Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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953 Production and Collections with Jeff Palmer & Thomas Bursich, DDS of Case Acceptance Academy : Dentistry Uncensored with Howard Farran

953 Production and Collections with Jeff Palmer & Thomas Bursich, DDS of Case Acceptance Academy : Dentistry Uncensored with Howard Farran

2/20/2018 9:28:58 AM   |   Comments: 1   |   Views: 402

953 Production and Collections with Jeff Palmer & Thomas Bursich, DDS of Case Acceptance Academy : Dentistry Uncensored with Howard Farran

One of the nation’s preeminent experts in the field of dental treatment plan acceptance, Jeff Palmer Founder of Case Acceptance Academy, understands the subject from all angles. His revolutionary methodologies for improving case acceptance aren’t based on mere theories, but years of hard-won experience. Because he has worked as a sales person, a dental management consultant, a dental office manager and also a practice owner, he’s had to apply everything he teaches in the real world, and get real results.

VIDEO - DUwHF #953 - Case Acceptance Academy

AUDIO - DUwHF #953 - Case Acceptance Academy

Howard: It is just a huge honor for me today to be podcast interviewing Jeff Palmer,  from the Case Acceptance Academy and sitting to his right is Dr. Thomas Bursich and my gosh, this is going to be so fun. One of the nation's preeminent experts in the field of dental treatment plan acceptance.  Jeff Palmer, founder of Case Acceptance Academy, understands the subjects from all angles. His revolutionary methodologies for improving case acceptance aren't based on mere theories, but years of hard won experience. Because he has worked as a salesperson, a dental management consultant, a dental office manager, and also a practice owner, he’s had to apply everything he teaches in the real world and get results.  And sitting next to him is Dr. Thomas Bursich, who is a Pittsburgh, Pennsylvania native and a huge Steeler's football fan. He graduated from Duquesne University Pharmacy School and after successfully operating pharmacies in the late seventies and early eighties, he went back and attended the University Of Oklahoma School Of Dentistry and graduated in '84. He currently practices in Sterling, Virginia, all facets of general dentistry from simple extractions, root canals, crown and bridge and implants and Invisalign and veneers. Dr Bursich has been the main contributor of Case Acceptance Academy from a clinical applicant standpoint.  Dr. Bursich is a very personal, highly skilled clinician with a down to earth chair-side manner that has helped him build two successful practices. These skills have been engineered into the case acceptance system making predictable results possible for the dentists across the country. And I wanted you guys to come on this show so bad because so many times people are always worried about the wrong thing and when you look at the data for just decay, just cavities show up on bite-wings, only 38% of diagnosed cavities get drilled, filled and billed and what's the dentist's question. "Well what bonding agent do you use? What composite do you use?" "Dude, you don't even remove the decay two out of three times." You'd be twice as good of a doctor if you could do two out of three cavities instead of one out of three. And you know I got four kids and four grand-kids. I don't want my grand-kids going to some dentist that can't even convince them to get their filling done. I mean, and then I'm in so many dental offices where they'll be in a medical dental building and there's four dentists in there and the average dentist is doing seven-fifty collection, taking home a buck seventy-five and then there's a guy over here doing a million-three taking home three fifty. And they have the same number of charge, the same number of everything, the same economy, the same government, the same everything. But the one guy is able to get two out of three people to get their filling done and the other three only get one out of three to get their filling done. And then the guy getting one out of three fillings done, thinks he's all that and a bag of chips because he's got his FAGD and his MAGD and his diplomat, and who gives a crap. And the bottom line is the dentist that can remove the infection two out of three times, is better than the dentist that can only remove the infection one out of three times. And that's what you guys are all about. So tell us about the Case Acceptance Academy. 

Jeff: So I met my father-in-law originally from working for another management company and for fifteen years I worked on the phone starting in '94 before the age of the internet, so doctors would send in a postcard because they wanted to know how to get in more new patients. And of course my job was then to sell them that course over the phone. So, for fifteen years I did that and talked to probably about ten thousand dentists, so I became very good at talking to dentists on the phone. Finding out what's going on in their practice and helping them to fix it. Now, in reality what happens when it came to the company we looked at the numbers we discovered nine out of ten times that they couldn't sell. So then we would teach them how to sell dentistry and the program worked really well, but after fifteen years of doing that I decided I wanted to work on my own. And so I called up my father-in-law who had a practice in Erie, Pennsylvania at the time and this was in 2009, so this was the beginning of the recession. So I said, "Hey, I want to do something new and would you be interested in going into a partnership where I can come and actually try what I've been telling other doctors to do for fifteen years and see how I do?" And so then that's how the case Acceptance Academy was born. 

Howard: Nice. So Erie, Pennsylvania that's on the Erie Canal. 

Jeff: Yeah. Well, it's a lot more eerie than the canal. They just had a hundred and thirty inches of snow in December, so they get a lot of snow up there. So we were up there for five years and then sold that practice and moved down to Sterling a few years ago. 

Howard: Nice. So it's weird how dentists routinely say, they admit it, they say, "I hate selling dentistry. I didn't go to school eight years to be a salesman. I hate selling dentistry." I mean they have a psychological barrier against it and then a lot of them slam it. They go, "I'm not a used car salesman. I don't sell dentistry." And that's just a bad attitude because if you don't sell that you have twelve cavities and you need to get them all filled, then we can't do our job. 

Jeff: Exactly.

Thomas: Exactly. 

