Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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941 Dental Practice Brokerage with Gary Boyajian, DDS : Dentistry Uncensored with Howard Farran

941 Dental Practice Brokerage with Gary Boyajian, DDS : Dentistry Uncensored with Howard Farran

2/7/2018 10:39:55 AM   |   Comments: 0   |   Views: 509

941 Dental Practice Brokerage with Gary Boyajian, DDS : Dentistry Uncensored with Howard Farran

Upon finishing his GPR at  St  Josephs hospital in NJ  Dr Boyajian purchased an exisiting   GP dental practice in Bergen county NJ plus a building.   The practice grew rapidly by utilizing  the proper marketing techniques and applying the latest technology and dental procedures.   His practice was fee for service and accepted high quality dental insurance. He didn't accept PPO insurance.  He felt one of his keyes to success was listening to practice management lectures and tapes by Howard Farran and Rick Kushner  Also clinical information from Gordon Christensen 

In subsequent years he opened 2 more dental practices in Fairfield county  CT.    After many successful years as a practicing dentist Dr Boyajian retired.  While he was in the process of selling his three dental offices he found that multiple dental brokers did not take a hands on role in the process, as they were not present when he met with the prospective  buyers  Further more the majority of the brokers did not get involved in the day to day transaction and negotiations as the deal moved forward with contracts, financing and lease negotiations . 

As a result of this experience  Dr Boyajian was inspired to start his own  dental brokerage firm that would provide unparalleled  amazing hands on 24/7 service  Health care practice sales  LLC  He is one  of the few dental practice brokers  that is a dentist and also has in house staff consisting of 2 CPA accountants.  

They deliver results and make sure your deal goes the the closing table.  They stay in constant contact with every party involved in the transaction including banks, attorneys and accountants.  as a result you will not have to handle any aspect of the deal on your own .  the sale process  will go very smoothly because they  stay on top of everything and are constantly available.

VIDEO - DUwHF #941 - Gary Boyajian

AUDIO - DUwHF #941 - Gary Boyajian

Howard: It is just a huge honor for me today to bring on Gary Boyajian, who’s been a friend of mine for thirty years. Me, Gary, and Rick Kushner used to always hang out back in the day all the time. 

Upon finishing his GPR at St. Joseph's Hospital in New Jersey, Dr. Boyajian purchased an existing general dental practice in Bergen County, New Jersey plus a building. The practice grew rapidly by utilizing the proper marketing techniques and applying the latest technology and dental procedures.

His practice was fee-for service and accepted high-quality dental insurance. He didn't accept PPO insurance. He felt one of his keys to success was listening to practice management lectures and (00:00:46 inaudible) like, Howard Farran, Rick Kushner, also clinical information from Gordon Christensen. 

In subsequent years, he opened two more dental practices in Fairfield County, Connecticut. After many successful years of practicing dentist, Gary retired. While he was in the process of selling his three dental offices, he found that multiple dental brokers did not take a hands on role in the process, as they were not present when he met with the prospective buyers. Furthermore, the majority of the brokers did not get involved in the day-to-day transactions and negotiations as the deal moved forward with contracts, financing, and lease negotiations. As a result of this experience, Gary inspired to start his own dental brokerage firm that would provide unparalleled, amazing, hands-on twenty-four/seven service, Healthcare Practice Sales, LLC. 

He's one of the few dental practice brokers that is a dentist and also has in-house staffing consisting of two CPA accountants. They deliver results, make sure your deal goes closing table. They stay in constant contact with every party involved in the transaction including, banks, attorneys, and accountants. As a result, you will not have to handle any aspects of the deal on your own. The sale practice will go very smoothly because they stay on top of everything. 

Gary's in Montvale, New Jersey. He’s about thirty-five minutes away from New York City. Whenever I lecture out there, I go see Gary because he's an amazing mind to pick and he was amazing. He had a limo and a limo driver back in the day when the phone was actually tied to the limousine. We would just drive around and you would just sit there and you were just wheeling and dealing dental offices. You knew the dentists, they all knew you. I mean you're truly amazing. How are you doing Gary? 

Gary: All is well. Having a wonderful time with a little frigid weather right now. 

Howard: Your website is By the way, my four boys think of you as - they used to call you a pretz man. When they were all little, two, four, six, eight, you were always sending us these big old barrels of chocolate covered pretzels. Oh my god, they loved it. I think of you as the limo man. My kids think of you as the chocolate-covered pretzel man. Do you still eat chocolate covered pretzels? Is that your secret to looking so good? 

Gary: Whatever it takes. A lot of those pretzels are handmade and they still make them coming out of Pennsylvania. I'll be sending you a package soon. 

Howard: A little logistics. Let's start off. People your age and my age where our kids are in their twenties, they read Dentaltown magazine. It's these young Millennials that are listening to podcasts. I always ask my homies, shoot me an email,, tell me your name, where you live, what country, how old you are. It's about 25% of them are in dental school and the other 75% percent are under thirty. Only get about one e-mail a month from somebody who's old as me. 

Right now I know what my homies are thinking. They're working in Aspen or Heartland and they think, "Well, Gary, I can't buy a practice because I’ve got $250,000 in student loans." What would you say to that Millennial who's not even looking at a dental practice to buy because she thinks she has too many student loans? 

Gary: Right now majority of banks, if you have a practice that cash flows, majority of banks are financing 100%. Not even one-hundred, they'll actually give a 105% percent, so they'll give about 5% working capital. Money is readily available for anyone that wants to buy a practice. If you have a fair credit score and you're actively working as an associate now, you're going to get financing. When we do deals, the least of our troubles are financing. Money is always available. 

Howard: What banks are you working with? 

Gary: We work with Bank America, T.D. Bank, there, of course, is Wells Fargo. There’s about six different banks that really can deliver, produce. We have a small bank near us called First Hope, Valley Bank. There's quite a few, but the money is available if the doctor is ready. If the doctor has any credit issues or financial concerns, sometimes we work through the money brokers who have about two-hundred sources that they could funnel towards us. But historically, our problems are not getting the financing. Money is available. 

Howard: They see all these commercials on TV, Credit Karma, check your credit deal. Is that real world? Do they need a credit score? You've seen those commercials. 

Gary: The average doctor does not have financial trouble. If they do, they let us know right away we try to work with them. Banks are looking for credit scores of approximately six-hundred eighty or above. Vast majority of doctors qualify for a loan. It's not a problem. 

Howard: Six-eighty and above. What's that scale? From one to what's the highest scale? 

Gary: Usually it can go up to eight-hundred. A good score is anywhere in the seven-hundreds. That's generally not an issue. 

Howard: The highest you can get is eight-hundred? 

Gary: I think it's about eight-hundred on the FICO score. Yup. 

Howard: That means my ex-wife must have an eight, oh, one. You just can't have that much cash and not have an eight, oh, one. You use a term they don't understand. You said they'll loan 100% of the practice, but they’ll go 105%, 5% percent working capital. They don't know what working capital means. What is working capital? 

