Dentistry Uncensored with Howard Farran
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201 Why Microscopes? with Matthew Costa : Dentistry Uncensored with Howard Farran

201 Why Microscopes? with Matthew Costa : Dentistry Uncensored with Howard Farran

10/21/2015 12:00:00 PM   |   Comments: 0   |   Views: 528

"I'm using microscopes for 100% of my dentistry."

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AUDIO - HSP #201 - Matthew Costa

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VIDEO - HSP #201 - Matthew Costa

Matthew Costa DMD shares why he made a smart move using microscopes the way he does (plus it saves his back!).



I was born and raised just outside of Philadelphia. I got my Bachelors of Science in Biology from Temple University in 2004, and graduated from Temple University School of Dentistry in 2008. I practice general dentistry in Quarryville, Pennsylvania, with an emphasis on microscope-enhanced aesthetic restorative dentistry, surgery and endodontics.




Howard: It is a huge honor for me today to be interviewing Matt Costa who has 4000 posts on Dentaltown. I don't think there's a townie out there who's not a big fan of you. Thank you so much for giving me an hour of your time today. What made …

Matt: Thank you for having me.

Howard: What makes a guy like you share so much on Dentaltown? I mean, because when you look at the data, 99% just either ask a question or lurk. Then there's guys like you who share 4000 times. What do you think it is in your make up, your constitution, your personality, that makes you do that? Is it more being fearless or …

Matt: Yeah, probably on a part of it. I think a lot of it is just paying it forward. I mean, when I got on Dentaltown about six years ago or so, there was guys doing the same thing, and that's how I learned so much. I think it's just kind of a way of giving back and keeping the cycle going. People out there graduating need this information, and someone's got to keep doing it, so it's just a way to do that.

Howard: I'm a huge, huge fan of you and your posts and all that. You practice in Quarryville, Pennsylvania. You were saying that was a …

Matt: Yeah.

Howard: … in Lancaster County?

Matt: That's correct.

Howard: Is that closer to Philadelphia or Pittsburgh?

Matt: That's a little bit closer to Philadelphia, about an hour and a half west of Philly.

Howard: Then everyone wants to know, are you an Eagle's fan in Philadelphia, or are you a Steeler's fan from Pittsburgh?

Matt: Unfortunately, I'm a Philadelphia sports fan.

Howard: Oh, man, I can't believe you're an Eagle's fan after last night's Monday night football game. That was a wild game. Wasn't it?

Matt: It was a good game.

Howard: That was a wild game. In fact, they won it in what, like five seconds to go?

Matt: No time left, actually.

Howard: There was no time left when they won?

Matt: [Crosstalk 00:01:45] yeah.

Howard: Oh, God, that was a crazy game. You practice with an emphasis on microscope enhanced aesthetic restorative dentistry, surgery, and endodontics. I want to talk about that because …

Matt: [Crosstalk 00:01:56].

Howard: … you graduated in 2008. I came out in '87, and the big thing then was that, in '87, that you're going to be a lot better dentist if you got these 2.5X loops. It turned out to be true. Then that turned … went from 2.5 to 3.5 and 4.8, and now it's, like, forget that, it's like, let's do a microscope. So you're using microscopes now for what?

Matt: For 100% of my dentistry. For …

Howard: Oh my God.

Matt: … preventative dentistry, endodontics, oral surgery, basically anything, exams.

Howard: Do you wheel it from room-to-room, or do you got this hanging in the ceiling?

Matt: I have them hanging in the ceilings. I have two of them.

Howard: You work out of two rooms, and each room …

Matt: Mm-hmm (affirmative).

Howard: … has a microscope mounted on the ceiling. What kind did you go with?

Matt: I actually bought Globals.

Howard: Globals? And they're …

Matt: Yes.

Howard: … what? Out of Kansas City or St. Louis?

Matt: Yeah, Michigan or Missouri, something like that. I think Michigan.

Howard: Global's out of Michigan?

Matt: I think. Yeah, don't quote me on that.

Howard: Don't quote you on that? How long have you had these? Did you buy them at the same time?

Matt: No. I bought one about two years ago, was when I bought the first one, and then six months later I had actually adapted pretty well to working with it, so I just decided to buy the second one, because I didn't want to keep working out of one room. [Crosstalk 00:03:15].

Howard: That has always been a buy signal for me in dentistry, is the repeat business. You know? Like, I remember when I got out of school, they came out with this Nd:YAG laser and it's 50 grand, and they sold, like, 1000, and then went under. The one thing I noticed after sales of, like, 200 or 300 or 400 is that nobody was coming back and getting another one. Then you look at things like this where … like those take home sleep devices. A dentist will buy one, a stat DDS, and then, sure enough, you come back a year later and he owns three of them. You got a Global microscope hanging on the ceiling and within … How long did it take you to get the second one?

Matt: Six months.

Howard: Six months and you bought a second one. How much were these?

Matt: The first one was, I think, 27,000. The second one was about 19. I cut out a lot of the extra stuff on the second one because I didn't find that I … it was completely necessary to have, so I just bought a little bit more of a stripped down version to make it more affordable.

Howard: Generally speaking, what is the magnification you're working with? I mean, how many times …

Matt: From the scope it's like 6X.

Howard: You're basically doing 6X?

Matt: Yeah.

Howard: That's what you spend most of your time on?

Matt: Most of it, yeah, the majority of it, yeah.

Howard: I also know some of the dentists. Now, you're a younger person. How old are you?

Matt: I'm 33.

Howard: Yeah, you're a … I'm old enough to be your dad at 53, but people my age … I can give you lots of names of people my age doing this because they trashed their neck, their back, and they can't lean forward anymore, so they had to buy a $27,000 microscope by Global hanging on the ceiling just because they have to sit up straight and look ahead. Was ergonomics anything to do with this, or for you …

Matt: [Crosstalk 00:05:02].

Howard: … at 33, or was it just magnification?

Matt: No, absolutely, ergonomics was what pushed me over the edge, and it was neck pain. I started …

Howard: Really?

Matt: Yeah. I started going up in loop sizes, so by the time I get to 6X with the headlight on there, it got rather heavy, and then so starting to have cervical issues and stuff like that. I found that between the pain that I was having with my neck, and wanting more magnification, it just … It was, kind of, the choice was already made for me, so I just decided that I might as well jump in while I'm adaptable rather than trying to make that transition when I'm in my 50s and already having pain and used to practicing dentistry a certain way. It'd be a little bit easier just to go in and do it now.

Howard: Yeah, I used to get mad at my instructors notes because they made us wear gloves freshman and sophomore year on a model. We're like, "Well, is …" They said, "We don't want you to ever get used to touching these instruments without gloves on, because it's really going to throw you off when you're working on a patient. All of a sudden you've got this glove on for the first time."

Matt: Yeah, [crosstalk 00:05:59].

Howard: Do you think that dentistry was giving you cervical issues, or do you think it was the weight of the loops and the light on your head?

Matt: It was a combination of the weight, and I wasn't really practicing in an ergonomic position. I had the tendency to lean more with the loops on, so I just … I think, with time, and basically over that, it just … it ended up causing me pain.

