Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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869 Reach Your Goals with Eddie Risi : Dentistry Uncensored with Howard Farran

869 Reach Your Goals with Eddie Risi : Dentistry Uncensored with Howard Farran

10/29/2017 9:02:52 AM   |   Comments: 0   |   Views: 238

869 Reach Your Goals with Eddie Risi : Dentistry Uncensored with Howard Farran

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869 Reach Your Goals with Eddie Risi : Dentistry Uncensored with Howard Farran

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VIDEO - DUwHF #869 - Eddie Risi

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AUDIO - DUwHF #869 - Eddie Risi

Eddie graduated from University of Toronto in 1995  with an HonsBSc and began his foray into the dental industry shortly thereafter. His love of science, nutrition and people led him to pursue a sales career in the medical and health industry. His search to work in this industry was realized when he began working for Bosworth and then American Dental Technologies. He has been with Henry Schein Canada now for the past 17 years. He is married to his beautiful wife Gina and together they have 2 amazing children , Cristina and Michael. Eddie is an avid learner and continues to look at life with a curiosity mindset.


Howard: It's just a huge honor to wake up in my house Saturday morning, eight o'clock and have Eddie Risi stop by the house, how lucky am I Eddie? thank you so much for coming by.

Eddie: I appreciate it, thanks [00:00:17] [inaudible].

Howard: So, just love following you on Twitter, love your energy, love your karma. Eddie graduated from the University of Toronto in 1995 with an honorary in Bachelors of Science and began his foray into the dental industry shortly thereafter. His love of science, nutrition and people led him to pursue a sales career in the medical and health industry. His search to work in this industry was realized when he began working for the Harry J. Bosworth company and then the American Dental Technologies. He has been with Henry Schein, Canada now for the past seventeen years. He is married to his beautiful wife Gina, twenty year wedding anniversary, must tell him, don't take it for granted, the twenty year anniversary is when my wife fired me, so you never have it in the bag Eddie, so don't take it for granted. And together they have two amazing children Cristina and Michael, how old are they?

Eddie: Cristina is seventeen and Michael is fifteen.

Howard: Okay, so your life's going downhill really rapidly. So, when you hand them car keys till they're twenty five, that's the crazy years. Eddie is an avid learner and continues to look at life with a curiosity mindset. The reason I wanted to have you come by is because, you're from Canada.

Eddie: Yes.

Howard: [00:01:27] [Inaudible] a hundred Canadians or a hundred Americans and you said, describe a dentist or their physician, they're not going to say, down to earth, easy to approach, just a great guy. They say, well, arrogant, condescending, talks down. When you look at people... when you see two girls, and girls make 91% of all the healthcare appointments, and they refer their friend to a doctor, they'll say, we'll go to my OBGYN, and you look at the reason why, it's not because he's board certified, only half the one million physicians in America are board certified, the other half... the boards certified... I would think if you're wanting to send your friend to a great doctor you could cut the herd in half saying, well, which ones are board certified? They'd have to have five years experience and go through a rigorous oral examination, it's tough to get board certified. Half the physicians don't even go for it, don't even care, and that's the lame half. They never say, well, he's board certified, they go, oh, he's a great guy, you can talk... you'll love him. They're always reinforcing that chair-side manner because that's what doctors don't have. And you especially see it in the value chain. So, you go into any other business, like, my dad had Sonic Drive-Ins, there was a man that sold my dad $million worth of meat a year. Well, that's your buddy, if you're buying $million of meat from someone a year... and they would talk, I remember as a little kid sitting there listening to my dad, and he said, he always networked with his value chain, he said, Eddie, I only make money from eleven to one, that's my lunch hour, God dang it I can't stand it when I'm making money and you're back there knocking on the door wanting me to check in fifty boxes of meat. And Eddie's like, oh my God, I didn't even realize that, I'll never deliver me from eleven to one again. And dentists, they treat their value chain... the worst example, the most horrible example is Delta Dental. So, you go to some guy and you say how much did Delta give you last year? And you'll look at the deal and Delta wrote him a check last year for $100000, And I'll say, well, name the CEO of Delta Dental of Arizona, they don't even know who it is Mike. I'm like, dude, somebody gave you $100000 and you don't know his name? Shit, for $100000 you should go over there and cook him dinner.

Eddie: It's the insurance companies that...

Howard: Yeah, I mean, you should literally make the guy a pan of lasagna and bread, and you're Italian, go make him your best lasagna, your best loaf of bread and give it to him. They don't even know his name. And then California, which is just disgusting in how they treat Delta Dental, Delta will go out and sell... Delta of California, there's like, nineteen different Delta's, Delta, California every year sells over $1 billion of insurance in California, do you think the California Dental Association has ever had the guy speak? No. But they brought in Bill Dickerson and he had a course, Delta or the Devil. So can you imagine being the president [00:04:28] [inaudible], I sold you bastard, assholes $billion worth of insurance, which you don't have to take, and did your California Dental Association, did they sell you any insurance? No, but you give them dues and they're a nonprofit just like your ass would be no profit if you didn't sign up for Delta Dental, you know what I mean? So, they're just arrogant, and I have always... every other industry, the whole value chain sits together, works together, vacations together, networks together. I have always... now, as far as using Henry Schein or Patterson or Burkhart or Benco or whatever, I've had the same dental assistant for thirty years, she's been in charge of that and she's actually followed one rep who worked through a couple of these companies, and so, when those companies said, well, why did you switch from Schein to Patterson or Patterson the Benco or Benco to Burkhart? Or whatever the hell it is, it's like, well, my girl's been following one rep, and her rep is her, she likes her buddy, and so that personal relationship is what, value. But like, sometimes only like a rocking hot employee, and I'll say, [00:05:39] [inaudible], who do you think is the best, I mean, they're always there, are you running out of something? Or you've got a big case in the afternoon and you need something, but you've got to treat that value chain with respect. And why I wanted to bring you on the show is, the dentist only sees their office, how many offices do you call on?

Eddie: Actively, about sixty, sixty five.

Howard: So, there's not a single dentist listening to you that regularly walks in sixty five dental offices, hell, the busiest consultants in the year aren't in sixty five offices in a year, they wouldn't have the time. So, I was wondering, you're in sixty five offices, what do you think the offices are doing that are crushing it, what are they doing more that the ones who think the sky is falling are doing less?

Eddie: Yeah, I always see that the ones that communicate effectively with their team and actually have the dentist as the leader and all the teammates on his team doing what they're really good at, and really relying on them for the skills that they have rather than thinking that they can do everything on their own and control everything on their own, which never works in any business as you probably know.

Howard: So, it was... so, notice he didn't say the ones that have the most alphabet soup, bullshit initials behind their last name. Oh, it's the ones that are FAGD, MAGD diploma in this and diploma in... you didn't say that.

Eddie: No.

Howard: That was the right answer, you're supposed to say that.

Eddie: Oh sorry.

Howard: Yeah. But it's always the leadership, isn't it?

Eddie: Yeah, definitely. And, yeah, and those that actually value their teammates, the people that are their assistant, their front desk person, which, it's named after a piece of furniture.

Howard: I know.

Eddie: But yeah, like, all of these people that coordinate and make things happen for the dental office, and then the leadership always starts at the top with the dentist the owner.

Howard: So, in your sixty five offices is what you call in, in sixty five offices what percent of those do the dentist order all the supplies with you through Henry Schein, versus who else would do it?

Eddie: So, out of that sixty five I would say probably about maybe 20% that the dentist really has control on all that.

Howard: And are those guys doing the least amount of production and collection, I mean, are those your lowest volume accounts?

Eddie: It would seem that way. Those that are really keen on making sure that they save as much money as possible...

Howard: I mean, if you've got time to order your supplies you should also be mowing your yard, you should fire your yard man. I mean, really, I mean, there's no delegation. I mean, dentists are... all humans are controlling, all social animals that work in packs, the evidence on sapien, that for the last two million years they think we're an average group size of about one forty, and so you have a pecking order, and I think that it's very unnatural to delegate. Yet your brain has to be smarter, your frontal cortex has to be smarter than your walnut brain hypothalamus, the same thing you've got with a turtle and a reptile, to delegate.

