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AUDIO - HSP #257 - Lisa Knowles
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VIDEO - HSP #257 - Lisa Knowles
Lisa Knowles asks about
• Hiring and firing skills
• Choosing a location for your practice
• And, his yoga workouts
Dr. Lisa Knowles offers real-life dentistry expertise in the areas of business communication, oral & systemic health, and leadership development. She is a strategic, big picture thinker and thrives off of helping others be better. She is a natural teacher with a competitive coaching edge. Dr. Knowles speaks internationally and writes prolifically. She graduated from Alma College with a B.A. in Communication, and then graduated from the University of Michigan School of Dentistry in 1998. Her blog site is Beyond32Teeth.com. Find more on her website at IntentionalDental.com.
Lisa Knowles, DDS
Lisa: I'm Dr. Lisa Knowles with Intentional Dental Consulting and I have an honored guest today, Dr. Howard Farran, who I will be interviewing about his new book called Uncomplicate Business. This will be on my blog post as well as the YouTube channel, so thank you so much, Howard, for being here today. I know you are a lecturer, you have your own media company, now you're an author. Is there anything else I missed? A dentist. Anything else I missed that you want to share in your intricate bio?
Howard: Just a father of 4 boys, Eric, Greg, Ryan and Zach, who are 20, 22, 24, 26, and the oldest one gave me a 3-year old granddaughter, so that's probably half my time. The other half, I still practice dentistry, still lecture, just love all aspects of dentistry and my boys.
Lisa: In the great state of Arizona, the warm state, right?
Howard: Oh my God. It's so freezing.
Lisa: Except today maybe.
Howard: I woke up this morning to go work out at 5:00 and it was 45 degrees.
Lisa: Yep. That's like Michigan weather right now, but we have 3 to 5 inches coming in Michigan this weekend, supposedly, so you're going to skip that. You can be happy about that, right?
Lisa: Well, I know you're busy. We're going to jump right in to your book, if you don't mind, and I have some questions for you about your book, and I just loved it. I loved the feel of it. I'm a book reader. I try to be an e-reader and I do a lot of online reading, but there's still something about a book I like, and I just enjoyed your book, the feel of it, all of it was nicely done. I appreciate that. After I read your book, one of my favorite lines from the book was a quote you paraphrase from an American proverb, "Love many, trust few, and paddle your own canoe." Tell me why you chose that line and why you think that's so important for anyone in the business world today.
Howard: Well, the whole book started off ... Actually, the whole book started when I had my granddaughter, and I'm 53 now. I was 50 years old, and I looked at my granddaughter and I realized the circle of life, I had kids and now the oldest kid's having a kid, and so I know that on the circle, I'm the next one out. My dad died at 60, and both of my grand-dads died at 60, and I stood there, and I was realizing, that I'd lived half a century and by the time Taylor was 10, if I went out at the same time as my dad and grandfathers did, she'd only be 10, and if I made it 10 years past that, she'd only be 20 and might not be ready for this stuff.
I really thought what I wanted to do was I wanted to write a magnum opus of everything I'd learned in half a century to little Taylor, and I didn't know what business she would be in. I didn't know what she would ... She could be a farmer, a plumber, a dentist, I didn't know what she'd be. When I thought about that, I looked at every column I'd written from '94 to 2015, and I looked at everything I'd learned in my MBA and all that, and I realized that business is business. It doesn't matter what you do, it's just people, time and money. I think 80% of it is people, and I think in answer to your question, love many, trust few, paddle your own canoe, people are ... I don't mean to be rude or anything, people think they're these magical, mystical things, but at the end of the day they're talking monkeys.
This planet, which travels around the sun once a year, has 7 billion talking monkeys and they call themselves humans, and they claim they know the guy that made the entire universe, and of course, it's a human just like them. It looks just like them, and it's always a man and they know his name. They say all these things and the reason people let you down is because you hold their expectations too high. If you realize that your dog and your cat never let you down, because you have no expectations for them. You go to the zoo and you don't yell out to the giraffes, "Hey, you lazy giraffe. Get up and do ..."
You have no expectations for all the other animals on Earth, but you raise all these crazy expectations for your friends and family, which you even have higher expectations for than a stranger that lives across from you or in the apartment next door, and you do love many. I love them all. You do trust few, but at the end of the day, you better paddle your own canoe, and if you're going to get to the end of your journey and say, "Well, I didn't do this because of Sally, and I didn't do this because of my mom, and I didn't do this because of my sister ..." You know how many dentists have told me, "Well, you know, if my wife would help me more in my office, I'd be successful?" It's like, "Well, you weren't dating your wife and marrying your wife because she was going to be the most rocking hot office manager. You just paddle your own canoe and be ..." My favorite Michael Jackson song, Man in the Mirror ...
Lisa: Me too.
Howard: Look at the man in the mirror and lower your expectations of everybody around you, raise the expectations of yourself, not compared to anyone else, but of who you were yesterday. If every day you can just be a little bit better of a man in the mirror than the day you were before, whether that's your weight loss, your dental office production, your relationships, and just take responsibility.
Lisa: Yeah. Yeah, awesome. That resonated with me, too, is we can so easily fall into the blamers category of somebody else's issues, somebody else didn't create my success. I loved that, paddle your own canoe. I hadn't heard that before. I'm sure it's some famous American proverb that I just ...
Howard: We see that in dentistry all day long. Every consultant will tell you ... Only 1% of the 7 billion earthlings live in a country they weren't born in, and the immigrant dentists that come here that were not born in the United States, every consultant will tell you if they graduate from dental school, and they were not born in the United States, they're already 3 steps up the stairway, and you come back 5 or 10 years, because whatever that kid had to make it from Asia to the United States, and get out of dental school, they're already halfway up the stairway.