Howard: You know, every lab man I know who's been doing it for more than 10 years, when they look at a full mouth reconstruction, you hand them the model, they can tell you if the dentist is right-handed or left-handed, and which way his head's hanging.

Matt: Yeah, which way they lean.

Howard: Yeah. We're all leaning. You know?

Matt: Yeah.

Howard: What position are you on this patient? Are you 12:00 behind, or …

Matt: 12:00, yeah.

Howard: The head's right in your lap?

Matt: Yep.

Howard: Right looking …

Matt: Yep, right in my lap.

Howard: ... right down the middle.

Matt: Correct, looking straight out, like you said. It's pretty comfortable. The chair has an armrest on it, so I'm just sitting there statically and very comfortable.

Howard: Did you have the same dental assistant before microscope and after? I mean, it …

Matt: Yes.

Howard: The same one? That …

Matt: Yes.

Howard: That kind of changes her world.

Matt: Yeah, she hates it. She absolutely hates it. It's completely in her way.

Howard: Right, right.

Matt: In reality, I mean, if I'm laid up in the hospital with a cervical fusion, she's not working anyway, so I think she'll take the tradeoff of having me healthy and being able to work, than having a crippled dentist that puts her unemployed.

Howard: My favorite joke with my assistant, Jan … I've had the same assistant for 20 years. Whenever the shine lady walks in, Valerie, I say, "Yeah, you guys sell CAD/CAMs and Microsoft. When are you going to start selling droids to replace Jan?" She just laughs. Sometimes I call her all the names of the Star Wars, you know, the CP … C3PO or CP3O or whatever the heck. Do you think it's increased your quality?

Matt: I think it has. Actually, what I think it did was, I think it shortened my learning curve more than anything. Things that would traditionally take dentists years' worth of experience to get used to seeing, perhaps looking at models, looking at things coming back from labs, I'm able to see it blown up, very easily with the scope, so I think that helps a lot more, not necessarily making you better, but I think it definitely helps with the curve.

Howard: You know Stevie Wonder would be making horrible crown preps.

Matt: Yep.

Howard: Everybody knows that you go from naked eye to 2X or 2.8 or whatever. I mean, I just think seeing is believing. I was talking to an endodontist the other day from Canada, and I was saying, "What are the keys to successful endodontics," and first thing out of his mouth was, "Loops, magnification, anything to see better, any …" Talk about the light of the microscope. You're seeing it 6X better, but there's more light, too.

Matt: Yeah, the newer ones have LED lights. They're extremely bright. You need more brightness as you go up in the levels of magnification, so typically you won't need a whole lot. At 6X it's about 25% of the way, 50% of the way up, but it is remarkably bright. I mean, it is very, very well-lit, and I think that's equally important as the magnification is having the light just shining everywhere where you're working. It makes it very easy to see.

Howard: How far down can you see in a canal when you're doing endo?

Matt: That varies. It depends on how straight the canal is, but typically you can get, if in a straight canal, and central and size are with a wide open canal, you can see straight to the apex. Molars not so much. I mean, you can the coronal third of it, maybe, at least for me, anyway. I mean, I'm sure an endodontist can probably see more if he's positioning it properly.

Howard: Seeing is believing and you … The other big question, did you find it slowed you down?

Matt: No, and actually I think it sped me up more than anything, because you're not constantly stopping and trying to reassess thing. I mean, basically you're able to process information visually, and so it allows you to just rapidly move through your progression. If anything, I think that it got me a little bit faster with … It's definitely counterintuitive to what you would think.

Howard: I think the … If I had to go back and look at all the time I spent with CEREC, CAD/CAM, I still would say that 90% of the overall positive everything I associate with that thing is seeing my preps 40 times bigger.

Matt: Yeah, it's humbling [crosstalk 00:10:24].

Howard: I mean, just … It is so humbling and it just … I mean, seeing is everything.

Matt: Yeah.

Howard: I mean, seeing is everything. I mean, I remember asking, you know, would you rather lose your eyesight or your hearing? I mean, you know, or your tactile sense in your fingers. I mean, to see that prep and you think, wow, and to look down in the canal and just seeing … Seeing is just, I mean, it's just damn near everything.

Matt: Yeah.

Howard: Do you use it during surgery?

Matt: Yeah. Yeah, believe it or not, I'll use it during surgery as well.

Howard: What kind of surgeries?

Matt: We do a lot of surgery in our office, extractions, obviously. We do implant surgeries. We do periodontal surgeries. I do some apicoectomies, things like that. I'm pretty much routinely using it, sectioning teeth, it's very, very helpful. Root tips.

Howard: Do you do all your surgeries sitting down or do you do them standup?

Matt: Yep. No, all of it sitting down. Yeah. I'm very lazy, so I like to be sitting down and not straining at all.

Howard: Huh, that is … I don't know why I have to, but I always stand up during surgery, and I always sit down during restorative, and I [crosstalk 00:11:26].

Matt: Yeah, my partner does that, too. He likes standing up for extractions and stuff, but I think it's whatever works best for you.

Howard: I guess whatever you got used to.

Matt: Yeah, pretty much.

Howard: Yeah, and just however you started out. You graduated in 2008, right?

Matt: Yeah, and that was a great time to graduate as a dentist.

Howard: Same year as Cory Glenn.

Matt: Yeah. Yeah, I guess so.

Howard: Yeah, 2008. You're young enough, you're experience, you're in that sweet spot where I'm afraid guys my age might not be able to connect with the recent grads, but let's switch to new grads, because I look at guys like you and Cory Glenn that just came out of the gate and got so far so fast and, I mean, it's just like … I mean, half the dentists in America will never be as accomplished as you two, and you guys just got out in 2008. I mean, and just a little 08' to '15, you guys are just amazing. Flip that around, what advice would you give to these kids? I mean, you can place implants, you can do apico, you're using a Microsoft. How did you get out of school and start on this path so that just eight years out you can do an acipoectomy, do surgeries, place implants? What was different about your journey?

Matt: This is the point where I would have to plug Dentaltown for you, so you smile a little bit there. I owe a lot of it, basically, to Dentaltown that plugged me into more information than I ever knew was out there, and would have taken me decades to accumulate that kind of continuing education, but I had access to it round the clock. If I'm sitting at home, just pop on the computer while I'm watching TV. I can go through the threads about anything, surgery, endo, restorative stuff, practice management, you name it. It was all there.

Everything was chronical, dialoged, so it was really good. It was really helpful. I just poured through the threads and it was … The best part about that for me was, as a new grad, it was free. It didn't take anything other than my time to sit down and go through it. Outside of that, I mean, it was, being willing to sit there and go through it, and spend the time on it. It was great.

Howard: How many points do the Eagles have to be losing by to when you would just switch to Dentaltown? What was the point mark where you say, "Okay, it's time to switch to Dentaltown?"

Matt: I casually divide my attention between … and I'll mute the Eagles and then watch Dental, and pay more attention to what I'm reading on Dentaltown, but …

Howard: You know what's funny is when they came out with the Dentaltown app, I forgot that I hated commercials. You know? Like, you'd be watching and I'm like, "Aww, a commercial." Now when a commercial [inaudible 00:13:55], I'm like, "Oh, cool," and I just pick up my iPhone and hit Dentaltown and start reading a thread. Then all of a sudden I realized, "Oh, no, it's back. The TV's back, and you got to put it down." Now I could care less about commercials anymore.

