Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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832 Myths, Realities, and Illusions of Dentistry with Dr. Manu Dua : Dentistry Uncensored with Howard Farran

832 Myths, Realities, and Illusions of Dentistry with Dr. Manu Dua : Dentistry Uncensored with Howard Farran

9/4/2017 11:40:36 AM   |   Comments: 0   |   Views: 395

832 Myths, Realities, and Illusions of Dentistry with Dr. Manu Dua : Dentistry Uncensored with Howard Farran

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Dr Manu Dua graduated from UBC in 2012, upon graduating he worked in northern Alberta to hone his skills which included hospital privileges. After years of associating, Dr Dua built a successful startup in a recession in his home town last year.

 One of the first things Dr Dua did after graduating was complete a dental  mission trip in an orphanage in Peru which changed his life and set the tone for the rest of his career. His last dental mission trip to the Amazon was one of the most adventurous and amazing journeys of his life.

Giving back to the community is an important aspect of Dr. Dua`s vision; he has been involved in the C.U.P.S program, volunteering to provide dental care for those less fortunate in downtown Calgary.

As an average dentist Dr Dua is humbled daily by the challenges of dentistry and hopes he can provide a valuable service for his patients on a daily basis. 

Howard: And it’s just a huge honor for me today to be podcast interviewing Doctor Manu Dua, and he’s got forty-five or fifty-four hundred posts on Dentaltown, so I feel like you’re my brother, that we live in the same dorm. He graduated from UBC, University of British Columbia, in Canada in 2012. Upon graduating, he worked in Northern Alberta to hone his skills, which included hospital privileges. After years of associating, Doctor Dua built a successful startup, in a recession, in his hometown of Calgary last year. One of the first things Doctor Dua did after graduating, was complete a dental mission trip in an orphanage in Peru, which changed his life and set the tone for the rest of his career. His last dental mission trip to the Amazon was one of the most adventurous and amazing journeys of his life. I remember you posting about tarantulas and anacondas, and…

Manu: Yeah.

Howard: Giving back to the community is an important aspect to Doctor Dua’s vision. He has been involved in the C-U-P-S program, volunteering to provide dental care for those less fortunate in downtown Calgary. As an average dentist, Doctor Dua is humbled by the challenges of dentistry, and hopes he can provide a valuable service for his patients on a daily basis.

Manu, I’m so glad you came on this show today, because when you look at who’s all using Dentaltown on desktop, it’s all baby-boomers. If you look at everybody who’s downloaded the app it’s all millennials, and I’m sure the millennials get tired of listening to a bunch of old farts like me all day, and would much rather listen to someone five years out of school. Alright. Now are you technically a millennial?

Manu: I am borderline.

Howard: Well, 1980 was the beginning, what year were you born?

Manu: ‘86.

Howard: Oh hell, you’re six years into being a millennial.

Manu: Oh, okay.

Howard: So you talk about the illusion of dentistry. Well, first of all, huge fan of your fifty-five hundred posts, I mean I just love you to death. I feel like I know some of your thoughts, I’ve been following your journey. You’ve been a member since 2012. You talk a lot about the illusion of dentistry versus reality as a newer grad in terms of growing as a person, both personally and professionally, the scary gap in knowledge between dental curriculum and the real-world practice.

I’m thirty years removed from graduating dental school. So I remember when I was in dental school, I could name you every teacher I had. From kindergarten to the end of high school.

Manu: Right.

Howard: At fifty-five, you remember, like two teachers.

Manu: Yeah.

Howard: So you’re just five years removed. What was it like, looking back at the journey from leaving dental school to where you are now, five years out?

Manu: I think I’m trying to forget my profs to be honest.

Howard: You’re trying to forget your what?

Manu: I’m trying to forget my dental profs.

Howard: You’re trying to block them out of your mind?

Manu: Yeah. My sister’s a dentist she’s eight years older. So when I started, I was like ‘okay, we’re going to work Monday to Thursday, nine to five, my buddies are in med, they want to do residency’. But the reality is when you get out, because there are more dentists and it’s being beaten to death, is you have to work harder. That’s kind of where you’re talking about the millennials, it’s supply and demand. Do you have to work Saturdays? You work Saturdays. Like, I work Saturdays, I work Sundays. You do whatever it takes. When I signed up I thought I’d work Monday to Thursday, I’d get paid and I’d get laid. If I don’t get paid, I don’t get laid, and now I have to work Saturdays and Sundays. So, I think…

Howard: You thought you’d be a rich baller by now? You thought you’d be a rich baller driving a fancy car?

Manu: The problem with dentistry is (inaudible 03:46) it’s just that wherever you go you don’t get support. You go to your friend there’d be like ‘where’s your Ferrari?’ The reality is you have to grind it out like any other job, but we don’t get the acknowledgement for the hard work. We get all the stigma of you work three days and you make a million dollars, because dentists make too much money and so on and so forth.

The problem is for the younger guys, we’re still in the shadows. There’s guys that have been practicing twenty years, they’re set. They’re doing well, but the younger guys, they don’t. So when people talk to you, when you deal with even patients, they assume everybody’s like that guy thirty years out who’s doing well, if provided you take care of the finances. But they’re doing well and they’re established. Where the younger guys, most guys I know are working two to three jobs, working Saturdays, working until nine p.m., and just doing whatever it takes. But you don’t get that acknowledgement either.

So what I’m saying is not that it’s a bad thing, it needs to be more acknowledged, so we’re real. Nobody’s real anymore, it’s all fancy stuff, it’s all the less you work. Anyone successful, they tell you about hard work. In dentistry, people are actually proud of making more money and working less, like it’s not a bad thing, but you’ve got to acknowledge that they’re people. A lot of my patients are poor, so I understand. When we immigrated to Canada, my mom worked three jobs, worked at Walmart until eight in the morning. There are people working day and night. We deal with the public every day.

So if you’re bragging about working two days, how are you supposed to relate with your patients? Why do you think they’ll ever feel sorry for you for working two days and taking seven figures, or whatever it is. So I think there’s a disconnect, because we are healthcare. There are different aspects of dentistry, just like medicine, but I’m in healthcare. A lot of my patients are paying, a lot  of them are poor. I can’t sit there and pretend I’m not, so you’ve got to relate it to your patients. Yeah, I think there’s just a disconnect between what dentistry is, what students think it is, and what it actually is. And there’s even a disconnect between the way you’ve practice and the environment I’m coming to. So…

Howard: So satisfaction equals the perception of what’s happening minus what you expected.

Manu: Right.

Howard: So you’re saying that when you were in high school, you expected dentistry to… what was that rhyme you said? Getting paid and getting laid. You thought you’d work a lot less hours, make a lot more money and get laid a lot more, and the perception, that didn’t work out that way.

Manu: No. I can’t even afford expensive internet, man.

Howard: Yeah.

Manu: But no, and the problem is obviously the debt, the more debt that you pay. You’re getting the same degree, the degree hasn’t changed between when you graduated, it’s just a costly degree.

Howard: Your initials are MD. Do you think you should have become an MD, instead of the DDS?

Manu: I thought it’d be obnoxious if it would be MD, MD. Right. MD squared. I thought about that.

Howard: MD squared. So are you a DDS, or a DMD?

Manu: I’m a DMD, close enough.

Howard: You’re a DMD. So your initials is MD, and your degree is DMD?

Manu: Yeah. Yeah.

Howard: That should be your brand, MD DMD. That is so damn funny. Or DMD squared?

Manu: Yeah. DMD squared. Yeah.

Howard: Your classmates from high school, and grammar school, and college. Do you think it would have been a better move to go into medicine, or law, or programming. Did any of those guys come out easier and ahead, making more money in less hours than your DMD?

Manu: I don’t think it’s easy. If anything it’s harder in those things. What I mean is opportunity costs, because with medicine or dentistry you get some of the best years of your life. Your mid-twenties and that. So there’s a lot of potential. The problem is you don’t even know what real dentistry is until about two years out. So in the first two years, especially DMD, we’re sitting in the classrooms doing PDL, just useless things that has nothing to do with dealing with patients or dealing with dentistry. So I was even told that I’m too type B of a person, I should become type A.

