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VIDEO - DUwHF #921 - Julie Varney
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AUDIO - DUwHF #921 - Julie Varney
Julie Varney, CDA, FAADOM, Director of Dental Practice Coaching and Team Training for Darkhorse Tech, Inc is a motivational in-office coach, empowering while equipping dental teams with Simple Solutions Today for Powerful Results Tomorrow.
Julie earned her CDA from Hudson Valley Community College and in 2016 was awarded Fellowship with the American Association of Dental Office Management, where she is an active member as a Chapter President. In 2016, she was named Top 25 Women in Dentistry by Dental Products Report magazine.
Focusing on building confidence and organizing chaos in the dental practice, Julie’s mission is to enhance each dental team members career, by embracing their passion and bringing out the leaders within them.
Howard: It's just a huge honor for me today to be podcast interviewing Julie Varney CDA, FAADOM (Fellowship of the American Academy of Dental Office Managers). She's Director of Dental Practice Coaching and Team Training for Darkhorse Tech, Inc, is a motivational in-office coach, empowering while equipping dental teams with Simple Solutions Today for Powerful Results Tomorrow. Julie earned her CDA from Hudson Valley Community College and 2016 was awarded Fellowship of the American Association of Dental Office Management where she was an active member as chapter president. In 2016 she was named Top 25 Women in Dentistry by Dental Products Report magazine, focusing on building confidence and organizing chaos in the dental practice. Julie's mission is to enhance each dental team member’s career by embracing their passion and bringing out the leaders within them. Julie thank you so much for coming on the show.
Julie: Thank you for having me.
Julie: Thank you.
Howard: Congratulations on being named Top 25 Women in Dentistry. I would have named you top one but I guess the top twenty-five ain't bad either. I wanna start out with a hard-hitting question, right between your eyes, punch in the nose.
Howard: If I go to dinner with ten dentists and I ask each one of them, “What stresses you out the most? What's the worst part about being a dentist?” They always say the same thing, 'My damn team drives me crazy'.
They say that leading a dental assistant, a hygienist and a front office is like leading three cats around the block, it's like herding cats.
Howard: What advice would you give to dentists listening to you today? Or maybe there's a hygienist listening that says 'I love my patients, I love my job, but my dentist is detached, he hides in his office, the receptionist fights with the assistant. I hate the office politics. I love my, patients I hate the part.' So it seems like staff is just what makes you almost wanna quit being a dentist some days. What would you say to those guys?
Julie: Right. You know, I say that to each of them, they need to embrace their differences and they need to empower, to educate them to be their own leaders. It should be a self-led dental practice where all she has to do is come and do dentistry and people want to grow their careers and he has to give them the tools to do that, which in turn is going to be him more productive and profitable if everybody is their own leader. So it's make them their own leader, hold them accountable and give them the tools to continue to grow their career.
Howard: How does he get from here to there?
Julie: By putting the proper tools in place with the hygienist, being part of her association, giving her more continuing ed. The front office, ADOM is a great resource to help learning and grow the front office. I'm a big believer in tools and systems and educating more. My boss gave me all the tools in the world to make me better at what I do and to help others grow.
Howard: If my homies are listening go to JulieVarney.com. What are they gonna find, to help them go from getting beat up by their staff and having it be the worst part of their existence to being a good part?
Julie: Well, the thing that I find is it's all about me for one and what I can do for their practice providing that simple solution. I offer in-office coaching, I believe as a dental assistant that your hands-on learning is the best. So, I offer two to four-day workshops for them, monthly coaching, but my whole thing is, what do you want to fix today that you could be more profitable tomorrow?
Howard: So, I love your website, I'm sitting here lost on it, reading it, and really, it's a good website. So, you do in-office consulting?
Howard: How does that work? How does my homie get you to come to his office and what is a great client for you? What problems do you like to fix? How much does it cost? Does it have a contract? Do you see a monthly? Is it a year-long program, two-year program? This is dentistry uncensored, get into all the brutal facts about how you do that.
Julie: So you usually start with the initial call or I have some doctors text me and talk back and forth to text, which is fine, emailing, I'm on some forums on Facebook that I found a couple of clients, and then we talk about what their real struggles are. I don't want to go in and fix everything and be a cookie cutter. If they want to fix their schedule, I'll help them fix their schedule. If they want to know how to get more patients in the door, I'll help them with that. If their front office doesn't have systems in place for repair or accounts receivable, I'll help them with that. I'm really simple - my price is $1500 for two days, plus the cost of my travel.
Howard: How much was that?
Howard: $1500 for two days, plus travel.
Julie: Plus my travel and then each additional day is $500.
Howard: And what does the average client have you do? Do they have you come in for two days, is that the average or do they just have you come in for...?
Julie: Yeah that's the average. It's usually because the first day I observe them and then the next day I'll help them implement and change what needs to be fixed.
Howard: And you're out there in the field a lot coast to coast. The person listening right now is all by themselves so they know what their problems are but they are probably wondering, what are you hearing out in the field? What problems are people calling you with? And what are you hearing in the field?
Julie: A lot of times is it's they have empty chairs. Why are people canceling or no-showing their appointments? Why aren't my co-pays getting paid? Why are my account receivables going up? How can I fix them? My clinical team is not as efficient as I'd like, what can I do better chairside to help them be more efficient to be more productive? So those are some other things that I hear out there.
Howard: So you're doing more business stuff: empty chairs, no-shows, cancellations, account receivables, not staff issues so you're dealing with mostly business issues?
Julie: Yeah or I meet with the office manager and she says, 'I don't know how to get Sally Sue up front to be more productive and do what I need to ask of her,' and sometimes it's just having conversations with them that make that office manager a more effective leader with her team. This is how you can handle it, this is how you can make that person accountable for their actions and help them grow as a leader and be more individual and help the practice grow.
