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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Howard:

It is a huge, huge honor today to be interviewing a guy in my backyard. Thank you so much for coming over today.

Scott:

This is awesome.

Howard:

We're mourning today, the loss of the Arizona Cardinals and we know they're not going to be in the Super Bowl. Are you going to live or ... ?

Scott:

I'm going to survive.

Howard:

You're going to survive?

Scott:

I'm a Green Bay Packer fan. I've been crying for two weeks now.

Howard:

That was a wild game. My God. That was the sloppiest win I've ever seen the Arizona Cardinals win. I called you. You didn't call me. You're in my backyard. I hear just amazing things about you all the time. Let me read your bio. "Scott has been coaching dental teams since 2001. He was an astonishing record of doubling the net income of most of his clients within 18 months. Scott is more than a dental consultant, he's a coach with an eye for results. Scott has 15 years experience in corporate America, where he was in charge of the litigation unit for State Farm Insurance. He rose to the highest position in the field as a manager who was in charge of an annual budget of $135 million dollar operation. Scott leveraged the business skills from this experience as a business manager for a multi-office dental corporation. Later, Scott worked as an executive coach for Tony Robbins and is currently a trainer for the organization." I guess Tony will be here Monday. He has a show Monday.

"Scott Day is a certified behavioral and motivators analyst expert with a certified master practitioner in neuro-linguistic programming. Scott loves training dental teams on communication skills and leadership skills that count. Scott is a great, dynamic and entertaining speaker." You need a speaker for your organization, this is one that your entire staff will love. "He has spoken three times to the Russian Dental Clinics Delegation." That had to be cool. How many shots of vodka did you have when you were in Russia?

Scott:

Absolutely none.

Howard:

Really? None? Oh my God, when I go there it seems like they all drink vodka. "He holds a B.A. degree from the University of Wisconsin and a law degree from the University of Toledo. Scott enjoys golfing and is a basketball and football official." So, how are you doing?

Scott:

I'm doing great.

Howard:

What did you want to talk to my homeys about today?

Scott:

I want to talk about really setting accurate goals. I go in offices all the time and they say, "We have to have goals." I go, "Well, yeah, you have to have goals. But, how are you setting these goals and how are they really doing?" If I had to really put it down, really what goals are, are results. You want a result. To get that result, it has to be attached to some type of action plan. To really say, "Okay. We want to have a production goal of $80,000 a month." That's great, but it's pie in the sky. How does it happen? How do you get to $80,000? Maybe you use it, look at the previous years the next particular month and say, "We did it every year, for the last three years and that's why we're setting this goal." You really have to have some kind of action plan behind that.

Really what it is, Howard, is when you have an action plan behind that, the smallest goal can create massive results. When I go to a dental office, I just was in an office last week, I'm going to use that as an example. I'm going to show you the numbers. They had appointment in Head and Hygiene, for example. They've got 1,200 active patients, meaning that was 1,200 patients individually came into their office last year in hygiene. That's an active patient. Everything else is not an active patient. That's fly-bys, is what I call them. They just come in, get a toothpick and get out. I want to talk about active patients.

In this office, they had only 300 people appointed to Head and Hygiene. That's 25% of their active patients. I'm telling them, the best practices is somewhere between 90% and 95%. If I told the team, you need to go from 25% to 90%, they would go ... It's like a computer downloading and doesn't have the download. It just shuts down because it can't do it. I told them, how about 10%? Month after month after month after month. You'll see the results in a moment when I talk about that. It's exponential. Anybody can handle 10%. No one can handle 75%. That's what I do. That's how I do it.

I go into offices and I say, "Let's get clear about where we're at. Let's look at the gaps in your office. Let's set goals that have meaning to them with an action plan that's clearly and easily attainable by the whole team."

Howard:

What other types of goals do you like setting in offices?

Scott:

It depends. Here's the key and here's what I think has made me very successful. There's no two practices the same. I don't have the same thing for each practice at all. It's different for every office. It depends on where they are and what they're doing. I've been to major cities like Miami, L.A. and I've been to rural communities like Vernon, Utah. Which is like three hours east of Salt Lake City. I've been all over these little places and things. They're all different. They all need some kind of attainable goal to reach their outcomes. We have to get to a point where we realize, what the heck. We go to work day after day, week after week, year after year. It seems to blend in. I remember you, and of course, everybody remembers when they were in high school and college. You got new classes, new instructors and new classmates here every six months. Everything was different and changing.

When you're in the working world, everything just kind of blends and seems the same. We really start focusing on those specific goals and making those goals work for each individual office. There's no two offices the same. Never seen it, never will. I never practice that way.

Howard:

I also, the consultants have a huge major advantage because, you've been doing this for decades. You get to see hundreds of different offices. Whereas, a doctor only sees his office and they often times don't even see the possible or they just think, this is just how it is. You get to see all these huge distribution of best practices. Another thing, in your intro you said that you like to double their net income within a year and a half. I see people arguing on Dental Town where be two practices that collect one million dollars, or a guy says, "Well, my office produced a million dollars so that's just worth a million." The consultants like, "Well, yeah, you did a million dollars, but you only netted $100,000. Here's a practice that only got $400,00, but it netted $200,000. It's worth twice as much as your million dollar practice."

If someone called you up or went to your website. Your website is fastforwarddentistry.com, if they want to email you at scott@fastforwarddentistry.com. If they said to you, "My overhead's high. I would like to increase my net income, not my gross." What would you tell them? What's usually going wrong when they aren't making that income?

