwHF #907 - Ann Marie Gorczyca

Dr. Ann Marie Gorczyca has been a clinical orthodontist for over 25 years. She wanted to be an orthodontist since she was in the seventh grade when she had her own orthodontic treatment! After completion of her orthodontic residency program, she worked with world reknown orthodontist Dr. T.M. Graber in Evanston, Illinois. Since moving to California, she has  taught at both UCSF and University of the Pacific Dental Schools and worked in a multispeciality group practice prior to opening her own orthodontic office in Antioch, California.

Dr. Gorczyca opened Gorczyca Orthodontics in Antioch in 1996.  She has enjoyed serving the great East County community including her patients, the community and greater East Contra County dentists.

In addition to her private practice, Dr. Gorczyca is an adjunct clinical professor at the Arthur A. Dugoni School of Dentistry at the University of the Pacific. She has also taught at UCSF Dental School, and Northwestern Dental School.

She is author of the book It All Starts with Marketing and is a frequent lecturer on dental management. Dr. Gorczyca is also founder of the East Contra Costa County American Association of Dental Office Managers Study Club (AADOM). She has received three teaching awards for her service to post-doctoral orthodontic education.

A graduate of Wellesley College, Harvard School of Dental Medicine, and Harvard School of Public Health, Dr. Gorczyca completed her advanced orthodontic residency and received a Master of Science degree in oral biology from Northwestern University.  She also has a Master's Degree in Public Health.

Howard: It's just a huge honor to bring back my idol, my role model, Dr. Anne Marie Gorczyca, my favorite orthodontist in the world. We did a podcast with her on Number 42, then we brought her back for 339, and today she's coming back because each time I bring her on it's because she's wrote another book. She is a clinical adjunct professor of Orthodontics at the Arthur A. Dugoni School of Dentistry, University of the Pacific, where she speaks on practice management topics including marketing, teamwork, treatment co-ordination, customer service, management systems and human resource management. She has been a speaker at the 2011, '12, '14, '15, '16 and '17 American Association of Orthodontists' Annual Sessions and teaching and in private practice for over twenty-seven years. Dr. Gorczyca is formerly a faculty member at UCSF School of Dentistry. She has received teaching awards from UCSF and the University of Pacific Dental Schools. She's a diplomat at the American Board of Orthodontics, a member of the Angle Society of Orthodontics. She's in private practice in Antioch, California. This is her third book, 'At Your Service: 5-Star Customer Care for a Successful Dental Practice'. You should go back and read the podcast. 'It All Starts with Marketing' - it's an amazing book - '201 Marketing Tips for Growing a Dental Practice'. And her original, 'Beyond the Morning Huddle: HR Management for a Successful Dental Practice'. Ann, I want to start with this question: when I ask a dentist, you know, "What keeps you up at night? What makes you not want to go to work in the morning?" It's always the staff. It's always H.R., and if it's not H.R., then I say, "Well, what bothers you next?" It's the patients. You know, they ... you know, this denture's been cracked for three weeks and now they need it fixed in an hour, because they're headed for the airport. I mean, people drive people crazy. They're the best thing about life. I mean, I wouldn't want to be born all alone on earth - that'd be weird. So, other people are the greatest joys of life, but they're also the greatest stresses, aren't they?


Ann: Well, human beings are human beings. But let's look on the bright side, and let's look at our patients as a blessing, and let's focus on the great impact that we have that we can make on this world through our dental care and through our patients. And, you know, that's really starting off with your why. Why do you get up in the morning? You get up to serve your patients, you get up to make the world a better place. And I think that if all of us as dentists can focus on the big picture, rather than a small problem which has a solution - every problem has a solution - I think that we're going to have a little bit more optimism and a little more healthy outlook and be a little happier in our practices. So, you know, starting on that point, what makes a dental office great and how can we improve the customer service in our office? It starts with the culture, and the culture is determined by leadership. So, let's start with that topic, Howard, for all the dentists out there. Leadership.


Howard: Well, you know, the Mafia always said that the fish rots from the head down. So, the head creates the culture. So, I agree that if the office is dysfunctional, the buck stops with the CEO.


Ann: That is correct. And being a practice owner, you have earned the right to be the leader of your practice. You are in charge of the leadership. So, you know, the culture is not optional. If you put the things in place which you want to achieve with your team and with your patients, and then follow through, you will be able to build the dental practice of your dreams and put together the culture that you would like. Now, in that culture, it begins with recruitment. Who are you going to hire? Okay, so, my situation would be to say to that dentist, if someone is keeping you up at night, maybe you need to eliminate that team member, right. Because great H.R. managers know you can't change human nature. So, you can ask once, you can ask twice, but after the third time, if something is performance-related and it's not being achieved in your office and you're frustrated, well, like a great coach of a basketball team, maybe you need to sit down with that team player and say, "You know what? Maybe it's time for a time out for you. Or maybe the service of dentistry, maybe this is not the industry for you."


Howard: I agree, Ann. I also think some people are much better at H.R. than me. I remember, I hired a bookkeeper twenty years ago and she was just so ... her name was [00:05:14] [sounds like: Laurie Zalowski]. [0.7] She's still there and she was just so much better at an interview. And she, I think, sometimes dentists, what they do is they don't realize that they're not interested in something like ... dentists are smart. I mean, they got A's in calculus, physics, geometry, trig, they know the Krebs cycle, but if they have no interest in managing a team, if they have no interest in leadership, if they have no interest in H.R., some of those guys are just so better off getting an office manager that can do that kind of stuff.


Ann: Perhaps, but it's hard to find that person.


Howard: Oh, yeah.


Ann: It's hard to find a good office manager. So, let me go over a few tips that might help the dentists with their leadership. The first tip is the recruitment. That when you recruit new team members, take your time, hire slow, go through as many resumes as you can. I would say that if you're recruiting team members, give it a month. I would say, collect resumes for at least two weeks. Have resumes on file in the event when you do need a new team member. Do one or two working interviews. Involve the team in the decision of who you hire and take your time, because hiring a new team member is like dating. I mean, you are going to spend the rest of your life with that person or, hopefully, your whole career with that person. So, it's a big decision, and it's not an easy decision. And we do make mistakes in hiring. One example is, let's say the Ritz Carlton. It has a 20 percent dismissal rate the first ninety days of hiring, and the Number 1 reason is attendance. You know, attendance is a big thing in dentistry. We work with a small team and we cannot afford to have one team member who consistently does not show up for work. So, that would be one behavior that you want to eliminate that behavior on your team. You have to have reliable team members.


Howard: When you say Ritz Carlton has a 20 percent let-go rate after the first ninety days?


Ann: That is correct. During the first ninety days.


Howard: And these guys are the most sophisticated H.R. interviewing people on earth!


Ann: Well, they are customer service leaders.


Howard: So, if the very best doesn't get it right one in five times, what do you think the average dental office does?


Ann: Well, I would say that a dental office that has never had anyone quit or never let anyone go, I would say that maybe their standards are not critical, maybe they have no standards. Because, as you said, human nature is human nature, and people change, and things change. So, imagine a basketball team: imagine a basketball team that never has a change of team players, right. You know, after fifteen years, you'd have all like really aged, un-fresh team members, you know. You have to keep refreshing your team. And people make decisions. They move on. They change careers. So, I think there is a level of change which is a healthy level. And I always consider every change to be a positive for your office, not a negative. Because with each change, you have the opportunity to get someone better than the person that may have left.


