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Howard:
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it is just a profound, huge honor today to be podcast interviewing one of my brothers from another mother Karim Khalife. Did I pronounce that right Khalife?
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Karim:
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That is just perfect. The honor is all mine.
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Howard:
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Oh my God …
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Karim:
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You're making me blush. I hope nobody’s watching the video.
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Howard:
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Oh my God, you have sixteen thousand posts on Dentaltown. I feel like I know you from the inside out. It seems like I know every thought you've had. You can't read sixteen thousand posts from someone and not feel like you live in the next room over. I also have an interesting, funny thing to tell you. You were born and raised in Lebanon, right?
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Karim:
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Yeah, born in …
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Howard:
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My name Farran means baker in Arabic and before the Internet was out and people seem to see your name in print in Phoenix I always had these Lebanese people driving clear across town for an hour thinking they had found a Lebanese dentist. They’d walk in the room and they’d see my white face and they’d say, “You're Dr. Farran?” a hundred percent of the time they were Lebanese. When you study the name almost eighty-five percent of all the people with the last name F-A-R-R-A-N live in Lebanon.
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Karim:
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Do you have, I guess, Arabic or Lebanese roots? Is that where you're name comes from or is it just coincidence?
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Howard:
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I've been chasing down the story. I live in Phoenix which is a lot of Mormon population, very high Mormon. Mormon’s are very big into genealogy. I went to their temple and a ladies been chasing trees. She thinks that a Lebanese person migrated to Ireland several hundred years ago and then, of course, slept with a few redheads along the way and got me. She thinks the name is Lebanese, but obviously the ancestry tree goes back to Ireland. It's hard to say.
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Karim:
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All right, [crosstalk 00:02:05] interesting.
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Howard:
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Did you ever know any Farran’s in Lebanon?
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Karim:
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Myself no. when I was born in Lebanon, actually I was born at the beginning of the war. The war was fairly nasty, so our ability to move from area to area was very limited. I was mainly raised by Catholic nuns and priests and didn’t know much about Lebanon or didn’t really know many people other than very close friends. Then, around the age of thirteen the war had gotten so bad we just left it all and ran away under the cover of the night, took small boats from the coast and didn’t sink like many of those are sink these days and made it.
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Howard:
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Who was the war with? Was the war with Syria?
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Karim:
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It's really hard to tell. I think it was international.
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Howard:
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Was it a civil war?
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Karim:
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It was with Syria. It was with Israel. It was with there were some American Navy there. It was France. It was so international it's very hard to understand. It feels like nothing’s every gotten solved over thirty years of fighting. It keeps going on, so I'm just very grateful to be here; very, very thankful for my parents sacrifice and very grateful for Canada to take us in. For the opportunity to become a dentist, to meet people like yourselves and other colleagues and just have a llfe. It's amazing.
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Howard:
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I think people just don’t think of how lucky they are. You hear people whining today about the economy and I'm like would you have liked to have practiced dentistry through the Civil War when nearly a million people were killed and we burned down the entire country? Is this as bad as World War …? You know what I mean? We're just so grateful. I feel spoiled rotten and my boys are spoiled rotten not to have had to live what you lived through. That's just amazing that you overcome so much and have come so far.
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Karim:
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That is all true. You guys have earned it. You fought for a country, for our continent and built and amazing civilization that works very well. Nothing is perfect. Anything can be criticized, but compared to many other places this is a [home 00:04:12]. I'm just very, very happy to be here.
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Howard:
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Now, you were from Lebanon and you said in the war the French were there. You went to … Are you in an English, are you in French Quebec or are you in English Ontario?
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Karim:
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I'm in French Ontario actually. I'm exactly on the border with Quebec. You just cross a bridge and you're in Quebec. Our area is eighty percent French. I'm probably almost one hundred percent French raised as well, always went to French schools, studied dentistry in French. Mostly I'm better at French as anyone who wants to be successful I guess a bit controversial. You still have to learn some English, so there you have it.
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Howard:
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The only French I know is je t’aime la [French 00:05:03].
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Karim:
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I’ll take it, that's a nice word.
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Howard:
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Did I say it good enough for you to know what it means? What does it mean?
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Karim:
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Yeah, that sounds great.
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Howard:
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What does it …?
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Karim:
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That's a nice expression of affection and it works for anyone.
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Howard:
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What’s it mean.
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Karim:
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Very nice, it means I love you very much, but it also can mean I like you very much.
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Howard:
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Yeah, je t’aime la [French 00:05:22] Karim.
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Karim:
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Moi aussi.
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Howard:
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What's that?
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Karim:
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Moi aussi or me too.
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Howard:
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That's … really I think it's just there's so many dentists that came to the United States or Canada that just overcame such extreme adversity whether it be from Vietnam or Lebanon, these war torn countries. It's just a great reminder of how lucky, luck has so much to do with your success now that you’re just born in a country that wasn’t in war. You were born in a rich country with good education and Internet access versus a poor country. When I go into some of those countries in Africa a guy like me and you I don’t know if we could’ve had any of our success. You know what I mean?
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Karim:
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Yes.
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Howard:
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People laugh when you say it takes a village to raise a child. Heck, it takes an entire country to raise a child. So many dentists who think they're all that would've been nothing if they’d been born in the Congo. They might not even be alive right now.
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Karim:
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It's very likely that what you're saying is true. Certainly, they say, I don’t know the exact wording in English, but in a way adversity has a way of showing you who’s the man and who’s the coward. It's not just the matter of being a coward. It's a matter of being built in a way that you can resist the pressure. When you're at war there's no innocence. You either survive or you die or you go crazy. I did go back to the Lebanon once or twice and it's fairly obvious. There are a lot of people who simply just lose it.
