Howard: It is just a huge honor to be sitting here in Sydney, Australia with my very good friend Mr Carl Burroughs, looking over the Sydney Harbor. My God, I live in the desert. There’s just sand, and this harbor is so exciting. Ryan and I have been going on a two hour walk every morning, a two hour walk at night, just walking around the harbor. You just lose concept of time. It seems like every time I was on a walk I was like ‘God, I’m getting tired. How long have we been walking?’ We look at clock, it’s been like two hours. Looking at all the boats, and in fact I heard… that was the funniest thing today; I heard a train and I turned to the guy and I said ‘Where’s the train?’ They go ‘No that’s a boat, that’s a yacht’, and it had the same damn horn. Did you remember hearing that? Sounds like a damn train.
Carl is a true serial entrepreneur; he started making money, serving his shop at the age of eight. He brought his first house at the age of seventeen. He was fundamental in the success of the very first combined legal and real estate business in the UK, taking a sixty percent market share of all property listings in his home city of York. In 1993 he immigrated to Australia and started the telecommunications retail chain, Communique, building this to twenty-six locations and an annual revenue of over $12,000,000 within five years.
In 2000 he bought a Sydney-based marketing company which formed the foundation of his current company, ‘Integrated Dental Marketing.’ In 2001, Doctor Derek Mahony asked Carl to speak at an orthodontic conference in Sydney, which was his first introduction to the profession of dentistry. Since his time, Carl has built the first and largest advertising agency in Australia, dedicated to the dental profession, IDM. He started the first dedicated dental patient finance plan, Smile Card. He was the co-founder of the dental group, Dental Partners now known as Maven, and has created hundreds of new dental brands across the country for his clients.
More recently Carl started the Marketing Dentistry Institute, bringing speakers to Australia such as Doctor Bill Dorfman, Doctor Mark Costes, Doctor Michael Abernathy and the incomparable Howard Farran. I actually wrote that part in. Carl also owns two dental practices himself, where he practices what he preaches, growing the first practice he bought by over two hundred and twenty percent in the first fifteen months of ownership. He is married to his beautiful wife Angelica, and together they have their ten year old daughter Grace. Any down time is spent motorcycling, and he recently came back from a month motorcycling around Nepal. Did you go to Kathmandu?
Carl: Yes. Started in Kathmandu.
Howard: You started in Kathmandu. Did you go to the base of Everest?
Carl: Yes, we flew over Everest as well, and we got as far as four thousand meters up on the bikes, which is about as high as you can get on motorcycles.
Howard: And Everest is eight thousand.
Carl: Yes. That’s right. So, yes.
Howard: So basically, I had this crazy idea that I was going to climb the tallest summit of all seven continents.
Carl: Yeah.
Howard: I started in Africa, which of the seven is the middle, it’s nineteen thousand. Last time I came to Australia and lectured, you brought me down.
Carl: Yeah.
Howard: They have climbed the hot ice on Kosciusko.
Carl: Yeah.
Howard: Which is the shortest mountain of the seventeen. But when I was lecturing in Kathmandu, I went to the airport and I chartered an aircraft to fly me over Everest because I wanted to take a look at it. The guy said ‘well I can’t fly over Everest’. I said ‘what?’ He goes ‘well in the Rockies in America, the tallest mountains are fourteen thousand feet’. He goes ‘base camp of Everest is higher than that, and it’s twenty thousand feet’.
Carl: Yeah.
Howard: ‘So your high Rockies, you’d have to double.” So I’m like ‘okay, I want to see this’. So we flew and we got that thing, I was looking at the window. That was the creepiest…
Carl: How do you work out which one it is? It’s like amazing isn’t it? From the air there’s so many, and in fact I had to have the pilot say ‘that’s Everest’. It doesn’t even look like the tallest one from the air.
Howard: From where you were at? Fourteen thousand?
Carl: No, no. From where we flew.
Howard: Oh, yeah.
Carl: We had a scenic flight over. I never understood the depths of the Himalayas. I always thought it’d be Everest was one mountain. It’s… Yeah.
Howard: Yeah. They have hundreds of peaks.
Carl: Yeah. Absolutely.
Howard: That are over twenty thousand feet.
Carl: Yeah.
Howard: Or something.
Carl: Yeah.
Howard: But I looked out that wonder and I saw the thing. I thought it just looked eerie.
Carl: Yeah.
Howard: You got an appreciation of what twenty-eight thousand feet looked like and the last, I would say the last, four thousand feet looked like just a suicide mission.
Carl: Yeah.
Howard: I want to start off with this question. So, you remember Ruth and George Park?
Carl: George (inaudible 04:4).
Howard: Of Park Laboratories. George passed on. They start bringing me down here in the ‘90s, three times they brought me to lecture in Auckland, Melbourne, Sydney, Brisbane, Gold Coast, Perth, and I did that like every five years. I think three times. And in the ‘90s the problem was everybody was booked two months in advance, what do you do with emergencies. It was crazy. Any dentist could open up and be booked out a month, or two months in advance.
I remember meeting a dentist in Brisbane, he had no openings for three months. Now flash forward to 2017, my God, in the last three years you let in ten percent more dentists just from Asia, you doubled the number of dental schools, corporate dentistry chains, medical insurance companies like Bupa building practices. It’s really changed in Australia, from a completely noncompetitive environment to a very competitive environment.
Carl: Absolutely it has. Yes.
Howard: Would you agree with all that?
Carl: Yeah, totally. Even when I started in 2001, and I’d go and see practices here in Sydney. The biggest problem they had was they couldn’t find an associate dentist. So this marketing mumbo jumbo we’re not interested in that. We’re already booked out. But yes, you do say fast forward. Yeah, it’s an ever shifting thing. when you came out for me two years ago. David Penn had opened, talking about the doom and gloom. We’ve had pretty much the same conversation for maybe four or five years, and dentistry is not falling off a cliff.
This is testament to the fact that there’s a very strong patient doctor relationship. So it’s not as if a piece of technology comes in, like Uber, and everything changes overnight. But it’s a slow death, and people’s incomes are starting to diminish, and when you’re in a pretty good income and fifty grand drops off we don’t tend to notice it. Then a hundred Grand drops off. But it’s a slow decline. So it’s getting far more competitive.
Howard: Is that going to keep going? Ten years from now will it be even more competitive?
Carl: Oh, totally. Every year is going to get more competitive, which means people have to get smarter about the way they run their businesses, and actually look at the business side of the practice. Dentistry is one of the greatest professions in the world, because you get paid for helping people, and the more people you help, the more money you make. So there’s no conflict in that. But getting the business side of the practice right is no longer an option, where at one point, if you didn’t get it right you’d still be busy.
Howard: So you have many mini websites. You have idm.com.au, you have marketingdentistry.com.au, divinedental.com. Shall we start with IDM?
Carl: Yes.
Howard: Or not?
Carl: Yeah. IDM is my marketing businesses.
Howard: It’s Integrated Dental Marketing.
Carl: Dental Marketing. Yeah. And that’s been my introduction to the dental profession, and that’s what I’ve been doing for the last sixteen years, but it does lead to an awful lot of other ventures. So the friends I make through IDM, and obviously the marketing power that we’ve got, tends to lead onto other things.
Howard: Can I tell you why I would not start a dental marketing company? If I was you? You know why I wouldn’t do that?
Carl: Why?
Howard: Because I would be afraid that I would do a great job for dentists, and they wouldn’t know it. The data I see from America, ten people have to land on your website before your horrible website can convert one to call the office. Three people have to call your office before your untrained receptionist can convert one to come in. Three people have to come in with a cavity before your horrible presentation can give her one dental filling.
So the average dentist’s office in the United States collects seven hundred and fifty in revenue, and they take home one-eighty. So to take home one-eighty to do that filling, you’d have three to come in. for three to come in, nine had to call. To have nine to call, ninety had to land on your website. So I would be afraid I’d do a bunch of marketing and these horrible offices say ‘well, it didn’t help’, because you literally have to serve them ninety leads.
