Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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Marketing Fallacies (And How To Defeat Them) with James McAnally : Howard Speaks Podcast #111

Marketing Fallacies (And How To Defeat Them) with James McAnally : Howard Speaks Podcast #111

8/3/2015 2:00:00 AM   |   Comments: 0   |   Views: 606

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"We're a gadget-oriented profession...The reality is patients don't care about any of these things unless it's going to make their life easier, faster, cheaper, better, less painful..." Tell your patients--in their language--the actual benefits of these gadgets.

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AUDIO - James McAnally - HSP #111

Watch Video here:

VIDEO - James McAnally - HSP #111


Founder Big Case Marketing; a niche practice consulting company.

Developer of The McAnally Selling System - Dentistry's only check-list approach to selling backed by Harvard, Stanford, Yale and Columbia research.

Author of multiple #1 books in niche marketing and selling for dentists.


For web-based services, online trainings, low cost options:

For Private Consulting - must already be producing $2M+


Howard: It is a huge honor today to be interviewing James McAnally. I guess we grew up down the street from each other; I grew up in Wichita, Kansas, and I'm Irish, and McAnally, any "Mc" has to be Irish. You grew up - were you born and raised in Oklahoma or just go to dental school there?

James: Born and raised.

Howard: Born and raised, where in Oklahoma?

James: A little place called Sallisaw, right on the border of Arkansas and Oklahoma. Eastern side of the state.

Howard: I always thought it was funny because my mom's brother, Mark, he moved down there with a son and seven daughters, big Irish Catholic family. And the baby two girls had moved from Kansas to Oklahoma, oh my God, we were there the following Christmas and the two-year-old and the four-year-old talked just like she was born and raised in Oklahoma, but the ones who were, like, seven and older kept their Kansas accent.

So how are you doing? Thank you for joining me today!

James: Good! You know what, Howard, my father and grandfather were both dentists in that area, and my grandfather, in what was Indian Territory before Oklahoma was even a state. In his day, the only rule was you had to take your firearm off before you came into the office. 

Howard: That was your grandfather?

James: Yeah, that's only been just over a hundred years ago. Isn't that crazy?

Howard: Wow, that is amazing! Yeah, I was born in 1962, which was one hundred years after the end of the civil war, which was 1862. Times are...

James: [cross talk 00:01:42] you know? Where we've been.

Howard: So your dad and your grandfather were both dentists?

James: Absolutely.

Howard: It's kind of interesting, because when you go into dental school, it always seems by a show of hands that about a third of the class, I'd say "raise your hand if there's another dentist in the family; your mom, your dad, your uncle, your cousin" and about a third of the hands go up. And of course when you go around the world, I think it's very interesting to note that most families, probably six billion out of the seven billion Earthlings are in a Nuclear family, where the whole family lives in one house; mom, dad, grandpas, brothers, everybody. Number two, you're born into your occupation. If you're born in Tanzania and your dad's a goat-herder, 

James: That's right

Howard: that's what you are.

So how young were you when you knew you wanted to be a dentist like your dad and your grandpa?

James: You know, I can remember conversations, particularly with one of my grandmothers, she was the big cheerleader for dentistry, really, in our family, 

Howard: Your grandmother?

James: Yeah. Of course my grandfather's wife. She was literally saying when I was ten years old that I would wind up being a dentist.

Howard: Wow. Well my mom was saying since I was, could walk, that I'd be the first American pope.

James: Ha. Well,

Howard: She did. She took us to mass every single day, that poor lady, she always told me I'd be the first American pope, that all the popes were Italians, and I'd be the first American pope. But it worked on my two sisters, they left high school, went straight to the Catholic nunnery. 

I was going to be the first American pope until I met a little blonde girl named Jane, when I was sixteen, and she just trashed those plans. So,

James: Pope of dentaltown

Howard: What's that?

James: You're the pope of dentaltown.

Howard: You know what? The only pope that I created was, I always think it in my head, was Pope, poo, P-O-O, doo, D-O-O Pope Poo Doo. Those are the first letters of the nine specialties recognized by the American Dental Association. So if you think P-O-P-E, P-O-O, D-O-O, and the reason I do that is because having a monthly magazine, I'm always telling the staff, "Pope Poo Doo! Pope Poo Doo!" Meaning, don't go three months without an article in Endo, or Perio, or Prosthedont. You got to, seven of them are clinical, and two of them are didactic oral radiology and public health. 

I first met you and heard about you on the scene, you're huge into this big case marketing. Tell us how that came along and how you got interested in that and also how you went from Oklahoma to Miami.

James: Well, in a roundabout way, Howard, I wound up going to residency, a general practice residency at the University of Washington, which was very heavy surgical-based and anesthesia-based, and after that program I bought a program in the Northwest, in Seattle. I went through several different transformations of what was just sort of a family practice into a big insurance-based general practice, and then transforming it again into a restorative and implant-based practice over a number of years.

Really what I learned in that journey was to do those larger cases, you have to have some pretty specialized marketing, and you have to be very focused on how you sell those cases. So over many years of trial and error I came up with my own solutions to those things, and then also we started selling those to other dentists in the profession, as far as teaching them how to do those cases as far as teaching them non-clinically, of course. There's plenty of people who can teach you how to do these clinically, but almost no one who can get you there from a non-clinical side for the marketing and selling. 

Then ultimately, I teamed up in my current consulting business with Dr. Larry Brooks, who's up in the Boston area, and I eventually moved to the East Coast just to be in the same time zone as our back office, basically. From the start of dental school to now, it's been, what, twenty-two years? So interesting ride, and now obviously dentistry is looking to me for solutions for what I'm doing now.

Howard: Tell them, what is big case marketing? Is that more of a direct mail, is that more case presentation, is that social media? Is that all of the above? 

James: It can be a little bit of all of the above, Howard, but the reality is, when we say "Marketing" in dentistry, it should always be attached to another word: sales. The reality is, most practices have no focus on really how they sell a service, they do a lot of marketing, but they really don't have much structure in place for selling. 

Especially outside of the insurance system. Most patients show up with these insurance-based practices, and the only selling that is done is "Well, does my insurance pay for this?" We're going to go into the category where patients are writing us checks for ten thousand, twenty thousand, thirty thousand, fifty thousand, a hundred thousand dollars, which, can happen, for the most broken-down patients, there's got to be a sales process for that to occur. 

That's really where we start all of our trainings, and that is, let's hand you a real sales process to use with these cases, teach you who does what at what phase of the process, who says what, what you don't say, what you show the patient, what you don't show the patient, how you're going to set yourself apart from everyone else selling that same service in your area, basically give you all the tools you need from A to Z to get those cases closed.

