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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Fred Joyal co-founded the 1-800-DENTIST referral service in 1986. It's the largest dental referral business in the country, with over 250 employees and serving every state. 1-800-DENTISTS strives to be the best way to find a dentist, by screening dentists on an ongoing basis, and having more information on the practice than any other resource. Joyal has written over 100 television commercials, appeared in more than 25, and directed 20 of them; his goal is to create a single commercial that makes everyone in America want to go to the dentist immediately. Joyal currently lectures on practice marketing to groups of dentists around the country, focusing on building patient loyalty and increasing production by better communication, mindset and attitude. He published his first book, “Everything is Marketing: The Ultimate Strategy for Dental Practice Growth,” and just released his newest book, “Becoming Remarkable: Creating a Dental Practice Everyone Talks About”.

www.goaskfred.com

Howard: It is beyond a huge honor to be interviewing my buddy since 1987, I don't even know how many years that is, because I only took geometry, I never took algebra. You are dentistry's, you are like a Mogul media rockstar. Nobody in dentistry except for you spent a quarter of a billion dollars in advertising. Isn't that what 1-800-DENTIST has spent over its lifetime?

Fred: It's actually at half a billion now. 

Howard: Half $1 billion. If you took everybody you've ever listened to, and combined all the marketing experience they have, it wouldn't be a rounding area on the dollars that Fred Joyal has spent, a half-billion, and Google management was one of the best books I ever read, because they said, "I don't care what your thoughts are or how you feel, this is Google, show me the data," and Fred has seen more data from dental marketing and advertising. You've seen a half-billion dollars worth. I mean you're just a legend, and then you wrote a book about it.

You wrote a book, Everything is Marketing, which I swear to God is the only book in dentistry that I went back and reread again. The only other books were some Pulitzer Prize ones, the Rise of the American Healthcare Industry written in 1984 by Paul Starr, that was a classic. Guns, Germs, and Steel, 10 years later, I was smarter and I wanted to go back and read that. 

You're the only guy who ever wrote a book that I actually went back and reread, bought copies for all my staff, and now you just came out with another book that just flippin nailed it, that marketing really has to do with becoming remarkable, creating a dental practice that everyone talks about. Damn Fred, what are you going to do for an encore? What could you do next? Are you going to run for president? 

Fred: You've trumped me, so I can't start a whole podcast thing, so I'm going to have to slipstream on you this way. 

Howard: Actually you should podcast, because my number one complaint on podcast, the number one complaint that I hear all day long is that you don't do enough, I have an hour commute to work, an hour ... I was doing a couple a week, and then I was doing one for their commute to work, now I'm two a day, or one for their commute, and one to come home, so I do two a day, but that's only Monday through Friday, and I get emails all the time, "You should do some for the weekend." 

On Dental Town anybody who has a podcast and up load it, I can't believe a dozen people have, I can't believe some broadcasters don't do it, they're crazy, because they'll put it up on iTunes for free, why wouldn't you put it on Dental Town for free when there is 205,000 registered dentists? Everybody who has put their podcasts on Dental Town, said their iTunes downloads exploded, because it's marketing it's free. 

Fred: It just goes back and forth, sure.

Howard: Yeah, so when I started Dental Town it wasn't howardfarran.com, and it was all about the community, not me. When I started these podcasts I try to push out and share everybody. I've been on Gary Takacs four times, Thriving Dentists, I'm scheduled to be on Dental Hacks I think Friday. Yeah, I think podcasts are the fastest growing, because they are high-quality, low-cost, they are free, and you can multitask. Where else can you learn while you're driving to work?

Fred: Yeah, people like to listen, and you bring a lot of energy yourself when you bring in high-energy people, it gives them something to think about and jump starts their day. It's incredibly valuable.

Howard: Fred, I started with you in 1987. You actually got me in trouble. I joined 1-800-DENTIST, and took a full-page yellow page ad out, and got a free dinner from the executive director of the Arizona State Dental Association, his name was Craig McFarlane. Who spent the whole lunch telling me how I'm demeaning the profession, this is cheap, if you had cancer Howard would you go to the Yellow Pages? If your wife had breast cancer, would you go to 1-800-BREASTCANCER? Blah blah blah blah blah.

I stayed with it because I was getting 100 new patients a month between you two, between the Yellow Pages and 1-800-DENTIST, it was a cash cow. I still can't believe people ... Then when people tell me, "Oh, that doesn't work." I'm like, "Dude, my friend Mike Dotola was on a waiting list trying to get on 1-800-DENTIST during the entire length of his practice. He signed up the first day and a decade later ..." Nobody that bought it would quit. I mean your repeat business is off the charts, so I don't even know ... 

Then you're also the Steve Jobs of dentistry, not only because Steve Jobs said, "You're not a leader if you're not an innovator," and everything you've ever done was not a me to project. Everything you did was complete innovation, built from nowhere, and then the company that bought it, Private Equity in 2010 squeezed you out like a Steve Jobs, and now you reclaimed back your company.

It's basically parallels to Apple Store to the tee, especially the part when you're doing acid in the '70s at a Grateful Dead concert.

Fred: Is that documented, I didn't realize that? 

Howard: I read that on Wikipedia. Fred, God dang you're a legend, where do we even start? I want to start with, I know you probably don't want to start there, I'm going to start back with how is it coming back to 1-800-DENTIST and taking the reins over? How is that business? Is your brother Ron, is he back with you? Did he go somewhere else?

Fred: Yeah Ron came back too.

Howard: Ron, I love your brother, and I love my brother. Ron is the coolest brother next to mine.

Fred: No, I appreciate it. I needed somebody with that much of a depth of knowledge of the culture, and Ron was very much the heart of the business. I am the brains and the visionary driver, but Ron was the man who could make it happen every day, and they trusted him, and they trusted him also to keep me under control, but it's been very exciting to come back knowing that we had drifted away from our core values, but everyone here was just eager to snap right back into them, and put the dentists first, and their success first. 

We're basically going through and reengineering the business, of course you have to adapt to the new environment, because television advertising which used to be 95% of what I did is now less than half of what I do because so much stuff happens online, so much of the consumer behavior is evolving, and that's a lot of what I talk about in the book, is that ... 

Howard: Which one?

Fred: ... These generational changes, in the new book Becoming Remarkable, the reason it's called Becoming Remarkable is because I mean that word literally. That you need to become a practice that everyone can't resist talking about, because when they talk, they talk with their thumbs now, and it becomes likable, and searchable, and shareable, and undeletable. It lives 24/7 on the Internet, and so you have to create this experience that people want to talk about, and that's why I call it remarkable. It also means you need to be remarkable, you need to be an amazing practitioner with an amazing practice.

Howard: Fred, I remember you telling me the only thing I was remarkable at was how unremarkable I was. 

Fred: I didn't say that, but I meant to post that online somewhere. It's a perfect tweet. 

Howard: Fred, when anyone emails me anything about the podcast, I always reply back and say, "Tell me your demographics, I'm just curious. Age." They are all kids, they are all under 30, I don't think there's anyone listening to you right now that's probably over 29. Tell them what they may might not know even what 1-800-DENTIST is, they might not know how it works. I know you and I would think that is crazy, but there are a lot of kids who might not know.

Fred: I meet people all the time. It's a nationwide referral service where we run advertising in all media. Whatever media that works, but what we do is we bring all of those callers through a live call center that operates 24/7, and we filter out the people that we can't match with any of our members, and then try to do the best job of matching them with a dentist that they're going to go to on a regular basis.

We get everything from emergencies to new movers, to the main portion of them, which is procrastinators and neglecters, which are great patients. They are just looking for a great dentist, and they haven't found one.

Howard: Those are the patients that are only compliant with their noncompliance.

Fred: Yes. They unsupervise neglect themselves. 

Howard: Let's talk about that. That's one thing I get frustrated with some of my best friends from dental school, is they always badmouth this person that hadn't been in the dentist for five or ten years, and they show up and they didn't have an appointment, they want in today, who are these pigs who haven't taken care of their teeth for a decade? I'm sitting there thinking, "Dude, a fireman would rather go to a five alarm fire then your hay in your shed got caught fire because of your turtle warmer. A policeman would rather catch someone who's a mass murderer then go arrest grandma for jaywalking." 

