Dentistry Uncensored with Howard Farran

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

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Howard Farran:

It is a huge honor for me today to be podcast interviewing Lorraine Guth. Lorraine, thank you so much for doing this with me today. Lorraine’s background includes many years of business administration, and successful treatment presentation as well as extensive studies in communication, and leadership skills. In the last eight years as a practice management speaker, Lorraine has enjoyed learning and laughing with thousands of dental professionals across the US, and Canada, and Sweden. Her presentations are known for offering easily implemented simple solutions for enhancing the new patient call, treatment presentations, and systems implementation.

One of Lorraine’s specialties is assisting business owners, and managing difficult, or conflictual conversations with team members and patients. Recently, one attendee was thrilled when she was able to go back to the office, and in the next week convert a patient to schedule and complete a case, including multiple crowns, even though her practice did not participate with a patient’s insurance company. Lorraine thank you so much for accepting my invitation to do this today because the bottom line is dentists go to school eight years, and learn math, physics, chemistry, root canals, fillings, and crowns.

Then they graduate, and realize that pretty much all their problems are going to be dealing with the other seven billion talking monkeys on this planet, whether they’re patients, staff, employees. I’ve always said the other people are the best thing about your existence on Earth, and they’re also the worst thing about your existence. People are just complex, aren’t they?

Lorraine Guth:

They’re very complex.

Howard Farran:

What I see is dentists have multiple issues going on every day with their patients, and their staff, and what they usually do is just go in their private office, and shut the door. They know if they shut that door everything will take care of itself. Is that true?

Lorraine Guth:

Well, that would be wonderful wouldn’t it? That would be wonderful. That would be great to work in child rearing as well.

Howard Farran:

Oh my gosh, I tell my four boys every time, they are the hardest job I’ll ever love. Bottom line is, what is your assessment of dentists? Do you think they’re well equipped to deal with people issues whether it’s dealing with patients, or staff, or do you see a little improvement needed, or a lot of improvement needed?

Lorraine Guth:

I think we all need a lot of improvement. I think dentists have a very difficult job, Howard. You have ... The clinical side of dentistry alone is enormous. With the clinical side, you have systems implementation, you have clinical processes involved in that. Then you have to deal with people’s emotions all day. You have the patients, you have the team, you have your own personal baggage that you bring in the door.

Howard Farran:

Oh, I don’t, I don’t.

Lorraine Guth:

I know.

Howard Farran:

My ex-wife says I’m perfect.

Lorraine Guth:

Yeah.

Howard Farran:

Well, and it’s just tough. When we surveyed dentists, and we asked them what is your biggest headache? 80% always put staff. 80% is staff, and then number two would be the bat shit crazy patients. They never say “Well what sealer do you use during a root canal, or what’s the square root of four?” They never have a science, or a math question. It’s always the people. Where do you want to start? Do you want to start talking about staff or patients? Where do you want to begin?

Lorraine Guth:

Let’s start talking about staff.

Howard Farran:

Okay. My first question on the staff is who’s the craziest? The dentist, the hygienist, the assistant, or the receptionist. Line them up in order of most insane to least insane. Who would be number one? Is it the dentist?

Lorraine Guth:

I think we’re equally crazy.

Howard Farran:

We’re all equally nuts?

Lorraine Guth:

I think that what happens is in a practice, and any organization you get a whole group of people that come together. They come together with different ideas or understandings about what’s appropriate in how you work together, and how you problem solve. It’s interesting. I’ll ask you Howard. Do you think you’re more connected to people that you disagree with, or with people you agree with?

Howard Farran:

Gosh, agree with.

Lorraine Guth:

Right, it feels that way doesn’t it?

Howard Farran:

Yeah.

Lorraine Guth:

Really, if you really care about somebody you’ll learn to disagree with them well. If you look at organizations that grow in a synergistic way, and exponential way, they learn how to disagree well. They learn how to come into alignment. In fact, I bet just from what I read of your book, and what I’ve seen of you. You have a group of people that work for you that are comfortable disagreeing with you.

Howard Farran:

Oh yeah, absolutely.

Lorraine Guth:

Right?

Howard Farran:

I’ve said for 30 years that 95% of all my ideas get rejected. They counter, it’s 95%, it’s only 80%.

Lorraine Guth:

We need people around us that we can effectively disagree with, and then come into alignment. You still have to have a leader in the organization. We need to learn how to have differences together. We need to learn how to have conflict together effectively. Now you think about it, you bring people into an organization with very different viewpoints. I’ll give you an example, when I grew up, I grew up in an Italian household. I don’t know if you’re familiar with that.

Howard Farran:

You talk with your hands. How come we can’t see your hands?

Lorraine Guth:

I know. We know right? In fact, we have six kids so we have eight people around the dining room table all trying to talk at once. In fact, polite table manners were don’t interrupt the other person, and point at what you want. I found out when I went out in the world that it was not polite to point across the table. We have different viewpoints. When I come home sometimes my father would say things like “What did you do, come here, what is this about.” Then he’d say “Give me a hug, I love you.”

Right? I understood that direct confrontation when I grew up meant love. My next door neighbor, Maggie, always spoke like this. He was very monotone. When he expected you to do something, and get it done right now he’d ask you in a question. Would you mind? Coming from my family I ignored those things. I didn’t know they meant anything significant. I’d go over there, and I’d get in trouble for not responding to Bob, my friends’ father’s instruction. She’d come to my house when my dad was expressing himself loudly and she was scared to death. I think it’s just a good example of how we have these different expectations about what is appropriate in how we communicate, and in practices I think we need to talk about that a little bit more.

It’s interesting, I had one assistant that was really having a tough time working well with her boss, who was an excellent surgeon, a demanding surgeon, and he should be. He had some look he made when he was frustrated and of course the patients were under. As soon as he made that look, she’d stress so much she couldn’t think, which is the worst thing for a surgical assistant to do when they’re working with a demanding surgeon in a complex procedure, right?

I think one of the things that I see in these organizations is that we all need to get better at understanding what are our standards in how we work together, and how we communicate. What’s acceptable, and also understanding that the way you were brought up isn’t necessarily the right way. Just because maybe your boss is more direct doesn’t mean that’s bad. It just is. Does that make sense?

Howard Farran:

Absolutely, it just is what it is.

Lorraine Guth:

Right.

Howard Farran:

You’re right, everyone comes to the table with a lot of baggage. You started with dentist has a very tough job because I miss the little deal. My dad owned a restaurant. People are so happy when they go to a restaurant. They are about to eat a bunch of food, and they’re just the opposite when they come to a dental office in pain, and have to get a shot, and give you all their money.

Lorraine Guth:

Right, and they’re wired out. They’re not at their best. I think you can also look at different personality types. The way somebody that’s type A, that’s in control of their life more demanding, the way they react to stress is probably much more directive than somebody who’s more introverted and passive. The way we ask for help is different.

The way that’s somebody is type A, and more direct to ask for help is very different than Maggie, my friend. When I grew up. That creates conflict sometimes. Sometimes I see, for example, team members who will categorize a patient as being a difficult patient to work with. Really they’re not, they’re just telling us what they need in the best way they can for the moment that they’re in. That’s a compliment.

Howard Farran:

When I look on Dental Town, and it’s got 50 different categories, root canals, fillings, crowns, whatever. When we go to staff management issue, and I scroll through those topics before I knew I was going to talk to an expert today. One of the most stressful staff management issues is the dentist thing overheads too high, and all this, and now the hygienist wants a raise. He just goes on Dental Town, and just verbally unloads this whole stress.

