|
Howard Farran:
|
It is just a huge honor for me today to be podcast interviewing Christopher Hoffpauir, all the way from Alvin, Texas. Where's Alvin, Texas?
|
|
Christopher :
|
Well Harold, Alvin is about 35 miles dead south of the center of Houston, and it's the birthplace of Nolan Ryan.
|
|
Howard Farran:
|
Nice. Life began for Christopher in Lafayette, Louisiana. Poor experiences at the dentist led him to a path of dental phobia. In 2002, a severe dental infection changed his life. Seen firsthand what a difference proper dental care can make in someone's life, Chris decided to go back to school in pursuit of a degree in dentistry. Returning to school at 30 years of age, he was not the typical student. Years of work experience in various fields gave him a different perspective than that of most students. He graduated Magna Cum Laude from University of Houston, Clear Lake with a BS in Biology with a focus on Molecular and Cellular studies, and his DDS from the University of Texas School of Dentistry in 2012. In 2013, Dr. Hoffpauir opened a new start up practice in Alvin, Texas where he continues to practice today. Dr. Hoffpauir has a special interest in utilizing the latest technology to offer the best possible care to patients, with a focus on helping patients with dental phobia overcome their fears.
|
|
|
My dental office I graduated May 1187 and I had my doors open September 21st and so many of these kids come out of school, and they feel like they got to work three, four, five, six, seven years somewhere before they open up. What do you think was the difference in ... How long did it take you from graduation to opening your own office?
|
|
Christopher :
|
I actually technically other than the ceremony graduated a little bit early. I realized that basically the requirements in the curriculum were a game. and if you figured out exactly what they wanted and how they wanted it. you could overlap certain curriculum requirements. I finished up a little bit early, graduated in May, and by October of 2013 I had my own practice. I just had to save a little money up first.
|
|
Howard Farran:
|
Basically, five months out of school you were bada-boom bada-boom.
|
|
Christopher :
|
It's about when we started, yeah.
|
|
Howard Farran:
|
Wow. What would you be telling a kid right now who's just graduated last week? I mean we just had 6,000 new kids graduate, and a lot of them just think that you just can't do that. Why do you think you could do it?
|
|
Christopher :
|
Well, okay, there's a couple of reasons. First of all, I have an unfair advantage. I put my wife through school, and she's a veterinarian, so I knew that I didn't have to make any money I just had to break even for the first year. That was definitely a lot of load off the plate. I began a business club in my first year of dental school. I realized that they weren't teaching us enough,, and I asked some of the upper class men and some dentists who had just graduated, they weren't teaching us anything about business, and so I knew I had to go and learn it myself. We would actually split off and one of us would go and do Scott Leune's courses, and somebody else would go and do some other management course. We kind of pulled our knowledge so that we could teach each other the things that we had learned at CE, and every single one of us out of eight or nine people in that class, all except for one ended up owning their business within two years.
|
|
Howard Farran:
|
Nice. That is an amazing story. You guys should write that story up sometime. That'd be a great story to publish in Dentaltown Magazine. Then every year, we have a new grad edition that comes out once a year for new grads. That'd be an amazing article for the new grads. You had eight people who did they all go learn from? You said Scott Leune.
|
|
Christopher :
|
One was Scott Leune, some of us took took lessons off of Dentaltown actually. As students we would get CE from there. I actually went out to a couple of practices and shadowed and just said, "Look, I want to run my own practice one day, what are the things I need to know?" I'll tell you, the one thing I would have added to our little curriculum there, would be coding an insurance regulation. That's something definitely we ... It was under covered in the studies that we did.
|
|
Howard Farran:
|
What do you mean that that's something that you found very important to learn?
|
|
Christopher :
|
I found that it was something that not only did they not teach this in dental school, but in a lot of the classes that we went to, we didn't learn about that there either. I mean let's face it, we get out of dental school knowing only enough to not kill somebody. That might be a bit of a bad thing to say, but it's true we really don't know a lot about dentistry, we don't know a lot about business ownership, we certainly don't know anything about talking to patients, and how to to make the connection with a patient as a real person. That's where I see a lot of my colleagues falling down as new grads they ... Let's face it Howard, when you went to school, you probably worked your way through school, and you worked your way through college.
|
|
|
Now, a lot of these kids, they go to kindergarten, and they go to first grade, and from first grade they're in school all the way until they graduate as a senior. Then right after graduate as a senior, they might have a job as a short-order cook or something and they go to college, and then right after college they go to dental school. There is absolutely zero work experience and real life experience dealing with difficult people, dealing with difficult situations, dealing with even some of the ethical things that come up working for people. I think that that has been invaluable for me.
|
|
Howard Farran:
|
No doubt about it, they are. But you know what? You call it communication I mean dentists, can't even call a patient a customer. They can't even say they want new customers, and they don't believe in selling. They just say, "I didn't go to school eight years to sell." How do you how do you talk to a dentist who says, "I don't believe in selling. I'm going to used car salesman. I'm a doctor."
|
|
Christopher :
|
Well, Howard let's say a person comes in and they've got an abscess. Let's say it's a subclinical abscess, they're not in pain. You know they need to get it fixed, right? How do you convince them to do that? You're going to talk to them about the health issues with it. You're going to talk about what's going to happen if they don't. It might blow up on them eventually they will be in pain. You want to get them healthy. In order to do that, if you can't convince that patient to do their needed treatment, you are no good as a doctor. You have to be able to bring the message of what has to be done to the patient. Sales is not a four-letter word. It's an integral part of what we do, and until you begin to embrace that fact, you are never going to be able to help patients the way you really want to help them.
|
|
|
A lot of times I find in online discussions, I mention the word sales and everyone flames me, and they think I over treat everything. Someone comes in with a class one filling, they're going to have a crown. That's not the truth. The sales aspect of things is convincing patients of needed treatment. Sales is not a dirty word. It's important.
|
|
Howard Farran:
|
They think it's a dirty word because, the way I see and I've said a million times, when you look at insurance data, basically only 38% of cavities are drilled, fill them bill. That's one in three. Then you look at within any medical dental building or city, there's the dentist doing 750 because they're getting one in three people to do their cavity. Then there's a dentist doing one and a half million, because they're getting two out of three, and in my practice you look at, one out of three humans are just are not going to not going to buy period, but I would think you would be a much better dentist getting your claws from one and three, to two and three, then switching out your bonding agent to some new high-tech, latest, greatest, bonding agent.
|
|
Christopher :
|
Whenever we first talk, I told you we're going to disagree about some things, and I thought this was going to be one of them, but you're absolutely correct. It's not the high-tech treatment modalities, or the new fancy gadget, although I will fully admit, I love my new fancy gadgets. It's being able to get a patient to move to treatment, and for more reasons than one there's the financial reason of being able to pay for your staff, and pay for your equipment, and keep your practice open, so you can help more people. Which is something I think most people don't get. If they can't pay the bills, they can't stay open, they can't pay their staff, they can't do good dentistry.
|
|
|
The other thing is, if you are only doing one filling a week, and someone else is doing five fillings a week, who do you think is going to be better at it? Practice is going to ... Well, practice makes permanent, but you know my thought there. If you're getting more practice, you're going to get better and better. You're going to get more efficient. If you need to change out your bonding agent, maybe that's when you're going to find out it's not when you're doing one filling week it's when you're doing enough dentistry that you've got a significant sample size to make that decision.
|
|
Howard Farran:
|
What did you think we'd disagree on?
|
|
Christopher :
|
I thought we're going to disagree on hi-tech. I've listened to your podcast for quite some time, and I told you we're going to argue about something. That's probably going to be high tech.
|
|
Howard Farran:
|
Let's talk about it. What hi-tech do you love? You called it fancy gadgets. What high tech do you love?
|
|
Christopher :
|
Well I absolutely love my i-CAT. I got it because I wanted to make sure that I could practice as close to the level as a specialist, when I'm placing an implant. I think it's important. Since we got that, we have actually saved at least two lives. One for a 98% block it's on one side, and 89% on the other side. One from a cancer that had actually metastasized from her liver. Her physicians were having a hard time figuring out what was going on with her, why was she sick, why her blood tests were crazy. I saw what looked to be like a pseudo system, actually scientists for mucous retention says whatever nomenclature you use, and it just didn't look right. It was coming from the lateral wall, rather than the base of the sinus. I said, "Look, I think you need to get this looked at." It turns out after the biopsy it was cancer, and it had metastasized from her liver, so her physicians had an answer. They knew, "Well, look this is what's causing it. She has liver cancer."
|
|
|
Her physician told her, that because of me and because of that machine, she wrote me this beautiful letter, she was going to live to see her kid who's three years old, graduate high school. That sells me on the technology. A lot of it to me isn't necessarily about what you can do, but about the connections it makes with your patients, and in the lives you change.