Eddie: Yeah, and it's relinquishing that control that actually shows true leadership I believe.

Howard: So, 20% of the dentists order their own, and that's the lower volume.

Eddie: Yeah.

Howard: And the 80%, who does it?

Eddie: It's the assistant.

Howard: Is it ever the hygienist?

Eddie: It's very rare, but some offices, yeah.

Howard: Does the assistant pick the hygienist supplies and the dentist supplies, or does the hygienist and the dentist pick them and tell the assistant? .

Eddie: It's more of the latter, the hygienist would say this is the supplies I need, I like these type of Hu-Friedy instruments, I can't use any other ones, so then the assistant would take that information and then order that, same with the dentist.

Howard: So, the hygienist and the dentist tell the dental assistant and then she orders with you?

Eddie: Yeah.

Howard: And then what is your most common... I guess where I'm going on this, what is the best supply system? Because I got out thirty years ago, my office... I graduated thirty years ago May 11 1987, and then September 21st, it took me a hundred and thirty three days to go from graduation to opening up my office. So, September 21st will be my thirty year anniversary in my office, but what do you think supply costs should be?

Eddie: We always see around 5-7%.

Howard: Five to seven?

Eddie: Yeah, [inaudible].

Howard: Because labor should be 28%, lab 10%, you say supplies...

Eddie: Five to seven.

Howard: Five to seven, okay, I've always said six, five to seven that's perfect range. Rent five, advertising three, what am I missing? Labor, lab, supplies, rent, advertising and the biggest problem that we see in dental offices is labor problems, and they seem to be in the older offices because these older guys they give their staff a dollar raise every time the earth goes around the sun. So, they started drifting up to twenty nine, thirty, I've seen them thirty eight, some of these dental office consultants go in there and these old guys got the best girl ever, but their labor's at 40%, they're not making any money. And the concept people don't understand is like, if you were to work at McDonald's in Toronto, they'll give you $15 an hour, but if you work there thirty years you're still going to make $15 an hour. I mean, McDonald's has a 31% food costs and 19% crew labor, 12% goes to headquarters, they have their model and 19% crew labor is it. In dentistry it's 28%, that's it. And a lot of people don't understand that there's a top end of the labor market, and if a dental assistant says, well, I want to make twice as much money, well, then you have to go become a consultant or maybe you should quit dental assisting and go work for Henry Schein. I mean, I know there's people that work for Henry Schein that make six figures, but you're a dental assistant, and a dental assistant and has a range of pay, so does a hygienist. And dentists and hygienists and assistants don't understand that. I mean, there's dentists on Dentaltown that sat down with their hygienist and went over all her overheads and showed them how labor should be twenty eight, their labor's thirty two, the profits down, all this, and at the end of the conversation the hygienist says, well, I'm going to get a raise, right? And it's like, did you listen to one word I said? So, just because the earth goes around the sun doesn't mean that you earn more money, earning money is a percentage of sales, revenue, overhead. So, what type of... some of these offices that we look at their supplier's month to month, quarter to quarter, year to year their variance is 100%. So, I said labor 6%, you said five to seven, 5 to 7, so that's 5% plus or minus 1%. Sometimes you go in there and this month their supplies was 5%, next month it's 10%, next month it's 4%, but it just swings wildly, which can be troublesome when you're trying to pay your bills, you're trying to make payroll on Friday but you just swallowed another $2000. So, what supply system do you think keeps the tightest variance month to month.

Eddie: The best is our online ordering system.

Howard: Online ordering system? And what's that?

Eddie: So, just Henry Schein... well, in Canada it's

Howard: It's C-H-E-I? It's I before E except in German names, except after C and in German names, so Schein is German. S-C-H-E-I-N dot com dot ca?

Eddie: Yeah, because either way. So, the dentist would have, the office would have an account already set up with Henry Schein, they would just log into their account. Actually, you can even do a lot more than just ordering there, so there's inventory control with the ordering, so you can just, much like you would order on Amazon, just pick a bunch of products and have them sit in your cart when and you're ready to send it you go ahead and send it. There's even reports on there to show you how much you've spent in the past month, twelve months, whatever reports you want to generate. And also with the inventory control you can actually set up a budgeting system, so if you only want to spend $5000 a month on your supplies then you can actually have somebody set up to review that list of supplies before they actually get ordered. So, there's a lot of ways to control inventory on there.

Howard: So, say the last part again, you can have someone to review it to do what?

Eddie: So, if you... every week the assistant puts in a bunch of supplies that they want to order for the practice and then she presses send, and that will go to somebody that can actually review the budget, if there's an office manager in that office that wants to...

Howard: Oh, in your own office, not at Schein.

Eddie: No, not at Schein.

Howard: Okay, very cool. This is Dentistry Uncensored, so we like talking about all the things people don't want to talk about. Does it bother you that Amazon is selling supplies? Does it bother you that your own company Henry Schein sells all their Henry Schein stuff?. Did you know that, have you seen it on Amazon?

Eddie: I haven't seen Amazon in Canada.

Howard: Kind of a weird deal there, it's kind of a weird... I'm podcasting your boss Stan Bergman, when are we doing Stan the man? September 24th, but it's kind of weird because Henry Schein sells their stuff on, but if any of their distributor, manufacturers like 3M, or Ivoclar, [inaudible], if they did it they'd be in trouble, I mean, they'd get taken to the wood house and spanked, but Schein doesn't, so that's kind of like, what? But what are your thoughts on Amazon? I mean, you're married, you've got kids, what are your thoughts about Jeff Bezos? Do you think he's going to disrupt... do you think Amazon's going to be a disruptive technology in the dental supply business?

Eddie: I'm sure they'll have an online impact, but we were even saying that back in the day when the Internet came out, we thought everybody was going to order through the Internet and we were going to all lose our sales job, but it seemed to not happen. I think there's a lot of offices that still want to have that relationship and understanding like you were saying, I visit sixty five offices they see the one office that they work in only, so they would like to know what's going on around them and gain that kind of information in that. I think that kind of value will be here for quite a while until, I guess everything becomes a commodity eventually but hopefully not in my lifetime.

Howard: How old are you?

Eddie: Forty five.

Howard: Well, you've only got ten more years.

Eddie: Okay.

Howard: Then you'll be as old as me. Look at me, I'm almost dead.

Eddie: You're the hardest working man in dentistry.

Howard: Well, here's my thoughts on it. You're absolutely right, Amazon came out in what '94? Ryan, what year did Amazon go public? Come on Ryan, you're supposed to know that, it's Saturday morning and you don't know when Amazon went public? What are you thinking? I'm thinking '94.

Ryan: '97.

Howard: '97?

Ryan: According to this, hold on a second, '94.

Howard: I was right, Ryan, dad was right.. well, I lived through it, I remember that because Dentaltown was '98 because that was when... and you know why Amazon started with books?

Eddie: No, why?

Howard: So, he wanted to... his original brand, despite what... the myth is always bigger than the man, so now he walks on water and all that stuff. He was going to disintermediate the direct mail business, so all those catalogs that come to your house, he thought that's what you'd order online. And the biggest catalogs going to your house to sell you stuff is what?

Eddie: Books.

Howard: No.

Eddie: What?

Howard: No it was to the women, fashion and cooking and those types of things like that. But those are all needed to sell with a jpeg image, and the pipes in '94 were so small and the AOL dial up was so slow... like, we didn't do Dentaltown till '98 because, truth of the matter, in '94... Ryan, you were born in what, '95?

Ryan: '93.

Howard: '93.

Eddie: Oh, I got that number.

Howard: Why does it make you feel dead inside when your father doesn't know the year you were born? You know I can't love you if I didn't know what year you were born. And those all required an image, so he started with books because that was the only thing you could just sell with text.

Eddie: Right, okay.