Howard: It's funny how so many dentists get the Fellowship at the Academy General Dentistry and they wear loupes but they never think well maybe my assistant hygienist should wear loupes too and maybe my front office should get their Fellowship and the Academy of Dental Office Managers. They make it about themselves, you wear loupes and you have your FAGD, why don't your assistant hygienists wear loupes and why don't you have the girls up front join the American Academy of Dental Office Managers and get their fellowship. That would really balance the teeter-totter and make the team more homogenous. Agree or disagree?
Julie: Oh I definitely agree. The more you can give your team educational wise, the better off they're going to be. I mean some people you can't change and that's the thing where you have to let them go. But a lot of times they become stagnant or compliant and it's just because they want to do something different, they want to be something more. But they don't have the tools or they don't know where to look. So hiring an office coach to come in to help them will make them love their job again and in the end it makes you more productive because people are happy.
Howard: So you said you're mostly deal with empty chairs, no shows, cancellations account receivables, what were the other ones?
Julie: Chairside efficiency with assistants.
Howard: Collections, chairside efficiency. So let's go shoot some of those. When someone's complaining about empty chairs, what is the average office you're seeing? I mean do they have four of? What does it look like in these offices that are calling in with empty chairs?
Julie: Usually the average that I'm seeing is they have two full-time hygienists and they have three or four open holes a day. And is it their confirmation, the way they are confirming the appointments, or is it their, the way that they are scheduling the appointments? They're not giving them enough time so patients feel rushed? Is it because they’re in or out of network or something the hygienist did the last time that they are not coming back? So there are a number of reasons what can be happening, but you just need to pinpoint the reason to fix it.
Howard: When you when you're talking about empty chairs the average that you're seeing has two full-time hygienists, they have three openings a day. A lot of people on dentaltown are starting to get disillusioned with their hygiene department because so many of them are on PPO's and are getting $55 for cleaning and their hygienist gets paid $40 an hour, so then you throw in three openings a day for two hygienists. Is a hygiene department just a loss-leader so that hopefully you'll find dentistry to do out of there for a higher fee or do you think the hygiene department can be a profit center, even though so many people are taking PPO's?
Julie: I definitely do think they can be a profit center. It gives them time to educate the patient by having that one-hour appointment. A lot of times the doctor comes in and diagnoses and then they end up walking out and they turn to the hygienist and say, 'Well what's that all about?' and they give time to educate. Your hygienist and your hygiene team can be very profitable by putting systems into place and giving them the tools to be more profitable.
Julie: I've worked with Inspired Hygiene, it is a great tool for any office. If I can't take care of the hygiene department they can do it with Rachel Wall. You've interviewed Rachel Wall.
Julie: Yes. I love her tools, if there is a hygiene department that I go into that really needs help that's beyond my scope. I will refer them to Rachel because they can get it fixed.
Howard: What are some of her tools because you also talk about no-shows and cancellations a lot of people say...what is the best way? Some people say hand-fill out a postcard, they get it with their own handwriting and they should get that two weeks to four, there's a lot of technology you can buy that does...so what do you think is the best confirmation system?
Julie: I love RevenueWell it's an up-and-coming and it integrates with Eaglesoft very very well. It's been great for offices that I've used it in where patients get the tax, the email, they have a patient portal, they can pay right online, they can view all their information. It works awesome! A lot of the older generation are even catching on with, 'Oh great. I can get an email or text' and there are some that still will want that phone call. It's just I think communication the new technology way, that's the way it's going for patients. And texting 90% of people will answer text first before they answer an email or a phone call.
Howard: When I called my four boys they don't answer the phone and they text back, 'Waddup'
Julie: So you might as well just text them, texting is the way to go.
Howard: I never have figured out that, ‘How can you be texting me back but you can't answer your phone?’
Julie: Pick up the phone and answer your father (laughter).
Howard: So you like RevenueWell?
Julie: RevenueWell yes I do.
Howard: Is that is a dental play RevenueWell or are there many different versions.
Julie: They are actually, they integrate with Dentrix, Eaglesoft, Open Dental and Practice Work.
Howard: No what I mean is RevenueWell, is that company only focused on dentistry or do they do chiropractors, physicians or.
Julie: I believe they are only focused on dentistry right now.
Howard: Really! OK.
Howard: RevenueWell.com, grow your practice by engaging your patients and attracting...very interesting. So tell us more about RevenueWell.
Julie: So I found out about RevenueWell from my Patterson rack when we were looking for a new patient communication system in her office at the office I worked at for twenty-four years. So we were using an Eaglesoft. It is the best I find for Eaglesoft that integrates flawlessly, it sync's right with Eaglesoft, it pulls all your demographics and your information, your patient information. It has a very user-friendly dashboard, so if you're not computer-savvy you will be able to use it very very easily.
Howard: What features does RevenueWell do?
Julie: My favorite is the patient portal because they can get all their treatment plans sent to them, they can look at videos from Caesy Patient Education, they can schedule an appointment. The patient portal allows them to kind of be more involved in what goes on in their treatment.
Howard: Wow, I just went to RevenueWell on Twitter and they tweeted out, seven best podcasts in dentistry and there it is Uncensored Podcast - Dr. Howard Farran as the founder.
Julie: You should have Alex Nudel on your podcast.
Howard: Alex Nudel?
Julie: I'll tell him he's actually coming here to Syracuse next weekend. He's riding his Harley from Buffalo to Syracuse with Anastasia Turchetta for my Tooth Fairy run.
Howard: Alex Nudel?
