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"Dentists are not interested in business" - Dr. Stephenson
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AUDIO - Bruce Stephenson - HSP #121
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VIDEO - Bruce Stephenson - HSP #121
Practice management doesn't have to be big and scary. Bruce Stephenson, DDS shows that it might be easier than you think to do it well.
I graduated from dental school in 1977 and opened a practice from scratch. We grew over the years and in 2008 one of my associates bought half the practice with the understanding that I would retire in 5 years and sell him the second half. Well, it actually took 6 years but now my former associate, then partner, is now my landlord! I continue to practice in the same office, renting space for my 3-day per week Invisalign only practice. At one point in my dental career I also founded an IT company just for dentists (a lot more work than fixing teeth!) so part of my “rent” now is doing IT support for his practice.
Over the years I became interested in not only computers but practice management and have been lecturing and consulting on these subjects since about 1986. I have spoken at the ADA and AGD annual meetings and continue to do (occasional) seminars and webinars.
Since I “retired” in June of 2013 and have become even more involved in our practice management consulting business with my former office manager. We currently have clients all over the country that we “meet” with using Skype and GoToMeeting. It’s fun and very interesting. Although each practice is unique, it seems we are all stumbling over many of the same rocks in the road.
Last year we published our first book, “How to Run a Dental Practice,” which has not made it to the best seller list yet but does get very positive feedback from dentists. We discuss just how dramatically dentistry has changed in the last 5 years and how practice management systems need to change to keep a practice profitable. Our next book (if we ever get around to it!) will be titled “Dentistry 3.0,” to further reflect these changes.
Howard: Hey, this is a huge honor for me today to be interviewing Bruce Stephenson. We have the same name. My dental office is called Today's Dental. You have Today's Dental Consulting. It's an honor that you were here with me today because you and I have been in this [inaudible 00:00:26] 30, 40 years. Lots of things are happening. When we got out of school, Orthodontic Surgeons of America had made it to the New York Stock Exchange and had $1 billion market cap.
There was a dozen on Nasdaq. Then they all went away. 10 years, nothing. They're back. That's management. Corporate dentistry is huge. I want to ask you. What is your assessment of the dental industry today?
Bruce: It's certainly changed a lot since I got out of school which was 1977. When I got out of school, most people, most dentists did not do a 1-year residency. Most just opened up a practice, which is why I did. It was really possible to do that. Then the banks were more than happy to loan you money. There were lots of patients. I think I practiced during the Golden Age, if you will, of dentistry.
To me what's changed so dramatically in the last few years, I think dentists are more aware of it in the last 5 years but it's certainly been in effect longer than that is this dramatic change towards the control of dentistry by insurance companies by the squeezing of our fees, if you will, and to some extent the controlling of our treatment plans, or at least the attempt to do that by insurance companies. This was just unknown during most of the time that I practiced. That's a really profound change in dentistry.
Howard: I don't mean to interrupt my guest but to our listeners our there, a lot of them are kids. What they don't realize is that dental insurance came about I believe it was the New Jersey Long Shore something about 1958. They came out with a $5,000 max but if you too those 1958 dollars and adjust them to 2015 real dollars, if they adjust that for inflation, it would be about a $5,000 max. What they did is they went in there and had $1,000 which was unbelievable. It was all full-mouth rehab in 1958. $1,000 would go a long way. Now that's 1-tooth dentistry but I found that profound that for someone ... How many years have you been in dentistry, '77 to 2015? How many years is that.
Bruce: That's 38 years.
Howard: In 38 years when I opened up with the big boogie man corporate dentistry from Orthodontic Centers of America at today's Heartland and Steven or Pacific Dental Care, you just dismissed that instantly and said, "No." You would write the dental insurance. You thought that was the real issue.
Bruce: I do. Certainly the DMOs are important. The other thing that happened in dentistry though is the money it takes to operate a practice is a lot more now than it was when I opened a practice. When I opened my practice, the most expensive thing I bought was a dental chair. I can't remember how much that cost. I wish I could but I still have that chair 37 years later.
Howard: What was it? It must have been an [Adak 00:03:56].
Bruce: A Pelton & Crane chair. I love [crosstalk 00:04:02].
Howard: Where is that made at? Is that made out of Indiana?
Bruce: I'm not sure where Pelton is. They don't make that chair any more but you could pick them up used. We have. We've bought several of them used. You get them recovered. It looks like a brand new chair. They can go through circuit boards, motors and stuff, if you have to get them fixed but I just love that chair. Anyway, that was quite a good investment for me in 1977. I'd say my ROI on that was very good. That was the big deal. That was a big expense.
Today, you're looking at cone beams. You're looking at [Serax 00:04:42] or other kind of CAD-cam things. You're looking at all this stuff they're doing with computers. It's a lot more money. You better pay attention to the business side of dentistry that we never had to in the past. We had high margins. The insurance companies were there as really a big benefit to most dental practices. That's changed.
Because it costs more money and because dentists I think as a group don't go to dental school to become businessmen or women, they go to dental school because they want to treat patients. In the past you could just do that. You didn't have to be much of a business person. Now you do. Things have changed. You talked about the young people getting out of dental school now.
My advice would be to decide do you want to be a dentist and just patients, in which case you're probably much better off working either in a group practice or some sort of a DMO setting, but somebody has got to do the management. If you wanted to be more of an entrepreneur and willing to do the management yourself, great. That's certainly possible. I think that's fun but most dentists don't.
Howard: You got out 30 years ago in 1977. When did you start todaysdentalconsulting.com? What made you get interested in consulting? Tell our listeners about that.
Bruce: I, almost from Day 1, had an associate. My first associate was my best friend in dental school. We're helping each other out basically but I've always had associates. About 15 years ago, my associate left on good terms. He bought a second practice. He already had 1. For about a year, I did not have an associate. I was going crazy. I stopped taking new patients. I was just way busier than I wanted to be but at that point, I realized that some time I'm going to retire. A young guy walked into the office, literally just walked into the office, and heard about me through another patient. He just graduated a couple of years before.