Lisa: Definitely important. Another part of your book that stood out to me was when you discussed where to open a practice, and how you went through that and decided to get to Arizona. For me, when I was trying to figure out where to open a practice, I kind of narrowed it to Michigan. It seemed just insane to open or buy a practice where all these other dentists were. For Michigan, Ann Arbor's the pipe dream because you've went to school there, a lot of us, and it's just a great city, but it's so saturated with dentists and I thought, "Wow. I don't think I really want to be there."
Unless of course, it's a growing population and there's some things that might make it a good reason to go to a highly trafficked area. But apparently, you kind of felt the same way. I was hoping you might be able to walk me through, and some of the dentists who are out there right now trying to figure out, go through some of that data, collecting it. Where did you go? I know it was awhile ago, but I'm sure you have some insight into that as did you use the ADA? Did you use national data collection things? How did you figure out where would be a good spot to land for your dental practice?
Howard: Well, you know, business in 3 words is supply and demand. You graduate and you're going to learn how to make a supply of root canals, fillings, and crowns, and you're going to need people to demand it. You need to go where they ain't, and that's ... Go where you ain't, and so I was born in Wichita, Kansas, and back to these immigrants, look how smart 1% of the population of the planet, 7 billion humans on Earth and only 1% stands out and says, "You know what? I bet there's someplace better than this." I ask dentists, "Would you graduate from dental school and go to Tanzania? Would you graduate from dental school and go to Syria or Somalia?"
Well, if you know you wouldn't go to Somalia, or Tanzania, or Ethiopia, why the hell do you not look at the United States of America, and in fact, I think the United States of America, that is the most confusing term in the world. Because when you look at Europe, nobody compares Germany to Greece. Nobody compares Italy to France to England, and all that stuff. But the United States, when dentists tell me, "Oh, yeah, I visited your country." I'm like, "Really? Where'd you go?" They go, "Oh, I went to the Greater New York Dental Meeting. I was in Manhattan for 7 days." I'm like, "Wow." The you talk to them, they think that's America. It's like, "Manhattan isn't even a rounding error." When you grew up like me, in Kansas, I mean, you certainly didn't take in America if you went to Manhattan.
I can remember the first time I went to Manhattan. I was 27 years old. It was my first lecture. It was August 21st, 1990, and I was stunned. I remember looking out the window with my dentist friend, Craig [inaudible 00:08:49] and we were looking out the window and we were just going, "Wow." It looked like an inverted Grand Canyon. I was in Wichita, Kansas. Most people consider Kansas to be the armpit of America. The tallest thing was a grain silo, and the population had never changed, of anything I'd ever seen. It had always been 280,000. The joke was that whenever a girl got pregnant, a guy left town.
I was visiting probably half a dozen dentists regularly that went to the University of Missouri Kansas City dental school, and then I was visiting another 6 or so regularly that went to Creighton, because those were the two dental schools and you needed letters of recommendation and all that stuff. From the 6th grade to the end of dental school, they were all telling me they all had their incomes on [inaudible 00:09:36] and they were all showing me how every year their incomes had gone down for 10 or 20 years because those blankety blank, blank, blank, blank dental schools just keep letting out another class, and they would always tell me, they'd say, "You know, this population never changes and every year 30 more dentists come in from UMKC. They should shut that school down and blah, blah, blah, blah."
I saw all the charts of here's the city, constant population, every year another class comes out, every year the total income goes down. I wrote senior year, this is before computers, there were no laptops, Smartphones, I wrote the Washington D.C. Department of Economic Security, and I said, "What is the economic projection for the United States?" They sent me, back in '87, their ... At the time, they had the '85 study and they said from '85 to 2000 the United States would create 30 million new jobs and half of them would be in 5 markets: Boston, Tampa, Phoenix, Orange County and Silicon Valley. I'm like, "Okay," so then I looked at those 5 cities.
I didn't want the cold of Boston, I didn't want the insects of Florida, and truthfully, this sounds so bad to say but I'll say it because it's how you feel when you grow up in Kansas. I thought everybody in California was on drugs and nuts and there was no way. I wanted to get married and have children, and I just didn't think you could possibly raise great children in the crazy city of California. Then I looked at Phoenix. I just wrote Arizona, and I wrote their Department of Economic Security, and they sent me this 6 year street plan of where they were going to widen the streets. They sent me the 6-year water plan of where they were bringing in a 2-foot water pipe. They sent me the projections of housing permits, all that.
I got a 6-foot by 4-foot map, I traced out the 303 census tracks. We had index cards, little recipe cards. I don't even know if your viewers even know what a recipe card or an index card is anymore, and with a number 2 pencil. I made a card for each one of those, and I just started with how many dentists per 1,000, and it started at the top of the list with a dentist for 6,000, and the bottom quarter inch of the stack was a dentist for 500. I saw 2 ZIP codes that had a dentist for 6,000. Both of those ZIP codes were issuing 90 housing permits a month, and so I just realized that for me and my future family, it was worth moving 1,000 miles away from Wichita, Kansas to Phoenix, Arizona, where 2 of my mom's brothers had retired. My mom's 2 older brothers, Chick and Pat, had already retired out here, so I had family, and I came out here, and I signed up where they ain't, where there weren't any dentists, and where it was growing.
It was amazing because I would go in this town and I'll never forget, there was a 6200 South McClintock, and there were like 30 dentists in one building, and you're just thinking, "What are you thinking?" Then the worst, I should pull that up. Can you pull up my ... It's downtown San Francisco, there's a building. Have you seen that? I'll pull up my ... Anyway, yeah, I should pull up my [summer 00:12:53], but there's a building in downtown San Francisco that has 100 dentists in one building. I have a picture of it. They'll blame it on Obama, they'll blame it on the economy. It's the gold standard. It's every single thing known to man, and then look at the geniuses in our lifetime. Look at the first dentist that I know of that became a billionaire, was Rick Workman of Heartland Dental.