Howard: But then later he added a pair of like, shoes and cooking and all these things that he was selling, and this big Amazon river of steel. But the thing about Amazon is, if you look at their play it's always been B2C. And dental office, the small [inaudible] deals is B2B, like, last year, Netflix invested 6 billion in content, because Netflix you know they make movies and they have all these movie series, so you'd think the next major player investing in content after Netflix would be who?

Eddie: Like Amazon?

Howard: You thought that huh? You see, I would think the average person would think it'd be like, HBO, but it was Amazon at 4 billion. So, here's Amazon trying to get into the Netflix business because they want those vast ocean B2C markets. And then you come down and say, well, you must sell dental supplies to a few little dentists, that doesn't get them excited, doesn't get Wall Street excited, it's just too small. And Dentaltown, when we started in 1998 there were actually twenty Internet companies that were alive and now I get to brag, I'm the only one still standing. And you know why I'm still standing? Because there were five Cs of the Internet, do you remember what they were back then? Five Cs, there was commerce, which is like, and that's what the other nineteen went into. Then there was commercials, which would you be like, banner ads. There was content, and we've had our magazine online to air the content and the message boards. There was connectivity, so this thing would connect all these things, but the last C of the Internet was community. And and the other nineteen people, Dental Exchange, E-dental, there was one, I forget which one it was, it was like E-dental but that was back in the, from '94 to 2000 was the big Internet bubble and all that stuff. And one of those guys got $20 million of venture capital, and here I was building Dentaltown with one guy in the back of my dental office and we just, that slow little turtle. And they were saying, ah, they were going to disintermediate the supplies, and everybody was saying that Schein sold this much, Patterson, Benco, Burkhart and it was always to the Chinese math, well, if we just got 10% of the market it'd be a gazillion dollars, and I was sitting there looking at my Schein rep at the time was, Al Hughes of Patterson was who Jan used the first decade, before he retired, and I would sit and look at Al Hughes and say, the dentists aren't going to give up Al Hughes, because Al Hughes is our only connection to the outside dental community. And I know my homies, I've been in dental offices where we'd be sitting back there and we'd be talking about like, endo files and my dental buddy across the street would say to Al, he'd say, well, what endo file is Gittleman using? I mean, he's an endodontist, I mean, what are the endodontists using? And then he would sit there and tell you what five different endodontists use. And then we'd be talking about this and sometimes he'd say, oh, you should do that, that's really slick in oral surgery, you should try that, Les Fisher's using that. And you're like, wow, well he's like, a really, really smart oral surgeon, really Les uses that? So, he was your connection to the outside world. And after you get done paying labor 28% and your lab bill, 10% now we're at 38% of the cost, the dentist gets 35% of the cost. I always put the supplies as the same as the light bill, who gives a shit? I mean, you're not going to make or break your dental office model on 5%, one nickel out of a dollar. Now, your labor, if that gets thirty cents and that's six nickels out of a dollar, yeah, that can start choking you. But after you get done paying labor you're not going to go put a lock box over the thermostat, I mean. you know.

Eddie: Yeah, that's like, small thinking, right? [00:22:18] [Inaudible].

Howard: Oh yeah. And so I thought to myself, the tagline for Dentaltown was when I saw the Internet I thought, oh my god, no dentist will ever have to practice solo again. Again, that need to reach out for their camaraderie, they're isolated, they're lonely, they want to talk to someone. And so they're not going to get rid of the rep. Now, the small 20% will, because they don't have it going on because natural selection, they were only chosen to go in dental school because they got A's in math and physics and chemistry. But it's the chair-side manner, the communication. So, what else are you... you see sixty five offices, what else do you see the successful ones doing more than [inaudible]?

Eddie: Like, grasping new technologies, going advanced in newer technologies, stuff like... well, digital x-ray's been around for a long time now and then the next thing I see is...

Howard: Well, stop at digital x-rays, of your sixty five clients, what is the adoption rate of that technology?

Eddie: I would say about 75% now have digital X-rays.

Howard: 75% digital x-rays?

Eddie: Yeah, so the other 25% still using film, but eventually...

Howard: So, I'm just curious, are those guys all like, sixty five to eighty, or...? Who's using film?

Eddie: Yeah, there's still people that are within sixty years old.

Howard: What percent of the people using film right now have a liver spot on their head?

Eddie: Is this going to go live?

Howard: What percent have a liver spot?

Eddie: I just think that the apprehension's actually computers. So yeah, there's still that older faction of...

Howard: So, you're saying those 25% all have a liver spot and wear Depends?

Eddie: I didn't say that, just for the record.

Howard: You didn't say that, Ryan said it. Okay so, of all the technologies is that the highest adoption rate technology?

Eddie: Now it is, yeah.

Howard: I mean, was it was higher than Practice Management Software? Schein sells Dentrix in Canada, right?

Eddie: Yeah.

Howard: Would you say all those 75% with digital x-ray also have adopted Dentrix or...

Eddie: No, it's a vast mix. Not everybody, not all of the 75% are going to be in Dentrix.

Howard: Well, I mean, a computer versus a chart.

Eddie: Oh, yeah. So, the majority do have at least one computer in the front office that they can use the charting, then there's like, another 10% that have no computers whatsoever.

Howard: 10%?

Eddie: Yeah.

Howard: Now, do those people have a liver spot or Depends? And currently do not have a pulse? Okay, so, what would be the next highest technology adoption after digital x-rays at 75%?

Eddie: Now I see a lot of dentists looking at other means of diagnosing caries like the CariVu, I know you've probably come across that.

Howard: Talk to me about the CariVu, Ryan, can you send me the CariVu, text me the CariVu link?

Eddie: So, CariVu is a transillumination of the tooth, basically it's like, an integral camera that sends a bright light over the tooth and then you can actually see where the carious lesion is on the surface of the tooth.

Howard: And the crack?

Eddie: And the cracks and the fissures, yes.

Howard: And why that's really important is if dentists do a million root canals with an insurance company, in sixty months of a general dentist [00:25:50] [inaudible] 10% are extracted, and if an endodontist did it 5% are extracted. The dentist have double the failure rate because so many times they do the root canal and then tell you to come back and get the crown and the patient doesn't come back and get the crown, and you've got to do the root canal and the crown, they fail from infection from the top down. But the endodontists, when they're doing them, they're not seeing the crack, I mean, that's the biggest deal on that CariVu, is amazing at looking at cracks and decay.

Eddie: Yeah, and the only apprehension with that is a lot of... I don't know how it is here in the States, but doctors feel like because they can't bill for it, they can't bill the insurance company for it, then they're worried that it's not going to pay them back at all. So, I don't know how you get around that.

Howard: Meaning because there's not an insurance code?

Eddie: Yeah.

Howard: Yeah, well, historically, I'll tell you, so, here's the picture of it... CariVu detection device, and how much does something like this cost?

Eddie: About $6700.

Howard: That's my favorite CariVu. It's $6700?

Eddie: Yeah, I think it's cheaper in Canada. First time ever it's less expensive, something's less expensive.

Howard: Because of the way your dollar's trading?

Eddie: Yeah, maybe they're just giving us a break or something, because I think in the States it's about eight.

Howard: I just lectured in Australia, just came back on a couple days ago. And... I think it's the sixth time I've been down there, but it seems like you could almost really get good at trading the Australian and Canadian dollars against the US Dollars because there just seems to be...

Eddie: Volatile rate, yeah?

Howard: Oh yeah. I mean, every time it gets a little too high you know it's going the other way, it's just ebb and flow, I've always wondered... but it's $6500. Well, dentistry... Ryan, when did Roentgen invent the x-ray, the radiograph? Wilhelm Conrad Roentgen? How do you spell Rontgen?

Ryan: R-O-E-N-T-G-E-N.