Howard: That is something that they didn't have thirty years ago these deals. Does that make you wonder why, you say RevenueWell comes out and it integrates very easily with Eaglesoft and I wonder why Eaglesoft and Dentrix didn't have all these features
Julie: I think Dentrics had something like demandforce or solutionreach or something like that out there. I'm not really familiar with Dentrics’ products but Eaglesoft had at one time, another company and I can't remember the name of it but it wasn't as good and utilized as RevenueWell, it didn't really integrate, I think they really made it for Eaglesoft now everybody else catching up.
Howard: So Alex Nudel, it says he lives in Florida so he's coming to speak to you so are you the president of a New York chapter?
Julie: I'm the Syracuse Chapter President of ADOM yes.
Howard: And he's gonna come speak for your group?
Julie: Well actually he's not coming to speak. He's riding his Harley to raise money for my non-for-profit.
Howard: For your non-for-profit?
Julie: Yes I have a non-for-profit.
Howard: And what is that?
Howard: Well tell me about that.
Julie: So myfirstdentalvisit is raising funds to give children access to dental care. In our surrounding counties a lot of kids don't have access to dental care because there's no pediatric dentist so we have an annual Tooth Fairy run and Anastasia Turchetta and Alex Nudel are riding their Harley from Buffalo which is about two and a half hours away, to Syracuse Harley store for our run that's on October 1st and raising money to do that.
Howard: That is just amazing, what's that website, myfirstdentalvisit.org?
Howard: And so tell us your journey, when did you start with that? Tell us more about that.
Julie: Oh sure. So last year a group of us, myself and a company called orabrite, oraline are a dental marketing company for toothbrush products. Our team got together and wanted to start a Tooth Fairy run. So we started the Tooth Fairy run to bring the dental community together and we wanted to keep the funds in the community so Lisa Rogers and I and Lisa Spradley, which you've interviewed Lisa Spradley before, the front desk lady, got together and started a non-for-profit so we could keep the dollars in the community because a lot of non-for-profits when you raise money for them, you hand it over and it doesn't stay in the community.
Julie: So our goal is to keep dollars in the community, support local businesses bring the dental community together. My goal eventually is to have the race come across to different cities and keep those funds in the community for dentists to do days of dentistry.
Howard: I just re-tweeted @orabright_ and retweeted your myfirstdentalvisit.org, on twitter is @myfirstdntlvisit just retweeted that orabright is getting ready for the Tooth Fairy run, sign up today and another one is win a 2018 trip to Disney. Visit ToothFairyrun.com for more information. Is that you also?
Julie: Yes you can go to ToothFairyrun.com and register. Yes.
Howard: My god you gotta be the busiest person I know.
Julie: That's what Ruben says, it's like you're so busy he didn't even know that I had the Tooth Fairy Run, was like, ‘oh there's a Tooth Fairy Run?’ and I'm like yeah it's kind of mine and some other people's race for our area
Howard: That is cool.
Julie: Thank you I like to bring the dental community together, we always get together at conferences and learn and learn and learn, but I don't think there's really a lot of events to get together to socialize hang out and have a good time.
Howard: And Lisa Spradley is involved with this too?
Julie: Yes she's on the board of myfirstdentalvisit, she's involved in it, the front desk lady.
Howard: And she just she just donated one of her kidneys?
Julie: She did, she just donated one of her kidneys to a lifelong friend who also a dental assistant and worked with her for many years.
Howard: That girl was a dental assistant, they worked for her?
Julie: Yeah worked with or worked for her yeah.
Howard: I mean that is going to be the biggest gift anyone can ever give.
Julie: She has an amazing heart, an amazing spirit.
Howard: What is her tagline, the front office lady?
Julie: The front desk lady.
Howard: The front desk lady. I think they should rename her the front desk saint. That's approaching saint, that's Mother Teresa, Calcutta level stuff when you're a front desk lady and you donate your kidney to the dental assistant.
Julie: Yes yes. I know it's amazing.
Howard: Name one person who did one thing that beat that in dentistry.
Julie: I can't even tell you Howard, I don't know. I'm speechless.
Howard: That is just at another level of love.
Julie: Oh it is. She's an amazing person and she wears her heart on her sleeve.
Howard: Yeah my gosh that is just, that is just unbelievable, unbelievable unbelievable unbelievable. So you talk about no-shows and cancellation. You said you liked RevenueWell. Let's move to the ugliest part of dentistry having to ask for money, they don't like to sell dentistry. They sat in their dental school for seven years to be a used car salesman and they sure as hell don't want to ask for money. Talk about account receivable and collections.
Julie: I think you first start with a financial agreement in your office because if the patient knows what's expected of them. Just like when you go to your local grocery store, get your hair done you know exactly what you have to do when you walk in there and you have to pay. So if you have a financial policy when you come into the office that the patient is aware of, what their expectations are, there shouldn't be an issue asking for money. And you really do need a strong person up front to ask for money. If someone doesn't like to ask for money they can't be the front desk person. I don't have an issue asking for money because I feel they've already known the expectation, I've explained their treatment and you put it to them in such a manner that they're like, 'oh OK that's all I have to pay?’ ‘Yes this is all you have to pay today. Cash, check, credit card, care credit, however you want to pay for it.’
So I really think it's starting with having the patient to know what the expectations of them are for collecting and what they're hoping for and that's all they want to know. They just want to know what the they're responsible for.
