Dr. Collin Larson is a 2016 graduate of the University of Louisville School of dentistry. His first year out of school he and his brother worked together for a DSO in Kalamazoo, MI. He now works as an associate for a private practice in Prospect, KY. Collin has focused on CE early on in his career, earning just shy of 100 hours his first year out of school in the areas of endodontics, dental implants, orthodontics, periodontal surgery, and practice management. He is a member of the ADA and AGD. He lives in Louisville with his girlfriend Mary, who is also a dentist. His hobbies include traveling, reading, videogames, and amateur beer brewing.
Dr. Matthew Free is a 2016 University of Louisville graduate. Matt is currently on the tail end of a completing a 2 year scholarship with the NHSC in a rural clinic in Michigan. Since graduation Matt has been engaged in CE, currently working towards his fellowship in the AGD. He is a member of the AGD, AACD, ADA, and Michigan Dental Association. Matt hopes to purchase a practice within the year and transition out of public health into ownership. He is married to his wife, Caitlin and they have a 7 month old little boy named, Graham and a 2 year old golden retriever named, Juno. Matt’s hobbies include traveling, learning, cooking, paddle boarding, and hanging out with his family.
VIDEO - DUwHF #1004 - Collin and Matthew
AUDIO - DUwHF #1004 - Collin and Matthew
Howard: It is just a huge, huge honor for me today to be podcast interviewing Dr. Matthew Free and Dr. Collin Larson. Matthew is from Presque Isle, Michigan?
Howard: And you're from Louisville, Kentucky?
Howard: Louisville, Kentucky, and they bought Louisville sluggers as gifts and I think his last name is Free because he probably clubs anybody who tries to arrest him. Thank you for the gifts, gentlemen.
So let's go to Dr. Matthew Free is a 2016 graduate, University of Louisville. Matt is currently on the tail end of completing a two-year scholarship with the NHSC, National Health Services Core in a rural clinic in Michigan. Since graduation, Matt has been engaged in CE, currently working towards his fellowship in the AGD. Congratulations. He's a member of the AGD, the AACD, the ADA the Michigan Dental Association. Matt hopes to purchase a practice within the year and transition out of public health and ownership.
He is married to his wife, Caitlin, and they have a seven-month old little boy named Graham and a two-year-old golden retriever named Juno. Matt's hobbies include traveling, learning, cooking, paddle boarding, and hanging out with the fam.
Dr. Collin Larson is a 2016 graduate at University of Louisville, School of Dentistry, also. You were guys were classmates, right?
Howard: His first year out of school, he and his brother worked together for a DSO in Kalamazoo, Michigan, which is where Upjohn was, right? Upjohn Pharmaceuticals?
Collin: I think, yes.
Howard: That was the home of Upjohn, but I think they got swallowed up by someone else.
He now works as an associate for a private practice in Prospect, Kentucky. Collin has focused on CE early on in his career, earning just shy of a hundred hours his first year out of school in the areas of endodontics, dental implants, orthodontics, periodontal surgery and practice management. He is a member of the ADA and AGD. He lives in Louisville with his girlfriend Mary, who is also a dentist. His hobbies include traveling, reading, video games, and amateur beer brewing.
You brought me baseball bats instead of a beer? You don’t know I’m Irish?
Collin: I know. I didn't think it'd make the flight.
Howard: I went from a seventh grade to the dental school with John Lees who's now an endodontist out in Southern Cal and his dad made his own beer and raised pigeons. We were young and at that age, in seventh, eighth grade, you only care about beer, but the racing pigeon thing was so cool because he took that more seriously—he was a pharmacist and he took racing pigeons more serious than anything. I mean, he was just really focused and so in his pigeon shed, there is no straw or hay because you wouldn't want stuff in their eyes and then you put these measurement things and these guys would take these pigeons several hundred miles away and they'd all let them out and who came back and then you'd clock him in. It was real scientific who won the race. But their droppings… I mean, you walk in there and their droppings, the ammonia burning your eyes.
So me and John, when we were planning our tomatoes and pumpkins mostly. So we'd plant a pumpkin or a tomato plant, but we’d dig a hole like the size of a pickle bucket and fill the bottom half with pure pigeon shit and then put dirt and put a little plant there and people would walk by our tomato plants and they’d go, “What the hell did you do? It looks like a tree!” And the pumpkins! I mean, in the seventh grade, I was growing pumpkins I could only roll over, I couldn't even lift them up and people would say, “What is the secret?” and I’d say, “Pigeon shit.”
But I did watch him brew a lot of beer and that's the story behind the story. You know that's why they ended Prohibition?
Collin: People were brewing their own?
Howard: Well, the 18th amendment was to ban alcohol and the 21st was let to back in, but do you know why the 21st was passed? Everybody was making their own and the amount of blindness and disease and death and sickness and they’d just sit there and said, “I'd rather them buy something made by a master brewer than make this shit in their bathtub because it's really turned into a public health disaster.”
But I'm so glad to get you on the show because we've done a thousand shows. So we've done a bunch on endo, perio, pedo, pros, practice management, all the deals but I’d like to get these kids, it's about 5% of our viewers are pre-dent, 25% are in dental school and then the remaining almost 99.99% are under thirty. In fact, shoot me an email email@example.com and tell me who you are, where you're from, what country you're from and so I'm sure everyone in dental school would much rather listen to someone couple of years out of the gate than a bunch of old farts that have graduated thirty years ago in a different time and place.
So what advice, if you were a junior or senior in dental school, they're probably wondering—gosh, I mean they are so focused on graduating from school, but in the back of their head they got an upset stomach thinking what happens when I walk through the door? I mean, I want to graduate and I want to throw out my cap, but what happens when that cap hits the floor? What advice would you give them? What have you learned along the way?
Matthew: Yeah, I'd say one, get really serious about CBD, as serious as you can be. AGD has really helped me just stay focused on CE and then I would say figure out what your personality, what you are wanting to do and really have kind of almost a sit down once with yourself and say, “Okay, do I want to go and own a practice right out the gate? Or do I want to be an associate?” and really try to get a hold of what you want out of dentistry I think is a big thing. And then after that, once you kind of have an idea of what you really want to do, start emailing people, start making contacts, start pushing. If you don't find the right place, go look for another place. Don't be scared to keep looking and finding and I think that really helps as far as finding a good place around the school.
Howard: So now did you have any student loan debt?
Matthew: I did, yeah. I was out-of-stater, Louisville and I applied for an HEC scholarship my third year. I had three years left so my first year I applied for it, I didn't get it. I applied the second year exact same application, everything was basically the same. I got it. So it took my out-of-state tuition to an in-state tuition so I think I have to two forty, somewhere around there as far as tuition.
Howard: In 2016, it's 2018 so you've been out a year and a half?
Matthew: Yeah and I paid couple of loans off, put a few of those in deferment to save up money for practice. So they're not making any jumps with the loans, but getting ready to buy a practice.
Howard: Now when you were in dental school, were you ever presented a lecture from a DSO telling you that you're never going to private practice that corporates taking over, it's like join us or be killed by us. Did you ever get lectures like that?
Collin: I think we had one or two. The school was pretty, they kind of had that locked down like it was very selective on who could come in and even give lectures. I mean for the most part, we had to go find out like financial advisors and stuff like that. A lot of them weren't allowed to come into the school so we had to kind of head off-campus meetings like that students had organized, stuff like that. But I think there were one or two DSOs that came in and they were basically saying this is the way of the future.