There's 2 million dentists around the world, and we only have 200,000 on Dentaltown, so we only have 10% of them, and the neat thing about these podcasts on iTunes and YouTube is they're … When I do an iTunes podcast, people are downloading it from every country on iTunes. What would you say to a dentist in Africa, Asia, Latin America who's saying, "What is Dentaltown?"

Matt: It's an online education forum. Basically that's what it is, and it's a way to connect to other dentists all over the world who are there for the same reasons, to discuss dentistry and discuss our careers, more or less, and learn from each other.

Howard: There's 53 forums. There's root canals, fillings, crown … Did you find yourself when you're out of school, if you had a problem you'd go to endo, or were you just reading today's active topics, and were you all over the board?

Matt: Yeah, I mean, mostly I would go through today's active topics and then when I got through all of those or I just wanted to see something different, I would go back into the different categories, and spend some time just going through the sticky endo tabs or the surgery ones or whatever, so just kind of slowly working my way through them, one after the other. Most of the threads on Dentaltown I've probably been through.

Howard: What other advice would you give to a new guy, because … Let me ask you a very specific question they're asking me. They're saying, "Howard, I just graduated with 250 to $300,000 student loans. Should I buy a practice that's $400,000, or should I go get a job at Heartland or Pacific Dental Care and take a job for a year or two or three and work some of this student loan debt down?" That's their first crossroad. What would you say? How would you answer that?

Matt: I think it depends on the personality. I think I would have gotten myself into pretty big trouble if I'd bought a practice right out of school, just because, you know, the cliché is that you don't know what you don't know, and I think that's really, really true in a lot of areas of dentistry, particularly with practice management. I think that just going and learning the ropes on somebody else's watch, I think it's really, really helpful. That would be my recommendation, is to just go get some experience wherever that may be, if it's private practice, if it's a corporate, whatever, and you'll start to get a feel for the stuff in dentistry that you like to do and that you want to continue to do over your career.

Howard: How long between your graduation in 2008 before you actually bought into your own practice? You said you have a partner?

Matt: Yeah. I'm in a group practice. I have three partners, actually.

Howard: There's four of you in one deal?

Matt: Yes.

Howard: How long between 2008 graduated and you signed the dotted line and became a partner?

Matt: That was four years.

Howard: Four years?

Matt: Mm-hmm (affirmative).

Howard: Did you work for this group the whole four years?

Matt: Yes.

Howard: You were an employee, associate, with them for four years …

Matt: Correct.

Howard: … then you pulled the trigger?

Matt: Yes.

Howard: You agree that … See, the other thing I don't understand is why a lot of people in Dentaltown badmouth going and work … taking a job in corporate dentistry. I still don't know what corporate dentistry means, because the CPAs tell me that pretty much every dentist is incorporated. I'm sure your guys are incorporated.

Matt: Yeah.

Howard: Back in the day when I got out of school, people would sign up for the Navy for four years and go sit in a boat in the middle of the Pacific Ocean to get experience, and we all thought that was a great idea. The thing I like about corporate dentistry is you're not in the middle of the Pacific Ocean.

Matt: Right.

Howard: You know? You're not away from land for six months. I don't care what city they're in, you're still on land. What about, the second most common question they're probably asking is, "Should I do a residency, or should I get a job?" What would you say to that?

Matt: I mean, same type of thing. I think it depends on the person. I think if you're comfortable and you feel like you're ready for your next step and you want to go, then go, but I … even a lot of my classmates, they didn't feel quite ready and didn't want to go out into private practice, so they did residencies or GPRs or … I think that's fine. I think it's just whatever you think you need to do to prepare yourself to be out in private practice, I think that's what you should do. I think there are a lot of advantages to it. There are some disadvantages to doing further education, but that's something that, I think, in the grand scheme of things, it doesn't set you back or … it doesn't alter your career all that much if you choose one over the other. I think either way is acceptable. You just got to figure out what best for you.

Howard: You worked in this group for four years, and now you've been a partner for four years.

Matt: Mm-hmm (affirmative).

Howard: Okay, so I'm going to throw this one-liner at you. People say, regarding partnership, they say, "Well, you know, you get married to a woman. You have great sex, great kids, and that fails half the time. You just turned around and married three other dentists platonically. You have no sex glue holding you together. You have no children. You don't celebrate holidays." How does that work? What's the glue in holding four people together without kids and family and holidays?

Matt: I mean, I think it's just a common goal. It's a common philosophy. You know? The practice has been in existence in the community for over 50 years, so it's just … It's basically a lifestyle for them, and that's kind of how it is for me, as well. You just go in and everyone's working towards the same goals. You know? We're helping each other out, and we're just trying to basically earn a living and serve the community, and keep the practice going.

Howard: How do you do things like, you want two microscopes for your two rooms, what if the other … Out of the other three people, how many of them use microscopes?

Matt: None.

Howard: Okay, so that's a classic example. Then they're thinking, "Okay, dude, you bought a $27,000 Global One, a $19,000 Global two," do the other three guys have to chip in on that, too, because you're one group, or how does that work?

Matt: Traditionally, yeah. Traditionally all of the equipment expenditures would be done as a group, but the scopes, that was the one thing that I specifically did separately, because I wanted them so badly, and I didn't … Knowing that they wouldn't use them at all, I didn't think it was really fair to have them cover portions of the bill, so I just … I bought those on my own and then figured, I'm using them, they're mine, I own them, no big deal. If our partnership goes bad, then I can still take them off the ceiling and off I go. I wanted to get into it badly enough that it just didn't matter to me, so I did them on my …

Howard: You said you knew they would never use them. Is that because they were old like me, or what was the …

Matt: Yeah, you know, old like you. One of my partners is 63 now, and the other one's 59, so they're a little bit more established in their careers, so I just …

Howard: By established in their career, means stuck in their old way and grandpa ain't ever going to change his mind?

Matt: More or less. You know, dumping something like that on those guys, I just knew it wouldn't be an issue for them, and they wouldn't … They 'd have no interest in it, so I just figured, do it on my own. It's not a problem.

Howard: It is so true. I mean, consultants, you always hear them talking about how they want these young kids to do this or that right out of the gate because everyone knows, if they start with this other technique, you're never going to change. It's kind of like golf. Do you notice everybody who's a great golfer, like Tiger, started when they were five years old? Then you start when you're in college and, you know, there's … It's so much easier to learn something right the first time then to learn something less than ideal and try to change it.

Matt: Oh, definitely.

Howard: Yeah, and that's probably the truth about scopes and just …

Matt: Yeah, I think so. I think it helps a lot to at least get exposed to it at a younger age. I think it's definitely helpful. I had some dental students up to the office over the weekend, and they were looking through them for the first time. They were amazed at what they were seeing, and I could tell, they were like, "Oh, this would be cool. I could definitely work like that," and I think it just … It helps because they don't have a lot of the biases that other dentists would that have been practicing for a while.

