Howard: It is just a huge honor for me today to be podcast interviewing Doctor Usa Bunnag. She is the recipient of the American Dental Association Humanitarian of the Year Award for 2017. That is such an amazing accomplishment, congratulations on that. That is amazing. Doctor Bunnag is a general dentist with extensive training in comprehensive dental care including restorative and cosmetic dentistry, periodontics, endo, ortho, implant surgery, temporomandibular disorders, Botox and fillers, Cerec crown, sleep apnea, Invisalign, and Clearcorrect. She continues to expand her horizons through extensive continuing dental education and seeks the best practice and treatments for her patients so that they can obtain optimal dental health.
Doctor Bunnag is a Fellow of the American College of Dentists, International College of Dentists and the Pierre Fauchard Academy. She is also a member the American Dental Association, the Academy of General Dentistry, the International Association of Orthodontics, the American Association of Sleep Dental Medicine, Cerec Doctors and the Dawson Academy. Before becoming a dentist, Doctor Bunnag was a certified dental assistant. After completing her prerequisite classes at Montgomery College, she went on to Howard University School, which was named after Howard Farran and graduated with distinction in 1994.
In 1996 Doctor Bunnag founded her comprehensive dental practice in Bethesda, Maryland. Just recently, Doctor Bunnag purchased another dental office in Four Corners, Maryland. She is currently working in both offices. Aside from her dental career, Doctor Bunnag is also the President and Founder of Smiles on Wings, Inc., a non-profit organization that provides humanitarian aid in Thailand. Since its founding Smiles on Wings has provided dental care to thousands of children and villagers in Thailand. The organization was involved extensively in the 2004 tsunami relief effort.
In 2009 the American Dental Association awarded a grant of $70,000, for Smiles on Wings to set up a dental program in Southern Thailand, to provide dental care for those that were affected by the 2004 Southeast Asian Tsunami. To date, with grants and donations from our generous donors, Smiles on Wings continues to provide extensive help with a mobile dental clinic in Northern Thailand, a permanent dental clinic in Southern Thailand, and a scholarship program to send young at-risk tribal girls to college and to return to their communities to make a difference. Smiles on Wings has graduated four young ladies from remote villages in Northern Thailand, and currently has eight more students under the program. You can read more about this at smilesonwings.org.
Doctor Bunnag is also known locally for her philanthropic endeavours and received awards from numerous organizations in Montgomery County and the state of Maryland. She volunteered to provide urgent dental care for the hurricane Katrina victims that relocated in Montgomery Country after the storm. She also volunteered in New Orleans with Mission of Mercy to provide dental care for the residents after Hurricane Katrina. After Hurricane Sandy, Doctor Bunnag and her Smiles on Wings team also delivered items and necessities to victims of the hurricane in New Jersey and Staten Island.
Doctor Bunnag is a native of Thailand. She came to the United States when she was fourteen years old. She has two grown children and is a caregiver for her husband, who suffered a massive stroke in 2009. She is an avid gardener, a self-taught watercolour artist, a mindfulness meditation coach, and a dog lover. Gosh darn women, do you ever sleep?
Usa: I do.
Howard: Do you ever sleep?
Usa: Actually. I do. People ask me that all the time, do I sleep? I do sleep. I guess I’m just very OCD and very compulsive but just like most dentists. I'm lucky that I have great teams of people to help me in all these different aspects that I’m doing. So it's not a one person job. Everything that I do in my life I have great teams to help me.
Howard: How did you find out you won the Humanitarian of the Year Award? Was it a phone call, a letter?
Usa: It was a…
Howard: How did you find out?
Usa: It was the phone call from the President of the ADA and I received an email and then the phone call. So, that to me, it's a great honour to be able to receive the award and to be the first women to receive the award as well. I'm just very proud and it's a privilege to be recognised for the work that I do.
Howard: Wow. So, you're first woman too?
Usa: Yes, I am.
Howard: Wow, I did not realize that anyway. Well, double congratulations then.
Usa: Well thank you. Thank you.
Howard: So you got out of school in 2008 and I got out of school in 1987. It really has rapidly gone from a male profession to a female profession.
Usa: Yes. When I graduated in 1994, during that time at Howard University in my class there fifty percent males and fifty percent females. So that was, I think, the start and then I went to dental school with two children, two babies. So I think it’s another trend that is happening right now, is you see more and more women with children going back to school, continuing on with higher education. So I’m proud to be able to be able to achieve my dream of becoming a dentist, while I was raising two children.
Howard: Now, you're from Thailand. In Thailand are dentists mostly male or female, or is it fifty, fifty?
Usa: No, mostly female.
Howard: Mostly female?
Usa: Mostly female.
Howard: What about your other Asian neighbours? Cambodia, Malaysia, Vietnam, China, what would you say?
Usa: I think it's the same. I think it's about the same. It's mostly females for dentists but I think now I do see the trend… the trend in Thailand is that, I do see more males going into dentistry. So that's something that I think is an equal opportunity for both.
Howard: Well you know what my bias is? Maybe I'm a jaded person. Maybe I need an attitude adjustment but, to me it seems like in every country I've been to, if there's money in the profession it's all filled with men and if there's no money in it, it's all women.