It’s kind of like a moth and a light. It’s like dentistry, there’ll be money. But no one’s telling the reality, so I think that people are still in this perception, because nobody tells the truth. The problem is it’s a good job but it’s a dirty job, and there’s a lot of psychological components nobody talks about. Every person that comes in pretty much hates you right off the bat. They don’t know you. So my favorite (inaudible 08:35) is they come in and the patient’s like ‘I hate the dentist’, so I’m like ‘I hate you too’, and they’re like ‘Whoa’, and I’m like ‘Well now you know what it feels like’.

But the point is nobody tells the truth, so you don’t even know what you’re getting into. Now you’re going to spend half a million dollars on your education, or three hundred, or whatever it is. You should probably know what you’re getting into. You buy a house, you know what you’re getting. So that’s where I’m coming from. It’s that some of those kids could have done something better, because…

Howard: You said a couple of times everybody lies to you. You mean on student-doctor network? Who’s all lying to you?

Manu: I’m not saying they’re lying. I’m just saying people kind of glamorize it, because nobody actually tells you how it is. They’ll tell you about their technology and all the cool toys, but the reality is they’re buying all those toys because they’re bored. They’re bored that they kind of lost interest in what it is.

Howard: And I don’t want to settle for PISS, which is Patient Interaction Skill Set. I’d rather you have great PISS than a laser, or a CAD/CAM, or a CBCT. The thing I tell kids when they come out of school, the person who’s going to crush it is the warm, caring person who can connect with people. Not the idiot with a laser, and a CAD/CAM, and a CBCT, and all that alphabet soup bullshit behind your name. Almost every patient (inaudible 09:52) there’ll be a realtor or something, and they’ll have all these initials buying their name. Nobody knows what any of that stuff is, you just know if you like the guy.

I’m going to steal your line when I said ‘would you do it again?’ You said ‘well my patients are glad I did it’.

Manu: Yeah.

Howard: So now when someone asks me ‘are you glad you have children?’ I’m going to say ‘my children are glad I had children’.

Manu: Yeah.

Howard: Just kidding. But it is, it is. Children are the hardest job you’ll ever have.

Manu: Yeah.

Howard: But it’s great, especially if you have four incredibly crazy boys.

Manu: Yeah.

Howard: I’m sure my life would have been so much easier if I just had four innocent little daughters. But my dentist friend with daughters says ‘no, that’s a delusion too’. You’re just five years removed from graduating dental school, I’m thirty years removed.

Manu: Right.

Howard: Looking back, closer just five years out. Did dental school prepare you for the real world?

Manu: They took my money that’s what they did, but whether they prepared me. No, not really. They motivated me, because most people don’t have a good experience from their dental schools, it’s not getting any better. The ones that did shape my life were the instructors that taught part-time.

Howard: Yeah.

Manu: They practice in the real-world, so they could tell me what’s what. The guys that were there full-time they got paid the most, ironically, did the least and that’s where there’s a huge disconnect. Your dean probably didn’t even practice a year in private practice. You know nothing about staff issues, dealing with overheads, dealing with…

Howard: Did you know, when I was in dental school in ’87, half of the deans in America weren’t even dentists.

Manu: Right.

Howard: It’s been a new trend that maybe the dean should be a damn dentist. Back in the day they thought they should be a doctor, a PhD in education.

Manu: Right.

Howard: It’s just crazy. But you’re right the part-timers were in the real world. So you agree that the part-timers getting paid the least tell you the most?

Manu: Yeah, I get a letter asking for a donation, and I almost want to write him back, asking for my money back. I wonder what their refund policy is, because I (inaudible 12:12)

Howard: You should. You should, and then post it on Dentaltown. See what their reply is.

Manu: Ironically the people that taught me the most didn’t get a dollar from me, it’s people that just generally love profession, love what they do. And even on DentalTown there’s some people that give a lot of good advice, a lot of salesmen. But the ones that actually helped, even in my startup, they didn’t get a dollar from me. It’s just because they genuinely loved it, and that’s where there’s a disconnect, because education isn’t there to teach. Education is the business.

That’s where there’s a bit of an issue. When you’re paying half a million dollars, that’s an investment for your startup. You can build a business for that.

You don’t just build a clinic and say ‘hey, here’s half a million build a clinic’. No. You’re going to look at every detail, every cost, every so on. Why is it in education I pay half a million and I don’t have a clue, no one’s accountable. What’s real, what’s not, what’s relevant, what am I going to come out with, what’s tangible. So (inaudible 13:13).

Howard: And it’s not like you get paid half a million. You lost eight years of your life, when you could have had a job earning money and learning a trade. Everybody agrees that it takes about ten thousand hours, which is about ten years, to master something. So by the time we go to four years of dental school.

Manu: Right.

Howard: Or four-years undergrad, four years of dental school, you could have almost mastered something else than earning money and mastering something. I got a lot of classmates that, by the time I got out of dental school, they’re already millionaires from their own thing. You know what I mean?

Manu: And that’s the thing, because you’ve invested so much time and money; it’s hard for you to do something else. Maybe your true calling was something else. You could have done something a little more relevant. So that’s the thing, you’ve invested so much it’s hard to switch, like if you’d only spent twenty grand for your dental school and something better came along, you could have switched and you’ve done your true talent.

So there’s a lot of miserable professionals out there, and it’s hard for them to love teeth, because they’re so vested in now that they’ve got founding responsibility. It’s like a vicious cycle. Part of that is just no one’s real on what the reality is, like you said, there’s so many different ways with social media and online apps. The jobs out there have expand, and they’re so creative. You didn’t have them before it was traditional like you go you get a doctor, guaranteed, you’re going to get paid and laid. Now it’s like you get out and you’re grinding it out just like the plumber, just like you got advertised, like everybody else. It’s like your profession doesn’t really buy you that competitive advantage it would have.

Howard: So…

Manu: That’s the issue.

Howard: Walk us through your journey when you got out of school. How long were you an associate before you opened up your private practice? And opine on your classmates to, how long did the average associate last? So how many years did you associate before you opened up your own practice, and of your graduating class, was that about the same experience, or a lot of them still associates, or…?

Manu: I don’t really talk to my classmates. I think there’s a few that have started up, but most are associates. I did about four years, three and a half, four years. I can’t remember now.

Howard: So your practice has only been open one year?

Manu: It’s been one year, yeah, this year.

Howard: So the four years of associates, was that four years at one place?

Manu: No, four years at every place. So I moved around I went up North. Worked in a small town… I just wanted to get… my own main goal was to start my own practice, so I want to work at different places, different high-end, low-end.

Howard: But that is something I want to key in on, though, because when corporates out there told everybody that they’ve gone from zero to twelve percent of the market in the last fifteen years, and in the next ten years they’re going to go from twelve to twenty-four. So they think in a decade, they’ll have a quarter of the market. When I look at private practice and I look at corporate, associates aren’t staying anywhere. It seems like the only people that stay in their own place are the ones that bought in and owned. It seems like the only place you can find a dentist that stayed some place for ten, twenty, thirty, forty years, was an owner. Do you agree that the associate turnover, no matter what setting, they’re just fly by night?

Manu: I can tell you why being on the short end of everything, is that when you get out you’re supposed to have a doctorate, you’re supposed to be colleagues. Right. You work for someone. That’s not how it is. When they look at new grad, they’re either looking at cheap labor, that’s their first thing. How can I use them to my benefit? Or two, they’re treated as employees. They did show more respect to their own staff than to the guy who has a degree. So it’s not a collegial thing.

Not saying it’s true everywhere, but it’s more like you’re treated like an employee ‘this is our equipment, this is all you get, do it that way’. That’s why if you don’t have a buy-in no one good’s going to stay. This is not the way you wanted to do work, it’s not the way you want to treat people. This is the way the office manager tells you to treat people. You’re not doing it your way. Dentistry’s still individualistic, I think that’s part of it.

Howard: Yeah. So did you do a Denovo, or did you buy a practice?

Manu: I just started from scratch.

Howard: So you did a start-from-scratch De novo, and you’re one year into it. So talk about that part of the journey. Are you sleeping with one eye open, with atrial fibrillation, or are you scared, or are you doing good? Where are you at?