I love ... The number thing one thing I love in dentistry is pain chair, emergency chair. We have an emergency operatory that's never scheduled, so anybody can walk in, they call in, they come down, and it works perfect too, because usually a lot of times it balances out a no-show or a cancellation. Why do I like emergencies? Those are your biggest treatment plans, my God, as opposed to Mrs. Whimpleton whose came in every three months since she was born, and flosses three times a day, are you kidding me? I've never done a book a buckle pin on her. I want your worst patient unless it's under three and crying.

Fred: Certainly the dentists who have succeeded with us over the decades are the ones who are willing to see emergencies, because they know that they're going to give them not just get out of pain, but they're going to give them a great experience of dentistry. The reason they've avoided the dentist is they never found one that they wanted to go to, and when they suddenly find that dentistry has changed, or there are practitioners who not only have great hand skills, but a great environment and actually care about you, and that they can trust, then they start going and accepting real treatment, and they are neglected.

I never met an emergency that didn't need $1000 worth of dentistry. Now could they afford it? All of them? Maybe not, but if you're in an emergency, you need some work. You don't need a Prophy. 

Howard: You know what upsets me the most about my homies is that there are nine specialties recognized by the ADA, Ortho, Endo, Perio, and they always want to talk about Ortho, and Endo, and Perio, and they always want to talk about that implant should be one, or dental anesthesia, but they never want to talk about dental public health, and 8% of all the emergencies in the emergency room hospitals in America last year were for dental pain, because if it's a Sunday in Phoenix, you're better off getting in a car wreck or breaking your leg, because if you've got a toothache, you're not going to find a dentist. There's going to be no one open.

Fred: It's a huge problem. 

Howard: It is a huge problem, and did you hear what happened in Australia? The Australian government got mad at this baloney going on in Australia for years and years and years, so they started this big marketing campaign to foreign dentists. They said, "Do you want your license in Australia?" They had 10,000 dentists, and a year later they let in like 1600, and the dentists are all screaming and moaning, but when I was talking to non-dentists in the bar, they said, "Oh yeah, finally now there's a dentist open on evenings and weekends, and it's so much better, you don't have to wait a month to get in." 

I fear that there is no sympathy for dentists from my senator, Sen. John McCain. All they hear about dentists is, "You can't get in, after five they're gone. They're not available on weekends." 

Fred: Right, you can't get a hold of them after hours. If you get an emergency, you get their service. 

Howard: This exploding Obama care cost, they're looking at the data that 8% of emergency rooms are dental related. 8%, that's one in ten.

Fred: It costs three times as much to treat somebody in the emergency room for dental work, and they don't solve the problem most times. 

Howard: Right, right. It's a lot of money.

Fred: It's triple the cost, and it falls right on the county no matter what. 

Howard: Specifically, this is dentistry uncensored, so how much does this cost this 1-800-DENTIST? Tell me how do I join, how much does it cost, what is my return on investment?

Fred: We run between $500 and $2000 a month depending on where you are. The ROI, usually in the first year is about 3 to 1, and then after that it's 5 to 1, and that's basically on ... What happens is people start producing more in the second and third year, and I've had dentists who leave 1-800-DENTIST, and they're still at 5 to 1 two years later, because they're still doing work on the people that we sent them two years ago, and five years ago.

The factor that a lot of people don't think about is, when somebody comes from advertising, comes from me, is they connect you to a whole new group of people. Your word-of-mouth patients come from your patience. Somebody who comes from advertising taps you into a whole new social circle, whether it be friends, family, and coworkers. A really good practice should be getting five word of mouth patients from every advertising patient, so even if you weren't getting 5 to 1 from me, if you check the next level of referrals and word-of-mouth, you would be getting way beyond 5 to 1, and I've had dentists that have done this year in and year out.

The ones who actually track their results, they never quit because the numbers are there. Of course they're going to have no-shows, and they're going to have people who come in for emergencies who do minimal work the first time, that's part of the game. Dentists keep wanting the cream. They come to me to, "I just want the really good patients," it's like I keep saying, "Cream comes from milk, you need to get the milk and decide, grow the patient's from the people that you get in," that's why I want them to see emergencies as any much as anybody else.

Howard: I spent five weeks down in [inaudible 00:14:42] Pain Institute, and the first hour I got in this huge argument with the director Oren Becker, who I love and respect and I went through all the pain institute, because I wanted to learn how to make a Mercedes-Benz, but his opening deal was, "You want to build practice with these A patient's." He described the A patient's, and not so much the B, then he described the C, and the D, and the F, when he got to the D and F, he just described the entire Farran family pedigree from Wichita to Parsons Kansas, and I'm like, "What are you saying? There's as much money ..." Would you rather own Ruth's Chris, or McDonald's? 

Fred: Yeah, where's the gross income? 

Howard: I think it's gross when a doctor prefers a higher income, higher educated patient instead of any of my uncles, or cousins, or nephews, or nieces do you know what I mean? Why a doctor ... It's like when doctors listen to the insurance people, then where are Americans going to go when they need a doctor? I'm the doctor. I'm representing you, and I don't care what your background is, your education, your race, your religion, and most of my full mouth cases are done one tooth a year over the next 10 years, and there's nothing wrong with that. 

We'll deal with the one that's worse today, and then next year we'll do the next worse one, and we keep them fixed, I've been keeping them fixed up for 28 years. 

Fred: Yeah will that's what happened sometimes with us, is they'll get a patient from us, and because they're trying to make the ROI right way, they overdiagnose right away. They try to convince a classic neglecter that everything has to get done right now, and the person just doesn't believe it. You destroy your credibility, because they're not going to die if you don't do full mouth restoration that day. They've neglected themselves for 10 years, so build the trust, build the relationship, take them out of immediate discomfort, and start to fix their teeth. You're going to be in practice for 20 more years. Treat them for 20 years. 

Howard: Fred I want you to talk about historically how marketing has changed. I remember when you and I met, the most advanced marketing was writing murals on cave walls, we were writing hieroglyphics, and so I want to ask you is Yellow Pages dead? How has it changed in the three decades that you've been watching it, and while you're looking at half a billion dollars spent measurements seeing what worked, and what didn't work.

Fred: Yellow Pages is pretty much over except in some very specific areas. They don't even put Yellow Pages in hotel rooms anymore. Google has changed the game where you can find anything you want by saying it to your phone, and Yelp has changed the game because people can get a review of anything they want, and so it's not just young people that are doing this, once you figure out how easy the Internet is to use, you use it. My 85-year-old uncle's online all day. This is a tool that gives you access and connection to information.

Howard: What would you say to the dentist who is my age that says, "Fred, Yelp, everybody who uses Yelp is under 30 and they only use it for restaurants. No old people use Yelp." What would you say to them?

Fred: This is one of the chapters of my book is when a person uses themself as the paradigm for what works, they are usually wrong. 

Howard: Self projection on the marketplace. 

Fred: Yeah. 

Howard: That's what everybody does. 

Fred: What do the statistics say, 60% of Google searches start on a mobile phone. 70% of people looking for a dentist will read a review about that dentist before going, even when I refer them on 1-800-DENTIST, they are looking up Yelp, that dentist on Yelp while I'm talking to them, and I can see the dentist Yelp … 

Howard: What's for common, a Yelp review, what's more impactful, a Yelp review or a Google review? What do you think gets more eyeballs?

Fred: I think Yelp gets more eyeballs right now. Google gets a lot of eyeballs, but they go to Yelp for reviews. They go to Google to find the doctor's website. 

Howard: I just need to educate my viewers, that one old guy listening that's over 40, Google is like Bing. 

Fred: Yeah. It's like Netscape.

Howard: Yelp is more impactful than Google.

Fred: From a review standpoint. Yelp is more successful at getting new patients I think, and we spent a half million dollars a month on Google ourselves, 1-800-DENTIST, promoting our dentists, so it's definitely very powerful, and it's obviously the only search engine that people are using at this point.

Howard: Can you advertise on Yelp? If you give them money every month does that help you on Yelp?

Fred: Yes.

Howard: It does. How could giving a site with honest reviews, how could giving them help me? It seems like a conflict of interest.