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In the face of adversity it’s a real test of character. It’s possible that having been at war for so long, for almost all of my childhood. I might have grown to be a stronger person and that made me who I am today. I somewhat disagree with the idea that I might be necessary for people to live in the face of adversity in order to become survivors. I often hear those who are frustrated with international politics say that sometimes Canadian or American civilizations should experience war themselves in order to feel how it is and feel grateful for what they have.
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My perspective is different. I think you guys are extremely lucky from not having to go through all that. In a way if you are not grateful every day or if you are feeling a little bit, how to say, if you take things for granted then all the better. I wish that my children who are born in Canada would be able to live such a life where they would never hear a bomb or a gun explode. Just be able to be so carefree and just enjoy their lives. There’s nothing more beautiful than that and that's what I'm striving for.
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I don’t really care for perspective for my children. I just want them to be happy, to be good people. I walk away from religion because of these wars and all these fights. I'm just teaching my children and trying to influence whoever around me to just be good for the sake of being good. Just be grateful for what you have whether you know that there's hardships or not because there's nothing more horrible than being at war for having lived it myself.
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I've been shot at with everything bombs, machine guns, snipers. Even the American Navy had its battleships shooting large bombs at our mountains and I was there. I can tell you that if anyone can make it without having that perspective that's what I'm aiming for for my kids. It’s such a better life.
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Howard:
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I'm just aiming to be like you when I grow up. No, I'm serious. I'm not even kidding. I just think you're an amazing man. You said you were raised by Catholic nuns?
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Karim:
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Yeah because …
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Howard:
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My two older sisters went into the Catholic nunnery straight out of high school, so I apologize on behalf of my sister’s institution because them are some crazy ladies. What do you mean you walked away from religion? Was the war religious based and it made you more … Did it make you atheist, agnostic, spiritual? What do you mean by you walked away from religion or would you rather not talk about it?
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Karim:
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I probably don’t know the exact definition of my current status because I don’t exactly know what each term might mean. Basically I have decided that I no longer believe in a higher power. If anything, nothing should be scared in a democratic society because of anything is sacred then it cannot be negotiated. When too many things become sacred you start to have conflicts.
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We're starting to see that already as we try to be too respectful of human rights. We allow whatever is sacred to anyone to become accepted as such. You start to create social boundaries between different groups. I guess my way of being is that I don’t believe in an actual higher power that created us because there's no evidence of it for my own perspective.
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What I tell my kids is that we need to be careful not to decide that we should feel superior to others because we believe in this or that thing. We should just believe that all human life is scared, no exception. Anything that comes in the way of that needs to be forgotten about or we should educate generations against that. In my perspective that is what religion has done for too many years.
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It's very likely that some people benefit a lot from religion. It's likely that it might be necessary, but my past experience has been that religion as the cause of so many horrors. In a way people seem to legitimize their cruelty as much as possible in the name of religion. We see it on a daily basis if we get interested in the news and things that happen in other countries. It's just crazy. It just makes you feel like you wish for the entire concept of religion to disappear and for people to start to focus on what really matters.
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If ever there was a God, if I sound blasphemous to too many people, my take on it is that if there ever was a God my humanitarian way of being and my desire to always strive to be a good person, to try to help others, to not harm people or the least possible or not do it voluntarily. Then, if ever there was a God in a way there would be little doubt in my mind that I would be picked first to go to heaven whether I choose to say I believe in God or not.
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My dream would be that one day the human race will mature beyond the need for religion. That whatever it is poorer countries; African nations; Arabic nations; men that think that women are inferior; men that think that they are better than others; men who think they are chosen by God while others are not; Buddhists who attack Muslims or what not. All of that has to stop. We have greater challenges that are ahead of us and there you have it.
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Howard:
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They always say never talk about sex, religion, politics or violence and we just covered all of those.
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Karim:
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That's right.
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Howard:
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That's why I call it Dentistry Uncensored because too many people live in bubble and they get offended if someone’s saying something that they don’t approve of. Political incorrectness is a problem. I'm so proud of you for saying what you said because in the United States, just like Saudi Arabia or Iran, it’s extremely politically incorrect to say that you don’t believe.
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Karim:
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That's very true, yes.
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Howard:
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There's many, many dentists who would never, ever admit to their patients or their colleagues on DentalTown that they no longer believe. I had a serious issue with that, nothing like what you lived through. Mine was extremely minor, but my dilemmas very top of [inaudible 00:13:31] my two older sisters went straight into the Catholic nunnery. In fact, my oldest sister just started her own order of nunnery.
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They're just very extremist people and my little brother. I only have one brother. I have five sisters, two older, three younger. Then, I have a little brother. He was born gayer than Liberace. I knew he was gay ten years before he did. All my friends were like, ‘You know your brother’s gay, right?” I'm like, “Yeah, obviously.” The torture that we went through and he finally moved to Sydney, Australia. Can you imagine having to leave America? Just enough was enough was enough. He's so happy there when I go visit him because so many gay people who were going to kill themselves decided hell I’ll just go to the other side of the Earth.
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Sydney has one of the largest gay populations in the world. There so many people even on DentalTown who don’t even that it should be legal, should have rights. I hear dentists saying they should be killed. I'm like are you kidding me? You're a dentist and you fix teeth and you think like that? Are you just bat shit crazy?
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Karim:
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Higher education, huh?
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Howard:
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People think that he chose to be gay. He didn’t know at four years old what gay was. He didn’t know what it was at ten. I think he was maybe twelve or thirteen before it started to, you know? Hell, he was seventeen years younger than me. Okay, enough of sex, religion, politics, violence. Di you learn French in Lebanon?
