Dentistry Uncensored with Howard Farran
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789 Mastery of Case Acceptance with Treatment Plan Academy Founders John Estefano, MBA and Dr. Chad Abed : Dentistry Uncensored with Howard Farran

789 Mastery of Case Acceptance with Treatment Plan Academy Founders John Estefano, MBA and Dr. Chad Abed : Dentistry Uncensored with Howard Farran

7/28/2017 9:21:36 PM   |   Comments: 0   |   Views: 517

789 Mastery of Case Acceptance with John A. Estefano, CEO and Chad Abed, DDS, COO of Treatment Plan Academy : Dentistry Uncensored with Howard Farran

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789 Mastery of Case Acceptance with John A. Estefano, CEO and Chad Abed, DDS, COO of Treatment Plan Academy : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #789 - Tx Plan Academy

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AUDIO - DUwHF #789 - Tx Plan Academy

John Estefano, C.E.O. and co-founder of the Treatment Plan Academy, achieved his Masters Degree in Business Administration from UC Irvine, going on from there to cultivate his client experience techniques and becoming a skilled business executive. In John’s past ten years in the dental industry, he has gained a particular expertise in treatment plan acceptance having authored the book, "Plan for the Plan : Dental Team Strategies for the New Dental Economy," helping many dentists to expand their practices. In the past ten years, john has personally helped patients to the tune of 25 million dollars worth of case acceptance one patient at a time. Having presented his biggest accepted case of $134,836.00, by applying treatment plan academy's core principles of empathy and education.

Dr. Chad Abed, C.O.O. and co-founder of Treatment Plan Academy, did his undergraduate studies at the University of Michigan and earned his DDS at University of Detroit-Mercy. Practicing since 2003, Dr. Abed has successfully grown all different types of dental practices in four states. He has maintained licenses in New York, Illinois, Michigan, and California. He is newly married and welcomed his first child into the world in 2017. Besides family, Dr. Abed is an avid nonfiction reader and gamer. He plans to pursue his MBA in 2018 with a concentration in Business Analytics. 

Howard Farran: It is just a huge honor for me today to be sitting in my house and having these three fine people come over and thank you so much.

Dr. Chat Abed: No problem.

Howard Farran: This is the team, the crew of the Treatment Plan Academy.

We'll start with you, John Estefano, co-founder of the Treatment Plan Academy. John achieved his Master's Degree in Business Administration from UC Irvine, going on from there to cultivate his client experience techniques and becoming a skilled business executive. In John’s past 10 years in the dental industry, he has gained a particular expertise in treatment plan acceptance having authored the book, "A Plan for the Plan: Dental Team Strategies for the New Dental Economy," helping many dentists to expand their practices.

In the past ten years, John has personally helped patients to the tune of $25 million worth of case acceptance, having presented his biggest accepted case of $134,000. All of this, one patient at a time by applying Treatment Plan Academy's core principles of empathy and education.

Right here, I have Dr. Chad Abed …

Dr. Chat Abed: Abed.

Howard Farran: … of Abed and Costello? Pronounced it same?

Dr. Chat Abed: That's right. Pronounced the same.

Howard Farran: Are you Abed or Costello?

Dr. Chat Abed: I'm Abed, of course.

Howard Farran: You're Abed?

Dr. Chat Abed: I'm shaped like Costello. I'm not sure.

Howard Farran: Dr. Chad Abed, co-founder of Treatment Plan Academy, did his undergraduate studies at the University of Michigan. You're a Wolverine?

Dr. Chat Abed: That's right. Probably.

Howard Farran: And earned his DDS at University of Detroit-Mercy. Practicing since 2003, he has successfully grown all different type practices in four states. He has maintained licenses in New York, Illinois, Michigan, and California. He is newly married and welcomed his first-born child into the world in 2017. Congratulations on that.

Dr. Chat Abed: Thank you.

Howard Farran: Besides family, Dr. Abed is an avid nonfiction reader and gamer. He plans to pursue his MBA in 2018 with a concentration in business analytics. An avid non-fiction?

Dr. Chat Abed: Yeah. I like to read true stuff.

Howard Farran: Same here. I [crosstalk 00:02:04] …

Dr. Chat Abed: Biographies, ...

Howard Farran: history, biography …

Dr. Chat Abed: … business books, psychology, dentistry.

Howard Farran: … and that type stuff. People always say to me that they're dentists and they don't even know what their treatment plan acceptance rate is. They're sitting there reading Lord of the Rings. If I've read all this stuff, it's like, "Are you out of your mind?"

Dr. Chat Abed: That's right. I actually read …

Howard Farran: Then, they whatever.

The reason why I'm so excited about having you guys on this show is because I'm dentist and physicians, they don't call the customers, they call them patients, which comes from, "Be patient with my screwed up medical office and wait in the waiting room."

Can you imagine if you want to buy a new car that they'd say, "Be patient and wait in the waiting room?" They'd have a sales person on you right there. Dentists don't like that but the reason I like that is because if you don't sell the case, they take their money and they go to Disneyland and buy an iPhone. They walk around with a cavity. Then, that cavity, they have a new-born baby and they kiss on the mouth and inoculate that kid with Streptococcus mutans and they give it to their wife.

We have herd diseases. If you talk to any farmer who's got pigs versus one that has cows, when they're all … Their herds have diseases. This is a communicable disease that you have a new-born baby and you'll hand it to your grandmother who's got an upper denture, lower partial, 7 millimeter bleeding pockets. The first thing she'll do is kiss it on the mouth. It's like, "You go, grandma! You go!"

John Estefano: It's true.

Howard Farran: But it's absolutely true. The herd understands that below the belt, there's diseases that we transmit. They all came from animals. Gonorrhea and syphilis came from cattle and sheep. Herpes is only found in rabbits. Chlamydia from koala bears. It's crazy. HIV was from the green monkey. The whole society knows that below the belt but they still haven't dawned on them that above the belt …

Now, we have oral cancer, which is being passed by kissing. People go to bars and they think if they put a party hat on, they're all good. Then, they transfer HPV and they die of oral cancer. Dentists don't give them the HPV vaccine. Here's the deal on the funnel. What we know for pretty much a fact that for the 211,000 licensed dentists in America, it takes probably 100 hits on their website before three to four actually call. Then, so the conversion from the website to the deal because their website sucks. It's five years ago. There's no video of them. If you Google dentists and NEA, that whole thing ...

Dr. Chat Abed: It's same thing, same template everywhere.

Howard Farran: Oh, yeah. You've got a mug shot that looks like he's been arrested for a DUI. There's no video where he can sit there and say, "Hi. I'm friendly. I know you don't … You know, come in and see us." There's no video. It's some mug shot and a bunch of alphabet soup shit behind his name that no one knows what any of that means.

It's going to be 100 people hit the website for three to four to call. Then, your [resubstanance 00:05:05] has no training like the dentists has eight years, eye dentist has four. My assistant, Jan, went to school for a year. No training at all. It takes four people to call her before she can convert one in. Then, when that one sits down, we're just talking cavities. Nothing fancy, no veneers, implant, all-on-fours, no $134,000 treatment plan. None of that stuff. We're talking about a filling.

When they diagnose 100 million cavities, they drill, fill, and bill 38. You have to have three patients diagnosed with a cavity for you to do one because they don't understand anything what you're all about, Treatment Plan Academy. You get those three people, they need nine people to call their receptionist without training. To get that 9 people to call, they're probably going to need 9,000 hits on their website. The funnel is insane.

Then, the funnel reverses itself. The high dentist sees eight people. She only schedules six of the eight for a six-month recall. On that one day, you just lost 25% of your practice. By the time you get to 5,000 charts, 4,000 of them have never been in one time in 24 months. Then the six that comes in, one has emergency calls and she'll get back with you. No one ever gets back with her.

By the time they get the 5,000 charts, 4,000 of them are inactive. All of dentistry, when they do 750 and take home a $1.45, it's just this little sweet spot in the middle of the hourglass, right, Ryan? I want to make a meme of an hourglass just showing that this is how many it takes to even get anything done and this is what you fall apart out the back door.

The entire dental industry is just this little sweet spot in the middle. The reason they say, "Well, I don't like sales." Then, get out of dentistry because I want you to create a dental office that you want to send your children there when you were dead or your great-grandchildren. I want a dental office that I can send my two grandchildren there and not have to worry about anything. If I die and my grandchildren here go to the dental office, they have three cavities, I want you to be able to transfer value and [edjumacate 00:07:15] them so they know that they have to get a credit card. They've got 250 for a filling. They bought this on a credit card. They went to Disneyland on credit.

Americans will spend every dime they've got. So will the government. The 20 richest governments, they've raised taxes as high as they could and they've borrowed about $40 trillion in the government-backed bonds. Most Americans spend about 103% a year. Every time they make a dollar at the end of the year, they've spent $1.03. They're going to spend all their fricking money. If you don’t take that patient as a customer and you don't take treatment plan presentation as serious as a heart attack, then you can't do your job. You can't fix their teeth. You can't give them optimal oral health. They're going to spend their money.

I tell my staff, "My job is they're going to max all their credit cards. I'd rather them max them out in the 17% economy for your health than max it out at Macayo’s and Disneyland and all that stuff.

Dr. Chat Abed: It's a wiser investment.

Another thing, we do teach this at Treatment Plan Academy. We call it TPA for short is, if you take the time to listen now to their problems and then educate them, what you're actually doing when you prescribe them the right treatment, you're actually saving them money in the long term. That's another, another big benefit as well. Another thing I like, your mindset, we share exactly the same is …

Howard Farran: That's going to [crosstalk 00:08:40].

Dr. Chat Abed: That's probably what it is.

Howard Farran: You notice all the [crosstalk 00:08:43].

Dr. Chat Abed: You know what? It's [crosstalk 00:08:45].

John Estefano: I'm a ball dentist at heart.

Howard Farran: You're a ball dentists at heart? [crosstalk 00:08:49].

Dr. Chat Abed: And Kelly and John and I talk about this all the time. We like to run. We like to manage ourselves by numbers. I like how you've went through the steps of the funnel and the percentages and all that stuff. That's something that I say extremely few modern dentists or dentists in history had either done or didn't realize that they need to. This is something that needs to be done now. It's very [crosstalk 00:09:13].

Howard Farran: Like people always said, it saves them money in the long run. What's funny is and hilarious is that, for 54 years, you always hear Americans in Phoenix say, "Why did it take him a year and a half to widen that street? They've been working on it for six …" Because all of America was built by the lowest bidder. They ask John Glenn when he got back to Earth, the first guy to orbit the Earth in a satellite or whatever. They said, "Well, what were you thinking up there?" He said, "I thought I was in this spaceship built by the lowest bidder." He wasn't sitting in a [crosstalk 00:09:43].That was bidded out. It was built the cheapest thing they could do. NASA wouldn’t try to build a [inaudible 00:09:51]. If your roads didn't go to the lowest bidder, they wouldn't take four months to do a little project. If it went to the highest bidder, the bridge wouldn't collapse after 50 years. Patchwork dentistry is not going to save money.

John Estefano: To go back a little bit, one of the core principles that we have in Treatment Plan Academy, when you mentioned that if somebody was sitting in a waiting room for a few minutes and that wouldn’t happen in a normal situation where somebody buys something, one of the things that we believe is that we're asking people to make decisions on their treatment plans unlike any other decision that they make on a daily basis on what they buy.

For instance, using your example of a car lot, somebody goes into a car lot, there's one guys that greets them, shows them. "What are you interested in?" Interviews them, shows them a car. Takes them around the car. Takes them for a test drive and says, "Well, what do you think? Let's write it up. Let's see if …"

I've bought a few cars in my time. Then, he takes them through the entire process. That's a very integrated experience. It's just one guy taking him through the entire thing. We're asking people to forget about how they buy things in a dental office and basically adapt to our methods and say, "Okay, so you have a website that's designed by, I don't know, one of the template companies and it doesn’t communicate what you're really about. Then, you're expecting one thing and you call the office. Then, you actually have a person answering the phone that doesn't really communicate what the website says. So, that's one break in communication, so it's more fragmented. And then when they come in, somebody else probably takes them to the back, takes x-rays. That's another fragmentation, a different level of communication. And then they meet the doctor. That's a different level of communication. Another fragmentation."