Scott:

When they're talking about net income, we're really talking about cash flow. The cash flow, the overhead's part of the, creating that cash flow. What I see, Howard, when I come in and I'll do a practice performance profile, is what I call it. A PPP. I take a look at everything in the office. Everything from the front office to the back office. What they're doing. All the procedures and everything going on and I see, I find just gaps in between where they are and where they really want to be. For example, typically, I want to use one example and one example right now. That is what I call new patient retention. I'll go in an office and I'll go and I'll go a year previous, whatever month I'm in. Let's say it's January. I'll go to the previous year, January. I'll look for a report that shows me all the new patients that came that month. Just that month. A year ago. I want to make sure they had a comprehensive exam and they did go and have a prophy and they're in the prophy schedule.

Then, what I'll do is, I'll track them. I'll track them. I'll see if they came in six months. Then, I'm looking for them to have an appointment a year later. You know what I find? It blows people's mind every single time. Every single office I've gone into has been somewhere between 35 and 50% of new patient retention. They think they're like 80-90% when I asked them. It's really, really, a low thing. We'll have this discussion and the conversation, I always do it, say, "What's the most important date of a new patient? "The first phone call. Oh no, the first time they come in we want to wow them. Oh, no, when they see the doctor." All these kind of things. I'm going, "No, no, no, no, no, no, no."

The most important date of a new patient is the very first anniversary. Why, you ask me that. I would say, "Okay. They've seen the doctor. They've seen the hygienist. Then they reschedule six months later for their hygiene if they're not perio, right? Maybe they've seen the doctor in between there. Then, six months later is a year and they're back in that office. They're back in that office on their anniversary date, it's over. They're done shopping. They're your patient. I don't know what you've read, but I've read a lot of things about how long a patient stays with a dentist. The longest they stay with a dentist on average is 19 years. Right? It's like, they're done shopping. That's the most important thing.

I even have a team that sends an anniversary card to every single one of their patients on their first year anniversary date, which is really fantastic. That's the most important date. When I go in, to answer your question now, when I go in and see that 35-50%, we're making changes on that. Now they're tracking every new patient all the way along the way to see what they're doing and how they can improve in making those, giving them surveys and saying, "How are we doing? Give us feedback" and making sure that they're back in the hygiene schedule. They're coming on a regular basis.

Howard:

That is interesting. I don't know if it's because we're  social animals and we don't like rejection. They probably don't want to track how may people reject you. I remember in college, my roommates would ... you could sit at a bar all night and they would just stare at the girls. They would never go ask one to dance because they were afraid she's say no. You probably don't want to track how many people said no and I never came back.

What do you think keeps a patient in the office on a one year anniversary versus all the ones that didn't come back?

Scott:

That's a great question. I think it really is the team. The entire team. How we communicate to the patient. That is really, really the key. How we prep them. I would love to hear, all the time, and I don't hear this all the time, of just doing pre-framing. What I mean by that is letting the patient know what our expectations are of them and are they on board with that? If they are onboard with that, they're locked in. When you, if a doctor came in for the first time to talk to a patient and say, "Thank you. Welcome to our practice. We're so glad to have you here. You were referred by X. She's a wonderful person. She's been with us for years. Here's how it works in our office; we expect every single one of our patients to come for their hygiene, whether it's two or three or four times a year, every year. From now until forever. We really take seriously, your health care. Including your whole body. Do you agree with that? Do you promise to come in at that time?"

The patient has a commitment to make right then and there. If the patient's on board, they're going to do it. If the patient's not onboard, then you'll know immediately that this patient is shopping around or doing whatever. It's really the commitment of the whole entire office to get really focus. The value of the patient. Do you know the value of a new patient is, if you just looked at it over a 20 year period of time and just doing just a little bit. That's over $60,000 a year. $60,000 walking into your office ...

Howard:

The problem that we have, Scott, is that the front office didn't go to school for a day on being the front office. The dentist went to school for 8 years and we spent all of our time learning calculus, physics, geometry. I don't know anything I ever used from a math class. I really don't. How do you go into an office where the assistant, my assistant, dental assistant, she goes one year. My hygienist four years. Me, 8 years. The front office 0 years. Almost all my training is in the Kreb Cycle and the periodic table, which has had no value.

What do you do as a consultant when you go in there to get this culture going?

Scott:

Exactly. That's probably the difference in terms of what I do. I coach the entire team. It literally is coaching. It is rewarding them and complimenting them when they're doing great things and literally kicking them in the butts when they don't. Really, it's all about communication. It's all about focus. The number one thing I would say about, every time I come into a new practice and talk about it, every time I go to a practice, is that the outcome for every single practice is to create raving patients. Where they just run out of your office and want to tell everybody about how great your practice is and that you should come to this practice. In order to create that, we have to really focus on the communication for the entire team. I spend a lot of time with the entire team teaching them how to become awesome, great, fantastic communicators.

I start with a disc. You might have heard that. The DISC and their behavior style and literally walk through the whole team and let them get to know each other in a different way and what their behavior style is, which teaches them how to be a better communicator with their patients and communicating with their style. All of a sudden, we start talking about, I hear all this stuff about case acceptance and how you can go your case acceptance to whatever. When we know the behavior style of patients, when we really know the behavior style of patients, some patients will sign up right away. Some patients need to go back, based on their behavior style only, maybe it's their finances. Based on their behavior style only, go back and say, "Hey, look. I want to think about this. I want to do some research on this. I've never had a root canal before. I'll get back to you in two or three weeks." That's okay. That's great. That's when the patient really appreciates the us, being a dental offices and dental practices appreciate and understand and view, literally, view the world through their eyes. That's what we do.

Howard:

Scott, you're looking at thousands of dentists right now. I know my homeys. I know them because I am a dentist. Every time there are offices collapsing and every time they're not profitable, they always think the best money spent is on a shiny, new toy. They'll go buy a $130,000 Cad Cam. They'll go buy a $75,000 R Laser, a $100,000 X-Ray machine. Then when you say, like, how much do you charge? What is your cost if someone wanted you to help them?

Scott:

I charge $2,000 a month, plus expenses.

