Nancy Zelno, author and leader in healthcare practice improvement, shares the strategies and systems to help your practice improve. Her long history of creating winning results for healthcare teams stems from holding every position in a practice (aside from provider), which has given her a comprehensive understanding of the entire practice.
After more than 15 years in the dental and medical fields and eleven years in corporate settings such as Reader's Digest and IBM, Nancy set out to help numerous healthcare practices master success by helping them organize their practices, stressing the need to work smarter and not harder.
Since 2001, when she founded Dynamic Administrators, Nancy's unique approach to practice
Development has helped her clients to create effortless and fulfilling lives and to grow their practices using a "team-first" approach. She has brought her lively, enlightening presentations to consulting and meetings across the country.
Nancy was awarded the Manchester Who's Who Registry as a Platinum member in the "Honors Edition" for executives and professionals, providing a vast networking platform of more than 200,000 highly accomplished professional worldwide. In 2015, Nancy earned a B.S in Law from Post University.
http://www.dynamicadministrators.com/
VIDEO - DUwHF #1065 - Nancy Zelno
AUDIO - DUwHF #1065 - Nancy Zelno
Howard: It's just a huge honor for me today to be podcast interviewing Nancy Zelno with Dynamic Administrators all the way from Dunedin, Florida, a suburb of Clearwater. Nancy Zelno, author and leader in healthcare practice improvement, shares the strategies and systems to help your practice improve. Her long history of creating winning results for healthcare teams stems from holding every position in a practice — except from the provider — which has given her a comprehensive understanding of the entire practice. After more than fifteen years in the dental and medical fields and eleven years in corporate settings such as Reader's Digest and IBM, Nancy set out to help numerous healthcare practices master success by helping them organize their practices, stressing the need to work smarter and not harder. Since 2001, when she founded Dynamic Administrators, Nancy's unique approach to practice development has helped her clients to create effortless and fulfilling lives and to grow their practices using a "team-first" approach. She has brought her lively, enlightening presentations to consulting and meetings across the country. Nancy was awarded the Manchester Who's Who Registry as a Platinum member in the "Honors Edition" for executives and professionals, providing a vast networking platform of more than two hundred thousand highly accomplished professional worldwide. In 2015, Nancy earned a B.S in Law from Post University. Nancy, thanks so much for coming on the show.
Nancy: Oh, thank you so much for having me down.
Howard: Should we make this the last podcast I ever do since your last name starts with Z?
Nancy: Okay, that would be the story of my life.
Howard: We started with A and we ended with Z. I have four boys, and the last one was the last one, so we named him Zach. So my boys are in alphabetical order; it's Eric, Greg, Ryan, Zach. So it's E, G, R, Z and they're going to have to invent a new letter of the alphabet. Tell us about your journey. You wrote a book and it's on Amazon and it's called "Consent Workbook". Tell us about your journey that ended in writing a book, "Consent Workbook", on Amazon.
Nancy: My journey started as even in the corporate field and went into dentistry, and you know how you find something in your life that you just jive at, that it just comes natural? And I, leaving the corporate world, went into dentistry and went from front desk where it was just me and the doctor in an office in Manhattan and I left saying dentists are cheap and mean. He used to throw things at me, was horribly mean, and cheap. So, I left and I went back to the corporate world and I just couldn't get out of the dentistry. It just seemed what came natural to me. As I learned along the way of what to do and what not to do by making mistakes, and/or by improving practices, we got to the point of bringing together Dynamic Administrators because I was told by somebody that we were doing a speaking engagement with, they were like, "Wow, you're like dynamic." I'm like, "Oh, great word." So I utilized it, and I actually started the business as a freelance office manager type of position to help a lot of different offices because sometimes they didn't need somebody full-time, so I would go in and work with them on a part-time basis and then it just blossomed into learning more about the business. And when you said 2001, I kind of cringe because I think, "Oh my God, has it really been almost eighteen, seventeen years?" But I guess it has. So I've learned, like I said, along the way and I got into the "Consent Workbook" because there were so many offices that I was in and finishing up with my law degree, I thought, we're not protected and there are so many mistakes that dentists make and I think you've really got to make sure you're listening to the right people when it comes to advice. They do leave themselves open to risk in a lot of areas. And I had some people asking me to put together some consent forms, so we put them all together into a book.
Howard: It's funny because right now is the time of year- This is May 30th. Right now you're having fifty-six dental schools all graduate. All these dental students are being dumped onto the market now. Six thousand of them. And how much training in business do you think they received after eight years of college and four hundred thousand in student loans?
Nancy: Well, I think that's why me and all the other dental consultants are in business for as long as we are — because they're not. And the problem is, is like I said, I started in the corporate world and in the law arena, but was able to bring it into the dentistry, and there's many of them that will openly admit, "Oh my God, I don't know anything about a business." And the tagline to my business is, "Don't worry, just practice", because so many of them would say to me, "I just want to do the dentistry. I don't want to have to know all this stuff about the business." It doesn't matter if you want to or not, you need to, because it is your business. As a matter of fact, the dentist I told you about that was mean, he had his mom work for him and nobody else, and she wasn't allowed to leave her chair and she wasn't allowed to talk to him. She had to write notes, and I said to him, "I can't believe the way you run your business," and he said to me, "It's not a business. It's a dental practice." And this is somebody that was in business for many years. I thought, "Wow, here's a place for me." So that's how it ended up developing.
Howard: And the reason he could be rude is because he went through his whole life being a baby without anybody just beating the crap out of him. When I see these totally dysfunctional people, they had helicopter parents, had thought baby was precious and they just had to talk to him. Whereas when we were little, 100% of my friends feared their father. Their father loved them, but you knew if you crossed the line, your father would kill you.
Nancy: He said that to me about my kids, and they're like, "You rule by fear." And I'm like, "No, my kids aren't afraid of me. They're afraid to make me mad. They're not afraid of me." And I've always said through all the things that I've seen dentists do, they will keep doing it till there's a price to pay because some of them will keep making the mistakes or doing things that they're really not supposed to do until there's a price to pay, until they get a lesson learned, like you just said.
Howard: Yeah, I always tell all my friends when they would whine about their kid getting in a fight at school, it's like, "Your kid needs to get into a fight in school to know that you shouldn't do that. That's how you get better." And I went to Catholic school where I watched a priest one time, throw my best friend, through a- You know they had those doors that had a little slim window deal? He poked his finger in a nun's chest and was backing her up and he came from behind him and grabbed him and threw him through that window, and that guy was Gary Lux. He was the greatest friend, guy in the school, but he learned one thing that day, that you never poke your finger in a nun's chest when you're talking to her. And yeah, there's so many people that you look at their behavior and just thought, "I'm sorry you didn't get your butt kicked on the playground when you were little because that's not the way to act."
