Dentistry Uncensored with Howard Farran

How to perform dentistry faster, easier, higher in quality and lower in cost. Subscribe to the podcast: https://podcasts.apple.com/us/podcast/dentistry-uncensored-with-howard-farran/id916907356

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Howard Farran: First of all, this is a huge honor for me today to lecture to a good friend of mine for years who has been doing stress management. She has a course on Dental Town, an online course, stress management in a dental office. But Jen, you have been published 16 times in Dental Town. And as a – I think the reason we are able from 1994 to 2014 to build the most successful dental magazine in dentistry if you measure by direct request board dentist signing the card and saying yea, I want this because we go by data. Instead of the old world where an editor says I have a gut feeling this is good guts are filled with intestines and whatever is in intestines. We go by when these magazines are mailed to an office they are also printed online. We get to measure not only the view, but how long do they stay on there. Do they just view and go in and they are gone in five seconds or they read the whole thing. Then more importantly do they come in afterwards and I’m embarrassed to say this because I own the magazine. But actually you and Doug Carlson are actually more popular than me and Tom Geocobi. So me and Tom Geocobi should be throwing away and your buddy Doug, you know who I am talking about, Doug Carlson. I want to thank you for your thousands of posts on Dental Town, but this subject hits me very hard because we both live in Phoenix. I think last year three dentists killed themselves. I don’t know if it is because I have a big brand name or an easily accessible whatever, but I get the suicide call. I have never gone three months without a wife sending me an email saying what should I do. I feel like they are lucky they contact me because I know what to say. I know the brokers. I know that you can’t go through six months of recalls with no practice and you have nothing to sell. Everybody has found a new home. And a lot of dentists get stressed out about which bonding agent they should use. But some dentists hang themselves by their ceiling fan. 

I had you come into my office last Christmas, which was an awesome Christmas present for the office. We have 50 employees. They loved you. You know, I still always hear them say at staff meetings well Jen Butler says blah, blah, blah. Well Jen Butler says blah, blah, blah. In fact, we just had a meeting last week with the four dental assistants. There was a little bit of drumming going on about something who is in charge of this or that. People are still quoting you. I want to start this conversation on the dark side that there is stress in dentistry. We do know we have the highest suicide rate that is garbage. The military now dwarfs everything. They are killing themselves while they are under suicide watch. I mean those boys are – they got sent back way too many times for way too many years. They got more post traumatic – but dentistry is stressful. I think it is stressful at the beginning for a couple of things. Number one, my dad owned a Sonic drive-in. If you ever worked in a Sonic drive-in from age 10 to 20 you see the happiest side of people because they are about to eat a foot long chili cheese dog and tater tots and onion rings. I remember one time I was going to Disneyland and everyone waiting in line is – I mean everybody – you see the greatest side of people. Then you go into dentistry and they are in pain and they didn’t sleep last night and they are broke and they are going to max out their credit card. Sometimes when patients are stressing out or you give them a shot I feel my heart rate go up. I feel myself getting tense. Sometimes I have given a lower block and walked out the room and breathed. 

If you don’t listen to Jen Butler some day you might be eating vicodin, doing nitrous oxide, drinking your Listerine and hanging yourself by the ceiling fan. This is absolutely serious. So, Jen, when do we start this conversation? And then the other side is dentists are trained eight years technically on root canals, fillings and crowns. They weren’t stressed on how to manage five people. I don’t want to say this because I don’t want to sound sexist, but the research is clear with monkeys and apes when you look at other apes humans, gorillas, chimpanzees, orangutans, bonobos female apes and female monkeys interact with another monkey or ape five times for every one time a man does. And half of these dental offices the man is the leader. And they just did a study from the University of Chicago which has the most Nobel Laureates in economics and they just did a study that showed the average man in America says 2300 words a day and the average woman is over 7500 words a day. I think that mathematically translates to a complexity. If you are saying three times as many words and talking to five different people and I’m the dentist – and what do dentists do after every procedure? They go in their office and they shut the door and they just don’t even want to deal. What is excellent about you is you understand the stress, but just as equally you understand the practice management side. 

Here is a doctor – I want you to start the conversation like this: I am a doctor and I got five – I got two receptionists, two assistants and a hygienist. And there is just always drama going on. The only way I can deal with it is to go in my private office and shut the damn door. If I bury my head in the sand – if it gets too much after work screw it I am going to go home and watch ESPN and drink a six pack of beer. So start with that. 

Jen Butler:          Well, I think the important thing that you recognize is that typically it is the males that – it is the male doctors that have a tendency to do that. Men have a tendency more to seclude themselves, not want to engage. Females statistically want to gravitate towards others. So that is why you actually see a higher depression rate in men, but go untreated. You will see a high – 

Howard Farran: No. It’s treated with Budweiser. 

Jen Butler:          Yes. Yea. It is the crus but not necessarily true. The first thing I would say is get on Dental Town. Honestly. Connect with someone somewhere. If you don’t have the energy to engage in a conversation get on Dental Town. Get on the message boards. Start messaging. Start reading through. There is a lot of guys – a lot of doctors out there that have been where you are at regardless of where you are at, right? Get on Dental Town. Start reading the threads. Post a thread. If you don’t want to go public go private. Pick a doctor that seems to be where you were and send them a private message. Going and – 

Howard Farran: They can send you a private message. 

Jen Butler:          Send me a private message – absolutely. I get them regularly. I can’t say I get them often, but I do get them regularly. 

Howard Farran: And if they are not on Dental Town can they email you directly? 