Do you see that situation? Do you agree that that’s a-

Lorraine Guth:

Absolutely.

Howard Farran:

What’s the answer? Your overheads high, you feel like you’re not doing well, and the staff wants a raise because it’s justified because the Earth made a complete revolution around the sun, and whenever the Earth goes around the sun they want their dollar raise. It’s all based right there in the stars, it’s the astrology straight forward. How do you handle this? Do you just go out there, and look and make sure that mars just passed Uranus, or–

Lorraine Guth:

This is funny. It’s interesting that ...What I find it team members in dentistry, and I spent a lot of years as a team member with very misguided beliefs. Team members in dentistry are never taught business, and how money works, and how wages work. You begin to learn that as an entrepreneur because you simply have to for the market place. One of the things I see, one of the patterns, I’ll just give you an example. Let’s say that in your office you had Susie that works for you. She’s been with you for a long time, and maybe the last couple of years she’s slacked a bit.

That can happen, and maybe now you have Jamie who starts working for you, and you bring her in at an entry level. She’s just enthusiastic, and really takes a lot on, and within a year you’re really happy with her performance so you give her a dollar raise, which is far more than any other business would. Businesses give raises by a percentage for a reason we have to keep our overhead costs in line. Jamie comes in, and you give Jamie a huge raise on the first year. Maybe because you’re frustrated because your other long term employees aren’t doing as much. Then the second year Jamie’s really excited, so she keeps working hard, and keeps working hard, and so the second year you give her another buck right? The people that have worked for you for a long time you can’t do that because they’re over what they should be getting paid for the marketplace.

You create these conflicts. What we’re doing now is we’re teaching Jamie that if you do a great job ever year you get a buck. One of the reasons that people come to you with expectations sometimes that don’t work well is because we’ve taught them that. What you look at ... I was listening to the average pay increase in the US for people from entry level beginning position to the end of their career is generally 2% to 3% per year. If you look at it, it makes sense in line with business overhead cost. When you get this hygienist who’s coming to you, and they’re frustrated because it’s been a year so they should get a buck.

I think sometimes we have to look at the fact that we taught people that this is how it works. Then the problem with this is, that if you don’t begin to have real discussions about how wages work, what people think is the way to get a raise is to quit working for you and go somewhere else. They apply for a job for somebody that’s been shorthanded, and they’re desperate so they get a raise for taking that job. Does that make sense? I think there is this conversation that we can start to have that every job gets capped in wages.

Howard, as a dentist, there’s only so much that you’re ever going to make as a dentist if you don’t adapt your practice. It’s the real world. I think for team members the question becomes A, understanding what is the market range for their position? At what point do they get capped, and how do we motivate, and incentivize people that are with us a long time? In the real world you can’t pay a dental assistant $100,000 a year and stay competitive in the marketplace. We have to start having a conservation about wages.

Howard Farran:

You got a thousand kids listening to you now that just walked out of dental school in the last five years. How are they supposed to find out what market wages are for a hygienist, or an assistant, or receptionist. Where is this data found?

Lorraine Guth:

That’s the frustrating part. There was a time I use to work at a hospital, and we were able to take positions by category, and look at real wages, look at various government institutions, and census reports, and really see what market wages were. We’re not doing that really well. The best way to do it that I found, which is not a great way is when you’re interviewing you make people on the application, or on the resume submit what they’re making, and what they hope to make.

Understand that if somebody over shoots in their expectation, don’t diminish them for it, they just don’t know how to negotiate wages. It doesn’t mean they’re not a good candidate. You can start to look at all of them together, and get an idea on your market. Then call your colleagues, call your colleagues, and ask them what they’re paying. If you don’t have colleagues that you have a relationship with in your community, that’s a sad thing.

We all need to work together. Then there are the salary.com and some of those. The tough part of this too, Howard, I look at, for example, Philadelphia. In Philadelphia there’s an area where 20 miles apart, people get paid more from the other 20 miles because there’s the transportation across the highway is a problem. It’s hard to get people to work in this one same spot so people get paid more. How do you judge? It’s just, I think, really tough.

Howard Farran:

Do you think Dental Town should do a salary.com deal to help my homies? Do you think that would be a good feature, or would that be a collusion, and illegal, and all that stuff?

Lorraine Guth:

I don’t know think it would be illegal because I don’t think we’d have salary.com if it was. I think it’d be a great idea. I think we would have to look at it in connection to wages plus benefits. This is one thing that I learned early on when I started. I’ve been in private practices in dentistry where compensation was really cash heavy. It’s how much you make, not so much the benefits. I went to work at a hospital, and I took a $3 an hour cut in pay. I had a discussion with HR about that. I was frustrated with that, and my discussion with them was based on that I believed that they were out of line with the market place.

What they said to me is, that in the past you’ve been getting wages in a cash rich way with fewer benefits. In our organization, we considered 30% to 40% of your wages as your benefits. We had amazing benefits. I ended up with, when I was out on leave with my son, I had six weeks of pay, and that was awesome. I think when you look at salaries, you have to look at that. Also, as a business owner, you have to look at from what market you’re pulling. Part of the reason employers will say here’s my percentage that I can afford to put towards compensation.

You have to look at what market you’re pulling, and in your market offering health insurance is important, then usually that means the hourly rate is lower in that market. If you’re working in a market where no one offers health insurance, which is more common, then you’ll see a higher dollar an hour rate per hour. Then for employees that don’t understand these kinds of business decisions, it’s confusing. I use to make this much at this office, and now you want me to make this much less.

Here’s the other piece that affects salary. I can tell you this is something I did when I was learning, and coming up then ranks. I got my raises, I got my raises, I always managed to get good raises because I performed. Then there was a point that I got capped. I couldn’t get anymore. Finally, there was a point I took a job with a very difficult doctor who couldn’t keep people. I got a big raise, and the reality was in that organization nobody lasted more than a year. I figured out very quickly that I was getting combat pay. That’s what it was. It was combat pay.

In the end, quality of life trumps everything. There’s a point then when I went to leave there, my thought was going to interview at other jobs that they should pay me just as much as Mr. combat payer more. I found out that wasn’t true, so sometimes that’s part of what it is. If you’re wages ... I’ve had people who have had tremendous turnover, and are having trouble hiring people. One of the pieces of advice I’ve given them is increase your wages, and get better at leadership, so you don’t have to pay people too much to work for you.

Howard Farran:

What do you think is normal staff turnover? When you said he had a high staff turnover, what would you say the normal is? Also, how much is normal worth because when we build relationships, not teeth.  When you’re talking about you got two assistants, and one’s a new one and she did good. You gave her a buck raise, she did great another year, you give her a buck raise. Sometimes you’re looking at that older one who’s been there nine, ten years, and is puttering out in her life or whatever. Then you’re trying to put an economic value on what is ten years of a relationship, value, trust?

When you go to sell a dental office, you have equipment, but you also have blue sky because of the name brand of this practice. How do you put a value on, "Wow, I don’t want to get rid of a dental assistant that’s been assisting my patients for a decade because everyone knows her, and loves her, and trusts her."? That’s a lot of questions at once, but what do you think is a healthy staff turnover, and how valuable is a person who’s been with you for ten years as far as a relationship? What type of economic impact is that when you trade that lower performing NFL player who you don’t think is going to get you to the super bowl for maybe a more energetic player? Is that enough questions for one question?