Gary: Working capital is money that you'll be using in the practice for cash flow because initially you're not getting all of the insurance money and you want to do a little extra advertising. You don't have as much - you want those extra dollars to be flexible, to carry overhead. So you have extra cash flow; that's what the extra 5% percent is for. 

Average practice may sell 65 to 72% of one year's gross or if you’re working with a private equity group, four and a half - five times EBITDA, four to five times EBITDA. But generally with the doctors, we just try to explain if it's a normal overhead, practice is selling for somewhere between 65 to 72%. But those numbers are all going up. The percentages are going up. 

Howard: Okay. You said EBITDA, so they don't know what EBITDA means. Explain EBITDA. You said four to five times EBITDA if you're a venture capitalist. 

Gary: EBITDA is essentially your net cash flow coming out of the practice. 

Howard: It stands for EBIT plus depreciation plus amortization. You have your total expenses due to depreciation, amortization back to your company's EBIT. It's a measure, earnings before interest, taxes, depreciation, amortization. Because remember when you file your income taxes there's all these weird things like, there's a deduction for children, depreciation. It's an IRS baloney thing. But it's four to five times EBITDA or 65 to 72% of gross collections. 

Gary: That's about your national average sale. But in the end, the practice will sell for what the bank is willing to loan, what the buyer thinks it's worth, and what the seller is willing to let it go for. That's essentially because this is a seller's market. That combination has to be there. I've sold practices as high as 90%. We sold one six months ago, 90% because it was in the community that the doctor wanted to be in. 

Howard: These fundamentals are all macroeconomic. You and I have been in this game for three decades. Why is it sometimes a seller's market? Why is it sometimes a buyer's market? Why is it a seller's market right now? 

Gary: It's a seller's market because the average buyer, I would say the word is fear. They're worried about their student loans. It's a more conservative buyer I find nowadays. The buyers are not opening up from scratch. That's the biggest holdup right now. They have fear. They're not opening from scratch. Although the money is there, they're afraid to open up from scratch. Therefore, they're waiting for about three to four years post graduating and then beginning to look for a practice to purchase. 

Also, you have a lot of females in dentistry and I'm not sure what their future is like as far as starting a family or if their spouse is going to be moving a job. They may not know exactly where they'll wind up, so you do have that happening also. But it is a seller's market, not a buyer’s market. 

Howard: What would you say to a twenty-five-year old girl who says I have my heart set on - I want to go to a certain town in the middle of Kansas? Should she buy an existing or start a scratch? How should she wrap her mind around that decision? 

Gary: It's a personal decision, but historically, you're far better off buying an existing practice because, first of all, to build a practice is going to take you six months and a lot of aggravation, no income during those six months. An existing practice you have the staff is there, equipment is working, you have a patient load, you have cash flow. That combination gives you some level of security. They're better off buying an existing practice. If they're not pleased with the equipment or the appearance of the office, they could slowly renovate, but it's the cash flow which is the key and existing patients. It's very expensive to get a new patient in your chair, whereas an existing practice, you have staff and patients. 

Howard: My thinking on that is like I've seen so many kids and they want to go back to their small town in Iowa and there's eight dentists. And old man McGregor is selling his practice and he thinks, "I don't want to pay that. I want to start my own." That town had eight practices, so now he starts number nine. He thought he went to this town with eight old codgers that are open Monday through Thursday to five. But then that old guy sells the practice to another highly energetic, motivated thirty-year-old kid. He could have just replaced one - so you've got a pizza with eight slices in a town of five-thousand. You could have just bought one of those slices, but you didn't. Now you added a ninth slice. Then that sixty-five-year old guy who was winding down to nothing just sold it to some highly motivated, married guy with three kids who's going to go out there and just crush it. Yeah, buying is a lot less risk. 

Speaking of buying, Gary, you're thirty-five minutes from Wall Street and you see massive mergers and acquisitions, M&A activity. It seems like every time I know a dentist who's doing three to four million dollars a year it's because over the thirty years every time the old guy across the street retired he bought the practice and merged it into his own. How come Wall Street sees so much merger and acquisition activity and cottage industry dentistry doesn't utilize that tool?


Gary: Well there are dentists that do constantly attempt to purchase a practice, but, remember, to purchase charts or a practice close by, if you want to incorporate into your practice, you're looking for something in suburban area within a five mile radius. Those doctors that are selling, generally want to sell their practice, and the equipment, and location. In a suburban area there aren't that many, so to speak, chart sales available. Maybe in Manhattan a little bit more so, but, once again, they want to sell - because a chart is going to sell for a lot less, maybe 35% of one year's gross, whereas a practice on location with equipment, you're at 65 to 72% average numbers. Again, those numbers are going up. There isn't that much readily available practices. Remember, you have a demographic situation, you can only pull so far. That's one of the issues. Well, unless you buy a satellite office. 

Howard: This industry really was started forty years ago by Alan F. Thornburg, who started AFTCO. He recommended something that a lot of people find very controversial and that is say this twenty-five-year-old Millennial wants to buy a practice. She gets her broker and then the dentist selling, she gets her broker, and then the brokers go to war. Alan said you know what, you need dual representation. You need the broker selling the practice representing the seller and the buyer. Then, of course, every lawyer in town says, "Well, that person can't represent two people. They've got to represent one." What do you think of a broker, dual representation, like AFTCO does versus each party has their own representation? 

Gary: It's very simple. I don't believe in the dual representation platform. It doesn't work because, for example, you take your contract, right? If you start working on your contract and do allocations of purchase price, 80% goodwill, maybe 10% for equipment, the higher the goodwill, it's a benefit towards the seller, the lower the goodwill is a negative to the buyer. It takes too long to pay that off as far as depreciating. You just start off with the contract; you're diametrically opposed; what's good for the buyer is not good for the seller. You have to represent one or the other. 

We are representing the seller. But at the same time we're bringing the buyer to him to meet. If the deal doesn't work out, we bring the buyer to another seller. But ultimately our responsibilities or our fiduciary responsibility is to the seller. You can't have dual representation and just as any attorney says, it doesn't work. It's either one or the other. 

But at the same time, a broker is in between trying to negotiate for both parties to move them forward. That's what we do. We get very intimately involved with the deal right until the very, very closing, which separates us from others. On the day one, we'll bring the buyer to introduce to the seller. We'll never send the buyer to see the seller alone. You can't do that. You have to be there every step of the way. 

Howard: What states do you cover? People are listening right now from everywhere. What states do you cover? 

Gary: Well we’re exceedingly busy right now. We're on the four states of New York, New Jersey, Pennsylvania, Connecticut, but we are branching out to maybe Florida and other states around the country. There is just tremendous potential out there for us and that's what we plan on doing next coming year. We've already started just change our website, but we're going to go more on a national basis very soon. 