So if you were giving the commencement speech to- There's some six thousand graduates walking out of school and they all start with this unicorn fairy that, "You know what? I'm just going to go get a job in an associate and I'll just live happily. I won't have to worry about anything in the business." And then they go get a job as an associate and they realize that if you're a dentist, physician, lawyer, if you're highly skilled, you can't take orders, you won't listen to what anyone else says. The only people that can have a million people work for them under their thumb and do whatever they say is if they're all high school graduates or less or they're all under twenty-one, like in the military. So they all go get a job and they just say, "Oh, this is great. I'm just going to go get a corporate job and make a lot of money," and then they all find out they're miserable after a year because they're being told they have to do this and they can't do that, and they got to sell, blah, blah, blah, blah. They're all miserable, so after two years, 80% of them start looking to own their own business. So I always tell them when they graduate, "Believe in unicorns, Santa Claus, the Tooth Fairy, you live in the world of whatever," but about two years out, they start thinking, "Damn Nancy, I want my own place. I'm tired of having someone under my thumb." So what would you advise them on their journey? How would they get the business skills so someday they could own their own place and do what they want to do and not live my life according to what you want me to be, but according to what I want to be?
Nancy: It's interesting that you say that because there were a couple of times throughout my career in consulting where I went back to being an office manager. For me it was, "I want to find out more of what's going on. I want to be in that seat and learn more." But I have to tell you, exactly the same thing happened. I could not work for somebody else and I just have that personality. My advice to them would be, be careful who you take information from, make sure that you do your research and while you're taking those two years in some of those corporate companies, absorb what you can. Learn the good, but also learn what they do wrong. I worked for a dental practice back in the day and I guess it was my second dental experience and I learned so much from them, what to do, and I also learned what not to do. But I was able to, in my head, understand that morally, some of the things they were doing were not correct and how to make it right. I think that the thing is they have to be careful who they're taking advice from and who they're listening to. Other dentists sometimes give wrong advice because they're already doing it wrong. If they're going out and looking for a new practice, are they looking for a partnership that the person eventually buys out? You and I know how that always works where they go in and, "Oh, I have a five-year deal with the current dentist," and they fight the entire five years and they end up in a lawsuit. So there's so many different things to be aware of, but watch who you're taking your information from. It's very important. And you know what they also need to know? Because honestly a lot of dentists still don't realize this. Your team will make you or break you and if you don't have a dream team, they are out there. You have to be able to learn how to interview people and make sure you have a dream team. That's the bread and butter of your business. The patients come.
Howard: Yeah, I love what you say: listen to who you're getting the information from. Because I've always believed that at least 80% of humans, if not ninety, they always go to the person for advice who they think is going to tell them what they want to hear. Imagine you're a young girl and you have advice and you could go ask the nun, you could go ask your party friend who's literally an alcoholic, you could go ask your mom, but you go to the person that's going to give you the answer- I'll never forget that. That's what I love the most about my takeaway in a Catholic school and the library, is I was having to do a book report on planet Mars, and so I took this book out and the librarian says, "Why did you pick this book?" And I said, "Because I'm doing a book report on Mars, and it was Mars." I showed it to her. It even had the red planet on the cover. She goes, "Who wrote it? What if your mom wrote this? What if your best friend David (unclear 00:11:35) wrote this?" She goes, "Who wrote this?" I'm like, "I don't know." And she taught me how you do an author search first and then she asked me, she said, "Who do you think would be the smartest person talking about Mars?" And a little kid back then who watched Neil Armstrong land on the moon in '69 when I was born in '62 — and I'll never forget that — I said someone from NASA. She goes, "There you go, so let's go do author searches. Let's see if someone from NASA wrote a book on Mars because I would believe that guy a whole lot more than your buddy David (unclear 00:12:09) or any of these guys.
And today, you see on fake news like people or dentists are sharing news stories on Facebook from like US International World, USA. And you're like, "Dude, look at this source." And then you read from Facebook that 90% of shared news stories, the guy sharing it didn't even open it and read it. It's just clickbait and yeah, people take practice management advice from people who have never ran a dental office, owned a dental office, and what's sad is that in consulting, the people who tell you what you want to hear are more successful than the brutally honest people who tell you what you don't want to hear.
Nancy: I have that problem all the time. I'll go into an office, and it just happened to me recently here in Florida that I said, "Are you ready to listen?" I was with a practice- Because I do mine a little bit differently. We're actually on site. I'm in the trenches with them. I go in every single week and I'm in the trenches with them, working with them, saying, "This is what came up. Okay, how do we handle it? Let me show you a better way," and we can handle things right then and there. And there was an office that I was with him for quite some time, an older gentleman, and he says, "Nance, this month, the numbers are so down," and I'm like, "Are you ready to listen now? Are you ready to listen to me or are you going to keep reading these articles that really are not pertained to your practice?" Every practice is different. There's a lot of consultants out there. Some have drastically different views on things and like you said, I have a hard time being a consultant where I walk in the door and I say, "Listen, this is what we're going to do," because then I lose the client. They don't want to hear that. They want to hear what they want to hear. So my way of doing business, I've got to find a way to tell them what needs to be fixed the way that they're welcomed to hearing it. So it's a little bit more psychology than anything else, but you're absolutely right.
Howard: The thing with consulting is, the first thing Americans need to learn is there's no such thing as the United States of America or the EU. Like if you were a dental consultant, you couldn't compare any practice in Germany to that of Greece or Portugal to Sweden. You can't compare Manhattan to Clearwater, you can't compare Anchorage to San Fran or Kansas to Albuquerque. So even when they started the Federal Bank, the Congress knew that there were- They divided America to into twelve different economies. That's why you have a Fed Bank in Kansas City. That's why you have one in Mini Apple, St. Paul, San Francisco because there's all these different Americas. So I always tell people the consultants, if you're in Lyons, Kansas, I would ten to one rather have someone who's done a hell of a lot of consulting in Kansas than someone who's really big in Beverly Hills or Key Biscayne.
Nancy: Right, and that's what I said. We've always been the best kept secret of the East Coast because I'm in the offices on the East Coast, but I've worked in Manhattan, Madison Avenue and I've worked in Philadelphia and I worked down here in Florida. Not only there are different laws, there's different employment laws, there's different dental things. Every state is different, like you said-
Howard: What percent of the dentists in Florida though are transplants from New York and New Jersey?
Nancy: Oh my God, as a matter of fact, they're at the point where they won't even give out dental licenses down here unless you already have one because everybody wants to move down here. So they're very, very strict on giving dental licenses even in Florida anymore. So yeah, transplants.