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Karim:
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Yeah, Lebanon was actually an ex-French colony until after the Second World War when France was almost on its knees. It ended up giving us our independence. We remained being Christians. We remained highly attached to French culture. I guess it goes back a very long time ago.
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Howard:
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Did Napoleon annex Lebanon? Was that one of his; was that part of the Napoleonic Wars?
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Karim:
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In all honesty I wouldn’t know exactly when it started. I think it was mainly after the Ottomans.
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Howard:
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The Ottoman Empire.
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Karim:
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Yeah, when the Ottoman Empire broke apart the actual borders, my understanding of the actual borders is that they were devised after the First World War. That's where France and England had their influence in the Middle East mainly in the modern ages. Our true link to French culture goes back to the time where Christianity was created and then they had the Crusades and stuff like that. The Lebanese Christians, I believe, as well as the Egyptians, are part of the first Christians that remained there after Europe was sent back by the Muslim armies. Our roots go a very long time back, but I'm not certain exactly at what point it started.
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Howard:
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I probably shouldn’t say this, so I absolutely will, but I've never been to Lebanon, but I have lectured in probably fifty countries around the world. I have always thought France, Paris, France, had the most culture, whatever you define culture. It’s just like they're just more into all the fine dining and clothing and bags and finesse.
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It just seems like, not to be rude, but go to a farm woman in Kansas or a 60-year-old British woman in Manchester or a 60-year-old german woman. They're just slugging it along, but you go to Paris and it's just classy. I always thought Paris was the classiest city. In fact, I love Montreal and Quebec for the same reason. Would you agree that they're very into culture?
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Karim:
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Yes, it’s true that probably France and somewhat Montreal are, a good part of Quebec as well, might be more into refined stuff and less about the big end the huge volume and the rights and whatnot of the American way of life. In a way, you always look at what you don’t have and you wish for it. What would be better is some balance.
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My opinion differs slightly from yours perhaps in the sense that I dream of being here. I dreamt of being here. I dreamt of being in the United States and when we lived in Lebanon we had all that. We had the French culture influence, the refinement, the nicer restaurants, the fine foods and whatever else comes with it. Whenever we came to the United States my parents always sent me for the summer.
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We have an uncle who lives in Virginia. He's a doctor there, fairly well off. He would take us into his home for a couple of months to get us away from the war. Every time we were to leave to go back home I would tell my Mom why can't we just stay here? Why can't we just live here? My point, I guess, is that what some people seem to criticize about the American way of life, about the lack of refinement and things like that might not be as crucial or critical to a society as what some might make it.
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I am not at all in agreement with those who laugh about the American what you mentioned, these typical stereotypes, the person too big, extra-large, a bit rudish, not refined or whatnot. You guys built the probably most stable and more fun to be in country on the planet. We don’t have much to criticize when we look at you guys. We have much to learn. Perhaps the French culture with its slightly snobbish attitude might need to tone that down a little bit and learn to let go of some ways that slow your progress or make you, how to say, make you vulnerable to humanities vices in a way. Am I making sense?
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Howard:
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Yes, you always make sense. Let’s move it to dentistry before some of our podcast viewers are like are you guys ever going to get to dentistry? What made a guy like you post sixteen thousand times since 2006? Because so many DentalTown’s every time I meet a Townie they never post. They say I get on there a couple times a week. I lurk for an hour. I say why don’t you ever post and they say they're not smart enough to engage in conversation. They’re not going to add anything. They're afraid if they post an x-ray someone will make fun of it. Do you think growing up in a war torn country the last thing you are afraid of is that someone on DentalTown disagrees with you because you’ve been shot at? Words are probably pretty minor compared to a bullet and a bomb.
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Karim:
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Perhaps the answer to that question is that DentalTown has helped me a lot. Probably same as most new grads. When you graduate you feel relief that you know it all and that you're going to be the best dentist. Then, you start practicing and you start seeing failures and all of a sudden you're distraught. You're dream of you being the ultimate dentist is not happening and you're wondering where to look, where to find answers.
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You start taking courses and very often many of these courses aren’t controlled enough I guess and the content isn't exactly what you need to see. It may even put you more in trouble. I met a dentist who told me about DentalTown as it had just started on the Internet. I logged on and immediately found a crowd of people who helped me tremendously. All of my dentistry, as it is today, is radically different and light years better than when I started in large part thanks to DentalTown.
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I just felt very grateful. I felt the need to give back as much as I could. I also felt that whenever I type something that would be wrong there would be a lot of people reading it would correct me and I would improve as well. It’s these two things that made me addicted to DentalTown. I am constantly logged on. I'm always trying to help those who I think I can help and always hoping to get help from those who think that they can help me improve.
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I guess that's what it's all about, right, as a dentist? You want to minimize your frustrations. You want your life to be as pleasant as possible. In order for that to happen the basics have to be there. You need to be good at what you do. DentalTown is probably the only and best resource that I have found that's always there and always full of ways to improve and that's where it came from. I stopped counting a long time ago.
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Howard:
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Yeah, I think it's funny the thing that dentists fear the most that someone’s going to say they're wrong on something is actually the biggest [inaudible 00:22:44]. I've had a monthly column every month since March of ’94 and I always feel so blessed because if I ever wrote anything wrong I had all these letters telling me I was wrong. I thought how cool was that because you talk to your uncles and cousins and they got all this misinformation or out dated information in their head.
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You know that's one of their biggest problems. To have the mechanism where someone can say you say that's blue, but I think it’s red and to point out to you. You’re like wow I'm so glad that you pointed that out for me. Maybe it's a lot to do with humility too. I really think that these dentists you post aren’t thick skinned to the criticism. I think they're humble people who just have no problem. If they're wrong they're wrong. Thanks for showing me Karim that I'm wrong and I feel so much happier now that I see something differently than I use, because everybody knows what they know, but they don’t know what they don’t know.