We actually make the process really fragmented. Even though some people talk about handoffs and some people talk about how you pass a person from one place to the other effectively, it does not substitute for a cohesive experience or an integrated experience where everybody in the office is actually speaking the same language and passing the patient along the exact same thing, which is what we want to incorporate into dentistry. We want to have the patients feel no difference between accepting a treatment plan or going to buy a computer at the Apple Store. I know that that sounds weird because one's health related and one's a consumer product but they're more used to and they're more willing to go buy a computer at the Apple Store or go buy a car than they are to whip out their wallets at our offices.

What do we do? Do we just keep doing things how we're doing them now or do we adapt to the way that they're used to whipping you their wallets?

Dr. Chat Abed: That's right because the mindset for most dental offices is and we doctors, we're trained like this. We're so educated. It's either implied or it's actually quite deliberate. We expect, "Oh, I know what's best for my patients, so if I tell them, 'You need such and such treatment, root canal,' et cetera, they're going to do it because they know that I know that."

That's not actually true, especially when you factor in with the way the dental economy works and how it's different than medical. When it comes to major treatment, you're talking about asking them to part with some amount of money. Insurance companies, they haven't risen their premiums in decades. Even fixing one tooth that's severely damaged, a patient's expected to have to part with a fair amount of money to invest in their health.

Going over with what you said earlier as well is another fact of reality that we've built into TPA is, the vast majority of people, patients, et cetera. They really don't want to go to the dentist. We all hear jokes about it and, "Oh, you know. No offense, doc, but I hate being here." All that kind of stuff.

The reality is we actually have to incorporate that factor into our treatment. What do I mean by that is when you go in, like you said, using patchwork dentistry, I think it's proper for those dentists who are doing such things to tell the patients, "You know what? You know how you hate coming to the dentist and hate getting shots? If we do it this way, you're going to be seeing me sooner than you expect or we can do something that's going to be longer term, more durable and it may last you instead of a few years, could last you 5, 10, 15 years or more. What would you rather do?"

Also factoring in the economic aspect. If you fix something with an extremely large, let's say, direct restoration, then you have to factor in the repeated repairs that need to be done over the years. The classic example is doing a bridge versus an implant. Bridge is a long time, quite often will be more expensive.

We've factored in the fact that patients in fact, we have to just accept the fact that the vast majority, there are patient who do love to come into the dentist. "I love coming into the dentist. I've been coming since I was a kid," and this and that. I'd say, 8 out of 10. You might say 9 out of 10, I don't know, would say, "You know, I don't want to be here," or it's come and go and they're very nervous, et cetera.

John and Kelly and I have sat together and really thought through this process. Exactly what John is talking about, we've picked it apart, started from scratch. What are we doing in dentistry when we present our treatment to our patients?

Then, when a patient, which is just another consumer, just another human, goes and makes other purchase decisions, how is our process different than the other process, using Apple as an example? We saw there's huge differences. We've actually picked it apart and reconstructed it to make it much more integrated, as you put it.

John Estefano: And it's not based on sales. It's more based on education of the patient and really reassurement of that fear that they have may be based on some misinformation that they've had many years ago. We take the time to explain that to them. Also, we take the time to tell them what would happen if they don't get the treatment, how much more expensive it would be so making a strong value proposition for today. "If you do it today, we're going to save you time, a little bit of pain and a lot more money." Those big three is what we call the big three in the foundation of the Treatment Plan Academy acceptance principle. If you save somebody time, pain, and money, they're more likely to believe that this is the treatment that's right for them. They'll get out of their own way to get the treatment that they need in order to be orally rehabilitated.

Howard Farran: The biggest problem you're going to have is my homies don't even know their treatment plan acceptance rates. They're sitting in there listening like, "Everybody, if I tell somebody they get a cavity, they get it done." They believe it. You literally have to walk them all the way to their Dentrix and their Eaglesoft and show them.

John Estefano: You have people talking about their 95% closing ratios. Every time I hear somebody saying, "Well, I have a 95% closing ratio on my treatment acceptance," I'm like, "You don't know what you're looking at." There is not one person in the world that closes 95% dollar per dollar of everything that the team of …

Howard Farran: It's worse than that. We have 4,000 [endots 00:17:09] in the United States who spend 80% of their time doing retreats. I've never met a dentist who've had a root canal fail. Ask any dentist in America, "What percent of your root canals fail," because the insurance data says that at the end of 60 months, 10% of all molar endos are extracted. If the endodontist doesn't, it's 5%. When and endodontist does a molar root canal, 5% extracted in five years.

Go talk to any dentist on Earth. "What percent of your root canals are extracted over five years?" "Well, no darn good."

John Estefano: I'm golden.

Howard Farran: I'm like, "Well, there's an endodontist down the street and 80% of the time ..."

Dr. Chat Abed: Ask him.

Howard Farran: No dentist has had to fill root canals. Endodontists must only treat immigrants that had root canals done in other countries.

Dr. Chat Abed: Or people who are on their death bed and pass away.  That's an excellent example. We all think exactly alike, Howard, is thinking, using the brain as intuition, we talk about this in our videos. Brain's intuition let the mind, the human mind is magnificent. It's great for many things but we've also measured in detail in psychology what it's not good at. This is things like that.

When you think, "Oh, I'm so great at root canals, I can't remember the last time …" You know what? That's because you have to actually sit and measure them. You have to record things. We talk about that when we do our statistics. We have numbers.

John Estefano: We have entire modules based on statistics that we keep including treatment proposed versus treatment accepted that get reported to us on a daily basis. We give automatic feedback to all of our clients that tells them how they're doing.

Dr. Chat Abed: Yeah. That's what [crosstalk 00:18:41].

Howard Farran: I think more than most interesting is the human mind for 30 years, all the science has been saying, "When you go in a jury and you're an eye witness, say, 'I saw him shoot her,' everybody's like, 'That's the most credible. He was there and he saw her.'" That's actually the worst evidence. Now that there's all these cameras everywhere, almost everybody that gave a statement, by the time they found out the 7-11 had a camera, "Oh, was that that black car?" "Yeah, it was white."

"And that blonde chick?" "Yeah, she was a brunette."

Dr. Chat Abed: It's very disturbing.

Howard Farran: "And that man was a woman." Your mind is bat shit crazy.

John Estefano: Yeah. We don't like people making us wrong. When we do something wrong, we don't like people pointing it out to us. We actually actively shy away from making ourselves wrong. We hate that more than we hate people making us wrong. That mechanism doesn't allow us to see our faults. It doesn’t allow us to see how many root canals fail.

Howard Farran: I would suggest that on the website, the first thing you do is you're going to have to edjumacate these people on how to run a report …

John Estefano: We're really. Ready and able!

Howard Farran: … on how to figure their close. That would be a good article for Dentaltown, too, because just like the eyewitness. "Well, I saw her stab him." Then, the video says, "Okay. Okay."

Dr. Chat Abed: It was a gun.

Howard Farran: We're humans. Yes.

Dr. Chat Abed: They got pistols.

Howard Farran: This is predictable. This is a trillion circuits of … In fact, if I had to get a tattoo and I've never got a tattoo because I haven't ever seen a bumper sticker on a Ferrari but as soon as I see a bumper sticker on a Ferrari, I get the biohazard one because when they came out with HIV deal in the 80s and they came out with that biohazard emblem. I saw that logo, I thought, "Kudos to the government. One government agency got a badass logo."

Dr. Chat Abed: That's true.

Howard Farran: That biohazard thing was so cool because that's what all humans are. They're a biological hazard to themselves. The first thing you're going to have to do is point their nose in the data. You need to teach them how to go to denture. About 80% of them are off Dentrix and Eaglesoft. Dentrix by Henry Schein, Eaglesoft by Patterson. You got to teach them how so they can see how bad it is because when they're back there doing a root canal, they have no idea that four people called Gloria, and, "How much is a crown?" "A thousand dollars." "Okay. Thank you very much."

The next one now. "What are your hours?"

John Estefano: We actually, on our website,, have old fashioned logs that we like to use to ... They're free to download for any office.

Howard Farran: Can you text me because website Treatment Plan Academy.

John Estefano: It's

Dr. Chat Abed:

John Estefano: We have all the forms that we use on our day-to-day basis, how to keep a log on proposed versus accepted treatment, a call log that measures where all the people that are calling your office are actually calling from and your success rate on how they're being scheduled. Not only are you tracking your conversion rates but you can also track where your patients are coming from and if you have better conversion rates from certain marketing sources. All of those are available free on our website.

Howard Farran: I feel sorry for marketing. I tell everybody in marketing company, "Don't do it unless you can figure out a way to track incoming calls," because docs going to spend $25,000 and then he gets no patients or increased revenue because he doesn't know that generated 100 calls. Fifty percent called when you were closed because they work nine to five, Monday through Thursday.

I think nine to five for me means I work 95 hours a week. I have my whole life. It's 13 and a half hours a day and that's true, seven days a week.

They don't know that half the calls came in when they were closed. When the calls come in when they're open, half went to voice mail. They don't know. They can't even tell you, I'll say, "Well, what percent of the calls are left in voice mail did anyone even listen to?" "Well, Gloria's … I mean, she's amaz- She's my child's godmother." I say, "Well, what does a baptism have to do with the fact that Gloria doesn't even listen to 10% of the voice mails?"

If you can't give them because doctors are good on data. They got to be using calculus, physics, geometry, trig, chemistry. You can't get into dental school or med school if you don't ace out all that stuff. They know the math. You got to show them that. You got to show them numbers, say, "This is what's going on in your office."

John Estefano: Yeah. We do that on a graphic format. We do graphs and statistics based on seven core graphs that we keep and that help basically pinpoint areas of deficiency in any practice. We are happy to have everybody go into the website and download this once for free and at least start tracking it for themselves. If they want our help, we'll happy to help.

Dr. Chat Abed: Kelly helps us every day. She helps us run those statistics and interpretation, et cetera. We go even a step further, Howard. Maybe not all the doctors are like us where we enjoy measuring things. For me, it's about seeking the truth, getting as close to approximating the truth or objectivity as possible. Some doctors and I can understand this. Some of our colleagues are like, "I'm focusing on doing my procedures. I don't want to do that kind of stuff." We teach the office how to do it but we even tell them, "Listen. Just give us the numbers and we can help do it for you." When I say, "It," we also mean interpretation and action plan, et cetera.

John Estefano: Yeah. Action items.

Howard Farran: It was it is. If they say, "Well, what do you love doing?" They say, "Well, I love placing implants." "How can you place a month?" They say, "Well, you know …" Because you have to do a procedure once a week to be critical in my house. I've never seen anybody do an implant a month and made that income. By the time you factor in the CBCT, going all the way to Dominican Republic, buying all these systems, all these courses and you do one every month? Furthermore, I don't want my granddaughter getting an implant done by some guy that places one a month.

If I was going to get a serious operation like a vasectomy, I'd want some guy that's doing it every hour and knows the difference between your nerve and your vas deferens. If they're only doing one a month, if they increase their treatment plan acceptance rates, they could get to critical mass, which is one a week because if you're not doing a sleep apnea, and Invisalign, or an implant once a week, drop it.

You can't master everything in 2017. That's why they have 58 specialties with physicians. They have nine specialties with dentists but if you're not doing it once a week, not only are you not good at it, you're not making money at it. If you're on Shark Tank, Mr. Wonderful would say, "Oh, your sleep apnea retainer once a month, that's a hobby. That's a hobby. Here's how much money you're spending on a hobby. Maybe you should go Jet Ski on the weekends and quit doing sleep apnea," you know?

John Estefano: Very true. Very true. Absolutely.

Dr. Chat Abed: That's very insightful what you just said. Go ahead. No. Go ahead.

Howard Farran: They're all driving to work right now, probably 85%. I retweet your last twitter. I'm @HowardFarran, I just retweeted your @TPAcademy17 to our … What is the 17, @TPAcademy17? What is 17?

Dr. Chat Abed: You mean TX Plan Academy?

John Estefano: It's T for treatment, P for plan, A and written out academy. We officially were founded this year, which is the year of our …

Howard Farran: Oh, so it's 2017?