Howard: You walk into McDonald's and order a hamburger, a sixteen-year-old kid says give me three bucks and they give you the hamburger. Then you go into dentistry and you say I want a $1000 crown, they go do the $1000 crown, then when they are walking out the front they're saying, 'oh by the way you owe me half of that right now', and then the next thing you know...over thirty, over sixty, over ninety. It seems to me it's a nightmare for the young dentist that just opened, seems like they have to learn that lesson the hard way. How do you how do you get to be more like McDonald's where pay your portion first and then we give you the hamburger instead of giving the hamburger then begging for money?
Julie: Right. It's preparing your patient. So I think it starts initially when you make the first appointment with them. These are expectations that when the doctor diagnoses that treatment and they come up and say how much that costs. This is the expectation that you're responsible to pay for and them knowing it. So you tell them when they make the appointment they leave, you tell them when you get their pre-offer if you still do that. You call them a couple days before their appointment you let them know just to let you know your co-pay is X, Y and Z. How did you wanna take care of it? Do you need help taking care of it? Do you need some tools? So by not sticker-shocking them when they come in and preparing them. Communication is a the big key about that.
Julie: You have to prepare them for that and they'll tell you whether they can afford it or not. Well a lot of times they just want to know the cost so they can prepare. They know they need it done. They just want to know how to prepare for that.
Howard: I'll talk to dentist and sometimes I'll say to them, 'Do you think you're a good dentist?' and they'll say, 'Oh hell yeah, I've gone to Spear and Pankey and Kois,’ and all this stuff. And they have all this alphabet soup behind their name, but then you're looking at their office and they have the national average treatment plan acceptance is 38% so if he diagnoses a hundred cavities, we're not talking about veneers and bleaching we're talking about decay. He drills, fills and bills 38% and he thinks he's a good dentist. Then across the hall is someone who didn't go to Kois, Spear, Pankey, or Ross Nash or any of these institutes, and he has a two out of three treatment plan acceptance rate and I can tell you after thirty years that one out of three patients aren't going to do anything you say whether it's quit smoking or whatever. I have patients that show up to the office in wheelchairs with oxygen tubes in their nose smoking. So not everyone's going to do what I tell him to do, but then I see the dentist when talking about a treatment plan, he doesn't like sales he doesn't want to sell, well how can you be a good dentist if only one out of three people with a cavity get the decay removed and I think the guy across the hall's a better dentist because he removes the decay two out of three times. And you say he's no good because he uses amalgam and you use composite. How do you approach selling in dentistry? It is a four-letter word in dentistry
Julie: It is and I really think it stems with the patient relationship and the connection you make with them and answering all their questions giving them the facts up front, having the hygienist and the assistants be educated, the whole team.
I mean there's nothing worse, and I was an assistant, that you turn to the assistant and you're going to ask you, 'What it did the Doctor just say?' and if you can't answer then his message and his value has been lost and it makes them look bad. If he doesn't have his whole team on board with what his beliefs are, or his visions are, or his diagnostic qualities are, then it has to be carried out front. So if the assistant brings them up to the front and says Sally, Sue needs this crown. And then she leaves and we get them scheduled and the lady asks the front desk and she's like, 'Well I really don't know what a crown is'. Well then the message is lost again so it really makes them question, 'Well nobody knows what a crown is, why am I here because I don't even know what it is. Why should I get it done?’
So I really think having the same message and the patient handoff, I'm a big believer in a good patient handoff, really carries the message through.
Howard: My astute listeners know what I'm about to say and if you just joined the program a thousand shows later. I think it's so interesting that when I talk to dental office consultants in the real world working coast to coast. I said well what is the average (inaudible). You said empty chairs, no-shows, accounts receivable, collections and I said on empty chairs, ‘Describe an average office,’ and the first thing you said was two hygienists, three openings a day. Do you realize what I'm going to say is the fact that the average dental office does 750 and doesn't even have a full-time hygienist and they net 174. You go to consultants and they have been doing this for a long time. I'll say what (inaudible) they go a million, two million. So her average client has two full-time hygienist and that's what we keep telling you guys because you want to make an investment and you want to be better. So you want to buy something so you get Chairside milling, all scanners, CBCT all the stuff like that, but it's the consultants that bring highest return on investment. Get your house in order.
Everybody I know that's my age fifty-five to sixty-five doing two to four million a year has used a dozen different consultants in the past ten years to get there. And I know you want to learn dentistry but you just have to, you are stressed out at your office, fix that! Your staff doesn't get along, fix that! You have empty chairs, no-shows, cancellations, fix that! Your account receivables, collections getting out of line, fix that! But what do you want to do? You want to go learn bone grafting in the Dominican Republic and then when you get back from this very amazing fun bone grafting course in the Dominican Republic.
Julie: You have to implement it.
Howard: I got to go back to my office and deal with my crazy staff and my overheads and blah blah. Get your house in order. Get so you can get poised for go. I want to ask you another philosophical question as I know my dentistry. I have been one for thirty years. I've been on dental town four hours a day since 1998, seven days a week including Christmas, Easter and Hanukkah. Some of the dentists, I'll just tell you they don't believe in office managers and they don't believe in treatment plan presenters, they think the dentist should present the treatment and they think the dentist should be the office manager. What do you say to that guy? I mean does that work better with an office manager and does it work better with someone else presenting the treatment or is Doc usually the best office manager and the best treatment plan presenter?
Julie: I don't think he should wear that many hats. I think he went to school to do dentistry and I think he should find not so much a manager, sometimes using the word manage means people think you're going to be like little puppets on strings. So I think having a leader on that can carry your vision and run the ball. Just see your vision. I think they should help present the treatment, but I also think your team can sell more dentistry than yourself.