Jeff: Yeah and that was one of the main things that I had to figure out how to do, was how to come up with a system that made the dentistry sell itself basically, because dentistry is such a unique profession. Everybody has to go to the dentist, eventually. Even if they're just going to get their extractions so it's one of the few businesses where people are coming to you because they need what it is that you're offering and the challenge becomes is that most of the time they can't feel, they don't feel the pain of a cavity. That's the reason why they're hard to get accepted. The acute abscess is a lot easier, but the cavities are difficult because they don't feel. So the opportunity is teaching dentists how to present the diagnosis, not the solution, not the treatment. How to present the diagnosis so the patient says, "You know what I don't like this and I want to fix it. What do I do about that doc?" And that's really the simplicity of it. 

Howard: And it's not just the dentist, even the front desk. It takes three people to call a dental office before the receptionist can close one of them and get them an appointed and the dentist doesn't even measured that. And then you'll see him at Gordon Christian seminar saying, "Well, [inaudible 00:06:52] at eleven microns a year. [inaudible 00:06:52] at fourteen microns a year. Which one do you recommend?" It's like, "Dude, three people just called your front desk and said, "Well, how much is a crown?" And she said, "A thousand dollars." Two hang up and the third one only came in because they actually were going to come in no matter what and then you sit there and say, my God, the front desk can't. If she just closed two out of three inquiries into a scheduled patient, the practice doubles. Fix that. When you tell three people they each have a cavity and only one gets it done, and now you get two people that are done, you doubled your practice again. You fix both ends. Now you got a several million dollar a year practice, but dentists don't think like that. They always think, "Should I buy a laser?" 

Jeff: Mmm, exactly. And that's one of the things that we teach as a part engineer case acceptance is how to schedule eight or nine out of the ten people. And not just schedule them, but have them show up in the office. So that's something that we measure when we teach our clients how to measure, is how many people are calling and how many people arrive as a butt in the seat. And that's the biggest hole in the funnel right there.

Howard: So let's start with the funnel. So your starts with the incoming call.

Jeff: Number one, yeah, the incoming call, because if you don't have enough people coming in you don't have enough people sell.

Howard: And how many dentists in your estimate even measure how many incoming calls they have per month? 

Jeff: So when I do the seminar and there's fifteen doctors in the room and I say, "How many of you know how many new patients you've seen last month?" Eight out of ten say they know how many they've seen and I'd say, "Okay well how many of you know how many new patients called your office?" And one out of fifteen or ten will raise their hand. They don't measure how many call because there's only one way to do it really and that's by writing down a little hash mark at the front desk. That's the only way to do it. So they don't do it because the call tracking will measure calls coming in, but not all those calls on new patients, so you have to listen to every call to even see if they're a new patient. 

Howard: Yeah, every time the two major practice management systems has an upgrade it's always like changing the font or adding some useless features. Well, why don't you connect the damn thing up to the incoming phone call so that when they call if you're an existing patient it pulls up your screen and if they're not in your system says, "New patient alert," so that you can sit there and put the other call on hold, or whatever and focus on this and converting it to butt the seat. So you want to start with the incoming call to try to increase that conversion rate?

Jeff: Sure.

Howard: I mean you're saying that you think eight or nine out of ten could come in. God, if you could just get two out of three your case Acceptance Academy would be priceless. 

Jeff: Yes. Well, that's the first thing that I teach is how to do that. And as you know there's plenty of people that will teach how to schedule a new patient and my particular system though was developed because I've worked on the phone for fifteen years, calling into doctor's offices and selling doctors. And then I went into a dental office and in 2009 at beginning of the recession we were advertising for a free comprehensive exam and X-ray.  So everybody knows in dentistry that when you advertise free you get horrible patients. Well, that was the only way we were getting the phone to ring and on top of that it was a fee for service practice. So I had to listen to a lot of phone calls and schedule some patients myself and then I came up with this method of how to basically handle the number one thing that when people are answering the phone, they mess up. And what that is, is when someone calls into the office they usually have a question for the front desk, such as, "Do you have Saturday hours? Do you take Delta Dental? How much does a crown costs?" And the number one thing that the person likes to do at the front desk is try to answer the question and it sounds like human nature to answer a question, but the moment you start answering the question and you give them an answer they don't like, they go click. So what we do is we teach them how to basically take control of that conversation and so when you take control of the conversation and you start controlling it then you could actually get them to schedule and come in and answer their question. But the number one thing is you got to take control of the conversation because if the patient is controlling the conversation then they're going to hang out up if they don't like what they're going to hear or they'll schedule and then not show up. 

Howard: So do you want to go over some of those questions and how you would answer them or...  

Jeff: Yeah, sure. So you're the new patient calling up. What's the thing that they call your office or you hear them say the most that patients want to know? 

Howard: Well, actually I'm a dentist so I actually don't really answer incoming phone calls. I mean you would know that more than me. 

Jeff: So they usually say, "How much does a implant cost?" So they'd call up and they'd say how much does an implant cost? Now, most people would say don't give our prices over the phone, so what you would say is, "I'd be happy to help you with that. May I have your name?" So all you're doing is you're asking the person for their name and they're going to say, "Well my name is Mary." "Oh okay well thank you Mary, so what's the best number to get a hold of you in case we get disconnected?" "Well, it's two, two, two, five, five, five, four, four." Okay great." So you need an implant because another doctor diagnosed you're needing an implant and now we can have a conversation about it. Rather than, "Well doc said we can't give our prices over the phone."  Or an implant is $3,000, so the first thing is to actually take control of the conversation and then you can have a conversation about what it is that they need. What is the actual need? That's the number two thing. Take control and find out exactly what they need. 

Howard: And I love it. Take control and start a conversation instead of just saying the answer is X. Let's start doing something to create a conversation.

Jeff: Exactly.

Howard: What do you think of the fact that when some doctors tell their front desk that they can't give out prices? What do you think of that advice in general? 