Howard: I want to ask, since you're working … since I'm 53 and you work with a 59-year-old and a 63-year-old, I want to ask about this. A lot of people our age are now getting associates and partners of your age. Is there any blanket generalizations … There's a lot of books saying that they think different ways. I mean, you have to understand how a baby boomer thinks versus their parents, versus the generation X and the millennials and … Do you think talking to guys my age, hiring guys like your age or younger out of school, do you think we see things differently just in life that we should know about? I mean, there's so many books and papers written on millennial thinking versus baby boomer thinking or …

Matt: Yeah, I think you're opening a can of worms with this one.

Howard: It is Dentistry Uncensored.

Matt: Yeah, it's … I mean, I don't know if I'd stereotype any of that, but there's definitely a generational gap that makes it different, and I think even just the fact that you're at different stages in your career is really what complicates it. I mean, most of the time these older docs are looking to get out of dentistry and to start looking forward to their life outside of it. Then, for us, we're looking to come into it and start our careers, so it's … you know, there are opposing forces sometimes, and what's in the best interest of the older doc is not in the best interest of the younger one, so that's … I think a lot of it's the issue of it is just that. You know? It's the two opposite directions.

Howard: Do you think there's a difference in work ethics? Sometimes you hear a lot of the older dentists screaming that, "Man, that kid, you know, he'll … The minute it's 5:00, he runs out the door, and he thinks his generation has a higher work ethic." Do you see a difference in work ethic, or not really?

Matt: No, not from generation-to-generation. I think that's something that's, regardless of the age of the person, I think some people just tend to work harder and work longer than others. I think that's just how it is.

Howard: Yeah? I do notice one variation of work ethic, though, but it's not age related, it's just birth related. I don't care what age of the game they are, if they weren't born in the United States, they work harder, longer, more hours. I mean, if they come here … If they were born in a very poor country, they don't blink at doing 7:00 to 7:00 Monday through Saturday.

Matt: Right.

Howard: They don't even see that as a … "What? Am I working a lot? Really? How is that a lot?" You're just like …

Matt: No, we're …

Howard: … "Dude … "

Matt: … definitely spoiled here, and I think that, you know, especially for dentists in America, I mean, if you think … if you say that you're working 45, 50 hours a week, they think that's a ton of hours to be doing. Now, doing dentistry it is, but I mean, in the grand scheme, working 50 hours a week is not all that much.

Howard: Fifty hours a week in Asia, they would think you were the owner. You know? Or retired. I mean, really. I mean, I've gone to Asia and, I mean, the average work business hours is sun up to sun down, six days a week. Then Sunday is your day to get your personal life clean and get all ready for the next … I mean, they just work sun up to sun down. I mean, it's just unbelievable. What other advice would you give the kids? Oh, let me ask this. Okay, so they got out of school, they got to know … They only know what they know. They don't know what they don't know. We both recommend they get some residencies, work in corporate America, join the Navy, be an associate. It doesn't matter.

Now they finally, they bought their practice. They own their practice. Let's just say they're alone, and they're trying to pay down this $250,000 student loans, and they're looking at $150,000 CEREC CAD/CAM or E4D from Planmeca. They're looking at $100,000. They're looking at a $75,000 BIOLASE. Address the big toys. What major purchases would you tell them to jump on?

Matt: None. I don't think they need to buy any of them. Those technologies are great, but they don't necessarily make you a better dentist at all. You can completely do without CAD/CAM. You don't need lasers, at least in the beginning. If you need a cone beam for something, you can … There's imaging centers that you can use. There's mobile centers. I just don't think that it's something that you necessarily need to go into buy. I think it's foolish to go into debt, and to compromise your business long-term, and to add stress to your life. I think it's crazy. I think, traditional dentistry, there's … it still works. It's still great, and I think that that's a lot … That's what I would focus on as a young owner. If I didn't have access to partners that helped me out a lot, that's really … I'd be doing a lot of, just, traditional stuff.

Howard: You have four people to share an expensive toy.

Matt: Yeah, exactly.

Howard: Did you guys have any expensive toys? I mean, did you buy any …

Matt: Yeah.

Howard: … of those?

Matt: We have a number of them. We have a CEREC Omnicam. We have diode lasers. We have Electrocon pieces. I have my scopes. We have stuff in the office, digital X-rays, so I mean we're pretty well-equipped, considering the expense of some of this stuff.

Howard: It worked for you guys because you're sharing it four ways?

Matt: Exactly, yeah. I mean, I'm only buying … I'm only paying for a quarter of any of that stuff, but the [crosstalk 00:27:04].

Howard: Yeah, and that's what my health care economist friends … I went to ASU, their MBA program, and those PhDs in health care economics and all that, that's what they say drove group practice in medicine is that when you … When MRI machines were coming out and they cost a million bucks, you know, one guy can't buy one, and that a lot of these toys, like CAD/CAM and lasers and CBCTs and all these big, expensive toys is really what's driving group practice.

Matt: Yeah, definitely, definitely.

Howard: It's not Heartland and Pacific. It's not Steve Thorne and Rick Workman creating something out of thin air. What the underlying forces were was that the overhead was going up higher and higher and higher, and …

Matt: It's a mutualistic relationship. Everyone's, again, going back to that, we're all working towards a common goal and we're all sharing in that expense. It helps us out. It defrays the cost over all of us, and it makes us more prepared.

Howard: I want to talk more about the group practice dynamics and the fact that, how do you do conflict resolution? One's 63, one's 59, you're 33?

Matt: Mm-hmm (affirmative).

Howard: How old's the fourth one?

Matt: Thirty-seven.

Howard: Okay, so there's two young ones, two old ones.

Matt: Pretty much.

Howard: There's two dentists who have two associates that could be their kids. Is that other one one of the kids of the older ones?

Matt: No, no.

Howard: There's no relation in there?

Matt: No relationship, no.

Howard: Is it a straight democratic vote? If you have an issue and three say we're going right, and one says left, you just … everybody just shuts up and goes right? How do you do conflict resolution? What do you do when four partners don't agree?

Matt: Fortunately, we haven't really had a situation where all … where we weren't in agreement. You know? I mean, I think it's … It is something that is somewhat democratic where we all have our own voices, but, I mean, a lot of it is … the reality, I defer a lot to the senior docs, too, because they have so much more experience, that a lot of the issues that get raised, I mean, I basically ask for their opinion right out of the gate and most of the time I'm willing to go with what they think is right, because they usually are.

Howard: You're humble and you trust them, so they've earned your trust, and you're a humble guy.

Matt: Yeah, pretty much.

Howard: Yeah, and that is the … When you're dealing with dentists, physicians, and lawyers, and CEOs of small and large businesses, everyone agrees that the one indicator that will predict who will be the most successful at the end is the humble guy. They'll listen to their employees. They'll listen to their customers. They'll listen to their stockholders. They listen. The belligerent guy is always the one who goes off the cliff. In fact, when he's going off the cliff, no one's even going to tell him, because at that point, everybody's hoping he goes off the cliff. You know what I mean? They're, kind of, like, pointing to the cliff, like, "Over here, over here." Amazing. That just seems like very special dynamics. Also, so you're in the small town of Quarryville?