Now, as part of that, most practices do tend to alter their marketing as we teach you better sales process. So while it may all start with selling and case presentation, we eventually wind up in the marketing camp and fixing a practice's marketing, too. I can tell you there's not a single practice that listens to your podcast that if they spend a single nickel on marketing they won't get a huge return, by just focusing on sales process, without changing anything they're doing marketing-wise. But yet that's a discussion you just don't hear in the profession because "Sales" is typically seen as a dirty word. Of course, by doing it correctly and ethically, we can wind up helping a lot more patients, which I would think is what this is really all about anyway.

Howard: I agree. You know, my book, when I turned fifty, I'll be fifty-three in two months, when I turned fifty I had my granddaughter, Taylor, and my goal for myself was, you know, my dad and both grandfathers died at age sixty, and I was fifty, and I thought, "God, by the time she opens up her own business, I might not even be here!" So I wanted to tell her everything I knew about business in one book. 

It's exactly what you said, business is, you only manage three things: people, time, and money. A business only has three functions: you make something, sell something, and watch the numbers. And dentists don't want to sell anything, and they don't want to watch numbers. Look how big Jay Geier's business got, I mean he built a multi-million-dollar business because he realized that your advertising had to generate four calls to the front desk, just for your front desk to convert one of them to an appointment!

James: Exactly.

Howard: And he's like, "Let's go in there and forget advertising more, let's go in there and get Sherry up front to actually recognize it's a sales call, and she needs to close the sale and get them scheduled!"

James: Right

Howard: Yeah, and,

James: Our latest, literally our latest rebuild on our case presentation course, we actually have an entire phone training session because you've got to deal with that.

Howard: Now, the first thing, I always try to predict questions. You know, this dentist, she's driving to work, you know, most of my listeners tell me the same thing, the reason these podcasts have exploded is because the computer jumped into the cell phone, making it the smart phone in 2010, then came the apps, etc. 

And she's driving to work, and most of these commutes are an hour, whether they're rural or urban, and she's driving to work and she's saying, "Aw, here we go again, James McAnally, he's down there in rich Miami Beach, so he's selling all these big cases," because most people think of Miami as the retirement home for all the rich people out of New York and New Jersey, and she's sitting there thinking, "Hell, I'm in Edmonton, Oklahoma. And there's a reason mister doctor left Oklahoma and went to Miami." 

My first question is, are there big cases anywhere? And then the other person is saying, "Dude, I'm across the street from corporate dentistry. There's a corporate dentist office that's open Monday through Saturdays, seven to seven, taking every type of PPO" so address those two concerns.

James: Yeah, absolutely. You know, one thing it would also be "Edmonds" Oklahoma.

Howard: What did I say?

James: You said "Edmonton"

Howard: Oh, Edmonton? That's Canada.

James: It is. The funny part is, our best performing clients are actually in these sort of secondary and tertiary markets, Howard. The competition is not as steep. Let's say the compare, let's say the compare Edmonds, Oklahoma to, say, Los Angeles, California, where do you think the competition is going to be more keen?

Howard: Right.

James: Los Angeles. So actually in these markets, it's cheaper to reach the cases, you may not sell one hundred thousand dollar cases, but you're going to sell a whole lot of thirties and forties. In many cases there's even more need in these areas because of background of the population, the education they had, the exposure to fluoride, those kinds of things. In many ways they're more, there's more big cases to be done in these areas. Our doctors in Texas, Oklahoma, Arkansas, Kentucky, they clean up. Because they go to the market, they let the market know what's available in dentistry, and then they sell effectively, you know? 

If you're in one of those tertiary markets I say go for it, because there's actually more opportunity there than there are in the big markets like New York and LA. So that's number one.

So now the PPO market, right? You've got to change-

Howard: And corporate dentistry, when your grandfather was around a hundred years ago, there wasn't really corporate dentistry. Your dad probably saw some if he's, is he still practice, your father?

James: No, no, he's deceased.

Howard: He's deceased. So did he live long enough to see Orthodontic Centers of America make the New York Stock Exchange, or any of those things? So what do you think about the birth of corporate dentistry in your career/lifetime? You got out in 1993, 

James: Since that, then. You know, what's really happening is, in order to sort of survive as an independent in this climate, you have to set yourself apart from everything else that's going on. You've got to either be better, you've got to be faster, or you've got to be cheaper, or you've got to be some combination of those things, and those things will set you apart.

You also have to let the public understand why you are different, and yet most dentists do absolutely zero work for creating any differentiation with their practice. They don't say, "I'm painless compared to others. Let's talk about that conversation." They don't say, "I'm faster than others. Let's talk about that conversation." All of these things are happening with the corporatization, yet the dentists sort of sit there and they don't do anything to set themselves apart from them, they just try to compete on price, which is impossible.

The other side of it is that, here's a marketing tip that is pretty advanced, but in this day and age with the internet, we can actually do online strategic research on what these companies are up to with their marketing. We can target, we can actually scan their websites, scan the ads they're running, and we can see what their targeting with their own marketing. So we can actually leverage off of the money they spend to benefit our own practices. In some ways it's nice these entities are out there spending money because they're generating interest in the marketplace, and we have the ability to sort of tag along for the ride if we do this smartly. 

I bet you I'm probably the first person to ever tell you that, but it does exist. One of our expert internet marketers, that's what she does with our clients. She does spy work on the competition and then uses it against them.

Howard: Just for your office?

James: What? No, no, no, for our clients.

Howard: Okay, for your clients. Tell us about that. Tell us about that. How many, well, I want to make a comment you made talking about, you know, price, if you, you've got to be cheaper than everybody, if you're not going to be cheaper than everybody you've got to differentiate, you know? I just want to add, you know, technically, if you're just going to be the cheapest, it's a commodity. A commodity, by definition, are things that trade on price, like gasoline, corn, soy bean, I mean no one goes to a gas station to pay more for better gas than across the street, they just compete on price. So getting into a price war is always tough because the easiest way to lower your price is to give up your profit. You just lower your price, and if you're on the S&P 500 and you're a commodity, you probably only got a five percent profit margin. 

If you can differentiate yourself, like look at even McDonald's. McDonald's, you know, you go there because you want a Big Mac, you do not want a Whopper. Look at, differentiate with Starbucks. When I was a little kid, all coffee was free at a gas station, I never saw anybody pay for coffee at a gas station, they had a coffee pot and a little Styrofoam cup and you just poured yourself some. But then Starbucks came out and said, "We're different."

So you're saying what's the number one thing every dentist needs to keep on top of their mind about dentistry as a business?

James: You just hit the nail on the head with the corporatization side of it. None of our practices create their own demand by just sitting there without telling the public they exist. You have to go out and announce your services in a very big and bold manner. You've got it, sell what you do. Nothing that we do in dentistry will sell itself, so you have to focus on these things. Got to be marketing, got to be selling.

Howard: But first, though, you're not cheaper. You're better. So, you first developed-

James: Or faster.