Jeff: Well, I understand why they do it, but consumers today are very educated and when you're doing a search for implants, the search is how much do implant cost? And usually when they go to another doctor, the number one shocker is how much it costs, so what they're doing is they're shopping around on price. So the consumers are smart, so if you say well we don't give our prices then they're going to say, "Well, sorry, I want to know how much it costs and I want to know how much the implant costs and [inaudible 00:14:26] cost and the crown costs." And they're going to start to drill you, so you have to start by taking control and maybe you're going to schedule and maybe you're not, but you definitely don't have a shot if you just say, "Well, it's our office policy that we don't give our prices over the phone." 

Howard: Now how long have you been doing the case Acceptance Academy on your own now? 

Jeff: Since 2009. 

Howard: So 2009 to 2018, so nine years?

Jeff: Yeah.

Howard: What percent of the time do you tell the doc, "I'm sorry, but that person up there can't answer the phone. They don't have it. They're not trainable. You need to get a new one."

Jeff: More than 50%. 

Howard: Yeah.

Jeff: More than 50%.

Howard: Do you think a lot of that is birds of a feather flock together, so the only reason you got into dental school or medical school is because you were the nerd geek who sat in the library every night, while all the people who were joining frats and had girlfriends and going to bars, they didn't get accepted into dental school and medical school. So this guy after sitting in the library for four years, he wants to hire a librarian for an assistant, a librarian for a front desk. I tell dentists you can smell a million dollar practice the instant you walk in. All the dental offices doing seven fifty, you walk in there and you're back in the library and it's just...

Jeff: Right.

Howard: And then when you go in there and someone's like, "Oh my God, Jeff. How are you doing? Did you watch the Super bowl? “That’s a million dollar practice. 

Jeff: Right. 

Howard: So half of the time you're saying the dentist hired someone like themselves, afraid of their own shadow and they're not even capable of answering the phone? 

Jeff: Right, exactly. They're capable of answering people's questions.

Howard: Right.

Jeff: They're not capable of selling a person on an appointment. 

Howard: Yeah, and then he can tell me everything about his bonding agent, but he can't tell me how many incoming calls he had for 2017. 

Jeff: Right.

Howard: Some of these offices you go in there and you start digging deep and you find out that every month thirty seven messages are left on voicemail and no one even checked it.

Jeff: Right, exactly.

Howard:: And then he tells the guy that he's spending money to do advertising that he's a loser, because the advertising's not working. What percent of incoming calls in the average dental office go to voicemail? 

Jeff:: I think from what I've seen, somewhere around thirty or 40% and some of that is even during business hours so ... 

Howard:: Right, so they can only convert one out of three to come in and that's the one begging to come in and they lose two out of three, that's we're talking about that funnel. Thirty to 40% go to voicemail and the dentist doesn't even have a measurement on it and then you say, "Hey, what do you think of your girl up there, Rwanda?" "Oh, she's awesome." Based on what?

Jeff: Right.

Howard: Based on what? What day did you have that she's awesome? And that's not how she...

Jeff: She shows up on time. That’s...

Howard: And she's nice. And she smiles.

Jeff: And she's nice...

Howard: Yeah, I mean it's just crazy. So when you signed up for the Case Acceptance Academy, do you do this all virtual or is there a boots on the ground in the dental office? How's that work?

Jeff: We do a combination of both. So what I do is I go to the office or they come to me for two days and we go through two days of training on how to answer the phone. How to talk to patients when they come in. How to present cases. How to present finances. How to handle objections and all the staff to keep track of, and then over six months we do virtual training. We listen to phone calls. We have record [consults? 00:18:14] and we review them.  We set up in the numbers and we teach them how to manage by the numbers. 

Howard: And what is your track record over nine years working with my homies?  

Jeff: So the average person that comes to me is doing about 30% case acceptance just like you said, so that when I run the numbers it's just 30%. So usually they'll get up to somewhere around forty or 50% comprehensive case acceptance. So the same thing on the phones when we start tracking the phones usually they're somewhere, we call it a scheduling efficiency so they're usually somewhere around sixty or 50% on the scheduling efficiency. So then usually we push them up to around eight...

Howard: So what percent are they on scheduling efficiency?

Jeff: About fifty or 60%.

Howard: Okay and then what do you get them up to?

Jeff: And then we push them up to 80% plus.

Howard: Those are huge numbers. So is it cheaper to go see you for two days than you come to my office for two days? 

Jeff: Yes. 

Howard: So what's the price of each and what's the different now? What's two days of training if they go to Washington DC? Well, you're in Sterling, which is twenty miles west of Washington DC? 

Jeff: Yep, yep so it's fourteen thousand for two days and then also for the mentor-ship for the six months afterwards and that's to train your whole team. 

Howard: So your program is fourteen grand for two days of training and six months of mentor-ship? 

Jeff: Mmm. Now, if I go to see you then it costs more depending on where you are. I'm going to see an office in a couple of weeks, probably in three weeks, and they have forty five staff. They have a twenty operatory office and then they have some satellites, so I'm charging them more because there's going to be more people training. More manuals, more follow-up, so I kind of tailor make it based on the circumstance because they already have a huge...

Howard: What do you think does that office already collects? What do you think that office does a year? 

Jeff: Nine million.

Howard: Okay so homies listen, you always want to spend a $145,000 on a cad cam, which you don't need. A $135,000 on a laser you don't need. You don't blink at spending $100,000 on a CBCT, but the people who spend money on [consultants? 00:20:41], look at this guy $9,000,000, $9,000,000. 

