Dr. Paul Caselle completed his undergraduate studies in biology at
Boston University College of Arts & Sciences, then went on to New
York University College of Dentistry to attain his DDS degree. After
graduation, Dr. Caselle completed a residency program in family
dentistry at Forsyth Dental Center in Boston. He opened his dental
practice in Wilmington, Massachusetts, and has provided the community
with family oriented dental care for 42 years.
VIDEO - DUwHF #1125 - Dr. Paul Caselle
AUDIO - DUwHF #1125 - Dr. Paul Caselle
Dr. Caselle has Fellowship Certification in the World Clinical Laser Institute, Invisalign and Six-Month Smiles Certification. He is on the Biolase core training faculty and has presented seminars to other dentists on such topics as CEREC technology, laser dentistry orthodontics for the general dentist and practice management. He has written several articles which have been published in leading dental publications. Dr. Caselle is a graduate of the Sirona Speakers Academy, and a member of the American Dental Association, Massachusetts Dental Society, Middlesex District Dental Society, and Tri-County Dental Study Club. He is also a member of the Wilmington Chamber of Commerce, Toastmasters International, Dental Speakers Bureau and National Speakers Association.
Howard: It's just a huge honor for me today to be podcast interviewing Dr. Paul Caselle who completed his undergraduate studies in biology at Boston University College of Arts and Sciences then went on to New York University College of Dentistry to attain his DDS degree. After graduation Dr. Caselle completed a residency program in Family Dentistry at Forsyth Dental Center in Boston. He opened his dental office practice in Wilmington, Massachusetts and has provided the community with family oriented dental care for 42 years Dr. Caselle has fellowship certification in the world clinical Laser Institute, Invisalign, Six-month Smile. He is on the bio lace core training faculty and has presented seminars to other dentists on such topics as CEREC technology, laser dentistry, orthodontics for general dentists and practice management. He's written several articles which have been published in leading dental publications. Dr. Cassel is a graduate of the Sirona speakers Academy and a member of the ABA, the Massachusetts Dental Society Middlesex District Dentist ID and Tri County Dental Study Club, he's also the member of Wilmington chamber of commerce, Toastmasters International, Dental Speaker's Bureau, National Speakers. My gosh I've been a big fan of yours on Dentaltown, you were one of the first 100 dentists on Dentaltown and now you have 3,307 posts. Thank you so much for coming on the show today, how are you doing Paul?
Paul: My pleasure, my pleasure
Howard: So what I'm trying to on these podcasts looking at the data looks like 25 percent in dental school, everyone else is under 30 email me Howard@dentaltown.com tell me who you are why do you like to show, what do you want more of or leave the comments in the youtube channel but basically Paul their what my show trying to do is their they're coming out of dental school they got three to four hundred thousand dollars in debt and they're trying to find their way and they look at someone like you who's been crushing it in Boston for 42 years and say here's this the Saint question, Paul I got four hundred thousand in debt, I just graduated how do I grow up and be a dentist like you someday?
Paul: Well that's one of the reasons why I'm really interested in helping young dentists kind of sort that out. You know dentists go to dental school, they learn how to do dentistry and they come out and very often they have to work in an office for a few years just to kind of hone their dental skills and after a few years they realize that I want to open a practice. I want to either buy a practice and open a practice from scratch. I think really it's hard to find a good quality practice to buy and so it's something they just have to figure out, I mean you have to kind of live within your means come up with a budget and look and see you know. One of my opportunities out in the marketplace trying to start a scratch practice I think it's very difficult especially in the Boston area because a lot of competition. So that's really something to have to look at and I've talked to some young dentist and they're ready to take the plunge. Somehow they manage it to meet their obligations but also try to make a living in buying a practice and I think that's really the way to go for a lot of young dentist.
Howard: So Massachusetts has two dental schools Boston University and Tufts?
Paul: They actually have three
Howard: What's the third one?
Paul: Well you have Harvard and you have Tufts and you have Boston University of course. So you have three dental schools in the area.
Howard: What are their class sizes?
Paul: Well I think you know Harvard's the smallest, I'm not sure on the class size but I think you know Tufts probably has around a couple hundred maybe more you have a few more in Boston University probably around a hundred some-odd students there so you have a lot of people coming out and you know it's difficult a lot of Doc's go to corporate to kind of hone your skill and try to figure out who they are what they want to do and I did a lecture recently and I had some young dentist come up and you know they really are at a loss, they really don't know too much about business because they don't teach business and dental school they know very little about the dental business never mind even running a business and so they very often don't really know what, they don't know they you know they get into practice and they realize boy it's a lot more expensive than I thought it was and it's a lot more work than I thought it was. They don't realize we dentists kind of wear many hats in the course of a day. Whether that's in charge of marketing and sales at HR or IT or their's a lot of different things you have to do and running an office. So I think that's overwhelming for a lot of dentists and so I see my role at my point my career right now is is trying to lecture these lecture to these young dental students to hone down and have them understand the business concepts that they need to have going forward to be profitable because they come in they have no concept of expenses, they have no concept of what how to manage a business and so now I see myself coming on board and trying to educate them and how to run a business and how they look at the bottom line, how to run a profit and loss statement. I really you know run their business based on what they're doing income wise.
Howard: and you know I've always lived in an aquarium. So you know everything I did right everything I did wrong,I always liked living in an aquarium because you got so many townies like you to tell me hey Howard that is absolutely wrong or hey try this, it really helps when you post on Dentaltown, a lot of dentists email me a question like well why do you want my opinion?, you're in Boston why don't you post that on Dentaltown and maybe there's more local information there's other experts. So what I did if you look at my darkest secrets my dental office is 31 years old but my management team they're all been there 20 years. So I spent 11 years running around trying all these different things and what really was a game changer for me is I bought my first laptop and I went to ASU sign up for the evening MBA program and it was two classes a trimester for six trimesters two years and I took all the notes that applied to my dental office and worked on implementing those two things every trimester I eventually made the 30 day dental MBA which is for free on YouTube on Dentaltown even the iTunes audio podcast but the business of dentistry that's the game changer. If you don't understand the business of dentistry you're gonna work for a dentist who understands the business of dentistry. So you're either going to be an employee because you're a dental operative surgeon in a surgery and don't know business, or your gonna understand business and if you understand business you don't even have to do the dentistry like Rick Workmen. You know it's 850 dental offices he hasn't given everybody a shot in ten years because he can hire people to dentistry. I want to get right to some dentistry and Center things because I'm you're either gonna be a dentist whose high volume low price take every PPO in Medicaid or you're gonna be a low volume dentist with higher prices, fee for service and you're gonna have to be to do that I mean we're in the playoff seasons and I predicted it last week and I even post on Dentaltown that all the home teams were gonna win. I mean you knew the Rams you know you knew because those people there's only probably 15 guys in the whole world that could be a quarterback to take you to the Super Bowl and the Rams have one, the Saints have one, the Patriots have one, the Chiefs have one and so you've got to be a Drew Brees of the Saints, you've got to be a star quarterback and to do that you got to be a super dentist and you've been being a super dentist with lasers and Invisalign, Six Months Smile. Let's start with lasers because I know what how my homies are thinking that I'm saying Paul I graduated with $400,000 student loans you're telling me to buy a hundred and thirty thousand dollar laser how did I get my money back on that. Will buying a laser help me be Joe breeze of New Orleans Saints or the guy from the Patriots, what's his name but I'm teasing you because you're from Massachusetts but do you think laser can help you be a low-volume high-margin superstar dentist?