Manu: Well I don’t know the definition of success, but nobody’s died in a year, so let’s say I’m doing good. But yeah, the recession was huge and part of me is like, ‘I was real’. That’s the issue I have, is a lot of dentistry is like ‘do the fancy things, do the implant invisalign’, but most dentistry is real world. We call it ‘janitorial dentistry’, because you’re in there. So I focused on just the basic things like root canal, extractions. We at five hundred something patients. We broke even, I think, five months in. So I can’t complain, I just kept my expectations real and just took care of the patients and the rest. Everybody’s success is different. The numbers never end. I love this quote from Bob Marley it says, my paraphrase is wrong, but he’s like ‘if you chase money you’ll never be happy, because money is numbers and numbers never end’. That’s it.

Howard: Nice. I love that.

Manu: That’s why a lot of people that are making millions…

Howard: Bob Marley trivia. Do you know what he died of? How he died?

Manu: No, what?

Howard: He died from skin cancer.

Manu: Really.

Howard: You know why?

Manu: Why?

Howard: Because he’s Jamaican, you think he’s very dark complected, but not on the bottom of his feet.

Manu: Yeah.

Howard: So when you’re laying on your stomach on the beach, the underside of his little toe. His little toe got skin cancer in the part that’s not pigmented, and they told him he had to cut it off, and he wouldn’t because he was a Rastafarian and it was against his religious belief. So it metastasized to his brain and it killed him.

But I love his lyrics. Another thing that’s interesting about his lyrics is whenever you lecture anywhere in the Caribbean, but also all of Africa, Tanzania, Somalia, South Africa, Soweto.

Manu: Yeah.

Howard: Bob Marley just rules Africa and the Caribbean, because he’s got so many meaningful lyrics like that.

Manu: Sure.

Howard: I love that song. What song was that in?

Manu: Oh no, it’s just a quote he said.

Howard: Oh, I thought it was a lyric.

Manu: He was talking about money. Yeah. But that’s it. What everybody’s idea of success, as well, to some context. But if you have good content, you’ll always do well.

Howard: So did you do demographics? You’re in Calgary.

Manu: Yeah.

Howard: Were you trying to go into the rich area of Calgary, the middle class, the poor, downtown?

Manu: Oh hell no. I worked high-end and I couldn’t do it, it’s just not me. So I knew I was going to work blue-collar, that’s me. Yeah. Blue collar, middle class. Good working people, those are the best. It’s not the most glamorous work, but it is rewarding for sure.

Howard: Yeah, I…

Manu: So, I kind of knew I worked…

Howard: Yeah, I agree. One of my classmates who’s all handsome and hot, and he liked all the cosmetic and the high on, and I did his location for him in North Scottsdale, and he crushed it. But I was a Kansas boy, that wasn’t me at all.

Manu: Yeah.

Howard: It’s like I wasn’t going to go up there in hoodie-toodie cosmetic stuff with all these hot people like that. I’m across the street from the Guadalupe Indian Reservation, those are my favorite patients.

Manu: Yeah.

Howard: Then my practice is actually in Phoenix, and those are my next-to-the-normal patients. But yeah, so you figure you’re being true to yourself, that you were a blue-collar boy, and so you want to have…

Manu: I was a ghetto dentistry, blue collar, that’s me.

Howard: I never heard of that, ‘ghetto dentistry’.

Manu: Yeah, and janitorial dentistry. That’s real-world.

Howard: What would GG Hood’s practice be? I know she’s your mentor.

Manu: She’s really great. She knows

Howard: So, GG is hood dentistry? Is that what you said?

Manu: Yeah. We need to celebrate that more, because that’s the fun of dentistry, that’s the healthcare dentistry.

Howard: Well, (inaudible 22:21). So on the online CE, we make that free in the third world.

Manu: Right.

Howard: All these cosmetic courses are on veneers and lasers. But for all of Africa, and all of Asia, and all Latin America, cosmetic dentistry is some girls crying because she lost a front tooth.

Manu: Right.

Howard: Some dentist there wants to learn how to make a flipper to replace her front tooth, and when you do you rock her world. I have spent since 2004 to 2017, trying to get one damn cosmetic dentist to make me a course to make a flipper for a front tooth. When I’m in Africa, and Asia, and Cambodia, and Indonesia, and Thailand, that’s what they’re saying, they say ‘we don’t want CBCT courses. We don’t want any CAD/CAM chairside. none of that shit’s ever going to happen for one-and-a-half million out of two million dentists’. Cosmetic dentistry is a rocking hot denture but more importantly, it’s a flipper. Sometimes it’s a partial. I can’t get any Americans, because their ego is too big to settle down to the common man…

Manu: Forget Americans. I tell you Calgary has one of the highest LVI dentists in probably North America. I go to study clubs, even ten minutes away, their demographics are so different. So I go to study clubs, I’m watching these bourgie, I can’t say the word here, but like they’re out there on their own and…

Howard: What’s the word? What’s the word? Bourgie?

Manu: Bourgie motherfuckers. But I can’t…

Howard: You can say it. It’s dentistry uncensored.

Manu: Yeah. Alright. So it’s like bougie motherfuckers, and they’re sitting there, and it’s like ‘well when we come, we take thirty-two’. I’m like ‘the fucker’s in pain’. Most of my new patients are for an extraction or recon, that’s all we need. So you’re sitting there looking at the occlusal plane and saying ‘for fuck’s sake. You know what I mean? It’s like ‘seriously, bro’. That’s what I mean, like most people are day-to-day, patients are paying like $20 a day, saving up so I can pull one tooth.

When I started out I had a girl call us, I had no patients, and she’s like ‘I’ve called five clinics, I’m in a lot of pain. I have $90. Will you do it?’ I said ‘yeah, fuck yeah. Let’s go’. I’ll do extractions all day, for me it’s no big deal. I came and took care and we’re like, ‘we’ll never see the money again’. She came back and paid, and brought her kids and there. So that’s real-world and that’s helping people because not actually everybody likes it. But I’m like, ‘I didn’t invite Kois or Spears, come live a day doing ghetto dentistry’. Those guys wouldn’t last minute, because that’s real world. I have buddies that are ER doctors, they have my number, they’ll text me, they were like ‘I had one of your patients here, what should I give him?’ It’s either the ER or my clinic. So that’s real world, because I heard they were like one night away from infection.

Howard: About what you just said now, Kois and Spear, whatever. Not only did the dental schools take you for half a million dollars, but when you get out the dental industry sees a dental student with a big target on his back, and say ‘oh my god. We got another young dumb one’.

Manu: Yes.

Howard: ‘Let’s go get him a hundred and fifty thousand-dollar chairside milling.

Manu: Yes.

Howard: ‘A hundred thousand-dollar CBCT, and eighty-thousand-dollar laser’. They try to double your student loan debt in an hour. Do you agree with that assessment, or disagree?

Manu: One thousand percent, because like you say, when you build a practice, you learn how to do extractions and root canals. You’ll build a practice. You want to ruin your practice, you get a bunch of cosmetic people that will never be happy, because you’ve got to be happy with yourself. If that smile bothers you that much you’ve got a whole lot of other problems, other than your teeth. You can’t treat someone’s mental condition. Yeah, it might do it superficially, but you learn the basics. Nobody learns the basics, all they want us to do is the C-rack. They should call it C-wreck, because nothing ruins an enamel like young doctors on a C-rack.

What’s Serona stock? It’s like doubled, tripled in the last year. So the business of dentistry is more than the actual dentistry. And you’re right, nobody’s learning, everybody wants to go to Kois and Spears. It’s like once you learn how to do a (inaudible 26:35) filling, once you learn how to do those WTF amalgams, or whatever in the back, second molar in a fat lady. Try that. That’s real dentistry. But nobody wants to do it, because they’d rather get a cone beam and get an implant and do that, but you got to from somewhere…

Howard: What percent of the dentists on the circuit make all their money selling stuff to you?