Howard: It's kind of interesting with dentists and retirees. If you're east of Mississippi, you're from New Jersey and Manhattan and you're going to Florida and as soon as you're west of Mississippi, you're going to Phoenix. Also, I think it's extremely cute in Phoenix, in my backyard, where if you come from New Jersey or New York for some reason you want to go to Scottsdale. It must have an amazing brand name in New Jersey and Scottsdale because if you come from Minneapolis or Kansas, you want to go to Glendale, Chandler, Mesa, Tempe. But gosh darn it, if you come from New York or New Jersey, you just have to go- You go to Scottsdale. There's areas of Scottsdale where I swear to God, you'd think you're in Manhattan. It's just like almost everybody there has a New York accent. So my homies are driving to work, they're all by themselves, they know their world, they don't know your world. You see all these people. When people call you and say, "Nancy, I need help." What are the top three problems? Obviously if you go to a dental office, the top three problems are going to be cleaning exam, an X-ray, a filling and a crown. What is your cleaning exam X-ray, a filling and a crown? Why are people calling you? What problems are you solving?
Nancy: So we saw problems in accounts receivable. "Nancy, so many people owe me money. Can you help me with my accounts receivable?" But between you and me, there's usually a bigger problem there. So they'll ask me, "I'm not making enough money," "My team is driving me crazy," or "I don't have enough new patients." So those are the main buckets per se that they fall into. I don't have enough new patients, but you know what? After we dig down, because I don't just say, "Okay, well then let's find you more new patients." I have to look at how many who are coming in and how many are you keeping and even though some of the softwares will tell you how many are coming in, the only way to know how many you're keeping is by doing it by hand. So back when we said Reader's Digest, I was a statistical analyst for their website, so sitting down and saying, "Okay, you've got forty-three new patients last month," and they're like, "I did?" "Yeah, out of all of those, ten had a cleaning. Five are set up for recall. I'm not getting your new patients. What you need to do is fix your system so that those new patients are more efficient for you." Accounts receivable, usually it's that the people at the front desk aren't collecting the right amount of money at the front desk; now we have to go chase it. And I have a part of my business where I sit down and all I do is fix people's accounts receivable. Look at (unclear 00:18:21) with their patients, I make the phone calls, I do the letters, then I send them on to the collection agency. So I'm willing to help, but why not fix the problem that the reason that your accounts receivable is $250,000? So those are the main buckets. And lastly, it's usually, "It's not me, it's my team. My team sucks. It's not me." And usually we boil it down to what's the common denominator. It's usually something in with the dentist that may have to change and if not, they didn't fit as a team; why did you hire them? So we look at those types of things and we get their team running and actually owning the practice, like part of the dentists do. So those are the main areas that they come to us.
Howard: Man, there's so many things to talk about. Look, let's start with the accounts. First (unclear 00:19:05), I'm sorry to say to this you, but when I get on an airplane and the guy next to me is reading a book, I don't have to ask him if he's a grandpa. He just knows he it. So podcasters are millennials, so a quarter of everyone listening to you is still in dental kindergarten. They don't even know what account receivables is. Talk about what account receivables is, and then for the ones that do know account receivables, what's smarter to do: to fix your policy or to go chase uncollected money?
Nancy: Well, obviously the cheaper way would be fixing your policy, but let's go back to your first question. Accounts receivable is when we have patients come in and do their work, there's always — unless it's a cleaning — some sort of out of pocket. I don't like to say copay because that's a medical term. There's some sort of out of pocket or patient responsibility. Then we send things off to insurance companies and a lot of times the insurance don't pay what we're expecting. Now it's back to a private balance. So our accounts receivable is the money that's being held by other people other than us, but it's due to us. It's owed to us. So the accounts receivable should be under, and this includes for me, and insurance receivable should be under one month's production. So let's say you have a smaller-sized practice, you're producing a hundred and twenty thousand a month and your accounts receivable's at two fifty, including insurance outstanding. Okay, we have a problem. Your ninety-day column is losing you money because the longer it sits there the harder it is to collect and there's a lot of legal ramifications once they get to a certain point as well. So that's all the money that walked out the door that you didn't collect for your services at the time that they should have been collected. I see a lot of people do payment plans and you know when the economy changed we had to change a little bit. We had to be a little more understanding of patients in order for them to get their work done, but there's ways of doing payment plans with either outside companies or us controlling it. So we don't run into carrying so much debt. Then this is what a lot of people don't understand. You've done the service, your expenses are gone. That money that's sitting on the accounts receivable, that's your cash because you've paid your help, you've paid your supplies, you've paid your lab fees. Now all that money that's sitting there, that's your money. So that's in essence of what the accounts receivable is. How do I fix the systems is much cheaper than going through and chasing after accounts receivable because when I sit down and I chase after accounts receivable, I charge hourly plus I charge a percentage of what I collect. The national average is 9%. Collections of anything at ninety days are 9%. Now you're saying, okay, the rest of it, the 92% of what I have outstanding, I'm never going to see. Then your collection agency takes it up to 50%. Now I work with one that only takes five, but hey, they're still taking their money and you should have gotten it before they walked out the door. What about the interest that you could have been making on that money? So fixing those systems is easy to fix, it's quick to fix and it saves you a lot of money. Usually when they call me in and they say, "My AR is out of control, we start by collecting their money for them so then they can invest in learning how to create the new systems.
Howard: I always think it's hilarious; you walk into McDonald's and the sixteen year old kid, you say, "I want a hamburger." She says, "Okay, give me three bucks," and you said, "No, just give you the hamburger and then bill me." She would look at you. She'd throw the hamburger at your head. And then you graduate after eight years of college and he'd come in and say, "Oh, I need a root canal." Okay, it's a thousand bucks, your insurance's basic, et cetera. You owe me four hundred. And they go, "Can you bill me? I'll pay you next week or I'll pay you next-" Hell, they're most motivated to pay right now. You come in my office and you broke your tooth and need a root canal and crown. I'll say, "It's two thousand bucks, insurance pays a thousand. Your portion is due today." And they say, "Well, I don't get paid till next Friday?" "Great, let's go upfront and find an appointment for next Friday." "Oh, but I want to have it done now. I want to have it done now." "Okay, we take credit cards, American Express, Visa, Mastercard." "Oh, I don't have a credit card." "Dude. In America, they start sending you credit card applications before you're ten years old. So you're twenty and all these billion-dollar banks like Chase and Wells Fargo, none of them will give you a credit card. So what are you? You're a deadbeat."
