Dentistry Uncensored with Howard Farran

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

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Max is a general dentist from Elm Grove, WI; a smaller town outside of Milwaukee. He has been in private practice for 5 years since graduating from Marquette University and has a dream of retiring in a world where the Green Bay Packers win the superbowl every year and private dental practices still thrive and do not look like today’s medical practice with crappy customer service and no real relationships with patients. Max and his wife Susan, a Pediatric Dentist, live with their dog Gilbert Brown and In their free time they enjoy hiking, binge watching Netflix and helping to run a small 501c3 called United By PAT, chartered to providing dental care to those with big need and little access.

http://www.honestteeth.com/

Howard: It's just a huge honor for me today to be podcast interviewing Max Meinerz. Thank you so much for coming over on the show. He's coming up on his five-year anniversary. I like to think of this as a variety show of dentists at all different stages. We've done our fair share of a bunch of sixty-five-year- old white-haired men who wrote textbooks and are the specialists in their field. It's fun to get consultants. I think it's really fun to get a thirty-year-old, because I always ask you, "Send me an email at Howard@dentaltown.com, and tell me your age, where you're from". Dude, 25% are still in dental school. The rest are all under thirty. I get like one email a week from someone who's forty or fifty. I think the oldest email I got was sixty-one and I'm fifty-five, so there's only like one guy listening to this show that's older than me. 

Howard: Well, let me read your bio. Max is a general dentist from Elm Grove, Wisconsin, a smaller town outside of Milwaukee. Now, are you old enough to remember Laverne and Shirley?

Max: Absolutely, I've seen that show.

Howard: Really?

Max: Oh yeah. Re-runs probably.

Howard: Okay. Re-runs. He's been in private practice for five years since graduating from Marquette University and has a dream of retiring in a world where the Green Bay Packers won the Super Bowl every year and private dental practices still thrive and do not look like today's medical practices with crappy customer service and no real relationship with patients. Max and his wife Susan, a pediatric dentist, live with their dog, Gilbert Brown, and in their free time, they enjoy hiking, binge watching Netflix, and helping to run a small 501(c)(3), called United by Pat, chartered to providing dental care to those with big need and little access. God ding, that’s cool. So, that name. I've never seen a dog with a first and last name. So, Gilbert Brown, that must mean something. Is that a star out of a movie or something? 

Max: Gilbert Brown played for the Packers in the mid-nineties. He was a monster defensive lineman. 

Howard: Wow. 

Max: And my dog happens to be brown, so it just kind of made sense. 

Howard: And the Packers was Vince Lombardi, right? 

Max: Absolutely. Way back then. 

Howard: So, that's why the Super Bowl trophy is Vince Lombardi.

Max: That is correct. Yep. We wish we'd win it more, but at least we got it... 

Howard: So, you have to just explain to me one thing before we can move on. I'm obviously an Arizona Cardinals fan, and it never snows here and we have a roof on our stadium. And then I see some of your games where it's sometimes hard to even see the field. It looks like a white album. I'm like, why does Arizona have a roof and it never snows. So, why did you guys not add on the roof? 

Max: I think it's because everybody in the stadium is so drunk, they all feel warm and it's like they're 12th defenders. So, I don't know. That's a good question. I'll have to talk to them, next time I'm up there.

Howard: I've lectured in that stadium. They have rooms up on the side there. So, there's an amazing lab up there called Lord's Dental Studio. And they had me come up back when Renny Challoner owned the lab. They used to have me come up every couple of years. 

Howard: And you went to Marquette and Renny Challoner ...  So, now they're opening up all these new dental schools. When I got out in '87, they were closing down a bunch of dental schools. They closed down Emory in Georgia, St Louis, Washington U, Howard University, Northwestern. I think it was six or seven dental schools. And they were going to close down Marquette, which was a private Jesuit school. I went to Creighton Undergrad in Omaha, a Jesuit school. And the owner of Lord's Dental Studio, Renny Challoner, said "That's a really bad idea". And he was such a mover and shaker. He was able, he was so, you know, your net worth equals your network. And he was able to get the governor, the mayor, the dean of the school, he got everybody in a freaking room and said, "What is going on?" They were in there and Renny had all these post-it notes and grease boards. And a marathon, twelve hours later they figured out the money, the stake, costs, who was going to do what. He saved the whole damn dental school. If it wasn't for Renny Challoner, there wouldn't have been a Marquette. 

Max: That's pretty amazing. Yeah. 

Howard: Yeah. What an amazing guy. And then he eventually retired, and I think he lives in Florida now. Just an amazing guy. A lot of history up in that state. My two favorite labs over the years was Lords in Wisconsin and Green Dental Lab in Arkansas, because those two labs got one third of all the dentists in their state to use them. So, there's these other big labs like Glidewell, that make 5% of all the crowns in America. Sure. But they're spread out all over the United States. Nobody got the density. And they got that density, say for like in dental school, they were totally connected in their backyard. They put on online CE, and they said, "We don't need to go to Indiana and Texas and Kansas. We just want to concentrate on our backyard. Lord's Dental Studio always had hands-on courses, online CE courses. 

Howard: And I always try to carry on that, Wisconsin Lord's Dental Studio and Green of Arkansas, with these dentists on continued education, they always think they got to get on an air plane and fly across the country and drop $3,000 a weekend with some fancy instructor who's not going to be there when your case fails and you go to the board. And there's some amazing endodontists across the street from you that'll teach endo. There's an amazing periodontist or oral surgeon. True, true. Probably half of them live in fear and scarcity and thing. "I don't want to teach you molar endo. You just sent it to me." And the quicker you can identify that someone is toxic, you know, because you're just going to be a summary of the five people...

Max: People you're with...

Howard: Close to your life. So, if you find out there's two oral surgeons across the street and one's toxic and lives in fear. Well, you don't need that shit. If you need that shit, all you got to do is watch Fox News and CNN and MSNBC and all the media companies which are just all publicly traded for profit, fearmongering bullshit. 

Howard: You just need to start finding the five specialists in your area. You want the orthodontist that's going to teach you Invisalign, not the orthodontist that lives in fear that you might learn Invisalign. You know what I mean? So, I really loved their business models. It was kind of like Patterson when Pete Frechette was the CEO, he wouldn't let him go overseas. Stan Bergman spread like fifty-six different countries. You go to lecture dental conventions around the world, Shein's in most every country I've ever lectured in and has a booth in the back and all that stuff. But Pete Frechette said, "Dude, America does a hundred and nineteen billion dollars a year in dentistry. 

Max: There's a few bucks (unclear? 07:01).

Howard: We don't need to go to Mexico and Peru and China.

Max: True.

Howard: And he just focused on the States. He eventually added Canada, which makes a lot of sense, because 90% of Canada lives within hundred miles of the US border. So, we just moved our northern border, just a simple one hundred miles. Canada would just be polar bears and maple trees. 

Howard: So, what have you learned? Let's go back. Let's start with the 25% of our listeners that are still in dental school. They want to graduate so bad, but the closer they get to the finish line, the bigger the knots are getting in their stomach, because they realize, "Oh my God, I'm going to graduate from dental kindergarten school".

Max: Absolutely.

Howard: "Where I've lived in a protected refugee from kindergarten to doctorate." And now they got to go enter the real world. 

Max: It's terrifying, right? 

Howard: Yeah, it is. Because it's change, and the only people who like change are little babies who crapped their pants. Adults don't like it. 

Max: That's (unclear? 08:01), but yeah.

Howard: So, what advice would you give these kids in dental school? 

Max: Yeah, if I could go back and do it all again, I'd probably take a few more of those like dead afternoons where the patient cancels and you're looking for the golf course or the gun range or the bar. Kind of create your own luck and do a little bit of a better job of kind of filling your time. Whether it's going to volunteer in one of the specialty clinics, just hanging around somebody that knows more than you, and utilize that time a little bit better. And then also, walking out with your diploma, your shit still stinks. I think getting to know that and appreciate and respect that is really important. So, making a priority, a budget line item when you get out for associateship or whatever else it is that you're doing. That you're reinvesting in yourself, going to bug your endodontist buddy down the street, to learn a little bit better about all the specialty things that you're probably not as good at as you may think on graduation day. 

Howard: Yeah. I think it takes five years after graduation to realize that you suck. A lot of kids come out and they went to Jamaica and placed like fifty implants on a weekend. 

Max: Sure, yeah. How many of them are still there?