Howard: If someone has a question in New Jersey, New York, Pennsylvania, Connecticut, or Florida, what's the best way to contact you? 

Gary: Just give us a ring or an e-mail and we can get right on it. We'll answer them. 

Howard: What is that ring number and e-mail? 

Gary: Phone number is two, oh, one, six, six, three, zero, nine, three, five. Or you could send us an e-mail at PerformDent We're changing that. It's going to be a Gmail address soon but you could use that for now. Or just call us on the phone. It's easy. We'll get right on the phone. 

Howard: The phone is two, oh, one, six, six, three, oh, nine, three, five. And why are you changing it to Gmail, just because Millennials don't know what AOL means? 

Gary: We're just changing the whole platform. I was supposed to be retired like eight years ago. I didn't know how I got into this but one thing led to another. Someone came up to me and said, "Can you sell my practice?" and we just got crazy after that. 

Howard: I guarantee you, there's three people in the world that will never retire: you, Rick Kushner, and myself. You would be too poor. You’d drive your poor wife crazy. If you retired, she'd probably go move to Rio de Janeiro and not tell you where she went. 

Gary: It's the action which will keep you alive. 

Howard: A lot of older people think should I really be contacting a practice broker, you, at or should I just call the big DSOs, like Heartland, and Pacific, and Aspen. Who's buying more practices? When you go to sell a practice, who is buying more, the big venture capital DSOs or the young dentist coming out of school? 

Gary: It depends on the growth of the practice. Right now the DSOs are interested - I'm working with a few of them now. Some of them actually pay my commission. Practices over of approximately eight - nine-hundred thousand perks their interest. Anything below eight-hundred, they're really not looking at. The majority of practices being sold are like five-hundred thousand gross or below. They're interested in those million-dollar plus practices and if the doc is willing to stay on. That's one market. They are paying a higher dollar amount also. 

You always need a broker. You need somebody in the middle. The reason why is because a broker can sense the temperature and sensitivity of the seller. He can be that person in the middle. If you go one-on-one and there's a fight, there's an argument, there's nobody to negotiate in between. And you need somebody to move the deal forward constantly, just gathering the data from sellers is so time consuming. That's one of my accountants spends a good portion of his time doing. As an in-between person, we're able to move the deal, listen to both parties, handling the issues, and handle all the bumps along the road. 

Howard: When we met thirty years ago with Rick Kushner there was Orthodontic Centers of America buying all the ortho practices, trade on the New York Stock Exchange, a billion dollar valuation. There were a dozen on Nasdaq. They all imploded. Then they disappeared for a decade. Now they're all back and not one of them could go to Manhattan and do an IPO. I mean Snapchat could do an IPO but not Heartland or Pacific. Is that a red flag to you? 

Because some of these Millennials they think this, they go, "I don't know if I want to buy a practice or start practice because in ten years," thirty years ago all the pharmacists had their own office. Now they all worked for CVS and Walgreens. A lot of Millennials say, "Are these DSOs, are they going to take over the whole market? Are we all going to be working in McDental's? Will they all be publicly traded on NASDAQ?” Or do you think the same thing is going happen to them as last time and that what goes up must come down? 

Gary: Well, first of all the majority of practices being sold, a retiring guy, most of them grossing five-hundred thousand or below. DSOs are not interested in those and they're not buying those. Occasionally they'll buy the charts, but generally those practices are being sold dentist to dentist. The majority of our sales are dentist to dentist. The large ones over a million, yeah the DSOs are involved in that market. 

How long they'll be around? It depends because if there's another investment that will return the same - they are only netting about 15 to 19%, but if there's another investment that will return a higher yield, you're going to see that private equity market switch to the new investment. I don't know what that is or when that will come. 

Howard: If it was truly a 15 to 19% return on investment, they could go to Nasdaq and do an IPO. How come not one of them has done an IPO? Why are they not publicly traded? 

Gary: I can't answer that question. 

Howard: Well, Wall Street can answer it for you. 

Gary: I think so. There is one I know. One of the companies I worked with in the past, I forget their name, they've merged a couple times, they've been around for twenty-seven years I think. They're one of the longer ones, but most of them do (00:20:07 inaudible) every five years.

Howard: Which one is that? 

Gary: They've switched so many times. I forget their name right now.

Howard: Is that (00:20:10 inaudible), Interdent?

Gary: I don't recall because it's only been that last six months that I'm starting to work with them a little bit more now because I'm so engaged with the private practitioner buying another private doctor's office and that takes up the majority of our time.

Howard: What are buyers looking for when they're buying a practice? If you're an old guy like me listening to you, because some of these old guys think, "Well, if I want to sell my practice, should I invest in digital X-rays or upgrade or this or that." If you're a young person, a lot of the young people listening to you are just saying, "Well, Gary, what should I be looking for in a practice? What are fundamentals where you think - I'm twenty-five, I want to get married, have two kids like Gary so I'm going to be here for forty years." What should they be looking at or looking for?

Gary: Well, the primary thing obviously is going to be cash flow. If the practice doesn't cash flow, there isn't enough net profit, the banks are not going to finance it. It should be cash flow, but a lot of the younger dentists are really focused on - they are focused on location, equipment. Everybody wants digital. Everybody wants digital X-ray. Everybody wants computerization. Those are one of the primary things they look for. Is it have a modern look to it? Are they computerized? Are they digital? That's some of their main focus initially. 

But then they get into reality when they speak to their accountant and they deal with the bank, it has to be enough cash flow. Nowadays what will happen even before they see a practice, they want to see financials. That will be your tax returns, profit loss, discretionary expenses. It's going to be the lease. It's going to be the payroll. Their accountants and their team is looking on the cash flow very clearly to see where they're going to be and how they could grow in the future. But a lot of them are also swayed by a beautiful looking office with incredible equipment and totally that they don't have to renovate. That has a factor to it. There's a couple of different issues that will go through a buyer's mind. But location, nobody wants to travel too far. 

Howard: Okay, but when you say location, if you go to and hit the old hamburger symbol, the three line hamburger things, one of them is Townie perks. One of the perks we offer is a demographic deal, REALscore. Do you - and there's another one out of Utah. There's only two people doing demographics, REALscore and Doctor Demographics, out of Utah. When you say location, location, location, do you recommend that they spend a few hundred bucks and get a demographic profile of that practice they're looking at? 

Gary: Oh, they should get a demographic, but the average suburban practice is generally just pulling in from about three to five miles away. Manhattan and city, much less than that. They should get a profile of the practice. They are acutely reviewing all data on the practice before they sometimes will see it the first time. Their accountants are reviewing it. Their bank is reviewing it. They're reviewing cash flow and demographics are important, but nobody really wants to travel too far. 

Howard: You keep saying cash flow but when they're in dental kindergarten, they don't know what cash flow means. What does cash flow mean? Explain that to a twenty-year-old kid in dental school. 