Jeff: Yeah, he knows his closing rate's already 30%, he knows that and he's like, "If you take me to 40%, he goes, "do you know what that's going to do in my practice?" And I'm like, "Exactly." So I know I'm not charging him enough, Howard. I know I'm not charging enough, but just by taking him up a few percentage points on $9,000,000, he's going to have a huge effect on...

Howard: I'm romantically in love with my dentist. The fact that I admire their passion to just want to keep learning more and more clinical dentistry. I admire those guys who get their FAGD MAGD and their diplomat. I love the fact that they love their art, their craft, they're surgeons. They work with their hands all day in an operatory. Dentists are all surgeons. I love that, but my God, if you love surgery you can do twice as much of it if you get your house in order.

Jeff: Yeah.

Howard: And that's where they go, "Fourteen thousand that's a lot of money." Well, what if it was a $140,000." Here's an idea. Right now you take an impregum impression for seventeen bucks, send it to your lab man who's made ten thousand crowns and you get it back in two weeks. Here's your idea. "I'll tell you what I'll do. I'll get a $140,000 cad cam and have my assistant, who's never mulled a crown in her life, I'll have her start doing it. "I mean it's almost like every time they get a great idea, it's the wrong idea.

Jeff: Right.

Howard: And then when I say you spend all your money only on consultants. Just get your business on. Get so efficient and rich then you can buy a cad cam the same way you'd buy a Porsche. Then you can buy a millennial bi-lase the same way you bought your cabin. Just get your house in order and then buy your toys. I know boys need toys. I get it. I raised four boys. They wouldn't take a bath unless there were twenty things floating in the bathtub. They wouldn't play in the sandbox unless there were twenty Tonka building trucks and all that stuff. I get it, but you got to get your house in order and $14,000 for two days of training and six months of mentor-ship. You're going to get all that back on the acceptance of one case for fourteen thousand.  

Jeff: Exactly. 

Thomas Yeah, exactly.

Jeff: Exactly.

Howard: Yeah, so first of all when you say a 30% case acceptance you walk into an office, the two major systems are Dentrix and Eaglesoft. How do you measure case acceptance? What data are you looking at?

Jeff: Good question. So the easiest lazy, man way to do it is to take the last year and you pull the report that says undone treatment, so you take the report, it's all of the dentistry that was treatment planned that was not accepted. Then for that same time period you run the collections. Okay, now this is going to take in everything into account. All the hygiene, all the exams, everything. This is why it's kind of lazy, but it is a work [inaudible 00:23:47] to do it. So you add those two together, so let's just do simple Math here, so let's just say that you collected a $1,000,000 and you had $3,000,000 in undone treatment.  Okay, so you add those two together what do you get? $4,000,000, right.

Howard: Yep.

Jeff: Then you divide the collections by the four million because that's what you actually had accepted. That was your acceptance is what the money came into the bank so that's a 25% case acceptance rate. So that's on the simple Math, so normally when I do that equation it's somewhere between thirty and on the high side 40%, but usually it's around 30%. That's what we did with this $99 practice. He knew and I ran the Math to check it they're at 30% across the board. So what we do and what we do at our office here, we're at about 50% or greater. 

Howard: In who's office?

Jeff: So ... Tom...

Howard: In Tom Bursich's office?

Jeff: Yeah, so this is my lab right here. This is where I practice everything that I'm teaching to people in their practice.

Howard: And then Tom you're running at 50%? 

Thomas: Yes.

Howard: That's awesome buddy. 

Thomas: Yep.

Jeff: Yeah, and this is comprehensive case acceptance. This isn't like just presenting what the insurance will pay this year, so this is comprehensive case acceptance. But as a part of the process what we're doing is we do something I call a pre-consult dental interview where the treatment coordinator is meeting with the patient before the exam to find out, what does the patient want? What do they need? Do they have any anxiety? Do they have any budget concerns? And we're really finding out where this patient is at because one of the things that really shocks patients is when they think they have no problems and then they get to the doctor after he's done his examine and gone over the x-rays and they're like, "Now I got all these problems." And then that's when trust begins to be weighing because it's like, "Hey, I didn't know I had anything. I don't have any pain." Or "I've been seeing this doctor I love for thirty years and he never told me I had problems and now you're telling me I need all this dentistry." So we have a way of finding out what's going on in the patient's head so if there's a lot of stuff showing up on x-ray, we have a certain conversation with him. 

Howard: We're talking about a 50% case acceptance rate. Congratulations on that.

Jeff: Thank you.

Howard: I wonder who had a higher a pass acceptance rate, Terry Bradshaw from seventy to eighty three or Ben Rothschild from 2004 to present. Which one of them had a better case acceptance receiver treatment plan acceptance?

Thomas: Let's see here, Uncle Terry. 

Howard: Yeah, man when I grew up he was the man. 

Jeff: Yep.

Howard: What did he get, four Super bowls? 

Thomas: He did, yes.

Howard: Amazing, my gosh. Do you have a jpeg of that formula? I mean is that a slide in your seminar? 

Jeff: Yeah, so ... yep.

Howard: You should email me that, and put your and just say something on that. Everyone should figure out this number. It's so easy. I love the lazy, man deal. I mean that is a nice deal and it'll blow the dentists mind. I mean they have no idea how much money they're leaving on the table and it's not about money leaving on the table in business, it's about untreated disease.

Jeff: Right.

Howard: I mean that's what irks me. What irks me the most is friends, family, you're always meeting people.  I took my kid there he said, "He had three cavities." I said, "You get them done?" "I said no." I said, Why?" Half the time they don't even know why.

Jeff: Right, mmm.