Howard: I personally think the most competitive industry I've ever seen in the world is actually the NFL sports team. I mean, you go into Phoenix, Arizona, and there's only four or five grocery store chains. The NFL has thirty-six teams. I mean, you know, there's not thirty-six competitors in any space, and they have a 30 percent employee turnover per year. They burn and churn. I mean, the average NFL player is only three and a half years, so they're burning and churning big time.


Ann: Yes. Well, you know, in my office I think I have a healthy change rate. And personally, I like to focus on performance. So, I will always be requesting of my team members, "Did you do the things I asked you to do?" And when we have our team meetings, they're going to present to the group, "Here's what I did." And as the leader, I'm going to be checking that the things that I need done were done. Now, someone who is not living up to the goals of the office or the standards of the office or they are not getting the job done, they're not going to stay around, because in management one of the biggest things you have to keep things flowing is your team meetings and the accountability that people have to their team. So, that's one way that doctors can achieve what they want to achieve, is to assign individual performance goals to individual team members, make them accountable, and have them report at the team meetings, to get things done that they want to get done.


Howard: Ann, and there's also generational problems. I mean, the richest man in the world right now is Jeff Bezos, at one hundred billion Dollars, and Amazon's average employee is only a year. And it's all these millenials that Facebook is Number 1, and it's only two years, and Apple and Netflix and Google - that's FAANGM, two As - Facebook, Apple, Amazon, Netflix, Google and Microsoft, which is my favorite because now it's in the big bubble territory in 2017. But it was also in the big bubble territory in March from '94 to 2000. So, you know, Microsoft's diversified, they have seven major forms of income whereas Google and Netflix and Apple and Facebook - Facebook and Google are both making almost 95 percent of all their money just on ads. But these companies are plagued ... you know, Baby Boomers like us, like my uncle, he got a job with Mobil Oil in the mailing room when he was 16, and he stayed with him till he retired at 65. And these Millennials are flipping jobs every two years. And when I talk to the CEOs of dental services organizations, they have the same thing. I mean, they can't keep their average associate for two years. And when you go to private practice it's the same thing. These associates that they work here for a year, then they go on the other side of town for a year, then they start dating somebody in another city and fly to that city and start working there. So, how do you have in your new book, '5-Star Customer Care for a Successful Dental Practice'. If you are talking to a CEO who had five hundred or eight hundred dental offices, and how do you have 5-star customer care when every time a patient goes in, they're flipping doctors? And then to see hard core data there's only three publicly traded dental companies on earth, two in Australia and one in Hong Kong, I mean Singapore. And in their filings, since they were publicly traded, they're all burning 20 percent of their dentists a year, which is actually better than America because 20 percent a year means your average doctor stays with you five years. But in American DSOs, your average dentist is only staying with you two years. So, how do you have 5-star customer care if your dentists are flipping every two years?


Ann: Well, that's hard. That's hard. But here's what I would say, okay, dentistry as a service industry is an incredibly local service, okay. So, one thing that is very positive is that when you hire people that grew up in your community, their relatives live in your community, they married someone from your community, and they have lived there their entire lives. That immediately gives you a better chance that they are going to be long term, loyal employees, okay. The second thing I would say is, in your interview process, you need to find people and ask questions that distinguish: is this person going to love dentistry and are they going to love working for your company, okay. So, as the leader, and hopefully you are the transformational leader of your dental practice which you own, okay, as the leader one of your jobs is you are trying to find people and inspire them from going from wanting to work for you to enjoying working for you to loving working for you, okay. And that is our goal, is to find people that their calling is to serve the patients and that they feel that what they're doing is changing people's lives and making the world a better place in their own community. So, the high turnover nationwide across all industries, all companies, all businesses, in the United States, the average employee stays three years. That's the average for the whole United States of America for all industries. So, you know, anyone who stays in your practice beyond five years, that is a very loyal and dedicated employee and they should be respected and rewarded and appreciated for staying. Now, the Internet makes changing jobs very, very easy. You know, any dentist right now, I could probably go on the Internet right now and type in 'orthodontist Northern California' and I would probably find a job posting where I could find a job today. So, people that are career climbers, they're not devoted to the community, they don't want to work in your practice. They're going to be switching jobs all the time, because the resources are out there. So, one of your jobs as the leader of your dental practice, is to build a culture that people want to be part of, and to hire people that share your vision, share your core values, and want to work in your practice, and love what you do.


Howard: So, it's kind of interesting, so, if the Number 1 lowest turnover of the FAANGM - Facebook, Apple, Amazon, Netflix, Google and Microsoft - is Amazon at Number 1, and they are most likely to become the first publicly traded company with a market cap of a trillion Dollars, it almost seems like the most competitive beast are burning and churning faster, you're saying. So, I thought Facebook ... and Facebook of the FAANGM is the best. Their average employee stays two. But you're saying in American it only averages three. I mean, it looks like there's a lot of pros and cons for turning over, just looking for better and better talent, but, so.


Ann: Well, to make a comment about Internet industry, okay, because I'm in northern California ...


Howard: I know, you drove a drove me and Ryan to the home of Twitter and we were tweeting them from outside the building, saying, "Let us in and give us a tour", and they didn't reply.


Ann: Yes, well, I have a lot of friends that have worked for Apple, worked for Google, whatever. Those are very high pressure cultures. There is a lot of high pressure there and they work long hours. They get paid to work overtime. They feed them meals in the building. So, their modus operandi is to have their employees literally stay at work ten hours a day.


Howard: How many days a week?


Ann: And that's fine. If you're young and mobile, that's fine, but once you're married and you have kids, things change. And that's a lot of reasons why people after a few years, they leave some of those Internet companies.


Howard: Yeah. Yeah, that is truly amazing. So, Ann, what made you write your new book, 'At Your Service. 5-star Customer Care for a Successful Dental Practice'? One of my pet peeves against that thinking in dentistry is people always talking about the new patient experience and I always think, "The new patient experience?!" G*d, your existing patients are far more valuable than your new patients. I mean, it should be flat out 5-star customer care for a successful dental practice; doesn't mean if it's a new patient or the first patient you got thirty years ago. It's all about the patient experience.


Ann: That's right. And it's all about all your patients. All your patients. Your existing patients are your Number 1 referral source. So, you want to treat each individual right. And in 5-star customer service, we all know the Golden Rule of customer service is treat people the way that you'd like to be treated. But the Platinum Rule of customer service is to treat people the way that they want to be treated and to know your patients so well that you know what they like, their individual likes, their dislikes, their wants, their needs, and how you can serve them best in your practice.