He was doing another genius thing which I recommend. He was calling the insurance companies and saying, "Okay, you see dental insurance to everybody in the great state of Illinois. Do you ever get complaints from the people with the insurance that say there's no dentist provider?" These insurance companies like Connecticut General are telling Rick, "Oh, yeah. Here's 10 towns that don't even have a dentist, and they all have like 2,000." That was the Walmart water, Sam Walton and his wife Helen, realized that Sears, Gibson's, TG&Y, J.C. Penney, were not going to go to small-town America, and they were in Bentonville, and Sam went all the way to J.C. Penney, all the way to Gibson's, said, "I don't want to put my life savings in a store if you're going to come in there. They go, "Where are you from?" He said, "Bentonville, Arkansas." They just laughed. Who the hell would go there?
Because they were supposed to order out of a Sears catalog. If you're a rural farmer, all you get is a catalog, but you got to be an urban city slicker to be able to walk into a nice store and that's what Rick Workman did. Rick Workman basically took Sam Walton's cheat sheet and just started calling the insurance companies. What I would do, if I wanted to practice in Michigan, first phone call I'd make, I'd walk into Delta Dental and say, "You sell state contracts for police and fire, and teachers, and all these things. Where are your complaints from?" They'd just tell you. In fact, some of these states, like Iowa is doing a genius program where Delta Dental of Iowa, they got skin in the game.
They're selling insurance and there's no providers, these small towns, so they're going to small towns and they're saying to the Mayor, "Okay, you got to First Street and Main, and half the buildings are boarded up. You give me a free boarded up building and kick in a hundred grand. Delta will match what you kick in, a hundred grand, and then we'll go to the dental schools and say, "Hey, you come here, you get a free building and 200 grand off your student loans, and they're just signing them up right and left. Yeah, I'm trying to get them to write an article or a podcast or whatever, because that's the model. We'll get rid of so much misery if we just make sure these new graduates are going where they ain't.
Lisa: And it fulfills the access of care issue, too. You look at it, to me when we try to keep having more and more providers and we kind of lean to access to care, access to care, I think it's an access to where we have too many people. It's a distribution issue sometimes when we're in the access to care issue.
Lisa: We just have to be more creative and that's a great way, innovation is helping out that situation. Awesome.
Howard: It's funny, sometimes you'll be with a dentist in Manhattan and they'll say, "Wow. That's crazy. Look. There's a Starbucks on 3 of the 4 corners." I'm like, "Well, first of all, each one of those corners is at the bottom of a 40-story building, and if you went into that building, there'd be a Starbucks on the 10th floor and the 20th floor, too, but more importantly, why would that surprise you? Because medical/dental buildings are still the norm in dentistry, and there's 8, 9, 10 dentists in every one of these buildings and you never see 8 or 10 Starbucks in a building." Have you ever seen a triple-decker McDonald's, where there's just 3 McDonald's stacked on top of each other?
Lisa: Right, no.
Howard: But you'll see it in dentistry all day long.
Lisa: Yeah, it is interesting. I'm going to switch topics here. Something else that caught my eye in your book I think is an interesting part of it, is when you talk about your hiring and firing methods, and you talk about George Steinbrenner and you know, if I've heard it once, I've heard it a thousand times that the dentists complain about, it's not the dentistry we do, it's the management of the team and the staff, and the human resources.
You recommended being like Steinbrenner in how he picked his pictures, and not think about how long a team member has been with you, but rather, you must ask what the team member is doing for you now, and make the hard decisions as necessary. How would you recommend a new dentist acquire these hiring and firing skills, and how should they look for the best team players in the world, kind of like a Steinbrenner approach, or a Howard Farran approach?
Howard: Well, I think the most difficult thing of a human being is that at the end of the day we're genetically a social pack animal. We're no different than cats and dogs and monkeys and apes, so we all have to get along. Like a shark just swims through the ocean, doesn't ever need his mom or dad again. He doesn't need to smile, he doesn't need a buddy. He doesn't need 3 other sharks to take down a fish. They don't need anybody, so it's a completely different animal.
A human is hardwired that every relationship they're in, they're either submissive to the 400 pound gorilla or they're dominant to the 100 pound gorilla if they're 200 pounds or whatever. We're just always trying to get along. George Steinbrenner is probably known as just the most consummate ... Well, I don't want to use the word I was thinking on your YouTube video, but he didn't get any awards for being charming, and handsome, and nice. He was an ass, and the bottom line is if George Steinbrenner thought that there was another pitcher on another team that was just slightly better than Lisa, what would he do to you?
Lisa: You're outta here. Beat it.
Howard: Yeah, and he wouldn't even call you. Your husband would bring you the paper the next morning and say, "Lisa, you've been traded to the Royals." They'd be like, "Oh my God. I can't believe that last year I got this award and this award and this award, and he traded me. He didn't even talk to me." When the Patterson rep walks in, when the Schein rep walks in, when the Benco or Burkhart rep would come in, and I would say to them, I'd be 24 years old and I couldn't go teach a hygienist to be the greatest hygienist in the world.
I graduated from dental school May 11th of 1987. I was 24 years old. I got my office open September 21. I'm 24, I wanted the best hygienist, and I would ask them, "Who do you think is the best?" My assistant, Jan, worked for a very famous dentist, who still teaches continued education and hands-on ... Oh, my mind's drawing a blank. He's in Scottsdale, lectures all the time ... Oh my gosh, I can't believe ...
Lisa: I can't help you out.
Howard: Yeah, I can't believe his name ... But anyway, she said, "Well, I think she's the best." I called her up and I just said, "I want you to come work for me." She said, "Well, you know what? I'm not feeling appreciated. I've been here 8 years and everything, and you seem like you're teachable and humble and trainable." I just always wanted the best. My 3rd hygienist I hired was Missy, and Missy ... I remember we were all sitting there working, and this woman walks in, and she just walks right past the patient waiting room, and she just starts walking around the dental office and just like she owned the place. Everybody's like, "May we help you? May we help you?" She's like, "Hi, I'm Missy and I ..."