Gary: Cash flow is going to be the net profit of the practice after you have removed all the discretionary expenses. What are you going to wind up with in your pocket? That will vary among practices. We have a practice now that it's like, I don't know how we're going to sell it. He's spending 23% percent of his gross income - he's doing about two point eight million. 23% of his overhead is going to advertising. 

Howard: 23%? 

Gary: That's off the boards. It's off the boards. We thought it was discretionary that was thrown in there. It's not. That's what he's spending because he's not doing a typical return on investment of what those advertising dollars are bringing in. That is a very difficult practice to sell for us. Again, we say cash flow, everybody looks at it and say wait a minute, there's hardly any money left after we've finished paying for that. Where is he should be paying maybe 3 to 8% for advertising; he's paying 23% percent. Hard to sell that practice. 

Howard: Go through that. When you're looking at dental offices, what should they be spending on advertising, labor, rent, the overhead, supplies? 

Gary: It depends. Now Manhattan (00:24:48 inaudible) your rent is going to be a lot higher. But rent 5 to 10% of your overhead. 

Howard: Well, 5 to 10%, that's a huge swing. You're saying 10% Manhattan and Downtown San Fran, but 5% everywhere else.  

Gary: Right, you (00:25:03 inaudible) to suburban you want it closer to your 5%. Then you get labor costs could be 18 to 25%, in that range. Advertising 3 to 8%. But that's a big area that people don't spend enough money on is advertising. I find it's one of the biggest faults that people don't allocate enough money is to advertising, a young practitioner. They're so focused on a digital pan.

Howard: So rent, 10% if you're in some huge metro like London, New York, San Fran Downtown. 5% you're suburb/rural. Labor eighteen to twenty-five. What's the highest you've ever seen in labor? Are most people within that range, eighteen to twenty-five, or are a lot of people outside that range?

Gary: Twenty to twenty-five. Now when you have an older practitioner that's been practicing for thirty-five years, it's going to be escalated. His salaries are all escalated because they've been there so long. 

Howard: Right, how high is that escalated labor?

Gary: We're talking 30 - 32% sometimes.

Howard: I just wrote a column on that. It's called “Legacy Staff.” These dentists don't understand that they started thirty years ago when they would submit a crown to Delta for a thousand. Delta would just pay half. You submit a root canal for a thousand, they paid 80%. Now they've switched it around where now they're sending you the fees, but you gave your staff a dollar raise every time the Earth's went around the sun and every time the earth passed Uranus you gave them another dollar. 

You go in these practices you're like, “Okay, your dental assistants making $30 an hour and I could replace her in four minutes for fourteen.” You just got to go to your staff and say, "Okay, look it's 32%. Here's all your wages if we get that down to 25%.” Then they're all emotionally upset and then they're butt hurt and they're all mad at. 

When I talk to these DSOs, you're exactly right. They want bigger than a million because they want two doctors and there's an insurance policy, so if one waxes out, they've still got another one. They don’t have to close shop. Number two, they want the doctor to stay on. Number three, if they have to give all your staff members a decrease in pay, they'll pass on the practice. They'll say you're the founding father, you go fire all these legacy staff people that are from another - they're still back in the "Happy Days" and "Big Valley" and Fonzi and they don't realize dentistry ain't that way anymore. It's PPO land. What do you do when a doctor calls you up and says, "Sell my practice," and he's an old fart with legacy staff and he's got 32% labor? 

Gary: Well, that's going to come up to the - again, where the money is going to come from is from the bank. The bank’s going to make comment about that. The buyer’s going to have to have some level of comfort. But then you have a situation, the connection to the patients is the staff. The old patients, that connection is your staff. You're kind of locked in right away. 

Occasionally, I'm seeing some of the senior staff members work a few less hours. They're open to it. That eases overhead. But a lot of these doctors are increasing their revenues 20 – 25% in the first year, if they do their marketing advertising, work the extra hours. The revenues are going up and they've been successful in trying to maintain the staff. Other times, some of the staff members are more senior and they move on after a year, so the salaries will stabilize and normalize. 

Howard: okay, well, you just said it was important that if I'm a young twenty-five-year-old and I go back to Salina, Kansas and buy this practice, the staff have been there a long time and you see value of keeping them on, correct?

Gary: Yes, you've got to keep them on.

Howard: You’ve got to keep them on even though they're all paid too high. But how long should the doctor stay on? Some people say I want the doctor to sell to me, give me the keys and leave. Other people say I want you to see all the recalls one time and you introduce me to all the recalls one time for six months. What are your thoughts? You want the legacy staff to stay on, even if they are highly overcompensated. How long do you want the selling dentist to stay on? 

Gary: Well, that's going to depend on the cash flow of the practice. If you're buying a practice that's only grossing three-hundred thousand, you don't have the financial room for two practitioners. Unless the practice skyrockets right away, there just isn't room. However, if you can focus and you should be focusing on the growth of the practice ahead of time. Websites and everything should be set up ahead of time not after the practice is purchased. There's not enough financial room to keep that doctor on, unfortunately. Yeah, it would be great if he’d stay on for a long period of time, introduce to everybody, but what’s he going to do? Sit there all day, one patient at a time. That's where the staff is key. 

Remember, the doctor is only one component of this purchase. You have the front desk person, who the patient meets for the first time, who have known them for ten - fifteen years. You have the hygienist. You have the assistant. There are familiar faces there. You can get by without the doctor after a period of time. But if the practice is grossing enough, at least seven-hundred thousand, there may be room to keep him on part time, keep his name in there and it does make it a bit easier. Plus there's always something to learn from him. 

Howard: Gary, I know you're a humble guy but you are a freaking genius advertiser and you were advertising back when it was taboo. When I got out of school I got in trouble by the Arizona Dental Association because I took a full page ad out in the Yellow Pages. In fact, it got me a free dinner from the executive director telling me, “Well, if you had prostate cancer, would you pick the oncologist out of the Yellow Pages?” and all this stuff like that. But what is advertising - when I started it was Yellow Pages. Again, to the listeners, I've known Gary for thirty years. Ask Rick Kushner, who has three-hundred Comfort Dentals, Gary is a genius advertiser. What's working in advertising in 2017?

Gary: Well it depends on your market. For example, New York City, Zocdoc works quite well. However, you go to the suburbs of New York, Zocdoc doesn't perform as well. Certainly with Google, Google advertising, Google AdWords. However, that's getting extremely expensive. In Manhattan right now, an attorney could pay up to $50 a click. It's gotten very, very expensive. But the beauty of Manhattan, for example, you have density there. 

Ultimately, people make a decision based on gut feeling. You can just go out into the street and meet people. There's still a market for that. But certainly it's Google AdWords. It's Google advertising. There's so many. It's all internet and website is about 85%. I think that's where most of your money is going, it's on the internet, about 85% of your dollars. But it's getting so expensive. 