Howard: I mean it blows my mind. Well he told you your kid had three cavities. Well, "Did you do them?" I mean and that's why you preach same day dentistry. Damn, they're standing in your office. They're standing in your office and your first gut reflex is to walk them up front and schedule them for an appointment. Hey, here's an idea. Why don't you just do it right damn now?

Jeff: Right.

Howard: And you know what they said? "Well, we don't have a chair." Oh, so you got money for staff and lab and supplies and mortgage and equipment and computer and insurance and [professionalism?], but you don't have money for an extra chair. Are you out of your mind? 

Jeff: Yeah, mmm. 

Howard: And then I tell them if they're as fat as me why don't they work through lunch? The last thing fat Albert needs is lunch and so yeah they've got to get the case acceptance treatment up. If you get them from a 30% case acceptance to a 40%, which you say is doable all the way to 50% what Tom's doing, I mean you just made them twenty five to 50% better as a dentist. 

Jeff: Right and then over a career that's several million dollars in production. 

Howard: Yeah. 

Jeff: Several million when you start young.

Howard: What other metrics do you measure? We're still at the front right now, right? 

Jeff: Yeah. 

Howard: What other metrics are you a keying in on, on the front desk? 

Jeff: So, well just on the sales funnel, we just pay attention to the new patients, so it's new patients called, new patients scheduled and new patients seen. So that's the receptionist main numbers. 

Howard: Called, scheduled and seen.

Jeff: Yep.

Howard: Nice.

Jeff: So, and part of the thing with the case acceptance is so then once they're there, the two main metrics we track is dollar value of treatment presented and then dollar value of treatment accepted. And the accepted number gets a little bit difficult for some people to track, but here's the way that I define it. Accepted means the patient has paid for the procedure, so what we do is everybody they go for a formal treatment presentation, even if it's a few fillings and everybody has an out of pocket. Even if they have insurance, they're going to have it out of pocket. So let's just say even the insurance is $30 out of pocket so in order for the person to book the appointment, which is very logical to do after we've gone through our process, they will make a 50% or a 100% of their out of pocket to reserve the time of the doctor's schedule. So we say we require 50% of the out of pocket to reserve the time that the doctor's schedule and most everybody commits to that. So on the back end on scheduling it's not very difficult because people are already financially committed to their appointments that are in the schedule. Plus it increases the cash-flow and the case acceptance, so that's kind of how we handle it on the back end. So the most important part is getting them in and then once they're in the system it moves pretty smoothly 

Howard: And to prove that to the opposite extreme whenever you go around the world and or just in the United States, where they set up these free dental clinics for the poor. They're on Indian reservations or in Medicaid clinics and when they're completely free, they have a 50% no show rate. Everyone I've ever walked in for thirty years says, "Well what do you do because half of our patients don't show up, but then if you double book and they both show up, what do you do?' I said, "Well what you do is you don't let them make an appointment and let's say open up their wallet and give you the same cash that they gave at KFC or Taco Bell or bought their last dime bag of weed because ...

Jeff: Right. 

Howard: If they don't have any skin in the game they don't value it. And then people think you're crazy. 

Jeff: Right, exactly. And what we find is that when we go through the process and the patient has said, "Yes, I want to get this done and this is why I want to get it done." They want to schedule and we're not doing a whole lot of same day dentistry because the schedules so full and we have only have four operatories, but people commit and they come back. They commit financially and they come back for their appointment and the ones that don't, Howard, really weren't committed to getting it done anyways or they didn't have the money and they just didn't want to tell you. So you're eliminating a lot of the cancellations and no shows because they weren't really committed and they really don't have the money anyway, but they were just embarrassed to tell you. 

Howard: Yeah and the American people have right now one point [$1,3,000,000? 00:32:36] on their credit card and almost 85% of it is for shit. It's for crap.

Jeff: [inaudible 00:32:51].

Howard: And, yeah, and you can't get them to pay half of their out of pocket to schedule the appointment so they have skin in the game and show up because you always diagnose the pocket book and say [inaudible 00:32:59] money and if you saw what was on that credit card bill between shoes and fast food and eating out, and I mean what percent of that [1,3,000,000? 00:33:08] on a credit card do you think is an absolute need versus a want? 

Jeff: A fraction.

Howard: Right, right.

Jeff: A small fraction.

Howard: Yeah. You got to get them financially invested and financial investment gets them emotionally invested. 

Jeff: Right, yes.  Well what we do Howard, just on that line speaking of the emotions, so prior to the financial conversation we you get them emotionally committed to that problem. Speaking of doctors talking clinical, the number one mistake that dentists make in case presentations is they present the treatment before the patient owns the diagnosis, so they're talking about crowns, bridges, fillings, cavities, right, rather than making sure the patient understands that if they have a filling. Right now they have a cavity and if the cavity doesn't get fixed then it's going to be a root canal and then if it's going to be a root canal then it's going to be ten times the cost of that filling and then if you lose the ... so when the person really understands it like the dentist understands it they're emotionally committed because most people don't want to lose their teeth, most people. So it's just a little bit different conversation we have so if they've already said, Yes, I want to fix this. Yes, I want to save my teeth. How soon can I get started?" 

Howard: So I want to go back, so half the time your expertise determines that we have the wrong person answering the phone. 

Jeff: Yeah.

Howard: How do you figure that out? How do you fix that? How do you figure it out? What? How do you figure that out? 

Jeff: So we have the protocol, so the front desk is trained in the protocol. Everybody's trained in the protocol, including the doctor, and the doctor always says, "Yes, I want you to follow this protocol." So then once we go back they always have some type of call tracking system so we listen to the phone calls. Okay, so we then assess the phone calls. We go through an assessment. We say that this, this and this was good, this needs to improve. Now the standard management protocol for progressive discipline is if the patient is trained twice and they don't get it on the third time, then they're not going to get it ever. So if we're training somebody and after three times they don't get it, then they're not going to get in on the fourth, fifth, sixth, or tenth or twenty, so we know within a few phone calls and a few training's that they're actually going to get it or not. 

