Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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917 Changing the Dental Landscape with Dr. Josh Turnbull : Dentistry Uncensored with Howard Farran

917 Changing the Dental Landscape with Dr. Josh Turnbull : Dentistry Uncensored with Howard Farran

1/8/2018 2:11:55 PM   |   Comments: 0   |   Views: 386

917 Changing the Dental Landscape with Dr. Josh Turnbull : Dentistry Uncensored with Howard Farran

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917 Changing the Dental Landscape with Dr. Josh Turnbull : Dentistry Uncensored with Howard Farran

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Dr. Josh Turnbull is founder and CEO of Lydian Dental, a new aspirational brand of dental clinics with locations in Phoenix, AZ and Austin, TX. Dr. Josh’s story began in 2008 where he was doing research both at the Mayo Clinic and with Dr. Gordon Christensen at the Scottsdale Center for Dentistry. This led him to pursue an MBA at Harvard after he completed his DMD at Harvard School of Dental Medicine. During these years, Dr. Josh realized that the dental industry was experiencing massive consolidation, but he was disenchanted by much of what he saw in the corporate dentistry world. He asked himself, “Why is there no Mayo Clinic of dentistry”? Thus, Lydian Dental was born. 

Lydian is out to make dentistry more affordable, convenient and fun. They like to call themselves the “anti-corporate” brand of dental clinics, with a focus on great design and user experience, which they were recently recognized for nationally in Wired Magazine. They currently have 3 Lydian branded clinics in operation and a mobile clinic which launched in Austin 3 months ago and is providing services to companies across the city. They are also developing a Membership that they feel could disrupt the traditional dental insurance model. Lydian is also committed to giving back. Through their Lydian Smiles initiative they provide pro bono services both locally and internationally. 

Dr. Josh is also a proud father of 4 children and is married to the most wonderful woman on earth. 

Lydian is expanding nationally and is looking for dentists to partner with. For more information, contact Dr. Josh at

Howard: Am I back? You're the first person that ever requested to see my face live again. You are like “It's frozen.” Well, you know Aspen is the only, in my opinion a roll-out, where they have a brand new name. Every location is Aspen. They're branding it out, they all have a similar ... I think it's the most closest to a prototype roll-out and I also think they have the most focus because they're focused on under served areas and they want to work Medicaid. And that's actually a branded target going after, like out here in Phoenix every all the dentists want to go to North Scottsdale, they want to go where all the money is. None of them... 

We still don’t have a dental office in Eloy. I mean Eloy is just thirty miles south of here and doesn't have a dentist. Across the street from me is Guadalupe, Guadalupe doesn't have a dentist. 

Aspen is saying, we are  gonna go where the dentists aren't going and we'll work the Medicaid mill. And that's pretty interesting. 

Let's switch gears completely to the dental insurance landscape because I know you're doing a lot of pioneering work with your membership program. What do you think of the state of dental insurance that basically started in 1948 with the Longshoreman's Union where every single container that came in and out of America went through the Longshoreman's? And they were the first ones that unionised against their  boss saying we want dental insurance. That eventually turned out to Delta of Washington, Delta of Oregon. Basically that's where it started. And now it's 2017, where do you think dental insurance fits in the model and what are your thoughts on your new membership program? 

Josh: Yeah. I think dental insurances get a little bit bad of a rap in the sense that I think they've done a lot of good in the industry in bringing more awareness around the importance of oral health. They've got a lot of people to buy into dental insurance and carry dental insurance which helps. I think there is a pretty massive opportunity though for some innovation. I think we have essentially the same product. It's been the same product for how many years, Howard? Over forty? 

Howard: Well 1948. I mean it really hasn't changed. This is 2017 right? 

Josh: Yeah.

Howard: 2017 minus 1948. I mean it's been sixty-nine years. 

Josh: Sixty nine years. 

Howard: It still has the same max,  it's the same one thousand dollar maximum. 