Manu: Shit. I don’t know the percent. I’m sure there’s a lot. You’re right. When you ask them what they do in their daily life, because you have to practice what you preach. You’ll find it ironic. Did you know that Steve Jobs didn’t even let his kids touch technology? They limited their technology time? So…

Howard: (inaudible 27:24) Right.

Manu: Yeah, but I think I was watching a TED talk, talking about a lot of the guys in Silicon Valley. They actually limit their time that their children spend on technology.

Howard: I know it’s funny how America was pushing back on the Syrian refugees, when it’s a country built on refugees, and Steve Jobs, his father’s a Syrian refugee.

Manu: Yeah.

Howard: It’s like, really?

Manu: Yeah.

Howard: The insanity of politics is crazy. So what are your hours like? How many hours are you putting in a week?

Manu: When you’re in a business you don’t want to get technically on hours; you’re always on. So the hours that our clinic is open is by five, six days. But it’s whatever we can fill up, because we’re startup so we do the best we can. But your mind is running seven days a week.

Howard: That’s a question I want to ask, because owning your own business is a lifestyle.

Manu: Yeah.

Howard: When you work for corporate dentistry, that’s what they advertise the most, that dentistry doesn’t have to be your life. You just come in and do your time from Monday through Friday to five, and have your own life. We’re always told, I’m a baby boomer, that the millennials are so different. I don’t really know, I only really know four millennials, that’s my children.

Manu: Yeah.

Howard: But what percent of the millennials do you think want the lifestyle to be an owner/operator if they could, if it all worked out, versus what percent of millennials will say ‘no way. I’m not going to work like my dad, that was crazy. I’m not going to have five kids like my mom. I just want the eight to five. I don’t want the lifestyle of an ownership?’

Manu: It’s really about percentages because it’s all anecdotal. I think everybody picks on millennials but you’ve got to understand that millennials are coming at a hard time. They expected, well, everyone was supposed to retire, that’s our parents and our grandparents, like, the reason they screwed up their finances. Most of them are working until seventy, they won’t give it up. So when you’re a new grad, like you said, coming out in half a million debt, I know old guys are just not giving it up. So what do you expect them to do? It’s a bigger bowl if I can, it’s hard to generalize if it’s just one. But they’re not coming into the liquid  environment. They get a corporate, cannibalizing clinics, you got old guys that should give up their clinic. I mean half of them at seventy, eighty, who can barely see. How are you going to clean an MB2. Crazy, just…  

Howard: Well the answer is that. I've actually spent the day in a ninety-two-year-old dentist office. His name was George Ruine in St. George, Missouri. I've done it several times. The deal is when you're ninety-two all your patients are eighty, ninety or a hundred.

Manu: Right.

Howard: So it's mostly a social visit.

Manu: Right.

Howard: This George Ruine, his wife had passed earlier. Hell, when you're ninety-two you're the hottest man in the city to every woman who's over eighty-five years old. Can you imagine being an eighty-five year old widow and you could go to a ninety-two year old dentist, and then he would have one patient the morning and then he'd take her to lunch.

Manu: Yeah.

Howard: Then he'd have another hot date in the afternoon, then he'd take her to dinner. He would just live in the high life, man. He had two dates a day. So he probably didn’t even think about the MB2.

Manu: (inaudible 30:55).

Howard: What's that?

Manu: That's the lifestyle I was promised.

Howard: My God, he was the St. Joe Baller man. But you're right when he did a DO he put three spills and amalgam in the pulp. When you're eighty-five you probably have a hell of a lot less pain tolerance, it just worked somehow. You know what I mean?

Manu: Yeah.

Howard: Crazy times.

Manu: The millennials don’t have the opportunities as easily granted because they're coming in, your debt is higher and job opportunities are less. It's hard to blame them. But I think…

Howard: Okay. Yeah. By the way, when you're listening to me and I'm throwing molotov cocktails at millennials remember it comes from love.

Manu: Of course.

Howard: If I was trying to sell you something I might be telling you fluffy stuff.

Manu: Yes.

Howard: The fact that I'll tell you what I actually think, is a sign of love and respect. But one of my beefs about millennials is, so many of those millennial dental students graduated, their parents immigrated from another continent, another hemisphere. Thousands of miles and then when they get out of school I say ‘well can you just not go in downtown Phoenix, and go forty miles out into the rural where you'll just crush it?’

Manu: Yeah.

Howard: They're like ‘I'm not going to go to Maricopa, that's thirty minutes away’. I'm like ‘dude, your mom came from Vietnam and you can’t go to Elway, Arizona?’

Manu: Yeah.

Howard: So what is that all about?

Manu: I think it's not the actual going there. I think fifty fifty their parents also spent eight years in school. Like you said, they've already done a fair amount of sacrifice when they got out and now they have debt. It's just one after the other, there's no light side and it's not for everybody. The reason why they're upset is, the whole point of doing dentistry, is you can enjoy your lifestyle where you want to live and do it there. If I had to go live in a but-fuck rural town, I would've done engineering or done something else, because I’m killing my legs. It’s not for everybody.

Howard: They’re killing your what?

Manu: If you were born in the city, all your friend is here and that. You'd have to give up a lot to do what? Just do a couple of fillings here in the middle of... Like that's not for everyone is what I'm saying.

Howard: But you know what would be the gamechanger on that though?

Manu: What is?

Howard: So think about when you're at home that every day, maybe a space of an hour, watching the news, or watching a movie, or on your computer, or something like that, with driverless cars. You could have a rural practice, live in the urban and crawl out of bed, and your driverless car might just be a box with just a bed. Say your practice was an hour and a half, you might be supposed to get up at seven, you just might get up at five thirty, go crawl into your bed and hit go and the driverless car takes you.

I think driverless cars is what's going to push so many people out even farther from these big cities, because these big cities are too expensive and also think about this. Think about if you worked in a typical cubicle, an engineer and you're at home, a spouse and the kids, you can’t get work done. Then when you're at work everybody's come by your cubicle talking to you. You can’t get shit done but you've got to be there for the meetings or whatever. Even if you live two hours away from work, you can get in your driverless car, get on your desk, do all your work, all your email, all your spreadsheets, whatever it is you do.

Then get to work, do your meetings all that kind of stuff. Then go back to your driverless car, two hours work and then you could get home, and completely unhook and disengage from work, and engage with your children. I think driverless cars is going to be one of the biggest social engineering. And why would you have this gazillion dollar office space in Manhattan and San Francisco when you could push that two hours out of town.

Manu: Yeah.

Howard: I think the biggest lesson in retail was when Sears spent one billion dollars on their high overhead Sears Tower while Walmart started with Bentonville, Arkansas. Where the owner had a door over two saw posts and ever since Walmart built that billion dollar building, they never made a billion dollars a year in profit from that day forward, because they were just too high overhead. If Sam Walton killed anything he said ‘I’m not in downtown Chicago in a billion dollar overhead building. I’m in Bentonville, Arkansas with no overhead’. Who won that game in the long run?

Manu: Yeah. That's true. Like I said, I’m down to rural right. There's pros and cons. You could do it for a little while but I've worked in minus fifty-two celsius and that's less than minus forty fahrenheit. I was alone. Why would I want to repeat that? I did whatever it took, I paid all my debt. It took a year and a bit to pay back all my student loans. I've done it, I’m just saying it sucks. It’s not something I can do for twenty years.

Howard: So you must have made a lot of money out there then?

Manu: Yeah. Yeah.

Howard: So you made a lot of money in Rome?

Manu: Yeah, but the social aspect...

Howard: You paid off your student loans.

Manu: I paid all my loans but it comes at an opportunity cost, it comes with sacrifice. So I sacrificed...

Howard: Your social life.

Manu: Going out. Yeah. So everything has a cost to it.

Howard: Did you try dating a moose or caribou?

Manu: They're picky those ones.

Howard: Those moose and Caribou are picky?

Manu: Yeah.

Howard: In reality who usually goes rural? The one's with the most debt and they've already got the woman, family out of the way. They're usually LDS Mormons, already married.

Manu: Yeah.

Howard: Already got kids and they don’t care if they're in the middle of nowhere, because when they get off work they just want to go home and play with their kids.

Manu: That’s it.