Howard: I think it's incredibly important because, you know, when I go to the Ritz Carlton, who you say is the leader in 5-star customer service, it's transparent what they're selling. I mean, they sell a hotel room. When I buy an Apple phone, I know what I'm getting. When I buy, you know, when I buy almost everything I buy, I know what I'm buying. But when I go take my car to an auto mechanic because the engine light comes on, whenever the engine light comes on, since I grew up with five sisters playing Barbie dolls till I was 12, I always call it the 'idiot light', because I don't know the difference in a transmission and a spark plug. So, when the guy comes out and says, "Well, that light means you got to do this and it's $1,000", I'm hopeless, I don't know what to say. And that's how our patients feel when they come in and you say, "Well, you have four cavities", and they're like, "I just came in because I wanted cleaning. I want to get my teeth whitened. I don't have any problems. And I have to trust you that you really are serious. You're not trying ... I mean, each one of these fillings is $250. It's pretty easy for you to just say, 'Give me a grand!' Do I just give you a grand?" So, how does 5-star customer service help the patient establish trust that what you're saying is true and I want to get those services done?


Ann: Well, Howard, you're absolutely correct that we are in a service industry. Dentistry is a service industry and we have a product that we give to the patient, but our actual product is patient happiness and patient trust. That is actually what we're selling. So, in a very short period of time, whether it be the new patient exam or the existing patients, we have to build that trust in our patients. And what is trust founded on? Number 1, it's founded on our ability, that we translate our ability to the patient to show them: this is the work that I've done, these are the patients that I've treated. That they come in our office and they feel confident that we can deliver the work that needs to be done on their oral health, okay. The second thing that builds trust is benevolence.


Howard: What was the first thing now? You said it was ...


Ann: The first one is ability, okay. We must be able to deliver the goods to the patient. So, you know, it doesn't matter how good your customer service is, if you don't have the ability to deliver a good product, whether it be an implant, a crown, a bridge, orthodontics, whatever, we're not going to have good customer service, we're not going to have the trust of our patients. So, ability in dentistry is very, very important, okay. The second thing is benevolence. That when the patient walks in and we care for the patient, that they get the feeling that we care about them more than we care about ourselves. We are there to help them. We're there to serve them. We're there to take care of them, to take care of their healthcare needs. So, benevolence, that we put the patient first, that is very, very important. And the last thing is integrity. That our office has integrity, that we have a good reputation, that we say what we do, what we say we're going to do, we do that, we deliver that, and we're consistent. So, that's something that distinguishes a service industry of dentistry from other industries, our ability to provide a service, our benevolence and our integrity.


Howard: Yeah, it is totally trust. We sell the invisible all day long. Can you really build trust if every time the patient comes in, it's a different hygienist? Like, you know, I'm torn with the guys that fix air conditioners in this house. I've switched out because the biggest name, the biggest brand, the one that everybody uses, every time you call them they send out a different person. And then I say, "Well, what about the last guy, the guy that installed this two years ago? Where is he?" And you just see this burn and churn, and burn and churn. So, what I finally did over the years is every time a tech came out, I got his individual name and his individual cell phone number, and, so, now follow them from company to company to company, until they started their own. But, it's just so hard to establish this karma in your dental office, with the high rate of employee turnover. I like your advice about hiring people born in the town, raised in the town, their mama and their sisters living in the town. I've been burned so many times by hiring dental assistants who are married to people in the military. They move everybody every two years. IBM doesn't stand for 'International Business Machine', it stands for 'I've been moved'. I mean, my gosh, just trying to slow down staff turnover and build this ability, benevolence and integrity, it's the key. Where do you think ...? Go ahead.


Ann: Let's talk about one more aspect of that, and that is the teamwork, the teamwork, okay. And I mentioned that at Gorczyca Orthodontics we describe teamwork, we use the word 'tocare', okay, trust, ownership, communication, alignment, results in excellence. Okay, those are the six aspects, and we've talked about trust, okay.


Howard: Okay, 'tocare', that's T-O-O-C-A-R-E?


Ann: No, T-O-C-A-R-E - to care.


Howard: Okay, trust, ownership, and then what does 'care' stand for?


Ann: Communication, alignment, results in excellence. So, let's talk about ownership, because ownership is key, that the employees, the team members, they have ownership in the practice, okay, they own the experience, they own the patient experience, and what you just mentioned about asking for a specific customer service leader at a specific company, okay. Whoever your patients ask for by name, they are your Number 1 customer service leader. So, for example, in my office I have Jolene, you know, she's going to be with me now twenty years. There are many patients who come in asking for Jolene. They want Jolene and Jolene is the leader of the team. She is the leader of dental assistants in my office, because she has ownership, she has ownership and experience, and she has loyalty and commitment. So, that is very important. I think there are two aspects of the office experience with ownership that I think are very important, and I mentioned the first one and that is attendance, okay. Your team members have to have excellent attendance. If they don't have excellent attendance, the other team members are not going to trust them and they're going to pull your office down, because, you know, when one person doesn't show up for work and everyone else on the team has to work twice as hard and no one likes uncertainty. So, that's the first thing that I would say for ownership that's very important. The second thing is staying on schedule, being on time and staying on schedule. And I don't know how you run your practice, but in my practice every team member has her own column of patients and she's assigned to her own chair and she is responsible for staying on time with her own patients. So, that's another thing that builds trust of your patients that, you know, they come to your office, they're going to have a good experience, that they're not going to be waiting for a long time. Now at Disney World, at Walt Disney World, obviously people wait in line for a very long time for the rides. But, do you realize that whatever the time says at Walt Disney World: your wait is thirty minutes, right? Your wait is actually half as much as what it says. So, they over-deliver, they over-deliver. And when you get on that ride after waiting fifteen minutes, you're happy because the sign said thirty minutes and you only waited fifteen minutes. So, that's another customer service tip that I would give the listeners is that, when there is a delay and you go to the reception room and you say, "Thank you for being here. We'll be with you in ten minutes", okay, make it five minutes. Actually say twice as long as the wait is actually going to be, so that you over-deliver on what you can say. The other thing is it's good to have an extra chair, a roll-over chair, that the patient can always be seated on time. Even if the service is not started at that minute, you can at least seat the patient so that they're acknowledged, and they know that you know they're there and you can seat them on time.


Howard: And, since you are selling something not transparent, you can also - fifty shades of truth - a pre-process wait in the waiting room is infinitely longer than an in-process wait, because in the in-process you think you're doing something. So, having those extra rooms is critical. I mean, we seat them on time in extra rooms and then I'll go numb them up and I'm running twenty minutes late and I'll say, "You know what? I want this to really soak in. I do not want you to feel any pain. In fact, I'm going to let this soak in for like twenty minutes so it's completely, profoundly numb", and they're like, "Yeah." So, then they're waiting in process, they think, "Well, I'm doing something. I'm waiting for this to get really numb, because I don't want pain either." But if they were waiting that twenty minutes in the waiting room, they'd be blowing a stroke.


Ann: Yes, that is true, that is absolutely true.


Howard: Yeah.


Ann: So, you want to seat your patients on time. And also, it's good to let them know ahead of time how long the appointment is going to be, because people are in a rush these days. And, for example, if your initial exam is one hour long, you should tell the patient, "Please plan to be here an hour. We do a very thorough exam. We're going to be taking some x-rays. We're going to give you a treatment plan and a diagnosis, and the process is going to take an hour", so that they are not surprised by how long it takes and that they see that as a positive and not as a negative, because people are in a rush these days. So, the more information you can give them, the more you can communicate with them, the better customer service experience they're going to have.