Josh: Nothing's changed. The problem with dental insurance is it's really not designed to get people healthy. There are waiting periods, there are yearly maximums. Dentists tend to treatment plan around what their insurance covers and so they put off needed dental treatment. And A lot of people actually never use it, over 50% of those who carry and pay for dental insurance never even use it. In some areas it's like 80%. 

That model is kind of broken. And I think you're going to see, and it’s really at the end of the day it is nothing more than a discount plan. Not that many people will go out and buy dental insurance on the private market because it's 400 bucks a year. It covers a couple of free cleanings but then you're pretty much out of your pocket for most things. So if you do the math, you know, unless your employer is subsidizing your product, most people when you talk to them they actually don't even know how much they're paying for their dental insurance. I mean, how often does that happen ever, where people have no idea what they're paying for? They have no idea how much monthly their employer is taking out of their paycheck, nor do they really understand what it's covering. I mean there are a ton of challenges with it. When I was at Harvard Business School we did a study, I did a study with a really well-known figure in Healthcare. Her name's Regina Herzlinger. 

Howard: Oh my God! I loved her books. What was her first book? Was it “Health Versus Wealth”? 

Josh: Yeah. And then She wrote “Who Killed Health Care.” She's written great works and ….

Howard: Does she still teach? 

Josh: Yeah, she's brilliant. She is absolutely brilliant. 

Howard: Is she your friend? Do you have her email or contact? 

Josh: Oh yeah, for sure. 

Howard: Oh my God! Fix us up. That would be the ultimate podcast. I quoted that woman so many times over the years. I mean she's just a brilliant genius, she was one of the biggest early influencers. She was the pioneer of Health Care Macroeconomics in my mind. 

Josh: Absolutely. Yeah a lot of people call her The Godmother of Consumer Driven Health Care. She is the influencer on Capitol Hill when it comes to health care. She actually gave a talk at a leadership seminar when I was in dental school and I was only, I think I was in second year. There were a bunch of leaders from the dental industry that were there in attendance. And I just asked the dean of my school if I could go just to see what people were talking about and he let me. So I heard her say at that seminar, " Look I've never actually written a case on the dental industry at HBS and if any of you are interested let me know". So I remembered that when I got into HBS and I contacted her and so she and I wrote a study on the dental industry and actually we were going to write it on a DSO but we actually didn't find one with an interesting enough story to write a case on. And in that process- that's what gave me the access to kind of visit with all these COs of the DSO’s and all that, but we ended up doing our study on a Brazilian Dental Insurance company which gave me the opportunity to go to San Paulo and eat the best steak I've ever had in my life. I don't know what they do to their steaks down there, but it was, Oh my gosh I still dream about it. We ended up writing a case on a dental insurance company called Odonta Breath, and I'll send you the article Howard it's pretty interesting. 

Howard: Did you publish it? 

Josh: Yep, she actually teaches it at her course. 

Howard: Where was it  published? 

Josh: Just in Harvard Business Review.

Howard: Just in Harvard Business Review. 

Josh: Actually I’m not sure if it's HBR, but it's available. It's taught in her course. She teaches a course called Innovation and Health Care. And so she teaches that in her course. 

Howard: You're  only, the second guy I know who's been published in Harvard Business Review. The other one is actually Chuck Cowen, him and his brother Rick Cowen own Benco. They’re third generation. 

And Harvard Business Review was doing an article on family owned businesses and what happens to them as they’re passed down from generation to generation and Chuck wrote a piece on there. That was very cool. So congratulations on that man. You're a unicorn. 

Josh: Yeah, in her course. We traveled, I got to visit with their corporate team and learn the insurance business in Latin America. Odonta Breath is the biggest dental insurance player in Latin America. And they had a bunch of different products but they had one that involved a clearance process. They got people healthy and then what they found after that clearance process was that the costs of that patient once they were cleared were very predictable. And so their whole goal was to get rid of all these waiting periods, the yearly maximums. Let's just focus on getting people healthy and once they did that their costs were super low. 