Nancy: So then we're supposed to take their credit, right? That's what I don't understand. If you're not going to get approved by Citibank, why should I? You know what it is, Howard? They live in scarcity. The doctors live in scarcity. If I let it go, I won't have money coming in. If I let the patient go, he'll go someplace else. He'll never come back and my doors will close. They live in that scarcity, and then what it does is it creates more financial problems for them than they even understand that.
Howard: What percent of dentists do you think live in fear and scarcity versus hope, growth and abundance?
Nancy: I fear to say at least 75%.
Howard: So the eighty-twenty rule.
Nancy: Yeah, because I know a few that don't live that way, that are moving forward, that are not in that scarcity. A lot of us do it with our own lives, but once you live in that scarcity instead of abundance and expecting the abundance and expecting people to walk in, that's what causes those doors- Because my dad used to say, if you have a puppy on a leash and you're pulling the leash, what does it do? It pulls away. When you give it enough leash, what does it do? It always comes back and when you're pulling onto that, that patient, that money, all you're doing is scaring them away and there's so many times I've heard patients say, "Why are you trying to close me so fast?" Because the doctors are so afraid of them walking out the door. "You know what? I'll give you payments. How about if you pay me for the next two years? We'll charge your credit card twenty bucks a month." And I'm sitting there going, "What? What? How are you carrying their debt?" Pain pays, like you said, that's their best motivator and if they cannot afford it- And there have been times that there are patients that just could not afford the dentistry we were doing and I had to say to them, there's a hospital or a community center down the street that might be best suited for you.
Howard: I think the bizarrest stat in all dentistry is that the average American between age sixteen and seventy-six will buy thirteen new cars their lifetime and the average median price of a new car is thirty-three thousand five hundred. They'll go finance it for five years, sixty months. They'll pay interest rates and then you go look at the dentist. 95% of dentists will go their entire career without selling one case that's thirty-three thousand five hundred and in every single zip code in America, there's another dentist who only works Monday through Thursday because every Friday is his big case day where he's doing All-on-4, he's doing a full mouth rehab and he does a full mouth rehab for $25,000 to $50,000 every Friday his entire career, and then the seven other dentists in the medical (unclear 00:26:25) says, "Well, there's no money in this town. Nobody has any money." I was just having a dinner at a restaurant in a small town in Kansas and this dentist was telling me I didn't get it because he's not in Phoenix, he's in a small town in Kansas and there's no money and while he's telling me this at a Mexican restaurant, I point to the QuikTrip. It's the QuikTrip. And I said, "How many cars are across the street at QuikTrip?" And he looked over and he says, "There's no cars. There's only trucks." "How many trucks?" He said seven. They were all Ford-150's to Ford-250's. They were all $40,000 to $95,000 cars. There wasn't a car on the lot that was thirty thousand and under while this guy's telling me there's no money in this small town in Kansas, and it's like, yeah, there's no money because that's what you believe and we all live in belief system.
I'm going to go back, one thing about statement, cash flow. So the accountant only gives you three statements in accounting since the beginning of the accounting. They'll give you the statement of cash flow, which you'll never get if you're a dentist. I know dentists that have used same accountant for thirty years and don't even know what one is. The other one's a balance sheet, what balances your asset equals with what you owe, your liability minus your equity and you only use those when you're getting a loan or divorce, once you need other people's money in your account, I'll give you that. And then there's a P&L, which dentists think is their accounting report of profit and loss statement of income, but that's only your relationship with the third party tax collector, the IRS — unless you're publicly traded, CSCC. But the main thing is cashflow. And when we look at business bankruptcies, most of them are profitable businesses that ran out of cash. Running out of cash, number one problem of bankruptcy. I can explain to you real easy. So if your overhead is a dollar a month and your patient isn't going to pay you for three months, well your overhead was a dollar that month, when you do the dentistry next month, you'll need to spend a dollar. The sixty day over, you'll need to spend another dollar, the over ninety, another dollar. So you'd have to have four months of your gross production in your savings account to pay all your bills, rent, mortgage equipment, labor malpractice, FICA. So what happens is the businesses are profitable. They go like, "Oh, I did a million dollars worth of sales. I sold all these parts for combines." Well, what happened? "Well, everybody was paying me ninety to a hundred and twenty days." And you're so right." After ninety days, only 9% of it's going to come because people think, "Hell, it's been three months. And it's also the number one cause of lawsuits, because when someone owes you a thousand dollars or $5,000, they have five thousand reasons in their walnut brain to justify why they're not going to pay. "It doesn't fit and it doesn't match and I never liked it, I told you so and I'm going to write all these bad reviews on Yelp, and I'm going to file a letter to the Arizona State Board of Dental Examiners," and all this bullshit.They come in, they need dentistry. They need a hamburger. That hamburger's three bucks. Give me three bucks. You don't have the three bucks, leave. Give me the three bucks, we do the hamburger. It's order hamburger, collect money, give them a hamburger. That's what they do at McDonald's and the dental office who do that, what they'll find is 5% of your practice, one in twenty walk, because those one in twenty never ever, ever intended to pay you to begin with. And the really good sociopaths prey on the younger dentist because they know they're young and they're green and people who really know what they're doing, go get the brand new young dentists because they know by the time you're forty, fifty, sixty, you've been stung by so many scorpions, you don't fall for that trick. So young dentists beware of the professionals.
Nancy: Right, and they're out there. A couple of weeks ago working in one of my offices, they did an All-on-4 and along with the oral surgeon — this was a prosthodontist office — the woman came in and I said, "You need to pay us. We've taken the impressions, we're giving you the teeth, you're having your surgery." She's like, "Oh, well I was going to pay the oral surgeon." And I'm like, "No, no, we'll collect it here. I'd like it in full." "I have insurance." I said, "Eh, I'm sure they're going to eat it up over there. We'll get it in full." She showed up the morning of and wrote a check and I thought to myself, guys, I don't know that you should take that check. Guess what? Boing, boing, boing, boing. $30,000. We found her going to other dentists to try and get the rest of it fixed. She had the teeth, now there's lawsuits and all pending, but she never had any intention of paying, and guess what? New dentist. Hasn't been open a year. And I'm like, this is a pro. They're out there.
Howard: So let's talk about that. Ryan, who's the number one plastic surgeon? It's Larry. What's the guy's name?
Ryan: In New York?
Howard: No, in Phoenix. He's a guy from New York. It's Larry…
Ryan: I don't know.
Howard: Gosh darn, but anyway, one of my buddies — I just know him by Larry — he's a big player. He's the best plastic person-
Ryan: Is it Body By Leverett? Is that it?
Howard: No, that's Ahwatukee.