We did everything wrong. We didn't go out and put ads out, interview people and so forth. This guy walked in and says, "Hey, I'm a dentist. I need a job." I said, "You're hired." It worked out pretty well. He was an associate for about 6 or 7 years. Then he bought half the practice with the understanding that in 5 years, I was going to retire. He was going to buy the second half of the practice. Actually, it took us 6 years but that's what we did. Now I've been "retired" from dentistry for 2 years except I'm not really retired because he is now my landlord. He was my associate and my partner
Now he's my landlord. I rent space from him and basically just do [Invisiline 00:08:06]. I kept 2 people with me in my practice, [inaudible 00:08:11] and my office manager. Now that's a long story about where I've been in dentistry but I got involved in computers way back in 1985 and lecturing about computers and dentistry. That's how I got into the management. I've always been in the management part but when I retired especially, we geared up. Supposedly, I'm half-time doing Invisiline and half-time doing the consulting. As a matter of fact, I'm full-time at both of those jobs. I'm working way too hard.
Howard: You're in San Leandro, California.
Bruce: Yeah. That's right next to Oakland, which is right across from San Francisco.
Howard: You're a Raiders fan.
Bruce: I'm not a sports fan. If you want to talk about sports, you better interview somebody else.
Howard: I can never give anybody crap who loves reality TV because I have no idea why I love the NFL. I have no idea why I want the Arizona Cardinals to beat the Oakland Raiders. It makes less sense than watching Housewives of Orange County or whatever. You started off in dental computers. I want to talk ... What computer system were you [inaudible 00:09:21]? What year was that? What system?
Bruce: I bought my first dental computer in 1978. I bought an Apple 2 in order to write my policy manual, my office policy manual. It didn't do any billing. We went from there, and I don't remember the name, the system, but it was basically a terminal. Back in those days, Delta Dental was California Dental Service. This was part of what they did. They would do the processing for you. They had little paper cards that you put in the slot and so forth and then went from there to DOS-based computers. We'd just gone through a series of software and computers over time. In 1993, I decided, "We really ought to just put all our records in the computer and be paperless."
Howard: You went paperless in '93?
Bruce: Yes, not because I thought, "This is going to make a big difference in the practice." It just was a lark. As a matter of fact, that one made a very profound change in the operation of the practice. I didn't have all this foresight to see all these things coming but it worked out extremely well, that [crosstalk 00:10:36].
Howard: What system did you go paperless with in 1993?
Bruce: Initially with Dentrix.
Howard: What are you on today?
Bruce: Open Dental.
Howard: I see that a lot on Dental Town. We're coming up on 200,000 members. It seems like on all of the computer management information systems, it's mostly groaning, whining and complaining but the Open Dental Form customers, they just love it. I'm making the switch too but I want to ask you why ... I can't ask you this too much because if someone's listened to all 85 of my podcasts so far, they don't want to hear this story again but it just blows my mind there's no accounting in any of these software package. You go into any dental office in the morning and say, "Hey, what's our break-even point today? What do we got to do to pay all the bills?"
This office has been open about 16 days a month steady for the last 20 years. You've got the same 5 people in here for the last 20 years. You have consistent overhead. What do we have to do to break even? Every single person looks at you like a deer staring at a headlight that has no idea. Could you imagine watching the Cardinals play the Oakland Raiders and there was no scoreboard? All the fans left. They said, "Who won?" Good game. It was a good game. We had a good time.
Why do you think they can't do the obvious, just the absolute bare minimum, stupid obvious of sitting there and having the Number 1 expense, staff, all clock in and clock out on the system so that you know what your labor costs are per hour or per room. How many people do you know that are paying their hygienists $40 an hour and they're billing out $90 an hour? Since the billing's not paid, they don't even realize they lost $15, $18 every time their hygienist sees the patient.
Then the dentist looks at me and says, "I'm thinking about going from 1 hygienist to 2?" I'm like, "Why don't we sit down and figure out how many hygienists you will have to have to go bankrupt?" You write it all up. You say, "As soon as you can get these 6 full-time hygienists, you will be bankrupt and unemployed. You can go get a job at Peter Piper Pizza." Why do you think management information system has accounting at Long John Silvers and Kentucky Fried Chicken and not dentistry?
Bruce: Dentists are not interested in business. It's what I said before, that that's not why most dentists went to dental school. Now I think it's fun. I'm interested in that but most dentists are not. In the past, you could get away with that. Again, we had really high margins. There were lots of patients. The insurance didn't control our fees. Things [crosstalk 00:13:20].
Howard: Let me ask you a profound question. How many kids did you have?
Bruce: None. See my dog back there?
Howard: You picked a furry one. I guess the point I'm going to ask is now that I'm 52 and you're 10 years old than me, basically do you think humans at 25, if they don't have an interest in business, that they're just hard-wired programmed that way or do you think guys like us can make a kid at 25 get interested in something they've never been interested in? Do you think it's a personality trait they're born with or ...
Bruce: It probably is a little bit but I think it also is definitely a learned skill and a learned interest. When you get hungry enough, maybe you'll pay more attention to business. When you hire your sixth hygienist and you finally realize that you're going out of business, maybe you'll do something. The information is out there. Unfortunately, it's not just 1 thing that you can do. You have to do a whole bunch of things.
One of our graphics we use are pieces of the puzzle that have to fit together. It's not just 1 big piece. I'm just going to go and do this direct mail piece. That's going to solve all my problems. It doesn't work like that. There's a whole bunch of things that you have to put together to run a successful dental practice.
Howard: Take it away. Tell them what those things are. Right now, you've got 5,000 dentists listening to you. Most of them are on their commute to work. THey're driving into work. Take them through a spin of what they need to do to get their office to the next level.
Bruce: I would say Number 1, pay attention to your metrics. You were just discussing that. I have talked to the dentists who don't know what their accounts receivable are. They don't want to know what their accounts receivable are. They're afraid of that. "The staff takes care of that." You can't have that attitude. There are several metrics you need to look at. That's one of them that's very important. I'm going to do the standard things. Pay attention to [crosstalk 00:15:25].
Howard: What do you like to see on on the account receivable?
Bruce: One months' production, about two-thirds of one production. If you get it down to half of one months' production, that's good.
Howard: When you see account receivables go over 30, 60, 90 days, what do you think the issue at hand is? What's broken?