Howard:

Okay, so a $75,000 laser would buy three years of consulting.

Scott:

Right.

Howard:

I know I sound like a broken record, but what I feel sorry for you, is that everybody who's trying to go from one million to two, or two million to three, they use consultants all the time. Everybody who needs them the most, they'll never get help. Or, they'll go buy a new, shiny toy. I want you to try to connect, you charge $2,000 a day, or, what do you charge?

Scott:

A month.

Howard:

$2,000 a month. What do you think will help them double their net income more, $2,000 a month, you coaching them or buying a new, shiny toy?

Scott:

Definitely. See, there's so much involved. Definitely having a coach. Think about it. Everybody has a coach. Every athlete has a coach. Right? Individually. I mean, golfers have three coaches. Every actor has a coach. Everybody's out there because you can't see your blind spots. You can't see your blind spots. You need someone to help you say, "Here's where you are. Here's where you want to go because you told me you want to go this way. Here's how we're going to get there." Then, you need pushing to get there. You can't do it by yourself. You need pushing. Right? Just because you're an owner-doctor doesn't mean, and you are responsible for the whole team doesn't mean you need to be pushed too. That is really the key, is really getting someone to push you and to get you in the direction you want to go.

The shiny things, you're right. The shiny things look good, but they don't get the patients in. I just showed you from talking about the new patient retention that there's patients going out your back door, in every single office I've been in. If that's true, then what do we got to stop that? We got to stop that flow and take a look and do that. Dentists are so busy during the day and by the time they're done they're so tired and beat, they just want to go home and relax. You need a coach to help your entire team. I coach the entire team. I just don't coach the doctor. I coach the doctor once a month for an hour over the phone, just to connect and get going. I come into the office on a quarterly basis and coach the entire team.

Howard:

They're all multi-tasking right now. Probably 85% are driving to work. Our brand is an hour long because that's what they all told me they wanted. They have an hour commute. What's weird about that, you'd think an hour commute would be in L.A., but even the rural guys, they live in a town of 5,000, they commute a hour down a two lane highway. They're down there for an hour. I want them to get help. Try to paint scenarios where this dentist is listing things you like to go on. I mean, we know a fireman wants to put out a fire and a policeman wants to catch a bad guy. A policeman doesn't want to put out fires. What are you? What are your fires? Paint scenarios that this is going on in her office and you can come in and fix. What are red flags for her, listening to you right now where she's like, "Yeah, I probably need some work in my office."?

Scott:

There are several things. I told you one was appointing the Head and Hygiene and really getting your active patient base to really be all in on hygiene. That's one of the things.

Howard:

Do you think she even knows how to run that report?

Scott:

No. I really don't think so.

Howard:

I don't think any of them do. Every one I know that, when you go into an office and look at the report generator, 85% of the reports have never been ran one time. Do you agree with that?

Scott:

For some, yes. Yes. As a generalization, yes. Do they care? Absolutely. Do they know their numbers in terms of collections? Absolutely. Are they concerned about their schedule and what's ahead? Absolutely. Those things are really key. What's circling behind it, everything's connected. For example, the number of people that come in to hygiene equals the number of people who have new discovered restorative, which is the number of people that get in the doctor's schedule, which is the number of people, other collections. It's the whole thing that becomes combined and gets together. What I said by coaching is you don't know what your blind spots are. Every office is different. When I go into an office, I'm looking for what's great because every office does something great, Howard. I don't care what it is. If it's just teeth whitening or Invisalign or just dealing with kids or dealing with old people, or whatever. Every single office does something great. Then, they also have needs improvement areas. That's why they hire me.

Here's the deal. I can give you strategies. You can look at strategies. There's been plenty of dental consultants that wrote tons of books and articles and stuff on strategies. If you can just implement the strategies of doing that, bingo, you're golden. But guess what? With the whole team, even though strategy's more important, what's even more important than that, before we can even implement any strategy, is a story everybody in the office has about what can and cannot happen. You can just imagine the stories I hear. "Oh, they can't afford that. I didn't call them because their parents are sick and they won't come in." All these stories they create. "We've tried that, it won't work." All these stories that I hear. I've got to get the entire team past their story first. If I can't get them past their story first, I don't care what strategy I have, it's not going to work. Then, once I get them past their story, I've got to change their mindset. Their mindset is, "I'm just doing this day in and day out."

Like we talked about earlier today with regards to everyday when you're working in a business, every day kind of blends into every week Every week turns into a month. Every month turns into a year. Every year turns into decades. I got to get them out of the mindset. Here's a real truth, for most patients, they come into the office twice a year for hygiene. That's two hours of their entire year. There's 87,000 hours in a year. Two hours they're in your office and you better make a great impression on them, right? You better make a great impression on them, otherwise, they're not going to function. That's a really important hour for them. That can be a routine, "Oh, another patient" hour for you. That can't happen. It cannot happen. Ever.

Howard:

What is it? When I look at my best friends who are crushing it, and they're my age, 53 to 73. They've had half a dozen consultants, last three years. Then, everybody that needs one doesn't get it. Do you think they don't get it because, do you think it's pride? They don't want you to come in and see that they ... do you think it's pride and lacking humility or do you think it's ... Well, what do you think it is?

Scott:

It's some type of fear.

Howard:

It's fear?

Scott:

Yes. Absolutely.

Howard:

Okay. It's fear.

Scott:

It's a fear of, "This is my baby. I don't want anybody doing an evaluation on me." Or, the fear is, "Oh, I really messed up and I don't want anybody to know." Or, it's a fear of ... one lady came up to me and said, she heard me speak and she's excited. She needs a coach and she goes, "You look like you cost too much." I go, "I don't cost that much. As a matter of fact, I pay my way because you're going to grow so much and it's going to be easy for you to pay."