Fred: The thing about Yelp is it's all anonymous reviews, and there's no way that Yelp really vets those reviews. They let anybody write anything about anybody, and they don't take them down unless they are absolutely obscene, and even then, if they are half obscene, they leave them up, but they are in the advertising business just like Google. They get paid to feature people, so if you search Howard Farran in Phoenix on Yelp, you're going to come up, and there's going to be advertising for 13 other dentists in that page that they present you and your information. 

If you pay Yelp, then you come up alone with any paid advertising appearing on it. That's the big difference. Now does it work?

Howard: Let me pin you down, so are you saying that my listeners should advertise on Yelp, that that would be a return on their investment? 

Fred: This is my premise about all advertising, is you have to try it and track the results, and see what works for you. I know some dentists who have built their entire dentist on Val Pak.

Howard: Me, yeah I used that forever, until it stopped working. Every time we gave the guy $300, we'd get, and they sent them out quarterly, yeah it was always a return investment for about 10 or 15 years, but we measured it, and then it stopped, and we kept thinking, "Well something's wrong," kept doing it, it took about a year of using it when it didn't work.

Fred: My feeling is that if you can get a new patient, even for $100, $200 in advertising, you get a new patient, it's worth it. They're going to spend $20,000 over the life of the relationship, so track it and see. If you're spending $500 on Google, or on Yelp, or with me, and it gets you two or three solid patients a month, you're up. Every dentist is going, "I remember when I sponsored a softball league, and it cost me $200, and I get 50 patients," so that's their measurement. Everything is trying to meet that standard. That's a ridiculous standard. Is it repeatable? You want to be able to do the same thing over and over again and get the same results.

Howard: You said that 1-800-DENTIST costs $500-$2000 a month, that's a 400% variance, why does it sometimes cost $500, and sometimes $2000?

Fred: It costs me so much more to advertise in urban areas, and bigger areas.

Howard: Like New York City, than Wichita Kansas? 

Fred: In many ways it parallels usual and customary fees. In Beverly Hills, or Santa Monica, they can get $1200-$1500 for a crown. You try that in St. Louis, you'll go out of business, so it's just how much that varies, what the insurance company will pay, and what I pay for various types of advertising whether it's online advertising, or television advertising. 

Television advertising is the only model that's gone really bizarre, because the audience keeps shrinking, and the audience keep DVRing everything, but the cost keeps going up, so I've had to get more and more cunning in my approach to television as time has gone on. 

Howard: You know Fred, tell the young kids to the old kids what has changed in the television metrics? I've just heard some radical numbers about hours of television watching plummeting on kids under 30. Talk about television advertising.

Fred: Actually television, the teens and millennial's have their amount of network viewing dropped 25% from 2014 to 2015. 25% in one year. They don't watch TV on big devices anymore, and they don't watch anything in real time, so the advertising has to approach them at certain times, at certain events. There's certain types of shows that people watch consistently, and don't record them. News shows, morning lifestyle shows, the late-night talk shows, and some of them they don't even watch those anymore, they watch clips of those on YouTube. 

It's become a multi-device viewing scenario for many, many people, and television has to modify, television advertising has to modify. You can advertise on Hulu and Netflix, and all of those companies, but it doesn't yield like broadcast does, but broadcast ... The Super Bowl is $5 million next year, for 30 seconds, so if you're not selling cars, beer, or potato chips, it's almost not worth it, because that's not who the audience is. 

Howard: Last Thursday night my son Ryan and I were eating dinner, I was a judge on a dance contest raising charity for a shelter, and there were three judges. The other judge was worked on the Adam Sandler podcast, Adam Corolla podcast, which she said was the largest podcast, but anyway she was telling me all the data how podcasting is killing radio.

Fred: I believe it, yeah. The appetite for this type of content is ever increasing. There's way more people trying to improve themselves, hey and there's way more people trapped in their cars. You and I travel all over the country, what city do you go in that has no traffic at 5 o'clock? I haven't found one. People complain about LA traffic, it's like, "Hey, I've been in Dallas, I've been in Austin, I've been in Seattle, traffic is madness in all of these places." They can't keep up with the infrastructure.

Howard: As you get older, how many times can you listen to the Rolling Stones and U2, and Grateful Dead, and Red Hot Chili peppers. I remember flying 15 hours from New York to New Delhi to go lecture, and I listened to Gary Takacs thriving dentist podcast for 15 hours. That's far more brainiac and stimulating and interesting than just listening to music. You can't listen to music for 15 hours from New York to New Delhi.

Fred: Watch TV or movies. I think the energy when I watch three hours straight of TV is I've drifted into this dull alpha state as opposed to listening to something like this, or reading a book, or anything that's connecting me and stimulating my brain, rather than me being passively involved. This is actively engaged.

Howard: Okay Fred, so it's $500-$2000 a month, so it's closer to $2000 if you're in Beverly Hills or Manhattan, it's closer to $500 if you're from Kansas or Oklahoma. How many states are you in? How many dentists are there? What percent of the ZIP Codes is this still available? Is it like a real estate thing where the first guy who gets the ZIP Code, it's only that guy, or how does that work?

Fred: We are right now since I've come back, we are on an expansion mode because we're trying to increase our distribution, and we're actually moving more and more towards dentists who are have high-end technology, just because the demand is there from consumers more and more. I believe for example, I believe that CEREC, I believe single visit dentistry is the single best consumer advantage to get a visit a crown handled in one visit, versus two, is an enormous benefit, and so we have dentists all over the country right now.

We're in every state, we've only got one guy in North Dakota in Fargo, but the rest … 

Howard: I just found out he's in a wood chipper right now, only his leg is sticking out. What happened to that guy? 

Fred: Yeah, and North Dakota it depends on how Fracking is going. Sometimes they're so busy they don't need me at all, but we have over 3000 dentists now, and we're going to be adding another 2000 in the next year, just because we're broadening our distribution, and increasing our advertising every single month, and changing the medium and changing the message as well. I'm going at this business all different ways. We're going to make it so the millennial's they don't want to talk to anybody, a lot of them, so what's going to happen on 1-800-DENTIST, is they're going to be able to make an appointment directly right there on the website with the dentist of their choice … 

Howard: On the 1-800-DENTIST website?

Fred: … They want to do it one transaction without a human being.

Howard: You're saying on the 1-800-DENTIST, those customers can make an appointment at the dental office on your website?

Fred: That's what we're going to launch in January. We're building it right now.

Howard: Okay, Fred my job is to guesstimate what 7000 individual dentists are thinking in their car, and I'm pretty good at that because I've been on Dental Town like four or five hours a day every day, seven days a week since 1998. When you said patients want single visit CAD/CAM, some people almost drove off the shoulder and wrecked their car because you hear a lot of people on Dental Town saying, they don't buy it, they don't buy it. Now about what? 15% of dentists have bought a CEREC CAD/CAM? 

Fred: Yeah. Something like that. 

Howard: What would you say about 15%? The other 85% are saying, "Fred, show me the beef, come on this is a Wendy's commercial, show me the beef." How do you know consumers want single visit dentistry? Where are you hearing this from? What's your data on that?

Fred: From everything that we do when we serve patients internally, is that that ... The younger they are, the more convenience they want in general. They want better hours, they want to see the dentist last. When I hear a dentist say, "My patients don't mind getting a crown done in two visits," that is the most absurd thing to possibly say. Who could possibly want that. What human drive would that be to protract a dental treatment? Masochism I believe is that drive. Anything else is that's inconvenient.

The average person to get a Prophy done has to take a half a day off of work, because they don't just have to show up for an hour, they've got to leave work for an hour or more of driving, and so they need this time, and so any other treatment they need has to happen during work. Less and less people want to take time off from work, it's why dentists are getting killed if they don't have convenient hours, if they don't have early morning, evening hours, Saturday hours. All that's going to happen is the corporate dental office is going to open across the street, and have convenient hours and vacuum out all their patients.

Howard: Dentists are daft. Explain exactly what convenient hours are, because when you said that they were like, "Okay, well instead of being open Monday through Thursday, till 4:00, I'm going to stay open until 4:30 one night a week." What are convenient hours that you can prove that patients will reward you, you'll see more patients and collect more dollars if your hours are what compared to what?