Like for instance, in America, teaching. Teachers are almost all female because they’re at the bottom pay grade. When I go to countries where there's no money in dentistry, it's all these lovely women who are doing it because it needs to be done, and someone's got to take care of these people. Then you say, ‘where are all the men?’ ‘Oh, they're all in the military or selling cars’. It seems like the men go where the money is, and the women go where they have passion, calling and where their heart is.
Usa: I agree.
Howard: Or is that a bad statement?
Usa: No. No. No. I agree with you. I think it's the maternal instinct in us that we have. In Thailand my aunt was a nurse, most of my teachers were women and I had maybe two male teachers. Now, even when I go to visit some of the remote villages in Thailand, most of the teachers are females and most of the dentists are also females. I think it's the passion of giving that we have.
Howard: And I guarantee you, as soon as the GDP of that country passes $35,000 median household income per household it'll be men applying. I mean that’s just all I've seen. I believe men are different beasts than women. Good or bad they just are, but whenever you say that you're always called a sexist. Like if I said, that you had maternal instincts... Oh my God. I would get thrown off the bus, but you can say it because you're a woman and it's true. But I believe men are more motivated by money than women.
Usa: I am motivated by money too, but…
Howard: I’m not saying it's good or bad and you can’t generalize. You can’t say all men are this. Like I'm a hundred percent Irish, and you can’t say all Irish are drunks because only thirty-eight percent are. Sixty-two percent just drink a lot, but are not drunks. So, yeah, but I do see it. So why did the ADA give you the Humanitarian the Year Award?
Usa: Well because I received the award…
Howard: Is it more like of all the things you've done over a lifetime? Or was it a specific event?
Usa: It has to be more than ten years and it has to be sustainable. The work that I do has to be sustainable and it has to be able to deliver results. It's long-term success and the requirement is for over ten years. So I think it's a lifetime. I started it in 2003, so that's been fourteen years that I've been doing it. It’s the stainability, I think, is the importance of what we do.
Howard: Absolutely. And talk about that because a lot of humanitarian, charitable, missionary dentistry. It's kind of like they'll find some really poor, remote area and they all dive in there with all this fancy stuff and do all this dentistry. Then three days later they disappear. That's really not a solution. As opposed to… I was taught missionary dentistry by Jerome Smith, and he went down there and the first thing he did is, ‘well who's the local dentist who's going to be here year round, and let’s adopt that guy and when we're down there, let’s teach him how to do stuff. And then let’s get connect to him via email so I can go to Patterson, or Schein, or Benko and get a bunch of expired supplies’.
Sustainability is everything, and these dentists would do more good by thinking about sustainability, than how many people they can treat on a four day trip to some poor village.
Usa: I think in the beginning when I started out doing the work, I wanted to go in just like anybody else. You going in and do the mission dentistry. You want to make a difference in the time that you're there. The four days we’re working, but as I go back I see that you can’t just teach someone to brush their teeth when the village has no water. What do you need to do to make that happen? The children again, the parents don’t have the money to buy toothbrushes or toothpaste. So you kind of just have to look at what you can do to continue to make difference.
It's very difficult when you want to try to do something and have a goal of unsustainability, because you have to also have the local person to help you make that happen as well. So I was lucky that I found the right people to help me being able to carry out my vision as well. So I can work from America and then the clinic. We built the clinic in Southern Thailand that is being used all year round, and when we're not there the local dentists and local dental hygienists will provide the care for the children.
You're going in, you do a hundred extractions, a hundred fillings, you see a hundred children, but that’s just one time but you need to just make sure you are able to continue the care. The philosophy that I use is the same, as when I see children under medicaid program in the state of Maryland in my community. Because I started out seeing medicaid children under a loan repayment program with the state of Maryland, and a lot of these children that came to me, they had big cavities, teeth needing extraction and I could provide the emergency care. But for me to help them obtain long-term oral health, I have to make sure that I continue seeing these children every six months like we see our patients.
I've been doing this for more than fifteen years, and I'm happy to say that a lot of these children now have healthy smiles. I use the same philosophy when I work with Smiles on Wings. So we end up just staying in the local area, one village, one town that we can continue to make a difference.
In the fourteen years that we have been doing this, the most important thing is now we have graduated a nurse, teacher and health professional… health officers that are now able to go back to the communities that we have served in the past. They are the ones who are providing the care for the villagers, for their communities. I think, to me, the empowerment that I can give to the new providers, that's so important. Right now, we also have nine more students in our scholarship program.
Howard: My gosh, what a lovely website. So if one of my homies is listening to you talk right now, and wants to get involved should they go to smilesonwings.org? And what can they do?
Usa: Right now we are in a process of reorganising our mission, and normally we would be doing our dental mission twice a year, in January and in July. However, because there are some changes in the rules and regulations in Thailand, we have to go back and revisit what we can and what we can’t do. So right now they can send us the email at email@example.com then our administrative director will be sending them the information, and we'll keep them informed of…
Howard: Is it because Thailand wanted to make sure the people coming in dentistry were licenced or were they worried people would come in there that weren't dentists? Or what made Thailand change their regulation?
