Dr. Ira Kamp sat down with Howard to discuss integrative oral health, acupuncture, massage therapy, practice management, and his book, Journey to Mudryi: The Wisdom That Underlies All Healing
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VIDEO - DUwHF #963 - Ira Kamp
AUDIO - DUwHF #963 - Ira Kamp
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Howard: It's just a huge honor for me today to be podcast interviewing Dr. Ira Kamp all the way from Ithaca New York?
Ira: Correct.
Howard: Ithaca, New York. He graduated from Emory University School of Dentistry in 1978 in Atlanta, Georgia. Did a GPR in Upstate Medical Center in Syracuse, New York. He's on the Indian Health Service Navajo Indian reservation right here in Arizona from 1970 to 1980. Private practice Ithaca, New York since 1985. Certified acupuncturist, New York State, 1983. Eastman Institute, Oral Health Rochester New York, 2006 to present. Clinical instructor. Teaches practice management courses. His hobbies are music, basketball, meditation. It is an honor to have you. Now I had your son on.
Ira: That's correct.
Howard: And your son was podcast number 773, Dental IT Support with Reuben Kamp. Great kid. Congratulations on having a great kid. Now, how old is Ruben?
Ira: He's thirty-one.
Howard: Thirty-one. How many kids did you have?
Ira: Two.
Howard: Two. Is the other one in dentistry too?
Ira: No, she's a nurse practitioner at Cornell.
Howard: So she's in healthcare?
Ira: Yeah.
Howard: I know what the red flag in their mind was, it that acupuncturist? They don't teach that in dental school. How did you get interested in acupuncture?
Ira: Well, I was always interested in that. Even from when it first started. It came to the United States in 1972. One of Nixon's staff was in China and he had appendicitis. He had his appendix removed and he got acupuncture for his recovery, which went really quick. So when I was in college I heard that. And then, when I was in my residency at Upstate Medical Center, there was some - I wasn't involved, everybody heard about it. There was some research on acupuncture there and giving the lock zone and that it would actually reverse the effects of acupuncture, because acupuncture can release endorphins. And then, in my travels, I took a course in homeopathy. And then a person teaching it just told me about another dentist in Woodstock, New York that did acupuncture. I went to visit him and he inspired me. And it just happened that New York State was offering a certification program. And I took it.
Howard: Now did that dentist go to Woodstock?
Ira: Pardon me?
Howard: Did he go to the concert Woodstock?
Ira: I don't know that.
Howard: You did never ask him that?
Ira: I never asked him that.
Howard: They say if everyone who says they went to Woodstock actually did, it would've been like, half the country would've been there.
Ira: Yeah, I didn't ask him that.
Howard: So, a lot of dentists are conservative. They hear anything about naturopath or holistic or acupuncture, they just go crazy. And I always operate in the field that, when you go back every hundred years back in time, and we just, I mean, leap frogging up and so we know what we know, what we don't know we don't know, I'm sure a thousand years from now we're going to look like we're in the Flintstones. So I was operating the mode that, we only know probably, what percentage of all knowledge do you think homo sapien is aware of right now?
Ira: Probably about 20%.
Speaker 2: OK. So they don't even know what dark energy is, dark matter, they don't. So what's the science behind acupuncture?
Ira: Well, it is scientifically...
Howard: Do you think it's real or do you think it's psychosomatic?
Ira: Well, as I stated before, there was some research done in 1979. I heard about it, that they did research with people and they found the effects of acupuncture were helpful, and then they injected them in the lock zone which was reversing the endorphin release. And they found that the effect of acupuncture would be reversed also. So that's one of the first studies I heard. And then acupuncture is something that's licensed in New York State and other states probably. I guess it's licensed here, there's acupuncturists. And to get a license, there has to be some scientific evidence that it does have an effect. So.
Howard: And there's also looking for niche markets like, I know a dentist who, you know, everybody else's advertising this and that, or their hours or what insurances they take, and they said "My dental office is off the grid". All of our energy is ran by solar power. And he has millennials driving an hour across town because they just, they really relate to someone. And another huge buzzword on websites is, natural, alternative, holistic. And I know the dentists on Dentaltown, they just cringe when they hear that kind of stuff. But my God, the market wants it.
Ira: Yeah, I use the word integrative. In fact, there's a sign in front of my practice called Integrative Dentistry, and that's what my website is. So it's more about bringing it into what also works. It's not leaving anything out, just checking things out, what works and what doesn't. We also do surgery, we do implant surgery, and we do oral appliances for sleep disordered breathing and we do general dentistry and we have massage therapists that work in our practice. That's probably the one thing I can recommend for people. If you're looking at making something work in your practice that makes a difference, is having people have massage therapy while they're practicing dentistry. And what it does, it does two things. One, it has the patients be real comfortable in the chair and also helps us dentists.
Ira: Dentistry is a very stressful process for dentists. We're so close to the patient's face and we're doing this work that potentially it hurts. So what it does is that the patient is so comfortable in that chair that there's less expression of being nervous or it being maybe painful. And what that does, it reduces the stress on me immensely.
Howard: Sure.
Ira: In fact, I tell my patients "You're doing this for me, not you". Because I feel so much more energy left after I practice in a day that the massage therapists are there. So the one thing I would recommend highly is having massage therapists in your practice. I don't charge the patients for it. We used to charge in the beginning and they wouldn't pay $25 for massage. They will pay a couple hundred dollars for restoration, but they wouldn't want to pay $25. So we just incorporated it in there and it works.
Howard: So the massage is in the dental chair?
Ira: Sure. Yeah. So they're at the patient's feet.
Howard: It's what?
Ira: They are at the patient's feet.
Howard: Oh, it's only foot massage.
Ira: Yeah. Before and after they'll do other things or sometimes they'll do their hands and arms, but primarily it's foot massage.
Howard: And you have a very successful practice.
Ira: Yes.
Howard: Okay, so first of all, here it says on this website, identalspa, his mission 'to practice in an environment that offers comfort to our patients, delivering caring therapy and commitment and excellence in the services we provide'. Our services. 'We integrate traditional dental services with sleep therapy, acupuncture, massage therapy, nutritional guidance and natural remedies.' And counting (inaudible 07:16), he’s got four doctors in there. Ira is in there, Mavis, how do you pronounce...?
Ira: Mavis Ng.
Howard: Ng? Mavis Ng? Elizabeth?
Ira: Recchion.
Howard: Recchion. Gabrielle?
Ira: Ciornei.
Howard: Ciornei. That's your secret to success. Four dentists' names you can't pronounce. We've got one, two, three, four, five, five hygienists, three massage therapists. I mean, this is hugely working, isn't it?
Ira: Oh yeah. There's a few things about my practice that I think are important. The first thing is with my staff. My assistants are specialists. So one of my staff - and they can assist with general dentistry - all of them are cross trained. So they can do the front desk, they can assist, they can clean up, seat the patients. So they're all cross trained, there's not just one job they do. I have one of my assistants, Tracy, she does the sleep medicine oral appliances, so she handles that. We have a computer program through DS3 and she handles all the insurance...