Fred: If you open Saturdays that will fill up for three months in your schedule. It will book straight out for three months, and you can have them prepay for it, because what happens is people cancel on Saturdays more then they cancel other days a week, so you say, "Look, that's our premium time, in order to hold that appointment we're going to get your credit card for $200." "I don't want to do that." "Great, come in on Thursday."

Howard: What's the penalty on the credit card? You take their credit card number and if you don't show … 

Fred: I say, "We're going to hit your credit card for $125-$200 for the visit," if they're coming in for a Prophy, you're going to say you're just going to prepay the Prophy, you have to show up, or you have to let us know within 48 hours, or you lose the money. That's not true on Friday or Thursday, but it's true on Saturday because those are our premium hours.

Howard: Wow, that's cool, so if you miss your appointment on Saturday we're still going to bill you for the recall.

Fred: Right, and you know what? You don't have to do it. If it's a good patient with a good excuse you don't do it, but what you're trying to do is retrain your patients that your time is valuable, because they're used to disregarding it. They don't even think of you as a surgical suite, they think of you like a general physician who's just got a stack of files, and a stack of prescription samples, and an empty exam room. You've got a half a million dollar surgical suite that you're operating, and they don't see it that way, so you're retraining them.

The other times are evenings till 8 o'clock. Pick a night, Wednesday is usually the best night, Tuesday or Wednesday. Early morning, Tuesday or Wednesday, or Thursday. Coming in at seven versus nine, and watch how fast it fills up in your schedule, and that's what you're really testing. You test one, you let people know what's available, and you see how quickly it fills up.

Howard: Okay, how do you talk to those older guys. I'm 53, my assistant has been with me 20 years, I've got a bunch of women who have been with me for 20 years, and so they've been there a long time, they're making a lot of money, and they are spoiled rotten, and if I went back and told Jan she's going to have to stay out until 8:00 two nights a week because Fred Joyal told me, she knows who you are, she would probably be on the first Southwest Airlines plane to Los Angeles. What is a dentist supposed to do like me who's got a bunch of people who have been with them … For me a new girl has been with me since the year 2000.

Fred: That's one of the fresh employees, yeah.

Howard: What's an old guy do when you're telling a bunch of spoiled staff that works Monday through, I mean all mine start at seven, we're basically Monday through Thursday, 7 AM to 5 PM.

Fred: Yeah.

Howard: What does a dentist like that, should you get different staff for Saturday?

Fred: You see you're working that 7 AM works for you, and it works for your patience, and so most dentists if they're going to adapt like this, get an associate. That associate gets those hours, and there's some people, not every hygienist wants the bankers hours. Some of them want the free time in the afternoon, some of them want to show up at noon and work till eight. 

Howard: For the first 20 years when we were open on Saturdays, the Saturday hygienists and assistants were all ex-hygienists and assistants who decided to stay home and have kids, and they just wanted to work one day a week. Do you know what I found was the most interesting? They wanted to work one day a week sure because they're a hygienist, they want to keep their hands and it, they were an assistant, they want to keep their hands in it, but more than keeping their hands in it, and more than the money, do you know why they stayed with it and wouldn't quit working in it?

Fred: Why's that? 

Howard: They wanted their male husband to have to focus on the kids for eight hours. 

Fred: Fascinating.

Howard: If he was there, he would just be observing and watching college football and all that stuff, and that when she would come home from work Saturday at 5 o'clock, he was the most exhausted, said it was the hardest day of the week, and never ever while at work saying, "Well I work, and you stay at home," they made sure their husbands new how crazily intense it was to babysit kids all day long.

Fred: Yeah. They get the day off, they get to go in and clean teeth.

Howard: Yeah, and they had to change diapers, and feed them, they loved it, they said it was the best thing for a husband to have to do. 

Fred: That's great, and that's what you can tell them. If they say, "Oh no I've got all these responsibilities on Saturday, I can't work Saturday," and you say, "Try it and see what happens. You may start to love it." 

Howard: Fred another question we get asked all the time is … Okay so I want you to go back to macroeconomics from 1987 when I first met you, and started using 1-800-DENTIST, now it's 2015. You've spent half a billion dollars, where were you spending money in '87 versus '97, versus 2007. Where are you spending money now? The other question that everybody keeps asking me, "Howard is it different if you're in America," what 117 Metros, or half of Americans, and then 19,000 small towns, are the other half. Is it different marketing in a small town of 5000 in Eloy Arizona, versus the big Phoenix Metro, 3.8 million? Is that enough questions for one question? I like to get 10. 

Fred: It's a historical stream. We started on radio, we did radio alone for two years, then we switched television.

Howard: What year was that? What year did you start that?

Fred: '86 we started on radio.

Howard: No kidding. 

Fred: In LA.

Howard: Wow.

Fred: It worked extremely well, but the real breakthrough was when we went onto television in '88, and then gradually our mix shifted from 50% radio, and 50% TV, to 90% TV, and it stayed that way until around 2001, 2002, and we started to use the Internet and now TV is less than half of our spend and the Internet is the other half of our spent. Part of it is having a robust website, and getting organic search, what we call SEO, and part of it is paying for it to come up in search results.

What you're finding with Google now is that if you don't pay, you're not on the first page anymore. Google has figured out that all that real estate on the first page is for sale. If you're not bidding on a click, you generally don't show up on the first page. That's a big change really since April.

Howard: Wow, so if you're not paying, then you're not getting … What does that mean in the real world? Should you always be running a Google ad? What does that mean, how does a dental think? 

Fred: Really I know some dentists who their word-of-mouth is so strong, that they don't need to do any marketing or promotion at all, but they're becoming a rarity, whereas the rarity when I started was somebody who wanted to advertise. Now since the recession, dentists are coming to me, dentists who basically sneered at me and said I was destroying the profession for 20 years, they were on bended knee going, "I'll take emergencies, I'll take anything you have," because they watched their cosmetic practice collapse in on them in nine months, and so now what we're seeing is that you have to do, you have to have a website presence, you have to have an effective strategy to be managing your online reviews and generating online reviews, and you have to have a social media presence.

In each of those, you may or may not have to be paying to appear depending on how competitive it is in your area. It's getting harder and harder to manage, it's just like Google changes the game every three or four months, and Facebook is becoming a very powerful force in how people gather information. I just saw a study that said patients trust recommendations from their friends three times as much as they do on Yelp, and just like 20% shy of word-of-mouth. They trust 40% they trust Facebook, or 48% they trust Facebook, 68% they trust word-of-mouth, and 13% they trust Yelp, so they are seeing social media as a way of gathering information about brands and businesses that they want to use more, and more, and more. 

This wasn't true at all five years ago. Five years ago nobody would find a dentist on Facebook. It wouldn't even cross their mind, now more than half of them would be willing to do that, so this stuff is moving fast.

Howard: You are the fastest mover and the leader. Nobody has spent a half billion dollars advertising. For years everybody has been saying that the American Dental Association has been spending money on advertising, and now it's new point because they couldn't even do a fraction of the advertising that all the general dentists are doing. You've done more advertising in dentistry, and watching you more over the years, I think Mahatma Gandhi was talking about you when he said, "First they ignore you, then they laugh at you, then they fight you, then you win." You were at least two decades ahead of your time on all forms of marketing.

Fred: The AD itself, they spent four years trying to make me illegal state-by-state.

Howard: I know.

Fred: I had to fight them state-by-state, and instead of helping dentists grow their practice, they would take the dentist dues and fight me and buy politicians to try to outlaw dentist referral services.

Howard: Did they ever go back and apologize to you, or say sorry for all the harassment Fred, we really were complete assholes?

Fred: It never happened oddly enough.

Howard: Isn't that amazing?

Fred: No, and they wouldn't let me exhibit at the ADA for 10 years, because I eventually had the FTC give them a good bitch slapping for restraint of trade, and so the old guard didn't like that, so they wouldn't let me exhibit at the show, but now the ADA let's me put CE online, I exhibit at the show, and they don't talk about how bad advertising is, they just go back to taking money from people like that is their basic business model.

Howard: Fred back to specifically, you say you're not going to show up on page 1 on Google search if you're not giving them money, so how would a dentist give them money?

Fred: You bid on clicks.