Usa: I think it's the licensing issue just like anywhere else. I think it's because Thailand is becoming more developed. The country is now looking to make sure, they have some regulation to prevent someone else coming in to do dentistry without a licence. So technically we use to be able to go to work and work under the supervisions of the local dentists. Now we have to just go back and revisit of what we can and can’t do, but we still have the local Thai dentist doing the work. At this point we are still waiting to see what would be the next step and I'm going back to Thailand in January and I will revisit, have some meetings and figuring out what the next step for us would be.
Howard: So are you able to fly a non-stop? You're in Bethesda. What do you do? Go to Washington DC.
Howard: Do you go non-stop to Bangkok?
Usa: Oh no. No, DC to either Japan or Korea and then from Korea to either Chiang Mai, or Bangkok, or Phuket.
Howard: So there’s no non-stop flight from…
Howard: Really? New York City doesn’t even…?
Usa: Thai Airways use to have a non-stop flight from New York City and that's nineteen hours but I still have to go to New York. So the connecting flight is not all that great.
Usa: After you fly…
Howard: So how do you justify living in Bethesda, Maryland instead of Bangkok? You can’t go from Bangkok to Bethesda, Maryland. Weren't you going the wrong direction? That is one rocking hot town.
Usa: Bangkok? I didn’t grow up in Bangkok so...
Howard: You're a country girl?
Usa: I’m a country girl. I’m a country girl.
Howard: How far away from Bangkok did you grow up?
Usa: It's actually near the border of Cambodia. So it's like about twelve hours by train.
Howard: Oh, Bangkok is twelve hours by train?
Usa: No, from my town.
Howard: Oh okay.
Usa: I grew up in Ubon.
Howard: I just lectured in Cambodia and it was so amazing but I have to say something very bizarre about Cambodia. When I talked to dentist that were my age, fifty-four, they were so traumatised from the Khmer Rouge. You could tell they were almost dead inside. And then their children who are dentists, the age of my kids. They were all vibrant and loved life, and sometimes I'd pull a kid to the side and say, ‘what's wrong with your dad? He doesn’t seem to be peppy or is something going on?’ It's because the Khmer Rouge killed his wife, his mom, his dad, his sisters. A point where you kind of lived through so much trauma in the killing fields that it's hard to get happy again, isn't it?
Usa: I know. How can you recuperate from something like that? It's very difficult. I grew up in Ubon. It used to be an airbase during the Vietnam war and even though I didn’t get to experience war first hand. But I hear the B-52, the Phantom, the planes going and dropping bombs and come back. You get to feel that sense of war that was happening and when I heard about the killing field... It can be traumatic. I just don’t know how people survive that kind of experience. They lost the people that they love.
Howard: What was the total population when the Khmer Rouge took and then how many were killed? It was like...
Usa: Millions. It was in the millions.
Howard: Yeah, it was millions of people.
Usa: And it was the educated. They wiped out the educated people of Cambodia.
Howard: I didn't meet a single fifty-year old dentist, my age, that wasn’t just so much pain inside.
Usa: Oh my gosh.
Howard: I mean not one. So I shouldn’t have gone from your beautiful Humanitarian Award but you did grow up on the border of Cambodia and I thought that was very profound.
So a lot of people will say to you today that dentistry has been taken over by corporate dentistry, PPO's. Delta really has ninety-five percent of dentists have signed up and it's really a PPO. I mean they’re setting your fees. When I got out of school thirty years ago, Delta paid me $1,000 for a crown and $1,000 for a molar root canal. Now they pay me $600 for a crown, $600 for a root canal. There’s corporate dentists here on every corner. What's your advice as a female role model to young women dentists coming out of school? Is this still the glory days for dentistry? Can she still go out and set up her own practice? Or do you think she'll be working at a corporate chain for the rest of her life?
Usa: Well, that's a tough answer to give. I think for the new dentists coming out I know it's difficult, because even for me I had the experience of a year and a half ago buying another dental practice and it's an older practice. I had to do an upgrade in everything. Digital x-ray, adding computers to the system. I’m a Cerec user, I have been using Cerec for last ten years. So I really didn’t want to practice without Cerec, so I added a Cerec into the repertoire.
You're looking at spending hundreds and thousands of dollars on top of the price of the practice, and if this was a new dentist coming out with all these loans that they have to pay. How can you start a practice without worrying about money? To me, I think it's a difficult time to start a practice but you can. However, I think, like you said, that corporate dentistry is taking over. But I think I can have a mini corporation, meaning I can have multiple offices that I can provide an ideal office for a new graduate to come in and work. Then we can work on not having to sign up with all the insurances.
So it's a difficult time. I think with insurances, with the technology for you to be able to provide the care for your patients now you have to spend the money to reinvest in the office. When I started out my first dental practice, I spent less than $50,000 to start my first office. Here I had already spent so much money and it seems like I'm spending more and more. And then of course you need to have that, need to have this, and I do so many different procedures and again, you have to be able to keep up with and be able to provide for your patients.
So the supplies are really expensive, and that's all we do is spending money for supplies. Of course they don’t sell things in smaller amounts, you have to buy it in bulk and then they expire, and you end up having to throw things away or I take to Thailand. I think for the new graduate, I think it's difficult because of the loan. I understand it's about $200,000, $300,000 now?
Howard: The private schools are up to $500,000. In fact that's what I wanted have you do, is expand your Smiles on Wings program to where if you have over $300,000 in debt, you would fly them to Bangkok and get them a Thailand licence, then they don’t have to pay their student loans back because then they'd be missing.