Howard: Or faster. So you first developed some amazing skills. You became a comprehensive dentist. Tell them the skills that you do.

James: So, half-prints and implant reconstruction, surgery, grafting, any of those things that a reconstructive patient would need. In the days since I started, now it's about speed with those services, so if you're going to compete in certain markets now, you have to be the fastest, even with these services, because there's going to be another twelve practices that'll have the same price, but they'll do it the old slow method. You always have to be looking for "What is it that's going to differentiate me from these others?"

Howard: Which is what, same-day dentures, same-day teeth?

James: Same-day services, where you can literally have your implants done in a day, you can have your cosmetic remake done in a day. Now, realize most patients won't qualify for the service because they don't have the right clinical conditions, or they may not want to pay for what that service costs, but yet you've been able to talk to the market differently than everyone else so now you have more people, are going to contact you because they're more interested in hearing about those services.

Howard: Now didn't the, the first and largest implant company, Nobel Biocare, which was started by Brandmark, who just passed away this year, don't they have centers in, across the United States that are doing these "All on four," isn't that a Nobel Biocare?

James: Yeah, it's originally their procedure that they basically taught the profession. There's been other advancements since then, in particular a guy here in Miami, Tony Sclar, has an advancement over their technique. And there are very few dentists that really do the procedure, and even fewer dentists who are actually willing to go to the market and market it effectively. They're not, most of us aren't willing to get on TV and talk about their services, you know, they aren't willing to have comprehensive sales process, but when they will do this, they clean up. In fact, these Nobel-affiliated centers, Clear Choice, they're not really owned, they're not owned by Nobel but there is a relationship there, you know, they-

Howard: They're not owned by Nobel?

James: No. But they, they-

Howard: Do they only place Nobel implants?

James: They place Nobel products. I'm sure there's

Howard: So there's a connection to them.

James: There is a connection, for sure.

Howard: And that's called Clear Choice?

James: Yeah. 

Howard: So, is that publicly traded, or who owns Clear Choice?

James: I believe Clear Choice is owned by a venture capital company.

Howard: Okay.

James: But they, you know, they essentially market heavily and have a great sales presence, although mine's even better than theirs. 

Howard: Well,

James: Your listeners that are fearful of these corporate chains, we don't teach anything to these corporate chains. I'm a believer in independent dentists. We have these guys approach us from time to time and we tell them we're not interested.

Howard: Well you know, it's interesting, because there's five thousand ophthalmologists, and four hundred of them do all the laser surgery. Four hundred to, like, ninety-nine point nine percent. So if you're in ophthalmology, you just focus on four hundred ophthalmologists if you're going to sell them a LASIK laser or something like that. 

Because very few will invest in the laser, and then of those that invest in it, very few is going to go on television and radio and billboard and just, like I'm in Phoenix, which has a metro of about four million, and everybody just thinks of Kleiner Perkins, you know, just this one huge center and you go down there and they're doing hundreds of them a day, get all the ophthalmologists that you go see in the neighborhood, the don't even have a laser. 

So is it kind of that way with this All on Four with general dentists?

James: Exactly. Usually in each state there's going to be just four or five people, but those practices, Howard, they are cleaning up. Five, six, seven, eight million dollars with two practitioners is not unheard of with this procedure when it's being marketed well.

Howard: OK, so what's the single-most neglected thing in dental practices?

James: Well, hands down, I'm going to say sales process. Everything from the minor sales to everything that is under a thousand dollars, the patient would write out of their own pocket, to major sales which is two, three, four, five thousand and higher that they're going to write checks for. In reality, most practices do have some sort of Okay, minor sales process they use, but step into a hundred practices and ask them "How are you going to sell something that costs ten thousand dollars?" And they're going to just shake their head. So that's the biggest thing, you know? 

And the reality is if you're doing fee-for-service marketing, so you're a practice, you're trying to get fee-for-service cases outside the insurance system, if you fix your sales process you're looking at a twenty-five to fifty percent more return on the cases coming out of that than if you have no sales process. So it's a big deal, you know? Again, you don't read it in the trade magazines, it's not talked about at the ADA meeting, it's just simply not, you know it's not on the average practitioner's mind.

Howard: Well, speaking of marketing, I would love to market you. If you ever decided to create us an online CE course, or series of three course, or whatever, we just put up our three hundred and seventeenth course, and they've been viewed over five hundred thousand times,

James: Wow.

Howard: And it's, and everybody, by the way, who's putting up these courses, it's exploding their speaking career. I know a person who put up a one-hour lecture and got seventy-six speaking gigs from here to Kathmandu in Australia, because a lot of meeting programmers, like say they're told to get a speaker on Endo. So they go to dentaltown and there's six guys each doing a one-hour lecture each on Endo, and that's kind of like a big debut, and I would love to have that. 

So specifically on that, do you, yourself, you know you're a good-looking guy, you're in a suit and tie, you're clean-cut, in your office do you present the treatment? Do you go for the close? Or in a typical dental office, do you teach your clients from Kentucky to have a treatment plan coordinator do this?

James: Well, here's the thing, Howard. If you're asking a patient for an incredible amount of money, if the doctor can present the fee well, it's much better for the doctor to deliver the final fee and then the staff handle the arrangements. But let's face it, if you really are an impediment to your own success in this, in this reality of sales, then someone else in the practice has to be that person.

So while I'm always going to stress that it's best the doctor he or she does it them self, if they really suck at this, let's get them out of the way so that someone else can handle it. Because when you look at it from the viewpoint of, if it's not handled well, the patient loses, then let's get it fixed no matter how we do that.

Howard: Now some people have said things, and I was wondering, the worst thing in the world to do is generalize all humans, but one person told me that one of the reasons that the doctor has to present the big cases is because this consultant believed that if you couldn't afford to buy the treatment, you'll never be able to sell it. You'll just, in the back of your head you'll be thinking, "That's way too expensive" so if it's a hundred thousand dollar case, you know, you could afford it, Dr. McAnally could afford it, but maybe the dental assistant couldn't afford a hundred thousand dollar case, so she won't be able to effectively sell that. Do you agree with that statement or not?

James: No, again, it's going to be my sense. Not so much who can buy it, because I know putting up top people in real estate, who they can't afford the multi-million dollar homes that they sell, but they sell them left and right. Same goes in the dental office. I've had, I've had staff that were more than capable of selling twenty, thirty, forty, fifty thousand dollar cases, and they certainly could not have written that check themselves. Now the catch is, most, most dentists, they've hired people that aren't sales people. They've hired people that have been around dentistry too, for too many years,

Howard: And they think that's a plus. The dentists always think that's a plus.

James: They think that's a plus, and it's a big negative for the most part.

Howard: Oh yeah. "She's got twenty years experience!" "Oh, really? Where?" "Oh, you know that dentist who hung himself last year? He was on twenty PPO plans? Yeah, she was there for twenty years! I'm getting a really experienced person!"