Paul: Well I think basically you have to look at technology whether it's lasers or anything else and you have to look at return on investment. So the question is if you're not doing soft tissue prestigious now in your office and you're referring a lot of these procedures out you have to ask yourself okay can I do these procedures more comfortably with no bleeding no swelling little or no discomfort at all and if you can do those in your office why wouldn't you do it in your office why refer it out. So I'm a firm believer to do as much as you can in your office but you have to do it smartly and I think lasers allow you to do that because it's pretty much a easy process once you get the technique down. That's the other thing that you know dentists have to realize if you make an investment technology you have to make a commitment to learning it and incorporating into your practice, so that you can you know get return on investment. So many dentists go off and buy technology and they don't devote the necessary resources to develop that skill. I've run into offices where you know Doc's kind of collect technology and they wonder why well why isn't this paying off, they're paying the payments month after month and not really making any money on it. So you have to one look and and listen to what your patients need and want and can you meet that need and my particular offices we're a low volume and you know high fees and we're able to make it work because we're doing a lot of work in-house whether that's lasers or using CEREC and so forth. So you have to listen to your patients and look at your needs if you're referring a lot out and the question is can I, we keep this work in my office and do it easily and quickly and have the patient walking out happy at the end result because they're not having pain or discomfort and I bought a laser because the soft tissue applications because I was looking at an analysis in my office says I'm referring a lot of this stuff out and people come back six months and recall and say "I didn't go" well why not; Well I have trust in you doc and why can't you do it. So I worked at laser and they said well I can comfortably do these procedures using the laser and it doesn't take much time to do all of these procedures and I'm gonna have to worry about stitching people up. I'd have to worry about people call me at 10:00 o'clock saying hey I'm in pain or I'm bleeding. That's all eliminated with lasers and the fact that I can do multiple quadrants restoratively with these people makes it very cost-effective. So it's all a question of how much you can produce in that hour or thirty minute appointment you have and the ways that allow me do this very effectively.
Howard: So would you consider your practice of 42 years high volume low fee PPO driven or would it be more low volume high fee.
Paul: Low volume high fee. We don't take any PPO's the only two plans were associated with is Delta Dental and BlueCross BlueShield other than that it's all fee-for-service.
Howard: Yeah and everyone who I've ever talked to that actually had really good research and data on the US market ever since I started looking at it in the 1980s was that America their's two customers in America, one is high volume low fee and one is high touch superstar dentists, I'm afraid of a shot I trust this guy. So some people when he gets through dentistry they want to pay extra out-of-pocket higher fees because they want to go to Paul and they don't wanna go anywhere else and other people are like you know fillings the fillings of filling, I just want to go my insurance I go here makes sense ect. ect. and by the way you said something month to month, you know when you look at a laser let's say it's a hundred thousand dollars well I don't ever see a dentist paying a hundred thousand dollars for a laser I see them doing like a five year lease so let's say your lease train was a thousand dollars a month well if if they put a hundred thousand dollar asset into your dental office with nothing out of pocket and then you generate say two thousand and three thousand dollars a month in revenue and you only have to pay with a thousand dollar payment then you just increase your return equity. Remember I do dentistry for a dollar and and I have a profit of a dime my profit margin is a dime but if I built a dollar dental office and I only do one dollar a month then my 10% profit margin is my 10% return asset. So the trick like Southwest Airlines they get their planes flying twelve hours a day while all their competitors are eight hours a day so that increases our return on asset but if Boeing gives you a fifty billion dollar aircraft you don't have to get fifty million dollars for you just have a million dollar a month payment then you increase your return equity because you have a profit margin, net income over sale and then you have return on asset which is your sales over your asset and then you have return equity which is the equity you put onto it versus the asset, so that's called leverage. So I want to get specific what laser are you talking about and how much is it and what exactly does it do? Do you just have one laser in your office?
Paul: I have two lasers, I have a diode laser Epic X laser by Biolase also have an IPlus laser that dissolves tissue by Biolaase as well.
Howard: So you have two lasers and they're both by Biolase?
Howard: Okay and is that still ran by KGB Keith Bateman?
Paul: No he's left a company long time ago
Howard: I know the guy what's his name..
Paul: I forgot his name you have a new CEO that just came on recently
Howard: but anyway so this is not a commercial for Biolase, I'm on his show I can't even recall his name. So why are your two lasers from Biolase?
Paul: Well I've been a long time Biolase customer since 2003 when I first incorporated lasers into my office and I decided back then I wanted to be a laser dentist and the only way it can really incorporate lasers is getting two lasers because they're very specific as far as tissue interaction. So if you take a diode this can be very effective for working on soft tissue, tissue that's pigmented and your Iplus and all tissue laser you have a target tissue of water and hydroxyapatite and so one laser you might want to use for soft tissue applications versus the Iplus which you can use and more application you can restore teeth you can prepare teeth and do a lot of soft tissue but these because we know soft tissue a lot of soft tissue has water so in those areas where you can use that it works very well. I like using the Iplus most of the time because most of my work involves doing you know frenectomy the fibroma removal and restorative and the diode very often can be used by the hygienists that do the laser bacterial reduction and you can treat this else's and herpetic lesions with the dial very effectively. So it's nice having both ways because of the tissue you might be working on, You have a very hyperemic tissue you might want to use the diode because of its its ability to interact with pigment a tissue.
Howard: Nice,and so how much are these, so how much is each laser and the payment and the procedures to figure it out if it's a return on asset or return on equity?
Paul: Well a lot depends on how you structure your deal you know some dentists though will buy both some dentists will buy one and I'm not really sure on the pricing of the laser that's usually left to the salespeople. I just trained people but you know you look at these lasers or it's around $6500 for the diode and they have you know two diodes one is a Epic X and the other ones just an Epic and they also have the Iplus, which probably retails around $85,000 in that ballpark and but you know a lot depends on the training you get and the package that's put together and what is done by the sales team. so I you know I don't know exactly but you have to look and see what procedures you have in your office and which procedure you're referring out and can you do the procedures in your office and also laser is also positioning you well because a lot of people today are looking at minimally invasive dentistry and minimally invasive medicine. So you know laser allows you to do a lot of things minimally invasive and people like the idea of you know minimally invasive. So you if you take a small area of decay on a tooth and say look we can take care of that minimally invasively by using a laser which very often could be done with a local anesthetic people really really appeals to people and their feeling is if I can do a minimally invasive that's really great because what we'll put that filling in we'll put a bonding in there and that will be filled in very nicely for the next many years to come.
