Howard sat down with Laura Hatch of Front Office Rocks, Sandy Pardue of Classic Practice Resources, and Dr. Gina Dorfman of YAPI to discuss all things practice management, human resources, profitability, and more at this year’s Townie Meeting 2018!
VIDEO - DUwHF #1007 - Management Gurus
AUDIO - DUwHF #1007 - Management Gurus
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Howard: Well, I have to be the luckiest man in the world to be sitting with these three hot women at Townie 2018. I am with Laura Hatch, with Front Office Rocks; I'm with my idol and role model, Sandy Pardue. From where are you? Baton Rouge, Louisiana?
Sandy: That's it. Baton Rouge.
Howard: My g*d, she's the full package: beauty, smart and can cook anything. And, my gosh, at the other end I've got ... I've got Los Angeles here ...
Laura: No, opposite, San Diego.
Howard: No, San Diego here, I've got Los Angeles ... Gina Dorfman, who probably has the most well-run dental office I've ever seen.
Gina: Thank you.
Howard: How many people do have?
Gina: About thirty-five now.
Howard: Thirty-five. I've met her entire team several times. She's the founder of YAPI, which stands for 'Yet Another Practice Management System' - 'Yet Another Practice Management ...'?
Howard: '... Interface'. I'm a huge fan of yours. I mean, these guys consult others to do it; you fricking do it in your own office.
Gina: Every single day I'm doing something.
Laura: Except for during Townie.
Howard: On Dentaltown you're Mopsy.
Gina: I'm Mopsy on Dentaltown. I've been posting on Dentaltown for sixteen years now. You too, right?
Sandy: Oh, yeah, me too. 2002, and I've got around twenty-nine thousand posts and I'm one of the most followed on Dentaltown as well. I've got four hundred and seventy-one followers. More than you, Howard!
Howard: You have more followers than me? We just celebrated our five millionth post. And Dentaltown, it's so funny because we came out - I'm Irish, 100% Irish - we launched it on St Patrick's Day, 1999, so this coming March on St Patrick's Day will be our twentieth anniversary.
Laura: That's crazy.
Howard: And I just want to tell you a little history about social media, how it started back in '94 was email groups, and it was Dentists on Compuserve, Internet Dental Forum, Generation X - there was another one. Oh, what was the other one? Root ZX for endo; but you would open up your email and it would just be an endless barrage of emails, and then you couldn't find your work email. And then, all the original social media, all they did is they took the same format and just got it out of your email, so, Friendster, Myspace, then later Facebook, Twitter, LinkedIn, Instagram, Snapchat - you open it up and it's just this endless fricking barrage of unorganized sh*t. And what we did is, the Internet was started by ARPANET and the military scientist that still makes all your military, nuclear sh*t to this day, uses the bulletin board system. It was called Computerized Bulletin Board System, and the function of it was, it's organized by subject. It's all there and it's all searchable. And what we see now is, we see with this endless newsfeed stuff, there's no organization, and then when you see the Facebook groups, if I believe that all amalgams are toxic and should be replaced by inert plastic sh*t composite, and you come in there and say, "Well, amalgams last thirty-eight years, your sh*t lasts six years", they just delete you.
Sandy: Yeah, that's funny.
Howard: So, you see this vulcanization of like ... you have people getting deeper into the bubble, where if they don't like what you say, you're gone. And I always make the analogy, my two oldest sisters are Catholic nuns. Do you think I could send them to a one-day seminar and make them Buddhist or Hindu or Muslim? It's impossible. And so, what I think is the beauty of Dentaltown and why it's still ... you know, I used to say it always grows a thousand members a month. The last three years we've been growing fifteen hundred new members a month.
Sandy: That's interesting.
Howard: And what they like about it is the fact that people are saying stuff and you just can't delete them and make them go away.
Gina: I think it's really easy to search Dentaltown too.
Sandy: It is.
Gina: The search feature is excellent, and when you put in some terms and you find this vast amount of information, you don't get that on Facebook. On Facebook you can maybe find some recent searches and you're going to get a lot of ... if you mention amalgam, you're going to get a lot of results that are not necessarily relevant.
Gina: And you can do ...
Sandy: The topics are random.
Laura: I also think ...
Gina: You can do ...
Laura: On Facebook there are so many groups now. There's a new group starting ... I'm in seventeen different office manager/admins, but then they're all about front office and there's no doctor perspective, there's no assistant perspective. But on Dentaltown, it seems like you get other doctors' perspectives, you get help from consultants, you get help from business owners.
Sandy: And it's good advice. Because if it's bad advice, you're going to be called out on it. So, it's almost peer review, right?
Sandy: Not officially, but yeah.
Howard: And it seems like also with Facebook groups, they're always preaching to their own choir.
Howard: It's like, why would you want to spend all that time preaching to the five hundred people who already know everything about you, instead of doing it in front of a potential quarter million people? But for everyone that's ... so, when you're on my show, it's heavily weighted towards dental school, because on Dentaltown, all the four hundred and fifty online CE courses, they're all free for dental students. They're always on the iPhone, taking the online CE, [inaudible] the podcast. 25% of our viewers are still in dental school and the other 75% are all under thirty. So, you're talking to dental kindergarten, they might not have ever even heard of YAPI. What is YAPI?
Gina: Thank you. YAPI is an automation software. It connects with practice management software such as Dentrix, Eaglesoft, Open Dental, and it increases its functionality. It helps practices to go paperless without any shredding or scanning or data entry. It helps to remind patients of their appointments, it helps them schedule recall appointments, it also provides important actionable information as patients either call or come in, there will be popups reminding team members to take care of important things: collect balance, schedule an appointment that's past due, maybe wish patient a happy birthday. All of it is popping on the screen as it's needed, and once you take care of it, it goes away, so there's no useless information. The problem with a lot of the practice management software - and we used to do this in the past, we no longer do this - is we used to print routing slips every day for the following day and then highlight what we need to do so we don't miss it. YAPI completely eliminated that as well. And, of course, another important part, we have a virtual huddle that also kind of accomplishes the same thing and really gets the entire team on the same page; and it has an interoffice communication component which allows team members to talk from one room to another. Our goal has always been to increase practice efficiency and help doctors to really do more with the same team members and stay on track and make sure that nothing falls through the cracks.
Laura: I have to tell you, I use YAPI in my office. I found YAPI, I don't know, three or four years ago at AADOM, with the office managers, and I remember saying we were "paperless".
Sandy: Yeah, no.
Laura: We had more paper in the dental office before YAPI. You get the paperwork, you scan it, you did data entry. When we found YAPI, that completely made our office paperless. But again, it's been great with the iPads that the younger dentists are getting in. It's the older ones who are like, "I'm used to my charts, I'm used to my paper, I'm used to my route sheets", but it has made ... and people are worried about patients not being able to use an iPad!
Gina: Patients love it.
Laura: In my team, we don't have a scan pile anymore. We don't have to dig through the papers to find. Everything has been great.
Sandy: I always say that on Dentaltown, that it's the true paperless solution. I remember the days when we had paper charts and there were no route slips. The route slips came with the computers because we needed to take the data from the chart, the physical chart, and put it in front of you. So YAPI has replaced the route slips.
Laura: It's awesome. Yeah.
Sandy: And I think that's really key, and people are like, "What do you even use a route slip for?", well, YAPI will help you. And did you mention text reminders?
Gina: Oh, absolutely, text reminders ...
Sandy: YAPI will replace any other services you're using for text reminders and emails for patients, for recall - there's an entire recall system.
Laura: And consent forms, just having them sign and go right into the software.
Sandy: So, you don't need to have a lot of services.
Gina: Yeah, thank you.
Howard: Let's back up a little bit. The bottom line is, I'm in these dental schools. I go lecture to them all the time. They're scared. You're in California? You're in California? You have six dental schools down there. You have University of the Pacific, University of California, San Francisco, UCLA, USC, Loma Linda, and if that wasn't enough, they just opened up a sixth one, Western.