Howard: So, you talked about 'tocare' - trust, ownership, community, alignment, results, excellence. Anything else you want to add to that?


Ann: No, that's it, that's it. Now, for communication. One thing I'd like to just mention is, there are four different types of patients and, in delivering customer service, you are going to be resolving complaints, okay. There will be a complaint in your office and you are going to be resolving complaints, and the customer service leaders, we want them to immediately resolve whatever needs to be taken care of. So, in my practice we have a saying, "If I see it, I own it, I resolve it." Okay, and if they can't resolve it, let's say it's an insurance billing question or whatever, they'll say, "Well, let me find out, let me find out for you." But they follow through and they get the job done so that there is immediate service given to the patient. Now, there are four different types of patients, and 97 percent of our patients are just A patients and they're a delight to serve and, should there be some little glitch that something comes up, they will say, "Oh, I understand." You know, you apologize to them, "I understand. See you again next time. Everything's fine", whatever. That's 97 percent of the patients. One percent of the patients are a little bit insecure, okay. We call the first type of patient, 'I'm okay, you're okay'. The second type of patient is 'I'm not okay, but you're okay'. And that patient is a little bit insecure, okay. That's the patient, you have to put them in the quiet room. You have to really explain everything to them. They're a little bit sensitive. And those patients, if everything's going well in the office, everyone's smiling, everyone's happy, you're on time, you're on schedule, they're fine. But should there be a little variation, they are going to get very nervous, okay. So, you need to understand that about human nature, about these nervous types of patients. Then there's the 'I'm not okay, you're not okay' patient. That is the really grumpy patients, okay.


Howard: Is that 2 percent, or is that another one?


Ann: That's another percent.


Howard: Another percent.


Ann: That's another percent.


Howard: And what do you call them?


Ann: I call them the 'I'm not okay, you're not okay'. I call them the 'grumpy cat' patients. They're grumpy, okay. And you just have to understand that's the way they are. It's not you. That's the way they are and don't take it personally and just give them as much love as you can, okay. But the last percent, and this is what I want your listeners to be aware of, the patient who comes in and they're okay but you're not okay, okay. They're okay, but the last four dentists they went to are not okay, okay. That's the patient that has the 'warning, warning, warning' flag above their head, because they cannot be pleased. They just ... there are some .... the very small percent, 1 percent, that they are just never going to be happy and they think they know more than you do. They think they know more about implants than you do or perio than you do or ortho than you do. And that's the one type of patient that you need to try to avoid.


Howard: What do you call those guys?


Ann: Well, I call them the 'I'm okay, you're not okay'. I mean.


Howard: You called the first one insecure, the second one grumpy, what's the third one? Toxic?


Ann: I would say the 'dangerous' patient.


Howard: Dangerous.


Ann: The dangerous patient. They're going to cause problems for you and they're going to cost you a lot of money, because they waste a lot of your time.


Howard: Well, I think people like us who, you know, my dental office celebrated its thirtieth anniversary this year. I think you eventually learn all these lessons the hard way after thirty years. But if you were just out of school, if you're a Millennial, you're under 30, what are some warning signs, red flags, to fire these guys before you get in trouble and are at the Board getting sued and losing stomach lining?


Ann: Well, I think at the initial exam someone who is already complaining, and you haven't even done anything yet, that is a warning sign. I mean, I remember I had an orthodontic friend and he said he was doing an initial exam on the daughter and the dad was already complaining about the x-ray machine, about that, you know, he didn't want x-rays taken or he thought the radiation was too high a dosage or whatever. That's a warning sign. Or someone who comes in and says, "Well, this isn't right, that isn't right. This isn't right." You know, when you get a transfer, you should always ask, "Well, what is it that you didn't like about that other dentist? What was it that didn't go right at that other dental office?" and listen to what they say and ask yourself, does it make sense, you know, does it make sense. I mean, maybe they didn't pay their bill, maybe that's the real reason why they left. Maybe it's not that whatever they're saying is the case. So ...


Howard: Just one classic example. I've been told a hundred times by patients in thirty years that the last dentist had to put their knee on their chest to get the tooth out. Yet I've never met a dentist on earth who ever put their knee on the chest. So, when people are routinely telling you this, the human mind has false realities. I mean, no dentist has ever reported this behavior, but you hear it from patients routinely. So, I always tell the young Millennials, you know, when they start telling you what a nightmare the last dentist was, you know, take all that with a grain of salt.


Ann: Well, you have to be cautious. You have to be cautious about that.


Howard: Yeah.


Ann: And if you have a patient like that, don't be afraid to give them some referrals. You know, you could say, "I see that you are a very exacting patient, and you have a lot of questions about this procedure. Maybe you should go to the university. Maybe that's the type of environment that you need to be in so that you can really, really ask a lot of questions and really get a lot of information."


Howard: Wow! That was worth the whole show for me because, when I got here thirty years ago, Arizona didn't have a dental school and now we have A.T. Still in Mesa and Midwestern in Glendale. Oh, my g*d, today I'm going to get referral pads made up for those two. So, let me ask you the most asked question on Dentaltown by young Millennials, and you just mentioned it. What do you do when a patient says, “No, I don't want any x-rays.”


Ann: Well, legally we need to take x-rays.


Howard: But they don't want it.


Ann: That's the standard of care.


Howard: They don't want it. They don't care. They don't want it.


Ann: Well, I say, “I'm sorry, I can't treat you.”


Howard: Exactly!


Ann: Okay, I cannot diagnose and treatment plan you properly. Now, there is one situation where you don't have to take x-rays, and that is if the patient is pregnant. If the patient is pregnant, you do not have to take x-rays, but once they've had the baby, then you take the x-rays.


Howard: Yeah, so, you know, the problem with the young Millennials is they went into dentistry and healthcare and they wanted to serve. They wanted to help, and they would they want to be so kind and loving, but they don't understand boundaries between the doctor/patient relationship, and what you're saying is one out of every one hundred of your patients is stepping over a boundary and they're dangerous and sometimes the best decision is not to serve them.


Ann: Well, you know, as you mentioned at the beginning of your podcast, if you're not sleeping at night because you're so upset about one patient, well, there's something wrong there. You know, maybe, I don't know, maybe there's a conflict and you need to resolve it, or maybe that person's not a fit for your office, maybe they're asking for something that you don't offer and maybe you can refer them somewhere else.