James: You know, hire the clinical ones with a little bit of experience so they're not hard to train, but everyone else who's not in clinical? Get them from somewhere else, and they can be sales stars for you. They can, they'll be able to get credit cards over the phone to pay for diagnostic appointments, something unheard of for someone who's been in dentistry for too many years. They'll be able to sell cases and get the fees if needed. 

Yeah, I don't buy that guy's recommendation.

Howard: Yeah, so, what do you, so what's the biggest thing holding dentists back as it relates to niche procedures? Is it the training? Not going for the training? What is it?

James: It, you know it's mostly about getting too attached to how other people feel about them. Not, maybe some of that's from patients, but a lot of it's how other dentists perceive you. Dentists are really fearful about what other dentists think about them. You know, one of the quotes that I like personally even read for myself is something that a guy named Marcus Aurelius said, Roman emperor from you know, almost two thousand years ago, he said, "We think so highly of ourselves, but yet we're so concerned about what other people think about us." Instead of just being concerned about with what our own opinions are of ourselves. So you know, dentists get into this mindset of "Oh my gosh, what will other dentists think," and that's not what's important at all.

You know, Howard, there's also another thing I wanted to followup on, on the, under the neglected thing in the dental practices. We talk about sales, you know, all the sales-related things, I think the travesty here is that we've now got almost fifty years of real behavioral-based science behind persuasion and influence, we have huge professors out of Harvard, Yale, Princeton, Stanford, you name it,

Howard: You know the guy who wrote Influence, he taught at my MBA program, Arizona State University!

James: Yeah, Cialdini's actually on actually on, he's also faculty at Stanford, we got a lady named Ellen Langer at Yale, you've got Daniel Kahneman at Princeton, Sheena Iyengar at Columbia, you've got all this data, and yet you mention these names to dentists and they have no clue who any of them are. And yet their science would help so many more patients in our practices if, if we would pay attention to it. And that's all part of selling.

Howard: Right. Yeah, his Influence was an amazing book for me. 

James: Yep

Howard: He thought one of the most powerful words was "Because," because when you're a little kid and you only had a ten-word vocabulary, you learned real early on that, remember when we watched Peanuts when we were little and how did the parents always sound? Waw, waw, waw waw, waw waw. And he realized that that's what parents sound like, and you always see that. 

You always see the young parent talking to a one-year-old, with a fifteen-thousand word vocabulary, and you're like, "Do you not know this kid probably only knows twenty words?" But they learn very early on that whenever dad says or mom says "Because," you're going to have to do it because all the waw waw waw waw afterwords, but they end up, they have to do it, and that was a big takeaway from me, that book.

So what's the biggest mistake dentists make with technology?

James: Well, you know, we're a gadget-oriented profession, Howard. You go to a dental trade show and ninety percent of what we see there are new devices, right? And the reality is patients don't really care about any of these things, unless it's going to make their lives easier, faster, cheaper, better, less painful. Any of the business of dentists, those kinds of things they could care less, yet most, most dentists buy these technology and don't put them into terms that make any sense at all to the public or in marketing, or in how they sell. In fact I just got an email from a potential client this week, where they'd invested a hundred and ten thousand dollars in a new Cone Beam CT Scanner, you know these are the devices that take three-dimensional cone beam images of the maxilla and mandible, right?

Howard: Right.

James: And it's sitting there doing nothing because he's really not putting it into any kind of communication to the public where there's any benefit to them whatsoever. So he's got this huge lease payment, which could very well be his marketing budget. Which I find kind of, you know, kind of sad that that's what's happening. So that's really it. Unless we put these gadgets and tools and great things that they can actually do something that means something to the patient, they just sort of don't do us any good, they don't do the public any good.

Howard: I don't like CBCT as a word, because number one, if you talk to a maxo-facial oral radiologist they say that it's not even technically, truly, a CBCT. It started out that way and now it's technically that anymore, at a very technical level. I just like it going from 2D to 3D. You know, when I got out of school we had 2D images, and today we have 3D images. But what is the message that you tell your public behind a three, I assume if you're an implantologist, would you call yourself an implantologist?

James: Yeah.

Howard: Yeah, so I assume if you're an implantologist, how do you, what's the message behind your 3D,

James: Well you know, what's happened is that they know these scans, they know that there's a price tag associated with the scans, so in the marketing it's simply, you know, come to whatever it is you're doing, and you're going to get this scan for free. Normally the price is X. So the scans have really become nothing more than a prospect generation tool.

Howard: In your office?

James: Yeah, and in all my clients' offices that have these, too.

Howard: Yeah, so do you recommend that they buy a CBCT, or just have access to one?

James: It's going to depend on the practice, you know? It really a per-practice basis. My really, my biggest caveat there is that if it's going to consume all of your marketing budget, then we need to be very careful with creating that expense in the practice. Because again, if you're not marketing for cases, what are you going to do with this expensive device?

Howard: Yeah, and I always kind of tell people you know, one of the biggest things you've got to watch is what you're hard-wired for. Because a lot of success is massively counter-intuitive. Like, you want to control everything but business people delegate everything. Social animals are concerned with what other people think because they're a social animal so they're only going to survive as a pack, so they're very concerned what everybody thinks, and being successful is not caring what everyone thinks and just differentiating yourself and being different. 

I always think the funniest thing is, every time you let your dog out your front door, he goes and pees on all four corners of the territory, because dogs mark their territory, they're very territorial, and I've seen so many dentists that were in with a partner, they were in as an associate and they didn't own anything, and they were making three hundred thousand dollars a year, but they just had to own, so they left that and started up their own and now they make a hundred thousand a year and they're stressed out of their minds. So I'm just like, "I'm sure glad you get to pee on all four corners of your office every morning, because, so people are just territorial."

So what's the biggest misunderstanding in this procedure marketing?

James: One of the biggest is that you've got to invest, you will have to invest more to find your niche cases. Let's say you're, let's say you're really interested in fast ortho, right? These cases that you're going to complete the ortho in six months or less. There are these techniques now, you know, and the public's interested in that, they want fast. Or let's say you're going to look for patients that are interested in last perio, which is all about saving your teeth without surgery, right? 

Well, you can't expect to spend the same money marketing for those cases as you would just your general practice, because you're going to have to go bigger, and over a wider geographic area to find enough patients who can afford the dentistry you're going to be selling. So you're going to spend far more and so dentists get trapped in this mindset of, "Well I was only spending one percent a year marketing my insurance practice." Well, those patients were coming to you basically for free via the insurance, and you were also basically taking part of a marketing fee out of the case, because the insurance company's taking fifteen percent or twenty percent a case. 

Also with these niche cases you're going to have to realize you're going to have a lot less case acceptance than you do with your general practice patients, and therefor you've got to have a sales process to deal with that. If you sit around and listen to people tell you no, at the cases you're presenting all day, it's going to become very disheartening and you're going to give up. So you have to have a sales presence to get down to the patients who are most likely to say yes. That's one of the other biggest misunderstandings. 