Howard: And here's the problem that dentists have. Again they chose a profession of hands on surgery on their fellow man. They're filled with empathy and sympathy and the caring hands, and then you're a social animal and you want your patients to be your friends. Even though the most genius anthropologist of all time, Abraham Maslow who came out with a hierarchy needs food, clothing, shelter, belongingness, needs, all the way up to self-actualization, says that an employee cannot be your friend because you have to reserve the right to fire them.

Jeff: Right.

Howard: And you will never fire a friend because they need that paycheck for rent and mortgage and car payments and groceries and all that stuff and that's why you have to emotionally distance yourself. I mean you said [inaudible], even a great like Terry Bradshaw needed a coach and he needed a coach to push him. If the coach is Fred and Terry said, "Dude, I went out last night and got shit faced.  I didn't get home till three. She's still laying in my bed. You care if I just not come in today." It's Fred and say, Sure."  But that's not what Terry Bradshaw needed for [inaudible 00:36:45]. He needed some hard ass guy that was pushing him and your employees are not your friends and I cannot believe how hard it is for dentists to fire people and it's because we're hard wired to be tribal. To stick together and it's so painful and then when you tell them, "Sheila E up there's got to go," and then it's, "No, no I love Sheila." I was like, "Okay, then go marry her and get her out of here, but she can't stay." And it's one of the most stressful things for a dentist, physician, empathy. I'm sure lawyers can do it all day long. 

Jeff: Right.

Howard: I mean I'm sure they don't have a heart or a soul, but for dentists, gosh darn it, it's so hard for them to fire anybody. But you got to do what's right. You got to do it for the patient. 

Jeff: And when you have the recordings, you have the objective. I know I've never have...

Howard I want to back up a little bit when you said dentists have call tracking. They don't. How do they get set up for recording their phone calls? Do you do that for them or do you use any local vendors? 

Jeff: I actually set them up with my marketing people and he'll just use the call tracking even if he's not doing their website.

Howard: Is that the name of the company?

Jeff: The name of that company is Patient Pursuit and then his company is Express Promotion.

Howard: So the name of that company is Patient Pursuit?

Jeff: Patient Pursuit is the name of the call tracking company.

Howard: Okay. 

Jeff: And then the company that will do it just for the website, like he'll set up the whole thing and he'll put it on their website because Patient Pursuit won't do that, is Express Promotion.

Howard: And what percent of Patient Pursuit is in dentistry? What percent of their clients are in dentistry?

Jeff: Most of them they do medicine, but most of it I do believe is dentistry. They do medicine, they do veterinarians and some others, but the thing that's unique about Patient Pursuit is somebody actually listens to the call on their end and they categorize it as a new patient or existing patient and answered or not answered, and scheduled and not scheduled. So it's kind of unique in that somebody else is actually listening to the call first.

Howard: On Patient Pursuit?

Jeff: Yep.

Howard: And you just said there's basically a hundred and fifty thousand dental offices and a million physician offices and, but most are business and dentistry, so I know I'm hard on my homies, but as  mismanaged your dental office is the dentist and vets and chiropractors are three to four times as sophisticated as the MD's.  

Jeff: Yeah.

Howard: I mean every MD I go to still has the glass wall, slides it over, stiffs the clipboard in front of me. I mean so I'm very proud of dentists to be like that. So Patient Pursuit does that. The second one was what?  Express...

Jeff: So Express Promotion, yeah.

Howard: Can you find that one. Express Promotions. And what percent of Express Promotions is in dentistry only? 

Jeff: 90% 

Howard: Nice.  And where are those companies out of?

Jeff: They're in Springfield, Virginia right over here and one of the owners in the company is similar to me, is that he runs a dental office for his mother-in-law as well, so he practices in that office and then brings those services out to his clients.  

Howard: Well, could you hook me up with him? I want him to come on a podcast.

Jeff: Absolutely. 

Howard: He should follow you.  That's Patient Pursuit or Express Promotions? 

Jeff: Express promotion.

Howard: Okay. Do you know the owner Patient Pursuit? 

Jeff: I do not, but I have a contact there, yeah. They're up in Texas somewhere. 

Howard: Yeah. 

Jeff: But I can connect you up.

Howard: Yeah, let's do that because I really want to get this done. I mean we need to get this implemented and done. So, and one other type of question, the two major dental office management information systems are Henry Schein's Dentrix and Patterson's Eaglesoft. I think they both suck. I use Open Dental the only one. 

Jeff:: We do too.

Howard: You what? 

Jeff: We got Open Dental too.

Howard: Oh yeah I know, but when you tell a dentist about it they're like ... you could give them an hour lecture on why Open Dental is better than Dentrix and Eaglesoft and then they'll say, "Do you use a micro fill or hybrid?" It's like, "Dude, did you ... I remember I was teaching Math to my oldest boy, Eric, one day we were doing the homework, Math, and I explained this whole problem to him and you know what his next question was? He said, "Dad, did you know Michael Jordan scored twenty seven hundred points last season?" I'm like, "What does Michael Jordan have to do with this Math homework? But do any of the systems have a better or connected to the incoming call so that when I call you, like if you call my cell phone and you're in my iPhone and it comes up that this is Jeff Palmer, and when I used to have a land line, the number come up. Do any of these [inaudible 00:42:03] management systems have a connection to the incoming call so it will pull up the screen?