You could get an A in your job, you could serve in ninety leads. It would only translate to one filling because you serve them a lead to their website, but their website is so horrible it can’t convert. They call the office, the untrained receptionist can’t convert. In America, for just cavities, they only have a thirty-eight percent close rate to drill, fill and bill.
Cark: Crazy.
Howard: So you could get an A, and the customer writing the check, the dentist says ‘well, Carl, it didn’t work’.
Carl: Don’t get me wrong. Over sixteen years, that has happened on many, many occasions. I learned very early on one of the very first big marketing campaigns we did for a client, we did a huge fly drop. Fly drop was going out on Monday and Tuesday, he closed his office on a Wednesday and didn’t even tell me. So the phone wasn’t manned. So the phones lit up and is going to an answerphone. So I learned very early on that you have to take a holistic view. We will only work with clients who’re prepared to actually embrace every part of the business.
Howard: So when you do Integrated Dental Marketing, you do more than drop flyers and deliver leads to the website? You try to follow…
Carl: Yes.
Howard: To the website, to the phone call, to the come-in?
Carl: Where we possibly can. We take on all sorts of clients of different sizes, but where we work best is where we get an engaged client, and they’re prepared to listen to all aspects. So business is a jigsaw puzzle, and marketing is only one of the pieces. It’s an important part, because it starts the conversation. But if conversation doesn’t then continue in the right way, it’s spinning wheels and it’s wasting money.
So we tend to be a little bit picky who we work with, I want people who are going to make sure that they’re looking at their internal systems, make sure that they’re looking at the patient experience, make sure that all the messages are right. And we’re lucky that we can be a little bit picky who we work with, because as you said, there’s just literally no point in spending money on advertising, in particular, if you haven’t got the other pieces in place.
Howard: Well, that’s great that you’re picky, because that’s why I’ve never joined a country club, because I wouldn’t join a country club that would take me as a member. If you take me as a member, I’m not joining. So if dentists went to idm.com.au what would they find? What would you do for them? Is that the site they should go to, or…?
Carl: Yeah. That’s a good site to start.
Howard: To start.
Carl: But our service really starts consulting with a new client and seeing what their needs are, and it’s not a matter of rushing in and doing a whole week of marketing. It’s much of understanding what their needs are and trying to get a program to fulfill those needs. Very often there’s big gaps in the service that they provide. Very often there’s no point in marketing it, because maybe the actual location, or the fit-out doesn’t have a standard that I think is worth promoting.
So we will advise in that situation, and we’re not shopfitters, and we’re not other things. But we would lead them and say ‘well you really should fix that first’. I’m working with a lovely practice in Melbourne at the moment, and I say ‘well everything’s right your motivation’s there, but your place looks like a whole… get rid of the carpets, paint the walls, and by that time we’ll have a new website ready for you’, and they agreed to do that.
Howard: Yeah, I remember one time, we were having a staff meeting, and I wanted to buy a CBCT, and it was a Carestream CBCT. I think it was $120,000 or something, and my girls up front said ‘oh, my God. The dentist owns the place, so we’re going to upgrade our 2D Pano to a hundred and some thousand dollars 3D CBCT, and this place hasn’t been remodeled in eight years, and the colors are horrible’, and this and that, and this and that.
I don’t know. I can’t say it’s me being a guy, that’s sexist, because maybe I’m just… I’m sure there’s guys that are more into it than I am, and I was looking around and said ‘look at this place, it looks nice’, and they’re like ‘are you kidding me? This place. It’s so outdated, the colors are so bad’. So to get them on board, to buy my $120,000 CBCT, I just spent $70,000 repainting. They wanted new linoleum in the operatories, they wanted new paint, new carpet and everything. In all honesty they redid the whole thing, to me it was just a total waste of money, but I was very surprised at how many patients noticed it, how many people looked at it.
Carl: Exactly. Good on you for doing it and good on you for listening to your staff, because your staff are often your best source of real feedback. But a lot of people won’t listen to them.
Howard: Yeah, I mean the three Hs, I mean you’ve got to be humble, you’ve got to be hungry, you’ve got to hustle, and dentists aren’t humble. They don’t listen their staff, they don’t listen to their patients. But I see a big bias in marketing. I like to make decisions on data, I just want the data. I just want the facts, and I don’t have a dog in all these decisions, I mean I just want to see the data. I think I learned the most when Sergey Brin and Larry Page of Google wrote a book called ‘Google Management’, and it is basically saying ‘look, we know every point-and-click, we have all your cookies. It should be all data (inaudible 14:45). So if you go into Google and say ‘well I think we should do this’. They say ‘well that’s great. Show us your data’. If you don’t have any data you say, ‘oh, that’s just my opinion’.
Carl: Yeah.
Howard: You’re off the management team. They’re like ‘go program, you’re not a manager. We only want data’. And when I look at marketing, I see a bias between baby boomers like me and millennials. Millennials hate direct mail, but I think it’s because they’re environmentalists, they don’t like going to their mailbox getting direct mail, they personally don’t like direct mail. They’re always on Facebook all day long, they want it all digital. But I look at the data, direct mail is still alive and doing well. But all the millennials are convinced that it doesn’t work, and you should just be doing Google Adwords and Facebook Adwords and SEO.
Carl: So we live in constantly changing times, and you’ve got to look at your media and say what’s changed in the last ten years. So Yellow Pages was on the nose for a very long time, I was taking my clients out of the Yellow Pages ten years ago, and of course, that’s now just the norm. But you look at how media changes. Here television has become massively fragmented in many ways.
One, we’ve had an explosion of TV stations, which is actually the means that it’s affordable to advertise on TV, but then you haven’t got the audience. We’re not watching TV as much, or if we are, we’re tuning out. So you look at all these different mediums, and you say ‘how have they changed?’ Radio, people are spending more time in the car because of the traffic problems. Radio is probably on the up-and-up. But the letterbox essentially hasn’t changed.
Howard: The what?
Carl: The letterbox. The mailer.
Howard: You call that a letterbox?
Carl: Yeah. We have to empty our letterboxes.
Howard: So it’s a letterbox.
Carl: Yeah.
Howard: I never heard that term.
Carl: So we still collect our mail every day, and there’s less mail. But there’s also less junk mail as well, as millenniums are saying we don’t want to do it. So the cut through I’m finding is pretty much as it was ten years ago. We get a quarter of one percent response rate. So if we send out ten thousand flyers, we broadly get twenty-five new patients. That’s okay. It’s expensive.
But the difference is the twenty-five new patients we get from those flyers would not have found us on Google, they would not have found us in another way. It’s a different patient, and quite regularly, maybe it’s an older patient that might need some more work doing. So when you track something, you’ve got to track, just not on the raw numbers, but how that turns into the tail. You get one person who spends enough money out of the fire, it makes it worthwhile. You get a lot of people just coming in for an exam off Google Ads. You’ve got to look at all of that.
Howard: So I’m in Phoenix, right? There’s a lot of retirees in Phoenix. I cannot tell you how many grandpas… when you say older, what do you mean by older? How old? What is old?
Carl: Well where I live in Queensland, it’s an early retiree capital. So anybody who’s made a bit of cash, fifty-five and over, tends to be there.
Howard: Good. I’m fifty-four, so I’m not qualified.
Carl: You’re not there yet.
Howard: I’m not old yet.
Carl: And of course, the fifties, we’ve been used to the internet for twenty years, so we’re pretty up on it. So, the people we’re getting from mailers, it’s a broad spectrum. But it tends to be the older person, sixty and up.
Howard: So the main thing they’re going to come out with are microcomputers, which was Microsoft, and now they call it the personal computer? But a lot of people said ‘well, this isn’t going to fly’, because people don’t type, and most people didn’t have typing class. I still have old grandpas, somebody else said, ‘well do you get on the internet?’ and this guy goes ‘well I never typed. Now, my wife, she took typing in high school, so she’s on the internet and the computer. But I’m not a typer’, and I thought to myself ‘you missed the whole internet because you’re not a typer’.