Lorraine Guth:

That’s pretty good, so if I lose track of any it and –

Howard Farran:

I think I got 37 question marks in that question.

Lorraine Guth:

You did, so I’ll start.

Howard Farran:

I fear my questions are so lousy that if I throw 20 of them out there, one of is good and will stick.

Lorraine Guth:

They will stick. There’s a term I use, and I think what you want is appropriate employee retention. We don’t want employee retention at all costs. We have a team of people to work together, and so I look at a difference between family and team. There are things that I’ll do for my family because that is all about relationship, and not about money that are very different. There’s dysfunction that we put up with. I’m sure we all have some of that. In a team relationship, if you let one person fall too far off the grid so to speak, it says all the wrong things to the rest of the team.

I think we have to be leaders and deal with that. I want to appropriate employee retention. I want long term employees. What you see out there? Typically, one of the numbers I heard is the average, I can’t even remember where I heard this, the average dental employee lasts two years in a practice. It’s interesting, my husband, I was just talking to him the other day, and he was listening to a program that says our kids coming out of high school are going to have 12 careers in their lifetime most of which we don’t even exist yet. We have to expect that this is a time in our human kind tremendous opportunity, and technology, and possibilities.

People are going to move more, and they’re going to change more. I would say if you’re a dentist, and you are having turnover every year all the time, and there’s a lot of conflict, you have a problem. If you have people that are happy that come to work, that perform and produce, and you have people that turnover for better opportunities sometimes when they’re going to be stagnated in your practice, I think that’s okay. We need to invest in people, but sometimes there are people that are really star performers, and there’s no way for them to go up in your organization. We have to accept that. I like seeing a range in a practice of anywhere from 1 or 2 years to 10, 15, 20 years. I like to see a mix.

One of the things that happens ... It’s interesting that long ago, I was helping someone who had the same group of people that have worked for them for 25 years. That worked really well for a long time, but then people started to have ... One of them had a severe physical problem, and retired out. Some things started happening in that regard. The doctor said “My gosh, why am I have all this transition?” My answer was “this is age related.” It’s because this is a time that people are going through changes, so you’re not likely to keep your entire staff consistent until they are 65.

Howard Farran:

At what age do you recommend taking your assistant to the vet, and having her put down because she’s just too old?

Lorraine Guth:

Well, I think age is relative isn’t it?

Howard Farran:

Oh, it’s funny. My Jan, my dental assistant has been with me 28 years, and what’s going to take her out is actually all of her softball injuries. I’ve been begging the woman for five years to quit playing softball. She’s not going to have a job related injury, it’s the softball. I thought what you said was interesting about medical benefits that it really depends on where you’re at. I always had a different angle on dental. I’ve always been arguing with these dentists. You hear them, they go into politics, and they don’t want universal healthcare, and then they don’t provide it for their staff.

I always provided medical insurance for all my staff, and a 401k because I thought it was criminal that if Jan stood by my side from age 25 to 65, and I walk off retired, and wealthy, and she walks off to a trailer park on Medicare. That just wasn’t fair. I always provided it  because I always thought it was a right wrong issue, but you’re right. It does depend on what they’re use to. I believe the dentist who don’t want any government regulation from the state board, but then they’re going to call their peers out from doing malpractice dentistry. If you don’t want the government, then we have to do it ourselves. I’ve always believed that hell we’re in healthcare.

I’ve always provided medical, and all that. What about ... Go back lessons on hiring. One of my pet peeves about dentists is I look at the NFL, and 38 franchise, though I have 6 or 7 full time employees that scout every single college player that could ever play any position in the organization. When they go to hire a quarterback, they’ll have the complete list of all the boys in the universe that are eligible for this job. Then when a dentist needs an assistant they’ll throw an ad on craigslist, two people will walk in on Monday and they’ll hire one of the two. I never thought they take HR serious, and some of these dentists are the biggest sports fans in the world, and then they’re own recruiting is just like whatever.

Lorraine Guth:

I know, isn’t that interesting? I think everybody is afraid of it frankly. They feel like it’s time consuming, it’s demanding, and they don’t know how to do it. They throw in the towel, and they do what’s easiest. The Craigslist thing, it’s interesting. I’ve had people talk to me and say it’s so hard to find good people. I ask them, what do you do to look? I put an ad on Craigslist. I’m like, “Okay, well that’s not that much.” Part of what I like to tell people is recruiting is marketing. Just like marketing with patients. You need to get out there, and let people know that you have a job. I talk about Craigslist, there’s Monster, there’s Career Builder, there’s LinkedIn, there’s iHiredental.

If I’m looking for a star player, just like you talked about with your football teams, right? I’m looking for a star player. I want to get those ads out there everywhere where somebody might see them. One of the complaints I get when you bring it up is people will say well that costs money, that’s expensive. My answer is one of the things I tell them is write down the number 25,000 and put a dollar sign in front of it. That’s what you’re spending. When you hire a new employee in a dental practice you’re spending that in six months easy on time spent in training, on lost opportunity.

It’s a big investment, and so in these same people. These same doctors if they were going to drop $25,000 in the stock market would do a little research. I think if we’re going to hire we need to realize this is a significant investment in another human being that has a lot of potential for variable. We need to put those ads out everywhere. We need to not worry about the fact that it costs $395 to put an ad in Monster. My gosh what are we going to make on a great employee. Look at your assistant, if you thought about how much more you’ve made economically because you had her by your side, right? That’s worth the price of an ad.

Howard Farran:

I also got to say one thing about Jan because some of my colleagues thought I was a jerk is that when your favorite team steals the best player from another team, everyone claps. When I stole Jan from one of the greatest dental offices, it was actually Michael Schuster, the famous Michael Shuster whatever, whatever. When I stole her from there some of my friends thought “Dude that was rude.” Why? It’s what you do in the NFL, it’s what you do in hockey. Furthermore, if you can steal Jan from me, my hat is off to you. If I’m not making her happy, and you steal her from me that was my fault.

You know what I mean? Oh, I want to ask you this specific. I see some dentists that will only hire an assistant, or hygienist, or associated dentist with five years’ experience. Then I look back, and a lot of my friends had some really good luck, especially the front office just taking someone off the street from another service. The best receptionist I ever had, I stole her from Chase bank. She was just so sweet, and attention to detail, and she came over from banking to the front desk and she learned soft then in about an hour. What’s the trade between five years’ experience, and no experience?

Lorraine Guth:

I tell you what, I think in our practices if we really want to go where we need to go in dentistry. We’re going to have to start acting like businesses in a much more significant way. I think we can all be successful if we start putting good, sound practices in place. This I can only hire somebody that has dental background ... There are great people out there, and so when I talk to people about hiring, I let them know you’re hiring two things. You’re hiring behavior, and you’re hiring skill set. I want you to think about it. What's easier for you to teach a person in your practice, Howard, behavior or how to set up for a composite?

Howard Farran:

Behavior.

Lorraine Guth:

Behavior is the easier, or the harder?

Howard Farran:

Behavior is the hard, it’s almost untrainable.

Lorraine Guth:

It’s hard, right?

Howard Farran:

Yeah, yeah.

Lorraine Guth:

I look at the human being that I have matters. I want to hire people number one, for not what they already know because that’s history. You can take two candidates, and you can have one candidate that doesn’t have as much of the knowledge base and they could be a better candidate because they learn better. I care about what you know, but I care about how you learn, I care about how you learn under stress. I care about can you take feedback? Can you take critical feedback and go on, and let go of your own emotional needs, and focus on the patient and problem solve?