Howard: R-O-E-N-T-G-E-N. Those damned Germans and their names. So, Wilhelm Conrad Roentgen invented the radiograph in 1895 and dental insurance was 1948, The Longshoremen's Union. So, every ship that entered America was going to be unloaded by a ship docker, and they were the Longshoreman's Union, and they the first one that... and it was 1948 because remember America's big boom was at the end of World War II. Because what people don't realize about World War II is, that generation of people they'll always tell you that the reason, the conspiracy, that governments go to war is because it's good for the economy. Well, Vietnam and Korea weren't good for the economy, Afghanistan, Iran weren't good for the economy, but World War II, the two greatest economies, Germany and Japan, were the ones that started these wars and they got leveled. So, at the end of World War II Europe and Japan was leveled. If you wanted to buy a car, a washing machine, a dryer, any factory still standing was where?

Eddie: In America.

Howard: In the United States and Canada. I mean, that was the only place not bombed that had a export manufacturing industrial capacity. So, it was just a bonanza and a lot of Americans are having to readjust to this mentality because not only did Germany and Japan... Germany and Japan... I mean, Japan had two cities nuked, Germany was rubble it literally took till 1980 from '45 to 1980 it took 35 years to clean up that rubble and rebuild it. But when those two came back on stage you also had some new players, India, China, Korea, all... Sweden, Scandinavia, all these players, you have twenty amazing countries that are exporting quality stuff in dentistry and abroad. So, there was so much money laying around and the shipping, the exports, so those guys went and got dental insurance, that was the first people that negotiated dental insurance and they decided they were going to cover x-rays at 100%. And in 1947 almost... not one dental office... so from 1948 to 1895 would be three, nine from four is five, so the x-ray was out fifty three years and dentists didn't have it, I mean, almost no dentists had it. Then here comes the Longshoreman's dental insurance, and they say we cover x-rays at 100%, within two years 80% of all the dental offices in America had a damn x-ray machine. So historically it follows the money. So then fast forward to 2017, oral cancer kills fifty thousand people a year, but the insurance doesn't cover an oral cancer screen. Could you imagine the outrage of women in America? Because it's the same technology downstairs because it all came from downstairs with their swabbing Toluidine Blue, looking through the lights and all that stuff like that. And every company that's applied it to the mouth has gone nowhere because it's not covered by insurance. But could you imagine if the society took away insurance coverage for screening a girl for vaginal and uterine cancer? The women would be like, this is outrage. But flip that woman upside down and look in her mouth, it's not covered. And if you really want to address oral cancer, money is the answer what's the question? And it's sad but true, I mean, you would think that the dentist were like, well, we're just better than that we're going to an oral cancer screening even though we're not going to get paid for. Well, you believe in tooth fairies and unicorns and, I mean, just, yes. So this is $6700, what type of fee is there? I mean, so you think when a dentist uses the CariVu they should charge for it?

Eddie: No, I think what it does is helps the dentist to see exactly what's going on in a patient's mouth. And there's a lot of patients too that don't like to take x-rays, there's all the hype about x-ray, radiation and how people are avoiding that. Or even on pregnant women that you can't take x-rays on. So, it's important to be able to see... hasn't the evolution of dentistry gone with being able to see more, right? You went from no x-rays to x-rays, now there's even microscopes, 3D, cone beam. So, it seems like the more advanced we get in dentistry...

Howard: Well, I totally believe that you would never want to go to a blind dentist, and I totally believe that seeing better is the low hanging base of the pyramid of being quality going from [00:32:26] [inaudible] to loupes, no brainer, endodontists, before they obturate they want to pull down a microscope, look in those canals at about eight times greater, then they'll find missing canals, they'll see still there's slop in one of the canals. The thing I like about digital x-rays is I have never scanned my prep and looked at it on the monitor and wasn't just humiliated, embarrassed, and went back and tried to smooth this and you put on sandpaper disc and burrs with, in-cutting burrs, I mean, oh my God. I mean, your prep looks perfect in the mouth, and then when you take Impregum and you're looking at a negative of it in dark purple, I mean, you can't see dark purple, but so yeah... anything, any form of [00:33:16] [inaudible] really, that's why I like the what the Isolite, a lot of people like the Isolite because it retracts better than your assistant, true, but it's the flooding the light in the area. And maybe it's because... you're forty four, you said?

Eddie: Forty five.

Howard: You're forty five, I'll be fifty five next week, and I'll tell you what, man, between forty five and fifty five your eyes, there's a big difference. At forty five you totally see it, at fifty five, I mean, look, you don't go anywhere without your damn readers. So yeah, more light, more magnification, that's the the base of being a better higher quality dentist.

Eddie: And then you're saying too about scanning your preps, you use the Cerec, right for...?

Howard: Yeah, but I don't like to say that on TV, I don't like to say that in public.

Eddie: Oh, I thought it was a [inaudible].

Howard: It's in the closet. I'm in the closet about two things and one of them is Cerec. Ryan's like, dad what?

Eddie: It's on your website.

Howard: It's not. But no, the reason I don't like to admit that I have a Cerec machine is because it's $150000 and these kids come out dental school $350000 in debt and I want them to buy their own practice, I don't want them to be an employee. And a CBCT is great but you know what? Your periodontist and oral surgeon... if some young whippersnapper sets up a dental office that the periodontist and the oral surgeon want a relationship with her so bad and they know, the oral surgeon knows she's going to pull teeth but they know she's not going to pull all her wisdom teeth. And the periodontist and oral surgeon know that maybe she'll start placing some single implants or... she ain’t going to do all on fours. They all want a relationship with her so bad, if she calls them up and says, when I need a CBCT can I send her over to your office? Hell Yeah. I mean, what percent of the periodontists, oral surgeons say yes to that in your area?

Eddie: Yeah, they would definitely say yes.

Howard: What percent would say yes?

Eddie: I would say the majority, for sure.

Howard: And what percent, if she said, I don't want to fly from Toronto to New York City to see an implant course, I don't have patients this Friday, can I come in and glove up and assist you in placing implants on Friday MR oral surgeon or Mr. periodontist, what percentage of the oral surgeon and periodontists would say hell,yeah?

Eddie: Actually, I think they would be a much higher percentage than those that would even ask to do that.

Howard: Say that again.

Eddie: What percentage would even ask to glove up and assist an oral surgeon? Because then that's admitting, Oh maybe I don't know what I'm doing, I don't want to ask somebody who is a specialist. That's the thing about community, right? Are they willing to ask that?

Howard: Well, they have to, because when you've got $350000 of student loans, to learn something you shouldn't have to get an the airplane and fly to another city or province or to Vancouver, you shouldn't... I mean, the fastest way to learn the most information is a textbook, and my gosh, Ryan, where's my [00:36:17] [inaudible]? Yeah, I want to keep plugging these just because these are two great readers. But these books are $200 each, they're both eight hundred pages, and this isn't a commercial, I'm not getting paid a dollar for this a dime, nothing. Misch's, who just passed away, Carl Misch, Avoiding complications in Oral Implantology, if I was going to learn implants I would start with what the hell goes wrong, what goes south. My favorite business books was Collins, and he wrote Good to Great. What was his name?

Eddie: John Collins.

Howard: No, Good to Great, what was his name?

Eddie: And Built to Last, that was the next one.

Howard: Built to last, very good. God, you’re crushing it. What was the other one? Okay, Good to Great, James Collins. My favorite... when I was in MBA school the only thing you could agree on with all the instructors in the MBA program was that the greatest business book writer was Jim Collins, he wrote Good to Great, he wrote Built to Last. And he built... what was his other one?

Eddie: Was it What Got You Here Won't Get You There, something like that?

Howard: Good to great.

Ryan: How the Mighty Fall?