Howard: Do you think that's true?
Collin: I don't think so. I mean, I've worked for both. I worked for a DSO last year.
Howard: A small regional one or a big national one?
Collin: I guess it depends on your definition of big or small. I think the organization I worked for had about a hundred and eighty-two offices at the time and I think their plan was to expand about 10% a year, something like that but as far as the company was concerned, I was treated really, really well. The benefits were good; I could pay rent out of the school, they paid for a lot of CE, decent mentorship.
I just didn't like the area I was in, I wanted to get back down to Louisville so found a good associateship opportunity where the doctors doing things that I think that I want to do at some point. So I kind of hopped on board for the mentorship in hopes to kind of pick up some of the skills that she has.
Howard: Now you’re completing a two-year with public health. Would you call it public health?
Mathew: Yeah, yeah, for sure.
Howard: Two public health, what you call the National?
Matthew: National Health Service Corps.
Howard: And National Health Service Corps is also public health?
Howard: So there's public health and then Indian public health?
Matthew: So the NHSC, nonprofit, government, public health, I think that branches out into the Indian health services as well. I'm not sure. That's kind of the broad start I guess for the nationals and NHSC and then from there, it goes into different areas. I'm technically right now in a nonprofit.
Howard: And are you glad you made that decision?
Matthew: From a financial standpoint? Yeah. From a clinical standpoint, I’d like to be in private practice to be perfectly honest with you. There's definitely a ceiling with what you get to do in private or excuse me, a nonprofit. So you quickly max out on doing the type of procedures you can do. You're not going to do an implant, you’re not going to do ortho, you're not going to do a lot of the interesting things out there and so if that's something that's appealing to you, like it is for me, I want to be in private practice soon as I can because these things I want to do.
Howard: So when you were in public health, were there a lot of career dentists in there that were employees that have been there in ten, twenty, thirty years and loved it? Or is it more a rotating door of young graduates?
Matthew: A little bit of both. In our organization, I would say for public health, they do a good job taking care of their doctors and so there are a few career doctors in there. But for the most part, yeah, it's a revolving door.
Howard: Well, what percent would you say are career doctors versus what percent of revolving door?
Matthew: I mean, like I said, they do a good job and it's kind of a remote area where we're at so I'd say maybe fifty slash fifty. So not what you would typically expect in public health.
Howard: Okay and what about when you were with the DSO that had a hundred offices?
Matthew: So I had maybe about four good friends that I had made my first year there and I think three of them left after the first year so kind of a 75% turnover rate.
Howard: Because a lot of kids are in dental school thinking I don't know owning my own business kind of scares me. I think I'd be much happier in a DSO when I could just do dentistry, not do the business and I say, “We all live once and no one gets off this rock alive. We're all going to die and we're all going to end up in the same size home in a coffin.”
But if it's really that panacea, then show me the data because all I see with associates in private practice and DSOs, DSOs are the most visible so they're the ones that always climbed up the pole the highest. That's what everybody's pointing at. But private practice associates is the lion’s share and DSOs and I just see the employees after a year or two, they all want their own place.
Collin: I think it has to do with the allure of that kind of immediate income. I mean they're offering a pretty substantial amount.
Howard: What is that amount?
Collin: I made a hundred and sixty my first year out.
Howard: Nice. Ryan, if you make $160,000 a year in America, what percent of income are you in? I mean, is that the top 5%? One-sixty to one sixty-five puts you in the top 6%. So you came at school in your twenties? Late twenties?
Collin: Yeah, I graduated, I was twenty-eight.
Howard: So when you were twenty-eight becoming a dentist, put you in the top 6.5% percent income in the world's richest country?
Collin: Yeah. My last job I made like seven twenty-five an hour.
Howard; Yeah and a lot of these dentists, they're always crying the blues about how bad it is and how tough it is and I'm like getting out my violin. Like, okay, you're 28, top 6.5% income. I mean it's still a hell of a good gig. So and what was your student loan debt?
Collin: I had four seventy.
Howard: Okay so if you would have lived in a van down by the river, you could have paid off half of your student loans in the first year. Well, third.
Collin: Well, after taxes.
Matthew: Why didn’t you do that? I don’t know.
Collin: Yeah, why didn’t I do that.
Howard: Because Chris Farley is living in his van and he's like, “You should have taken a Louisville slugger and kick him out.” So what advice would you give juniors and seniors in dental school? Did you do a residency? When you came out of school you just went straight into employment?
Collin: Yeah, I went straight into employment. I was fortunate to have a couple of good mentors. One of my dad's best friend was a dentist and his partner, I got to be really close with as well and they kind of guided me and pushed me in a direction like, “Hey, you need to focus on this when you're ready to flip the switch. Here are some CE you need to go do.” So I kind of have had a good direction that I was pointed in and I felt pretty comfortable with my clinical skillset that I got while I was in school and I just figured I'd learn on the fly and go practice a little bit, get some firsthand experience.
Howard: And you dental students, listen, they keep mentioning CE continuing, continuing, continuing. You got hundred hours the first year. And did you know when you're in dental school, those four hundred and fifty online CE courses on Dentaltown, they're all free for you. And I'm sure you have the greatest instructors in the world, but we get some pretty flipping amazing instructors on Dentaltown.
I mean, there's a nineteen-hour endo course that cost $1,000,000 and five years to make and every endodontist that I know that has watched has said, “Son of a bitch, you guys summarized all of endo in nineteen hours” and it's free. I know your own instructor’s good but I mean, gosh darn. I mean if you ever looked at a lesson where somebody took an endodontist and thirty years, took five years and million bucks to just try to transfer everything he knew into your brain in nineteen hours on a very complex subject.
So you're both looking to buy a practice.
Matthew: Correct, yeah.
Collin: I’m still working as an associate for now, I hope to own in the next couple of years. I'm just trying to learn some of the skills that I want.
Howard: And you married a dentist, right?
Collin: Not married yet.
Howard: But your girlfriend's a dentist?
Collin: Yes. She works in a town just over the river in southern Indiana.
Howard: Was she a classmate of 2016, too?
Collin: No, she was in the year below us.
Howard: So she was 2017?
Howard: And how common was hooking up with a partner in dental school in graduating class?
Matthew: Not very common.
Collin: Yeah, I don't think.
Matthew: Maybe two?
Collin: Yeah, two or three. One of our classmates married another classmate and so that was pretty cool.
Howard: So only two or three and how big was your graduating class?
Matthew: It was one twenty?
Collin: A little less.
Howard: So only three out of a hundred and twenty and what percent of the class had a dentist in the family?
Matthew: Probably a good percentage, wouldn't you say?
Collin: Yeah, I'd say maybe a third.
Matthew: Somewhere around there.
Howard: That's what you see all around the world in every occupation. I don't care like you’re in Kansas, nobody just graduated high school and borrows money to buy a weed farm. You inherit your grandma's weed farm and so farming, dairy, soybean, corn. You go to Africa, all those farms and ranches and so the 25 to 30% of everyone is in a family business. I mean, you just have such an advantage. I mean, if you grew up milking cows your whole life, by the time you get out of college, you probably know a little bit about dairy as opposed to just someone who walked out with an agricultural degree from K State and then decides to go but half a million dollars of debt buying a dairy operation and so on.
So when you buy practice, what are you looking for?
Matthew: Yeah, I'm looking for a good track record and I'm looking for a great place for, like I said, in the bio, I have a seven-month old son now. So looking for a great place for family; we liked the rural setting so we're going with that philosophy of rural.