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Karim:
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That's it.
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Howard:
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You have a lot of thoughts and views about the supply of dentists going on right now. The addition of dental schools, all that stuff. Share your views with that. Share your thoughts and concerns.
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Karim:
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Man, let's see where to start on that one.
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Howard:
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At the very beginning.
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Karim:
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All right, let's see, when I graduated from dentistry I had an extremely hard time trying to get a stable job. Even if I was being solicited by very well established practices. The dentist himself over there, the one that has the big name had a lot of work and was very successful, but didn’t have really enough work to provide a new grad. That was very shocking to me.
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It took a long time. It took me almost three years before I could find an opportunity that could work well. I literally felt like I was swimming in a pool of sharks. Where I felt like these dentists were almost like sharks. I saw things that were so shocking to me that I'm used now after sixteen years, but at the beginning I couldn’t believe it. It was very difficult to understand.
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Howard:
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What did you see that was shocking you? Talk about those specifically.
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Karim:
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To say impolite words dentists were double crossing dentists and shooting at each other in ways that were completely unacceptable. Myself, for example, I wanted to establish myself so I was trying to purchase a practice. One practice that we saw there was a dentist who declared that he was afflicted by cancer and likely to die in a few months and wanted to sell the practice. Long story short, he's still practicing now.
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The practice was bought by a young guy, not myself, I'm one his friends. We knew them well, so we learned the story later on that the guy never actually died. There turned out not to be enough work after he weaseled his way back into the practice. They had to buy another practice in order to survive.
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Another dentist, extremely well established also, seemed to be pretending, now I know, to want to sell his practice to a young guy. He recruited lab technicians, went to their labs, looked at their stone models to try to find a high quality dentist to sell his practice to. After a lot of back and forth, the deal didn’t go through because it felt fishy. Eventually, I saw plans with his names on it in one of the big dental companies that were designing a new office for him. It turns out it was going to be across the street that kind of stuff.
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There was a lot worse, dentists who lost their licenses for all sorts of reasons, all sorts of pretending and lying. A dentist who got me to start working for him saying that he was intending to sell his practice because he had lost his license. After three years of me working with him he calls me one day and says all right soon we're going to talk about the practice sales. I'm ready. I made my last payment and we're going to strike a deal.
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On the day where he had set the appointment I walk in and I find five other dentists that had started working there. He spread out the workload it turns out. He was more afraid at the fact that I had been there for a while. That kind of thing after three years of trying work is very discouraging for a young dentist. That kind of thing only exists because dentists are hungry.
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As long as dental boards choose to ignore that reality and try to find other false justifications for why we have problems in our profession this will only get worse and worse. The Ontario Dental Association in its last economic survey, which was published to dentists only who are members of the ODA, concluded at the end of its report that someone is sleeping at the switch. That was their actual wording.
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How can dental boards not react to that? Guess what, they haven’t. They don’t care. I guess as long as dentists don’t mobilize nothing is going to truly change. In a way dentists will not mobilize because they're under pressure to make it. They have huge financial expectations which is normal. I have nothing against that. They also have huge financial burdens and not too many dentists have the luxury to decide to become fighters and just lose it all for the cause.
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What solution do we have? I was having that conversation with some of the new grads locally over here who are interested in trying to solve these dilemmas. My advice to them was they had to take it public. Policies don’t change unless governments are willing to change them. Governments are only willing to change them if the public pressures them to do so. The rich dentist is too small on his own to be able to do that and there you have it.
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Howard:
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These dental schools basically we've had pretty much no inflation since Paul Volcker raised interest rates in 1980 to about twenty-one percent to break the backs of inflation. Now, looking back, that was obviously too brittle of a move, but we basically haven’t had inflation.
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You look at the price of dental school. They can just keep raising and raising and raising because they know they're going to get five thousand applications for less than a hundred seats. Every time they raise the price ten thousand a year they have no change in number of applications. It seems like these private dental schools just have zero concern of cost containment and they charge $70, $80, $100,000 a year. They don’t even care.
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These young kids are thinking I'm going to be a sovereign dentist, so this is all good right? It’s like where’s the stewardship of our profession to let these private dental schools get away with these exorbitant costs?
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Karim:
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It's very tragic to see that. In Quebec where I've studied costs are still relatively low, especially compared to the United States. On other parts of Canada it can get truly expensive. I met with a new grad from British Columbia who told me that her education ended up costing here $250,000. That's incredible. You don’t have any experience yet. You've barely graduated and you already have this huge financial commitment.
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Most dentists, and it are very understandable, will delve into over treatment in order to get themselves out of that. It's very tragic. Most economic, if not all, economic indicators according to any report that I've read, and I've read many, always tell you that whenever there's an oversupply of doctors or dentists or whoever else in the medical field you tend to see an elevation of over treatment.
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It’s very dangerous for society to think that by putting up more doctors on the market they are going to end up lowering the cost to the patient. That just never happens because the cost to the patient, as we very well know, is not only dependent on profit margins. Profit margins in dentistry are interesting, but they're only interesting of there is profit volume because without profit volume we all fail. That's where we stand right now.
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Dentists seem to be artificially creating higher volumes in their practices in order to survive. The public doesn’t see that because it believes what it is being told by I guess official channels that these moves will inevitably bring down the cost of dentistry. That's just mathematically impossible. It has to … go ahead.
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Howard:
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An, go ahead, no you go.
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Karim:
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All right, I want to touch on a subject that was very shocking to me because it happened recently. In May of last year, I attended the yearly conference that we have in our local association here in the French Quebec. It's a two, three day conference same as the [88 00:31:49] type of thing where we have lectures and people that show off their new products.