We've designed a membership that's very similar to that which involves a clearance process. No waiting periods,no caps. We just want to get you healthy because we give you healthy discounts on the front end and then once we get you healthy then pretty much everything that relates to keeping you healthy going forward is covered under the membership. 

So essentially crowns, fillings, extractions, once you're a cleared member, Howard let's say you came in and you know you had a cavity. We'll fix your cavity, you're cleared, you're a member. Next time you come in and you need another filling, it's completely free. Or you need a crown, it's completely free. So everything that relates to keeping you healthy on an ongoing basis, it's covered at 100%. We've been developing that now for about three years and the economics on it are looking really strong. 

We see it as being a very disruptive dental product on insurance. We're going to see a lot of players in my mind in the next five to ten years come in this space and if the dental insurance companies don't innovate other players will. So I think there are some serious challenges on the horizon for dental insurance. I think dental insurance the way that we see it now, is going to be extinct in five years I'd say ten years at the latest. 

Howard: Holy moly that's a big prediction. But I mean you're right they haven't done anything. The biggest truth is, this is 2017, jobs come out with the iPhone, the smartphone in 2007. A decade later you walk into any dental office in America and they have to bring in paper forms and then if you want to figure out what's going on they don't trust the website they've got to call a live human. 

I've sat down with my staff where we will have three different people call the exact, same dental insurance company asking them the exact, same thing and I've got three freaking different answers. And it's like how come if they have Delta Dental why don't they just come in my office and open up their Delta Dental app and there's some barcode and then we scan it and then that tells me everything. 

That was what was so sad about Obamacare because he had a big heart. I mean he went to get rid of pre-existing conditions and let kids stay on their parents deal. 

But they didn't do the one thing to address the cost. And 30% of the cost of healthcare is pushing paper around. These medical insurance and dental insurance companies haven't tried or done anything to try to get rid of that. That part of the equation should be a utility that shouldn't cost more than 1-3%. You shouldn't have to be spending 30% of all the people in every hospital, medical practice and dental offices filing forms. I mean it's completely maddening insane. 

Josh: It is insane. I mean we hire a full time team to just manage the complexities of dental insurance. There's probably at least 15 to 20 % of inefficiency costs baked in that product. Someone's going to come in and innovate. We as a company that's our Mantra. We want to shake this industry up. We see an industry that is pretty still; hasn't been innovated in a long time. Our goal is to make your next trip to the dentist more convenient, more affordable and an enjoyable, fun. We believe that a trip to the dentist can actually be fun. 

Howard: Are you going to develop an app for this insurance? Will you use a smartphone technology or?... 

Josh: I mean eventually an app will come. I can't really talk about exactly the strategy that we're pursuing but we need to pilot it for a little bit longer and get more data back. Once we do that we can start rolling it out on a larger scale and that's where the apps and stuff comes in. 

But the one other thing I'd say about the membership is technology. Technology is really important and we need to bring technology into the product to drive behavior. So how do you do that? It's been our our vision from the beginning that we want to bring smart toothbrushes into the product at some point which will reward people for brushing their teeth and provide discounts on their insurance products. We can also do other perks inside our clinics like Invisalign, whitening and things but we think using technology as a way to drive behavior is very important. The company that's probably doing something interesting there is Beam. Beam Technologies have you heard of them? 

Howard: From the Smart toothbrush? 

Josh: Yes. So that you'd know they've built basically down insurance product on their smart toothbrush. But we see we'll be introducing that at some point as well. But anyway the last thing I'd say about our industry is the incentives. The incentives are so messed up. 

I'm paid based on my production. If you're a patient, our incentives run directly against each other. What I would like to see with our membership is to see our providers compensated based on quality outcomes instead of being paid on how much they produce. And I hope that we as an industry, as we look at innovative ways to restructure the way that incentives are built which right now is completely backwards, I'm hoping that we can find ways where we can align incentives between patients and providers so that we are compensated based on keeping patients healthy and not based on finding as much as we can wrong with them and trying to create these expensive treatment plans etc. etc.. That's what I'd like to see. And that's what I hope we can develop with our membership product as well. 