Jen Butler:          Yes. Absolutely. I put up my cell phone number and my email address publicly all the time. 

Howard Farran: Give them your email right now. 

Jen Butler:          It is Jen@jenbutlercoaching.com. J E N B U T L E R C O A C H I N G .com. Jenbutlercoaching.com. And my cell phone number – 623-776-6715. I just tweeted today and put it on Facebook today that people don’t die of suicide. People die of depression by suicide. And that is a significant difference. I think Robin Williams death is really bringing that discussion to the forefront. But getting back to the doc that is sitting in his office get on Dental Town. Start reading. Start connecting with people. Don’t be – 

Howard Farran: I’m going to go back. I am going to enter your cell phone number. By the way 50 podcasts and you are the first one that gave out their number. I don’t know if you deserve a reward or your husband is going to shoot you when he finds out. What was that number again? 

Jen Butler:          623-776-6715. And the important thing get on Dental Town or call me. The thing that I want to make very clear about me is my intention is to help dentists live a stress free or stress less life, right? I don’t charge for phone calls. I don’t charge for emails. If you need to reach out and I’m the only one that you can do so there is no fee for that. I want to make that very clear to anyone watching or listening. 

Howard Farran: Living in our back yard you see the suicides too. 

Jen Butler:          Oh yes. I have attended the funerals. I am very lucky I work with clients privately one on one coaching. Many of them start at the point where I am their last ditch effort. They are all dentists and I have statistics to show that through coaching even just over the phone sometimes I have never even met my clients. I have the statistics to show and the personal testimonials to prove that you don’t have to live like this. Dentistry is not inherently stressful. You can learn to manage being a dentist. You can learn to love being a dentist. Being a leader. Working with women or working with difficult patients. I actually present and talk a lot about how to work with difficult patients. And my – 

Howard Farran: Let’s get the dark side out of the way first. When a dentist usually kills himself what – is it like one type of scenario is it basically two? Is it basically three? What is a typical scenario to where they end up dead? 

Jen Butler:          It is that they feel like there is no hope. Ultimately that there is no hope. 

Howard Farran: What percent of it – is a lot of it just substance abuse. Is a lot of it just stress. Is a lot of it mental illness? 

Jen Butler:          86% this is a true, accurate number in the United States. Multiple research studies – I know you are a research guy. Multiple research studies in the US by the ABA, the AGD, the Census Bureau have put out studies in dentistry because of that claim that dentists have one of the highest suicide rates. Doing research on the health and wellness in dentistry 86% of dental professionals self proclaim that they have high, moderate to severely profound stress levels. 86%. Howard, so every time you go and speak in a room think to yourself in that moment 86% of these doctors listening to me right now have high, moderate to severe stress. 86% of Townies that attend Townie meetings. The people sitting in that room the thousands of people 86% of them. And the reason in my opinion the reason it perpetuates so much is we are not talking about the right issues. There is lots of dental consultants and many of them are my very good friends. They come in and they look at processes and systems, which help to reduce stress. I argue that. You are not helping to reduce stress. What you are doing is you are possibly eliminating a stress trigger or a stressor for that dentist. You are not teaching them how to reduce stress. You are not teaching them how to manage stress. You are not teaching them the fundamentals and skills on what it takes to do that. 

Now every office needs processes and systems to be fiscally and have successful business growth. If we are really calling a spade a spade there are very concrete steps to stress management that doctors don’t typically get from professional partners that they work with. And that is important to know. We need to make sure we are dealing with the root issue. 

Howard Farran: The other problem with the male dentist I ___ males don’t like to open up about this stuff. They like to show you what they did good. They want to show you the deer head with 12 antlers, a picture when they went to Hawaii or a million dollar practice. They don’t want to really open up about what is going wrong. 

Jen Butler:          First of all, the male typically I mean we raise our boys to be the providers. Culturally that is what we do. The boys, the men, they provide, they are leaders, they are head of a family. Culturally male doctors already have that stigma. Now, on top of that they are a doctor so they are a fix it person. They are supposed to fix other people. There needs to be a sense of – a strong ego. A confidence in order to become a doctor to step into a room and say you are in pain I can take care of you. There needs to be something in the ego that does that. So when you have a male doctor that says he is preconceived to I am the leader of the family. I am a fix it person. I should be able to fix myself. It is just a feeling. Why am I feeling sad? I should be able to fix that. I need to fix it myself. So they have a tendency to seclude. They have a tendency to think that they can fix it themselves so they don’t reach out to anyone. And they are also very embarrassed to share with patients, their team, their colleagues because by sharing they think that is a semblance of weakness and vulnerability. The last thing is again, this astounds me but how – over 60% of doctors when asked if you were to see a therapist or a coach your license – it would have penalty against your license. Over 60% of doctors think that if they have any kind of mental health ding or taking any kind of anti depressants and if people find out about that it will actually impact their license in some way. That is a total myth. 

Howard Farran: I am going to start playing double ___ with you. I am a dentist and oh yea, I got stress, but I don’t have any more than anyone else. Tell a dentist how to think about himself if he thinks no, dude. You got a lot of stress and you need help. Tell your viewers about things that they can look at to where maybe they do need to call you. 

Jen Butler:          That is a great question. One of the things that is important is that we have to know our stress response. Everyone has a different stress response. When we are well in tuned with our stress response we can get ahead of the game, right? So like I know when I want to go eat a package of Oreo cookies I must be stressing. I must have some stress. There are four things that really manifest themselves especially in the dental practice. The first one is a loss of energy. This shows up in the dental practice by doctors not even wanting to go in on a day so they will cancel their whole day. I hear from office managers across the country about how they are struggling because their doctors will just cancel a day because they don’t have the energy to come in the door. 