Laura: No wonder we have so many dentists in southern California!
Sandy: Everybody wants to be one.
Howard: So, they're sitting there thinking, "G*d, I would love to live in LA, but when you've got six dental schools and anytime you throw a dead cat, you hit a dentist in the head", do you think it's still doable to graduate from USC and practice in Los Angeles or San Diego?
Gina: Of course it's doable!
Howard: Well, talk about that.
Gina: In any town, anywhere you go, you're going to have two dentists on the same corner. One is doing amazing and one is not. And a lot of the doom-and-gloom stories are coming from people that are not doing well, but it's because - we were just talking about this - because it's what's happening in their own office and not necessarily in the larger area. Yes, LA is more competitive. Yes, it's easier to go to a remote location that really badly needs a dentist and start a practice there. Anyone can do it probably. You go to LA, you're going to need a little bit more business savvy. You're going to need a little bit more training. You need to train your team. We're always talking about that as well. You need to have good business practices. I'll be speaking with you in Arizona in two weeks and I'll be speaking about ...
Howard: You'll be speaking in Arizona?
Howard: With me?
Gina: With you!
Howard: Where am I?
Gina: Action [inaudible]. They'll tell you. People will tell you.
Howard: Okay. [inaudible]
Sandy: It's just like on Sutter Street. The doc's on Sutter Street, in that one building, and in San Francisco you have all those doctors ....
Laura: A hundred and fifty-five dentists in one building.
Sandy: ... and I had one of them sitting on the front row of my lecture in New Orleans, doing one point five million and working three and a half days a week. He has a nice life. He's happy.
Laura: We moved from east coast to west coast, not doing our research, realizing how much competition is in southern California, and we moved in 2008 and we opened a fee-for-service practice and everyone's like, "You are insane to open a fee-for-service practice in southern California during the recession!" And we have a $2,5 million practice, $3 million practice. It's all about systems, customer service, it's about hiring the right team, it's about training the team, it's about knowing the business. It's not about the dentistry. And so many dentists are worried about giving the discounts and competing - it's not! It's about taking care of your patients.
Gina: May I go back to ... we were talking about young dentists, I graduated from dental school ...
Howard: You mean me?
Gina: Yeah, yeah! I graduated from dental school in 2000, from USC with a huge debt.
Howard: You did?
Gina: I did. I went to USC for my undergrad and for dental school, so I really had some debt there and I started from scratch two years later and I didn't know anything about practice management. I didn't even know how to practice dentistry because four years of dental school just gives you enough opportunities to be dangerous with that handpiece! And I needed the resources to learn. I couldn't afford a lot of [sounds like: high-end education}. One day my dad calls me, and I was talking to him about my practice, he goes, "What does 'O' stand for in MOD?" I'm like, "Dad, that's a weird question. Why do you want to know?" He's like, "I found something. You need to check this out." And that's when I logged in on Dentaltown. I learned to practice dentistry on Dentaltown. I learned to run a business on Dentaltown. Everything I'm doing, I've learned from this lady as far as practice management, recall. A lot of the features that we've built into YAPI, I stole from you!
Sandy: That's okay.
Gina: I give you credit.
Laura: That was on the record, right there.
Howard: It was your idea. You just stole it from Sandy.
Laura: She made it digital.
Sandy: I don't mind if she does.
Gina: And I started listening to your MBA programs and I would have not been able to have this kind of practice. We're above three million now. We're doing so well.
Howard: You graduated in 2000?
Gina: I'm sorry?
Howard: You graduated in 2000?
Laura: Oh, 2000.
Howard: 2000. From dental school?
Gina: From dental school.
Howard: Okay, so, you graduated in 2000 from dental school. You have one child.
Howard: Two. What year did you have them?
Gina: Feels like five some days!
Howard: What year did you have your babies?
Gina: I had them 2005 and 2008.
Howard: Okay, I want to ask you a question that I can't answer. Half that dental school is women, and the women always ask me - I don't know how I'm supposed to answer - they say they have very mixed feelings, they want to own their own business, but they want to be a good mom, and biology says the mom is more important. I think my four boys are more important than anything I've ever done in dentistry and they're my top priority. But if you wanted to be a super-mom, would it be better to go work for Steve Thorn at Pacific or Rick Workman at Heartland Dental, so that you could just do your eight to five and then go home and just be a mom, or do you think to be a super-mom, you'd rather own your own business because if you wanted to go to the play tomorrow at school, you just tell your staff, "Cancel my appointments."
Gina: Okay, this is a great question and you know what? I'm going to tell you that neither, and the reason is ...
Gina: Neither. It's the wrong question. They're asking the wrong question. Whether you should own your own business depends on whether you have the skills to run it, because when you have the skills to run a business, when you have a team that you can lead, when you have a team that's trained to take care of that business when you're not there, then you have the flexibility of having your own business, you have the free time, which you don't have with an eight to five job, you can take time off anytime you want to. Last month I was in my practice literally two days. We took a two-week trip to Israel. I spoke at the Practice on Fire events, together. I don't even remember where I was. I'm here now.
Laura: She travels with her kids more than anyone and runs a very successful dental office.
Howard: So, let me ask it a different way. When you're in dental schools, you're talking to dental kindergarten, what percent of the girls and/or boys do you think really want to own their own business? Where it's even a dream?
Sandy: I have an answer for that. I was giving a seminar last month and one of the attendees walked up to me and said that she was a junior in dental school and she said, "When do you think I could get an associate in my practice?" Now, she's a junior in dental school. She hasn't graduated and she's thinking about an associate, and it surprised me, and I said, "An associate! But you haven't graduated." And she said, "But I don't want to practice dentistry."
Laura: So, she wants to manage.
Sandy: So, there you go.
Laura: And I'll tell you, for my business, I have a lot of the new graduating dentists who are using Front Office Rocks, and they're binge-watching my videos. They're going in and they're watching every video - I'm watching, because I can see when they watch the videos - which I think is a good sign because I know when my ex-husband got out of dental school, there was no place to go to learn how to run a business. You just kind of did it. You went on Dentaltown. You went to see the speakers. We came to Townie years ago. But now they're actually realizing, I need to know what my front office team is supposed to be doing. I need to know how to lead my team. I need to know how to talk to my office manager. So, I actually think we're in a better position now with technology than we've ever been.
Sandy: Oh, sure. I think so.
Laura: So, I think it will change. Right? I personally think that the younger students coming out of dental school realize, "I should know what happens in the front", because I'm telling you, most of the dentists walk by the front going, "I hope they know what they're doing! I hope they're answering the phone the right way!"
Howard: What is your website? Front Office Rocks?
Laura: frontofficerocks.com. It's online.
Howard: Ryan, can you send me Front Office Rocks? And what are you selling online? It's videos, DVDs?
Laura: It's a subscription-based website. It's $149 a month and there's over a hundred and eighty videos, webinars, resources, and so basically, unlike Sandy, who I look up to and love, I have no desire to go in office. I have no desire to help offices. I just wanted to train the team members, training them on answering phones, training them on how to deal with an angry patient, training them on how to ... so, I'm about bite size bits of training the employees. But I'm finding that the new dentists are actually doing it too, because they're used to YouTube and videos and ...
Sandy: And they have to, they have to.
Laura: Right. And so, I think they're setting themselves up even better. So, it's a subscription-based website that basically has the nuts and bolts ...
Howard: Ryan, take a picture of us and then text it to her. So, if you go to the frontofficerocks.com?
Laura: Basically, we teach everything from receptionist, brand new employee, doesn't know anything about dental, all the way through scheduler, treatment coordinator, financial coordinator, office manager, and it's subscription-based. It's all video-based training.
Howard: For one forty-nine a month?
Laura: One forty-nine a month, yes.