Howard: Explain that, half the people don't even know what you're talking about. I mean really, when I go out to a bar and watch a football game with those guys, not one of them has ever read or seen a Yelp review, they wouldn't know how to … Do you want to know something funny? I lived in a house five blocks from dental school in downtown Kansas City for four years, these were my best friends for four years. I still love them to this day, I go deep-sea fishing, not one of them has ever got on the Internet, bought a book on Amazon. I say to my friend, "Well Craig if you want a book, what do you do?" "Well I go tell my office manager, I just tell her the name…" "When you go to the towny meeting, how do you buy a ticket?" "I just tell Anna and she ..." they are all enabled with secretaries. 

Fred: Yes.

Howard: It's one of the last professions where every dentist as a secretary. When they came out with the answering machine that was the largest job destroying technology in the last American century. Some 3 million secretaries got fired when they invented an answering machine, because that's all your job was to make take a message "Well I'm on an important sales call, or whatever." Dentists is one of the last industries where every lawyer and dentist still has one or two or three secretaries, so they don't ever have to buy a book, or buy an airline ticket, or do all this stuff, and so when you sit there and say, "Bid on clicks on Google," I know everybody I lived with in dental school like a deer looking at a headlight, like, "What is he talking about?"

Fred: Why did he start speaking Chinese? Yeah. It's basically the way Google works is you say, "I want to promote my website. I want my website to come in ..." When somebody searches for a dentist in my neighborhood, I want to come up. I want my website to come up in that search, my name. That's what it all leads to, your name is in there, and your address, and your phone number is right there in Google, and Google offers it up. You can just call the number, but most of the time people want to use it to connect to your website, so what you do is you're saying to Google, "All right, I'm going to give you $500 a month Google, and anytime somebody searches Dentist Brentwood, I want to come up, and I will pay up to five dollars every time somebody clicks on my link to my website," and so that's what I mean by paying for clicks. Somebody says, "Oh I searched dentist…" 

Howard: See I thought you said paying for chicks, and I thought that was illegal unless you work for the NBA.

Fred: There's plenty of websites for that too apparently. Then what happens is you will get ... They will tell you how many people clicked on your website, on your link in that search, and so you can also pay for other keywords, what they call keywords. You're saying Dentist Brentwood, that's one keyword, then your Dentist 90025, you're going to pay for the ZIP Code too if somebody searches that, because it's whatever they put in the search box. 

They may put dentist emergency, or dentist toothache, or cosmetic dentist, and you can bid on any one of those keywords, those phrases that people might search, and you only pay if somebody sees your name and clicks on it, and goes to your website or chooses to use that information somehow, and so every time somebody clicks, Google decrements your $500 account until it runs out in the month, and then they send you an email that says, "Your money has run out, would you like to spend more?"

You can decide whether you spend more or not. Now a click is a long way from a patient. It's somebody who just looked at your website, you have no information about them whatsoever, and so you're just relying on Google to say, "Oh, well somebody clicked 40 times on your website, and so your money is gone," but you may or may not have any patients, or may not be able to attribute those patients to the clicks. There's no follow-through, that's why my business is about I sent you this person, and ideally I sent you a dozen people in a month, and you get six or seven of them in, and four of them were very productive, and three of them were somewhere between flaky and procrastinating some more.

Howard: I know my dentists, and I really do, and people are always telling me, "Most dentists think this." Dude, do you know how many surveys I've done on Dental Town since 1998? I get about 300 emails a day for messages, or private messages, whatever, and I think the whole deal of consultants, I think what consultants don't get is that they are always afraid to go on Dental Town and give a course, or tell them everything they do, because then they think the dentist is going to do it and they won't need them. 

It's exactly the opposite, the ones who tell everything they're going to do, then the dentist says, "Okay I get it." It's like going to a restaurant. I want to know, "Are you going to make a cheeseburger, a pizza, fish, salmon," and then you lay out the menu, and then he says, "Okay, I'm going to buy this consultant, because I want the pizza, not the cheeseburger, or the salmon," and so a lot of dentists just listening to you just said, "Okay Fred I believe you. You've been doing this three decades, you spend $500 million on advertising, but I'm not going to do any of what you just said, who can I give money to to do this SEO and Google ad words," who do you recommend doing that? They hear all kinds of names, does your firm do that, if they were at 1-800 … 

Fred: We don't do that, because what we are is full service in that they give me a certain amount of money every month, and I send them a certain amount of patients. All of that, figuring out where to spend the money, and matching the patient … 

Howard: Do you know how much per head these dentists paying, and is it different from Beverly Hills to Omaha Nebraska?

Fred: It's different everywhere, and it's different for every practice, because there is dentists who accept every insurance plan. They're going to get more patients in. There are dentists who are still trying to be full fee for service, they're going to get a lot fewer in. Some see emergencies, when they're open, some see emergencies. I can call them at one in the morning and they'll say, "Yeah I'll have that patient meet me at the office. I'll send them to an ATM machine on the way."

Their results, their mileage varies widely, but for them it works. There are guys if I send them 12 people and they get two good patients that have become their premium patients, they are happy. They have built that boutique practice, so I've learned not to judge that too. I'm not as happy because now I've got 11 disappointed patients for the two happy ones that I've referred out, but generally they are doing, they are paying a couple hundred bucks, between $100 and $200 to get somebody into a chair, and some of them are more than happy to pay $300, $400.

I get guys in Beverly bills that go like, "Hey, if I can get a new patient, an average new patient costs me $400, I'll take a million of those," because they know, one they know how to produce dentistry, they've got fast hands, they know how to sell dentistry, because they believe in what they do, and they know how to meter it out with the patient. They decide when the patient is ready to accept treatment, they find that out in the conversation, they treat what the patient needs at that moment, and then they build up an appreciation of the value of dentistry over a year, two years, five years. They don't care, they're eventually going to redo that person's whole mouth.

Howard: I've heard the most expensive click on Google is a personal injury attorney in Manhattan, is about $1100 a click. Do you believe that? 

Fred: Oh yeah, it's actually for the class-action for the mesothelioma, things like that, it's even higher.

Howard: Okay so Fred I want to go back to the advertising, the things that consumers are looking for. When I saw you on today you spent a half a billion dollars on marketing, what things are consumers looking for, and back to that high-tech, you said that people were looking for some same day dentists, or tech, that you said that you're focusing more on high-technology practices, but technology is a very broad word, what specifically are we talking about?

Fred: Honestly, my energy is going to go to more towards, because I consider the most powerful consumer advantage is single visit dentistry is crowns in a day with using CAD/CAM because my experience tells me this, and my brain tells me this, that the consumers wanted this. I think this is going to broaden the whole category of dentistry, because when you make something easier and more convenient, more people do it. That's the reality, whatever it is, when you're raising money for charity, the easier you make it, the more people do it. 

Howard: Okay, but be more specific. There's a lot of different signs. Let me go through a list a bunch and you tell me. There's same day appointment CAD/CAM, there's lasers, there sleeps medicine, there's short-term six-month smiles, will you go through the buzzwords that you see flying all around and think, and let me tell you why I'm saying this, because why I'm saying this is this Fred, most of my audience is under 30. They walked out of school with $250,000 in debt, and they don't want to spend another $150,000 on a CAD/CAM or $75,000 on a bio laser, or $100,000 on a CD CT, or go commit to learning sleep medicine or short-term ortho, they've got to start somewhere.

Fred: Right.

Howard: Work from the best bang for your buck to the least bang for your buck from all those things I just said which you committed to memory instantly.

Fred: Yeah. The best bang for your buck to me is CEREC, because it's offset. If you do a crown a day or less, it's offset by your lab bill. The cost of the machine is free, and you've made it more convenient for the patient significantly so. 

Howard: You made it more convenient. 

Fred: Convenient for the patient. You've made it so they only have to come once. 

Howard: Can I say one thing about CEREC, is I really missed the boat, because I've had a CEREC since 1989. It was a CEREC one, and I had the CEREC … The most famous CEREC teacher in the world, and the best, is Sameer Perry, who I love to death, and I had a CEREC before he was in grammar school. You know the reason I like it? I didn't even like it for the same reason. You know what I liked it for? No temporary falling off, not having phone calls, "Well that temporary fell off." 

Fred: Oh yeah.

Howard: That's the thing that's least talked about by dentists, they're like, well they talk about impression versus scanning, and lab, and this and that, but they always talk about dentist focused issue, and I think the business manner is always patient focused. What's the number one complaint about a crown besides the cost.