Usa: Oh my gosh.
Howard: What do you think about that?
Usa Wouldn’t that be great?
Howard: They could change their name and everything.
Usa: Wouldn’t that be great? But I don’t think the Thai Dental Council would agree with that.
Howard: We could call it the ‘dental witness protection program’, and just change their name and fly them straight to Bangkok.
Usa: Oh my gosh. After I graduated from school twenty-three years ago, my loan was under $50,000 and I thought that was hard to try and pay back and that was difficult. And then again, I started my practice though struggling to do that. That's difficult. I think let say right now, if I were a new graduate, I think what I would do is to maybe go into partnership with another dentist, maybe two or three dentists. You can really share the expenses and share the office, and be able to buy expensive equipment. You need to have the CT scan now if you're doing implants, and you need to have the Cerec or other digital camera to be able to do different procedures. So I think it's probably better to go into partnership with someone else.
Howard: We were talking earlier about your class size was fifty, fifty women. You were the first woman to get the Humanitarian Award. I want you to talk about Cerec because a lot of people say that Cerec is great marketing for same-day crowns. But I have to tell you in Phoenix, Arizona for thirty years. If I sell somebody a crown, half go into fear ‘oh my God, are you going to give me a shot? Is this going to hurt?’ The other half go into fear of cost ‘oh my God, how much is this going to cost?’
I only have about one person a decade who says, ‘my main concern is the same day’. And so if I was a woman dentist I'd want to partner with other women dentists, because I totally believe the market thinks women are going to hurt you less than men. We saw it happen in OB GYN, when I was little they were all men, now they’re all women. I think paediatric dentistry is following that suit, and many of these paediatric dentistry programs that I lectured in their school, there's not one man in the entire program.
When you ask moms, ‘who do you think's going to listen? Who do you think's going to be easier on your little Johnny and little Milly?’ Who do they think it's going to be? A man paediatric dentist that looks like me, or a woman who looks like you? Who are the women more comfortable to ask questions to? You? The women are telling me this with paediatricians that, maybe they have concerns about vaccinations. Okay. Maybe their confused. They feel like if they go ask the man paediatrician, he's just going to bark. But if she said those concerns to you, you would listen to her, you'd validate to her, you'd talk it out.
So if I was a woman dentist and I wanted to split the cost of a CBCT, and a CAT scan, and a Cerec, and a laser, and all that stuff. I'd partner with another woman. I'd have an all women dentistry, I've seen that done where their Logo is like a rose, or we’re soft and gentle, will never hurt you... because I think that's half the market. I think it's half fear and half cost. What do you think about that?
Usa: I might get in trouble if I say something.
Howard: Hell no, this is dentistry uncensored, in fact, please use profanity.
Usa: Oh my gosh. I don’t use profanity that much. But I think for me, I'm just going to speak about my own experience. I think if I were to open my third office, Howard I probably would partner with another woman. I think maybe we share the same understanding, we’re moms, we have children. Even though my children are grown but I'm going to have grandchildren in the future. I want to be able to have the flexibility, that I'm going to be with someone who will understand. I'm a caretaker for my husband, so if he gets sick I want someone to understand that they can come in and cover me, and I have to take time off to take care of my husband.
I used to have associates that would come into my practice that had small children. I know that there will be time that children will get sick, and we have to be flexible in rearranging the schedule and allowing her to go pick up her children, and last minute changes. Do you agree that I think that women would understand each other more than the men will do? I mean I think, to me, I want to be flexible for my staff as well so it's important for me to have someone that will be able to understand what I am going through.
Howard: There is some hardcore facts that women and men have to acknowledge, one is that women and all apes and monkeys, talk five times as much as men. I mean that's a given. Women are north of seventy-five hundred words a day, and men are south of fifteen hundred words every time they do the study, and it's the same with gorillas and chimpanzees, orangutans (inaudible 31:12). So I think when you make five times as many words, that's five times as more quality communication.
Like a lot of young women dentists will say that they were an associate for a male, and he'd just bark all these orders and the staff would all do it. Then she bought the practice, then she barked the order then they'd all talk to her and she almost thought that was an insult. Well you're just supposed take the order and run and I'm like, ‘it's a compliment’, they didn’t feel safe talking or trying to communicate with the seventy-year-old guy they bought it from. He was incapable of communication.
I think moms want to go to women because you talk more, which is communication. I think staff are happier with you guys because you just communicate more. But I want to ask another question. Your husband suffered a massive stroke in 2009, you've been taking care of him for eight years. Half the marriages in the world fail. Talk about a Humanitarian. So many people when their spouse gets sick or whatever, they move on. Good at you for taking care of your husband eight years after a stroke. Where did that come from? Just you?
Usa: I guess that's just me. It’s me. I practice loving and kindness. That's why I am a humanitarian. That's why I do what I do and it's because it’s important. Actually my husband sent me to school. He supported me through dental school so I can’t abandon him. We worked together. When I was working as a dental assistant and I told him I wanted to go to dental hygiene school, in the beginning, he just said why don’t you go to dental school. Do it all the way because he knows that I'm smart and I was capable to make it happen.
So he helped me take care of the children, I would study late and he would be with the children. When I graduated from school and I started the practice, he came to work with me and then he went home to take care of the children, to pick up the children after school. It allowed me to be able to be the breadwinner of the family and able to start my business, start my practice. So when something like that happens you just don’t abandon that person.
