Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1036 Go Rural! with Dr. Jennifer Sarsland & Dr. Noah Piskorski : Dentistry Uncensored with Howard Farran

1036 Go Rural! with Dr. Jennifer Sarsland & Dr. Noah Piskorski : Dentistry Uncensored with Howard Farran

5/30/2018 7:10:20 AM   |   Comments: 0   |   Views: 205

1036 Go Rural! with Dr. Jennifer Sarsland & Dr. Noah Piskorski : Dentistry Uncensored with Howard Farran

Doctor Jennifer Sarsland was born and raised in Bowman, ND. Dr. Sarsland earned her Bachelor of Business degree from The University of Mary in Bismarck, and after working in the insurance industry for a few years, decided to go back to school to pursue dentistry. She received her Doctor of Dental Surgery from the University of Nebraska Medical Center College of Dentistry in Lincoln, May 2011, and moved back to her hometown to join Dr. Patrick Kelly’s practice. Dr. Sarsland is a member of the American Dental Association, North Dakota Dental Association and West Slope District Dental Society. She enjoys keeping up on advances in dentistry by reading the latest dental literature and attending a wide variety of continuing education courses. Dr. Sarsland’s husband Curt also grew up in the Bowman area. They currently ranch northwest of Rhame and Curt runs a carpet cleaning business. In their spare time they enjoy following their four children, Caleb, Julie Claire, Gabe and Anna in their various activities.

Doctor Noah Piskorski was born and raised in Ord, NE. Dr. Piskorski studied Nutritional Science at the University of Nebraska at Lincoln.  He received his Doctor of Dental Surgery from the University of Nebraska Medical Center College of Dentistry in Lincoln, May 2011.  After graduation he moved back to his hometown and worked as an Associate for three years in the nearby town of Burwell, NE. He then had the opportunity to work for Family Fist Dental in Ord for one year before buying the practice. Dr. Piskorski is a member of the American Dental Association and Nebraska Dental Association.  When not at the office he is spending time with his girlfriend Georgina, her daughter Haezel, and their 6-month-old son Edwin.  With what little time he has left he enjoys playing golf and tennis, gardening, and mead making.

VIDEO - DUwHF #1036 - Jennifer & Noah

AUDIO - DUwHF #1038 - Jennifer & Noah

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1036 Go Rural! with Dr. Jennifer Sarsland & Dr. Noah Piskorski : Dentistry Uncensored with Howard Farran

Howard: It is just a huge honor to be podcast interviewing Jennifer Sarsland, and sitting next to her, is Noah L. Piskorski. Is that Polish or Polish?

Noah: It’s Polish.

Howard: We’ll introduce Jennifer first. Dr Jennifer Sarsland was born and raised in Bowman, North Dakota. Dr Sarsland earned her Bachelor of Business degree from the University of Mary in Bismarck. That's got to be a Catholic school?

Jennifer: Oh yeah.

Howard: Oh yeah. And, after working in the insurance industry for a few years, decided to go back to school to pursue dentistry. She received her doctorate in Dental Surgery from the University of Nebraska Medical Center College of Dentistry in Lincoln, May 2011 and moved back to her hometown to join Dr Patrick Kelley's practice. Dr Sarsland is a member of the American Dental Association, North Dakota Dental Association and West Slope District Dental Society. She enjoys keeping up on advances in dentistry by reading the latest dental literature and attending a wide variety of continuing education courses. Dr Sarsland’s husband, Curt, also grew up in the Bowman area. They currently ranch northwest of Rhame and Curt runs a carpet cleaning business. In their spare time, they enjoy following their four children, Caleb, Julie Claire, Gabe, and Anna in their various activities. We both have four kids. Are you old enough to regret it yet? Just kidding, Ryan. Since Ryan’s six-foot-tall, I should stop making jokes about it or else I'm going to get my ass kicked one day.

Howard: Dr Noah Piskorski was born and raised in Ord, Nebraska. He studied Nutritional Science at the University of Nebraska at Lincoln. He received his Doctor of Dental Surgery from the University of Nebraska Medical Center College of Dentistry in Lincoln, May 2011 too. They were classmates. After graduation he moved back to his hometown and worked as an associate for three years in the nearby town of Burwell, Nebraska. He then had the opportunity to work for Family First Dental in Ord for one year before buying the practice. He is a member of the American Dental Association and the Nebraska Dental Association. When not at the office he is spending time with his girlfriend Georgina, her daughter Hazel, and their six-month-old son Edwin. With that little time he has left, he enjoys playing golf and tennis, gardening, and mead making.

Noah: Oh yeah.

Howard: What is the mead making?

Noah: It's a wine made from honey.

Howard: A wine made from honey?

Noah: Yeah.

Howard: Very interesting. You two have been making my point that I've been screaming at the Pew Organization. Have you ever heard of the Pew Organization?

Jennifer: Oh yeah.

Howard: It was named correctly, it's actually pronounced ‘Phew’. Where they think if you increase the number of dental graduates and dental therapists, they think if you bring in dental therapists, that when they graduate, they're going to go cut down a tree and dig out a canoe and canoe up the river and work on native people under a tree for the rest of their life. When you graduate them, they go back to wherever they're from and if you want rural dentists and engineers and CPAs, you got to recruit people from the rural. But, the people from the rural don't get in because when you're in a class size of twenty, you only got to be smarter than nineteen other people. So, you think, “God, I'm the smartest guy in the class. I don't have to study”. But if you were in downtown Phoenix and there were two thousand people in your high school class, you could be really, really smart and there could be a hundred smarter people than you and Algebra and Physics. So, you just keep getting pushed and pushed and pushed. And so, the bottom line is rural kids don't get in. And I know so many rural businesses in dentistry, in mining in Arizona and Kansas where I go talk to the owner and I say, “Well, what is your biggest problem?” They go, “I can't get a mechanical engineer from Phoenix to commute two hours to our mine. And then when our kids in our town of five thousand apply to the mine, they don't get in because they don't make it into Algebra. So, Pew, if you would ever listen to anybody other than your elitist self-centered self, these kids both practice in rural because that's where they were born. But anyway, enough of that rant. I’m so glad to have you on. So, you both own your practice?

Jennifer: Yes, I own 50 % of the practice, by half and my partner is still working and then I recently renovated the clinics, so, I own that building separately and then our dental practice.

Howard: So, you own the land and building whole.

Jennifer: Yep.

Howard: And then you own the practice fifty-fifty.

Jennifer: Right.

Howard: Are you guys the same age? Are you’re going to go forever or was he an older guy kind of transitioning out.

Jennifer: He just turned sixty, so when I came in…

Howard: But you said, is that old?

Jennifer: No, that’s young.

Howard: That’s nice. Nice.

Jennifer: Seven years ago, he for sure wanted to work at least six more years and now he's down to three days a week. I work four days a week. I handle the business steps, so he likes it. He comes to work, does the dentistry, he can go home. And I like having somebody else there because if I want to leave for a week the office isn’t closed or if I want to go to my kid's ballgame, there's somebody there to do hygiene checks and we worked well together. So, I think he'll still work a few more years. As far as I'm concerned, he can work till I retire or until I can find somebody else to come there.

Howard: Watching this rodeo for thirty years, the retirement date never comes because you said, “Well, I'm going to retire this year”. And then they start thinking, “I need a new truck”. And then you're like, “I'll work six more months”. Your wife's like, “We need a new, we need to redecorate. I mean to actually some day to just sit there and say, “I never need any more money till I die”. It doesn't happen. And then the thing that you've got to realize is, bonds are paying, they just hit 3% and everybody's like, “Oh my God, that's so amazing, 3%”. So, let's say that a simple calculation. Let's say you just want to make a $100,000 a year from bonds. Well, take $100,000 divided by point-oh-three. You need $3,333,000 in your bond savings at 3% to make a hundred grand a year.

Howard: My next-door neighbor, Kenny Anderson, just celebrated his fiftieth anniversary because he says you barely make any money and you realize how you'd have to have a million dollars of more bonds just to make a little bit of money. So, they just keep slowing down. I tell older people, which is anyone over fifty-six that their goal should be every year, “I work an hour less and make a dollar more” and if you just keep chasing that hour less, dollar more, that's the way to ride out. So, do you guys have different passions or are you overlapped? Does one do ortho, one do implants? Or do you both do the same?