Matt: Yeah.

Howard: How big … What's the size of Quarryville?

Matt: Population is about 2500. I mean, it's very, very small.

Howard: Oh, my God. That is really small.

Matt: Two stop lights, and that's about it. You know? I mean, it's very, very small, a lot of farmland, a lot of Amish community near us, so it's a very small town.

Howard: What is it like going to an Amish dentist? [Crosstalk 00:30:23].

Matt: Am I the Amish dentist? Is that what you're …

Howard: No, no, what is it like going to an Amish dentist with no electricity, no technology? What is that like?

Matt: I think that, yeah, I don't know. I could only speculate that it wouldn't be too much fun.

Howard: I grew up in Kansas and that, actually, I think, technically, has the largest Amish and Mennonite community in all of America.

Matt: Really?

Howard: Have you heard that?

Matt: No, I haven't. I …

Howard: Yeah.

Matt: … didn't. I know Pennsylvania and Ohio have pretty large communities, but I would believe that, yeah.

Howard: Everything I read growing up in Kansas, we had the largest population. I mean, and it was amazing, and what I always found the most amazing about the Amish is their work ethic. Holy crap. When disaster would strike, like if a tornado would come and wipe out 10 barns, not one of them blinked, and at sunrise the next morning, they're all ready to go, sun up to sun down, seven days. I mean, the guys … I mean, you just have to applaud their work ethic.

Matt: Yeah. That's why I …

Howard: [Crosstalk 00:31:18].

Matt: … try not to complain too much about the hours that I'm putting in at the office because a lot of my patients are Amish and I'm … they're outworking me by a long shot.

Howard: Oh my God, they work hard. Is it fair to say in a town of 2500 you really wouldn't have to market advertise? I mean, how can you live in a town that small and not everyone know all the players and all the businesses in the town? I mean, do you guys …

Matt: Yeah, we [crosstalk 00:31:39].

Howard: … do much marketing?

Matt: No, really don't do a whole lot of marketing. Most of it's all internal and word of mouth stuff. There's a couple other offices in the area, but basically it's just, we have enough patients and we show up to work, and we haven't had the need yet, [crosstalk 00:31:54].

Howard: Now, were you born in that town, born and raised?

Matt: No, I wasn't. I wasn't. I was …

Howard: Where were you born and raised?

Matt: Just outside of Philadelphia, a town …

Howard: A suburb of Philly?

Matt: Yeah, pretty much.

Howard: How far away is Quarryville from Philly?

Matt: About an hour, hour and a half.

Howard: Where I'm going at is, it's pretty obvious that about almost 2/3 of all the dentists go to the urban areas where half the people live in America, and about 117 metros, and then only about 1/3 go to where the other half live, in the 19,022 small towns, and just … if you just divide dentists by that one divider, everyone that goes rural makes more money than everyone that goes urban, because economics, in three words, is supply and demand. My question …

Matt: Right.

Howard: … to you is, are you married now?

Matt: Yes.

Howard: Was she from that small town? Was she from Philly? Was that …

Matt: She was from a different suburb of Philly and then, you know, we got married and obviously went through dental school together and …

Howard: Oh, she's a dentist?

Matt: She's a dental hygienist.

Howard: A dental Hygienist?

Matt: She's close. Yeah. Then she had just about enough of the city as I did, so we kind of figured we'd go to a little bit quieter area, a little bit more rural [crosstalk 00:33:06].

Howard: So she was kind of burned out on the big city?

Matt: Yeah, pretty much.

Howard: Yeah?

Matt: We mutually agreed that we'd move somewhat out. I was fortunate enough to find the office that I'm practicing in through a contact at Henry Schein in a practice transition consultant. It just led me out there. In the beginning I was commuting. I was driving, which took about an hour, and basically we moved out closer now, so I'm about 25 minutes from my office now.

Howard: That's why these podcasts have exploded, because what I picked off is the hour commute crowd. In fact, that's why they're an hour long. People ask me, "Well, why are they an hour? Why not 15 minutes, hour and a half?" It's because I asked them, and almost everyone told me they have an hour … Everybody that was listening to a podcast, whether it be dental hacks or a thriving dentist show or whatever, was saying, "I have an hour commute, every morning, every night, and I'm tired of talk radio, and you can only listen to U2 and Pink Floyd so many times." They just love this.

Now you were an hour and a half out from Philly, so now you're an hour from Philly and now you drive another half hour to your practice?

Matt: Yeah, more or less.

Howard: Where does your wife work for hygiene, in your …

Matt: She just temps in offices, because we have young children, so she took the time off. Now she's just doing some temping.

Howard: Yeah?

Matt: Mm-hmm (affirmative).

Howard: Does she like the small town, rural area?

Matt: She does, yeah. She likes the small community. She likes knowing people and she hasn't complained yet, so I think I'm on the right track.

Howard: You found a non-complaining hygienist?

Matt: Yeah.

Howard: No wonder you married her. She might have been the only one. You found the one non-complaining …

Matt: [Crosstalk 00:34:40].

Howard: … hygienist, so you thought, what the hell, I better just marry this one.

Matt: Don't bother looking. I got her.

Howard: I always like to ask hygienists, "Who's crazier, the dentist or the hygienist?" They just, "Yeah, go to a bar and ask three hygienists who's crazier, the hygienist or the dentist?" They'll all tell stories until midnight, but their physicians are convinced it's the nurses, and the nurses are convinced it's the physicians. The hospital stories are even more batshit crazy because there's so many of them in the hospital and it's 24 hours a day, 7 days a week.

Matt: Good [crosstalk 00:35:10].

Howard: What other advice would you give? We both agree on so many things. They just got to go rural. I mean, and where I see the people that's going happiest to rural is they've already got their personal life in order. Like a kid that comes out of dental school and he's Mormon, LDS, and he's already got a wife and two kids, he doesn’t need Hollywood. He doesn't need the big nightlife and he's …

Matt: Right.

Howard: At evening he's just going to be with his family, anyway, and you'll point him to a small town of 2500 people in the middle of Iowa, and they'll go out there and do a million dollars the first year and take home 400, but his single friend who wants to find the girl and goes to North Scottsdale where there's a massive nightlife, restaurants and shops on every corner, and three dentists on every corner, and they just do nothing.

Matt: Yeah.

Howard: Do you think, in order to go rural, you have to have your love life in order? I mean, do you think you could have gone to the Quarryville and found the love of your life?

Matt: I don't see why not. I don't believe [crosstalk 00:36:15].

Howard: First of all, let's check. Is your wife ever going to be listening to this podcast?

Matt: Probably not.

Howard: Okay, she's probably not. Okay, so then tell the truth, could a guy leave dental school in Kansas City or a big city and go to something like Quarryville single, and still have a life?

Matt: Yeah. If I was single I would have followed the same path, I think. I would have went rural and just figured out a different way to have an enjoyable nightlife if that's what I was after. I don't think that it would have restricted me in any way, but I think having stress at the job, if I was living in the city with a good nightlife and being broke because I didn't have any patients to treat and just not doing … having a fulfilling career, I think that would have been much, much worse. I think, yeah, I mean, if I was a bachelor, I would have done the small town, too, no problem.