Howard: So you’re right. It'll be the hardest for a single.

Manu: And the thing is, you're already struggling. You're a student for x amount of years to me it’s getting longer, because it's getting harder to get in. Nine years. So you're living on a budget for that long until you get your degree, and now you've got debt to pay. So now that eight years becomes ten, eleven years of being frugal. Now you're watching like nineteen year old kids making millions on apps, and you're sitting there and you're like ‘I'm a so-called valued healthcare provider with all this education, and I get treated like shit. Patients don’t trust us. I spent the last twelve years of my life and I can’t even live where I want to live’. So I can understand why people aren’t jumping onboard. They'd rather suffer for the social aspect, because there’s more to it than just billing.

Howard: So you're one year into a start-up. What were your lessons learned? What are you looking at one year on saying ‘man, I got an A on that’ and other areas saying ‘man, I wish I would not have done that?’

Manu: (inaudible 38:08) My first lesson was actually to put bars in day one. Gigi's actually told me this, and I kind of laughed about…

Howard: Fitted it what?

Manu: Put bars on my windows.

Howard: Oh.

Manu: I got broken down one month in and they stole my iPads. The only thing that pissed me off was they stole my PlayStation. That is the only thing that annoyed me. I put a PlayStation in my office because you're going to have time.

Howard: Does Gigi have bars on her windows?

Manu: Actually she’s got double locks. She's ready for a zombie apocalypse.

Howard: Yeah. Yeah, I love that woman.

Manu: It was Friday night, I had patients on Saturday. So the hardest part for me and I have bills to pay, trying to do extraction in my mind, there's cops doing their thing. That wasn’t a fun day for me.

Howard: And the other thing when you get robbed, for me it was the emotion. You feel like you've been violated, you feel like you've been raped.

Manu: Yeah.

Howard: That you’ve been taken advantage of.

Manu: Yeah.

Howard: Then you're mad because you’re a victim, that you didn’t have cameras. At that point, you would give your car away just to catch the bastard with your own hands.

Manu: They found my safe blown up twenty kilometres away on the side of the road. They matched the serial number. Someone took my safe from my office and blew it up. The emotional part is the worst, for sure. My staff were like ‘oh my God they stole the iPads and cash’. I’m like ‘I don’t care’. All I cared about was my PlayStation. That's just me. But I agree, it's that personal. It hurts.

Howard: So you got broken into, you weren’t expecting that. Then you open it up during a recession, did you see that coming? Did you rent or build a building?

Manu: I’m leasing.

Howard: You're leasing. When you signed the lease, did you know or smell that a recession was on top of you?

Manu: Yeah, that's the thing. I was in such a bad place working from one guy to the other. I had so many carrots hanging in front of me. You can buy in, this and that and that's so many people pull it away. I was just pissed off at that point. The no matter what, I knew this area, I knew the people. I was going to do it in recession and hopefully do it, it's just determination.

Yeah, we've been flooded, I've had guys who installed the vacuums didn’t do it right. One day my sterilizer went down. So immediately the guys were to come fix it. It's Friday and I'm like ‘where's your guy?’ He's like ‘oh he's somewhere else’. I’m like ‘well I have patients tomorrow’ and they’re like ‘oh well, too bad’ and I’m like ‘great’.

So I had to pack up all my instruments, go to my buddy's clinic at six in the morning next day, get them sterilized, come back. When you have a business you'll do whatever, and it's not a millennial thing. I think what's more is you should say there's like grinders and there's non-grinders. In your generation, you have people that didn’t grind. It's the same. I think it's just grinders vs. non-grinders. Some people do whatever it takes.

Howard: Yeah.

Manu: Some people find an excuse not to do anything.

Howard: But do you think an associate dentist would've taken all the dirty instruments and gone to his buddy's place the next morning and autoclaved them to come back to work to keep the team on schedule?

Manu: No. 

Howard: No?

Manu: You've got no incentive.

Howard: I know. So Rick Kushner has been telling me for thirty years he only believes in owner operated dentistry.

Manu: Yeah.

Howard: He's always telling me, and the only people that seem to tell me how great of the associate dental industry is, is their corporate. They want a thousand dentists to work for them as an employee. I’m having a hard time seeing it, and I don’t like to throw my friends. I really respect Rick Workman at Hartland, I really respect Steve Thorn at Pacific and I want to make clear. It's the same problem in private. In my thirty years as owning a practice it's always been an A if an associate stays with you ten years.

Manu: Yeah.

Howard: I’ll give them a B if a couple of them stayed seven years. A couple of Gigi's friends stayed with me seven years but the vast majority are just there looking for the next best opportunity to come their way. Where they end up wanting to be is owning their own business, and I can’t fault anybody for that.

Manu: What I was going to say is, you might respect those guys but I don’t. The reason why I don’t is, like you said, those guys in the Ferrari’s and like Kushner, he's got a private jet, talks about elitist dentists. Don’t you find that a little ironic? Well it's people making more money off the backs of dentists. They’re not in there. So when you're sweating with me and trying to pull out that XO, the abscess, your triple mass, then I respect you. You're sitting in a palace in there and telling me what dentistry is like, I don’t think so.

Come here and ride it out with me right now and right here, I’ll respect you. You're sitting in a palace, who the hell do you respect? Yeah, you've built a business great. So did Sam Walton, so did all of them. But don’t tell me about dentistry. That's where I have an issue. Like you're still practicing and I respect that, that's a tremendous (inaudible 43:40), honestly, because it's very easy to sit there and talk about an industry. But you're there in the trenches, I'd respect every word you'd say. But guys in their gulfstreams, talking about being an elitist on (inaudible 43:53) Ferraris, that's not real world. He can’t relate to me. So he doesn’t know my struggle.

That's kind of where I have an issue but the reason why the associates do is because they’re treated like labour. It's not slave labour, because of that debt. When somebody comes out he'll do whatever it takes, twenty years ago maybe you wouldn’t. But you've got half a million and you might have a family in there, you'll do whatever it takes. So I don’t know. It's a very difficult position for people to be in and it's very easy to take advantage, and that's the issue. I'm not saying private practice don’t take advantage but (inaudible 44:29) is institutionalised.

Like I went to business school right... It's institutionalised taking advantage of someone's debt load, that's what it is. They're leveraging someone else's misfortune. You've got to name an immigrant, they don’t have a job in there. You can take advantage of them easily. Whereas somebody who's well connected and that, so that's where I have an issue where I think there's a newer breed. I like it that the younger dentists that are building start-ups because we're more knowledged and a lot of our knowledge is from Dentaltown. So we can fight.

If I had known none of this, if I didn’t have Dentaltown. Honestly, I wouldn’t know a fraction of what I do now. You only know what you know. If I don’t know how (inaudible 45:10) are working, what other people are actually doing in other cities. I would have no idea Kushner and Workman can give me an offer, and I'd take it because I don’t know any different.

Howard: So if someone's listening right now and they’re a big fan of this show. But they've never gone to DentalTown and they’re not a member of DentalTown, or they’re a dental student and never heard of it. This is the first time. Tell them what DentalTown is and what it meant to you. How does DentalTown play a part in your journey?

Manu: I think DentalTown in a place where people would actually listen. A lot of times, like you said, dental practice alone is you wonder if this is you, should you feel this way. Maybe you don’t like your job. I don’t blame you because wherever you go overseas ‘oh I love dentistry, I love teeth’. What if you don’t? What if you like your staff, what if you like your patients as people but what if you don’t like this or that? Who's going to hear you? All of a sudden now you've got thousands of dentists, and they're like ‘hey, I agree with you’ and then all of a sudden, you're like ‘maybe I’m not the one’.

We always think we're the problem. Maybe you’re not, maybe it's just the way it is, or someone’s frustrated being an associate, and someone else is (inaudible 46:20) and more issues. Nobody likes to suffer alone. So there's a little camaraderie and you're like ‘ok, what can you do better’. (inaudible 46:27) if you don’t like your owner. That's why I don’t have one in my clinic and I’m like, I work for a jerk off office manager so I said when I build my clinic we're not going to have an office manager.