Howard: But they never saw their patient again, they don't know what the hell happened to them. So, they come out and they start doing all this, placing all these implants and doing all this. And it takes a year or two to realize, these fillings fell out, it de-bonded, the implant failed. It takes five years to find out that you actually don't walk on water, you're shit does stink. And then you have to either commit to continue education the rest of your life. That's why I'm against dental therapists, because the reason I'm against dental therapists is that, when you're a fully trained doctor, you barely know what's going on and you need five years and about five hundred hours of CE just to get average. So then someone is saying, "Oh, you don't need a full doctor, you need a half doctor". 

Max: Yeah.

Howard: And it's always that hypocritical stuff. Like, Bill and Hillary Clinton were massively against private vouchers for private school and said, "No, public education only". First question, "Where does your only child go?" "Oh, private school." And then you say to these people that want dental therapists, say, "Well, if your tooth broke, would you want to go to a half doctor?" "Oh no, I'd want to find the best doctor. The best dentist in Scottsdale, Beverly Hills, I'd want the best of the best." "Okay. So, you want the best of the best for yourself. But for the little people, a half doctor will work fine for him?" 

Max: It's kind of amazing how good we are dictating other people's lives for them, whether it's, you get the half doctor, but I'm taking a full one. I've never known anybody to do the half ass thing for themselves, whether it was their ass on the line. So, you make a valid point. I think that the dental therapy programs are well intentioned, but definitely aren't going to work terribly well in practice. 

Howard: Well, the bottom line is that they miss the whole point. If you want kids to go back to a town of five thousand, you got to get the kids from the five thousand. That's what Jack Dillenberg found out. He said, "You know why the kids don't go back to the Indian reservation? Because none of the kids came from the Indian reservation. And you know why none of the Navajos got in dental school? Because you're fixated on this DAT score that measures algebra and trigonometry and all this bullshit that you don't even need when you're a dentist." And Jack came out there and said, "You know what? We've got Indian reservations with no Indian dentists on it. We've got small town rural." And he was the first dean to say, "No, we're going to accept kids from the Navajos. I don't give a shit what their GPA is. What are you saying? That the Navajos should not have a Navajo dentist, because that's better than having a Navajo dentist who's not good in algebra?" I mean, how stupid is that? 

Max: Yeah.

Howard: And then the same thing. There's a mine up there in northern Arizona that we stopped by and talked to them. I said, "What is your biggest problem to grow?" Then he goes, "Well, we can't get any engineers up here". I said, "Why?" They said, "Because the kids that applied from this town don't get accepted an issue." You know, who gets accepted an issue? All the kids from Phoenix who got 4.0’s on math and chemistry and geometry and trig. And those kids stay in Phoenix. So, if you want to support rural, if you want to support Indian reservations, not creating half doctor therapists, because if that half doctor came from Scottsdale, well, they sure as shit ain't go on to some rural farm. They're not going to get in a canoe and go out into the backwoods of the Yukon and Alaska to work on Eskimos like your little fantasy world things. If you want some kid to practice in the Yukon, and by the Bering Sea, well you better find an Eskimo from there that wants to come. So, they completely missed the boat. But what did you do right when you graduated? When you graduated, what was your, what was your first move? 

Max: Oh man. Yeah, that was private practice. So, my mother is a dentist. Full time mom. Part time dentist. 

Howard: Your mom is a dentist?

Max: Yeah, one of those ladies. 

Howard: That is so cool! And you married a dentist? 

Max: Yes. There's probably a lot of weird...

Howard: You know Mark Zuckerberg's dad is a dentist. 

Max: Yeah. 

Howard: And he's married to a female MD psychiatrist. Mark Zuckerberg. I just thought it was so cute that he married a female MD. 

Max: Oh, I did not know that. 

Howard: And your mom, was she like a role model idol? 

Max: Oh absolutely. 

Howard: And then you went out and found your mom a role model idol, and you married a female pediatric dentist.

Max: Pretty much.

Howard: That is so damn cool.

Max: Yeah. Yeah. So, I'm a pretty blessed guy surrounded by lady dentists. 

Howard: Strong women dentists. 

Max: My wife is the boss. That is for sure. I'm a smart guy and...

Howard: Now when she gets mad at you, does she make you drink silver diamine fluoride?

Max: Yeah, she switches it on, and lets it stain. Yeah, exactly. "You're going to work like this." 

Howard: Your mom rinsed your mouth out with soap and now your wife switched to silver diamine fluoride. 

Max: Malice. Yeah, the 2018 kind of punishment I suppose. Right? 

Howard: So, when you graduated you wouldn't work for your mom? 

Max: For her and like three or four other dentists at the same time. It was kind of cobbled together, a full time...

Howard: In the same town?

Max: Yeah. It's probably at the worst driving about an hour and a half. 

Howard: So, you were born in Elm Grove?

Max: In a town that's kind of a mouthful. It's called Wauwatosa.

Howard: Wauwatosa?

Max: Wauwatosa. W-A-U-W-A-T-O-S-A. 

Howard: Wauwatosa?

Max: Yeah. 

Howard: Wauwatosa. Is that the town right next to the (Unclear? 14:39) 

Max: That's a good question. I'll have to look at the map when I get home, man. 

Howard: So, you're born in Wauwatosa? 

Max: Yes sir. 

Howard: And your mom's practice is there?

Max: In Elm Grove.

Howard: In Elm Grove. So, you would practice, you would work a day or two a week for her...

Max: Day or two, yep. Day or two at the other guy, day or two at the guy down the street. It was kind of a mess for a while. 

Howard: And then how long did you do that? 

Max: Couple of years. Until the practice that I wanted to be in, the one that my mother had started, had grown up to a place where I could resign from those many associateships. Now I'm there full time. It's fantastic. 

Howard: And is your mom there full time too? 

Max: She retired a couple of years ago.

Howard: How old is she? 

Max: She is, I'm probably not supposed to share this, but she's a little bit older than you. 

Howard: Why is it that, I'll tell anybody my age. Men will always tell you their age and they'll always show you their scar. 

Max: Sure. 

Howard: And women never tell their age. I mean, if men gave babies and had stretch marks, they'd show you. I mean, it's like when you meet a vegan, they always have to let you know that...

Max: They're vegan, yeah.

Howard: Within three minutes. Men love to show their scars, are proud of their age. But anyway, so she retired?

Max: She retired.

Howard: So, what now. Are you still living there now? 

Max: I've gotten a partner recently which has been kind of an interesting and new and really fine development and we mutually have a part time associate as well. 

Howard: So, you sold him a half? 

Max: I did, yeah. 

Howard: Or did you just buy half of your mom's and she sold the other half to him?

Max: No, I bought the whole thing. Sold half to the new guy. 

Howard: Okay. So, let's talk about that because some people say we only get married, you have great sex and you share a dog named Gilbert Brown and your holidays and weekends, and that fails half the time. 

Max: Absolutely. 

Howard: So now you married a... Is he a male? 

Max: He is a male. 

Howard: You guys have great sex. 

Max: We don't have great sex. He's got great hair. So, I thought about it, but no. We have a pretty nice clinical and business partnership mostly because the areas where I know that I'm most efficient, he's really strong and vice versa. 

Howard: Where you're efficient...

Max: And strong, he's maybe not so well.

Howard: So, you have competing skills? Complementing skills? 

Max: We have complementing skills. 

Howard: So, what is Max Meinerz' complimentary? What are your skills? 

Max: I know a ton of really shitty jokes. I do like to get a little bit more into the blood and guts, so extractions or implants, doing that kind of stuff is really fun to me. That's the kind of stuff that makes Kyle, my partner's hair...

Howard: Now when you say blood and guts. Does that include endo? 

Max: Not so much on the endo, that's his thing. 

Howard: So, what's his name? 

Max: Kyle. 

Howard: Kyle. So, Kyle likes endo, and what else?

Max: Cosmetics is also his thing. If I had to pass on every veneer case where there's a middle-aged divorcee that wants to look twenty years younger and more beautiful, I just can't do it. 

Howard: There's this guy up the street from me. He has this fellowship in the academy of cosmetic dentistry and all this stuff and every crazy bat shit woman, crazy eye that wants all these veneers and everything. I just listen to her long enough to where I can interrupt and refer her to this guy up the street and then he always thanks me for it. And I would say, that that is so damn cool. 

Max: That is kind of cool. 

Howard: I'd rather work at Taco Bell then treat that woman and you're sending me a thank you card. 

Max: Yeah.

Howard: So, complement each other. So, you do extractions and implants. He does endo cosmetics. So, the rest of just be a restorative...

Max: All kinds of stuff. We do a little bit of clear aligner therapy. 

Howard: When you say clear aligner, what brand are you using? 