Howard: DS3?
Ira: DS3. That's Dental Sleep Solutions.
Howard: Ok. Dental Sleep Solutions.
Ira: Yeah. So she handles all that. She handles the insurance...
Howard: (inaudible 08:38) linked to DS3.
Ira: She handles all the insurance, making sure that...
Howard: Is that medical or dental?
Ira: It's medical insurance, but computerizing it has made it a lot simpler. I've done oral appliance therapy since the early two thousands and we've been using this for about a year. It has made a difference in finding out how much the insurance is gonna cover, which makes it easier for the patients. So she handles that and I can talk about the whole hour about just that and how we run that. We have Dr Ciornei, she's actually a practicer out of Rochester, and she comes out once a month. She's double-trained as a oral surgeon and a periodontist. And she comes down and we have her come in and do implants on her patients. She is awesome. She's world-class. Every patient has to get a cone beam...
Howard: So she is a board certified oral surgeon and periodontist?
Ira: I don't know if she's board certified. She's an oral surgeon and she got...
Howard: An oral surgery residency?
Ira: Well, she got trained in Romania with oral surgery and she got trained at Eastman Institute of Oral Health for perio.
Howard: So she's a periodontist in the United States. And a oral surgeon from Romania? Can you place implants too?
Ira: I have placed implants. I do mostly mini implants, for people who can't afford it. At a reduced cost I'll put mini implants in for people, mostly for single crowns. I'll do that.
Howard: For her implants do you have a CBCT?
Ira: Yeah. She has one in her office. Our patients have to travel a couple hours, but she makes it so reasonable for them. It's a few hundred dollars rather than a couple of thousand dollars if you stayed in Ithaca. She uses it and she makes surgical guides out of that.
Howard: Do you mind sharing what you pay her to do that? Is there a percentage?
Ira: OK, well the patients pay about $1,850 for the implant to be placed.
Howard: Just for the implant?
Ira: Yeah. And then about $1,800 for the crown, the abutment and the crown.
Howard: So the whole thing is 3,600. You split that like...
Ira: No, I pay her $700 for every implant she puts in.
Howard: So you pay $700 for an implant, but you charge...
Ira: We charge about $1,600. 1650. Now the idea is that...
Howard: So you pay her seven hundred but you charge sixteen fifty. So what percent is that?
Ira: That is probably about 45%.
Howard: Seven sixty... would it be seven sixty? No, you seven hundred, right? You said seven hundred.
Ira: Seven hundred.
Howard: Divided by sixteen fifty is 42%. And the point I try to make with this is that a lot of dentists think "Well I'm going to go learn how to place implants". So they buy a $100,000 CBCT, they'll fly to the Dominican Republic, they'll buy a bunch of inventory. They've dug themselves into a hole of like a quarter million dollars before they place an implant. And I wouldn't want an implant placed on me placed by someone who only placed one implant. The only way you placing implants gets profitable is if you, or anything profitable in dentistry, you got to do at least one a week.
Ira: Yes.
Howard: That's why you probably all do fillings and crowns you do, but these dentists that do one every two weeks or they do 10 or 15 a year. If they would've had a specialist come in like you and pay him 42% on what they do, they'd had no debt and they'd had extra income on their existing assets. So they'd increase their return on assets, they'd increase their return on equity, their balance sheet doesn't get burdened with debt and that's just the way to do it.
Ira: Actually, she's the third surgeon I've had. And teaching at Eastman has given me the opportunity to meet people who have special skills in this area, whether oral surgeons or periodontists. And I've invited them down. So I've been doing this for about 13 years. She's the third surgeon.
Howard: And how far are you from Eastman?
Ira: That's two hours.
Howard: Two hours. So you have people come down from there?
Ira: I had people come down. Yeah.
Howard: And a lot of these big implant centers that you see in these big major cities, you don't realize that the people placing all the implants are, like they have a big one in Phoenix and there'll be the specialists coming down from Flagstaff or up from Tucson. So they'll go put it in these big implant centers and they'll get surgeons to come from some town at fifty thousand, that's a two hour drive away, that says "I wasn't going to get any of this market anyway, I'll just come in and..."
Ira: When you have somebody come in and doing the work and this person is world class, so I would trust her with just about anybody, you also get back up. We get back up 24/7 if we need it. She's really there for us. Not only for these cases but we can discuss the cases with her and she's restored them also when she taught it at Eastman Institute, she also did restorations on the implants, and therefore she has a perspective of not only putting them in, but how to put them in so they're restorable.
Howard: Did she restore them?
Ira: No I do it. But she's capable of doing it.
Howard: Does she only use one implant system?
Ira: We use Straumann.
Howard: Straumann?
Ira: Which is expensive, but I want to give my patients the best there is.
Howard: So why did you the most expensive, Straumann?
Ira: Because that's what she picked. It was either Astra or Straumann, that's what the surgeon said.
Howard: And Astra is Dentsply Sirona?
Ira: Yeah.
Howard: And Straumann is the largest implant company in the world because they bought, what's the number one implant system in Brazil?
Ira: I don't know.
Howard: What is it? Neodent. Good job, Ryan. They bought Neodent, they bought, what's the one in Israel? The initial standard IMS some implants... I think it's IMS, stands for something... Israel? What does IMS stand for? Make it simple. IMS, Implant of Israel, make it simple. So he bought a lot of other regional players but, yeah, so you think it's worth the money?
Ira: I think it's definitely worth the money. Not only do you get the implant and then you get to restore the crowns or bridges or dentures over dentures, you also get somebody to back you up. That you don't have to worry. That person is part of your practice and therefore any problems that come up within your practice, you don't have to worry about going...
Howard: And the young kids watching this, they don't realize that when you get out of school at twenty-five and do ten veneers on someone, that ten years later, is any of that going to need rework?
Ira: Could be.
Howard: So you placed an implant out of school and you saved $100 on the implant because, like the country of Italy alone has over a hundred different implants, so you found some implant on the Internet and then ten years later something goes wrong and the company is non-existent, you can't find the part. And if it did go to court, you know what the plaintive is going to say "Well show me the research on this implant". Oh, they're out of business, I have no...
Ira: Well going back to my assistant, Joyce. You and I were talking about assistants and having them as specialists. Well, her thing is that she runs our implant practice. Now Dr. Ciornei only comes one day a month, but there's definitely enough work of arranging her patients appointments and making sure we have the right radiographs. And so some of it is arranging all of that. So she does general dentistry and...
Howard: Who's this?