Howard Farran: At that point is that in treatment? Is that when he needs to go to – let me get clear because a lot of doctors they are smart people so they can rationalize anything. When you have 8 to 12 years of college you can find some reference to rationalize anything. If I just – I just can’t do it today and I call in and I cancel. Is that a you just crossed the line buddy? Is that a you just crossed the line? 

Jen Butler:          Absolutely. 

Howard Farran: Back to that office manager. I have been to many funerals where the wife, office manager, everybody is balling because they all knew what was going on and they did nothing. What if an office manager or a dentist’s spouse or what if a dentist is watching this on his big screen with his spouse and you just said you just canceled a day what exactly should that dentist do? 

Jen Butler:          Go see their medical doctor immediately. I am not a doctor so I don’t diagnose depression. I don’t diagnose where people are at on that burn out scale. The burn out inventory scale is the scale that medical assessment that doctors will use to determine if there needs to be bio medical intervention. I will tell you the one thing that culturally if we could get away from the stigma of anti depressants in this country that people don’t need them. If they take them they are weak and get back to the biology of what anti depressants truly are which is truly when we have our chronic stress cycle stops the flow of serotonin, dopamine and other hormones into our system our body biologically and physiologically needs in order to function just like insulin or just like thyroid. The T3s, the T4s we need all of those hormones in order to function. Anti depressants your doctor will determine if you need an antidepressant to help you with those hormone replacements. 

Howard Farran: Did I hear you say low thyroid is also an issue? 

Jen Butler:          Yes. As a matter of fact hypothyroidism can lead to – a side effect is that you don’t produce serotonin and dopamine and so a lot of people that have hypothyroidism often take antidepressants – serotonin uptake inhibitors – not necessarily because they are depressed, but because their bodies don’t manufacture the hormone. 

Howard Farran: We are still on ___ I have never canceled a whole day, docs listening, I never canceled a day what are some lesser – some other warning flags that haven’t led up to canceling the whole day? 

Jen Butler:          You make it into the office and now you are looking at your schedule but now instead of diagnosing dentistry you do a lot of watches. We are going to watch this. We are going to watch that. No, you know this doesn’t look too bad we can reschedule. Rarely do same day dentistry. There is no sense of urgency. And the team what is great about office managers and dental assistants is they will see the pattern. They know their doc would be right on top of doing an anterior root canal. Or they would be right on them to diagnose SRPs and get them into the hygienist’s chair or composites. The team sees the spiraling of the doctor. And often times they will approach the doctor lightly. Hey doc, are you sure you’re okay? Hey, doc are you sure that’s a watch? But it is the doctor. It is the leader. The owner so they don’t want to cross any lines. 

Howard Farran: What if the office manager, assistant, hygienist loves the doctor, the spouse and they are not getting through with him should they call you? 

Jen Butler:          Absolutely. At that point give me a call. I’ve many, many times I have gotten a call from a spouse or an office manager or an email from a hygienist who really partners clinically with her provider and saying can you reach out and talk to my doc? I talk to docs all the time. Weekly just giving advice. Just trying to hook them up with additional tools and resources. Free. Within their local community. So all the time. 

Howard Farran: So canceling the day would be the big one. No same day. Low energy. Watching instead of fixing. Any other low hanging fruit there or you want to move to number two? 

Jen Butler:          The other thing is a lot of forgetfulness or the slowing of loss of concentration. If a doc typically has like a 10, 15 minute crown prep and all of a sudden they are turning into 25, 30 minute crown preps. If appointments that typically will take them 20 minutes to do a – or a 10 minute composite is now turning into a 45 minute composite the lengthening of procedure times is an indication that the doctor might not have the concentration necessary to complete the procedure. Or they have forgetfulness meaning they have to look at X-rays multiple times. They might have to look in the mouth multiple times. That they you can tell when a doc is kind of losing their focus almost by the sound of the drill where the drill starts and stops quite often instead of a nice, steady flow. There is not a team that I haven’t talked to or met in office that won’t tell me we knew. We knew something was wrong. 

Howard Farran: You said four things. What is number two then? Loss of energy is number one. What is number two? 

Jen Butler:          Loss of concentration. That is number two. 

Howard Farran: Loss of concentration? 

Jen Butler:          Loss of concentration absolutely. 

Howard Farran: And loss of concentration. Having to go back and forth from the chart. The X-rays. The mouth. And the reason why I like to go in detail is again I have said for 25 years man if you are a doctor of anything law, medicine you can rationalize anything can’t they? They have read too many books. They have always got an argument for denial. 

Jen Butler:          Let’s go back to facts. Doctors were sent a survey and were asked would you ask – in the face of struggling. In the face of being completely stressed and losing your practice would you ever ask for help in the means of hiring a consultant or going outside and asking a colleague or hiring a coach or something like that. 75% of doctors said they would never ask for help. 75%. That is an astounding number. That they would never even reach out to anyone. 

Howard Farran: Jen is that also because what percent of dentists would you say are introverts? Is that also a theme with introverts? What percent of dentists do you think are introverts? 

Jen Butler:          I don’t know that number I would say the majority. I don’t know the number, but I would say a majority. 

Howard Farran: Is this also a comorbidity problem because they are introvert and they are a dentist or? 

Jen Butler:          Not necessarily. Extroverts might tell a lot of people. Introverts might go to a study club and share with their study club group. Introverts would share one on one. So they would share with at least one other person. But we are talking about they wouldn’t tell anybody. 75% is an astounding number. 