I think the next one on the list would be that the sales process is going to be longer than what you're used to. Most dentists are used to presenting a couple of teeth they have due to the examination and they, that's the case presentation there, and it goes forward, it happens, if not, then the sales presence took what, maybe twenty minutes? And yet if you're talking about a fifty thousand dollar case, that sales process may be everything from a few weeks to six months to a year. So we have to have something to manage that. 

As part of the sales training and process I developed we actually have a seven-page checklist to get people from the first phone call all the way through to the check is written and they're in the treatments. So there's a whole lot more that goes into this than they can imagine. 

Last but not least, I'll say, too little focus, Howard. These practices, they want to do everything, they say, "I want to be the biggest guy in implants, I want to be the biggest guy in ortho. I want to be the biggest guy or gal in perio." On and on and on. And each one of these niches that we have, each one of them requires its own marketing. And you've only got so much time, money, staff, and energy to market anything. So you get spread out over too many niches and you get less results, period. One of the best advice is to, with this misunderstanding is just don't focus on too many niches. Pick one or two that you really care about and hone in on them.

Howard: And you picked implantology? Is that,

James: I did.

Howard: And you, do you own your own practice and place all your implants? Or do you have a partner or associate, or?

James: At the time I was practicing, Howard, I was placing everything. All the surgeries and everything.

Howard: But you're not practicing anymore?

James: No, this is full-time now, this consulting business.

Howard: And how long has it been full time?

James: Five years.

Howard: Oh, wow! Well congratulations to that.

James: Yeah, it's been fun. That's how old you guys now are

Howard: That's how old I've gotten, wow. Yeah, I'm turning fifty-three, and the first thing I noticed that went with me, I'll say to my boys, I've got four boys, twenty, twenty-two, twenty-four, twenty-six, I'll say to my boys, "Boys you remember five years ago when we blah blah blah?" They're like, "Dad that was ten years ago." And just this morning I was telling Zach about something and he said, "Dad, I'm pretty sure I wasn't born." And I'm like, "Oh, my god." 

James: To finish up on the misunderstanding, too, Howard, the only other thing is, especially with this abundance of associates that are available now, you can also build these niche procedures into procedures where you've got hired help doing the procedures. Because ultimately the front end of it is marketing and selling, the back end is delivering of the service. So you can hire the help to do any of these things. It's also important that the dentist doesn't get too concerned about "Oh my god, I've got to be the one that's educated with all this stuff." That's just not the case anymore.

Howard: Yeah, and I want to point out on the, one of the biggest sections on dentaltown is obviously, it's a digital magazine, obviously there's, we're just coming up on two hundred thousand members who have posted four million times, so that's huge. But the classified ads get about twelve hundred to fifteen hundred unique dentists per day because we have free classified ads, and they're just like, has every feature that any Craigslist, Monster jobs, anything like that has. But it was a surprise to me how a dentist will just say, "Associate needed." And there's, like, 

James: It used to be its own-

Howard: Two words, dude? Really, doc? Wow. Wow.

James: One of, like, having a sales presence is you can apply this to hiring your associates, see?

Howard: Yeah, I was think, you know, it'd be a fifty percent better ad if you just put in a third word. How about, "A associate needed," or "An associate needed." But yeah, I would, I think the free classifieds are totally underutilized. I think you should go into great description so it says "Hey I'm a general dentist and this is what I do. You know what I do not do, I do not do all these things, and these are my hours, and this building sits here a hundred sixty eight hours a week, I'd really love someone who could either come in and do these other products."

But let's talk about dental insurance, because the way I look at, what's the best advice you give regarding dental insurance, because I look at dental insurance as nothing more than a volume discount. I mean, I have to go out and advertise on 1-800-Dentist, or social media, or direct mail, or Yellow Pages, or a billboard, or any of those things, to get an individual.

But if I sign up for Delta, they'll just send me, you know, a couple hundred patients. So those couple hundred patients on Delta, it's going to be a group discount but there won't be any marketing cost. And I also think the most interesting thing about an individual patient versus insurance that blows my mind is a dentist won't blink signing up for a PPO that drops his fees thirty-five percent across the board. And then you go back and say, "You don't blink at doing that. How about taking your marketing budget from one percent to three and a half percent?" And they're like, "No way, I'm not going to that!" I'll say, "Okay, drop your fees a third." "Right on. Where do I sign? Just show me the X." 

So what are your thoughts about dental insurance?

James: Well, you know, probably one of the best discussions about dental budget would be in Volume Three of The Dentist's Unfair Advantage. 

Howard: Okay, raise that up again. And talk about that, because the truth of the matter is, eighty-five percent of the people are just hearing this right now, but fifteen percent see, but hold it back up again. When did that book come out? The Dentist's Unfair Advantage, Volume Three. Does that mean it's a three-book series?

James: It is, and columns two and three are in print. You can get them at Amazon, or at our website. Volume One is getting into reprint, so not available again yet.

Howard: Now would you recommend that all three books be read, or is it more like the third edition of one book. Is it like the third edition of on book?

James: Completely different books.

Howard: Their complete [crosstalk 00:38:24] Well you know how you could sell a gazillion of those books? Make a,

James: How?

Howard: Make an online CE course for each one of those books! I call it deconstructing the sales process. So there's two million dentists around the world, so if you're going from a guy, two million dentists around the world, and dentaltown, digitally, we mail the magazine to a hundred twenty-five thousand, that's got two hundred thousand members on the website, and they read it all around the world. 

Do an online CE course for book one, book two, book three, and after, and so they'll go from "Okay, who is this guy?" And then after they listen to you talk for an hour they're like, "Yeah, I want to..." because it probably takes what, six hours to read a book, and I think that would explode your brand. Not just, you already got a hell of a reputation in the United States but it would really explode it in Canada, Australia, you know.

James: You're saying just do this, the one-hour CE course for the books type of thing.

Howard: Yeah.

James: All right.

Howard: Absolutely. That'd be an honor to have you do that.

James: Cool.

Howard: But in answer your question, what's the best advice you can give regarding dental insurance?

James: You know, you've already touched on some important parts of this, and we could obviously spend a ton of time on insurance, and most times really get, they don't realize what their spending on marketing by taking the discount. Right? So that example you gave of thirty-five percent, that's just that guy's now spending thirty-five percent of his production on marketing. It just, he's not writing a check for it.

And that same guy could very well afford, if he didn't have that contract, to spend eight to ten percent on marketing, going through fee-for-service patients. But you have that conversation, people now they almost have a coronary, right? I think it's important that we realize that insurance still has a huge roll in generating a first step to get someone into the practice. Even if you're not on the contract it's important to really embrace the insurance because again, it is a tool, and someone says, "Hey you can file my insurance form, you let me come in to listen to what you have to say about the dentistry. 