Howard: The CEOs name of Biolace is Todd Norbe, I think he's just been new there what six months or so
Paul: It could be, they've had some change in that top, had been Harold Flynn he stepped down someone else came on board. I'm not sure you know who's on who's running the company now as a CEO.
Howard: but you definitely recommend their two products and you're doing a hard tissue to so you're doing operative dentistry with it?
Howard: I would think we had the epic legend of dental lasers in pediatric dentists, well what was his name, I got a in Chicago let me what was his name the guy who did the lasers in pediatric dentistry, do you remember who I'm talking about?
Paul: No I don't
Howard: So far our IP podcast series that people I've done I was Fred Margolis in Chicago he was a pediatric dentist who pioneered dental a version of pediatric dentistry. We had Carl Mich, Robert Ibsen, Yvan Kirchner, Dennis Myers, those are five guests we've had on the show that are no longer with us and a shout out to obituary of my other friend Kent Weathers who I tried to get on the show a couple times, he passed away over Christmas his health was failing him he lived up the street in Scottsdale of an Indo magic. Did you ever get to see Kent Weathers lecture?
Paul: Never heard of him speak.
Howard: Oh my gosh an amazing guy anyway Fred Margolis he was on my podcast two years ago and he was like how can you be a pediatric dentist and not have a hard tissue laser. I mean the kids afraid of a shot and then you gotta give her a shot and then you gotta let it soak in ten minutes, he goes I just sit down with my hard tissue laser and the time it takes you to get him numb and wait ten minutes for it to work I'm already done with the procedure and then mom's mom monkeys and apes talk five times for every one man monkey or ape. So here's mom bringing the kid into the dentist sees this laser, so she's gonna more likely tell five other women housewives with children then some dad is gonna tell five male employees about this and he just, he was really I think the the guy who really got hard tissues taking on PA dentistry, but could you see a reason a pediatric dentist wouldn't have a hard tissue laser?
Paul: I have no reason why they shouldn't they absolutely should I mean the pediatric patients I've treated that I've used lasers on them you know and they really like the idea of no shot and you're absolutely right as far as mom singing in the room there and seeing us use the laser just amazed. What's the other thing that's very amazing too is that we use this on adult teeth as well like upper anterior how many patients you think like getting a shot in the upper anterior for a class three resin there?
Howard: If they're single none of them, if they're married they're already use the pain and suffering so it's really no big deal but yeah my gosh and and here's another thing you know this is Dentistry Uncensored we can say it but aren't sealants extinct I mean you're taking technology of how to acid etch enamel and dentin and put in these bonding agents and resin but you're not but if the pictures are filled with crud and crap and bacteria and viruses and parasites and Oreo cookies and Doritos and you do a sealant it's only about a $35 fee and half of them fail within the year and they're all gone in two years, whereas if you pull out a drill or a hard tissue laser and you clean out that pit and fissure you're in debt and every time and now you're doing an occlusal composite which in five years 95% them are still gonna be there where's your sealants none of so don't was that too controversial for you I mean do you agree that sealants are a failed ideology and should be replaced with preventative reservations which are clean.
Paul: Yes I agree because you look at sealants and the biggest question I have when you see a sealant ask yourself is their decay underneath that sealant and how many sealants do you just take the exploring just kind of flakes right off it's you know the leaking it's actually having it's almost having a leaking filling in your tooth and so that's why I think lasers appeal to a lot of moms because you have a kid that comes in has you know a small lesion you say okay let's go any with the laser take care of it no anesthetics require me just go put some bonding in there and you now you've sealed that up and you know it's good tooth structure underneath and not have to have any questions about what's going on and that sometimes is a big question. I mean we really don't do sealants my office any longer because of that same issue how do you know you're really on the tooth structure, you don't.
Howard: and when you have that lid over the most of the pits and fissures, you're protecting it from the atmosphere which is 40% nitrogen 20% oxygen so the anaerobic bacteria that I always see under these sealants where all the sudden there's an oxygen free zone and then the decay mushrooms out and then the other thing is the insurance companies don't really you don't see CEOs of Delta coming on my show and under they it's a very the insurance companies they play in one parking lot and the dental the dentist's or in another and it's not a very good solid relationship but when you're lecturing. I lecture a couple of hundred insurance guys down in Florida and they were showing me their data but they would let me have it or print it or anything like that or come on the show but basically if you look at the 32 teeth there's just six major spikes doing all the dentistry it's the first molar you got four first molars. So the tooth most likely to be root canal, crown, extracted, replaced. So putting a crappy little sealant on your six-year-old granddaughters tooth of these four molars that are most likely to be root canal, crown, extracted. I mean why wouldn't you just do it right and remove, clean out all the pits and fissures put in a composite or an amalgam you know that's what I give it my grandson's. It's like look you know do you want to replace a pretty little tooth colored composite at 90. Look at grandpa he has seven fillings and they're all gold because gold is the best and I had a lot of a couple my boys actually always chose the gold fillings so some of my boys have gold fillings but yeah I don't understand the business economics or the clinical dentistry of doing a sealant. I just think it's garbage, would you call sealants garbage?
Paul: Well I wouldn't go that far but you know I would say I'd rather use a laser to clean out the the pits and bond something in there I know it's gonna be there solidly and what's the benefit of having a laser is that I can do it minimally invasively but you don't have the mechanical trauma you would have with a high-speed drill. So I know I'm going in here very gently removing that decay area and sealing it up with a resident filling. So that you know that to me is really the better way to go long term.
Howard: So I'm on the Biolase.com, by the way these aren't commercials like how I forgot the the new guys owner Todd Norb the first name, trust me he's not paying for commercial Paul's been using them for 30 decades, there's no money changing hands but on the Biolase.com website these have all tissue dental lasers and then they had the soft tissue dental laser. So you got the all tissue dental laser water lace and then you got the soft tissue dental laser Epic Pro, am I correct their or not?
Paul: You have, I have the Epic X. Epic Pro is a higher level machine and that's one of the new products and the Epic X is what I have currently, it's a more universal type of laser more applicable to general dentist mainly by the hygienist.
Howard: That's what you're using just for soft tissue stuff?
Paul: Yeah correct and then well I'm using that mainly that's basically a soft tissue laser. I'm using the Iplus which is the all tissue laser.