Howard: But do you think some of that came from your roots? My memories of Thailand, they’re all Buddhists. Were you raised Buddhist or Hindu?
Usa: I'm a Buddhist and I'm a practicing Buddhist, because that's part of my fullness and meditation training.
Howard: I love Buddhism because the worship a fat bald guy. Any religion that worships a happy, fat, bald guy I really like.
Usa: That's more of a Chinese buddhism than Thai buddhism. But anyway, I don’t think it matters if you're a Buddhists, you’re Christians. I think it just has to be in your heart. It's who you are, it's how you were brought up, it's what is in you that is so important. It doesn’t matter whether you are a Christian, Hindu, Islam, whatever. It’s just been in my thought that I would not have abandoned him. What kind of example I would teach my boys if I do that?
Howard: Yeah, that's a beautiful thing. You're a beautiful person. You said you bought a Cerec ten years ago. A lot of people are very stressed about a Cerec because it's expensive. So digital x-rays, that's adopted by eighty, ninety percent of dentistry. Computers eighty, ninety percent adoption rate. But Cerec, I'm only counting probably about fifteen percent adoption rate because it's so darn expensive. So walk them through, why did you make that purchase? Why was the price not a problem for you? Walk them through your love and passion for Cerec.
Usa: Well, I started out buying the Cerec when it was the redcam. There was a lot of problems with the redcam and so I stuck with it, I was frustrated, I banged on it so many times. I called my Patterson rep so many times. It was frustrating. Then the blue cam came along so that was an improvement. So I upgraded it and then the software has changed. But now with the Omnicam, I just have to say I would not practice without a Cerec. That's why it was so important for me to buy the Cerec for my second practice. Without the Cerec, I would not be able to go to Thailand to do my Humanitarian work.
I was leaving for Thailand in January. Last December I started a case for a patient. A set of veneers, upper and lower, from number five to number twelve and then number twenty-two to number twenty-seven. I started that to finish. I didn’t finish it one setting, but I was able to prep, to scan, to deliver the case before I left for Thailand. That has been very significant in taking care of my husband as well. I was able to get the patient in in one appointment, in two hours I will finish the crown, number three, number four, number five, whatever that I'm doing within two hours and I'm done.
Before I bought my second practice, I was working three days a week so that I could take care of my husband. That had allowed me to be able to have the same productions, and not having to worry about getting the patient back, setting up the room again, getting the patient numb. The first appointment, then you have to make the temporaries, you have to take the impression and the temporary will come off and then you get the patient in. Before the Cerec, I would go to Thailand and I would worry. Obviously, I want to make money before I leave, so I start the cases and then I would worry if the temps will come off, and then I have to get someone to cover my emergencies.
So with the Cerec that eliminated that and I was able to take care of the patients. I would have a patient flying in from New York, or take the bus in from New York one Saturday morning, and she would leave by two o'clock with four crowns. To me I think that's a service and as far as the time management, I think it really makes a big difference for the practice. Sometimes when I place implants I can also fabricate the abutment, and insert it next time but I can have all of that. So I don’t use a lot of impression material.
I'm very savvy in Cerec, I utilize it every day doing anterior, doing abutments, doing implant crowns, screw-in retains, cement retain and bridges. Now with the SpeedFire, with the Cerec and zirconia, I am able to put in bridges for my patients as well and I think that's a service. So is it expensive? Of course, it is expensive but it eliminates the lab fee and my assistants are helping me to make the flow very efficient.
Howard: Well I tell you if I kicked over a bottle and a genie popped out, and she said you've only got one wish. My wish would be that you made an online CE course on that Cerec machine for Dentaltown. There's a quarter million dentists on Dentaltown. But when they came out with a smartphone, we came out with an app, and fifty thousand dentists downloaded the app and they were all millennials.
Howard: So all the old people like me are on the desktop, and all the millennials are on that deal. We've put up four hundred and fifty courses and they've been viewed, coming up on a million times. We haven’t really done a CAD/CAM course, and another one I'm going to say this since this is dentistry uncensored. You know what our number one complaint is about Dentaltown, the magazine on the CE?
Usa: What is that?
Howard: The number one complaint is, and to me too they say, how come every time you do an article by a dentist, it's a man and if it's a woman it's a hygienist or a dental consultant? Why are all your courses made by men? You can ask Ryan. Our waiting list to get on this show is very long but when a woman doctor wants to be on this show, oh my God, we move them. I don’t have a good CAD/CAM Cerec machine. The millennials are very stressed because it's a lot of money. You could buy a house for $150,000.
Usa: Oh yes. Yes. Absolutely.
Howard: So I really wish you'd make a course. I'm firstname.lastname@example.org but the guy in charge of the online scene is Howard Goldstein so he's email@example.com. And you’re in Bethesda, Maryland, he's in Bethlehem, Pennsylvania. I don’t know if that's close? I really wish you'd make a course on that because…
Usa: I would love to. Actually I’m working with Patterson right now to be a local trainer for the Cerec. I gained the experience when I bought the second practice, and my assistant and I were training the former owner to use Cerec and we found that we are pretty good. We make a good team and I'm working on it. If that's something you would like for me to do, it will be an honor for me to put together.