Jeff: The only one that I know that does that Weave.

Howard: Yeah and another [inaudible 00:42:15] they're out of Utah.

Jeff: Yeah.

Howard: Do they merge that with Open Dental?

Jeff: Yeah, but we used Weave and the reliability of their phone system was not there, which was...

Howard: Because it was an internet phone voice...?

Jeff: Yeah, but it was their phone system and they admitted it because you get an alert when the phone goes down. They may have been working on it. People use it and they love it and it would be awesome if that worked, but at the time the phone was going down during the day and on the weekends. And when the phone goes down, even on the weekends calls don't get forwarded, so we just couldn't tolerate it. 

Howard: So let’s technically explain it to our homies, so what that means is they use an internet phone, a voice over internet protocol, and it's bleeding edge technology. It's not completely perfect leading edge technology, yet. 

Jeff: Well we use a voice-over IP now. It's just their system for whatever the reason couldn't handle what it was doing yet. 

Howard: So Open Dental, Dentrix, Eaglesoft, Soft End, nobody really has a connection to incoming phone line to pull up the difference between if this is a patient record.

Jeff: No, the only thing that we do is on the new patient calls when they're a call, you can set up on the call tracking system to whisper in the phone that this is a new patient and from what referral source. So it'll say mailer or website, so then it whispers in the person's phone and the only the person that's answering the phone can hear that. So they do know that it's at least more than likely a new patient when they're calling. But not before they pick up the phone. They got to pick up the phone and put it in their ear first. 

Howard: Yeah and healthcare and government are the last two industries that don't have that. 

Jeff Yeah.

Howard: I mean Dairy Queen probably has it. Burger King probably has it. I mean it's a...

Jeff: Yeah. I mean you can watch your pizza being cooked on line on your phone. You can see hey, it’s in the oven. The drivers coming.

Howard: I know unbelievable. So then the other one was, is it, Ryan, is that what you sent me? Yeah, when you Google that Express Promotions dental, the only thing that comes up as Is that it? 

Jeff: No, that's not it. You got to spell Xpress with an X, not an E.

Howard: So then what's next? What were you talking about next? After I've interrupted you five or six times.

Jeff: So we were talking about the treatment presented and treatment accepted is where we kind of left off. The other thing is that doctors are always paying attention to their production and collection numbers. They want more production, they want more collections and the thing that I get them to focus on is focus on how much you're presenting first, because you will never ever collect what's not presented. 

Howard: Nice. 

Jeff: And if you have a million dollar production goal and your closing rate is 30% that means you need to present three million to collect a million. If you have a million dollar collection goal and your closing rate is 50% then you only need to present two million. So by focusing on those numbers presented in your closing rate you could then figure out, okay, well how much do we have to present and how much do we have to get accepted to make our goal? Because it's guaranteed that if you don't present enough treatment and get accepted, you will not make your goal that's Math and so really banging their heads, you have to focus on these numbers and when you focus on these numbers and you can influence them positively, you'll be more likely to make your production and collection goal. It's not mysterious. 

Howard: Okay. So I asked you earlier what percent of the time is the person answering the phone not cut out for it and you said it's half. So now my question is what percent of the time do you tell the dentist [inaudible 00:46:33] you can't present dentistry? We need to get a treatment plan coordinator and also we always hear things from people in the industry that most orthodontists within two years out of school will realize that the reason they became an orthodontist, because they got A's in Science and Math and Chemistry and Physics and they're not presenting ortho cases. An ortho case is $6,500 so they'll be wondering why they're stuck at like ten, twelve starts a month and then the old guy up the street who's getting twenty starts a month says, "Dude, nobody would hire you for sales. Get a treatment plan presenter." What percent of the time you'd say to the dentist, "You couldn't sell a heater to a freezing man. We need to get a treatment plan presenter."

Jeff: Well here's my approach is that I like to teach the dentist how to do a case presentation because the only person they're never going to fire and is never going to leave them is them.  I have the treatment coordinator as that part of the process, but we do something that's called a hand-off. So the doctor's going to do their part and I teach them a very quick way of how to go over the x-rays and the photos in a way that's non-clinical. That gets the patient to say, "Yes, I want to fix this." And when the treatment coordinator is then brought in to say, "Well this is what the patient wants. They already know how much it's going to cost. They don't have any questions. Now you can get it wrapped up." It goes fast.  It's actually easier because if you have a treatment coordinator that's great at closing, that's good. But you know what happens with treatment coordinators that are good at closing?

Howard: They get better jobs for more money.

Jeff: Yeah, they get better jobs for more money. Their husbands get transferred. They have children. They do all kinds of things, so if you're just relying on a treatment coordinator and they leave, then you're toast. 

Howard: So you're saying if you have a good treatment plan coordinator you should sterilize her and kill her husband. 

Jeff: Exactly. I think you're onto something.

Howard: I think I'm on to something. Well, I'll tell you what I know two different treatment plan coordinators as personal friends and she got a job at an office doing seven fifty for $20 an hour, took them to a million five and for five years she said, "Why does a hygienist get forty and I only get twenty when I doubled your practice and dumb ass wouldn't do it." So she quit and went to the other end of the city and the one point five went back down to seven fifty and then some new guy, who's actually a girl, hired her and for the price of a hygienist and took her from seven fifty to one fifty and thanks. And then when I go into the small business administration, the two highest paid employees in every small business that's doing less than say five million and fifty employees, is the owner and the sales guy. 

Jeff: Right.

Howard: And everybody at the back, in the [Widgers? 00:49:51] shop, in the manufacturing shop, in the plant is the lowest paid. 

Jeff: Right.