Jennifer: For the most part, we both do the same. He had been doing ortho in the office because we really live in the middle of nowhere. So, we don't have any specialists close. Our closest specialists are a hundred and eighty miles away. We do have a couple of orthodontists who come to a town that's eighty miles away as a satellite practice. But, when they want to get the braces on and they've got to go.

Howard: And that's why the University of Lincoln taught you so much orthodontics and you did so many cases in school because they know half of the Americans live in the rural and pay half the taxes in these public schools and their doctors need to come back and train. And that's why the orthodontist thought in hope, growth, abundancy, and rural people. How much Ortho did you learn in college?

JENNIFER. Zero. Absolutely zero.

Howard: Yeah because the orthodontists care more about themselves, more about their wallet, it's all money to them. They don't give a shit about half of America.

Jennifer: Yep. So luckily, I went into a practice where they'd been doing Ortho and then I went and took classes and we actually have Ortho Day. So, when you do Ortho at our office, you come on the second Thursday of each month and that's when we've got everything set up for Ortho.

Howard: The second Thursday of every month? One day a month. Because everybody needs to be seen once a month, so it’s Ortho Day?

Jennifer: Yeah.

Howard: Are you taking Ortho?

Jennifer: I went to Atlanta and did some classes with Jerry Samson.

Howard: Now, is he a board-certified orthodontist?

Jennifer: He actually is one of the very few that will teach.

Howard: Here's another thing, when I was their age, the only person that was board certified [inaudible 8:10]. It was Richard Litt, DDS, he ran the University of California San Francisco Program. He was the chairman of the Ortho Grad department. Then after ten years he went to University of Georgia where he still is and since the first time he started teaching general dentist, he's been blackballed. He's not published. He's never spoken at the AAO. You would think this guy was Attila the Hun, Mawby Sung, Joseph Stalin, Idi Amin, and Pol Pot all wrapped up into one because they taught someone who lives in the middle of nowhere. Because the [inaudible 8:42] is saying, “I'm worried about my practice in Scottsdale and Beverly Hills and Wichita, Kansas. I don't give a shit about your people”. It's true, isn't it?

Jennifer: I know, it is. Yes.

Howard: They wouldn't even admit it, that it's all money to them and you know who’s going to kick their ass. Invisalign. Invisalign got tired of them. They bought, what was it?

Jennifer: Smile Direct.

Howard: Smile Direct Club and so now what do the orthodontists do, they finally are going to have to realize they can't think in fear and scarcity, which they shouldn't because the Ortho market is massively growing. When I was little, everybody was Catholic, had seven kids and only the ugliest child, who had no chance of getting married, got braces. You're just trying to fix her up so maybe someone would mate with her and have offspring. And now it's like everybody only has two kids. They both come in, they come back and they're thirty-five and “this tooth is a little crooked”. Now it’s gone from orthodontics to being hero dontics to just fine tuning. So, are you doing a lot of Invisalign or fixed wire?

Jennifer: On kids, mostly fixed wire. I do adults and I do some Invisalign. My partner, he really hadn't been doing much adult Ortho and so I've incorporated that with Invisalign and fixed wire.

Howard: And Ryan, did you catch the name of the orthodontists in Atlanta, Georgia?

Jennifer: Yes.

Howard: He must be a rebel southern confederate.

Jennifer: He must.

Howard: How do you spell his name?

Jennifer: S-a-m-s-o-n.

Howard: Samson?

Jennifer: Yes. Gerry, G-e-r-r-y. And his courses are very small classes. I mean there's maybe twenty of you in there and he has a lot of pediatric dentists. He believes in a lot of phase one. So, I think there was maybe three general practitioners. The rest were pediatric dentists and a couple of orthodontists.

Howard: The orthodontists who don't believe in phase one. I was going to say to them, “Well then why are you treating that thirty-five-year-old? Is that phase two? And what happened to the fifty-five-year-old lady getting fixed up, is that phase three?” So, you don’t believe in phase one, but you believe in phase two, three, four, five, six and eight. But they don't believe in phase one. And why don't they believe in phase one?

Jennifer: Because schools don't teach it.

Howard: Because they're not getting the money from it. The pediatric dentist is getting it and they're like, what pediatric dentist or doing Ortho and getting an insurance benefit, we’re against it. They’re against anybody getting any type of care unless it benefits them. I say this on the day of the American Association of Orthodontic meeting in Washington DC, which you couldn't go to. If your husband was an orthodontist and you’re a general dentist and you say, “Well, can I go to the convention with my husband?” “No”.

Jennifer: It’s crazy.

Howard: I own Orthotown and I can't get on it. And I own the site and the reason I berate them is because the bottom line is they need to stop thinking in fear and scarcity and start thinking in hope, growth, and abundance and their old ways, the quicker they die, the healthier their industry and the more money they're going to make.

Jennifer: Yeah and it is nice because you do meet a few that are really good. I've got one in Bismarck who, he's willing to let me call him with questions and stuff. At our Spear Course that we were just at, there were two orthodontists in that course and they were just great to visit with and bounce off different ideas and cases and things like that.

Howard: The check on them to see if they [inaudible 12:15], you just walked up to them and [inaudible 12:17] and say, “Are you a dentist?” And the elite ones will say, “No, I'm an orthodontist.” But the good old boys, will say “Yeah” because I mean they went to dental school, they go “Yeah, what up?” But anyway, what were you going to say?

Noah: When you talk about them, thinking in fear and scarcity, all you have to do is be better. Just do it better and then you'll get patients. I don't know why you have to be so afraid to teach other people and just be better at what you do.

Howard: The bad guy is a pediatric dentist doing phase one or some kid getting orthodontic treatment, one hundred and eighty miles from his office and then you ask him any metrics, “How many people land on your website each month?” “No idea.” “How many of those convert to call your office?” “No idea.” “How many of those calls does your receptionist convert to come in?” “No idea.” Oh, but none of that's the problem. It's some pediatric dentists doing phase one and some kid in Bismarck.

Noah: Yeah, which you're just making their job easier down the road.

Jennifer: The more you learn about something, the more you see it's needed. The more you learn about implants, the more you see places that implants would be great. The more you learn about Ortho, the more cases you see coming in that you're like, “Oh, this would really benefit from Ortho.” So, by them teaching general practitioners how to do it, they're going to get more cases because the general practitioners are going to see more Ortho.

Howard: Right, no doubt. So, how big is the town that you were born and raised in? Well, how many people?

Jennifer: Eighteen hundred.

Howard: Oh my God. Now, that's not even a town.

Jennifer: That's the largest town in eighty miles. So, the closest to Walmart is eighty miles away.

Howard: Oh my God, so does that mean you don't have to take any insurance of any form?

Jennifer: We do.

Howard: Do you take cash and file for them, or do you actually take their portion and file for them?

Jennifer: We are a provider for a few. The practice I went into, they had been and our reimbursements, I analyze them. They're not terrible and we probably could go where we to not taking it. I haven't because I feel like, I don't know, we're doing good with taking it.

Howard: Now, when you're born in a town of eighteen hundred, eighty miles from a Walmart, and you come to Phoenix, do you always come here and think, “My God, I wished I lived in this town.” Are you always glad to go back to your hometown?

Jennifer: I'm always glad to go back.

Howard: Tell us, because no one understand this, there's not a dean in America, except for one. [inaudible 14:53] It was Jack Dillenberg and I lived through every dentist talking behind his back and throwing mud on him because he was saying, “Why are we sending white kids to go work in Indian public health on the Navajo Indian Reservation?” But, well, none of the Navajos got accepted to dental school and he said, “There are nineteen reservations in Arizona. I'll accept every kid that comes from the Navajo. Every kid that graduated, do you think he wanted to go live in Scottsdale? No. Where did everyone of them go?

Noah: I assume back.

Howard: Yeah and the Indians, they want to go where someone speaks their language and knows their culture and they see at their local churches and functions. I don't want to see some Irish cracker who drove three hours to Tuba City and works three days a week and doesn't speak the same language. I mean it's just so obvious. But explain to people who could never comprehend why you don't want to live in Scottsdale.