Howard: Yeah the incentives in healthcare. You're right. They're completely insane. They want to do a $100 000 bypass. They don't want to sit there and try to get you to prevent a heart attack. I mean when I went to MBA school there were two hundred people in my class at Arizona State University and all two hundred of them had rejection letters from Harvard Business School. And so we were the island of misfits out there in Tempe. 

But those hospitals said that the incentives were insane. They lose money on all their visits to the hospital, but if the hospital has to do three to four major surgeries a day because Medicare or Medicaid will give a $100 000 dollars for a bypass, $70 000 or @80 000 for mastectomy, $50 000 for a knee and $80 000 for a hip. 

And they have to keep that surgeries going because everything else runs at a loss. And so the whole thing is driven by you. You want that one Medicaid check for 100 grand. You don't want a thousand little checks for twenty five dollars. It's just Mrs. Jones is there asking her doctor questions. The whole system is designed just to fillet you open nonstop. 

Josh: I got an infection in my elbow recently. They still don't know what might have caused it. It might have been that I went down to Houston to help with the hurricane efforts down there. It might have been from that. But I went to one orthopedic surgeon and he told me I needed surgery. I inherently didn't trust him because I know that's how he buys his Porches and his expensive house. Inherently there's distrust there. I got a second opinion and actually checked  Yelp reviews which is interesting because I don't think that used to happen. You used to just trust whoever your doctor sent you to. And that's who you went to. 

This first guy didn't have great reviews. I went to one that had great reviews and he was like, "No, we're not going to do surgery we're going to get you on antibiotics" He's more conservative and I'm fine. I think the same thing applies with us in our profession and I think Gordon Christensen has written really good stuff about how the dental industry has slipped. If you look at Gallup polls twenty-five years ago, dentists used to be the number one or two top three most trusted professionals. And now we've slipped significantly and I don't know where we're at today. But while there is still a lot of trust in dentists there's also a pretty big part of the population that has lost trust and a lot of this is the fault  of some of  these chains who are really focused on efficiency. 

I'm not demonizing all these chains, don't get me wrong, I mean it's not they're all Satan. But I do think there's a fair amount of pressure that a lot of these dental chains put on their dentists to produce unnecessary pressure. I think it's common. It happens. And so I think revisiting and kind of hitting the reset button and trying to figure out how we can structure dental insurance to align incentives between patients a providers, that would be amazing. And I want to be a part of that process in whatever I can. 

Howard: Well, trust this everything when you're selling the invisible. I mean when you come to me and I tell you have four cavities, I mean you don't know that. But you know if your Starbucks coffee is empty and you want a second one. You trust a brand like an iPhone, you trust a can of Coca Cola  but you don't know if you need surgery on your elbow, you don't know if you have four cavities. And I think one of the things I've noticed the most in my fifty-five laps around the sun is that social media has destroyed trust. 

Right now you look at all these articles posted on Facebook, Twitter LinkedIn and Google Plus, it's to the point now where I can't really trust anyone and everybody I talk to. Fake news is the biggest new term I've heard in the last couple of years. In fact what are the social media and drug dealers have in common? 

Josh: What? 

Howard: They call their customers users. They sell an addictive product and they get you hooked on opioids or fake news or all that stuff. And dentistry - a lot of that is their fault going all the way back to the Reader's Digest article twenty-five years ago where a guy took a set of study models and an FMX to  thirty different dentists. And how many different treatment plans did they get? Thirty. All the way from zero dollars to thirty thousand. So then the government looked at that. I think it was the NIH. I need to track that down. They looked at that and they said “Is that for real or was that crazy journalism” I mean it was Reader's Digest. That book sat on every grandma and grandpa’s nightstand. So they went. They increased the sample size to a hundred and they got ninety-eight different treatment plans because the first two people said you needed nothing. So then treatment plan three to a hundred, not one of them was a duplicate. Look at Dentaltown, you could post a picture of just anything and look at what those... I mean you know someone could post a chipped tooth and someone can start screaming Veneers and other one Invisalign, Bleaching, Direct Bonding, Smooth Out! Dentistry is not a consistent product like an iPhone. 