Max: We're using Invisalign right now. 

Howard: You know what, it's funny because Invisalign has decided to, they don't need to orthodontist or something, right? They bought, I think 17% of SmileDirectClub. 

Max: That's correct.

Howard: They're opening stores in malls. So, the orthodontists are very livid mad about this. 

Max: Sure. 

Howard: But almost everyone I know, I say to, "So, then what brand do you use now?" They say, "Well, I still use Invisalign". I say, "Why?" They just say all the incremental improvements, the retainer, the plastic, the materials. They just say, "It just works better, moves better moves faster". 

Max: And it's easy.

Howard: So, they're so mad at that company, but they won't quit using their product. Because there are some substitutes. ClearCorrect.

Max: Sure. I think they're down in Texas. 

Howard: Yeah. And they went under, didn't they?

Max: I don't know that. I still get marketing emails from them. 

Howard: So, you're using Invisalign? 

Max: Yeah. Yeah. 

Howard: Both of you do Invisalign?

Max: Well, we both do a little bit of that, but it's really limited stuff. We still have a pretty healthy relationship with our orthodontic colleagues in the neighborhood. 

Howard: So, you're in Elm Grove? 

Max: Elm Grove. Yeah.

Howard: What's the population in Elm Grove? 

Max: Elm Grove, that's got to be a handful of thousand people.

Howard: Just a thousand?

Max: A handful of thousand.

Howard: What's a handful of thousand? Five thousand?

Max: Five thousand, yeah.

Howard: But you're using Invisalign?

Max: We are using Invisalign? Yeah. One thing I have been, and this is not something that we've attempted on anybody other than myself. I've got a case in process. The Blue Sky Bio's are developing an ortho module. Interested to see how that all....

Howard: Blue Sky Bio? Which is Cory Glenn. 

Max: That's correct. Yeah, he's their... 

Howard: Cory Glenn, love that guy. And then who's the podcast, the founder of Blue Sky Bio that we did? But anyway, what are they doing in ortho? 

Max: So, they've got a CAT planning kind of module for orthodontics. So, if you wanted to bring that service that Invisalign dings you seventeen, eighteen hundred bucks for or whatever it is in house, you can dig around and do the planning and have the aligners made in your office. 

Background: Sheldon Lerner.

Howard: Sheldon Lerner. Are you doing this now? 

Max: No, I have like one case. Literally I'm attempting it on myself just to do some really minor orthodontic corrections. 

Howard: Would you 3D print the trays? 

Max: So, if you have a scan, a captured arch with an internal scanner or a table top scanner, you can create sequential printed models and then form your (unclear? 20:55) down. 

Howard: And what internal camera are they recommending? 

Max: Blue Sky Bio doesn't have one. Anything open source. So, you can use whatever. 

Howard: It sounds like the Copenhagen, Denmark, is now at the best with their TRIOS. 

Max: Yeah. That one is pretty nice, that's for sure. 

Howard: Yeah. And it seems like that's pulling away from 3M's True Def scanner. 

Max: Yeah. I've not tried the True Def, but I would obviously trust your opinion on that one. 

Howard: But for the cost people, it sounds like just taking alginates and then putting that in a box scanner is going to be the lower cost. So, you do extractions, implants, Invisalign. Your partner Kyle does endo cosmetics, Invisalign, and then you both split the restorative crown and bridge and hygiene checks and all that? 

Max: Yeah, for the most part. 

Howard: So how many ops do you have?

Max: Seven equipped and plumbed are eight. 

Howard: Okay. Are you both there the same hours or do you try to spread your hours to be more available to the patients? 

Max: We try to be a little bit more available to our patients. So, we've got probably fifty-five clinical hours a week that we're open. 

Howard: Nice. So, the average dentist is thirty-two, so double that is sixty-four. I mean, thirty-two to fifty-five, that's a lot of availability. And it really helps your Google search because so many dentists they'd say things like, "Well, I use this firm and they got me on page one". Dude, if I type in your exact name, you'll be the first one to come up.

Max: Sure.

Howard: When you say you're on page one, that didn't tell me anything. What search? Is that page one Google near me? So, what are your hours? Monday through what? What are your hours? 

Max: Seven to seven, Monday, Tuesday and Thursday. Seven thirty to seven.

Howard: Wait. Seven to seven?

Max: Monday, Tuesday, Thursday.

Howard: Seven thirty?

Max: To seven. Yeah. 

Howard: Seven thirty to seven. What days? 

Max: Monday, Tuesday, Thursday. 

Howard: Thursday. Okay. Then Wednesday?

Max: Wednesday is seven thirty to four thirty. Friday is seven thirty to kind of whenever we finish, usually two. If there's the right case that I want to do, I'll stick around. 

Howard: And what about Saturdays and Sundays? 

Max: I'm open one Saturday a month. My partner does not like working Saturdays. So, I kind of enjoy it. 

Howard: So, the point I'm making is this. Say, the number one surgeon in dentistry on Google for anything is near me. So, you're on vacation, Mexican food near me. 

Max: Sure.

Howard: You're looking for a dentist, dentist near me. If the guy across the street closes at five and you're the only one open, well, it doesn't benefit Google to send you to a business that's closed. Just like when I'm in Phoenix and I need to go withdraw money at a bank and I say, "Chase near me". Well, if the one three miles from my house is closed, that's not the first listing. The one that's four miles south, that's a twenty-four hour one, will pop up. And I think when you Google, "Chase bank near me" and it's after midnight. I think Google will just say, "Dude, really? Really? Why don't you just go to bed? You need to go to bed. All the chases are closed." 

Howard: And that's why I think dentists should open up their funnel and just, you could be open seven to seven even though the dentist is only working eight to five. 

Max: Sure. 

Howard: Because if you open that funnel that you're open to calls, then that really helps your Google search. If you don't want to be open Saturday, well how much would it cost you to put some lady in there to answer the phone on Saturdays and even Sundays or forward the calls even to her...

Max: Cell phone.

Howard: To her cell phone. 

Max: Sure.

Howard: Because if those were your hours, seven to seven, seven days a week and you call and it's open and you two are on call or whatever. You'd be getting all the Google search for Saturday and Sunday. 

Max: I wonder how Google would treat that though. If nobody's GPS on their phone had ever actually put them on site that date or hour, that you'd want it to be open. 

Howard: Well, you could pay her to go sit in the office.

Max: Sure. Yeah. 

Howard: I mean if you're hung up on that, then just say, "Oh, I'll pay you", but yeah. And then I say, the craziest thing about all these SEO people is that they're always telling you how Google works you know, they know everything about Google. And it's like, okay, and you're in the Holiday Inn and you know everything about Google? Well, why don't you go tell Bing how Google works, because they'll pay you a billion dollars cash if you can fucking tell them how Google works. 

Max: How to make Bing work well.

Howard: Because Microsoft, which owns LinkedIn, Word, Excel. I mean, what I love about Microsoft, it was in the last bubble, '94 to 2000. It was Microsoft and Intel and Dell and Cisco, and then everything crashed. Now they're back in the second bubble thing, but let's look at Microsoft. They have seven sources of revenue. Facebook and Google, both of them, about a 110-115% of all their revenue comes from advertising. The reason I say 115%, is because they write off so much money in all these projects that have failed, that if they weren't doing all those projects, when they say ninety cents earnings, well they would have had one hundred twenty cents earnings if they weren't putting all this money into all these losing projects, which they do because they're paranoid. They only have one revenue source. 

Max: That's true. 

Howard: And then Amazon actually, is too. Half of their money comes from cloud storage. 

Max: Yes. 

Howard: But everybody only talks about their retail stuff. And then their cloud storage is massively more problem. But Microsoft, what a solid company. Seven forms of revenue. So, the point that I was making is that anybody who tells you they understand SEO is completely full of shit because if Bill Gates actually thought you actually knew what you were talking about, they'd pay you any frickin' amount of money possible to go and get some of Google's market. And Google does look like its heyday is over because it's really weird, on the desktop everybody uses them, but on mobile, the number of Google searches on mobile has been drifting downwards for... 

Max: Yeah. And what's replacing it? 

Howard: Other apps.

Max: Sure.

Howard: Voice. You know, Siri.

Max: And Alexa.

Howard: Alexa. Amazon. I think Amazon has 70% of the voice search now. 

Max: Really? 

Howard: 70% of the voice search. 

Max: Yeah. 

Howard: Have you been in anybody's home yet where they said, "Hey Alexa." 

Max: Yeah. Oh yeah. Yeah.

Howard: Do you have it in your house? 