Howard: Okay the Iplus is the stand-up machine?
Howard: Okay let me view all tissue dental laser products I'm clicking there so you got ok I see the water lace Express and then the water place I plus so you bought the Iplus?
Paul: I have the Iplus, it usually came out with the Express which is a more powered machine and Express is a nice machine for pediatric dentist, it's less costly has less power so it worked well for a pediatric case but for a general dentist you probably want to consider getting Iplus, has more power and has more applicability with the Iplus.
Howard: and what did that cost?
Paul: The water I think it retails or list price around 85,000
Howard:Okay that would be a balance sheet number but you know a balance sheet you need if you're gonna go get a loan or divorce for your assets equal or balanced with the equity you have into minus what you owe on it but on a statement of cash flow number what would the monthly lease payment be?
Paul: I don't have the slightest idea,I don't handle finances
Howard: Does your wife manager who does who would know that
Paul: No well I mean I paid off my Iplus off you know a long time ago and I actually got the money from my local bank and the rate was very competitive and the advantages to using my local bank is that I could pay it off ahead of time if I wanted to and in my mind that for me that was a better option because let's say you generate that extra cash from the night class, you can probably pay that off within one or two years.
Howard: Doing what procedures with it?
Paul: Well I mean you think in terms of restorative I can work on all four quadrants. Very often you have somebody come in to have occlusal restoration need to be done on all six ear molars and so back in the old days maybe you do with half them off today and half them off next time. You do frenectomy as you do fibroma removal your parry regeneration you do your crown lengthening so just imagine...
Howard: How about cord packing I mean a fibroma and frenulum attachment to be a very rare procedure but like most dentists pack cord two or three or four times a day, do use it to pack cord or no?
Paul: You can use it and avoid the need for cord since I use a CEREC I usually tend to like the keep the cord in use a cord in and use the laser as well to create a trough and pack the cord in and just keep everything dry and accessible and I'll leave the cord in until after I submit the case in because then the cleanup is a lot easier because all that cement and bonding agent comes out with the cord and just makes it easier to deal with.
Howard: and do you recommend, you're a member of the world laser, do you recommend that to get to know lasers. I mean or dental town online CE where where would a young homie learn how to use that laser.
Paul: Well they go to one of the training sessions they have training centers in one in North Carolina, one I believe Chicago and in California.
Howard: Who does? Biolase?
Paul: Biolase runs a training center in each of those cities
Howard: Okay tell me the three cities again
Paul: That's gonna be a North Carolina
Howard: Where's that at North Carolina
Paul: I think it's in Charleston, North Carolina. Then one in Chicago I'm not sure the town and then the other one is in California Irvine, California that's at the Home Office.
Howard: So you would recommend them going to a course at those one of those three centers to learn how to use this laser?
Paul: Correct and usually training is part of the whole package you know they you talk to a sales rep and they will you know put together a package of what you want to do and they have various training options the other training option is a have a doc like me come down to your office and train you in your office which is a good way to go if you have associates. Then you have all your associates there and we train them over Friday and Saturday and learn how to use the laser how to implement the laser in their office which is you know a very important thing to do because you know how it is you go to a course of training and you sit there and for two days and learn how to use the machine and go back to your office now you're kind of scratching your head okay well how do I start. So having somebody like myself come to the office and show you how to implement this is tremendously helpful and know the office I've gone to they've really have been very successful using the laser.
Howard: and how does that work, how long do you go into the office for?
Paul: It's' usually a two day process
Howard: and what does that cost?
Paul: I haven't the slightest idea, thats handled by Biolase as part of the package they put together for the docs buying the laser. So I'd go in with theirs a set curriculum we go in and for two days and show them how to do all the core procedures of how to use a laser and how to implement it and it's very helpful to the staff because they're there very often to learn how to take care of the machine and how to get a position and ready to use.
Howard: Okay you did a couple online CE's. You did one "mill in, send out", let's talk about that.
Paul: Yes a CE article
Howard: Let's talk about that article. So we talked about lasers you're also big into cad/cam correct?
Paul: Correct yeah, I started CAD/CAM back in 2001.
Howard: So that was that CEREC number one?
Paul: No that was CEREC number two
Howard: Okay I'm actually older than you, my first was CEREC one back when it was owned in France remember that?
Paul: That's before my time Howard.
Howard: Looking back you know CEREC one to CEREC two to CEREC three. What nobody talks about is the quality of it was not tracing the company it was tracing Intel's microprocessors getting twice the number of processors on the same amount of area Moore's law every two years and they just couldn't design the software to do everything they wanted it to do back in the 80s and 90s because you didn't know the hardware that's why Amazon started out selling books because books was the only thing they could sell that didn't need an image and Jeff Bezos know that as the pipes got bigger then he could put an image and start selling books sports fans and eventually someday could be a video. So anyway what would you say to someone today who's thinking about buying CAD/CAM, first of all what brand?
Paul: I had that question up to me close to me at a talk I did a young dentist came up and said hey I want to buy a CEREC I said well you have to look and see how many units per month you do how many units do you do and what's the break-even point between a number of units in your lab bill because then I reach a point where you have that breakeven and everything else you're doing in that crown is just material cost and so that's where it comes in you have to decide what that inflection point is at what point you're making it just making crowns just on materials materials only and the other question is you look at people to come in your office and they ask I tell them you need a crown with what are the people saying to me saying Oh doc I need a crown oh that means I need a root canal does that mean it's gonna be three or four appointments and I had a crown before and I kept losing the temporary and people are really amazing you say look you come in it's gonna be one and done we're gonna get this done in one visit and so that's a big big selling point for a lot of people because they look at time today we're looking at a environment where people don't have time and they look at I don't want to take time on my schedule, come back three or four times by having a crown done conventionally so you know a CEREC allows you to do today dentistry and I'm a big advocate for because I've been using for the last you know almost 18 years now and it's amazing how people come in with a broken tooth and you say look I can get this crown today for you and they're very happy to get it done because people don't want to come back. So the answer the question is is how many crowns a month you do and what your breakeven point I mean we know crowns today can be relatively inexpensive but more importantly is the power of having it done today. You can go to my website you'll see people say hey I broke a tooth, my dentist couldn't see me today but I called you. I came in got the crown done and I wasn't expecting getting it done but I got done and I don't have to come back and see you. So how many referrals does that mean you know to me that meant referrals of that patient's wife and his two sons and one of them got orthodontics done by me. So it really is a draw for people the fact that you get this done in one visit and I've had cases out there for 18 years and they looked as good as the day I put them in. So you see the longevity on the restorations provided that done well.