Howard Farran: For the men what percent of their wives would you say they know. They just are in denial? 

Jen Butler:          I would say 100%. The wives that I talk to and when I work with clients and when I go into offices I like to talk with the office – I ask to talk with the office manager and the teams and the spouses; whether it be a husband, wife, partner, girlfriend whoever is your significant other. Because going through stress management if you have some depressive issues, if you are indifferent, if you are in burnout, if you are in denial you need a supporting network. And I like to be able to give the extended – immediate network support and give them some information. 

Howard Farran: Another thing – don’t you think a lot of dentists when their world is collapsing they just think if they just built the million dollar practice and had more money it would solve everything? That is just chasing the disease. 

Jen Butler:          That’s right. And it’s suffocating the disease. It is burying the disease. That will always come up. It is like an infection – it is like a doctor looking at a patient who has a small infection but the patient doesn’t feel any pain. Saying hey that is going to hurt you some day. Or this you have a small cavity. Oh, it’s small I don’t want to deal with it right now. You know that a cavity is going to turn might take years, but it is going to turn into a painful abscess, right? Same thing with stress management. We can’t see the sore. We can’t see the infection. We can’t see it, but it is there. I always equate it to periodontal disease. Patients can never feel it, but there is an infection going on. 

Howard Farran: Alright. So what would number three and four would be? What is three? 

Jen Butler:          Forgetfulness. 

Howard Farran: Okay. Loss of concentration was two and three would be forgetfulness. Now are you talking about the forget-me-nots or forgetfulness? And what was four? 

Jen Butler:          Loss of focus. 

Howard Farran: Loss of focus. Okay. I also think another comorbidity is they think well if I am a doctor and I am successful how could there be anything wrong with me. Answer that. I want to get back to denial is not a river in Egypt. I want you to punch harder between the eyes about – convince this doctor that it is too much. He needs help. He needs stress management. Let me tell this – I think a lot of doctors they might not want an office manager because they don’t want anyone to find all the problems in their office. They just want to live in tis delusion that I would rather just bury my head in the sand. I am afraid a consultant is going to come in. This is what they don’t want to hear – this is the most unorganized office in all of Alabama and you’re a loser. Or they would just rather not deal. They don’t want to find out how bad the problem is. I am the opposite. I believe in total transparency that if you have a problem just taking it out of the closet and presenting it to your whole team now you got your whole team working on it. That has always been a big deal. When you came in Laurie was telling me – Laurie runs my company – she was telling me you were working on issues that me and Laurie didn’t even know existed. You impacted so many different teams or we didn’t know it was an issue. In fact, Laurie and I were talking the other day we think we want to have you come back again just to focus on one team. Instead of everybody we want you to work on one team. Email me on that. We do want to do that. 

We are half done. We are 30 minutes down. Give them more stress management tips. Some more stress management tips – go where you want to go. 

Jen Butler:          You want to say punch them between the eyes. If you got that doctor that is sitting there in denial thinking that the answer to his or her prayers is just if I could just have the million dollar practice. If I can hit to 2 million, 3 million. If I could get to that second practice, multiple practices whatever that next thing is that that is going to be the answer to their prayers. Unfortunately that is 100% again a myth. It is cultivated by the culture that there is in dentistry when you go to study clubs or when you go to conferences people are leading with well how many offices do you own and what did you do this year and what kind of X-ray machine do you have. Or oh this is what I am doing in my office. Are you doing mini implants or are you doing – it is always the one upmanship. And it is so superficial. And that’s fine. That culture is fine. But it is about creating a balance. Where then do you go where you can really talk about – I don’t identify them as problems. I have a mantra actually that there are no problems only opportunities. I really do believe that that there are no problems only opportunities. As a matter of fact I have talked about it with my children so much my son got it tattooed on his arm in my handwriting. Because I truly do believe that. 

When you are walking to your office and you see an opportunity the more opportunities you can identify that creates a positive perception about problem solving and – 

Howard Farran: She is frozen. 

Jen Butler:          I can’t see you, Howard. 

Howard Farran: You can’t see me? Well, then you are a lucky woman. 

Jen Butler:          There we go. 

Howard Farran: All women when they meet me say will you enhance your appearance by either turning the lights out or putting a bag over your head. 

Jen Butler:          I don’t believe that. 

Howard Farran: Me being a dentist and hanging out with these guys forever – no offense to the women I just think the men dentists have a much bigger problem with this. Is that a fair assessment? 

Jen Butler:          It is a statistical fact. 

Howard Farran: Yea. The men have a much bigger problem. So now I know the second thing men are going to say. First about the embarrassment of it. I had a consultant the other day tell me that she is always amazed that a lot of dentists are too embarrassed to have a consultant come in their office. She was telling me that the most successful practices in the world – in fact, I remember one time I was having dinner with Jerome Smith who has probably got the number one most efficient implantology practice. He is in ___ and we were sitting there having dinner he was talking about a consultant coming into his office and the guy said why would you have a consultant come in your office? He goes that is why I am successful. I have one in every year. Every year there is someone – I have never had a consultant that didn’t come in and generate a return on investment and what you see here is 30 years of a consulting visit every year for 30 years. We had you come in and all that stuff. 

