Dentistry Uncensored with Howard Farran
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779 The Business of Implant Dentistry with Joy Millis : Dentistry Uncensored with Howard Farran

779 The Business of Implant Dentistry with Joy Millis : Dentistry Uncensored with Howard Farran

7/21/2017 8:25:50 PM   |   Comments: 0   |   Views: 214

779 The Business of Implant Dentistry with Joy Mills : Dentistry Uncensored with Howard Farran

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779 The Business of Implant Dentistry with Joy Mills : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #779 - Joy Millis

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AUDIO - DUwHF #779 - Joy Millis

Joy Millis is the foremost authority on the business of implant dentistry, with a unique combination of specialty and general practice expertise. As a professional speaker and trusted advisor, Joy helps dental professionals accelerate the implementation of their strategic goals and objectives. She is an innovator in practice development solutions, influencing patients to receive quality dental care, getting paid without insurance interference, developing referral relationships and recovering lost patients.

Joy came to the profession of dentistry at the age or 15, filling in for dental team members where her mother served as a receptionist. Joy's personal life was changed through orthodontics and orthognathic surgery. Implant

dentistry was introduced to Joy in 1978, when she joined a practice investigating the service. Moving from surgical assistant to administrator, Joy skillfully developed the marketing, management and communication

systems for the practice that quickly became a training center for doctors from all parts of the globe. Joy’s business expertise and hands-on knowledge enhances the value that she brings to the platform as well

as in the private practice setting. As one doctor stated, "Apart from her abundant enthusiasm, what sets Joy apart from the myriad of other speakers that can talk the talk--Joy has walked the walk!” For over 20 years, Joy has taught the business of implant dentistry as a visiting faculty member for continuing education at Georgia Regents University, The University of Texas Health Science Center and Oregon Health Science Center.

Joy is the proud recipient of the Seattle Study Club 2006 Charlie English Community Education Award. Her 20-year Seattle Study Club relationship has included giving the Symposium opening keynote, several breakout sessions, emceeing the Symposium, along with providing presentations for over 200 Seattle Study Club events, with clubs requesting that she return again and again.

Howard Farran: It is just a huge honor to be sitting in my house today, and have Joy Millis come by. Thank you so much. Her website is She comes from Charlotte, North Carolina. Joy Millis is the foremost authority on the business of implant dentistry with a unique combination of specialty and general practice expertise. As a professional speaker and trusted advisor, Joy helps dental professionals accelerate the implementation of their strategic goals and objectives. She is an innovator in practice development solutions, influencing patients to receive quality dental care, getting paid without insurance interference, developing referral relationships, and recovering lost patients. 

Joy came to the profession of dentistry at the age of 15, filling in for dental team members where her mother served as a receptionist. Joy's personal life was changed through orthodontics and orthognathic surgery. Implant dentistry was introduced to Joy in 1978 when she joined a practice investigating the service. Moving from surgical assistant to administrator, Joy skillfully developed the marketing management and communication systems for the practice that quickly became a training center for doctors from all parts of the globe. 

Joy's business expertise and hands-on knowledge enhances the value that she brings to the platform, as well as in private practice setting. As one doctor stated, "Apart from her abundant enthusiasm, what sets Joy apart from the myriad of other speakers that can talk the talk, Joy has walked the walk." For over 20 years Joy has taught the business of implant dentistry as a visiting faculty member for continuing education at Georgia Regents University, the University of Texas Health Science Center, and Oregon Health Science Center. Joy is a proud recipient of the Seattle Study Club 2006, the Charlie English ... Oh my god, I love Charlie English. How long ago did he pass away?

Joy Millis: Did you know it was about ... Oh, I guess about eight years ago.

Howard Farran: Oh my god. I get sad every time I see the name. 

Joy Millis: Oh, me too.

Howard Farran: What a friend. Charlie English Community Education Award. Her 20 year Seattle Study Club relationship has included giving a symposium, opening keynote, several breakout sessions, emceeing the symposium, along with providing presentations for over 200 Seattle Study Club events with clubs requesting that she return again and again. Thank you so much for coming by.

Joy Millis: I'm glad to be here.

Howard Farran: Let me tell you something about Charlie English that I love the most, is these dentists ... The difference between Dentaltown and Facebook is Facebook if you post your implant case and someone says, "I don't like that. You should have done this." They just unfriend you. 

Joy Millis: Right.

Howard Farran: Where on Dentaltown, there's a quarter million dentists on there so you put an implant case there, you better have balls that drag on the sidewalk when you walk because if a hundred people ... They have to say it politely. If they're rude then they can hit the ... What is that called? The button.

Speaker 3: Report abuse.