Josh: Yeah that's true. Yeah it's very subjective. 

Howard: So you're a Harvard MBA. What practice management software system did you go to run these multi-location dental offices that are mobile? 

Josh: We currently use Open Dental. 

Howard: So do I. All the smartest MBA’s do. 

Josh: Yeah it's great. I mean it's not sexy or anything but it's functional, it's intuitive and it's cheap. 

Howard: And it's open. You can actually program to it. I got five programmers because of Dentaltown and if there is something that you want to do with that special. I mean that was the whole reason Jordan Sparks started. He was a dentist. He had Dentrix. He was just trying to pull up his own customers' addresses. And he noticed not only could he not but he realized they went out of their way to make sure he couldn't do it. And he called them up, and he goes “This is my data. These are my patients. We entered it. I want to export that” and they were like “No” and that was the birth of Open Dental, just pissing off Jordan Sparks. 

Josh: I wish someone would create a one stop solution for practice management. I mean it's insane how many different cheques we have to cut every month to five different people from Open Dental to Dental Intel to (00:21:36 unclear)

Howard: I'll tell you what you got right now. So Jordan is a dentist, he started Open Dental and that wasn't his heart and soul. His brother Nathan now who’s  been running that for the last decade. Nathan is the only guy I have met in the whole practice management software deal who is totally open. And so if you sat down with him or you met him or you told him. He's talking to every member of my team because I have to pull that stuff out of Peach Tree  accounting and then stuff out of Open Dental and make spreadsheets. 

And he's like “Dude we'll automate all that. Just tell us what you want.” Just tell us what you need. So he's one of those guys who's really smart people like yourself. You establish a relationship with him. I think the guy hired four more programmers last month. They're really scaling and they don't do any advertising. They’re the only practice management software system that doesn't do any advertising because they're growing faster than they even want to grow. So if you told him what you needed and you told him you're a Harvard MBA and this is what we need and blah blah blah, he's all ears and he's completely approachable. 

Josh: Yeah I'd love to. If you could connect us that would be great. 

Howard: Yeah I will. I’ll do it now. So then the obvious question. I only got you for two more minutes I can't believe this. That's the fastest hour ever. How do you feed this new upcoming office? How are you finding your new patients, what's your secret marketing sauce? 

Josh: I don't know if we have a secret sauce. We've done a lot of obviously due diligence both inside the dental industry and outside, but it's a mix of online and print. We still do print in Austin, we did billboards, really fun billboards. We still do mailers, particularly when we open. We did some magazine ads as well here. You know a lot of social media, geo-targeting. (00:23:43 unclear)  the local businesses around here .... It's a multi-prong strategy and I don’t know if we  have necessarily a secret sauce I think it's more about execution. It's just about doing it and doing it well. 

We've learned, we weren't perfect on our first practice by any means we learned a lot. We ran through more cash than we thought. We haven't been perfect but we've learned. We've learned a lot. And I think we're in a good place right now. 

Howard: I just emailed Nathan, you and me are now on an e-mail string so let's just take it from there. Yeah he is. I just love Nathan, I mean he's just so damn cool. So the million dollar question. You said you were on a Yelp review. You're thirty eight and I'm fifty-five. I've never seen a Yelp review and I've never been at a restaurant with a bunch of Grandpa dentists. I've never physically seen anyone use Yelp in my life but I do have the Uber app though. I've never used it and Ryan says it’s all ready to go. I'm just sitting there thinking if I'm lost some day. 