Max: I don't. Partially because I'm always like about two steps behind the curve when it comes to technology. But my brother, he's a tech nerd. He's a big Google guy. He's got the Google Home and he swears by it. 

Howard: But I want to go back to your partnership, because I was talking to this one lawyer who says, "You know what, when you have a lover and you have love and pets and furry friends and family and holidays, that's a glue". He said, "You know, money is a very strong glue".

Max: That's very true.

Howard: And if you got a partner and you're making each other money and you're making a lot of money, he thinks that a lot of men, a lot of dentists, male or female, that it's actually easier to walk away from their spouse than it is from their cash cow, the goose that's laying the golden egg. So, it's just a different kind of glue. But how long have you and Kyle been partners? 

Max: We literally just finished up our first quarter together. So, we're still kind of in a honeymoon phase.

Howard: So, were you classmates or how did you meet this guy?

Max: Yeah, we met in dental school at Marquette. I thought Kyle was a huge asshole the first time I met him. So, kind of funny how that's all come around, but yeah, we trained together. He's been my dentist since I graduated and mom hung it up. So, I know he's a fantastic clinician. That was the easy part. We have a lot of fun. On the weekends just hanging out as well, we're really good buds. But yeah, it's been a very fruitful partnership so far and very pleasant to have somebody you can trust.

Howard: Now, was your dad a dentist too? 

Max: No. No, he's not weird enough to be a dentist. He's in business packaging, chemical and food. 

Howard: Wow. That is so amazing. So, what do you think your secrets have been out of school? Has continuing education been a part of your success? Would you say you've taken a lot of CE? Average? Less than average? The bare legal minimum? 

Max: No, no way more than that. I would say I'm slightly above average when it comes to the amount of CE credits that I tackle. A lot more of it being now online. So, using like a Dentaltown's CE module or Spear's got a pretty good digital kind of suite of services. 

Howard: How much is Spear a year for their online CE? 

Max: They ding you for like a hundred and fifty bucks a month. So, whatever that is.

Howard: That's the fee? $150 a month? 

Max: Thereabouts. I wanted to say it's $149 a month. 

Howard: Well, you see, first you said it's a hundred and fifty. Now you're saying it's a hundred and forty-nine. Make up your mind. 

Max: Okay, well a hundred and forty-nine and a half. 

Howard: So, that's $1,788 a year.

Max: Yeah.

Howard: Which is $149 times twelve. And now does that put you in a meet in the flesh study club or is it totally... 

Max: No, that's like Max hanging out in his underwear watching a video on the Apple TV or something. 

Howard: Yeah. Apple TV?

Max: Yeah. 

Howard: So, you're doing Spear Education? We've had Imtiaz Manji on the show. We've had Sameer Puri on the show. 

Max: They're right down the street, right? 

Howard: Yeah, they're right up the street. Well they're in the rich section of Scottsdale. I'm in the poor, born in the barn trailer trash section called Phoenix. So, you said Spear Ed and Dentaltown online CE? 

Max: Yeah. 

Howard: So, tell me what your honest thoughts are of the Dentaltown online CE. 

Max: Dentaltown has got a ton of content which I really like and there's a lot of diverse thought whereas you are in the Spear camp if you're using their product. Understandably so. So, I like being able to search and check out a bunch of different kinds of avenues on Dentaltown. I will say they kind of dummy proofed it at Spear where it's like, this is your pathway, so course A leads to B to C. So, that's really helpful if you want to learn that one thing, Spear's got a pretty good...

Howard: And what is that one thing with Spear? 

Max: Well, obviously they're pretty good at occlusion. I do think Spear also has a really nice business management and culture promotion. 

Howard: Let's back up to occlusion. Your wife is a pediatric dentist? 

Max: Sure. Yeah. 

Howard: I think the only controversy they have among their group... Is she your same class, same age, thirty-five years, out in May? 

Max: Yeah.

Howard: It seems like the only controversy they have is silver diamine fluoride. We got a silver diamine fluoride rockstar here in Phoenix, Jeanette MacLean. 

Max: Sure. 

Howard: Hell, the New York Times did a cover story on her. It's like amazing. Loves it, swears by it. Whatever. Some of the other people, they're not big fans of it. Turns a tooth black. They don't think it kills everything, you know, blah, blah, blah. But when you go to endo, I can't even think of a controversy among endodontists. I mean, they're just so homogenous, oral surgeons, they hardly disagree, but when you go to occlusion, holy shit. 

Max: Yeah, that's pretty wild. 

Howard: It's like "Well, I'm Judaism". "I'm Islam." "I'm Confucius." "I'm Buddhist." Do you agree that that's the way it kind of is?

Max: Very much the case. And I also think, whether it comes to occlusal dysfunction, your outcomes, everybody's working on some sliding scale of madness. TMJ joints are really rocking sore, they never get fixed. It's always some improvement but never fully rectified. So, all those different pathways and treating those different disease states, it doesn't seem like anybody's clearly got their finger on the pulse. 

Howard: The other thing is, human. I put a human in the same category as a cockroach. 

Max: Sure. 

Howard: And an ant and a beetle, because they live on all seven continents. Every type of geology environment. Snow, cold. I mean, I've seen some of the most messed up bites, grind down cross, but I mean, I've seen some of the craziest shit period. It's working fine. And then you'll have another case where they'd had braces, Invisalign, they're almost perfect, and it's like one little filling throws them off the deep end. So, there's probably a lot yet to be discovered over the next thousand years to figure it out. And stress. I mean, it seems like when I see people with their occlusion on haywire, you don't have to ask many questions. They're going through a divorce, lost their job, credit card maxed. 

Howard: So, it's like you got all this occlusion stuff, but I mean, shit, you just answer them. Any stressful change, you know, loss of a parent. I mean, they might be going through three other emotional, traumatic things. So, then you're like, "Is this psychosomatic?" And is the stress causing your brain to spasm? Your jaw to spasm, your lower back to go out, your irritable bowel syndrome and your heart contracting, which is the five major stress spasms degrees? Or do we really have a bite issue? 

Max: Yeah. I think, all of us in healthcare, if we get to a place where the only little part of the body that we take care of is the only thing we're thinking about, that's when we get ourselves into these kind of confusing and head scratching kind of problem areas. You got to take care of the people attached to the teeth and they've got a bunch of unique problems as well.  

Howard: Yeah, and it's funny because the dentists are always talking about the oral systemic link. 

Max: Sure. 

Howard: But you talk to your physician friends and they're all like, "Well, I used to be an internist, but now we're really getting into the full body". Or you talk to a kidney specialist. "Well, you know, we did a lot of kidney, but now we're really thinking about how the kidney is interacting." So, every one of the fifty specialities in the MD world and all nine specialities in the dental world, that's that phenomena where everybody is discovering that the thirty feet down in the mouth holes direct them, and it's all related. I think the most exciting stuff is how they're finding out how that gut microbiome in your large intestine probably has a lot more to do with your decay rate and your periodontal disease than you've ever imagined. 

Max: Yeah. I think that's going to be a really exciting place for our future in the next twenty, thirty years of healthcare in general. How can we use the bugs that are living in and on us to our advantage instead of just trying to kill them all, sterilize everything, a slash and burn kind of technology. So, that's a place that I'm looking forward to seeing what all comes of that. 

Howard: Yeah, those studies are amazing. I was reading one gastroenterologist and him and his buddies. They all pooped. What they do is they, I guess they freeze it, then they shattered it to where they can disassemble the whole thing and then scan all the DNA and then the computer's put it all back together. And then they would go to either the Amazon rain forest or live with a tribe somewhere in Africa or the aborigines, or the Amazon. And just two weeks of just eating whatever the hell they ate. 

Max: Sure. 

Howard: And their whole gut microbiome change. 

Max: Yeah?

Howard: I mean, that is just amazing stuff. So, your wife is a pediatric dentist? Which when I was your age was a pedodontist. And I'm still not sure why that's offensive word to them. I mean, if you ever called them a pedodontist, they'd say "No!"

Max: Gave them a good little eye roll. 

Howard: "I am a pediatric dentist." I'm like, "Okay, well you were a pedodontist thirty years ago and that's one word and now you're..." I mean, we didn't go from KFC to Kentucky Fried Chicken, we went from Kentucky Fried Chicken down to KFC. But you went the other way. You went from pedodontist to pediatric dentist. So, in like ten years, is it going to be like pediatric dentist, Sir? So, what's she doing? She's solo? Associate? What's her plan? 

Max: Yes, she did kind of like an associateship to reverse associateship with a selling pedodontist or pediatric dentist, whatever you want to call it, in a community near us. 