Howard Farran: Report abuse button. But what I liked about Charlie English is every implant lecture, every cosmetic dentist goes and just shows all their most perfect cases and they just walk away and they got everyone in this illusion that they're perfect. And Charlie English says, "Well, that's not real life. That's crazy," and all of his lectures are on all of his failures. He didn't show a single successful case. It was the most impactful way to teach, because when you see that he skipped a step and it all went south, it really had an impact. 

Joy Millis: Right.

Howard Farran: So there's greet and fear but Charlie English he had to be humble.

Joy Millis: Oh he was terrific. One of the things that I would call Charlie on. Anytime a company wanted to sponsor me to speak, if I didn't know the company I'd want to know their credibility I would call him. If they were an implant manufacturer and I'd say Charlie tell me about this company. Are they good people? Are they going to be here tomorrow? Should I work with them? Should I not work with them? He would tell me everything about them, what was good about their implant, whether I should work with them, if they had good management, good people. I love that. 

But the other thing I loved about Charlie, we would be on the same meeting lot because I've spoken at implant meetings now almost 40 years. Can you believe it? And Charlie would be at the meetings and sometimes he'd walk up to me and he'd say, "Joy you're looking good." Sometimes he'd walk up to me and he'd say, "Joy you look tired." If Charlie English said, "Joy you look tired," I looked tired. He was honest. He didn't-

Howard Farran: And his last stint was Green Laboratory in Arkansas?

Joy Millis: I think that was it. I know it was Little Rock, Arkansas. Was it Green?

Howard Farran: The name of the dental lab was-

Joy Millis: I'm not sure it was Green but he was in Arkansas.

Howard Farran: Yeah, I think it was Green Dental Lab. Will you Google that Ryan? Is there a Green Dental Lab? You know the funniest thing about that?

Joy Millis: What's that?

Howard Farran: It was in a dry county.

Joy Millis: Oh and Charlie was-

Howard Farran: So to get liquor ... It's hard to imagine that there's still dry counties. So I said does that ... One of the last times I ever talked to him, I said so does that suck, you got to get in the car ... I said how far you got to drive for liquor and he said like whatever it was 45 minutes or whatever. I said does that suck? He goes, "Oh hell no. I make 300 bucks a trip. I just load up the whole damn truck and then when I get back to the lab I sell it to everyone else."

Joy Millis: Oh god.

Howard Farran: So he was a bootlegger.

Joy Millis: He was a great guy.

Howard Farran: Congratulations on speaking I mean prestigious events, 200 times Seattle Study Club. You're in Phoenix speaking. What are you passionate about today? What are you speaking about?

Joy Millis: I'm here to talk about communication. We're talking about team. How the team influences treatment acceptance. How patients are lost and how we lose patients because of communication and/or lack thereof. I'm also going to talk about heroes. There are a lot of heroes. Depending on where you are the economy's great or the economy's bad. I've been in dentistry long enough to see it ebb and flow and up and down and all that.

It's been kind of interesting for me to see incredibly thriving practices and sometimes it's some of the team members and staff members who are doing things that nobody else is willing to do that makes a difference. The main thing that they do is they know how to keep patients. Patients are lost.

Right now, and I don't know what your research or what you're finding in the marketplace, but right now patient retention is a big deal. Everybody calls me and says, "Market, market. Help me market. How do I get more new patients?" I say well learn how to keep the ones you got and then we'll find you some more. But if you learn how to keep the ones you've got, you won't need any more new patients. You're not treating the ones completely that you have.

Howard Farran: It's funny because dentists are an entire generation behind the S&P 500. Like everybody on television advertising is a loyalty program. Everybody's gone to Chase and Costco and Wal-Mart and [inaudible 00:07:04]. They only want to keep their patients. And the most hilarious you'll go to a small town of 5000 people in the middle of Arkansas and here's this dentist his [inaudible 00:07:13] 25 to 65 in a town of 5000. And you go to him [inaudible 00:07:18] "Well what do you need?" He goes, "Well I need new patients. What do you recommend for advertising?"

I'm like, dude you pissed off everybody in the entire town. How do you need new patients 40 years later in a town of 5000? And then when you sit there and say well let's not spend ... You know when I got out of school 30 years ago, advertising was taboo. And then with 10 or 15 years it's supposed to be 3%. Now a lot of people are running around saying it should be 5-7%. Then you say to that person, why don't you give a painless shot? Why don't you get nitrous oxide? Why don't you do anything that'll make the customer happy?

Joy Millis: Be nice.

Howard Farran: Hire staff that communicate.

Joy Millis: Right.

Howard Farran: So I want an answer to this question. If I line up 100 dentists and I say what keeps you up at night? What stresses you out? It's never their bonding agent. It's never their implant system. It's always the fact that their staff is driving them nuts. The assistant's fighting with the hygienist. It's always HR. And if it's not the issues with the staff, then it's issues with the patients. It seems like the only thing that stresses out humans is other humans. And then the dentist after he gets done doing the root canal, he sees the crazy so he just goes right to his office and shuts the door. He hides. So what advice do you give these guys?