Howard: And this is also a red flag with employees too. I mean, I tell dentists all the time, you know, I'm talking to him and obviously one of their employees is just making them sick and I say, "You should never give someone money that you don't want to play with in the sandbox." I mean, if you're not ... I mean, I love to get to work just to see all of my buddy employees and ask them what's going on, what do their kids want for Christmas. But, man, when you are trying to walk on eggshells around someone, whether it be a patient or an employee, get rid of them. I mean, it just solves so many problems. I'm surprised at how many dentists keep on patients and staff members that they can't stand. Another red flag for me is this, the patient or the employee will be really lovely to me, but then really be making someone else ill and, you know, they're really upset, and a lot of arrogant doctors think, "Oh, that patient's great", or " I love her. She's the best dental assistant in the world", but I don't care if she's the best dental assistant in the world. She's always fighting with the hygienists or someone up front. That's toxic, you've got to let it go. And I had to fire my best friend as a patient from my office, because when he saw me, I mean, we're drinking buddies, you know, we watch football games at, you know, Zip's and Brad's Place, and I just love him to death until he passed away a couple of years ago. And, my g*d, but he just drove my front office insane. And one day, at a morning huddle, which you wrote an entire book on - 'Beyond the Morning Huddle' - they were telling me everything he said and did, so I just pulled out my iPhone, I had his number on my deal, and I said, "Hey, buddy, love ya, but my staff doesn't. You're not allowed to come here anymore. You live in Ahwatukee. I'm sending your records to this dentist. You know, I don't care if you even want to go to that dentist, I'm sending all your records to my buddy up the street." And he told me he had the same problem with him too. The dentist loved him, but he just ... and what is the front office about? Money is the answer. What's the question? They just want to get all this dentistry done. They want their boss to pay for it, Medicaid to pay for it, Medicare, someone else should pay for their whole body and they'll spend all their money on their house and cars and iPhone. And, so, yeah, people are just so crazy. The older I get, the more I realize, I think I might be the only normal person on earth. Would you agree that I am?


Ann: Well, analyzing that story, okay. I will say, Howard, you did the correct thing for leadership, okay, because you are the leader of the team. The team came to you and expressed what needed to be done, that there was a situation that was not ideal for the benefit of the office, for the culture of the office, the care and the climate. You listened to your team. You gave them respect. They respected you. You respected them, and you made a change. And leadership is change. So, I would say, in that situation, you did the right thing.


Howard: Well, you just dropped two words. You said 'care' and 'climate', but your book's really in three parts. You talked about 'tocare', which is about Part One: Culture, where you talk about 'tocare': trust, ownership, community, alignment, results and excellence; but you just dropped two words: 'care' and 'climate'. But, go through Part Two of the book, Care, where you talk about friendliness, attitude, engagement, smile, a parent's impression; and Part Three, Climate, empowerment, preparedness, assistance, fulfillment, creativity, preservation, 5-star customer service, or sum it up, because explain those two words you just dropped: 'care' and 'climate'.


Ann: Okay, so we've discussed the culture, okay. The culture basically is made by leadership, teamwork and living your vision, your mission, your core values. Now, when it comes to the care of your patients, the actual interaction of serving patients one-on-one. It is based on friendship, likeability, fulfillment of the patient's needs, okay. And that is delivered one-on-one by the doctor, by the dental assistant. So, in that discussion of the patient experience, attitude is very important. Friendliness is very important. And I'd like to leave your listeners with two words - if you can remember these two words, you will have a great care environment. The first word is 'yes', okay. The most powerful word in customer service is 'yes'. Say 'yes' to your patients. Try to do what they want you to do. Yes, I can do that. Yes, I can treat that now. Yes, we can take care of that. Yes, we'll work out those arrangements for you. Yes, yes, yes. The second word is 'fantastic', okay. When your patient comes in and you say, "How are you doing today?" and they say, "I'm doing great," and then your patient says to you, "How are you doing today?", okay. Your response, I want it to be, "Fantastic. I'm fantastic. Love seeing you today. So glad you're here. I'm happy to be here. We're so happy to serve you." What you don't want is some other response like, "Well, not feeling so good today. Busy day", you know, whatever it might be, you know, that's not the patient's concern. You're there to serve the patient. So, your response is, "I'm fantastic and I'm so happy to be here with you today." So, the words that you say are very important.


Howard: I say, "I'm fabulous, darling." I don't say, "Fantastic!", I say, “Fabulous, darling.”


Ann: Yeah, so those are two words. There are other customer service terms that you should be aware of, okay. Let me just review a few: saying thank you to the patient. Thank you for coming today. Thank you for your referrals. Thank you. Okay. The next thing is: glad you're here, letting the patient know, I'm so glad you're here. Okay. Those three things. Now, you want to ask your patients questions, okay. I would ask every patient, "How did we do?" When they go to the front desk, the front receptionist or concierge at the end of the appointment, "How did we do today? How did it go today?", right. You want the response to be, "It was great!", right. If it wasn't, then you need to find out what it is and fix it, right. Because you certainly don't want your patients leaving not happier than before they came. You want your patients leaving happier than before they came to your office, okay. Another question you can ask is, "What is most convenient for you?" Okay, now, you may not be able to schedule the appointment exactly when the patient wants, but at least ask the question, "What is most convenient for you?", so that you can accommodate the patient the way they would like to be accommodated. Another thing is to apologize when something doesn't go right. "Oh, I apologize. This appointment was a little longer than we anticipated", or whatever it might be, okay. And then also to say, "Thank you. We look forward to seeing you again", okay. So, those are just a few things in your daily interaction with your patients, if you have a few scripts and a few phrases that you review with your team, just like Walt Disney World or the Ritz Carlton, you're going to have a little bit higher level of customer service. You want people saying, "It's my pleasure to serve you." One thing we did, which I absolutely loved about your book, is this book has my team member testimonials in it, just like you have in your book, and I love that because, first of all, it shows the engagement of the team members, their commitment to customer service, but then the team members, you know, can serve as role models for other team members and for their colleagues and share ideas with their colleagues. So, that's one thing I have to say, we got that idea from you. And that's one thing I like about this book. One thing we do for my team is we take a book and I assign every team member a chapter and we'll say, "Okay, at the next team meeting we're going to go over these next five chapters. Each one of you is going to report on one chapter", and that's the way we go through books at our team meetings, and we learn things, we discuss, you know, the pearls that we learn in the different aspects of the book. So, I like that. I like that. So, now, let's move on now to 'climate', the climate of your office. And every office has a climate and you decide what the climate of your office is going to be. Now, I want my office to be a bright, sunshiny day kind of office. I want everyone to be happy and I want the office to be decorated. I want it to be cheerful. I want it to be fresh, right. So, you decide the climate of your office and the climate of your office is highly dependent on management systems, the management systems that you have, and customer service is highly dependent on management systems. So, the first management system you want is how are you going to compile, collect, communicate and correct customer service items, okay. So, let me give you an example. You are going to collect customer service items by having a survey. So, your office should have a survey somewhere where a patient can fill out a survey, let you know what could you do better. And on the survey, it would be a good idea to have every team member's name, so that if someone is maybe not delivering the type of customer service you want, that you can talk to that person, you have it in writing that this person was disappointed by something that was said or something that was not followed through. So, in the book I give two examples of customer service things in my office. One example is, I had a gentleman, my patient say I have no magazines for men, okay. So, I immediately went out, I got Sports Illustrated, I got Cycling magazine. So, now I have magazines for men in my office. Another patient told me once, "Dr. Gorczyca, I love your office, but the National Geographic videos have got to go", right. So, now we have a television in our office in the reception room. The patient can watch whatever they want to watch. So, that's how you get information back. Now, on a daily basis and at your team meetings, you're going to want to record what are the mistakes, re-work, breakdowns, inefficiencies and variations in your office which cause systems management problems, okay. And I got this idea from the Ritz Carlton. The Ritz Carlton has documented over a thousand customer service interactions that can go wrong. So, in your dental office - and they call this Mr. Biv, Mr. Biv: mistakes, re-work, breakdowns, inefficiencies and variations. So, every day, when you have your huddle, or you have your team meeting, say "Well, what could we fix? You know, what is it that we could fix?", because your ultimate goal in customer service is to have everything run smoothly and have everything perfect, you know, that you go in and you have a perfect day. Everything is done perfectly. No headaches. Everything runs well. But the hard work of customer service is fixing these items one by one, so that they don't happen again.