Howard: Do top down, what would be your number one return on investment in advertising? 

Gary: Again, that's more of the back end of it now for the dentist because once I sell that practice they're more involved in it and I don't get as involved in that to see where the patient flow is coming in as and if they're spending enough. A lot of them still don't spend enough on advertising. 

But it’s some type of Internet base. Your website is key. The website is going to bring the people in. There's still a small percentage that you can do with direct mail, a small percentage. People who are so far away from direct mail, there are very few people doing it now. But it may be a small percentage of your advertising could go in that direction too. But meeting people direct, face-to-face, all the business owners and so forth because choosing a dentist can be an emotional connection. On the other hand, it's the PPOs. Some dentists are just joining all the PPOs, bypassing the insurance. 

Howard: What do you think of that strategy, joining all the PPOs? 

Gary: I'm not a firm believer in it because once you do that, you get very comfortable with having your chair filled with PPO patients. You have no empty slots. You're working, and working, and working and you have 25 to 30% less. You begin neglecting your marketing or advertising. I know someone doing that right now, 95% of their office is PPOs because it was easy to sign up, your chairs are filled, but your crown fees are 30 to 40% less. It's crazy. I have practices in Manhattan that are still fee for service. There's a number of them, believe it or not, that are fee for service and are doing exceedingly well. 

Howard: What’s your definition of fee for service? A lot of doctors say “I’m entirely fee for service. I don't take any PPOs.” I’m like, Really? You don’t take Delta because if you go to Delta's website they say 95% of all the dentists in every state take Delta and Delta gives you the fee schedule so isn't 95% percent of all the dentists technically, legally on a PPO?” 

Gary: A true fee-for-service practice has no insurance accounts receivable. That's what a true fee for service dental - I have one like this in Manhattan. 

Howard: So you mean I go to you, I pay for the crown and you give me the super bill to send off to the insurance? 

Gary: That's right. They're not involved in it. They'll help you. They'll assist you, but they don't have an accounts receivable in insurance. That is a true practice. But a lot of them that do say they have fee for service maybe will accept one plan like Delta Premier. That's about it. There are still a few of those around or you have a practice that the doctor’s accepting the only fee for service. He may have an associate that is on one of the PPO plans. 

Howard: Yeah. Now there are some big lawsuits going around some of these states because now some of these state insurance companies are saying if you're not network and I go to you and you give me a super bill to bill the insurance and they'll (00:34:48 inaudible) me, that they're not going to do that. 

Gary: Well, you’re getting locked into the insurance companies. That's the problem. Most of the young people feel the only way is to join the PPO and their chairs are filled, but then, think about it - I think it was a year or two ago, Delta reduced their fees by like 4% and then 7% the next year. You're locked in and you never spent the time or the marketing efforts to build your practice. As you’ve always said, the insurance companies are feeding you fish, whereas you really should be going out and getting fishing poles. 

Howard: Well, what I never understood is a dentist will not spend 3 to 5% of collections on advertising but then someone will send him a PPO plan, where the fees are on average - the average PPO fee is 42% less and you'd say, “Hey, do you want to spend 3 to 5% on advertising?” “No.” “Do you want to do dentistry 42% cheaper?” “Sure.” It's like my god, 42% - what do you think the average dentist spends on marketing? 

Gary: They’re probably like 2 – 3%. Very little money. It's the first thing they cut back on. 

Howard: I would say it's three for anybody that's even just remotely trying. They'll take 42% as the average PPO reduction price. Forty-two divided by three, fourteen times lower. Advertising is a fourteen times better investment. Advertise, advertise, advertise. I want to throw in something. You like Google AdWords? What do you think about Facebook? 

Gary: Facebook is really coming along. If you get into Facebook with the video, it's going to be a lot cheaper than Google. Google AdWords is really placing themselves - it's crazy. It’s $50 a click for an attorney in Manhattan. It's gotten crazy. It's not cost effective. In Jersey here, I think, I sold the practice, they were going to charge him $15 a click. It's just not cost effective. He’s just not doing it. 

Howard: I want to say one other little caveat though. Thirty-five-year-old Millennials who do yoga three times a week usually don't get all on four implant cases, but my buddies that are all doing three to five million a year in an implant practice, direct mail to people that are over sixty-five is still their whole gravy train. The orthodontist who are targeting kids in high school and their young, yuppie mommies, Instagram is killing it the best. 

I think everybody should be really going into Instagram because I'll tell you what's going on. Right now the average organic feed on a Facebook post is 6.5%, so if you make a post on Facebook and your dental office has one-hundred people following you, only six (00:37:37 inaudible) are going to see that. The only direct feed still in existence is Instagram, LinkedIn, and Twitter. 

You know Mark Zuckerberg paid a billion dollars for Instagram and you know he's going to change that to pay to play and get rid of the direct feed, but he's not doing it until Snapchat is dead. Snapchat went public and Twitter and Snapchat, their trading prices is half what their IPO price is. But he does not want to screw with the golden goose laying the golden egg, Instagram, until he is absolutely positive Snapchat is going to go the way of MySpace and Friendster. 

Right now is the time where - I got fourteen-thousand followers on Instagram. I make a post they all see it. I got twenty-two thousand on Twitter. I make a post of this podcast, they all see it. LinkedIn I’ve got thirty-six thousand, make a post, they all see it. Facebook, I’ve got three-hundred thousand followers. I make a post only twenty-thousand will see it. If I give them one-hundred bucks, they’ll only bump that up to maybe - if I give them $300 on this podcast we’re doing, they’ll only bump that up to maybe fifty-thousand of the three-hundred thousand. If I want all three-hundred thousand of my Facebook friends to see this podcast you and I are doing, I’ll have to give them a grand. 

I'm saying, if you've got an implant practice, direct mail. You've got an orthodontic practice, Instagram. This is probably going to be the last year where Instagram is just a low cost, free gravy train. 

Howard: Hey, Gary, young kids one of the ways they're different than us is they're going to live forever. I’ve got one foot in the grave and one in a crematory and one reaching to the electric chair belt. But you always talk about how they never get adequate disability, life insurance, overhead insurance because hell, they’re only twenty-five, dude. They're not going to get pregnant. They're not going to get an STD. They're never going to get injured. They’re never getting in a car wreck. Talk to young kids about the importance of disability, life insurance, overhead insurance. What are your thoughts on those? 

Gary: If you’re going to focus on anything before you buy a practice, you have to understand the concept that tomorrow, tomorrow, you could be uninsurable and you can't get life insurance, disability, overhead. Can't get it. Nobody can think that way because they think they're just invincible.


Out of dental school for whatever reason, I got crazy about insurance, disability insurance, life insurance, got the maximum I could. Back then it was easy to get life insurance. You didn't even need a blood test. Under a million, you didn’t need a blood test. Now it's changed radically. Disability companies are far less than there have ever been. They've cut back on that and they don't even have the lifetime disability anymore. That's been cut out. Most of them end at sixty-five, seventy. You can't buy lifetime disability that I'm aware of, anymore. 