Joy Millis: Well you got to ... If you're not going to be the communicator, you need to find someone who can. If you're not going to know what's going on in your practice you need to find someone who does. And as a consultant, many times when they call a consultant is when it's already too late and they're imploding. They're not only out of love with their staff, they're actually suicidal or depressed and hate it and I wish I wasn't doing this sort of thing. 

So it's a critical issue. I recommend that you have meetings, that you certainly get together and find out what the issues are. Most of the time when I go into an office and the doctor's pointing the finger at the staff, the staff is just as eagerly pointing the finger at the doctor because they don't like the doctor. The doctor won't talk to them. Won't tell them what's going on. Won't pay them. Won't educate them. Won't bring them along with them in the process of having them in the office. It's like strangers just happen to show up and work together. But they're not engaged. 

With staff the ideas people support the most are the ones that come up with themselves. So what I try to do is help the doctor engage the staff in learning how to do things. But more importantly learning how to think. Doctors will tell me here's one of the things for example. "I tell them over and over and over again how to do something and they keep coming to me with the same question. It drives me crazy. Why do they keep coming to me with the same question?"

And it's very simple. It's because you keep answering the question. You keep giving them the answer every time they come to you instead of saying what do you think? Many times the staff are not thinking, they just need to learn how to think. Some of the times they don't think because they've been confronted by a doctor who says you're stupid, you're an idiot, you can't do this. And so as a result they stopped thinking. They stop asking questions. They just show up, do a bare minimum, do what they can do to get by just to keep their job as long as they possibly can because they're afraid. Because doctors get angry when they're asked questions instead of engaging the staff member in learning how to think on their own. How to figure out the answer. How to be trusted with an answer that they have.

I had one doctor that hired me for consulting. Immediately she told the staff she said, "You know I really like the ideas that I've heard from Joy. I've heard her speak a few times and I like the ideas and if you hear ideas from her you want to implement, run it by me first and then we'll decide what we're going to do." The same week I went to another office. The doctor said to me, "You know I like your ideas," and as she engaged her staff, it was two female dentists. As she engaged her staff she said, "You know if Joy's got an idea you think is going to work here go to it. Just get it done. Just put it in because I trust you guys that you'll make a good decision about what we do and Joy's got some good ideas."

In working with those two different offices, the one office where the doctor said run it by me, run it by me, was the one who ended up not getting things done as quickly. It took two years for her to really get engaged in transforming her practice into one of the largest in the country. The other doctor immediately jumped on board and started taking action and doubled over the time to get things done much faster than the rest of the people.

Howard Farran: It's basically natural selection. You couldn't get into dental school if you didn't get straight A's in calculus, physics, geometry, all this stuff and those aren't any of the skill sets any of these dentists need.

Joy Millis: No.

Howard Farran: It's kind of like the deans you know the research shows them that by doubling the supply of dentists you're not going to get dentists out in the rural. The only way you get dentists in a town of 5000 is you got to take kids from towns of 5000. Only a kid that was born in a town of 5000 goes back to a town of 5000. So if they really want rural dentists, then only let in rural people. And the only thing a patient judges you on is how you make them feel. They never remember the dental work.

Joy Millis: No they don't.

Howard Farran: You can point to a bridge, a gold crown. I've worked on patients that only had one implant. I said well who did that implant? It's like how did someone get in your mouth and stick a piece of titanium in your head and you don't know ... So many dentists, so many patients will know the name of the office. They'll say, I went to Saddle Creek Dentist. What was the dentist's name? They don't know. I tell the dentists when you come out of dental school what matters the most is that you have an amazing bedside, chair side manner and that you have amazing staff that you attract and retain and keep for 10, 20, 30 years. My assistant Jan is going to be 30 years. Today was my ... Laurie, we call each other Batman and Robin. She's celebrating 19 years today. And I said do you think you'll go for 20 and she goes, "Well I'm going to beat your ex-wife. She was there 20." She goes, "I'm definitely doing 21 just to beat your ex by a year.

If you can't attract and retain long-term staff then you're not going to attract and retain your patients. What we know now in the average dental office by the time you get to 5000 charts, 4000 of them are gone.

Joy Millis: Let's talk about that.

Howard Farran: So they want a bunch of new patients because that's easy. It's easy for me to write a check and put up a billboard, a monument sign or do a direct mail campaign. What's hard is to look in the mirror and say, why did 80% of your patients never come back?

Joy Millis: Right.

Howard Farran: So why did 80% of my [inaudible 00:14:48] patients never come back?