Carl: Yeah.
Howard: So I imagine if you were looking for older patients for implants and removable and fits, that direct mail would have to be far more effective, wouldn’t it, if you’re building up an implant practice?
Carl: It’s broader than that in the sense that you really need to be across all mediums. And some traditional media fits most practices, as well as online. Online is great because you’re matching buyer and seller. So when you’re looking on something for Google, you’re interested. But what about brand building? What about building your image for somebody who doesn’t need your services today, but might need them tomorrow? So then other media is still relevant for that. So you’ve got to look at it in a holistic approach, and with the flyers, you get people of all sort of age and groups. But you do it because maybe you wouldn’t have got that person through another medium.
Howard: So a big taboo question is on your flyers, on your advertisements, whether or not to mention price, or an economic incentive, or a coupon.What are your thoughts on…?
Carl: Well it’s not a debatable point. If you send a flyer around without a price, you may as well just throw your money down the drain. You’ve got to give people the knowledge of what they’re coming in for. Now we have certain rules here in terms of how we incentivize dentistry, but if you have a fixed price, which is what I do with my practices, you can certainly advertise that fixed price. You think about the fears that people have in dentistry. Affordability is one of those, so take that off the table, tell them how much it’s going to cost to come in.
But you need to do all of this, in my opinion, in a very, very professional manner. So a voucher that is fluorescent green that has $99 scale and clean, could work for some people. It wouldn’t be my choice because it’s not promoting a quality message. Are you going to hurt the patient? It’s a matter of getting lots of messages across. So when we do a flyer, we use what we call a long copy environment, so all the time talking about something of quality. It might be implants, might be orthodontics. There will be a price of an examination scale and clean as well. So you’re ticking the box, with there might be pitch of one of doctors giving a check to charity on the flyer as well. So it’s more like a newsletter format but with the financial offering built in as well.
Howard: So a lot of these kids are coming out of school, and every graduating class since the beginning, since Adam and Eve, has claimed that when they got out of dental school, the dental school didn’t teach them how to do anything. They didn’t know how to replace the implant, do Invisalign. I think it’s a bad wrap on the dental school, because I couldn’t imagine taking a hundred kids off the street in college. Four years later, turning them loose licensed to do root canals and crowns.
So there’s just not enough time in the day to teach them everything, but when they come out of school, they’re saying ‘Carl, I have a lot of student loans, and I just bought a practice. I have a lot of debt. What are consumers wanting to buy the most? Should I learn Invisalign? Should I go out and learn placing implants? Should I learn cosmetics? Sleep apnea? If your ten-year-old daughter was just walking out of dental school, let’s fast-forwarded her to twenty-five, and she said ‘dad, what services are most in demand?’ From your marketing point of view. What would you tell her to learn first, second or third? Where would you tell her to prioritize?
Carl: Well if she was a young graduate, then I’d want her to get some experience before she started to take any of the sub-specializations, and I think people can often rush that period. I’ve got a young graduate working for me in one of my practices, and she’s wonderful. So she came to us because she knew she’d be mentored, so she’d help the other doctors in the practice, she didn’t want on too much responsibility too quickly, so she didn’t want to take her own practice at early twenties, and I think that’s quite smart. I think too many people skip that apprentice period.
But in terms of where they should go with their learning, well clearly they’re a doctor, so they should be looking at areas that they look to enjoy, and maybe have an interest. But I’d be starting with demographic. If they’re in a certain area, you want to understand the demographic of that area, and what are the services. What’s the point in doing orthodontics if you’re in a mainly retiree market, what’s the point of doing implants if you’re in a brand new suburb that’s full of young families?
So I’ve been looking at the demographics first, so my decision was based on what the market demands. Saying that, any practice that is ignoring orthodontics now is foolish, because it’s going to be the biggest growing area of dentistry. It’s now a rite of passage for lots of kids and adults, and for me, I think, that would be an area that I want in my practices for sure.
Howard: When I grew up in Kansas it was a quarter Catholics, having four kids was a small family. My mom and dad had seven, my friend Brian Hussey, they had twenty-one kids in their family. So only the most severe child got braces, though the advent of the smaller family coming delayed, and they’re only having two kids. You’re right, everybody gets braces. It is a rite of passage. I see kids getting orthodontics for the mildest cases in the world. Just slight little crowding, and everybody gets it.
So you have more than one website. So we talked about idm.com.au. Let’s go to marketingdentistry.com.au. What’s different about that site? What will my homies find at marketingdentistry.com.au?
Carl: Well they’ll see lots of pictures and videos of you on there, so…
Howard: Of me?
Carl: Yeah. So Marketing Dentistry I started five years ago, and it’s just a very simple three days of three cities, and I’m trying to bring out the best dental minds in the world. So far we’ve had a good response, and we’re going to continue to do it. It’s really trying to get the Australian dentists, to give them more exposure to what’s going on overseas. I’ve looked to America for all the speakers. So all my speakers today have been from America, because I look at what you guys have gone through, and you went through it a lot earlier than us. So, I’m hoping that…
Howard: So when is your next major meeting?
Carl: Next major meeting is next August.
Howard: Next August?
Carl: Yeah.
Howard: And who are your speakers going to be next August?
Carl: Don’t know yet.
Howard: You’re still thinking on it.
Carl: Still working on it.
Howard: And what was Mike Abernathy’s message?
Carl: I’ve really liked it, and thanks for the introduction to Mike, I was really pleased with Mike’s approach, I felt that he had some very, very solid messages, and we got really good feedback. But again he talked about dentistry in a holistic way, so it wasn’t as just a singular message, getting all the pieces right. So not just the marketing, not just the patient experience, but you have to get all the pieces right.
Howard: So what other websites do you have? I’m looking at Divine Dental, that’s your dental office?
Carl: That’s my dental office, and the reason I gave you that one is it’s got a nice video of my daughter on, which I’m very proud of.
Howard: Oh really?
Carl: Yeah, we got her to do a bit of a pop video. So when I took on this practice, we’re in a very early retiree type.
Howard: Is that (inaudible 26:38) and one is your daughter?
Carl: Let’s have a look. So when I took over the practice, there you go.
Howard: That’s nice. Oh, wow. How adorable. Oh, how adorable. That is amazing. She got that showboat from her daddy?
Carl: Possibly. Her mother’s a ballerina. That helps.
Howard: Is your mother a ballerina?
Carl: Yeah.
Howard: Wow, that is a brutal sport isn’t it?
Carl: (inaudible 27:31).
Howard: Yeah, I’ve seen some of these pictures of ballerinas’ feet standing on their toes.
Carl: Yeah, yeah.
Howard: Can she still do it?
Carl: She teaches that.
Howard: Yeah.
Carl: She teaches.
Howard: But can she stand on her toes still?
Carl: She hasn’t done it for a while.
Howard: Yeah.
Carl: Yeah.
Howard: That’s brutal, isn’t it?
Carl: Yeah.
Howard: Yeah. But anyway, so what are you most passionate about today? What are you doing now?
Carl: So the IDM, my marketing company, stays the rock bed of what we do, but it brings really, really interesting projects. So at the moment I’m marketing a new corporate group called Smiles Inc., so we’ve been employed to market that group.
Howard: You’re marketing Smiles Inc.?
Carl: Yeah, which is a new corporate group. It’s based on a joint venture partnership, and so where by the dentist retains ownership of the practice at a local level, and big brother does all the things that big brother needs to do at a corporate level.
Howard: And so it’s Smiles Inc.
Carl: Yeah, .com.au.
Howard: .au, and this is a new corporate chain?
Carl: Yes. Yeah.
Howard: And who’s the CEO of that?
Carl: So my old business partner Mike Timoney.
Howard: Mike.
Carl: Yeah, so Mike and I started…
Howard: Oh, that’s right. T-I-M…
Carl: T-I-MONEY.