Howard: If you couldn't have found a woman in that small town, would you have done a mail order bride from Russia or China?

Matt: Russia.

Howard: Russia? Okay.

Matt: [Crosstalk 00:37:08], yeah.

Howard: We'll put that in the notes. Got make memory. It is Dentistry Uncensored. What other advice would you give these young kids? We both agree we're old. We both agree, you know, what else?

Matt: I think just, I don't know, just practice. Find a place that you can go to work and be somewhat enjoyable about it, and then try to get a little bit better every day. Read what you can, go on Dentaltown, learn what you can, and just keep practicing.

Howard: I want you to go back to … You named that you found a consultant, a practice transition, from Henry Schein, which is, like, one of the largest dental companies in the world. I mean, there's Schein, Patterson, Danaher, now the Dentsply/Sirona merger. Talk about … That might have flown over a lot of their heads. What were you talking about Henry Schein? How did you …

Matt: It was a [crosstalk 00:37:59].

Howard: What are you talking about?

Matt: That was [crosstalk 00:37:59] scenario for me, because it was actually my senior year in dental school. We had a lecture form a transition consultant who was talking about how we would go about finding associates and things like that. At the end of the class I went up to her, because she had been working in the area. I asked her if she knew of any practices, and she just so happened to know about the office that I am currently in. She said, "Well, you know, give me your CV and I'll pass the information on." That's how it works. It was pretty fortunate circumstances that led me to that one, but there are consultants that specialize in job placement and transitioning practices.

Howard: Henry Schein has this department?

Matt: Yeah.

Howard: Henry Schein … Do you know what it's called? Do you remember?

Matt: Not off the top of my head, no.

Howard: Just go to the Henry Schein and … Henry Schein Practice Transition Consultants?

Matt: Yeah.

Howard: And they could go to the …

Matt: [Crosstalk 00:38:52]. Yeah.

Howard: Yeah. I love their CEO Stan Bergman, and the reason I love their CEO is twice I've been on some charity dentistry out in the middle of Timbuktu, out in the middle of nowhere, and you're literally in the jungle, and then out of nowhere, here's this little building, completely equipped with six observatories, like I was in your office or you were in mine, with this little bitty sign, donated by Henry Schein. You know what I mean?

Matt: Yep.

Howard: I mean, Stanberg, I mean, he's a saint.

Matt: Mm-hmm (affirmative).

Howard: I mean, I worked on a … in a orphanage in Africa, and he completely decked the thing out. I'm just, like, "Why here? Why … Who did this? Why? How does this even happen?" It was Stan "the man" Bergman. He is an amazing man. He definitely gives back. When you're a young dental student, and you're out there, and this Henry Schein practice transition specialist gives you three names, knowing what you know now, when they're interviewing the dentists, I mean, they probably think they're trying to get a job. They're hoping that the associate hires them, but whoa, whoa, whoa, whoa, maybe you don't want to work for them. What would you say the red flags are for this dentist? Just because someone hires you doesn’t mean you want the job. What should these young dental graduates be thinking about when they're applying at a office?

Matt: I think that you need to be considering the ethics of the office and how treatment plans are going to be getting set up, what types of things you're going to be asked to do. At the end of the day it's going to be your license, but you need to get a feel for just how the office is going to flow, and how they're going to treat you as a dentist, or a doctor, if they're going to … If you're just going to be there to produce for them, then that's one you need to run from. Obviously if you're going to have a little bit more latitude with some of your treatments, and it's probably not going to be a bad scenario for you to be involved with.

Howard: Be more specific. You're saying that … Did I just hear you say that if they do the diagnosing and treatment plan, and you're set out to do the production, that's what you run from? Is that what you said? And then if you have …

Matt: Yeah, [crosstalk 00:40:54].

Howard: … more say in the treatment plan …

Matt: Yeah, I think the …

Howard: What do you mean by that? Because I know a young … How does a young dentist … she's 23 years old. She walks in the office. She sits down there. How does she figure out if Howard and Matt are ethical or unethical?

Matt: That's tricky. You usually don't know that until you're already working there, so it's something that you kind of learn on the job, but I think that I would ask … One question that I would ask would be if something was in my schedule, a procedure for me to do, if I didn't feel comfortable doing it, how is that going to fly with the management? Is that going to be something that's acceptable to them? Or is that going to be an issue that I'm not following the laid out procedures? I think the right thing to do is, if you're not comfortable doing a procedure, you should always have the option to not do it. I think that's important. That would be, I think, a big hang up, and that would be, probably, the first question I would ask.

Howard: A lot of the early … these corporate dentistry chains have changed business models a lot. When I got out of school, what they would do is they would find the most aggressive treatment planning dentist to do all the new patient exams, and all the hygiene exams. Then all the shy, quiet, zero personality dentist doing the drill, fill, and bill. They were all sitting back there doing dentistry that they didn't agree with the treatment plan at all.

Matt: Right.

Howard: It caused them mental anguish, and as soon as they could find another job, they went. That business model I've seen. It is, for the most part, destroyed. You almost don't see that business model anymore, but I … My red flag, my best red flag, is to go around the office and just ask, "How many times has the dentist been married?" Then go around and ask each staff member how long they've been there. By the time the dentist has been married four times and no staff has been there more than two years, they … he needs to be taken to the vet and just be put down. That's why in office consulting is so horrible, because all the people that would benefit from a consultant think they can't afford it, so they don't buy one. Then a lot of the consultants that go in there, the dentist is blaming Obama and the economy and the high … just blaming everybody and everybody's just looking at this dentist, like, "Well, you're a nut job." You know?

The consultant really needs to be a Dr. Phil, so I … it's just so bizarre that everybody who has a million-dollar practice, a million collection taking home 3 or 400,00 is always hiring consultants, and then the dentist that's doing 250 and doesn't know what they're doing, and if they just hired any consultant who's been in the biz for 10 or 20 or 30 years, someone like Sandy Pardue, can just double their office overnight, and they look at that and say, "Well, that costs money." It's crazy. Find out, how many times has the dentist been married, and how long has the average staff been there. When you go around an office and you meet really, nice, warm people, and they've been there 10, 20, 30 years, that's the story right there.

Matt: Yeah, that's pretty [inaudible 00:43:54] and that was the case when I got to my office. Some staff members 20 plus years, most of them 19, 17, you know, across the board they're lifers. They've been there forever. That's pretty telling of the kind of docs that they're working for.

Howard: Yeah, but there is some special circumstance with an asterisk. If you're in a small office, like say it's a doctor and one girl that's been there 20, and then no one else has been there two, she's the psycho that runs everyone off, and she's usually either sleeping with the dentist or embezzling with the dentist, or treats the dentist like God, and then the minute he's gone turns into Godzilla with his staff. That's a red flag there. You place implants?

Matt: Yeah.

Howard: How do you go from … Address this concern. I graduated from XYZ Dental School and I never learned how to place an implant. How am I going to go from, I've never placed an implant to Matt, who places implants? How do you go from never to doing it?