Howard: But there was a third one before, I was going to get to that Ryan, that was my close. But my favorite book, and his smallest book was How the Mighty Fall. So, what Jim Collins does, he's a business university instructor up in Colorado, and he has his grad students and they just look at data. And about every five years they said, okay, we've been looking at data five years, let's write a book, Built To Last, and they pull out which companies outperformed and which ones did the worst, and they try to show you statistically factual things, what the companies that went from good to great did more of. But my favorite book was How the Mighty Fall, and that was his shortest book, and it was so obvious you know what I mean? But it's... so, the point I'm trying to make is that I don't want to go see a cosmetic dentist who did a thousand cases then comes up and shows you the five that turned out perfect, because he's just up there with no self-esteem and he's trying to get validated and all that stuff. I like the instructors like Carl Misch who go up there and say, here's every mistake you could ever do, look at... and he show you all of his mistakes. And a lot of these aren't all his mistakes, a lot of these have been ones he's retreating, but Avoiding Complications in Oral Implantology, eight hundred pages of everything the greatest implantologist in America, Branemark was probably the first and greatest implantologist, this guy's the second. And then here's another one... and that by the way, Misch's book is the number one selling book in dental textbook history of all categories. And this one is number two, but number one in endo, Cohen's Pathway of the Pulp, eleventh edition, eight hundred pages. And my buddy Brad Gittleman, that I was talking about earlier wrote Chapter eight. But that's how you learn the most information the cheapest. The second way for hands on is to walk across the street to your periodontist or endodontist, any young dentist could call up Brad Gittleman in Glendale and say, man, I don't work Thursday can I come sit... hell yeah. And Brad would do it because he's just that type of guy who loves to teach. But then if you take an implant course in another state or province and then you have a failure, what is that instructor going to do in New York City when you're in Toronto? You want your homies to bail you out, you want to be able to call up your buddy and say, you're not going to believe this but I just stuck an implant in the sinus, I just really messed up and you need your buddy to say, no worries send him over right now, just get in the car drive him over. I remember when I got out of school, I loved wisdom teeth, I loved them more than golf. I mean, that was the only procedure, my staff get so mad at me because that's the only procedure that when they fail the financial arrangement, they don't have money, they couldn't pay or whatever, they're going to back there and say, well, you don't have money you have to go now. And I' like, okay, but I just want to do it anyway. Because you know what I mean? I did, I just loved doing that.

Eddie: What did you love about it?

Howard: Well, it's instant gratification, it's not like a root canal, takes an hour, I mean, an extraction, one tooth, I mean, we're looking at like ninety seconds or less. It's instant gratification, you got it out. It's like you versus the tooth, like, the mandible's saying, you will not take me, and I'm like, I will take you and the tooth, we're fighting over it. I mean, I can just love it. But when I was young in '87 a lot of times I couldn't get it all out, and my hours were... I wouldn't post till seven o'clock at night. There was only one dentist in town that was still open and it'd be Bob Sundberg, who was two miles up the street. I was at 48th and [00:41:22] [inaudible] and he was at 48th and Baseline and I'd call up Bob and say, man, I've been on this tooth for an hour, I can't get out the root, and he'd say, all right, just drive him over, and I love Bob, Bob Sundberg love you to death. And the joke was, whenever we were together, that I'd always pull out the top half of the tooth and Bob Sundberg would pull out the bottom half. But after a dozen times... but when he did it I'd watch him and think, ah, and he'd always say, it was always the same things like, well, I can't pull it either, I can't see it, you need a bigger flap. And his flaps were bigger, his flaps you could see white mandible bone, and once he got access, magnification, could see, boom it was gone.

Eddie: Do you find it's because they do more of them or they see more problems so they know how to get around problems? Like, a dentist doing it maybe once a week is not going to be able to do it as well as an oral surgeon, or is it just a confidence...?

Howard: Well, I love that you said once a week because I will swear to the moon and back, in fact I will take the bet to hell and back, that if you don't do it once a week you don't make money at it. You should make money on what you do every week, fillings, crowns, cleans, x-rays, exams. But if you get into like, say, Invisalign you do a case once a month you never get good enough, fast enough, easy enough. These guys that spend a $quarter million getting into implants, they'll go buy a $100000 CBCT they'll chase a [00:42:48] [inaudible] all the way to the Dominican Republic. They'll buy all these drills and sets and they do one like, every three months and that day they're like, okay, what do we do again, and how do we set this up? And they never just get it. And then first of all, if you were going to have a surgery done, you're forty four, so I don't know what surgery a forty five year old would get.

Eddie: Nothing.

Howard: Nothing yet, but say you need a bypass, would you want to go to a guy that does a bypass every quarter?

Eddie: Of course not.

Howard: You'd want to go to the guy that does it every day. So, one week is the critical mass in doing that, so if you're not going to do it once a week don't get into sleep apnea, don't get into Bizline, don't be placing implants. But the problem they have all humans have are fear and greed, and fear is bigger than greed, that's been proven. I mean, let's say you're in Africa in the last two million years and you're sitting up in a tree and you're dying of thirst and there's a little pond there but there's three twelve foot long crocodiles sitting there, I mean, how thirsty are you? Are you really going to walk down there and drink in front a twelve foot long crocodile? So, fear is bigger than greed, you can measure it in the stock market. The ten biggest down days are twice as big as the ten biggest up days. When monkeys get scared they run, so they see that second molar, so they say, I'm going to refer you to the endodontist. Well yeah, the first hundred are going to suck. I remember the first one hundred wisdom teeth I pulled, I mean, there were times in '87 where I would spend one hour trying to get out one impacted wisdom tooth, an hour. Now, all four wisdom teeth they'd be done, 99.99% of the time all in under ten minutes. But the first hundred second molars you do, when you study implants the first one hundred implants has twice the failure rate as your second one hundred implants and that's why all the specialists are going to say, well, that's why you should refer to me. Oh shut up, you did your first one hundred implants and they suck, you did your first one hundred root canals. Everybody's got to do their first one hundred, and if you don't feel morally, ethically about it well do your first one hundred root canals on your family, your cousin, I mean, that's what family is. Mother in law is a Latin word for research monkey, My first sinus lift, is that a Hippa violation if I say my first sinus lift was on a mother in law? I just said a mother in law.

Eddie: Not yours, yeah. So then, it sounds like setting the expectation too of the patient, right? Saying... would you, as a new dentist, say this is my first root canal, you're my first patient root canal?

Howard: I wouldn't say that. You could to your cousin Eddie, you know what I mean? Your uncle. I mean, I saw that in dental school, there were dads and uncles that just loved to come in there and sit all afternoon so his little princess could do her first whatever. But I would just do it man, you're a doctor, just do it. And a lot of people are caught up in the [00:45:58] [inaudible], they don't like it. Well, you know what? You have to do a lot of things in life you don't like to achieve the goals that you do like. That sounds pretty good Ryan, you have to do a lot of things you don't like to achieve the goals you do like, I mean, that really is [00:46:12] [inaudible]. So, let's go back to adoption of technology, because I know dentists are in the herd mentality. I mean, it's one of those things where if all their homies are doing it they'll do it, and if none of their homies are doing it they get nervous. And back to CAD/CAM, a Cerec machine, only 15% of American dentists have one. So, when you say 75% percent have digital x-rays, when you say 75%... what percent would you say have a computerized practice management system?

Eddie: I'd say 85%.

Howard: Okay, so 85% have a computer, 75% have a digital x-ray. So, only 15% have a CAD/CAM, so obviously you don't have to have a CAD/CAM to be successful because a 85%... but speaking of CAD/CAM, very interesting, Henry Schein now gets to sell the dental supplies for Sirona. Sirona, used to be part of Siemens, they spun that off, it was the biggest dental company in Germany. Dentsply traded x-ray, they got married, and then the next thing they didn't renew with Patterson, the exclusive distributorship, so now Henry Schein gets to start Cerec when?

Eddie: September 1st.

Howard: So are you excited about this?

Eddie: Yeah, it's very exciting. They came to... we're going to have some formal training as well, all of our techs will be trained on it and yeah, starting September 1st we'll be able to hit the ground running. They came and they even talked to us about Dentsply Sirona World, Have you ever been to...?

Howard: I have.

Eddie: Yeah, it seems...

Howard: I feel bad, I feel so bad they invited me to speak for them last year in Vegas, and then I got invited to speak at this big European conference in Portugal which was much bigger, and I've already spoken in Vegas a hundred times, so I really wanted to go to this one in Lisbon, Portugal and then right before the Lisbon, Portugal do I had a family member get sick and go to hospital so I had to cancel, but anyway, it was all crazy. But yeah, I mean, their Sirona World coming up is, when is the next one?