But these young kids they want to go live in Cupertino. They want to live where all the Googles and Ubers and Facebook's.. they want to live by you and Austin and Dell and Amazon and I notice out here you're in Tempe in Queen Creek. 

Do demographics matter? Are you of the free spirit, the Janis Joplin, Freedom is when you have nothing left to lose and if you want to live right here, you just live there and be happy. Happiness is what it's all about. Or would you be coaching these kids coming out $350 000 in debt, some of them $400 000 in debt to study demographics, go rural? Talk demographics. As you're rolling out your (Lydian 00:25:43 ) dental centers, what are you thinking in terms of demographics? 

Josh: Yeah I love that you quoted, you dropped Janis Joplin. I grew up a fan of Janis Joplin. My dad loves her actually. On our South Lamar clinic on the side of our clinic, we have this big wall that we're doing a mural on and she's actually in that mural. Come to Austin sometime and we'll grab some barbecue. 

Howard: Well you know Janice actually was right. I think I had my first eureka moment on happiness. Straight out of dental school I did a missionary dental trip down in Chiapas and opened  my own office, I was all busy, I was working around the clock and everything was crazy. A friend of mine Jerome Smith convinced me that I need to take four days off and go down there. I had babies at home but I just did it. 

And I went down there and I saw five thousand Chiapan Indians with no electricity, no running water, no nothing. And they were the happiest people I've ever seen in my life. All they did was giggle. They thought everything was funny. It was just family, babies, a simple diet. They had zero stress, they didn't own a car or they didn't have house insurance and they didn't have student loans and you couldn't beat the smile off their face with a stick. In fact when you start to hit them in the face with a stick they'd probably just start giggling and run. 

Josh: That's funny I had a similar experience down in Chile when I was a missionary down there. The first Christmas I saw was very simple but the happiest family gift exchange I've ever seen; deodorant socks and basic basic stuff but completely happy. 

Yeah.. demographics. I think you have to recognize who your target market is first. We've picked, we've selected markets that are pretty competitive actually in nature. And in these markets we've had to execute really well on our marketing on everything. If you're a solo dentist just coming out of school, I think if you were to enter the markets that we’re in right now I think it would definitely be a battle for sure. I think you mentioned these kind of more, less dense underserved areas. I think those are areas where you can come out with less sophistication and with less of a business plan behind you and still hang a shingle and do just fine. There are some really good third parties that you can use. Scott McDonald is one I'd throw out there but every single market will have brokers, typically dental brokers, that can do that for you and they can sit down and see what's your plan. They can make a plan with you. But I would say yeah if you're going to go into a market that's competitive where the concentration of the ratio of patients, the population to dentists is anywhere south of two-thousand, you better have a very sophisticated  (unclear 00:29:06 ) behind you to do well. 

Howard: No doubt. Last question. We're three minutes into overtime. So Amazon might come there, Amazon just released the other day. They bought licenses for pharmaceutical dispensing in thirteen different states and now now they're going after Walgreens and CVS. They had a booth at the Greater New York last year. The Greater New York is the day after Thanksgiving in New York City. But Amazon was there last year. Who are you buying supplies from? And do you think Amazon is going to come in and disrupt that space? 

Josh: I think the dental suppliers in the states don't take Amazon seriously. I think they're going to be in trouble for sure. I think Amazons going to come in and compete. We use Burkhart. I'm a huge fan. We actually in our first mobile clinic, I will just tell  a quick anecdote, put  a plugin for  Burkhart. Their services is phenomenal. We could go with Scheiner or Patterson who actually have built a lot of capabilities to service bigger DSOs but we sticked with Burkhart because of their service and we had one of their reps here in Austin. We had these little dental assistant carts with these drawers but they didn't build separators into the drawers. My dental assistant was like, "I wish I had a little separators in here so I could organize all my supplies." And the rep was, "Oh you know what I'll go home and get my saw and I'll make you dividers." So he came. It was like middle of the summer and the guy came down during the day sweating his face off and sawed her out  little dividers for the whole cabinet and they are always there. I mean as far as service goes you know they're there. 