Howard: Okay. So you like rural. Were you born rural?
Matthew: Yeah, I grew up in a town of twenty thousand. Some people may call it rural, some people may not. I currently practice in a town of ten thousand. We live in a township of sixteen hundred people. So going from mobile to that was a fun adjustment after school. I was just telling Collin here Amazon Prime two-day shipping is like a week shipping now. So there's pros and cons to going rural. It's really quiet, it's slow-paced, people are really friendly, everybody knows you even if you don't know them.
Howard: So when you're buying a case of beer at two in the morning in your underwear kind of like, “Oh my God, that’s my dentist!”
Matthew: “See you in the morning at 8:00!”
Howard: So is it a competitive advantage of going to a small town as opposed to staying in Louisville?
Matthew: I think so just because a lot of doctors don't want to go up there. Where I'm at it’s just for example, where we live now, it's thirty minutes to the grocery store, to a mall, sport hours. So it's rural and some people that's going to be great for them, some people it's not and so I think that weeds out a certain amount of people that are looking for practices and it makes it easier to define practices because practices are on the market a little bit longer than maybe at a hot spot in the suburb where practices are on the market for a week or two and they've got a few bids already.
Howard: I can give you ten names from the last year where dentist turns sixty-five, he's already retired, maybe he had a health problem, a stroke or heart attack and he's got it for so and so. After a couple of years, no buyers, he just walks away and they just close it down and then you put a practice up for sale in Scottsdale and you've got four bids on it the day it's listed. So it's liquidity.
So a dental office in a rural area can be an illiquid asset but in those small towns, they don't even have to advertise, do they?
Matthew: No. I mean, you do see when you're looking through their PNLs, some offices I’ve looked at, you do you see a marketing budget. Sometimes it's a pretty normal, healthy percentage in there.
Howard: Like what?
Matthew: Gosh, I'm trying to remember. One of the ones I was looking at was a million-dollar office with like $30,000 a year marketing budget that included a boat slip. So you go to small towns, it might include a duck blind or a hunting land or something like that they use for PR, that sort of thing.
Howard: Yeah. So why would you want to buy existing instead of just starting from scratch practice?
Matthew: My brother-in-law started from scratch.
Howard: So your wife's brother is a dentist?
Howard: Was he a classmate, too?
Matthew: No, he's been out probably about a decade and she was there to help him. Actually, she works for an office and kind of got him off the ground and she was there to help him. It's been good to him, but it just seemed like a scarier path at least for my personality. A lot more investment as far as time to the office initially and so those were things that made me a little bit nervous about starting from scratch rather than going into someone already has a cash flow that's existing and I can already have a patient base and systems in place that I can build on. Something that's interesting for me.
Howard: It is absolutely less risky. I mean, so like in the 2008 crash just in my backyard of Phoenix, I think eighty-five, you hear there about but eighty-five practices went under and they were two, you could divide them in half. Half of them were scratch practices that just started. We thought they were going to open up and do a direct mail and get all these new patients and marketing went to zero. I mean they couldn’t market, they couldn't basically get any foot traffic. And the other app, all these cosmetic dentists who for the 1994 to 2000 bull market run and the next run after that, all they knew how to do is take out all your amalgams and PFMs and replace it all with empress glass and they completely lost their ability to do molar, endo, extractions, wisdom teeth. They didn't like any blood. They just liked the white and fluffy stuff, cosmetic dentistry, bleaching, bonding, Invisalign.
In a turndown when you think you're going to lose your job, the payment you walk away from last is your car payment and the next payment is your phone payment. But you'll walk away from your house and you sure as hell aren’t going to go get a tummy tuck and a boob job and ten veneers on your upper teeth. I mean so that market just died and what's funny is some of these cosmetic dentists on Dentaltown, they're all talking about diversifying their 401(k) and it’s of all people that talk about diversification, you're a guy that can’t do a root canal, can’t do Invisalign, can only do this one little narrow thing. And when I think about diversification, I'm just like I'd rather have a diversified ability to do dentistry than relying on my 401(k) because I've seen those stocks go up and down.
I mean, you guys ever think about this for every million dollars—Ryan, what's the government paying right now on a thirty-year bond? 2.8%? What did I say? What did I say? So if you take $1,000,000 times 0.28 that is a $28,000 a year income on a bond. The guy who motivated me to be a dentist, my next door neighbor, Kenny Anderson, he just celebrated his fiftieth year and even though he has cut back to like Monday through Thursday from six to noon, that income there. I mean, let's say that you made just a $100,000 from a year from sixty-five to seventy-five, $100,000 divided by 0.28. That's equivalent to having three and a half million dollars in your retirement.
So bond yields are disastrous because all through human history you want to hold the same hand as the government. So if the government is stockpiling gold because that's where they think the future is in gold then you want to buy gold. But when the government is that twenty trillion dollars in debt, do you think they want to pay it back with gold bars or counterfeiting currency and keeping interest rates near zero? Because if interest rates were historical like 5% like right now, if interest rates were historical 5% forever my God, the government interest payment would be 40% higher from 2.85%.
So not burning out. It's like when dentists tell me, “I want to buy a laser but I have no return investment.” Dude, if that laser keeps you from burning out, if you buy a laser or a cad cam, I don't care what you do. If you buy that and it makes you run every stop sign on the way to work, it's priceless because what's the most expensive thing in the world? To sit there and say, “I hate dentistry. I hate driving to work. I want to get out of here” and I'm always like, fix that because that's worth an extra three and a half million dollars in bonds for every $100,000 a year you want to retire on. So why are you burned out? Is it biological? Do you need a psychiatrist? Is it psychological? Do you need a therapist? Are you not exercising? Like I had one dentist telling me, “I'd rather be taken in the backyard and beat with a belt then do a root canal.” Stop doing root canals! Just stop there. Call an endodontist, there are four thousand of them because I don't want you to get burned out. It's so expensive to walk away from a car.
It's like right now they're talking about our greatest player on the Arizona cardinals, Larry Fitzgerald because he should've retired every year, but he always decided to do one more year and you just look at one last year payment. It's like, Larry, you couldn't have had enough savings in the world to be invested to make that much money next year. You know what I mean? I mean, it's just priceless. But the neat thing about those guys is he's still, he says it's obviously not the money. When he grew up with no money and has crazy money, but he still loves the game and it’s like he just smiles like it's just tough to walk away. So what about you, you’re going start from scratch or you’re going to buy?
Collin: I don’t know. I think buying an existing practice is probably the best bet. I'm not really sure; that's one of the big things that Matt and I were just talking about is why I'm kind of holding off, too is I'm not sure where I want to go yet. You hear a lot about these rural areas in Kansas, Texas, Oklahoma where you can go out and you can buy an existing practice or even set up shop out there, start something brand new. There are people on that group that we were looking at that were paid off $300,000 in debt their first year out of school opening a brand new practice.
Howard: They opened up a brand new practice and paid off $300,000 student loans the first year?
Collin: Wasn't it or did he take over? Some people were taking over a practice. I think one guy took over a practice that was collecting three hundred and sixty thousand and then bumped it up to, was it like one point two million or something in like a year.
Howard: And how did he or she do that?
Matthew: That particular case was IV sedation and implants brand. CE.
Howard: So the dentist wasn't doing IV sedation?
Collin: No. He’s bringing in like a whole new skillset.