Howard: T-I-MONEY.
Carl: T-I-MONEY.
Howard: Timoney. Mike Timoney?
Carl: Yeah.
Howard: So is he a dentist?
Carl: No.
Howard: So he started a new corporate company.
Carl: Yeah. So his journey was I met him back, I think in 2004. He’d just landed in Australia. His then wife was a dentist, and they formed a dental practice on the Gold Coast called Totally Teeth, and I did all the marketing…
Howard: Turk…?
Carl: Totally Teeth.
Howard: Totally Teeth.
Carl: Yeah. So I did all the marketing for that, including branding and coming up with the name. that was a big success. Off the back of that, Mike and I decided that we’ve formed some corporate group, that we became Dental Partners, Mike was the CEO of that, and that grew very, very quickly under Mike’s command. We sold that out to New Zealand group, it’s now called Mavin, and then Mike’s been sat on his hands for a few years, plotting his next venture. So he’s employed us to do the marketing for that…
Howard: That’s Smiles Inc.
Carl: Yeah. I’m very excited about that. It’s a different model, so one of the problems with corporates is that once you purchase the practice, the dentist is then in effect of an employee, where in this model the dentist is retaining ownership at a local level. Very much in the same way that Specsavers often work on a fifty fifty basis with the optometrist and the head office, or the Flight Center which is often a sixty forty split between the manager and the head office function.
Howard: What’s a Flight Center?
Carl: It’s our biggest chain of travel agents.
Howard: Oh, okay, Flight Center.
Carl: Then it means that the person opening the door still has a vested interest.
Howard: What percent?
Carl: Forty percent
Howard: Forty percent
Carl: Yeah.
Howard: And how many offices does Smiles Inc. have now?
Carl: None at the moment, that’s the project.
Howard: So that’s a new project?
Carl: Yeah.
Howard: Do you think it’s a game changer that now medical insurance companies like Bupa are buying dental. What do you think of big medical insurance providers buying dental office?
Carl: It’d be interesting to see if any others go down the same path as Bupa. Bupa has certainly changed the landscape, they bought Dental Corp here, as you know, and then they’ve rebadged Dental Corp. So they’ve got a good foot print. If they’re the only one who comes into the marketplace, I don’t see them that much of a challenge. They have an eight percent penetration in terms of…
Howard: Eight percent?
Carl: Eight percent of the population are members of Bupa. So that gives us another ninety-two percent of market too. But they’re aggressive, they’ve got a great brand. When I was a nipper in the UK, if you’ve got a job, and you’ve got Bupa insurance as part your job you’ve felt that you’re a rock star. So they’ve got that prestige, probably less so in Australia than in the UK.
Howard: So Bupa’s in the UK too?
Carl: Yes, they’re very, very strong there.
Howard: And New Zealand?
Carl: Yes. I believe so.
Howard: But they haven’t bought eight percent of dental offices in the UK?
Carl: No, I don’t believe so. I think Australia and the rest of the Dental Corp
platform they bought is a new venture for them.
Howard: How long ago did they buy Dental Corp?
Carl: A couple of years ago.
Howard: And who is the head of Bupa over their dental division?
Carl: Don’t know.
Howard: Don’t know.
Carl: No.
Howard: Do you think they like that investment? Do you think it’s going well for them?
Carl: I think so. They’ve done the same with optometry over here as well. So they’ve got Bupa optometry. Yeah.
Howard: What do they call the dental? Just Bupa Dentistry?
Carl: Yeah, Bupa Dental.
Howard: Bupa Dental. You think they’ll get bigger? Do you think they might buy more corporate chains?
Carl: I’m sure they’ll continue to expand. But being their core patient is the Bupa member, and they’re really don’t have a lot of pulling power to pull people in outside of that. They’re just another practice. Then it’ll be interesting to see. I don’t see them becoming a monopoly in Australia by any means.
Howard: Yeah. So you’re excited by Smiles Inc. with Mike Timoney?
Carl: Yeah, very excited about that. It’s great.
Howard: Timoney, is that Irish? Timoney?
Carl: Yes, originally.
Howard: Yeah, it sounds like it.
Carl: Yeah. But no, these things are exciting to me because it’s a new venture. I did do the marketing. I don’t take any sort of judgment on whether it’s a good thing or not. I have to do the marketing. So the marking for that has been very exciting. We’ve been marketing back to the profession, as opposed to marketing to the public.
Howard: Dentists get mad at me but I think corporate in industry has been good for dentistry. I have one of my very good friends text me today, he said to me on text ‘whatever you say I want you to know, that I think you’re an asshole’. The reason I think it’s good is because when I was little, I was born in ’62, on a Saturday or Sunday if you walked down my street for eight blocks, every third or fourth house, the dad, and his brothers, and sons, are spending a whole day in the garage trying to fix their stupid Ford, Chevy, and Chrysler. The cars were horrible.
It wasn’t until Japan, and I remember when Germany started to sell its little Volkswagen VW’s, and Japan was selling these little Dodson V2 10’s. Everybody laughed at these toy little stupid Japanese and German cars, and they never stopped. When I was little General Motors sold half the cars in America, and now they don’t even sell thirty percent. And it was Japan and Germany, the competition that forced Ford Chrysler, and General Motors to build a decent car. In fact I think advertising is funny because they always advertising the weak spot, like, when they say ‘two scoops of raisins in every box’. That’s because there’s no raisins in raisin bran. Only American cars talk about their warranty.
Carl: Yeah.
Howard: They’re shitty cars. They don’t talk about warranties in Japanese cars, and German cars because you know the cars going to work. And Phoenix, Arizona you’re better off to get shot or break your leg on a Sunday, because the ambulance will be there, they’ll pick you up they’ll take you to the hospital, they’re open. There’s not one dentist in Phoenix, Arizona open on a Sunday.
Carl: Yeah.
Howard: What corporate dentistry is doing, it’s providing competition, and it’s making this cottage industry rise up to their A game on facility, on equipment, on consumerism, on hours, on affordability, on insurance. You know what I mean?
Carl: Totally.
Howard: And that’s good for the patient. Also if you build a dental office too big, like in America the only house that you can sell like that is a three bedroom, two bath. But by the time you get a house that’s a million dollar house, with six bedrooms, and a nine car garage, you can’t sell it. It’s an illiquid asset, and when you build a practice that’s between two, three, and four million, no kid comes out of dental school and buys his practice like that big.
But corporate chains like Hartland, they can come in and pay a check for four million dollars for this beast today. So they gave liquidity to the too big of offices, when the kids come out of school, the dentist, they don’t hire associates and expand their hours. Who hires about half the graduate class every year? It’s corporate dentistry. So they provide jobs for the kids, they provide liquidity to the retirees and make everybody else bringing their A game to compete. That’s good for industry.
Carl: Absolutely. I think the thing is it’s changed, and there’s no point of having negative rhetoric about change, it is going to happen. So as change happens you have to adapt to this, the people who go ‘well I wish it hadn’t happened’ or ‘I don’t agree with it’, big deal it’s only an opinion it’s not going to stop the change.
Howard: The other thing is the average dentist in America, general dentists made a hundred and eighty. Okay. How many people in Australia will feel sorry for you if you make a hundred and eighty thousand a year? Is that a good job?
Carl: Yeah, well look I’d feel pretty sorry for you if you make $180,000 as a dentist here, because our guys who make quite a lot more money than that.
Howard: I know, but still.
Carl: Yeah.
Howard: Is $180,000 a damn good income or is it not?
Carl: Absolutely.
Howard: If your daughter came to you, and she came to you at twenty-one and she goes ‘dad, the bad news is I’m only making $180,000 a year’, would you start crying or you say ‘God dang girl, that’s good money’.
Carl: Yeah.
Howard: I mean 180 is good money.
Carl: Yeah.
Howard: There’s a lot of dentists that if they shredded their dental license, they couldn’t go out and make eighty outside of dentistry. How many dentists do you know that make one eighty in the United States if they lost their license, couldn’t get a job for eighty thousand a year, what percent?