Bruce: The billing systems, obviously. A lot of dentists have a lot of money sitting out in insurance claims where there's no follow-through. We see that all the time. The dentists are unaware of this. That's the sad part. You say, "What should the dentist do differently?" They should tune in on this. One of my pet peeves is that the dentists don't understand the software, whether it's Dentrix, Soft-Dent, Open Dental or whatever it is. The dentists don't understand how to use it. They're very dependent on their front-desk staff.
I don't think you can do that. I think it should be the dentist showing the front-desk staff how to use the software and setting the policies. Even though you're not going to bill the insurance yourself, you need to know how it's done. You need to know what the most efficient way to do it is. That's the first thing. Pay attention to the metrics. The next thing I would do, and I think this is ...
Howard: What are the metrics? Account receivables?
Bruce: Account receivable, collection, production, looking at the production as a percentage of your gross ... I'm sorry, your collection as a percentage of your gross production, not true adjusted production, because you're paying overhead on that gross production. I can make your percentage of collections look really good. I'll just write off everything. Now my net production's real low. Now people do that all the time. You can't do that.
Howard: I'm sorry but I've got to interrupt you. There's a lot of kids out there listening that don't know the difference in gross production and adjusted production.
Bruce: Your gross production is actually what you put on the books. A patient came in today. You did treatment for $100 but they have a PPO that is only going to pay you or allow you to bill $89, let's say. Your gross production is going to be $100. Your net production after you adjust off that $200 or, I'm sorry, that $20, is going to be $80. I'm saying look at your collections compared to the $100, not compared to the $80.
They also besides writing off, and I'm just picking that as a PPO write-off but you also have write-offs where people don't pay you, where you didn't collect the money, lots of problems there. Let me address another metric that we really like and find very useful because it looks forward instead of backward. All these other things, the AR and production, collections and so so forth.
By looking at what you already did, it's too late to change those things but if you look at the scheduled production for the next 7 days ... Monday morning we look at the next 7 days, and we refer to that as the Hawthorne number. That's the little tag that we gave it because the Hawthorne effect in industrial psychology says that if you measure something, it tends to get better. You look at this number, whatever it is. Let's say it's $10,000 for this upcoming week.
You share that number with the staff and say, "We've got $10,000 this week. Last week we only had $8,000."The following week a week from now, we look. We've got 12. We know that we're going in the right direction." Everybody has to share the information because this is how you're measuring it to try and improve that number. As a matter of fact, it works. Now there's lot of things to go into improving production, obviously, but using the Hawthorne number is a really simple thing.
Again, it looks ahead. If you see, "Gee, our Hawthorne number for this upcoming week is really bad," we've bot time to do something about it. If you look at how much you produced last week, maybe was real bad but there's nothing you can do about that now. That's one of the metrics that we particularly like.
You asked me what else should a dentist do [crosstalk 00:19:52]. How am I going to change my practice? You're going to look at your metrics, pay attention to that. I think a really easy thing to do, a really effective thing to do, is improve your customer service. I can't say enough about having awesome customer service. The nice thing about it is it's free. We have something that we call the happy cat dance. This is something you train staff to do. You can measure it.
When that front door opens, regardless of who's there, the front door opens, everybody that's inside of the front door, including the dentists, turns, acknowledges the person and smiles. It doesn't matter what you're doing. Everybody does the happy cat dance.
Howard: Let me stop you right there because when you go into a doctor's office, seriously, the majority of times, about half, there's a window there. You go. You sign in on a sheet. Maybe she'll open it up and hand you a clipboard. You're lucky if it comes with a pen. Then if you stand there, she looks annoyed and says, "You can go sit down."
I say, "Do you mind if I just stand here?" They look at you like, "That's weird." My question to you is do you think you can train a person like that to want to do a happy dance or do you think that is a character trait that they're born with?
Bruce: It's difficult to train attitude. It's easy to train dentistry. It's difficult to train attitude. I think you hire attitude. I've never hired anybody that worked in a medical office because they're the antithesis of what we're talking about. What you just described is just the opposite of the happy cat dance. The things about the happy cat dance, and it's a little frivolous but ...
Howard: Are you saying cat like kitty cat, happy cat
Bruce: Yeah. It's a happy cat.
Howard: You should film that. You've got a lot of [inaudible 00:22:08]. You should film that. If ou film with your iPhone, you could save it to YouTube. Then you go to Dental Town and just [crosstalk 00:22:14].
Bruce: We've got lots of videos.
Howard: Post some of this because you know what's interesting? Again, I don't like to review myself but I always do. Every consultant I've ever talked to when you walk into an office, that's what you said. You either have the happy dance or you don't. You can sense and smell a million-dollar practice in literally 3 seconds.
Bruce: Absolutely. The thing is it doesn't matter who's walking in the front door. If it's the mail person, if it's the UPS guy, I doesn't matter because you want the reputation of being the nicest office in town. That is the key. You have to have that reputation. It starts when people ... It really starts over the phone but the physical pat of it starts when they walk through that front door. Everybody can be trained to do that.
That's something the dentist needs to monitor. I made the point that when that front door opens if that dentist is within eyesight of that front door, he or she has to do the happy cat dance too. Then you run in the back real quick.
Howard: You're going to start a thread. We have 51 forums. It's going to be a big month for us. We're coming up 4 million posts and 200,000 members. You need to go to Practice Management Forum and start a post called the happy cat dance because the bottom line is when you walk in that office if you don't smell or sense that, it's never going to be a million-dollar practice. It's just not going to be.
I want to go back to your metrics though because the thing is I seriously don't really have a lot of faith in changing the minds of 40, 50, 60-year-old dentists but what inspires me is the kids that are coming out of school. The older people, they won't change about transparency with their numbers. They just don't want to share it. I almost think it's because they think the staff's going to figure out how much they make, which is crazy because you know how much every player in professional sports makes.
You know how much all the people make. No one's stopping your staff from going to dental school. If they find out how much money you make and want to go to dental school, knock yourself out. THere's 56 schools but what would you say to these younger kids who it must be hard-wired in a social pack, animal, monkey, cat, dog, human to not be transparent with your numbers. In culture, if you're at a party and someone said, "I'm a lawyer," and you said, "How much do you make? How much do you gross and make every month," you'd be like, "God, what a freak."
I think that culture carries over to the dental office because I can't find a dental staff that knows their numbers, the metrics, the overhead. In my office, they're all posted and plastered all over everything, the break room, the go room in the morning huddle. We tell them what the break-even point is for the day. If we do this, we'll just break even. We want to do this. What would you coach to these young kids who I believe are hard-wired, social pack animals to not be transparent with their metrics?