Howard: Yeah. So that's the pattern we've seen for thirty years. So you look at the numbers and old man slugger is doing $750,000 a year and you think it's a good practice, you buy it. Then you go in there, you don't realize $100,000 a year was molar endo and you're referring it all to an endodontist and another $100,000 was wisdom teeth and you're referring all that to an oral surgeon. You realize that you just bought a $750,000 office, but you could have only done $500,000 of that production. And the reverse of that, which is the goldmine, is when you go into a dental office and this guy has referred out a $100,000 a year of endo and $100,000 a year of Invisalign, a $100,000 a year of wisdom teeth and he didn't do IV sedation and you sit there and say, “Okay, you're doing three fifty and I can do all of that, but I'm going to buy this restaurant and all you sell is hamburgers and I'm going to add pizza and you just sell French fries and I’m adding tater tots and onion rings” and it's a goldmine.
Collin: Yeah. So I can definitely see the allure of something like that.
Howard: So now your girlfriend’s a dentist, would you guys buy a practice and work together?
Collin: We've talked about that. Everybody that I've talked to says that's probably a really bad idea to spend that amount of time with a significant other. Like you're there all day long and then you go home and you're all together all day long, all night long. It's just a little much so I don’t know, we'll see what the future holds, but I think we both kind of decided probably not.
Howard: Well, when I got my MBA at ASU, they had an entire course. It was two courses a trimester so six courses a year, two years, twelve courses and one of them was decision making and I found that to be one of the most interesting class in the world because it's all psychology. One of the biggest takeaways is that if you're not sure, just give it more time. The poorest decisions are made when you're not sure, but you make a decision and if you give any decision or enough time, you're not sure left, right. Someday it becomes so clear that it's non-debatable. But if you're sitting there wondering, should I or shouldn't I? Well, if you're wondering then you need some more time. Why does any decision have to be made today?
Now you're looking a practice with a broker or a non-broker?
Matthew: I got a broker and that started from Dentaltown. I'm getting on there and reading a lot about what people have to say as far as going with a broker, without a broker. Jason Wood, Tim Lot both of those are on big Dentaltown posters on there and reading their stuff really helped a lot. In fact, I'm using both of them as I'm going through the practice process.
Howard: Tim Lot’s an accountant, but he's a specialist. He's a dental accountant, he only does dentists. That's one of the biggest mistakes I see in dentistry is they have an accountant and he's got fifty clients, only one or two are dentists and all the advice they get, it'd be like me advising a Chinese restaurant or in a dairy farm and a goat farm in Ghana. I mean, if you had cancer, would you just find a doctor who did everything or would you find? I mean, if I had a problem with an organ, if I had a kidney problem, I want to go to a guy that only does kidneys. I don't want to go to my local MD and Jason Wood is an attorney who’s second generation.
Matthew: Yeah, I'm actually working with his dad. I’ve been working with their law firms.
Howard: That's all they've done is dentists for two generations. So are they pro broker or against broker?
Matthew: They recommend going against if you can do it. So you can send out letters to the areas you're interested in. I've done that. I didn't have a whole lot of success with that, but that was one thing I did. You can look on broker sites, you can look at the offices the brokers have listed, but you don't have to work with them. You sign a nondisclosure but you don't have to send it to them for them to represent you and at one point I thought about working with a broker, but for me it was just way too pricey. I was seeing, they wanted 5% of the sale and so if you're looking at buying a million-dollar office, 5% of that gets up there pretty quick.
Howard: What is it? What is 5%?
Matthew: You’re putting me on the spot here.
Howard: My gosh. Three doctors have to go to a--one million times 0.05 is $50,000. By the way, I showed Ryan something today on the iPhone he thought was pretty cool. You guys have iPhones?
Collin: I don't.
Howard: Do you know on the clock, on the iPhone app actually is a clock that shows the time? It's the only app that's moving. So you're trying to say fifty thousand bucks.
Matthew: Yeah and I feel like you think about I could spend $50,000 or I can just put a little more time after work and do the legwork and contact offices, cold call offices, figure out where you want to be and just start pounding away at it. I think that's something in my life that's worked very well is just pounding away at whatever you're trying to do is if it's getting into dental school, if it's getting out of dental school and get your skills up or if it's looking for an office, just keep pounding at it until you finally figure out what you want and where you're at.
Howard: Now on the Dentaltown app, do you guys have that on your phone? You have it on your phones. They classified it as one of the most overlooked things on Dentaltown. It's free by the way, on the classifieds. Did you look at any of the practices there?
Matthew: Yeah, definitely.
Howard: Were there a lot of practices listed there?
Mathew: A ton, a really good resource because you kind of see bits and pieces with other brokers sites. But yeah, on Dentaltown it kind of seems that most of the brokers are putting on their site and on Dentaltown. So you kind of get an aggregate of different brokers putting them all together and so you can search by state and I've done that because at one point we were looking at a couple of other states besides Michigan.
Howard: Yeah, a lot of brokers like say you're in Arizona, so you've got your listings on All Arizona, Arizona site and you advertise to the local Arizona Dental State Journal, whatever, whatever. But there might be some guy in the navy in Okinawa who wants to come back here. So these international sites or something plus they're free. If you're trying to sell a million-dollar practice, why wouldn't you list it for free? By the way thank you, Dentaltown we just had our five millionth post. I mean we're twenty years old now; we launched in 1998 and Facebook launched in 2004. We were six years before Facebook, five million posts. Did those five million posts help you in dental school?
Matthew: So much, yes. Especially with the business side and looking at offices and reading and getting an idea of what was going on outside of dental school. I found that dental school is almost like this enclosed space where you really didn't know what was going on outside besides the few stories you would hear from dentists or from other dental students that talked to dentists and so Dentaltown kind of gave you a pulse on what was going on outside and what to be looking for on the business side for sure.
Howard: Yeah. And how about you?
Collin: Yeah, that was actually one of the first dental resources that I've ever even thought of or heard about was Dentaltown; went on and I had to like fake an ID or something to get in because it asks for your license number. So I just type stuff and I think I got through, I don't know.
Howard: Well, there should be a category B dental student.
Collin: I don't even think I looked at that. I just signed it in somehow. But yeah, I was looking around at forums before I even got into dental school. So when I was kind of toying around with the idea and then looked through some of the message boards while I was going and now I've been doing a lot of the CE and I did your thirty-day dental MBA course.
Howard: By the way, that's another iTunes show. So if you're listening to me on iTunes, it's Dentistry Uncensored, but we also have Dr. Farran’s 30-Day Dental MBA and what's really the craziest thing about that and it makes me realize the same thing will happen to this show, is nothing really changes in geometry, algebra and trig. And I did the thirty-day MBA in 1990, twenty years ago and on just iTunes it’s still downloaded like thirty-five thousand times a month and I get all these emails and they're from Cambodia and Kathmandu. And I said, “Well, was it pertinent?” Some people don't even know it was twenty years old and older people that it was twenty years old they go, “Well, I mean what changes in business? I mean, what changes in accounting?”
Collin: Yeah, I think a lot of the stuff felt true so I think it holds up pretty well. I think you need to bring back the opening song to maybe one of your new episode.
Howard: What was the opening song?
Collin: Some guitar riff, I think.
Howard: Really? There's openings song?
Ryan: It’s like an intro with a video and all this stuff, but it's fun when you just listen to it on audio, people are like, what is that with this super long intro.