|
|
Howard Farran:
|
Oh my God. You should write article how my i-CAT saved two patients lives, and write those cases. I'm serious.
|
|
Christopher :
|
I believe I have actually but ... I think I have one appearing in Dentaltown at some point in the near future, about i-CAT. I could be mistaken, you probably know better than I do.
|
|
Howard Farran:
|
Well actually Tom Giacobbe is the editor of Dentaltown Magazine since the year 2000, so he does that, and Howard Goldstein does the message boards. They won't give me a job there. That's why I do podcasts.
|
|
Christopher :
|
My office staff won't let me up front either, so you know, I get it.
|
|
Howard Farran:
|
Do you consider yourself a high tech person?
|
|
Christopher :
|
Relatively so. Evidently, Ryan has me beat whenever he comes to Skype, but I pick up computers relatively easily in the early 80s, I was building computers. I get them. My wife thinks they're magic black boxes that things happen inside of, and then you get something on the screen. I've been known to tear apart one or two. We have an E4D, we have a planned scan. We've got diode lasers. We have a microscope with a CCD video camera for doing endo, although I've done a lot less endo recently than I used to. I just found that it's just not a procedure I want to play with anymore. We do guided surgery. Trying to think of anything else here. I mean it's-
|
|
Howard Farran:
|
What is the endo gadget?
|
|
Christopher :
|
It's a microscope with a CCD camera, so that I can actually put the access and the canals up on the screen, and then my assistant can see what's going on there. I actually loaned it to a friend of mine last week, because I was using it so little, so that was definitely probably expensive.
|
|
Howard Farran:
|
Who makes that?
|
|
Christopher :
|
That ones made by Seiler. It's a Seiler Evolution xR6, and it's a sixth stage surgical microscope with a solid-state camera, and video output.
|
|
Howard Farran:
|
Let's walk through some of these. Why did you go for an E4D, owned by Planmeca, and not say the CEREC by Dentsply Sirona?
|
|
Christopher :
|
As much as I like Apple products, I don't like their closed architecture, and I don't like the buy-in of anything that forces me down a service fee road, where they say, "Well you know, you just bought this 150,000 dollar machine, but now you have to pay us every month to use it. I think it goes against my DNA.
|
|
Howard Farran:
|
Are you glad you bought it? Do you have buyer's remorse? Are you using it?
|
|
Christopher :
|
If you had asked me last month, I had a little bit of buyer's remorse because there were some things going wrong because they did some updates, but I've consistently used it since we-
|
|
|
[Silence]
|
|
|
Honestly, it renews my love of dentistry every time I do it. It's not just about them. A lot of it's about me, and how it makes me feel about the way I practice.
|
|
Howard Farran:
|
Man, what a beautiful story. I love dentists. I mean people who go to college for eight years to heal people with their hands, they're just a separate breed of cat. I mean some of the coolest people I've ever met in my life are dentists. That's just an amazing story. On that true definition scanner, that's the only scanner that needs a powder. Did that bother you, or not really?
|
|
Christopher :
|
No. At the time it wasn't the only scanner that needed the powder. The Sirona still did. They were making claims that the new cameras wouldn't ... I believe that's about when they came out with the blue cam, or was it the Omni? I think it's blue cam then Omni. They still need a powder and of course the lava which came before the true def. I'll be honest, I still have that little can of powder around here, and when I'm scanning a gold crown, I dust it. Because it gives me a much crisper scan, and there's not as much refraction of light. You'll find if you talk to a lot of people who use digital, that a lot of them will say, "Yeah, you still got to use a little powder." But no, it didn't bother me much.
|
|
Howard Farran:
|
A lot of people who go to the chair site milling, will tell you, you know, "I got to block off three hours to do this," whereas if I was going to make it to appointment, it would just be an hour appointment and then come back in two weeks for thirty minutes. Is that what you were finding or not?
|
|
Christopher :
|
What I found was ... I originally tried to do same day crowns, and as much as patients want that, frankly if you look at it as a business person, okay and you say, I'm either going to make you know this 1,000 dollars today doing a crown, and it's going to take three hours out of my schedule, and it's going to block out a chair, and remember Howard I have three chairs, so that's a big deal for me. Or I can put them in a temp just like normal, I can mill the thing after hours, and if we have any problems I can fix it then, because that's when things really compound, it's when something doesn't cut right, or a bar breaks, or a block breaks whenever you're milling. To me it was just a much smarter business decision to take this crown and treat it just like a regular crown, and just bring them back.
|
|
|
Then I tell them, "Hey, two to three weeks your crown's going to be done." Then when we call them a little bit early and say, "Hey, Dr. Hoffpauir decide to make your crown himself from his CAD CAM machine, and guess what? It's only been three days. Isn't that cool?" Well, the patient's in love with the idea, and they got the crown faster, and their temporaries didn't fall off. You don't really get that same bang for the buck I guess, but you also don't block your chairs out for two to three hours. Does that make sense?
|
|
Howard Farran:
|
Oh yeah. I still think one of the single biggest return on investments in dentistry is getting a dental consultant to come in and get your house in order, and adding a chair. I mean just by end of story.
|
|
Christopher :
|
I agree.
|
|
Howard Farran:
|
I mean it's just chairs are not your cost labor ... PPO insurance adjustments is 42%, labor is 28%. Those are your cost, with insurance adjustments and labor, why are people waiting around for a chair? I mean, just get extra chairs. You should add chairs until every other day, one of those chairs no one ever sat in once.
|
|
Christopher :
|
I completely agree with you there. We're trapped into an area right now where it's a little bit small. We have the intention of renting the area next door to expand again to it, because I couldn't afford to do a scratch build-up, just a scratch start up. We're kind of thinking about it right now. We're going to hit our 10-year lease mark soon in about three years, so I think it's about time I start looking at not just this lease site, but also building out fresh and other lease sites as well. If nothing else, then to have something to bring to the table for negotiations.
|
|
Howard Farran:
|
Are you still using your 3M True Definition Scanner? Are you taking scans, and then emailing the scan to labs, or what percent are you milling out on your E4D Planmeca, versus scanning and sending to the lab, versus just good old Vinyl Polysiloxane or [inaudible 00:21:10]?
|
|
Christopher :
|
Well, I am scanning almost 100%. If it's got a really, really deep margin, let's say I had to do some bone re contouring or something, or we had some really superfluous tissue back there, and we did a gingivectomy, a lot of times I'll do a PVS. That's about 10% of the crowns we do. Most of them are scanned. So far as milling, we mill about 20% of the crowns and send the rest off to lab. Now, that's all with the plan scan. Now the True Def still gets used on a regular basis, but it's so that it can hold the pano x-ray apron. It's an apron holder at this point.
|
|
Howard Farran:
|
10% impression, 20% chair sight milling ID, so that's 70% you're scanning and sending, but what are you scanning with?
|
|
Christopher :
|
I'm scanning with the plan scan.
|
|
Howard Farran:
|
The E4D, the scanner part of the E4D?
|
|
Christopher :
|
Right.
|
|
Howard Farran:
|
That's called the plan scan? Do you need powder for that?
|
|
Christopher :
|
Not usually. Gold crowns like we were saying earlier, I will still break out the powder, just to make it an easier scan, but you don't really need it. Anything that's super shiny is going to refract the light.
|
|
Howard Farran:
|
What lab are you sending it to?
|
|
Christopher :
|
I use Pro-Esthetics a lot. We have used Glidewell, but Glidewell tends to kind of fluctuate a bit in their quality. It seems like sometimes you use them and you get this amazing quality back, and sometimes you use them and you get crap back. I've been trying to use smaller local labs, or smaller labs where I can meet with the owner, and just discuss my needs, and not just be a number.
|
|
Howard Farran:
|
Is that in ... Pro-Esthetics is that in Alvin, Texas or you said you're ... What did you say you're an hour south of Houston?
|
|
Christopher :
|
That's correct. No Pro-Esthetics isn't local. It's actually in Buffalo. I've met with the owners, and anytime that we have an issue, I can call the owner or his partners, and say, "Look, this crown didn't fit correctly, I'm sending you an x-ray, and I'm sending you another scan. Let me know if it was on my end on your end." The great thing is, these guys you know ... Joe is the owner I think I've got his number right here actually. He's partnered with Mike Curran, and Ben Oppenheimer. Ben Oppenheimer is an implant dentist. Mike Curran runs and owns Apex Dental Marketing. Really great guys. Anytime we have an issue, I can call and say, "Look, let me know. Was it on my side, or was it on your side," and they're pretty honest. If they messed up they say, "Hey look, we're doing it for free, we're sorry. This is what happened. Send it back." and it fits. Beautiful aesthetics too.