I think letting go of this whole idea of we need somebody that has dental background ... And if you look at it, it’s interesting. I was at dinner with a client one night, and then hostess, or manager of this restaurant, was fabulous, right? Just unbelievable, and this is a very nice restaurant. Then I said to him, give her your card. You need somebody. Give her your card, have her come in and interview. He said but she doesn’t know dentistry. I said “Look at her running this restaurant.” She’s able to get all these people with different backgrounds, and look at how consistent this place runs.

I bet she runs whether the place was profitable at the end of the day. She’ll be thrilled to find out that if she works with you she doesn’t have to work Christmas eve, or New Year’s Day. It’s interesting, I look at when I travel, The Marriot, when I walk in the Marriot and get this great consistent service at the desk where people, when you walk in, automatically know to look at you and make eye contact instead of looking at their computer. We need to start looking outside of dentistry. Dentistry is great, and I love having people that are experienced, but we need to be thinking in terms of hospitality services, and sales skills.

At the front desk, when you're answering the phone, if you think about it, I have to through a piece of plastic, convey value to somebody that's never seen us before. That's pretty powerful.

Howard Farran:

Lorraine, you said she, and I noticed that when I got out of school, all the gynecologist were men and now they're all women. We're seeing the same thing with pediatric dentistry. The pediatric dentistry graduating class of 2016 is pretty much all girls. It's all growing girls but from 1980 to 2015, the United States lost about 15 million manufacturing jobs. Now for the first time in my 28 year career, when I put out applicants, I'm getting as many men as women. Is there anything we should be thinking about as dentistry. I've read it in hospitals too. It's a percent thing. When boys used to only be 4% of the employees, if it goes to 6%, that's a 50% increase.

With an exploding population of males looking for healthcare jobs, any issues we should think about that or is it really a non-issue?

Lorraine Guth:

No. Actually and in fact, one of the things I'm seeing is, I think some of the male dentists that I work with who higher male assistants or male admin team members, they love it. I'll quote them and I'm not saying I agree or disagree with this  because I don't want to be politically incorrect but they say, "There's a lot less drama." I understand how they think. Working around how a bunch of women problem solve is hard for me. I'm the odd man out. To some extent there's a leg up. If you look at the jobs out there, being a dental assistant or a hygienist or valued admin team member in certain areas, pays really pretty well compared to a lot of the options.

It doesn't require that you have a master's degree. I think people that historically haven't looked in our industry are going to start looking in our industry more.

Howard Farran:

This is so politically incorrect that most people can't believe I'm going to say, because I can believe I'm going to say it because this show is called Dentistry Uncensored, with the most uncensored mouth in dentistry. I've switched to an all male Dental Office Manager, that used to run like a hundred of the big bucks corporate, so massively too over-trained for my little office. Two of my four dental assistants are males and I personally think they're far more easier to deal with. Is that because I'm a male or just because males only say two thousand words a day, women say seventy five hundred. Every time a man talks to another man, a woman will talk to five. Do you think it's just more simple?

Lorraine Guth:

I think yeah, there are gender differences. People have different opinions on this. My opinion is men and women communicate differently. We think differently. We sort differently. If you look at it, for a male dentist that comes in with all the responsibilities and all the details, to have somebody next to them that they don't have to figure out all day long, that's easier for them. I'm not saying it's right or wrong but it's easier.

Howard Farran:

The data on monkeys is clear. It's math. A woman says sixty five hundred to seven thousand words a day. A man is under two thousand and all age of monkeys, every time a male monkey talks to someone, the woman talks to five people. That just makes a lot ... By the way, you talk about four quad employee performance review. Can you explain that in detail?

Lorraine Guth:

I think sometimes, I will going to a practice and I'll hear an employer that's frustrated about employee issues and how an employee is behaving and functioning. One of the questions I'll say, "Well let me see their performance evaluations." What I find out is all of their last performance evaluations were great. It's like your now so frustrated you don't know if you can stand it anymore. Why do they have all those performance evaluations that way. The answer is, they were grading people on technical skills only. I think people live up what you direct them to.

I rate people under 4 quads. One of them is 25% is if I'm rating an employee how well do you work me as the owner? Do I have to have angina for 3 days before I ask something different? Are you going to cry if I do that or am I able to communicate with you effectively in a way that fits my nature but is appropriate to you? We all have to make some concession, right? How well do you work with me? Let's say I give you a feedback as an employee and you're  nice to me and pleasant but you walk around passive aggressive for 3 days and you go in the lab and tell everybody what a jerk I am.

Well, I'm paying you to do that. That's going to make me rate you lower as an employee because I'm not going to build you for success. It's interesting sometimes I go into practices and I can see which employees have the best relationship with the owner and being able to give them receive direct feedback. The way I can see this those are the employees that get all the opportunities because it's just easier to walk up and say "Susan, what I need is this" and Susan's not going to get upset because you said it in a certain way. She's going to know that if you said it in a frustrated way it's because you trust them and you need their help.

I think part of it is being clear about rating, "How well do you work with me? Can I communicate effectively? Can I give you feedback in a regular way?" I'll challenge your Howard if you can't give an employee, if you can't have a good working relationship in a way you give effective critical feedback and positive feedback you will not develop that employee, that's one. The other 25%, is how well do you work with your team? If your technically a star performer and your always great to me as the owner but the team can't stand it when you walk in the room.

I still have a problem because great patient care happens because we move information appropriately around the office. There's so many details in patient care so if you have an employee that doesn't work well with the rest of the team I don't care how good they are in any other place you're going to have problems. There is that, Do they work as a team? Do they listen to other people? Are they effective? Can they effectively disagree and exchange ideas?" There are all kinds of parameters and I have a sheet where I go through different ways that you can judge and see that.

It's interesting I was talking to one of my clients once and it was right before I was coming out and he said he hasn't realized that he's hygienist and his team members were so at odds. They were really at odds and I said,"Why hadn't you noticed?" He said, "They never came to me and told me" and I said "Did you ever watch the way they talk to each other?" and he said "Not really" and I said "Do you ever really see them together you know just shooting the breeze when you're not around? Do you never see them connecting together?" and he said "No" "When they walk pass each other in the hallway do they acknowledge each other?" He said "No" and I said "That's how you know you have a problem".

Two women can't walk by each other in the hallway and not acknowledge each other. I think men can do that, women can't do that. You got to have people that can work well together and understand that's an important piece. I have a do you work well with me as an owner? Do you work well with the team members? Then how do the patients respond to you? It's interesting I had one gentlemen I was working with and he said I have 2 people at the admitting area and one of them the patients love her and they always talk about her, they always say her name and the other one they don't say anything about or they call her that woman up at the desk. Does that mean there's a problem? My answer is one's connecting with the patients and one isn't right?

I think there all kinds of ways that you can judge whether someone is doing well with the patients and I look at, do the patient's love you? Do they say their name? Do they buy from you? If you're a hygienist and your working with patients and no one ever tries to improve their health after working with you then that's a bit of a problem because we're supposed to be helping  people get their life's better and make their health better.

I've got now you the owner, your team members, and the patient. 75% of how I wage your performance is based on those things, the other 25% are your technical skills. To me, let's say you’re a dental assistant and technically you’re the best dental assistant in the world but if you don't get along with the team, if the patients aren't in love with you and if I have to have an angina every time I talk to you, then you're not really a valuable employee for me.