Jennifer: I don't like crowds and it's all what you like and what you're interested in. We live in an area where our kids, they can be in every sport year-round, they don't have to try out for the team. They can be on the baseball team, they can be on the basketball team, they can run cross country, they can play golf and you don't have to do these traveling teams where everything is so intense. And there's always good and bad with everything. It's our friends who live in Nebraska, Lincoln, their kids get to play cello and they're in Lacrosse. We don't have those options where we're at, but my kids drive all over our ranch.

Howard: What is the age of your four kids?

Jennifer: Thirteen, eleven, nine, and eight.

Howard: Thirteen, eleven, nine, and eight. Did you know that I grew up in Kansas. I've only crashed two times. I totaled my first car at fourteen or fifteen. Anyway, long story short, I totaled two cars before I got my driver's license and that was not an anomaly of any of my friends. Grandma's house. I mean she has a small militia. The kids would go over there and shoot AK47 and four tens and twelve gauges and blow up rivers and it's a good life.

Jennifer: And it's great, you really do know pretty much everybody in your kids' classes, so if you can't make it to something, there's always another parent there, who you know, if your kid maybe gets hurt in a basketball game or something, they know your kid well enough that they're going to be comfortable helping take care of them. Or if your kid is at the pool and they're doing something that they shouldn't do, there's another mom there who's going to tell them to stop because they know your kid. So, it's nice because everybody watches out for everybody. They know you.

Howard: And I can't tell you how many times the policeman came to our house when they under ten. “I caught your kid riding a Honda fifty down the street.” I was like, “And was somebody injured? Was there a problem?” “It's illegal.” It's like every law is written by an idiot. “And if my boy wants to ride a Honda fifty down the street and around the block, why are you so crazy? I mean, why are you so angry about this?” What I liked the most about Kansas, is when you were out playing with your friends, every tree was a public restroom. You never have to ask anybody, “Where’s the public restroom?” It was like, “Dude, there’s a tree right there.” That's what I liked the most. So, let's go to you. So, you work with someone for a year, then you bought them out?

Noah: No, I worked for three years, right out of dental school. Handshake agreement. I don't recommend it. I had hopes that he would expand the office. It never happened. And so then in my hometown, there was an opportunity to buy the practice from a corporate dental office Family First. So, I worked for them for a year and ended up buying them out.

Howard: Okay. So, but back in reverse guys. So, you got out in 2011, you said you worked with a guy for three years?

Noah: Yes.

Howard: On a handshake with no contract?

Noah: Yes.

Howard: Okay. So, go over that because that’s serious. We live in a society where there’s one million attorneys and one million MDs and so what would you say to some young kid, and a lot of them, you know the worst abuses I see. Girls working for dad because something in our society, it's just hard to tell your dad off, so, you just keep thinking it's not worth it. It's not worth it. But I said, if you're a girl working for your dad, I don't know what it'd be like with a boy working for his mom but I've never heard that complaint yet. But if you're a girl and you're going to go in with your dad, you got to have a contract. And if he says I'm not signing a contract with my own daughter, what would you say?

Jennifer: You should. I actually did a handshake deal too. I mean the first six months I was an associate and that was really just a handshake deal and then we worked out and we had talked about buying and then the price, but there was really nothing on paper. But luckily by the time we got it all on paper in December and January first, I bought half. We still were under the same agreement, but I wouldn't recommend it because it is nerve wracking,

Noah: Just dumb luck for me. But it worked out so well and he was really great guy and he kind of understood it. He knew that if anything ever came up in my hometown, I wanted to live there. That's what I was living. I was just commuting at the time. No, good contracts create good relationships. You can't do it on a handshake because I just had expectations and they weren't met and when they weren't met, it's like well I can't stay here now.

Howard: And, you get that with prenuptials. They're like, “Well I met my girlfriend on Disneyland and she felt a pea under nineteen mattresses and we're going to live happily ever after” And great, that's awesome, but half the time that's exactly not what's going to happen. And, so did you guys get prenuptials on your wedding?

Jennifer: No, I was twenty-one when I got married. So, that's a long time ago. I didn't even think about being a dentist.

Howard: Now in a town of eighteen hundred, you were the oldest girl that ever got married at twenty-one. What's the youngest age of marriage that you've seen in your town, in your lifetime?

Jennifer: Eighteen, but that’s pretty odd.

Howard: When I got out of school in 1980 at my graduation class, 10% of the girls were showing. Those are just the ones that you could look at and say, “She’s definitely pregnant.” Who knows about the ones that were only one or two months. But anyway, it's really come a long way. The only way I could see a marriage with one million attorneys and you being a rich doctor, is you don't need a contract with your lover unless you're going to bring a child into the earth. Then if you're going to bring your child on the earth, I'd get the contract before you make the child. Do a prenup. Say, “Okay, you're going to go off the pill, well here, let's sit down, work some shit out because a child is a project for twenty, twenty-five years. It's a twenty-five-year project. I mean, it really is. My Dad, the funniest thing, he had seven kids and every time the last one would move out, another one would crash and burn and moved back in. And he'd always just say, “Am I ever going to get to live alone with your mother?” And it's like, “No dad, you had seven kids. That's too many odds. Years.

Noah: You were lucky. At eighteen, mom never said, but we were out.

Jennifer: He was number twelve out of thirteen kids.

Howard: Twelve out of thirteen. Were you Catholic or Catholic?

Noah: Very Catholic.

Howard: You know that Poland is 98% Catholic.

Noah: I have never heard that stat, but I totally believe it.

Howard: And, you know where the largest Polish community in the world is outside of Poland?

Noah: I have no idea.

Howard: Chicago.

Noah: Is it really?

Howard: One in every seven. I lectured in Warsaw every five years and all I got to do is fly to Chicago and every four hours, they have a nonstop flight on Lot to Warsaw and back. And when you lecture in Warsaw, a 100% of the room has a cousin that lives in Chicago and they're all Catholic. But anyway, so were number one of what?

Noah: I was number twelve of thirteen.

Howard: Wow. And why did she even stop at thirteen? I mean, why do you stop at thirteen?

Noah: I think all of my dad's brothers said you just got to stop. Like this just has to end. And she was forty-two. 

Howard: So, twelve of thirteen. So, when you were born, how old was the oldest one?

Noah: Oh God, I don't know. There's a twenty-year gap. We always make fun of my mom for being pregnant for two decades.

Howard: So, you feel close to him?

Noah: My oldest, her. No. Well, somewhat. But there's a few of them that I don't even know them really. I couldn't even tell you all their middle names and they would be mad if they heard that.

Howard: Yeah, because when I was seventeen my little brother was born and because if you use any form of birth control, it's a mortal sin, you'll go to hell for eternity, which is a burning… Actually, my mom would spell it out to my sisters. It's called [inaudible 23:44], a burning pit of sulfur for eternity. I'm just like really? But I feel really close to my brother. But I made an effort because I left for college when he was born. So, I realized, man, I'm feeling towards him like I do my cousins that you just saw on Christmas and Easter or something. So, were you the only dentist out of thirteen kids?

Noah: Yeah, I have an older sister that was a hygienist. She was the one who pointed me towards dentistry. I was a sophomore in college and didn't really know exactly what I wanted to do. So, she's like, “You should give that a try.” I job shadowed for a week and I was like, that was really cool. So, then I just applied and ended up getting in. A lot of dumb luck.

Howard: Did she ever work for you?

Noah: No.

Howard: She’s not in town or you just don’t want to mix family?

Noah: No, she lives in Overland Park, Kansas and I don't want to mix family with business

Howard: Overland Park, that’s a long commute. How long of a drive is overland park?

Noah: Probably six and a half, something like that.

Howard: Yeah. So, what do you like to do in the office? What type of clinical do you like to do?

Noah: I enjoy some of the easier Endo, oral surgery starting to get into that. I refer most of my Orthodontics out, extractions I do enjoy. I don't know. I like emergency patients. They come in, they're in pain.

Howard: How big is your town?

Noah: Two thousand two hundred. Somewhere around there.

Howard: Twenty-two hundred. So, how far away is the closest specialist? Oral Surgery? Endodontist?