|
|
Howard Farran:
|
How did you an hour south of Houston, find a lab clear up in Buffalo? I mean that's almost Canada.
|
|
Christopher :
|
Well, actually I used Apex for marketing for implants, and as we know PPO is the most expensive and probably least efficient method of marketing that that's out there. I wanted to reduce my dependency on them, and do more implants, because I love implant dentistry. I found a company that specialized only in implants, and I found them by taking an online course. Howard I swear it may have been on Dentaltown. Has he been on Dentaltown as a CE provider?
|
|
Howard Farran:
|
Is who on Dentaltown as a CE provider?
|
|
Christopher :
|
Ben Oppenheimer. I remember it was online, and usually if it's online-
|
|
Howard Farran:
|
Send me Ben Oppenheimer. I'm so old and senile with so much dementia I can't remember the names of all 411 courses. I try so hard.
|
|
Christopher :
|
I'm young and senile, so there you go. I don't remember if it was on Dentaltown, or if it was in a different venue, but I took some CE from him, and I saw the very, very bottom of the CE, it was talking about who he uses for advertising. I called them up and that was Michael Curran, and just formed a relationship with them, and they've been just amazingly responsive to anything I need. Then when he bought into this lab he said, "Look, Ben and I are buying in to this lab, the first 10 cases you send us, we'll only charge you X amount." He said, "Please try us out. Let us know what the problems are," and he's been amazing since then. We had some rough starts because they weren't really geared for digital at the time, and because I do so much digital, and because E4D is a little bit different it doesn't use the reshape program to export STLs. It was a little bit clunky at first, but now we have the workflow down, and it's working really well.
|
|
Howard Farran:
|
That's a proesthetics.com and that Joe guy is Joe Procopio.
|
|
Christopher :
|
That is correct. Thank you.
|
|
Howard Farran:
|
He's got to be Italian, Italian, or Italian.
|
|
Christopher :
|
I believe he's A and B.
|
|
Howard Farran:
|
He's A and B? You know I really love your website. There's two things on your website that I really enjoyed and loved, and one of the reasons I want to get you on the show. One, you have that really cool video, in fact I want to steal that video showing that 40% of people don't have dental insurance, and you have an in-house insurance plan. Then the second thing, that you do that's controversy on Dentaltown , is you have a really cool video about mini implants. Of course on Dentaltown, we have 50 categories: root canal, saline count, under implants. We had to separate mini implants, and dental implants-
|
|
Christopher :
|
I heard that was the only group ever separated.
|
|
Howard Farran:
|
We have a report abuse button, I'm well aware that on Facebook if you don't like someone you can just unfriend, them or block them, or whatever, but on Dentaltown, you have to be nice. Because you can't unfriend people's comments, so we had that report abuse button, but we had to separate mini implants because obviously in dentistry, there's a huge group of people who don't believe mini implants should exist. I really love your video. Talk about the controversy. Why are you doing mini implants?
|
|
Christopher :
|
Well, Howard I do both mini and full-sized. In my demographic, we have a whole lot of people who don't have insurance and don't have a lot of money, but they have really crappy dentures. I was faced with the choice of telling them, "Okay look, there's this great thing you can do, and you can put a titanium screw in your jaw, and those dentures are going to locked down, and they're going to be hard to take out." Or, "We can do nothing." They said, "Oh well doc, let's just remake the dentures and see if we get it better this time." I said, "Look, you don't have any vestibule. You have a really long palate. They're not going to stay." I had a friend who was doing them and ... I'm trying to remember who turned me on to them. I went to a few different CEs. I did probably about a year worth of CE, going to 3MS courses with Raymond Choy, going up to Steven [inaudible 00:27:51] over in Dallas, and quite a few others before I did it.
|
|
Howard Farran:
|
3M was in tech, right?
|
|
Christopher :
|
Right. 3M did [inaudible 00:28:01].
|
|
Howard Farran:
|
Are they still selling these?
|
|
Christopher :
|
They're not. They're absolutely not. I believe Stern Gold picked up the, what is it? A 510 K on that, and they made their own. I called them. I said, "Look, why aren't you selling these?" I said, "I know I'm used to using yours, and I want to know what's going on. Are they failing? Are they breaking? What's happening that you've decided to stop carrying them?" They said it was a business decision, they were losing money in other areas, and they shut down a certain amount of sections, and mini implants wasn't as profitable as other things. It really stinks, because I think that basically they were poised to really take off with people starting to ... We were starting to gain more acceptance for their use in limited circumstances.
|
|
|
There's a lot of dentists who use them, and there's some good friends of mine, and they can do amazing beautiful things with them that I will never attempt, because I don't agree with it. They're putting fixed on minis, I won't do it. I don't believe that the biology supports it. I don't believe that they're made for that. Now, with that being said, I also have a hard time with anybody who for some reason believes that the body can look at a 2.9 millimeter diameter titanium oxide rod with threads on it, and look at a three millimeter diameter titanium rod with threads on it, and somehow decide that the 2.9 millimeter isn't a real implant and rejected it. Now, I think that there's some give-and-take in that argument, but we as dentists we like to be right. We are as informed as we want to be, and we take all of this CE and gosh darn it, we paid a lot of money for it, we form these opinions, sometimes without ever looking at the other side of the road.
|
|
|
I know guys who only do mini implants, and I think they're going to disservice to themselves, because there's so many more things that a full-sized implant is appropriate for. My philosophy's kind of always been this, if I can get two millimeters of bones circumferential around that implant, then I look at the size and I say, "Can I do what I want to do?" If I can't put a 5 millimeter implant in as a full sized implant guy, I'm going to look at a 4.5. Does the 4.5 get me the bone I need? Because God is a hell of a better dentist than I am, and he intends for our teeth to have bone around it, and so I figure he probably intends if we're going to put an implant in there, for them to have bone around them. If I have the choice between no bone and bone, I'm going to go with bone. Does that make sense?
|
|
Howard Farran:
|
Yeah. I agree. You're don't like all these minis with all these fixed on it, unless it was for like congenitally missing laterals on a tiny girl.
|
|
Christopher :
|
Exactly.
|
|
Howard Farran:
|
You're mostly using your minis underneath removable?
|
|
Christopher :
|
Correct.
|
|
Howard Farran:
|
What's your typical? Do you also do maxilla, or is it mostly mandibular?
|
|
Christopher :
|
Well, frankly as you know most of the desire comes from people who have mandibular dentures. Let's face it. The mandibular denture is about like chewing with a frisbee. They're just not a great device except for in very, very deep vestibules, in people who can learn to bite only on the canine, and don't have a huge muscular attachment underneath the tongue to throw the thing up every time they smile. Usually we see them on the mandible. I do both maxillary and mandibular for minis, but usually it's on the mandibular.
|
|
Howard Farran:
|
How many do you put?
|
|
Christopher :
|
On the floor, I'm always going to put between four and six. I believe in over-engineering my cases, and in the top I'm usually going to put between six and eight, and if I have the bone for it, I'm going to put 10. That's if they have a really thin ridge, otherwise I'm going to go to a full sized implant.
|
|
Howard Farran:
|
You say the three of in tech, what did you say it was of? 504?
|
|
Christopher :
|
I'll be a 510k. I believe it is.
|
|
Howard Farran:
|
A 510k went to Sterngold?
|
|
Christopher :
|
Correct.
|
|
Howard Farran:
|
Is that what you're using then? Sterngold mini implants?
|
|
Christopher :
|
I'm actually using OCO. I've used Sterngold-
|
|
Howard Farran:
|
Out of Albuquerque.
|
|
Christopher :
|
Correct.
|
|
Howard Farran:
|
Why do you like OCOs over the Sterngold, which is the old intacs?
|
|
Christopher :
|
I like the fact that there's a continuum. They make everything from the smallest implant you need, to the largest implant you need. Their kits are very, very simple. In fact, it's funny because my assistant told me the other day, she said, "Doc, what are we placing here? Are we going to put a Nobel in?" I said, "No. We're going to put an OCO." "Oh good. I like their kit." When your staff is happy, and when you get good results, it's a no-brainer to me.
|
|
Howard Farran:
|
Talk about the in-office insurance plan, because I kind of smell 30 years ago I could charge 1,000 for a root canal, and 1,000 for a crown. Now 82% of dentists are on PPO's and now actually most of the crowns are going to be adjusted down 40% for the industry, 42%. Now you're getting 600. I see this in the UK where the NHS kept lowering, and lowering, and lowering, and lowering the fees, finally dentists had no choice. I mean they had to start dropping it. America has a big base of people with no insurance at all.