Joy Millis: Well because they became invisible in the practice essentially. I go into an office when they hire me and they want me to do marketing one of the things I do is sit down at the computer if they've got one I can sit down at. You know because they all hog the computers and I can't always get to them. Or I'll sit down at the computer with one of them which is my favorite thing to do. And I'll say let's look at patients because when they hire me to market I want to know that the marketing plan is going to be effective because they keep the consumer. They retain the consumer. They're not just going to get them in there and lose them because that's a failed marketing plan. That's ineffective. It's got to be a plan that will not only get the consumer, the patient in this case, but also a plan that will keep that patient.

Because if you lose them you've just wasted your dollar. You've spent money on marketing whether it's 5-7% whatever it is now, you've spent money on marketing and then it's wasted money. And so then you're continually trying to get new patients. Now some doctors like doing that. It's just like let them run through here. Let's get hundreds of them in here. It's the law of averages. We'll keep some we'll lose some but doggonit what if you were able to get fewer and did more and kept them forever and they referred people like them. That's pretty excellent marketing with no significant expense going out the door.

So I would sit down. I would go through records and usually about 20 records maybe 50 if there was time that I could go through records. Straight in a row in the alphabet beginning at about M in the alphabet. I started there because the hygienist always worked the A, B's and C's. When the doctor goes on vacation what happens is the doctor says, "While I'm gone, why don't you go through some of these records, get some of these patients back in here. We've got holes in the schedule. There are holes in the hygiene schedule. See if you can get some of these patients back in."

So they start going through the records after the doctor leaves but they hate doing it. The moment the doctor walks out the door the assistant or whoever is there says, "I don't want to call these people. You want to call these people? If they wanted to come in they would have been here. I don't want to call them. You want to call them? What a waste of time. I don't want to bug them." Then they'd say well okay, I'll call one. They call one and say do you want to come back? Didn't think so. Hang up the phone and now what I'm finding, years ago, I've been in dentistry for a long time. Years ago we would give patients a three-year survival rate. Some brilliant assistant came up with the idea years ago to put a little date sticker on the edge of the chart. You remember those date stickers?

Howard Farran: Yeah, I do.

Joy Millis: That was to make it easy to get rid of your patients while you were on vacation. You would leave. We'd call one. They wouldn't schedule so we just go through the chart rack and pull out everybody who had not been in in the last three years. Now we're computerized. We've got wonderful computer records and we've got all these records that are invisible, out of sight, out of mind and the doctor goes on vacation. "Why don't you go through these patients records. See if you can get some of these people back," and so we start going through the records and we get tired of it and then we just pull out that little easy button. It's a key on the keyboard there on the computer that archives. Bang, patients are gone. 

And what I'm finding is patients are gone within one year. They're archived in a year. Doctors will run into a meeting I give them a little task to go through records and see really how much dentistry is filed and forgotten. You mentioned 5000 records, 5000 patients. Let's say we've got 5000 patients in a town. On average when I go through 5000 record and I don't even have to go through all of them but you can. When I go through, half of them don't have an appointment for anything. And these are 5000 active patients. Patients we say we're treating. 5000 active patients. They're not even archived. I just go through active patients. 50% of them are not even scheduled for anything.

And I look at that and I think this is like crazy. How can we have hygienists, have a schedule, have doctors sometimes with a hole in their schedule. How is it possible? And when I go through them and find that if you have 5000 records, 5000 patients, and half of them that's 2500 of them don't have an appointment for anything not even hygiene, and let's say we value them at what the average value that insurance companies say they're worth each year, $1000. And you've got 2500 who don't have an appointment for anything. Average value of about $1000 which is what insurance says they're worth. Why wouldn't they be worth that to us? $1,000 and you've got 2500 ... That's $2,500,000 filed and forgotten, invisible, waiting on you to go on vacation and somebody to push the little button and they're gone.

Howard Farran: That's almost a free divorce just sitting in your charts.

Joy Millis: Right there.

Howard Farran: My gosh.

Joy Millis: I went to one office. The doctor had four doctors, four hygienists and holes in their schedule. I walked in they had the hybrid system. Hybrid being computer records and charts on the wall. They had both. The hybrid system. And so I said what can I look at? Can I look at the computer? Anybody got a free computer I can get to the computer? And immediately realized my gosh it's more than 50% are lost. More than 50%. So I said to the staff, I said you guys have some time on your hands every now and then. You walk up front, your patient's not ready. Patient's not here. Their insurance hasn't been verified, it takes 45 minutes to do that.

And so you're waiting, waiting, waiting, waiting, waiting and you're standing around. Walk up to the chart rack. Just do that. Walk up to all this active patient because the boxes were in the room next door. Walk up to the active patients on the chart rack. Pull the next chart and we'll put a little marker in there. Pull the next chart and when you pull it out just simply ask the question, do they need any treatment? Everybody needs hygiene. Everybody needs that, that's a granted. Do they need any treatment besides hygiene because everybody needs that?  Do they need any treatment and then the next question is are they scheduled or not?