Howard: Are you friends with the CEO? 

Josh: No I'm not. 

Howard: That is just like classic American business. The Fortune Five Hundred employs like 17% of Americans. The whole world is built on small business and they’re family businesses. 

Anytime a patient comes in in  the military I say, "well are you the first one in your family to be in the military?" And they’re "No. Oh no. My uncles in the Marines, my dad served.." You know it's same thing with dentists, if you go to any dental school. Raise your hand if there's another dentist in your family tree somewhere. And it's between a quarter and a third of all the hands. And I've lectured in fifty different countries. I lectured in five continents last year and Benko is a third generation family owned business. Burkhart's a fourth generation, it’s a one hundred and fifty year old company and she's the great granddaughter of the founder and we've had this explosion of women dentists . I think she must be very shy because I've emailed the Burkhart management team to say “Come on.” I think her unique selling proposition...couldn't you get a bunch of women dentists just to buy from her because just for the fact that she's a woman and right now on every newspaper there's Harvey Weinstein and I mean I think those women should stick together. I think the best marketing she could do would be to come on the show and tell us about this fourth generation family business because it's really a very romantic story. 

Josh: I love those guys, I'm a big fan. 

In fact a lot of people always thought Benko, which is really dominant on the East Coast, and Burkhart which is dominant on the West coast, that they'd merge and be the ultimate coast to coast national player. But they're both family businesses. That's not even on their radar screen. It’s not even a goal or whatever. Interesting times. 

I'll tell you what man, you are a fascinating man. And it was just a huge honor to get you to come on my show today and talk to my homies right now, they were so damn excited. Since I couldn't get into Harvard Business School if I just sent you my ASU diploma would you at least just sign it for me? 

Josh: That is the most ridiculous thing. 

Howard: Well I could  say I only got a degree from ASU but it's signed by a Harvard MBA. And, my gosh, and Regina Herzlinger getting her on the show to talk about disruptive because I think that's another thing. 

Fifty five laps around the sun. It seems like when I was little, from like ten to twenty to thirty, progress was just very, very slow. But it looks like the disruptive forces in the economy, it seems like the disruption of the last five years previously would have taken ten years and previously would've taken twenty years. 

Everything is just going faster, faster, faster, faster, faster. So I agree. I think we're going to see disruption in Amazon. They just put in a new CEO in Patterson. And I thought the most telling sign of that was that you think it would have been their biggest, baddest, best regional manager that's got twenty,  thirty years of skin in the game and they didn't. They brought in an outside business consultant and I thought, hmmm. I wonder if he plans on running Patterson or selling all those distribution rights to Amazon. Didn't see that coming. They're definitely not going down any traditional road to bring in who they just brought in as a CEO. So yeah. And I hope you disrupt the dental insurance industry, the supply industry. It's all going to be disrupted and it's going to start getting disrupted at the speed of light. There will probably be more change in the next five years than there was in the last ten. You're the first person I ever podcasted that's sitting in the car and that's a first for me and I will repost that Wired magazine article today and then I'll send you the link on Dentaltown so you could post some of your mobile clinic pictures. If you post on YouTube, you know they’ve got that share button, right next to it is embed where you can pick up the code and then if you go to Dentaltown there's a little YouTube icon above a post, you click that and drop that embed and you can drop your YouTube video. 

A lot of guys out there listening got some amazing video you put. You could explode your YouTube video views by dropping them in a thread on Dentaltown.

Man, Josh thank you so much for your time. And next time you're in Phoenix we’ll have to go grab some barbecue. 

Josh: That sounds awesome. 

Howard: All right buddy. I hope you have a rocking hot day and best of luck with those four kids. I'm jealous I wanted one little girl named Megan. I got four little  boys. And you got your girl right out of the gate so the three boys are just extra so on that note I hope you have a rocking hot day. 

Josh: Thanks Howard I appreciate your time. 

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