Ryan: There's a Larry Leverett in Phoenix, plastic surgery.
Howard: Yeah, it's- But anyway, here, let me… "Larry… plastic… surgeon…" And by the way, he did not do my face. My face is au naturel. Everyone thinks I had surgery and that's not true. Don't spread those rumors.
Nancy: (unclear 00:32:01)
Howard: "Phoenix… Arizona…" Yeah, there he is: Lawrence Shaws, MD, FACS. Best one ever, love this guy. I didn't know his name was Lawrence. I used to call him Larry, but Larry, you have to pay for the appointment to schedule because the reason he's the best is because he's not on a treadmill. He sees one patient in the morning and he sees one patient in noon. Do you know what's the number one cosmetic surgery is in America? It's so embarrassing to say. You know what it is?
Nancy: No.
Howard: It's eyelid surgery.
Nancy: Eyelids? Okay.
Howard: I've never ever looked at a woman in my life and thought something was right or wrong with her eyelids. I don't even know how you could improve or harm your eyelids. They're flipping eyelids. What are they going to do next? Pupil surgery? "Oh, her pupils were only four millimeters and we augmented them to eight." But anyway, so he says, "Look, the reason I'm good is because I'm an artist and I want to be able to spend the whole morning on your face," so you have to give him the money and then if you want that appointment booked today, you got to give them a certified check. If you give him a check, your appointment is still open for anyone else until your check clears and these are the guys that rise to the top of the food chain. They don't play that "I'm going to get on a treadmill and try to do four surgeries today and then some aren't going to turn out right because I ran out of time and I had to botch this surgery and I didn't have time to do it right and then she didn't pay and then blah blah blah blah". By the way, it's over 90% of all plastic surgeries are women.
Nancy: That's not surprising. We're more vain than y'all are.
Howard: A lot of people ask me if I'm going to get a hair transplant so they don't realize that I'm actually not naturally bald. I shaved my head because when because when I let my hair grow, everyone thinks I'm Brad Pitt and it’s so annoying.
Nancy: That's so annoying.
Howard: So I just shaved my head and then they don't confuse me. But so let's go to the next topic. You talked about accounts receivable. The team sucks. They never know that the fish rots from the head down, and if you have a bunch of people that are crazy, if the leader of the team is crazy- But here's the problem. It's natural selection. You can't get into med school, dental school, law school, unless you get straight A's in calculus and physics and geometry and all this stuff. So what do you get? You don't get the well-rounded kid who was in a fraternity, had a girlfriend, went out three nights a week and saw all the top hit movies. You get that flipping psycho me who sat in the library for years where every night you heard the same thing, every single night. "Ping! The library will be closing in ten minutes." So now you have this natural selection, and everybody that comes out is this scientist, engineer deep from the library and he'll even tell you, "Well, I'm not going to sell dentistry." They couldn't have a staff meeting and they don't know HR. How do you attract, retain and lead patients that stay? Because you have nothing to work with. It's kinda like let's say Nancy Zelno had a singing institute, but the only people that showed up for services couldn't sing.
Nancy: Right, then you're in trouble.
Howard: That's what you are. That's why you're in trouble if you go into HR for dentists, physicians or lawyers because you have people naturally selected against all social skills. Usually when a dentist, physician, lawyer takes a personality test, it comes back blank.
Nancy: Or insane, right. And you know, finding the right team and the way that I actually- I tell my dentists, see how many times a person smiles. Out of your entire interview, the one thing you should pay attention to, because if I say to you, "Do you know Dentrix?" "Yes, I know Dentrix." They don't ask the right questions. They ask yes or no questions. Instead of saying to them, "what would you do if", "how would you handle this". And so counting how many times they smile- Nordstrom is known for their customer service and they tried to put some of the customer service lead people out into the speaking environment, how to build great customer service, and they said, "No, because the only thing we do is see how many times a person smiles. We can teach the skills. We can't teach nice." The problem is when the doctor is not nice and they finally do get a good team and then they leave because the doctor doesn't know how to, like you said, motivate them and retain them so they may have a dream team, but they don't know how to maintain it. So a lot of times when they come to me and they say, "My team's insane," like you said, it's the trickle effect. It only rolls downhill so fast, so we have to look at also their interactions together, their communications, and you can't always just be yourself. Sometimes it just can't because like you said, you don't have the right social skills to handle people the way they need to be. Did you ever see that movie "The Devil Wears Prada"?
Howard: Yes. Who starred in that? Meryl Streep?
Nancy: Meryl Streep.
Howard: I have two favorite actresses in the world. It's Meryl Streep, and then who's the other one I like?
Ryan: Kathy Bates.
Howard: Kathy Bates.
Nancy: Oh, Kathy Bates, yeah.
Howard: What I love about Kathy Bates and Meryl Streep is their interviews to where- There's only like six guys that have ever made more than fifty movies in their life and most of them are dead, but one of them is- Who's the producer? I think he did "Apocalypse Now"…
Ryan: Oliver Stone.
Howard: Oliver Stone. He called it utility. He says, you can give those two girls any part, anything in the world and they'll do it. So many other actresses, they only play this type of a person or some of these famous movie stars if you look at them, like every role, they had the same personality, but you can tell those two to be psycho, murderers, lovers. You just tell them what you need and they deliver and it's just amazing how they can just take the part. I just love those two. They're my two- I would say actors. I wouldn't even call them actresses because it doesn't matter if they're boys or girls because they're just my two favorites.
Nancy: That's awesome. So "The Devil Wears Prada" movie, I had a personal assistant at the time and I said to her, we need to go see this movie. We went together and I kept leaning over and going, "I don't do that, do I?" She's like, "Yes." And then I lean over again, I'm like, "I don't do that to you, do I?" She's like, "Yes." She says to me, "The day you come in and throw your coat on my desk, I'm leaving," and it had this reality of like, I'm in my world and I'm doing my work as I need to do it, and I didn't realize how I was affecting it on her and she was a great person. She could laugh it off and she would tell me when I'm being that way, but you can't be that way in a dental practice when you have- We were one on one, so we were good friends and we were able to do it, but dentists don't understand that there is a responsibility of being the boss as well. You can't walk in the door ten minutes after your patient's in the chair and expect all your team to be on time because you're leading by example. So maintaining that team, even though they may find the perfect team if they're lucky because most of them don't have the skills to find them, how do they maintain it? It's such a small community. How many times do we hear this dental assistant is over here now and that office manager here? Oh yeah, I know her. She used to be with Dr. So and So. It's a small community because we have this specialized skill. If you ever were an office manager and you tried to go outside of medical and dental and go to construction, they're not even going to look at you because it's a specialized industry. So the dentists, their problem is learning how to maintain and motivate those people too. Not all. There are some dentists out there that do a really great job with their team, but for the most part- And I love it when a dentist says to me, "I have a dream team of except maybe one or two, so that's good, right?" No, that's not a dream team. You have your one or two that's infecting everybody else and you have to find the way to get to the right team.