Howard: And by the way if you watch this on iTunes, you can also subscribe to us on YouTube. We’re youtube.com/dentaltownmagazine.
So how far out are you do you think from purchasing a practice?
Matthew: Yeah, so I finished my obligation with NHSC this summer and looking to purchase right after that essentially. So July, August is maybe four or five months out is where we're at.
Howard: So being two years out of school, they're going to come out of school and they're going to like when you were in school, did you did an Invisalign case?
Howard: Did you place the implant?
Howard: So a lot of times if a kids walking down and they’re quarter million dollars in debt. I mean all of these institutes are expensive Pankey and Spear and Koss and Ross Nash and then buying a cad cam that's a $145,000. If I wanted to get into LANAP that's anywhere from $87,000 to $125,000 depending on what package you bought.
So they're sitting there like what do you think, what would you recommend they learn and they can't learn it all overnight. I mean, you can't go mad and then there's their sleep apnea, which the media is obsessed with. I mean, not sleeping well will cure male pattern baldness, erectile dysfunction. I mean, the things I read in sleep media. It's like, dude, I think. But anyway there's so many things they didn't learn in dental school and that's not the dental schools fault. I mean, they took you from a kid to licensed to give my granddaughter a shot and drill on her tooth. So basically, they said, “Okay, you're not going to kill my granddaughter. You're out now.” Yeah. But what CE journey would you recommend?
Collin: I would definitely recommend going out and finding a good endo course. I think that's something easy that a lot of doctors just don't like doing right now. So if you build up some confidence, go out and take a course. It doesn't matter which one, just something that teaches you a little bit more specifically, molar. I don't know how many students get access to molars. We didn't get too much.
Howard: So what percent of your class graduated not liking molar endo?
Collin: I'd probably say a significant portion almost didn't get to do it.
Matthew: Yeah, most of them didn't get to do it.
Collin: I got to do one.
Howard: One molar?
Matthew: I didn't do one.
Howard: So you graduated a quarter million dollars in debt, how much were you in debt?
Matthew: Two forty.
Howard: So both a quarter million in debt and you didn't do a molar and you did one? I mean, Brad Gettleman who's the most amazing endodondist I've ever known. He co-wrote one of the chapters of Pathways of the pulp, Steven Cohen and we went to UMKC together, class of 1987, we had six full time endodontic faculty and I think I did fifteen molars. And then you look at these private dental schools in our backyard and they have like one instructor in endo full-time for an entire private school. These kids are coming out on a half million dollars in debt, they had one instructor and you did zero and you did one. I mean, that's just insane.
But you're exactly right. You all go to like a TMD course and occlusion course and it's like, everybody wants to learn more about occlusion. I say, “What percent of your practice is TMD and occlusion?” “I don’t know less than 1%.” Okay, so why are you here? Because you don't do molar endo because molar endo, if I come in with a tooth ache. From a public health perspective, I need my dentist in the city to be able to treat that patient. I don't want to say, “Well, I can bleach your teeth, I can do veneers, I could adjust your occlusion,” you know what I mean? And so I think extractions and root canals.
Matthew: One thing I was going to say, I knew I was going into public health so I knew I needed to be comfortable with taking out teeth and so I looked at it that way. So in school whenever we had an oral surgery rotation, I was all about that and trying to get as much experience as I could and then that helped. And then I've looked at my time in public health doing extraction, surgical extractions, getting comfortable with thirds as preparation for implants. So if you can section a molar, how much better are you at getting ready to put an implant in? So that's what I've tried to. I would say probably like you're saying extractions.
One big thing that really helped me is the AGD has pushed me to get more CE than I would have otherwise. It's been a great motivator to say, “Okay, I want to do the fellowship” and that's five hundred hours of CE. You can get it as early as—
Howard: What made you want to get your fellowship?
Matthew: We have people come talk to us in school, a couple lunch and learns and they talked about how they had some type of studies where if you had your fellowship, you made this much more money. If you had your MAGD, you made this much more money and they talked about you can do more procedures and you get out of school, at least for me and you realize, wow, there's so many things I don't know and I just don't feel comfortable not knowing, or knowing as little as I did at a school. So it really prompted me to just get serious about pushing myself with CE and so the AGD was a great motivator for that.
Howard: So there are nine specialties recognized by the ADA and zero specialties recognized by the court system. So you remember that big lawsuit in Texas. Specialties is only something that our country club the dentist does and the American Dental Association, it's not a legal thing at all. But of the nine specialties recognized in our Church of the American Dental Association, the public health one is the one that gets the least attention. People want to talk about endodontists, periodontists and oral surgeons and from a public health point of view, shame on you dentistry that 8% of all emergency room visits are odontogenic in origin. And then you tell me “I don't like molar endo” and “I don't like pulling teeth” and “I just want to do Invisalign and veneers.”
Well, you know what you're a doctor, I mean, can you imagine going to the emergency room with a broken leg and they go, “We don't do legs we only do hands.” I mean, it's like dammit, you're a doctor and especially rural. I mean everybody thinks of the specialties where half of America lives in a hundred and forty-seven Metros. Well, what about the other half of America who lives in nineteen thousand and eight towns and they are four hours away from a mall and they show up to your office with an abscess and you've just decided that public health dentistry doesn't exist and you're a cosmetic dentist and you want to be an ophthalmologist. No, you're a damn doctor. You're a doctor and public health specialty is I think the most important because people die when they don't have abscessed Ludwig's angina. I've had a patient die.
In my thirty years, I had a patient that came in waffling about an extraction, didn't know what to do, told me they’d get back to me and it was I think it took like two days and my assistant was crying because she called them the figure out what's going on. Oh, he died, he was telling his wife, woke up all swollen, took to the emergency room, IV antibiotics, died, and I mean people die from dental infections. Furthermore, you have to sell someone veneers and bleaching and bonding. I mean, you've got to sell someone that and you got to—Ryan, will you go get me that little box on my desk that what's it called? To help case presentation dentistry.
So when you're trying to sell grandma who's had dentures forever and by the way, I accept no advertising money. Nobody paid me for this.
Collin: Dr. Buchanan. Does he make those?
Howard: Yeah, Santa Barbara, California.
Collin: Oh yeah, that’s him.
Howard: I did not even put that together. Everybody is talking about and they're loving this, but you have to sell an implant case. You’ve got to have great communication case presentation sales. You don't have to with extractions and endo, they're coming in begging you, can you pull this tooth, can you get me out of pain? It's a thousand dollars. You don't want them to end up in the emergency room because in the emergency room, they'll ding them if they're cash or insurance, it’s going to be about $1,500 and they're not any further. They just got an X-ray and some Pen VK and some Vicodin so you've blown fifteen hundred bucks and you're still at square one. And so that is my gosh, if you learned anything in my one thousand episodes, learn extractions and learn molar endo and number two, you're exactly correct. It's harder to remove a molar than it is to replace it with an implant. So if you get extractions down, well then implants will be easier because it's a lot easier to place an implant than it is to remove a tooth. I'd say at least a third easier.
So we talked about endo and extractions. How does someone learn extractions?
Collin: I think for me it was just trying to get into like Matt was saying like the oral surgery rotation at school. We had a lot of really good instructors there and a lot of hands-on if you wanted it. Some of the students weren't really keen on doing it so you can jump in and take whatever cases were being offered. So I think as a student get in there, get comfortable, make the mistakes there because you've got people to bail you out and I think that'll make you more comfortable when there's nobody to bail you out and then I think just once you get out into private practice, do take on the cases that you feel comfortable with starting out, but try to take a couple that kind of push your comfort zone a little bit. Start sectioning the teeth a little bit more and I think the more you do it, the more confident you get and you can take on the bigger cases. I think that's the way to go.