Howard Farran:

Is it a small sample size that I think this or using it? When I meet women dentist that are just crushing it they tend to have a more all male staff do you notice that ever or you do you not notice that?

Lorraine Guth:

I have noticed that.

Howard Farran:

You have notice that. Is that in Arizona desert thing?

Lorraine Guth:

Maybe it is a desert thing.

Howard Farran:

I want to go back to the team, building a team since that's your most stressful thing. Do you see anything’s that are more successful teams do more like morning huddles or getting wired up on walkie-talkies or how often should the office have closed down and have some, what do you call it? A retreat or... what do you call that? Sap meetings.

Lorraine Guth:

Team Building, sap meetings

Howard Farran:

Sometimes some officers will actually go away, they'll go to a resort on the other side of town and have a retreat. Can you talk about any of those things? Do you think any of those things technically help team development or do you think it just comes from the leader?

Lorraine Guth:

It's a bit of both. If you look at it, a great leader is going to make sure there are systems in place to create a creative great team. They’re not going to hide in their office, it doesn't work. It's interesting I think morning huddles are critical.

Howard Farran:

What percent do morning huddles would you say? In your observation what percent of the 150,000 dental offices in America start with a morning huddle?

Lorraine Guth:

I would say at least lees than 1/2. I think people talk about it but they don't do it and then it becomes a problem because somebody has a hard time getting there on time or people come in late, they're still eating breakfast when they walk in to the huddle they're not prepared. You have to be a leader...

Howard Farran:

Oh Lorraine I'll throw my homies under the bus. It's because the dentist doesn't want to get there early. He wants to walk in at 1 minute till 8:00 and walk in [Inaudible 00:41:33] for and numb up the patient. I see the laziest person in the office, the dentist.

Lorraine Guth:

I'll tell you right. If I were going to pick a key component of success, when the dentist is the first one there, and when the dentist is the last one to go. When there's leadership in the office from the beginning to the end it sets a standard. I can even say, practices that run on time, work with patients, one of the common things I'll see is, I'll see a dentist ... In my mind, I call it prancing, they’re in the hallway or in the lab waiting. If they're supposed to be in a room at 8:00 at 5 to 8:00 they're waiting like "where are my patients? I need to anesthetize somebody" they're not in their office on their e-mail. I think things that make a difference huddle absolutely makes a difference.

Howard Farran:

Why? What happens in a huddle that helps the team?

Lorraine Guth:

a. it sets a tone for the day, one of the things especially if your leader's a good leader it says I'm in leadership of this practice and I'm going to make sure today goes well. It sets the tone for the entire day and you've got a group of people who are coming in that day who could be off emotionally, who could be not focused. You need somebody to pull that together to lead the charge, right? They have to follow you. The other thing is there's a lot of information related to patient care that people have to be on board with so when you have a morning huddle it says to your team "You need to come to work, you need to come to the game prepared".

I don't like huddles where people come in and they haven't reviewed the charts, they haven't looked at any information. They're coming into huddles waiting to be told what to do. I want a team that comes in and everybody has a piece they come prepared for. One of my great mentors that I worked with years ago, I had to come in to the huddle from the administrative side and talk about, for example, the new patient's coming in that day. What was important to them and also I would tie that to where had holes in the next week. I might say, "Doctor, Mrs. Smith's coming in today. I know she's going to need perio. Here's what she told me. maybe she won't but... I have a 2:30 opening on Thursday.

We train the hygienist that would be perfect for perio. If you could tell her if she needs how important it is for her to get in then that would be great. We fill it as a team. There are all kinds of things you can do in huddle that matter if you come prepared. On the administrative side, many times doesn't understand what's happening on the clinical side of the equation as they go through their day. This is where you bring that together.

Howard Farran:

I like the way you talk about everyone showing up prepared. I mean I've always thought that on a sports team every single player either help you win or help you lost there was just no average players. It's like you caught the ball and made the touchdown and you didn't catch it and that's why we lost. You're either a winner or a loser. What about staff meetings and team retreats? How often do you think at dental office have a staff meeting and do you think going off site for retreat is a return investment? What are your thoughts there is that seem to be a game charger to your helpers for the most successful?

Lorraine Guth:

Yes, it can be. I'm going to give you a sport analogy to this for a moment. A number of years ago was taking my son to prep football practice once again. It was like we're always going to football practice and I'd sit in the parking lot with my computer and do my work and I was getting frustrated one night because they practice all the time and they only played 8 games a year and then all of the sudden I thought about it and I thought "You know, in our industry we're playing the game all the time and we never practice and we wonder why there are problems, frustrations, conflict."

I know the national football league they only play so many games but they record, they watch recordings, they have departmental meetings, they have joint meetings, they have leaders in various places and they practice over and over and over and i think we're playing the game way too much and we're not practicing enough. If we are going to have to learn to be more effective in business we need to quit whining and complaining about the changes in the industry and be good at business which means we need to build people. When I work with people one of the things I work with them on is to learn how to be a leader and have a good meeting.

You as a boss having a meeting you could have a lot of meetings where you as the boss just rant and rave for an hour is not going to be effective. You have no idea what's going on in the minds of you employees and they're not able to contribute. Learning some professional team meeting facilitation skills is absolutely an asset to a leader in a business and then have a regular meetings and judge how often and how much they're based on what you’re trying to do. As an example if you're heavily embedded in PPOs and you want to go fee for service you need to have a lot of meetings because you have to look at how are we going to change our service standards?

How are we going to change our day to day just basic functionality in order to be worth our patient's paying us 40% more than our competitors? How are we going to do that? You need more team meetings. If your busy and your running a t a fast pace once a month you need to sit down with your team and have effective meetings. When you have effective meetings you'll know because they're talking more than the boss and you see balance engagement it's facilitating the room. I like team meetings.

I think one of the things we're missing is we are not having one on one engagement with the team enough. One of the things that if you notice I look at HR and HR is changing out in the industry. Instead of the annual performance review, you're seeing more organizations step away from that and instead have what they call more on time performance review and more intermittent and more on going. Especially when you think about, if you want to have long term employees there's only so much you can ever compensate somebody in wages but if you have time where you acknowledge them and learn how they think and what they need, that's powerful.

It's interesting I've been asking people just to get a feel "If you were entry level, mid level and you went to work at apple computers when Steve Jobs was alive and let's say Howard you did a fabulous job that year and I'm your boss and I sit down in your performance review and say "You have a choice Howard, you can have a 3% raise or you can have 2 hours with Steve Jobs what would you pick?"

Howard Farran:

2 hours with Steve Jobs.

Lorraine Guth:

Of course, right? I mean how wonderful would that be to be acknowledged at that level, too be able to ask questions about your own organization to be able to understand about your own organization. One of the things I'm working on with my clients on and I'd like to see in the industry more were dentist if you’re the lead that you actually have structure time that you meet with an employee, just to find out what they think and I give them a process. "What's happening? What's working well for you?" A great question to ask  an employee is tell me about something that you've done that your proud of that I haven't notice that I should have."

I'm probably sure there's an answer in there. Let them have a place to say "Here's what I'm doing for you" and ask their opinion about some things in the practice. We all want to feel like we're part of the decision making. I was reading a Gallup Poll about employee engagement in America and off the top of my head I can't remember the numbers exactly but it's at least I think 67% are either not engaged or not significantly engaged but out of the people in this Gallup Poll that are engaged, most of them are leaders r managers.