Howard: His team can't sell any dentistry because he tells the hygienist and the assistant that they can't diagnose X-rays, they can't diagnose he tells them to stop. My assistant and she has a new patient and she's taking each X-ray as she throws on the screen she says that's the filling and that's the cavity. And then the next they say, ‘See that cavity that agros the nerve, you came in saying it hurt on this side see the cavity and the nerve, so that tooth, you're either going to have to pull the tooth or do a root canal’. I have no problem with all my staff saying that and so many dentists say, well she can't say that and I'm like how many dental assistants are in jail today for saying that, I'm pretty sure you're in jail for selling drugs and stealing cars, not reading bitely X-rays. So that's a huge problem.
Julie: I mean as an assistant before, I mean I worked with the same dentist for over eighteen years and the one before that and they trained me to read the X-rays how they wanted to diagnose their treatment and what was right. I could, like you said, take an X-ray and I could tell the patient you know what, that tooth doesn't look very good, let me get Dr. So-and-so and I'm going to have him tell you what needs to be done, but it looks like you might have to have a root canal on that tooth.
Howard: And is he serving time in prison today?
Julie: Oh no, he's not.
Howard: He taught you how to read a x-ray. There’s dentists out there think he should go to jail.
Julie: Yeah, well probably, but no, one's retired and living in Marco Island and the other one is still practicing, he's down to three and a half days a week and he's doing well. He has a very successful practice.
Howard: I'll go into a dental office and they have a 38% treatment plan acceptance rate, and then when doctor goes into the hygiene check, the hygienist stood there for an hour and she says you might, you might want to check there's a little something on the upper right. I'm like: “A little something on the upper right? You went to four years of college? What the hell's a little something on the upper right?” My hygienist would have taken a PA to bite wing, diagnosed with that it’s a caries in the nerve, told the lady we can either extract that and it would be nicer if after they extracted they put in a bone graft, it would be nicest just to do the root canal, build-up and crown. If you can't afford the root canal, build-up and crown, you can't do the root canal and then walk around with a temporary for a year cause not having a (00:31:34: inaudible) is the number one cause for root canals failing and if you did extract it, later we'd go back and place an implant and a crown. I mean, they'd explained the whole damn thing. But that Doc is his worst enemy because the demon living between his ears says that she can't do any of that.
Julie: Right, and we always had a motto in our office and my team that when Doctor would walk in the office they would say, ‘Hey doctor, tooth number thirty-one doesn't look so good, it's a really big area of concern. I want you to take a look at it and I came to you in the office and talked to you about it in your office and discussed it before,’ so we kind of prepare them. We always prepared them and we've already told the patient that that tooth didn't look good so they were kind of waiting for the doctor to tell them why it didn't look good or what they needed done. And after the doctor would diagnose and walk away, we would tell them: “Okay, did you understand what they said, this is why you need it done and so on and so forth”, so we always like to prepare the doctor. Yes, we cannot can't technically license and diagnose, but most of the time the person's been in the chair for the hour, they have your trust, they have that hygienists trust, they have that assistants trust, then a Doctor swoops in and tells them they're kind of like: 'What?' But if you've prepared them, we were all big believers in preparing and the case acceptance rate was great because the patients trusted everybody's recommendation. What would you do with it if you needed it done?
Howard: When you see your average office has two hygienists, three openings a day. You talked about, you believed in a great hand-off, is the hand-off to someone whose title is treatment plan presenter or just the dental assistant or the receptionist are great hand-offs, or is it usually one person you handle? When you come in my office, I say Julie, that tooth's broke, there's not enough tooth for a filling we need to do a crown and I hand you off, who do I hand you off to? An assistant, front office, treatment plan coordinator, is it one person? Does everybody cross-trained for that? Talk about that what you meant by a great hand-off?
Julie: We taught each other to be, everybody's cross-trained, so everybody does the same hand-off. So, if you walked in the room and the patient’s in the chair and they’re diagnosed, whether you're in the room with the hygienist or the assistant, that hygienist is going to say: “Joe did you understand what the doctors say?” And if he didn't then she'll explain: “Okay, let me get you up front to Christina, she's going to make that appointment for you for X, Y and Z.” And then when she asks for it, I'm a big believer you just don't let the patient be unattended any time in your office. You walk them up and say, ‘Hey Christina this is what doctor recommended today, this is what needs to be done, Joe is going to get scheduled for that, so do you have any questions?’ And then ask Christina and then Christina should say to Joe, ‘Joe, let me get you scheduled what doctors had said and what needs to be done. What best works for you? What day better works for you, morning or afternoon? Do you have any financial concerns or issues? Let me go over that with you.’ So it's repeating the message all the way through, not just, ‘Hey he needs a scheduled appointment with doctor,’ and then they turn around and walk away.
Howard: You are also associated with DarkHorseTech.com
Julie: Yes, I am.
Howard: What is that association and what is DarkHorseTech.com?
Julie: So, Dark Horse Tech is your I.T. guy for your office.
Howard: I know that (laughter)
Julie: Dark Horse is a dental I.T. company and back in March Rubin has done a really great job with the amazing offices around where I live and he's supported my chapter of ADOM and he has offices across the country and I recommended a new office to him. And he's like, ‘This is like the tenth office you recommend,’ I'm like. ‘I'm just going to come work for you,’ he said ‘Great, you're hired, what do you want to do?’ And I said, ‘What?’ And he said, ‘What do you want to do?’ And I said, ‘I just want to make an office better with simple solutions I don't want to go in there and promise them that they'll make millions of dollars. I just want to fix what's broken and have them be better tomorrow, today.’ So I was hired and I started working for them as their practice management coach and I coach out some of their clients and more that are not their clients that hopefully we convert them to our clients
Howard: We had him earlier on the show, he’s my guy. What do you and him do what are the solutions that, what problems are you fixing? Because she's driving to work right now, she only knows her office, she only knows what she knows, she doesn't know what she doesn't know. When you go and observe for a day you say you're $1500 plus travel, two days, first day observe, second day fix broken things. What do you think is broken in her office and she knows what she knows, and she doesn't know what she doesn't know. What do you think she doesn't realize is broken that you guys fix?