Howard: You want to know how I learned it? Well, I opened up my practice and it just turned thirty years old last September 21st; I graduated 1987 so 2017 thirty years old. But I opened up my practice and there was this dentist thing, Gary Solomon that had these Sunshine Dental Clinics and they were in poor parts of town, did lots of extractions, lots of dentures, whatever and they were open seven to seven.
So I sat there and got a job, a part-time job with him and I wasn't a competitive threat because I was down in Ahwatukee and he was in Glendale and central Phoenix and there was another dentist with the name Nick Gidwani. And I mean in four years of dental school, I think I pulled fifty-four teeth to graduate. I was pulling that many in a week and if I ever got stopped which was all the time, Nick Gidwani would just try not to laugh in front of the patient and I'd stand there and he'd take it out in like three seconds.
So a lot of dentists might be in Beverly Hills an associate, but there might be somewhere in LA denture world and guys that go there and I thought it was fun camaraderie because you go in there and there'd be three, four, five, six doctors at a time and when I walked in there, I knew Nick Gidwani was behind me. I could attempt anything because he could bail me out and a lot of people are traveling to the other side of town, finding denture world, finding a clinic, finding where there's some mentor in there that could do the oral surgery but yeah, very important.
So extractions, endo, what's next for you?
Matthew: Implants. Definitely implants. Right now we're actually just talking about different courses we were looking at doing. Ingle Institute, looking at the Misch Institue, those are the two right now that are on the radar I think we’d be doing the next six months to get started with implants.
Howard: And where's the Ingle Institute? Philadelphia?
Matthew: They have courses in Detroit and courses in I think Raleigh, North Carolina, somewhere in North Carolina.
Howard: And that's an implant course?
Matthew: It is, yeah.
Howard: And then the Misch is in well, Carl Misch that's in Detroit or where's that at now? Or is it just in Florida now?
Collin: They have in Orlando and I want to say they have a couple in Las Vegas.
Howard: Are they in Orlando? If I'm going to Orlando on Monday to the townie meeting. Is the Misch Institute in Orlando?
Ryan: According to Google yeah, Misch is in Orlando.
Howard: Misch Institue, M-I-S-C-H.
Ryan: It recommended Orlando so let's see what's going on.
Howard: Because his brother Randy Misch.
Ryan: (50:01 unclear) program sessions starting February 16th in Orlando and December 17th. Let's see if anything else.
Howard: Well, email me that Ryan because we're going to be in Orlando for a week and might run by him. Sam’s such a geek. I mean I'll go to like Kathmandu, Nepal and people say, “Well did you see this temple, that temple or that temple?” and like, “No.” “Then what'd you do?” and I'm like, “Well I met seven new friends. I went to seven dental offices.
Ryan: (50:35 unclear).
Howard: Well, let's go visit. Let's contact him. I think it's Randy Misch, I think it’s Craig's brother. So you're going to do either the Ingle or the Misch and where is your mind? How will you pick between those two? Or is it Dentaltown message boards?
Matthew: That's a big part of it, yeah.
Howard: And what are they telling you to go?
Matthew: Well, so I actually just did a thread on that a couple of weeks ago or last week and a lot of them were saying, Ingle is good to just get your hands wet with implants. You place an implant the third day in the course and they'll help you just do basic cases and they're saying once you've gotten a few under your belt, looked to the Misch Institute to really level up from there. So that's kind of where I'm at right now and what I'm thinking about doing, but that could change.
Howard: And what about you?
Collin: I've been talking about with Matt, we were just talking about that and kind of going over the different options and that's kind of what we're leaning into. I think it's fun to take courses with buddies or something just makes the trip a little bit more entertaining.
Howard: Well, I look back and I think what was the best decision I did out of dental school. Number one was demographics, finding Phoenix. Number two is I joined the AGD and I was this little 24-year-old pissing vinegar kid and I was arguing with the AGD guys because they wanted me to take these courses in sixteen different subjects. I'm like, “Well, I don't want to do implants and I don't want to do ortho and I want to take it all in, fillings and crowns and root canals” and these old guys puttering around me say, “Howard, it's cross training.”
Anyway, looking back, I was sitting there. I was so livid that I had to take an implant course back in the eighties and I had it not only how many would be in that whole category, like sixteen hours or thirty-two hours or.
Matthew: Yeah, somewhere around there. S
Howard: So my walnut brain thought, okay, I'm just going to knock this shit out on one deal. So I only looked for what course could knock out the whole damn requirements so I could just go to hell, purgatory, do it, be done, check it off. And the next day I know I'm sitting in the front row in front of Carl Misch and I just fell in love and it was like I thought I lived in North America and I just discovered South America or Australia and it was just amazing. I look back at the fellowship HD, (unclear 53:00) HD, Diplomat International Congress of Implantology is not the–any of the courses are the alphabet soup bullshit behind your name, which none of your patients even know.
I remember when I got my FAGD, I put it on my car and I put it on my office. I was so proud of it. Nobody said anything for about two months and some eighty-year-old lady walked in and she said, “I see you're a fagd. Yes, my brother is gay” and I thought, wow, all it is a fagd and her brother's gay. That's cool. But I look back at it, it was the relationship you met. You can't go through one of those programs without meeting a buddy and you're just a summary of the five people you hang around with the most.
So if you graduate from dental school and you go and hang out with five dentists who hate dentistry, then you're going to hate dentistry. You get married and have a child and you go hang out with five guys who hate being married with a child and things. I mean, just whatever you want to be, find five people just like that and hang with them.
Collin: Yeah. That's a very good idea.
Howard: So what's after implants?
Matthew: Yeah, everything. Just do as much CE as we can. Sleep apnea is a big one I’d like to get into.
Matthew: Well actually, I went to an AGD meeting a couple months ago with Dr. Horowitz. I forget what group he's with, but anyway, the idea of being to save lives is really cool. As a dentist, I think you get into it you don't think you have that capacity and then you learn you can by addressing the airways, which is pretty cool. And then I came back from that course and I'm not doing anything with it being in public health, but you start seeing so many patients that are having signs and symptoms of this issue, they're having GERD, they have had blood pressure, they're overweight, they're grinding their teeth. All these things you're thinking, man, I wonder if you could use a sleep study. I wonder if this we've been official for you and improve your life. So that's something that's exciting.
Howard: Well and that's what I'm most excited about is hearing that there's stuff out there that you're excited about. I mean, when I see two thirty-year-old babies who just got out of dental kindergarten school, what I want to see is excitement. I want to see for kids running to the beach like when you go to the beach, I mean some people are running to the beach, some are walking, some are just camping they don't even want to put their foot in the water and whenever you see the young kids excited and think something's cool, their future is going to be great.
Matthew: Yeah. Another one’s Productive Dentist Academy or something. I definitely want to check into, want to look at doing.
Howard: He's got a course here in Phoenix this fall. Are you talking about Bruce Beard?
Matthew: Yeah, yeah. Oh, the Bruce guy, I think I've seen you talking about.
Howard: Isn't that with Blue Sky Bio?
Matthew: I'm not sure. I've just seen some advertising for their upcoming event. I remember being in Arizona, but I'm not sure exactly what that is there.