Anyway, long story short, she was a hygienist that worked somewhere else and saw this new office, and just wanted to check it out and everything. I didn't need a hygienist. I already had two. I started talking to her and I realized, "My God, this is the smartest, most enthusiastic, most amazing ..." I thought to myself, "Would you rather this girl be in your office, playing on your team or would you like to play against her for the next 40 years?" I just said, "Man, I don't have room for you, but I'll make room. I'll just put in another operatory." For me, I'm not into titles. My president, she doesn't have a college degree, she didn't have any ... It's just that attitude. It's that you give them a problem and they solve it, where everyone else, you give them a problem and they come back tomorrow, and they give you 3 reasons why they couldn't do what they had to do.
Some people wake up in the morning and they got this Godzilla problem, and they got some little lions and tigers, and some little ants or termites. What do they do? They wake up, in the first hour they check their Facebook status, and then they work on the ants and the termites, and they never even get around to ... Then there's another breed of cat, that you wake up and you say, "Okay, well, I'm ready to start the day. What's the most productive damn thing I could do today?" There's Godzilla just looking at you, and you just go after that. It's just a mindset, and I've always spent 80% of my time on employees.
In fact, right now I got about 55 employees, and probably every 3 months, when I'm in a good place, and I'm really happy, and I'm mellow, and I'm not hungry, I'm not tired, I just sit down and I look at each one of those players and I just think, "Okay, is this the person that dove for the ball and won the game or is this the one that always throws the interception and loses the game?" Because I believe that every single employee, there's no such thing as a neutral employee. Every one of them makes you money or loses you money. If you just get 55 people diving for the ball, 55 people that just solve the problems, and then also look at it like how much do they come to me for ideas? How much do they come for me to solve their problems?
Because I always think of management from the grave. Ray Kroc is dead and 40,000 make a Big Mac without him. Sam Walton's dead. Nobody at Walmart's asking where Sam is. I'm just sitting here thinking, "Okay, I give you money and then you ask me for the answer. I give you money, I give you a problem, then the next day you come to me with why it can't be done." Why am I on Dentaltown trying to find the ultimate recalls? Why do the hygienists come ask me, "Well, what kind of recall system should we use?" It's like, "Well, you're a hygienist, not me. Why aren't you on Hygienetown? Why aren't you on Dentaltown? Why didn't you come to me and say, 'Hey, there's 3 major hygiene recall systems and here's the thought leaders of that and this is what we're doing, but I really want to try that.'" I'll take that person any day over somebody asking me what do do.
Lisa: I liked your analogy in your book about the diving for the ball. I've played basketball, and you just, there are just those team players, the ones that watch the ball dribble out and then there's the ones that dive for the ball. I love that analogy, and you're right. It is tricky finding those spots. Sometimes when you park yourself where they aren't, it's a little harder to find some of those people, but they're there, and it just takes awhile in the hiring process sometimes to find those ones that are going to dive for it. You've had no problem if you don't find those people, clearly I'm sure you've hired a few that didn't dive for the ball and you had to let them go. I think that's a really hard thing for some dentists to do, this obligation, this caring persona we have, to let people go. Any comments about that?
Howard: Yeah. Most dentists, and I think the most competitive sport ... I think it's funny that you're a dentist that plays basketball, because they call that the non-contact sport, yet that's the player that's always coming in with their teeth knocked out.
Howard: Then football is a full contact sport. I don't think I've ever replaced a missing tooth from football.
Lisa: They just break their collarbones.
Howard: Yeah, and I think it's funny. Yeah, to call basketball a non-contact sport, you couldn't be a dentist and say that. But I think the NFL is the most competitive game. It's the number one in revenue. They're doing about 11 billion a year. Everybody's backseat driving them, the whole media covers their sport for free. They don't have to pay a penny in marketing. They got all these ... Everybody has an opinion on the NFL. Those guys have 25% turnover a year, 25%. Then you go into a dental office and he's got 2 assistants, and he's got 2 hygienists and 2 receptionists, and 2 of them ... I mean they'd almost have to burn the practice down to get fired. They're just like, "Well, you know, she's been here 6 years and I know she's crazy, and she hates her job, and she's burned out."
It's like what does she have to do to get fired? The reason you accept it is because you're a social animal. You're hardwired to get along. It's like my analogy, my mom and dad were very staunch Catholic. We had to go to mass 100% of all mornings our entire life. My 2 oldest sisters left high school, went straight to the nunnery. I never witnessed one person ever standing up in the middle of mass saying, "Excuse me. I don't agree with anything you just said." There's no argument, there's no debate, because you're hardwired to ... That's the 400 pound gorilla, and you ain't that person, and sit there and shut up. You go into your office and you know this staff member is crazy. You know she doesn't play well with others.
In fact, Ryan will you give me my core values on the deal there? This is what I walk up to my players. Everybody has this. It's a little bitty sheet. I walk up to them all the time when I'm coaching. I just say, "Okay, here's my 12 commandments." The Catholic church taught me 10 commandments and I didn't agree with the number 10, because I thought it was a lot of redundancies like thou shalt not steal, thou shalt not covet thy neighbor's goods, thou shalt not commit adultery, thou shalt not cover thy neighbor's wife. I thought there was actually only 6 original commandments, but I came out with 12. Are you creating a fun, positive, and professional environment and what letter grade would I give you on that? Are you passionate, enthusiastic and determined to make a difference? Are you humble? There's no room for arrogance.