Howard: What was the acronym again?


Ann: Mr. Biv.


Howard: M-I-S-T-E-R ...


Ann: No, M-R-B-I-V.


Howard: M-R-B-I-V.


Ann: B-I-V.


Howard: And what does M-R-B-I-V stand for?


Ann: Mistakes, re-work, breakdowns, inefficiencies and variation. So, a mistake, okay, let's think of a mistake that happens in your office. Like the delivery doesn't arrive, right. Let's say you have to deliver something to a patient and the patient arrives in your office, or let's say the patient moves up their appointment, they move their appointment two days earlier, and you were expecting to make that delivery two days later, right. That's a mistake. You have to figure out, well, you know, how is the front desk going to know when we have a delivery? If someone has a delivery, you're not going to change their appointment, or if you change their appointment, you go later, you don't go sooner. Or maybe you're going to assign a team member, that two days ahead of the appointment, they're going to go in the lab and make sure that the delivery is there, or maybe they're going to call the company and say, "Did you mail out the delivery?" "We're delivering it in two days." You know, that's a mistake, okay. Re-work, okay. Dentists do a lot of re-work. It's our goal never to do a re-work. How are we going to prevent that? You've got to prevent that by making sure your impressions are accurate. You know, re-take the impression. I always tell my assistants, "If you have to ask me, is this impression good enough. Don't even ask me. Just do it again. You know, I don't even want to see it, okay." Breakdowns ...


Howard: I want to add one thing on re-work.


Ann: Yes.


Howard: One of the longest, hardest lessons I ever learned in my life was, since I was so damn smart, I was always arguing with the birdie on my shoulder. And what you just said is profound. If you have to ask your assistant, "Do you think this is okay?" ...


Ann: No, if your assistant asks you, if your assistant asks you.


Howard: Yeah, and, but like, you know, just so many things, like it ... you just be intuitive with your birdie, it's your brain response system saying, "Don't say that to your sister", "Re-take this impression." But what humans do is they always talk to their birdie, they argue with their birdie, they debate with their birdie. Ryan and I do this all the time. I'll say, "Do you think this is good?" and he just says, "Dad, if you have to ask, you know it's not", or, you know, "Do you think this is over the ...", you know. So, I personally believe that the difference between senior citizens and teenagers is senior citizens, when they hear that intuition, end of story, it's over.


Ann: Right.


Howard: And young teenagers are always fighting with their birdie.


Ann: Yeah.


Howard: The birdie's there for a reason.


Ann: And don't waste time. Because it's a waste of time if you don't send a good impression. Same thing I tell my lab man, "Don't make anything with a poor impression. Don't even make it. I don't want it."


Howard: Yeah, but the lab men all tell me they're afraid of the dentists, that they're afraid ...


Ann: Well, they shouldn't be afraid.


Howard: But they are, and a lot of these dentists don't know that their lab man is afraid, because they haven't got trustworthy and honest and open with them, let them know, like, "Hey, I know you're afraid to tell a dentist that you need to retake this impression or there's not enough clearance or, you know, whatever, because they're just afraid you're going to say, 'Oh, screw you, I'll find another lab. I'm a doctor, I know everything. You're just a lab tech. Hush up. You're going to be automated by a CAD/CAM machine. I'm going to find someone else.'" You have to tell your vendors that it's safe for them to tell. I tell all my vendors, when my supply lady comes in, my lab people, I say, "Look, I'm short, fat, bald and humble. If you see something I could be doing better, I want to be the first to know. Don't be afraid." So, you got to call your vendors, you've got to tell them that they're safe complaining to you. Because so many dentists have burned them in the past. So, tell your vendors that you're psychologically normal.


Ann: Yeah, and what you don't want is to receive a product back and you're spending so much time in the chair adjusting it because it's not as accurate as it could have been, because you're now making up for the fact that whatever, you know, the impression wasn't as good or, I don't know, maybe, I don't know what it would be in dentistry, but I know, for example, for retainers, when I get a retainer, that retainer should just snap right in, maybe one tiny adjustment and that's it.


Howard: Do you use a local lab or are you mailing these somewhere across the country?


Ann: I have been using the same retainer maker for almost thirty years.


Howard: Local or what?


Ann: Local.


Howard: I know, that's another thing, that's another one of my pet peeves. These young Millennials with 200, 300,000 Dollars of student loans, they're always flying clear across the country and staying in hotels to listen to these courses on crown and bridge, and all that stuff like that, and they have a lab man right up the street that if they would just use the local vendor in their town and drove down there the old man McGregor, he could walk you through the whole lab. He could take your crown and bridge to perfection for free and then you make him feel safe with you, so he can keep giving you feedback. But these dentists, they ship their crowns a thousand miles away for a cheaper lab and then they fly a thousand miles away to learn how to do crown and bridge, and you use your same lab across the street for thirty years. I've been using just a couple of labs within, you know, a five minute drive of my office, and I remember going there when I was twenty-four and saying, "Am I doing good? Am I doing good?" And they're just looking at me with these eyes real big, like, "Aahh, aahhh!", and I said, "No, please, tell me." And they're like, "No, it's horrible." But then they showed me and helped me and then they also had friends that were 40, 50, 60 year old dentists back in the day and I was 24, that they'd call on the phone and say, "Hey, will you work with Howie? Can he come see you?" You know, just set me in the network. Local vendors are everything. So, I'm sorry to interrupt.


Ann: Well, also, they give excellent customer service. So, you know, my local vendor picks up at my office and he delivers back at my office. So, there's no mail charge. If I need a favor from him, if I need a rush or whatever, I can get it. And he knows exactly what I want. So, there's no explanation with him, you know. So, it works out really, really well, and he always delivers on time. He's never, ever once late with a delivery ever, in thirty years.


Howard: So, he's better than Domino's Pizza, then, it sounds like?


Ann: Yes, pretty, darn good. It's pretty, darn good. So, yeah, so, that's one thing I would say to the listeners. Now, another thing ...


Howard: You were on Mr. Biv. You did mistake, re-work, but now you've got to do Biv: breakdown ...


Ann: Oh, a breakdown in communication. Okay, front office, back office. Maybe there's an emergency patient coming in and the front office knows, but the back office doesn't know, and they put him in somewhere and, you know, that's a breakdown, okay.


Howard: You know, that's the Number 1 reason why my assistants someday are going to kill me. They'll call me over the weekend and I'll just say, "Oh, yeah, just come in Monday morning. We open up at 7 o'clock. Just come on down at 7 o'clock." And then, of course, I forget. Then, of course, I've told two people this over the weekend, and then, all of a sudden, your assistant's sitting there with blood coming out of her eyes, "Did you tell these two people to come down Monday morning at 7 o'clock?", and I'm like, "Yeah", but, anyway. So, yeah, that's a breakdown in communication.