Ira: No she doesn't do (inaudible 16:18). This is Joyce. She does general dentistry as an assistant. She doesn't practice dentistry. And then continuing with that, I have another dental assistant that loves the lab work. And now she's being trained to be a dental labtech. Right now it's just removable, but what I'd recommend for people who can bring somebody into their own practice, who loves doing dental lab work, you don't have to send it out. It does two things. One, it gives you immediate results. You can get that lab work back without having to worry to mail it or have somebody to pick it up...
Howard: So your own assistants do your dental lab work? Does she do the lost wax technique or...
Ira: Oh, we haven't gotten to the removable yet, although last week....
Howard: I mean crowns.
Ira: Yeah. But lost wax technique may be passe. Most people are doing zirconia now, right?
Howard: Right, so is she doing...
Ira: No, not yet. But we're starting. This is just kind of a new thing that we've taken on because she has the passion for that. So right now she's doing more removable, like flippers and Essix retainers, those are excellent appliances for replacing teeth after surgery. So that's what we're doing. But we're slowly building up. She has the skills and she's going to do removable. Probably not the frameworks because we wouldn't have room for that in our office to have that. But she'll make dentures, you know, whacks them up. And that's a great thing. If you're looking for ways to make your practice successful, having your assistant specialize in these things is a great thing. Not only does she do that, but she's a great dental assistant. Cross-trained, she does everything.
Howard: And how long has she been with you?
Ira: She's been with me ten years.
Howard: And the patients pick up on that the most. I mean, employee turnover is about the best way to measure anything.
Ira: Yeah. Most of my employees have been with me for ten or twenty years.
Howard: It's hard to grow real value in a service business, or actually any business, with a bunch of employee turnover.
Ira: Well it is. So what I'd recommend is giving your employees as much responsibility as you can handle and also within the legal realm of whatever your state board says is OK. But really give your staff as much responsibility as you can because that makes them grow. So I have another dental assistant, she takes kind of care of patient relations, to make sure everybody's good and comfortable. So that's her, that's (inaudible 18:42). So I have four dental assistants and each of them has a specialty.
Howard: Four (inaudible 18:49) just for you?
Ira: No, we have a four dentists that are working with us, although only two of us are full time. But having the assistants take on as much as that is possible.
Howard: So, the rumor is that, well, most animals are controlling because it helps with their survival. I mean, you don't want to have a chaotic environment, you will be eaten by hyena's, So a lot of dentists are very controlling and don't let their staff do anything. What advice would you give?
Ira: Well, if it works, keep doing it. I mean, sometimes that works. There is a space for it. The military does it, I guess. However, in my practice and how my way of being, it wouldn't work any other way. I wouldn't have time to control everything. And the word control is interesting because, you know what the opposite of control is?
Howard: What?
Ira: Trust.
Howard: Really?
Ira: Yeah. So the opposite of control is trust. So that's the thing to develop. Can you trust the people around you? Maybe the people that control so much don't have enough trust in the people around them.
Howard: What are the basic elements do you think in a successful practice? A lot of the people that listen to podcasts are young, they just got out of school, they're working as an associate somewhere, they want to own a practice like you some day. What are the elements of a successful dental practice?
Ira: Well, some of the things I gave you are part of the working. When I teach residents, they're from all over the world and have different cultures. So what that means is that they have more to learn about our culture. It's not like you can just speak about what it is like to be in our culture. So, there's three C's I call. One is confidence.
Howard: Confidence.
Ira: And actually the first one should be competence.
Howard: Competence.
Ira: You want to make sure you're competent in what you do. The second one is confidence. Have confidence in what you're doing and how you work. And then the third one is communication. So all of those three. If you want kind of a foundation of how to be in a practice, you have to look at yourself in those terms. That's important.
Howard: So competence. That was one of the reasons I started on Dentaltown the online CE. We now have four hundred classes. That's why I'm doing the podcast. I noticed over the last thirty years that no matter where that dentist started out of the gate, if they consumed a hundred hours of CE a year or more, or even two hundred, three hundred, the cream roasts right to the top. I'm trying to do the podcasts where they got an hour commute to work. Then you get to listen to all these amazing minds like you. They might not be able to go to the Chicago Midwinter meeting next week, but they can take 400 courses online. What do you think leads to competence the most? Is it continuing education?
Ira: I think we got to work together. The thing is we're very individual in our society. We don't have training or we're not trained to work together. We all have our own boxes, our own office and everybody is on their own. And the idea of working together, you're getting to partnership. There's a problem just like marriage, they don't work very well.
Howard: Yeah. And then the partnership in dentistry is a sexless marriage with no children.
Ira: I know.
Howard: And you don't spend the holidays together.
Ira: I've been there and done that.
Howard: In marriage or partnership?
Ira: Both. But I'm married too. I'm married a second time. But in partnership it didn't work.
Howard: So you had one divorce? But one failed partnership in dentistry too?
Ira: Yeah, they were happening at the same time. So that's a whole interesting story.
Howard: Yeah. Well, these dentists, they don't realize that there's a lot of glues that hold marriage together.
Ira: Right. So for young dentist, you're going to have to find somebody to coach you. When I take on an associate, the first thing I say, "I meet the excellence and I want you to be excellent". And I say "If it takes you an hour or the whole day to do a restoration, do it". And I think we as experienced people, have to give back to the people who are just graduating, rather than being a competition. We have to make it so it works for them because they're going to take our place. And hopefully they take our place in the context of excellence. So. having excellence as a basis of practice is really important. And I think for the young dentists "You need to find people who are willing to take this on".
Ira: So what I'd like to say is that our practice is like breathing. We breathe in and we use the oxygen and whatever else is in the air that we need and we give it out. And I think our practice should be the same way. Our practice in life. We have to learn how to take in, how to take a breath in, and people who are coming out of school have to learn that and they're going to have to depend on us to learn how to breathe in, with all the stresses that are there. And then the second thing is how to use it. How do you use the information in the best way, how to manage your practice. And then the third thing is giving back. I think it's important that all of us eventually, if not right away, give back. It's important for us to give back to the people who are graduating. Take them on. Take them out as a way to nurture your own lives. It will make our whole industry better and it will serve people better if we take on helping other people become great, excellent professionals.
Howard: It makes me wonder why you chose dentistry.
Ira: Wow. What a question. Well, my story is that I didn't. When I grew up, as a patient, dentistry sucked. It hurt. I didn't have any anesthetic. My dentist would threaten me with these black things that "I'm going to cut your tongue off if you don't hold still". So I didn't grow up with this thing "Wow dentistry, what a great thing". And by the time I was fifteen, my dentist finally gave me some local anesthetic. I said "Why didn't you do this before?" So anyways, it wasn't a friendly atmosphere for me with dentistry. So then my father, George, bless his heart, he's not alive anymore, but he was not really an inspiration for me. And I had an older brother and he wasn't an inspiration for me either. So my sister ended up becoming engaged in marrying this fellow Alan Shernoff, who went and applied to dental school. He applied to dental school and got in and so he was actually a male figure that I could look up to. I didn't have anybody else. If he was probably a garbage person I would've followed him. So he happened to be in dental school and I went and visited him at the University of Maryland, and he was making a denture. And I said "Wow, what a great idea". (unclear 26:00) So I went and applied to dental school. That's what got me in.