I had some little Post-it note read flags like you use in a bookmark or something. I had a few. And I said here's your starter marker kit. Just flag the charts. Just flag the charts and you might have to go to the computer see if they're scheduled. That's okay. Do whatever you need to do but I don't want the computer access to hold you back. Flag the chart. If they need treatment they're not scheduled flag the chart. I came back two months later. They had a lot of spare time apparently. And I walked in and the chart rack was full of these red flags. They had to go to the store, they had to buy bulk red flags, these little Post-it note flags. Red flags on row after row after row. We calculated the red flags not scheduled, if they were only valued at what insurance companies say they're worth about $1000 each year, $7,200,000 in their active rack just filed and forgotten. 

But this was a complex restorative practice. This was a practice that prided themselves on doing full mouth dentistry beyond the max that insurance limitations put on patients. And so we know that the average value of a patient was way more than $1000. But just if it was $1000, 7 million-

Howard Farran: You spent your whole life really coaching elite practices to be more elite.

Joy Millis: Right.

Howard Farran: What is your low hanging fruit for these guys to go to the next level?

Joy Millis: The low hanging fruit? If you get a patient don't lose the patient unless by choice. Now I do teach risk management. The time to decide you don't want to treat a patient is before you treat the patient. Many young dentists I think think they have to treat everyone.

Howard Farran: When I think of risk management I think number one, don't get married. Number two, don't have kids. Ryan [inaudible 00:23:10]. Sorry Ryan.

Joy Millis: Ryan. You can edit that out.

Howard Farran: If you can just stay single without kids-

Joy Millis: We'll adopt you. Ryan I've done that.

Howard Farran: All the risk is gone. So in risk management that is the difference between a young 25-year-old dentist and a 55-year-old dentist is that when you see crazy you can walk away from it. The young people-

Joy Millis: They need money. They need to pay the school loan back.

Howard Farran: ... they need money. They got student loans.

Joy Millis: And that's something they learn to regret that they talked people into doing treatment. It's very hard. Let me back up. On the young dentist the first thing I try to teach them is get debt free as soon as you possibly can.

Howard Farran: Oh my god they-

Joy Millis: So that you don't have to-

Howard Farran: If you want to hide something from a millennial you put it in the oven. They don't cook. They eat out every meal. You could buy a six-pack for $4 and they go buy the $9 drinks and they eat at ... My car is 2004 or with 140,000 miles and they drive brand new Beamers at the dental school.

Joy Millis: Well they learn the hard way. When they can't pay their bills and can't-

Howard Farran: Well I want to say one more thing on risk management. I'd say the biggest thing they don't know when to walk away from crazy but number two, they let the patient talk them into doing something that they don't want to do.  

Joy Millis: Exactly.

Howard Farran: And every time they always start the story with, "I knew that's not what I wanted to do but he insisted." It's like he insisted? Pretty sure you're the doctor. And they have to stick their tongue in the light socket four or five times before they realize. So they usually-

Joy Millis: Right. I ask-

Howard Farran: ...  The birdie usually tells them they're crazy and that's the wrong treatment plan and then they just do it anyway.

Joy Millis: Right. I asked a doctor on peer review, I said what do you do? These poor dentists, they let the patients talk them into doing treatment and compromise care. The doctor might have lofty goals for the patient and the tooth needs a crown for example and the patient says, "Oh I can't afford that can't you do something else," like a five surface restoration that the doctor gets talked into that might end up crumbling and having a problem. So I asked doctor in peer review in a state in the northern quarter of the United States. I asked him what are these young doctors to do? The patients are talking them into doing this compromised treatment. What should they do instead?

And he said they should do no treatment. No treatment. He said that most of the dents who stand in front of peer review did treatment that patients talked them into. It was compromised care to begin with. If you compromise on one thing you learn to compromise on another thing. One of my clients had a patient come in, a little old lady. She had told the doctor, "I don't want X-rays. I don't want X-rays." And the doctor had just been chewed out by a referring doctor, this was specialist that this happened to. Had just been chewed out by the referring doctor who said, "If X-rays are going to be taken, I'm going to take them. I don't want you taking my revenue. If X-rays are going to be taken I'm taking them." 

This doctor was a little gun shy especially when the patient came in and said I don't want X-rays. So she had the patient sign one of those almighty easy forms denying necessary care to neglect is what that little form is when they sign and say the patient refuses X-rays. That's agreeing to neglect. She had the patient sign that and a few months went by and she didn't see the patient again and all of a sudden the daughter of the patient came in and said, "I thought you might be interested in knowing what happened to my mom. If you had taken the images that day you would have seen that little starburst design that was the cancer that killed her. And I know she denied, she didn't want those X-rays I know that." And at that moment this doctor said no more. No more. I'm not compromising again.