Noah: Sixty miles.

Howard: So, an hour drive?

Noah: Yeah. It's not a big deal.

Howard: That'd be like me having to go to Tucson.

Noah: Is that a big deal, I guess?

Howard: It's really going to change. Or are you guys aware that Phoenix is a testing ground for driverless cars?

Jennifer: Can't wait till they come to my area.

Howard: And I think it's going to change everything because if I had to get it to be at the doctor tomorrow, and say this is a Sunday night, if I had to be at the doctor tomorrow at eight o’clock, and it’s a two-hour drive. You know the average new car is thirty-three thousand five hundred bucks, but twenty thousand for you to be the pilot. Once it's driverless, is just four wheels up, a battery pack and it could just be a box. So, the box was just a mattress with a blanket and a pillow. You just get up at six, walk to your garage, punch in your iPhone, go back to bed and then wake up. So, I really think all these inner-city problems are really going to disappear with driverless cars. And then you'll always have the law of unintended consequences like watching it out here, I see two things. It makes you realize that all news is bullshit because thirty-five thousand Americans are killed in a car each year, times ten will go to the hospital. One guy, one driverless car wreck. And it was just world news. And on that day did they once say, “Oh, and by the way, let's see. There's thirty-three thousand five hundred divided by three sixty-five. Well wait, did I get that right? Thirty-five thousand divided by three sixty-five. Did they mention that over hundred other people died that day by a man-driven car. And when we were little, the number one cause of death and mortality driving was drunk driving. And that doesn't even make top five. Top first is texting.

Noah: I totally believe that.

Howard: She's texting a picture of her cat while she T-bones a family of four. And that doesn't make the news. But the other law of unintended consequences, the driverless part of the car is what I didn't realize, it brought the bars back to life because now instead of being an alcoholic, drinking alone in your underwear in the corner, you can actually get a ride to the bar and be social again. And the other one was, the senior citizens who love it, they lose her license, cataracts, they can't get their license and they lose their sense of self and now that they can get back to driving again. So, I think it's really going to be good for alcoholics and the elderly. You didn't see that coming, did you? So, these referrals are an hour away. An hour is a big deal when you're the pilot and you're tired and you're drinking coffee to stay awake, but it's not going to be a big deal when you're back there playing video games.

Noah: I guess, I don't know. In my area, we're pretty used to having to go there for most things. Just like she said, like the closest Walmart, Home Depot, whatever is…

Howard: How far?

Noah: For me, it's an hour drive. So, you're going there anyways. You just pick up something and I haven't had anybody really complain about it personally when I send them to my periodontist or the orthodontist.

Jennifer: The people that it affects where we're at, are the elderly because they don't want to travel that far. We had one elderly gentleman and he needed number nineteen replaced and we talked to him about an implant. He was like, “Yeah, I'll do that.” And so, see him a year later he didn't do it. I'm like, “Well I thought you were going to do that implant.” “Oh, I don't want to go down there and so I put a bridge on him and he is the happiest person alive. And he's eighty-two, so I think that's pretty darn good service for a tooth replacement that I think that will last him the rest of his life. I feel confident.

Howard: Yeah. So, you bought your practice from what DSO?

Noah: Family First.

Howard: And how big of a DSO is that? Where are they headquartered out of and all that?

Noah: Thirty-seven, I think, they own now, western Iowa, eastern Nebraska mainly.

Howard: Who's the CEO?

Noah: Charlie Skoglund. Dr Skoglund.

Howard: Can you find that Ryan? Family First Dental and who’s the CEO?

Noah: Dr Charles Skoglund. Great guy, very friendly, and easy to work with.

Howard: So, did he sell to you because, a lot of them sell their small rural practices because they can't get anybody to go up there.

Noah: Yeah, that was the issue. We had a wonderful dentist. There was a practice I used to go to as a kid. He was fantastic. Bill Peterson, did a great job and then after that he sold it to a dentist who then sold it to Family First. And they kept on switching dentists every two years and I knew one of the hygienists who was practicing there and she said, “We are hemorrhaging patients because we keep on switching dentists.” And someone just wants someone who will be here for more than two years. It's all I wanted. And so when I bought, the way it worked out is, they told me I had to work for them for a year. I said, that's fine, but I kind of got it at a discounted rate, I think.

Howard: Now, did they finance or carrier or co-sign or did you have to get your own financing?

Noah: I had it all through Wells Fargo, which in hindsight was probably foolish. I probably should've just looked more at the local banks. I think they probably would have cut me a better deal.

Howard: Is that right?

Noah: I think so. Talking with my brother who now is working as a vice president at a bank in our hometown, he was like, “I don't know what you're thinking.” He's like, “We would've been able to work it out. There’s always a way to work out.”

Howard: Ryan, we need to do a whole video on how to get into a dental office and no money down. I coach kids where they'll go back to their hometown of a thousand, there hasn't been a dentist there, period. And they'll go talk to the mayor, city council, the bank. And they'll say, “Well, we have four buildings that had been boarded up for ten years on first avenue and Main.” So, they get a free building and then they'll say, “Well of course we'll give you a signature loan because you're born here and we want a dentist.” And then you don't need any marketing or advertising because an hour after you just say you're going to build a dental office. How long did it take your town to know when you got there?

Jennifer: Oh, they knew long before I got there. That was what I did when I bought half the practice, I worked with a local bank and I talked to Wells Fargo too because we do have a Wells Fargo in our little town. The paperwork that they needed versus the paperwork that the local bank needed was crazy different. And I mean it was, I think, I can't remember, it was either the same or a little better rate with a local bank. And then, I didn't experience anything where I could get like a free building or anything. But a lot of states have programs for starting businesses in the rural areas where, you might get some of your interests by down. And North Dakota's a little bit unique because we have a state-owned bank. So, when you're starting up new businesses or expanding. You can get interest by downs where you might only have 1% interest for a few years.

Howard: I'm surprised that redneck conservative state would have a state-owned bank.

Jennifer: Yes. We're the only state that has a state-owned bank.

Howard: Yeah, a state-owned bank, I would think that would be in California or Connecticut. I just would have never guessed North Dakota, which has more guns than people.

Jennifer: Oh, I guess way more. We have seven hundred thousand in the whole state. So, it's very, and it's a large state.

Howard: And are they only getting one season of small grains? Is it just one crop? Like Kansas gets two seasons of wheat?

Jennifer: Oh, no, we only get one.

Howard: But that still seems to work for the farm?

Jennifer: It does. It takes a lot more land to make it there. You might have a farm in Iowa where they can have six hundred and forty acres and they make a good living on that. There, you need a lot of land to make it because it's a short growing season. The soil isn't as good, at least on the western half. The eastern half, the soil's a little better. But I'm on the western half. I actually live on a cattle ranch. We raise cattle.

Howard: Milk or dairy?

Jennifer: It's a cow calf operation. So, we raise the calves, sell those.

Howard: And the kids love that?

Jennifer: Yes. Some days you think you wonder if they're going to appreciate living because I mean we really live in the middle of nowhere. We're thirty miles out of the town that I practice in and in our township there's, well now we're down to eight people who live in there, and there are six in our house. So, not many people out there.

Howard: And is Fargo your favorite movie of all time?

Jennifer: Yes, definitely.

Howard: It's a cold classic.

Jennifer: And I am about as far away as you can be from Fargo and still be in the state, because I'm twenty miles from South Dakota and twenty from Montana or about that.

Howard: If you've never seen Fargo, if anything, just for the accents. Oh my God. That's one of those low budget films that every year just keeps getting downloaded, like My Big Fat Greek Wedding. These little low budget films, Office Space, there's a lot of cult films out there. You know what the number one most viewed movie of all time is and no one's even close to number two.

Jennifer: No idea.

Howard: What would you guess? The Rocky Horror Picture Show!

Noah: Is that a fact?

Howard: Oh, it's like ten times more than Gone with the Wind.

Noah: Oh, that’s hilarious. It’s not a bad flick.

Howard: Did you see it?

Noah: Yes.

Jennifer: Yes, a long time ago.

Howard: I’ve never met anyone who hasn't seen it. My oldest sister who's a nun, probably saw it last week. It was so fun because we'd get off work at Sonic at midnight and they always had the midnight viewing and you go there and just the characters and then throwing the rice. It was just fun and it's still going at the same theaters.