I am going to get to the second thing I know a dentist is going to say; Jen it ain’t me. You see the five ladies over there they are crazy. They are nuts. I would be stress free. I would never throw an instrument. I would never have to go home and drink a beer if it wasn’t for those five crazy ladies. And Jen, sometimes that might be true. So talk about that. Is my stress causing them to be crazy? Is their craziness causing me? We are half done. Move into HR. Move into HR. Because there is a team here. I am getting ready to have a crazy party next week because my sister is getting married. I am going to have the honor of having all five – my mom, five sisters and my brother in the house. That is always a crazy day. How much of the crazy is caused from staff versus dentists? How do you know the difference? How do you deal with the comorbidity of crazy staff versus crazy doctor? Talk about the HR. 

Jen Butler:          Well, staff, team issues is the number five stressor in a dental practice. They are the top five. And the team issues are – 

Howard Farran: And it is number five. Five after the four you just gave me? 

Jen Butler:          No. 

Howard Farran: Now you are going to have to go through all five to get to – 

Jen Butler:          That’s fine. The number one issue is time pressure. 

Howard Farran: The number one okay what is this list called? 

Jen Butler:          This is the top five stressors in dentistry. 

Howard Farran: Top five stressors. Number one is time. 

Jen Butler:          Time. Time pressures. Always running late. Concerned about running late. Having too much time on their hands because they don’t have enough patients on their schedule. Too much patients on their schedule. Working too much. Not enough time at home. Too much time at home so just time in general. 

Second is patient demands. So that patient it is too cold. It is too hot. They want nitrous. They want gas. They need a bill – they have complaints. So just patient demands. 

Uncooperative patients is number three. So children, patients that are older, patients with significant sensitivities. Those types of patients. Uncooperative. High fear patients. High fear patients is in that group as well. 

Then number four is the significant – it is the aches and pains and the concentration that dentistry requires. Over 92% of dental professionals work in some sort of pain every day. 

Then the fifth one is team issues. 

Howard Farran: So did you want to – can we go to five or do you want to go back and talk about one through four? 

Jen Butler:          It is up to you. 

Howard Farran: I would like you to skip the first four and go to five because it is my belief that the most complicated part of a family or the business is the people. I just think people are amazingly complex. In fact, I think it is amazing we went from living in a cave to landing on the moon. How did these crazy monkeys ever get to the moon? They are crazy. With a capital K. I know I’m crazy. We are all crazy. And everybody is complex. There are areas of your brain that might just be perfect. I look at a brain like a bag of ping pong balls. And you might have perfect ping pong balls in this category and maybe tennis and root canals. And you might have missing ping pong balls in other areas. I would like to talk about HR. I think if you have the right team and it is harmonious and functional it makes everything so much easier. 

Jen Butler:          Here is the thing – this is a test – not a test but here is an activity that a dentist can do. Look back and on those days that he or she is out of the office. I know you are focusing more on the male. The day that that doc is out of the office how does the team function? Does work get done? Does AR happen? Do patients get scheduled? Does the daily business – does the mail get opened? Are there fights? Is there drama? Now let’s bring back in the doctor. How does it look on the day that the doctor is there? So that is a great activity to do. 

Howard Farran: Can I add one thing to that? 

Jen Butler:          Yea. 

Howard Farran: I can’t even count the times in 27 years when someone was gone for their week vacation and it took about three days for everyone to sit down and say god, I was wondering why these have been the three greatest days in the last year. And then finally I realized because crazy is on vacation. And I am talking about associate male dentists and I am talking about female staff. And that is a great eye opener. Like god, that was the best week I had this year. I think it was because that person was on vacation. 

Jen Butler:          When you look through Dental Town or you listen to some speakers they say fire quick. Don’t tolerate staff that is crazy or doesn’t work hard or whatever. I am not necessarily a proponent of fire quick. I am more of a let’s fire right. Let’s hire right, fire right because it could be the doc. It could be that the doc is sitting in his office not engaging with the team. It could be that – and I consult in offices as well. I have been in hundreds of offices. I have witnessed hundreds of huddles. I know what it looks like when the doctor doesn’t show up for huddle. Doc shows up 20 minutes after the first patient has arrived and just kind of comes in and takes the path of least resistance is what I say. That is going to upset some team members. What comes first that is hard to say. What I do know is firing all your staff because they are stressing you out is not the answer. It is just not the answer. You may need to fire one person. Maybe even two, but then you also need to balance that out by learning how to hire right. 

Howard Farran: Here is what – a lot of times when I lecture the doctor is out there at a booth looking at some DO and some assistant they always come in twos. They never come by themselves. Lecturing 1500 times men goes pee by themselves at the break. Women always have to go potty in twos and they always have to come up to me in twos or threes. This is the most common thing they will say – they will give me several examples and say well, when we have to remake a crown the dentist goes crazy and the lab man says that he deals with 15 doctors and he gives the worst impressions. But everybody is afraid to talk to the doctor. So then they come up to me and say will you talk about crown preps and this and that. I’m like well that is a band aid on a problem. I told my lab people up front back in 87 when I had to reimpress one time by the way are my crown preps really good? They are just afraid. They are afraid if they  said no, dude you graduated a month ago and you are horrible. I said I want honest. I want honesty. They said well you need to come down here. Then I started looking at the preps. I think a lot of the problems or I will ask you – you are more of an expert on this – what percent of the problems don’t come out because the staff doesn’t feel safe to communicate to the doctor? Or they  might have fear that if I say this the repercussion is well there is the door? 