Howard: So, is the seller a pedodontist and your wife's buying as a pediatric dentist? 

Max: I know, there is a little bit of tension there. They work together and have a really healthy little practice. She serves at kind of the western communities outside of town a bit. Funny you had mentioned the silver diamine fluoride, whatever. One of the practices that she works out of is a bit more urban and that's like totally fine to put the silver diamine fluoride on, and the other practice is significantly higher on the socioeconomic scale. So, there's like Lululemon, everybody's got the Maserati and none of the moms like silver diamine fluoride out there. You can have rampant decay, but you're not putting that black shit on my kid's teeth. It's interesting how that all works out. 

Howard: Is she doing any of the tooth-colored chrome steel crowns are just doing stainless steel?

Max: So, I never even knew this, but apparently they have a pediatric line of zirconia crowns and so she is looking forward to training on that system. She is currently doing, it's like (unclear? 39:54). 

Howard: Do you know the name of that company? 

Max: I don't recall the name of either of those companies. 

Howard: There's one out of Houston. 

Max: Okay. What's it called? 

Howard: I forgot. 

Background: What is it? Houston what?

Howard: It's a white pedodontic, pediatric dental crowns instead of chrome stainless steel crowns. It's a white pediatric crowns. 

Max: New Smiles might be it.

Howard: New Smiles. Good job. And your brain has an a calcified yet, so you still can recall memory. So, did you guys meet in dental school or undergrad? 

Max: We met an undergrad. In Bob Fitts' physiology class. She was the cute girl sitting four or five seats to my left. So, I think we were talking about hormones that day or something like that. 

Howard: So that was in undergrad. Where was undergrad?

Max: Marquette University. 

Howard: Marquette. 

Max: I'm a townie.

Howard: So, your undergrad. In your what? Townie?

Max: I'm like a townie. The guy that grew up and stayed in the same little town his whole life. 

Howard: Okay. 

Max: Yeah. 

Howard: So, you met in undergrad and then you went to dental school together. Then when did you get married? 

Max: We got married, let's see. We would have graduated in May and got married in September. 

Howard: So, you waited until after you graduated? 

Max: Yeah. Just out of principle I think. There's something about when you're not actually earning an income, you probably shouldn't have a spouse.

Howard: And did she change her last name to yours or is she keeping her name the same as her diploma? 

Max: Funny story. Yeah, so she graduated as Susan Angel.

Howard: Susan Angel?

Max: Angel pediatric dentistry. It's almost like a joke, right? It's great marketing. But she graduated as Susan Angel. We got married, she changed her name and did all the paperwork and stuff. Then, maybe about like a year later, it's like, "I don't really like your last name. I think I'm going to change it back." So, she's right now in the process of going from Susan Meinerz back to Susan Angel, which I could really care less about. 

Howard: Well, I was always really sensitive to sexism because I grew up with five sisters and mom would let me swim in the river. We grew up probably a hundred, not even a hundred yards, maybe fifty yards from Arkansas river. I could swim in it, but my sisters couldn't stand ten feet from the edge. I was putting jeans with patches. They were putting dresses, they got in trouble as well. If they were not on the yard when the streetlight came on, they'd be grounded for weeks. If I was playing at your house and decided to crash there and you know, back then you didn't even call and tell your mom and came home the next day no one even lifted an eyebrow. So, when I got married, I had these four kids. I thought it was pretty weird that they wouldn't have her last names. So, all four of my boys have their mom's maiden name. So, all their middle names are Wells. 

Max: Oh, very cool. 

Howard: And I thought that was better than a hyphen. And they're the only four Wells Farrans. Women just have a horrible history. I mean, not as horrible as a native American Indians or slavery. But my God, we still never had a woman president. I think right now in the Fortune 500, there's only five women there. And I can distinctly remember 1979 when Margaret Thatcher won. My dad and all his friends, which were devout Catholics, went to mass every day and just really great guys. They were all like, "What the shit would England do that for?" I mean, they were like, their brain hurt, like, yeah, that's our mother country? And they voted in a damn woman? Are they out of their flippin' mind? And all the women wear little hats over their head in the church and covered their head and all that stuff. So yeah, I'm really proud that the president of my company, (unclear? 43:34) woman. My office manager, Dawn (unclear? 43:38) woman. The lady in charge of circulation Dentaltown, Marie, woman. Director of Sales for advertising Dentaltown, Mary Lou, woman. I mean, I've always been sensitive to that. 

Max: Well, you kind of figure that the last place that's ever going to have a woman in a position of power is probably the government, because they never get shit done anyway. So, it's probably best that companies like yours are letting women take roles of influence, power, and leadership because you're getting stuff done. 

Howard: So, does your wife own the whole practice?

Max: She does. She's got a small team. 

Howard: The sole owner?

Max: Sole owner. I think there's five people on her payroll. 

Howard: No associates down there? Does she look at your partnership and think, "I want that someday"? Or does she just like the solo thing? 

Max: She is looking into partnership at some point. Yeah. The fear associated with, what do you do when your associate quits? That's going to be a real pain in the ass. Having somebody alongside you with skin in the game that you can get along with to me makes a lot more sense. Sure. It's maybe not great financially for me right now, to give up some equity and some profit year over year, but I think it's going to be the right way to go. And I think Susan seems the same way a on that whole train of thought. 

Howard: And I do think for marketing, Susan Angel, that's a hell. I could see someone going to Hollywood and cutting a demo and her name is Sally Minors and I can see someone in Hollywood saying "No, we're going to make you Suzy Angel".

Max: We can call you Suzy Angel. Yeah. That might sell a little bit better.

Howard: That was one of my favorite P!nk songs when she was writing that song about how they wanted her to be something else when she went to recording her music and she stuck to her guns. And the other one that I loved is, who's sings 'Don't Speak'? 

Background: Gwen Stefani. But that's when she was part of No Doubt. 

Howard: Yeah. And they insisted that she get breast implants. Same thing with P!nk. And these girls were, "I'm not freaking doing that. I'm not mutilating my body for...."

Max: For your entertainment.

Howard: Yeah. For your entertainment. I think that is so cool. But if it was your wife's own baby with pediatric dentistry? When I meet people that are really pro silver diamine fluoride, I almost wonder, I don't really sense that they're really pro silver diamine fluoride, what I sense is they're really against taking two-year-olds to the OR.

Max: Sure. 

Howard: And putting them under sedation, because really good board certified pediatric dentists with really good MD anaesthesiologists sometimes lose two-year-olds. And they would rather just paint black shit on the tooth every six months until you were in a safer zone. 

Max: Yeah. 

Howard: And two, I mean, my granddaughter Emma running around here is two, I mean, that's a little baby. And I also noticed this. The lawyers and Wall Street are the ones that see through the bullshit the fastest and the only three publicly traded dental companies on earth, 1300 Smiles and Pacific Smiles in Australia and Q & M in Singapore. As far as IV sedation to pull your wisdom teeth. They will not do IV sedation, except for if you're between seventeen and sixty-five ASA 1. Because their lawyers and their Wall Street people say, "Everybody that goes down..."

Max: Is not in that category.

Howard: "Is sixteen and under and over sixty-five. That's a sweet spot. Of your seventeen to sixty-five. Your ASA 1, no med history. We're publicly traded." Because you know, Southwest just had their first fatality today. 

Max: Really?

Howard: They've never had a fatality, and I guess the engine blew and part flew through the window and crushed, killed someone. They haven't found out the name, but what do you think Southwest Airlines are going to have to pay for one dead person?

Max: I have no idea. 

Howard: I mean, you think it's going to be a little amount of money?

Max: It'll be, I'm sure, a lot amount of money.

Howard: Yeah. So, the only three publicly traded dental companies, you got to be over seventeen. So, back to the pediatric dentists. What the anaesthesiologist says is that, you're thirty, I'm fifty-five. Our oxygen saturation might go down a little bit, but man, when you're dealing with six and under, sometimes it'll just drop like a brick. 

Max: Yeah, and I think one of my wife's biggest struggles too is, parents surprisingly are so quick to say, "Well, let's just go to the OR. I don't want Timmy to have a bad experience." It's like, what? You want to pump your kid full of drugs, so they don't have to have a bad day at the dentist, or whatever else. It's surprising to me how many parents don't recognize the kind of gravity of that whole process and that whole situation. I'm really interested though, I guess when you had said about those Wall Street and the lawyers kind of figuring out that these are the policies we're going to play with for IV sedation. That's probably the first time, I think, that corporate dentistry has ever really done anything good clinically for patients. 