We provide our clients with some tools that actually, say a patient comes in who's on Delta, and they've got a major case that needs to be done, and the dentist is hesitant to do it because it's going to take a discount on the whole case, because of the Delta contract. Well there are actually legal documents, you can now use that use federal HIPAA guidelines, to remove this patient out of Delta and into a different agreement with the practice so we can actually get the full fee. Again, something you're not hearing in the broader profession.

But I think when we look at where insurance fits in sort of this trajectory of dentistry in modern times, we need to understand kind of where we are and where we've been. You know in those early days, when my grandfather was practicing, this was all pre-fluoride, and they were just coming in to the main part of the industrial revolution in America, and so you had this huge part of the population with lots of need, not many dentists at all, and more wealth because of what was happening economically. So you had this booming dentistry in the early part of the twentieth century, up until the fluoride age of the 1940s. 

And then we hit a period just post World War II, where suddenly you had all this economic growth and all these people coming in to the workforce who now had also more disposable income, and we were getting better and faster in dentistry, so another boom in the profession. Everyone did great.

We get into the 1970s and then what? We have an insurance boom. And so, suddenly, all of these patients are flooding to practices because they got insurance, and we kind of got addicted to that model. And now we're sort of at an age, where the profits are being squeezed out by the insurance companies, that we're getting in a bit of a bind, so we have to think about this a little differently than we did in the years past.

And as we look at it as a tool to get people in the practice, we only take the plans that don't beat us up too much, so a little bit of discounting is okay but the massive discounting is not, and then we realize that we're going to spend a lot more of our, a lot more percent of our annual gross on marketing than any dentist have ever spend in their practices up to this point. 

And we can, because the cases are still worth it on the other side. The profit is still there if we market for bit cases. So you know, a very long answer, but you realize that there's a lot to the insurance answer, more than just a pat answer.

Howard: I think that's interesting, how you when to a historical perspective about your grandfather, a hundred years ago, no water fluoridation, and times are different. It really eeks me when I hear these young suburbian teachers and universities talk about Rockefeller and Carnegie as robber barons. It's like, dude, they were born in the Civil War. They saw the country completely destroy each other, they saw it as a personal religious mission, Rockefeller did, to rebuild America. And when he was rebuilding America and taking us from lighting candles to burning kerosene, oh, I'm sorry he wasn't as polite as you would be born in a suburb today in America. 

To call that guy a robber baron when he built America, same thing with Carnegie, they say "His labor practices, they weren't prudent!" Yeah, they weren't prudent compared to today, but, man, when you're growing up and people from the state above you are coming down and burning down your entire city and almost a million people are killed, what is a labor practice? If that's what you're born into. And it's funny, the guy who created the five-hour workday, who was the first pro-labor guy, Henry Ford, funny, he was born a year after the Civil War was over, you know what I mean? So he never even saw this kind of car-,

So, yeah, dental roots are huge and what people are born into. Like my four boys, their grandfather lived through the depression. So when he had three million dollars in a savings account, he still couldn't go to a restaurant because he'd just stare at the menu and go, "A steak is twelve dollars? We could go to the store and buy it for three dollars. Why would be pay twelve?" He still never got it, to this day, because he just nev-

James: One of the last things about insurance, too, Howard, is, even if you are an insurance-based practice, you need to have a sales process so that when a patient needs significant treatment, you can have the right tools to talk to them differently than their other patients. So that some of those patients will decide to go on to better treatment.

We're doing our insurance patients a disservice if we don't have those conversations.

Howard: But when you said, "I'm a Delta provider," but Delta doesn't cover implants, so you could have any fee you wanted for an implant, right?

James: There's other, the thing is there's this battle among various states where you can't go, the contracted fee may apply to the whole case. So in some states you're sort of stuck, like let's say you're on insurance plan ABC, and they say that no matter what the final fee is for the case, like twenty thousand dollars, your crown fee doctor can only be a thousand dollars a unit. When in reality, to do the case, you may need to charge fifteen hundred dollars a unit. And yet, but the contract, you're sort of stuck. Does that make sense?

Howard: Yeah, you know, and it's kind of weird how insurance companies, it's the typical human deal where, insurance was started to help a person get access to dentistry or medical, and then it turns into control. Like, I'm going to help them but now I have to control the provider. And that's a common thing with social animals, is they're always trying to be dominant over the other animals around them. So they're hard-wired to control and dominate, and it's just crazy some of those. 

The way I look at an implant is, you know, I tell people, look at a bottle of water, which is a buck. Which is amazing that bottled water costs more than gasoline in the United States, they still call Rockefeller a robber baron, but if it takes you ninety cents to build that bottle of water, then the little cap, that dime there, that ten percent, that's the profit. And if you want to make another dime, the hardest way to do it is to make another unit of bottled water and then to sell it and collect the money. The easiest way to make another dime is just to raise your price one dime. Or two dimes.

And what insurance has done to our physician friends, like look in Phoenix, Arizona. No physician can sell a practice, because patients aren't worth anything. I mean, you can't sell a family MD medical practice, because any idiot could open a medical practice and be booked up three months in advance with Medicaid, Medicare, Obamacare patients. Because there's nothing, there's no money in it. 

You can sell a dental office, a veterinary office, a chiropractor office, because those guys have margins of maybe thirty-five percent. What I like about implants is the fact that when I got out of school, implants were five hundred bucks under Obamacare, and the price has just kept coming down and down and down, and the prices have just been going up and up and up. So if you're down with paying, say, a buck fifty for an implant, a hundred fifty bucks, but you're charging fifteen hundred dollars to place titanium, that's a lot of margin! 

James: The reality is that not just with implants but any of these services where we can speed up treatment. Like I mentioned before, fast ortho or even a laser-based procedure where you're not removing any teeth or even putting implants in, the margin is incredible, and the patients want those services because what are they to do? It's faster, better, cheaper, less pain. 

Howard: So are you talking about that, what is it called, pro-puh, what's the fast ortho technology?

James: There's like five or six technologies, Howard.

Howard: Could you name any of them?

James: One of them is Six-Month Smiles,

Howard: Oh, okay, so you meant that type. I thought you meant the, Six-Month Smiles, yeah, I thought you meant there's some technologies that you can place on the bone,

James: There's a surgical procedure called Wilckadontics, it's sad that our oral surgeons and prosthodontists and orthodontists haven't really teamed up to market that like crazy, because patients, they want fast treatment. So it just baffles me that our specialists haven't figured it out yet.

Howard: There are some faster technologies.

So what is the biggest fallacy you find in practices that struggle?