And so some referring doctors don't want to work with this doctor but this doctor is safer as a result of not compromising. If you compromise on one thing you'll compromise on another.

Howard Farran: Yeah and you just can't treat everyone. I think that's amazing. Look at the number one cause of root canal failure. If you do 100 million root canals on a molar in 60 months, 10% of them are extracted by general dentists and 5% are extracted by [inaudible 00:27:48]. But what is the number one cause of the molar being extracted because the doctor said you need a root canal and a crown. And she said, "Well I can't afford the crown just do the root canal."

Joy Millis: Incomplete root canal.

Howard Farran: So you did the root canal you obturated and you didn't put a final restoration.

Joy Millis: Not finished.

Howard Farran: The saliva has one billion microorganisms, fungi, parasites and viruses per cc which is the volume of a nickel. And imagine that you needed a quadruple bypass and you said well I can only pay for two coronary arteries so just go in and do a double bypass and then I'll die of a heart attack next year while waiting for a quadruple. So I always tell them well it's a root canal and a crown so you can't ... It's like you're going to get your phone and your cable and your internet. It's all bundled together and you want to unbundle it then let's just pull the tooth now. Why wait five years? And spend that money on three other fillings that will need a root canal in two years anyway.

Joy Millis: Right.

Howard Farran: When you so into an office you spend more time taking million dollar practices at two million not taking the 500 to 750. Is that a fair assessment?

Joy Millis: That's correct.

Howard Farran: I mean the Seattle Study Club, those are-

Joy Millis: You know they have members though that are ... the doctors who join the Seattle Study Club are not all at that level but they want to provide better quality care.

Howard Farran: Well if they're not in that level they're in the Spokane Study Club. The Seattle is the big dogs. And they're [crosstalk 00:29:20] I'm just kidding.  

Joy Millis: Well no I mean they are moving in that direction. I know you're kidding. 

Howard Farran: But anyway go on.

Joy Millis: If you don't have a good example. If you don't have someone you can be with to learn from and know that this is state of the art, then they're going to do whatever the art is not necessarily move forward into doing the types of care that is available to patients now. They don't think it's possible. I'll just tell you. I tell dentists sometimes, be careful about going to your local dental society meeting. I mean support them, help them, encourage them. But if you go and everyone there is whining about how bad it is and how horrible it is you're going to start believing them after a while.

If on the other hand you go to a meeting where people are saying, "This is amazing. Yeah we've had a little bump in the road. It's kind of slow right now but it's amazing that we're still able to do the quality of care that we want to do without all the compromise that we used to do when we were only working for insurance."

Howard Farran: Well it's all self-learning place like you ClearChoice, the implant dental. Is it ClearChoice or Clear Connect?

Joy Millis: It's not clear to me but.

Howard Farran: So ClearChoice does about 18,000 [inaudible 00:30:46] full arches a year, a $25,000 arch. The medium price of a new car is $34,000. What percent of Americans in their lifetime will buy one new car around the medium price of $34,000?

Joy Millis: They will do it.

Howard Farran: And then every dental office in that ZIP Code did not do ... probably 95% never did one $20,000 full mouth rehab. I mean 80% of the dental offices haven't done one full mouth rehab in the last decade.

Joy Millis: Right.

Howard Farran: So 80% of dentists have never done one full mouth rehab and then there's these guys in every little market. I can name the guy in Havasu. I can name the guy in all these little Podunk places who do about the average price ... about a $30,000 rehab case. They got a couple of them going all the time.

Joy Millis: Sure.

Howard Farran: So why does one guy never did one in a lifetime when half of his patients in their lifetime will buy a new F-150? Do you know how much F-150 ... the number one selling truck, F-150, have you seen the prices of those things?

Joy Millis: Is it 65 now?

Howard Farran: Yeah with all the bells and whistles they're 98.

Joy Millis: Oh 98? Wow. That's nice.

Howard Farran: And all those patients buying them they'll say, "Well what does the insurance take?" And then the staff believes it and is like well the insurance won't pay for implant or the F-150.

Joy Millis: That's when I had to learn because I walked into a implant dentistry years ago and I had just come from an office where the doctor sucked nitrous to go to sleep at night because he couldn't pay his bills. He didn't believe patients would accept treatment. He didn't want his staff to ask for payment because he didn't want to offend the patients. He really just didn't think anything was possible and it was depressing. It was depressing.

So then I walk into an office where implant dentistry was the newest thing. We're going to check this out. We're going to find out if it can be done. One of the first conversations I had was with the plastic surgeon who when the plastic surgeon found out we were doing cosmetic surgeon of course. They probably call that in Phoenix. The cosmetic surgeon knew we were doing implant dentistry, reconstruction, full mouth reconstruction came to our office and said, "I need help." He said, "I'm doing cosmetic surgery and the patients still think they're ugly. When they look in the mirror they still see ugly."