I told my staff ‘you guys talk to each other. You have two minutes in the parking lot, you want to fight it out, fight it out. But talk to each other, you can make it work’. So I took everything I didn’t like and then practice what I preached. But I didn’t know that because in DentalTown I met so many other people that felt the same way. And that's what I would say DentalTown is, is just finding people.

Even if they don’t feel the same way, you get differing opinions, differing styles. Like I'll never be a maverick or any of that bullshit, but at least there are other people that that's how they practice. You get to see different styles, you can pick a style for you. When you're a young dentist you don’t know what's right. You might be working for one guy and maybe he's doing things that are kind of sketchy or whatever, and you don’t know if that's the right way because you don’t know any other styles to practice.

DentalTown just kind of exposes you to different styles of practice, different start-ups. You don’t have to do that accept the sexy cosmetic stuff, you can do good dentistry. That’s where Ryan McCall, like all credit to teachers. He opened up his own niche and all of a sudden you don’t have to do a full mouth of veneers. You could make a very good living and do a valuable service doing better work working in poor areas. Helping people, get them out of pain, doing extractions, changing their life. Nobody would’ve made dentures sexy. McCall did. Whereas if I went to the CE's, all the CE's are CADCAM this, Cerec, Omni it's like bullshit because there are many ways to practice. So, yeah, I agree with you one hundred percent.

Howard: So if you're in Calgary doing ghetto dentistry, janitorial dentistry and Gigi's doing hood dentistry in the San Fran area, what’s Ryan McCall doing? How would you describe Ryan McCall's? What's his practice?

Manu: It's no different. He’s just…

Howard: I love that. I've never heard of ghetto dentistry, janitorial dentistry, hood dentistry but you've got to be true to yourself. I've been across from the Guadalupe Indian Reservation for thirty years. Not one person there ever stiffed me, not one person never paid their bill and when you really felt sorry for everything you've put them through, three months later it's Easter and their bringing you corn tamales that they made by hand themselves. Just the most adorable people in the world.

Manu: Yeah.

Howard: And then I’m about a mile and a half away from this little rich pocket and there's people that own three or four restaurants that I did all this work on, and they didn’t even pay their bill. Back in the day, it's like ‘my God’ if someone says ‘well what's your major red flag on a patient?’ ‘Oh, it's if they drive a ‘Benz and are giving off this aura that they have money’. When they're walking from Guadalupe they’re just straight up.

Manu: No, and the reason why I like (inaudible 49:34) of friends we all do the same kind of ghetto dentistry. But the thing with that is the reason why we will never be as hoity toity as the fancy guys. You get (inaudible 49:43) every day. You do molar endo, you do surgery, you won’t get humbled. That kicks your butt that kind of dentistry because it's hard.

Howard: Okay. So you talked about endo and you talk about oral surgery and when I look at the incomes of general dentists, it's like one seventy-four, and when I look at endodontists it's like three twenty-four, and oral surgeons like three seventy-four, and then I meet half the graduating class and they say ‘well I don’t like blood and guts. I want to do cosmetics, veneers, sleep apnea, invisalign’. They want to do all this soft white and fluffy stuff, and I’m telling them all the money is in all the bloody stuff.

I’m not saying you have to learn how to place implants, but you've got to learn how to pull teeth, and you've got to learn how to do root canals. By the time you can pull any tooth in the mouth, that's twice as hard as placing an implant, and a first molar is ten times easier than removing a third molar. So what would you say to these kids that are in dental school listening to you right now or an associate. They used to say ‘I just want to do the white, fluffy stuff’. They call people like us bloody barbarians and they call them pulp loving, white and fluffy.

Manu: No, I would say we are healthcare providers and they work at a spa. That's the reality. People don’t go into medicine to just do Botox. We're here to take care of teeth. You can’t take care of teeth, be it extractions, root canal, like why are you here? I could never stand a few but it’s just everyone wants easy money, or what they think is easy money but it's not. Cosmetics, they have their own issues. Invisalign, if you don’t do it right you'll be in a lot of trouble three years from now.

It's just that nobody tells you why because all those things are being sold. Invisalign is a multi-billion-dollar company. They sold this dream but the reality is, probably the most rewarding, I don’t know about you, but when you get someone out of pain, that to me is the most rewarding thing and that's nobody's  glorifying that. There's no course saying ‘hey, do your job. Get someone out of pain’. You won’t get frustrated, you don’t have to buy those toys to make yourself feel better. Get them out of pain, they'll thank you for life. They'll tell ten friends. You built your practice.

Howard: What hi-tech stuff did you buy or should I say, what hi-tech stuff did you pass on?

Manu: I worked on a lot of...

Howard: I know for a fact you splurge on a game station, but besides your game station.

Manu: I've got a 34 inch. Yeah. I think my endo machine. I did splurge on that.

Howard: What's your endo machine?

Manu: It's like the Endo-tech motor, but what it is it's got a built-in rotary and apex locator. So as you’re drilling it’s automatic. 

Howard: So who makes that?

Manu: I don’t know, it's a German company but it's called Endo-tech.

Howard: Endo-tech? Can you find that for me?

Manu: Yeah.

Howard: Okay, so you have Endo-tech where you have electronics on the rotating 300 rpm file, so it's got apex locator built in, is that what you're saying?

Manu: Yeah, if you want to add anything in ultrasonic you just add it onto the cart and it works really good. So extractions, I’ve got the Karl Schumacher stuff from Germany. Endo and surgery I splurged, but what I splurged was on things I would use every day. Where I didn’t splurge was on things that didn’t matter. Like the chairs, I've got solid chairs that were hydraulic, the electric chairs have issues. The Serona chairs, I worked in an office where the hygienist, they weren’t even two years old. She sacked the LCD. The girl shits her pants because the screen was four grand. I got my chair for less than that. The chair has to go up, down, left or right. You don’t need LCD. It's just one more thing to go wrong.

Howard: So I found the Endo-tech. It's Endo-Tech?, you splurged on that.

Manu: Yeah.

Howard: What kind of chairs did you buy? 

Manu: I've got Forests.

Howard: Forest?

Manu: Yeah.

Howard: Now that's a name I haven’t heard for a while. That's a good medium cost chair.

Manu: Yeah. They’re all hydraulic, up, down, left, right, made in the US. Solid chairs.

Howard: Yeah. Did you buy a laser?

Manu: No.

Howard: Did you buy a chair (inaudible 54:34)

Manu: No.

Howard: Did you buy digital radiography?

Manu: Yeah. Digitals are x-rays.

Howard: And what did you go with there?

Manu: I think they’re like Quick grade and then their pans like you refurbish kind.

Howard: So you bought a (inaudible 54:55)

Manu: I've got to use that yes.

Howard: So what else?

Manu: Most of it’s pretty basic. Honestly, like we would custom make the equipment, custom make the…

Howard: Oh, Endo-tech that’s in Halifax, Nova Scotia, Canada. So that's on the other side of Canada from you.

Manu: Yeah.

Howard: You're West coast Canada and they’re East coast. Halifax, Nova Scotia.

Manu: Yeah.

Howard: Some of the best fishing in the world’s up there. Are you a fisherman?

Manu: No.

Howard: Oh my God, I love fishing.

Manu: Yeah, I don’t have the patience.

Howard: You don’t have the patience? Yeah, one of my best friends from dental school, Craig Steichen, we use to go to Cabo like every year.

Manu: Yeah.

Howard: God, that was so fun. Just sailing out there and you could just catch anything at the tip of Cabo. It's one of those areas where all these migratory patterns would cross. You never know what you're going to pull up.

Manu: Yeah.

Howard: I was fishing up one time by Halifax, Nova Scotia. Do you remember when I took you and the boys there?

Ryan: Yeah.

Howard: I told the guy and I go ‘what’s legal?’ and he goes ‘well, you’re not allowed to catch great white sharks up here’. Man, we caught a bunch of sharks.

Ryan: Oh God.

Howard: Cold water sharks. So what you do is, before you cast in he says you've got to tell the bait ‘no great whites allowed’. The guy was laughing and goes ‘isn’t that a stupid law? You can’t catch a great white. He goes ‘how the hell do you know what's going to bite this hook? You have no control over what's going to bite this hook’.