John Estefano: Mm-hmm (affirmative). 2017.

Howard Farran: Nice. Okay. I also think if they know why the number what it means, they'll remember it easier.  It's going to work. It's @TPAcademy17, founded in 2017. Very nice.

John Estefano: Those logs that I was telling you about are under our resources tab, which is in the top right side of the website. If you're on a mobile phone and those little three stripes, you press that three stripes.

Howard Farran: Yeah. What is that called? Does anybody know what that's called?

John Estefano: I don’t know.

Speaker 4: [inaudible 00:26:39]?

John Estefano: Those little …

Howard Farran: On all the website.

Dr. Chat Abed: Lots of little menu.

Speaker 4: It's called a QR code. Are you talking about the three lines? That's just the menu icon.

Howard Farran: It's a menu icon. Yeah.

John Estefano: Yeah, so the menu icon. You click on that, it gives you basically the same as the tabs that you would have on top. You click resources. All you would have to do is basically create a TPA login. Then, you can download all the forms for free.

Howard Farran: Yeah. For me, on that menu item, the reason I never knew those menu items is because I don’t think a restaurant is good unless the menu has pictures of the food. It's like at the waffle house. [crosstalk 00:27:10].

John Estefano: I've heard you say that. It's a good standard.

Howard Farran: Yeah. If that's a menu item, they should be a cheeseburger there or a waffle or a pancake. That's the menu item.

John Estefano: Menu item, huh?

Howard Farran: You go there and you push on the item that says, "Home about services, resources [crosstalk 00:27:24]."

John Estefano: It's under resources.

Howard Farran: Under resources. Then, to get the resources, you need to …

John Estefano: You just basically log in. Your first time there, you just basically put in a couple of basic forms of info, your name and your email. Then, you're done. Then, you can download any of the logs free of charge.

Howard Farran: You can also email them at,, right?

John Estefano: Absolutely, yeah. [crosstalk 00:27:55].

Howard Farran: How many children do you have?

John Estefano: Three.

Howard Farran: Three? You have [crosstalk 00:28:00]?

John Estefano: That I know of.

Howard Farran: You have one?

Dr. Chat Abed: Yeah.

Howard Farran: You have three?

Dr. Chat Abed: Kelly, how about you?

Kelly Christie:: No babies yet.

Howard Farran: No babies yet.

Dr. Chat Abed: Yet.

Howard Farran: There is one smart person in this room.

John Estefano: The men are glutton for punishment.

Dr. Chat Abed: Yeah. That's right.

Howard Farran: Yeah. There's one. We know there's one smart, rich person in the room. That's the other end. But I always say that writing a book is like having a baby. It takes nine months.

Talk us through your journey, John. What was going on in your journey that you decided to have three kids and a book. Now, you really have four kids.

John Estefano: My smallest child is three years old. He wasn't enough of a challenge so I thought to take on a book.

I think there's a lot of things that I really have been talking about for a long time with my clients. There are certain things that I wanted to put on paper like a foundation for somebody to just say, "Okay, look. There's an actually thing that can be done about the issues that you have in your offices and part of it comes from, as the title says, 'Dental team strategies for the new dental economy.'"

Part of it, that's the inherent problem is people don't recognize it as a new dental economy. I think that that's worth recognizing and pointing out in a written format because they're trying to do things how they were doing them 20 years ago. That doesn't cut it anymore. You need to change and adapt or be willing to accept new ideas in order to change with the times, because he was saying earlier, if the maximum allowable or the total benefit for a patient is $1,500 from their insurance and it's the same as it was in 1965. Now, it's 2017 and we have the same maximum, something's got to give, something's got to change.

Howard Farran: You said, "1965." Was actually 1948, the longshoreman's union. Every container that came in and out of this country, whether it be New York, New Jersey, Chicago, Seattle, those guys had the first strong union. Back in those days, the greatest generation, which I think is born before '33. Then, after that was the silent generation. That was the one that had the baby boomers. They always used to say, "War is good for the economy," when we were growing up. "Well, the economy is about all war because the war is good for the economy." Yeah, when the war is against Germany and Japan, who makes everything.

At the end of World War Two, everybody that made anything, Germany and Japan was leveled. America exploded. They started a dental benefit and it was $1,500 back then in 1948.

John Estefano: I did not know that.

Howard Farran: It's still that or less in 2017. Then, you notice Vietnam, Korea, Iraq, and Afghanistan. What percent of the items Wal-Mart are made from Afghanistan, Iraq. That trillion dollars was a total expenditure, a drag on the economy. That's why you see 2% growth. I would say, "I'm very pro military and pro war if it's only on factories that make cars, TVs."

Dr. Chat Abed: Competition.

Howard Farran: Yeah. Don't hit some other country. Just hit factories that make shit that end up on the stores of Wal-Mart but …

Dr. Chat Abed: There's some statistics there saying, and this is important for our doctors and for the public to know, is exactly what you were saying. First, I didn't even know it goes back to the 40s.

Howard Farran: Yeah, '48. Longshoreman's.

Dr. Chat Abed: If it kept up with inflation it's supposed to be close to 5,000.

Howard Farran: Oh, yeah.

Dr. Chat Abed: That's much more easy to work with in this and that. Instead, what we have to do is we have to help the doctors help the patients by educating them, we're listening to what their needs are, telling them what the risks and benefits are and giving them something that has what we call clinical predictability that will last a long time. On the long term, they save money.

Howard Farran: But I want to ask you cultural questions because there's 220 countries. Having someone, your government or your employer, help pay for your dental. That's only in a few countries.

Dr. Chat Abed: True. Right.

Howard Farran: That doesn't exist in Russia and China and India and Brazil. These guys, it's kind of a … Ninety-nine percent of the purchases Americans make, they're not having their … Could you imagine going to your boss. "Yeah. I need an iPhone. Could you pay half?" Then, come back. "Oh, yeah. I just bought a new car. Could you pay half? We want to redecorate our kitchen."

Then, you go into America. They tell you in America, half of America has no dental insurance but their entire business model is just in the 20 countries out of 220 that have dental insurance. Then, in those countries, the entire business model is just on the half that has the dental insurance. Why can't you just focus on the half of America that doesn't even have dental insurance?

John Estefano: We always use the analogy that people that are untrained, they're like water. Instead of going through a rock, they find a path of least resistance or where they can get the most help.

With training, we think we can reverse that trend, actually make people go through the little bit of hard stuff which basically means confronting the other 50% of the population that really needs the dental care and being able to have the tools to get them to accept treatment and pay for it so that you can produce on a cash basis and bring dentists back the security that they had probably 30 years ago because right now, there are some that are doing really well.

Howard Farran: But here's the other problem you're going to have. There's 211,000 licensed dentists, right?

John Estefano: Yup.

Howard Farran: There's 175,000 licensed hygienists. Eighty percent of the hygienists say that they're not allowed to diagnose. They're not allowed to say anything. They're supposed to sit there like a mime, a mime or is it a mime?

John Estefano: A mime.

Howard Farran: A mime. Charlie Chaplin. They sit there like a mime. If there were such and such asking a question on the phone like, "Well, is it sensing hot and cold? Does it wake you up at night? Are you ta-" "Hey! We don't diagnose over the phone."

You got these controlling doctors because controlling is part of any group species. When you go into a herd of lions or gorillas, they have the 400-pound gorilla and if all the gorillas all decide to go 20 different ways, we would have gone extinct. You obey the 400-pound gorilla. "This is the big lion. We're the small lions." The dentist walks in their office and 80% of the time, he's not going to let the receptionist diagnose over the phone. He's not going to let the hyenas like …

The assistants in there taking x-rays on an emergency patient, she goes, "Is it an abscess?" "Well, I'm not allowed to say. Doctor will take me out back and beat me if I say the obvious." How will you address that?

John Estefano: Because they don't have anything else to say. We actually give them the word tracks to say. Yeah. We're going to take a look at that together with the doctor. The doctor going to explain exactly what's going on. The same with the hygienist. The hygienist, they're not diagnosing when they see it. "You know, I see something here. We're going to ask Dr. Farran about it."

Dr. Chat Abed: Exactly.

Howard Farran: Who cares if they diagnose it? There's not on hygienist in jail today from diagnosing x-rays.

John Estefano: It's true.

Howard Farran: There's probably more hygienists driving down the street with a pound of weed in her trunk than there is hygienists serving time for diagnosing x-ray.

John Estefano: I agree with that 100% but here's the reality. When people go to a dental office, they're not there to see the receptionist. Sometimes, they're there to see the hygienist but they're really there to see the doctor.

We give the power to the doctor and we flow as much power to the doctor as possible so the doctor can be set up in his proper position so that when he does say something or something is wrong, then the patient is going to pay more attention because everybody in the office is speaking the same language of, "Yes, let's take a look and see what the doctor is saying or what he thinks that this is." That's the most effective way. I don't know. When I'm doing a case presentation, it's not that I can't take a look at an x-ray and say, "Oh, yeah. That's an abscess, man. You got to get that out right away." I can do that but I find it way more effective to actually play a little bit dumb and say, "Look. I'm not sure. I'm not a doctor. Let me call a doctor back in. We'll ask him what that dark spot is right there." Then, the doctor because if you call the doctor back in, what that means is that the doctor initially didn't do a good enough job to tell the patient what that really was and the consequences of not handling that.

The job of the treatment coordinator or the office manager, whoever's presenting treatment would be, "Hey, doc. Come here. Tell me what that is? I know you told me last week but I forget what that little dark spot it right there. Can you explain that to me?"

You put it on yourself because you don't want the patient to feel awkward. You put it on yourself. "Hey, I can be dumb for a minute. What is that dark spot again?" When you tell me what that dark spot is, "What happens when you don't handle that right away?"

The doctor has a dialogue with the treatment coordinator in front of the patient because believe me, that patient is listening more actively when two people are having a conversation about them, then when the doctor is telling them directly because they'll have questions that they won't want to ask the doctor because they're going to think that I don't want the doctor to think that I'm stupid or something, right?

Dr. Chat Abed: That's right. That's a common thing.

John Estefano: What do I do? I put myself and I ask the questions that they would be asking if I didn’t know anything about dentistry on behalf of the patient, making myself, putting myself in their shoes. I have a low dental IQ. Letting the doctor come back and build value and validate what he's finding on the x-rays.

That's the key to case acceptance. It really is just about education and me empathizing with the patients, knowing, hey, he may not ask this because he doesn’t want to look dumb in front of the doctor. Okay. I'm going to empathize with that. I'm going to do that for him.

Dr. Chat Abed: In effect, then, you become the patient's proxy.

John Estefano: That's right.

Dr. Chat Abed: You basically have a conversation with the doctor on the patient's behalf because we've set it up that way. Then, that way, the patient just becomes a spectator, which is very low stress.

We want to give you credit, Howard. That's a very brilliant point that you brought up that we discuss in our videos. What you discussed is …

John Estefano: In detail.

Dr. Chat Abed: … the status quo. "Oh, the hygienist, they do the cleaning and then they bring in the doctor for the exam."

In 2017 and in the future, new dental economy, one of the things that is very under-leveraged is our back office staff like the hygienist and even the dental assistants as well, which we'll get to.

With the hygienist, they have amazing training. They have a set of eyeballs like anybody. They're in there cleaning. Whether you want to call it diagnosis or we call it pre-diagnosis, the bottom line is that's a second set of eyes there. That's a second voice that the patient hears to say, "Oh, you know what? I see something a little funny here. Let me have Dr. Abed come take a look at him. Let me take a photo of it."

Then, when I come in there and I look at it, if I decide it's something should be treated, then I can say, "Yeah. It looks like we're going to put a crown on it or do whatever we need to do," but alternatively, I can also say, "You know what? I see a little something or I see what she pointed out. Do you know what, Mr. Jones? We're just going to keep an eye on that for now. Just make sure you come in on time for your checkups," which also builds up compliance with the recalls because they know that I'm keeping my eye on something for their benefit.

Another very under-leveraged staff member are dental assistants. An excellent example is what John was just mentioning.

Howard Farran: Absolutely.