One of the biggest mistakes the young practitioner makes, he's so focused on the practice, the digital X-rays, the computerization of the practice, he's so focused on that, he's not thinking about marketing, advertising, and definitely not thinking about disability, life insurance. 

Luckily, the banks force you to have some life insurance before you buy. But most doctors should get the maximum life insurance they can, right now, even if it's a term renewable, make sure it's renewable for a lifetime or you get the permanent insurance. Either way, maximize your insurance even though you may not have the funds for it, disability, life, office overhead.

And in every aspect, if you own a house, get personal umbrella right away. That would protect your car. Your biggest lawsuit is going to come from a car accident. That could cost 2- or $300 for a few million dollars of umbrella. Go out, find a great insurance agent, maximize your insurance, so important. 

Howard: I was lucky when I was young, I met some older dentists who had a bunch of boys. I have four boys and - their boys could run a red light drunk and T-bone a family of six penguins and a nun and it could go for millions of dollars. 

Gary: Oh yeah. 

Howard: Once you start having things like that - a big umbrella, especially if you have four kids. I don't know what happened to my four boys because I'm completely normal and all four of my boys are crazy. 

Gary: Great boys.

Howard: Ryan, how did that happen? Another thing you talk about is slow buy in transition, not recommended. What do you mean by that? 

Gary: It's a partnership. It is not going to work. I'm not a believer in it. 90% of these dental partnerships I see will fight. It may not be the two dentists fighting, but it could be the spouses or the cousin or the unemployed brother. Who knows? I don't believe in the slow buy in. 

First of all, a dentist cannot predict exactly a seller, when he's going to be financially comfortable to sell because things change. You can't predict the financial future. It's either sell right now or just wait or if you want to continue to work, then let the buyer purchase the entire practice. Buyer owns the entire practice, you, as the seller, become the employee. Now the buyer is in control. 

This slow buy in or I’ll buy 20% and then I'll get vested after three years, I've seen so many instances the seller after being vested, everything is iron clad contracts, says, “I'm not going through with this deal. It's off. Sue me.” The other practitioner has to initiate a lawsuit, five thousand dollars to start; he’s not going to do it. I don't believe in the dental partnerships at all. 

Howard: Okay, Gary in thirty years of you doing this, what percent of partnerships fail because of whatever, they divorce at the end? 

Gary: It's about 80 to 90% will fail. 

Howard: I know. This is where the Millennials - this is where you don't understand these throwaway magazines you read, where so many of these articles are printed because the same company bought an ad. Shit, it's right next to the article and I don't do that. All these Millennials read these messages from all these people selling partnerships and here we'll do your partnership. 

It's just like marriage. Half the marriages fail. That's when you're having amazing sex. You have children. You're celebrating Christmas, and Hanukkah, and Easter. You have all these social glues of everything that a marriage could bring and it fails half the time. Now you're going to marry some geek dentist who got an A in calculus and biochem and it's just going to be happily ever after. Are you out of your freaking mind?

When dentists tell me their blues about their partner, I always say, “Yeah, but at least you're getting great sex from the partner, right?” They’re like, “What? No, of course not. He's a man. I'm a man. What are you talking about?” Well, dumb ass. I mean a four-year-old could have told you not to get married to someone you don't have sex with. 

There's got to be an org chart. There's got to be a four-hundred pound - a partnership will only work if one has 51% and one has 49. Buck's got to stop somewhere. You got two four point oh’s from biochemistry class and one wants to go into cosmetic practice and buy a CAD/CAM and one wants to go implant and all. 

Here's the most confusing thing to a Homo Sapiens that goes all the way back to Homo Erectus and (00:45:27 inaudible) is that the greatest religions have one God. They’re monotheistic. When you're a dental assistant and one of your doctor gods is saying go right and the other one is saying go left, the staff is always confused. Then you start splitting the staff because this assistant agrees with Dr. A. and this one agrees with Dr. B. It's just total confusion. 

The only time group practices work is when one doctor is an alpha bull male and owns 51% and other people are employees. Someone's got to call the shots. You look at the NFL. They have one head coach. They don't have two. They don't have five. Except the Cleveland Browns, they didn't win one damn game.

Gary: If you want somebody to be a companion in the office, you don't want to be alone, hire an associate, grow your practice, have an associate. That is one of the key things. Get the associate in there. Grow your practices. I always did that. I never had a partner. I had great associates. For me it worked out well, all three practices, it worked out great. 

I don't want to get in an argument with anybody. Yes, I'm always moving. I’m always shaking. When I want to take vacation, when I want a write off, what equipment I want to buy, everybody's different and you're going to get into arguments. It will happen. 

There's one attorney, a firm I know, that have an attorney in the firm, all he deals with (00:46:51 inaudible) is formation, but more so the split up of medical and dental partnerships. That’s all he did.

Howard: Oh my God, I want a podcast him. What's his name? 

Gary: It’s Dennis. Dennis Alessi I think his name is. But I will get you all the information. I worked with him several times. Every time you have another partnership break up, time to call Dennis. 

Howard: Off the top of your head, you don’t remember his name?

Gary: I think it was Dennis Alessi. He works with Mandelbaum and Salsburg. 

Howard: A-L-L-E-S-I.

Gary: I think (00:47:22 inaudible) A-L-E-S-S-I. He works for Mandelbaum Salsburg, but he works in conjunction with Bill Barrett, who's a very good dental attorney. By the way you've got to have the right dental attorneys putting these deals together. You can’t have your friend, your cousin, your general attorney. You want to put the deal together, it's the right team, the right accountants, the right dental attorney. There's not that many. 

Howard: It's so sad because they're so adorable. This is the one I get the most, “Well the attorney was from my Mormon ward and we went to the same church.” It’s like, okay, I'm sure he's a great guy, but has he done fifty dental offices. Just because he sits next to you at church, doesn’t mean he knows anything about dentistry. 

Then the other thing - confusing emotions these young kids because they believe in democracy and they don't like totalitarian dictatorships like Singapore, and China, and Russia. But free enterprise is efficient because it's a totalitarian dictatorship. Everybody's always like, well, why is government so messed up. Because it's a democracy. Nothing can get done in the government. The reason free enterprise can crush it is because Steve Jobs can say, “No, we're not doing that. We’re doing this.” In a dental office - able to take a business and say we're going to make a right turn at the next intersection requires a totalitarian dictator. But you get to the intersection, you got four partners and one is saying, “Well, go straight. No, go left. No, go right.” It’s just crazy. 