Ann: So, that's a breakdown. So, communication, that's where the huddle comes in, that's where front office, back office, we have them come to the back, tell everybody this is the situation, whatever. Now, an inefficiency might be something doesn't get done fast enough or maybe you're asking someone to do something and you ask them once, you ask them twice, you ask them three times. You know, that's an inefficiency. You know, you want to touch it once, get it done. You know, that's why I like the 'I see it. I own it'. You know, 'I see it. I get it done'. And then, variation is, you know, you have your management systems. You want them to work really well, but then there are going to be some variations. There are going to be some that pop up where the system didn't work. It might be a collection system. Let's say you have automatic fund transfer, but then you have someone that, they have to pay January 1st because they have their savings account or whatever. Those are variations and how are you going to deal with those variations.


Howard: We already went over the hour. We already went six minutes over the hour. So, I want to ... we do these for an hour because that's our average commute. I don't want them sitting in the parking lot too long, saying, “When are these two going to quit talking, so I can go into my office and go to work?”


Ann: Okay.


Howard: But, I want to wrap up. I want to ask you a couple of overtime questions. Number 1: you created a course on an Dentaltown called 'Beyond the Morning Huddle', which covers your second book that you wrote. And so, if you want to ... it's a must-read course. I love that course. I made my entire office ... we all listened to this online CE course together. That's what I love about our courses. You know, they're an hour long. And that's how long the staff meeting is and what you do is you pay your staff for that hour, you send someone to Choke 'n Puke and get some pizza or chicken or wings or burgers or whatever, and you sit there, and you eat, and you watch this as a team. And I know you just want to learn bone grafting, but this is the soft stuff that makes it so you can afford, so that you actually have patients do bone grafting. But I want to ask you two off-the-wall questions that have nothing to do with this interview, but you're the most prestigious, elite orthodontist that I've ever met in my life. What do you think of Invisalign's move of buying part of SmileDirect and starting to bypass orthodontists for Invisalign. Do you think ... how does that sit with you and what are your thoughts on that?


Ann: Well, I think it's a poor decision. The reason is, like we are talking right now, customer service is everything, okay. So, in our lifetime, Howard, you graduated college in around 19-what?


Howard: '80 something.


Ann: 1983 or '87?


Howard: '87.


Ann: Okay, '87. You may have recalled the cover of Forbes magazine had an article about dentistry going into shopping malls. Do you remember that Forbes magazine cover?


Howard: Yup. Can you find that, Ryan? Yeah.


Ann: Okay, we saw that come and go. You know, there was the discussion, "Oh, dentistry is going to be corporate, it's going to be in every shopping mall, the small business owners are going to be out of business or whatever." We've been discussing this for thirty years, alright. We saw Smile Bright - remember Smile Bright, one-hour whitening? Come in and get my one-hour whitening done. We saw that come and go, right. We saw Orthodontic Centers of America. We saw that come and go. I think that there's a lot of competition out there. We now have ClearCorrect and I think that perhaps it was a move that they need ... they felt they needed to make but ultimately dentistry is a customer service industry, and it will always remain a customer service industry. It's caring for people. And I don't believe that people ever will be able to do their own medical care or healthcare. So, you know, it's something that it's curious but I'm not worried about it.


Howard: And let me reset the stage from when Ann Marie and Howie were little boys and girls coming out of school. Orthodontic Centers of America was the only one publicly traded on the New York Stock Exchange, a billion Dollar valuation, and they were starting to build their own orthodontic schools to make their own employees. And they vanished. And right now, you have all these DSOs that employ 12 percent of the dentists in America and everybody just thinks linear. Like since Bitcoin's gone up 2,000 percent this year, it'll go up 2,000 percent next year and 2,000 percent next. They don't realize that what goes up, comes down, and all these DSOs that you think are here for eternity, none of them are healthy enough to do an IPO and get listed on the Nasdaq, like something as stupid as Snapchat could do, or Twitter, who both lost half their market valuations since they went and did their IPO. So, just because you see a DSO with five hundred offices, doesn't mean it's going to be here in ten years. How many people foresaw that OCA, Orthodontic Centers of America, was going to implode and go to zero? How many predicted that?


Ann: I don't know, but ...


Howard: At the time, no-one.


Ann: ... in business management, a business management question. What's the Number 1 reason businesses fail?


Howard: Well, in MBA school they said it was cashflow, they ran out of cash, they were a profitable, growing business, but they ran out of cash. Their collection policy ...


Ann: And why is that? Over-expansion.


Howard: Yeah.


Ann: Over-expansion ...


Howard: Too much debt.


Ann: ... is the Number 1 reason. So, you know, one of the things that we have been so fortunate about is that, as a small business, we have the ability to change on a moment's notice. You know, something happens to the economy, the next day we can make a change. We are nimble, and we are the providers of the service. So, we will adjust on a moment's notice, whereas a big corporation cannot make those adjustments. And they've got a lot of obligations that we will never have. So, you know, I'm a big supporter of small business and I think that in a service industry, dentistry as a - if you want to call it a boutique profession or a small business service industry - it will always be here to stay, because we are offering a product, customer service, patient happiness, that cannot be duplicated on a large scale.


Howard: And I also want to tell you young kids, especially you guys sitting on $250,000 student loans, buying dental offices and houses and all this stuff, that, you know, I graduated from high school in 1980 when interest rates were 21 percent and inflation, unemployment, they were all ... all three of them were double digits. No-one saw that collapse coming. No-one no one predicted the Berlin Wall, let alone the Arab uprising, the collapse of Enron, which was the seventh largest publicly traded company, the housing mortgage bubble crisis in 2008, and all I can tell you, the lessons learned from all those is that everybody who didn't have all their debt fixed, were in huge trouble and there were so many dentists who had these big loans that were set up, floating 200 basis points over prime, and they literally lost everything. And, you know, America is at the verge of passing a new tax reform bill and you guys just believe that you can just keep adding trillions and trillions and trillions of Dollars to your debt. You're now over twenty trillion Dollars in debt, and now they're going to add another trillion. And you guys think that you can do this forever, and that bubble is going to pop too. So, just make sure all your debt is pegged. Last question: when you talked about Mr. Biv, you talk about mistakes, you talk about, like, the delivery didn't arrive on time, and when you said 'delivery', that made me think of the four hundred pound gorilla in the room and that was that had a booth at the Greater New York Dental meeting and last week Morgan Stanley issued a warning against the two stocks, Henry Schein and Patterson, saying that they believe Amazon is getting into the dental supply business. So, I went to and I did a search for Dentsply and there were 10,000 products listed for Dentsply. Do you think Amazon's going to come in and disrupt the dental supply business?


Ann: Well, that's a good question. Personally, I enjoy having a rep, okay.


Howard: As do I.


Ann: So, I think reps are very, very helpful and, in general, I tend to order from companies that have the best reps, that are the most helpful to me. So ...


Howard: And that's back to your 5-star customer service?