Are you embracing and driving innovation? I don't care that you worked for a dentist 12 years ago that always did it this way. I don't care. Follow the golden rule. You know the Golden Rule, treat other people like you'd want to be treated. My oldest sister, who's a cloistered Carmelite nun, who's read every single religion, said that is the only one line that's in every major religion. There's not a name of a city, person, place, nothing is in Hinduism, Buddhism, Confucianism, Judaism, Islam. The only thing you will find in every major religion ever written was treat other people like you would want to be treated. Mistakes will be made. Be accepting or accountable. Move forward. Risk equals reward. I want all my team to make mistakes and they'll learn. Never stop learning.
Be honest and respectful. Integrity is everything. Balance life and work and fully present in both. This is a pet peeve of mine when a dentist won't let any of his staff take personal phone calls and gets mad when they do, yet after every patient he goes back there and calls his wife. It's like, well if my assistant needs to talk to her husband about little Billy, treat other people ... You can't take a personal phone call if she can't, and if she needs to talk to her husband, she needs to talk to her husband. Strive to make everyone feel safe, valued and important. Do you know how many lab men tell me weekly, monthly, that they'll get an impression from a doctor and they're afraid to call because they don't want to lose the $5,000 a month account because they're not humble. They're arrogant.
When I'm sitting on airplanes and I lean over to a person, I say, "Hey, I'm just curious. I'm writing a paper. If you had to describe a dentist, with 5 adjectives, 5 adverbs, whatever, what would you describe it?" They never say humble. It's usually arrogant, cocky, conceited, know-it-all. All the labs are afraid ... When I got out of school, when I sent my lab in, everybody told me this German guy, he was schooled in Germany and they told me that he was the best guy and he was from Germany. I sent him my impression and I called him up on Friday and said, "So, am I good? Do you like my work?" He's just like, "Uh ...." He goes, "Well, what are you thinking?" I said, "Well, they say you're the best and I'm 24. Am I good or not? Is there anything you want me to change?" He said, "You know what? Maybe you should just come down here."
I went down there and once he sensed that I was humble and truly wanted to learn, then he could nicely tell me I was the worst dentist that he was working with, and I didn't give him reduction. Once I reached out and said, "Help me," ... And then back to the Commandments, number 11. Be remarkably helpful and the last, create opportunities to make our customers feel special. If you master leading the people, and you hold their high expectations, and you get that right, the time, the money, the marketing ... Right now I'm talking to you, I got 50 people making decisions, making things happen. I don't need to micro-manage. What's funny is that dentists won't delegate today, but they're definitely going to die. Just ask all your clients, "Do any of you plan on not dying?"
Lisa: But our succession planning in dentistry is not always so well thought out. Where's the operation? What's the system? A lot of times I go into an office and there's nothing. I think, "Well, what if? ..." I think you alluded to it, the hit by the bus or truck or something like that, too. I'm like, that's what we do too. Everybody has to have ... You're doing damage to the team, you're doing damage to the patient care, if you don't have a plan in place. I can appreciate that so much.
I want to go out ... There's a poem that you recited in your book. It's called Anyway by Kent Keith. It was said to be hung in Mother Teresa's children's home in Calcutta. It struck me as so powerful that I was hoping you might even just be able to read it for us today, and just give some people something to think about because we all get caught up in our little, "Oh, I shouldn't do this, or I don't want to do that, or they did this to me," blah, blah, blah. It was such a great poem, so I'd love for you if you could read it.
Howard: You know, I just want to say that when you grow up Catholic, Catholics are big into saints and they'd always have these saint stories, like Saint Francis of Assisi or all these saints, but my 2 favorite people out of the Catholics, or the 2 biggest role models was Martin Luther, who stood up to the Catholic church and wrote his 96 things he had wrong with them and nailed it right on his door and they tried to kick him out and kill him, and his wife was actually a nun from my sister's same order, a cloistered Carmelite nun, who hid him in a wine barrel and snuck him all the way to England, just so he wouldn't get killed.
The other one was Mother Teresa, who just moved all ... And I got to see her birthplace and gosh darn-it, what was it? The cities, I was in Albania, Moldova, but anyway, I saw the area right where she was born. But she had this poem hanging on her wall and it's the most important thing, and I have to read it all the time. "People are illogical, unreasonable and self-centered. Love them anyway. If you do good, people will accuse you of selfish, ulterior motives. Do good anyway. If you are successful, you will win false friends and true enemies. Succeed anyway. The good you do today will be forgotten tomorrow. Do good anyway. Honesty and frankness make you vulnerable. Be honest and frank anyway. The biggest men and women with the biggest ideas can shot down by the smallest man and woman with the smallest minds.
Think big anyway. People favor underdogs, but follow only top dogs. Fight for a few underdogs anyway. What you spend years building may be destroyed overnight. Build anyway. People really need help, but may attack you if you do help them. Help them anyway. Give the world the best you have and you'll get kicked in the teeth. Give the world the best you have anyway." Mother Teresa, her version of that, she added, "Because at the end, it was never between you and them anyway. It was between you and God. Just do good anyway." I just think, again, I will stress until the day I die that you have to get rid of this human being thing, because they're incomplete. You go to the zoo, 100% of all the animals are naked. But if you went to the zoo naked, you'd be arrested and go to jail.
You know what I mean? If you go to a movie and Arnold Schwarzenegger pulls out a man-made machine gun and kills 100 people, it's a family film. But if a woman would drop her shirt and nurse a child, it'd be rated R and we'd have to cover the children's eyes. People are, at the end of the day, they're apes. They're monkeys without tails, they're extremely complex, and you just have to lower your expectations, love them to death, and I do love them. I would not want to be born on Earth and be the only human being. I just think that would be incredibly confusing and lonely. The only great thing about this planet is all the people on it, but then again, they're the worst part of the planet. I mean right now, we're talking, we just had that episode in Paris. We always have wars. People are incredibly complex, but you just got to love them anyway.