|
|
Christopher :
|
Absolutely.
|
|
Howard Farran:
|
Everybody I'm talking to, including my own office, mytodaysdental.com these in-office insurance plans, patients love it because they just want to have insurance.
|
|
Christopher :
|
Exactly.
|
|
Howard Farran:
|
Talk about that.
|
|
Christopher :
|
It's the single biggest thing that keeps a patient out of your office. Patients truly believe ... I was one of them. Remember I went in, whenever I had my tooth extracted, I had $5,000 cash in my pocket. It was my entire life savings. I had taken that out of savings, and that was being saved for my wedding, because I want to pay for my own wedding. I had that because I thought that's how much the extraction was going to cost. The problem is that people who have a low dental like you, people who don't have a lot of experience with dentistry, they say, "I don't have insurance. I can't go to the dentist. It's going to cost as much as a car." Or it's going to cost you know $3,000 to get looked at, or what have you.
|
|
|
They have unrealistic ideas of what the costs associated are. Frankly that cost can be high, and they can be unapproachable for people who just don't have the money. It's not nearly as many times I find that that's the case, as I find that they had an inflated idea of what the cost were. Having something that tells them, "Well you don't have insurance, but you've got this dental savings plan, and you're going to get this great value." What we did is I actually enumerated everything that we do on a new patient exam, and I realized all the things I'm writing off, it's about $900 for the services. I thought, "Well do we really have to make $900 on a new patient exam? What are we making on insurance?"
|
|
|
I looked at my lowest insurance and my highest insurance and said, "Look, what the lowest insurance is paying us, I think is okay for a new patient exam. Let's do this, and let's give people an ability to come in and get seen, because if we don't see them we can't treat them. If we don't see them, we can't save that class two filling, from becoming a root canal, and a crown, and a [post decore 00:35:26] or even extraction." Again as I said earlier, God is a better dentist than I am. The longer I can keep his worth in their mouth, the happier I am. Because my work is going to fail, and as a dentist that was probably the hardest thing for me to come to terms with, is that someday, my work is going to fail. I think a lot of us have a hard time with that.
|
|
Howard Farran:
|
Yeah. I mean everything's is in a timing, eventually all your patients are going to die. You know what I mean? No one gets off this rock alive. Every single things in going to fail. That was one of the biggest errors I made when I opened up 30 years ago. I didn't have these ... You know I'm in Phoenix, and 10% of this town is a bunch of retirees from Canada and North Dakota. I get all these 85 year old men, and I would just keep patching because I was thinking, "What the hell ... He's probably going to die before he gets to his car." Then 10 years later they're still alive, then 15 years later they're still alive, and 20 years later it's like-
|
|
Christopher :
|
10 years later you have to look at that patch and go, "What the hell was I thinking? Why did I crown this?" or what have you.
|
|
Howard Farran:
|
I'll tell you what, some of the biggest clinical failure decisions I ever made in my life was thinking, "Well this guy is ... He should have been dead five years ago. Hell he's 92 years old." Then you patch up and do this crap, and he's still alive at 94, 95 ... I mean they just ... The fastest-growing segment of the American population is women over 100. Second, is women over 90. I mean they just won't die. The most controversial thing that Dentaltown Magazine ever did ever, it was a dentist like you, married to a vet and he put on a deer hunting continuing education course. You could bomb, and deer hunt, and oh my God. When dentists found out that the guy's wife was a vet, they're like, "How could she be a vet if she could kill a deer? Who could shoot Bambi and be a veterinarian?" Oh my God.
|
|
Christopher :
|
How can you be a dentist and eat a donut? Good God, right? It's crazy.
|
|
Howard Farran:
|
I mean we had more nasty letters sent in. I mean it was just ... I mean the phones were just ringing off the hook. I could not believe how controversy ... I mean I grew up in Kansas so grandma has how many rifles and ... Grandma has 20 rifles and a deer blind, and she's got an AK-47 too, doesn't she? I mean that woman could probably take out ... If someone invaded her farm, then she could probably take out the first 100 just from her deer blind. She's just a crazy lady. How successful is that in-office insurance plan?
|
|
Christopher :
|
We've just started it. Patients have started signing up for it. A little background behind that, you may have noticed it's called the joyous smiles plan. We had been putting it together for about a year, and frankly because I was worried that we were going to end up losing our rear ends on it. I finally decided we had to do it. There's been a lot of patient interest, but about a week before we launched it, and I know you're familiar because you do a lot of multimedia stuff, we had already branded everything and we had mailers made, and we had a website made, and one of our absolute favorite patients in the world was put on hospice. We were told she wouldn't be at her appointment that day, because they expected her to die tomorrow. It just killed us. Her name was Joy, and the staff was all crying and we had this thing, we're about the launch, and it didn't seem appropriate, so we waited a little while and I got to thinking. I said you know, "I can't think of a better way to honor her."
|
|
|
Because we had talked about the plan and she said, "You know I wish they had something like that for me," and so we named it the Joyous Smiles Program. There were a lot of tears, and I think it made it a little bit more special for everybody in the office too.
|
|
Howard Farran:
|
Man you are a romantic. You are. You're a special guy. That is so cool. I love that video. Everybody. Well, you have two websites, so what is the difference between Dentist Alvin TX, for Texas, dentistalvintx.com and mywinningsmiles.com? Why do you have two websites?
|
|
Christopher :
|
Well, whenever I first started up my practice, I had no money for marketing. What I did is I had friends put together My Winning Smiles for me. As I got to the point where I could afford more marketing, and afford some better consultation on websites, and how to not have a "SEO manager" because I don't necessarily know. I think that's a moving target. Just to have some advice on what to put up there. Search terms to use and things like that. Someone to actually run the locals web searches, and see what people were looking for, and it was dentist Alvin, Texas or Alvin, Texas dentist. We made a new site that was entitled Alvin Texas dentist, and that's why we have a second one.
|
|
|
Now the first one we did shut down for a little while, and I'm trying to do a little bit of a different marketing strategy now, and so each one is optimized toward different search terms. What I was told is if I did that all in one website, basically it was going to kick us out of a couple of algorithms, because it was too dispersed of a message, and so we decided to go with two websites.
|
|
Howard Farran:
|
Why did you bring up Apex Dental? I forgot why you-
|
|
Christopher :
|
Apex Dental Marketing. That's the-
|
|
Howard Farran:
|
Apex Dental Marketing, not Apex Dental Materials?
|
|
Christopher :
|
No sir.
|
|
Howard Farran:
|
There's an Apex Dental Material, that's John Kanca with his Surpass bonding agent, but you said use Apex Dental Marketing?
|
|
Christopher :
|
Correct.
|
|
Howard Farran:
|
Okay. Do you use Apex Dental Materials?
|
|
Christopher :
|
No we don't. I'm a huge fan of VOCO. I think they have a great product, with a great price. It works well in my hands.
|
|
Howard Farran:
|
For your bonding agent?
|
|
Christopher :
|
For my bonding agent, or my deposit, for my temporary material, realign material, or [inaudible 00:41:26]-
|
|
Howard Farran:
|
They are in [inaudible 00:41:26], right?
|
|
Christopher :
|
Yes they are.
|
|
|
[crosstalk 00:41:29]
|
|
|
They have worst names in the industry.
|
|
Howard Farran:
|
They have what?
|
|
Christopher :
|
The worst names in the industry. The bonding agent is called FU, Futurabond.
|
|
Howard Farran:
|
No. You're kidding me.
|
|
Christopher :
|
I'm not kidding you. There flowable, which is an 85% filled flow ball it's called Heavy Flow. I'm always worried I'm going to look over at the assistants and say, "Hey. Heavy Flow?" and she'd say, "FU." The patient's not going to what's going on.
|
|
Howard Farran:
|
I'll never forget when it was 3Ms, it was [inaudible 00:42:00] way back in the day, and these guys come up to me and they want to talk to me about the new bonding agent. It was Prompt L-Pop. I said, "Okay, the first thing you got to realize, this name's got to go." I said, "What the hell is a [Promptopop 00:42:13]?" They go, "Well prompt fast and it looked like a lollipop so we call it a prompt first, and it looked like lollipop, so we called it [Promptopop 00:42:18]." But it's an MBA lesson. In MBA they always taught you that you can think global, but you got to act local especially with marketing.
|
|
|
If you're a German company and you want to sell your product in Japan, you can't have a bunch of Germans writing the ads for Japan, and you can't ... It's tough with the Internet because when dentists around the world are talking on like Dentaltown, it's hard when they have 10 different names. GC does that a lot. GC like dentists from Australia it's called one thing, and then dentists get in to America it's called another thing. But they really have a ... I'm looking at the bonding gel. They have feature a bond that Admira bond, Futurabond U. That's what you're calling FU?