Howard: And on Twitter you are ...
Laura: There we go.
Howard: I am following you.
Laura: You're the one who got me on Twitter. I was on an interview with you before. You were telling me the benefits of Twitter. I'm like, we need to get on there.
Howard: I want to review Twitter real quick. When you get in bed with Facebook, it's pay-to-play. Mark Cuban's the one who explained it to me. He paid all this money to build up to a million followers, so he thought if he made a post, it went to a million followers. I have three hundred thousand followers on Facebook. If I give them $100, only ten thousand will see it. If I give them ... I don't know, I have to give them $1,000 for this podcast being watched by a hundred thousand of my own three hundred thousand followers. Whereas Twitter, you make a post, it goes to everyone. Instagram, you make a post, it goes to everyone, but Instagram, they're only doing that until Snapchat dies, and then that will be pay to play. LinkedIn, you make a post, everyone follows it. You only have to look at who the frick is the President of the United States, because you know what? Love him or hate him, you know what he figured out?
Howard: That at 7 p.m., only one million are watching CNN and only three million are watching Fox News, and he had fifty million following him, and at the time it was like five million, but he's still at a bigger following than Fox, MSNBC and CNN at the same time. He could be sitting on his toilet at three o'clock in the morning, reaching more people than every news deal.
Laura: We used Twitter when I launched my book, specifically for that. After you taught me that in the last time, we got our following going and then launched the book there. And everybody, we have people all the time saying they found my book on Twitter, not on Facebook. I love Facebook. I'm old.
Howard: Your app is YAPI app? Your website is YAPI?
Howard: Dot co. What's the dot co instead of dot com?
Gina: It's not available. It's hard to get that domain because YAPI is actually a Turkish bank or something like that.
Sandy: Oh, really.
Howard: A Turkish bank.
Gina: They own yapiapp.com.
Howard: And the Ottoman Empire is back, growing, on a roll. Do you not agree?
Gina: It's hard to compete with.
Howard: But don't you agree though that Turkey, I mean, it's the remnants of the Ottoman Empire. I see things in pendulums. If you look at a map of Poland, every hundred years it's a different shape and it grows and expands and contracts, and this and that. I see the Ottoman Empire back on its feet. Do you?
Gina: I don't really follow that. I'm so into dental.
Laura: Don't you love when you're talking to Howard and all of a sudden you're going to go ... On my first podcast with him, he went off on a tangent - I'm not even going to say because he's going to go on that tangent - and I was like, where are we going with this story?
Howard: I'm going to re-tweet. On Twitter, you're @yappicentral. I just re-tweeted your last tweet. And what are they going to find if they go to yapiapp.co?
Gina: It's going to be a complete description of our product, lots of pictures, some videos that showcase the product and they can schedule a demo, and they can also sign up for a webinar. I think I'm giving a webinar next week showing how I use YAPI in my practice for true paperless.
Howard: What would you say your core competency is? I don't want to butcher what I think it is, but to me, it's thirty years of being a dentist, I'll point to their only gold crown, "Who did that gold crown?" They never remember. I'm like, "Damn, someone got in your mouth [inaudible]. Did you ever wake up on the sidewalk and felt violated and some man was running down the street? I mean, how the hell does someone get in your mouth and turn your tooth gold and you don't know who did it?" When you get out of school, you will always get stressed because someone will call up and say, "Yeah, you know that crown you just did? Yeah, the whole thing fell off." You're sick and nauseous, you get there the next day, you did a crown here, it's clear over there, it's like, "Dude, I just did this crown a month ago. How did you think I was over there?" So, they never remember what you did. You can't believe a story they say, because for thirty years I have been told, at least every other month for thirty years, "In order to pull this tooth out, he had his knee in my chest", and I've never met one dentist in my entire life that ever put their fricking knee on anyone's chest one time. The patients are bat-sh*t crazy.
Sandy: It's really true.
Laura: And then they forget to pay when they come out. As soon as they get anesthesia, they're like, "I'm supposed to pay?", and you're like, "No, we do this for free."
Gina: Where's the balance coming from?
Howard: In my opinion, they never, ever remember what you did. They have no idea if what you did was good or bad. They wouldn't know as short root canal from a long. They only know one thing and that is, how did you make them feel. And I think what you do is all the extra touchy-feely stuff to bond the human relationship. Is that what you think YAPI's extra layer is, to go from the mechanical to the feeling?
Gina: You know what? You nailed it, because in a dental office, you walk in and there's a human who is like a giant octopus with eight arms, handling all the little minutiae that it takes to run the front office, and what we want to do, we want to minimize this so that they can have time for face-to-face relationships and then also remind them of the little touches, like if it's their birthday, and showing family members there so they can say, "Hey, how's your son, Ryan, doing?"
Sandy: All the things that they need to be looking at: incomplete treatment, who's due for recall, all of those things is in front of them.
Howard: But let me tell you, unlike these fines speakers, I've been banned from States, I've been banned from provinces. When I spoke for the first time at the ADA, they banned me for a decade. I have never, ever told you what you want to hear, I'm the asshole that tells you what you need, and everything they're doing, you know what you do? You numb them up, and then you go sit in your fricking office and shut the door, then you come back and drill with your mask on and all that. Then you leave, have your assistant pack the [inaudible]. YAPI is amazing, but what's more amazing is she actually has a personality and talks to her patients. When I'm running late, I walk my patients to the front, because number one, I want to joke with my staff, I want to go out in the waiting room and press the flesh like I'm running for mayor. I'll go up there and Dawn will say, "By the way, you see that lady out there, Mrs. Dorfman, very p*ssed! She had a 10 o'clock appointment, it's 10:15!" I'll walk out there, "Gina, I'm so sorry." I'll give her a hug. And then what's really weird is she might be up there just throwing a fit, but when I walk up then she's like, "Oh, it's okay. Don't worry."
Laura: It's always that way, right?
Howard: So, the bottom line is, you can't live in your damn private office. You've got to get out there and press the flesh. And then a lot of you will say to me this, "No, that's not my personality." I don't give a sh*t. Look at all the famous movie stars that got all the Oscars that were playing a serial murderer or some crazy. I mean, look at Meryl Streep. How many characters she played. Do you think she has twenty multiple personalities or when she gets to work, does she say, "Okay, I might be an introvert geek dentist. I might be most comfortable in a library studying physics, but I got a job to do. I got to be a leader for my team ..."
Laura: Well, that's the biggest thing.
Howard: "... and I got to build a relationship with my deal", and you go in there and you're running for fricking mayor. And YAPI has a million tools to help you run for mayor.
Gina: Right, and in fact, you mentioned being late. YAPI will start to flash when a patient is not seated on time and that's when you can ... and everyone in the office sees it, so the dental assistant can go get the patient quicker so that another assistant can jump in and help. In my office - and the only reason why we can do so much - we have several part-time employees, we have a lot of help - the only reason why we can do so much is because we can communicate well, and we can help one another. And then the dentist can walk in and say, "Hey, I'm so sorry I'm running behind", because they will understand if you are running late, they'll understand emergencies. They're sometimes late, but they will completely ...
Howard: One thing I'd add to that is when you're dealing with humans, a pre-process wait is the longest, an in-process wait is the shortest. So, the problem is your number one expense is a 42% reduction in your fee because you took a PPO, you have $1,000 for a crown, but you said you'll do it for six hundred. Second is labor, 25%. Third is lab, 8 to 10%. Fourth is supplies, 6%. Facility doesn't even make the top ten costs, and we don't run late because we have extra operatories. Operatories isn't my cost. PPO is my cost, staff's my cost, lab's my costs, supplies are my cost. An operatory isn't your cost. So, we seat them on time, and then I figured since every single president I ever voted for lies through his teeth twenty-four hours a day, seven days a week - I mean, you always know if your congressman or senator or president's lying because his lips are moving; if their lips are moving, they're lying. So, sometimes I'll numb them up and I'll say, "You know what? This is going to be a deep filling. I would like for this to soak in for at least twenty fricking minutes." And they're like, "Cool, cool," because they're waiting but they think they're doing something.