Jen Butler:          It’s interesting. I just read a study done on office managers of dental practices. Now this was not a study done in the US. This was actually a study done abroad in the UK where 97% of the office managers said that their doctor led by fear and intimidation. 97%. That is a huge – and what I think becomes a misperception is that intimidation and fear to illicit that response in somebody needs to be that you call them names or that you yell or that you stomp down the halls or something like that. That is not the case. Intimidation and fear can be equally created in another individual by just not talking to them. By walking down the halls and not addressing them. By not showing up for huddles. By asking why questions. Asking why questions elicits fear and intimidation because just the semantics of the word why in the English language requires the other person to justify and/or defend. Doctors being analytical and fact finders they gravitate towards the why questions. So when you are talking about complexity in people you are absolutely right. One of the things I speak about a lot is that some things that create stress or tension or friction is really just people being people. Like doctors are analytical they are going to ask why questions. They are going to want to know the facts first. It is not personal. It has nothing to do with you. When a team knows that they can go oh okay I can accept that now. It is the not knowing. It is the understanding that they then misinterpret as they are coming at me. They are attacking me. I need to defend myself to them when that is not the intention or the case. 

Howard Farran: And even in clinical it can be upsetting when ____ that filling we did. Well okay who is we. There are three doctors in here. So yea, doctors like facts. I would rather they came out and say this patient, tooth number 30 in the order. Don’t start telling me ____. Dentists are a tough breed. 

Back to the team members. I am a dentist. I got staff. What do you do – here is a common scenario – I am in a small town, Jen. I always think of two different Americas. And there really are – there are multiple different Americas. I like to think of the United States like Europe. Because no one in Europe would compare Turkey to Germany or Spain to Portugal or Italy to France. And you can’t compare Louisiana to San Francisco or Anchorage to Wichita. America is a dozen different countries flying under one flag. And then number two we got two thirds of the dentists in 117 towns over 100,000 people the big urbans. Then we got the other third of the dentists in 19,022 towns and this is what the dentist tells me all day long: Okay, Cheri has been here 12 years. Mary has been here 17 years. They hate each other’s guts. They are at each other’s throats all day long. And I swear to god if I fire one 4,000 people are going to know it tomorrow and then the rumors are going to go. Get me a beer. 

Jen Butler:          Right. What do you do for that guy, right? First of all, it is about taking training in communication. Feelings are irrational. We can get over feelings. The words I’m sorry, I forgive you have a lot of power behind them. It is almost like a magic eraser sometimes people with the words I’m sorry. I didn’t mean to. Our own sense of responsibility in a relationship. I would be hard pressed to ask or find a dentist that actively pursues taking training and even taking their staff to trainings that involved in communication, team building, problem solving those more soft skills per se when it comes to business. A doc will certainly pay a consultant to come in and do process the systems that are going to make them more money. Get case acceptance. Do more high production. How to sell implants. Something that has a tangible price tag. When it comes to those ethereal soft skills approaches to team building that has – it is difficult to track the ROI on that. Doctors are not necessarily inclined to invest in those. Even a Townie meeting or WRDC meeting here in Phoenix. 

Howard Farran: Tell me this – on your 60 articles which every single one of them afterwards the message board just lights up. There are more comments and replies after all your stuff because we track all that stuff. It is frustrating when you are the owner of the magazine and you are third behind you and the other bald guy, Doug. I always joke don’t publish any of her stuff I want to be the winner that month. Would you recommend should they start maybe a Friday where they read them together? Would you want them to read them individually? Was this a team project? Because I like to do a lot of luncheons where we just send someone to get a bunch of pizzas and sub sandwiches and we will just spend like of the hour – I know they got to check their Facebook and call their kids. So on a luncheon like that I say I’ll buy your lunch. I just want half your time. 15 minutes into it go check your Facebook do whatever. Let’s talk for 30 and they got 15 minutes to go play. I will buy lunch whatever. Do you recommend reading your 60 articles individually or together in a luncheon to decide if they need to call you and bring you in? Or where to go to get a diagnosis and treatment plan? 

Jen Butler:          Reading articles is a great start. I also blog. 

Howard Farran: Together or individually. 

Jen Butler:          Absolutely together. Because you know what? I hear that a lot with docs that say I have a team issue. You know what, I buy them lunch once a month. Okay that’s great, but what do you guys do at this lunch? And they talk about the things that they feel comfortable about and they ignore the elephant in the room. So buying lunch or having lunch with your team doesn’t address the issues. You have to plan on okay once a month or even once a week or actually what I do is and I will be happy to provide it free. Actually, I think I have it on my website but we can attach it to this Skype if you have that capability. Is I have what I call a business agenda. I don’t call it a morning huddle. I call it a business outline to kind of have that – I like patient centered, business oriented where it actually talks about the first three things they talk about is what team communication – miscommunication happened yesterday. What worked well for the team yesterday and how are we going to overcome anything today. So the first three things they talk about are around team. Because if the team doesn’t communicate it doesn’t matter how many patients are in that building. 

Howard Farran: And why I think it should be a team is because a lot of times in my seminar I try to make it as interactive as possible and I will say raise your hand if this is not an issue in your office. I will say something and the doctor raises his hand and then all of a sudden his assistant will take her napkin and throw it at his head. Like are you kidding me? You just raised your hand? And the doctor like has no idea that this person that has been sitting next to him in the same operatory for eight years feels exactly the opposite of what he just raised his hand to. Complete oblivion. 

Jen Butler:          Exactly. And part of that is having to do it and actually we have eluded to this a couple of times is that curse of perfectionism that runs so rampant in dentistry. It is cultivated in dental – well, it is cultivated at a younger age when even your four years of undergrad you have to be perfect or strive for perfection just to get into dental school. Then when you are into dental school your instructors have no problem putting you down if your margins are off just by the slightest little bit. We are talking millimeters. It really fuels that idea of perfectionism. If anything isn’t perfect. Anything including the team, the communication, the margins, the crown preps it doesn’t matter. If anything isn’t perfect it is a hard pill to swallow. It goes against the grain of who a dentist is. 