Bruce: I think you just do it. It becomes second nature. I've always shared that information. I'm not concerned about it. Your staff really is your n, little professional family there. They need to know what's happening in the practice. I think a dental practice is a ...
Howard: They also bring it home to their spouse which when you look at divorce, they say as a rule of thumb one-third finance, one-third subsidies, one-third sexual infidelity. The stay-home spouse thinks they're married to a rich dentist. They don't share all the numbers, turmoils and all that. Then the fastest way to get rid of their ... They're all freaked out because their spouse is home spending too much money
It's like, "Dude, that person doesn't even know what you're up against. They don't even know your payment. Why don't you pay bills together?" If one-third of divorces are caused by finance, why don't you do this together? Then sometimes their ego, they just want to come home and just be like a rich [inaudible 00:26:16]. They [crosstalk 00:26:17].
Bruce: I don't think they ever get over that. I think that's very self-defeating.
Bruce: Again, this training with the staff, it's part of a Hawthorne effect too is if the staff is more involved in what the numbers are, the numbers will tend to get better. Use everything you can to help the practice.
Howard: What I'm hearing on the Hawthorne effect is I should get my little fat butt to Home Depot and buy a scale and weigh myself every morning.
Bruce: [Crosstalk 00:26:46] about losing weight.
Howard: This is the best podcast I've ever done. I just learned that I should get a Hawthorne effect scale and weigh my ... Should I set it right in front of the refrigerator before I open it so I have to see how much I weigh? You talked about numbers [inaudible 00:27:02]. You talked about the happy cat dance. I can't wait to see that. When can you post that?
Bruce: The next couple of days.
Howard: Good because that will be up before I get this up. After the happy cat, after the attitude, what should [crosstalk 00:27:21] folks?
Bruce: Looking at things from the patient's point of view. That's part of what the happy cat dance does. You've got them in the door. You're nice. You're smiling and so forth. It doesn't matter, by the way, if you're on the phone with another patient or talking to another patient. You can still turn and acknowledge the person that came in, smile and then turn back to what you're doing. They can see that you're busy.
Another thing that we see with the practices, they wonder why the patient didn't show up for the first exam appointment. They scheduled it, then they don't show up. Why did that happen? Part of it was the way they were handled on the telephone. Part of it, perhaps, was a welcome letter that they sent or didn't send. We have examples of what we call the unwelcome letter. Some of these things that dentists send out when they do send a welcome letter, it's just absolutely atrocious.
They ought to be sure that they include the cancer warning that we have to post. I don't know if you have to do that in Arizona but we have to do that in California but everything we use in the office cause cancer here. You'll e lucky to get alive, not to mention all the radiation stuff. Put that in your welcome letter too. Let's see what we can do to chase the patient away, all your payment policies and all that stuff. If you don't sign this, we're going to turn you over to collection and [inaudible 00:28:41].
Holy smokes. People should take a look at this. Number 1, they do need to send a welcome letter but it ought to be welcoming and not [crosstalk 00:28:50].
Howard: Now when you post your happy cat video on that thread, can you also post your welcome letter?
Bruce: Sure. They're all posted on the website already [crosstalk 00:29:03].
Howard: You're talking about the website todaysdentalconsulting.com?
Bruce: Yes, no spaces, no apostrophes.
Howard: Yeah but for your marketing on your post, your todaysdentalconsulting.com as all of your signature. If you start a thread, if you added something to it every day, it would be on today's active topic because there's 4 million posts. Most people are reading what's on todaysdental.com. If you added 1 thing every day for 30 days, everybody would see your site.
Do you recommend that welcome letter be on ... My dental office website, they use dental.com. Do you se on a lot of dental websites where you can download your new patient forms, is your welcome letter a download on your ...
Bruce: Actually, what it has ... Let me back up a little bit. Welcome letters should not be mailed. Welcome letters should be emailed because you want to get the patient in as soon as possible. They can come in right after lunch today, and this is a new patient we're talking about, that's great.
Howard: Great point.
Bruce: You don't have time to send them all the forms. Welcome letters should be emailed. Now the way we do it is with Open Dental, you can have these little templates already set up with different letters. One of them is the letter welcome but that doesn't have things like things like the patient's appointment. We'll see you on Thursday at 2:00PM sort of a thing. We want that to be in the body of the appointment letter. We create that as a letter, save it as a PDF and sent it as an attachment to the welcome email.
That also has a link to our practice website portal so if the want to, they can download the forms there and fill them out online and then be sucked in automatically into Open Dental. If they don't want to do that [inaudible 00:30:55], I have a whole lot of geriatric patients in my practice. Asking them to fill something out online before they come in, they don't want to do that. They more comfortable with paper.
Great. I don't care. Do it on paper. You have to accommodate what works best for the patient instead of constantly thinking about, "Gee, I want to do this," me as the dentist, as the doctor. "I want to do it this way." I think a welcome letter is a very powerful PR thing to send out as part of your awesome customer service.
The second thing that people do not do is send thank you notes, thank you letters, Now that's something that can be mailed. There's no reason to email it. It looks nicer if you do it on nice stationery and mail it out. Those I would mail, not email but people, dentists, don't track their new patients. They don't know who to send the thank you note to. That's crazy. You want more new patients. You're so rude that you don't even thank the patients that send you a patient. I think welcome letters and thank you notes are really big on my list of things to do.
I'm driving to work. I'm thinking about things to do about changing my practice. I would definitely put those 2 things high on the list. The other thing, and this is trite and everybody says to do this but nobody actually does it, is have the dentist do post-op phone calls. That is so powerful. I didn't like doing those at first either but patients really appreciate them. Patients don't say, "Oh my God, I hurt so bad. Blah, blah, blah." They appreciate the call. Even when they're in pain, they tell you they're fine.
Howard: You know what? Again, let's just stop right there. It's something about the personality because I called my patients that I beat up, pulled a tooth, did whatever. I'd call them from my iPhone. When I call them, they said, "Oh, is this your iPhone? Is this your cell phone or whatever?" They [inaudible 00:32:57] it because I would say at least every week, 2 or 3 numbers come up and I always know that it's a patient because it's not on my cell phone and it's are code 480. I answer it. It's always a patient. I'm always so glad I took the call.