Dr. Chat Abed: They're not just assisting me. They're really assisting my patient, as in we all know, I think most of us know, when I leave the room, the only other person in the room and the first person the patient's going to look at is the dental assistant.

John Estefano: I've seen it hundreds of times.

Dr. Chat Abed: That's it. "What is this?"

John Estefano: "Is this okay. What do you think?"

Dr. Chat Abed: Another great and we talk about this, as he said, in our videos is, the dental assistant is an excellent sounding board to get feedback on how you're being perceived or how well you presented or how well you addressed the concerns of the patient because they'll hear the patient. They'll get the feedback from the patient. I'm always looking to the self-improve. I know John and Kelly as well.

I ask my assistant, "How did Mr. Jones, did they have any feedback or say anything?" Under leveraging or learning to leverage dental assistants and hygienists is a huge, huge deal.

John Estefano: Enormous.

Dr. Chat Abed: I would go as far as say it's a secret weapon.

John Estefano: In our university, they have their own curriculum on how they can actually learn how to participate in the case acceptance process. I'll actually raise you one there, Dr. Abed. The assistant plays such a key role that when we talk about fragmented versus cohesive treatment acceptance experiences, the assistant is the one that stays with the patient the longest amount of time. They could be that glue that binds the entire process together …

Dr. Chat Abed: That's a very good point, yeah.

John Estefano: … and creates a cohesive experience and not a fragmented experience. I just thought of this. I want to just touch on this. I think that everybody that's listening probably know this but I want to explain the difference or talk about the difference between empathy and sympathy because we talk about empathy a lot.

Howard Farran: I pulled up the definition.

John Estefano: Thank you.

Howard Farran: You call it empathy, "The ability to understand and share the feelings of another."

John Estefano: Right.

Dr. Chat Abed: Perfect.

John Estefano: As opposed to sympathy is just feeling sorry for somebody.

Howard Farran: Sympathy is feelings of pity and sorrow for someone else's misfortune. What's more important, sympathy or empathy?

John Estefano: Empathy.

Dr. Chat Abed: Empathy.

Howard Farran: Okay. Teach my dentists how to fake … How do you fake empathy?

Dr. Chat Abed: You fake it by not faking it.

John Estefano: First of all, I think most of them got into the profession and I believe this wholeheartedly. Most of them got into the profession because they are able to empathize with patient and want to do something about it but the difference between the …

Howard Farran: Sympathy is, "I feel sorry for you."

John Estefano: That's right.

Howard Farran: Empathy is I feel your pain.

John Estefano: That's right.

Dr. Chat Abed: I put myself in your shoes.

John Estefano: That's right. I can see what you're going through. Now, one, actually promote action. Empathy promotes action on behalf of that person because you're actively feeling what they're feeling.

Dr. Chat Abed: Precisely.

Howard Farran: That was why I think the male gynecologist went extinct because they were going in there and they [crosstalk 00:42:29].

John Estefano: They couldn't feel it.

Howard Farran: No. I'm dead serious. They go in there and seeing all these things. In the 50s, they were saying, "I think that's all in your head." She's thinking, "How many kids have you had?"

Dr. Chat Abed: Right. It's true.

Howard Farran: "How many times do you have a period each month?" They went to women because the women understood and have empathy. They go, "I'm a woman, too."

Dr. Chat Abed: That's a good point.

John Estefano: Then, to weigh it against the sympathy. Sympathy, when you feel sorry for somebody, that doesn't necessarily lead you to action. You just want to hold their hand and say, "This is going to be okay," but it doesn't necessarily drive the action that that patient's going to need in order to get rehabilitated. One actually leads you to action and …

Dr. Chat Abed: [crosstalk 00:43:08].

John Estefano: If you have sympathy for somebody and you're really feeling sorry for somebody, then you're actually going to adopt their level of fear. You're going to be in their shoes but in a bad way where it doesn't allow you to help them properly. We talk and hate sympathy but we always promote empathy because that leads to action.

Dr. Chat Abed: Right, because the outcome of empathy is helping the person, helping the human being.

John Estefano: Yeah. If you really feel like what somebody is feeling. If you really feel that they're being disturbed by that pain every day, then you can say, "You know what, man? If it was me, I would get that done today."

Howard Farran: I also want to say that the human mind is a very bizarre deal but one of the research I really like is the fact that the way the human mind is wired is when you're walking in the jungle and all of a sudden, a tiger jumps out, you don’t have time to sit there and think, "Well, that's bigger than me and by the shape of his carnivore teeth, I think he's a carnivore. I'm meat." Your trillion circuits fire instantly for your survival. You run up a tree. They showed in college. You read the question and instantly, your brain said, "B," but then you started thinking and thinking and …

John Estefano: You talk yourself out of it.

Howard Farran: … then you erase the B and then you circle C. I think that what these young dentists need to do is that, if I walked up to you 100 years ago in Salem and put this phone to you and said, "Hey, you want to talk to your uncle a hundred miles away?" He said, "You're a witch." They would have drowned you.

John Estefano: You'd be on that pole.

Howard Farran: Yeah. When I say this, it's going to sound like crazy talk but they don’t even know what dark matter is. Dark matter. They've been talking about ESP for years but when you're working on a patient, I always feel their pain. When I start to feel tense or my heart beat's going up, I'm listening to that all the time. The minute I start to feel tense, their brain somehow is telling my brain, "We're on the same wavelength."

Dr. Chat Abed: Right. That's right. That's very deep.

Howard Farran: That's when I'll stop and say, "Hey, are you okay?" Or, you know, "I need a breather," whatever.

Same thing with a shot. You have this same pressure except you have five nerves, hot, cold, movement, pressure, pain. You have the same pressure in your thumb as they do in their jaw. If you're feeling, if you're pushing the injection, they're feeling a shock but if you slip that in where your thumb doesn't feel the pressure, they don't feel the pressure. Young dentists need to realize that minute you feel any stress, it's coming from the person you're doing a fricking root canal on.

Dr. Chat Abed: Yeah. Very good.

Howard Farran: Stop! Slow down! Get empathetic.

Dr. Chat Abed: I want to add one thing, actually, because we talk this in our lectures all the time. It goes both ways. I always bring up this documentary that I watched by National Geographics and in Africa, there's a bunch of gazelles just drinking water on the watering hole. Then, one of them turns and sees a lion about a hundred yards away. The rest of them, without looking, run. They actually sense the fear in that one gazelle that saw the lion and they turn to run. The one that got eaten was paralyzed because they saw the lion and they're the ones that took off the slowest. That's actually a biological reaction.

Dr. Chat Abed: Motion has contagion, yeah.

John Estefano: It's a fight or flight response that we always have. The patient can give you that feeling where you stop.

Here's the other thing. When somebody has a $20,000 case that they're about to go present, translates to the patient. The patient feels it. Here's another thing. If the patient feels your fear, they won't know what's wrong. They don't know if it's the numbers. They don't know if that's the wrong treatment plan. They don't know what is the matter. They just know that something's off. What do they do? "I got to go home and think about it."

Dr. Chat Abed: That's right. You're actually giving negative signals.

John Estefano: That's right. That's right.

Howard Farran: Here what I don't understand about dentists, also. They don't like DSOs. They don't like corporate dentistry but there's ClearChoice, which is the implant company. They charge $25,000 an hour. They do 18,000 arches last year.

John Estefano: That's all they do.

Howard Farran: Now, I'm going to read you this ad. "The estimated average transaction price of a new car or truck sold in the US is 33,516." And every single dentist, hygienist, assistant, receptionist, they've all bought something around that mean average price. You've all bought a car for 33,560. ClearChoice does 18,000 arches a year. Not many people buy one arch so they're buying an upper and a lower. That's 50,000 but dentists, 90% of them, they've never done a $10,000 case. They're just like, "This guy's not made out of money." He's like, "This guy just drove in in a $33,000 Honda Accord." Why do they have that self-limiting block …

Dr. Chat Abed: Very deep.

Howard Farran: … that people only spend 33,000 on a car? They would never do it to have optimum oral health.

John Estefano: Our philosophy on that is when you go to dental school. We talk about this a lot is when you go to dental school, when you're first taking that drill and you're drilling around the tooth, at first, you're a little scared. Then, the more you do it, the more you practice it, the easier it gets until you're five years in and then you're doing a crown prep in five minutes and it looks perfect. You never have a problem with the lab. You're an expert at it.

Like you said, if you're doing one Invisalign case a month, give it up. If you're closing one $10,000 case a month, give it up. It's not your deal. You have to practice it and you have to have the tools to practice it so you become as proficient as the doctor is at prepping that crown in five minutes.

The problem is, the tools don't exist. They haven't existed in the past. What does the doctor do? The doctor says, "He's blaming himself." A lot of time if they're a good doctor, they blame themselves. "Look, I don't do a lot of $10,000 cases." He knows what to look at. He looks at the x-rays. He has $10,000 worth of treatment. Then, he starts pulling himself back, compromising the patient care because he doesn't want to blow that patient out of the water. The reality is, the person presenting that $10,000 case is inequipped to do it. They don't have the tools.

Dr. Chat Abed: They're under-trained.

John Estefano: They're under-trained. They don't have the tools and they don't have the knowledge to actually go with confidence and say, "Look. This $10,000, I know it may seem like a lot of money but if we don't do this in 5 years, 10 years, whatever, it's going to cost you 30. And I want to save you all that time, pain, and money and I want to show you how I can help you do that 10,000 in an easier way than just writing a check for it."

Howard Farran: I have one extra close on women instead of men. The average man is dying at about 74, America. The average woman is 79, almost 80. Women live about five years longer than men. If you go into a nursing home, there's 100 women and one man named Lucky. All men die pretty much at home with their wife [inaudible 00:50:32]. Women are your nursing home population. A lot of time, they'll say, "That's a lot of money." I said, "Well, I'll tell you what. You won't drive your car the last 10 years of your life and you won't live in your home the last five years of life. And I'll tell you what. When you're not driving your car and you are in a home, you know what's going to be rocking hot cool?" What's the only entertainment when you're 85 years old and can't drive?

John Estefano: Bingo?

Howard Farran: Eating.

Dr. Chat Abed: Eating.

Howard Farran: Imagine how much healthier you're going to be in the nursing home when you can rock out on broccoli, carrot. You can eat anything you want. If you go into a nursing home, every deal they have to have food for the dentures. They could have macaroni and cheese and cottage cheese …

John Estefano: Mashed potatoes.

Howard Farran: … and mashed potatoes and pudding because all those people who didn't do what they needed to do are edentulists. You're wearing a denture right now. "How many times has your husband seen you without the denture?" "Never." "How many times have your grandkids seen you without your denture?" "Never." "Oh, so you want to sit in a nursing home for the last four years with 89-year-old dry tissue with your dentures in the bottom drawer and every time your grandkids come, there you are with no teeth in? Why do you live in 175,000 house, drive a $35,000 car and don't want to have an implant-retained prosthesis so you can eat carrots when you're 102?"

John Estefano: My philosophy on why that person is in that condition is that nobody's cared enough about them to actually get them through whatever it is that's holding them back to do it. The most effective way of communication, I believe, is when you can put a picture in somebody's head. You're enjoying your food when you're 85. You bring them back to when they were 20 the last time before they had dentures and they bite into an apple. Those juices just spill all over, the juice from the apple just hits their pallet. It's super sweet. You can create that picture of that apple and them biting the apple. That's what actually leads to decisions. It's more they get more driven by the emotions that they can feel when you put a picture in their head than when you tell them what can happen if they don't get it done or you talk about a corn on the cob and biting the corn on the cob and that kernel exploding in their mouth. That is what drives decisions.

Dr. Chat Abed: We talk about that in our lectures where we have …

Howard Farran: When he said an apple, now I got to go leave and go get a Mike's Hard Apple Cider.

Dr. Chat Abed: [crosstalk 00:53:04].

John Estefano: Sounds good.

Howard Farran: When you said those apple juice.

John Estefano: Yeah, man!

Howard Farran: Mike's Hard Apple Cider.

Dr. Chat Abed: We all know you can even just picture a lemon and biting into one in your mouth and start watering but you know what you're talking about earlier, I want to tie in what we said just now to what we said earlier. We talking about empathy. This isn't woo-woo, foo-foo kind of, oh, you know, trying to help people, really mean it. What does that really mean?