|
|
Christopher :
|
Yeah. When you're talking to them they say FU.
|
|
Howard Farran:
|
Do they know what that means?
|
|
Christopher :
|
I don't think so Howard.
|
|
Howard Farran:
|
I remember when Chevy launched ... What was the name of the Chevy car that in Spanish it meant a no-go. Was it the ... Chevy launched a car, I forgot the name of it, but in Spanish in that no-go.
|
|
Christopher :
|
Nova. Nova?
|
|
Howard Farran:
|
What it the Nova?
|
|
Christopher :
|
Nova. No-go.
|
|
Howard Farran:
|
Nova. No-go. Yeah. Unbelievable. It was just hilarious. Hilarious. Hilarious. I want to go back to another controversial thing that you do. Probably one of the most controversial Howard speeches I ever wrote was on guided surgery. Again everybody that's 50 to 75, that displays five to 10,000 implants, they grew up on 2D panos I never use it on a guided surgery one time. They look at the kids needing a guided surgery and they're saying, "Well, did you start dreading those on?" I mean don't you need to learn how to be a surgeon. Talk about, when you're using a OCO bigger implants, what percent of the time are using the guided surgery?
|
|
Christopher :
|
I'd say about 80% of the time I use guided. My philosophy behind it is this, if I've got a patient that I'm working on, and I'm pretty sure that I can do a class-2 filling on them with absolutely no help from the assistant, no cheek retraction, no suction, but I have those things at my disposal. Do I avoid the possibility of cutting the patient's cheek, or having the patients sit upright because they're drowning, because there's no suction? Of course I do. It's a no-brainer. Guided surgery is the same thing for me. I started free hand, I still do a few freehand, but I like the ability to sit there, and think at night and run the situations through my head, and turn the skull around and look at it, and see where are we? How many millimeters of bone do we have around the entire implant all the way at the apex? I like the ability to park my implant exactly where I planned it.
|
|
|
Now, I think in dental school one of our big things was this piss-poor planning yields piss-poor performance. If you go in and you flap, the first thing you're going to do is you're going to have one half of a millimeter bone loss. You're going to need to bury your implant a little bit further than you want, so that you're not going to get exposure. You're also going to have more bleeding, more post operative pain, to me just about every single way it's better. But for what the older folks are saying, the more experienced, more seasoned clinicians, I would say this, I absolutely agree that before anybody ever places a guided implant, they need to place implants with a flap. They need to fill the bone with their fingers, they need to get a feel for when things are going wrong. A guide is not a panacea. It is not going to keep you out of trouble unless you already know how to stay out of trouble. Does that make sense?
|
|
Howard Farran:
|
It does. It does. I'm trying to find the other Apex. It was Apex Dental-
|
|
Christopher :
|
Solutions.
|
|
Howard Farran:
|
Apex Dental Solutions. What is Apex Dental Solutions?
|
|
Christopher :
|
They do marketing. They do flyers. They do mailers, brochures. They do my cool little animation for my mini implants you said you like. Right now they're working on some sleep apnea and snoring stuff for me. Let's see what else. Gosh. I had a couple of spots I put in a local theater, I actually ran some implant advertisements and denture advertisements at a local theater, which I was told was insane and would never work, but we've gotten quite a few patients from it. Because older folks like to go out to the movies, and older folks need dentures and implants. They're pretty much a full-service ad agency.
|
|
Howard Farran:
|
How did you find them?
|
|
Christopher :
|
Well, they were at the bottom of Dr. Oppenheimer's CE. Whenever I was taking Ben Oppenheimer's mini implant course, I did a video course because I'd already taken a few of them live, and I just wanted to ... I don't know about you whenever I take CE, I like to take similar level CEs multiple times so I can get different perspectives, different doctors opinions on certain things, and I can form my own based upon the information I've got. I was taking a Ben Oppenheimer course online and I noticed the little logo on the bottom of it, Apex Dental Solutions. I said, "What the heck's that?" I looked it up and I see it's a company that basically does education and marketing just for implants. I think if I want to sell implants that's who I want to talk to you. I called them up, and said look what we do.
|
|
|
When we sent out their mailers the first time, I don't know if you've had this situation occur before, but sometimes your ads can work too well, and I believe ... Let me make sure I'm not lying to you. Let me look at my statistics here. The first month that we sent out their mailers, we went from an average of 44 or 45 new patients a month, to over 75.
|
|
Howard Farran:
|
Nice.
|
|
Christopher :
|
Just in that month. Well it was really great except that we weren't prepared to deliver. We had so many people calling us, and so many people wanting appointments, that it was a bit of a scramble. But we learned our lesson from that, and we put some systems into place to handle higher call volume, then we launched a big campaign and things like that. It worked very well for us.
|
|
Howard Farran:
|
That is amazing. You also talked about sleep apnea.
|
|
Christopher :
|
Correct. Yet another controversial subject Howard.
|
|
Howard Farran:
|
Yeah. What made you get into sleep?
|
|
Christopher :
|
Okay. I have this wonderful little old lady, Miss Shirley.
|
|
Howard Farran:
|
Surely you must be kidding.
|
|
Christopher :
|
Shirley. I always ask her how Laverne is doing. Howard probably only you and me and about 30% of our people who are watching, know what that reference was for. She comes in one day, and her daughter brings her in. She's, "Doc, you have to do something about my mom snoring." I said, "What's going on?" She said, "Well, I live with her now and I cannot sleep. I know you make snoring devices, can you please do something for us?" "Well sure, we can do that." This was before all the sleep apnea stuff came out, and all the certification courses, and I guess this was back in 2014.
|
|
|
I made her a silent night, and I had her back in a week and I said, "Well Shirley how are you sleeping?" She said, "Dr. Hoffpauir I'm still snoring." She was so excited, and so just vibrant. I said, "Shirley, okay you're going to have to give me more information. You obviously, you seem happy, but I'm not sure I understand. You're still snoring, why are you so happy?"
|
|
|
She said, "Well, this morning I got up 7 o'clock in the morning, and I cleaned the house, and I wash the laundry." I said, "Okay, well what's important about that? I need more information." She says, "Well, usually I can't get up until about 11:00 and I'm dragging myself out of bed." I said, "Well honey, you may have sleep apnea. We need to look into that with your physician." She says, "I do." I said, "You have sleep apnea, why don't you use your CPAP?" "Oh I just can't stand that thing."
|
|
|
I inadvertently treated this woman's sleep apnea with a snoring device. It just made some wheels to start turning. I said, "Well I need to know more about this first of all, to keep myself out of trouble." Because that could be considered passive diagnosis of snoring if someone has sleep apnea. I said, "Well I better learn some more about it." The more I learned about it, and the more I start screening patients, the more I was horrified at the number of patients. I mean let's face it, we're in South Texas with lots of Tex-Mex food, and I'm seeing a lot of patients who are if not morbidly obese, at least obese in today's society.
|
|
|
What we ended up finding is I would say a full 50% of the patients that we screened in that first year, are class-3 or class-4 Mallampati, bilateral scalloping of the tongue, nighttime bruxism, positive critical mental angle, class-3 or class-4 consoles. I'm looking at these things and you know it's when ... When all you know is what you know, you don't see what else is out there. A lot of these cases where I was thinking, "Well gosh, this guy's brux is like crazy," and I start seeing the symptoms. I say, "Well he's also got a class-4 mallampati, maybe he can't breathe." That's kind of how I got into this.
|
|
|
We have been for the last couple of years just screening, and with an understanding with the local pulmonologist that, if they had moderate sleep apnea, or if they were intolerant to CPAP, we would send them back, and talk about an oral device. Out of the hundreds of patients that I've sent out, I got exactly zero patience back, to talk about oral device, and so I started doing the sleep test myself and being the gatekeeper. If someone has mild to severe sleep apnea we say, "Look, there's a couple different ways you can treat it. You can treat it with an oral device, you can trigger the CPAP for mild to moderate. An oral device has been shown to be just as efficacious. If you have severe you really need a CPAP, if you can't sleep with the CPAP and you can sign a release, we can talk about doing something but you must see a pulmonologist first."
|
|
|
I sent him a lot more patients than he sent me funny enough. It's because I don't just have a hammer and a nail, I've got options. Lately what we've been trying to do is reach out to some of the local primary care physicians and teach them a little bit more about sleep apnea. Because they really don't know a whole lot about it. I've been trying to forge some relationships with them to see if we can teach them a little bit more about it, to get some of their patients screened or patients who are just not compliant with their CPAP therapy health. In the end, what it's about is making sure the patient's healthy.