Howard: That's a pretty strong statement. I'd say it's just very anti DSL. 

Max: Not necessarily anti DSL, but it's just so infrequent that you hear about the way that a large Wall Street backs that size practice, really making an advancement

Howard: Well, they're just CYA.

Max: Yeah, but that's not a bad thing. It's not a bad thing at all, it's saving lives. 

Howard: Yeah. So, when you talk about the business of dentistry and matching ethics with metrics trend with DSO's and corporate, what is your view on DSO's and corporate? I mean, when you walked out of Marquette, were a lot of your class mates grateful for DSO's because they're the only people hiring them, or was private practice there to hire everyone? Do you feel like people went to DSO's because it was their only option, or do you feel like... 

Max: It's about fifty-fifty went to DSO's versus private practice, and I do think that DSO's are there, serving a place in the market. There are probably more people who are pursuing dental care because they're open late on Saturdays. They may be charged less for certain things, whatever it is. So, I do think that that's good. There's more people getting their teeth fixed, which is important. 

Howard: And some of them have demographic advantages. Like (unclear? 50:19), Comfort Dental, and Aspen. What I'm most proud about Aspen, they purposely look for the poorest of the poor where there's no competition. And they said, "Man, we'll go into the trailer park and we'll do well". But how many dentists say, "Oh no, I'm going to Beverly Hills". Like out here. I lecture at these two dental schools all the time, and it's like a 118% of the class wants to go to Scottsdale. And Aspen is like, "We don't go near Scottsdale". 

Max: We don't want to touch that, yeah. 

Howard: Aspen is the one with the billboard down by Maricopa County. So, Aspen and Comfort Dental, they go where the others aren't. 

Max: Yeah. And I think that that's great.

Howard: But anyway, what's your thoughts on them? 

Max: Well, of the classmates that I had that were working for a DSO, very few of them still are. So, I guess I can't speak to the experience day in, day out, I've never done it, but it just seems like they're having a lot of trouble keeping people in positions that they can thrive for a career there. 

Howard: So, you're saying they have really high turnover. 

Max: I would venture to guess that that's the case. Yeah. 

Howard: Yeah. One of the reasons they have high turnover is because they have high turnover with the assistants. I mean, I can personally name three or four docs within five miles here, that said, "You know, it's hard enough to be a year out of school and doing a molar endo or taking out a wisdom tooth. But really my assistant is not here again. And this girl just got out of Apollo college dental assisting program and this is the third time she's ever assisted a root canal." So, the turnover within the corporation causes more turnover within the corporation. 

Max: Yeah, it's definitely got a compounding effect when you're just kind of already...

Howard: Compounded turnover. I like that. 

Max: Yeah. But I think that there are some groups that are coming out, maybe there's a stronger emphasis put on a dentist remaining at the helm, having a lot of decision making autonomy. I'd be willing to bet some of these practices, even if there is a dentist in the CEO, CFO position, it might be more of an entitled kind of situation. Who is it that's owned by the teacher's union in Canada? 

Howard: Heartland. 

Max: Heartland, yeah.

Howard: Rick Workman.

Max: Yeah. And I've never met Dr. Workman and I've got friends that work for Heartland and have some nice things to say about that group practice. But I find it difficult, when an investment fund owns you, how do you keep the autonomy? All of us dentists are all kind of control freaks in some way, shape or form. How do you that? So, I hope that that's not a trend that we continue to see, maybe going slipping in the wrong direction toward our medical colleagues, where you go to your MD physician, and it sucks. Your MD hardly knows you. The lady at the front desk or the gentleman at the front desk that checks you in never makes eye contact. When you're checking in, they don't care about anything. It's just, "What is the insurance cover?" And this and that. So, I hope that we don't end up that way and I hope to retire in a world where dentistry is still a unique experience within healthcare, where medical is most definitely not.
Howard: Well, one of the things that you might think at twenty-five to thirty-five is, like when the stock market from '93 to 2000, I mean, monkeys throwing darts. Everything was going up. So, everybody was a stock broker. I had so many dentists tell me, "I don't even know why I do dentistry anymore, I'm better at picking stocks. I did when the market is splitting every twenty-four months.

Max: Everybody's amazing, yeah.

Howard: The chimpanzees are good. But then on March of 2000, when it went from fifty-eight hundred to fifteen hundred, you found out how smart you weren't, you know what I mean? So, a lot of people think linear. So, a lot of people think, well, if DSO's went from zero to 15% of the market in the last ten years, the next ten years they got to go from fifteen to thirty, then thirty to forty-five. But it's always a pendulum. What goes up must come down, unless you're going faster than the escape velocity of the planet and then you could actually land on the moon. But if you're not going to escape velocity, what goes up comes down. So, it's a lot of pendulum swinging. None of them could go public, they're not profitable. But the one thing I hope my podcasts can break through is, they're always going into the school saying, "We're taking over fee for services. The sky is falling. Build a bomb shelter." So, they just think it's inevitable. And what they don't realize, dude, when you're in dental school, if it's so inevitable, then you should be able to go to the graduating class that graduated two or three or four years before you. And they should all still be working there. 

Howard: So, if this was the promised land and the golden years, then why did everybody go there and quit? So, if you're in dental school and you're thinking, "Oh yeah, that's a ticket, man, I'm going to be able to work with a big corporation. I'm going to be happy and live happily ever after." Okay, well, if that's true then show me the evidence of all the people working there for five, ten, twenty years. Hell, you'd have a lot better chance in the military. I mean, I cannot tell you how many dentists I meet in the army, navy, air force, the marine corps is done by the navy. I would say it seems like half the dentists will do their four years, whatever they owe him and quit. 

Max: Sure. 

Howard: And the other half say, "Damn, this is a sweet gig", and they stay...

Max: Twenty.

Howard: Twenty, and then you retire with that pension and then move on. So, I would say, if you're looking for results, well, who was the happiest? Who is the most likely to stay twenty years? Well, I'd go military over DSO. I'm not seeing the twenty-year career veterans hardly at all in the DSO's. 

Max: And what do you think that DSO's are doing wrong, or how could they be better? 

Howard: Well, when you have an office manager making clinical judgements, then where do Americans going to need a doctor? I mean, if all the doctors work for Wall Street, then where do the Americans go if they need a doctor? When I need a doctor, I want a doctor. I don't want some doctor being told, "Well, 30% of all your new patients should have perio". Really? Well, do 30% have chlamydia? I thought you either had chlamydia or didn't. I didn't know that 30% of new patients had chlamydia. I mean, how could you say that? And then they're saying, "Well, the insurance will pay so much money for all these perio chips, these chlorhexidine chips and these (unclear: 57:17) chips and everything with a six-millimetre pockets. Put it in there. And they're going, "Well, here's a whole shitload of studies saying that that's all bullshit". It comes back to, I really, really love dentists the most because, who goes and studies eight years of college to help other people with their hands and surgery. I mean, we're doctors of dental surgery. All dentists do surgery in the operatory. They all work with their hands, like welders, plumbers, electricians, with their hands. When you go to the million MD's, 80% of them never load up a scalpel and cut on you. They just sit there and read blood work and write prescriptions. 

Max: Sure. 

Howard: Dentists are all surgeons, and they didn't go to school eight years, so that your revenue can be bumped by doing more root (unclear? 58:08). They want autonomy. They just want autonomy and they don't want you telling them what to do. And then also, a lot of them are told things to do that they're not comfortable doing. When they're saying, "Well, you should pull that". And they're like, "Well, I don't know if I can get it out". But who they're staying the longest with and when you look at (unclear? 58:32) Facebook, Apple, Amazon, Netflix, Google. They're staying the longest with Facebook and that's only two years and they're staying the shortest with Amazon, which is only one year. So, the job churn on younger people is very, very high. Not like in my generation, where you got a job at Honda, Toyota. Like my uncle, my mom's brother. He had a job with Mobil Oil when he was sixteen and he stayed there until he was sixty-five. Did one job. 

Max: Absolutely.

Howard: You just don't see that anymore. The turnover's high. Did you see that yesterday on Apple, where an undercover journalist went in there and people are so worried about their numbers and their time miss that they're peeing in bottles on the factory floor because they don't want to take the time to walk to the bathroom. 

Max: And is this oversees, where they're assembling?

Howard: No, I'm sorry, not Apple. Amazon.

Max: Oh yeah. I can see that.

Howard: Amazon factories. And then when I was in China, the dentists are all telling me that the Apple manufacturing plants, they have fishnet trampolines all around the base because workers jumped out of the window, commit suicide. And when he jumps out and commit suicide, you're going to fall in a net. And within twenty minutes they'll have you out of that net and back to your position on the assembly line. So, if you go jump out of the sixth-floor window, it's about a twenty-minute break. 