Howard: Oh my gosh, I would love that. That will mean so much. It solves several problems, number one, they've got to get over the sticker price, and the way they get over the sticker price, they need to see more information from a real-world person who's really doing it. I like the fact that you're in Bethesda, Maryland as opposed to Beverly Hills or Manhattan. Because a lot of the times when these dentists listen to these courses, they quit listening after ten minutes. They say ‘well that guy is in Beverly Hills. I'm in Salina, Kansas. That's not ever going to happen in Kansas’. But Bethesda, Maryland that's normal United States.
Usa: Yes. In a normal United States, even though we do have one of the richest counties in the US. But I think, for me, most of my patients, Howard, they’re just normal people. Even though down the street, there might be a house for $1.5 million but they’re just normal people and they want what's good for them, and I think that’s something that I'm very good at also providing comprehensive dental care for the patients. Allowing them to have an option and a choice of what they want to see. It's not like they’re going to do extraction, and if they’re going to do extractions, are we going to put in a bridge or are we going to put in an implant?
I work with the oral surgeon and so many patients that I talk to, if you give the patients the right information, and you educate the patients, they want what is best. If they don’t have enough money, there are CareCredit that they can look into that as well, and then we utilize the insurance for them. So, we have a pretty good team. I would love to be able to talk for the new dentists coming out, how to incorporate comprehensive dentistry into your daily basis as well.
Howard: My offices are across the street from Guadeloupe, Indian reservation and my patients are all millionaires but it's in Pesos. They can’t buy anything. I soon learned how to get them to convert that to the US dollar.
Howard: So back to Cerec. There's a lot of technical discussion out there. Are you milling, Emax, Lithium Disilicate, or are you moving to Broxer? What block are you using?
Usa: I’m still on Emax. I’m still an Emax person right now. In my first practice, I use Emax for everything. With Emax you can have a millimetre thickness, prep. A lot of times when you do the prep, you don’t have to do a full crown, so I do three quarter crowns, I do half crowns, I do onlays, I do Emax. I have great result.
Howard: But when you do inlays, onlays, all that are you not participating in insurance or PPO's? What percent of your practice is Delta, PPO's?
Usa: In my Bethesda practice it's twenty percent Sigma Geha and the rest, I don’t participate with Delta. I don’t participate with Blue Cross and Blue Shield. So the patients, again, they understand, they will come in and we'll submit the claim for the patient, they'll pay. We don’t participate in many of these plans, so when they pay us, some plans will pay fifty percent of our fee. Our fee is $1,450 for a crown, and we do get reimbursed for that. If not, we educate our patients about the quality that we provide and I think that's something it's important as well.
My second practice is all fee for service. But I will add, once the former owner retires in six months, Sigma and high-end option Geha to the practice as well. We also have inhouse insurance, I think that's something that we incorporated in the practice and actually I learned it from Lugram. I took a course with him and I think that’s a great thing to offer my patients to be able to have the inhouse insurance as well.
Howard: Do you do it yourself or do you do it through a company?
Usa: We do it ourselves.
Usa: Right now we don’t have massive amounts of patients so we're just managing everything ourselves, and that seems to be working very well. I think patients don’t postpone their regular cleanings, so they will come in every six months and if they need perio, they need something, we can offer our patients and they’re happy to have it. Because a lot of times they know that insurance you only have maximum of $1,000 and the premium that they pay, they understand the downside of dental insurances. So when we offer them in house insurance, some of them decided not to sign up with their dental insurance at all, because the premium is very high if they do that.
Howard: You are amazing on so many levels. I mean so many levels. Also are you placing implants?
Usa: I do. I do. I have trained a long time ago when I was a dental assistant, I used to work with a general dentist that was placing implants. I got to meet Karl Mitch as well. So after I graduated from dental school I worked with that dentist, and then I decided to take CE on with implant placement. That was a long time ago. I studied also with Nobel, Biocare and I also befriended a top oral surgeon in my hometown. In Montgomery County and every time when he would place an implant for my patients he would invite me to be there to observe.
Howard: So genius, I tell millennials that all the time. They say ‘which over the shoulder endo should I do?’ They want to fly to Santa Monica and Key Biscayne. I’m like, ‘dude, there's an endodontist across the street’. When I got out of school the best endodontist in town was Brad Gettleman, and if I ever saw a big opening, I'll say ‘can I come over and watch you?’, they always say ‘of course’. These oral surgeons and periodontists are sending you cakes and cookies on Valentine’s day, and Easter, and Christmas, and Hanukkah. They’re doing everything they can to be your friend, and then you fly three thousand miles away to go listen to a lecture when you've got one guy sinking them in your own zip code. So you’re street smart. You're not only book smart, you're street smart.
Usa: I’ve learned from them and the oral surgeon Doctor Bill Dezak, said to me, ‘Usa, if you want to do the extraction, if you want to do implants, if you have a problem, you call me’. He gave me his cell phone because he's busy. So, he taught me so much. Bone grafting and…
Howard: And how much did you pay to learn all that?
Howard: Do you ever refer him a case though?
Usa: Of course. I send him difficult cases.