Ira: It's been a hard road. Dentistry is not easy work. It's not easy work. And even from the beginning, I had to learn how to be an artist. I was not naturally an artist. I had to learn how to be an artist and luckily the school was able to teach me that. So that's how I got into it. But my passion, it's what we talked about earlier, before we started, my passion was really about helping people in their lives.
Howard: So you're born in Ithaca?
Ira: No I was born in Syracuse, New York.
Howard: Syracuse. Went to dental school in Atlanta, Georgia. My Gosh, I would think going from freezing cold northern New York State to Georgia. Was it hard to leave and go back to the frozen.?
Ira: Between there I actually traveled around. Family is what brought me back. My parents were still living there. My father was sick, he had lymphoma. And my wife's parents lived in Schenectady, near Albany. We had a girl, a baby girl, so that's what drove us back and we landed in Ithaca. I found a job in Ithaca, didn't last very long, but at least it got me there and Ithaca is a wonderful place.
Howard: And then you came out here to Arizona for the Indian...
Ira: No that's actually before. I moved from here and actually it was '80 and '81 that I was in Indian Health Service. (inaudible 27:30)
Howard: Oh, just '80 to '81? So just two years?
Ira: Yeah a year and a half I was here.
Howard: Was it in Tucson City?
Ira: No, it was a place called (unclear 27:37).
Howard: But in Arizona?
Ira: Yeah. It was about a hundred miles east of Tuba City on the same road.
Howard: What was your experience from a year and a half on the Navajo Indian Reservation?
Ira: Well how much time we got?
Howard: Because Arizona, 25% of the land is Indian reservation.
Ira: I know. It was a pretty awesome experience. I'm going to tell you one story that I got from there. I was a dentist in this area, (inaudible 28:03), which means 'no water'. The Indian Health Service built this boarding school and clinic where they didn't realize there wasn't any water there so they ended up pumping and then they found out why they called it (unclear 28:15). Anyways, I was a dentist and there was a couple of nurses on this compound and the closest physician was probably about thirty miles away in Ganado or Keams Canyon. And the first emergency I got was somebody came to my door and they were pregnant and they were were about to have their baby and they came to my door for that. So I said, "No, you got to go to the hospital". But then there's one morning, it was a Saturday morning and I'm allergic to bees, I wanted to put that out there. So I got a call from this girl on the phone and she says, "My sister has got a bee stuck on her finger." So I said "Well, take it off". She says, "I can't get it off". And I said "Where are your parents?" "Well they're out with the cows". Well, the cows, it's open range there and the cows just roam around. So they were out. So I said, reluctantly, I said "All right bring her over to my house". I had a screen door, so I was going to look through it and she had to bee stuck on her finger. What am I going to do? (unclear 29:04) family, how am I going to handle this person? And the nurses weren't around to handle it or anything. So she came and they came to the door and I looked down and there's this like three-year-old, and on its little finger, there was a B. But there was the letter B. It was the letter B, one of those refrigerator magnets and she had it jammed on her finger and couldn't get it off. And it blew my mind. I took her over to the dental clinic and cut the B off.
Howard: Oh my God, that's hilarious!
Howard: My youngest is allergic to bees and he was stung by bee one time and it got all swelled up and everything and we get an Epi pen. The second time he got bitten by a bee, it was an ambulance. So then we did that, allergy, started giving him the shots and all that kind of stuff.
Ira: But I was stationed in a place, as I said, thirty miles from anything. And I was alone, there weren't any other resources except the telephone to call (unclear 30:00) if I had a problem. And many types the phones didn't work. So in that I'm newly out of my dental residency and there I'm left alone in this place.
Howard: You have a dentist, periodontist who was trained in oral surgery in Romania, come in and place implants. What do you think makes a great implant restoration designer?
Ira: Well, first of all, she was also trained it in United States for perio. So she's double trained. What makes a great implant restoration. Well, first of all, it works. It's just like I say, when do you know you need a (unclear 30:39) Is when the crown falls off and you look at the crown and say, "Oh shit, I should've put a post in there". But what makes a good one is probably really good planning, to make sure there's enough bone around the implant. I think the ones that I've seen fail, usually there's not enough circulation. The bone is really thin and it just can't handle it. It's too thin for the circulation to handle and the bone recedes.
Ira: I think you've gotta also a success if the person who is placing them, has some experience in restoring them because if they're not put in the right spot, then our job is to restore them. That can be a real headache. It's really important that the patients have great care before the surgery. And that means making sure they've got the proper medications. Doxycycline seems to be the medication of choice after implants, at least for our surgeon, because it's not just for antibiotics, but it turns off the osteoclasts and therefore increases the survival of the implant. Our surgeon, she buries all the implants, all of them are, so it takes a second stage. So that has been very successful. But the main thing is the preoperative planning and making sure you have them in the right spot.
Howard: Yeah, a lot of the dentists want everything faster, easier, quicker. And sometimes that can buy you longer, and right now it seems like the problem. When we got out of school it was all periodontal surgery, doing all this heroic save the teeth. Then they got this idea led by manufacturers that implants have a 98% success rate. So they started treating all the periodontal diseases, furcations and all that stuff, with just titanium and steel. But now that I'm out of school thirty years, now we're seeing that 20% of implants have peri-implantitis at five years and a third have it at nine years. And the periodontists themselves don't even have agreed on a protocol for this. What do you think causes peri-implantation?
Ira: Well, that's a good question. Well, one thing is, and I came up with this on my own, although I'm not the only one that's done this, but I was having cement that's pushed down into the sulcus of the implant and that supposedly caused it. But nobody really knows why they fail. I think they fail also how they're put in. If there is not a bone around there, it probably won't work unless you're lucky. Luck has something to do with them working. But what I found restoring them is that, and I discovered this, one time a patient of mine had a PFM crown, which was one of the first ones I did, and I cemented on with permanent cement over the implant. He came back and the lingual cusp had broken off. So what am I going to do? Am I going to cut the whole crown off?
Ira: So what I did, I made a screw hole in it. I drilled in there carefully until I could find where the screw was and then I can unscrew it and it came out like a screw-retained. And I got something to say about screw-retained. So I got the idea, why not put a screw hole in the crown to begin with? Why wait until after they fail or someday the crowns come loose. Why wait until that happens to try to take them off? Why not have it already there? Now screw-retained implants do have that. And that's the great thing about it, except putting screw-retained implants when you have adjacent teeth (unclear? 34:28) to the tooth, is a pain in the ass. Especially getting contacts right. You put it in, you have to keep taking it in and out to get the contact right and then you torque it in and the contacts are to tight. Some people just leave them and hopefully it works.