Howard: Yeah and what you just said was also a superior thing I don't think the whole dental industry starts when I go to Paul and Paul says Howard you have two cavities and you need a crown and I have to buy have to trust you, you're selling invisible you didn't sit there and say here's the Starbucks coffee and here's an iphone. I know what those products are you're selling invisible it's like who's Paul he told me I need a crown it's $1,000 do I trust them and then am I gonna lean back let him touch me give me a shot perform all this stuff. So you know that's why I never went into rolling out a chain of dental offices because I don't know how I can roll out great locations, great demographic,s great marketing ,building great teams but you know the dentist is the whole product it's the 80/20 rule and so you on this CAD/CAM thing you would recommend it and do you recommend DENTSPLY Sirona or E4D out of Dallas?
Paul: Well I've used a Sirona product Sarek for 18 years so they have the track record and I've had good success with them and it's worked very very well for me and then you know the point I'd make - I think it's important for every dentist to consider having cameras in their hygiene rooms because as you mentioned people have to take your word for it so I tell my hygienist whenever we're looking at doing a crown on somebody I want three photographs of that tooth, I want buccal lingual a crucial shots so that we can show the patient exactly what we see knowing that - that documentation comes in very handy if you have a question from the insurance company because insurance companies might make a judgement based on the x-ray which is not very you know diagnostic. I mean we should see a big hole in the x-ray but in this case I mentioned this patient broke a tooth we were able to show them hey broken cusps undermine cost with the intraoral camera and basically trust is in the picture.
Howard: The digital camera is the number one return on investment piece of technology because these people you know when I was little only rich people or you work for the fortune 500 could fly in airplanes. Southwest Airlines lowered the cost so much so they give everyone the freedom to fly and they're in Parsons, Kansas they want to have veneers or implants and they're going to the local dentists website and their's nothing there. It's just like smile family that a Parsons family dentistry and a mugshot of the dentist and then their's this other guy that's showing up on their Google search and they're seeing before and after a work done and that is the game. To here every dentist I know who really gets into digital photography his treatment plan presentation closes go up high because they're showing internal cameras, they're showing digital photography. and they're just crushing it and then their website is filled with lots of pictures, say these are my cases and then I don't know a lot of these faces like I know patients in my area friends a family whatever that flew to like Kansas City or LA to have some implant guru do their implants and there's guys three miles up the street light like my buddy Tom mattern, I mean I think he's probably as good as any implantologist on the planet Earth but they just didn't know. So yeah, so digital photography is everything and again if you can't be that who's the, who's the quarterback for the Patriots?
Paul: Bledsoe...Brady yeah used to be quarterback Tom Brady's a quarterback number twelve
Howard: Yeah and he just reached into the playoffs the final game for the 8th time ever that that's just amazing but when you look at them but if you can't be that guy then you have to have an assistant wherever you're weak. So that's that's the important thing about a leader you know what you're good at you know what you're passionate about you know what you could do all day long where you never have to work another day in your life but what are you not doing you know you're not doing that because you don't like it you won't commit to it and if you're not committing to digital photography then you got to tell your team look I'm I'm weak in this area I'm gonna have I've gone to eight years of college, risk getting loans building a dental office but I don't have this digital photography down. So then you have to tell your team who's gonna do it it's gonna be the assistant is gonna be a high judge someone has to do that digital photography but it is so gosh darn important. So you didn't go with E for D you went for Biolase and do you think that Biolase it's probably I mean the CAD/CAM Sirona system. I think it's about a hundred and forty thousand, I think that lease payment it's gonna be roughly a thousand bucks a month. Do you think it's going to if I put a hundred and forty thousand dollar someone else's money sent in my office and I got a cash flow statement of income balance sheet statement of cash flow if I have to cash flow out a thousand dollar month payment do you think I'm gonna make money do you think it's gonna increase my return on equity?
Paul: Absolutely no doubt about it. I mean I can give me as example, I can do two crowns on the patient and frenectomy I did on this patient to a two and a half hour appointment and we reproduced over three thousand dollars and that was a one visit situation. So it's there I mean you can do it you just have to implement it and the problem with a lot of dentists they don't devote both the time that it's necessary to learn the technology so they can do it you know very expeditiously and sometimes you can even train your staff to know the case out and get the case all primed and ready for you. You don't have to be at the chair for two hours because very often when I do a CEREC I'll do other work within the patient so you do a whole quadrant so me a crown and made me a couple fillings so you're really maximizing your time. It's all about production per hour that's what I'm looking at and so if I can get that kind of production per hour I mean this machine will pay for itself pretty quickly.
Howard: and if production per hour is too much for you at least get a production per day get a break-even point. My dad used to call it a bare assminimum. I still think the only thing I learned at MBA school was taking profanity business terms and making them you know from bare ass minimum to break-even point but if you go in there I mean most dentists most all humans they're very in a routine they eat basically 10 meals is their whole meal pattern they basically the reason Google and all these people are selling your location is because most people when they go out their driveway they always go this way and almost never go the other way, they always go up to that stop sign and turn this way. Humans are extremely extremely predictable so most of us work about 16 days a month, so you got to take all your overhead and divide it by the number of days you work for mother and then your team's got to know Hey look man - just pay the bills we need twenty-five hundred dollars a day and we want fifty percent overhead we have fifty percent gross margin so we got to do twenty-five hundred do lunch then come back and do twenty-five hundred again I mean and you can't fix that by motivating your staff with a year-end Christmas bonus. You got to do the grind day-in day-out day and it's all about today it's all about answering the phones a day it's all about same-day dentistry it's all about getting people in they call in they got a broke tooth come on down now. It's not about oh we don't have a chair are you kidding me your staff is supposed to be 25% I routinely see anywhere from 25 to 35 percent the doctors are making 25% is associate all the way to 35% if they pay their lab bill 55 cents of every dollar is going to labor your Labor's sit right there so why are they waiting on an operatory why do you not have an extra chair why can't what when the phone rings - the third time why does it not roll over. You know what you know what the big DSOs are doing, all those phone calls on the third ring are ringing over to their call center and their call center is zeroed right in the schedule and Paul doesn't even know that I'm not at the dental office, Paul thinks I'm at the dental office right by his house in Boston and I'm in a call center in Effingham Illinois for Heartland Dental Paul thank you for calling how may I help you getting him in getting out then you have the notion cancellation rate so a lot of people are playing the double-booking game because you never know who's not going to show or come later or have a hard time getting numb or whatever but chairs are not your cost you need to answer the phones get them in today and you like the business decision of getting same-day dentistry so they don't make a temporary and come back for a second appointment. You think that practice builder?