Eddie: September 14th.

Howard: September 14th, in Vegas? So, September 1 Henry Schein gets to sell it, then September 15th it's in Las Vegas?

Eddie: Yeah, it's at the Venetian and the Palazzo.

Howard: Venetian and...?

Eddie: Palazzo, they're connected, two connected casinos.

Howard: Okay, so they built the Venetian and then the Palazzo?

Eddie: The Palazzo is just another building.

Howard: See, you can say it because you're Italian, that's why, I'm Irish so I can't say it. It's Palazzo?

Eddie: Palazzo, it just means palace.

Howard: Palace. But that's the second edition of the Venetian?

Eddie: Yeah, yeah.

Howard: Yeah, right next door to it.

Eddie: That's right.

Howard: And how many speakers are they having?

Eddie: I looked on the educational track and there's a ton of them, actually there's a friend of mine Dr. Manor Haas, you podcast interviewed him. He's going to be...

Howard: On endo?

Eddie: On endo, that's right.

Howard: An amazing guy.

Eddie: Yeah, he's a really great guy.

Howard: You know what? I really think they're actually... this is what I see, I see the attendance at conventions has been drifting down and I think Dentsply and Sirona are so huge they're basically going to say, well, we're going to have a meeting as big as the ADA or the CDA, because I mean, how many speakers are they bringing do you think?

Eddie: It looks like there's at least forty, from what I counted.

Howard: Yeah, it is, I mean, because these manufacturers are the ones bankrolling these dental association meetings by their [00:49:38] [inaudible], and then they get all this bullshit regulation like they can't sell or they can't take orders or... crazy stuff. And now they're just like, we'll just do these meetings ourself. I mean, this Dentsply Sirona World meeting is just beyond huge.

Eddie: Yeah, they even have Simon Sinek speaking, the author of Start with Why. Yeah, and then even Will Smith they're going to be interviewing.

Howard: Yeah. DiTolla, my buddy DiTolla, he was the first podcast I did.

Eddie: Oh Okay.

Howard: And DiTolla and I, I think we lectured together fifteen, twenty times, he's the funniest guy in dentistry.

Eddie: Yeah, I listen to his podcasts too.

Howard: Yeah, he's the funniest guy, that guy is so hilarious. He's the funniest man in dentistry, Mike DiTolla. Yeah, and he's into Will Smith, I asked him, I said, why Will Smith? And he goes, he just has this mass appeal, he said the data shows nobody doesn't like Will Smith, so everybody loves him and very motivational, very passionate, but what DiTolla also loves about him is that he's real fun. So, it'll be a real fun, motivational and funny interview with Will Smith. See, I would have gone with Usher, I think Usher... did you hear about Usher?

Eddie: No what happened?

Howard: He just... a woman sued him with that big celebrity attorney because he gave her herpes. And then when that went public two other people came forward and one of them was a man. So, Usher's the first person that's been publicly sued for giving not only a woman herpes but a man. So, obviously if you're married you and your wife can both like Usher because he loves men and women equally. And when you love him he'll leave you a little present, and and it might turn into a $million. So my gosh.

Eddie: You can call that Sirona World uncensored I guess.

Howard: So, that was Sirona World. Big shout out to Mike DiTolla, I would fire Will Smith and go with Usher and talk about... everyone loves Usher and Usher loves everyone, literally. But that is.

Eddie: That's going to be exciting if... so, there's always a sales contest, if I can get five dentists to sign up for Dentsply Sirona World then I get to go myself.

Howard: So, have you told that to your seventy five dentists in Toronto or is it sixty five?

Eddie: Yeah, sixty five.

Howard: Have you told that to them?

Eddie: Yeah, I'm going around letting them know.

Howard: Ha, I'll tell you what, I tell them... I'll tell you what, if they sign up for Sirona World, your sixty five, I will send them an autographed book of Dentistry Uncensored, how's that?

Eddie: Nice. I listen to that, the audio...

Howard: You go show them that. You what?

Eddie: I listened to your audio version, I'm glad you read it. I like when the authors read. And I sent it to a client of mine just starting up Dr. Novin Sabzevari, I sent him the audio version of your... because on Audible you can click send and share. Oh, thank you very much.

Howard: Tell them if they sign up for Sirona World I'll give them an autographed copy of my book, and anything I can do. The one thing I love the most about these conventions is, dentistry... the highest percentage of alcoholism of a profession that I've seen is actually gold medal Olympics. Imagine that all the other kids go to school every day, but on the way to school your mom drops you off at an Olympic size pool and you have to swim the hundred meters back and forth for an hour, then after school all the other kids go home, you've got to go back to that swimming pool and swim the hundred meter. You do this an hour before school, an hour after school from age five to twenty, it's a very repetitive task. And sometimes those kids they're being dropped off at the swimming pool and it just kills them that they've got to get in this damn swimming pool and swim back and forth for an hour. And dentistry can be, dentistry is an extremely repetitive task. I mean, I don't think anybody who's fifty four years old, who's done this for thirty years gets excited about an MOD filling. I mean, how many have you done, ten thousand? I don't even know how many fillings I've done but I know it's got to be ten thousand, it could be twenty thousand, I don't even know. And the only thing that's exciting about dentistry, the only thing that's new in dentistry is the the human attached to that tooth and that's what's... but dentists and their teams need to get fired up and motivated. And I'll tell you another thing, the dentists that go to Sirona World alone, I guarantee you, that's like the dentist doing his supplies alone, those people don't get it. It's the dental offices that take their whole staff. Because if you take your whole staff and they just fall in love with dentistry again, and they get fired up and they go to those booths. I see those booths as toys. So, I noticed when I was little and I put my four boys in the bathtub, if it was just a bathtub of water they'd be crawling out immediately. But if I threw a bunch of boats and trucks and balls in there they'd stay in there till all their skin was all white. Same thing with the sandbox, if you put them in the sandbox they'd leave, but you put a dump truck in there and all this stuff there. And that's where I really think these lasers and Cad/Cams and CariVu, if those things get you passionate about dentistry and make you run twenty red lights on the way to work, you have to have it. And you can't go get fired up at a CE course by yourself. Your assistant's burned out, your hygienist's burned out, the whole team. And my God, we've had a Townie meeting every year for fifteen years, in Vegas, where Sirona World is, we're going to do the next two years, we signed up in Orlando, mainly because I have grandchildren now who want to go see Mickey, and plus we've done it for fifteen years in Vegas, let's try a new venue for the next couple of years until my kids don't want to go to Disney World anymore. But take your whole office, get them fired up and there's nothing more exciting. Same thing, we were talking about magnification loupes, I mean, the dentist that goes to the seminars alone, you go in his office, he's the only one wearing loupes, and then he gets mad because his assistant who's not wearing loupes, left cement on the temporary, and the hygienists who's not wearing loupes left tartar on a tooth. Anybody with wet hands needs magnification, and maybe them wearing magnification'll fire them up. Internal camera, standard equipment in every operatory, you're Italian, you guys talk with your hands and you're right next to Greece, and a lot of Italian [00:56:19] [inaudible] is from Greece, and I've noticed the Greeks actually talk more with their hands than the Italians. Oh my God, I did a podcast with a Greek in Australia, I thought I was going to get hurt. I mean, it was like that. But I tell my staff, don't talk with your hands, stick the camera in their mouth. And digital x-rays is not about dentist folk because I don't give a shit if the dentist wants or does not want digital x-rays, the patient, it's their cavity, they have to have digital x-rays, then print it out on eight by ten, doctor means docera, meaning to teach, just like Bible is just a latin word for a book, docera is the latin word for teacher, and then put it on a clipboard like a coach, like a hockey coach, and circle the cavity, and write in there. Because they're going to take that receipt home to their tribe, the husband's going to go home and she's going to say, how was your appointment? Well, actually I've got a cavity, you see that? She circled it and... so, it's all about... we started this seminar that it's all about the personality, it's all about the chair-side manner, it's all about the leadership. And not only should you go to Sirona World, and this isn't a commercial for Sirona World, go to Vegas, take your whole team, do some evening events and it's just a... And by the way, when you tell your dental assistant something, well, you're just stupid Howard, but when Mike DiTolla says it on the stage it's gospel. When someone a hundred miles away from home with a briefcase or a projector or a slide presentation says it it's gospel. But when she's seeing you picking nose and farting and you still have milk around your mouth and, you're not all that and a bag of chips, but a stranger is, and so those things get them fired up. But I'll tell you this, I've lectured for thirty years, every single lecture one half of the room, every row is an entire doctor's office, doctor's, spouse, office manager, assistants, hygienists, the whole team, and the other half is all these dentists who came alone to save money. And if I went through there and picked up their ten forties for their IRS, these guys that [00:58:35] [inaudible] they make twice as much money. And then even if it's like, an endo course, like, it's a root canal, well, who's going to answer all the questions about a root canal? Doctor, who's a legend in his own mind, thinks it's always the doctor, the receptionist answers half the root canal questions, and you decided not to take her to the root canal course. And then when you leave the room you say to your patient, well, do you have any questions, no. Well, turn on your iPhone to record, hit record and walk out of the room and the patient turns to the assistant, now, what is a root canal?