Ira: But I didn't do that. Then I would have to take it out and torque it in, and it took me several times in and out. So what I came up with is, and I try to brainwash the residents about this, is to do a custom abutment for every case and make a screw hole in the crown. A zirconia crown, and then mill it exactly where that is and when you cement it, and I use permanent cement, once you use temporary cement, if you wait long enough, the (unclear? 35:24) you can't get them off. And what it does is that when you put the cement in there with the screw hole, the cement will vent out through that hole and you won't get that pushing. You won't get that force or pressure pushing the cement into the sulcus. So I think it helps with that. And then what you do is you clean that off and you put a composite on top of it. I have slides I show the residents that I don't care where the screw hole is. Even in number eight, I did it on a patient and the screw hole came out the buckle. I believe in this so much that I will just blend in the composite to that. And if there's ever a problem, it's really easy to take them off.
Howard: So just remember young kids that are still in dental kindergarten that dental manufacturers have a whole history of a misleading us. When they tell you their implants have a 90% success rate when all literature says at five years, 20% have peri-implantitis. And that excess cement, how bizarre is it that, that cement is called dental implant cement, with the ADA seal of approval and if there is any excess, that causes peri-implantitis, gum disease and failure. I mean, what do you think are the protocols for a dental implant success is that if a dentist missed some of the excess cement, it wouldn't cause catastrophic failure.
Ira: Well, it's also, you have margins that go subgingival enough you can't clean the cement off anyway.
Howard: How many product burns have you been through? What year did you graduate you said?
Ira: '78.
Howard: '78. How many product burns have we gone through? Dicor. Remember Dicor? They said, and this is back in the eighties, "If she's a beautiful woman, just do these Dicor crowns". What percent of yours broke?
Ira: I didn't do many Dicors. What I did with was...
Howard: What are the ones you did?
Ira: Procera crowns. They had aluminum cores or they even had zirconia cores, but the porce would fracture. So the first thing I did was...
Howard: So Procera had the titanium ones?
Ira: No, you know what would happen is the whole thing would fracture. When they were made with aluminum cores, after three or four years, the whole thing would break. Half would break off.
Howard: Remember (unclear? 37:42) calls her. The (unclear? 37:43) came off the glass. Ivoclar's Targis Vectris?
Ira: Yeah. You can tell the young dentistry and say you're going to learn a lot from us because we've had a lot of failures.
Howard: But I learn mostly from the millennials because when I was young and dumb and aggressive, I believed all the marketing and tried everything. Now at my age, it's like I'm going to let you guys all try it. I want to see everything you're doing five years later. You got all these problems, all these things you do that aren’t broke, but the younger are always trying the next best thing and I want them to try out the next best thing, and then I want to see if it works.
Ira: Yes, that's true. But it might be our responsibility, somewhat, especially in this venue to give advice to the younger dentists that "Hey, this works". And "Look..."
Howard: And don't try anything else for five years.
Ira: No, you can try. Yeah, don't try anything out for five years, but somebody's got to do it, but just know if you do it, the risks are high. Right now zirconia, although it does have its problems, is probably the best material that's come out for crowns. Man, it's like...
Howard: But someone will say, "Oh, here's a zirconia where you can put porce on". It's always a twist or a turn. And again, when you own your own practice like I do, where I used to place on all these Dicors, you know what percent of them ended up breaking eventually between five, ten, twenty? All of them. And guess how many I had to redo for free under warranty?
Ira: Right. And the lab doesn't take any responsibility for it.
Howard: Oh yeah, yeah. I mean you were doing art glass and Targis Vectris, you call your lab man. I did it, it all fell apart. Oh, you know, you should've done a PFM.
Ira: I got it.
Howard: Well, you do the PFM for free? No. So be cautious. Even that, what was that other one that, (unclear? 39:34) that thing for bone grafting, well just take the extracted tooth, throw it in that thing that looked like, in the movie Fargo, the pulp chipper, and you just had all this nice graftable stuff. Well, I don't know if any grafts that are part enamels, cementum, dentin, microorganisms, fungi, viruses, I don't know if that's a good idea. I really want it to be a good idea, but I'll let someone else try it first.
Ira: What you can do is, what I usually tell the residents and tell myself, "If this was your sister or brother or mother or father or child. Would you put that in them?" If you say yes, then that's a really good test.
Howard: That's confusing because if it was your sister, you'd kill her. Kill the patient. To your brother, you do it for free. No, I'm just kidding. You have two children?
Ira: I do. Actually I have four. I have four children because my wife has two. We got together. One is in Colorado and my two children are in Ithaca. I'm very blessed for that. And then we have a daughter that's in Colorado, Telluride, beautiful place, and then we have one in Washington DC.
Howard: But actually you have five children. Because you wrote a book, and I've written a book and I would say writing a book is like having a child. I mean, it takes you nine months. You wrote Journey to Mudrye?
Ira: Mudryi.
Howard: Mudryi. What was going on in your journey to write a book Journey to Mudryi, and I guarantee it took nine months to write that book.
Ira: Well, maybe more like twenty-five years.
Howard: Yeah, so that's why I say writing a book is like having a baby. I mean, it's a huge commitment. You don't write a book on a weekend.
Ira: Right. And I called it a journey because when I started writing, what I ended up with, is something totally different. So when I was in dental school, again, you're talking to somebody who was never really enamored with dentistry. I was more about service to people. So that's where I come from. I'm not this person that says, "Wow, look at these great stuff, isn't it great to be a dentist". It's more about how can I serve the people best and excellent. And in dental school in the seventies, it was '74 I started, it was a little more barbaric than it is now. You know, the anesthetics weren't as good and the instruments weren't as good, so it was more barbaric.
Ira: There has to be another way maybe to do this. So I started looking at alternative ways of doing things and it started with homeopathy and dietary things. I mean, you are reading about sugar and refined foods and I gave them up myself because I was telling my patients to do that. So I started bringing those in and I thought that that was the secret to having the patients be healthy. And I kept taking that in, and my book explains the journey. I kept taking on new things, like acupuncture, homeopathy, herbal supplements and nutritional supplements and looking at a lot of hands-on healing. And really exploring what was going on in alternative medicine. I was trained as a scientist through my undergraduate at the University of Buffalo and in dental school. Science was really important. So I felt myself as a scientist and I had this curiosity of what was going on here in alternative medicine.
Ira: And through my journey, I found that the wisdom about the relationship between the healer lies within the patient and not the healer. The healer can develop a listening for this and it's not something that comes out of their mouth, it's more something that's unconscious, but we can become conscious of it. So in my journey I discovered that the patient has the wisdom to guide us in their healing. We just have to do what we do, but we do it with their guidance. I needed a word that said, "A person who is sick and has wisdom", and there's nothing in the English language that has that. So I asked a Russian friend of mine who's an acupuncturist that I work with, Vladimir Bobkoff. I said, "Is there a Russian word that says, the person who is sick and has wisdom?" And he said "Mudryi". Although I think Mudryi means wisdom in Russian, it was so poetic, I just made it mean that. So the book is not about healing techniques, but it's how to develop a listening for our patients, and as a patient how we can generate a listening in the people who are treating us.