Howard:

That's an interesting thing you said, you fear because I like that better than pride or lacking humility. I've had dentist when I finally, when they show me their numbers, start crying. It was just so stressful to show me their report card. You know what I mean? Awwww. My Mimi. Tigger likes you. Hi Tigger. Yes, we are not a very hygienic family. The cats are allowed on the dinner table. You think it's the fear of them coming, because I want to just get it out. You think they're, this is their baby. It's personal. This is my practice. Now, Scott's going to come in and he's going to tell me everything that's wrong with my baby.

Scott:

Everything is wrong with your baby. Then, they have to go and talk to their team and say, "Hey, look. I'm bringing in a consultant and here's why I'm bringing in the consultant ..." The team really has a lot of influence on the doctor in terms of what happens and what doesn't happen. That conversation is also fear. A fear of being rejected by the team and then bringing someone in. What if it doesn't work? Right? I take all that out. Say, it's month to month.

Howard:

So you don't have a contract?

Scott:

No contract. It's a coaching agreement that says I agree to coach you and you agree to pay me these fees. That's all it is.

Howard:

And it's $2,000 bucks a month?

Scott:

It's ...

Howard:

I like, earlier about it, you said all athletes have a coach. I've always, you can agree true or false about this, what I always thought the best thing about consultants is, when you go back to dental school, when did most all your classmates study? The night before the test.

Scott:

Yes. Exactly.

Howard:

I think what coaches do the most, is they hold you accountable. My homeys are smart. They got As in calculus, physics, geometry.

Scott:

They're smart people.

Howard:

They're smart people. They memorize the periodic table. But, these reports they've never run. If you're going to call them Monday after work, or you're going to come in their office next Tuesday, I don't think they, the human nature is, they just don't get it into gear until they know, "Oh, Scott's going to be here tomorrow."

Scott:

Yes. Absolutely.

Howard:

So, they have to prepare for the test. What' I've always thought about the consultants is, I almost think it's 80% accountability to work on my business and 20% is the strategy. It's not so much the recipe. He's going to teach me to make lasagna. It's just that, we're going in the kitchen tomorrow and we're going to cook dinner. You know, accountability.

Scott:

Absolutely it's accountability. I hold them accountable all the time on what they're doing and what they said they were going to do. I ask them what their vision is for the next year and I hold them to that. "You said that this is what you want to do. I'm working on, focusing on, your vision and getting the team on board with your vision to get exactly what you want and how you want it." That's what I do. I hold them accountable. That's why I have the monthly coaching calls with them. It's really important to have continuous conversation about where we are, how we're doing and what's the results on a monthly basis? It's a key thing.

Howard:

I've always noticed that when you go to a seminar, half the room sitting over here and there's only one dentist for five people because the dentist sat next to the spouse and two front office and two hygienists and two assistants. The other half of the room is just all dentists coming by themselves. These dentists who bring their whole staff, they're always one million dollar practices, 1.5, two million. Then these guys all over here are $600,000 a year or less and they're always saving money by not bringing their ... Then, when I poll these people and say, "What is the number one thing that keeps you up at night and stresses you out?" It's never how do you do a root canal [inaudible 00:28:50] crown. It's always their staff. Then when I say, "Your office isn't performing right." They say, "Well, yeah. Look, my assistant ain't right in the head. My receptionist ... It's not my fault." I guess, my question is, back to sports.

When you go into an office, how many times do you sit there and say, "Okay. We're never going to have a winning team with that quarterback. We need to fire her." Or how many times do you say, "No this person's not being developed. We just need to edumacate her and bring her up to speed?"

Scott:

I would say the latter. It's usually a couple things, what I really see. Those, what you call non-performing offices typically have a pattern. The pattern is the doctor tells himself that he's not, or herself, that they're not a good leader. Therefore, they don't do morning huddles. Therefore, they don't compliment the team or reward the team. Therefore, they're always running in scarcity about money and about new patients and about their schedule. It's just this convoluted mess of nothing's working and I'm afraid to even try anything new. Yet, on the other side, you see morning huddles are a must. People actually get mad or upset if we don't have a morning huddle. They also have regular team meetings. There's also rewards and benefits and all kinds of discounts for the team. There's all kinds, even bonuses. There's all kinds of things that are going on. It's complete opposite.

When I go in and I have this conversation with the doctors, it's, "Okay, I'm going to work these calls that I'm having, I'm going to work on your leadership style. I'm going to bring out the best of your leadership style so that you're proud of that and that you can work with team. There's no correct or incorrect. There's no good or bad leadership style. It's just your leadership style. We'll get the team to form with your leadership style. Whatever that is. That's how we do it." That's how I understand it best to get them motivated. To get them into a positive attitude. They've got to have communication skills to work with their team. Obviously, they've got to have communication skills to work with their patients.

Howard:

Scott, when I got out of school in '87, 28 years ago, half of the patients going into the dental office just paid cash, credit card, check. Half had indemnity insurance, which was you would submit the insurance your fee and they would pay a percent. Now, 20 years later, most all the insurance is PPO. A lot of these dentists sit there and say, "Well, Scott. You don't get it. You don't understand. I'm out here in Parsons, Kansas and 85% of my practice is a PPO. They're telling me what my fees are. I got to work back from those fees. That's why I have 80% overhead and I don't have the money to do anything that you're talking about." What do you say? You know that in the United States there's a lot of places just like that.

Scott:

Yes. I have a client in Nebraska that is just like that. His practice is 92% PPO. I'm not afraid of that. He's not afraid of that either. You work with what you've got. It's just ...

Howard:

So, that's no necessarily a bad thing to you. If that's what it is, that's what it is?

Scott:

Heck, no. It is what it is. You can be very profitable with a PPO office as well as a pay-per-service office. There's really actually, not a lot of difference. You're just dealing with the insurance. Can you have a million dollar practice with a PPO? Absolutely. He does. There's no question he does. It's really easy to work with both of those things. I wouldn't object to any one of those ways of doing business. It works both ways.