If someone has severely broken-down teeth, whether they'll need all-on-fours or whether they'll need full mouth rehab, you really have to put yourself in their shoes. Do you want them to just come see you to do that one crown, that tooth that broke and they need one crown or they think they do. Their previous dentists had said … Or do you want to look and say, "Listen, this path that you're on of spending this to fix this one tooth. This is not going to last you very long. You're going to continue to have problems. We can fix it right the first time right now."

In other words, like you said, the treatment coordinators and especially doctors, they let their own fear get in the way of really helping the person. I mean, telling a patient what they want to hear isn't caring for the patient. Telling them what they really need and why they need it, that's how you care for someone. If they need that $10,000 case for example, tell them and tell them why.

John Estefano: Then, some people will argue, "Well, I don't want to lose them from the practice so I'll put them in hygiene for a year and then I'll hit them in a year." In that year, what happens?

Howard Farran: What if I understand is like the watch. Can you imagine going out in Kansas? "Well, there's a little termite hole in the barn but we're just going to watch it." You know what a farmer does when he sees a termite hole in the barn? He cuts out a 10 foot by 10 foot section and spray the …

Dentist like, "Well, it's just a little cavity now. Right now, it just be a little hole. Go home and eat some sugar, drink some Mountain Dew and then come back in a year." The watching is …

There are some many self-limiting … They'll say, "Well, you can't numb up both sides of the mouth so we're just going to do this one over here." Okay. Next door is an oral surgeon and he numbs up all four quadrants eight times a day for the last 40 years. There are so many self-limiting ways. Then, that guys afraid, "Well, would you rather have it all done right now?" Let's just get it all done right because you're afraid of the dentist. You don't want to come back.

John Estefano: The person that you're probably saying, "Watch that cavity," if they're a new patient in your office and a lot … We come from California, probably one of the most competitive markets in the world for dentistry.

Howard Farran: Five dental schools. No, six.

John Estefano: Yeah. They just … Yeah.

Howard Farran: There's a sixth dental.

John Estefano: Yeah. They just opened one more.

Howard Farran: Two in San Fran, UP, UCSF, UCLA, USC.

John Estefano: Loma Linda.

Howard Farran: Loma Linda.

John Estefano: And then there's a Western?

Howard Farran: Yeah.

John Estefano: Western now just opened a couple years back. They just graduated …

Howard Farran: Six damn dental schools.

Dr. Chat Abed: Yeah. It's the most sup- we use the term super-saturated.

Howard Farran: Why do you move there? Why didn't you stay back?

Dr. Chat Abed: I'm there for the water and the sunshine but I tell you something. Joking aside, you're bringing up a smart question. Me being there, I realize, "Well, look at this market, this is the worst market for dentistry that I've ever seen." As in, it's so super-saturated, that you're even seeing examples of doctors sometimes even bending their ethics a little bit to over-treat like attorneys have long had that reputation to [crosstalk 00:56:31]

Howard Farran: Chasing ambulance.

Dr. Chat Abed: Something like that whereas we're taking a step back. "Wait a minute. We don't need to do any of this. We're doctor. We're professionals. We're health care providers. How can we treat people well and take care of them?" That's where we started. We took it all the way back to the beginning and said, "It all rolls around being patient-centric, looking out for the patient." That's how we proceed.

Howard Farran: But patient-centric, that's a joke. When they say, "Well, yeah. Is it all about the dentist or all about the patient?" They go, "It's all about the patient." "Okay. What are your hours?" "Uh, Monday through Friday, eight to five."

John Estefano: Very true.

Howard Farran: "When does your patient work?" "Monday through Friday, eight to five." "Okay. They can come at lunch. When do you go to lunch?" "Same time they do, 12 to 1." "When does your phone explode?" "Six to eight," on the cell phones calling and all their getting is voice mail and takes 13 calls before one leaves a message. Then, they call at lunch and you're Little Miss Muffet has the phones roll over. Then at five o'clock, you're sitting on the LA freeway for two hours calling your of-

Patient-centric? Then you say to that doc, "Why don't you just work, come in Monday and Tuesday, start at six instead of eight? And then Wednesday, Thursday, start at maybe nine and stay till six? And give one Saturday a month." They're like, "Hell, no. I'm patient-centered. It's all about the patient." They don't even try to hustle.

Dr. Chat Abed: That's right. They don't have that work ethic.

Howard Farran: It happens. This is so racist. I know I shouldn't say it but this is Dentistry Uncensored. You know who the only dentists I see hustling in the United States, especially in California? The dentists who weren't born in the United States. They'll go to San Fran and work Saturdays, Sundays, evenings, aft-

But, man, if you're born in the United States and you grew up on the X-Box and you had maids, gardeners, the whole nine yards, it's Monday through Thursday, nine to five. Then, the deans complain that none of the dentists go to the rural. We already know because that's because you accept dentist kids from the big cities. All the research shows the only kids going back to a small town of 5,000 was a kid born in the town of 5,000.

I couldn't take Miss Hollywood to Parsons, Kansas. She'd shoot me or she'd shoot herself. If they just would accept kids from rural, like 25,000 and under and try to fill up the class with kids who weren't born in America, Americans would be better served.

Dr. Chat Abed: That's a cool strategy.

Howard Farran: Eighty-one percent of every billion dollar IPO done in the United States since 2008, 51% were foreign-born Americans. They hustle.

Dr. Chat Abed: That's one of the secrets of the strength of America. The brain drain center.

Howard Farran: Then, let rural kids in and they want to hustle. I tell students, if I was [inaudible 00:59:24], I'd say, "Sue your parents for being born here and then sell your offices to someone who was born out of here."

Dr. Chat Abed: Yeah, right.

John Estefano: Availability is very important. We want the patients to be in front of the offices. Again, what do we do when they're there? If you're not number one, you're not available when the patient is there. You inconvenience them and make them take them off of work, so they're already getting to your office pissed off because now they're missing work to come to the dentist. They're probably in pain. Now, they're double pissed off. Then, they're not treated well when they're at the office or made to wait. Now, they're triple pissed off.

What are the chances that that patient's going to say, "Yeah, no problem. Here's my credit card for 15,000. Go ahead and whack it. I'll see you next week where I'll have to take more time off of work."

Howard Farran: I want to address the most controversial part of treatment plan presentation. Money. Most doctors say, "I'm a doctor. I'm not talking money." Some people say a treatment plan presenter should present the money. Some treatment plan presenters say, "Well, if the doctor says the total cost and owns it, that helps me with the deal." Talk money. How do we go from …

John Estefano: I think that the …

Howard Farran: The dirty M word. For me it's the sales words. Sales, I think that's the filthiest word in the history.

John Estefano: Some people may think so. I personally love both words because they facilitate entire economies. I think that the doctor has a very distinct job. That's to educate the patient. Then, if we wear our hats in our office and we do them professionally, then there's no need for the doctor to have to address money because all they need to do is educate the patient and get them to a point where not only do they realize that they have a problem.

I'm going to talk about so this will address this issue for you. We have something in Treatment Plan Academy called the Treatment Plan Academy acceptance principal. It's three steps for actually getting higher case acceptance. Number one, as a doctor, sometime doctors, they get a little presumptuous. They say, "Okay, well, I see that you have a cavity that you had to do a crown there." Okay. The patient may say, "Mm-hmm (affirmative)." Then, "I have no intention of doing a crown." Why is that? Because step one of the TPA acceptance principal is identify a problem that's worth solving for the patient, not you. You can spot problems all day long but if the patient doesn't realize that it's a problem, it's not going to get solved.

Dr. Chat Abed: It's pointless.

John Estefano: That's the most violated step of any presentation process is that we don't take the time to make sure that the patient understand that it is a problem worth solving. That's the doctor's job is to educate the patient to make them feel like that is a problem we're solving.

Step two, when the patient understands, like say, "Oh, yeah. You know what? I see that. I'm probably going to need a crown there." Step two is, when they realized that they have a problem worth solving, they're going to assign a monetary value to that problem. Immediately, without thinking, it's going to be like this. And it's always going to be too low. How do I know this, because after selling $25 million worth of dentistry, I've never had one single patient tell me that I haven't charged them enough for something. It's always, "It's too much money." It's always going to be too low.

If you have a solution that is up here in price and your patient is down here in expectation, then you have a complete disconnect. You are not connected to that patient in the monetary level. What do you do? Do you compromise treatment like we talk about like most, they, "Oh, well. You know, we could possibly do a big four surface filing there," bring their solution down to the patient expectation, which happens a lot or we could actually do step three, build a value proposition that is strong enough to make the patient realize that this is not a $600 problem when you're trying to sell them a $1,200 crown. This could be a $5,000 problem. Now, your $1,200 solution is actually viable. They can accept it because they realize that if they bite into an almond and that filling that's cracked hits the wrong way and the get a crack down the middle of their tooth, they're going to lose that tooth.

Then, we use different verbiage when we're trying to demonstrate that. For instance, "If you bite into an almond at the wrong direction, then you're going to have to lose that tooth. We're going to extract it. Then, we're going to put some bone graft there and we're going to let that heal." Now, that's different verbiage than if I'm trying to get that patient to accept that implant because it's not going to be healing. It's going to be integrating because healing implies that it is painful or integration is actually something that happens so that the implant stays solid. It's much more digestible when you're trying to sell an implant.

"Then, we're going to wait about three months, then we're going to come back in for an implant surgery. We're going to put that implant in and then we're going to let that heal for about three months. Then, after that, you're going to come back and then we're going to take an impression with an abutment and then you're going to put a crown on there. By the way, a crown is all that I want you to do right now. I'm trying to get you to avoid all this."

If we do these steps, those things, then the expectation of the patient for that one tooth just went up here because it's a real problem for them now. They know that they have a problem that needs solving but if they don't do it now, here, they're going to have this big of a problem. What did we do there? We told them that if by doing the crown now, we're going to save them time because they won't have to come back for all those visits. We're going to save them money because it's not going to be a $5,000 implant. It's going to be a $1,200 crown, and we're going to save them pain. Extractions, healing versus integration, all of these are very powerful psychology words that people act on.

That's what we teach at TPA. That acceptance principal handles your consideration of the doctor even having to talk about money. What the doctor has to do is set it up for somebody to come in and say, "Oh, yeah. Our solution's only $1,200. Man, that's a deal!"

Dr. Chat Abed: Yeah. Educate them.

John Estefano: Right!

Dr. Chat Abed: That's what you mean by [crosstalk 01:05:40].

Howard Farran: What I mean is [inaudible 01:05:40] I can just name a city absolutely little hole in the wall city like Lake [inaudible 01:05:45]. I'm out there doing two million a year. Bruce Beard was in some small little town doing four million a year. Yeah, I know guys that place 90 implant a month in Lafayette, Louisiana. What's so bizarre is the self-limiting beliefs. I mean, that's … Every little town, there's some guy doing two to four million a year because they master treatment plan presentation.

John Estefano: That's right.

Howard Farran: Then, everyone else can. You're talking about your big cases. I want to take it down a notch just on one thing because she might be 25 thinking. I'm not even doing implants. I can't do [crosstalk 01:06:20].

John Estefano: ... talking about a crown.

Howard Farran: Yeah. Yeah, you're right. Yeah, but we were talking about all-on-fours.

This is what I see in every medical dental building I've ever been in. Just going to cavities. The average person has a one in three close rate, 38%. They have the same number chart, maybe 1,200 active charts are doing 750, taking home about 45 but through [inaudible 01:06:43] treatment plan presentation, on those three. Three people each have a cavity. One in three pretty much always gets it done and one in three pretty much never gets it done. What we keep seeing is that middle one in three. We started with this. The guy saying he has a 95% disclosure rate is … He's …

John Estefano: He's delusional.

Howard Farran: … delusional.

Dr. Chat Abed: Or he's measuring, he's skewing the way he measures, as we discussed.

John Estefano: Or the patient needed five cavities and got one done and they counted that as an accepted case.

Howard Farran: I always tell my boys, "I don't care if you lie to me. Just don't ever lie to yourself." If you look in the mirror and you tell yourself you have a 95% closure rate, we need to first have you pee in a cup to see what you're on. But it's that one in three in the middle.