James: Most of them are going to say "You know what, I don't have time to do all of this stuff." In reality, there's more than enough time. We're in an age where distraction's really the issue. People spend too much time on Facebook, they spend too much time at dentaltown, you know, they need to realize where they invest their time. There's nothing wrong with going to dentaltown, it's great. But you need to say "You know what, I can't be there for twelve hours a day. I've got to do my business and I've got to do these other things, and I'll do this, what makes sense."

Facebook, I think, is a total waste of people's time. Maybe it's great for keeping up with your family a little bit, but people get sucked in and then they go "What happened to all the time?"

Howard: The best way to build your practice with Facebook is to delete your account.

James: Bingo. There are some ways using reviews, where we post reviews about the practice on Facebook, but that's really it. Everything else is a disaster, and I've been preaching that since the advent of Facebook. It's just not the right place for dentists. 

The other part is that, I love to work by the eighty-twenty rule, and most of us never come to the conclusion that the science says that basically eighty percent of your results come from twenty percent of your work. And that one thing, by focusing on the eighty-twenty rule in your practice, can make a huge difference.

Howard: And what would that be?

James: Well, let's say, even in a procedure-based thing, let's go into the database and look at what procedures are done in the year, which ones were the most profitable, and then see how can we do more of those? Let's go into the patient base and let's see which patients were the most profitable, what do they look like as a group? And I guarantee you there's going to be some characteristics to it.

If you're a specialist, you do the same analysis, you're going to find you've got a hand, a core group of twenty percent of your friend doctors that send you all of your business. So why not focus on those guys and fire the rest?

Howard: You said dentists were into gadgets, you talked about, you know, you can't do everything, you've got to find a niche, you've got to differentiate yourself, you can't be the biggest implantologist, and the best orthodontist, and the cosmetic dentist, etc. We've seen a hundred twenty-five thousand general dentists in the United States and about, I'm thinking about twelve thousand of them picked up a hundred thousand dollar CAD/CAM machine. What are your thoughts on that? 

Because it's about, what would you say, ten percent market penetration? That's what I'm callin'.

James: I would say ten percent, and that's probably as high as they're going to get it. Unless the price keeps dropping, which it will.

The thing is, if you got a busy practice where you're doing a lot of units, you can get away with having a machine in your office and not have to market it at all, but what happened is most practices are not doing enough units, and the next thing they realize, "I've got this expensive device and it's not being used as much as I would like," and they're not willing to go out and market it.

One of my clients actually wrote a book about Cerec just for his practice. So now he can go to the market and say "Look, we're the only practice in the book about Cerec, so come see us for the service versus others." And so, that's the kind of thinking that's typically missing when they buy these CAD/CAM machines, is how am I going to package that technology in a way that matters to the public? Let's face it, with CAD/CAM it's about speed. It's like, "I'm going to come in have a crown done in an hour, hour and a half, and it's done." That's what the patient's interested in and on top of that, if you can promise that you won't hurt them, you've hit the trifecta.

Howard: Yeah, but I see CAD/CAM can blow up on you too, because if I asked you, "James McAnally," well a lot of dental offices you walk into, what they used to do is, first appointment's an hour and a half, and they would numb the tooth, prep it, take an impression, temporize and leave, come back in two weeks for a thirty-minute seat. And now a lot of those offices do that in one appointment, but that appointment is two and half hours.

If I said to a guy like you yeah, you see it all the time, and you see it with patient reviews. If I said to you, "Hey, James, you want an hour today come back in two weeks for thirty minutes, or you want to sit in that chair for two and a half hours and be done with it?" Ninety percent say dude, I can't sit in the chair for two and a half hours.

James: If I was those guys staying two and a half hours it'd better get back to Cerec's school.

Howard: Right, exactly. The masters can do it, but, I see a CAD/CAM machine as, like, buying a grand piano. You just can't buy a grand piano and know how to play it. You're going to have to practice and get good and get fast, and if you're not willing to do that, 

So what's the largest expense in a dental office is the dentist. The ADA says the average overhead in a dental office is sixty-four percent, that's two-thirds, that means the dentist then costs a third. The next biggest cost would be the staff. And we see staff costing twenty-five to thirty percent. What's the biggest issue you see with staff, which is at twenty-five to thirty percent, next largest cost maybe lab, eight to ten, then supplies, four to six. I always think it's funny how dentists, they're always kind of concerned on their supply cost. And I'm like, "Dude, you're lab cost is twice is much, and your staff, twice as big as that, and you're bigger than that! So why are you worried about the price of gauze?"

James: Gauze isn't going to kill you. It's the other stuff.

Howard: Because now the biggest deal with supplies is, did you see that Amazon, the fourth-largest retailer in America, it's Wal-Mart's number one, Costco's number two, Kroger is number three, most people haven't heard of Kroger because in each state their grocery store's different, like in Arizona it's Fry's, in Kansas it's Dillons. The number four is Amazon at ninety-five billion, and they just joined the Dental Manufacturer's Trade Association, and they absolutely plan on selling you all your dental supplies some day.

James: It's because they're fast, you know? They've got the distribution. 

Howard: Yeah, and with Amazon Prime, you can get whatever you need in two days, and once again, everybody wants to talk about that and I'm like, what are you going to talk about next, the light bill? I mean, what are we going to do, just have a morning huddle around the thermostat every day and have the women on menopause and the women on anorexia agree on what the joint temperature so we can decide who needs a shed closed and who needs to put on a, who cares? Labor! Labor's the big deal. 

So what's the big issue you see with staff?

James: First of all, especially if you're getting up to, how much did you say, Howard, for like, what you're reading with the top end of staff costs?

Howard: Well, everything I see is twenty-five to thirty percent. Now, a lot of dentists will say, "Well my staff only costs me twenty-two percent" and I'll say "well does that include FICA matching?" "Uh, no." "Does that include health insurance?" "No." "Is that uniform?" So, when I say twenty-five to thirty, that's everything it costs to have Yoni work in my dental office. You know what I mean? All the money that it costs, that's what I call labor. And it's twenty-five to thirty percent.

James: The biggest issues you have with staff is oftentimes, dentists keep the wrong staff on board. Because they're too afraid of hiring. They don't like hiring. One of the reasons we developed a hiring system to help our clients out, just because we know that they have a problem with hiring.

The other one is you know, even if you've got great staff that care a lot? We tend to not give them the right tools. Phone sales training would be a huge one. In reality, when you have staff answering the phone and you're spending a lot of money on marketing, the phone training never goes away. It just can't. Because you always have to be honing your skills in that area. So giving them the right tools, training them on the phone, and then rewarding them appropriately. 

There are excellent ways to actually have bonus systems that work well, if they're implemented correctly. And again, most of the bonus systems that you see out there don't work that well. And obviously we don't have time to go into any specifics today, but there are ways to motivate staff so that they do an even better job for you in your practice.

Those would be my biggies.