Fred: The fit.

Howard: The temporary. 

Fred: Oh well the temporary, yeah.

Howard: The temporary, the temporary, it's ugly, it fell off. Blah blah blah blah blah.

Fred: You have to take off the fill, it's not going to be perfect, it's going to wear on their tongue, and what is it? Micah Tola talks about this, between 5% and 10% of the time, the crown comes back from the lab, and doesn't fit. Now they're up for another temporary, and another round of impressions, and then another round of numbing and drilling to get the second temporary on.

Howard: The leaking temporary for two weeks gets so much bacteria inflaming the Denton, and the pulp and the whole nine yards, so to me if you're looking at technology and you want to be patient focused, CEREC eliminates the temporary, all the bullshit that goes with the temporary from a patient point of view. 

Fred: Right. 

Howard: The reason I went with the laser is because you're old enough to remember, before the laser was the electro surge. 

Fred: Right.

Howard: If you used the electro surge, they were eating Percodan for 10 days, and you do it with a laser, and that is all gone. You do it with a laser for the patient, not for you, so dentists always tell you, "You know what I prefer in my hands?" I don't give a shit about her hands.

Fred: Right.

Howard: It's all about the patient.

Fred: The other thing, and I've learned a tremendous amount about this because of guys like Sam Perry, is when you're prepping a tooth, and you're going to do a CEREC on it, you take off less tissue than you would with putting a temporary. You'll leave a cusp on. I know dentists that say, "I do a full crown so rarely because of my CEREC, because I can do an onlay and leave more tissue. I would never leave that fourth cusp up there because they're going to break it right off with the temporary 15 minutes after they get home and eat something I told them not to," but when you can do what is truly less invasive dentistry and leave more tissue, that's also patient centric too.

The fit is always right. They don't care if it came back from the lab wrong, you found the lab, that's your fault, so your fit is always right, plus your assistant should be doing 90% of the work. She should be taking the Omni Cam Picture, designing the crown, making it, bringing it in, adjust it, and you come in and bond it. You should be prepping the tooth and bonding it.

Howard: Half my assistants are males, and Ronnie and Zac always whenever they hear a podcast and they refer to an assistant as she, they always say, "Hey, you tell that guy that half of your assistants are guys."

Fred: I'm still learning to say she for dentists, I'm so old school on that.

Howard: Do you know what it is? After the 2008 financial meltdown, first of all Ronald Reagan starts his free-trade thing.

Fred: Yeah.

Howard: Since then we've lost 50 million jobs because the governments of Japan, and Korea, and China and all that said, "Oh my God, they just subsidize their industries," and we've lost 50 million jobs, and then we had the 2008 financial meltdown, plus liquidity, and healthcare is 17% of the economy, and the department of Bureau of Labor, men are just pouring into healthcare. I mean I see more males in dental offices and hospitals every time I go to check up on it. All girls are now, there's guys popping up everywhere, because there's no construction and manufacturing jobs.

Fred: It's the only … They come out of school and they can't pick a career that's going to be around 10 years from now. Dentistry is going to be around, healthcare is going to be around, but yeah, I meet more female dentists who's husband is running the practice. It's a heck of a combination.

Howard: Yeah, so I want you to succinctly summarize why a dentist with a $250,000 loan should buy a CEREC. 

Fred: He will actually … 

Howard: She will. 

Fred: She will, oh my God, I did it again. She will find that it will more than offset her lab bill, so essentially the device will cost her less. The device is an ATM machine if you use it, because if you can't find a way to do 15 crowns a month, then you're not doing a lot of dentistry, and if you don't do 15 crowns month, you're not ready for a CEREC machine. You're ready for 1-800-DENTIST because you need some patients.

Howard: Now put your father had on, and humans are control freaks. All dentists have the 400 pound grill and whatever. They won't delegate. They won't let them scan, design, mill, stain. You know Fred, I prep the crowd then leave, and when I come back, I don't even have to try it on.

Fred: Right. 

Howard: Jan's been there 20 years, I sit down, it's all ready and they start to mix. They won't delegate, so CEREC only works if you're not a control freak.

Fred: Right.

Howard: They'll take an impression and send it all the way to Kathmandu China, or Asia, but they won't let their assistant do it. What is up with that? They'll let somebody speaking Mandarin and Chinese make the whole crown, but not their assistant in Oklahoma. 

Fred: They say, "Well my assistant isn't qualified to do this." She's so much more qualified to prep and design a crown then that guy. Detola will tell you this too that the people working, especially in the big dental labs, 80% of them have never had one minute of chair side in a dental. They have no dental experience whatsoever, and 60% of them, English is not their first or second language, so she's looking at the actual prep. She's looking at the actual patient, she's looking at the occlusion everything. She's right there and she does it all day long. She does the real stuff all day long.

Howard: A lab man can't go back and get another oppression. She's sitting right there, she can rescan it. 

Fred: Right. 

Howard: She can rescan it, or she can come get me … 

Fred: The Omni Cam is such a phenomenal device, that it's taking the image and it's taking the upper and lower bite, it's taking everything surrounding the tooth, so the computer can say, "This is exactly the crown that goes there." That it's a nominal amount of redesign that she can do, and then she comes in with it, tests it, and probably needs no adjustment most of the time, and so it's highly efficient, and what happens is the dentist is finding that not only does he not have to … They just need to measure how much time they spend adjusting a temporary. Add it up for the month.

How much of your time is spent adjusting temporaries? Does it add up to two hours in the course of a month? I wouldn't be surprised if it were more than that. None of that is necessary. What I say to dentists is, "Let's say somebody needs a composite, why don't you put an impression, take an impression of it, and have him come back two weeks later and then put the composite it." They go, "That's stupid." It's like, "Exactly, just like putting in a temporary is now when you can make a crown right there."

Howard: Fred I swear to God it's Christmas in Arizona right now. The state passed the expanded functions duty assistant.

Fred: Oh my gosh. 

Howard: I almost Fred, go back to 1987, I almost stayed in Kansas and didn't come to Phoenix. I had by mom and family in Wichita, and I had my two uncles in Phoenix, and Phoenix was exploding, and Wichita was the same population every year for 30 years, because in Wichita every year a girl gets pregnant a guy leaves town, but I wanted to stay in Kansas because the assistants, the dentists just would numb up, drill. Then the assistant would go there and pack and fill, and do everything, so I almost stayed in Kansas just for that, and now it is 20 years later, and the problem now in Arizona is they passed it, now they're going to the dental school saying, "Can you certify this, you need some training." 

Fred: We've had it in California for at least a decade, and you could lose an eye and eight of your fingers as a dentist now if you've got an expanded skills assistant and still practice. It's amazing, and of course that's the other thing about it. It's way more, as an assistant, it's a way more interesting job and career to work chair side with a CEREC, rather than sucking spit for a living. 

Howard: I'll tell you what, I was in Shenzhen China about 30 minutes outside of Hong Kong in this lab with 4000 employees in this lab, and where this is a massive technology. I was in the UPS truck looking at the addresses of all these things. They are coming from places like Germany and Italy where a crown and bridge lab man charges like $250 a unit.

Fred: Right.

Howard: I mean it was just huge. The incentive to send it all the way to China. I mean the lab bills in Europe are twice of what they cost in the States. You covered CEREC, would be the next one? By the way, it sounds to me what you're saying is if you've got $250,000 of student loans, and a CEREC is $150,000, and Fred is saying that a game changer is expanded hours, maybe if you're a senior and your name is Shirley, and your best friend is Marlene, maybe you two girls should start a dental office together and one does 7 to 7 Monday, Tuesday, Wednesday, and the other does 7 to 7 Thursday, Friday, Saturday, and then you alternate so every other week you'd have a week off every other week. 

Do you think it's come to the fact that, because a lot of economists are saying that what caused group practices in medicine. The government Medicaid, Medicare, it was the million-dollar MRI machine, and you just couldn't buy one for yourself, and that it was the high price of all this equipment that doctors all had to go to group practice, and a lot of people are saying what's driving group practice is all this technology, so if you're saying from marketing that expanded hours, early evening, 8 PM, Saturdays, and then you're saying buy a $150,000 piece of technology, maybe you should be pairing up in dental school into pairs, do you agree with that, or disagree with that? 