Paul: Absolutely like I said I have people that give me reviewed because of that reason because we've taken care of them day. I mean someone calls my office for an emergency we get him in that day and if I have the time to do a crown on them and they need a crown it's get done. It gets done that day because think about most people come to the office figure to have to take a half a day out of work anyways. So they come down I'm gonna be here for at least half the day by the time I come down here and hang out and if if I can get the work done people really appreciate the fact they don't have to come back for a second appointment and so it really is a big practice building. I mean I had a neighbor of mine he called his dentist up and his dentist told him it's gonna be two weeks before we can see you so he said hey I'm gonna call my office said hey what can you see me today yeah come on down we'll see it will get you in and take a look and take care of your problem get them stabilized and if we can do the work that day if fine if we can't with them stabilized and back in within a few days to get the work done that needs to be done. So it's incredibly important to have availability and be able to work your schedule so that you can get these people in in the same day as there is big practice builder as well.
Howard: That is amazing I want to go the next thing that you're also into six one smiles because as I've traveled the planet for over half a century what I've seen is that you know in the 1940s 1950s there were large families everywhere I mean the whole globe was having five and a half kids and so only the rich kids got braces. Now with birth control and and getting the the most developed countries have AIDS and they're people out of high school and 40% out of some college and when they do that their amount of babies they're making falls below the reproductive rate of two point three kids for a family which is what you need to maintain the herd. I mean Japan's under 1 they're like 0.9, United States if you backed out immigration you would fall below the replacement rate but now that you're having they were you're waiting 10 more years to get married and only having two kids instead of five everybody can afford braces and I see em in in Malaysia, Cambodia, Vietnam. Where people might only be making five or six thousand dollars a year and we'll spend a thousand of it on Invisalign I mean whiter brighter teeth at the end of the day you're a peacock and when you spread out your little deals you're trying to survive long enough to reproduce that offspring and it's really hard to reproduce if you're sitting in a bar with an Android phone instead of an iPhone or you're sitting in a bar missing a tooth or they're crowded. So whiter brighter sexier dude I'm very bullish on Align technology stock because what Align is saying was that only 5% of Americans got ortho now Smile Direct Club went public they're saying well if we drop that 6500 on our price down to 2,500 we think another 10 or 20% will get ortho. What I'm telling you is that for the next century guaranteed you're not going to live a century from today. I'm telling you the next century whiter brighter sexier teeth to increase your chance of mating and reproducing and having an offspring Smiles Direct, Invisalign, all those things are big money makers. What do you think of that?
Paul: Well I've been a big advocate of general dentists getting into it. I started with Invisalign back around 2005 and then I get into Six Month Smiles actually I took the training course at the Dentaltown a few years ago when Brian Swain ran a course in Dentaltown and so I incorporated Six-Month Smile as a matter of fact that I did a CE course their on Dentaltown on crooked to straight a GP's journey and with that I talked about Six Months Smiles, Invisalign and using the lasers and CERCE to do this one case. We did a case study on this patient, young guy and a sturdy came with a crooked crowded teeth and know he had been to the orthodontist and he had you know thought about getting orthodontics done but no he was really interested in just getting his front teeth straightened he really didn't care about his bite because he felt this bike was good and so we looked at this case let's go Six Months Smiles in this case because the amount of movement we have to do and so we did that and we got the case done in nine months do we did a couple root canals an anterior teeth did a couple CERCE's then we had to do a frenectomy down on the bottom and some gingival plastic and some whitening and you know ten thousand dollars later the guy was happy is as can be and so incorporating orthodontics and the GP practice I think it is vitally important as you mentioned get smile direct it made obviously someone did some research to realize that that is a demand today as a need people want to have straight teeth so it really is incumbent for dentist GPS to kind of expand their menu of services and they do that by getting into orthodontics starting off with Invisalign and I tell Doc's look you don't need to treat every case that walks in you take a case that can be done twelve months or less and get it done within this line and you have the option of going Six Month Smiles for the cases that have maybe some more difficult movements that require it an extra force to move those teeth in the best positions. So I'm a big advocate for GP's doing often ionics of course you have to look at the cases and obviously don't go in and do an advanced case those cases should really be referred out to new orthodontist and we have the luxury of GP's of cherry picking the cases we want to do to get it done within a reasonable amount of time.
Howard: and how would you recommend my homies learn Six Months Smiles. I mean are you still a big fan of Six Months Smiles?
Paul: Yeah I'm a big fan of Six Month Smiles I mean I look at the situation. Very often a patient will come in for a consultation and don't be asking for Invisalign because that's what they know. Invisalign does a great job marketing and if they want Invisalign well obviously we talked to patients about the advantages and disadvantages of is Invisalign you mean obviously the Invisalign lost people that get their teeth straight it's clear comfortable and removable and of course the big question is removable. How dedicated that people going to use be to wearing these aligners and we have people come in and they're not dedicated and so their treatment never gets finished and so we really try to have people realize that maybe a Six Month Smiles option is better for them because it's kind of a no-brainer you just wear the appliance and it gets a teeth straight, you don't have to worry about not wearing the appliance. So I try to steer people into what I think is best or most appropriate because I want to treat these cases quickly I don't want to get into case there's more than 12 months because then it becomes the issue is it more is it not doesn't allow no longer become cost-effective me the treatment a case if it goes more than 12 months you have to look at you know chair time and cost and involved with doing the case. So Six Months Smile definitely has a place especially even cases that have teeth that have a lot of rotations and need a lot of movement.
Howard: Six Months Smiles is huge and let me tell you something, I mean that the patient's paying for I mean the reason parents pay for ortho is because you know the the kid I mean the kid came out of you. So when your mom and your your walking through you know Walmart your kid looks like he can eat corn on the beef corn on the cob through a chain-link fence. I mean you look like you know there's someone shouldn't have bread with you and so they're cleaning them up so they can get married and reproduce that offspring and the midline in the bite is secondary to the the way the human wants it to look and I'll tell you what I cannot tell you how many dinners I have sat at with orthodontist because remember I own Orthotown, the website and the magazine and I'll say , I'll get the wife's midline I'll look at her talk to her enough to know right where it is and then I'll tell the wife look away from her husband, where is your own wife's midline and their's I don't even know. Okay you've married this woman and you reproduce and you have three kids with a woman and your not thoughts you don't know where the midline is and so it's not the middle it's just some Tom Cruise freak saying words sitting off you know several degrees it's just not noticeable they just want whiter brighter sexier teeth they just want to smile and reflect a bunch of light and that you like it and I think it's big money. If you're following me on Twitter I know you're driving to work, so you can't take notes so when so I just retweeted I just reposted Dr. Paul Caselle last two continue education courses and his in his Twitter and email and then I also did Six Month Smiles so you can see that. So you're just saying to do that you need to call 6 Month Smiles and they are going to show you where their courses are?
Paul: Oh you have to take a course with six months miles to get certified
Howard: Where would I get that, I see on their website how it works, cause, stories, find a doctor, where would I find on their website where the courses are?