Howard Farran: You know what ____ the older guys that would classify patients A, B, C, D and F when I have seen dentists throw an instrument before because his margin wasn’t quite right. He was running behind. And the patient hasn’t had a cleaning in three years. Came to the office with a 64 inch thirst buster. I am like this person doesn’t give a crap. You know what I mean? And he is drinking a Coke in a dental office operatory which is like bringing a bong to church you know what I mean? And why are you stressing out on doing C acceptable dentistry on an F patient. Now if Jen Butler was in my office or a dentist – I work on a lot of dentists yea, I would get it right and I would nail it because that guy really values it and will take care of it. But you shouldn’t be stressing out on clinically acceptable dentistry on people that don’t give a rats rear. In fact, the other joke in our office is every single person who has ever asked me about how much radiation are they going to get from the X-ray had a pack of cigarettes in their pocket. I’m like really. Do you even care? Who cares. 

Jen Butler:          It is the perception. Unfortunately it is perception of what dentistry is in the patient’s mind. 

Howard Farran: So, Jen, I only have you 10 more minutes. You said something profound I had never heard before. Hire slow, fire fast. You say hire right, fire right. In the last 10 minutes any more tips on HR? The dentist he has got five people. They are stressed. More tips on how to handle this. And they also tell me this they will tell me at the bar god, I just wish I could tell my hygienist blah, blah, blah, blah. Dude you give her a paycheck on the 1^st and 15^th. You can tell me at a bar but you can’t tell your hygienist? How come I give this person money twice a month and I can tell my friend Howie and I can’t tell my hygienist? What is that all about. 

Jen Butler:          Well, first of all it is that perception that doctors don’t think that they can be part of the crowd, be part of the team. Being a leader somehow separates them from the team. That notion is an incorrect perception. Being the leader means that you are the biggest part of the team. Not that you are separate from the team. Team members talk. Colleagues talk. Everyone – I always like to imagine or I always talk about that teams are a circle they are not a pyramid. Everyone has a piece of that pie. Everyone has a piece of that circle. Some have a larger piece. Some have a smaller piece, but everyone has a piece. And if one – if it is a bicycle wheel circle if one spoke is broken then that wheel is going to fall apart. You talked about team issues. The first thing that – I have a step process on how to hire right. First of all screen lots of resumes over the phone. Have predetermined questions that you are going to ask over the phone to do a prescreening. And part of those questions needs to be about how do you work in a fast paced office? How do you work in a slow paced office? The doctor of the office manager whoever is taking those resumes has to understand the environment in which their office works best. Some offices that I consult in they work best with a slower schedule because they get higher pace acceptance. Or that their patient base has higher production that is needed. So they work a little bit slower. With other offices they work at a faster pace because their patients are maybe more affluent, have better oral care so they have more patients on the schedule. It is important for that doctor and the office manager to know how does their office environment work best? How are they the most productive and efficient? And then screen people based on that over the  phone. 

So second is have several in office interviews. Several. So at least two, better three. First with the office manager. Second with two to three team members; the dental assistant, the hygienist, the office manager again. And then the last person should be the doctor. 

Howard Farran: Earlier, an hour ago you had said that a line you cross in the sand when you need to raise your hand for help is when a doctor wakes up in the morning and says I can’t do it and just cancels the day. What are red lines that staff cross where you need to evaluate? She has crossed the line. I need to get a consultant. I need to talk. What are lines that staff do or sometimes people call them insubordination or – 

Jen Butler:          Talk back. I hear that a lot. My staff talks back or is snippy or disrespectful to me. First of all, that is an indication that someone has high stress. Irritability is one of the top three bodily responses that we have is irritability. 

Howard Farran: What are some more? Irritability or what? When you say top three my walnut brain instantly wants to know the other two. 

Jen Butler:          The first one people gravitate towards when they are stressed are sleep issues. Most people have some sort of sleep issues either because they just can’t seem to fall asleep or because they are worrying about or running through their mind what happened that day or they are tiring to problem solve while they are laying in bed at night. Sleep issues. The second is nutrition issues. They don’t want to eat or they overeat. Whichever way they gravitate towards and then irritability. 

Howard Farran: I still haven’t figured out by age 52 which is the better stress solver – a Twinkie or a Ding Dong. So I just eat both. 

Jen Butler:          There you go. See. Problem solved. 

Howard Farran: Irritability – doctors are complaining they are talking back, they are snippy. And some people some assistants their response is the cold treatment. 

Jen Butler:          That’s right. Or they don’t talk. 

Howard Farran: I am just not going to talk. 

Jen Butler:          Right. I’m not going to talk to you. The other one is that they are emotional they cry. Let’s be honest women have a tendency to cry more freely and more publicly than men do. 

Howard Farran: Do you think that is physiology anatomy or just culturally shaping? 

Jen Butler:          Well it is culture – every human cries equally at birth. All babies cry the same amount. Toddlers. It is a learned behavior that males have to hold back the tears and that girls or women it is okay to cry in public, right? 

Howard Farran: I did think that was weird at my dad’s funeral when all four of my boys said that is the only time I have ever seen you cry. I thought well that is probably not a good report card. 