Carl: Yeah.
Howard: Yeah.
Carl: No idea but I mean unless they diversified their skills, probably a few.
Howard: Yeah.
Carl: There’s only so many people who can lecture, so many people who can do other things around dentistry.
Howard: Yeah. So are most of your clients in Australia?
Carl: Yes. Yeah.
Howard: So someone in Australia is watching this, what is your favorite client? What do you like to do? Who should be calling you?
Carl: Very simple, anybody who’s motivated for change, doesn’t matter if they’re starting off, if they’ve got a brand new practice or if they’re in their last five years of the practice. If they’re motivated to see change, and they’re actually signing up for change then we can help them. They’re my favorite clients, we help small, large, medium sized, but the one common denominator with the clients I like working with is they really want to see a difference at the end of the campaign.
Howard: You talk about spending more time on online marketing, and less time on social media, what does that mean?
Carl: Yeah. So because of the buzz around social media, I’m seeing a lot of practices spending a lot of time on the Facebook page, not Facebook advertising but on the Facebook page. This can suck up a lot of time talking to probably a relatively small audience, an audience that already knows you. No, it’s important to keep in touch with your patients in many, many, ways. And Facebook is one of those, but I see this has been an absolute just sucks up all the time and then they’re not spending enough time on online marketing. So Google Adwords, SEO, all the things that hang off Google Adwords.
All the tools, and as you say, Google are brilliantly published everything. If everyone just went and read what google published they’d all be experts, but I don’t see many people really using all the tools correctly. There’s a lot of wastage, people paying far too much for Adwords when they don’t need to. Not hanging off all the other things that can be triggered by adwords. Not spending enough money on Facebook advertising, not paying attention to that. But this Facebook which has been addictive, and probably somebody in the office who knows how to do it, seems to suck up all the time, so that’s what I mean.
Howard: Whenever someone sends me email, like your email. Can I get your email?
Carl: Yeah.
Howard: So you’re carl@idm, for intergrateddentalmarketing.com.au.
Carl: Yeah.
Howard: So when someone sends me an email, carl@idm.com. So I’ll hit reply and I’ll drop that in the deal, knock off carl and put www to see who the hell I’m talking to.
Carl: Yeah.
Howard: So I do that on all the emails, because I’m just curious who you are. Most people send me a question and just say Carl, I’m like, Carl who? So I go to their website, those websites almost ninety percent look like they were at a dental convention five, ten, fifteen years ago and they bought some canned thing. Half of them don’t even have a picture of the dentist, if it does have a picture of the dentist looks like a mugshot when they got arrested for drinking and driving. And then they wonder why ten people have to land before one will convert. So if you do all this Google Adword and you do everything right, what percent of the time is it going to drive them to a website that’s not going to convert?
Carl: Well we tend to not to do online marketing unless we’ve designed the website. So we would take control of the website as well, there’s certain elements of a website that it’s just essential. People want things to act quickly now and this isn’t just to attract a new patient. If you’re an existing patient or existing customer of any business, if you can’t do certain things easily, if you can’t book you restaurant table online now. People are not calling restaurants anymore, it’s all done on an app. If you can’t book your taxi, if you can’t book your pizza to be delivered and track it coming around the street corner. These are things that the public like and dentistry is no different. It used to drive me nuts.
My own dentist in Sydney, very good friend of mine Kurt Dean, and I go for a beer with him on a Sunday night and say ‘I’ve really got to come and see you. Can you book me in?’ He goes ‘no, you got to ring Jenny on Monday morning’ and of course I won’t ring Jenny on Monday morning because I was busy. So we need to adapt to people’s online requirements which is very simple. If your website doesn’t interact with the maps, if you’re not on Google map, if you haven’t got online booking, if you haven’t got live chat, if you haven’t got video, if it isn’t personable… you talked about photography.
We have a full time photographer, Simon, and he must have shot more dental practices than anybody on the planet. He just goes and shoots the dental practices, it’s still photography. It’s cheap and Sydney has got the personality of the practitioner, you got personality of the practice. Most of the stock images, I don’t like to dish the Americans, but most of our stock images look like American families, we don’t look like American families. I don’t think Americans look like stock images of American families either. So you’ve got all these plastic people on your website that don’t look like your patients, don’t look like you, it’s such a turn off. Put good photography on the site and start telling people who you are, if they don’t like the look of you, great you just saved a whole heap of hassle. Yeah, so there’s a lot to it but it is actually incredibly pragmatic.
Howard: On my website for my photo, I have a picture of Marky Mark Wahlberg, in his pretty little underwear and it’s worked very well for me.
Carl: Yeah.
Howard: Yeah. So you build them from scratch?
Carl: Yes. Everybody just uses a platform these days. Wordpress is (inaudible 43:36).
Howard: WordPress.
Carl: That doesn’t matter. It’s like a lot of technology, the technology now is simple, it’s the content, it’s the intellectual side that’s important.
Howard: So how does scheduling online working for you? What are you using for that?
Carl: So in my own practice I use healthEngine, there’s a number of platforms out there.
Howard: For scheduling online?
Carl: Yeah.
Howard: HealthEngine?
Carl: HealthEngine.
Howard: Is that only Australian market?
Carl: Yeah, I believe so. They’ve offered a plug-in. The dental software…
Howard: So it’s www.healthengine?
Carl: Yes, that’s correct.
Howard: So does it interface with healthe-n-g-i-n.com.au? How many of these practice management softwares does it integrate with?
Carl: It’s fairly simple, and it’s very easy to take the information and put it into your software, some of the software packages out now have integrated one so Dental for Windows have a good integrated package.
Howard: Which one does?
Carl: Dental for Windows which is probably our most popular dental software here.
Howard: Dental for Windows, I see on Healthengine it says ‘book a doctor, dentist, physio, and more’. Is a physio physical therapist?
Carl: Yeah. So we don’t use their website, we just use…
Howard: The plug-in.
Carl: The plug-in, so nobody knows that it’s them, nobody goes to their website but they use it on our website, and we get the information. I’ve got to say my practice we get four, five, online bookings a day. It’s a fairly small practice, and it’s not just new patients but it is existing patients who like the convenience.
Howard: A dentist told us yesterday that he thinks people who book online don’t show up, that they don’t show up to their appointments.
Carl: Well that’s absolutely true in my practice. So people who book online are the people who want to have the convenience of being able to talk to you after hours, most of the time. Most of our bookings at my practice would come in Sunday night, somebody either is having a dental emergency, or they just remembered and they go to the practice.
Howard: I’ve seen this rodeo before. I remember when the ATM machine came out and everybody said ‘well, nobody’s going to use the ATM when they can walk in there and see Mary Lou at the counter. Who would want to talk to a machine?’
Carl: Yeah.
Howard: When they can talk to Mary Lou, but it turned out actually more people prefer the ATM machine because it’s twenty-four hours a day, it’s seven days a week.
Carl: You said it before, these things are not anecdotal they’re statistical, my statistics show that people love to book online and they do turn up.
Howard: So have you met Dr. Marcus Tan? He’s the HealthEngine Founder, CEO and Medical Director.
Carl: No. No, I haven’t.
Howard: Angel, investor and father, not necessarily in order. That’s [inaudible 46:36] birth.
Carl: Yeah.
Howard: Interesting. So, you recommend the website, Books Appointments Online.
Carl: Absolutely.
Howard: You recommend their interface with Google Maps, they definitely have to have the website. What is it called when the website is mobile friendly?
Carl: Yeah, that’s it, mobile friendly.
Howard: Mobile friendly?
Carl: Yeah.
Howard: Or do they call it…
Carl: Fully Responsive design.
Howard: Responsive page design.
Carl: Yeah.
Howard: Some of my friends in Phoenix, some of the dentists I just love and adore, you look at their website, and their picture it looks like some cranky, old, man, and you just don’t see the chemistry. But then my other friends who works a YouTube video, when you see him talking on the video you think that’s an adorable guy, I like that guy that’ll be my dentist. Are you a big more fan of the dentist having a YouTube video on his website versus just a mugshot.