Howard: If someone's new, I understand that- You know when some kids start crying in an airplane, and the guy next to you starts getting upset, I always turn to him and say, "Dude, how old were you when you were born? Were you born twenty-five? I'm pretty sure that you are the same baby crying on an airplane. It's all you, buddy. It's not the baby." But the bottom line is, with staff training, I don't even believe in staff training because it all comes down to attracting and retaining staff. Once your staff has been there two, three, five, ten, twenty years- I mean, next month I got a whole slew of people that have been with me twenty years. My lawyer, my Stacy, my Ken, my Dawn, my Tom. I got all these peopling going twenty years. Well, you know how you do staff training you? You keep people for a long time. When someone's been on your team five, ten, fifteen, twenty years, you don't have to manage them, like so many people ask me how do I do all this. Why do all this? Because I don't do any of it. I got a bunch of people that do it all but what I get rid of right out of the gate is toxic people and it's sad because I think a lot of it's just inherent biology, like bipolar. They come in one day, they're all up and lovey and the next day they're down and pissy and that person that every single time you meet with them, you're meeting the same person, and build a team with a bunch of functional people that you're running red lights go to work. I have to get to work early because I just want to go shoot the shit with all my buddies. "Yhony, what up, yo?" You want to see your buddies and then there's vendors that are driving to work that are avoiding their own hygienist because they hate her and I say, "What do you mean you? You don't ever give money to someone you hate." You have to build a functional team and that person you hate, it might be right or wrong. I've noticed that some dental offices, they're all into country music and bowling and then other movies are all under (unclear 00:42:33) so you have your culture and it doesn't matter. It's not really so much right or wrong and just do you find people like playing in the sandbox together. I don't care if you want to be the dump truck and I'm the cement truck and you're the bulldozers. I don't really care, but if you can't build a team where everybody wants to play- But what happens when you go into a dental office? 80% of the dentists, when they get done doing that root canal, they beeline straight back to their private office and shut the door. And now we're watching the NBA finals. Where is the coach during the entire NBA finals game? On the sidelines, screaming, yelling, rotating players in and out, and then what do you do when you're done with a root canal? Hell, you don't even walk the patient to the front. You don't even shake hands with the next patient coming in and you don't even ask your team what's up? Imagine. What would happen to an NBA coach if halfway through the game he said screw this and went to his private office and shut the door.
Nancy: Right, it's funny you say that because I had an office that I started with very small- They'd been at this practice for about eight years. They said to me, I can't hit a million. Small, three operatories, one hygienist, can't hit a million. When I came in, we ended up redoing their team. We got a new hygienist, a new dental assistant, person at the front desk and that was one of the things I said to the doctor. I need you to greet new patients as they come in at the front desk. I need you to walk them out to the front when you're done. He goes, "I have to walk them out?" I'm like, "Yeah, they're your patients. You did the work. I need you to walk them out, hand them off to the front desk," and he's like, "All right." He was great at it. They got this whole communication team thing down. They texted me New Year's Day, the following year, saying then not only did they make a million the first year that they worked with us, but they were up and over and there's still time in their schedule to put more patients and they said that they didn't think it would happen, but because the doctor is more hands on, not a micromanager, but he was hands on with his team and working together as team- He was even taking care of cleaning some of the instruments. That's where they started that cohesiveness. That team wanted to play together and they played together and they got things done and their day moved quicker.
Howard: So when we were talking about movie stars, I got off on a tangent. We're talking about Meryl Streep and Kathy Bates. That's what you got to think when you're going into your office and you're an introvert geek and you're going to go in there and you park your car and I don't care what you have to do. If you have to look in the mirror, put on your lipstick or whatever you got to do. But when you go in there, you're now the leader. It's the same thing with presenting treatment. You talked earlier about this dentist telling you he needs new patient and you're like, "Dude, you got forty patients. Only five of them scheduled for a recall only- And then you tell me that you don't like to sell dentistry. Okay, so now you're going to have a lousy office the rest of life, because life is a mindset. Life is an attitude. Your attitude determines your altitude and you've already decided you don't like to sell instead of deciding-" Kathy Bates really isn't a psychotic nurse who found a guy who drove off the car drunk and back to her home and beat his kneecaps in so anymore than you walk in there and now I got a patient here. Her name is Nancy Zelno, she needs us this twenty-five-thousand-dollar All-on-4 dental deal and you're going to walk in there and you're going to put on your "I can do it" face and you're going to walk in there and you're going to be something that you're not natural and you're going to go in there and you're going to give a rocking hot presentation treatment plan and you're going to measure it. You're going to measure your closed. And at the end of the month, every orthodontist knows how many leads were served up and how many closed, and some orthodontists, they all want to close fifteen cases a month, like Invisalign or whatever, sixty-five hundred apiece. Some of them need thirty leads to close fifteen.
Nancy: (unclear 00:46:30)
Howard: There are orthodontists who need only sixteen or seventeen leads to close fifteen. And then the other thing I want to say is that some orthodontists, usually within two or three hours- Because I think the orthodontists get it more than anyone else because a lot of dentists, a new patient is a cleaning exam and X-ray and that's it, or maybe one filling. A lot of new patients are not even $450, but everyone to an orthodontist's sixty-five hundred, so they take it damn serious. But what do a lot of the orthodontists do? They've figured two years in, they say, "Well, I'm the dentist, I'm the provider, but my ops manager, Nancy Zelno, does it better," and within two years they say, "You know what, you're going to do the treatment plan presentation because I'm not good at it." Same thing with (unclear 00:47:16). I'll go into a dental office and this poor bastard is miserable and he's had ten, fifteen, twenty years of massive staff turnover and dysfunctional staff. And I said, "Well, who hired all these people?" And he says, "I did." I said, "Well, if you work for the Arizona Cardinals and you were a scout, you would have been fired eighteen years ago because every person you pick can't catch a ball." So if I can't choose find out maybe your dental assistant- I thought I was the best HR guy in the world till I hired Laurie. Every time I was hiring someone, she was telling me the whole time why that was a crazy mistake, and then I took about a year or two to realize, wow, Laurie calls every one of these crazy people the day I hire them. So I quit doing it. I was good. Laurie was ten X, she was ten times better. So if you can't pick people, pick someone that can pick people. Just like the owner of all these football teams, like you're down there in Clearwater, the Tampa Bay Buccaneers. I doubt the owner of the Buccaneers has ever hired one player in the last five years. He has professional scouts to do that.