Jennifer: But yeah, when you go over, especially talk to those local banks because they really want to work with you and they want people to come to the town in businesses and they know dentistry is a good business. So, they're definitely on your side.

Howard: Well, the neat thing about dentistry, like a 100% of the planet will see a dentist. I mean, even if it’s just to get something pulled, or a partial or something. Whereas chiropractors, it's 5% so 100% of the planet is not going to get an iPhone. Like people talk about booze. Half of Americans did not have one serving of alcohol last month. So, to be in a business where every single person is going to have to be a customer. And the other thing that I like more from my generation, when I see now, is back in my day, the way you got financing is the owner would carry or the banks say, “Well, we’ll loan you half if the seller carries the other half.” And what I liked about the owner carry is that they had skin in the game. So, if you lived in that small town and if he sold it to you and whatever you guys had spewed, and he's out there bad mouthing your words, if he wants that check every month, he's like, “That's the greatest dentist.” And then that seller could call them and say, “I had a problem patient. He only wants to see you and he's upset with me.” And then that guy would come down and work it out. Same thing in this restaurant business, man. I mean restaurants, the most brutal business in the world. And you see these young kids and they're going to buy some Chinese restaurant from some sixty-year-old Chinese couple. And they're young and it's all good. And it's like, “Well, why don't you make them carry half?” “Oh no, they won't carry a dime.” Well then that's a red flag.

Howard: And I would rather have a banker in my town than a banker in Wellsburg because if something goes wrong and your banker’s in San Francisco, I saw that in Kansas. Through a long series of acquisitions, there was a company in Maize, Kansas that made baling equipment. And then eventually that got bought up by International Harvester and then eventually I got swallowed up by like Fee Odd. Anyway, by the time we got to Fee Odd, they're looking back at this company on the other side of the planet, in the middle of a town of five thousand, and said, “That's just a waste of our time.” So, they shut it down. But, the business was good and the fired employees started it up and made it successful. But if that banker would have been in that town, he would have known that this was a viable business. And some guy in Italy didn't get it. So, I want to pose this to you. So, when you go to dental schools, the DSO market is better brainwashing than anything I've ever seen. And they go in there and they preach fair and scarcity and the sky is falling and in twenty years dentistry is going to be like Walgreens and CVS and everyone's going to work for McDonald’s and this is why you should work for us and not the other guy. And then they all sit there and think, “Well, you know, that sounds like a good deal. I got a guaranteed job. I got a guaranteed income.” I go to those senior class, they say, “I think I just want to work in corporate. I'll be good with that.” And then I always respond to say, “Okay, well I've done this more years than you're alive. I just don't see anybody that gets a job there and is happy ten years later. All I see is burn and churn. So, why is this going to work for you and didn't work for the last ten graduating classes. What would you say to that kid in dental school, and I hate to pick on you because you're a woman, but a lot of them say, “You know what, I want to have a baby and I want to have a kid or two or three and wouldn't it be easier to be a mom if I didn't have to worry about the business and I could just do my eight to five” and they go home to the soccer game. So, how do you deal with that whole thinking process? Will she be happy with a DSO job?

Jennifer: I don't think so, because they dictate. Anybody I ever talked to that works for them and I hate to throw them under a bus…

Howard: What percent?

Jennifer: But they try to dictate everything you do and nobody likes it. I've never heard of anybody long-term who likes working for a DSO.

Howard: Did you say nobody?

Jennifer: I don't know anyone.

Howard: She doesn't know anyone.

Noah: I've never met one.

Howard: I never met one, you never met one. Oh, but it's going to be you. You're going to be the first one who jumps over the moon.

Jennifer: I mean, I have had a few people have said it was okay to learn a few years, get a few years’ experience, but I don't think it's a good long-term plan really for anybody. I had two kids when I started dental school, four when I left.

Howard: You had two in dental school?

Jennifer: I did.

Howard: So, you're a Mormon then.

Jennifer: No. 

Howard: Only Mormons have kids in dental school. 

Jennifer: Just crazy.

Howard: You’re the first non-mormon I’ve met that had kids… What religion are you?

Jennifer: Lutheran.

Howard: Lutheran. Those were the first Catholics that could read.

Jennifer: My dad did say when he found out I was having a fourth, “You do know we're not Catholic, right.”

Howard: It was funny, when I was (inaudible: 40.25), my favorite role model was the Catholic priest, Martin Luther, because he was the only one that had the balls to stand up to the church with his ninety-six [inaudible 40:33] and tell them everything. And they tried to kill him. So, he hid in a wine barrel and the same Catholic monastery that my older sister’s in, and they hid him in a wine barrel to take him to England. And they got through all the check guards because it was nuns carrying a barrel of wine. And then when he got to England, he was free because King Henry didn’t like the Catholic church because he wanted a divorce. And so, I was telling my mom when we were little, I'd always say, “Lutherans were the first Catholics that could read, the first Catholics that could think.” I mean, he was just an amazing guy and that's a big inspiration for something like dentistry uncensored where I don't care. You know, a lot of people, they’ll say, “I was offended with what you said.” “Well then go watch Disneyland. Go watch, Build it, They Come. I would be more honored that you tell me what you truly believe, even though I disagree, than you sit here and pander to me and try to say stuff because you think that's what I want to hear. I think true love is to tell you what I really think. And I think pandering and politicians saying we're going to do all this when they know there's no way they're going to do any of that stuff. And that's why we can't get anything done because there's just no honesty.

Jennifer: Right.

Noah: But people still listen to them, even though they know they're not going to do anything. I don't understand that part of it.

Jennifer: That's another nice thing about ruralist. You don't have as much of that craziness and people know you and people aren't as [inaudible 42:04] happy as they are in the cities and things like that.

Howard: I've always had another theory about small town deal. You guys have a mayor?

Jennifer: Yes, we have a mayor.

Howard: Is it elected?

Jennifer: Yes.

Howard: How long is the term?

Jennifer: There's no term limit out that I'm aware of.

Howard: I've always thought when I was visiting grandma's and friends that lived on farms and things like that, it's different when you're a mayor with three thousand people and there's nine thousand weapons and everybody knows you and where your name and where you live, I think you would lie, cheat, and steal a lot less under those conditions than when you go to some big city and no one knows anything about you, where you live. Is that crazy talk or is that kind of reality?

Noah: I don’t know if I agree about the gun part being feeling threatened at all, but I feel like, you feel more responsible because you know them. Your kids play with their kids.

Howard: Well, you're connected when he's running for office, you know who this guy is.

Noah: Oh yeah.

Howard: You know his reputation, you know where he lives and on national politics, you’re picking guys out of a police lineup.

Jennifer: And that's another benefit. A lot of your patients who come in and now we draw from a large area, so that there are people from surrounding towns that come that we maybe don't know as well, but, you know a lot of them. You know you have that benefit a little bit too when they come in.

Howard: So, again, she's a little girl. She wants to grow and be a mommy. Are you a better mom if you work for someone else? So, you don't have to do the business and you just leave all that at home and be mom.

Jennifer: I don't think so, because I hate to admit this, but I think in a dental practice because I do like the business end and I pay a fair amount of attention to it, but I think in a small town dental office, I don't think there's as much that you have to really do with the business aspect of it because you don't have to do a lot of advertising, things like that. There isn't necessarily as much competition that you're fighting against other dental offices to even be known because they all know you’re there. So, no, I think being an owner and a mom is great. I mean, you can set your own schedule. If I want to leave early for a ballgame, they rearrange my schedule. They're great about it.

Howard: One of the longest threads on dental school, I hate to keep bringing up women issues, it's hard for me to be an issue or an expert in women issues, but, one of the longest, it started in the Economist, then it was in the Wall Street Journal, in the New York Times. I posted one of the articles on dentistry where one of the big problems in marriage counseling is, it used to be the man was always the breadwinner and now there's this huge fast-growing section where the woman's making more than the man and it's causing a lot of marriage issues. They feel emancipated, there's solid research. It’s part of the opioid epidemic. It's actually a part of that. It's scientists and epidemiologists say it's even a part of that, but anyway, I don't want to go into it. Have you seen, have you know anyone where that might be an issue?