Howard: I know. I know. The orthodontists are the worst. They are the worst. The orthodontists have the highest percentage of thinking and fear and scarcity. They're like ‘oh my God, if Usa learns how to do Invisalign, I'll go bankrupt’. And then I go to cities like in Sydney, where I'm lecturing next week. Where an orthodontist said ‘you know what I’m going to do for marketing? I’m going to send out a flyer to all my referring dentists and the last Thursday of every month, I’m going to have an in-office, teach you how to do Invisalign, bring your cases, I'll walk you through it’.
So, what did they all discover? That he built the biggest orthodontic practice in Sydney. Number two, that most dentists like eighty percent, after they do ortho for two or three years, they don’t like it anymore and then give him all the cases. Even if they do all their Invisalign or whatever, they’re not going to do the class twos, class threes. Same thing with oral surgeons and periodontists, if you think in abundancy you'll build a million-dollar practice, and if you think in fear and scarcity.
So if you’re a young millennial and you go knock on that oral surgeon's door and he says ‘well I don’t want to teach you how to place an implant, because I want you to send it to me. How am I going to feed my family if you do the implants?’ That guy's an idiot, and you just eliminated one idiot in your neighbourhood that you never have to bother for the rest of your life, and then you're onto the next oral surgeon, or periodontist, and endodontist, and orthodontist, because if you think and hope growth and abundancy, the only thing that matters to you is the patient.
Howard: There's enough work for everyone.
Usa: I agree because to be a successful general dentist and being able to do so many different procedures you have to be smart as well. You can’t just be doing everything. So you've got to know your limitations and if something is going to be difficult. I just said, if it's going to be difficult, it's going to be stressful for me then I refer and I work with two surgeons in the area. And Doctor Desak, he gets referral from me every week even though I still do the surgery part and the other doctor also taught me. The other doctor, Dr Serini, he even took me to the implant conference in Chicago for oral surgeons. That was the best experience because I got learn from…
Howard: Did he take you? Did he pay for it?
Usa: He paid for the course, he paid for part of the hotel.
Howard: But be honest, be honest. Since you’re a girl, he said you were the assistant.
Usa: No. No. He was the doctor. It was Doctor Usa…
Howard: I’m just teasing.
Usa: My husband went with me also. So it was the best experience because I get to learn with the oral surgeons. It was kind of interesting sitting there in a room. They were talking about 3Shape scanning and I was the only GP in there and I had already been using Cerec and I knew all of that and I think that was…
Howard: Yeah. (inaudible 54:33). The only course I was ever kicked out of was in San Diego, because it was Gary Carr and it's for endodontists only. I thought so I'd just check endodontist. They didn’t find out till the afternoon.
Usa: Oh gosh.
Howard: That me and my buddy were general dentists. But it's like how fear and scarcity are you? Like the best thing for an American is only the endodontist should have knowledge? I mean really? What kind of head injury did you sustain to believe something that completely insane.
Usa: I have a group of specialists that I work with. The endodontist that I work with, he knows that I do endo and if I have a question, if I get stuck, I'll get him on the phone and I say ‘Doctor San, this is what I'm doing, this is the problem what I have, what should I do?’ He'll give me the advice. You just have to get yourself a group of people that can help you. That have no problems in sharing their knowledge. I think that's so important, and I think you have to do that earlier on in your career so that you have a backup plan. So you’re not just going to do fillings and crowns. Being a general dentist is so rewarding. Don’t you find that it's so wonderful to be able to do all these different things?
Howard: And the other thing that is so wonderful is that when you get in trouble, and you get in over your head.
Howard: That guy that lectured three thousand miles away isn’t going to be there.
Howard: You need to be able to put that guy in a car and go to your buddy who's in the same zip code a couple of miles up the street.
Usa: Hey, I've done that. I had a patient that swallowed a crown and I drove him to Bill Dezak's office, and Bill helped me through all of that and that's important. And without even said ‘I told you not to…’.
Howard: How did he weed out that he swallowed versus were in the lung.
Usa: We took him to the GI doctors and we took an x-ray, and it was in his stomach.
Howard: My pulmonary doctors say, that's the craziest thing in the world. They go, ‘if a crown or something went into your lung, you'd be coughing, wheezing, sneezing’. It would be this dramatic reaction if you swallow something and it doesn’t go in your lungs, it goes in your stomach. There's probably no reaction. He's like, ‘if you drop anything in your lung you're going to absolutely know. You don’t need an x-ray to verify that a crown didn’t go in the lung. If it went in the lung you’d absolutely know it.
Usa: Yeah. So I just had to do it, but Bill was there to help me through. I did extraction and then the root was fractured, I couldn’t retrieve it and I sent the patient to Bill and then he helped me. So you have to make mistakes to learn from your mistakes and I think that's something that you have no fear. You just have to make sure you have a backup plan.
Howard: So what implant are you placing? One brand or many brands?
Usa: I started out with doing 3i and then I changed to Implant Direct, now I am going to be using Ritter. I just bought the kit so I haven’t explored it yet. But I liked using Implant Direct because it's very easy and it works with my Cerec. I have the tie-base, I have the scan post and scan body to use it so I can fabricate the screw retain restoration for the patient. So that's why I was using Implant Direct, but I’m going to give Ritter a try and see what will happen. Supposedly it's an easier step.
Howard: So Ritter. The same company that makes Ritter dental chairs?