Matt: You got to take a continuum of some kind, usually, so [crosstalk 00:45:01] …

Howard: Did you do a continuum?

Matt: Yeah, I did. I did one through Hiossen which was [inaudible 00:45:04]. That's a company, but they were based out of Philadelphia, so for me that was very convenient as far as travel-wise goes, because I did it when I was relatively a new grad, so costs were a concern for me, obviously. Just getting educated on it, and usually … There's a number of them out there that you can do, but I think that's step one is just going and learning about it a lot more.

Howard: Now, Hiossen, that's a Korean company, though, right?

Matt: Yeah, yeah, that's …

Howard: You said they were out of where?

Matt: They're out of Philadelphia, just outside of Philadelphia.

Howard: Is their U.S. headquarters?

Matt: Yeah, and they have a distributing branch there, yeah.

Howard: Yeah, and Gordon's big on that.

Matt: Yeah, [crosstalk 00:45:42].

Howard: Yeah, he lectures for them all the time. Spell Hiossen.

Matt: Oh, didn't know. Yeah.

Howard: Spell it.

Matt: H-I-O-S-S-E-N.

Howard: Why did you pick that, was it the training and this? Was it price? Was it convenience? Was it …

Matt: Yeah, they had it … It was actually because of a doc that I had met another CE course. He was on faculty there. Through that course I had come to respect him, and I just asked if he had any suggestions because I was interested in it. Then he let me know, he's like, "I'm on faculty at Hiossen. It's a good course. You can come do it. We do a live surgery and stuff like that." I ended up taking that, and I was pretty pleased with it. It got me enough to get started.

Howard: How long was that continuum? How many times did you have to go there?

Matt: It was several weekends. I think it was four weekends or something spread out over a couple months.

Howard: Of your four dentists in your practice, how many of them surgically place implants?

Matt: I do probably 99% of them. My other partner will place some of the simpler ones that he feels comfortable doing.

Howard: That's neat. You have a referral base that's in your own practice.

Matt: Yeah, pretty much.

Howard: Is this a big part of your practice?

Matt: Yeah, surgery is, yeah.

Howard: Surgery is?

Matt: Mm-hmm (affirmative).

Howard: This is another thing I don't know how to answer when a young kid will come up to me and they'll say their practice is flat and they basically do cleanings, exams, fillings, single crowns, CEREC, whatever, and then I see that their for endo and surgery and implants is zeros. Then I don't know if this is a generation gap or what it is, and I'll say, "Well, you know, you need to do endo," and they say, "Well, I don't like blood. I don't want any blood or surgery." I'm always thinking, well, how the hell did you pick dentistry?

Matt: Yeah.

Howard: I mean, shouldn't you be an electrical engineer working on my iPhone? I mean, how do you … I don't believe it. Do you think they obviously wanted to be a doctor and all doctors do surgery, and they just got scared and can that be psychologically turned around, or do you think someone really signed up for med school or dental school and didn't want to touch a human body, or see one bleed?

Matt: I can't imagine that someone would go in thinking that they wouldn't be coming across blood or bodily fluids of some kind. I mean, that'd be pretty bizarre to me, especially, I mean, dentists, we're up to our elbows in spit and blood and hopefully that's it, but you never know.

Howard: It's tough when you're bald, because you can actually see the blood spots on your head when you come home. With your hair, you just don't know it's in there, but when you're bald …

Matt: Yeah, because I grew …

Howard: … you come home and you're like, "Oh, my God."

Matt: Just massage it in.

Howard: There's blood on my head.

Matt: Yeah. Use it as volumizer.

Howard: Do you think that can be turned around, or do you think …

Matt: I do. I mean, I think that's probably a comfort thing, and just a matter of desensitizing yourself to it, seeing it enough, and doing it enough, eventually you'll get used to it. Human beings can get used to pretty much anything. I think a lot of it's just overcoming those initial fears and just getting into doing it, at least to some degree, you know, doing some of it.

Howard: You say you picked Hiossen because it was referred by one of the faculty continuum, and it seems to me all the implant research people say, "Titanium is titanium is titanium." You know, there's no [osteol 00:48:50] sites. Who really cares if the titanium is made by Nike or Reebok or whatever? It sounds like you picked your implant company from an instructor of the training program.

Matt: Mm-hmm (affirmative).

Howard: Do they have a rep in your area? Do you have a human relationship, like a rep, or do you deal …

Matt: Yeah, I …

Howard: … with these people mostly online?

Matt: Yeah, they have reps. They have local reps. I don't deal with them too often. At this point, now, I just … when I need to place orders and stuff like that, I just e-mail them in and say, "Process these and ship them out to me." That's usually pretty adequate. At this point we have a comfort level with ordering parts that we really don't need a rep to come out and hold our hands, so we don't need the kind of contact that they can offer, but …

Howard: Where is Hiossen's training facility?

Matt: I think they do several throughout the country. There is one in Philadelphia in Jenkintown.

Howard: In Jenkintown? And that's where you went to school, and you're only an hour away, so …

Matt: Yeah, I was pretty close, so it was convenient for me. I think they do them in California, I know, pretty much all over the country.

Howard: Their training facility, was it at their actual building, or did they just have a dentist, oral surgeon, periodontist …

Matt: No, I think they rented a space, like a conference center, and they did their lectures and stuff out of that, and then when it came time to do the surgical components, we went to one of the faculties' offices, and we had a patients go there.

Howard: Because, you know, I'm always trying to separate the wheat from the chaff of what makes guys and gals more successful than others, and getting it down. It seems like with the rep, like, say it's, like, [Tarune 00:50:18], he uses … [inaudible 00:50:19], he uses the most expensive one [inaudible 00:50:21] car, but he doesn't care about that. He's in love with the rep. You know? The rep is what's getting it all done. It seems like the people that are placed are getting it done. People that sit there and say, "Oh, yeah, I place them. I do them," and in your case, at a group practice, you do 99% of all the implants for four doctors, they always have some human connection. You know? Here was a teacher, it was only an hour wait, it was where you went to dental school or born and raised, or whatever, but there seems to be a human component.

Then I think the imaginary mind, they want to go online and save money and buy some implants made in Russia or Israel or Istanbul, and they're saving money, but it just never seems to take off. They just never become implantologists. I think social animals need a human, a friend, a buddy. You know?

Matt: Especially if they're …

Howard: It gets done.

Matt: … just starting out. You know?

Howard: Yeah.

Matt: I think you need support around you if you're … With any discipline in dentistry, I think you need support in the beginning to reinforce what you're learning and what you're practicing. I think that's really, really helpful.

Howard: It's the same thing, the people saving all their money on gauze and buying them online and hoping Amazon gets into the business. They don't get it. I remember when I got out of school, whenever I'd have an argument with my rep, Al Hughes, and say, "Well, Al, that won't work because of this or that or that," and he'd say, "All right. When do you have an hour and a half?" I'd say, "Okay, lunch. Right now, today, lunch, and I'll be back to my next patient at 1:30." Then he'd get in the car and he'd drive me to four offices, to his buddies, that were … You know, I was a young, dumb, 24 punk kid, and he's introduced me to 40, 50, 60-year-old guys. It's, like, "No, Howard, this is how I've been doing it." You know? That's what was getting it done, so he could get the decision done in my walnut brain in 90 minutes, because I had a human, that I don't know how I would have done that saving 12 cents on gauze buying them online.