Lisa: That's awesome. I love it. I'm glad you included that in the book. It's very ... Buying the book just for thought. Lots of reasons to buy the book, and that's another one of them. Of course, then I put the kicked you in the teeth, the dental part. It was especially good for us dentists. That was pretty fun. Okay, another thing you talked about in your book was this way of ... You explained a getting to yes method that you talked about in your book. I love the idea, you're collecting data, your team is collecting data about the patients all day long, kind of an ongoing process. Can you tell me a little bit more about what spurred that and what effect it's had?
Howard: What we've seen in dental offices, a complete disconnect between the doctor, who thinks she's patient-centered, but she's not. Dentists get up every morning, they go to the mirror and their national anthem is, "Me, me, me. Self, self, self, me, me, self, self, me, me, me. Self, self, self, me." They'll call up the front office, and your office hours are Monday through Thursday, 8 to 5, and the Federal Reserve is the largest employer of economists and they said 100 million Americans have a job they can't leave Monday through Friday, 8 to 5 and go to a doctor, 100 million, and their hours are Monday through Thursday, 8 to 5. They'll be calling up, "Well, do you have any early morning or evening?" No. Well, you should write it down. Lisa Knowles just called and asked if we had an early morning, and we said no.
Well are you ever open Saturday? No. Do you take Blue Cross, Blue Shield? No. Do you ... They don't track any of these nos, and then there's a dentist in the back, logging on to Dentaltown saying, "Yeah, I need new patients. Should I do a flyer?" Then they'll go to the Spear Education and drop 5 grand on a weekend to treat the worn dentition and how many people asked you for that? How prevalent is this in your office? They go to Pankey for 6 weeks to learn occlusion. Now the big fad is sleep medicine. But they have no data on what they should be making a supply of. How did I get into bleaching? It was 1987. There was no over the counter bleaching, there was no professional bleaching, there was nothing.
This company, it was out of Arkansas, it was called Omni Company with Omni White bleaching, and the Arizona rep was David [Killey 00:36:29], came by and he taught me all about it. It was like $900 for 6 bottles and I just laughed and said no. But we had this prescription pad by the front desk and it's getting to yes. Sure enough, out of nowhere, some girl called up and said, "Do you bleach teeth?" Then at the end of the month, I was looking at that, and I thought, "Okay, it's never happened in 2 years, and it was one, so that's an outlier." Then the next month, there was two. I'm sitting there like, "Okay, 24 months, I never got this question and then I got it one time. Then I got it 2 times." Then I'm looking for that business card. Where the hell's that David guy again?
I called him up, bought this stuff for $900 for 6 bottles and it just exploded. Then all these dentists were around were saying, "Well, you know it's not ADA approved, there's no 5 year research. Gordon Christian hasn't even commented on it," and I'm just like, "Well, you know, none of those people pay my bills. I'm a doctor. It's just carbamide peroxide. The teeth are just elephant's tusk, and the patients are asking it. I'm making bank on it." I think when we started it was like ... Because it was $900 divided by 6 for a bottle, whatever that is and I think at the time we were charging $499. I'll go back to the CEREC. There's a circle just dentists wanting to believe their own hype. All they talk about is that everybody wants a same day crown. Really? I get like 2 humans a year that ask for that. Two.
If someone ever says same day crown, it's a 99.99%, it's a CEREC doctor. The patients are asking me, "How much does it cost? Do you take my insurance? Will I get a shot? Will it hurt?" Same day is so far down on the list that ... The deal is to keep it real, I will always believe that in hockey you want a great goalie. In football you want a great quarterback, and whoever is answering that phone up front is the most important person in your office, and someday a droid will do the root canals. Someday it will not even be a human. You look at a CAD/CAM now and a CBCT, and an iPhone. Stick all those 3 together and some day Obi Wan Kenobi's going to go walk in there or R2D2 and just sit down and just fix the whole damn tooth.
Lisa: I hope you're so wrong on that one. I hope you're wrong on that one.
Howard: But what's never going to go away is that rocking hot receptionist that's intuitive and can feel and answer the phone and talk to the patient, and get them to come in and sit in your chair and part with their cash so that you can fix their teeth. If you have the best receptionist and the dentist is a Cyclops with one eye, you've got a million dollar practice.
Lisa: Yeah, it's the truth. It's true. It is about that, and I love that method. If you don't know, because you just mindlessly take those calls a lot of times and don't record it, and so I like that system. I think that if more people did that they'd benefit from it just like you did. Okay, so I have to ask you about your yoga workouts. You mentioned that in your book, and I read that pretty much you get up, you exercise every morning some form, some shape, whether it's yoga or running or what it might be. I know you just finished an Iron Man again, I think. Congratulations on that. That is a great routine, and I think you know that I'm a huge yoga fan and practice pretty regularly, too. I think we should just mandate this in dental school. It should just be a part of the curriculum. What do you get most out of yoga and your exercise routines?
Howard: The bottom line is the whole medical model for, going back to the Egyptians and building the Chinese wall is that you have something wrong and you go to a witch doctor, and they only have 2 things. They cut something off or they give you a lotion and potion. Dentists, you hear them, and I was a victim of this, my own thinking, where when my lower back would hurt, I would go to a chiropractor, because you're going to go to a witch doctor, and he would move you, or dentists take Ibuprofen or carpal tunnel syndrome - you go there and they cut into you and free up your tendons or whatever, whatever. The bottom line is by 50 my neck was completely jacked, it was completely miserable. I was going to a chiropractor 2 or 3 times a week, and finally one of my best friends, Dennis [inaudible 00:41:02] and his wife just kind of snapped at me in my own garage and said, "Howard, just go to yoga."
She said, "I'll drive you. They have a 7 p.m. class starting in 15 minutes. Let's just go to yoga right now." We went to yoga, and we were in there, it was 105 degrees, for 90 minutes you're stretching, and I felt instant relief. I have a good friend that just had double carpal tunnel syndrome. Well, no one will stand up to a doctor and say, "Dude, you're 60 years old and you haven't done a single push-up in 40 years. Do you think maybe if you just flattened your hand out on the floor and just did a flip and push-up, you wouldn't have to go to a surgeon and get all cut up with a knife and pain pills?" See, we want the doctor to move us from the outside in, a chiropractor. They don't want to move from the inside out, and the bottom line is the worst thing about dentistry is we have a desk job. We sit in a chair all day, and how many patients ...