Nancy: That's right, and that's what we try to say to them. I have an office that we worked in, I was with them for just a few months and I would go in every week. I started going in there twice a week as they needed so much help and there was not one person that worked there front desk, this is on my honor, they did not last a week. Every single person for about three months that I would come in the office, she had somebody new at the front desk and I said to her, "Who's hiring these people?" She goes, "I am." And I said, "Do we see the common denominator here?" I said, "You have got to get somebody to help you hire these people. Don't hire them until you talk to me, please," because you're right. They know their dentistry; they don't know these things. I used to have a dental assistant that would talk to the dentist and they would be like, "Okay, you know what? I researched this person that you want to hire. I went on her Facebook, I went on the judicial website. I went on this." She goes, "This is what I can tell you about that person." So you know, some people are better at it than you, but why is it so hard for dentists to admit that they're not so great at something?
Howard: Another one. I can't tell you how many people- This is what's really sad. They find out they were being embezzled from and by the time they find out it's been five years, but then they find out that she did it and she's in Arizona and that she did it in Florida and was arrested for it and went to jail for twelve months. So you hired a girl from Florida who did this, got arrested, went to jail, and now you're shock that she did it for you. Could you imagine me hiring you, Nancy, as the starting quarterback for the Arizona Cardinals, then after the first game we find out she'd never played high school football, let alone college football, and everybody's like, "Where the hell did you find that lady?" It's like when you're hiring ex-felons from another state. That is crazy.
Nancy: That (inaudible 00:50:39). I did a big speech and for a medical company called PlaneTree and they did a big conference in Baltimore last year and they wanted me to come in and teach how to hire and motivate a team and one of the things that I said was, "Are you going to check their references?" And they're all like, "Oh yeah, we check references." And I go, "Why? They're going to give you friends and people they know that are going to say nice things. Go to the judicial website, go and look up on their Facebook, Instagram, and anything else so you can see them being themselves and that's going to give you a better idea." But they were shocked. I said, "The judicial websites in those states, that is all common knowledge. There's no holds barred. You can find out what you ever you need to know."
Howard: I want to ask you another question. I want to go back to this guy who was getting forty-five new patients a month and then he tells you he needs some more patients. I always tell people the number one business you never ever go into is marketing, advertising for dental offices to get them new patients because you're going to fail every time because the dentist doesn't know what's going on. And that is what we know is about three hundred to funnel. Three hundred people have to land on the average dentist's website before nine call. Nine people have to call before your untrained receptionist can convert three to come in. Three people have to come in that each have one cavity before one of those converts to do a filling. So when you look at that filling, the average dental officers taking home a hundred and seventy-four thousand on sales at seven-fifty, but to do that, $750,000 of dentistry and fillings and crowns and root canals. To do seven-fifty, another million five had to come in. $1,500,000 worth of disease had to come in and not schedule for you to do seven-fifty. So to do that one filling, three had to come in, for three to come in, nine had to call, for nine to call, three hundred had to land on your website and then while you seven dentists are all saying that the sky is falling and it all has to do with Putin and Russia, North Korea and Trump and everything but that, then the guy at the end every Friday is doing a full mouth rehab for the price of a new car. So back to that funnel. How can you fix anything on that funnel to where this guy doesn't realize it's not a new patient problem, it's your treatment plan presentation. It sucks and you don't measure it. The girls answering your phone aren't trained. You can call up most dental offices and say, "Hey Nancy, how much is a crown?" "$1000." "Okay, thank you very much." It's like, "Did you get her name or phone number? Did you try to convert her?" So what would you fix on that funnel?
Nancy: Well, first of all, on that funnel, what we do is we track — by hand because it's again, it's the only way you do it — once they come in, who's referring them? Do they do a cleaning? Do they do a recall? Did we present treatment? How much did you present? How much did they do or schedule to do? So we need to know, out of those nine that you say make it into the office, how do we get those nine to stay? Out of those forty, like I said, the majority of them weren't staying. They weren't doing their work. They weren't presenting. So the first month that we worked with them, they were doing an average and I ran all their numbers for the year before. $90,000 a month was their average production. We didn't know what they were presenting because nobody tracked it. That's the only way to do it, got to track by hand. So out of that, the very first month that we were there, I took those forty new patients, showed them how to convert them to see getting in the door. We did a hundred and twenty-five. It's not bad for the first month; it's a nice increase. The second month, we did one fifty, then the next month we did one sixty and they maintained between that one fifty and one sixty. That's a big jump for a dental practice, but they were getting those forty-three. At the end of this first month, those forty-three new patients, we only had five missing their recall appointments. Some of them were referred in by other offices, so we didn't want to take up their hygiene. They go back to their other offices and some of them were, because being down here in Florida, sometimes we get transients, people that are just passing through on vacation, but they were keeping those patients. They were doing their work because they backed it up, had to find out how to present treatment and that's what they were planning. That three hundred that land on your website, I couldn't even tell you- I'm not the marketing person to say how do I get those three hundred to call me because I'm not a website marketing person and I wouldn't try to be. My job is when those people get to my phone from the initial phone call, how do we handle them now? We recorded everything in and out to be able to say where are they failing, where are they doing? Once we would train them, they were afraid to say the wrong thing. They actually paid attention to it and smiled and welcomed people to the practice. But otherwise, like you said, exactly the right thing and you know, where they were getting some- The dentist ended up being friends on this mommy's Facebook — it was a female dentist — so those patients that are coming in have already built trust. They already trust this woman because all these moms are talking about how they take good care of not just their kids but their teeth. So that's a big factor when they walk in the doors. How do we get them to trust us? They have to trust us from the beginning and back in the day when they started talking about, "Dental website, got to have a great website." I always said I don't have people that find the website that call me. I have people that look at my website after they've called me, but now with Google we're finding a lot more people are hitting those websites and calling off of it or sending messages from there and I don't think the it's the website, Howard. I think it's more the reviews.
Howard: Your website is dynamicadministrators.com. What am I going to find if they go to dynamicadministrators.com?
Nancy: They're going to tell a little bit about the industry. It's going to tell you about us and the different services that we have. It's going to also give you my speaker packet because I do speak at a lot of different places and I've had offices hire me just to speak at their office, but on the website as far as different things that they can do, they're more than welcome to call me. I'm always available to help them walk through. I always offer a complimentary practice analysis. They can sit with me on the phone for an hour. I can sit down and go through some numbers and some different things that they have and I can say to them at the end, I can send them out a proposal with some information of what they could do, some freebies. You guys need-
Howard: How does that work? How do they get the free consultation? Do they go to your website? Do they email you? How do they contact you to- Because I know my homies. Here's how my homies work. They all have this unique problem that you don't understand because it's my office and you don't understand my ops manager and you're from Florida and I'm from Lyons, Kansas and- They all have this totally unique problem that everybody in the business heard a hundred thousand million trillion times. But how do they call you up and tell you about their unique dilemma that's not unique?