Democracy doesn't work. There no evidence that even democracy works. The fastest growing economies in the world aren’t democracies: Singapore and China. You look at the twenty great democracies, they're all in their maximum debt they could borrow. They’re in the maximum - we're twenty trillion in debt with fifty-six trillion in unfunded liabilities. Basically the only thing democracy votes for is we're not going to vote, we're not going to make a decision, we're not going to work, and we want everything for free. It's very, very likely that a hundred years from now or a millennium from now you're going to have no democracies. 

Gary: Yeah, it’s (00:49:44 inaudible). I didn't want to forget, if it's okay if I can mention it now. I often call hundreds and hundreds of dental offices. We talked about advertising. It hasn't changed in how many years, answering the answering machine of these dentists, I can't tell you how many dentists on their answering machine say if you have an emergency go to your local hospital. It's like what you are you doing? Go to your local hospital? A lot of them will say if this is a real, true dental emergency, only then, and if you're a patient of record can you call our doctor. I'm like, what are you doing? 

Talk about advertising/marketing. This has not change as far as I can see in the last fifteen years. As soon as cell phones came about, we answered that phone twenty-four/seven because of that we got some great emergencies. A lot of them waste your time, but there's also some great ones. But it's just unbelievable what they do nowadays. They don't want to answer the phone. 

Howard: You know what I did when I was little? Gave every patient my business card, which then had my home phone number on it. It had the office and the home and now it has the office and the cell. But whenever they would call home, I live three point zero miles from the office, had four boys and I’d always say to the patient, I’d say, “Well, you live in Ahwatukee?” They’d go, “Yeah.” I’d say, “Okay, I’m going to I'm going to be at the office before you are.” Then I'd say, “Boys, daddy has an emergency,” and they would run for the SUV. We’d jump in there and go down there. Eric would put on the patient bib. Then when we were done, since we all did good, we'd go to Dairy Queen and get something that promotes diabetes. It's just called old-fashioned hustle and answering the phone. 

Gary: Of course now with the PPOs, it may not be worth it for some of them to come in but then it runs to the fact well, why didn't have more fee-for-service patients. 

Howard: I can’t even list all the patients who still say to me I’ll never forget - man it was Thanksgiving and you showed up with Eric, Greg, Ryan, and Zach. You're only in there for ten minutes. I mean god, you're only in there -  and it's some emergency. What is it? Pen VK, Vicodin, (00:51:54 inaudible) temporary. 

The only one that – I swear to god when she was done, I swear to go she just loves me so much. It was Thanksgiving and she was cleaning her dentures, she dropped them in the sink and it split. She had a house full of family She was mortified. She was calling from her bedroom. I said just run for the car, cover your mouth and I’ll be at Today’s Dental before you. 

Gary: There you go.

Howard: I went in there and just did a denture repair. Oh my god, that was the most lifesaving event for this little old lady. (00:52:27 inaudible)

Gary: She’ll tell so many people. 

Howard: Another thing - they’re thinking I'm going to sell my price. I'm going to get a half million bucks. Well, government taxes are due upon that at sale and if I buy you that practice for $500,000, now I got this big old asset. Talk about the tax implications because what Americans always say incorrectly - they always say the most money a person will ever spend is on their house. The second is in their car. Both of those are bullshit. The average American's number one expense in the twenty richest countries is taxes. The average American will spend twice as much in their lifetime on their taxes than they will on their house and their car combined. Talk about tax implications of buying and selling a dental practice.

Gary: Certainly. When you sell the dental practice, the sale price has to go through allocation. There’s allocation of sale price. Historically, it’s somewhere between 75 to 80% percent for goodwill. That goodwill, that doctor is paying capital gains at 20% on that. All right? The seller doctor wants as high a goodwill percentage as he can get because essentially the practice is the patients. Next it's going to be equipment, leasehold improvements, equipment. You’re at around 10%, somewhere around there. That is ordinary income. Now that Trump has reduced the taxes, it will be a little less but that will come in as your ordinary income be it 25, 28, 30%, whatever it is, that portion of the sale, which is going to be equipment, is going to be taxed at ordinary income to you. 

Therefore the seller, wants that price for the equipment as a low number, wants his goodwill higher. For the buyer, he wants a higher equipment. He could rapidly write that off and wants a lower goodwill. That's why this whole thing of dual representation is ridiculous because what's good for the buyer isn't for the seller. They have different percentages how it can, tax wise, benefit one or the other. When it comes to the sale, that 20% is the majority of the practice. 

Howard: I want to tell you, this Trump tax deal, Dentaltown - there is a thread on Dentaltown that's fifty-nine pages long and there are some major league CPAs weighing on those things. But the last time – fifty-five – the last time I saw a major tax change was with Ronald Reagan and it was with Tip O'Neill. Reagan talked about it all through his campaign. He got elected in ’80. I don't think they passed it until ’86, ‘87 and it was massively changed. But if you want to read about what's going down on all this stuff go to Dentaltown, download your app, just put in keyword search taxes and it's called “New Tax Plan: What Does it Mean to Dentists.” 

But my dad used to always say the easiest dollar earned is a dollar in expenses saved, the second easiest dollar earned is a dollar in taxes delayed, but the hardest damn dollar you'll ever make is it go do another dollars’ worth of business by drilling and filling crowns or my dad's business making more Sonic hamburgers or cheeseburgers and onion rings.


It's one thing to be dumb in sports, or music, or Trivial Pursuit, but god, you don't want to be dumb in taxes. It’s your number one damn expense. You’ve got to be smart. If you're going to be smart anywhere, be smart in taxes. I'd rather you overpaid for your house and car and underpaid on your taxes then got a really good used car and a really good used house and you're just throwing away money at your accountant. I know dentists that just go to the local chain accounting deal up the street. It's like are you out of your mind. The tax code is what? Six-hundred thousand pages. By the way, do you know any tax experts on this new tax plan? 

Gary: Well there's so many - most of the accountants will be on top of it if you get an aggressive, younger accountant. But even the senior accountants, they all have the bulletins that come out. 

But an important point you mentioned about accountants. You need the right team, the right dental attorney, the right dental CPA. I know some dental CPAs that are outstanding. They have two-hundred and fifty I think dental clients, so not only do they know the tax implications of all these dental transactions when we sell, they also have a comparative yardstick against their two-hundred fifty dentists that they represent. They know what's going on. 

When you do choose an accountant, it would be great if you have an account that has some level of dental experience because that accountant can look at his other dentists and do a comparative analysis, see where you're spending, where your percentages are, and so forth. That's very helpful. 

Howard: Who’s your favorite dental CPA firm? 

Gary: There's a great team there called LLI Advisory. They're out of I believe Cranford, New Jersey.

Howard: LLI Advisory. 

Gary: They’re in Cranford, New Jersey. I think it’s (00:57:45 inaudible) and Gerry Iacovano, but they’re great guys. 

Howard: How many dental clients do they have?

Gary: I think two-hundred and fifty-two. 

Howard: Wow, that's amazing. 