I'll never forget this patient, it's a good friend of mine, he was a heavyset dude for a long time, and he came in for a 6 month recall and he was just like a rocking hot body and I'm just like, "Oh my God, Mike the man. What the hell did you do? Did you join a gym?" No. He was depressed because he lost his high paying desk job. The only thing he could find was a construction job. He was hanging drywall 8 to 9 hours a day, and lost 100 pounds. He was making half the money and was twice as happy because he felt good. When you have a desk job like dentistry, you have to move your body. I'm addicted to the [inaudible 00:42:40], I think if you sat on a ice rink you couldn't stretch, so you're 98.6 degrees, so you go in a room that's 105 and for 90 minutes you start stretching, and I just notice a total difference in physical health and a total difference in mental health.
Lisa: Yeah, I agree, and we're so constricted, and I thought about that, too, is that not only are we constricted physically in our chairs, and bent over, but we're very constricted from a mind standpoint. It's very tight, it's very focused, and I'm always into the yin and yang type of theory that we've got to have the opposite to get that energy flowing again. Again, it was pain that drove me to yoga, too, but it make us change. But some people will pick up a scalpel and they think that's what's going to change them. They want somebody to change them, so I appreciate that you're a fan of that, and advocating it out there a little bit more. I hope more dentists start out that way, rather than end up that way, and save themselves a lot of grief, a lot of pain and suffering through their dentistry. You don't enjoy it. When you're in pain you don't enjoy dentistry.
Howard: And you know healthcare is 17 cents of every dollar in America. If you say anything like this, the whole society's going to, "Oh, you're holistic. Oh, you're a nut job. Oh, you're a fruitcake. Be smart, go to the doctor. Take the pharmaceutical pill. It's made by Pfizer. It's trading at $259 a share." The whole society is just, "Take the pill. Surrender to the 400 pound gorilla who's a physician." Look at your physician. What percent of your physicians could not even run a 5K?
Howard: That's the guy giving you a pill.
Lisa: Right. Yeah. It's a messed up system, and I couldn't relent to that too. I kept trying to get my patients some help and send them to their physicians, and sometimes they would come back, and I'm not knocking. I'm a believer in research and there's a place for medicine and bless the physicians for doing what they do in certain situations, but I think you're right. We're missing that mark a lot when we could be ... We could just be having people exercise more, eat better and [crosstalk 00:44:54].
Howard: You know what's a crime is they took physical education out of all the schools.
Lisa: I know.
Howard: Now when little Johnny's bouncing around, now they say something's wrong with him, so they want to give them a pharmaceutical pill because now he has ADD, whereas when we were little, we had recess in the morning. We had a hour lunch recess, and then we had a recess in the afternoon. Now you can't leave your desk and if you start jiggling or wiggling, you need a medication. Why would physical ed not be in dental school when they've had the highest suicide rate 5, 10 times in the last 30 years? How come at 10:00 at dental school, they said, "Okay, now it's dodge ball. Now you're going to throw you ball as hard as you can right at your teacher's face?" The whole mindset is just not ...
Lisa: Oh, yeah. I've done some speaking at the [inaudible 00:45:40] here on mindfulness and mindful and space stress reduction, so incorporating that and some yoga into the curriculum, I think would be so powerful for the graduates. You need that.
Howard: Look what their report card is now, all the dental schools. Every one of them out there. 18% of their graduates will go to in-patient Betty Ford Center for 90 to 100, 18 out of 100 dentists will not retire before going to in-patient care, and where is any mechanism to deal ... I mean that's almost 1 in 5.
Lisa: Yeah. Holy cow.
Howard: If you were the dean, if Lisa was the dean at school and I said, "Lisa, you're going to graduate 100 kids and 1 in 5 will be in the Betty Ford Center. Can we teach them how to do something so that at the end of the night they don't have to go home and drink a 12-pack?"
Lisa: Right. I think I'm tired of the argument of, "Well, that's ... Dentistry attracts a compulsive personality, or some type of personality, and there's not a lot you can do." I say wrong. Different answer. Come on. Give me something else. That's ridiculous.
Howard: My best speaker I ever heard, oh, I forgot his name. Who was the basketball coach, you're basketball? He was a basketball coach of the Miami Heat. He'd been a couple places, couple champions. He was the Miami Heat. He was a tall basketball coach, won a couple champions and I think he was at the Lakers or somewhere else.
Lisa: I don't know. Name recall is not my biggest ...
Howard: He came to our dental, he actually came to the Arizona State Hygiene Association. It was about 20 years ago, and he says, "Look, this is what they're going to tell you. They're going to tell you that when you're a dentist it's always different for you because all your employees are women, or all the dentists only got accepted to dental school because they got A's in math and physics and chemistry, and they're not extroverts." He goes, "Well, look at me. All my players are inner city African-Americans. 90% of them didn't grow up with a dad and their coach is a man. They'll surrender to a dominant female figure without blinking, but when a man comes to them, they'll roll back their chests, they're ready to knock you out." He goes, "Everybody's coaching people with a background. My employees, when they were little, they didn't reach for a beer. They reached for a joint. They didn't have a dad. They listened to their mom.
They weren't afraid of their dad. They didn't know their dad, but their mom they were scared to death." Everybody's got baggage, and we're all talking monkeys, so it's again, it's an excuse that, "Oh, they're all women," or "Oh, we're all ..." The bottom line is what do we got and what are we going to do with it? The deans are not addressing, they're not even talking about the fact that 18% of them will go to in-patient rehab, and it's a huge financial burden. I know a lot of the dentists, they had their practice paid off, they had their house paid off, but to keep their practice alive, you know the Betty Ford Center's $1,000 a day for 120 days, so that's 120 grand, but you don't want to come back and have all your staff with new jobs, so they literally had to go borrow a quarter of a million dollars to make payroll for 4 months so they could come back to a practice.