Sandy: Right. Communication again.
Howard: Yeah. So, have the facility, you got to be [sounds like: chair long]. And I go into every dental office and I see the most expensive people, the doctor and the staff, waiting around for a chair.
Gina: That happens.
Howard: You can't have 25% doctor costs, 25% labor cost, 50% of all your costs, waiting on a fricking chair. Get more chairs! They're not your cost. And every dental office I know that if you could pass this litmus test, we got an operatory that every other day we didn't even use, those have lower overheads. And then emergencies, come on down, because sure we don't have an opening, but what's your next question? How do you get rid of no-shows and cancellations? And so, catch the fish, because get them down there, get an x-ray, get a shot, because right when you go to tell him, "I don't have time to do this", they'd come and tell you your next one just canceled. And if you can't do it, then you just say, "You've got a big infection. I need to put you on antibiotics until I have an opening next Thursday at 2."
Laura: I think the biggest thing with the technology that I find is, invest in the technology because it's there now, and invest in your team. So, having the technology - you were mentioning, when it's flashing when a patient's late, it's no longer the front office employee going back to the assistant going, "Doctor!" and now there's an attitude. Now it's the technology telling you, we need to get the patients out on time; and then invest in your team. So many dentists are afraid to spend money to train their team. Your team should know how to handle all these scenarios. You should be able to get them the support and the training they need so that when the emergency calls in, they don't run to the back and go, "Doctor, what do we do? Should we would put him in the [inaudible]." Your team should know.
Sandy: It what causes all the stress because they don't know. One thing I want to say about technology communication, is the Apple watch. The ability for YAPI and the Apple watch. So, doctor's wearing the Apple watch, and tell them what it will do.
Gina: They'll communicate from one room to another. The front office can send the doctor a message, "Your next patient cancelled, so if the patient in the chair needs any dentistry, go ahead."
Sandy: Or a hygiene check.
Gina: Or a hygiene check. Exactly. And it just simplifies communication in the office. But the most important thing, again, what we're trying to do, you mentioned cancellations. Oh, I shouldn't say that word! Sandy teaches never to say it, you don't use that word. It's a last-minute change in the schedule.
Laura: I say ‘opportunity time’.
Sandy: It's a change.
Gina: If they're in the chair, they can't cancel the appointment, right? So, you want to get the dentistry done now. So, you send a message to the front, "Come in and present." They'll come in with an iPad, sign the treatment plan, you messaged the assistant, "Come in and set up the room." You've got to have the room, you've got to have good communication and everyone on the team has to have good verbal skills. Sandy talks about it all the time. It's so easy. Sometimes I hear things that are, "Oh, you know, we just don't use a good lab", or "Oh, I don't know if Doctor has time for it", or "Oh, most patients don't like to do it the same." Oh, my g*d, they're talking patients out of appointments, out of dentistry. They're making the doctor look bad. You've got to train people how to talk. And you could say the same thing in two different ways and get a completely different result. And one of those questions you asked earlier, for a business owner, if you want to be in business, you have to train your people. You've got to do this. In my office they go to Sandy's training facility every year, every single person who works in the front trains with Sandy, and in my office, everyone watches Front Office Rocks. In fact, we have a copy for our YAPI employees who are working with customers and that's how we teach them about the dental part - by watching those videos. They need to know, if they're going to work with our customers. The verbal skills are key. Can I pass this onto you? The verbal skills. Can you talk about this for a second? You know I'm huge about this.
Sandy: Sure, yeah, absolutely.
Howard: So, I want to ask you - this is Dentistry Uncensored. We don't talk about anything that everyone agrees on. I like to talk about the controversial, uncensored stuff. The truth of the matter is, when you look at all these DSO's out there. Regina Herzlinger was the first Doctor of Business Administration from Harvard who is female. She's been a healthcare economist forever. When one of her students wanted to do a paper on dentistry, she wouldn't let him do one on any of the DSOs because there's nothing unique about it. They're just a roll-up. What they do is they go get a $100,000,000 line of credit, they go buy a hundred offices doing a million a piece and then say, "Oh look, we got from zero to a hundred million in sales." Well, so did your debt sheet. A normal business, you would get a hundred million, you'd buy a hundred dental offices for a hundred million, and then the next ten 10 years your debt would go to zero, and your sales would go to two hundred million. That's not what we see. They're just buying sales. So, as their sales go up, their debt goes up, and not one of them could ever go publicly traded in America. Wall Street wouldn't touch any one of them. There are three publicly traded dental offices. There's two in Australia, 1300SMILES, Pacific Smiles; and there's one in Singapore, Q & M. All three of them said the only way they could be profitable is you can't pay a hygienist $40 an hour to do a $55 cleaning in a facility that has 65% overhead. So, those three, none of them have hygiene. When you go in the United States and you look at the only profitable dental chain, which is Comfort Dental, Rick Kushner, three hundred and fifty offices. Again, no hygiene, and what they do is they say, "Look, the assistant, the hygienist, 90% of time doesn't need a [inaudible]. She's setting up the room. She's seating the patient. Then when she goes in there to probe, she needs an assistant [inaudible], so you have the doctor go in there and probe. And then when he scales, he's also doing the exam, bonding with the patient, telling them what's broken. Then he leaves, then the assistant does the polishing, the flossing. So, my question to you is, since Delta is a PPO and since 95% of all dentists take Delta dental, the whole country is on a PPO, is hygiene dead?
Sandy: I don't see it. Maybe in a DSO, but I don't think so. Look at patient retention in these offices, that tells you a lot. I know that the hygienist and the hygiene visit has a lot to do with patient retention. The communication, the relationship, that's what holds the people there, so the DSO, if they're just taking people through the front door and out the back door, maybe so. I don't think hygiene's dead. No, I don't.
Laura: I actually speak a lot about this because so many dentists are about the new patient, the new patient experience. Which is great, we need that. But if your back door is open wide and you're getting fifty-five new patients but you're losing eighty, that's a problem. And I talked to a dentist recently, I said, "How's your relationship with your patients?" and he's like, "Amazing, excellent, awesome." But he's trying to get the profis down to like forty minutes. He doesn't want to give the hygienists an hour. So, I said, "Well, how often do you see your healthy patients?" "Twice a year." So, two forty-minute appointments a year. "How often do you see them, Doctor?" "Ten minutes each." "So, twenty minutes a year, you see this person that you have an amazing relationship with? How is that possible?" If you only sell somebody twenty minutes a year, do you really? It's the rest of the team: it's the hygienist, it's the experience; it's when they walk in and how organized your team is and how nice they are, and the social media you put out, it's all of those things, because all of our patients are getting marketed to by all of the competition and very easily they can forget what it's like. When they first came in, you were amazing; now they feel like a number.
Sandy: It's how they feel.
Laura: And all of a sudden, they're like, you know what? I'm going to go try that, you know the specials now: we're going to clean your teeth for $10, whiten your teeth for free, give you a toothbrush.
Laura: Why wouldn't I go there?
Sandy: There's no relationship there.
Laura: Right. So, I think that dentists, yes, moneywise you could cut the hygienists out and save a lot of money, but I actually think hygienists play a huge value in retention. Like you're saying, to remind the patient every time they come in, this is the dentist, so that case acceptance, five years from now when they're finally ready to do that implant or Invisalign or whatever, they remember why they're in your practice.
Sandy: They compare that visit to the last dentist they went to. Have you ever thought about this? A practice gets twenty, thirty, forty, fifty new patients a month. Where were those patients last year or two years ago or three years ago? They were in another practice's chair.
Laura: And they left.
Sandy: Yes, exactly right.
Gina: And that's why I don't like extended hygiene, because we agreed push the hygienist ...