In that environment in Nebraska, where it's a rural community and it's blue collar and everybody's got insurance, they're going to use it. It's the conversation he has with the patients with regards to their insurance. It's an allowance. It's not like your health insurance. It's an allowance. Allows you to have some of your benefits, some of the procedures that we're going to diagnose paid for. We're going to take care of your teeth. We're not going to diagnose your mouth based upon your insurance. We're going to diagnose your mouth based upon our view of what needs to get healthy and where you want to be in terms of your teeth. Do you want healthy teeth? Do you want a brighter smile? You want straighter teeth? We're going to do that for you, regardless of what that PPO says. It changes the mindset of these patients big time.

Howard:

What do you think is more important? I have always thought a lot of dentists believed in silver bullets. They're going to fix everything with a silver bullet. It's either going to be by a laser, by a cad cam, or they're going to do a marketing thing and bring in a gazillion new patients. What do you think are the real silver bullets. Someone who's saying, "I have high overhead. I'm stressed. I want less stress, more organization and more net income." What do you think the real silver bullets are?

Scott:

The real silver bullet, really, honestly, in every single office ...

Howard:

Hopefully you're going to say it's a Coors Light and you brought one. What are the real silver bullets?

Scott:

It's patient to patient referrals. I see it over and over again. The patient to patient referrals bring in the largest amount of production in an office than any other marketing, internal or external marketing there is.

Howard:

The patient word-of-mouth referral?

Scott:

Yes. Absolutely.

Howard:

How can a practice, what can a practice do to increase those?

Scott:

Here it is. I'm going to, it's a big thing. It's a three-letter word and I ... it's tough for people to do this, but I'm going to tell you anyway. It's my secret. Ask. Just simply ask your patients for patient referrals. That's all you have to do. They're in the mindset. Remember, we're changing mindsets not only of our team, but we're changing the mindset of our patients. Their mindset is, when they go to their MD doctor, it's right on the wall. "We are accepting no new patients." So, they assume we're not accepting new patients. When we tell them, all of a sudden, bam, bam, bam. We're getting new patients left and right.

Howard:

Why do you think they don't ask? Do you think it goes back to the fear of rejection? I'm not going to ask you to dance because you might say no. I'm just going to sit here and drink three pitchers of beer tonight. Or, do you think it's a pride thing. They're too proud to ask. Do you think it's pride or fear?

Scott:

I think it's a little of both, pride and fear and the rejection of, we're being greedy to the patient, asking the patient for patient referrals. It's just a simple matter of ... but, we do it all the time in other aspects, but not directly. We go see a good movie and we go to a good restaurant, we want to tell everybody. When we come to the dental practice, we forget that. If we just remind them of how great we are in our practice and they go, "Yeah. I got other people I want to refer here because I do the same thing when I go to a restaurant or a movie or a play or something. I tell everybody it was a great experience." That's fairly, simply all it is.

Obviously, some offices will do a contest. They'll give away an Ipad or something like that for the person who refers the most in that month, or something like that. Just to make it a little fun. Maybe a little more entertaining than simply asking for referrals.

Howard:

I want to ask you this, I'm just trying to get where all their excuses of why they're not, because they've got so many stories. They create stories. I've heard this, if I've heard it ten times, I've heard it 100. "I'm never going to have a really big success office because Scott, the bottom line is, I don't like to do surgery. I'm not going to start pulling wisdom teeth. I'm not going to start placing implants. I know that to be a million dollar practice, I'm going to have to learn to be an implant surgeon and pull wisdom teeth. I don't like blood and guts." Do you think the successful dentists always have surgery skills, place implants, or do you see successful practices where dentist refer all that stuff out.

Scott:

The majority of the practices I work with, they refer most of that out.

Howard:

I knew it! You say it and they'll believe you. I've been saying that for years. The market makes them think that you can't do the big numbers unless you do all these fancy sinus lifts and bone grafts and place implants. When I see a million dollar practice with a dentist taking home $2-300,000, they almost never have a Cerec, they almost never have a laser. They almost never place implants. They wouldn't know what a sinus lift was. If you told them to pull his wisdom teeth, he'd say, "Don't you realize this town has an oral surgeon?" Why do they believe that they have to buy shiny toys and do surgeries over their head instead of just saying, "Man, you can be really successful just having a family practice."

Scott:

Part of it is always looking for the shiny object. Just trying to try something different than what they're doing now. We always talk about doing the same thing and expecting a different result. So, you try something different. Really it comes down to coaching. It really comes down to having someone come in your office.

This guy I went to last month, he's got 300 people pointed at Head and Hygiene. I told him, this is actually what I did on the plane. I told him, increase it by 10% a month. The first month, this month, they're going to add 30 and then 33 and then 36 and then 40 and then on and on and on. Until, in December, they're going to add on 85 to that. They're going to maintain and keep everybody that has been into the hygiene program. At the end of the year, they're going to have 939 people appointed Head and Hygiene. That's just by doing 10% month over month over month. All of a sudden they go from 300 to 933. That's 25% to almost 80%. It's a remarkable change by just doing it by 10%. Right? If you really want to focus on that, you can really  focus on that.

What's the numbers on that, you might ask? Well, think about the number and labor that the front office has to do just to get those people back in the office. I just said, $20 an hour, it's going to take them 400 hours to get all those people back in that they didn't do before. Right? Automatically, if all those patients show up and they, most of them will., it's the difference between 939 and 300 is 639. I know I'm throwing a bunch of numbers out, but I'm trying to get you to think about, what's the value of doing just this one thing. Two prophys a year. $100 per prophy. That's $127,000. Then they've got, they get an x-ray and get two exams that year. Just for 639 patients, just coming in twice a year, that's over $231,000. Right? Just like that. You've done nothing but get them to point ahead. That's all you've done. Then, you've got to add on the restoratives for that. A quarter of them have restorative issues. That's 160. That's 500, let's say it's another $500 per person. That's another $80,000. Right there. Just right there. When you add those two alone, it's over $311. I'll put that on my website so people can see that. $311, $311,000 just pointing ahead in hygiene.