Howard: What I loved about Bruce Beard and what I loved about Carl Misch is Socrates said the best surgeons were trained in war and yeah, I was afraid to place implants and I was all dinky, dinky, dinky and then I went in with Carl in Detroit, Michigan back in the day. He was in his office, it was like seven three-day weekends and he would walk in the room and (unclear 56:30) already had them put under and everything. He’ll always be talking to you while he's like flapping retromolar pad to retromolar pads, flinging the lingual to the other side and you feel like you're in war, like you're in Vietnam watching this and he’s just all talking to you while he's just doing it.
You see a guy place six, eight implants in the lower six, eight in the upper in twenty minutes while half the time—So I get nervous when I'm with someone driving. Like a couple of my friends when they drive the whole time if they’re talking to you, they have to look at you and I'm like, “Don't look at me! If you have to look at me to talk let's just turn on the music” and to watch Carl Misch place half a dozen implants while I wasn't even looking out the windshield. Then when you went back to place your one little in a molar, you're numb to it. Bruce Beard and another one, Bill Williams is a $10,000.
Collin: He’s out of Georgia, right?
Howard: Out of Georgia. So here's Bruce Beard in the middle of nowhere, Texas. I mean to call that a town in the middle of nowhere and he does $10,000 to $12,000 a day himself and there's another guy in Georgia. So when I saw a guy that just expected to do $10,000 a day just by himself, all the other offices are like why do twenty-two hundred, I'm trying to do a goal of twenty-six hundred or twenty-eight hundred. Why don’t you set the goal at ten grand? Because it's doable.
Collin: So what do you think they're doing differently than the person like that you were saying that's doing?
Howard: Oh, 100% this case presentation. I mean there's just people in there that they walk in there and they got twenty-eight teeth and they just look at the one that's in pain and so you need a root canal and a crown and it takes them five to ten years before they can just say, “Well, if this whole quadrant is going to be numb anyway, why don't we just do it all?” And then they don't realize that the oral surgeons next door to him, his whole career numbs up all four quadrants and just does it all. If you ask any American, would you like to come in four times and get numb in four quadrants and do a filling in each one or you guys do them all and they just—it's kind of like the difference between wealthy people and poverty.
Like in poverty, I remember when I was an undergrad in (unclear 58:50) and it was in the poor part of town because it's a hundred-year-old university. So any neighborhood a hundred years later is as poor as (unclear 58:56). Then in Kansas City dental school, same thing it was in the poor part of town and I heard all of those people that I lived with for four years. “You won’t get into college. There's no way you'll ever afford a college.” So they're just telling them.
Then you go to rich families and Grandpa's telling his five-year-old, “So what college do you think you'll go to when you get older? Do you think you want to be a doctor, a scientist? What do you?” and you look at these five-year-old little girl saying, “Well, I know I want to go to ASU not U of A and that's when you know the kid's smart. That's when you know the kid's a genius.” Because why would you pay money to go to U of A? All you’ve got to do is drive by it real slow with your windows down, they'll throw a diploma in the back seat. They're sitting here five years old thinking do they want to be a vet or a scientist or a work on dolphins?
So when they walk into the case, I mean just totally believe that you're going to fix all your teeth and we're going to do it in one appointment. The only question is do you want to be put to sleep? Do you want me to bring in a sedation person? Because remember, when you look at the market of dentistry, half of America is afraid of the shot and the other half is afraid of the price?
So if you could address financing. So Bruce Beard and these guys are masters. Like other people walk in there and say, “Well, to do this one tooth is a root canal and crown is $1,600. Your insurance will pay a thousand, your portion is six hundred.” Where other people, their health history will get everything they need for the finance companies.
So while you're asking me if I ever had syphilis, gonorrhea, herpes, they're asking, have you had this thing, where do you work, have you had this job two years, where do you live, have you lived here more than two years? So they're asking because I'd rather have financial and psychographic data. I mean, I quit asking about STDs probably the first year I was in my office. This patient wouldn't come back and he wanted to see me in the private office and Jan walked him back there and then he wanted her to leave and then he pointed us to, “Have you ever had syphilis, gonorrhea or whatever?” and he starts getting all sad, telling me that in world war two, he had a four-day pass to the Philippines and he actually did get it. And I'm like, why? Why are you telling me that? Why are you dramatizing? What does having gonorrhea in world war two have to do with today?
So I started asking more questions like what did you like the most about any dentist you've gone to in your life? What did you like the least? What are you expecting to have done? If they'd say, “Well, I know this tooth needs pulled,” I know I would start with that. Why did you leave your last dentist? “Well, I just want to get my teeth cleaned and they said I needed this deep cleaning thing” and almost every single time someone says that got gum disease. But they obviously didn't present it right.
You're saying this is I'm Steve Buchanan's?
Collin: Yeah, I think so.
Howard: One of my classmates, Stephanie (01:02:00 unclear) tells me that Dr. Steve Buchanan is the most handsome dentists on earth and the only reason she took all of his endo courses is just because he was so gorgeous.
Collin: He’s a pretty smooth dude. I took his course back in October.
Howard: And what'd you think?
Collin: He walks the walk and talks the talk.
Howard: He's just amazing.
Collin: Yeah, he's cool. I learned a lot from him.
Howard: And if you ever get a beer down, you wouldn't believe the celebrities that he's done a root canal on. Did he mention (01:02:25 unclear) scores? Yeah, he's a class act guy. You need to get them drunk.
Collin: I'll get that next time.
Howard: Sorry you didn't get the heads up on that. But yes, he has done some of the most amazing celebrities. So you asked why did they do $10,000 a day? Because they take presenting the treatment as serious as learning how to do the treatment and most of your greatest dentists in the world are afraid of their own shadow. They can't talk. They're introverts. After every patient, they go lock themselves in their office and their staffs like beating on the door, come out, come out. Beard and Steve Buchanan and Charles Williams are guys that go out there, “Hey, how are you doing? How's the wife? How's the kid? How's the dog?”
So basically, Matthew, you haven’t been a dentist for five years. No big deal. I mean hell by sixty-five, almost 10% of Americans have zero teeth, another 10% are missing half. By seventy-five slash, 20% have zero teeth and times two missing half. And you're fifteen, you got a lot to work with. Here's what we're going to do. So what we're going to do is that you don't ask your daughter, “Well, do you think you'll go to college when you grow up? You might not get any student loan.” No, no, you're going to fricking college and so you're going to go to college, we don't know if grandpa will die and leave you some money or it's going to be student loans.
So this is what we need to do and then they present the whole deal in very simple terms and then they'll say, “Congratulations on your credit. I mean, you're doing good, you've had this same job, but basically it's going to cost you. You've been approved.” It is like looking at a car. Only 10% of the cars are paid in cash, 90% are financed. They finance them almost, it used to be thirty-six months when I was little then it moved to forty-eight months. Hell now, it's sixty months. It's five years.
So what it's going to do, it's going to cost them $480 a month, which I'm sure you can do that for sixty months. And my only question for you is, “I think you'll be very fine and comfortable. It'll be about a two-hour appointment. But do you want to be put to sleep? You want me to bring in a board certified anesthesiologist and put you out or do you want to do it when you're awake?” And they're like, “You know I'd like to be put out” and just wait. Okay. So it's probably going to be this what we're going to do, it's $488 a month for sixty months. We'll put you to sleep. Do you have any questions for me?” and people just say, “Yeah.” I mean because everybody wants their teeth. No one wants to lose all their teeth because then you have to tell everybody the rest of your life you're from Arkansas. I'm just kidding, it's Kentucky.