That guy isn't doing 750. He's doing a million three. He's not taking home 150. He's taking home 300 to 350. We're just talking cavities in Parsons, Kansas. It's the same thing with the recall. You go back in this little towns in Nevada, Missouri. Here's a guy that has three full-time hygienists because they pre-appoint and they pre-appoint them all. They don't sit there and pre-appoint six out of eight so you lost 25% of your new patients that day. It's on reschedule day of tickler files. Just paying attention to details of not, of closing your back door. Everybody's whose scheduled for their cleaning and everybody's staying on top of that. Then, focus on the treatment plan presentation doing two out of every three cavities instead of one out of every three cavities.

Then, when you're thinking about whether you're doing this or not, just again, imagine this. Imagine you're dead. Your granddaughter is 17 years old and goes to the dentists and she has eight cavities. Would you rather someone really focus on convincing your granddaughter that she has cavities, that these cavities can turn into root canals and grounds? That 10% of root canals are extracted after five years. Then, you're looking at implants. Then, when you do implants, 20% of implant have perimplantitis in 16 months because the herd is still slopping saliva with everybody that, they're all trading P. gingivalis among each other and all that stuff like that. This is the most important part.

John Estefano: It goes back to empathy versus sympathy. The guy that doesn’t get that second and third filling is just feeling sorry for that guy and saying, "You know, I get it. I feel sorry that this may cost you a little extra money. What we're going to do is we're going to watch that until next time you're here, see what happens with it," versus the empathy of saying, "You know, I'm going to put myself in your shoes and I'm going to save you a few thousand bucks and I'm going to help you get that cavity done right now."

That's exactly how you do it. You say, "Well, that's going to turn into a crown, possibly a root canal, most root canals fail. Then, you're going to need an implant. And if you don't get the implants, then what happens? A whole bunch of teeth are actually going to start migrating into the open space. You're going to get a lot of periodontal problems. You're probably going to lose all your teeth and end up with dentures."

Howard Farran: I want to make a couple points and ask you a big question. By the way, we are way over, way over, way over but it's so good I want to stay in overtime.

Couple deals. First of all, back with your staff. Everybody in the back with what hands clinical has to wear loose? I just can't see, the assistant can't see. Everybody's talked to it. We always talk about hygiene recalls but your back door is open 80%. By the time you get to 5,000 charts, 80% are gone, 4,000 charts are gone.

You don't just schedule people for a recall for a cleaning. When I do a root canal, I say, "Okay. Now, look. I need to take an x-ray one year after. See this big abscess here? This [inaudible 01:10:17]? After one year of that, infection should be gone. It should all be filled in with bone. I need to know if this worked or not and we won't know for a year. So Jan, go schedule Margaret one year from today, come in. I want to take a P.A."

Implant. Same thing. I need to check this. If it gets gum disease around it, we'll lose the whole implant. I need to take an x-ray of this thing at one year, three years, and six years, scheduled out. Keep scheduling reasons for those people to come back.

My definition of an active patients, when you're buying a practice, going, "Well, we have 5,000 charts and 3,000 are active." That's horseshit. I want to go to the computer. How many are scheduled for something? If you only have 1,000 people scheduled for anything, you only have 1,000 live charts. Everybody when they leave, there's going to the next thing but I want to …

The last question I want to ask you is you keep pointing to the thing that you're showing the patient. You're pointing to something. Talk technology. Are you pointing to an intraoral camera?

John Estefano: Yeah.

Howard Farran: A digital x-ray? A Patterson sells things like CAESY.

John Estefano: All of them.

Howard Farran: But talk technology. What's the return on investment to increase your treatment plan? Do you use all your grad students [crosstalk 01:11:34]?

John Estefano: The obviously low-hanging fruit is the intraoral camera. Even the most expensive one will pay for itself many times over. The most expensive brand goes up to seven, 8,000.

Howard Farran: My first intraoral camera cost in 1987 was a Fujikam sold by Patterson. It was $30,000 and the size of the refrigerator I had in my dorm room on a cart. Everybody said there, "Thirty thousand, in thirty years ago. That's a shit load of money. That's probably close to … Be twice that now." I don't know a single person who bought the Fujikam at $38,000 that didn't have any instant return on investment.

Dr. Chat Abed: Oh, yeah. I've had some colleagues tell me they've had a six-figure return. In other words, from less than $10,000 investment up to $100,000 return.

John Estefano: Yeah. We talk about these type of things all the time. What's tells us that what making is if you can make 10 to 1 back on your money. When you're talking about getting intraoral cams or even high tech videos that …

Dr. Chat Abed: iPads.

John Estefano: Yeah. That educate the patient. All of those will return themselves 10 times over. We use models. We use intraoral pictures in our videos. Actually, you can see us pointing to or the doctor pointing to the teeth that are in a big screen TV.

Dr. Chat Abed: Because that's what we actually do.

John Estefano: Yeah. Then that patients, the other thing to realize is that now you got to tie it all back in. When you have something that's outside of the patient's mouth and it's a big tooth that's on a big screen TV. It's 20 times the size that they would normally see it. Then, how do you bring it back into their mouth? We teach doctors how to do that. It's really very simple. It's something we call the finger technique where you have that picture up there. Then, you ask the patient for their index finger.

Dr. Chat Abed: You connect it to them.

John Estefano: Then, you connect them …

Dr. Chat Abed: Viscerally.

John Estefano: … physically with a little bit of pressure on that tooth that’s affected. Now, the patient just brought it all back. "Oh, man. That's … Hit that. That's in here?"

Dr. Chat Abed: That's right.

John Estefano: Right? All of these technologies have to be not only spoken about but tied back in to demonstrate that there's an actual condition. All of those things models, intraoral pictures, digital x-rays, pans, even CTs. All of those investments will come back to you if they're used the right way. How do you use it the right way? By tying it back to the patient and making the patient realize, step one of the TPA acceptance principal, that they have a problem worth solving.

Dr. Chat Abed: It's all systematized so just like you look at the same flow like an exam all the way across the arch and then go down to 17, go to 32, for example. You have to do the same thing every time. This isn't just about closing treatment. This is minimizing mistakes, just like pilots use checklists. That book Checklist Manifesto, where surgeons are being advocated now to go through and, "Okay, have I done this? Have I checked this?" Oral cancer screening, all these kind of things. Do the exact same thing every time so that you can minimize the likelihood of an omission. Who benefits? The patient, as always.

Howard Farran: I also want to make another point. When you go to intraoral camera, here's the low-hanging fruit on intraoral camera. It's not what brand, what price and that stuff. It's dumb ass only buys one intraoral camera for the whole office. They hygienist wants [crosstalk 01:15:08]. "I really don't want to get up and walk over there and get that so I'll just do this." Shitty presentation and they're not going to buy and skip another thing. The operatory is like Southwest Airlines. Every plane is a 737. Every one of them is the same. You should be able to go into any operatory and pull the med drawer and there's what you need.

John Estefano: That's right. Very good.

Howard Farran: Then, they'll do things like, "Well, you know, I don't … The hygienist doesn't need a high speed." Okay. Now, you need to just do a one second adjustment. You got to pick up the patient. Move the patient but we don't have a room. All because they don't understand operational logistics. Those intraoral cameras are in every one of my rooms. They come on in the morning so picking it up is seamless.

Another thing they save money on which is crazy …

John Estefano: They also don't factor in what it costs to actually break down a room in the time that it takes for the assistant to actually move them. That overhead, if you add it up over a year, it pays for a few high-speed [crosstalk 01:16:06].

Howard Farran: Talk about diagnosing trimline. I assume all laws are just suggestions written by idiots. I used to say, "I follow every law." Then, you're a lemming. Go fall and go over the cliff. When that hygienist, she has a stick. A stick's a cavity. When your hygienist says, "I had a stick on number 30." If you have to pick up and explore and get a stick again, your hygienist, she's either a pathological liar or she had a stick on 30. She'll tell you, "Don't blow air on the canine. It's real sensitive." "Really? Really? Give [crosstalk 01:16:44]. Ah!"

John Estefano: I can see for myself, right?

Howard Farran: He's like, "Don't tap on number 19. It's really sensitive to percussion." "Really? Really? Let me start beating on it."

The hygienist got a stick on number 30. Arizona, they can numb up. Every room's the same. Most hygiene rooms, their billings cover about 85% of cost and you don’t know that because you don't know any of your costs. Then you go in there and you have a rule that just occlusals, just on molars are done that day.

Then you go to mom. You got a child now. "Mom. Billy has a cavity. Do you want to go make another appointment so some other day you can leave work and go pick him up at school and go there or do you want it done now?" Every mom's like, "Please do it now." "But, see, we can't do it now because you don't have a high speed, you don't have any of your stuff. We'd have to move him to another room because your number one cost is adjusted production off a PPO. That's 42% labor, 28% lab, 10%, supply, 6% facility, 5% operatories show up on your cost."

Every room's the same. They diagnose, they numb. You go in there. How long's it take you to do an occlusal?

Dr. Chat Abed: Minutes.

Howard Farran: Minutes. Then, what is an occlusal? Another $1.50. You do one occlusal a day in the hygiene room. You just took your hygiene room from losing a Benjamin a day to breaking even. You do two, you make a Benjamin a day. If you think you're making money in hygiene, you probably have 103% close rate.

Then, one other thing I want to point out is this, for 30 years, everyone will tell you, every time we ever go to a course and it doesn’t matter if it's on root canals, fillings, crowns, practice manager. It doesn't matter. Then, you say, "Well, why?" Half the room, every row's a doctor office. There's a doctor, the spouse, the receptionist, the hygienist. The whole damn office is there. The other half of the room, it's all individual dentists who go there to save money. If you go through there and pick up what they're billing to the IRS, these guys are all making $1.45. These guys are all doing 275 to 400 to 450. The richest ones is when there's two rows of staff and the doctor didn't come because you say, "Well, why would you take them to endocourse?"

Who do you think's answering all the questions about root canals? The person answering the phone when they called in, the dental assistant, the hygienist. I hope you learned how to do root canals in dental school. They're usually not talking to you when you're doing a root canal. They got a rubber dam on. The bottom line is, that's why I brought this up because you have an online university learning center …

John Estefano: That's right.

Howard Farran: … for the whole staff.

By the way, if the staff has to attend, then you'll pay them as wages. If it's a voluntary thing, you can provide pizza or whatever. You could sit there and say, "Well, we'll go, we'll send someone to choke and puke, get some burgers and pizza. We'll watch these over lunch." How long is your average video on your online university?

John Estefano: It's roughly 10 minutes, under 10 minutes.

Howard Farran: Okay. That'd be an awesome staff meeting before we even start.

John Estefano: Absolutely.

Howard Farran: It could be a volunteer lunch and learn where I'll get some pizzas and some sub sandwiches or anything with a lot of nitrates. Then, we'll watch one but … One last thing about the online university, which I think what you've done is amazing is remember doc, the way humans work, they see you picking your nose, farting, doing dumb stuff. They don't believe you. An expert is anyone 100 miles away from home. I can tell my staff until I'm blue in the face. Then, they'll go to some course and then the rest of my life, I hear, "Well, Doctor [Hornbreck 01:20:24] said …" or, "Doctor Rosenthal said …"

Dr. Chat Abed: [crosstalk 01:20:27].

Howard Farran: Really? I'm pretty sure I said that 100 times.

Dr. Chat Abed: You know what, Howard?

Howard Farran: Then, they know you're just a dumb hillbilly.

Dr. Chat Abed: Go ahead.

John Estefano: No, no. Go on. Please.

Dr. Chat Abed: I'm going to say this. We always bring this back to the same, the tired line. The new dental economy. Modern times, things are different. We know that. The top layer but deep down, you have to actually change your practice. We have to grow. What does that mean? We have to leverage technology now. If we had the technology now where I can set my staff member whether it's a treatment coordinator, someone in reception or whoever it is, I can sit them down and have them watch videos and have that track where there's accountability where I can see what was watched and what wasn't. That saves me a ton of money. It's a huge investment. That's a huge, as we call it, overhead friendly.

Not just that but other key advantages, always offices, "We advocate cross training," and this and that, what better way to cross train some of the front office to the back office than watching their set of videos?