Manu: Yeah.

Howard: That is when I learned sharks were not very smart, because my boy pulled in like an eleven foot. It had this very distinguished scratch on the top of his head and so of course we catched and released and two hours later, another one of my boys caught the same damn shark and when we're pulling up everybody agrees and says ‘that's the same one’.

Manu: Yeah.

Howard: That's when I learned the sharks cannot be that smart.

Manu: There are people like that. There are dentists like that. They make the same mistake again and again.

Ended at 57:14

Howard: You're right! Point well taken. I think the funniest one dentists makes is when they start dating their ex. It's like "really dude? Really? I’m pretty sure you divorced that woman and now you're dating her again? How could that be a good idea?" So, you're right. So, I should leave sharks alone.

Manu: The only way you can be good at dentistry is like getting back up on your feet. So, sometimes that translates in the wrong way. Like you pray for a root canal, you don’t give up on root canals. You go back in there. So (00:57:48 unclear).

Howard: So, what’s the best advice did Gigi ever give you? You and I should start a mutual Gigi fan club. What's the best advice she ever gave you?

Manu: She's given me tons but I think she would say “don’t spend money on stupid shit.” She'd say like- all the fancy stuff.

Howard: And how many employees does she have?

Manu: I think it's just her and then the odd assistant or two.

Howard: So basically, has zero employees.

Manu: Yeah.

Howard: I think what dentists are not realizing but I think one of the best ways to get an education is to get out of your own tribe. Get to another country and I think one of the biggest laws of unintended consequences that ever affected me is lecturing around the world and you see so black and white clearly. So, many cases in Tokyo and Singapore where dentists follow Gigi or they say, "well, all these offices that are trying to have six, eight operatories and all this staff and your time and an office manager" and they went the other way and said, "I’m going to have one square, one chair, no employees. You want to call me, here's my iPhone and instead of doing $745,000.00 and taking home $145,000.00, they do like $200,000.00 and take home like $180,000.00. I mean it’s just crazy. I knew a dentist in a small town in Missouri and he won’t let me podcast because he's all humble and all that stuff, but he's basically in a small-town Missouri by himself. He does $300,000.00 out of  one chair and he takes home $275,000.00 and you see that a lot in Asia and so in America, and the sweet spot for bankruptcy, for a dental office is right around the $2 million mark. Between $1.5 million and $3 million they've got this one office, so they’re going to Wall Street so they go open up a satellite office and the confusion in there is insanity and by the time they get to the third office open, they go completely bankrupt and a lot of people make a lot of noise, and that noise is so expensive and then there’s people like Gigi who should be the St. Apollonia of overhead. You know who St. Apollonia is?

Manu: Yeah.

Howard: If your Catholic, that's the patron saint of dentistry and she's just the patron saint of no overhead. She has no labour and she's hardworking and no labour.

Manu: I think a part of it goes to... It's like if you don’t have a busy office, it's better to look like you’re busy and making money than actually making money because what Gigi does and those guys... it's not glamorous. It's nice to say I have twenty staff, or we have nineteen. Everything turns into like a penis measuring contest for whatever reason. No offence to the women. Women are better at this. Men are like, "I have twelve ops, and I have four associates". It's like (01:01:16 unclear). It's like "bro, you’re in healthcare. This is not (01:01:21 unclear). These are good people". It becomes less like what the numbers matter and more about what it sounds like because it's sounds way cooler to have eight offices right? If I told you I have three ops you're not going to be impressed. If I tell you six you're like, "wow". I could tell you I’m bankrupt, that's later but three ops could be doing like you said, double the profit. It's not sexy.

Howard: Well, that's how Napoleon took over half of Europe as he realized that all his other competitors, all the other countries, they all had paid mercenaries and he spent his entire career designing all these elaborate rewards and ribbons and titles and trophies and his men were diving for the ball, and when the mercenaries, when they would come to another country, they'd say Napoleon's army with all these gowns and sashes and ribbons and all these men, just all psyched out of their mind., most of them just dropped arms and ran. If you’re willing to die, you can die. I'm out of here.

Manu: Associates, right? They’re basically like healthcare mercenaries. Unless they have buy in, unless they have something into it, why would you expect them not to? Why would I pay a guy 60%, 65%, 70% and then do extra work on top of that right? So, it's a way if you don’t value add, you don’t anything consistent or make him part of your clinic. Of course, you’re going to walk out. You can’t bitch about associates. It goes both ways, right?

Howard: So, tell me about your dental mission trip to an orphanage in Peru and why did that change your life and then, why did you go back to the Amazon where you almost got killed by a tarantula and an anaconda?

Manu: The anaconda -someone killed but I'll go back to Peru. It's the first thing I wanted to do. The anaconda - a  lady killed with the machete in the morning.

Howard: Oh yeah?

Manu: That was a sight to see! It's a funny story. So, my sister use to volunteer. My sister is a dentist by the way.

Howard: And she's what? Eight years older than you?

Manu: Yeah, eight years. She's in Long Island but she was in Calgary for a bit. She used to volunteer downtown and there's a place where poor people come for extractions. So, I went there and I was shadowing her in high school and the guy who started that program and wrote my reference letter to get into dental school, and I promised him that someday when I graduate, when I can do extractions, I can come back and actually help out. So, the first thing I did when I graduated was, we went on that mission trip with a paediatric dentists. I don’t know if you've ever seen a thousand orphans but when you see an entire orphanage with a thousand children with no parents, that's something to take in and because of birth control being an issue, they'll literally drop the babies off at the doorstep so you have all these kids in there who's never seen their parents. Talk about gratitude.

Howard: We talk about in Peru because they're Catholic and don’t believe in birth control.

Manu: Well no I just think that’s the environment. The parents couldn’t afford to have kids and they wouldn’t abort the babies so they would just drop them off at the orphanage.

Howard: But that was in Peru, though right?

Manu: Yeah, that was in Lima.

Howard: Yeah and what percent is that Catholic?

Manu: I don’t know about the details. I just know that that's how we had a thousand kids at that orphanage.

Howard: Yeah, they’re all Catholic and we're going though that today in the United States where on the one hand they want to unfund planned parenthood because they don’t believe in that and birth control and all that stuff and then the flip side of that is, you go see an orphanage with a thousand kids who have never seen their parents. I don’t want to get into politics, sex and all that stuff.

Manu: But these are the best kids you've ever seen. That's the thing Howard. They were polite, they were just amazing and that gets to you. So, in any type of opportunity being grateful and that. A lot of these right off the bat, they’ve got a harder hill to climb. So, it was giving back with dentistry. It's very easy to bitch and complain. We're all like, "oh the patient was this  and that" and grumpy. Like you said, you’ve travelled and you work on good people. It changes your mind both on dentistry and on people because it's pure dentistry. There's no insurance, there's no worrying about this and that, it's just pure in itself and then you realize that dentistry in it's pure sense is different from what it is that's taught in schools. That’s true dentistry. You don’t have to worry about billing, you just go there, take care of the person and help them and leave. That's pure incense and that's what mission trips are.

Howard: I have to say one thing and I know people hate where economics. This isn’t a religious statement, I just want to say this... I grew up Catholic, I went to Mass, every single day from age birth to seventeen, all through grammar school, high school. I even went to Crayton Catholic College but all the Catholic countries are poverty and Peru is 85% Catholic, 11% Protestant, remaining 4% are Adventist, Mormons, Jehovah’s Witnesses, Israelites and the new universal pack but the bottom line is, I just want you to think about this. So, let say you have a pizza and that pizza is growing 3% a year but your population is growing 6% a year. That means every year your slice of the pizza gets smaller and smaller and smaller. So, if your population grows faster than your economy grows you're growing poverty which explains Mexico all the way to Argentina. All of central and South America, the problem is their economy is not growing faster than their population rate. And where did we grow the fastest wealth in the last, since World War II? It was in China and when you look at China's miracle, everybody talks about all these things but what they don’t talk about is, it was the one child rule. They knew that if they stopped their population growth, because you need 2.3 kids per family just to maintain the herd. So, when they actually went to one child per family, they had a shrinking herd. So, any type of growth of the economy. It could have been two, three, four percent was massive and they grew the most wealth in the world. Then you go next door to India which has about the same population and nobody would call India an economic miracle because when you go there half the population is under twenty-one years old and you have all these kids running in the street and because of religion and politics, the planet doesn’t want to sit back and think about "we have to control the rate and growth of this herd", and then I also what’s the hilarious thing about... Some of my biggest environmental freak friends who wants to drive electrical cars and recycle their trash and all this stuff, are my neighbours with eight children. It's like, "do you know the carbon impact of having a child?" If you want to save the planet, the first thing you should do is not have your current population, the seven and a half billion homosapiens turn into fifteen billion homosapiens on 2050! Every year earth has more babies than the entire state of California and this herd can’t drop forty million new frogs a year and then try to save the planet by recycling your trash and I know that we've got (01:09:22 unclear). Yeah, I love missionary dentistry because the first time I did it...