Julie: A lot of times it's a fresh set of eyes but a lot of times it's the communication with the patient how they answer the phone, how they schedule the patient, they just they see the white space on the schedule so they just plonk them anywhere. They don't listen to the patient or what's going on with them. They just say “oh well we will get that co-pay later” well no we won't get that co-pay later. So there's a lot of things that I observe for this to say, let's try this let's say 'Hi Howard, your copay is X, Y and Z' or have the hygienist say, ‘I'll make a check for your schedule for the next six months and take your copay,’ so that patient's already thinking they need their co-pay. So a lot of times I just see little things that could be tweaked that's going to make a big difference in the long run.
Howard: I practice in Phoenix but everybody when I open up my office thirty years ago it was Ahwatukee and then it got annexed by Phoenix, but I never heard anyone in Ahwatukee say I live in Phoenix, even though it's Phoenix Arizona and in Ahwatukee we have an Ahwatukee business chamber and there's I think four hundred businesses in Ahwatukee and the area's about eighty thousand people. But what I find the most amazing about all these businesses and Ahwatukee is the highest paid person in the business is the person doing outbound sales calls, or receiving inbound sales leads from the Internet or whatever and trying to answer that phone call get the sale, that person is making six figures and then the guy in the back in the machine shop making whatever that's the lowest paid person. And then you move to dentistry, that guy back in the machine shop making the fillings and the crown, she makes six figures and the person answering the phone is named after a piece of furniture, the front desk lady, and she has no training and they don't record phone calls they don't give her any training. She's the most significant person in the office. And I look at average dental office in America does 750 dentists, that is that's 174 shown on the IRS.
Howard: Twenty people have to land on their website before the crappy website converts one person to call. Three people have to call before your untrained receptionist can convert one to come in and three people have to come in with a cavity before you get one to drill fill and bill.
So they do that one filling you needed three patients which mean nine people have to call. Which means nine times twenty. God I don't even know what number that is nine times twenty, a hundred and eighty people had to land on your website and people say, ‘What do you recommend for search engine optimization?’ Dude the number one search in dentistry is ‘dentists near me’, so these consultants that say I'll make you show up number one on Google search. No if I am searching dentists near me in Phoenix, no-one in Syracuse is going to show up.
Google's going to throw you to the closest dentist in your zip code. The problem is a hundred and eighty people have to land on your website before you drill, fill and bill. So why don't you fix the one out of twenty conversion to call? Why do three people have to call the front desk before she can convert one to come in? And why do three people have to come in with the cavity to have one person get it filled? Talk about how you can fix any part of that funnel.
Julie: I think we are the first impression and the last impression. So we're the first people to answer the phone and take your call. And if you get Sally sourpuss on the phone, ‘Hi this is Dental Today how can I help you?’
Howard: Sally sourpuss, I love it. That is funny.
Julie: We want Positive Patty's on the phone. Upbeat, Positive Patty's that answer the phone with a smile, make you feel... ask your name. I mean this is all stuff that anybody can learn in five minutes, how to change your conversation when you answer the phone.
Julie: ‘How can we help you? Why did you call us? Oh someone recommended you? Oh great, well thank you so much for that. What do you struggle with with your last dental visit? What didn't you like about your last dental visit?’ It's all about a relationship. I mean I've turned the worst patients into the best patients. I mean I kicked the guy out of practice because he didn't want to get X-rays and he brought me the letter and he said, ‘All I have to do is to take X-rays to stay in your practice?’ That's all we want to do, doctor is not Superman he can't see between your teeth. We just need some X-rays.
He didn't realize how important that was. It was making that connection with him and finding what motivates him to do the dentistry that you want him to do.
Howard: It's all dental centric, you asked a dentist is your office patient centric or is it dental centric? Ok so your hours are Monday through Friday 8.00 to 5.00 and one out of three Americans can't even do those hours. You have no early morning, no evening, or weekend but here's where it's really dental centric. The biggest measurement, the dentist since he owns the office and he's lazy, he has two assistants but only has one receptionist and one hygienist and the receptionist, half the incoming calls go to voicemail and he doesn't even know it.
I would say, well if you give up one of your assistants and you made your temporaries and you took an online course on how to load Autoclave. I turn one of your assistants into a receptionist and your current one is 8.00 to 5.00 and I'll put your assistant up there and the phones start ringing at 6.00, I'm gonna have her go 6.00 to 2.00 and take a lunch 11.00 to 12.00 and may have your current receptionist that comes in 8.00 come in at 9.00 and she's going to stay to 6.30 p.m. And instead of half of your calls going to voicemail your going to answer twice as many calls. I don't care if you’re Domino's pizza if you answer twice as many calls you sell twice as many pizzas and they don't get that.
Julie: No they don't sometimes they think having more people be in the back can be more productive, but it's not because you're losing things that happen up front they're going to the wayside. And one person can only do so much. So it's finding a balance and equaling the balance to make it more productive.
Howard: Are you a fan of recording the phone calls?
Julie: Well it depends. I think it's a good educational purpose for someone to hear. We used to use, I forget the name of the system, but our phone calls were recorded and we would go over how we handled the call and why didn't they schedule and it's different but I think you should have someone to listen I think it should be a team effort. I think the practice leader, shall I say, should listen to how the other person is answering the phone and have someone listen to her to kind of bounce ideas off of each other. It shouldn't just be a one, the doctor saying, ‘Oh you didn't answer that right,’ because that person didn't schedule, well you didn't listen to the patient, they're Medicaid we don't take Medicaid, so she's not going to schedule.