I got a question or this or that. I just got one on Sunday. I had seen her but her daughter's friend had a wisdom tooth. She had all these concerns. I said, "You're fine. Just come in Monday morning at 9:00AM." My staff hates that because I don't know the schedule. I don't even really care. I figure we open at 7:00AM. That gives us 2 hours to figure out what we're going to do. If it gets crazy, we can always give them antibiotics or whatever the heck but I just make a religion out of availability. Other dentists, they're unlisted. You go to their website.
There's no email. You can't even email the dentist. They don't give out their cell phone. My card, which I can hold up right here that I give to every one of my patients, has got my email and my cell phone number. I tell them it's my cell phone number. Why does it not bother me that a freaked-out, sweetheart lady is worried about her daughter's friend's wisdom tooth? I generally wanted to talk to them. It made her feel better. Then I got a patient out of it. It ended up being for a wisdom tooth for $1,000.
Bruce: On the other hand, you've got most offices that don't even answer the phone 40 hours a week, maybe 30 hours a week. You're never going to get new patients. A long time ago I heard, and this is a long time ago, that the keys to a successful practice were availability, affability and ability.
Bruce: Availability, which you just talked about. Affability. Be a nice guy.
Howard: What's affability?
Bruce: Being affable means you're pleasant.
Howard: I don't think anyone's ever called me affable.
Bruce: I would call you affable. The last one is ability. Those are the 3 keys to success. In a nutshell, that's what I believe. That's a good one.
Howard: You were talking about ...
Bruce: You can use the same author.
Howard: You talked about being patient-focused. Define patient-focused because when I ask a dentist, I say, "Are you patient-focused or are you dentist-focused," and they say, "No, [crosstalk 00:35:28] often says they are. I say, "The Federal Reserve which has 3,000 economists," ... They did this huge study that says something like, "One-third of American workers cannot go to the doctor Monday through Friday 8:00AM to 5:00PM. Are your hours open outside of 8:00 to 5:00PM Monday through Friday." They go, "I'm 8:00AM to 4:00PM Monday through Thursday."
It's like, "Stop right there. Your own Federal Reserve with 3,000 economists says ..." If you've ever met an economists, these are people that don't have enough personality to become an accountant. They're just [inaudible 00:36:01] the data. This dentist is driving this car. She's sitting there in her Honda Accord. She like, "I'm totally patient-focused." Give her the criteria of what patient-focused would be.
Bruce: I have to think about that one for a minute. You know it when you see it. [Crosstalk 00:36:22] who said that.
Howard: You're talking about [crosstalk 00:36:24] in finding pornography.
Bruce: Pornography, yeah. It's true. It's the same with patient-focused. It's the same with customer service. You know it when you see it but there are some exercises like with customer service that you can do to improve things. I would say be human. I think that's a failing of an awful lot of dentists. It's interesting. We've seen an awful lot of dental offices. We can go into any office and fix the systems. We can work with the staff and fix the system but we find that in some offices, the real problem is the dentist.
Bruce: You know what? I don't know how to fix that. I wish that I did.
Howard: A lot of people ask me how come I don't have a chain of dental offices? I get that asked all the time. I also get asked a lot of the time why I'm not a consultant, why I just lectured, wrote books, tapes, whatever. My answer to that has always been, "I've never done anything I didn't want to do for money." I worked for my dad for 10 years. I'd much rather go to work with my dad who had a Sonic drive-in and a bunch of hot carhops making cheeseburgers and onion rings than stay home with my 5 sisters and play Barbie dolls. In fact, I felt sorry for him as I got older because when I was 10, 11, 12, he said, "No, not today," I would cry. He's like, "All right." Then he felt guilty because I was the only boy. I had 5 sisters. I just absolutely loved the actual work. Oh my God. I started thinking of my dad. I lost my train of thought ...
Bruce: I think a lot of dentists don't.
Howard: ... but the reason I didn't do in-office consulting is because you would go there. You would talk to the dentist. I don't know how you would do it. I seriously don't know how you would do it. Every dentist I talked to it's like, "You're the entire problem. Look in the mirror. Everything I tell you, you just argue with it. I can lead a horse to water but I can't get him to drink."
Howard: The other reason I never set up a chain of dental offices if because I always thought the unique selling proposition was the dentist/patient relationship. I don't see enough skills of economy, marketing, buying supplies and getting a good deal on a lab or ... That's not the competitive advantage. The competitive advantage is when you have a rocking, hot dentist who cares, has charisma and can explain and talk. You just can't stamp that out. I never saw a unique selling. I've had one little niche my whole life. My in-office consulting stuff, I just told the staff, "I think you should fire the dentist and hire an associate that will do what you say," because that guy is a ball and chain.
Bruce: It's sad. I wish I knew some way. Maybe electro-shock therapy might do it but some way to change the dentist. Sometimes it's the office systems. A lot of times it is really. You can help those things but when the rubber meets the road, it's the dentist. That's a very hard thing to fix. I don't know. Maybe somebody can fix them. I can't fix them.
Howard: In economics, if you want more of something, subsidize it. If you want less of something, tax it. Usually I think dentists more more motivated than physicians because if you're a physician at some big hospital and you're on salary, you really don't care but at least dentists are incentivized. They do know that if they do pay attention and figure it out, they can take home a lot more money. That usually gets them focused. That's why dentist, chiropractors and vets are far more business-oriented than your local hospital up the street because there are only so many owner/operators. What else would you tell this person? You told them, "Follow the metrics." You said awesome customer service. Get patient-focused. What else?
Bruce: Those are the biggies. Then put systems in place in the office. The dentist has to understand the systems. As I said before, the dentist should be teaching the staff how to use the software. The dentist needs to be involved at that level in order for the practice to be successful or you need to be an associate in a group practice or work for a PMO but I think if you're going to be the entrepreneur, if you're going to be in charge of managing that practice, you better understand how you're management software actually works. Don't delegate that to staff. I see all the time ... Are you okay there, Howard?
Howard: I'm okay. Just more [crosstalk 00:40:54].
Bruce: That won't do you any good. I see all the time dentists putting ads in for front-desk people, for example, that I want somebody with at least 5 years' experience with Dentrix, patient-based or whatever it is. That's crazy. You out to be able to teach that person how to use your software very quickly.