If you think about leaders and managers get to get their opinion, they get to be involved in decision making and they get to feel important. If we want to continue to keep people long term in jobs where people aren't going to be the boss, we need to find a way to give them voice. Staff meetings, huddle, and one on one that's not about a performance review or you’re just telling them what they did wrong. We need to learn how to give feedback effectively in an organization. We need to learn how to hear feedback.

Howard Farran:

Do you like to be the technological walkie-talkie things so that they communicate more all day?

Lorraine Guth:

I do, with boundaries. Some people put these things in place where I see walkie-talkies fail is people just decide to get them and they don't talk about it and then what you have is you have people having conversations about stupid things over the walkie-talkies in the wrong winded way. You'll see the doctor Ross just say "This isn't working." and that's not the answer. Walkie-talkies work when you use them with guide lines. They're about something that everybody should know and very short pieces of information and another fabulous.

Howard Farran:

I think there might be something wrong the corner with that new apple watch. You know that new apple watches?

Lorraine Guth:

Yes.

Howard Farran:

I'm already starting to see some dentist talking about getting message on their watch "Oh, your next patient is here" things like that. You said something about going from a PPO to charging 40% more and I think for service. What do you think really is going on? I mean when I get out 28 years ago half the patients just paid cash, credit card, check the other half if they had insurance I would cement my fees every year. I would do the best industry I want, I would cement the fees and the insurance would accept those fees and just decide what percent of that they would pay.

Now I'm at the other end of the square, 28 years later that's all gone and pretty much all the insurance starts with "No, here's a PPO." We see Delta doing this state by state and then they'll do it one state another state another state and you can see what 19 deltas, that do about 20% of our industry. I think they do 19 Billion a year and the whole industry is a 103 Billion. Now it's, this is what you’re going to charge for a crown, work back from that. What percent of practices or what percent PPOs these days compare to when you entered this industry and do you think it's a really viable business strategy to say we're going to ignore PPO's and just go fee for service? You're the founder, you call it Guth Dental consulting?

Lorraine Guth:

Yes.

Howard Farran:

Do I pronounce it right, Guth?

Lorraine Guth:

Yes.

Howard Farran:

guthdentalconsulting.com, what are people calling you up at guthdentalconsulting.com? What problems do you like to solve but do they call you and tell you that 85% of their practice is PPO's and there in Parsons, Kansas? Do you say that's reality and we need to work back from that or do you think that's a bad idea and your trying to get them off it like it's a bad drug?

Lorraine Guth:

It's different for different practices and I think everybody wants something right? I quote somebody, I won't say their name but I heard them say "Every dentist wants fee for service. They just don't want to take on the service part. They just want the fee we just want the fee". I look at the hotel industry, Ritz, the Ritz Carlton is known for certain things, people go there and they're happy to pay more and the Ritz has really worked at creating a consistent service philosophy down the line, so that you feel value in that.

You don’t get to be the motel 6 that says "Hey, we're not going to train our team, we're not going to work that level, we're not going to make a physical complaint look good but we want to get paid what the Ritz get's paid." I think it depends on number of things. I don't encourage one way or another and frankly some dentist are just not going to carry the leadership required to create a fee for service practice. The numbers that you see out there and fee for service what is truly fee for service now in the industry is 10-20% I hear different things.

What I tell my clients, if we know this is true, if you want that you've got to be in the top in every single way and that's hard work. You’re going to work hard these days whether your fee for service or whether your participating it's just what you’re going to work hard on and you do have to take location into account and this may be not popular but I have had a practice I'll just say that I've been to and they absolutely wanted to go fee for service. When I looked at the community and I looked at the physical plant and I looked at what the doctor was willing to do I said "You'll kill yourself if you do it".

Howard Farran:

What part in Detroit where you in? It's true because Detroit when I got out of school was 2.8 Million people, now it's 0.7 and at some point you got to gravity I know dentist that were in a small town of 5,000 that had 1 big plant that had a thousand employees and now the plant's closed and they still wanted to be a cosmetic dentist implantologist fee for service, demographics is real.

Lorraine Guth:

Demographics matter. I love what you had in your book and I actually have to say you call it uncomplicated business right? You really took a lot of complicated information and made it very simple to follow. You spend time on location, you had put very careful thought into location in relation to where you want to be and I think that's an important piece now. You have to look at it. It depends you know? I see people who can go fee for service but they are surrounded by a lot of people participating which means you have to spend a lot more money on money and marketing.

To some extent I think we got ourselves into this mess. If dentistry had been more effective as businesses are years ago there wouldn't have been a big scare, we wouldn't have so many people flipping to PPO dentistry and so there wouldn't be as much of a market for it. It's interesting I was at a business event with NSA and there was a gentleman there that was talking about what makes businesses effective. This is not about dentistry but he said great businesses understand that you have to get more business and you have to retain more business and you have to do that every single day.

That's has to be where your focus is. You look at everything you do and you think about "Okay, here's how we need to submit insurance and is the way we're doing it really get us more clients potentially if we do it this way or will it cause us to retain more clients? Are we doing it that way because it's convenient for us?" That's a question to ask. It's interesting I consult outside of dentistry with small businesses and I see that tendency in small businesses because they know they're closer. It's hard to keep a business alive outside of dentistry so they really do look at everything they do and think about the way I'm doing this will it get us more business, will it create more retention? We need to do that more.

Fee for service, sure, people can do it but you got to really do it. You've got to have great leadership, you've got to spend time building team, you've got to train on service, you've got to create service protocols, and you have to market. If you look at it right now, let's say you take a practice that's producing a million dollars a year and then participating it they're in a state of Pennsylvania they're writing of 40%, They're spending $400,000 a year, every year to be able to get those patients that they participate with. If you really want to go fee for service, spend a $100,000 a year marketing. You can buy a lot of marketing for that, invest in you practice but you really have to take the leap.

Howard Farran:

I'm really surprised you learned at the NSA because usually the National Security Agency in Washington D.C. does not talk about business matters.

Lorraine Guth:

They clarified the national speakers association.

Howard Farran:

Which actually is in my backyard, it's in Tempe I'm in Phoenix. Was that out in Tempe, Arizona?

Lorraine Guth:

Well this was actually at one of the chapters here, one of the people they brought in. I love going to the NSA meeting because you get to spend time with business consultants that are working in so many different industries and what you see is what's happening to technology is changing businesses in significant way. It's going to change our business even more than people realize. You get to understand what businesses go through out there that we've been shielded from.

I was talking to somebody from PNC Bank about 15 years ago and they said at the time that they considered someone wanting to open a dental practice they had a 97% chance of success. When I went to take my loans on top of my business I sat at the bank with 5 people who told me that I had 50% chance of not being in business in 5 years and they would absolutely take my house was I sure I wanted to take the loan? I think you see in dentistry we're getting to understand that we need to have sound business philosophy in place.

Howard Farran:

Can I keep going? I mean we're out of time but can I keep going on with you because you’re so amazing. I want to get to you first for my homies their used to an hour brand but I want to go over time with you what problems does guthdentalconsulting.com ... What does Lorraine Guth like to solve? I'll just set this up for you your talking to several thousand dentist and we having done this for 3 decades. The most bizarre thing about dental consultant is, all the rich guys always use them all time and have been for decades and then everybody were you would just be a saint, walk on water and be Mother Theresa of Saint Dental Co. is ,they never use them.

What I want you to do is I don't feel like I'm doing a public service talking about you to guys who've used 5 different consultants in the last 20 years because you guys all are return on investment. I want you to talk to that individual dentist who suffering, he's stressed, he's got all these problems. What do you like to solve? How could he contact you? What problems do you like to solve? Paint the picture so my homie listening this is there anything yeah I'd give anything that'd go away and what problems do you make go away?