John Estefano: That's right.

Dr. Chat Abed: Also think of the staff turnover, which is inevitable, no matter what you do, how great you are. You or I, we're going to lose people. Has anyone ever sat and calculated how expensive it is to train and expensive as in [crosstalk 01:21:52] …

John Estefano: If they train at all.

Dr. Chat Abed: That's right.

John Estefano: If they train at all.

Dr. Chat Abed: Whether they have to send for a course or if they have to take their own time out. If I'm training someone, that doesn’t necessarily mean I'm focused on my schedule, my schedule for tomorrow, et cetera. We've offloaded that. Like you said, you want to start. Docs now in this economy you have to learn to delegate more. It's not just a buzz word but it has to be done. We have to have a time for all our staff to be trained. What we've done is taken it off the doc's hands, say, "Listen. When you go on and become a member to TPA University, staff members having trouble figuring out how to …

Howard Farran: Is it TPA University or TX Plan Academy?

Dr. Chat Abed: That's the website and the name. We're going to call the online university, we call it TPA online university.

John Estefano: TPA online university, right.

Dr. Chat Abed: Yeah.

Howard Farran: TPA university?

John Estefano: Yes.

Dr. Chat Abed: Yeah.

John Estefano: What we're talking about is essentially like say you're marketing is actually working like somebody's actually doing something that's worth doing and you're marketing. You want to train one of your assistants to actually know how to answer the phone properly. You sit them in front of their reception module on how to take a good patient questionnaire when they're first calling in. Then, they'll know how to do that. Now, you have many people that are going to be professionals at doing that one task in your practice. No matter who calls and if a new patient calling, that's the most important phone call of that day. How do we get everybody doing the same thing?

Howard Farran: You want to have your mind blown? My oldest boy, Eric, back in the day. This is, god, 10 years ago. He, in college, he wanted to get a job at Subway because he actually likes eating Subway [crosstalk 01:23:29] just eating that shit all day long. Here they come. I saw him in my office. He had to take eight hour-long online videos from Subway and then have a full questionnaire before he could be hired and start.

Dr. Chat Abed: Isn't that amazing?

Howard Farran: Then, doc hires a receptionist. Guess how many hours of training she has before he throws her at the front desk?

John Estefano: Zero.

Dr. Chat Abed: Zero.

Howard Farran: Zero!

Dr. Chat Abed: Very good.

Howard Farran: It's more training to work at Subway.

Dr. Chat Abed: [crosstalk 01:23:59].

Howard Farran: I mean, the customer tells you da, da. [crosstalk 01:24:01].

John Estefano: Look at the business model. Subway expands. There are unlimited Subways out there. Then, doctor are usually struggling with one office.

Howard Farran: Why? They just passed McDonald's as the number one highest [crosstalk 01:24:12] thousand locations.

Dr. Chat Abed: In your other podcasts …

John Estefano: That's what I'm talking about.

Dr. Chat Abed: … you mention how … I've seen this time and time again, is the staff, especially in the front but also in the back, too often are just plain under-trained. Why is that? Because the doctor perceive it as time intensive. It's …

John Estefano: It makes it expensive.

Dr. Chat Abed: … [crosstalk 01:24:33]. All these kind of things but at the same time, you know as well as the rest of us that the front desk is the face of the practice, the first person that they meet. This old status quo thing with, we're trashing now TPAs of how the recession is the lowest on the totem pole. No. They're one of the most important people in the practice. Each role now has been given its proper prestige. This is all very important.

John Estefano: They touch every patient. They touch every patient.

Howard Farran: I just want to take it to another thing. Humans need … They all see motivation every day. One of the first big practice management gurus of all time was the Hawthorne Effect. The Hawthorne Effect was very interesting. This going back to, I think it was 1958, where they went into a factory. This guy thought, "Well, the …" It's a factory. This is on the line so they can measure up it.

He thought, "You know what? It's too dimly lit. So, let's put in some brighter lights." Productivity went up. All these people said, "Man! Give them more lighting and it'll increase productivity." Then, as scientists, so what do you need to control study to offset. Let's do another factory and we'll start dimming the lights. Make it darker." Their productivity went up.

They're sitting there. "Look at this stuff! How come you make it brighter and you don't change anything?" It was observation effect. When the employees think that you give a shit and they think that you're taking them to an online c-course and you're having a staff meeting and you're observing them, they need motivation. The minute they start thinking that you're observing them, giving a shit, recording the incoming calls like …

Any Fortune 500 company you call, it starts with, "This phone call …"

Dr. Chat Abed: Is being recorded.

Howard Farran: "… is being recorded."

John Estefano: That's right.

Howard Farran: The minute the receptionist thinks, "He thinks enough of me about how I answer the phone that he wants to record it and go over with me, so I'm not going to answer the phone like, 'What up?' It's going to be 'Thank you for calling Today's Dental. This is Valerie. How may I …'" They're like on Broadway. You sing differently in Broadway than you do naked in your shower.

Dr. Chat Abed: That's right. That the accountability aspect that we built into TPA University isn't just for kicks. We've through that step through in detail because we don't want to set up an online university for docs and their offices to, "Hey! Watch these videos." No. We've thought this through in detail where, no. What I want to be able to track that my teammates are watching the videos like they're supposed to and in a timely manner. Then, if I instruct them as mistakes never really happen. I make them myself. If one of my staff member needs a refresher, I'm going to assign you. "Go ahead and watch this again," or, "You know what? You're looking to switch from front office to the back or vice versa? Here. We're going to start your training with these videos. And then if you want to do some hands on at that point," they're already primed to go.

John Estefano: If they haven't logged in or they haven't done a course in, say, a week, then the system automatically notifies the office manager and the owner doctor of the practice that this person is stalled on their progress in their online university. Not only do they get a phone call from one of our customer service reps to make sure that A, is there anything wrong, like are you having problems …

Howard Farran: Do they, when they finish online university, do they get a diploma or …

John Estefano: Yes.

Howard Farran: … certificate saying … I tell you what, intrinsic rewards or [inaudible 01:28:04] awards. If anybody nailed the difference, it was Napoleon. Napoleon was in … He was the same time as George Washington. He realized that all armies were mercenaries getting paid. He said that people don't do anything for money. He designed the most elaborate system of badges, awards, titles. He said, "Men will dive into battle to get a ribbon but if they're just getting paid money, the minute they see that guy dive in …"

John Estefano: It's not worth it.

Howard Farran: "… and just drop their weapons and run."

John Estefano: It's not worth it.

Howard Farran: Napoleon's army would show up. Everybody was just these elaborate costumes and medals. They were all so motivated, they didn't really do a lot of fighting. I read the whole damn book on his [inaudible 01:28:45]. Most of the times, the opposing army, "Look at all these guys, all fire inside. I'm getting the frick out of here, man."

Dr. Chat Abed: [crosstalk 01:28:51].

Howard Farran: … going down.

John Estefano: "These guys are pros!"

Howard Farran: "I’m getting paid $10 a day. You can take this job and shove it."

Giving a dental assistant … Look at these other academies like, I remember running an LVI a year, [Dickerson, Hornburg, Rosenthal 01:29:06] where the instructors [inaudible 01:29:07] back in the day. People were getting their award for graduating LVI. They were dentists. They were crying. Humans need validating.

John Estefano: Absolutely, yeah.

Howard Farran: Think Napoleon. Think about how much more your assistant owns her job and she has a diploma from a university.

Dr. Chat Abed: [crosstalk 01:29:24] I also factor in, too, the psychology effect that so you're the doc. I've signed our practices up for TPA University. Let them know that there's accountability reports. That's all they need to know. It goes back to what you said, which was very clever. The observer effect. If the staff member knows that their progress is being tracked, the likelihood of compliance is going to skyrocket just because of that.

Howard Farran: Yeah. You only manage what you measure. You go walk into any office and go to the … I can go into any office manager in America. Not all of them. Some of them have their fellowship in the academy [inaudible 01:30:05] and it might be different but you go into any dental office and say, "Who's the office manager?" "You." "How long you been here?" "Ten years." "Okay. What software you on?" "Dentrix." "Okay. Does Dentrix run 5 reports, 10, 20, 30, 40? How many reports does it run?" "I actually don't know." Then, you go to the report generator. Ninety-five percent of the reports have never been run.

Then, you go in there and the Hawthorne Effect. You start to notice as well, I've looked at every report and we don't need to run 100 reports but I want this hygienist to run this report and then go over it with the team. At the end of the month, she has five days into the next month da, da, da. Morning huddle, whatever goes over. I want the assistant to go over this one. I want the treatment plan coordinator to get this one but just observe it.

Then, they're accountable because I don't want to go up to the front and say, "Well, the front desk should run these five," because then, they'll never get it right and I'll say, "Well, I thought you were going to run them." "I thought you were going to run them." The buck stops with one person. They're motivated because you pointed something out. You're observing. You're holding them accountable. If you measure it, you can manage it. If you don't measure it, it'll just fall through the cracks.

Dr. Chat Abed: We have modules going with what you're saying, Howard, in detail about statistics. A lot of the things and our doctors, we get a lot of great, positive feedback from this. We are tracking things that even the modern, even big name dental software aren't tracking or can't track.

Howard Farran: They don't track anything. I mean …

Dr. Chat Abed: They weren't made for that.

Howard Farran: Dentrix and Eaglesoft are called Stevie Wonder and Ray Charles. One of them's blind.

Dr. Chat Abed: I wanted you to say it.

Howard Farran: To call Dentrix a practice management software system is like calling me a Chippendale. You probably rather see me hanging upside on a pole naked then seeing what Dentrix doesn't show you because …

Dr. Chat Abed: Right, because it wasn't made for that.

Howard Farran: … it just can't do the obvious, which is hook up to accounting.

Dr. Chat Abed: That's right.

Howard Farran: Like they do at every Subway, Long John Silver's.

Dr. Chat Abed: Exactly.

John Estefano: Because they're customized software for that one utility only. It's not like we're trying to do 10 different types of [crosstalk 01:32:17].

Howard Farran: Then, you shouldn't call it practice management software.

John Estefano: Agreed.

Howard Farran: That is rubbing salt into a wound. They should call it …

John Estefano: CRM, at best.

Howard Farran: No. Dentrix should rename itself and say, "This is as good as it's going to get."

John Estefano: Yeah. That's true.

Dr. Chat Abed: The history … Those softwares have been around for decades.

John Estefano: There's also the factor of when we went to, which we don't really get into this because there's so many different software systems now, but it does go back to the same thing. Training and are you a pro at that thing that you're trying to do, which basically says what are you putting into Dentrix? Is it garbage? If it is garbage, what are you going to get out of the report?

Howard Farran: I'll tell you what because there's only one practice management system that doesn't advertise. That's Open Dental. Their biggest problem is explosive growth. They can't even handle the new business. They do no marketing. They don't even want to tell you about Open Dental. To me, I was on a SoftDent for 30 years. I switched onto Open Dental,  just because at least with one company, you have hope. The other ones, they don't even give a shit. That not one dentist in America doesn't know [crosstalk 01:33:23].

John Estefano: … programmers. They may include it in the next release.

Dr. Chat Abed: What you're saying right now is very insightful. Let's put it this way. We've done a lot of background planning on this is that part of our industry is overly ripe for disruption. Let's put it like that.

Howard Farran: Yeah. The person who says, "Dentrix and Eaglesoft are awesome," they have a 200% close rate.

John Estefano: Yes, absolutely.

Howard Farran: Because if you have no idea what's going on …

Dr. Chat Abed: Because you don't know what you're looking for. You don’t know what you don't know. If you don't know what you don’t know.

John Estefano: That's why we resort and honestly, everybody that we initially say use these logs that you have to actually hand write in which is key data that you really can't extract from those systems. When you use those logs and you put that data in, you can actually get metrics that are going to help your practice grow because it's not garbage in and garbage out.

Dr. Chat Abed: It's EKG.

Howard Farran: Okay. We have gone almost double time. Again, I just want to say, last thing, imagine if firemen only had a one-third close rate and didn't put out two out of three house fires.

Dr. Chat Abed: You know, that's deep.