My rep, Valerie, I mean, you can ask her an endo question and she'll say, "Okay, well, these endo file … Here's the endodontists that use this endo file. Here's the endodontists that use this endo file." You know what I mean? Then you can, "Well, do you got the number to that guy?" Yeah. The next thing you know, you're talking to some endodontist who's done 10,000 molars with this system. I mean, it's just, humans need humans.

Matt: Definitely.

Howard: Yeah. Okay, so I only go you for seven more minutes. Let's switch to endo, because we talk a lot about implants, but endo, what's sexy about endo is that you don't have to sell it to the patient. They come in, they're in pain.

Matt: Yeah.

Howard: It's not like I'm trying to sell you a veneer case or Invisalign, and dentists just don't like to sell. They're not made for it. If what got you to the party was getting As in math and physics and chemistry, you're probably not naturally hardwired for sales. Endo, they come in. They're asking, "Matt, will you fix me? Will you help me? My insurance will pay 80%, and Matt, the bottom line is, half the dentists out there won't do a molar endo."

Matt: Mm-hmm (affirmative).

Howard: Talk to that kid. She's telling me that she's got $250,000 in student loans, but I'm looking at her production. It's like, she refers out all of her endo to 4000 endodontists. How does she go from, "I don't like blood and guts. I want to bitch about a quarter of a million dollars in student loans, but I ain't doing molar endo because I don't like blood"? Talk to that woman.

Matt: I mean, typically, I would assume that, in that situation, you would probably have an ample amount of time on your hands, so if that's the case, I mean, would you rather sit around and do nothing, or would you rather sit around and try to get an endo accomplished? You can always refer it if during the procedure you just can't do it, and you're physically limited and you just … you have to refer it out, but I see no reason why you wouldn't, at least, try to expand your skills, and try to get better, and try to, at least, pick some cases that are a little bit more manageable and try to do.

Howard: What training would you recommend?

Matt: Training?

Howard: Yeah, education. If she wanted more endo education, where would you recommend?

Matt: Yeah, I mean, you can … some of the big names like Buchanan, some of these other guys. I mean, there are a lot of training facilities with endo where you go and work on extracted teeth, look through them, look through scopes and stuff like that. I think just pick and choose. Just go, get something, and start learning how to do it. I mean, a lot of them, there's overlap in pretty much any of the camps that you're in, regardless of who's training you. There's similarities, so you'll get where you're going just by picking one and trying to learn.

Howard: I would also always recommend this, you know, never forget that, that is, we all got into med school and dental school and law school because we sat in a library and didn't have a date or a girlfriend or a life, and we made straight As, so they're all shy, conservative people. Every time it's counter … success is extremely counterintuitive, so let's say you want to do endo, and you think in your small town, well, that would make the endodontist mad, because the endodontist wants to do all the endo. It's exactly wrong. If you call that endodontist and say, "I can't do any endo. I want to learn how to do endo. Can I come and be your assistant and will you teach me how to do endo?" He'd just light up. I mean, everybody wants a friend, a dog, a cat. Humans all want friends. Then that endodontist is probably thinking, "Well, right now you don't send me any. If you sat in my office for several afternoons on Friday and became my friend, I'm going to get something. I'd rather have something instead of nothing."

All [inaudible 00:55:37] specialties work like that way, except for, of course, orthodontists. We all know that. The oral surgeon assumes you'll pull the easy tooth, and you'll send him the wisdom tooths, you know, all [inaudible 00:55:46], but the orthodontists, if you ask them how to just slightly rotate number eight, he'd probably have a stroke. You know? The orthodontists don't want you to do any ortho, but [crosstalk 00:55:57] …

Matt: Our orthodontist is happy. I don't do any ortho.

Howard: Yeah, yeah. Yeah, but they don't see the business model of send them all the hard stuff and you do the easy stuff. They just don't …

Matt: No, I think with any of the disciplines, you become a better referrer the more you know about it. It's like …

Howard: I know.

Matt: … some procedures you're going to be better. You're diagnosing's better, I mean, so just you end up just being a better general doc and a good referrer, usually.

Howard: Yeah, every … all the serious people that look at the ortho education, it shows that the GPs who learn ortho, half of them will … They all refer. They all start diagnosing more ortho. At least half of them quit doing it themselves after they've done it for a year or two. They just learned and moved on, and realized they were more productive doing crown and bridge, but it's the diagnosing and the treatment planning. If you [edumacate 00:56:46] someone in diagnosing and treatment planning, they just become much better referrals. You got to think …

Matt: Yep.

Howard: You can't go through life thinking in fear and scarcity. You have to go through life thinking of hope, growth, and abundancy, and if you want the best training on implantology, root canals, then just start calling a local person that you don't even know, because chances are he's going to be an introvert geek, and wants a friend. Just say, "Can I come watch you," and they say, "Yes," almost every time. Then you get a relationship. You have a buddy, and then it just gets done. If you have a buddy that knows how to do this in your town, you're going to be doing it.

Matt: Yep.

Howard: If you try to do this, all … That's why we started Dentaltown. When I saw the Internet, I was like, "With the Internet, no dentist should ever have to practice solo again." If you get a buddy, you get a friend, and you start talking, it's going to get done, but if you're going to do it all by yourself, while you're sitting in your closet, you can think about it for 40 years, and it's never going to get done. Like I challenge this, if some dentist near you said, "Matt, can I come by your office and watch you place an implant?" what would you say?

Matt: Absolutely. Yeah, without a doubt.

Howard: Would you think that would be fun or stressful?

Matt: Fun, more than anything.

Howard: Yeah.

Matt: Yeah.

Howard: Would you go out drinking before the implant placement surgery or after?

Matt: During.

Howard: During? You would drink during the deal? That is just …

Matt: During.

Howard: … awesome. I think I'm going to fly out there to Quarryville myself. Hey, Matt, that's our hour, and I just want to sit there and say, "Seriously, 4000 posts on Dentaltown. I mean, God, dang, that is just … That is amazing." I mean, I just can't … I didn't start Dentaltown. Dentaltown is only because of guys like you. If there wasn't a bunch of guys like you posting all of that content, Dentaltown would be … Google says there's 300 million websites, and every dental website I go to is just a flyer for some company. You know? I can go to any website and it's just a flyer. I mean, it wouldn't matter if it was in my mailbox. But Dentaltown is only special because guys like you have posted 4000 times, and for that, dude, I just tip my hat, from the bottom heart. Thank you for sharing so much.

Matt: You're welcome.

Howard: You're doing it again, sharing another hour. The reason I wanted to do you is because I just thought so many people would want to meet the man and the face and the voice behind all those posts.

Matt: Yeah. Thanks for giving us a forum to share this stuff with.

Howard: All right, buddy, well, you have a rocking hot day.

Matt: All right, Howard, you, too. Talk to you soon.

Howard: Bye-bye.

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