Gary: Yeah, they're (00:57:57 inaudible).

Howard: The density of where you live is amazing. When I go lecture in New York City, when you fly out of LaGuardia or JFK, it's solid lights for an hour and then once you cross that Mississippi River, you can go an hour without seeing a light. When I'm flying into Phoenix from Chicago, the next time I’ll see light is maybe Kansas City, and then Albuquerque. From Albuquerque to Phoenix, that's an hour of just like you're on the dark side of the moon. It's just amazing. 

Gary: Life in Manhattan is incredible. In fact, we had a professional networking organization I belong to, and we were out in Manhattan about three weeks ago on a Monday night. They took over the entire restaurant. It was two levels and the bar. It was packed on a Monday night, had to be five-hundred people in there. It was just incredible. There is nothing like the action in Manhattan. Next time you come out, we have to go out, party a little bit. 

Howard: Yeah. I love it. What will my homies find if they go to your website, What are they going to find on that website? 

Gary: Well, we have on their listing in four states right now. All of our active listings are there. Our testimonials, of course, which really speak about how hard we work, and how engaged we are as brokers. In addition it gives a little bio. I think we have a small blog on there, advice for sellers. 

One of the biggest advice for sellers is please get the data organized. It takes so long for sellers to deliver data to us. Every buyer has this problem. Sellers take forever to deliver their tax returns, profit and loss, procedure code analysis, pay role, rent, lease. It just takes forever. We have a little thing on there about that. I think we mention also what a seller should do to be prepared if they don't have a computer. Not having that data will affect the practice sale. There's some manual things you can do to prepare for that. 

You have a variety of different information. Information is on there. Contact information to us. We answer the phone three-hundred sixty-three days a year. We just take off Christmas and Easter and twenty-four/seven.

Howard: That's because we’re old school. My boys are always telling me, “Dad, you work too hard, you work too hard, you work too hard.” You’ve got two twenty-year-old kids. I’ve got four kids in their twenties. Are we just old school where you just work yourself blind? Do your two twenty-year-olds work as hard as you do?

Gary: They own their own business, but they still are working all the time. I’m Armenian and everybody was self-employed in my family, my father, my brother so I got accustomed to it. But perhaps I like the action. I don't know. Last year I was in New Zealand and I took a call. I'm on the cruise ship. What's the big deal? Take a phone call. Speak to one of the clients. Then I go back to (01:00:53 inaudible) where they’re having a party. It's not a big deal. 

Howard: I can't think of too many things I'd rather be doing than taking a phone call or an email from a dentist. I just love it. I love dentists. They’re cool. Think of all the other businesses that your customers would be a pain in the ass, but all my customers, all my homies, they’ve got eight years of college. They're a doctor. 90% of them own their own business. They're usually doing a million dollars a year. Who do you want to talk to? Your crazy aunt Charlene. I'd rather talk to a dentist than 90% of everyone else I know.


They're just interesting people and they're very well-read. I have never spent the night in a dentist’s house, who didn't have at least a hundred nonfiction books in his library that he's read. Then if they're not a dentist, physician, or lawyer, there's no nonfiction. It’s like “Fifty Shades of Grey” and “People” magazine and they’re watching Oprah. It's like can somebody kill me right now. 

Gary: Yeah. One of the other areas we didn't touch on, I’d I just like to mention it now, a shortfall of some of the younger dentists. Especially now with YouTube, the information on YouTube, small business advertising, everything about finance, about insurance, it's all on YouTube. But you go to the supermarket, the number of people that have an earphone on, I listen to hours and hours and hours, probably over twelve-hundred hours a year just on YouTube about success stories, motivational stuff, nobody's listening. I don't see it. If you go to the supermarket, nobody has an ear phone on, unless listening to music. Nobody's listening. 

You could increase the capacity of your brain to such a high percentage if you would only listen. I used to listen to you, Rick Costner over and over again on the audio and it was great. The practice management, If you want to take it to the next level, the answers are there. 

Howard: Ryan, what's the name of my YouTube channel? Mine is Thank you for the – what do we have? Seven-thousand subscribers. That's why I don't do – the typical podcast is sound only on iTunes. I go to this great length to do the video because number one I just want to see the person I'm talking to. I'm feeding off the energy of your amazing, gorgeous face. Subscribe to my YouTube channel it's Yeah, YouTube is amazing. I got to tell you – 

Gary: (01:03:29 inaudible) yesterday.

Howard:  I've got to tell you two freakish YouTube stories. Talking to a kid, a patient, he works on Air Force engines on these planes that are - imagine how expensive these Air Force planes are. He says the Air Force manuals were written for this plane when they were designing it two decades ago. Every mechanic in the Air Force, if you're trying to fix a tank, a jeep, or load a missile onto a plane and you're stuck, you just open up YouTube and you say, “How do you put the screw in the L45 on a F16 fighter jet?” There's some kid, maybe stationed in another country, who did a two minute video. 

Then fast track a year before that, my car finally gets a flat where I have to change it. The tires (01:04:21 inaudible) and here I’ve got nine years of college and I’ve got two of my sons and nobody can figure out where the jack is or anything. What do we do? Go to YouTube. How do you change a tire on a Lexus L450 or whatever the shit and there is a video not made by Lexus, just made by some human. The minute I saw it, like oh, there's where it's at. Oh, that's how you do it. Yeah YouTube is just amazing. I'm totally addicted to YouTube. 

Gary: All the (01:04:53 inaudible) of success are there. They've been written about or they've been lectured about but people don't take the effort to read it. I'm talking about hours and hours and hours of listening. You just do it in your spare time while you’re (01:05:04 inaudible) around the yard. They don’t do it.

Howard: My buddy, Jared Pope, decided he wanted to learn how to place implants, but he didn't know what implant institution he should go to. Every night after he went for work, he’d put on his headphones, went to YouTube, and Googled dental implant surgeries and would watch like an hour every night. Within like three or four months he was doing all of his implants, fancy surgeries, every single thing. He never even went to – he didn't have to buy a book or go to a course. He's an amazing clinician and he learned all of those implants on YouTube. 

But Gary, I can't believe we went over an hour. It’s an hour and fourteen minutes. Love you to death. Thanks for - I told all four of my boys today that I was going to podcast you and they just screamed and giggled and laughed. They’ve known you since they were little puppies. 

Gary: They were so cute. 

Howard: Thanks for educating me so much, Kushner so much. Kushner still talks about your genius advertising from back in the day. I just saw him a little while. Next time you’re in Phoenix, I'm in South Phoenix, Ahwatukee, where the poor people live, and Kushner’s up there in North Scottsdale, where all the rich people live. Next time you’re down, we will have to do dinner. 

Gary: No question. Look forward to it. Thank you for taking the time. 

Howard: All right man, I hope you have a rocking hot day and thank you so much for coming on the show today. 

Gary: Thank you, Howard. 

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