Max: Well, maybe that'd be worth it then.

Howard: It's crazy.

Max: It's nuts though. 

Howard: But here's my deal. I want to say the break for the DSO. The dental turnover is just as high in the private practice as it is with the DSO's. So, when people are saying, "Oh well, they have all this burning churn", well, so does a private practice. And so does (unclear? 01:00:15) and they're giving them benefits, stock shares. They're giving them every frickin' thing. So, they've given you everything. You have pool tables, foosball, free snacks, stock incentives, and after two years at Facebook, you get a phone call from some guy from Uber who says, "Hey Max, you're having fun at work or do you want to try something new? Want to try driverless cars?" You're like, "Fuck yeah, I'm tired. I've been doing this for two years. I've already learned it. I'm not growing." Which is the key, because Heartland will tell you, by the way, Ryan, did you ever schedule Pat Bower? 

Ryan: Yeah, he is rescheduled. 

Howard: Okay. Because Heartland figured that out, that if you give them the most hands on continuing education and you sit there and say, "You stay with me and you're going to be placing implants, so we're going to put you through an implant program or endo program". And that's why they're leaving. That's why they are flipping around jobs in Silicon Valley, because number one, all those companies are in Silicon Valley. So, when you switch from Apple to Ebay to Uber to Amazon, you don't have to change your apartment, you know what I mean? So, Heartland is really trying, Heartland keeps them. Military keeps them the longest. Same thing with the military. You go work two or three years in the military and they're one of the best at getting you accepted into endo school, perio, pedo. I mean, there's dentists who thought they could never be an oral surgeon, but three years after the navy and the residencies and this and that, they've proved to some guy that he can do it now he's an oral surgeon or endodontist. So, CE is… teaching them new things, whether it's programming or dentistry is what keeps them intellectually stimulated. 

Max: And I do have a friend, he's a guy who graduated just a year ahead of me, who's been with Heartland, I think, his entire short career, whatever, six, seven years. 

Howard: That's a long time. 

Max: Yeah. But he's always spoken very highly of "Yes, they will pay for this and that, the CE, and they make it simple and straightforward to get too". So, I do think that that's a good thing. I guess, we're just going to blame it on the damn millennials then, huh? They're all jumping jobs.

Howard: Well, it's interesting. At the end of World War Two, 1945 when, I pretty much assume that's what everybody means when they're saying, "Make America Great Again". Well, I don't think they understand that the United States, Canada, Australia was not imperialism, you know, when people say, "Oh, Europe was imperialistic, and they conquered them". Now, we were imperialistic settlers. And those types of settlers, when they got to their land and they cleared their forty acres, they also cleared the indigenous people. There were twenty million Indians when they got here and there was only a million when they were done settling. And if you look at where the Indian reservations are, there's none, almost zero, on the northeast where the pilgrims landed, that whole northeast. All the reservations are west of the Mississippi river in Oklahoma, Arizona, all that stuff. 

Howard: And they brought over with them to the Americas, about ten million African slaves. 20% of them died in transit and they had very short life expectancy. So, I don't think any African Americans or native American Indians think that that was our glory days. I mean, make America great again. That was really, really bad. But after World War Two, the war was not fought over here. So, every industrialized country in the world from Japan to Germany was levelled. In fact, when war was over in 1945, Germany didn't declare the reclamation, or whatever it's called, over till 1980. It took thirty-five years to get rid of all that rubble and put their buildings back. 

Max: It's pretty fast. 

Howard: So, right after World War Two, the only unscaved industrialized world that could make a washing machine, a car, a dryer, a stove, or a refrigerator, was just the United States. Imagine if we had a civil hamburger war in the United States and McDonald's blew up every single Wendy's, Carl's Jr.'s, In-N-Out Burger, Burger King. And at the end of this four-year battle, the only hamburger store standing was McDonald's. What would that do for its sales? 

Max: They'd probably do okay, and we'd all be really fat. 

Howard: And then when it got rebuilt, there were new players on the deal. There was China and there was India, there's all these countries. So, after World War Two, and we had the nuclear bomb, and it would take Russia until the early fifties before they got a nuclear bomb. So, for five, six years, we're the only person. We were total power. Nuclear. We owned all exports. Right at the end of World War Two, for the next five years, America was half the global GDP. 50% of the world's GDP. Now you're back to a quarter, so you can't make America great again unless you go to war right now with Japan, South Korea, Germany. Anybody who makes shit that's high quality. If you blew up all those factories, you would get all your manufacturing jobs back. 

Howard: So, at the end of World War Two, the average American girl is having five kids and getting married at sixteen, seventeen years old. Now they're getting married ten years later. 

Max: Sure. 

Howard: And they're not even having two kids. So, to maintain the herd, you need two point three. Japan's down to under point nine. In fact, if you backed out immigration in Europe, all those countries are shrinking populations. Japan doesn't get any immigration, so every morning in Japan there's less people than the day before. So, these girls in Japan, I mean, I've lectured in Japan, I talked to them. I've talked to female dentists over there, and they say, "Look man, my dad stressed out all through grammar school, to get into the best high school, stressed out all through high school to get into the best college. Then got a job at Honda, did twelve hours seven days a week, come home, drink till he'd pass out, died of a heart attack at sixty-five. I don't want that life. I only get one life. I ain't spending it doing that. I'm not going to drop five frogs and be stressed out until I drop down of a heart attack." So they're like, "No, I'm not getting married at sixteen and have five kids". A quarter of the baby boomers just had furry friends instead of (unclear 01:06:47). They're expecting a third of the millennials to have furry friends over little baby naked apes. 

Howard: And yeah, I think that if after two years of working at Facebook, if you’re bored and Amazon or Netflix or Uber calls you up. Like right now, Phoenix is ground zero for Google's driverless car, the Waymo system. Yeah. And every time they pull over and I'm driving somewhere, I pull over and get out of the car and talk to them because it's pretty frickin' exciting. A lot of unintended excitement. You know who really is the most excited about it? How many people retire in Phoenix from Green Bay? 

Max: Sure. 

Howard: So, west of the Mississippi, they come to Phoenix and if they're east of the Mississippi, they go to Florida. And all these older people who can't see, don't have their driver's license, now they're free again with the driverless car. All of my alcoholic friends are so excited that they don't have to drink at home in their underwear watching Netflix. 

Max: Yeah, they get back in the saddle.

Howard: They can go to the bar and drink up and drive home in a driverless car. Blind people, elderly, disabled. It's really going to be quite interesting. So, let's end with, well first of all, when you binge watch Netflix, what've you been binging on?

Max: Man, House of Cards was really my most recent, I think, addiction. That whole Kevin Spacey, weird guy news that came out, kind of put a little damper on that for me. But that was something that I followed pretty religiously. How about you? 

Howard: So, when you say followed religiously, that means you watched it twice on Easter and Christmas?

Max: Yeah, right. That's about all I do. No, like finish the season in the first weekend. It was pretty bad. 

Howard: So, what's this 501(c)(3) called United by PAT? Who's Pat?

Max: Pat. Pat Hackett is her name, or was her name. Patricia Hackett. She worked at Marquette dental school. 

Howard: How do you spell Hackett?

Max: H-A-C-K-E-T-T. She was one of the ladies that would run kind of like an insurance office at Marquette dental school. Really a Rolling Stone personality. Ended up doing in her teenage years, or early twenties maybe, a hitchhiking trip that ended in Guatemala. From Milwaukee. So, just a really interesting person with a lot of life experience. Fell in love with the country of Guatemala and had this trip where she would kind of (unclear? 01:09:21) all these dentists from Marquette to come down for a week and do free dental work. 

Howard: Nice.

Max: And have a lot of fun. So, while I was at Marquette as a student, I got linked up with her to go on one of those trips. It was just a freaking blast. You're shucking teeth all day and then drinking beer with your friends all night. She had organized that trip, got it off the ground and unfortunately passed away a few years after I had the chance to meet her. 

Howard: How old was she when she passed away? 

Max: I want to say early fifties, mid-fifties. She was a very young woman. She died of cancer. 

Howard: Which kind?

Max: I don't recall. By the time I learned about her diagnosis, it was kind of spread all over the place. So, we organized that in her honor.

Howard: Now, Dentaltown has fifty forums. Root canals, fillings, crowns. One of them is humanitarian dentistry. Did you post it in there? 

Max: I have not. No, I didn't know there was a forum. 