Jennifer: I have not. I have several friends who are females who are dentists and I do know they make more than their husbands. And I don't know, it doesn't seem to be an issue for any of them. My husband does get crap from some of his friends that he's just a good tax deduction for me because he has the ranch and right now it's kind of a money pit because we were just getting started. But I don't know, it doesn't seem to bother him. He thinks it's funny, so I haven't seen it be an issue.

Howard: Yeah. You should read that thread on Dentaltown because there's a ton of women posting on that thread saying, “Yeah, it's a serious issue in my house.” And then there's a ton of dentists saying, “I'd give anything if my wife got paid more than me.”

Jennifer: For the people, I know it's not an issue.

Howard: I'm going to ask you another rural question. You guys both have Cerec machines?

Jennifer: We do.

Noah: We do.

Howard: And it's a very different situation when you're too…How many miles is the closest lab to you?

Jennifer: The closest is about one hundred and eighty miles.

Howard: Yeah, whereas I got ten amazing labs. I mean amazing labs within ten miles. So, do you think Cerec is a better thing for rural dentists? Three hours from a lab?

Jennifer: Well, it probably does make a big difference when like you have a lab ten minutes away because if you need something quick you can run it to them. We don't even have that luxury our office, it’s mail.

Howard: They run to our office and pick it up.

Jennifer: Another reason why it's so great where we live is, I have some patients who drive, I mean sixty miles to see me, let alone a specialist, So, when they take off a half day work for a crown prep and then another half day after a crown seat, that's kind of a pain for them. Now, do I get more patients because of Cerec? Where I'm at, probably not if I'm being honest, but I do think it's a big benefit to my patients because it's less travel time, less time off work. And I enjoy it.

Noah: Yeah, that was the thing that I just enjoy doing it but completely agree with what she said. You have people come in, they're coming in for a crown seat, a fifteen, twenty-minute appointment and they have to take a half day off work because they have to drive sixty miles to get to you.

Jennifer: I got labs where I don't have time to take a bite. Say, the second appointment with a denture, third appointment [inaudible 47:50] and whatever. He'll just run over and do it for me and I'll never even see the patient.

Jennifer: I wish I could do a denture on my Cerec.

Howard: You're close, the company’s right here in Scottsdale.

Jennifer: I hope so.

HOWARD. Havadent.

Jennifer: Oh yeah. I just actually read about that.

Howard: Havadent, they’re absolutely doing it. Next time you come down here, you got to email me and go take a tour of that stuff because it's totally here.

Noah: Awesome.

Howard: And in fact, one of the lead guys on is actually a guy from Poland that we podcast.

Noah: The best of.

Howard: I think he'll come out three or four days before yours does or whatever. It’s about a month lag by the way on these shows. So, when you guys say you enjoy Cerec, does that mean you enjoy having the service and all that, or do you actually do the scan, the design, the mill, the stain, the glaze. I mean how much of that is you and when you say you love it, what do you love about it? The service is available or do you like lab work and do you like doing all that stuff with your own hands?

Jennifer: Go ahead.

Howard: My God, she took the fifth on that. I cannot believe it. I could just see the brain going. Go ahead, Noah. Take the floor, you want to move the microphone closer.

Noah: I just like it because my assistants love it. It's something new. They get responsibility. They love doing the standing, they love designing. I'll pop in every now and again just in case they're having some issues with something. So, I love it because my assistants love it. They love it.

Howard: Who’s scanning?

Noah: I will typically scan.

Howard: Okay. Who's designing?

Noah: My assistants are.

Howard: Who’s milling?

Noah: My assistants take care of that.

Howard: Staining? Glazing?

Noah: Assistants.

Howard: Try on? Get it all ready?

Noah: It depends what the schedule’s like. If I have time I'll be popping in and doing that and cementing it, but if they might try it on.

Howard: I would prep, leave and I would not be back until it was perfectly on the tooth, to check everything. I just check it one-time, mix.

Noah: Yeah.

Howard: Now, you are settling your thoughts.

Jennifer: Yes. So, I do prep scan and I do design it, then they mill it, glaze it, fire it, and I bond it.

Howard: Who tries on adjusting it and gets it all ready?

Jennifer: I do, if I try it in. Sometimes I don't.

Howard: I always thought that was so funny, dentists would say, “Well that's against the law. You can’t have an assistant [inaudible 50:25] so, let me get this right. I can take emperor gum, send it to China. A communist Chinese girl that can't speak English can make the whole damn grab and once it comes through my invisible back door, now Moses parts the river and my assistant can't touch it. What about that story is insane?

Jennifer: My plan is to eventually have an assistant who can. We have one assistant who has been there, well my partner started in 1985 and she started three months after him.

Howard: Your partner started in 1985?

Jennifer: Yes, and our main assistant started three months later. Our front desk lady actually started, or office manager as you call her, the year before my partner, she worked for the previous dentist.

Howard: So, she started in 1984. One of the hygienists has been there over thirty years. The other one's getting close and now we have kind of a younger group. So, when I came in, I was kind of nervous about how they were going to like another dentist and they hadn't changed anything.

Howard: Bee there thirty years. How many times a month do you think, “I'm going to have to put her down?”

Jennifer: Never. She's been great.

Howard: Really?

Jennifer: When I came in she kept saying I don't like change. And, when we went digital, she was kind of upset about it, and I have to say I learned so much from her. My first year in practice, she taught me a lot and after we went digital she did admit, “I didn't think I was going to like that, but that was the best thing we ever did.” She used to have to stand in the processing room for ten minutes to run a sef in a pan on Ortho patients. Now, it pops up on the screen. And we moved to a new office this October, so, six months ago. And I was a little nervous too about moving.

Howard: How many ops for the last one and how many ops for the new one?

Jennifer: We had six in the last one, but they were very small. We had one bathroom for all the patients and staff. So, now in the new office we have nine operatories, five dental, four dedicated hygiene.

Howard: How many bathrooms?

Jennifer: Oh man, we got two for patients and one for staff. They love it.

Howard: I can’t say that, I’ll sound sexist, but women have a thing for bathrooms.

Jennifer: They do. Our staff, they're excited about their bathroom,

Howard: One of the largest selling Cadillac dealerships in America is in Dallas, Texas. And everybody studied him and they made more money on service than they do selling the car. And he actually knew that women were so serious about their bathroom that he sent a designer to one hundred of his existing customers who had bought a Cadillac. And the thing he was the most proud of is that the women said, “I go to this Cadillac dealership because if I got to go wait for an hour and I need to use the bathroom, his bathroom is the same as mine.” And as a man, he's like, “I don't know what your bathroom needs”, but he took an interior designer to his hundred best customers and most people just thought that was a joke. But if you looked at his sales, I think he'd sold three times as many Cadillacs in his dealership than the number two guy for all of America. And the other trick he did, which I thought was pretty good, whenever you brought in your Cadillac, if you wanted a rental car, he put you only in your exact car brand new. And then when they called to pick it up, they don't say you have two choices, just stay there. We'll send a person over to you, keep the car, we’ll buy your last car, and leave us a check for $22,800 or you can drive that new car back here and pick up your old car. And they're just like, they didn't have to leave. They drove someone over and all they had to do is go to their desk drawer, get out a check. What was it again? Twenty-two thousand eight hundred. And I mean the guy's a genius.

Noah: Yeah.

Jennifer: So, I guess back to that Cerec, then I have two assistants right now. One has been there six months and one's been there a year and I just don't have them quite up to where they're ready to do the scanning and the design. But hopefully we'll get there. Yeah, I got to give a shout out. One’s at the hospital right now having her baby. 

Howard: And what number’s that?

Jennifer: Number one for her.

Howard: Number one for her, so she’s sixteen? Did she get her driver's license before, so she could drive herself?

Jennifer: Just before. Last month.

Howard: So, that's another issue a lot of people think about rural. You know, when you're in Phoenix and the metro has three point eight million people, you can find hygienists, dentists, associates all that kind of stuff. What's it like when you're trying to find an assistant? Hygienists? What's it like trying to find staff when you only have eighteen hundred to pick from when I got three point eight million to pick from.