Howard: You know, thirty years chairside, I've read many things how, when people who go under severe cancer, stage four cancer, how their psychology and their deposition has so much to do with the outcomes. I mean, I have told people that were seventy-five years old "Man, you have oral cancer". They had like a big lump in their throat and they just like, wave and I'd say, "Well, you need to get this biopsy". And I'd show them and they'd be like "I don't even care". And I'd be sitting there, thinking "Wow". And it's amazing how some people are told they have cancer and they're just optimistic. I'm going to beat this. And they clean up their diet and exercise, they start eating lean and they're all positive and there's just a lot of people that say those people just have a much better success. I mean it is mind over body and there is just so much things that we don't know.
Ira: Yeah, that's part of it. The book is mainly about the relationship that we have with our patients. Whether we are acupuncturists or dentists or physicians, there is a communication that happens and I try to keep it as scientific as possible. I use Jungian psychology and meditation. And even some things of meditation are scientifically proven to show that it creates a calmness within us, it opens us up to a different realm of being.
Howard: Now is that book on Amazon?
Ira: Yes it's on Amazon.
Howard: You can also go get it on jtmnow.
Ira: Well jtmnow is my website for the book, this Journey to Mudryi. But that'll guide them to Amazon.
Howard: Well, all your reviews are five star. You don't have any reviews that are not five star. That's pretty damn impressive. I heard some dentist the other day, telling that he got a one star from a patient and he called her up and he said, "Why did you give me a one star?" Isn't that the best? So she didn't even know that one star was worse.
Ira: Oh right, that's awesome.
Howard: It sounds like one star would be the best when you're a homo sapiens living in our solar system, one star. I mean, would you want to live in a solar system with five stars in it? So it seems kind of not intuitive. So if there was a young dentist listening, which, you know, they are, a quarter of them are in dental school, the rest are under thirty, how do they learn more about alternative medicine? What you teach in a science base?
Ira: Well, the first thing to do is explore online, and at least get a taste of it. You have to have a passion for it. Which I do and I did. Part of my passion was to help people. And you have to have a passion for this. Is it necessary to run a practice this way? No, there are many successful practices and you don't need to do this. I would, my passion guided me this way. So, one thing to do is to go online and remember online, I don't know how much you really going to get that truth and science, because that's not what it is. What it is, is to try to get the information out and who knows if it's true or not. But that at least it gets you started in the language. There's a whole language that accompanies this. It's a specialty just like any specialty in dentistry. And once you learn that, there are things written in dental journals, and there are people that give courses on nutrition. You'd want to go to the Hinman meeting, that's where I go to every year in Atlanta. And there's usually people talking about nutrition there. And you can get some basic things there.
Howard: But, you know, nutrition to me it's kind of like politics or like (unclear? 48:17) medicine.
Ira: Yes.
Howard: When you look at nutrition, I mean I'm fifty-five, how many diet fads have we lived through?
Ira: Well, I think what you got to do is try it on yourself and your family. You want to kill your sister? (inaudible 48:31) First I started with homeopathy and all the supplements I tried it on my family and my children were really young and I saw that they had great reactions to natural remedies. Instead of giving them medication they were access for my experimentation. I used my own family and homeopathy works great on children. That's just a great thing because there...
Howard: But dentists are a conservative bunch. I know dentists. I mean, I've lectured a thousand times live to dentists.
Ira: Sure.
Howard: They tend to be conservative. They're more likely to be Republican. A hillbilly redneck. I mean they're conservative and dentists are coming to me saying "That's so cool that you talk about your brother on the show, that he's gay. I'm in a small town in Texas. My biggest fear in life is that the other dentists will find out I am homosexual. It would probably just be horrible." I've heard other dentists say "Well, I had to withdraw from the local dental society because I'm a holistic dentist and you know they just (unclear 49:38)". Have you got anything to push back?
Ira: First of all, the word holistic, I don't think it's empowering. Because in itself it separates. There's traditional and there is holistic and there's a tension between the two. That's why I think integrative is much better.
Howard: But does the market know what integrative means? I mean, they all know what holistic means. Do the consumers in New York, when they see integrative, do they think...
Ira: Well, you know, for me it doesn't really matter. Again, we're going to go back to the word passion. That for me, when I'm passionate about something, it's going to spill over to my patients. And I don't advertise at all. It's all by word of mouth. And so I just introduced this into my practice not to quite make money, although that helps. I don't sell the supplements much. It's more about service to the patient. When you give great service to the patient and it comes in the form of giving homeopathic remedies or nutritional supplement or giving medication, you know, giving doxycycline for people who have periodontal disease or having an implant, it's all in the realm of service. And if you can keep it that way, then there's not so much polarization there. I really would recommend, if you have the passion for this, looking at to integrate it into your practice rather than making your practice separate from other people. Because we all want to be special and so we attract patients, but what's going to attract patients is word of mouth.
New Speaker: Advertisement is okay. It's expensive. But word of mouth is the best thing. So, I had three things I wanted to talk about. One was my practice and hopefully you got a handle on some of the things that go on in my practice. And then I teach at a place where you get oral residency and I'd highly recommend that for a couple of reasons. One, I know dentistry is a branch of medicine, but we're not trained that way. But you go and practice in a hospital setting or even our practices, people come in with all lists of medications and we're supposed to know about it. If not, you know, we're not barbars anymore. So one thing, that teaching gives you an access about integrating medicine and dentistry and I think it's really important. Other countries do it. They start out in medical school and then become dentists.
Howard: Well, the Soviets do it.
Ira: The Chinese do it. I spent a week in China speaking at a dental hospital there.
Howard: And how does China do it?
Ira: They got to go to medical school first. That's another whole story. I don't know how much time we have left, but I could spend another hour talking about my trip to China.
Howard: Well, let's hear it.
Ira: You've got time?
Howard: I'm here.
Ira: Well China is a... They go to medical school first and they go for two years and then they branch off into a specialty of dentistry. So they have very little clinical experience in general dentistry. The fact is, there's very little general dentistry in China. There's no insurance, there's no social security. Everybody has to pay for their treatments and when they pay for the treatments, they want to have the best. So the culture generates this. So the dentist in China, at least that I've experienced and what they told me, they're all specialists, very few general dentists.
Ira: In Eastman Dental Center we have some of the dentists from China come and train with us for a year or two to learn about comprehensive dentistry. But that's not what the public does. The public wants, if they have a (unclear? 53:15) they go see an oral surgeon, if they have an endo they're going to see an endodontist and like that. And there may not be this care. The endodontist might restore the tooth there. Oh yeah, it was about a student becoming MD first. So what you learn is the dental assistants there have to be nurses. They have to be nurses in China. So it is more of a medical experience when you go there. They have dental hospitals, they don't have private practices.