Fred: Totally agree. One of the things that I talk about in my book is I think that the solo practitioner model is an indefensible model going forward. I think just because of the convenience issue. Just the exact thing that you're talking about. I met two dentists came out of UOP, they opened a practice in North Beach San Francisco, open 7 to 7 five days a week, Tuesday through Saturday. She worked the mornings. She worked from 7 to 1, he worked from 1 til 7, they worked a 30 hour week each of them. The practice was full in a year.

It was a Denovo practice. It started from scratch. The only marketing they did was convenient hours, and it filled the practice. That's how much convenience matters. Now they had CAD/CAM as well, so they were attracting the younger San Francisco audience who went, "This is great, I don't have time for this anyway, let's get this done." 

Howard: Okay so you've seen half a billion dollars worth of data on advertising. Go from top to least effective. Would hours be number one?

Fred: I think hours, yeah, convenient hours to me is a marketing strategy in and of itself. Convenient and comfort conscious technology is number two.

Howard: Name those specifically. What did you say convenient and comfortable technology?

Fred: Comfort conscious technology, so certainly lasers for treatment. 

Howard: Say it again. Comfort … 

Fred: Comfort conscious technology. What reduces, and CEREC runs most of the bases because it reduces the number of shots you need. It reduces the amount of drilling, because you don't have to cut the temporary off, and it eliminates impression material. It's the third thing people hate, is the pressure materials. Dentists don't think about that either, they're not even in the room when it happens, but people, most people have some sort of gag reflex, and when you have to do it two times, three times, take the impression material, that's another unpleasant thing that you eliminate in practices when you have … That's what comfort conscious technology is. 

Lasers that eliminate surgical procedures makes a huge difference in the experience in a practice. Digital radiography makes a difference, because people they are afraid of radiation. All they know is you threw a lead blanket over their genitals and left the room, so it's got a be pretty bad right? When you can say this is 80% less radiation when we use this technology, and we have instant results, we can show you on a giant screen instead of on a lightbox across the room which nobody can figure out how you can see anything on the film … 

Howard: It goes back to radiography. What percent of dentists have digital x-rays versus film? 

Fred: It's 65. 

Howard: You know what the dentists say? They look at you, and you're just like, "Are you a Martian?" They're like, "Well you know I prefer the film, and I can see it better on the lightbox." I said, "Dude, you just said I, me, me me me me, so so, Mimi, so so, me me, so, your dentist focused." With a patient I can blow that thing up on an 8 x 10, I can get a red pen, circle where the cavity is, or right now it's just flossing cavity, we can do it for $250. If it grows another millimeter to the nerve, now it's going to go from a $250 flossing filling to a $2500 root canal build and crown.

They can take them to x-ray, they can show it to their wife because a boy doesn't want to go spend a bunch of money at a dental office and get in trouble from his wife, because they say divorce is a third finance, a third sex, and a third substance abuse, and boys get in a lot of trouble spending $500 at the dental office without getting permission from their wife, so he gets to take home the 8 x 10 x-ray. To me, if you just get patient focused, and quit talking about yourself all day long, you're going to build a big practice. 

Fred: Yeah.

Howard: Keep going down. You said convenient hours. Then you said comfort conscious technology, and that would be CAD/CAM, lasers, digital x-rays, did I miss anything? 

Fred: You know if you're doing implants or you're doing ortho, then you need cone beam technology. You need three-dimensional imagery to do it … 

Howard: CBCT for ortho and lasers?

Fred: For implants. 

Howard: Ortho and implants? Okay Fred, so this person she just got out of school, she's $250,000 in debt. Let's say she gets a CAD/CAM, where would you spend your next money? Would it be laser? Would it be digital x-rays? Would it be six-month smiles ortho? Would it be learning how to place implants? Help her budget this, because you're not going to be Kois in 30 days. 

Fred: No. 

Howard: The thing people forget about Kois is, he's been doing this for three decades, he didn't get there in one night. Stage this out for her. 

Fred: Yeah, you start doing CAD/CAM, because that pays for itself. 

Howard: You'd start with CAD/CAM?

Fred: Yeah.

Howard: Okay. 

Fred: Then the next step is if you haven't got digital radiography, then you should get it, but that's third after doing some sort of clear liner. Six-month smiles, or Invisalign, or something, because there is a huge market for that, and it's a consumer benefit product. That's a classic example of broadening the marketplace, which I believe CAD/CAM will do just like Invisalign did. Invisalign is loaded with ... 

Howard: You go CAD/CAM first, and then Invisalign or some type of clear liner, six-month smiles, Powerprox, that would be your next? 

Fred: That would be my next thing, because it's another consumer benefit product, and it's a widening category. The CAD/CAM widens the category of dentistry. More people are going to want dentistry when they have it. Just like more people want ortho because they would never wear braces, but they could take the alignment …

Howard: Is this the story you're hearing on Invisalign that it was a man from Pakistan that invented all that and patented it. 

Fred: Zia, yeah. Zia Chisti.

Howard: Zia, spell it ZIA, what's the last name? 

Fred: Chisti. CHISTI.

Howard: CHISTI.

Fred: Yeah. 

Howard: Then he got kicked out of Invisalign like you got kicked out of 1-800-DENTIST, Steve Jobs, whatever. 

Fred: Yeah, he went public so that will happen. 

Howard: Yeah, and you went to Private Equity, and then now all their patents are expiring, and he went and he started a new company, I believe it's in Dallas, what is a clear connect? Clear choice? What's his new company? 

Fred: I don't know, but that's what happens is … He was doing 3-D printing in an incredibly expensive and complicated way, now it's really easy to make clear liners. Eventually the dentist will be able to make them in his office if he wants to with 3-D printers.

Howard: Your first was CAD/CAM, and your second was ortho.

Fred: Yeah.

Howard: With clear liners, and Invisalign, and there's going to be a lot of movement, so what I'm excited to see on that is that the thing with Invisalign, which I've never agreed with, is that the playbook for American history was make it better, faster, higher quality and lower price, and when Invisalign came out it was better, faster, easier, but $1000 more. I just thought, "What?" Now that those patents are expiring and all that stuff, I think Invisalign the price of that stuff is going to plummet. Would you agree? 

Fred: Yeah, it's much easier. The machines that he needed to make the aligners and the computer program that he needed to design them was phenomenally expensive, and now it's just not. Technology makes stuff cheaper all the time.

Howard: That's why CEREC was not good in the 80s and 90s, because the processors weren't fast enough. 

Fred: The margins were not good. 

Howard: The processors. 

Fred: Yeah, and you had the prep was entirely different, and you had to powder the tooth. You had to do a different type of prep, and the fit wasn't there, and the quality of the material wasn't there. Now, the Emacs and those products, they are phenomenal quality of blocks. 

Howard: They are phenomenal because of what Intel has done over the last 20 years. It was the gains in microprocessors that made CAD/CAM what it is today.

Fred: Yes. The Omni Cam, now when you've got a good three-dimensional camera that you can do basically a normal prep, and you don't have to powder, and you can get 3-D color image of both arches to just store on the patient, and the Lave now makes a margin that's as good or better than any lab is going to produce, you've got something.

Howard: We are staging this young girl. She's 25, she's got $250,000 in debt, she's going to learn CAD/CAM first, with CEREC, then she's going to learn some type of ortho, clear liners, six-month smile, Powerprox, Invisalign, what would be third, fourth, walk her all the way up to the second floor to where she ends up like John Kois?

Fred: She should have an inexpensive laser so that she can do some limited Perio. What you do now is you work for two years. If you work hard enough and you see enough patients, you can pay off the CEREC machine. Pay it off completely, now you're really in high cotton because you're saving all this lab money, and you've got a broad base of patients. Now she should start spending some money on advertising, fill the schedule up, and the next step for me is to start to do some implants to take some courses to do some single tooth implants, and either depending on whether she has a relationship with an oral surgeon, or prosthodontics, or a periodontist, they either join together and buy a cone beam, or she gets one herself. 