Howard:

You said you do a PPP on everybody. What does that stand for?

Scott:

A practice performance profile.

Howard:

If one of my homeys listening to you wants a practice performance profile, how does that happen? How much does that cost? How do they get that? Do you log into their computer?

Scott:

No. I will ask them for a few reports. They'll email or scan and email those to me. I will talk to them for about a half hour. Talk to them about what I just see on those three or four reports that I asked them. Then I'll come in and actually do a complete performance analysis. The complete thing on the first day I show up at their office. That's how I do that.

Howard:

When I meet a dentist I'll say, "What composite do you use? And he'll say, "Healy Molar." I'll say, "What's the wear rate?" He'll go, "15 microns a year." I'll say, "What do you bond it in, what's a megapascal?" He'll say, "27 megapascal." Then I'll say, "How many people are scheduled for a hygiene appointment?" And, it's like, blank. It's like, everything they measure. It's crazy because they know the wear rate of every filling they have, but their fillings don't wear down. They know the bond strength of all their adhesive materials, yet none of their things fall out. It seems like every number they know, they don't need to know and has no relevance in their life.

My question to you specifically is, what numbers should they know? What numbers should my homeys, if they're driving to work and they don't know these numbers, need to walk in there and get on Denture Eagle Soft, Soft Den, Open Dental. What should they be tracking, specifically?

Scott:

Wow. That's a great question. I track a lot of numbers. Like I said, it's different for every office in terms of what they are doing and how they're doing it. I look at different numbers. For this office, I'm going to be really focused on appointing ahead. I would say, as a generalization, in terms of what you should be looking at. Yes, you should be looking at production and collections. You should be looking at the number of x-rays you're doing and the number of exams you're doing as well. The really key thing is, I'm looking for new patients by referrals. I want every single new patient by referral. I want to know that. I also want to know how many people we appointed to Head and Hygiene. I also want to know how many people we appointed to Head and Restorative based on all those doctor's treatment plans and who didn't. I want a list of that.

Also, you know what, I also want a list of the people who called in and said they're no longer coming here. I want to know who's not coming here anymore. I want to know all those kind of things. Instantaneously, I want to know all those kind of things. Keep an eye on really what's the flow, what's the behavior style. What's the behavior of our patients? Are they coming in? How are they coming in? Are they accepting treatment? Are they appointed ahead in hygiene or in the restorative when we do the treatment. Are they, if we say they need perio scaling and root planing, are the accepting it and are they following through? Are they maintained in perio maintenance or do they just fall of the chart after a couple of perio maintenance treatments? Which is typically what happens.

Howard:

I always think that the psychological situation the dentist is at when their office is very stressful and falling apart and not working right. They just love to, at the end of Thursday, drive to an airport, fly away 1,000 miles, go to some dental institute and pay them thousands of dollars because they're leaving their town. Their going to a resort. They're leaving all their problems behind. They think if they just learn this one dental skill on a shiny new toy, they're going to come back and it's all fixed.

When I go into those offices, what I normally always see is this, the staff will tell me these things and then I'll say, "Well, what did the doctor say?" "Oh, I wouldn't tell him." It's like the people that could be helping the doctor the most are afraid to say. They might get fired. They don't want to, they just don't want to go there. It's like there's several 4,000 pound elephants in the room that nobody wants to talk about. How do you? It seems to me, and that's why I don't like, I don't do an office consulting. I wouldn't do your job for anything because when I started doing that a long time ago, it was crazy.

I almost thought that every office I went into, it'd be best to lock the dentist in the basement and have the office manager hire an associate that will do what she says and we'd all live happily ever after. Then you could just throw a bale of money down in the basement to him each month. That's really what I saw. I almost think that for you to be effective, you'd almost have to be an armchair psychologist. I mean, it's about getting the doc's head into the game. You know what I mean?

Scott:

Yes. Just like anything else, especially dentistry, 80% is psychology and 20% is clinical. It really is. It really comes down to that. That's why I say, when I go into an office, I look at office, every single office differently because they're all different. At the same time, I have to work with the whole team. I have to have sit down, realistic conversations about what's going on, why it's going on and what we need to do to move forward. I've had tears in the office. I've had joy in the office. I've had tough conversations. I'm not afraid of the tough conversations. I'm not afraid of the tough conversations because I know, once we get beyond that, there's freedom. There's excitement.

Howard:

You know it's the whole doctor's life. I mean, the lab man fears. He said 80, every lab man tells me 80% of their dentists, they can get horrible impressions and they can't call them and say, "Hey, Scott. You didn't give me enough reduction. I can't read. This is the shittiest impression in Phoenix." Because you're just going to say, "Oh, screw you. I'm just going to get a new lab." Then, the supply reps from Benco and Burkhart and Shine and Patterson, they're calling on 25 offices. They walk in there and they just see obvious flaws. But, they're like, "I'm just afraid 4 out of 5 times if I said, you know, you might want to think about this, they'd say, 'Well, who the hell are you?'" [inaudible 00:48:09].

How do you address, like I say, what perplexes me the most is, how do you get the doctor to go from this Saddam Hussein mode, where if you tell me something I don't like, I'm going to shoot you, to, I raise my hand. I want to be humble. What is my team saying? What does my assistant think? What does my lab think? What does the suppliers think? What do you think? How do you get them in that mode?