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There was a lecture that was given by a panel of local Board members of the City of Montreal. Some of them were young dentists. One of them is well known in DentalTown and the other one was in my class. I was so excited to see younger dentists becoming members of the Boards and I was hopeful that they would bring in their insight of the market. That they would help at least tweak the Board’s policies regarding these matters.
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In a way when they give us that course the course was supposed to be about diagnosis of decay. In the resume that described the course they were talking about how it was important to review with dentists how to diagnose decay properly in order to avoid getting sued for over treatment. Their understanding of the situation is just that is that they were saying that in their opinion they have seen a spike of complaints against dentists due to over treatment.
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That spike they explained it as a lack of understanding of proper diagnosis of decay. That's what young dentists were agreeing with the older ones. That’s what the panel was saying. It was a huge course where a room that was probably full of about a thousand to two thousand dentists were present. That's what all these dentists were hearing. They were hearing the Board panel telling them that the spike of complaints due to over treatment was related to the fact that dentists did not know how to diagnose decay [inaudible 00:33:32].
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I went to these two dentists who I knew personally. I told them how can you guys say this? How can you guys tell us here that we don’t know how to diagnose decay and that that is why there is over treatment? Do you really believe that? That's really shocking. Why is our Dental Board deciding to be blind to the reality that there's an oversupply of dentists?
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A while back it was agreed upon that this was probably the fact and University of Montreal had declared that it was likely going to bring down its number of admissions from eighty-four. There was talk that the number of admissions was going to go down to seventy. When the actual school year started we saw that they still took in eighty-four students and now they're up to eighty-nine.
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How did that problem magically disappear? What are we gaining by doing that? What is society gaining by doing that? Why do we have to graduate so many dentists on one end pretending that there's a need for them and on the other end we graduate hygienists. We allow them to have the right to practice on their own in their own practices which will basically undercut the already saturated market for the dentists? Now, we have mid-level providers in United States. We also have a form of that in Ontario as well.
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What is that game going to lead to? Who’s winning? So hard to understand, who’s winning in that? The whole thing is just going to crash and burn at some point. Totally nuts, I don’t understand it. Someone has to explain it to me.
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Howard:
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What other forms of over treatment are you seeing besides dental decay, diagnosing cavities?
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Karim:
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Lots of it, any treatment. You name it, you got it. [Gingival 00:35:22] disease, healthy people getting treated for gingival disease. I have personally seen several cases where the patients were told that perfectly, perfectly healthy teeth needed to be extracted and replaced with an implant and a graft. I've also seen patients many, many times that were recommended to have a root canal and a crown because of a deep cavity that was going to cause an infection upon investigation no cavity, could be found.
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These cases, many of them, are several years old. They became my patients so I have recalls to prove that I was not wrong when I told them that then had no issue with these teeth. That's so frequent it’s scary. It's not …
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Howard:
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Do you think another one is CAD/CAM where when you were busy you would just do a direct filling. Now, that you're less busy, more competition, you're milling out a very expensive, indirect, same day restoration, inlay/onlay?
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Karim:
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I think that is definitely the case. There’s no doubt about it. There’s also something a lot more grave is when it happens at the speciality level. I have seen actually to put it in a way where to give it some perspective I have, myself, learned how to place my own implants. I have myself learned how to do gum grafting, bone grafting, sinus lifts, all sorts of full out rehabs and things like that. I was having a hard time finding an honest specialist. It was difficult to do. I also learned how to do my own endo because of that.
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The patient’s would go to the specialist’s office let's say for their kid who would need ortho. They would recommend that the parent do ortho as well. Then, the specialist would tell the parent that they had issues with their gums, so they would refer them to the specialist. The specialist would send me a sheet with deep probing, eight, nine, ten, twelve millimeter pockets needing bone grafting. I would look at the probing and the patient would be upset at me. How come I have so many gum issues and you told me that I was fine?
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I'd be perplexed. I'd sit the patient down and start probing again. I would find nothing. All of the pockets are barely two to three millimeters deep. I go, all right, maybe I don’t know how to probe. Let's call the hygienist number one. She would probe and find nothing. Maybe she’s incompetent. Let's call hygienist number two, same concept. That's totally nuts that this patient was recommended bone grafting, gum grafting and what you guys call or what we call deep scaling, [inaudible 00:38:08] surgeries, all sorts of things before she could have her teeth straightened when she didn’t need any of it.
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It's not just CAD/CAM or x-rays, that's not what we're talking about. That would be not a big deal if that was the case. These people were offering their patients stronger, nicer, better quality restorations, so be it. They're more expensive, but they are actually more resistant and whatnot. They have some advantages. When it comes to surgery you're cutting your patient’s mouth open. That’s criminal. That's totally criminal. It's happening on a daily basis in our countries. That's shameful.
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You get these inspectors from the Boards that come in and tell you that they are there to ensure proper standards of care and all they look at is if the cotton balls are in a jar that suits their beliefs. If your bibs are in a locked in or whatnot and if you're taking sixteen x-rays during the root canal treatment, but that's not going to help our profession improve. That's ridiculous.
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Howard:
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Do you think that they should report when they see report when they see something like that? Do you think they should report that dentist to the Board?
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Karim:
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That's a difficult question. Deep down I would like to say yes, but I've never done it myself. My preference would lean towards no; although, not reporting might be seen as somewhat dishonest. Closing your eyes in the face of crime and allowing patients to get abused. In a way it's true.
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In another way, I wish that we didn’t have to do it ourselves as practicing dentists in order not to create animosity between colleagues. There is enough animosity and competition between colleagues we need to figure out ways to improve relationships between dentists rather than to creat adversarial relationships which is what we seem to be leaning towards due to how competitive the market has become.