Howard: You were like, extended.
Laura: No, assisted.
Gina: Assisted hygiene.
Laura: Assisted hygiene. Because the hygienists don't get a chance to build that rapport. It's person to person going in and out.
Gina: I keep interrupting you, I'm so sorry. In my practice, when I walk into the room to do that exam, I want a picture of a tooth on a screen in front of the patient. I want a patient staring at this tooth asking me, "Is this my tooth? Does that look bad? Is that bad? Do I need to ...? She said there's a problem." I want my hygienist talking to patients about what they see in their mouth. She's the most trusted person in that office. Dental assistant, same thing, most trusted. They're not going to trust us, the minute we walk out, they're going to be like, "Wait. Do I really need to have that?"
Sandy: So, there's your answer. All three of us are telling you the hygiene appointment is important.
Laura: However, you can't ... I understand production, we want to get more production, doctors think about production, delivery, production, delivery. Let's make them go faster. We have to remember that patients don't know about the dentistry. They don't know if it was a good margin. They don't know if you went to this advanced education. They know their experience, and if they come in and they're not greeted in the front desk because the girls are too busy scanning, and an assistant walks out and goes, "Come on. Come to the back", and then leaves them in the chair and the doctor's in and out and the hygienist, patients are going to go, this isn't the experience that I'm paying for, and if you want to get out of network, if you're interested in not being a Delta PPO practice, you better up your game.
Sandy: It's all about the experience.
Howard: Let me throw in some historical perspective, because unlike you - you're thirty or younger - I've done this thirty years or more. Every single publicly traded dental office in our careers, Orthodontic Centers of America, on the New York Stock Exchange, $1 billion valuation, imploded to zero like Enron. There were a dozen on Nasdaq. They're all gone. When you say, what's your perception? What's your bet on the ones now? There's no different. You just need to run the timeout long enough. They're not paying their debt to zero while growing. They're just wanting more debt. So, what happens is the venture capitalist says, "Well, I'm in the $5 to $50 million range." Then he holds it five years and then what does he do? He flips to someone who's in the $50 to $100 million range, and then they hold it for five to seven years. It's a hot potato. No one wants to own this potato, and this potato can't pay off its debt. They just keep throwing it to someone else. But I want to ask another ... the other dark side of dentistry that no one talks about is, you go find a dentist who went to Parsons, Kansas at age twenty-five and he's practiced there for forty years and now he's sixty-five. You say, "Well, what do you need, buddy?" "I need more new patients." Dude, you've gone through everyone in the city three times. Do you know of any dentist in your life today that cannot accept new patients?
Howard: So, everybody that you're listening to is full of sh*t because nobody has kept all their own patients. There are lawyers in Phoenix, Arizona that do certain class of law, that say, "No, I'm sorry, I can barely do the one thousand clients I have, but I'll tell you who is taking new clients." So, there's fricking lawyers who will not take on new clients all over where I live in [sounds like: Scottsdale]; not one dentist on earth. And this disease about the 'new patient experience'. Dude, it should be the 'customer experience' ...
Laura: The customer across the board.
Howard: ... for every fricking person in the office.
Sandy: That's right.
Howard: So, no one goes public. Everyone, every big group, DSO, historically has gone to zero, okay. The next question is this, back to associates, Millennials. I know Millennials hate to be called out, but the bottom line is when you look, it's not just dentistry, in corporate, they only keep their corporate DSO job for a year or two and they're gone, but it's not just corporate, it's private practice. All my dentists in Phoenix that have associates, there's two types of associates. Half of them they just one and two and flip, and then the other half will do seven and ten and it was a good deal, but no one stays. But it's not just dentistry, it's not just corporate, but it's in ... look at FAANG: Facebook, Apple, Amazon, Netflix, Google, their average Millennial stays with them one to two years. You look at these work environments, like Google, where they have every perk known to man. They got every amenity, free crackers, punch, foosball, pool, and after one year someone will knock on the door from eBay and say, "Hey, do you want to try eBay?" "Yeah. Why not?" And they'll go and work at eBay for a year and the someone will say, "Hey, do you want to try Uber?" 'Why not?" So, they just job hop all day long and these DSOs and these older guys like me are pulling their hair out thinking, "You came in here out of school, got a year’s worth of dentistry, half of it was sh*t. Then you quit. I'm redoing half your fillings and crowns and root canals." So, here's my succinct question. Am I making money when I pay a hygienist $40 to do a $55 cleaning? Am I making money when I hire an associate to pay him 25% of the dentistry, when he's going to quit in a year or two and I'm going to have to redo half the dentistry? Is it kind of coming down to the best way to make money in dentistry is do it yourself?
Gina: Oh, gosh, I hope not.
Sandy: I don't think so.
Howard: Is that too much doom-and-gloom for one question?
Sandy: It goes back to lack of leadership as well. It goes back to that that leader setting the standards for the associate, making sure they hire the right person, that production in hygiene, that it's not just profis. I see practices that start with us, with 3% of hygiene with perio. I mean, 3%! Are you kidding me? So, missed opportunities.
Gina: Definitely missed opportunities. Definitely lack of training. There's always ...
Sandy: And lack of leadership.
Gina: A lot of the associates coming out of school, they're just thrown in there and they're trying to - what's the expression? Swim or sink?
Everyone: Sink or swim.
Gina: Right, and associates need to be trained. We mentioned verbal skills. They don't teach verbal skills in dental school. They teach you, like you say, Greek and Latin, right?
Sandy: And the dental assistants are training the associates when they get there. I've seen that many times.
Laura: I think a lot of it, with the leadership is - not to quote Simon Sinek, but the why. Why are we doing this? Like if we were selling used cars and purses and jewelry it would be a whole other story, but we're dental health professionals. I think a lot of times we bring in an employee and we give them a task: "Here, make confirmation calls", "Here, do these fillings", but what's the why behind it? What is the reason we're making confirmation calls? Is it the call? No, it's to get the patient to show up to help them keep their teeth for life. Why do the associates ... like, you don't just give somebody a patient and go, "Here you go. Good luck!" You double check that their dentistry is good, because these are your patients that they're working on and you give them the purpose behind what your goal is as the owner, but I think owners, the doctors, they don't get taught this. They open a practice. I think their idea is, "I'm going to rid the world of cavities and gum disease", and then they wake up on Monday morning going, "I hate this, because of the insurances, because my team, because of ...", the biggest complaints dentists have, but really that comes from the leadership and your purpose as the owner. What do you want to be? Do you want to be a dentist? They just you get a hygienist, a dentist, an assistant. You're good to go. Or do you want to be a business owner? Don't say you want to be a business owner, but then not take the initiative.
Sandy: That really is leadership. Absolutely.
Laura: And train your team and invest in your team. Like we take - and see if you agree with this - I love it in dental offices, we take a brand-new employee and we try them out on the phones. I think the phone is the most important piece of technology in the entire dental office because I don't care if it's a CEREC or the Galileos, if the employee answering the phone can't handle that phone call, you're not going to be doing a lot of CERECs. So, we try out new employees on the phones. It's like train that employee before you ever let them pick up that phone, because that's our connection to the patients.
Howard: Let me hold your feet to that fire, because these young kids come out of school, and when you see a NASCAR driver, you see all the advertisements on this NASCAR driver that's supporting this driver, but when you go on the dental lecture circuit, they don't wear their NASCAR suit. So, the dental kindergarten class doesn't realize all the sh*t they're being sold on the speaking circuit, that they think is from a "calling". So, my question is this: do you see - you're yapiapp.co, you're classicpractice.com, you're frontofficerocks.com - they're sitting there coming out of school, they've got some hard decisions, $150,000 chairside milling, yes or no?
Sandy: No. Well, I'll tell you this ...
Howard: I want to hear yes or no.
Laura: If they believe in the technology, yes. But you have to implement, you have to integrate, you have to know how to.