Eddie: Yeah, they would ask, would you get that root canal done here?

Howard: It's all trust questions they don't ask doctors. My mom took me to mass and my five sisters every single morning seven days a week from birth to when I left home at seventeen, I never saw one person in seventeen years of mass raise your hand when the priest was doing the sermon and say, I got a question, there's no questions. He's on stage wearing a dress and [00:59:29] [inaudible] and all these props and it's all designed for you to be humble and shut up. And what's changed the most in dentistry is that Catholic Church experience, that in the '70s the doctor, the priest, the rabbi they were God, and they just told you to march and there's your marching order, you just shut up and you just do it anyway. Now the millennials have come along and they decided, well, you know who I'm mostly loyal to? I'm mostly loyal to myself, and we see strong evidence of this. You look at these corporate chains, most of them they're average dentists, How many corporate chains are in your area in Toronto?

Eddie: There's about, a good handful, six.

Howard: And what are their names?

Eddie: You have dentalcorp.

Howard: Dentalcorp.

Eddie: Yeah, we have Ultima. And those are the two big names. But then there's a lot of dentists grouping together and opening up ten, fifteen practices.

Howard: So, small corporate. Okay, now, in the dental corporate Ultima, do they have a lot of dental staff turnover?

Eddie: Yes, yeah.

Howard: A little bit or a lot?

Eddie: No, a lot.

Howard: How long do you think the average dentist works there?

Eddie: Two years.

Howard: Okay, here's my point, and it's the same in private practice, associates don't stay anywhere, I mean, I've been doing it for thirty years, I've had maybe half a dozen that stayed like, seven to ten, and for every one that stays seven to ten the next one will stay one to two, and one or two is the average. And so, they have a turnover of one to two and they're doing millions. They'll have others turnover one or two, and now they're doing tens of millions. They'll have one to two years... so in all this rapid associate turnover these offices are going from million to ten million to twenty million to a hundred million, which is complete proof that the consumer is no longer loyal to the dentist. The consumer says, well, you know what? That is my dental office, they have my insurance, it's accessible, convenient, available, I like their hours, they take my insurance and they're seeing dentistry as not going to the moon and back, it's a cleaning, I have a cavity, it's a filling. I mean, they're having faith that, I'm sure all dentists can do a filling, a commodity, the market differentiation that, oh, my filling is ten times better than your filling, I don't see evidence of that in the marketplace. I see where the dentist has rapid turnover the consumer is saying, well, I'm loyal to dentalcorp and I'll go to this chain even though every time I go there there's a different dentist because it's right by my house, the hours are friendly, they take my insurance. And so the evidence is overwhelming that it's shifted from... like, when I was little the priest said it, it was true. Now the Catholic Church says you can't use birth control, that using birth control is playing God, it's a mortal sin, you're interfering with God's plan. Well, what percent of Catholic women use birth control?

Eddie: Probably all of them I would imagine.

Howard: Yeah, all of them, almost all of them, you know what I mean? So, they're not even loyal to their religion anymore, it's, does this religion work for me? I mean, I'm going to look at this Catholic Church religion like a cafeteria, and I'm going to take the roast beef and pass on the chicken, and take some [01:03:00] [inaudible] and pass on the stuffing, and it's cafeteria style religion. And the dentists don't want to hear that, dentists want to hear that, well, you come to me because I mean, look at me, I'm all this. And it's like, dude. I mean, there's dental chains that have five hundred locations where 80% of their dentists work less than two years and they're still growing at millions of dollars a year. So, this shift of the consumer in my lifetime, has gone from, I'm loyal to the doctor, well, do you want to do that dentistry today? Well I mean, you're the doctor. Now it's not you're the doctor it's like, prove to me I have a cavity, and you whip out the CariVu, the digital x-rays, the internal camera. Really how much? And then they're like, okay, I know you went to school for nine years doctor friend but first I'm going to have to do a five minute Google search because my five minute Google search will equal your nine years of college, obviously. And so, it's a changing world.

Eddie: Yeah, that's where the younger kids are getting their reassurance from is from outside community, the digital world, right?

Howard: Practice analysis tool.

Eddie: Yeah, at Henry Schein we have what we call a practice analysis tool. So, we can take a snapshot of what the office is doing today and then show them where they can go in the future like, with their production take a report of all of their procedures that they do and then run it for their patients of record and for their hygiene patients.

Howard: And how many of your sixty five have let you do this to their office?

Eddie: I would say about 80% of them [01:04:34] [inaudible].

Howard: Are what's the low hanging fruit takeaways from doing 80% of your clients doing this practice analysis tool from Henry Schein?

Eddie: Just getting the patients of record, so if someone's come into your office at least once in the past two years obviously has some sort of trust with you, so getting them to come back and become hygiene patients, that's the biggest growth in a practice, that's what we've seen.

Howard: The biggest growth is what?

Eddie: Having a patient of record come back as a hygiene patient.

Howard: And how do you get that patient to come back?

Eddie: Just by keeping adding value to them and getting them to make an appointment.

Howard: Well, getting them to make an appointment, that front desk lady in every other business is either... when she answers the phone that's inbound sales, and if she's calling out to people who didn't come back that's outbound sales, and in every dental office... I mean, Henry Schein, who makes more money for Henry Schein, the reps out there on the street or all the employees down in headquarters office?

Eddie: Typically sales makes...

Howard: Sales makes the most money in every industry. And in MBA theory, one of the biggest debates is where should the CEO come from? The CEO should not come from sales, the CEO historically, should not come from sales because salespeople are hard wired to over promise and under deliver. And when you're a CEO and you’re managing employees in Wall Street and public traded you need to under promise and over deliver. So, sales people over promise, under deliver, and with the exception of the CEO, who's paid the most, the next a whole level of highest paid people are sales. And then you go to a dental office and that would be the lady named after a piece of furniture. The dentist eight years of college, the hygienist four years of college, my Jan went to one year of college and we just found this lady off the street, we throw her on a piece of furniture and the dumbest thing in the world is they say, well, why didn't you hire Marilyn? Well, she has ten years experience at the dental office across the street, well, what happened to that dental office? Oh, they went bankrupt and the dentist hung himself. Oh, that's your ten years experience? She worked there for ten years, no training, and my God you go into a dental office and you just start taking the inbound sales and the outbound sales, you start taking the front desk seriously. Here's another reason I don't like lasers, CAD/CAM CBCT, you'll go into an office, half the incoming calls go to voicemail, it's not even recorded. If you said to a dentist any day, how many inbound calls did you have today? Every company that does $100 million a year in sales knows exactly how many inbound sales calls they had. They know what ring they were answered, the dentist has no idea how many inbound sales calls came, he has no idea how many went to voicemail. And you go there and look at the data and say 50% of your calls went to voicemail, if you hired another receptionist... imagine if you were in the pizza delivery business, say you owned a Domino's franchise, if you answered twice as many inbound calls for Domino's what would that do to your pizza sales?