Lorraine Guth:

I help them learn how to deal with staff in an effective way so that they get a better performance it's not just about the systems. The other thing that I do is I do have some consistency and structure in some of the systems I teach but adapt them to different practices and I adapt the order in which we do it based on what's happening in practice. One of the things i spent time helping them with is if they need to hire how they can learn to hire effectively, how they can learn to vet  potential employees behaviorally.

I give them systems to do it so it's more time effective. What I do is help them get the team in place and I structure everything around that. I help them get better at how they problem solve as a group and that gets more production. The typical things that we work with and how you talk to patients about money and fees, how do you talk about insurance, financial arrangement, new patient call. Those are things that I'm very, very good at. The reason I'm very good at it though because I’ve studied communication in a significant way.

I've studied how people relate to each other so when I work with this things in offices I'm not really just teaching them scripting I'm trying to teach their team how to learn to listen effectively, how to understand that when a patient says something difficult to you it's a complement. They're actually saying, "I'm so frustrated about this but I want to do business anyway, Howard." and so how does an employee pull himself together and respond to that in an effective way? I do all those things and I work with practices in all ranges but I would say that one of the practices that I work with about half the time are very successful practices who are trying to make the next level and their trying to deal with success.

It's interesting we start up right? We start our business and we get excited and finally we have business and then what happens is we get really busy and we realize that you have to learn how to deal with that, that's a whole another level. It's interesting we start our business thinking things will be great for a dentist. Things will be great when I can get this practice where the schedules are filled and we're producing a Million and a half a year and the answer is Yes, it's great but there's a whole set of challenges that comes with that that you didn't know about and you have to change things then at that point. I help people learn how to manage success as well as learn how to create it.

Howard Farran:

See you just said Freudian Slip because you said a million and a half so the average dental office only does $675 but you probably your average practice that you deal with probably does  million and a half and that's my point.

Lorraine Guth:

Not necessarily. I have some in the 600 to the million a year.

Howard Farran:

It's still my point 600 would still be the 50th percentile, 675. You're saying 675 to a million and a half but the people that are doing 300 but the people that are doing 400, the people whose wife right now out selling Amway so that they can buy groceries they never call you guys.

Lorraine Guth:

No they don't.

Howard Farran:

I always tell them that every dollar you give a dental consultant you’re going to get the dollar back in that calendar year and then another quarter or quarter and a dime or 2 quarters they don't get it.

Lorraine Guth:

They're spending so much money not getting help, it's interesting.

Howard Farran:

I know.

Lorraine Guth:

What you see is, the people that get pass that, that do well will say over and over "I really wish I would've done it in the beginning" and in fact I will tell you when I opened my business the first thing I did was open a $60,000 line of credit and I hired a consultant for $30,000 and I had no clients, I had no business, I hadn't even marketed and it was a scary thing to do. I'm absolutely convinced I had not done that you and I wouldn't be having this conversation today.

Howard Farran:

The market is telling them that if they're suffering and they need to grow they need to buy a big shiny toy like Kad cam or a laser an extra machine and I always say that those on the same category if you want to buy a Porch or a cabin or a boat go buy it. I own all those things because I'm rich and I like to have fun but they don't make you rich. You need to build you business and they don't want to spend like how much is the cost to hire Lorraine?

Lorraine Guth:

It depends on what you're hiring me for.

Howard Farran:

What's the range talk range

Lorraine Guth:

What I do is I do a program where I have an initial visit. I don't sign people up for a year like some people do. I have an initial program and that allows people to see if I can work with them, if I can really make things happen for them. That visit could be anywhere from $6,000-$10,000 depending on what we do and I'm in your office for 3 days, maybe 2 depending on size. I have time that I observe because you can't implement systems unless you know what's happening and unless the team will trust you and you can't implement systems only from the dentist view point.

The team has a lot of knowledge about what's happening and I need to find out what they know that's getting in the way and I need to help them get that out of the way. That's the initial piece and then I create a plan just like you create a treatment plan. We have team training then at the end of it I give them 15-20 page report of here's what you need to do to get where you need to go and if I help you here's how much it is or go try to do it yourself that's okay too.

Howard Farran:

What percent of your clients do you think get their money back and make money? What percent would you say it was a return on investment?

Lorraine Guth:

I would say the vast majority at least 90% but you also have to look at the way I have it set up. I come in with that first piece and that's a qualifying piece and there are times that I've done I've gone through the follow up report with the doctor afterwards and said here's what you need but I don't think you should hire me right now to do that because here are the obstacles that you're not willing to deal with and unless you deal with those things I'm not going to be able to create a result. It was interesting, I have one doctor that said "You won’t take my money?" and I said "No because you'll be irritated you won’t get what you want so if you really want these things to happen here's what you have to adapt and without that it's just paper."

Howard Farran:

I just wish I would have been born in 1962. I wish I was born in like 2162 then you wouldn't have any staff it will just be droids I would just go in there like Star Wars I have CP30, RPC2 and just all droids program to be perfect like me.

Lorraine Guth:

You know what Howard? We need this diversity, we need this challenge. If you don't have people around you that bristle you that challenge you you'll stagnate right? I mean we absolutely need to have that. We fight it, we don't like it but... one of the things that I talked to leaders about is... I'll just ask you to think about this for you let's just pretend let's take an implant surgeon the best surgeon in Arizona, best implant surgeon.

Howard Farran:

You're going to say that it's Ralph Wilson. You are aren't you?

Lorraine Guth:

I like Ralph, I love their group. They are a great example.

Howard Farran:

I'm very mad at Ralph Wilson, he's a local periodontist, he's got 5,000 plus ... He stole my hygienist and married her, the nerve it.

Lorraine Guth:

Yes, I know.

Howard Farran:

She put in her notice the next thing I know she's living with Ralph and they're getting married. I still think he should return his wife back to me.

Lorraine Guth:

Howard she's in a better place right now.

Howard Farran:

How do you know Ralph?

Lorraine Guth:

Well I worked with their practice for about a year and a half.

Howard Farran:

You come to Arizona?

Lorraine Guth:

I do.

Howard Farran:

Right on.

Lorraine Guth:

I think they're a great example. One of the things that I get concern about in the industry is I hear this battle between corporate and solo and what's worth and what's better and I think we need to cut that out, I think we need to learn. If you look at some of the corporate entities they work together to collaborate on what works, what makes us successful and I think that particular group I've seen such a commitment to providing great quality of care and using the resources of the group to enhance what's possible in that regard, to enhance training and ability. I look at the culture there and the people there it's amazing.

Howard Farran:

I think the funniest thing about corporate is corporate dental office will come in and all this dentists all free freak out and everything. Well they got the same issues as everybody else they're having patient turn over, they're having staff turnover. I mean who cares if the dental across the street is corporate or a private group practice or whatever the heck. Everyone's dealing with the same issues and it doesn't matter how it's bundled. How do people contact you if they... what's the best way of if I'm listening to this I'm thinking I want to talk to Lorraine about something how do you like them to contact you? E-mail, phone, go to your website what do you like?

Lorraine Guth:

Whatever way works for them my phone number, my business line is 6362739500, my cell is 3143043176 and I will tell you I've got people I've never worked with call me at 9:00 at night because they just found something terrible and that's okay I can do that. They can e-mail me at lorraine@guthdentalconsulting.com or go to the website.