Sandy: I work with a lot of $2 and $3 million solo practices - that's when I'm impressed - and the ones that are doing those numbers do not have it.
Gina: I'm going with no, unless it really becomes a niche.
Sandy: It slows you down.
Howard: It slows you ...? How come they that message? Why is the overwhelming message that if you don't have CEREC you're just a loser?
Gina: I've been talking about it for years, no one's listening. There's a learning curve, and you know what? I have two the units in my office, so I'm not ... we don't mill, but we use the scanners, and I love the technology, but I've been in practice for seventeen years, I have long-term associates, I have a long-term team that's been there for ten, fifteen years and I can deal with the learning curve, but when you have an associate in your practice who is changing over every couple of years, or when you're a new person just learn to do it the good way, get fast.
Sandy: If it takes you three to four hours for a single crown, guess what?
Laura: Here's the thing, it's about implementation. So, I'm going to ... not to pick on YAPI, but I'm going to tell my story about when I brought YAPI in. It's literally taking, instead of a clipboard with paper, we're putting it on an iPad, and we have younger dentists in my practice and we would say, "Here's their new patient paperwork, take this iPad with you to the operatory and go over it", and if they couldn't get it to work, they were like, "Psh, give me a clipboard", and I had to go put the iPad back in their hand and say, "We're not doing clipboards anymore. You have to use the iPad." "Oh, but I can't find ... I don't know how to write ... there's no pen." "Yes, no more clipboards", and it took us two or three weeks to get the doctor to stop putting it down and going, "Give me the clipboard." It's the same with CEREC, or any of the CAD/CAMs or tech. You can't just plug it in and go, "It's going to work." You have to invest in it and train in it. I have a doctor who hates Eaglesoft. He did not shut down when they converted from Dentrix to Eaglesoft, so they learned Eaglesoft while they were seeing patients. His team hates it. Well, you don't just plug-and- play some of these technologies and expect it's going to change.
Gina: So true.
Laura: You have to invest in the training, you have to invest in it. Now, if you believe it, great; if you don't believe in it, that's fine too - but don't buy it because it's going to "fix your problem".
Howard: I don't know how dentists' brains even think anymore, so it's hard to figure it out. They take a $17 Impregum and then temporize it and in ten minutes you’re out the door and then they send it to the lab man, who's made ten thousand crowns, and they'll make it for a hundred bucks. They say, "No, you know what? I should buy a $150,000 machine, have my assistant scan it, who's never made a fricking crown", and then they're in there for two or three hours and then they say things like, "Well, you know, same day dentistry." I've been in this for thirty years, I only hear two things. They're afraid of the shot, they're afraid of me hurting them; or they're afraid of the bill. I've never heard one fricking person say, "You know what I'm afraid of? The second appointment."
Sandy: I don't want to sit there that long and wait on something, personally.
Howard: I know, three hours in the chair.
Sandy: I mean, I'm like, "I've got to go!"
Laura: But why do they buy it? Most dentists buy it for that same day dentistry concept, right, and no offense to like Patterson or Schein or whatever, but the salesperson comes in and says, "How was your month last month?" You're like, "People are busy. They don't ..." "Oh, you know what you need? You need a machine that does crowns same day." They're not buying it clinically because it's a better option for the patients, they're buying it because they think that's going to fix the problem.
Sandy: I have nothing against it.
Howard: Here's where I call bullsh*t. Okay, but dude, you've been a dentist, I don't care if you've only been a dentist for five years, five years out of school your hands are just now starting to find your ass, okay. Have you ever heard of anyone call your appointments and say, "You know, I'm really looking to have a crown done, but all I care about is, is it made the same day?" So, you're going to create a supply of some demand you've never heard. What do I hear? Are you open evenings? Are you open Saturday? Do you take my insurance? Can you knock me out? Do you have laughing gas? Can you put me to sleep? I mean, that's the sh*t you hear all day long.
Laura: Yes, no new patient calls in and says, "Oh, you don't have digital x-rays! Oh, you don't have a CEREC! Oh, I'm not coming."
Howard: And what did Southwest Airlines do? Herb Kellerher, a drunk attorney without a license to fly an airplane - he fully admits it. He drinks Wild Turkey on ice all day long and does not have a pilot's license - he sits there and says, "No one ever called up and asked, 'What are you serving for dental? Are you going to have lasagna or chicken?'" He said, "You know what the only thing they ask is? Do you take my insurance, which at Southwest Airlines means how much does it cost to fly from Atlanta to Phoenix?" So, he stripped out all the meals, he stripped out everything, and he only focused on what the frick are you asking for?
Sandy: And he made things predictable with the same type of airplane, so they have the same parts, so everybody's plane is on it.
Howard: Because no one said, "I'm looking for an Airbus, not a Boeing, and I want to be served lasagna."
Laura: So, I have a question for you. What do you think - because I get asked this all the time -for the dentists who are doing the Botox and the cosmetic stuff and the spa light things and the add-ons, what do you think about that?
Howard: I think if you can't make ... when Sandy and I see the million-dollar boys, that do a million dollars and take home two fifty, they don't do chairside milling and Botox and all that bullsh*t. They've mastered a long-term team. They have recall, where everybody comes in and says, "I want to see Sharon to clean my teeth." They've got long-term staff and they're just doing fillings and crowns and simple endo, and they're crushing it. And then these guys ... I mean, if you can't make money off hygiene, restorative, crowns and routine, simple endo, what? Now you're going to make money off Botox?
Gina: I've got to say something. As an associate, if you're going to come out of dental school, you're going to be an associate and then you're going start your own practice. There's no better way to get started is by learning to do some of the things, the simple things that require a lot more skill, like extractions, like root canals. They don't teach that in dental school. You have to learn that this. This is where the money is, not the fillings, not the Botox. Now, it's nice to have a niche practice and this might be a niche. Digital dentistry, that's a great niche. There's some of those guys that are gods of digital dentistry and they're doing it for fun, right? Now, patients are loving it and that's their niche, they're famous for it. If you're going to do it that way, awesome. Otherwise, learn to do the basic stuff.
Howard: Gina just said something else genius - that's why her name is Gina. Gina, the Genius.
Laura: Gina Genius.
Howard: The big, huge money is in extractions and molar endo. So, when you look at the oral surgeons, the ones that do extractions and implants, have about a 60% overhead. The ones that only do exodontia only have a 40% overhead. You have to sell Botox. When I look at the doctors who sell the most cosmetic dentistry, they look just like the ones selling all the facelifts, tummy tucks and boob jobs. They look like Bill Dorfman. They're gorgeous. They're in Beverly Hills, Scottsdale, Key Biscayne, they're in really rich areas. And then you look like Fred Flintstone's twin brother. No one would ever want to sleep with you unless there's going to be a lot of money involved, and now you're going to be a cosmetic dentist. I mean, dude, it's a whole different game, but the money, you have to sell Botox and veneers. But when they come in to you and they're in pain, they're begging you to fix them, they're begging you to pull the teeth. I'm in Phoenix, I'm not in Scottsdale, I'm not in Paradise Valley. A quarter of my toothaches are extracted. I can pull any one. Three quarters need a root canal. I can do any one. That's the huge, huge money.
Laura: Well, I think the other thing that's going on right now that I get frustrated with is this whole medical billing idea and the sleep apnea and all of the things that the dentist ... I'm seeing a bunch of people on Facebook or on social media talking about medical billing and the front office, "Get my team to do medical billing. There's more money in medical billing." Now, I think dentists learning sleep apnea and helping patients with their apnea is an amazing thing. You need to learn it, but you shouldn't be doing it for the money, and so many dentists are going, I think, to the sleep apnea courses because they heard you can get paid $5,000 from medical insurance. That's the wrong reason for doing it. If you really want to help your patients and you get your team to training for medical billing, but it's not as easy as going, we're now going to do Botox, we're now going to do sleep apnea.