Howard: We did a podcast with the downtown capital of Cambodia, it was the largest dental hospital.
Ira: So I'm going to finish up what I was saying about teaching. I really recommend people who are coming out of school, go back to teach. Teaching is a way you'll learn the best. What you do is you get to see all the mistakes that are made but other people are doing and you can learn a whole bunch. Also they come and ask you advice for things that you're supposed to know about it. If you don't know about it, it kind of encourages you, inspires you to learn about them so you can improve your own practice. It also will enhance your practice. When people find out that you teach at a university or a hospital, there's just this confidence they have in you that you must know a lot more because you teach there. And I think you do.
Howard: But we were talking about how nutrition is like politics where math is just pure science. There's hardly anything in math and geometry that people argue about. But when you look at like politics, like on, growing the economy. I mean the Ph.D. economists say one thing, but you know, politics is like half Voodoo half science. Nutrition. Every time I talk to someone that has a Ph.D. in nutrition, they tell me when they're hearing so much nutrition advice, they just cringe. So do you get any pushback from your colleagues? I mean, has that made you uncomfortable? That acupuncture or integrative medicine...
Ira: No, when I first started I thought so, but now acupuncture is so common it isn't. But I used to teach acupuncture and I didn't fear it. I don't fear it because I come from a place of service rather than trying to sell something.
Howard: But you do acupuncture in your office? Like how often?
Ira: I do it daily. Patients who choose that instead of a local anesthetic.
Howard: So you use acupuncture to do what type of procedures?
Ira: Well, mostly it's restorative. I mean, I have taken out teeth with only acupuncture, but you have to pick your patients really carefully. When you hear about these people getting surgery, which it can be done, the patient has to have a lot of tolerance already.
Howard: Who is the hypnotist we did in Ireland?
Ryan: Dr. Mike Gow.
Howard: What did he do on that lady?
Ryan: He did an entire implant, (inaudible? 56:25) using nothing but hypnoses.
Howard: And it was filmed and put on TV. It was a television documentary. I mean the mind is an amazing thing can be hypnotized for a rootcanal on the ground.
Ira: That's true. There are people that you can treat without getting them numb. Some people come in "Just take my tooth out". And you say, "No, I can't do that", but some people don't need it. And the nervous system varies from all across the country. When I worked in southern Pennsylvania with the mennonites and they hardly took any anesthetic. Maybe for extraction, but hardly any anesthetic. And I went to Navajo Indian reservation and they all took anesthetic. And now in Ithaca maybe 25% of the people do dentistry without anesthesia. They just choose not to do it. Some of it is the equipment and you use electric handpieces and things like that. It really helps in a decreasing the vibration of that.
Ira: So I want to go back to talking about teaching as a possibility. So the teaching, again, is the best way to learn and helps you integrate medicine into your practice in a way that makes sense. So that's really helpful and it also is a way to give back. I think wherever we are in our careers, giving back is really important. It's like exhaling. If you only breathe and hold it and bring it in, it's not going to work. We need to give back. So Howard, it's our responsibility to give back to these people that are coming in and you do a great job in the service that you give to people, in this service. But I think all of us can do that.
Ira: Another thing I'll talk about it is the third part. One was my practice, the other part was teaching. And the third thing is, how is the community? The community that you live in, is a great way to give back and also it will give back to you. So new dentists, you need to go out and join a church, a temple or something that's going to give you access to people and talking. And when you talk to people they'll say, "Oh, you're a dentist. Oh, that's pretty cool." So I'm involved in a lot of things. I'm involved in a temple, a meditation center.
Howard: A temple?
Ira: A temple, a synagogue. I am Jewish.
Howard: So you're in a temple and a what?
Ira: And a meditation center. I'm a treasurer of a meditation center called the Foundation of Light in Ithaca.
Howard: Foundation of Light?
Ira: Yeah. And that's again another whole story. Although that place is mentioned in my book several times. And then I play in bands.
Howard: What instrument do you play?
Ira: I play guitar, bass, and trumpet.
Howard: And what is your music genre?
Ira: I do a classic rock mostly. And then I also play in a Big Band. We do jazz. My wife sings in both bands.
Howard: And what's your favorite band?
Ira: I'm pretty eclectic. I like all bands. I like the Grateful Dead, I was telling your son. You know I can get into that. I can get into the Beatles. And then Maroon 5, and I know I'm leaving a whole bunch out. It's not coming out at this moment.
Howard: I just saw a study yesterday that was out, I think it was in the New York Times where they use all the data from Spotify. So you know, one of the neat things about these Internet apps is you have a large datapool, like when that mathematician got ahold of match.com's data. She found that the number one variable for hooking up another person was distance. And number two, believe it or not, you had to have a photo (unclear? 01:00:07), but the uglier the person was, the higher the chance they get hit on. Because if you look like Wonder Woman, all the men would say, "Well, I'm not going to get Wonder Woman". But when they see some short, fat, bold chick wearing boots, they think "I got a shot with her". So the research showed, that whatever your flaws, like if you're overweight, show a full body (unclear? 01:00:32).
Howard: But on the spotify deal, another mathematician, because when they're doing their thesis, they want to get a big dataset and try to find order. And she found out, did you read that paper Ryan?
Ryan: What's that?
Howard: Did you read that paper, that music paper?
Ryan: No.
Howard: That the greatest songs for a girl, come in at about thirteen and for a boy come in at about sixteen. So whatever biological change girls are going at thirteen and boys at sixteen, I remember my boys at about sixteen is when you started wanting to see Britney Spears instead of going hunting. You know I had four boys and one by one. I'll never forget the first time it ever happened that they knew there was a girl. We were walking in 7-Eleven and there's this big coke displayed, it had a big cardboard cut out of Britney Spears pointing to the coke and Eric elbows me and goes... Oh my God, he just realized there's girls on this planet. So when you're coming from playing in the backyard sandbox to realizing there's boys, girls. But yeah, they mostly (unclear? 01:01:45). So Beatles. How old were you when the Beatles came out?
Ira: I was probably in fifth grade. I was probably nine.
Howard: Yeah. And Grateful Dead. They only had one Top 40 song. There came out an album every year their whole life. And it was Touch of Grey.
Ira: Touch of Grey, right. That's an awesome song.
Howard: So that was the only one song that ever made it.
Ira: But getting back to the point, that's a great thing about music, but the main thing is get involved in your community. It's a way to give back and the more you get involved in your community, you will be able to talk to people, it's going to work much better than advertising. It is a way of advertising. But it's going to work much better because they get to see you and know you and so whatever you do, at least get involved in some kind of organization where there's folks around and communicate with them. Like a gym is good, but unless you communicate with the people and you're just there working out, it's gotta be someplace where you speak to each other and you've got to talk.