Howard: Back to, I've only got you for three minutes, we've already cleared out fifty-seven minutes, I want to get back to, so five years ago, you stopped doing big case dentistry, and you started big case marketing. Why did you stop doing dentistry and focus on this, and tell the dentists more about this and what it is you actually do.

James: Well, the transition [inaudible 00:57:38] over about a five year period, so I started this in 2005, and it continued to grow from day one up until where I did this full-time in 2010. So seriously what I realized is my best, my greatest and highest use to the profession was to work on what I'm working on, and dispense in the profession versus me just treating patients.

There are far more patients around the world being treated now because of me and this business than I ever could have treated on my own in one little practice. So that's really where I get my kicks out of dentistry now. 

As far as our services, we have the number one case acceptance training for advanced dentists, which you can read about at, you'll find all the information there. Then we also have some do-it-yourself marketing products, where I will even take a personal interest in the doctor's practice and develop a custom marketing plan for any niche service they're interested in pursuing. 

The reality is there's not a practice out there that couldn't benefit from our case acceptance training program, which is called The McAnally Selling System.

Howard: Now, is that a lecture? Does it start with a lecture, or tapes, or CDs, or how does it start?

James: It's all online, so it can be accessed as long as you have an internet connection. There are lectures, there are downloads with most of the sessions, there's materials for use in the practice that need to be customized,

Howard: So tell me what's on, if I go to bigcasemarketing, b-I-g-c-a-s-e marketing dot com, what are the entry level things? There's lectures that I can sign up for?

James: People can take our one dollar trial for fourteen days and the training, Howard, and they'll get access to the introduction to the course and also session one. At the website they're also going to find a twenty-five minute video that goes into all the details about the training, about everything they're taught, all the stuff they get as part of the training.

At the end of the course, they end up with having license to use the seven-page checklist in the practice to help them sell their largest cases. And then there's also plenty of other materials that are talked about in the twenty-five minute video they get at the end.

A big part about this is differentiation, Howard. Part of the training is literally getting them to do the work to finally decide "What is it that makes my practice different from the others around me?" and communicating that to the public. So in essence, we force them to improve their marketing, and differentiation is part of the sales training course as well.

Howard: I don't want to give you any marketing advice, because you're the man on that, not me, but if I could give you any marketing advice, I would take the first one hour of those lecture programs or whatever, and put that up for free on the online CE on dentaltown, because what we do at dentaltown is, I have fifty employees, so my business model is "I'll split whatever you do. If you put it up for free, we'll sell it for free. If you charge a dollar, we'll take fifty cents because I've got fifty mouths to feed." 

I've noticed that if you, obviously, a free online course gets the most views, I think the average course is eighteen dollars an hour. Some of the biggest names out there charge, like four hundred dollars for their courses on dentaltown or whatever, but I think you should put one hour, two hours, three hours up, and then just close it and say "If you want the next twenty hours, or thirty hours, go to," it'll be, like I say we've got two hundred thousand members, that would explode this.

James: We put the intro and session one up for free and then they want the rest of the course, they have to pay for the whole thing.

Howard: Yeah, I would do that. I think that'd be great.

James: We can always test it and take it off, right?

Howard: Yeah, on the internet they call it The Long Tell, because all retail is based on scarcity. If you study business models of retail going back to New York City in the seventeen hundreds, I had a two hundred square-foot shop, and you extinct me because the next generation put up a four hundred square-foot. And the next generation put went eight hundred square foot.

So now you have these hundred fifty thousand square-foot Wal-marts, Costcos, IKEAs, so because the bigger the box, the less scarcity there is especially in supply chain management, because when I was little you could walk in the grocery store and the entire aisle might be just paper towels. Now they're like, we'll just put out paper towels that don't run out and we'll restock every day so we have the maximum number of items. 

But the internet killed scarcity, because if you walked into the Barnes and Noble here in Ahwatukee where I live, they just closed it down, but that box was a big box but it still only held a hundred thousand books. Amazon online hold five and a half million books. Record shops are gone because they on average had ten thousand records, and iTunes has seven million records. And you know what's amazing about iTunes? They've never put up a book or a song on iTunes or Amazon that didn't sell one copy a quarter. So it could be the strangest, rarest song, found in a cave in Tibet, and somebody will buy that thing every three months.

So dentaltown has infinite tell, it doesn't cost us to put up your course, and I think what you're doing is extremely noble, because dentists think they compete against the dentist in the building, and it doesn't surprise me to go in there to see all this camaraderie on dentaltown, and I know, I'm smart enough to know, the only reason the love their fellow Townies is because they all practice far, far away. And then they're in a building with six dentists, and I say, "When's the last time you went to lunch with these five dentists?" And most of the time, they've never gone to lunch with any of those five dentists. 

My best friend is a dentist right up the street, Tom Mattern, and we're buddies. And then there's other dentist on the same intersection, they haven't talked to anybody in Ahwatukee in their entire career.

James: Under looked marketing opportunities is for four or five dentists to jointly market. I mean,

Howard: Yeah!

James: You get into,

Howard: Co-ops!

James: Fort Smith, Arkansas, or Wichita, Kansas, and they're forward view marketing, everyone will think you guys own the place.

Howard: Yeah, so I think what you're doing is noble because what we compete against is trips to Disney World, we compete against Carnival Cruise line, we compete against, I mean, look at my grandparents, when I grew up in Kansas, they had no money. They drove their cars til they had two hundred fifty thousand miles on it and every weekend was fixing it back together. Now every American, as soon as their car payment's up, oh, five years, paid for, trade it in for a brand-new thirty thousand dollar car with another five year program.

These dental students, they walk out of school and they're all whining, "I have two hundred fifty thousand in student loans" yet every single spring break they were in Cabo, or the Caribbean, or on a cruise, and I'm like, "you had more vacations in dental school than my parents had in their lifetime. And you're whining to me?" So humans part with all their money, and all the money they can borrow. They'll buy full-mouth cosmetics. Full-mouth perio, full-mouth ortho. But it takes you, to get in their mindset, to teach them how to go in there and present this so that, I tell my staff "They're going to spend all their money and they're going to max their credit cards. My goal is, they're going to max their credit card at my office, not at the mall."

James: Right.

Howard: But hey, we're completely out of time, we went five minutes overtime

James: Who's the best contact for doing the courses there?

Howard: I'm, but the guy in charge of the online CE, he's a Howard, too, Howard Goldstein, so he goes by "hogo;" H-O-G-O at So if you want to email me,, if you want to put a course up on dentaltown it's

Seriously, James McAnally, my Irish buddy, buy the way I'm a hundred percent Irish, have to grandparents, four grandparents, and eight grandparents. I'm not even going to ask you if you're a hundred percent because anybody whose name starts with a "Mc" has got to be a Jameson-drinkin' Irishman.

So thank you for all that you do for dentistry and I hope more people hear your message.

James: Awesome.

Howard: Have a great day.

James: Bye.

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