Howard: When you are dealing with clients, what percentage of them would you describe as a PPO practice and what percent do not participate with any PPOs?
Julie: So right now I would say about 50%.
Howard: 50% have PPOs?
Julie: Yes. If not more. Well see I would say make it sixty because I have a couple offices that they are not in network with any insurances, they work with me as a contribution towards your treatment, but they're not in network and they are very very successful. They are putting new systems into place, I wasn't there to make them millions more dollars. I was there to... they wanted a better re-care system they wanted a better treatment tracking system. So I was there to help with them. They changed over to a different patient communication system to better help them out and help the girls. But their numbers were great, it's just they wanted to be better. It's not that they want to make more money it's just they wanted to be better for the front office.
Howard: What do you say to a dentist who says seems like my number one my production is a dollar, but my adjustments are forty cents then you pay labor twenty-eight and lab ten and supplies six and rent five and everything else ten. I mean the adjustments, some people, that's just, it just wears on them. What do you think of this trend of so many offices taking so many PPOs?
Julie: I mean it depends on the area that you're in.
Julie: If you're in a lower income area where PPOs are rampant and that's how they're going to do their dentistry then fine, but if you're in Silicon Valley where people, the average, are making six figures why would you want to be in network with insurance?
Julie: I think it is really based on your demographics and how you can help your community grow and get the dental care that they need. I mean you can be more efficient chairside to keep your overhead down and your costs down and have your systems in place, but you can be a very successful PPO practice. I really truly believe it's just putting the right things in place. I mean like I said if you're in Silicon Valley I don't think you should be in network with because those people have loads of money to pay dentistry don't they?
Howard: A lot of times when a practice is not doing well the dentist says, ‘It's flat, I'm not really growing.’ A lot of times they have the impulse to make a very large purchase. I want to know if you think any of these large purchase are great return on investment and a great addition. There's chairside milling, there's oral scanners, there's lasers, there's upgrading a Pano to a CBCT do you see any of these major purchases advantageous? Are you ever going to say what you need to do is, you need to make a large technology purchase?
Julie: As one that worked in an office that's a high volume CEREC office I can say you need to really think about it and calculate it, because we purchased our CEREC in 2007 the first time we used it was in 2008. Why? Because we didn't do any implementation. We didn't implement it into the practice. We let it sit in the corner until I finally said what are we doing, this thing costs hundreds and something thousand dollars. It's just sitting here. So we went and we came out to Scottsdale the center of dentistry and we got educated. I was educated, I was the only CEREC designer in my office before I retired. So hopefully his new assistant was able to bring up to speed or he's been doing his own CERECS but so it's implementing any of these things that can make you more money you just can't take these $5-6000 courses and come back and regurgitate this material to your team and say OK make it work. It's not how it works. You should bring your whole team and then sit down and devise a plan on how you're going to get your return on investment back. If you go to sleep apnea or you go to implant seminars. Those are all great, but when you spend $3-4 or $5000 to educate your own self and then you come back and you throw a book at your team and say OK we're going to do this tomorrow. That doesn't work for me.
And I finally, I had gone through all the education and I'm the one that came back and implemented the conscious oral sedation that we did, this CEREC that we did, the implants that we did, the sleep apnea that we did, because it was a team effort. Your spending a lot of money, you want to make it work, you want to have a good return on investment. So it's really having people follow through.
Howard: So did you eventually make the chairside milling a profitable return on investment?
Julie: Yes I did. I truly recommend any type of chairside milling whether it's (inaudible) or whatever other ones they got out there E4D or something. As long as you implement and utilize your assistant to the best of your ability. You should be able to prep and walk away and come back and bond that crown in.
Howard: When you came out to Scottsdale did you see Claudia Lovato one of your buddies?
Julie: Yeah she is I was just out there when my plane, I was supposed to have a meeting with you, and my plane got mechanical failure, it was a big to-do. I didn't think I was going to make it to Arizona. But yeah I'm out there for her and the Morado Allied speakers thing.
Howard: And so you were going to do this at my house.
Howard: And we were so sad because we went ahead and we cleaned up the house, we mopped the floor and we vacuumed for no reason and then you didn't show, we even washed the dishes and loaded the dishwasher and then you didn't show. So how was the show?
Julie: It was great. I learned a lot I learned a lot about how I can work the room and my posture and I had my first speaking engagement at Henry Schein. And I'm only speaking to dental assistants, I will only speak to dental assistants, that's my comfort zone. I'm going out there to be their kind of like a chairside leader there it's good, it was a really good conference. It's a really good thing to be part of.
Howard: Dentaltown has like four hundred and fifty courses and I don't think we've ever made a course just for dental assistants.
I'll tell you what, it would be your best marketing and I spoke at every major meeting and the number one complaint is, after they do the dental meeting is, there's nothing in it for my staff. That is why you always see practice management people at all the conventions because if you just have root canals, fillings, crowns and bone grafting, then the hygienist and the assistant are saying, 'Hello'. That's why ADOM meeting has gotten so big. I thought that was very interesting that as the major meeting attendance is going down and ADOM is going up. When you read the complaints, and I've been shared those complaints for twenty years, it's always there's nothing there for my staff. So if you, it's like your demo tape, you do the hour online, calling for dental assistants only and then all these people especially meeting planners would sit there and say, ‘Wow we want to solve that problem.’