Howard: I always call it (unclear? 01:02:43). When I opened up my dental office you know what I did. I got a map of (unclear 01:02:53) every street, I colored them off with the magic marker, walked down every single street and knocked on every single door and I rang the doorbell. "Hey, I'm Howard Farran. You know the (inaudible 01:02:58) that dental officer, that's me. I'm twenty-five. I'm going to practice till I'm sixty-five." I started to get out and meet the neighborhood and had a backpack and I had gloves, mirrors, flashlight. One in every three houses made an appointment.
Ira: Wow, that's awesome.
Howard: And now, you know what my latest deal for the community is?
Ira: What's that?
Howard: Because it got so big. So you've Dentaltown. On Dentaltown, I've hired Ken Scott in '98 and he still runs the show. He's got five programmers on his team. So five programmers have been working on Dentaltown from 1998 to 2018. Twenty years, so a half million lines of code. I cut and pasted Dentaltown, I live in Ahwatukee, to Tukietown. And now I'm going to paste it for your town too. So it's pretty cool because Ahwatukee has problems with schools and freeways and we had a golf course that went bankrupt and (unclear 01:03:58) and there's a lot of issues with teachers. So instead of just podcasting dentist for Dentaltown, now I've, where is Tukietown? News, downloads, manage. Where are my podcasts? Right here. So I have done an hour podcast, right here where you're sitting in my dining room, with every leader of every church, every, you know, just forty-five different business and it's really helping the community come together.
Ira: That's awesome.
Howard: And I think getting community involvement is everything.
Ira: Yeah, you have the passion for this. You and your son I can see work well together in this.
Howard: Well he's dead inside. He's my son. And he came out of college and he said "Dad, your podcast show sucks, let me help you".
Ira: Yeah, that's awesome.
Howard: And now, after two years, has no will to live. He's dead inside and always crushes up glass and puts it in his food. That's his nutrition.
Ira: So there was one more thing, at least, what I'd like to talk about and that is money. Because it underlies everything. I've heard one time, there's three things in life that we have conflicts with. One is sex and the other is money and the other is God.
Howard: Money, sex and God?
Ira: Yeah, those three things usually. And money, we know what that is. Sex, we know what that is and God in my realm is everything else. It's how we live our lives. But let's talk a little bit about money. Because we were talking for younger dentists who are listening to this and that really is, especially when you start,. that kind of rules the roost. You can pray, but you still gotta be able to manage money. So, I think what it is, we're not trained very well in dental school about business and we're supposed to go out, and you were talking about starting your own business.
Ira: I remember when I (unclear? 01:06:04) I didn't even know I had to pay state income tax until it was too late. Nobody told me to do that. It's really important to spend some time studying about money and how to manage it. And I'm not talking about just growing your wealth, but how to make it work in your practice. One thing that I found and for many years I've done this is give a bonus to my staff. And how this works, I haven't heard anybody else do this, but what works for me is that I pick out an attainable amount that we collect, not produce, an attainable amount. So let's say now in my practice, it's $112,000. If they reach that $112,000, they get 1% of that display. And how it's split depends on how many hours you've put in for that cycle that month. And if you go on vacation, it doesn't count. So other people benefit more. So then anything after that threshold, they still get 1%. So if we do a $120,000 they get $1,200 a split. And that has been something that each of my employees, and we spread it out, makes up to $2,000 more a year out of that. So it's this underlying motivation that you can give your staff. Pick an amount that will work. You don't want to pick something that is not attainable because then it doesn't really matter. But pick an amount that will work and you'll see that it will motivate the people around you to work harder to attain that. And then if you make it that it works, it may not be able to work in the beginning, but once you get some cash flow in, it really helps doing that.
Howard: Well, we went over, our brand’s an hour and we're eleven minutes over, so I'll just send out one little rant of bonuses. But I truly believe on bonuses that the more money you make, the more bonuses motivate. So someone who's making $10 an hour at a job, well if they were really motivated by money, they wouldn't be working in a job for $10. But someone making a $100,000 a year, man, they're completely driven by money and they'll jump through hoops for ten thousand. But back to the wages of a dental assistant that you're working closely with. We have bonus systems and all that stuff, but one of the things I've always done is, if I ask her to work through lunch so I can do a $1000 root canal, damn it they love cash. I you just missed your lunch, I'm going to go back to my wallet, I'm going to get some cash, I'm going to go put it in her pocket, and they love it.
Howard: You know, they got things to do after work. The assistants have children, they want to get out of there. 27% of baby boomers had no kids, they think it'll be a third of millennials. So usually if they have children, they'll skip lunch, but if they don't have children, they'll go long. But you know, when you stay an hour, two hours after work to do a root canal, build up an CEREC CAD/CAM crown and you close at five and they stay there two hours late and I got to bill out, what does that, 2000 bucks? Then just stick a Benjamin in her hand, just right then and there because you stick a Benjamin in their hand for working two hours late and plus you're getting paid two hours. They light up. That's how restaurants do it. They don't tip out the bartenders and the bus boys and the waitresses on the first and fifteenth, they do it that night. You busted your ass all night, you're getting out late and they split the tabs and everybody goes home happy.
Ira: That's great. And that's just one part of it. For I'm thinking about the dentists that are just coming out or in practice, probably talking about bonuses is, is a hard thing to give out money when you have a half a billion dollars of debt underneath you or more. So connect with other dentists and use us. I'm going to put it out there. We're willing to give you our services and our advice to help you be great practitioners and successful in your business. And I'm going to challenge all of us older dentists, that I'm sixty-five-and-a-half and I've still got the passion and this is what drives me, is to serve. And I'm going to invite other dentists to come and help the younger dentists coming out. Give them advice. Send them patients.
Howard: On that note, thank you so much for coming by the house today.
Ira: Sure.
Howard: Thank you. Tell your son Reuben...
Ira: Reuben.
Howard: Thanks for referring dad. And I noticed your website was made by Darkhorse Technologies. And Reuben's podcast was, there it is, seven, seven, three. Great son! And then we talked about sleep medicine. That was in episode 286 with Dental Sleep Solutions with Gy Yatros and Richard Drake. And then we talked about the dental hospital in Cambodia. That was Roomchang. I have so at 650. Roomchang Dental Hospital with Tith Hong Yoeu. In downtown Cambodia was it?
Ryan: Yeah.
Howard: And then dental hypnosis with Mike Gow. One last final thought on that. The one thing Mike Gow blew my mind away is that, when someone has anxiety, then you just put them to sleep. He didn't treat her anxiety, he just masked it. He just knocked them out. And he never liked that. He wanted to deal with your anxiety and by discussion and talking and hypnosis he thought it was a lot better (unclear? 01:11:44) because now he treated their anxiety. And whereas Americans are just like, "Oh, you got a problem here, let me put a blanket over and knock you out with propofol. And Mike's like, no, let's, let's do hypnosis. But on that note, thank you so much for coming over.