Howard: Are you medically billing for sleep apnea?
Howard: Are you doing Botox?
Howard: It's noise.
Sandy: And she has a very nice practice.
Howard: It's noise, noise, noise. And she has one of the larger, you know, probably the two most successful, well-run offices I've known in my [inaudible] have been yours ...
Gina: Thank you.
Howard: ... and Jerome Smith.
Sandy: Which was my client two times.
Howard: My third question is implants. Are you placing implants?
Gina: Not personally, but we place implants in our practice.
Howard: And who places them?
Gina: I have a dentist who's been with me actually for thirteen years, fourteen now. Fourteen years. General dentist. He does endo, oral surgery and implants. That's all.
Sandy: Jerome has an amazing practice.
Gina: Yeah, and it's amazing to be able to do that. It's amazing to have a patient in the chair and to say, "Look, I can possibly save the tooth with whatever, crown lengthening and endo and that's going to be a cost, or we can do implants, or your dentures are slipping out, we can retain them."
Sandy: I want to be her patient.
Howard: Sandy, she's talked about YAPI app which, to me, works on top of any practice management system. I switched to Open Dental after thirty years. I think yours is a relationship bonding because if you don't have a relationship, you're a commodity. So, what a commodity is, is anything that trades on price and half of America acts that way towards dentistry. So, when you buy a gallon of gas, you don't give a sh*t if it's from Saudi Arabia or the Alaskan pipeline. When you buy a car, when you buy things that only trade on price, it's a commodity. Half of Americans look at dentistry as a commodity. The other half look at it as relationship. If you're going to be a commodity, you're always going to have new patients, revolving door, and your twenty-five new patients, like Sandy said, were at the office across the street the day before, and I will say that nobody in America is keeping their patients 'till death do us part'.
Sandy: No, it's about forty ... we run those numbers first thing when people sign up and it's running 40 to 50% retention.
Howard: 40 to 50%? So, one out of every two people that walks in your office leaves. I would think that would check your ego. You're still an arrogant ass and half the people that meet your office and team never even come back and you still think you're all that and a bag of chips. You need to get humble like me. I am the humblest son of the bitch I've ever met because I'm willing to ask anybody for help. I'm willing to show anybody my problems. I am willing to try to get the team. I listen to all my staff, I listen to all my patients. I talk to so many dental assistants - even at this meeting - "Will you go talk to my doctor about that?" "Well, what does he say when you ask him?" "Oh, my g*d, if I asked that, he'd fire me!"
Sandy: I can believe that.
Howard: And it's like, "You're afraid ..."
Sandy: That's lack of leadership.
Howard: "You're afraid to talk to your own doctor!"
Sandy: That's terrible.
Howard: That's horrible.
Gina: We hear that all the time.
Howard: And then the reason that dentists don't want the hygienist diagnosing x-rays, saying, "Oh, that's a cavity. I don't need a filling and I don't need to work on it." He says, "Oh, that's illegal", which is so full of sh*t because there's not one person in jail today from reading an x-ray that was a hygienist. I mean, I don't even follow half the laws, but if they're not enforced, I don't follow any of them. You know what I mean? So, when the assistant is taking a new patient [inaudible], she takes a [sounds like: piazza], "Oh yeah, that's a cavity. See that? That's a filling. See how the x-ray's absorbed. That's why it's all blank white. That's a cavity." And when she goes through that whole FMX, she's already done the diagnosis and treatment plan, and they believe her because she makes $20 an hour, and they believe the hygienist because she makes $40 an hour, but they don't believe the guy who lives in a freaking mansion, who pulled up in a Lexus SUV. That's the guy selling you. So, they trust dental assistants, but you don't let them speak because you're a control freak and then you think ...
Laura: And you don't train them on how to speak and how to talk to the patients.
Howard: And then your ego, when you sit down and realize half the people that come in here never come back. I mean, that should make you turn into Ghandi. I mean, like, what the hell?
Sandy: Once in a while we'll see one that's retaining like 65%.
Howard: So, we talked about yapiapp.co. We talked about Front Office Rocks. What will my homies find at classicpractice.com? Who is your client? What problems are you seeing in the field? What are you helping, what are you fixing?
Sandy: We're the systems specialists. People come to us when they want to get organized, they want to get organized, they want to work on their practice. The systems I think of like a recipe, like it's set up and this is what they follow. Many offices, when they get new team members, they just do it the way that team member did it at the office down the street where they used to work, and we believe in finding a good system that gets good results, that's followed consistently, and we have online training videos to match each system in the practice, so that when new people come on and they can watch and be trained in the exact system so that everybody's on the same page saying the same thing. We're very comprehensive. We work with forty-two different systems in the practice. We teach leadership and management to the dentist and we work in a soft tissue programs and hygiene. We train dental assistants. We train the front office. A full package.
Laura: Whenever I talk to an office and I ask them why they do something, and they go, "I don't know. That's just the way we've always done it", I refer them to you. Because I'm like, if you don't know why you're doing something, you probably ...
Sandy: It's really true.
Howard: Do have one program? What's the fee?
Sandy: We've got a couple of programs. We have a new dentist program that we've started about the last three or four years. It's done really, really well. They're on a budget, they can come in for $15,000 for six months of handholding. We're watching their numbers every day. Regular management consulting. Unlimited contact. They can call me on a Sunday morning at 7 a.m., 7 p.m. Twenty-four hours, 24/7. That's what we're about and we have that available. Watching their numbers. I have people just looking. Oh, they had broken appointments yesterday ...
Howard: So, when they call you on Sunday at 7 a.m., are you answering that call live from Bourbon Street, in the bar?
Sandy: Live from Bourbon Street!
Howard: Are you still in the bar drinking?
Sandy: That's another thing, that's a bonus. When they're on our program, they come to our 7,000 square foot training center, they get good food.
Howard: Here's my beef. I have told you this my entire life. You look at that $15,000, you're like, "Oh, man, that's a lot of money." And then you turn around and buy a $150,000 CAD/CAM.
Laura: Right, to "fix the problem".
Howard: And then you buy an $87,000 laser, when I use a 15 blade.
Sandy: And that's a new dentist. So, an established practice, we're $44,000 for a one-year program.
Howard: But when I figure return on investment, like you'll say, "Okay, well, I'm going start placing the implants"; first, you have this asset that you bought for $1, it's doing $2 in sales. First, you by a $100,000 CBCT, then you buy $50,000 of implant systems and training in the Dominican Republic, and by the time you place your first implant, you've already dug yourself down $200,000. You have to do $200,000 implants just to get the fricking zero. And I'm like, "Dude, you can go to the next town and get a periodontist to come into your practice one Friday a month to place all your implants for 50/50." So, I've got my $1 asset. He comes in and places a $1,000 implant. I get five hundred, so my now $1,000 asset gets another $500 for my return asset. I have no debt. I mean, it seems like every time you fricking open ... every time you have a great idea, it's more debt. It's more debt, it's more debt.
Sandy: And they need to be looking at the missed opportunity.
Howard: And the only debt that has a return on investment, measurable, is dental office consultants. And I tell dental office consultants, "You're in the wrong business. You should just build a shiny box with aluminum foil and lights and antennas, because if it's 1 $100,000 box with dials and digitals and it says, 'laser'" - which does not stand for 'light amplification by stimulated emission of radiation', it stands for 'losing all savings equals reality' - and get your house in order, because I get it. I'm a dentist. I have all the toys. Boys love toys, but I'll tell you this, you get your house in order, you get your debt gone, you get rich, and then if you want to buy a Porsche or a laser or a girlfriend, make your choice, make your choice.
Sandy: So, our average return is about 30% and some people will go as much as 100%. I can't promise that, but I would be really disappointed if somebody didn't improve by 20%. Really! I expect that.
Howard: What are you improving on? What is the low-hanging fruit?