Paul: The courses, you have to go to that you have to go to 6 Months Smiles website
Howard: Yeah I'm on it
Paul: Okay and there should be something on there it tells you exactly where it is they have them in different cities otherwise that
Howard: and by the way 6 Month Smiles, they're using the numeral six so it's numeral six month smile it's not "six" month smile. Free practice assessment get trained okay I'll click get trained I still ok so let's like okay so here's where they are they're in Scottsdale right up street from me and January 25th there are New Orleans March 8th Calling, Texas February 8th Las Vegas June February 22nd New Orleans in March Orlando March 22nd Bethesda April 8th.Sso they got lots of training but I always thought or that was the biggest Lambright because an ortho case is 4500 to 6500 dollars so if you took a 5,000 like Richard Lynn is the only board-certified orthodontist I know he taught at U of P for a decade or no University California San Francisco for a decade as the chairman over at the department then he went to university Detroit. His lecture is called fours faculty orthodontic restorative service whatever he teaches his whole course is like for three-day weekends for 5 grand and I'm like dude if you took that when you graduate you do one class you got your money back. How do you not, same thing with learning Invisalign, getting Invisalign certified I mean why would you not do that, or 6 Month Smiles. I mean orthodontics is one of those deals where you can go to any of their training courses and get all your statement of cash flow money back the same month you paid the tuition correct or fault.
Howard: You go exactly. Yeah so and I think you're gonna be a high volume low price if you're just competing on price and insurance and convenience but if you want to be a lower margin I mean a lower volume and a higher price you yourself doc you got to become a Tom Brady of the New England Patriots a Jew breeze a New Orleans an Eli Manning of the Giants a Ben Rosenberger the Pittsburgh and Andrew Luck of Indianapolis and Aaron Rodgers of Green Bay. How would you recommend I think of you I mean Paul you are the Tom Brady dentist of Boston and I've known that for 30 years I've followed your 3,000 votes no really you're a legend you'll always be a legend in my mind in so many townies how would that young kid become a Tom Brady, a Drew Brees, a Paul Cassell. Would you recommend the Scott's Dillon's to would you recommend the Raw Smash, Panky, Spear ,who's my Greek buddy in a Seattle I love him the most choice where everyone he's 100% Greek so what's the big fat wedding gonna go to and say John do you recommend spraying Windex in the crown before you see that movie.
Paul: Yes I did.
Howard: Remember the Windex guy and you might not afraid that if you said that you would offend him but he laughed so hard on that joke he likes Greek jokes, but how would you recommend. I mean she's listening to you right now, she's on her way, she's an hour commute to go work at Aspen and someday, she wants to own her own place and be like you. How does she become a Tom Brady or Drew Brees?
Paul: Well first you have to find a good office to buy or startup and then you have to figure out what your patients want. The first question is what do you patients want, what do they need you have to listen. You obviously have the basic you have you know roll camera how all the other stuff you have and then you have to decide okay if you have a lot of crowns coming in and so for if you have to think about well the CEREC makes sense for me.What's my return on the investment, and what do I have to do to make it pay off. If see a lot of soft tissue cases how much am I referring out on a monthly basis and so you have to start somewhere and once you find out what your patients want you can decide okay do I go to panky do I go to these other areas to get the additional training that I need. It's all questions what your patients need and where you're at and what kind of practice philosophy do you have. So first you have to figure out what's your vision for the future, I think young dense has a kind of map that out once he gets or she gets a sense of you know their community what my patients want and meet their needs but more importantly you have to really devote the time and energy into learning whatever you're going to learn. I've run into cases where people just tend to collect technology you walk into an office they have the CEREC in the corner, they have a laser over here and I have you know this over here and you walk in you ask "hey Doc you use that much" no I don't and just this collecting dust and so they buy things they don't devote the time. So my suggestion would be start somewhere, listen to what your patients want and pick a technology that you like or and then develop that fully before you think about other things. Whether that means I'm going to put implants in, I'm gonna do orthodontics, you have to find out what the patients need and then address that need by getting whatever training you need.
Howard: and who's the CEO of 6 Month Smiles now? It was started by Ryan Swain
Paul: Yeah he sold out to a company and I don't know who's in charge at that point at this point they have a dental director
Howard: Who's a dentist, who's the dental chair
Paul: I don't know his name
Howard: Oh see CEO here I found it Perry's low CEO 6 Month Smiles. Are you friends with with him?
Paul: Yeah I don't know the gentleman but
Howard: They're out of the colony, Texas 6 Month Smiles interesting but yeah so you'd recommend 6 Month Smiles, ortho lasers CAD/CAM you recommend all those?
Paul: Yeah Invisalign as well too
Howard: I want to say another genius thing about you following your post for a long time one of the easiest ways to go from a high volume low margin PPOs Medicaid is instead of just the patient comes in and points to a tooth and it's broke and or hurts and you do one two dentistry you first evolve into well gosh if I'm gonna have this whole quadrant numb let's do the whole quadrant and then you get a little faster easier better and then you say well God let's just do the right side if you're gonna be in here let's do the right side and then you eventually realize that the oral surgeon in your own zip code for his entire life numbed up all four quadrants and did the whole mouth on that when people have a bypass they don't go in and have the left side of their heart done they go back to six weeks living it's right son and then you eventually get to just full mouth dentistry where the dentist works Monday-Thursday 8/5 and Fridays are knocked off usually just because that's when an anesthesiologist comes in he's board-certified put someone to sleep they do the whole dang mouth and on these big cases a lot of dentists they don't want to do they don't wanted to come in and do three molar root canals. So they'll get some board-certified endodontist and then you know maybe they live in Phoenix so get one to come up from Tucson or Flagstaff and come in and do three molar root canals in a row and then when that's done then the they'll have a periodontist come in and place the implants and a lot of these dentists that are doing a twenty five to thirty five forty thousand dollar case every Friday they're not even doing the dentistry they're having specialists come in and do the endo and the implants and all that kind of stuff but in order to do that you have to present the treatment and ask the close and you have been a big fan in Toastmasters and I and that is just so genius because if you can't talk to a person and get them quickly to trust you, explain what you're doing with digital photography, intraoral cameras or Panos. I love the Panos, anybody tells me a CBCT is the greatest invention in dental radiology I tell them they're an idiot because when you show a CBCT to a bunch of dentists half the dentists don't even know what they're looking at but when you show a Pano to a patient first thing they say is that R is that the right side. The greatest invention in dental radiology was whoever figured out the R on one side the L on the other and if you can show them that pano and that patient gets it and if you can show it some intraoral camera or photos or digital photography and you can talk to the patient and get them to say yes let's fix up my whole mouth and I'm not gonna have you pay $25,000 today cuz that's not how you buy your cars. You buy your car at a monthly payment and so we can do everything you said everything we talked about we can do for two hundred and twenty dollars a month for the next sixty months you want to come in Friday we put sleep do the whole damn case. So tell us about your journey with Toastmasters International and do you think it increased your case presentation?