|
|
Howard Farran:
|
Supreme Court justice Justin Scalia, I mean he died from not using his CPAP machine. I mean that the compliancies ... What do you think the compliancies of CPAP?
|
|
Christopher :
|
I'd say 50%. I've actually talked to a couple of physician friends of mine and they say it's lower than that.
|
|
Howard Farran:
|
What are you using for the home testing device?
|
|
Christopher :
|
Well we have a couple of different home testing devices that we use. One of them is an easy sleep testing device. Right now we're trying out a new company that also does home sleep test. I own a watch pad, but frankly whenever it came to doing medical billing, and it came to being the person, I didn't want to be the person who was telling them, "You need a CPAP," or "You need a sleep study," "Oh by the way I'm profiting from this." I want it to be an outside person, who they're getting their sleeps study, they're going to pay them. I got a reading from the pulmonologist. That way I could be a little bit more hands-off and just be me. Just do the doctor and say, "Okay we'll look, this is what the readings mean. This is what the study says."
|
|
Howard Farran:
|
Who's your outsource for your ... To send them the device at their home?
|
|
Christopher :
|
Right now we're using Easy Sleep. They'll send the home sleep study in, but we're also talking to a new company. Someone from ... Boy I'm just going to open a can of worms here. Someone from Nearman went out on their own, and someone from Easy Sleep went out on their own, and so we're looking at a couple of different medical billing options right now, and a couple of homes sleep study options right now.
|
|
Howard Farran:
|
Rose Nierman?
|
|
Christopher :
|
Right. One of Roses' guys went out and they made pristine medical billing, and our experiences with them have been great so far. The home sleep study place is called sleeptest.com
|
|
Howard Farran:
|
Which one do like you like better? Easy Sleep or sleeptest.com?
|
|
Christopher :
|
I'll tell you what, give me about six months with them and I'll let you know. Right now I think it's too early to form an opinion. They haven't messed anything up yet. They've been very communicative, and they haven't lied to us yet. It comes down, like I said earlier, it comes down to the relationship. We'll see how it turns out there.
|
|
Howard Farran:
|
Tell me this, do you agree ... I always say this [inaudible 00:56:03] that, if you don't do something once a week you're never going to really get critical matters, you're never going to get good at it. You're never going to make profit out it. Do you think you have to do an Easy Sleep or place so many implants or?
|
|
Christopher :
|
There's a saying that says, to become an expert you need to do something 10,000 times, and I absolutely agree with it. At this point I think I'm an expert at fillings. Well, I've done 10,000 of them. Now, I'm not an expert at implants yet, I'm not an expert at sleep apnea yet, and that's why we offer referrals. It's one of those things as a dentist, you get out of school and you've done 10 crowns, 15 crowns at the most, in most dental schools, do you not do any crowns when you get out? Because you haven't done 10,000 of them, or you haven't done one a week.
|
|
|
I would absolutely agree. You need to do one a week to even become confident, and I would say more than that to become an expert. Should that stop anyone who wants to expand their practice? No. I don't think it should, but they need to make it their business to very carefully select the cases of your treatment. Whether it be sleep apnea, whether it be a full mouth restoration that they're doing, they are already implants. They need to pick the cases carefully and know enough to pick the cases correctly.
|
|
Howard Farran:
|
Some of these case things like it won't even be 1% of their production, but it has solved a much bigger problem, you know, boys and their toys, it got them out of burnout. Like I know dentists you know ... Dentistry, whenever you do a repetitive task over, and over, and over, I mean you know it can get boring after some time. I know dentists who all they do is study TMJ, and they're obsessed with it, but when you look at their books it's only 1% of their revenue. But when you look at the fact that it's their passion, it's their life, same thing with these finishing schools. Like I know people that completely burned out, and then they went to Kois and fell in love with John Kois, Or they went to Spear in Scottsdale. Or they went to the Pankey Institute, or the Dawson.
|
|
|
A lot of times you'll sit and say, "Okay well then you need to drop three grand to learn that this weekend, but if you come back and you got a kick in your step, as opposed to what's the alternative about 14% of dentists will go to rehab once in their lives. I mean if you're drinking Listerine in between patients, and you buy a [sea rack 00:58:31] machine, or a [Interro 00:58:33] or a laser, or whatever, and it makes you run 20 red lights on the way to work, God then you can't afford not to have that. I just got to call bullshit when people say you have to have this very expensive toy to be a great dentist.
|
|
Christopher :
|
I agree there. Like I said, I like my toys. I would go so far though Howard and I'll disagree with you a little bit there. I think that you must at least do the due diligence to say, can this possibly be something that I add to my practice that brings in revenue? Is this another profit screen? Is this another profit center, or is this just my Corvette, or my Porsche, or my Lamborghini, or whatever you just bought. I know for instance my i-CAT could have been a pretty nice boat, but the direction I wanted to take my practice required that I do things this way. Like we said, you can place implants with just a pano. I don't think it's going to be standard of care for very much longer to take this pano.
|
|
|
I wanted to be ahead of the curve, I wanted to know the technology, and I wanted to do 10,000 of them. I wanted to do one a week, or more. To be able to get to that point that whenever it's no longer standard of care to take pano to place an implant, I'm already there. Just kind of my two cents.
|
|
Howard Farran:
|
Again back to the [Interro 01:00:09] or a CVCT, how much did you pay for that?
|
|
Christopher :
|
About 120 grand.
|
|
Howard Farran:
|
Without a bit of boat for freshwater lake, or are you close enough to the Gulf? Would that have been an ocean boat or fresh water?
|
|
Christopher :
|
You know I'm only 35 minutes away from Galveston, so probably an ocean boat.
|
|
Howard Farran:
|
My point is this, I mean like I'll know people who haven't place an implant yet, and before they place an implant, they wouldn't bought a six-figure deal. It's like you can outsource-
|
|
Christopher :
|
They can't do that.
|
|
Howard Farran:
|
A lot of the specialists are trying to do anything to strike up a relationship with a referring doctor. There's so many periodontist oral surgeons, that if you call them and said you know, "Until I get going on this, and until I'm like reaching critical mass, can I send my patients to your office" They can even do the CVCT and blow it out.
|
|
Christopher :
|
If you don't want to have that conflict of interest, why not your local orthodontists? There's a lot of orthodontists who are doing sea CVCTs for ortho treatment now. They have no vested interest in placing an implant or not, and it seemed as the relationship between. That's actually what I did before I got my CVCT. If I took my caliper reading, and the bone just didn't seem like what I wanted, or whenever I was palpating it. I thought I felt an undercut in the mandevilla posterior region. I was going to send for a cone beam. Then I would have him help me look at what the heck was going on, because when you first look at one, let me tell you, it opens a whole new world. It's not like just reading an x-ray.
|
|
Howard Farran:
|
We went over, the shows an hour, we are 6 minutes over. So many young kids right now are unhappy and miserable, working for an associate, or some dude they ... Old guy, whatever corporate, but they're just afraid to start their own. Final thoughts, what would you tell that kid that's miserable at some corporate chain, or working for some old guy that should have been a wheat farmer, and they want to start their own but they're just scared.
|
|
Christopher :
|
My advice to a new dentist who wants to start their own practice. The first thing, if you can, I know you want to do things your own way, and I know you want to write your own plan. I know you want to be the guy who's in control, but if you find someone who's willing to sell their practice, buying a practice with a normal patient base and income already coming to that practice is always a better idea, a five-year break point. Meaning, at five years you're going to be out ahead of anybody who starts a practice new. Both in debt load, if you carefully negotiate that price and do it correctly and get a broker involved.
|
|
|
Also in income that's coming into the practice. My second thing I would tell you, is to plan for six opps if you think you're only going to need four. Always over plan the number of opps you have, just like you were saying earlier you. You don't need new equipment. Buy used equipment. You can finance it. If you get good used equipment Pelton & Crane, A-dec. Somebody who has a really good reputation, and you can get good used equipment that way, do it. Buy it off eBay. Buy it off of Atlas. There's lots of people who resell their-
|
|
Howard Farran:
|
The classifieds on Dentaltown. There's 6,000 free classified ads on Dentaltown.
|
|
Christopher :
|
If you do that you're going to save yourself if not hundreds of thousands, significant tens of thousands. You don't need every new toy in the world. Let's face it, you barely know how to not kill somebody. Concentrate on your fillings, your crime bridge and forming relationships with your patients. Because if you don't do that, it doesn't matter what GeeWiz things you buy, you're not going to get to use it. If you can't convince a patient to do the treatments that you want and need, or they want and need, then it doesn't matter what toys you have in your arsenal, learn your numbers. Learn what your cash flow says. Don't print out a big old P&L and try to figure out what the hell it means, because it doesn't mean a damn thing. Look at your cash flow. Look at where your money is coming in, and where your money is going out.