Sandy: Missed opportunities. It's everything, the telephone, the telephone training, the new patients, they're not collecting, the open time because nobody filled it, the patient retention. We work on all those systems. Unscheduled treatment is huge in practices. And so, we helped with them recognizing patient objections, so they know more how to talk to the patient, the patient experience. Nobody's gotten worse. Everybody gets better.
Howard: Can I make one point on the deal? The Fortune 500 gets all the press. I mean, all they talk about is the Fortune 500, and the Fortune 500 doesn't even pay 15% of Americans. We've got three hundred and twenty-five million people. They live in a hundred and fifty million homes and 80% of Americans work for a small business. And when you crawl across those small businesses, they're all about the size of a dental office. But you know what? When you go into those businesses, and say they make a side baler for a combine, in the middle of Kansas, they'll do three million a year in sales, the owner will take home a million bucks, but who's the highest paid person in that deal besides the owner? It isn't the guys in the back working the welding shops, the machine shops, whatever. It's the person answering the phone, wearing in a suit and tie, inbound sales. That's a $100,000 a year employee in the middle of fricking nowhere Nebraska. And then when that guy doesn't buy and didn't schedule his appointment and he calls them out, that's outbound sales. That's still the only guy in the factory that has a suit and tie on. So, I think it's amazing that in every business in America, the highest paid person is whoever is touching that phone. Inbound sales, outbound sales. Then you go into dentistry. The highest paid person is a dumb ass on the machine shop making the machine weld, which will be replaced by a robot. And the person answering the phone is the least trained person.
Sandy: I tell dentists all the time, that person that's your scheduling queen is going to determine the house you live in and the car you drive.
Howard: Say that again.
Sandy: The person who’s the scheduler, the scheduling queen, the appointed scheduling queen, I'll never tell her that. I'm never going to tell this person that, but she's going to determine what kind of car that doctor drives, what kind of house they live in, what kind of savings they're going to have. That person does.
Howard: And she's not your receptionist. She's inbound sales.
Sandy: Don't tell her that.
Howard: And then when she calls, it's outbound sales. And that is the number one employee in and every business in America, except for industries: healthcare and government.
Sandy: I lectured here yesterday ...
Howard: Call the Department of Motor Vehicles and you'll wonder if she's on a work release program.
Sandy: I lectured here yesterday. I had fifty-five, sixty people in the room and I asked a question. I always start with this question. I would like to see the hands of all the scheduling queens in this office. You're a scheduling queen and you know it, in this room, raise your hand. Not one person raised their hand. One girl did this, "Well, I think I am that person, but I'm not sure", so I went ahead and gave her a Starbucks $5 gift card because she thought she might be, but out of all those offices, not one person thought they were responsible for the schedule.
Howard: So, this here's success. YAPI has all the stuff that Dentrix and Eaglesoft should have had thirty years ago and still don't even know that it's a problem. Front Office Rocks, I mean, it's the front office rocks, you think you're all that because you're a dentist and you know what? No one knows anything about your dentistry and when you're done with it no one will remember what tooth you worked on. It's all this.
Laura: All of this.
Howard: This is the front. This is the return on investment. This will make you decide whether you're just a cup of coffee or a Starbucks. This is a different between your office being a used car, a Chevy, a Pontiac, an Olds, a Buick, a Cadillac, a Porsche, and you're going to win or lose on your frontline.
Laura: And part of the thing is, I think, if you come to meetings, like I'm glad that Sandy spoke yesterday, I'm speaking today, and there's not enough at these meetings for the front office. Invest in the front office. You come to a lot of the meetings and it's all the clinical and it's all hygienists and it's all assistants, which is all great, but for those of us in the front, it's like, well, where are we getting training?
Sandy: Where's the heart of the office? The heart of the office is the front.
Laura: We're the first and last impression.
Howard: You want to place fifty implants a month? Have the periodontist from the next county come and place them on Fridays. You hate molar endo, go to the next city, have an endodontist come up to your office, load up all your damn endos. What percent of the dentists that have a $1 million practice, take home $250,000, do not have chairside milling, a laser and don't place implants?
Sandy: Well, I think $1 million ... because $1 million is to me, pretty average. I mean, you're getting ...
Howard: Okay, let me stop her right there. Okay, let me stop her right there, because this is something you always see. We've got to go, but this is something you always see. So, the stats, the real statistics - remember the ADA economist, Marko Vujicic, he was from the United Nations and World Health Organization, he's the most stunning medical healthcare economist I've ever met. The average dental office collects seven forty-five and takes home one forty-five, but see you talk to consultants, they say, "A million, that's average."
Sandy: That's nothing to me.
Howard: Why are these guys doing $3 to $4 million? Because the people who use consultants are always at a whole other level. So, never ask a dental practice management consultant what is the average anything because they only deal with the upper class.
Sandy: That's right. That's the ones that see the need.
Howard: What would you say your average dental office is doing?
Sandy: One point five, one point eight.
Howard: Okay, so that's a double practice. So, you're a hamburger and she's a double cheese burger.
Sandy: I do get people that call me that are starting out at five, six hundred. If you're doing five or six hundred, to get you to eight or nine, it's like that.
Laura: But the biggest thing is, like we talked about with leadership, the people that work with Sandy's office, the people who invest in Front Office Rocks, that do YAPI, see the bigger picture and they invest in it. Consultants - I'm not a consultant, I'm a trainer - but consultants have a bad rap in our industry and it has nothing to do with the consultant. Sandy's amazing. Her team's amazing. It's the dentist who goes, fixed "Fix my problem", and they walk away. It's like you have to ...
Howard: I've got to end on this story because they're telling me I've got to go lecture. I want to end on this story. So, I got out of school in '87 and I came to Phoenix and I started to build my practice - it took four months to get it open, but I wanted a job. I was looking for a job. I ended up working for [sounds like: Gary Sullivan] who owns Sunshine Dental, but there was another lady who was about, I don't know, ninety, and she was a Jewish lady and it was the most amazing thing. So, as Adolf started his rise to power, she got the hell out of there and when she came to United States, they would not accept her dental license - and I get that, because Germany makes like Porsche and Mercedes and Volvo and we make Chrysler and Chevy and Ford, so I'm sure the Germans didn't know how to make a dentist - and she cried and cried and cried because she came with the shirt off her back. She barely got out of there and she didn't have time to go through dental school. She was married with children and all that stuff. So, she went and got a lawyer and the lawyer said, "No, you can't, you have to go through an American dental school. It's part of their trade union, it's part of their teamster's union bullshit. But legally you can own a dental office." She cried and cried and cried. She was handcuffed behind her back. So, she was forced to only do management. Oh, my g*d. She had four offices. They were each doing two and a half million a year. She was, I don't know how old she was, probably eighty-five - you know they're over eighty when their lipstick leaves the familiar border and traces the zygomatic arch and then comes back down on the other side and you say, "You are right handed and over eighty!" She had a driver that drove her around. I thought to myself, she way outlived her eye-hand coordination to do root canals and fine motor skills. She loved life and she told me the best thing that ever happened to her was they took away her license to practice dentistry, so she could only do this stuff. And this is what made her a multi-gazillionaire, and she was always my role model. And what happens is when you graduate from dental school, they give you a lawnmower and they say congratulations, you're a Doctor of Lawnmower, and you push a lawnmower the rest of your life. And some time you have to turn off that lawnmower and to the back up and say, I need to be able to run a lawnmowing crew. How come I can't get someone to push the lawnmower and the weed eater and the blower and climb the palm trees, and maybe I can start working on getting new clients and marketing and advertising and then get up another crew and case acceptance. So be that little German Jewish lady who lost her license to practice and it might be the best thing that ever happened to you.
Sandy: And take control.
Howard: Thank you so much for coming on the show.
Everyone: Thank you.
Howard: Have a rocking hot day.