Paul: Well yeah I mean the great thing about Toastmasters is that it allows you to develop a skill set, that skill set is talking to complete strangers to a roomful complete strangers and very often you have you learn presentation techniques that help you be more effective in your communications know that - they have these topics they come up and you have to kind of think on your feet which is also very helpful because how many time we will see a patient and you never know what the patient is going to say to you or what they're gonna present you with and so you have to be quick on your feet to give them a good answer to any questions they may have. So it's useful training for people who don't like to talk I mean you hear about cases or situations where a dentists will walk into the operatory and they say hi how are and never it really connect with the patient and I think connection is so incredibly important if you want to build trust within the patient you have to connect with them in some type of level and Toastmasters allows you to make that connection, they train you as part of their training to make connection with your audience. Why audiences enjoy having you speak or anyone speak is because you make a connection with the audience they can understand what you're saying to them because they can relate to the stories you tell them and the same thing with patients you know you've got to find out where the patients are coming from you don't walk in and tell the patient look that's gonna be a $5,000 case and yeah you can show them a couple pictures and so forth and they say well yeah doc I don't know I gotta think about it, well what do you have to think about exactly, because you haven't taken the time to really understand what patients needs what they want you don't know what else is going on in their life maybe their kids getting braces right now maybe the kids out doing soccer and so when you deal with families it's really helpful to kind of get a feel for what the patients are feeling connect with them so that you can build that level of trust because people buy on trust as you mentioned before people buy in trust if they've trust you and they will eventually get the treatment done maybe not today but you laying the groundwork for that purchase later on.
Howard: I'll tell you Toastmasters is just a must to do it if you're shy and you don't and you're not going to lead your team and you're not gonna lead your case presentation if you just can't stand up and and talk. You just need to learn that skill set another one is Adele Carnegie clubs they have these Dale Carnegie clubs another one is Harvey Mackay, swoon with the sharks not eaten alive. He sold manila envelopes well there's no way I can have an advantage of selling a plain manila envelope like this other guy where they all look the same they're all the same price. So he had these sixty-two things where all of his salesmen every time I called on Paul I'd answer one of these 60 things. Is he married is he single what's his favorite sports team and eventually they would develop a relationship with you so you'd be buying all Harvey McKay's white manila envelopes instead of everyone else's and another one in these big towns like Tempe has a comedy club. I went to that school it was three nights a week for six weeks then they had to improv and they had another one but those are just great structural things it's like a comedian when a comedian walks onstage and I've been I've done a hundred venues on stand up I mean you have one minute max before your booed off the stage they don't like you. So you got you got to go in there and you got to enter and you just got to enter and hit it and and until you can do it and like I say you don't have to do the dentistry. Rick Workman owns 850 dental offices and he doesn't do dentistry. You could the the biggest value is presenting and selling the case and then in fact I know some dental offices many dental offices where the head dentist all he does is a new patient, emergency exams, and the recall exams and then he has associates periodontist and a daughter's coming in doing all the clinical dentistry and a lot of times that started with a problem like maybe they lost an eye or they got tremors or a health issue forced them away from clinical and they thought will hell the clinical that's something where the value is anyway. You can hire 4,000 endodontists to do a molar root canal, now you can hire 10,000 orthodontist to do braces but what you can't do is set up good demographics. You know patients come in explained to them with photography and radiology what they need they trust you you bring an installment credit you close the deal and then voila. Well then let anybody fill the order. So Paul I can't believe we went over an hour is there anything we didn't talk about today that you wanted to talk about?
Paul: No I think we covered all the areas and you know I see my mission at this point going out and try to educate young dentist to think like a business person. You know look at things and understand what it takes to run a business and then three things that you need to have running businesses, you have to have a great staff and you have to have a process for hiring people you just don't hire people like you used to back in the old days back in the 1970s, 80s. It's more of a process today and the more you go through that process the more likely you are to have a person who is going to be a good team member and then you have to look at technology at the look and see what technology that works for you. I mean Sarek and CAD/CAMs work for me extremely well, lasers have been extremely well, as well as orthodontics. Those are three areas that I've introduced my office over the years it's really helped me become more successful and finally it comes down to management, you know what reports and things you need to do the look at and we mentioned it earlier in our discussion about you know how much it cost you to run your office per day. What do I need to reduce just a break-even, how much does it cost me to open my office and docs have to look at that and if you're thinking about getting into an insurance plan taking the insurance plan it's a cost effective to have that plan. I mean I've gone to offices in Pennsylvania and some of the plans are so so poor and reimbursements that you question whether or not is really cost effective to have that plan as part of your product mix. So you have to look at these things and make decisions as far as the business aspect of your office and create a vision for your office and that means thinking strategically. I mean it's impossible to put in you know all this technology at one time you have to phase it in based upon where your patients want and that's so incredibly important and also important to have consistency in your operation. It's important to have consistency because that consistency allows you patients to feel confident that you know what you're doing, your staff knows what they're doing and what that confidence comes a level of trust that they build in your team as well as yourself the dentist and so they're more likely to follow your recommendations going forward and so it's it's three key points that you know every dental office has to really incorporate and keep in mind and I look forward to helping dentists achieve those goals and come up with a action plan for the future.
Howard: Well guy you said so many genius things there I mean that was amazing. I can't tell you how much I agree with you, just got get the right team get the right court make yourself a Drew Brees. Make yourself go get the skills and if you're not interested in doing that then you got to start doing a higher volume lower margin and at all whether you're making a McDonald's or a steakhouse both their business models both could win you just got to decide what you want to be do you want to be at McDonald's in and out burger or do you want to be a steakhouse there's no right or wrong it just is what it is and it depends on your demographics. I mean I wouldn't want to have the mercedes-benz dealership in a small town in Beeville, Texas them rednecks when an f-150 Ford and they don't like foreign cars and then you know if you're in LA or Hollywood it could be completely the opposite just know your people know your market get great. Are you going to Townie meeting?
Paul: I don't think I can make it this year.
Howard: Oh man I'll tell you what I can't believe it's gonna be our 20th annual Townie meeting. Can you believe that I'm so damn old that we have 20th meeting I can't believe but hey thanks for all that you've done for Dentaltown if it wasn't for guys like you that became members your Dentaltown deal says that you became a member in 2001 and that was only because that was when we added the feature of tracking the members. I think you were we opened it we started programming 98 we got to open on st. Patrick's Day 99 and you were one of the first 100. So thank you Paul for all they've done for me personally, for Dentaltown. I just think you're a hell of a guy thanks for being the Tom Brady of dentistry for Boston.
Paul: Thanks alot Howard.