So they want to keep her teeth. I mean, nobody would go to an eye doctor and they say, “Well, do you want to keep your eyes?”
Matthew: That's a great point.
Howard: “Do you want to keep your hearing?” Well, no one wants to lose their hearing, their eye or their teeth. No one wants their body to start falling apart.
So they present the case, they have confidence and they don't tell them this enormous price like imagine going into a car lot. Two doctors and you just paid a $165,000 a year and let's say that your fantasy car, which all four of my boys had the same fantasy car. A Ford F-150 pickup truck which is sixty thousand with nothing in it and hundred thousand loaded and they said, “Matt, we're going to need $100,000. Are you going to get that to me in cash? Gold bars?” I mean, the average selling car in America is thirty thousand. How comfortable would you two just handing me a check for thirty thousand right now?
Matthew: Not comfortable at all.
Howard: But that's what dentists do in dentistry and they say, one tooth, give me a thousand in. The guys doing older cases are breaking it up into sixty months.
Collin; So what kind of financing? Do you do like CareCredit or do you do like an in-house financing?
Howard: What I love the most about CareCredit is CareCredit will come into your office and show you what all the other offices are doing a month because a lot of dentists say, “Well, you don't understand. I'm out in the middle of Parsons, Kansas. There ain't no money around here.” Yet I was just in Kansas the other day and this dentist was telling me that it's in a small town. I think it was a five thousand people and it's like, “Dude, across the street is a 7-Eleven. Let's talk about every car in there.” Almost every car was an F-150 pickup truck. I said, “So here we’re out in the poor country and I'm looking at ten cars across the street and five of them are sixty to one hundred thousand dollars.”
So where CareCredit come in is when you sit there and playing the blues, “Well, the problem is it's everything but me.” And they go, “Well actually, in your zip code and there's fourteen dentists and this guy, he's doing ten thousand a week and this guy doing eight thousand and you're doing three hundred a month. So you really think that you're in the richest country in the world and you're in Kansas and what, we're a third world country and there's no money and runaway inflation?”
I mean, no, it always the man in the mirror and everyone who has an ego and is arrogant blames it on everybody else and it's a humble man who said, “I wonder why I can't present any big cases?” and then they go take a course and learn. They get on Dentaltown, they do whatever and they always assume because they're humble that someone else knows more than them and they can learn something and it's arrogant to blame it on everything else and it's nothing's their fault.
Matthew: So if you're going to recommend a course for case acceptance?
Howard: Bruce Beard and what's the other one? Bill Williams. And what's Bill Williams site? Do you know?
Collin: I don't know. I know he's in Georgia. I forget what part.
Howard: And there’s some other idiosyncrasy things. A lot of dentists say, “Well, I don't like talk about money.” Okay, well now we have some little lady who's not a dentist or anything coming in, they're presenting the deal. If the dentist doesn't say the amount of money, you don't own it, the patient doesn't own it. The charge is high. When I say yet, we do the whole thing for four hundred and sixty-six a month for sixty months. No worries. What is four sixty-six a month times sixty months, that's a $30,000 case. And here's the mind shatterer for you, what percent of Americans do you think in their lifetime will just buy an average new car? Before they die one time in their life will buy the average new car.
Matthew: Gosh, I don't know. What would you say, Collin?
Collin: I have no idea. I couldn't even put a percentage on it.
Howard: What would you guess?
Collin: No kidding. Wow.
Howard: So I'll tell you why I'm a little nervous about the economy. So in 2008, I think we were selling in the United States, I think it was about seven million cars a year and then it went up to eight to nine to ten. Last year, it was like fifteen million. What scares me about that is of that those fifteen million, five million were leased. Well, what happened to the 2008 deal? It wasn't the lending to the dentist and the people with a good job, it was the subprime lending.
So now, whenever you push the regulation, like the government passed all this regulation, well that's just game theory. It's like, okay, well this is all we can do that if we redo it. Well now when you don't qualify for a loan for a car, they're leasing it. So and then when the qualifications don't, I can't get a loan for a house or whatever through the banks because of the regulations because I don't qualify. So what's all popping up? All this peer-to-peer lending where they go to high net worth investors and they say, “Well, you're only making 2.8% in bonds, we'll give you 10%.” “Well, why would you give me 10%? How are you making your money?” It's subprime lending again.
So you look at all these big people burning money on TV with all these quick-end loans and rocket loans and all these loans, and they have this monsterous high approval rating. Why? Because the banks can't give them money because of all the regulations. So they're going to millionaires and billionaires and saying, “Hey, you got a billion dollars at 2%, we'll give you 10%” because I can loan it out at 14% or 15% to people who don't qualify.
So I'm seeing this huge bubble again in subprime lending, but this time subprime lending is leasing cars instead of buying them and peer-to-peer loans and of all the corrections I've lived through, no one ever predicts it because it always comes from somewhere you haven't seen and these are the two new areas that no one's seen. How do we have? But here's the deal, here's the Eureka moment. Then I'll end on this because I know you guys are tired and late and you're wishing you never would have come by my house.
Collin: I’m good, man.
Howard: You’ll come by?
So four out of five Americans, at one time in their life, they buy the average car which is $30,000 and then you go to 90% of them and say, “have you ever once time in your life sold one $30,000 dental case?” Nine out of ten will never do it in their forty-year career from age twenty-five to sixty-five because their townie got no money. So 80% of the people in your town bought one. I mean what's a $30,000 car or that'd be a Toyota Camry or something.
Collin: Yeah, something like that, yeah.
Howard: So four out of five Americans can buy a brand new Toyota Camry once in their lifetime, but you never sold one in your life and then CareCredit can show you that there's this little boy up the street and he sells one once a week and when you add a $30,000 case once a week - so that's a times fifty weeks a year. Oh, that's just one point four million, and then they sit there and you see the average dental office students seven fifty and taking home one seventy-five and then you see one guy in that street having a one and a half to four million dollars. Bruce is doing four million a year and it's because he knows you want to leave this car lot in a brand new Toyota Camry. I mean, what do you want to go home in? A Uber? You want me to call you an Uber? Do you want the city bus schedule for Inna, Oklahoma.
Matthew: Yeah, if there’s a parking lot.
Howard: You can make these car payments, but America, nine out of ten people can't hand you $30,000 for an average new car. Only 10% can and who are those? Those are the retirees. Their kids are gone, their house is paid off, they got a savings account and they figure, spend it now instead of giving it to your spoiled children and your rotten grandchildren and then they just write it in cash.
So that is my story. I'm sticking to it. I'm sure you Ryan, everybody's saying, Dad, you're supposed to be an hour show. It's an hour and fifteen minutes. There's people in the parking lot trying to wait for me to shut up so they can go in and go to work.
Congratulations on sharing where you're at in your journey with our homies especially since 5% are pre-dent, 25% are in dental school, the rest are thirty and under. Thanks for bringing me two baseball bats. And that was the last time the grandkids were here, me and Zach had to take one to the dental office and do a front tooth composite. Remember that? Because she was pretending to be paddling and paddled out her brother’s front tooth. So I know one thing, I know I'm not going to hide these when my grandchildren come over, but thanks so much for coming over.
Matthew: Thank you so much for having us.
Howard: Thank you so much. Ryan, thanks for working past sundown.