Lisa: Oh, man. Yeah, those are the big things, the dust under the rugs that just gets swept away that I think we have to keep talking more about, and that's part of my communication background where I pushed to do what I'm doing, too, is that acknowledgement. We can't just keep pushing this under the rug. I'm tired of hearing about the ASDA student who took her life or the dentist down the block took his life. That's just ... And I know. I know why. Because it's competitive and it can be, and it's stressful and it can be, but with some tools and some guidance, there is so much more. There's so much more, and what that devastation that leaves behind is incredible, so I'm glad to get some of this out there mainstream.
I know some people who are like, "Oh, holistic," too, and they start labeling you, but I'm like, "That's all right. You can label. You can label me what you want." It's treating the whole people, treating our whole selves as dentists, too, and it's going to pan out in the long run, I think. Anyways, let me keep going here. Okay, so dentists, in our stressful, busy, crazy lives, where we have lots to do, why do you think dentists should take the time to read your book. I know we've recapped many crucial points today that I would just certainly buy it, just knowing what we've talked about today, but what else, and why do you think it's important for them to take the time to read your book? And then where are they going to find it? Where can they go buy it?
Howard: They can buy it on Amazon, amazon.com, but you know, the bottom line is when I was in dental school and the under-grads were coming in, and you were meeting with them, you're interviewing them, saying, "Why did you want to be a dentist?" They'd give you all these phony answers like, "Well you know, I really liked working with my hands." Well, hey, I'll save you 4 years of college and a couple hundred thousand dollars. Go get a job laying bricks. They say, "Well, I think I want to be an orthodontist because I like bending wires." Well, then go be an electrician. You don't need to go to 4 years of dental school to bend a wire.
I think everybody that said, "I'm going to go into delayed gratification. I'm not going to earn money now, and I'm going to go be a dentist, a physician, a lawyer, an engineer, is because I want to have more money later. I want a return on my investment," and they're paying 70, 80, 90 thousand dollars a year for dental school, and you're not going to learn any business in business school. I want to tell you that the richest dentists in the world haven't touched patients in 10, 20, 30 years. I still treat patients only because I like it. I love pulling wisdom teeth the most. I love molar endo. I'd rather do a retreat molar than ... I don't want to do a root canal on number 8. I think the assistant should do all the single canals.
I love working with my hands on patients, the challenge. Probably the funnest thing I do is when you pull a tooth on a baby and they don't know it, and then you go tell the baby that you're not going to pull it today and go give this to mother. Then I walk the baby out in the waiting room and the little kid says, "Well, he's not going to pull my tooth today and I'm supposed to give you this," and the mom looks and then realizes, "Oh my God. He pulled her tooth and she doesn't even know it." I love that. But that has nothing to do with having a very successful business. Like I say, I call it managing from the grave. The greatest companies in the world, their founders are all dead, whether it's Ford or McDonald's or Walmart or whatever.
If you learn how to manage the business, you'll make so much money, then you won't have to do dentistry to make a certain amount of minimum monthly payments and living behind the gun. Dentistry's stressful enough without having the financial stress. I think dentistry if far more fun when you're rich. When you're rich and you do it, it's fun, but if you have to do it every day, month after month, year after year, and like I say, they've got no training. The ones that are crushing it, I'd say the number one thing the ones crushing it have in common is their mom and dad owned a business, whether that was a farm, a restaurant. But there's so many dentists where mom stayed home and made Catholic cookies every day and dad worked on the line at GM, and they made it all the way to a physician, a dentist, a lawyer, and they don't know the first thing about business.
In fact, I lecture so much, I'm always bumped up to first class with all my miles and everything. I've sat by 3 US Senators in my career, and talking to them on the plane, you realize just they were lawyers. They didn't know Business 101. They didn't know Economics 101. One of them, you remember the big deal with the Balanced Budget Act by Gramm-Rudman? I mean, I sat by Gramm and I had him autograph one of my books. The guy couldn't tell you the first thing about accounting. But since he's a lawyer, he thought he was the smartest man in the world. I just try to get dentists to just skip one bone grafting course and just read my book and learn how to just sit there and crush it on the business side.
Then you'll be bone grafting implants, that's your hobby. Some people make wooden bowls, some golf, some fish. I like to pull wisdom teeth and do root canals, but separate all those dreams from money. The other thing is 3% of millionaires, 3% of Americans households, there's 330 million people living in 100 million households and 3 out of every 100, they're millionaires. I always tell dentists, "Dude, if 3 out of every 100 houses can be a millionaire, why the hell can't you? When you know the Krebs cycle, geometry. You have the brain. You just haven't committed to just doing it." Just get the millionaire thing down and then everything else is real easy.
Lisa: It does make business a lot more easier when you don't have that financial burden. I know when I paid off all my debt, it was kind of a little personal goal by 40 and I reached that and it was like, "Ah. Wow. Now what? We're going to do some of these other things." It is more fun when you don't have that big burden, and that's why it is a concern with all these students walking away with so much debt right now, and with no business skills to pair with that. That's even scarier, right?
Both, the combination, so read Howard Farran's book, get your business going. That's what I could tell the younger dentists, or the older dentists who just never really took much of an interest in business, or you better hire well, right? Hire somebody who really enjoys the business side of dentistry and that you can trust. We went beyond 32 teeth today, didn't we? That's kind of the fun. That's where I enjoy it, and this will be a good blog post. Can't wait to see it up there. Thank you so much, Howard.
Howard: All right, Lisa. Thank you. Have a great day.
Lisa: Okay. You too.