Another thing that took off huge was out of Atlanta Georgia the Scheduling Institute, exploded because (Hindman) in his own backyard, they never had a course for a front office. I mean who would have a course for a person whose occupation is named after a piece of furniture? Why would they? The front desk course sponsored by IKEA! I mean they never addressed that, even though it's a huge complaint and in the same city, Atlanta, the Scheduling Institute says we're going to make a course just for that lady that answers the phone because Howard said about that at the Ahwatukee business chamber. Usually the person in sales answering the phone, answering the leads that's the highest paid person and in dentistry it's just an oversight.
Julie: And Lisa the front desk lady she has a great course too on dentalpost.net/edu, Lisa does, about phone conversations and stuff. So she is really great. I was just at a course in our local area and they too they had something for the doctors, risk management and infection control and they had some oral systemic thing and then they had some for the hygienist, but they had nothing for front desk and nothing for assistants. So a lot of these conferences are wondering why their attendance is down because it should be a team building event. They should have something for everybody in the office not just certain somebodies.
Julie: It's a whole team thing.
53.36 Howard: Yeah. I'm a big fan of Claudia, all these people you’re talking about, I'm looking on, you guys when you were out here, I think it was Deborah Sabatini, Lisa Marie Spradley, Susan Robinson, Danielle Purcella Claudia Lovato, Mary Beth (inaudible: 00:54:00).
You girls have done so much for dentistry and a big shout out to Mary Beth, when I was lecturing for Patterson at a the Rock and Roll Hall of Fame which was so cool.
Julie: I can imagine.
Howard: It's the shape of the old phonograph and they have escalators going up and then the big opening of the top is the speaking room which all these famous people had played in and all that stuff like that. But she picked me up, her and her husband, and took us out to, I forget the bar district, but it's a couple block area downtown, Cleveland, where they paved the streets, no cars. Just an amazing person. Yeah, you girls are doing amazing things for dental offices.
Julie: Oh thanks, I love it.
Howard: I can't believe we've gone an hour.
Julie: Oh my gosh, are we over our time limit?
Howard: I was wondering. You sound like your best is two days, $1500. The first day you're just gonna observe what's broken and then the second day you're gonna fix it. Who is your ideal client? Who is listening to you right now? Who should call you to come to their office?
Julie: My ideal client, the one that goes home at night and the doctor says: “I just wish I could fix X, Y and Z. I don't want to hire a big consultant to ramp up my whole practice. I just want to fix my schedule.” I worked with a wonderful doctor a couple of weeks ago in Ohio for four days just to fix the schedule.
But when I got in there, there were other little things that he could tweak to do better and I gave those tips to him too. So my ideal’s one that just says: “You know, I need help with getting the account receivables under control. And how do we get patients to pay? Can you work with them on how conversations?” I go in there and I'll answer the phone and I'll check out patients. I know how to use your software problem.
I'll help out in any way I can. I don't just sit there. I get myself right in as I am part of the team. The office I went out to in Ohio. I spent an hour and a half with his assistant showing her how to take a series of X-rays, because she was new and she wanted to be better. And I said: “I’ll sit with you, I'm not just here for, I'll help you however I can help you. So, I want the one that just has one pain of theirs and they just want to fix it.
Howard: And I can sit here and tell you most of all my listeners - I'm old enough to be your dad and I'm telling you and I'll tell you...
Julie: I'm only forty-three.
Howard: I'm fifty-five
Julie: You’re not old enough to be...well maybe... (laughter)
Howard: OK if you were thirty, I could have had you at twenty-five, plus since I grew up Catholic in Kansas they started having kids a sixteen. When I graduated from high school in 1980, 10% of the girls in my class were showing.
Julie: Oh my god!
Howard: At the ceremony you knew they were pregnant, 10%! So if I'm seventeen years older than you I could be your dad if you grew up Catholic in Kansas.
The point I'm always going to beat over your head is gosh, just get your house in order.
Howard: You'll love dentistry more, you won't burn out, you'll make so much more money. And you always solve it exactly the wrong way. You go into more debt, more debt, more debt and then the more debt causes more stress, more burnout, more disease, more depression and every time I meet a dentist who just has a simpleton practice - they just do cleanings, exams, root canals, fillings, they don't place implants, they don't do sleep apnea, they don't do Invisalign, they don't do all the stuff. They don't have all the initials behind their the name. They just do a million a year and take home three fifty on a four day work week.
God, they are so happy and those are the guys that if they decide to get in the chairside milling, they just write a check for a hundred and fifty and buy the damn machine. If they wanna get a (inaudible: 00:58:14) or they wanna get CBCT, they write a check. Whereas the other person is completely broke, $350,000 in student loan, $750,000 practice debt, there overheads are out of control, they're stressed out, their house isn’t in order and they're going into more debt. So I'm going to say for the eighteen millionth time, dental office consultants, and there's all types, and by the time you're fifty-five you'll have had a dozen different ones come in, but all my homies who invested in consultants make two to three times as much money as all the dentists who invested all their money in clinical skills.
And there's nothing that pisses off the best dentist in the county like, ‘Well, why am I the best dentist in Salina, Kansas, and I make the least amount of money and that idiot across the street, who is not a good dentist, he's driving the big old Range Rover and has all the money and the big house. It's not fair.’ And you know what it's not fair when you are little deer and you go to the creek to drink some water and a damn tiger jumps out and eats you. Life is not fair!
Julie: That's a good analogy.
Howard: Life is a summary of all the decisions you've made.
Julie: Right - good or bad.
Howard: And you went to school to become a dentist and now you own a business and so you can’t just be a dentist - you own a business. And I think the business is 51% of the challenge and the actual dentistry is 49%, so get your house in order.
Julie can get your house in order. I'll vouch for her any day of the week. Thank you for your time today.
Julie: Thank you too Howard. Anytime anytime.