Eddie: Yeah, you'd increase them for sure.

Howard: It would double them. And you're like, dude, you want to buy an $85000 Biolase laser when half of your inbound calls went to voicemail? And many of these dental offices, the number one piece of equipment they could buy is a highly, is another inbound sales person to answer, and then when she has downtime she has a tickler file that you gave her, showed her how to find everybody who's come into your office before for a cleaning who's not scheduled for a cleaning, so on her downtime she'd be calling you up, Eddie Risi, this is Valerie from Today's Dental, how are you doing? Eddie we haven't seen you for a year, what's up with that? And then if your hours are patient focused instead of dentist focused, you go on these deals, and everybody in Canada works Monday through Friday eight to five, so all the dentists are open Monday through Thursday eight to five, but the ones that get patient focused instead of dentist focused say, well, we're not going to open eight to five, we're going to open seven to seven, or we're going to open Mondays and Tuesdays 7 a.m. close at three, but Wednesdays and Thursdays we're going to open at nine and close at seven, and we're going to do one Saturday a month and get patient focused with inbound sales, outbound sales. I mean, these dentists can crush it, but they'll crush it on all the having the staff fired up because you took them to Sirona World, when you start recording your phone calls and going over them she's like, oh, you're paying attention to me, so now I'm not singing in the shower naked with soap on my head, I'm on Broadway, I'm in front of that audience, I'm being taped. And everybody just performs better and you nail all the business stuff you'll double your game.

Eddie: Yeah, and get the whole team involved, like you were saying. So, the person at the front is just as important as the person that's assisting the dentist, just as important as the dentist too, so everybody working together. And then, like you're saying, bring them to the CE events and then they all feel that they're part of the team.

Howard: Absolutely. Well, my God, that was the fastest hour ever, we even went over an hour, we did an hour ten. So they're at work, they're sitting in the parking lot and they're saying, will you two apes shut up so I can turn off my car and go into office. On that note man, seriously, it's just so awesome waking to you coming over. Ryan, thanks for waking up on a Saturday and doing this podcast with your old man. Eddie, thank you for all you do for dentistry, good luck getting the CAD/CAM account, and one last final thing about the CAD/CAM account, I'll just say this, you get a Cerec machine and you're either gonna love it or you're not, but if you don't you'll always have it there when you need it. But what I see with... your worst case scenario with CAD/CAM, if you don't like it, well then have your assistant do it. If you and your assistant end up not liking it, a lot of my friends they scan all their teeth and then they have a lab person come over one night a week after she gets off work at her lab and then mills out all the crowns for the week. And another deal what I like the most, is scanning the prep and sending in the impression digitally, and when you do that your turnaround times are faster but the laboratory... here's what's really real and something to think about, when you scan the impression of the tooth my God you can see it so well. And when you see it that well you can clean up your prep again and go over it two or three or four times, so your prep is always immensely better and cleaner. But the labs are saying that when I send in, when Impregums come in or [01:11:30] [inaudible] they have a 6% remake but when digital scans come in they have a 1% remake, and it's for those very reasons, I mean, if you scan a tooth and you see the margins here then here, it disappears, I mean, you see it you go back and you fix it with an in cutting burr, the sandpaper disc from 3M whatever the hell, you clean it up so by the time you send in the scan your prep looks so much better and then the lab likes it because instead of taking an impression pouring it up in stone I mean, that that technique comes from the Egyptians. The Egyptians figured out the lost wax technique like, four thousand years ago, and so it saves them because now they don't have to have a human, because the problem with the human is a smallest thing we can see is fifty microns. Well, these things can see and you know in them at the micron level, monkeys see at the fifty micron level. And so, it is an amazing technology. But still you can make a ton of money without that stuff, get your house in order. If you're using Henry Schein or you're not using Henry Schein, look at this, they'll come by do the practice analysis tool, and the other one I love is CareCredit, are you working with CareCredit?

Eddie: No, we don't do that.

Howard: Do they have it in Canada?

Eddie: I'm not familiar with it, no.

Howard: With CareCredit.

Eddie: To help patients pay for care?

Howard: Yeah.

Eddie: Yeah, it's very limited in Canada.

Howard: Well, CareCredit has one of the most amazing deals where they will come in to your office and they will show you how much work every dentist in your state financed on a week by month by year, because so many dentists have these self limiting beliefs like, well, it's the economy, it's all this, it's anything but the man in the mirror. Then CareCredit comes in and says, okay, you're in a medical dental building with eight dentists and you're financing $500 a week and the guy across the hall from you is doing $15000 a week. So, does he have a different President and a different country, a different economy? All your self limiting beliefs are that you can't present treatment. And when you sell something in the United States and Canada 90% of everything sold that costs over a $1000 is financed, and only 10% of cars and houses are bought in cash they're all financed. Anything over $1000 is financed 90% of the time. CareCredit not only finances, but when you're team, when you start looking at your team thinking, well, I thought my office manager was really good at presenting treatment, but we only do eight hundred thousand a year and shit the guy next door to me is doing two million a year, we're only financing $10000 a week in dentistry, next door they're doing $20000 a week. And then you start, and again, this is why you work your value chain, then you say, well Eddie, what's going on next door? And you go well Carolyn does the treatment plan presentation over there, Let me introduce you to her. We should all go to lunch, let's all go to Subway, let's all talk about this. Work your value chain,, and that dentist across the street isn't your competition your competition is new cars, new houses, vacation to Las Vegas, big screen TVs. But you know how many people and patients and friends I've heard in the last two weeks say, oh my God, you know what I got that forty eight inch screen, we've been saying we're going to get a sixty inch screen but we're getting it for the fight, and we're having a fight party and we're getting the new big screen, and they'll have guacamole and beer and they're going to drop a $1000 on a fight, And you think they don't have a $1000 dollars to fix their tooth? They've got a $1000, I mean, they're going to waste a $1000 watching Floyd Mayweather knock the shit out of some Irish boy in about 60 seconds, and they've got the money, you've just got to convince them that they need to part with it. And it should be easy because a fool and his money always part, it's only the rich people that keep their cash. And so since 95% of Americans can't hang on to money, they just spend everything they get paycheck to paycheck to paycheck to paycheck, max their credit cards, they'll be fifty years old and they'll refinance their house on a thirty year mortgage, really? You're going to be making payments when you're eighty? I mean, crazy stuff out there. So get Henry Schein to come by and do a practice analysis tool, how much does that cost for you to come in and do that?

Eddie: All it costs is doing business with us, basically.

Howard: Yeah, but would you do it for a new client who doesn't do business before yet? And hoping that maybe you could get his business.

Eddie: Yes. That's , yeah.

Howard: And who's the greatest dentist in the Toronto area?

Eddie: They're all great.

Howard: Who's the greatest dentist in Canada?

Eddie: They're all great, right?

Howard: Glen Van Haas he said it, you heard it first. Glen Van Haas the man with class from Vancouver the laser guy. That is my favorite Canadian dentist, big shout out to Glen Van Haas. Have you met him?

Eddie: No, I haven't.

Howard: You should have him come out and lecture to your group, yeah, he would do it. Yeah, you should get him to come down, you should put on a continued education deal. If you ever get all your sixty five dentists in a room since you came over to my house for free, you get your sixty five dentists in a room I'll come to Toronto for free.

Eddie: That's great.

Howard: But the rule is it ain't going to be in January or February or March, it's going to be in June, July, August. But Eddie, thanks so much for coming by, your twenty year anniversary is?

Eddie: It was Wednesday.

Howard: Oh, was this last Wednesday? So, what did you do for your twenty years?

Eddie: We went out to a restaurant with a whole family. We were down here with my in-laws and the kids came out, we all went to a restaurant.

Howard: [01:17:10] [Inaudible] had a forty year anniversary, I said what's the secret? He said on our twenty year anniversary I took her to a European vacation in Italy and on the fortieth anniversary I went back and picked her up. On that horrible note, have a rocking hot day, thanks Eddie.

Eddie: Thanks.

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