And I said well you should do better work. And the cosmetic surgeon said, "We do beautiful work. We look at our before pictures. We look at our after pictures. What we did is perfect. The only problem is the patient still sees ugly. So we started looking for the ugly and the ugly is the teeth or lack thereof. And we can only stretch tissues so much. We can only cover up so much but if their teeth are still ugly and they see ugly, they're ugly." So they said we need help.  

In talking to them they started asking what kind of fees do you have for this type of dentistry and I told them. They said well how do you get paid for this kind of dentistry and I said that's hard. You know you must make financial arrangements according to the patient's ability to pay or you'll lose your patients. Have you heard that one? I lost my patients with that because if you make financial arrangements according to what the patients say they can afford or what they say they can pay, it's a nonpayment plan. A non-treatment plan. Patients say one thing but in reality if they see the value that outweighs the price, they'll find a way to buy that instead of the F-150.

So these cosmetic surgeons said how do you get paid and I said it's hard. We try payment plans. We work with their insurance. They said why do you do that? And I said because we don't want to lose patients. They said which patients would you lose? I said well I guess the ones who weren't going to pay. Then they said what would that make room for? I said well patients who pay because patients who pay refer patients who pay and so on.

That being said, what they taught me was you need to change your thinking if you want the patients to change their thinking. If I didn't think they had the money. If I didn't think they would accept treatment. If I'm in a small town and I don't think patients are going to put down $35,000 for life changing care, they won't if I don't think they will. But some of the practices I've consulted with in implant dentistry have been in small towns and they're the largest practices around.

Howard Farran: I know. There's people in places like Lafayette, Louisiana where they still haven't invented shoes yet. And there's friends of ours that are placing 90 implants a month.

Joy Millis: Sure.

Howard Farran: In Lafayette.

Joy Millis: Yeah.

Howard Farran: And then the dentist in LA says there's no money out there.

Joy Millis: Exactly. Exactly. When people tell me well we can't do that here I say you're right. You can't. As long as you think you can't, you can't. And this is not positive thinking mumbo jumbo is I learned firsthand. Patients would come in. The cosmetic surgeon said to me, "Why don't you just tell them what you can do. You guys tell them what you can do and let them tell you when they can do it. Tell them what the fee is and they're tell you when they can pay it. They may not have the money today."

And this is when I ran into this lost patient situation. When a patient says no today, that might not mean no tomorrow. But I would rather they say no today than to get something cheaper today and regret it tomorrow. I'd rather they wait until tomorrow to do the right thing instead of just doing the compromise care.

Howard Farran: But how do you coach these guys because the natural selection was you're only going to get in this club if you get A's in chemistry and physics. I was the biggest geek at [inaudible 00:36:37]. I didn't have a car or date for three years and got accepted a year early and I was proud of getting accepted a year early. I was almost 40 when I realized yeah you got accepted a year early because you're a stupid geek idiot who lived in a library for three years.

And so your classmates, they're honest. I don't like sales. I didn't go to school ... I didn't sit in a library and get an A in calculus to sell. So should the dentist just admit that I hate selling and get a treatment coordinator that likes to sell? Because I've noticed some of these offices that are struggling, no one in the office likes to ask for money.

Joy Millis: Well that's a hiring issue.

Howard Farran: Some people love it. Some people absolutely love sales. Can you make a-

Joy Millis: Here's how I hire someone who can talk money for example with a patient. Number one, will they show up? Number two, will they act like they're happy to be there? Because if they're running every time it's time to talk about money, it's going to be tough for them to be successful. So will they show up? Will they act like they're happy to be there when it's time to talk about money? Will they get in there? And number three is do they believe in the value of the dentistry?

See if the dentist doesn't believe in the value of their dentistry, none of the staff are going to believe in the value of the dentistry. Because if the dentist is backing off constantly, the staff are backing off constantly. I tell dentists, your actions, what you say, what you do, how you treatment plan, is a lesson that they're learning. They're learning to think small. They're learning to think insurance. They're learning to make that all the total conversation. And with insurance whoever brings it up first pays. If you bring up insurance the whole conv-

Howard Farran: Did you see the HBO movie the Bernie Madoff movie?

Joy Millis: No I didn't. 

Howard Farran: I mean he was the largest pyramid scheme ever, $50 billion. And he's talking all through the movie that when you go to dinner when you're networking with these serious investors that if he mentioned the money ... Do you need to take it?

Joy Millis: You know my brothers call me every day and I love it. That was my brother. I have three.

Howard Farran: I would but my brother is in prison they can only use the pay phone on Saturdays. But no, but Bernie Madoff is a great move because Bernie Madoff when he go to lunch, he would not bring up the fact that he has an investment fund and he wanted you to invest millions. He said if I bring it up first, then I'm selling and they won't give me their money. And he had the biggest whale in the world and he sat there and dinner was almost over and he was starting to leave before the guy said, "How's your investment fund doing Bernie." So yeah if you bring up insurance first, you blow the deal.