Howard: Doc, if you need to chase some incentives, you need to talk to my consultant friends. When they go into an office and hired as a consultant, about 50% of the time they find embezzlement. The doctor has no clue for the same reason. They don't even know how to run a report.
Bruce: That's the other thing. That's the other big thing, another big reason, why the dentist needs to understand the software and be able to run their own reports and not depend upon the staff. The other thing, you talk about where you've got her driving to work in her Honda there, what else should she do? She should record the way her staff answers the phone. You've interviewed Jay Geier. There's just a long thread on there about people being upset about Jay's advertising, which is a little bit over the top but I actually enjoy it.
's the guy several years ago ... This is a scheduling institute, for people that don't know. I'm not recommending his methods necessarily and certainly not advertising methods, although I find they're pretty amusing but several years ago he's the one that suddenly the light went on over my head listening to him to say, "We have to answer the phone differently. When that phone rings, that's a potential $10,000 case."
Just like you do the happy cat dance when they walk in, physically walk in, the front door, you've got to handle that telephone correctly. We have to stop looking at it as an interruption. Yeah, I understand it is an interruption. We're doing something. The damn phone rings. We have to answer it but we have to understand that our goal when we answer that phone is to schedule that appointment.
I would say 95% of the offices don't get that concept. The Scheduling Institute, again, I don't agree with all the stuff that he says but he's the one that, at least in my case, who brought that out and said, "Listen. Look at this thing differently." The other thing that he ...
Howard: Go ahead.
Bruce: Go ahead.
Howard: No, you go ahead.
Bruce: The other thing that's related to this is using checklists. Checklists, management checklists, and you can use clinical checklists too but management checklists, we're really bit on that because that just improves your outcomes. Anyway, having a telephone checklist, and again, this is on our website, that lists 1, 2, ... That's got 7 steps on there. It's on a little pad, the little yellow telephone that we used to have where you'd ask for their great-grandmother's maiden name and all this superfluous information that you don't really want, this has got the 7 steps that you go through.
It's a checklist for using the telephone but, again, we've got to record those calls and see how people really are answering the phone because I've got some shocking news for people. That is that people lie, including staff. They say, "Oh yeah, that's how we always do it." No, it's not the way they do it. "We always collect emails." No, they really don't. When you look at the numbers, they really don't do that. When you record the telephone calls, mystery calls, and find out how they really answer the telephone, it will really clue you in as to why you don't see more new patients. I think those are important things to do.
Howard: Humans always, always think what they want to believe. They can rationalize anything. It's the most complex thing in the universe is the human brain. I want to go back to Jay Geier because ... By the way, you said you watched me interview him. I haven't interviewed him yet but I just realized I should.
Bruce: That [inaudible 00:45:07] interview that you did with him.
Howard: He interviewed me.
Bruce: [Crosstalk 00:45:09] one of your podcasts.
Howard: Yeah but I should do a podcast. John, remind me to do ... I need to do that but I think what was interesting with Jay Geier, it's interesting how he put simple, stupid what he really discovered is that the dentist had 8 years of college. The hygienist had 4 years of college. My dental assistant, Jan, did a year of Apollo College dental assisting. These receptionists walked in off the street. Then they're not trained. He was just blown away.
I've been a client of his 4 years only because my best friend, buddy, dentist, who's right up the street from me for 28 years, Tom [Matter 00:45:49], he had been a client. I think he was a client with him 8 years. It took Tom 4 years of telling me, "Howard, you need to do this." They come in and tape the phone calls. I was blown away. You said you do Invisiline. The first phone call I listened to, my sweetheart ... I'm not going to say her name because I don't want to throw her under a bus.
She's been with me 15 years at the front-desk. One of Jay's phone jumpers said, "Do you do Invisiline?" She says, "I think we used to but I don't think we do that any more." Man, [inaudible 00:46:23] like, "What the hell," but I also believe this. I also believe this. People do things when they're private. You might pick your nose in the bathroom but you're not doing to do it at the dinner table. I think that the minute your staff realizes that all calls are recorded and that every ... I forgot how often they come in.
I think once a quarter Scheduling Institute comes in our office on a Saturday morning. There are 4 receptionists are there. I go sit there. They play back an example of a great call or a call you could have done differently maybe or a WTH, what-the-hell call. I think it's been powerful. Jay basically, he totally believes that when it takes 4 people to call you and want to be a patient for your receptionist to close 1. He said, "How much is a crown?" "$1,000." "Thank you very much."
They didn't even try to get them in the office where a trained person will say ... "How much is a crown?" "That's a great question. Can you come down right now because what I'll do is if you come down right now, I'll put you in a chair. The doctor will look at your tooth. He'll tell you what type of crown it is. I'll tell you how much it costs. We're at the corner of 48th and Elliott. When could you come down?" They don't even try to close.
Bruce: Yeah but the other thing that you see is [crosstalk 00:47:47] ...
Howard: The thing too is after I'm done talking to you today, I'm going to call Jay Geier and say, "I want to do you for a podcast."
Bruce: I think that would be worthwhile. What I started to say was that people say, "Let's hire somebody for the front desk," and very commonly throw them in and say, "Answer the phone, 'Dr. Stevens' office,'" and that's it. That's all the training they get. We have a list. Again, it's on the website. People can customize it themselves for frequently-asked questions
I know your office will be a little bit different than my office but you've got 10, 12 or 15 questions that come in all the time. That's one of them. How much is a crown? Those are shoppers. You should have a pat answer for that. Those things should just roll off of everybody's tongue. You can take a brand new person, give them the checklist. When they ask questions, they sit down, memorize these things, practice a little bit.
They're going to be much more effective on the phone. People don't do that. After you put the office together as a group and say, "A new patient on the phone. How much is the crown? How do you answer?" Go around and see. Boy, you'll get some interesting [crosstalk 00:48:57].
Howard: It's funny because they asked Thomas Watson, Jr., the founder of what we know as IBM, they asked him, "How did you get 70% of your market and become the leader," he said, "It's easy." He goes, "When I was starting computers, there was 7 different computers. No one knows computers. No one knows how to understand them. I knew if 7 out of every 10 people worked for IBM, we'd have 70% of the market. What we did is when we hired a new sales person, we put them through a 6-week training course.