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I guess my official answer would be no. I would rather the dentists don’t tell on each other. I would rather that Boards become more effective at creating circumstances where this type of behavior would be minimized. Whenever they are witnessing such behavior that they take actual action that leads to true tangible results. There are too many dentists that get caught, get punished, but the punishment is so minimal that within just a few months they are back on track. That's the real problem.
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Howard:
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I think humans are so complex. I hear these dentists on DentalTown bad mouthing America to get a universal health insurance. Yet, they don’t provide health insurance for their employees. It’s like okay you don’t want the government to provide universal health insurance, but you don’t provide it for your dental assistant, your hygienist, your receptionist. That doesn’t make sense.
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Dentists get very mad when the government checks and balance or the Board and they want the government out of their lives. Then, they don’t want to police their own profession. It’s like if the dentists don’t want to police their own profession then why is you mad at the government doing it? You believe that the government shouldn’t provide health insurance, that free enterprise should, then why don’t you provide it to your assistant, your receptionist and your hygienist?
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The older I get the more I just the only way I can sum up the planet is that the surface is covered with seven billion talking monkeys. At the end of the day the only thing that can explain their behaviors is they're no different than a dog or a cat. You keep thinking this human is this spiritual, made in God’s image and is logical. I've lived half a century, I'm fifty-three. The only explanation that explains what I have seen around the world is that it just infested with talking monkeys. They're literally bat shit crazy.
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Karim:
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Can I comment on that?
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Howard:
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Yes, are you mad at me that I called you a talking money?
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Karim:
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Not at all because I feel that way myself. You have to wonder who’s the holder of the truth. Here’s the thing. A long, long time ago an extremely wise and admirable man said something that stayed with me and every day I remind myself of that saying. It’s so true. That wise man is you Howard. That's not a free compliment. You've earned it, so here goes. The saying was that don’t worry folks we can always rely on human nature. That’s it. That’s the saying.
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Human nature when people were panicking because of a recession or whatnot that it was never going to become again what it used to be. You were commenting on DentalTown that dentists were panicking over nothing and that people would always go back to their habits and to their nature. That things will definitely go back to the way they used to be because that's how people are.
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Now, knowing this we know that not all humans are the same. Some are meant to be leaders; some are meant to be followers; some are geniuses; some are not and that's the way it goes. Now, those who can be leaders are not many, those who are brilliant are not many either. The dilemma becomes when it comes to what you were mentioning that dentists are curious. They don’t want to provide insurance to their employees and they don’t want the government to do it for them, so there's a dichotomy there.
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In the end that is human nature. People are naturally insecure. People are naturally scared of change. People also naturally will not do the right thing unless they are forced to do the right thing. We need proper policing whether it's through a socialist system like the one we have in Canada or a more free democratic system the way you have it I the United States. Either way nobody will always be content or happy because of a law that forces them to do something.
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Down the road if we do allow our Boards and our governments to police either the professional or the whole of society in a constructive manner whether we're very happy about it or not in the end it leads to more positive results. Whose role is it to police the profession? Can we rely on everybody to do the right thing? No, we can't. That's probably the biggest fault of our modern society in Canada and in the United States.
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We have so many rights and we expect everybody to be able to manage themselves logically according to these right. We're very into words what we call, how do we call it? I forgot the word, when a society starts to decay that's where we're at now. We call it decadence, that is the word.
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We are now at a point where our society is becoming decadent because we push so hard towards the point where we want to recognize everybody’s rights to do whatever anybody wants to do. Total equality between men and women; inability of our teachers to discipline our kids in schools because of rights; inability to say a bad word to someone because it could be religious or whatnot. Everything has become a right and everyone can sue for whatever reason. There is no limit to anything anymore.
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We are seeing that reflect itself in every aspect of our society. Whether it's because people divorce all the time; families break up. There’s no order. There's no respect towards the police force. There's cynicism everywhere. That has to be curved down a little bit. In a way who do we blame for that? Can we blame the people? No, we can't because people need limits. As long as you don’t give limits to people they will continue to behave freely.
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The same thing goes in dentistry. No matter how well educated dentists are if they are not given limits and punishments for going beyond these limits they will not behave. Same as people on the streets you need cops to stop them from speeding. It's not enough to just tell them don’t go fast or to have signs or to have red lights. If there were no cops enforcing these lights nobody would stop or maybe just you and I would stop and the few other Townies, but that would be it. I don’t think I would stop either probably I would keep going on most of them. That’s it.
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Howard:
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It’s funny how normal depending on where you live, right? We’re talking about the oversupply of dentists from dental schools, but the very nice thing about dental schools in the United States and Canada is they're very standardized. A car is a car is a car. They all have air bags and [inaudible 00:47:25]. It’s a pretty standard product.
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When you go to Brazil and India and China you have two different dental schools. You have the public which is the old English/British Empire four year, undergrad, four year dental school, eight years of college to be a dentist like you and I. then, you have all these private programs that are taking a kid from start to finish in under twenty-four months. Then, they both set up a sign.
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We're both dentists and here Green went to eight years of college and then here’s Howard across the street that went to twenty-four months of college. that's funny how history repeats itself because that was a problem the United States had back in the 1900’s, in fact my favorite book on that was a Pulitzer Prize winning book by, I believe it was Paul Starr, “The Rise of the American Health Care Industry”.