Carl: Not totally, videos are really powerful but it’s got to be done correctly, video can backfire if it’s not the right video, and you’ve got to adapt the video to the personality of the practitioner speaking or the practice in general. If you go to our YouTube channel for IDM which you can get to off the IDM website, you’ll see we’ve done hundreds and hundreds of video for different practices around the country. But they’ve all got a very different style because we’re trying to achieve different things. If you have a quick look at my daughter singing on my practice, now that’s not just because I wanted to have a fun video, it was very, very strategic.
All the practices in my area, where I live, very much targeting the early retiree, and there’s lots of young families with lots of kids. So I wanted to get a fun message out, nobody else was selling fun so we sold a fun message. The kids looked like it’s going to be a fun place, if they think that it’s going to be a relaxing vibe that they’re going to say to the parents ‘well that would be the practice I’d like to choose’.
We’ve engaged through the school, with the same video, we got the school involved with the video, we got all the acting schools locally, all the kids in that video, they’re all in the acting schools, and the ballet schools. So we’ve got no end of business from that, but it was also strategic it wasn’t just bit of a laugh. So video’s got to have a purpose like with all marketing.
Howard: This is going to be kind of a long question. How much student loan do you think the average Australian dentist walks out with?
Carl: About 240,000.
Howard: 240,000 that’s Australian or US?
Carl: Australian.
Howard: And what were 240,000 Australian dollars be in the US?
Carl: That’ll be around about 180.
Howard: 180?
Carl: Yeah.
Howard: So, they come ask when they say.. I’d been a dentist 30 years and it seems that if I tell Carl ‘you need to go to the dentist’ it seems like half of America are afraid that you’re going to hurt me, a shot, a drill and the other half are afraid of cost. All I’ve really heard is I’m afraid of fear and cost, but she’s hearing all these people saying ‘no, you need chairside milling, that’s 180,000’. So she bought chairside milling. She could double her student loan and debt by making one decision. And I noticed you talk a lot on your marketing about the effective use of payment plans. So, my question is complicated. Do you think the Australian market is divided basically into just fear of the dentist and fear of cost, or in just fear in cost? Or do you think these equipment purchases have a great return on investment from your marketing-savvy that people really want same day crowns, they really want a high-tech laser office, they really... Would you put your money on high-tech? So, I know that’s a long question. Hopefully there’s something in there that you could grab. Is there anything in there worth commenting?
Carl: There are a few things that… look technology is fantastic. We live in a high-tech world and people like technology. But it’s not the technology that makes the difference; it’s the doctor’s passion about that technology. So, the machines, what a great piece of kit, but I see a lot of them just collecting dust because they’ve been sold and not used. And I’ve seen practices that have built their entire practice around the Cerec, and wonderfully so. I think it needs to come from the philosophy of the doctor. Whatever the doctor is passionate about, if that passion will be taken on by the patients. As with all people that we trust. But you mentioned that it’s the fear of cost, fear of pain. There’s another really big one out there which is just people get apathetic. Lots of people just don’t go to the dentist. 50% of our society never go to the dentist outside of an emergency. These are 50% of people who are in business, and I’ve got lots of business friends who when I ask them when did they last go to the practice? It could be ten years ago. And they’re in business; they’ve got the money. It’s not the fear of pain, it’s just they get busy and they don’t prioritize it. So, I think, personally, I think ADA do a very poor job of promoting.
Howard: The ADA, the Australian Dental Association, or the American Dental Association, or the Antarctica Dental Association? What kind? The penguins, the Americans or the Aussies?
Carl: No, the Australian. They’re probably the same. Probably wouldn’t matter. [inaudible 56:06]. We have this bullshit Dental Awareness Week once a year which doesn’t even hit the TVs in any real form but, there’s a lot more to educate. The Victorian Dental Board published a pamphlet in 2013 citing twenty six medical ailments that are linked to dentistry-fantastic report. I email that to every single patient, new patient.
Howard: Will you email it to me?
Carl: Yeah, of course, I will.
Howard: Gosh, I’d love to get that. NSW?
Carl: That is the Victorian Dental Board.
Carl: Yeah, in fact it’s even on my website, The Divine Dental, it’s actually I keep it on there for patients to read.
Howard: I love the name.
Carl: If you click on that it’ll take you to a report. But this is the information the public need to know.
Howard: “Links between oral health and general health - the case for action”. Nice. So, equipment is good if it’s your passion.
Carl: If it’s your passion, and if you’re going to use it in the right way but equipment for equipment’s sake, absolutely not.
Howard: I always THOUGHT chairside milling, and lasers, and CAD/CAM. It’s kind of a musical instrument; just because you buy a guitar doesn’t mean you’re going to practice and be good at it. Some people buy a guitar and the next thing you know they have a rock band. And how many kids got a musical instrument at Christmas and can’t play one song on it thirty years later. So, you’re right. If it’s your passion, then you can’t afford not to have it but if it’s not your passion, then you’re just buying it for a business return on investment. That’s not going to do it. So, what do you think is… what is effective marketing? And what do you think is not effective marketing? What do you think is the biggest marketing mistakes that you’re seeing in dentistry?
Carl: Not understanding it, first of all, so, not taking the time. So, as a dentist, you are in the top 1% of the intelligent people in the world. You know how to study and yet for some reason you can’t read a marketing book and understand that. So, to think that it’s some sort of mumbo jungo, and SEO, and PPC, are outside the realms of understanding of a dentist. It’s just nonsense. If you’ve learned how to be a dentist, this stuff’s simple. So, to spend some time, so you’re not hoodwinked by all the people that are banging on your door. There’s plenty of companies out there who just want to sell you their product, and it’s very easy, especially when products can often be very low cost. I went to a practice in Melbourne about 3 or 4 months ago, walked in and he just said, “All my patients are only interested in price.” I said, “Is that true?” He said, “Yeh”. “Price is the only thing they are interested. All my new patients are only interested in prices.” That’s fairly interesting because that’s not my experience, and you’re in quite a nice area. I said, “What marketing you do?” He was doing Groupon, you know what Groupon is. And he was doing Shopadocket. So the two…
Howard: Shopa-what?
Carl: Shopadocket. So, when you get a docket from your supermarket, you turn it over and there’s a special offer. These are the most lowly marketing methods out there, and of course if you’re turning over your docket because you want 50 cents off your cup of coffee or you want Scaling and Cleaning cheaper, you’re probably going to be price-focused; nothing wrong with the patient. But you’re advertising in a price-focused environment, so you’re going to get a price-focused patient. So, take in some time to understand what the different mediums do and to avoid all the nonsense out there. There are a number of clients who’ve engaged in cinema advertising. Oh what a load of nonsense that is. If you go to the cinema, you’re going to take a two hour journey, some magical journey; last thing you can do is to do is remember the adverts at the beginning of the movie for a dentist. You might be motivated to go buy some popcorn or Coca-Cola by advertising but that’s about it. Take some time to understand that. Then you can… when somebody pus a proposal in front of you, that makes sense. You can actually understand it yourself and say, “Yep, that makes sense to me.” Then to track it to make sure you’re getting statistics and nothing is anecdotal. If you say, you’ve got a hundred people come to your website and you’ve got 5 patients from that, what is it? Where on the website have they been? Have they watched the video? Did they fill out a form? Did they enter into a live chat? Live chats are just phenomenal. Live chats cost nothing to put live chat on your…
Howard: Is that done by a robot or your staff?
Carl: Staff. If it’s done by a robot, then don’t do it. But it just dings, so what’s the difference between a phone? You never not answer the phone…
Howard: It dings on your staff computer.