|
|
|
Figure out, and this is going to sound obnoxious, but figure out what your cost per procedure is. When you're looking at a filling, how much is the composite costing you? How much is the labor costing you? How much do you need to make per hour, per chair, every single day, and that's your nut to crack every single month. Then plan for 10, or 15, or 20, or 30% over that because that's where you need to be if you want to run a successful practice. Because let me tell you brother, sometimes you're not going to hit that nut, and having that extra cash is going to be nice. It's also going to go to pay and hire better people, and it's going to pay for all those really cool gadgets that you want, and all those cool CE classes that you want to take so that you can learn how to do new stuff. Tackle one thing at a time. If you want to learn to place implants, tackle implants and then say, "You know what? I need a new bone grafts of these implants. Learn bone grafting, learn tissue management, then learn your implants.
|
|
|
Focus on it until you get so good at it that when you go to CE you go, "Well shit, I didn't learn anything." and then see if you can find someone better. If you can't find anyone better, well guess what, you're ready to add something new. Don't add it before that, because all you'll do is you cause frustration with your staff. You disperse your efforts and you disorganize your path. If you can stay the straightened arrow and add one thing at a time, and add one profit center at a time, and take care of your patients, the money will come. That's what I would offer somebody who's getting ready to start a practice.
|
|
Howard Farran:
|
You're a profound dude man. I just love you. I love listening. I could listen to you all day long. One of the things you said that's so profound, people don't realize those A-dec chairs made in Oregon by Ken Austin, I mean I've been pricing 30 years I had friends that bought used ones 30 years ago, and they're still using them.
|
|
Christopher :
|
There's only one change from what I understand that's been made. I think maybe they changed one bolt in the back, and they change the back from wood to metal. Because we've got to be a bunch of fat asses.
|
|
Howard Farran:
|
You know why he did that?
|
|
Christopher :
|
I assumed it was because we're getting really fat. Why is it?
|
|
Howard Farran:
|
Ken Austin, he's an engineer and his idol was Henry Ford. He's also an antique car collector. What he loved about the Model T, is that when you were a farmer and your Model T broke down, but you knew 10 miles up that dirt road in the creek was an abandoned Model T from 20 years ago, you could go take out that part and stick it in your brand new Model T and it worked. The only thing Ken had to change in all the years of A-dec was for obesity, and so he had to get a bigger like say a back plate, a bigger ground plate because they were struggling to lean back big people and the chair would start to fall over. It was only obesity that changed that plate, but the A-decs ... The other thing is a lot of people will stand and say, "Well you know that thing's 30 years old." Well all you do is go to anybody does who car upholstery, and they come in your office they'll do one chair up and close per night.
|
|
Christopher :
|
That's the thing Howard, you put your finger on something right there. If this right here, if that said, dental coffee mug, or dental hot liquid mover, then this thing would cost me 800 bucks. We've got to stop letting people rape us just because we have the word dental in front of something. Look at where things came from. if someone is selling you PRF vials, okay? PRF is a big thing now. It's something I love, because it makes amazing differences in the healing. I went out to medical suppliers and I said, "Hey, I need a red top glass lid vial. I need a bad container" It was half the price of buying it through the down supply houses.
|
|
|
I understand they have to make their buck too, and they probably buy it from the medical suppliers, but when I look at things on my wife's side of things, whenever she buy something from Henry Schein, and I buy the same thing for Henry Schein, and it's made at the same place, I know it went through the same testing. I know it's got the same FDA approval, except one says human and one doesn't, and one has dental on it, and I'm paying four times as much, there's a problem. The problem is us. Much like a reason that PPOs are such an issue right now, the problem was us. We allowed the insurance company to act as a go-between between our patients health and us. We've got bean counters telling us how to practice dentistry right now, and I guarantee that they are not qualified.
|
|
|
Even whatever you've got the dentist who's overlooking it, and he says, "Oh no, that case is denied because you don't need a crown on that tooth." Yes I've seen the patient, and if I were to offer medical opinion not having seen the patient based only on x-rays, I'm pretty damn certain the board would frown on that. We've done this to ourselves, we need to stop. We need to stop letting people rape us, we need to stop putting ourselves into bad financial positions, because we feel bad about the word sales, or we feel bad about making a good living or good profit. I think we've won the lottery in a lot of ways, if we will just take our profession back. Where else can you help people every single day, day in and day out?
|
|
|
Where else can you make an absolute change in someone's life the way that we can? Either through giving them new teeth, taking about a pain, figuring out why the hell their jaws been hurting and they have headaches. Save their life with sleep apnea. Where else can you do all that and be able to see your family every day, and be able to work three days, or four days, or five days a week? I saw you wince at three days a week, but where else can you do that, and have that kind of work-home balance Howard?
|
|
|
I mean we have won the damn lottery, but we're screwing it up for ourselves. If we don't start to do something about it, then we're going to lose it all. This year I'm the president of the ninth district Dental Society for ADA, and I see a whole lot of people who just ... They want to make a change but no one knows what to do, and no one's willing to throw themselves out in front of the bus and say, "Hey this has to stop," but maybe I'm just that crazy guy who's going to do it, we'll see.
|
|
Howard Farran:
|
Well man you're dripping with passion. Take away your passion, you're a dentist, your wife's a vet. What's the pros and cons of being a dentist or a vet? Do you sometimes go to bed and say, from a business point of view, not the passion, do you sometimes go to bed with your wife and say, "I wish I would have been a vet," or does she sometimes go to bed with you and say, "I wish I'd have been a dentist." What's the difference between the business of a vet, and the business of dentistry?
|
|
Christopher :
|
I would say there's definitely pros and cons on both sides. Okay, if somebody comes in to her office, and this is one of the things that kills her. Someone has a dog that's its teeth are falling out of its head, because it has periodontal disease. Dogs get periodontal disease as well. They have to have a full mouth of extractions. Well, the owner in many cases would just say, "Well, it's not hurting him." When in reality, that same patient if it was them who came into my office, would see all the bleeding, and they'd feel all the discomfort, and they'd see the bone loss on the x-rays and they'd say, "Oh my God. This is a problem." At least if they're educated well.
|
|
|
There's a personal buy-in to the people doing dentistry that there is not always in veterinary. However, people will ... Hey, I swear two to three times as much to get their dog's teeth clean because they have to be under general anesthesia, as they will for a cleaning in my office without complaining about it. "Oh well, I'm just going to do what the insurance pays for." I think that in some ways it really depends on the patient who you're dealing with, whether you've got the plus or the minus there. Variety of what she does, if I had just stayed doing fillings and crown, and bridge, I don't think I would be as happy, because of a variety of the things that I get to do now. Her variety is insane, and sometimes I don't even know how she does it. Let's face it. She has to be the anesthesiologist, she has to be the dentist, she has to be a general surgeon and pulmonologist, and she has to do all that for 15 different species. There are certain medications if you give it to one species, it will kill another species. There are certain dogs-
|
|
Howard Farran:
|
Would all the dogs fall under one species, or do you separate all of them? When you say 15 species-
|
|
Christopher :
|
No. All the dogs fall under one species, but you get ten Chile's, you get birds, you get dogs, you got cats, you get guinea pigs, and get horses, and cows, and goats, and there's probably some I'm not even thinking of. But within these species, for instance [inaudible 01:12:55], if they have white feet you don't give them ivermectin, because ivermectin could kill them, but all the other dogs are safe on it. It's interesting. It's a lot of variety, anything from internal surgeries, exploratory surgeries, to find out what a bowel obstruction is, all the way to doing what we do. Except for implants. They don't do implants. I'm trying to convince-
|
|
Howard Farran:
|
There's seven and a half billion people on the earth, so on the Western Hemisphere, North and South America there's total from Canada to Argentina's 1 billion people. Africa, that continent has 1 billion people and the economists always points out that Americans spend more money at the bet than all of Africa spends at the doctor. We spend more money on our dogs and cats, than Africa does for 1 billion humans. Isn't that amazing?
|
|
Christopher :
|
It's insane.
|
|
Howard Farran:
|
The point I was looking at though is, what percent of your wife's business do the customers have insurance?
|
|
Christopher :
|
None. Absolutely zero. When they first came out, she looked into the different insurance plans. Much like any insurance plan, and very much like dental, our missing tooth exclusion, well if you have a dog that's considered to be prone to certain things like hip dysplasia, well they're not going to cover it. Period. She started looking at this, and it was all these people who are getting animals that are prone to certain things, like dachshunds with back problems. "Oh well in case he ever gets back problems, no it's excluded." She realized what a ripoff it was to begin with, and started having that conversation with her patients, and with her patients owners I should say. I guess she has the same conversation with her patients, you know, roll over, bark whatever but she started talking to the owners, and I think most of them realized what a bad deal it was. It has not been a huge upseter for her practice.