Scott:

I first start off, I'll survey everybody in the office before I get there, including the doctor. I'll have the doctor, I'll survey the doctor and I'll also survey his team, online. It comes directly to me. It doesn't go to anybody else, so I get a flavor of what is going on in the office. The second thing I do is, when I get there, I'll have a sit down with every single employee to get a flavor. I can look at the numbers all I want. I don't even have to come here to look at the numbers. You can just send them to me and I can figure things out. What's really happening in the office, that 80-20%, that 80% psychology has, the conversations that are going on amongst the whole entire team. I really want to know what's going on inside that.

Then, I'll have a one-on-one, long hour and a half conversation with the doctor before I even show up and say, "Hey. Here's what your team is saying. Here's what you said. I already did your disc, behavior style. I know what your leadership style is. I already know some of the things that are going on here. What do you really want? What do you really want to do? How do you want to be? How do you want this to work? We're going to have some tough conversations on what needs to happen in order for you to achieve that." I set them up for success, rather than set them up for failure. I really set them up for, "Okay, we're going to deal with this."

If you just go to read, "Good to Great" by Jim Collins, he says one of those thing is that [inaudible 00:50:04] from good to great is just realizing the brutal facts. I'm happy to realize brutal facts. Once we realize brutal facts, then we can set goals. We can set parameters. We can function on that. Will some team members leave? They always do. The people who are not on board, see me coming in and see where we're going, seeing the direction that we're going, there's always someone that says, "I'm out because I want to maintain the status quo the same way. Do the same thing. I don't want ..."

You know, some of the team is afraid of me because I know their job. I know what they're supposed to be doing. I know I can read an A/R report. I can read the outstanding insurance claims. I know exactly where to look to see where it hurts. When they see me looking at that, they just got to go, "Oh, Oh," and they know I'm going to tell the doctor about what's going on and what needs to be improved and how that's going to happen. One of the things that I really want to focus on when I'm going in a team is that I'm not here. Right? I'm not here to point blame at or find fault. I'm here as, I ask myself two questions. The number one question I ask myself when I go in a dental practice is, if I owned this practice, what would I do? That's the number one thing I ask myself. I embody that as if I'm the new owner of this practice and I do that.

The second thing I ask myself, Howard, is, what am I missing? You know? They can hide stuff. They cannot say stuff. They cannot say what the doctor told them and all this kind of stuff is. I always want to figure out if I was the owner, what would I do and what am I missing? That keeps me up at night sometimes. I'll tell you the truth.

Howard:

I think one of the funniest things is if you asked them all, what's the biggest problem in dentistry today? The majority will say, corporate dentistry. It's like, man, I see them turning over more patients faster than any game in town. If you said to say, "Well, who looses all their new patients the most?" Well, it's corporate dentistry.

Scott:

Probably.

Howard:

I mean, I think it's hilarious that they think that's the biggest threat, when I really think it's the biggest joke. I mean, Simon, there's 460 DSOs and some of them, some of them, the worst reputations in all of dentistry are owned by some of these DSOs.

Scott:

Oh absolutely. It's a competition scarcity thing versus, and you know as well as I do, there's an abundance here. We're doing our best to catch up with the number of dentists that we need. Especially the number of dentists we need in rural America. It's unbelievable. I went to a practice in Bangor, Maine. A husband and wife team. They both work six days a week. They have a day off each where they are not seeing each other. They're just so overwhelmed.

Howard:

I know but they all want to go on the corner of big, downtown Boston, downtown L.A. They want to go to San Diego and have an office on the beach. They don't believe in demographics. They believe in, "if you build it, they will come." They saw it on Hollywood, so it must be true.

Scott:

It's such a shame though, too. There's such great opportunities out in rural America. It's not far from the big cities. What do you do Monday through Thursday anyway, in the evening? I literally told this one associate, buy this practice. Drive up there on Mondays. Drive back on Thursdays, to San Francisco, because he wanted to be in San Francisco and you'll be the richest guy in San Francisco of all your classmates. He goes, "No, no."

Howard:

Most people don't realize that the richest dentist in the world, Rick Workman, who owns the Heartland Dental, which is the most well-run DSO out there, he stole that play card right from Sam Walton. Sam Walton knew that Sears gives Miss TGNY and JC Penney who are only going to be in Dallas and all the big cities. When Sam Walton realized that nobody ever had one thought of going to Bentonville, Arkansas. He thought, "Really? So, we're just supposed to buy out of a catalog because we don't live in Dallas?" Walmart was in 32 states before it hit a major metro and Rick Workman was in ... He just crawled around all these small towns and he was a 100 millionaire before anyone knew what was going on. So, do you like doing this?

Scott:

I love doing what I do.

Howard:

Do you love it?

Scott:

I can't believe how much I love doing what I do.

Howard:

Why do you love it? What do you love about it?

Scott:

Number one, I love seeing results. I love seeing my, I love seeing the team and the doctor gel together like they really should. They just didn't have the know how or the thing to do it. I love to see how they increase their revenues without even adding an hour to their schedule. I love that! You know what? I would say a lot of my clients, my average, I just figured this out, the average client stays with me 34 months. The average.

Howard:

That's three years.

Scott:

Almost three years. I only start with idea of doing it for one year. The reason is because I become a part of that office. I become a part of their family. I know their kids. I know their spouse. I become a part of their family. They become my friends more than anything else. I'm still a coach. I still hold them accountable. Don't get me wrong. I'm not floating away on that. I think, every time I come into their office, they know that I'm going to do both what's great and what needs to be improved. They like that because they've got something to go on.

Howard:

I'm just curious. There's a lot of dentists out here. There's 150,000 general dentists in the United States. 25,000 specialists. Anyway, is there any particular profile to who's most likely to use you as a consultant? I mean, or is it mostly older, 60 year old guys getting their practice ready to sell? Is it young kids who just bought a practice? Is there any particular profile of who's using you the most?