Ann: Yes. Yeah, my rep …


Howard: I mean, the other observation is that every dentist who saves money and buys all their implants online through someone else, they never hit critical mass, where in critical mass in dentistry, if you don't do the procedure once a week, you're never in the profit zone. If you place one implant a month, all the money you put on the training, your courses, your implant, you never even get your money back. The dentist that goes out learns ortho and does an ortho case once a month. I mean, if you learn to do sleep apnea, I don't care what you learn, Invisalign, if you don't do one case a week, you're not in the profit zone, and 100 percent of all the dentist I know that are placing one implant a week, are attached at the hip with their rep and, you know, so, that's that customer service, about, "Oh, my g*d, I've got implant surgery tomorrow. I need this or that." And a lot of times it's not what the rep knows. Usually, in my case, they go, "Oh, my g*d, you need to talk to, you know, talk to this person or you know what? Thursday night, we're all going to eat at ..." - what's that other bar across from [01:11:45] [sounds like: Chandler on Ray]? [1.0] There's a rep who holds Thursday night drinks and Mexican food at Sandbar and every time I get an invite there, I know I'm going to go sit there and there's going to be five or six dentists who place an implant every week, and he's the ringleader of this club and he doesn't [01:12:05] [sounds like: [0.1] think] in fear and scarcity, you know. He does ... oh, what does he do out of South Korea? Seoul, South Korea. Not Straumann, MegaGen. He's the MegaGen rep. He don't care if you're placing no ... he don't care what you're placing. It's all in the family. It's no fear and scarcity. It's all hope, growth and abundancy, and I wish more dentists would learn more ... same thing with the reps, I mean, like when she'll say well this endo file is cheaper. Have you considered switching to this endo file? Well, you're a rep. You don't do root canals. She knows me. She'll say, "Oh, I know who your favorite endodontist in town is. It's Brad Gettleman, or it's Jason Hales. And they switched to this. They're using that", and when she says that, I light up like a Christmas tree. I'm like, "Really? They switched to that to save money?" So, I just ... at the end of the day, it's all human relationships. And another thing I want to say ...


Ann: That is absolutely correct. Relationships are everything. And it's the same with your team. It's the same with the leadership of you with your team. That going back to your right to be the leader, the respect you have for that team, the relationship you have with your team. It's not built in the office, it's built when you go out and you have your Christmas party, or you have your once a quarter get-together. That's how you build relationships and become a closer team. And, so, I want to end just to say that customer service ... it is a privilege for all of us to work in dentistry and to focus on the patient, to change their life through dentistry, when your patient matters, your work matters, and you matter. So, put your patients first, and put customer service as part of your culture, and you will continue to love dentistry for a long time.


Howard: You're so amazing and I want to add one thing: the people business, it doesn't matter if it's just your employees, your customers, or your family. I've always thought that so much of this H.R. stuff - and I watch how you operate around Richard and you're better H.R. with your own son than anywhere else - so, I've always said to an associate, you know, a red flag on working for someone, you know, when you're going back to Parsons, Kansas, and you've got a chance of working in two places, and one place no-one's ever stayed there for three years, and the husband's on his ... and the dentist is on his fourth wife. Then the other place, they got a few staff that have been there ten, twenty, thirty years, and he's been married to one person. These are huge red flags. So, my final, final, final overtime final question. You got my [01:14:55] [unclear]. [0.3] You dedicated your book: "To my grandmother, Bapsie, immigrant, wife, mother, seamstress, farmer, cook, director of the family farm stand, and delight of customers. Thank you for everything you taught me." So, I’m guessing, 'immigrant', I'm looking at your name, Gorczyca. Is that ... did she come from Poland?


Ann: Yeah. My grandmother came from Poland when she was 16 years old, all by herself.


Howard: Oh, my g*d! 16 years! By herself!


Ann: 16 years old! Pre-World War One, and ...


Howard: Was she running because she knew a war was going to break out?


Ann: Oh, yes, yes. And at that time in Europe, someone had gone over to Poland looking for workers for the one set of mills in New Bedford, Massachusetts. And they hired three hundred workers between the ages of, like, 16 and 21, put them on the boat, brought them over to the United States, and my grandmother was one of them, my grandfather was one of them. And she and my grandfather worked at those mills. They had third grade educations. And then they bought a farm. They bought a family farm. I grew up on that family farm. We grew everything. Every fruit, every vegetable, we had white-face Hereford cattle. And my grandmother had a vegetable stand, and from the age of about five until I was in dental school and my grandmother died, my summer job, every summer, was on that vegetable stand. And one thing my grandmother taught me is, you know, smile nice, be nice to the people, be happy, thank them for coming, and give everyone a little something extra, and tell them, "Mrs. Jones, let me give you this tomato just for you. I'm so happy you came here today. Please take this as my gift", right. And that really stuck with me. And everyone loved my grandmother. When she was 86 years old, she was still on that stand, going out there and meeting people and she was growing flowers. She sold bouquets of flowers, or whatever. One of the best jobs I ever had was working on that stand. And in the summer, all the kids from Massachusetts, my high school friends, they'd come over and sit outside with me there at the stand, and those are really happy memories for me. So, I attribute that to my grandmother, and a lot of customer service people, if you take Shep Hyken or [01:17:37] [sounds like: Cal Smiles], [0.4] some of the people who endorse the book, they talk about that humble beginning, that it's actually our humble beginnings which make us want to serve people, you know, and I cherish that memory of my grandmother.


Howard: I agree about humility. I've always thought I was the humblest person I ever met in my life. That is a beautiful story. Her apple did not fall far from the tree. Have you ever lectured in Poland?


Ann: No, I haven't. I've been to Poland three times, but I've never lectured there


Howard: Can you still speak Polish?


Ann: Yes, I speak Polish.


Howard: Oh, my g*d, they love ... okay, so the largest population of Polish people outside of Poland is actually in Chicago. One out of every seven people in Chicago. It has a nonstop flight to Warsaw from Chicago every four hours on LOT. I know the godfather of Poland, Marcin Dolecki, he brings me over there about every five years. They love American stuff. Send me an e-mail, I will reply back to Marcin Dolecki and tell him I've got the hottest H.R. person, she's Polish and she speaks Polish. And, I mean, that guy, every time he brings me down there, there are monster crowds. I love that place. I just love Poland. It's just one of the greatest places ever. So, do you want to lecture in Poland?


Ann: Oh, I would love that. Yeah, I would love that


Howard: Okay, well, send me an email and I'll fix you up with Marcin Dolecki, who actually is the neatest dentist I know. I mean, he's just so cool. And, you know what's a trend for orthodont ... you know what they call orthodontics in Poland?


Ann: What?


Howard: Chirodontics.


Ann: That's interesting.


Howard: Yeah, they ... because it's not just teeth.


Ann: Right.


Howard: It's also jaws and they're ... chiropractic is manipulating your jaws, moving jaws, moving alignment, so, and they call the tanning salons - that's a most interesting thing about Poland, I swear to g*d there is a tanning salon on every corner and I think they call them 'solarteriums' or something like that. Everybody in Poland has a tan. But, Ann Marie, thank you so much for spending an hour and a half of your valuable life coming on my show, talking to my homies. I love everything you do for dentistry. Thank you so much for coming on the show today.


Ann: Well, thank you. My pleasure.

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