Manu: But those kids didn’t do anything. None of this is they’re fault.

Howard: Oh, I know.

Manu: But like that's what I meant a lot because you actually (01:09:39 unclear) who's done nothing wrong. All else to politics and it's got nothing to do with the poor kid. It's just a poor kid with an abscess and that's why it's pure. It's just, there's a kid. You helped him and made a difference and so every time you’re in your office and you’re pissed off, it's been a long day and insurance, you have Delta who's denied your claim and then you think back to that moment, you realize man, it's not dentistry. You're blaming dentistry. It's not dentistry or the insurance or the political scene, it's not dentistry. So, in its pure sense don’t blame the dentistry.

Howard: Yeah, and the most fun about growing up Catholic was that every quarter they'd send you to a retreat. You had to unhook. After Friday, you get in a bus, you go to the seminary and you couldn’t do your routine. So, it just forced you to think and you know you’re doing all these lectures but a lot of it was just unhooking and unplugging and thinking. In fact, I thought that was an amazing thing and I remember, first time I did (01:10:46 unclear) in Mexico, a hundred patients stood out there all night in a tropical rain, holding their babies in the rain because they really wanted these Americans to check their babies tooth because she had a toothache. We were sitting out there drinking beers on the porch, looking at these stoic women holding their babies and I thought, "man, that is the meaning of life. Can you imagine standing out there holding a baby in the rain, all night long just for a chance that one of us lazy butt Americans is going to fix your child's tooth tomorrow". But you know the weirdest orphanage I ever saw in my life, Tanzania. And guess what the orphanage is for? You know the kids, what's that skin pigmentation that Michael Jackson had? Vitiligo? Are you familiar with Vitiligo?

Manu: Yep.

Howard: Are you?

Manu: Yeah.

Howard: So, it's kind of like a deep pigmentation in the skin.

Manu: Yeah, ok.

Howard: And in central Africa, when the medicine, those are worth like a black rhino, the medicine man wants those and paid dearly for them because they use pieces of their body and their witchcraft and their lotions and potions, and so relief workers, whenever they see a young kid or that, they know he's going to get kidnapped and killed and cut up into pieces so they drop him in this orphanage. Now it’s an orphanage and there's hundreds of these little kids with all this deep pigmentation deal and their all in there with these ten-foot walls with razor wire all the way around it because it was like worth catching an elephant or rhino if you could get one of these kids. And they had to keep them in there until they were the size of you and me and can fight some sixty, seventy-year-old witch doctor. 

Manu: Even the Amazon.

Howard: Yeah, tell us about your Amazon trip.

Manu: Yeah. So, went to (12:53 unclear) and we stayed in the middle of Eco Lodge and every day we loaded up our equipment and went village to village literally. In a boat, unloaded in the heat. Got there, set up our things and then just facing (01:13:05 unclear) and we had a group of medical doctors with us too. I remember the funniest thing I did was, I jacked a medical boat because I just wanted to drive a boat in the Amazon. I don’t know why, it just seemed like a good idea. So, I’m taking this boat, honestly driving down in the Amazon in this boat Double Rainbows. That was something I'll remember for life but what I mean is mission trips can be fun and going village to village, seeing these people and man, they're so patient. They don’t even know what it means to take. When you give them something, you give toys and that... Depending on where you go in the world you'll get swarmed but you’re not a (01:13:45 unclear) and if they did they would take it and give it to someone because it's not even in their cultures to give, not to take and that kind of struck the chord and just patient. They've never seen anything. There are rural villages in the middle of nowhere so that really changes your perspective on things. The funniest thing though, I was doing an extraction and we had an OBGYN, he was part of the medical group. He said, but a little bit odd "I'll come help you suction". I’m there, doing ghetto dentistry in the middle of the Amazon and pulling this tooth out and the guy's looking at me. He gets all faint and he passed out. The OBGYN passed out. When he gets back, I asked his wife, "what's wrong with him?" I mean, OBGYN, they see some gruesome stuff. He's like, "yeah, but it's different in the mouth". I’m like, "are you kidding me?" I thought that was interesting. Maybe that's (01:14:40 unclear), I don’t know but it was a different experience for sure.

Howard: Yeah. We've got fifty categories on Dentaltown and when I’m out there lecturing on the road, you’d think that the one's with the most (01:14:58 unclear) like endo, implants, practice management. When I’m out there on the road, the one's that talk about Dentaltown almost get (01:15:05 unclear) because we have a category called Humanitarian Dentistry, and so many times dentists will say to me, "you know what, I was burned out, I was fried, I didn’t know the meaning of life" and whatever, and I was reading this thread under Humanitarian Dentistry, under Missionary Dentistry,  (15:21 unclear)  Dentistry. So, I took a trip and I did a Missionary Dental trip to like Haiti or Mexico or Africa or whatever,Vietnam, Cambodia, and they said it totally changed their lives. Just completely changed their lives. And one of my biggest mentor practice management consultants right up the street here, is Greg Stanley. He's very big into these missionary trips to Haiti for that exact reason. He'd be listening to these doctors and you think, "ok, am I a practice management consultant or am I a psychiatrist? Are you talking to me over the phone or are you laying on a couch and I need to help you?" And he thought the best thing these guys need first is, I’m going to take your butt to Haiti so that you could get your head on straight and then when we start coming back here and start talking about your practice, you’re not going to have all these irrational expectations and beliefs and self-limiting beliefs and a pity party and all that stuff, and he was just really big on "ok, this guy's lost touch with reality". So missionary dentistry is huge and I think that's so telling of you. You're only five years out of school and you've already done two trips to Peru and Amazon and you already claim that it changed your life and set the tone for the rest of your career. I love you to death Manu, I really do. I think you’re all that and a bag of chips and I love reading your posts. I love reading your posts. So many times, I'd read your posts on Dentaltown. You make me smile from ear to ear but I can’t believe we already went over an hour and twenty, but seriously dude, thanks for sharing your journey on Dentaltown since 2012. Thanks for sharing fifty-five hundred posts. So many people believe but keep in the closet. I always look on Dentaltown and so many people will send me an email or something. This long drawn out thing. I'll say, "well dude, post it on Dentaltown so that everybody can share". "No, I’m too embarrassed. I don’t want to do that. I just want to talk to you". Its guys like you who share these thoughts from A to Z that really make Dentaltown what it is.

Manu: I appreciate that. You make Dentaltown what it is.

Howard: No, I didn’t make Dentaltown. I’m no different than the ATNT phone company. I just provided a cord from you to Gigi but it's you and Gigi talking on Dentaltown. Are you and Ryan McCall talking on Dentaltown... That's what Dentaltown is. I didn’t do a damn thing.

Manu: I've got nothing to sell. I have no book. I just wanted to be like, "this is real dentistry". I just wanted to give a shout-out to the guys because there are a lot of guys like me and Gigi doing hard work. Not glorified stuff but helping people out and I think we should applaud that for the new grads. That's where it's at.

Howard: Alright well, good at you mate and I can’t wait to see you again sometime. Maybe I'll see you at the next townie meeting? After fifteen years in Vegas! Now that I'm a selfish bastard and have grandchildren and I already signed up the next two in Orlando because my grandkids want to go. I'll see you around buddy!

Manu: Ciao!

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