Carl: Yeah, it makes a little ding, so no difference to the phone ringing, and yet you can type and often… and my staff could multi-task as well. And it’s not going off all day. Last month, we got 14 new patients via live chat. Now, that, considering the fact that live chat cost almost nothing to run, wonderful. And that helps augment the expensive google apps, or helps augment the…
Howard: Whose technology do you use for the live chat?
Carl: We use a company called Live Chat.
Howard: Is that a dental play or just…
Carl: Just… and we provide it ourselves, we have a sub-license.
Howard: But again, I like data. I mean, Dentaltown has had a monthly poll…
Carl: Mm hmm.
Howard: …since 1998. And so when I say four out of five dentists think this or three out of four knows like that, I’m looking at data. I’m looking at a poll on Dentaltown, and a lot of times people would say, yeah, but that was only three hundred and eighty people voted on that. Well, this Robert Murdoch… what’s his name?
Carl: Rupert Murdoch.
Howard: Rupert Murdoch. I mean when Fox news is having a poll of a “Who’s going to be the next president?” A lot of the times they’ve only surveyed a thousand people. So, I’m like ok, well, that’s a thousand Americans out of third of a billion, and I’m polling three hundred and fifty dentists out of just two hundred and eleven thousand. So, my polling is far bigger than Rupert Murdoch’s, and he’s going to call the next president of the United States or whatever. And, so, when I look at the data, people who have data, they’re saying that 50% of the phone calls going into a dental office, while they’re open, go to voicemail.
Carl: Mm hmm.
Howard: So, I’m thinking, my God, so, I mean, couldn’t a dentist double his revenue just by hiring another human to answer the other half of the calls that are going to voicemail?
Carl: If the statistics were true, absolutely. I would doubt that’s the case in Australia. I think we’re better manned in our dental practices than that. I don’t have clients who don’t answer their phone because they’ve made it a priority. Now, if they answer their phone well or not, that’s a different thing. So, if they’re still going “Dental surgery?” we have to work with those a little bit. So, that’s a journey but no I think most phone calls have been answered but my argument is that a live chat should be answered in the same way. There’s a lot of people who are becoming phone phobic. We don’t like receiving phone calls as much as we used to do. There’s a lot of people who just literally can’t make a phone call between 9 and 5. Stuck in an office or on their computer, live chat’s the new phone. And, it’s free. So, why wouldn’t you embrace it?
Howard: So, when you’re consulting Mike Timoney with smilesinc.com, two questions are in my mind. In America, at least 80% of the offices are open Monday to Thursday, 8 to 5, and they roll their phones over to an answering machine at lunch when the Federal Reserve retires more economists than any company. I think they have almost four thousand PHD economists and they do all kinds of research and when they get to healthcare they are talking about availability that one third of Americans, something like a hundred and nineteen million workers can’t call their doctor between Monday to Friday eight to five because they’re working, and then they get on their lunch break twelve to one and they call, and that’s when the dentists roll their phones over. So, do hours matter?
Carl: Of course they do. Of course they do. We live in a fast paced world. No matter where you live, people have got busy lives. I live in a relatively small town. But, we open on Saturday, wow and Saturday’s we’re booked out. The previous owner of the practice said [inaudible: 1:00:44] working, where everybody goes to the beach. No, a lot of people fly in, fly out because where I live, they can't go.
Howard: So, what hours would you recommend?
Carl: Very much depends where you are. So, if I was in the city, as in Sydney, like we are now. I’ll be open seven days a week. I’ll be open very long hours before and after work. You’ve got to be there when people want you, and the argument is and I hear this all the time, is that “Oh we’ve got a gap at eleven o’clock so why will we open at seven o'clock in the morning?” Well, the reason you open at seven o’clock in the morning is that person was never going to come at eleven, so it doesn’t matter if you’ve got a gap at 11, that’s a different patient. You’re opening at seven; you’re going to get that patient who needs to see you before work, or after work. So, it depends on where you are. For instance, where I live, Sundays would be irrelevant because Saturdays is enough capacity and people do live where I live for lifestyle reasons. In the city, seven days a week.
Howard: And what about demographics? Would you tell Mike on his new venture, demographics don’t matter or would you say demographics do matter? Go rural where there’s less demand. What is your thoughts on demographics?
Carl: Well, Mike’s got big plans, so he wants to be everywhere. So, the demographics matter. But he actually wants to be nationwide, and in every regional and city environment because he wants to build a national brand. If you’re buying a practice as a sole practitioner, then demographics matter ever so much. There are certain pockets within Australia, that are just massively over-serviced, and there are some that are reasonably. There isn’t many pockets that are under-serviced anymore. But, yes certain areas you just wouldn’t dream of opening yet another practice. Normally, within around about two hundred meters of a dental school they seem to want to leave dental school and open quite close to where they learn for some bizarre reason.
Howard: Because you went to school there four years you might’ve met your spouse in that same town of four years. You learn that… In America, like in Kansas City they’ve got the Royals, they got the Kansas football, they have The Palazzo _ they say if you live in Kansas for four years who the hell wouldn’t want to live in Kansas City but the money is made when you get about two hours out of town. Do you think there’s more money to be made in rural Australia than in downtown Sydney?
Carl: Certainly there was, but that’s… and there may be just little pockets left but a lot of that has been… those gaps have been filled now. And also, they’re quite dangerous environments in terms of the tipping point between under-serviced and over serviced is quite finite. You take a city like Sydney, they can always accept another dental practice, it can always accept another coffee shop. You take a rural town that might have twenty thousand people and it has six practices and suddenly now it’s got twelve _ and this has happened. You can’t continue to put practices into those very defined populations.
Howard: So, you’re saying that it got so competitive in Australia that the rural actually got saturated.
Carl: Yeah, because…
Howard: We’re not there in America yet.
Carl: A lot of it is rumor and the rumor goes around, people go “Oh, rural is where to be.” So then there’s a gold rush, we’ve seen in towns like Mackay which literally went from six practices to twelve practices in two years because there was this “Oh, we need to go rural.” Also, the government was paying quite nice subsidies to open practices in rural areas. But like a lot of government subsidies it’s very easy for them to end up having a negative effect, not a positive effect.
Howard: So, wow, that was a… I cannot believe we… we went over an hour and six minutes. The time flew so fast. Is there any other questions we didn’t cover that I wasn’t smart enough to ask?
Carl: We didn’t touch on the topic of payment plans.
Howard: Oh, yeah. Well, that was part of my long question: half have a fear of pain, half have a fear of cost.
Carl: Yeah, so, this is something I’m really passionate about at the moment, is that the presentation of a treatment plan is often presented in a way that people are just left with a big number. Most dental practices these days will have a dental payment scheme of some sort. Most of the time it’s tucked away in a drawer and only gets pulled out when the patient is motivated to say is there any other way I can pay for this? And often that’s too late. So, in my practice we present every treatment as a weekly figure. So, if you’re in my practice…
Howard: As a weekly figure?
Carl: As a weekly figure.
Howard: How much does it cost per week?
Carl: Yeah, in a payment plan. So, if you’re coming in to see me and I was presenting to you the treatment, I might say the doctor today has prescribed a crown and a two surface fillings. That’ll be $2,200, and the way we do that here is just $49 a week. Would that be okay for you, Howard? So, that language means people are starting to know that they can pay it off over time. It’s also meaning that it’s about my financial arrangements with you, as if you’re buying a car, a car on the lot’s 50,000 but it’s a $199 dollars a week. And, it’s not making the patient feel: a) have bill shock, but would also feel bad about their own financial situation. Too many times people say “Yeah, the treatment the doctors prescribed is a crown and two surface fillings, that’ll be $2,200”, and they shut up, and then you have this massive resistance to “Oh, I have to think about it, I have to talk to my spouse, I wasn’t expecting that”. And then if somebody says, “We can organize a payment program for you”. You’re already feeling bad about the fact you haven’t paid for it cash, or you had to even think about it, and you’re on the back foot and the chance that person’s going to leave and as soon as they’ll leave their motivation for dentistry leaves with them, unless they’re in pain. So, the correct use of payment plans I see as being a real big area that’s what the professional needs to look at. I think, if done correctly, it gets people into more treatment that they need. If they need the treatment it’s good for the patient, it’s good for the practice, it’s good for everybody,
Howard: So, are you carrying the paper?