Jennifer: Well, we had there were two hygienists there when I came and there was another one there and she was from a town pretty far away. Her and her husband were from the eastern part of the state and they had ended up deciding they want to live closer to family so moved back. We got another hygienist who came down from Bismarck, I think she thought she’d live there six months and now she, she started probably about six months after I did, so she's been there six and a half years. And now she married a local guy and loves small town life and will be there forever probably. And then the girl and her husband who moved away, they actually moved back. I think they've been back two years now. They decided they missed it and really liked it. And so, right now I've been okay for hygienists. Assistants… when I got into dental school I thought you needed somebody who had went to school for assisting and I've learned you can train somebody on the job as good as you can as somebody who went to school. It just takes a little while in North Dakota, they have some licensing requirements, like they can really pretty much just suck spit until they have six hundred and fifty hours.

Howard: Yeah, but how much of that is enforceable?

Jennifer: That's very true. I have no idea.

Howard: I have broken every law ever written on any subject from A to Z. In fact, Ryan [inaudible 56:28] sit down and look at all the categories of laws and see if there was just like one category. People are so worried about, I mean, I know a dentist who waited like two years before he got his sign ordinance to put up a sign. It's like you really think the sign ordinance lady would driven by your office and caught you and then when it was already built, I mean really. Drug dealers are driving around with five pounds of heroin in the trunk and docs waiting two years for a sign permit.

Jennifer: But it seems like they enforce those things because they're just easy.

Noah: Easy to enforce.

Jennifer: But I actually have a young lady from the area who just graduated assisting school this weekend. So, she's starting next week, so that'll be kind of interesting to see how it is to have a trained assistant. But no, we don't have any schools close. So, far we haven't had trouble getting people out there, like for hygiene and assisting.

Noah: Yeah so far, I haven’t had any issues. But I do have gals will drive forty-five minutes to get to work. But other than that, I've been able to find amazing assistants and hygienists so far.

Howard: Okay, so you got a Cerec, but you say you had a MCXL milling unit and iBeClear program furnace.

Noah: Yeah. It’s just the whole setup.

Howard: The whole setup?

Noah: Yeah.

Howard: And you are placing implants?

Jennifer: I don't place implants. We just got a cone beam. Well we upgraded. We had a pan that was upgradable to 3D.

Howard: Was that a Planmeca then?

Jennifer: No, it was a Sirona.

Howard: Okay. So, when you say it was upgradable, they came and changed the software or they took your last unit and credit to the new unit.

Jennifer: No, they came and changed the software and they put this new plate in there to the tune of a lot of money. So, I think that's in my next five-year plan to go to some classes and learn how to place implants. But I listened to a lot of your podcasts and, like you say, “What are you going to give up?” And that's kind of what I'm looking at. Is it really worth my time? We have some oral surgeons in that town that in Rapid City, South Dakota, and they have recently bought a Cerec scanner and they have the same cone beam, so they have this new system where, I can scan them at my office with the Cerec, take the cone beam, send that to them. So, then they'll mail the surgical guide so that the day my patient shows up, they dropped the implant in.

Howard: Who drops the implant in?

Jennifer: The oral surgeon.

Howard: Oh so your patient goes there and they ready to go. And how far away would that be?

Jennifer: It’s a hundred and eighty miles.

Howard: That's three hours.

Jennifer: Three hours. But again, the patients are kind of used to it. I mean if they have to see an ENT, that's where they go.

Howard: Whereas if you do Ortho one day a month, so you lined all of your implants up one day a month.

Jennifer: I should.

Howard: You could get a periodontist, a starving periodontist from Omaha, Kansas City, Aletha, all those to come in there and do it for 50%.

Jennifer: I see the periodontists in our area and the oral surgeons, I mean they're not starving so they're not willing to drive up from the day to do that.

Howard: Right, right.

Jennifer: But they’ve done it so that now when my patient then goes for the integration check, they scan it, send it to my lab or back to me if it's one I can do at a Thai base. And so, then when my patient comes there, we have the crown ready to go. So, it limits those appointments.

Howard: How are you going to start your journey on implants?

Noah: I don't know. I've heard a lot about Andrew Garg.

Howard: Arun Garg.

Noah: Arun Garg, sorry.

Howard: Arun Garg, out of Miami?

Noah: That's what I keep on hearing, but I don't know. I don't have as many patients that I see needing them. You talk a lot about this on your podcasts, if you're not going to be doing it very often, you're obviously not going to be good at it. If you're not going to be good at it, you probably not going to enjoy it and it's not going to be a good service for your patients.

Howard: Absolutely. If you don’t do it once a week, you’ll never [inaudible: 1:00:20].

Noah: Yeah and that's why there's no way I'm going to touch a maxillary first molar and do a root canal. I don't do enough of them to be good at it. There's no way. And I love my periodontist. He makes me look good.

Howard: How far away is he from you?

Noah: Hour and fifteen minutes.

Howard: But, you're saying that in your area that's not a big deal.

Noah: I'm saying that I guess I haven't tracked it to try to figure it out. I haven't really asked the patients, but it doesn't seem to be an issue and it's not a limiting factor. I haven't had people not do the implant because of that, that I know of, but I don't always track those things.

Howard: Well, I want to go back to old guys like me read books. And your generation is all digital and [inaudible 01:01:06] when I get on an airplane, I'm reading a book and the guy next to me is reading a book, I don't have to ask him if he has grandchildren. It’s like you can just see it in his book and if you're reading a Kindle or all that stuff, but I always say, send me an email at, tell me who you are, where you live, what country you're from. What's most shocking to me is 5% are pre-dent. These are people that are applying to dental school. I always say twenty-five, but it might be twenty-five, twenty-eight, thirty, sometimes some months it’s a third are still in dental school. And then all the rest, there’s almost no-one over thirty.

Howard: I can't believe we passed an hour, but give him some advice. Give the dental students advice because I'm in the schools regularly. Here's what they're thinking. Just five years ago we'd always say, these kids are coming out with two hundred and fifty to three hundred thousand in debt. But the dental schools are aggressively realized about five, six years ago, that every time they raised the tuition ten thousand, then no decrease in applicants So, rapidly now, they've gone from seventy to $100,000 a year. So, routinely they're coming out with $400,000 a day just from dental school. Then they had undergraduate debt, maybe they bought a car, whatever. So, she's scared to death. She's $400,000 in debt. She doesn't sleep at night. She's nauseous. What would you tell her to do? Because I don't know if you guys remember this at dental school but when you're in school, you're kind of that other world that you're not thinking about other worlds. You're trying to do your requirements and pass your test and then one day you're like, “Oh wait, I'm walking through the door. Oh my God. Now I'm in a whole new world.” So, they get stressed and more stressed when they're half a million dollars in debt.

Jennifer: I would seriously say consider rural and you don't have to be as rural as I am. You can be sixty miles from a major city and you can find a guy who's been practicing thirty years and you get a contract, right?

Noah: Yeah.

Howard: It’s for the marriage. She’s talking about marriage contracts, a prenuptial. This is marriage uncensored.

Jennifer: And plan on being an owner. I think you can make a lot better living. I think you can make more choices on what you want to do procedure wise, how you want to set up your business, what days of the week you want to work, what hours do you want to work? Right, that's my suggestion.

Noah: Yeah, and I thought it was kind of funny, you keep on saying, when they come out with so much debt, they've got all of this debt. Do you really need the Cerec? And I was joking with you, I'm like, “Oh, we don't really fit the mold because we went out and did that in the first six years.” But you do bread and butter dentistry, you should be able to make enough money.

Jennifer: Right.

Noah: And I just don't buy the new car. Don't buy a brand new house. I don't know why you need all that stuff and get your debt paid off. And then like you said, when you go rural, there's all kinds of programs out there that will forgive your loans. Take advantage of that, use that. You’ll be done with your loans.

Howard: Can you tell it’s a bachelor pad when there’s flies around. I live in a barn and we don’t have this many flies. This is what happens when you live in a bachelor pad, you try and have a podcast. Okay, now I want you to address the men in dental school because they're totally different than the women. Older men are looking at you in the rural thinking, “Well, how do you go buy a case of beer at twelve thirty at night in your underwear if you live in a town of two thousand? Like that's the guy who’s supposed to do my root canal tomorrow.” Do you wear like a ski mask or camouflage?