Scott:

I would say, I've done all of those. I have a, I just got back from a dentist who is 76 years old and I also have a dentist who's been out of dental school for two years. I do the gamut. I would say this, majority of my clients come from referrals. That's why I'm telling you guys in terms of patient to patient referrals ...

Howard:

This interview came from a referral.

Scott:

What?

Howard:

This interview came from a referral. I had several people call me and say, "You need to do Scott."

Scott:

Yes. Most of them come from referrals. I would say the majority though, the majority of my general, because I do specialists too, the majority of my general dentists are first time buyers of a practice. That's what I do the most, probably. That's why they stay with me for so long. They realize I could have never gotten this far, this fast, this quickly, without him.

Howard:

I know this question is going to sound crazy and we're almost out of time, but I want an objective [inaudible 00:58:00]. You know the dentists always say the hygienist is crazy. The hygienists always say the dentist is crazy. Between the dentist, the hygienist, the assistant and the receptionist, rate them from the bat shit craziest to the least craziest in the office. When you going in their office, rank the crazy scale.

Scott:

It depends.

Howard:

I would say the bat shit craziest is always doc. Next up is the hygienist. Next up is the assistant. It seems like the only normal person in the office is always the front desk. I mean, I just lost all my podcast here since all my homeys, I've never had anybody email me that listened to my show that wasn't a dentist, that's just a dentist. But, I do, I think it's, I've said this before on my show, I think it's the adverse natural selection. I've made this case several times that in college, if you were well-rounded, joined a frat, had a girlfriend, went to all the games and made As, Bs and Cs, well, you would never be a physician, a dentist or a lawyer.

If you sat in the library for three, four years, like me and all you did was study and you made straight As, it's this natural selection that you're dealing with all these dentists that the only way they could get to this party is they have to be bat shit crazy, smart, live in the library and memorize calculus, physics, geometry. I just don't see well-rounded, communication, manager skills. You almost think they should have only accepted people for the actually dental office. They should have only accepted people from frats and sororities and whoever got the most DUIs, or went to the most ballgames or is in the band, or whatever. You know what I mean? You have this natural selection of some tightly wound scientific-minded people. Then they are thrown out into a dental business.

I'll give you another example. My two older sisters are Catholic nuns. When I first came out with my 30-day dental MBA, my sister Mary Kay, who's name is Sister Ann [inaudible 01:00:03], she read it and she said, "You know what? It's the same problem in the priesthood. They go to the priesthood for eight years and all they do is memorize the bible. Then, an hour after they graduate they're thrown into a parish with an elementary school, upset teachers, losing money. All these problems and this Catholic priest is like, "What the hell did eight years of seminary school didn't prepare me ... I'm supposed to talk to a teacher and a parent and a budget?" She was taking my 30-day [inaudible 01:00:31] and sending them to all these young priests. These priests were all writing me letters saying, "I learned more about how to run a parish listening to your dental MBA tapes, then I ever learned in years of the priesthood."

I think it's a tough problem. They selected people with skills for math and physics and now they're in the people business.

Scott:

That's where I come in because I teach them all those other skills. I help them with the communications skills. I help them realize where they are in terms of their leadership skills and really get them to hone in on their strengths rather than ... They beat themselves up over and over again on the weaknesses, which they'll never improve. I want to really get them to really get there. I had several of my teams go to Tony Robbins event and just come back just amazingly happy and amazingly on board with the doctor's vision and making all those shifts that they needed to make because they ... What did they do? They changed their focus, right? They changed the meaning they attached to what was happening. They started doing things betterly.

Howard:

Betterly?

Scott:

Better.

Howard:

I like betterly.

Scott:

You like betterly?

Howard:

I named my book Uncomplicated Business. The reason I wrote uncomplicated is because when I typed it out on the word document, it gave me the red squiggly line that it wasn't right. I said, now I know it's right.

Scott:

That's awesome.

Howard:

If Microsoft Word didn't like it, then I knew it was for me.

Scott:

My biggest fun, challenge for me is to take a doc that's like that and make that doctor into that communication, fun-loving communication guru. Not only with his team, but also with his patients and his whole community. I love that. It's possible. They just didn't learn it or didn't know how to do it, or was afraid to jump out there. Fear is a great inhibitor.

Howard:

What's funny, and we're two minutes overtime so we've got to wrap this up, but what's funny is when I look at the most successful dentists out there and I crawl back in their life and think, what really helped this person out? It wasn't the math and the physics and the chemistry. It was that she was a waitress through undergrad and she was serving tables. That's where she learned people skills. Or, he was a bartender. I always joked for years that dentists would all probably double their income if they got a part time job on Friday and Saturday nights being a bartender and just learning how to talk to people at a bar. If they ever just got relaxed and became a waitress or a bartender or something in the people business ...

Scott:

Or hire the coach.

Howard:

Or hire the coach. But, hey dude, seriously, thank you so much for coming over. I know you're a busy man and coming over here to let my son Ryan and me harass you for an hour. Thank you for all that you've done for dentistry. Can I promise my townies that someday you might build an online CE course on Dental Town?

Scott:

I will definitely do that.

Howard:

I think, I just want to get it done. I think if the course was focused for the whole team and I think if you watch these ... do a lunch and learn. Go get some pizza, burgers, sit your staff down and watch a presentation together and get the whole team going, "We're going to do this. We're going to bring in a coach and we're going to go to the next level." Just be humble about it. Be honest. Be humble. Just tell them, "I'm stressed out. I'm not sleeping at night. I'm upset. Something's got to change." Then, what's neat about Scott is, he's the bad guy. You're just the innocent dentist who raised their hand and said I need help. Then let Scott come in and deal with all the complex people.

Scott:

Eventually, they all love me in the end.

Howard:

I bet they do. I love you. Thanks for coming down, buddy.

Scott:

Thank you.

Howard:

All right.