Jen Butler:          This is one of the reasons why 56% of the American or 51% of the American population has significant stress is because we don’t as a culture we don’t let our feelings be known publicly. We always want to do things behind closed doors for a variety of reasons. Let’s get back to that staff. They are irritable, they are snippy, they are disrespectful. They are given the cold shoulder or they will write notes to the doctor instead of talk to the doctor or the other team members. They won’t stay for lunch. They show up only when they are – to start work. They leave immediately when they can punch out. They don’t stay around for chit chat. And they are emotionally – publicly emotional. They cry or something publicly. Those are some key indications that there is something going on with that staff member. 

Again, I am more about hire right. Fire right. I would want to have a conversation with this person. What is going on first? Are they having stress in their life personal life that they are bringing to work. Not to say that is okay and should be tolerated. Does she need to take some time off? To go deal wit things? Does she need to is there something going on within the office that we can support her by additional process and systems? Does she need more training in something? Going through training I have heard some of the most – I have heard you talk about it. I have heard lots of other speakers and consultants talk about it. I just was listening to a CD by J. Gaier in a doc’s office the other day where he was just hammering when there is issues, when there is problems, when there are opportunities the one thing that people typically don’t do is get more training, but the one thing they should be doing is getting more training. 

There are lots of great consultants. There is myself. I work one on one in offices around team and communication. I have written about it. Hey, excuse me I am talking here was an article we published last month or the month before that did really well. I know it has had a couple of reprints as well about how do you talk to your staff. 

Howard Farran: I want to do – I want to do your close. We only have three minutes. I just want to say this to doctors: I think Mark Cuban might be everyone’s hero became a billionaire. Bought the Mavericks. They did good. Now he is on ___ and he says something all the time that is so profound for dentistry. When they are presenting their charts –they haven’t done their homework when they say this around Mark Cuban. They talk about their exit strategy. And Mark Cuban says dude if you got an exit strategy your heart is not in this thing. And I always hear all of these dentists talking about I want to retire by 55 or I want to get out of there when I’m 50 and they are talking to your very good buddy and the guy I love to death Dough Carlson about that. How much money do I want to have to put away to get the hell out of here and retire and blah, blah, blah. I always think god, the happiest dentists I know were still practicing at 80. When I look at the retirement plan if you just worked two days a week from 60 to 70 that two days a week in income is more money than you could ever have interest off of pension plan. I always think if you want to retire something is wrong. And if Jen Butler can change us around – that guy said to me just last week he is like Howard I would rather be taken out in the backyard and beat with a belt than do a molar endo. I said dude they are call endodontists okay? Don’t do molar endo. I would rather do molar endo than play 18 holes of golf. I mean you’re Stevie Wonder, Ray Charles picking a lock and this three dimensional thing and it is just a mind trip. The number one thing I get after molar canals when I stand there looking at the clock I’m like oh my god where did that hour go? I thought I was I there for three minutes. If you can get Jen to come in here and make it so you want to come to work. 

It is the same reason with toys. I don’t like it when doctors bad mouth toys. I raised four boys and if I threw them in the sandbox and there was nothing in there they would get back out. But if they had Tonka trucks and pails and shovels they would play all day long. If a doctor wants a laser or a CAD cam or a CBC if he wants a toy give him a toy. Because if he is running 20 red lights on his way to the office to play with his laser awesome. And I believe that when you want to retire by a certain date that the best money you could get is have Jen Butler come into your office and figure out even that date you were talking about is five to 10 years off. So you are going to be miserable for 10 years just so you can get out of there? Why don’t you recreate your environment so you are with the people you like, you are communicating functionally, you are happy, you are healthy because the longer you want to play the dollars are going to stack up. 

And I will give one hero advice to this. I just talked to my buddy the other day Bob Ibson. He founded Denmat, he founded Rembrandt. He is 81 years old. He sold Rembrandt. I know I am not supposed to disclose the numbers so I am only telling Jim Butler everyone else cover their ears. It was a quarter of a billion dollars. He is 81 years old. You know what he does Monday through Friday? 

Jen Butler:          Goes to work. 

Howard Farran: Goes to work at the dental office. And he has got so much money he can’t really – so you know what he does? He just does volunteer dentistry on homeless people and girls in shelter where they sign a release. Hey I’m 81 and you didn’t give me money this is all charity. And he calls me and tells me about cases he did at 81 years old. I am going to ask you this question what percent of the dentists if they had a quarter of a billion dollars in the bank like Bob Ibson would just never go to their office again? What percent? Of the stressed ones. 

Jen Butler:          I can tell you that 22.1% of dentists right now, today are in complete and full burn out. An additional 31% are on certain burn out. So at least 50%, over 50% of the dentists practicing today are not wanting to go to the office. That I can for sure tell you. 

Howard Farran: And if you are at 50% I can vouch for Jen Butler. She is the rocking real deal. She is in my backyard. I know a gazillion Townies it will change your life. If you are in that 50% if you don’t call Jen Butler hell you gave your damn number say it again. 

Jen Butler:          623-776-6715

Howard Farran: You are the only consultant I can say a lot of consultants make dentists faster, easier, more efficient, high quality, but Jen Butler you actually save lives. 

Jen Butler:          I do. I do. I can say that honestly because my clients tell me so. Honestly. 

Howard Farran: Thank you for all that you do not only for dentistry and all you do for Dental Town but for saving lives in dentistry. 

Jen Butler:          Thanks, Howard. 

Howard Farran: Thanks a lot for sharing an hour with me on my birthday. 

Jen Butler:          I know. Happy birthday. 

Howard Farran: Alright. Have a good one. 

Jen Butler:          You too.