He goes, "Everyone walked out with the same suit, the same briefcase, all of the answers. We all played so that when they walked in to fix a computer, they were trained." This guy only focused on the sales part and got 70% of the computer market. That type of sales cash flow allowed the R&D to build big computers but it's all focused on and it starts at the front desk. It starts with whoever answers the phone.
Bruce: Absolutely. Lastly, it starts with the website. That's another thing. We're talking to the person that's driving to work today. They need to understand how important their website is as far as new patient flow is concerned. We like to see half the new patients coming in as a result of the internet and the other half coming from existing patients but not spending any money in order to do that. SEO, search engine optimization, really is [inaudible 00:50:19].
What people ought to do as soon as they get to the office today is go on Dental Town and look up everything that Mike Barr, B-A-R-R in Florida, has written. Now he's written a lot of stuff about his 50-caliber machine gun. You don't have to read those but read the ones that he has written about websites and SEO. That's the only textbook that you need. I would suggest that dentists make SEO their hobby.
It's really kind of fun and make their website their hobby too. People spend an enormous amount of money to have these nice-looking websites but it's like putting your office sign-out in the alley behind your office. Nobody sees it. You need to get it out there where it's visible. That doesn't cost anything. You can do that yourself. That's another one of my pet peeves.
Howard: It's funny you said Mike Barr because I just interviewed him last week for a podcast. He'll be coming out soon. He is a great guy. By the way, what you said about is [inaudible 00:51:24] and all that stuff, on Dental Town we take religions and politics off today's topic but if you go to Leisure, there's a area there under leisure like arts, all these different things, movies, sports but there's a private form called politics and I want to say enter if not easily offended.
Another one's religion. Enter if not easily offended but we don't let those show up on today's active topics as ... It was during one Presidential election campaign between her and '98. Every time I opened up Dental Town, it was just like every other post was about the election. I said, "I just want to go to a dental house and talk with friends about dentistry but I know they have to vent politics." It is there, if you're that way.
I want to ask you a more focused ... There's a dentist driving to work right now. You've been crushing it for 38 years. You've got a todaysdentalconsulting.com. How would this person driving the car know if Bruce Stevenson is the fit for him? What would you do for me? How much does it cost? How do I contact you? Would I email you or would I call you? Do you have a canned program? Is it you come to my office 1 day a month for a year? Tell us what you do. Give us your elevator pitch.
Bruce: We typically do not go to offices. We do everything over the internet. One of the things that we do, like this with Skype, we use GoToMeeting but the same thing. One of the things that we do differently is to use GoToMyPC. You install GoToMyPC on your computer. We go in. Usually, we don't have enough computers so we can have our own in your office.
We'll come in on weekends, off-hours or whatever and download information. I want to see how you run your practice. I can see that getting the reports that we need, looking at the metrics that [inaudible 00:53:21], just looking at the way that you're using your software. That's where we start. You'll call me up and say, "I'm interested. What do we need to do?"
I say, "Go to GoToMyPC on your computer. It's free for 30 days. We'll come in. We'll take a look. Then we'll get back to you. We'll spend probably 2 hours actually looking at your office metrics and trying to understand how your office operates and then come back and have a 21-hour appointment with you." That's all free. That's our lost [inaudible 00:53:48] hour appointment with you. That's all free. That's our lost [crosstalk 00:53:55].
Howard: That's funny damn cool that you would do all that, that you would spend 2 hours on any of my listeners' computer, spend 2 hours, and then talk to the dentist for free.
Bruce: Typically, that's an hour introductory meeting and another hour when we come present what we see. It's probably only about 4 hours into it. The reason it works is because people at that point sign up with us. What do they sign up for? We charge flat rate of $1,100 a month. That's what it is right now. It may go up in the near future but right now, that's what it is. What you get are 2 meetings over Skype or over GoToMyPC with your whole staff but you also get a lot of what I call the iceberg under the water part where we're coming into your computers.
We're looking at what's going on in the office. We're doing 1-on-1 training or 1-on-2 training with staff or with the dentist. That's in addition to the staff meetings, the 2 staff meetings a month.
Howard: It's $1,100 a month. That's an amazing value but am I locked in for a year or is this month to month?
Bruce: No contracts.
Howard: No contracts.
Bruce: No contracts.
Howard: Let me tell you something. That speaks volumes of [inaudible 00:55:14] that you don't have to.
Bruce: Hey, why do I want to make an enemy out of you, if you decide that I'm not helping you? Fine. I don't want to do it if [crosstalk 00:55:25].
Howard: How do they contact you? What do you look for, email, phone?
Bruce: They can go to the website. There's contact information on there.
Bruce: Yeah or they can call Linda. She's (209) 603-9944. That's her cell. She's my partner in crime here in Today's Dental Consulting. We do the staff meetings together. She's in Manpika. I'm on Oakland, so we're 60 miles apart but the only time she ...
Howard: It's (209) 603-9944.
Howard: How long has she been in dentistry?
Bruce: 30 years. I hired her as a chair sided 30 years ago. Then she, like a lot of chair sides do, got promoted up to the front desk kicking and screaming. She was our practice manager for 20 years. She [crosstalk 00:56:15].
Howard: [Inaudible 00:56:17] Dental Town?
Bruce: Not too much but sometimes, yeah.
Howard: Do you think she'd be a rocking hot podcast?
Howard: If she wants to do it, if she wants to come here because the thing that I always wonder about a podcast, are they going to listen to 2 old dentists where maybe if it's a 25-year-old dentist, maybe Linda will be a better ... Maybe Linda will connect with our listeners better than you or maybe you'll get one market and she'll get another market but if she wants to do it, I'm all for that because I think the economy is top. As we are talking today, Greece is threatening to default.
The European, the Wall Street, the markets are ... It's just not easy. I don't get you for much time. I'm down to 4 minutes. I want to ask you a couple more closing questions. You say you rent space and you just do Invisiline. What do you say to the dentist out there listening when you know ... What percent of general dentists in America have never done 1 case of Invisiline? What would be your guesstimate?
Bruce: I don't know the number but I suspect it's quite high.
Howard: How high would you guess?
Bruce: I would guess it's probably 90% ...
Bruce: ... but that's a guess.