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Where finally in 1900 the government did take control ad they set up the State Boards and they closed down abut ninety percent of all the medical schools in one day. Then, you were going around town saying you were a doctor with your lotions and potions made out of, they all had the same three ingredients, morphine, heroin, alcohol and cocaine. It solved everything from cancer to hair loss. It was a big purge back in the 1900’s. now, here it is a century later and that purge is going to have to happen in Brazil, India, China and to some extent the health care system right now it seems to be on the op pf the agenda of … We're in an election year.
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You guys just elected a new President and your parties swung from one party to the next. America’s in an election year. How do you like your swing? You're not supposed to talk about religion, sex, politics or violence. Do you like the swing that your country just made?
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Karim:
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Whoa boy, personally I did not vote for this new Prime Minister.
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Howard:
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His father was a Prime Minister a long time ago right?
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Karim:
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That's it; I wasn’t in Canada yet at that time. I was just barely born I think when his father became Prime Minister. My knowledge of what he did is also fairly limited. I think in a way he was very liked.
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Howard:
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Say his name.
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Karim:
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Trudeau.
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Howard:
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He's French.
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Karim:
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Yeah, Prime Minister Trudeau.
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Howard:
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Now his son is the Prime Minister.
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Karim:
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His son, Justin Trudeau.
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Howard:
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Like George Bush 41, George Bush 43.
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Karim:
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Yeah, I'm actually shocked that he was elected. When you ask people on the streets if they know what they voted for most don’t, many don’t. I was very shocked. I was shocked to see that my own parents who are usually well-informed and have lots of implicated friends are usually very knowledgeable about what's going on, didn’t seem it understand what his electoral platform was based on.
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He's basically we're at risk of getting totally ruined by this new government. His program is to create a $40 million deficit for a thirty million souls population that's a huge deficit. I'm shocked also to see that my own tax bracket is going to go down as a dentist with the money that I make I'm expected to pay less taxes. Go figure. I should be happy about that and in a way, yes, I do profit from it, but it will ruin the country.
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Howard:
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Since eighty percent of our, since you're a dentist and eighty-three percent of my listeners are from the US, seventeen percent are from a hundred and thirty-four countries. There's a lot of dentists out there. What do you think of the Canadian Health Care System versus what they would call the socialist or single-payer system versus the US model? What would you like to tell the Americans who have not lived under their system? Do you think Canada’s got a better system or not? Do you think United States should follow Hillary and Bernie into a universal health care or do you think that's trading one can of worms for another?
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Karim:
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I think you're last conclusion is its trading one can of worms for another, but perhaps my opinion on the matter might be skewed. In a way our system it's a good system for the needy, but for those who have money it's not a good system. My perspective of life is that I work hard to make money and I am making money. I can afford private care. When I go for private care I get better service there is no doubt about it.
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I've had an operation recently. It was minor. I tried to have it done in the public system and I couldn’t convince a doctor to do it for me because it wasn’t life threatening. For some reason they were all tippy toeing around the issue; although, it was extremely annoying to me and limiting in my daily life. I went to a private doctor; paid a lot of money for that, within five minutes she had concluded that I needed an operation. The next day I was seeing a specialist who concluded that I needed an operation and could operate me within two weeks. It had been years that I was trying to get that operation done in the public system.
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The public system in a way has some major flaws that if they could be addressed would make it an amazing system. The issue with the public system is access to care. It's a real issue where a lot of people, myself included, cannot find a regular doctor as a first step into the system. It takes more than a year before you can find a doctor who’s willing to see you as a new patient. They’re working hard at trying to fix that, but it's not working very well. I guess it's very complicated to move an entire system out of its old ways.
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From my perspective is do prefer some form of private insurance where you have access to a doctor at least for the day-to-day stuff. On the other hand, when it comes to more grave disease our system might become better because whenever you have a life threatening issue if they see you before you die then you're in good hands. They treat you well for no money out of pocket which is an amazing thing.
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Even then our system has some limitations where as some medications are not covered. You often hear people complaining that they have a type of cancer or whatever rare issue and the government is not paying for their drugs and they're not expecting that. No one can fork off $200,000 for a medication when they're not expecting to have to do that.
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I don’t really know if there's an answer to your question Howard. I'm uncertain if our system is better than yours. In some cases probably yes, but for day-to-day needs I would say definitely no. I’d rather pay $200 and be seen on time in a clean area by a doctor who takes the time to speak with me and actually solve my issue rather than be waiting in a crowded waiting room for hours and hours and hours as if time didn’t matter. Then, be told that I have nothing when I do have something and I actually needed an operation.
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You know when something is free people perceive it as unlimited. Again, it boils down to the same thing human nature. Everything has to be limited. Everything has to have a bit of value. Maybe a middle ground would be beter. Totally free, in my opinion, is a big can of worms and for that reason perhaps your system might be better if there was a way to ensure that most people had some form of valid insurance truly effective and useful insurance.
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Our system unless you're dying, it's very tough to say that. I don’t like it because not everybody’s going to have a problem that's life threatening, but it can affect your quality of life. You need to have a good quality of life or else what’s the point of working hard? Now, as a dentists I'm paying taxes, not using the public system and paying immense amount of money to go into the private system in order to get proper care. It’s not because our doctors are incompetent that's not the problem. The problem is the way it's structured. You don’t actually have access to them. Is that better? I don’t think so.
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Howard:
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Karim you've been practicing a long time. You care if I give away your age or is that personal to you.
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Karim:
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No that's fine.
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Howard:
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You're the big 4-0. The fans of this show are mostly juniors and seniors in dental school or they've been out five years. Almost ninety-five percent of the emails I get they're not even thirty years old. I know that you are politically incorrect or you'll just be honest and tell it like it is, but they say to me this. They say Howard I'm graduating $350,000 in student loans and according to everything I read I need to double my debt on just three pieces of equipment a $150,000 CEREC machine, a $100,000 CBCT 3D machine and a $75,000 Biolase laser. Karim, does that kid opening up his own practice need to buy those three machines to be an elite doctor like you, yes or no? Do they need the double their debt?