Howard: Yeah, it's one of the forums. I'm really into that. I'm into that because a lot of dentists, they get irrational expectations. See. So, Dentaltown magazine, equipment, finance, health topics, hygiene, humanitarian dentistry. 

Max: Okay. 

Howard: And we divide it in two, charitable dentists and missionary, because it's two distinct group. The missionary ones are truly doing it all for God and the charitable ones are truly doing it all for the poor.

Max: Doing good. 

Howard: Income inequality. So, is yours a charitable or missionary? 

Max: Definitely charitable. Yeah, I think one year we went to mass. I think.

Howard: So, you know why I don't have to go to mass? 

Max: Why is that? 

Howard: Because my mom, clearly just have to keep the Holy Sabbath, but my mom took us seven days a week. So, I went from seventeen times three hundred and sixty-five days, so I went to mass six thousand two hundred and five times. Now, I was only supposed to go on the Sabbath, so I six thousand two hundred and five divided by seven. Is that right? Yeah. I don't have to go back to mass till I am eight hundred and eighty-six years old. 

Max: I think that math though would assume that you were listening all the time you were there.

Howard: Well, you couldn't listen because it was all in Latin.

Max: Sure.

Howard: But you know what I liked the most about going to mass every day?

Max: What's that? 

Howard: Same reason people like going to yoga. Some reason people like meditation. Because you have to unplug, you can't do all the things that are distracting you. You need to sit there for an hour. And you just start thinking about your day. What do I do today? I got a spelling test. What is everybody else doing? I thought that it taught you how to think. And I look at these kids who wake up, and first thing they do is they go to their smartphone and they're looking at their Facebook.

Max: Instagram. 

Howard: It reminds me of a rat in a cage you know? He runs on the wheel. Then he drinks and eats some food. Then he runs on the wheel. Then he had sex with his partner, then he drinks, and he's just distracted twenty-four hours a day. And I thought what the neatest thing of church was, especially Latin, I prefer that they go back to Latin was just, you couldn't touch your cell phone, you couldn't touch your email, you couldn't talk to Ryan. You just have to sit there, and you have to be alone with your thoughts. 

Max: That's very true. 

Howard: And I thought that was a really, really healthy thing. So, are you still trying to raise money for your 501(c)(3) United by Patricia Hackett. 

Max: You bet. PAT's always trying to raise money. So, every year, I mean, it's super easy to get a trip off the ground and raise the money for supplies and such. 

Howard: I didn't finish my thought on that. These dentists, they're all stressed out because they're trying to build a million-dollar practice and trying to pay off their student loans. They're trying to do all these things. And then you go with them to work on an orphanage in Tanzania, Africa or Chiapas, Mexico. And you get unplugged and you realize, "Okay, here's five thousand Chiapa Indians that don't have running water, electricity, or sewage. So, what were you all stressed out about again? 

Max: Yeah, it does make you appreciate stuff.

Howard: So is Greg Stanley. So, Greg Stanley is one of the most amazing dental consultants ever. And he's in north Scottsdale. He's been taught here for thirty years. And when he listens to these dentists, they're so irrational. He really pushes them to this one deal in Haiti because Haiti is the poorest country in the Americas. So, he has a dental deal with them. And when he starts hearing just completely irrational expectations, irrational and just bat shit crazy, crazy, crazy, he's had the most success for years by getting them to go do a missionary deal with Haiti. And it just kind of resets your clock. 

Max: Absolutely. 

Howard: It's like when we were little kids in school and we had to go a couple of times a year to Catholic retreat. So, Friday after school, instead of going home playing all weekend, you had to go over to the monastery and live with them until Sunday night late at night. What was so great about it, again, just unplugging from your everyday life and listening to motivational tots or other thoughts or whatever. Just breaking the cycle. And I think, charitable dentistry, missionary dentistry just, I mean, how do you wake up every morning in the United States, Canada, Australia, New Zealand, Japan, South Korea, Western Europe, and think you're under all this damn stress? I mean, have you never seen Tanzania, Ethiopia, Syria? Have you never seen the poorest of the poor in Calcutta? 

Max: That's the problem though. A lot of people don't have the means or make the time for travel and different experiences like that. And quite honestly, you turn on the news and you can't even really trust it, so you're not really learning much from those mainstream news sources per se. So, it's really difficult to put yourself truly in another person's shoes without going to live it. And I do think that for all of its greatness, 2018 is just a busy time in history to be living. So, unless you're intentional about making the time to live those experiences, it's easy to just kind of interact and live your life and nose on the grindstone. And I think that's really unfortunate. 

Howard: Well, the news though, Americans never ever want to look in the mirror and blame the man in the mirror creating problems. So, what they want to do, they want to blame everybody but themselves. And the bottom line with the news is, no one will pay for it. So, the only business model is to sell ads. So, CNN, Fox News, MSNBC, all these companies are publicly traded for profit. And nobody will pay $10 a month for the New York Times, the Wall Street Journal, the Washington Post, the LA Times. So, now you're down to journalism that's for sale. So, you have your advertisers. I know that. When I started my magazine, I was a purist and from 1945 to 1998, it was the Farran Report and it was $10 an issue, no advertising.

Max: Sure. 

Howard: And I had like four thousand dentists out of a hundred twenty-five, and all the hundred and twenty-five dentists would say, "Well, look at these magazines. These guys, they're like NASCAR drivers. These guys, write for this company, these guys, write for that company". And the most hysterical one I ever read was one of the magazines, they call them throw away journals. 

Max: Sure. 

Howard: One of the guys' articles was actually the instructions sheet of the kit. If he actually had bought the $500 bonding kit, the frickin' article was the instruction sheet. And then I said, "Well, the Farran Report is no advertising". So, it's like, "Well, would you pay $10 a month for the New York Times, the Wall Street Journal, the Washington Post?" "No." And then you say, "Oh, it's all fake news". Well, **** you, you get what you pay for. If you're not going to pay, they got to get revenue. So, they're going to go out and sell ads and they can't do journalism about how bad these companies behave, if they're buying all the ads. Why do you think when you turn on the news, it's just one pharmaceutical pill after the other? Because if I'm Viagra and Cialis and I'm buying a commercial every hour, then you're not going to do a story that says, "Well, you know what? People with erectile dysfunction and taking Viagra and Cialis, they've a very high mortality rate". Because when your only goal of the species is to reproduce, have offspring, and your ding dong don't work...

Max: It means you're not healthy enough to do it.

Howard: Yeah, you're not very healthy. When they say, "Ask your doctor if you're healthy enough for sex". You know, if you have to ask, you're not. So, why are you not? Because you're smoking, you're drinking, you're an alcoholic, you're fifty pounds overweight and you don't ever exercise. And I'm just talking about me. So, they're not going to do stories, as soon as your ding dong starts working and you're on one of these pills, you ain't living very long. 

Howard: So, everybody that's got shit they don't want out is buying all the ads. So, they're never going to talk about that. So, what are they going to talk about? The Machiavellian principle. Let's get a common enemy overseas. So, let's talk about the terrorist. When last year in the United States fifty people were killed by a television falling on them. There weren't fifty people killed by a terrorist. You had a better chance of being killed by a tv falling on you. So, we're going to talk about Putin and terrorists and Kim Young Song, whatever, June...

Max: That guy.

Howard: Whatever that guy is. And it's not CNN and Fox news' fault because they're publicly traded, and they don't make a profit. They'll go bankrupt. It's the Americans who want their cake, but don't want to pay for it. 

Max: That's a very true statement. 

Howard: So, if you want journalism, open up your wallet and pay for a journalist. They don't want to subscribe to the newspaper. "Oh well, I'll just get it for free on my smartphone". "Okay, well that's fake news." "Well, it's free."

Max: Yeah.

Howard: "I'd rather have free fake news than I actually pay to have my local newspaper delivered on my driveway."

Max: Yeah, put the blinders on. It's easier that way. 

Howard: Yeah. So, everybody's at fault except for me.

Max: True. Fact.

Howard: That was my favorite Michael Jackson song, Man in the Mirror.

Max: Yeah?

Howard: And the reason they always want to solve your problems is because they wouldn't even consider solving their own problems.

Max: Especially because I don't have any problems. Right? 

Howard: But seriously, I cannot believe, you came an hour. It's already been an hour and a half. I just think that it's so damn cool, Max, that you have the self-esteem to be transparent, to come share your journey five years out of school with your homies, so that no dentist will ever have to practice solo again. I seriously thank you so much for coming by and sharing your story. 

Max: Absolutely. Thanks for having me on.