Howard: Okay but [crosstalk 00:57:31] 92.8% of all statistics are made up. Let's just agree to make up that 9 out of 10 dentists have never done it but I believe it's 90% too. I don't have a hard number. Talk to that person right now.
Bruce: It's crazy. You've got so many patients in your practice that ask you ... Think about it. How often has a patient said, "Can you fix these crowded teeth? I don't like these crowded teeth." What I used to say for 30 years was, "Yeah, we can send you to the orthodontist, You can have braces and he'll make them nice and straight." "No, I'm not interested in braces." Now you've got another tool.
Everybody knows Invisiline. The advantage of Invisiline is name recognition, brand recognition. Invisiline walks you through the cases, is easy. I did a little talk for a dental study club that says, "Why Orthodontists Should Not be Allowed to do Invisiline." I had a happy face at the end. I had 7 orthodontists show up just to jump on me. It was actually very congenial but it was very tongue in-cheek. My point was that Invisiline uses the skill sets that general dentists already have. Bond a little composite on the tooth.
Do a little IPR, inter-proximal reduction, easy things that we already know how to do. It's really staff-driven. The [inaudible 00:58:56] that I took with me from besides Linda from the other practice does all the work. I sit around and don't do anything, just like a real orthodontist. Why wouldn't you do Invisiline? People are put off by the high Invisiline lab fee but that's like gravity. You just deal with it. I'm sorry.
Howard: If you can't do an Invisiline case, I think it's time to just turn in your dental license and go home. Come on. You're not even trying. Don't come to me and whine about how hard it is and about the economy, Obama and all this crap.
Bruce: Even us old retired guys can do it.
Howard: I know.
Bruce: It's easy. That's why I'm doing it.
Howard: I have to lead my leaders on just to go to the bathroom. That's how old I am. Hey, but my last question. We're at 59 1/2 minutes. Your last question is this. There is a dental school graduate that's just graduating here last month in May. They're going to walk into a dental office like that kid walked into your office a long time ago. It turned out good where eventually after a year and he worked for you as an associate for 5 years. Then he decided I guess ... Then he bought the practice, ...
Bruce: Half the practice.
Howard: ... half the practice. You worked for him for 5 years.
Bruce: No, then we were partners for 5 years.
Howard: What advice would you give that young kid? They just walked out of school. They're about to go take a job with an old guy like us. Talk to that kid for a minute. Would you talk to a lawyer? Would you get a contract? Would you just take a job?
Bruce: You're just walking in right out of dental school or right out of a 1-year residency. I wouldn't be too concerned about buoying into that practice, even though Jason, and that's my landlord's name, when he came in and I interviewed him for the job, I said, "Listen. At this point I'm now looking for somebody potentially to buy into the practice." I never said that to an associate before. I said, "I'm not proposing we get married. This is a first date."
I think that's what you have to do when you walk into a practice is learn it ... Figure you're not going to stay in that practice. If you want to make up some statistics, the odds are you're not going to stay in that practice. Learn everything that you can. Learn the good and the bad and then move on.
You're going to apply what you learned in this practice with the next one but at some point where you're sure that you want to buy in and the senior doctor's sure he wants to sell, I think you have to bring in somebody with some experience in transitions. Often, that's a lawyer or a broker. Unfortunately, there's a lot of people out there that aren't very helpful.
Howard: We are out of time. I just want to say that I love the name of your company because my dental office is todaysdental.com. You're todaysdentalconsulting.com. I personally think if you're driving to work and you're stressed ... Einstein said the definition of insanity is do the same thing every day and expect a different result. Come on.
If you're driving to work right now, you're on the treadmill, you're washing your car and you're stressed and here's Bruce who just said, "I'll dial into your computer, look at your data for 2 hours, have [inaudible 01:02:20] call you and it's free," and your worst-case scenario is ... $1,100 a month. That's 1 crown, so just 1 crown a month to have a guy who's been around the block 10 times Skyping you and your whole staff 2 hours, 2 different Skype meetings a month, right?
Howard: Man, that's rocking-on value but I just want to end it on one thing. What you should really do to market this ... It sounds counter-intuitive. I can't believe more dental consultants don't see what I am seeing is that when I go to a restaurant, I order a pizza or I order a steak or I order fish. The dentist knows when they order. The dental consultant should go to Dental Town and put up a 1-hour course.
I think they don't want to do it because they think, "If I put up a 1-hour course, then everybody's going to see what I do. I don't have any secret. I'm not worth anything. I'll die out of business." It's exactly the opposite. The dentist looks at that 1-hour course and say, "Exactly but I'm never going to [crosstalk 01:03:18]."
Bruce: Let me say one other thing.
Howard: It pays to have you make a pizza and deliver it but they've got to see on that course what the pizza is because they don't want to sign up with you and be afraid that you're going to come in and say, "Oh, drop all your interns. [Inaudible 01:03:31]. Only work on moving stars." They want to know what you're going to do. You and Linda together should make a online C course for Dental Town.
Bruce: Okay. I will do that too. What I was going to say is we're very transparent about what we have. We have a whole list of what we call the beset practices. We have 24 things on there. We have our metrics and our benchmark metrics. Those are on our website. You can look at those things but we'll completely share that with you because that's not our job. Those are pieces of the puzzle. We'll give you the pieces of the puzzle. Our job is to help you put those pieces together. Our job is [crosstalk 01:04:09].
Howard: Implementation. Exactly.
Howard: When I go to your website, I just want to see the menu. I want to know I want the bacon-wrap fillet. You just don't want a surprise. I think you and Linda should make a course but I'm completely out of time. Seriously, Bruce, thank you so much for your hundreds of posts on Dental Town. You've been a member since 2008. You've been a member for 12 years. You have several hundred posts. I just think you're a rocking hot, awesome dude. Thank you so much for spending an hour with me today.
Bruce: Thank you, Howard. It's been a lot of fun.
Howard: All right. I'll see you on the boards, buddy.
Bruce: Take care.
Howard: I want to see that happy dance. I want to see [crosstalk 01:04:48]. I want to see you dancing.
Bruce: Uh oh.
Howard: Do you [crosstalk 01:04:52] and high heels?
Bruce: I can't promise that.
Howard: All right. Have a good day.
Bruce: All right. You too. Thanks.