Nancy: So they can call my cell directly. I don't put up any fronts. They can call me directly at two-o-three-five-five-eight-nine-six-six-four. That's my direct cell phone line.
Howard: Say it again. Two…
Nancy: O-three.
Howard: O-three.
Nancy: Five-five-eight.
Howard: Five-five-eight.
Nancy: Nine, six, six, four. ??Howard: Nine, six, six, four.
Nancy: Right, because I'm a transplanted New Yorker too, by the way.
Howard: And if my homies are listening to this and right now they're in a bathroom of 7-11, are they allowed to write it on the wall?
Nancy: It depends on what state.
Howard: No, her number is two-o-three. Cell phone. Two-o-three-five-five-eight-nine-six-six-four. Her website is dynamicadministrators.com. What about email?
Nancy: nancy@nancyzelno.com, or they can do nancy@dynamicadministrators.com.
Howard: So homies, this is what I'm telling you. I understand boys and their toys. I get it. I understand that you only live once and if you want to keep my four boys in the bathtub when they were little- If I put my four boys in the bathtub and there is nothing in there, they'd all be out before I get the last one in but if I filled it up with boats and bowls and even the sandbox toys- They even liked their dump trucks in the bathtub. So I understand lasers and CAD/CAM and I understand all that stuff, but that has nothing to do with business. If you think you're going to be a millionaire because you're going to switch from polyvinyl siloxane to an oral scanner from 3Shape and start chairside milling your cans, crowns and buy a laser, you are completely out of your mind. What I've been telling you to do for thirty years, first, the only return on investment is practice management consultants. I don't care who you get. I don't care if you get Nancy. I don't care who you get because all of my fifty-five year old friends who are grandpas who've been in it thirty years, over thirty years, they've had damn near every consultant you can name because they've never brought in a consultant and didn't give her a bunch of money and at the end of the year get all that money back and more money. So what you do is you get your business poised for growth and where does the dentist decide he's going to go cheap? Not on the private dental school that he paid $100,000 a year for and comes out $400,000 debt. Where are they going to go cheap? Oh, not on a chairside milling machine. They paid a hundred and fifty or a CBCT a hundred, or some millennium laser for eighty-seven to a hundred and thirty-five. Oh no, they'd never go cheap there. Where do they go cheap? On practice management consultant. Their overhead’s out of control. They don't have any business systems and that's what drives him crazy. I tell people, you know what the litmus test is if you want to buy a laser? Write a check for it. You want to buy a Porsche? If you can write a check for that little Porsche, go get the Porsche, go buy it. And you should look at chairside milling just like a Porsche or a fishing rod. I'll tell you what, you got to do more consulting in Louisiana. Most of these dentists, the highest-priced toy they have in their office is like a $200,000 bass boat. It's unbelievable, and it's so cool. One of these guys, we were out there fishing in the Gulf and I said, "Dude, you drop two hundred on a bass boat?" And he goes, "Well, it was either going to be that or a CEREC machine. And I chose the boat." But the point is, he has a rocking hot business and he's brought in three or four or five consultants over the years. I tell people, get your house in order, get your debt under control, live below your means, invest in practice management consultants, and then when you're rich, I don't care what you buy. I don't care if it's a cabin, a boat, an oral scanner, just business is business and you don't need any technology for your craft. What you need to do is get your business in order and once your debt's going down and your income's going up and your 401k's fully funded, guess what? A lot of your burnout, disease, depression, all that kind of goes by the wayside.
Nancy: Yeah, one of the other things that we do too is we do a coach on call where I guarantee a phone call back before the end of the day if they have any issues that they need handled over the phone, be it team members, be it "Hey, I had this patient come in, how can I present it?" Whatever it is, we guarantee a phone call back at the end of the day and at the end of the month they actually get a listing of all the different items that their whole team (unclear 01:02:16) available to us. We're available to the whole team. They can call us and we can say these are the different items that you guys had come down during the month, so if it's not somebody that wants to jump in and change their entire practice — which we don't do; we take step by step — but if it's somebody that says, "You know what? I just need somebody there to bounce things off of,” I'm there as well, and sometimes they can start that way and sometimes they want to do the practice management that needs to be done.
Howard: So again, homies, get your house in order, get your business under control. Another thing, dentistry is such a small world. How long have you been in this consulting business?
Nancy: Eighteen years.
Howard: Yeah, you can't be in dentistry consulting for eighteen years because everybody you consult with didn't like you and it didn't work and whatever. Just get your house in order. You have no training in business, finance, marketing, your funnel. You only know your office. How many offices have you actually been inside and digested?
Nancy: Over hundreds.
Howard: Yeah, so you're living in your little bubble and there's people out there who have seen a hundred different bubbles and guess what? You're all the same-
Nancy: And it's (inaudible 01:03:32). I've been in the (inaudible 01:03:33) and it's still all the same. They are not unique.
Howard: Well, physicians and dentists and lawyers, that's cut from the same cloth. That's three pods in the same pea. It's the same thing. I have flown so much. Three times, I have sat by a US senator and I'm not going to say their names. McCain twice and Graham from Graham (unclear 01:03:52). But what was the most shocking to me is that they were just dentists. These guys were some of the most powerful people in the world, but like dentists- And I absolutely asked him, I said, "Accountants only give you three statements. Can you name them?" "No." "Okay, they're a statement of cashflow, a balance sheet, a P&L. Can you just tell me the difference between those three statements?" They can't, and that's why we're $19,000,000,000,000 in debt. That's why we have fifty-six trillion of unfunded liabilities and that's why you're not rich. That's why you're a doctor in the richest country in the world and you're broke because you don't know what you're doing so call people like Nancy. They make a living out of helping people like you. Nancy, it was just a huge honor that you decided to give an hour of your life today. Ryan pushed out your manual on Dentaltown, Facebook, Twitter, LinkedIn, Pinterest, all that kind of stuff, and thank you so much for all that you're doing for my homies and I hope you have a rocking hot day.
Nancy: All right, thank you. You too. Take care.
Howard: But remember when the Tampa Bay Buccaneers do play the Cardinals, I only wish the worst for you.
Nancy: That's okay. I'm all about the Lightning instead of the Buccaneers.
Howard: Okay, have a great day.