Noah: I don’t go in my underwear, that’s for sure.

Howard: Do you have a drug dealer that goes and buys it for you and brings it to your back door.

Noah: With my personality, it's not uncommon for me to have a beer or two on the golf course on Tuesday nights.

Jennifer: Or five or six.

Noah: We don’t get ridiculous. We go to the bar, have a couple of beers. People in my community know me. They enjoy me. They don't have a problem with that, but if I was getting plastered, a completely different story.

Howard: Now, back to the girls. Now, they’re thinking, “Would I have to drive a truck?”

Jennifer: No.

Howard: Could they still drive their little two seat beamer.

Jennifer: Yes.

Howard: Down a dirt road?

Jennifer: Sure.

Howard: I thought they only allowed F150s and F250s to go down the roads.

Jennifer: I don’t know, I drive a Yukon I suppose. I got four kids, I can’t have a beamer.

Howard: To recap, let me just say a couple things. I've never met a dentist who came out of school with a half million dollars in debt that if they were two hours away from where a Southwest Airline plane takes off, weren't successful. End of story. I've also never found a dentist who didn't make it, who didn't take a hundred hours of CE a year, every year till they dropped dead. That's one of the reasons I did this podcast for free on my phone is if you've got an hour commute and you work two hundred days a year, I thought, damn I can do that. You don't have to do anything because you keep putting enough information in your head, you’ll eventually figure it all out. It's not rocket science.

Jennifer: And I would say that's the other thing. Plan on taking a lot of CE because you get out of school and you don't know anything.

Noah: I don’t know if I just forgot it.

Howard: But you won't know anything when you're fifty because like when I got my diplomat of the international congress [inaudible 01:06:51], my fellowship of the mission stew. We were on panos and I'd say, “Oh my God, I got an inch a bone. I could put a twenty millimeter implant and flap it back” and it'd be like this piece of paper by the time you word it all down or you had like this much left. Right now, the shits that's come out just in bone grafting in the last year or two, ceramic implants, Peri implantitis, and that's why they call it practicing dentistry because the technology curve is like surfing. In the technology curve, you're always going to wipe out. You will never ride that technology curve. And in my perception, it keeps going faster and faster and faster and faster.

Noah: Yeah, definitely does.

Howard: I mean just look at prescription pills that come out. There'd be a couple new ones this year and when I got to school thirty years ago, a pharmacist without opening a book, could tell you all the new pills that came out last year. Just like when we were little, when we were out there playing on recess, we could name every car that went down the street. That's a Volkswagen. I mean you just knew now it's like Jiminy Christmas, So, it’s a hundred hours of CE every year until you die if you want to crush it.

Jennifer: And I think too, that makes you enjoy dentistry. It's like this, it's great for us to meet up down here and we don't see each other otherwise. You can meet up with your classmates, go on vacation, get some CE. That's great.

Howard: And how often do you guys feel like you need to drive an hour into town? It's sixty minutes for you. How far is it for you? Take me to Walmart.

Jennifer: Eighty miles.

Howard: An hour, so eighty miles for a Walmart? Sixty for you and how often do you have to make that to go to Walmart? Is that a weekly thing? Monthly thing?

Jennifer: Never.

Jennifer: There's a grocery store in my town. There's a ShopKo hometown. There's an Amazon, delivers anything I want to my front door in two days.

Howard: Amazon? Do they really?

Noah: Two days, yeah.

Jennifer: And I live away. I still can't believe they actually deliver it to my house.

Howard: And who’s delivering it, the US postal service?

Jennifer: UPS or Fedex.

Howard: It’s not the United States postal service?

Jennifer: No. I only get mail three times a week, Howard. Our town gets it every day, but my house, yeah. 

Howard: So, it's FedEx or UPS.

Jennifer: I don't think my Amazon stuff ever comes through the postal. I guess I shouldn't say ever.

Howard: Well, I have the best UPS story ever. The guy that delivers UPS packages to my dental office, he won the sexiest UPS driver in the world and part of those guys, my staff kept dialing and votes for them. I think each one of my staff members voted for him like eight million times, but Frank actually won the contest as the sexiest UPS driver.

Jennifer: I didn’t even know that was a thing.

Howard: Yeah. I didn't either. But, seriously it's just such an honor that you would come by the house and share your journey to a bunch of homies that want to hear what it's like. Really.

Jennifer: Thanks for having us.

Noah: We were thrilled at the opportunity for sure. One thing we were worried about though, is we always listen to you at two times speed.

Howard: Oh really? Do you really?

Jennifer: Yeah.

Noah: And one day, we were talking to a few other people at that the Spear class, that we were coming here and like, “Oh my God, that's awesome. You guys are like celebrities.” Yeah, I know, right and so when you were telling stories about some of the things that you would typically say and you would say it at two times speed.

Howard: Tell me a story at two times speed. I want to hear myself at two times speed. Give me your best Howard Farran impersonation at two times speed.

Jennifer: Why you just can't think in fear and scarcity. I mean, you got to think in hope and abundance.

Howard: Nice. Now, who’s really going to be laughing is when she hears herself say that, it’ll be four acts. like, oh my God, who was that? Well, I think it's a cool technology. I think, Steve Jobs changed the whole world because like I say, when I was a kid and this was an IBM mainframe that only rich governments and corporations had, and now that IBM mainframe is in everybody's pocket. It’s flattened out there and I think from this launch, this came out in 2007, I think the hundred years after that will be humanity's finest century. And people have no concept of history. I mean people are walking around today saying, “These are the worst political times ever.” I say, “Really? Did you miss out on the civil war? Really, when one out of every thirty Americans was killed. Really, this is worse.” I bet everybody that lived through the civil war, wish they were sitting here in these tough political times and the economy, and they think the economy's bad. Really?

Howard: Do you remember from 1932 to ‘36 when one in four Americans were unemployed for four years, when one in three banks went under, oh and the environment is so bad. Did they forget the dust bowl, when Kansas was just blowing dust for four years before they had cars. I mean, it's always the drama, crisis of the moment and it's just because people love drama. Like no one wanted to talk about a hundred people killed in a car wreck. They want to talk about the one that was killed by a driverless droid. I mean the monkeys all got scared and they all jumped up and down and threw bananas at each other. But, ah man, times are good and for you to be able, I mean there are guys that went before you, see Carl Misch who could lecture every weekend for forty years and now Jamie Amos started a podcast on Dentaltown and called it, A New Practice and he has six hundred and eighty-seven thousand downloads. That's just on Dentaltown. God knows what he has on iTunes.

Howard: It's like, he lectured to more people than Carl Misch. I mean, technology's amazing. And think of the plow. I remember when everybody thought technology was going to ruin jobs. Like right now, everybody's afraid that these driverless cars and robots, everybody's going to lose their job. Well, remember back when the textile mills and they went before the king. They were all losing their jobs to textiles mills and they demanded the king throw them into the ocean. They almost did, they thought he was going to get lynched. And the funniest one was when the president of India, canceled all farm equipment from John Deere, all tractors and everything because he had too much unemployment. So, they hired Milton Friedman to go talk some sense into this guy. And the guy says, “If I get a tractor, well one guy has a job, no tractor and a hundred guys have a job and well, I got a better idea. Let's take away their shovels and give them spoons.

Howard: And then they started thinking about that, how dumb that was because when textiles destroyed all the jobs, what did the people do? Do they just go crawl in a cave and die? No. They became hygienists and dentists and made iPhones and also everybody's afraid of losing a job that they wouldn't do. It's like, well, if you have four kids, would you like want to be a truck driver that just drives up and down I 70 back and forth his whole life. Oh, you want to save a job that you wouldn't do and you don't want your four kids to do. And, I cannot wait, I think it's almost going to be heaven when I can open up my Budweiser app in a droid. I just have to leave the window open a little. A little robot comes in, here's your beer and flies away and dings my debit card.

Jennifer: It’s the best day in my husband's life when the kids could open the fridge finally to get him a beer.

Howard: Well, thank you so much for coming by.

Jennifer: Thank you so much for having us.


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