A cone beam pays for itself too, because you can basically when you combine it with a CEREC machine, you can do a full on single tooth restoration in a day without surgery, from start to finish and make $3000 on a tooth. You do that twice a month and you now you've paid for the cone beam as well, and you've got this incredible diagnostic tool. The more dentists I talk to who say, "I love my CEREC machine, but when I jumped to getting a Galileo's or some sort of scanner, CBTC scanner, that's when I really felt like I was at the level, the standard of care that I wanted to offer, that I had the information I needed about this patient that I couldn't get anywhere else, and I couldn't get anywhere near the degree of accuracy that I used to be able to get, and I can accurately diagnose and treat, I can do a root canal," that's actually before I would get the CBCT, I would get some experience in doing at least half of my own root canal therapies myself, learn to do Endo, because … 

Howard: I have to disagree. You said the first thing you would buy is a CAD/CAM, and you know what? I completely disagree. Do you know what I would buy first? A Star Wars droid so you don't have to have any staff. You want to put your money in droids, your labor is your highest cost Fred, you want all droids from Star Wars, so you don't have to pay … 

Fred: The thing about robots is they'll work a 24-hour shift without complaining.

Howard: I know, I want all droids. Do you know when CEREC will be coming out with droids? 

Fred: You know I'm not allowed to reveal what Serona has told me about what's on the drawing board, but it's definitely ... It's going to be more and more technologically assisted. All of medicine is more and more technologically assisted, and it's going to continue to be that way.

Howard: Fred, in all honesty, this girl just got out of school, she goes to Amazon. Where would she buy your book, and what is more important, your Hall of Fame classic Everything is Marketing, or your new book Becoming Remarkable, what would be, stage that, which book first?

Fred: Okay, you got to start with the first one ...

Howard: Everything is Marketing. 

Fred: ... It's foundational. To understand that everything that the patient experiences either increases or decreases case acceptance, and so everything they see, touch, taste, hear, and smell from everyone, from the environment, and that your clinical skills are a nominal part of what's appealing to the patient. Everything else is what's really appealing, and what builds the trust, and what builds the value of dentistry. You have to understand that by reading the first book.

The best place to get it is gone on goaskfred.com, which is my blog site. 

Howard: I heard that was a porn site. I just stumped Fred Joyal, he can't even respond to that.

Fred: You know when you throw a lob over the fence, and there's three ways to hit it, and you end up not swinging at all, I had the collision of three responses, so I got nothing out.

Howard: Goaskfred.com, just like it's spelled, GOASKFRED.com, goaskfredjoyal.com, and you're going to the website of the only man in the history of dentistry who's spent half a billion dollars in advertising, and I don't know a single dental rockstar on the speaking server who still doesn't say you are the … Warren Buffett says, "You only want to deal with ..." He will only buy a company if the CEO's got high integrity, high intelligence, and high-energy, and God dang, I don't know anybody who rocks it out of the house more on integrity, intelligence, and energy than Fred Joyal.

Fred: Thank you Howard. I really appreciate it. Yeah, so start with the first book. 

Howard: I'm sorry. I didn't mean to say Fred Joyal, I meant to say Ron Joyal your brother.

Fred: Oh okay, yeah, well. 

Howard: It was a slip of the tongue that I said Fred. 

Fred: Yeah, but if you've read the first, and really and as you said ... 

Howard: How much is the book Everything is Marketing on goaskfred?

Fred: Goaskfred, and you've got a use FARRAN as the discount code okay? I'm setting up a discount code just for you, and the book would be $10 shipped if they are in the US okay? They need to put that FARRAN in all capital letters.

Howard: Is that an audiobook if they are a multitasker? 

Fred: You can get the audiobook as well, and I'm about to make an audible version of Everything is Marketing, and then the second book, I'm still recording it in a week or two so I'll have the audio version of that as well. 

Howard: Becoming Remarkable?

Fred: Yes.

Howard: How many hours will take you to record that book in audio? How many hours does it take to read a book?

Fred: It takes me about 18 hours to record the book. It's very efficient. It's surprisingly so. 

Howard: How long would it take a listener to listen to it? 

Fred: It would take probably 10 or 12.

Howard: 10 or 12 hours to listen to a book. That is ... That would be basically one week of commuting to work.

Fred: Yeah. As you say, it's get the team to read it, because you want them all reading from the same playbook you know? Get them aligned with the thinking. I have dentists who say, "Look, if they won't read the book, I won't hire them, because this is how we operate, this is the experience we're trying to create," and to me the best marketing tool you have is the team. 

You can have great hand skills, and a great-looking practice, if you've got a team with bad attitude, you can't grow the practice. You'll suffer every day, and the attrition on patients will be brutal, and the case acceptance will be a half or a quarter of what it should be. 

Howard: I've stood behind 100 times where a dentist is talking to the patient, and he's talking about his treatment, and you see the hygienist or assistant rolling her eyes. I mean they just don't get it, they'll never get it. You walk into an amazing office, and you smell it instantly. 

Fred: Yeah.

Howard: The other phenomenon for my team, I have 55 employees, and if I tell them that, well you're a hick from Kansas, you only bathe twice a week, if an expert 100 miles away from home tells them something, and they love you, they adore you, so when you tell them in a book, no one disagrees with a single word.

Fred: Yeah.

Howard: If the dentist tells them ...

Fred: Well I try to make a persuasive argument in the book about why this is true, because I talk about human nature, and that you can either accept it or resist it, but resistance is futile with human nature. People are going to behave the way they are going to behave, so you adapt to it. 

Howard: I'm going to end on this human behavior. I look at the data of the current podcast listeners, and the online CE people, and there is hardly any overlap. It's a different behavior, of a podcast multitasking I'm going to work and back, versus online CE attracts all the people that want to register credit for their FAGD, MAGD, whatever. We put up 350 online CE courses, and they've been viewed over 550,000 times, over half a million views. You've never made us a CE course. I just want you on there to give credibility, and be a Hall of Famer.

You should do an hour course on either Everything is Marketing, and another one Becoming Remarkable, or some package deal where Everything is Marketing, Becoming Remarkable, you buy the online CE course for an hour where you talk about this, and be talking about it as if you were in a staff meeting for an hour over lunch, or a lunch and learn, and then if they watch that course they get the two books shipped to them. 

Fred: I like the idea. 

Howard: I want to do it, and by the way when I grew up in Kansas, my dad's vacations he always wanted to go to all the theme parks, all the Six Flags over Texas, but it was half that and we'd always go see something else. We went to St. Louis and saw them make Budweiser beer, and then to their themepark, and we went to GM and saw the exact model of our station wagon. My dad always liked to mix it up.

One time I took my RV on a summer vacation, and we went and stopped with 1-800-DENTIST and met you, all the way up the whole West Coast and ended with A-dec over in Oregon, and we stopped by about 10 different Glidewell labs, and taking my four boys and showing them all these dental industries, and it's so funny how 20 years later, the only person they remember was you, and the guy from A-dec, he has his part-time hobby was getting antique cars and fixing them up.

My boys were climbing around that, and all their staff told me later that when you go into his room with 200 fixed up model T's, and all these cars, that you are not allowed to touch any one, and my four boys were the only time they'd ever let him see anybody climb up and sit on their cars and tractors, and fire trucks. He must've spent three hours with them going over all these old cars.

Anyway, the point I'm trying to make is my four boys Eric, Greg, Ronnie, and Zac, still to this day they'll text me, "Hey, I just saw Fred on TV." Every time they see you on TV they've got a text Dad and tell me they just saw you on TV, so thanks for touching my four boys lives. Thanks for helping me out in 1987 as an early adopter of you being so far above the curve.

Thank you seriously for all that you've done for dentistry. Fred I think you're the smartest marketing business genius in all of dentistry, and thank you so much for spending an hour and 24 minutes. This is the longest podcast I ever did.

Fred: Thanks for having me for so long Howard, I appreciate it, and I love you. It's been a tremendous friendship over the years as well. 

Howard: Thanks again Fred, and if you want to do a course with those two books, I just think that would be rocking. Where I get my Ya Ya's is finding ways to get these dentists what they need and be happy, and healthy, and functional, and love dentistry, as opposed to burned-out, hate it, I want to retire, or drink, or eat Vicodin, or kill myself, do you know what I mean? 

Fred: Yes, I agree, me too. 

Howard: Thank you for all you do.

Fred: Thank you Howard.