|
|
Howard Farran:
|
Because it's amazing people in America believe that you just have to have an insurance driven practice, when 40% of Americans don't have insurance, and of the 220 countries in the world, it's only found in about 20 countries. When you start going to Asia, you can see their brain actually starts hurting when they start thinking about dental insurance, because they don't know why, how come-
|
|
Christopher :
|
Why would you do it?
|
|
Howard Farran:
|
Well they're like, well if you drink Coca Cola and eat a Hershey bar, and don't brush your floss, why would your boss or your president be in charge of your dental bill? They think it's a perverted incentive. You're incentivizing bad behavior. They even say things like that you know, every time you sell a pack of cigarettes in the United States, $2 ought to go towards your bypass, and then so when you smoke 2 bucks say for 40 years, you need $100,000 bypass, you prepaid your bypass, because this is that behavior. The Chinese, I mean they just dental insurance is a bad idea, you're subsidizing bad behavior. It's a highly preventable disease.
|
|
Christopher :
|
I have a question for you in regards to that. How did we get to this point? Americans used to be, and I know that you're a history guy. We used to be savers, and at the time that we were savers, we also had these pension plans that were "saving for us", but we were still saving ourselves. Well, pensions are gone, how did we get from the point where we had this little guarantee of money that was coming in, but we still saved money on the other hand, to not saving money, and not having this guarantee of money, and expecting the welfare state to take care of us in our old age? Not making financially sound decisions to put money aside to take care of ourselves, or to take care of our medical needs, or our housing needs, or our repair needs for the junk that we bought. Now, how did we get here? What's your historical perspective on that?
|
|
Howard Farran:
|
I think it's because the lessons of the Great Depression, which were a serious impact on my boys grandfather I mean, even when he got up to having $3 million in a savings account he still ... If you took him to a restaurant he's like, "Why would we pay $19 for a steak we could go to Safeway and buy it for $3?" Then the next thing they forget and forget. What they basically don't realize is that the $19 trillion debt bubble could pop. I mean, they've never seen hard times. I mean they talk about how difficult their life was, they're like, "Well, do you remember the Civil War when one out of 30 people were killed? Do you remember World War I going into the Great Depression?"
|
|
|
They think this living paycheck to paycheck is always going to be there, and they don't realize that history always repeats itself, and we're living in the biggest debt bubble. I mean people talk about the real estate bubbles, and that last one popped in 2008, we're completely back in bubble territory. But you know they always talk about stock market crashes, and March of 2000 you know whatever, but what they don't realize is the biggest bubble ever created in the history of all bubbles, is the sovereign debt bubble, where the United States has 19 trillion of debt, and the other 20 economies have about another 21. There's a $40 trillion debt bubble that if that thing collapsed, these people would find out, they'd be saying, "Why do I have no savings?"
|
|
Christopher :
|
Okay, and there's a bit of perspective there, but just between you and me, we used to have a two medal system where our economy was based upon money that was backed by hard currency, which had limited amounts. That meant that all inflation and deflation was artificially controlled by what was there. You want to make more money, you go and you mine more silver, you go and you mine more gold, you make more coin. Now we have a system where our money is backed only by the consumers' believe in what it can purchase, and for some reason, people have gotten to the point where, and I don't understand the mathematics of this, how people can not understand this. Where they think, "Oh hell, we need to get people who are on minimum wage raise up to $15. That'll be great. They'll have more money to spend." They don't realize that that decreases the value of the dollar and inflates the cost of all things that they're going to buy with that $15. I don't understand how that disconnect occurred. What do you think about that?
|
|
Howard Farran:
|
Well actually we're entering the third disconnect, so we went from what you said a gold standard, where currency was backed by a hard metal gold or silver. Then we went to government fiat money, where you just have to believe in the government, and now they say-
|
|
Christopher :
|
Thank you Alexander Hamilton.
|
|
Howard Farran:
|
Now they say ... Did you see the play?
|
|
Christopher :
|
No, I did not.
|
|
Howard Farran:
|
It's coming to Phoenix. I'm going to get tickets. It's coming to ASU. Now, all the PhDs are saying that it could very well go to the new blockchain technology for Bitcoin, and everybody is not so much looking at the company Bitcoin, but they're looking at this blockchain programming. What driverless cars could do to taxi drivers, and semi-truck drivers, if this blockchain technology takes off, then it would just be the biggest upset to banking and finance, and Federal Reserve and it's a pretty ... They think it's going to be the biggest disruptive deal since going from gold to Fiat, from Fiat to blockchain. That'll be interesting to watch. It's an amazing world and it just seems to be going faster, and faster, and faster.
|
|
Christopher :
|
May you live in interesting times.
|
|
Howard Farran:
|
And we do. Man, seriously dude. Loved this interview. You are awesome, unbelievable. One final parting shot. I've been a member of the ADA since dental school, and I always figured, you know the ADA is like your parents, they're the only ones you got. I mean yeah, I wish my mom was a little different in certain areas, but she's my mom, and the worst decision I ever made in my life was setting her up on a computer with email, because she emails me 10 times a day and they're always forwards. They're always forwards. Anyway, I've always been a member of the ADA, but some of these young kids are coming out, and they're deciding they're not going to join the ADA and it's like, dude.
|
|
Christopher :
|
I'll tell you ... I mentioned earlier that I'm the current president the ninth district. The reason that these kids are not joining, it's interesting because I talked to some of the leadership, and they truly believe that it's a matter of cost. They think that if they just drive down the cost of membership, that these students will join. It's not true. I've talked to a lot of younger people, a lot of people who are just graduating dental school. As I said, I was the old man on campus, and they don't believe that the ADA does anything for them. They don't see the difference, they don't see the change.
|
|
|
It's kind of like you said earlier. It's like your wife, right? If you don't like what your wife is doing ... Now, I've been married quite a number of years. I got married in 2003, so I've learned to tell my wife what it is I need, and what it is that I'm upset about, or unhappy about, and she does the same with me. It's called communication. These kids, and I alluded to this earlier, they grew up differently than we did. Being able to tell a big scary organization that's supposed to be the gatekeeper to dentistry, "Hey, I'm not happy with what you're doing. I need you to show me more of this, or to do more of this, or just show me what it is you have done with the money I've given."
|
|
|
They're not comfortable there, and so instead of taking on positions of authority in the ADA and making the change, and communicating, and asking the hard questions, and talking to the big scary doctors who are just like you and me. They're not that scary. Just because they've been practicing for 20 years doesn't make them someone who's unapproachable. They won't do that. They check out instead. It's been a big problem, but just as big of a problem is our more seasoned members. Because they think one thing is happening, but they haven't damn well asked. They haven't asked them, "Why don't you join? Just tell me the truth I want to be better." I think it's a two-way street, and if we don't fix this we have some very hard times ahead of us. I agree with you. It's the only game in town and it's-
|
|
Howard Farran:
|
I know and and what they're doing is state by state, state by state, I mean it's a political action committee at the state level. They're fighting this on 50 different fronts, and I know a lot of people my age that they're still members but they don't like to go to the meetings because ... I mean in all honesty, if you have eight years in college, I don't care if you're a dentist, a vet, a lawyer, an MD, if you have eight years of college you can't get two of those guys to agree that today is Tuesday. Because when you haven't graduated from high school, and you're young, you do whatever the Marine Corps guy tells you to do.
|
|
Christopher :
|
Right.
|
|
Howard Farran:
|
But when you got eight years of college, my God you know it all, and if you don't believe it, just ask them, so it's hard for those guys to get agreement on some of these issues.
|
|
Christopher :
|
Two sayings there. I don't know if you've ever seen this, when there's a poster it says, 9 out of 10 dentists agree that the 10 dentist is an idiot. That's about all you can get us to agree on, and that 10th dentist, they kind of rotate. The other one is a Samuel Clemens quote I know you're probably familiar with. When I was a boy of 18, I was amazed at the ignorance of my old man, and by the time I had turned 21 I was astounded at how much he had learned in three short years.
|
|
Howard Farran:
|
I love that. Well, hey man thank you so much for spending so much time, coming on my show today, talking to my homies. I mean this was just an amazing talk. Thank you so much for all that you do for dentistry.
|
|
Christopher :
|
Thank you Howard.
|
|
Howard Farran:
|
Thank you for volunteering in your 9th district down there in Texas, and thank you for all that you do.
|
|
Christopher :
|
Thanks brother. You have a good one.
|
|
Howard Farran:
|
All right. You too.
|