Howard Farran: Imagine if the police department only had a one-third close rate on bad guys. I don't want my grandchildren … I want everybody to build a dental office that they feel is for their own children. Treat other people like you or me. My oldest is a nun. She's read every major religion. I think the earliest one was Hinduism or Buddhism, Judaism, Christianity, Islam. She read them all. They don't have one person, place, city. There's nothing in common in all those works except one piece of plagiarism, says, "Treat other people like you want to be treated."

You should be treatment planning like you would want treatment planned on. You should build a dental office where you'd want to go. You should build a dental office, a culture. They say when a fish rots from the head down, you should create a dental office that if you died or you are whatever, that your team would still take care of your most … Think of you as the most vulnerable time in your life. What would that be? Five, six years old, going to the dentist? The dentist says, "You have a cavity." What is a six year old going to say? How would a six year old know they have a cavity or not? You'd want to go to a place you could trust and you'd want to be a place that you could send your grandchildren, you want us to create that place.

If that place can't convince your 18 year old granddaughter who wants to spend all of her money on clothes she bought off Instagram and purses she bought off Snapchat and wants to go to the mall and buy god knows what bullshit. Then, she comes into you and she has a $250 cavity and you can't convince little Meghan that she needs to get her cavity done, you're not doing your job. You're not doing your job.

Dr. Chat Abed: That's right. Very, very well said. That's right.

John Estefano: May I just add one thing. I know we're way over but I wanted to give the viewers and the listeners one tip that is going to minimally make them an extra million dollars in the next few years and that is if you are going to sit in front of a patient and diagnose, diagnose as if everything only costs a dollar and let the TC handle it. If the doctor just looks at …

Howard Farran: TC? They don't know what [crosstalk 01:36:37].

John Estefano: Oh, sorry. Treatment coordinator, office manager. Whoever's doing your case presentation. If the doctor just looks at every problem and puts in his head, "Yeah. That's a dollar. That's a dollar. That's a dollar. That's a dollar," he's going to just diagnose and not let that monetary thing get in the way.

Howard Farran: Sorry. I got to tell you. I want to finish out one story. Ann Phoenix in Indianapolis, Indiana, which is, by the way, the largest city in the United States on geography, I've been told. They have no suburbs in Indianapolis. When the forefathers laid out the city there, they laid out the whole damn thing. I knew an office that was doing 750, hired a treatment plan presenter. He went to a million five. After five, six, seven years, she didn't think it was fair that she didn’t make the same money the hygienist did. She made what the assistants made. She said, "I want to be paid the same as those two hygienists." He said, "No." She quit. He immediately went back down from 1.5 to 750.

Dr. Chat Abed: [inaudible 01:37:40].

Howard Farran: She went across the street and that 750 went to 1.5.

John Estefano: That's right.

Howard Farran: I have another one in my back yard. That guy I know, he says he gnashes his teeth every day because it was so dumb. His assistants were getting 20. The hygienist were getting 40. She took his office from 750 to a million five, but the [inaudible 01:38:01]. "Well dental assistants don't make 40." It's not dental assistant. It's a sales person. Most sales people pay on commission. If you can't afford a $40 an hour sales person that sells 750,000 more dentistry than before you hired her.

John Estefano: That's thirty one on your investment.

Howard Farran: Then, these dental say, "Well, I'll go to your course alone. Then, I'll take all the information back and explain it to my dental assistant in three minutes." He'll save money and he'll come back and it's like, he'll still be that 750.

John Estefano: The moral is under-training is extremely expensive. Under-investing in your staff is extremely expensive. If you don't invest in your staff, with the training, with TPA University, with the other things, you think you're … What's that phrase? You're picking up pennies and leaving dollars. It's plain foolish but again, a lot of docs, we're educated but we're not into the numbers, the analytics. We miss all that stuff.

Howard Farran: Then, all dentists say, "Well, what if I spent all this money educating my team member and then she leaves?" Would it be worse if you don't educate her and she stays?

Dr. Chat Abed: Right. Yeah.

John Estefano: That would be a lot worse.

Dr. Chat Abed: You're helping her, too. When one of my staff leaves or goes onto the next level, I've had a hand in that. I feel good about myself. It's not making money and things like that.

Howard Farran: I've had two assistants go to dental school. I've had several of them going to sales and industry.

Dr. Chat Abed: Very, very grateful. Yeah, grateful.

Howard Farran: I know. I got staff that I …

Dr. Chat Abed: More power to them.

Howard Farran: … [crosstalk 01:39:33] $10 an hour. Now, they make six figures at other places.

Dr. Chat Abed: It's amazing. Yeah.

Howard Farran: I feel honored to be a part of the journey.

Dr. Chat Abed: They'll tell everyone about you. I work [crosstalk 01:39:45] …

John Estefano: Because he flowed in enough power to actually shoot them on their way to where they want to be. Yeah, man. That's the key. You know what? We're not talking about a lot of money, either. We're actually making the university accessible to anybody. It's going to debut in mid-July. The subscription's going to be $400 a month until it doubles in size. We have 93 videos right now.

Howard Farran: Four hundred bucks a month. Can you guarantee that they'll do two more $200 fillings a month.

John Estefano: One hundred percent.

Howard Farran: Yeah. Then, they'll freeze that 400 on you.

John Estefano: That's 400.

Howard Farran: That's two fillings.

Dr. Chat Abed: But it's our next production. That's right.

Howard Farran: That's the whole filling.

John Estefano: That is two whole fillings.

Howard Farran: Think of it as four half fillings.

John Estefano: Or eight quarter fillings.

Howard Farran: Right. Quarter fillings, yeah.

John Estefano: What I'm talking about is not a big investment that you're going to get more than 20, 30, 40 to one back on your money if you put it in front of them, they get trained. We will help you with the accountability, make sure that they're actually doing it. Then, you'll see the benefits. We're making it really accessible to everybody. Everybody can just put $400 on a credit card and then wait till the end of the month and see if they've increased anything.

Howard Farran: You know what? This is June, right? This is …

John Estefano: Yeah. It's coming up in two weeks. Two weeks.

Howard Farran: That's why a lot of offices say, if the office collects this much at the end of the year in April, we're taking it over to the next townie meeting in Orlando. I know dental offices that don't take their staff on those four day cruises out of California. It just observe them. They love to be observed. Tape their phone calls. Get involved. Make them feel a part of it. Always take them to sea. On lane sea is absolutely the fastest, lowest, easiest [crosstalk 01:41:33].

John Estefano: And we want to contribute that to Dentaltown as well. We're going to definitely add to your library as far as [crosstalk 01:41:39].

Howard Farran: I think the best thing on that is these people who already have 20, 30 hours of content, put an hour of it on a website where there's already a quarter of a million dentists. It's marketing.

John Estefano: Yeah. Our aim and purpose is to get the word out about the university. We want to actually give you a few videos where we can put them up and then help you guys.

Dr. Chat Abed: Our goal is just like our perfectly aligned with yours, Howard. By helping dentists, we end up helping the population. We help humanity. Helping dentists to care for the patients, get the care that they need. I know you're big on that. You're global, helping dentists around the world no matter which part of the world to help more people, more human beings. That's [crosstalk 01:42:29].

Howard Farran: Everybody's got their jobs. I'm in here in Arizona. I mean, they come to the dental appointment with a 64-ounce Mountain Dew. I'm like "[crosstalk 01:42:41]. Do you take your bong to church?" Then, the saddest thing about the … I don't like calling the third world because, I mean, it's …

Dr. Chat Abed: It's an old, archaic time.

Howard Farran: But poor countries, Africa and Asia. Africa in particularly, a billion people. The number one cause of death is the mosquito, actually, giving you malaria. Then it's dirty water, cholera so all the doctor are saying, "Drink Coke because the dirty water has cholera." You know what's happening in Africa to their teeth when the doctors are telling everybody drink Coca-Cola because it's a better decision. I'd rather have my granddaughter with eight cavities than die of cholera.

John Estefano: That's right.

Howard Farran: But we all have our challenges in every country. When you have countries where you're afraid of dying from a mosquito and you're drinking Coke because you don't want your child to have cholera. We all have challenges. We could all get out the world's smallest violin and complain about why it's so hard to be a dentist in crowded California. I'd rather be a dentist in crowded California than treating a population where you're actually the most … Like when you're in Soweto, like in South Africa, it's 50 million people. They have a 25% HIV positive rate.

When you go into the dental office. The dentists and the hygienist are like, "Well, I don't really care about [inaudible 01:44:04] and gingivitis and a cavity. I want to spend 30 minutes with this child explaining HIV because she's not going to die from gingivitis. We all have our regional issues and problems to deal with. Just get a great attitude, hustle, and confront them. We'll all win. Thanks so much for coming by, guys.

Dr. Chat Abed: Thank you. A pleasure. That was really fun.

John Estefano: Thank you very much. Loved it.

Howard Farran: Thank you very much.

John Estefano: We're going to be talking about the opinion leader. This is something that you won't find on practically any other site. Nobody talks about what an opinion leader is, how much they mean to the patient, what it is that you have to do in order to not just overcome the opinion leader but really make them your ally.

Dr. Chat Abed: Right.

John Estefano: Any thoughts on this.

Dr. Chat Abed: First off, the reason that it's not talked about is no one's taking the time to go through this in detail. The psychology of being a good health care provider and how to present treatment to make sure that patients get the care that they need. We delve into this in detail. We've distilled it for you guys. Now, we're going to share it.

John Estefano: Excellent.

Dr. Cross: Dean, I want to point out a couple of raw things that I'm a little concerned about regarding Mauricio's cracked tooth that's been giving him problems lately. Adam, do you mind giving me the [inaudible 01:45:30] model? Let me show you what I'm talking about.

Dean: You said cracked tooth, right?

Dr. Cross: Yes. He has a cracked tooth on there that with the dentin exposed, causing sensitivity on there. The way to take care of that is basically reducing that tooth in size a bit to make room for the porcelain material and then cementing a crown on that. By doing that, we're basically reinforcing and making that tooth nice and strong again, the way it used to be.

If we don't do that, he's at a risk of having that tooth crack even further, which can lead to an emergency visit, have the tooth removed, having a bone graft put in and then we got to put an implant in, costing you guys time, money and …

Dean: And a lot of problems.

Dr. Cross: … more involved. Absolutely. You want to avoid any emergency visits like that. If you take look here on the screen here, that's his tooth over the bottom right. You notice that crack over there?

Dean: Yes. That missing piece?

Dr. Cross: Yeah. That missing piece. That can crack further and he can have a vertical crack that can go further into the bone. At that point, the tooth is just hopeless. It can't be saved. We want to help Mauricio out and put that crown on there and make the tooth strong again.

Dean: Mmm (affirmative).

Dr. Cross: Yeah?

Mauricio. Hand me your finger. I'd like to show you and show Dean here. See. It's right over there, this bottom right tooth.

Mauricio: Yeah.

Dr. Cross: Feel that?

Mauricio: Yeah.

Dr. Cross: See it?

Dean: Yeah.

Dr. Cross: That's the one that's giving you issues.

Dean: Okay.

Dr. Cross: Yeah.

John Estefano: Great video. Expertly handled by Dr. Cross. I love the fact that he isolated that there was an opinion leader in the room. Tell us a little bit more about …

Dr. Chat Abed: We've all run into this situation. I can speak for myself for sure. You have a patient who's in the chair. There is another person, let's say, in the waiting room whether it's a spouse, relative, et cetera. What we call an opinion leader who is going to help make the final decision on the treatment.

What normally is done, okay, the status quo and I've made this mistake many times early in my career is the opinion leader's in the room but what do we do or what do I do? I sit and I still just talk to the patient as if they're just a fly on the wall and just basically almost ignore them. What does that mean? It makes them feel like they're not important and that's going to be to the detriment of the patient and getting the care that they need.

John Estefano: That's right.

Dr. Chat Abed: This, what we've done here and I would recommend our viewers to watch the video again. Notice in detail what exactly we're going to discuss and the points here in this part of the segment. What we do is exactly the reverse. Go ahead.

John Estefano: Yeah. We want to start by talking about what is an opinion leader. Why are they there in the first place? An opinion leader is basically the person that the patient is counting on to help them make this decision.

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