Joy Millis: It's going to be all about that.

Howard Farran: If you don't bring in insurance first.

Joy Millis: Yeah I don't bring it up. I let the patients bring it up.

Howard Farran: But specifically, you've been doing this how many years?

Joy Millis: 30 years.

Howard Farran: 30 years. In 30 years do you have success taking dentists who hate selling and making them sell? Or do you think the better solution is let's go to HR and let's find somebody who loves it? Because some people actually love it. So do you like to convert a dentist, I hate to sell to sell or do you like to bring in someone else and be a treatment plan presenter?

Joy Millis: I guess I don't ... What I do is not necessarily teaching sales, sales, sales. Instead teaching value, value, value. What is it that you want to do? What is the value of that? Do they understand the value of that? Do they know why it is worth it for a patient to do this? And then let's bring everyone along. Sometimes when I go in to work with dentists, they don't necessarily see the value of their dentistry. So that's one of the first thing I want to look at. I want to look at their treatment planning process even though I'm not a dentist. I want to see what is their thought process? Usually they just focus on one tooth or their staff member has already told them their insurance will pay for this and that's it.

And so they focus on what kind of dentistry I can sell, if they even use that word, just within that insurance limitation. I rarely find a dentist who cannot communicate. If they can't communicate then I do want to hide them or not let them ruin it because sometimes they'll talk too soon. Talk too fast. Simple things like for example I time the consultation on doctors. How long does it take for a patient to accept treatment? How long? Is it five minutes, ten minutes? Is it 15 minutes or 45? I don't tell doctors talk five minutes and shut up. I just want to know when are you effective? When does a patient say yes in the conversation? When does the light bulb go on and they say oh I see this is what I want. When does that happen? 

Many times their staff members know and their staff members know when the doctor should shut up. Know what the doctor says that they shouldn't. I was in Nacogdoches, Texas, implant practice and the doctor wanted to do more implant dentistry. His staff told me, "You know he'll talk and talk and talk to a patient going from treatment plan to treatment plan to treatment plan to treatment plan until they accept a swing lock partial. I'll never forget that visit. I didn't even know what a swing lock partial was. 

I said what do you mean? What's a swing lock partial? They showed me. Little posterior segments that clicked in, locked in. At any rate, I said what do you mean he talks and talks until they accept a swing lock partial? And they said, "It's the last thing he's got to offer." He just presents this. If that doesn't hit he presents the next thing. If that doesn't hit he presents the next thing until the treatment value goes down and down and down and down and down until he has nothing of less value than the swing lock partial. 

I said so what should he do? They said, "If he would just shut up patients would accept treatment." I said well how can we get him to shut up? One doctor I timed, if he talked more than 15 minutes we audited simply the function of time. If he talked more than 15 minutes, patients would not accept the treatment. If he talked 15 minutes or less, patients would accept treatment.

Howard Farran: So your website is  Love it.  What do you do for [inaudible 00:43:32] what do you do? What do you charge? What's the cost?

Joy Millis: What I normally do is I speak, I love to speak for their study club. I love to speak for their small group. I love a group of people who want to be there because not just for the credit but I love people who want to be there because they want to learn. I speak for them. I do specialized consulting in the area of the business of implant dentistry is my number one special area. Moving a patient from not even knowing anything about it even though it's in the media and it's ClearChoice and all over the TV commercials. But do they understand what it is? How to talk about it. How to get paid for it. That's a big thing. How to get paid for it because the fees are often much more than what the fees would be for conventional dentistry.

And so how to get paid for it. Managing risk. How to prevent loss. Risk management loss as well as patient loss. The whole system of how to incorporate implant dentistry into the practice, that's my field. My business has been complete referral or repeat.

Howard Farran: And how do they contact you? Just go to

Joy Millis:

Howard Farran:

Joy Millis: S-H-O-U-T spelled out. S-H-O-U-T-F-O-R-J-O-Y dot com.

Howard Farran: I just want to say congratulations on all that you've done. You spoke to the Seattle Study Club 200 times.

Joy Millis: Oh more than that.

Howard Farran: 200 times I mean that alone [crosstalk 00:45:02]

Joy Millis: They're having their 25th anniversary this coming January. I've been to 24 of their symposiums and done a lot of things there as well as-

Howard Farran: It's amazing the Seattle Study Club, Amazon, Microsoft, Boeing, Starbucks. It's a hot bed of free thinking people out there. It really is.

Joy Millis: And you.

Howard Farran: And me.

Joy Millis: What a treat to meet you.

Howard Farran: Hey, honor to meet you. Thank you so much for coming to my house.  

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