Carl: Well, we use two methods. So, one, yes, it’s just a direct debit and I’m carrying the paper; and then we also have the credit facility where we get paid up front but we pay the interest on behalf of the patient.
Howard: And who’s that through?
Carl: So, the one where it’s interest free, but we pay the interest, is a company called Certegy Ezi-Pay.
Howard: It’s called what?
Carl: Certegy, we just spell it C…
Howard: Is that an Australian player?
Carl: Yeah, and then the direct debit service I use is one called Dental Members, Australia, but it’s just literally a direct debit so which is very simple to use, incredibly good platform, lovely people behind it, and we use it in various ways.
Howard: By the way on marketing, so many of these Australians have .com.au. Do you think they should also buy just the .com without the .au?
Carl: No, we only relate to the .com.au. We see .com as being either American or global.
Howard: American or global?
Carl: Yeah, but the .com.au is the default here.
Howard: So, Dental Members, have your teeth fixed with easy weekly payment, and capped-free dentistry, up to $10,000 dental procedures with easy, weekly payments. So, dentalmembers.com.au, that’s the direct debit?
Carl: Yeah, that’s the direct debit. So, they have other services as well. The gentleman behind that, Dr. Safa Souzani- you need to get him on your podcast. The man is a genius. I think probably one of the brightest thinkers in dentistry today.
Howard: And then what was the other one?
Carl: Certegy Ezi-pay
Howard: Certegy Ezi-Pay. What is Ezi-Pay?
Carl: So, that’s a credit service, they offer six, twelve, eighteen, and twenty four months interest-free to the patient but we pay the interest.
Howard: So, you pay it up front? Let’s say, I had..just easy math, a thousand dollars of dentistry done.
Carl: Yeah, so then they would deduct… if you wanted to pay it off of six or twelve months, they’ll deduct, I think, 3.9% and then send me the balance. If you paid it off of twenty four months they’ll deduct 7.9 % and then send me the balance. Either way, I’ll get paid up front.
Howard: So which do you prefer? That- where you have a discounted rate to get all your money today, or…
Carl: I use a mixture of both. One of the reasons I like the direct debit is we’re setting the terms. It’s my money, we’re setting the terms, I give my staff a set of parameters to work with, and they know what to work with. As far as I’m concerned, from my point of view, I don’t care if the dollar’s in my bank account or on a balance sheet, it’s still a dollar. So if I’m going to get that money over time, and I’m also building a future income. So, when I walk into a practice on the first of the month, I know I’ve got a set amount of income coming in and it builds over time. Some people starting off in practice may be not as well established. They may be more concerned about cash flow so, then they should be using the credit facilities. But the direct debit service is great because no credit check; you make a value judgment on the patient; you can be flexible; and it’s human. So, the way it works, we haven’t had one bad debt, not a single bad debt. But we’ve had payments fail. So, the girls get on the phone and they say “Oh, I’ve got to take the cat to the vet and do that”- “Don’t worry just catch up next week.” It’s part of the service. And we deal with humans all day long so it’s nice to have a human solution. We’re providing dentistry to people who need it, who may not have had that dentistry otherwise.
Howard: Do you think we made a mistake in treating humans when we should’ve been treating the cat? I swear to God, if I had a dollar for every time in thirty years.. I’m across the street from the vet, his office is twice the size of mine and he does twice the money that I do, and I’ve known forever, and I cannot believe how many people say, “I can’t afford that. I just spent $5,000 on my cat.” I’m like, “$5,000 on your cat?” Wow. But I’ve got to tell you, a couple of finance stories and we’ll it leave on that, I know I’m on overtime with you. There was like eighty five different amazing sewing machines until the Irish diaspora and then after that you only heard of Singer because when one million Irish died during the Irish famine, and another one million landed on the shores of America forty years before the statue of liberty, and the only jobs were textiles, and you can only get a textile job if you owned a sewing machine, and Singer saw that, and they didn’t have 50 bucks; they came with the shirt on their back. Singer was the first guy who said, “Tell you what,” They don’t have 50 bucks, so he went out with installment credits, “Look Irish boy, I’ll give you a sewing machine and you’ll get a $3 a week job but every Friday you bring old man, Singer, a dollar.” He eliminated every other sewing machine company in America, and if you ask, any grandma in America today- what’s the greatest sewing machine ever? They’ll all say Singer, and it was because of installment credit; and then all the Americans will say that Henry Ford invented the assembly line, and so OK, we’ll keep going with the story because why did that assembly line close down? Why did it end after 10 million cars? Why did they go bankrupt and shut down? And it’s because General Motors launched GMAC financing with old man Ford, you had to give him your $668 dollars and you’re a dollar short, you didn’t get a car. And General Motors came out with GMAC financing and said, “Our Chevy is not $668. We have installment credit over 3 years.” And what’s amazing is GMAC financing has delivered 3 dollars of profit for every one dollar GM has made in selling cars. So, if you make the damn car, you make a buck. If you finance the car, you make 3 bucks. And then you look at America, what is America actually number one in? Well, its military, its movies, its music, but it’s mostly insurance, banking, and financing, and a little known stat if you don’t realize that Manhattan, just Manhattan, has a larger GDP than all of Russia _ and they don’t make cars in Manhattan. It’s the New York Stock Exchange, it’s Goldman-Sachs, it’s insurance, banking, and financing. And there’s actually… ask any MBA, there’s more money in finance. Look at all those boats in the harbor. Would you rather own the business that’s making all those boats or would you rather own the business that’s financing all those boats? And I guarantee you; the guy that’s financing all those yachts makes more money than the guy making all those yachts. So, yeah, I think what I tell these kids is when they come out of school, I say, I want you to be hungry, humble, hustle, if I get to pick one trade for you to have, it’d be a chairside manner that conveys trust, likability, communication with your patient and your staff. Secondly, they’re afraid you’re going to hurt them so talk about nitrous oxide; being gentle; raise your hand and we’ll stop; and then address cost. And in America, the stats are very clear for the thirty years I’ve been watching them that in America if it cost more than $1000, 90% of the time it’s financed on the credit card, monthly payments. Only 10% of houses and cars in America are paid for in cash, and those are usually the retirees. Their kids are gone, their house is paid up and that’s the only people Americans give discounts to. We’ll give you a senior citizen discount because your kids are gone; you’re retired; you no longer have a house payment, car payment, and whatever, so we’ll give you a 10% discount.
Carl: And here we just… vast majority of dentistry is still just expecting the patients to have the money. That’s not how most people live. Most people live pay packet to pay packet.
Howard: Pay packet?
Carl: Yeh, pay packet , wage bill, wage income, whatever you call it.
Howard: Pay packet. I’ve never heard it called the Pay packet either. So, that’s your paycheck?
Carl: Paycheck. Paycheck to paycheck.
Howard: But you call it pay packet. A packet of pay. Huh, and what do you call a mailbox?
Carl: The letterbox.
Howard: The letterbox, I love it. I love it. All right. Well, hey Carl, I’ve been a big fan of yours for a long time. Thank you so much for all that you do for dentistry.
Carl: It’s Great to see you again, thank you very much for having me on the show.
Howard: And good luck with that ten year old daughter.
Carl: Thank you.
Howard: I hope she turns out to be the love of your life.
Carl: She already is.
Howard: Because my…I had four perfect boys before. [Inaudible 1:16:05] was sixteen, I was going to write a book on how to raise perfect children, and then one by one they got their car keys, and got in more trouble. Since you have a 10 year old little girl, as soon as she has her own car and her own car keys…
Carl: We’re in a very sweet zone. We have a lot of fun.
Howard: You’re the in the sweet zone, exactly. You’re in the sweet zone. All right, well good luck on everything you do.
Carl: Well, thank you very much.
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