Howard Farran:

What's that last name Guth? Is that Scandinavian?

Lorraine Guth:

It's German.

Howard Farran:

Okay, G for [Inaudible 01:10:09]. One last thing and I'm sorry I got you in triple overtime, sorry I keep going but 2 things a lot of dentist sit there and say "You know what I'm not going to deal with any of this stuff I want to go to the Scottsdale center and learn how to do [Sirach 01:10:27] and I'm just going to hire an office manager. Will that solve all my problems?"

Lorraine Guth:

No, they'll just be a recreation of your inefficiency. You'll just recreate yourself with somebody else and so I think yes we do need to have leadership in our practices and sometimes we need an office manager, a business administrator but I think you really have to look at yourself and one of the things that concerns me is I see too many people that they know that their practice isn't going well so that's what they do. They go buy a [sirach 01:10:57] or they go get in to some new program or I'm going to place implants now or whatever, that's not your problem.

If you look at businesses that make it, step outside of dentistry business make it understand you can have a great product and go bankrupt very easily. You need to have a great product and you need to run a major practice effectively. In dentist you need to build leadership skills if they're going to be an owner. There's a phrase I'll give you real quick. This is one of the things one of my coaches said to me they said "Lorraine do you want to be an entrepreneur or independent employee with large checkbook and no controls?"

If you think about what an entrepreneur does, an entrepreneur a yes we want to have a great product but we look at what's happening in our business, we look at our numbers, we look at what's happening in industry, we're proactive, we plan ahead, we build our teams, we learn how to be better leaders. An entrepreneur is always looking for a way to grow and build their business and make it more effective. An independent employee is somebody that's really great at what they do and they own a building, they don't have a boss, and they don't take care of things.

If you look at like I've been an employee, I've been a business owner being an employee I was very different in my view points. There were things that I didn't care about, there were things I care very much about, I wasn't balance in running the business and that's okay because I wasn’t an employee but if you’re going to be an entrepreneur, if you’re going to run a Million, $2 Million a year business you need to learn how to do that. You read, you talk about how many books you read?

Howard Farran:

I think it's funny one, one of my favorite books ever was only the Paranoid Survival by Andy Grow the founder of Intel and he's exactly the opposite of all the dentist's trouble. He says in his book that you got to be prepared as a leader that when something really bad happens that you just completely erase your schedule and you just stay there and work the problem. I believe that these agencies like Scottsdale Center, [inaudible 01:13:00], the implants whatever is their so stressed about office.

The thought of just, "I'm going to go to the airport fly to Scottsdale and stay in a resort, and buy a new shiny object, and learn how to cut into gums and suture and place implants that will solve all my problems" whereas Andy Grow and I would tell you "No, you need to clear out all your schedule and work the problem and if you can't solve the problem you need to get a coach, every Olympic athlete has a coach, call a dental consultant to come there in the middle of your office where the shit is hitting the storm, solve that fit your business, get rich then go to a resort and buy a shiny new toy, a Porsche, a serac, a CBCT."

Lorraine Guth:

You see the difference between somebody that really makes it is their ability to work with pain because running to Scottsdale is fixing your business in a way that feels comfortable and easy for you. That's not how you fix your business. What I see is the people that the do the best that are most successful their able to be in that pain situation, that discomfort situation and then take a breath and they don't whine about it, they don't complain, they acknowledge it, accept it and figure out what to do. They're better at being in pain.

If you look at your practice is running badly and your having lots of problems and you don't want to deal with the issues and you run off to a CE course on whatever it is that is clinical related. You're running away from the problem. It's not that isn't valuable but don't run away from the problems. People that are really great in business, and are great leaders are good in pain. I don't mean we should be terrible to ourselves but they deal with it. It's interesting there was another coach I was listening to, this was in another national speaking NSA event, national speaker association. This is the gentlemen that has made a gazillion dollars as a consult and he was talking about the way he's done that as he has people he’s worked with for a piece of the profits at a small fee, large corporation and some people he just charges them a big fee.

There's a room of consultants there who are hearing this and are getting nervous because for somebody like myself to go for a large corporation and dump my income for a year and take a risk that you’re going to do things is a big deal, that's a make or break for me. They're asking him "How do you decide who to take the risk on?" and he said "That's easy. I listen how they talk about what's happening in their industry, what's happening in their own organization, what the problems are and if they talk about it from acceptance and problem solving and ready to do something about it I charge them with small fee and I take a big piece of the profit. If they spend a lot of time whining I charge them a big fee and I go off." Isn't that interesting?

Howard Farran:

That is interesting. Last but not least is my 14th last question.

Lorraine Guth:

I'm sorry.

Howard Farran:

We haven't even talk about this but what are the ways my homies would make a return investment with you the most is you also outstanding in training staff on treatment plan presentations and collections and in our profession when a dentist diagnoses a hundred fillings they only draw filling bill 38. Hell if they just took that from 38 to 45 I'm mean you'd gain 5 fold return on investment, when you go into an office what percent of them have a really well oiled treatment plan presentation and financial arrangement collection machine which is just one of the foundations of a dental office?

Lorraine Guth:

Very few. I do have some people that I work with that are very successful. They bring people in because they know it's time to pay attention to things not because anything is wrong. There's a feeling of I'm going to work on my business when things are going on real well because that's when I can make exponential benefit. I have some people I go into and what they’re doing is really great, we fine tune it but the vast majority it's not done well and I think one of the things I talk to people about in that is that I think everybody has a listening battery like on your cell phone you have a little battery.

I see people when they come in at the door of your office they have that battery on their head and it's not at a 100%. You don't know what it is but it's not a 100% and then they go into clinical area and we talk and talk about things that they don't care about and their listening battery's dead. Then when we put them with somebody at the front desk God forbid at the front desk with a bunch of other people to talk to that patient about the finances for three crowns. It doesn't work. We need to look at how we facilitate this whole process in a different way, very few people do it well.

Howard Farran:

What do you think would be a better return investment for a dentist to have a consultant come in and fine tune their treatment plan presentation and financial arrangements or to go take a course in a sleep dentistry or inclusion?

Lorraine Guth:

Treatment plan, you need to have people around you that force you to do those kinds of things.

Howard Farran:

Alright Lorraine we're out of time and we went 18 minutes overtime because your just that damn amazing but seriously thank you for all that you've done for dentistry, thank you for what you've done for a lot of my friends and just thank you so much for sharing an hour with me and if you're a homie listening this just fix your damn business and then go to resorts, buy toys and for every time you buy a CBCT maybe get a boat or a cabin or whatever. Fix you damn business you'll be happier, you'll have less stress; you won't be looking at your 41K every month wondering when the hell you can retire.

The happiest dentists I know are 75 or 80. A dentist walks up to me in L.A. 92 years old, the only dentist alive today that survived Auschwitz and he just bought a $100,000 CBCT, he says he's having more fun at 92 years old. I've got another year at Missouri, I had a George Rui in St. Joe Missouri practice still, he was 92, he's wife passed at 88 and he said if it wasn't for his amazing staff and practice and patience we wouldn't know what he was going to do for the 4 years after his beloved wife passed away. If you love dentistry like you told me I had to retire from dentistry and I can never pull forwards and teeth or do a molar canal again, I would cry. If you just burned out and want to retire fix it and Lorraine can fix it, I know you can. Lorraine thanks for spending an hour and a half with me today.

Lorraine Guth:

Thank you

Howard Farran:

Alright have a good one.