Usa: Yes. I was surprised by that too. So I got a good deal on the kit and the implants so I’m going to try it and see if that will work.
Howard: Wow. So you started with 3i which is bought by Zimmer, then you went with Implants Direct which was Jerry Niznick. Did you ever hear one of his lectures?
Usa: Yes, a long time ago.
Howard: Yeah, and now you went to Ritter because you like their starter package?
Usa: I just bought it. I spent what? $1,900 and I got ten implants and I have the surgical kit for free. I’m still using Implant Direct because it's less expensive. 3i was very expensive and Implant Direct you can get the whole system for under $200 and it works very well. Another reason that I switched from using 3i to Implant Direct is because Bill Desack was using Implant Direct. So if it's good for the surgeon then it has to be good for me too.
Howard: Well very good. Very good. Well I tell you what… I can’t believe… that was the fastest hour, we went three minutes over. That was the fastest hour I've ever done. I could talk to you forever. You really are a role model for me.
Usa: Thank you.
Howard: Between your Humanitarian Award, taking care of your husband, excelling in dentistry, Cerec, Ortho, Perio, occlusion, leadership, Smiles on Wings. I mean, my God. They should not have given ADA Humanitarian Award. They should have given you the ADA Everything-of-the-year Award.
Usa: I’m a jack of all trades but anyway, if you are serious about the online course I will really work on it and look into it, and I really would like…
Howard: I would love that.
Usa: So I will keep in touch and I’ll send the…
Howard: And I will absolutely tell you right now, I will do your Smiles on Wings but only if it's in downtown Bangkok.
Howard: Across the street from the bars.
Howard: I want you to pull up your mobile clinic and I'll do dentistry during the day and drink all night.
Howard: Their beer, their music and Ryan would you go with me on that trip? Ryan's going too.
Howard: I have to go talk at least three of my four boys to go to Bangkok.
Usa: Okay, I will see if that can be arranged. But I’m more of the mountains, and rural villages, visiting different villages.
Howard: Well you know what was really nice? Last time I took my boys on a mission dentistry trip it was an hour away from Acapulco. So you had to fly into Acapulco and stay at a five-star resort, and then every morning we had like a fifty-minute drive up to Odioc. So, then you could do jungle dentistry all day long but later that night you could be having booze...
Usa: You can do that too.
Usa: Our permanent clinic in Southern Thailand is a block from the beach.
Usa: So hopefully that would be something that we can continue doing. So I'll definitely work on getting you to lecture in Thailand, and the online course for the Cerec, I would love to be able to do that.
Howard: Well we would love it more than you. We would love that. If you’re listening out there, we would always rather have a course made a woman dentist than a male dentist because that class, no I’m serious, that class is half women.
I was lecturing at a dental school in New Jersey. This is about two or three years ago. And this little bitty girl walks up to me and she goes ‘is this your magazine?’ And it was Dentaltown Magazine. I said ‘Yeah’, and she goes ‘yeah, I see the entire editorial board is men’. And she flipped the magazine at me and turned out and walked back.
Usa: Oh my God.
Howard: I’m so dumb, I pick it up and look at the deal because it never even crossed my mind. I'm thinking dentistry and implants and all. I wasn’t thinking gender. I looked at that and called my team and they go ‘Howard, we're aware of that. We've been trying so hard. Do you know how hard it is to get a woman on the editorial board’. And this is what my team says, they say ‘when a man's a dentist his wife feeds the kid, raise the kids and all that. But when you're a woman dentist…’ it's still kind of sexist.
If you’re a woman dentist, your husband's a male dentist. You're still expected to do all the cooking and cleaning and all that. They just said ‘it's very, very hard to find a woman dentist who is a leader, who is all that and a bag of chips, who as any time because she's got to be the domestic kingpin along with the professional kingpin and that is why it's so hard to find women, role models and leaders because until their kids are gone’. I've noticed a lot of the ones out there were the ones who didn’t have any kids.
Usa: I know it's not an easy thing to do. I know we're running out of time but I just think that it's delegating. You have the book that you wrote and I’m reading it, and I think that’s so many different things that you talk about. Delegating, finding the right people to work for you, delegating your tasks and trusting them to carry out your mission and your work.
So it's the same thing with my two practices. Train them, give them the training and the same thing at home. I have someone to help me take care of my husband and then of course I have to let go. The kitchen doesn’t belong to me. The house, when she's there, she takes over and that's important that we have to just learn to let go. I think that’s something…
Howard: Find the best people and get out of their way.
Usa: Yeah, that's it and that's what I do. That's so important. I just let them do what they have to do. They are capable and then I can coach them. With the new practice that I have, the person who is helping me, who is the office administrator, I trained her from knowing nothing in dentistry. I'm training her to do all these different aspects of dentistry and I can let her do all of the work and then I have the assistants. The new assistant that I have, I'm training her also. I didn’t hire someone with experience. It's just someone that I teach from the ground up and then train them to do what I'd like them to do and coaching, leading and coaching. One thing I require from my staff is that they have to be coachable. So I know we're running of time but it's a pleasure to speak to you.
Howard: Well, Ryan's telling me I have a two o’clock appointment. I've got to run.
Usa: Oh okay
Howard: Thank you so much. I look so forward to your online CE course. Thank you so much.
Usa: Thank you, take care.