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Karim:
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Absolutely not, not at all.
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Howard:
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Talk about that.
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Karim:
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All right, my advice is what many dentists have given as advice on DentalTown to young grads as well. Keep our debt load as low as reasonably possible. If you need to buy an office do so. If you want to start from scratch do so. I would prefer buying an office. Don’t buy any high tech toys. Don’t invest in any of that at all. Keep it as low key as cheap as possible. Focus on creating trust between you and your patients that's what's lacking most and that's what would impress people most.
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As you become successful and you have a true following if you'd like to indulge funner things because you like what you do and you enjoy what you do and you want to have more fun and maybe inject some fire into your practice. Then, by all means, invest into these nice toys. Patients will be impressed and pleased with them, but it will not bring you in more patients.
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What will bring you in more patients, what will make you successful is focusing on building trust between you and your patient so that you could work comfortably with that patient and not be scared of what we often hear on DentalTown in the United States market mainly. The fear of [inaudible 00:58:33]. Everything seems to be focusing on that. Eliminate the fear of [inaudible 00:58:38] by creating strong relationships with your patients that's what successful dentists do best.
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They have good relationships or they create credibility because their patients learn to like them, learn to love them and learn to trust them. That’s what matters most. Reduce you financial pressure so that you don’t feel other pressure when at work. If you don’t feel under pressure at work you'll be able to talk and just communicate better with people. You'll just be more comfortable. You'll be more yourself. You won't have any major hurdles, goals that you have to meet or whatnot, all these things won't matter anymore.
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The only thing that will matter is that you and your patient be able to talk together properly, decide what his goals and needs are and you'll notice that you can meet all of his needs and goals without any of these bells and whistles. I have them all by the way. I have a CEREC. I have a huge office. If you go online you can visit, walk through my office. All of these things are in my office. It's a super expensive office. Having all these toys I'm telling you that you don’t really need them.
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Some days I tell myself maybe I regret owning all these things and creating all of that financial pressure. I do enjoy working with it though and I don’t regret doing that. I’ll probably not go back to working without them because I enjoy them too much. When it comes to having patients, doing work and whatnot these things don’t change anything whatsoever that's it. That's like my patients [crosstalk 01:00:18].
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Howard:
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I think you said it perfectly because I have all those toys too. I have a CEREC machine. I have a [Terastream 01:00:23] CBCT. I have all the lasers, but I saw them as a Porsche for a rich boys toys. They can always say you can measure a boy by his toys. They're toys. They weren’t fundamental necessities. There's nothing wrong with a $14 Impergum impression and sending it to a lab and saving yourself $150,000 CAD/CAM machine.
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Karim:
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Exactly.
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Howard:
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Who do you think would make a better crown? Your lab man or you on your CEREC machine?
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Karim:
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Today I would say myself on my CEREC machine, but that's after sixteen years of experience.
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Howard:
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Exactly.
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Karim:
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Using my CEREC machine on day one I would've been a total disaster, man.
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Howard:
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Exactly, it's like buying a piano.
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Karim:
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Just think about, just thinking about it pity the patients that I would've treated with the CEREC machine on day one.
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Howard:
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Look at me I didn’t even have the advantage of starting with a CEREC 3D [inaudible 01:01:16] cam. I started with CEREC 1, then CEREC 2, then CEREC 3.
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Karim:
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You worked up.
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Howard:
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Yeah, it's like buying a piano and you got to learn how to play yeah piano. Did you hear about my dental student payback program that I started myself?
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Karim:
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No, I haven’t, can you tell me about it?
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Howard:
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Yeah, I have four boys. The oldest one did me good and got married and had me a granddaughter, but the other three aren’t married. If a woman dental student out there has student loan debt and wants to marry one of my three boys and make me another granddaughter I’ll pay off her student loans.
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Karim:
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Okay, I have offer for you.
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Howard:
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Okay, you got one?
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Karim:
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If any of them wants to turn gay I'm game.
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Howard:
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Hey, Karim seriously je t’aime [French 01:02:03]. I Love you man. I've been a huge fan of your sixteen thousand posts. It’s so amazing on DentalTown how you might not see a person or get to have a meal with them or whatever, but I just feel like the know you from like a sibling, Gosh darn, 2006 to 2016, so a decade with sixteen thousand posts. I feel like I know every core of your body.
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Karim:
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In a way I feel the same way Howard. In spite of everything and all of the challenges that we seem to discuss and overly discuss probably, it's still a great time to be a dentist. We have so much available to us. We can do so many things. We can impact people’s lives tremendously. DentalTown is certainly one of these greatest tools. Totally in expensive for a dentist and nothing comes close in terms of its ability to provide information and help you become just a better dentist overall. Thanks to you, in a way it has become for me an amazing last, I guess, ten years since I've been on DentalTown.
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Howard:
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It really has nothing to do with me. I just saw the infrastructure. What makes DentalTown is someone else invented the infrastructure, but what makes DentalTown is Townies like you who have shared sixteen thousand times in the last decade. Without you guys DentalTown would be an empty website. Karim from the bottom of my heart there's probably a hundred people who are the core of DentalTown and dude, you are one of them.
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What a great guy and thank you so much for all that you've done for dentistry, all you've done for DentalTown and thank you for starting this podcast sharing your story. You shared so much personal stuff. Many people just can't do that. Love you lots, can't wait to see you next time.
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Karim:
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Thanks a lot Howard. It's a great honor. Thank you very much.
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Howard:
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All right, take care.
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Karim:
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Bye-bye.
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