Howard: And then you go into dentistry and that guy back there making a wooden bowl is the highest paid person because he's the dentist and she's the hygienists, but that person selling all the sales isn't making bank.

Jeff: Right. 

Howard: And they just got it completely wrong so it's a cultural bias that when you're in healthcare it's not about money, it's not about business. We don't sell and we pay the people working on the shop the most. And in all other business the people, your top salesman, there's many, many companies where the top salesperson in a company doing five million, ten million a year, where the top sales people are actually making more money than the owner. 

Jeff: Right, exactly. And so we train the treatment coordinator to be a very good closer so to speak, but it is dependent upon the doctor. And your friend, I'm sure she's very good, but they're unique and there's no school to send your front desk to be a treatment coordinator that's going to close you a million dollars’ worth of dentistry in a year. There's no school for that. So that's what we do is we teach the doctor how to work as a team approach with the treatment coordinator so they can close more cases, but then if the treatment coordinator leaves or they get recruited to go somewhere else, then you we'll just bring somebody else in and train them up. 

Howard: So do you call them a treatment plan presenter or coordinator?

Jeff: Treatment coordinator. 

Howard: Just treatment coordinator?

Jeff: Yeah, that's what I just call them, yeah. 

Howard: And what percent of dental offices do you think have a treatment coordinator?  

Jeff: I would say probably about half of them, but usually the treatment coordinator is going to be the office manager in most instances. 

Howard: Correct. 

Jeff: And so very few have a dedicated treatment coordinator, unless they're like a specialty practice. 

Howard: Yeah and the average general dentist is making for 2016 latest numbers was making one seventy four.  Oral surgeons were four eleven. Endodontists were three sixty. Pediatric nurses three ninety. All the specialists are damn near a double plus on the general dentists.

Jeff: Right.

Howard: And one of the two reasons the specialists have a double [inaudible] dentists always say, "Well, they have higher wages." That's not what it comes down to. It comes down to specialist don't want to tell the referring dentists, "I can't take your emergency." The last thing an Endodontist wants is, "Hey, I got a patient with a toothache. Is there any way you can see him?" And you say, "Oh no, you referred to me five molars a month. Here, why don't you call one of my competitors I can get him in" So they all have one or two extra rooms they never use for walk in emergencies. Your average Endodontist and oral surgeon and pediatric dentists and orthodontists all usually on average have two extra emergency rooms.  

Jeff: Mmm.

Howard: And then I call your office, "Well, is there any way I can come in today?" "Well I don't have a chair." Oh yeah and money for payroll, rent, mortgage, equipment, lab bills, supply. You had money for everything under the sun, but you don't have a chair. Why don't you buy a lawn chair and put it in the break room? I mean so they have the infrastructure to get them in there and they have a treatment coordinators. 

Jeff: Yeah, they have treatment coordinators. 

Howard: So they have the capacity and they focused on closing the sale.

Jeff: Right.

Howard: And they almost double. Almost every specialty doubles plus what the average general dentist does. 

Jeff: Yeah and I have specialists that I train, it teaches the same system. It's just by the time they end up on the specialist doorstep, you know you got to do something so their case acceptance should be higher, but they usually do have dedicated treatment coordinators and they're built for that.

Howard: Jeff, you know what I really wish you would do buddy?

Jeff: Tell me.

Howard: If you go to Dentaltown so there's a quarter million dentists they've posted five million times, they post five thousand questions a day, but if you just go in there and do a search for treatment coordinator. I mean I just wish you would answer some of these ... I mean there's do you bonus your treatment coordinator? Is a treatment coordinator in charge of collections? I mean there's just pages and pages of question and it'd be good marketing for you because you answer the question, but in your signature you could say Jeff Palmer, Contact information all that kind of stuff. But...

Jeff: Treatment coordinator that's a good one. Yeah because I look at threads on case acceptance, but not treatment coordinator. I like that one.

Howard: Yeah and so some people get it. The specialists all understand it, but in the general dentistry only the million dollar practices get it.

Jeff: Right.

Howard: And they record the phone calls. They put a lot of time in. The dentist has eight years of college, a hygienist has four. The assistant went to a nine month program to a year and then the most important person in the office, the girl answering the phone, her last job was she was an Uber driver and she has no training. And the only reason she got the job is because she didn't talk during the interview and the librarian and dentist loved her and yeah so it’s...

Jeff: And she hid her tattoos.

Howard: And she hid her tattoos, yeah. That's kind of a regional thing. You know when you go up to between San Francisco, Portland and Seattle I mean the dentists are [inaudible 00:55:20]. 

Jeff: Right.

Howard: But by the time you get into Texas, Oklahoma and Kansas that would just scare everyone out of the room, but in Portland, Oregon that's just the norm.

Jeff: Is that right?

Howard: Yeah, it's very regional. So what are my homies going to find if they go to

Jeff: So there's a bunch of free tools on there. You can go to my YouTube channel and watch some videos and I go over ... I give it all away on my YouTube channel.

Howard: But you guys are on the YouTube when you're answering those questions on Dentaltown, if you've got a YouTube video, you hit reply. Then you go to your YouTube video and you know how you put share it and it shows you the link? 

Jeff: Yep.

Howard: The next one over is embed. You click embed, you copy that code. Then when you go to the Dentaltown reply, you hit the YouTube button. Drop that code in there and now you just answered that question with one of your YouTube videos and then everybody in dentistry who does that then their YouTube channel explodes.

Jeff: I'm on it.

Howard: Because people will click that YouTube video and then when they like it, they'll hit subscribe and they all get it. I am a big fan of your YouTube channel. How many YouTube's do you have? 

Jeff: There's about a fifteen that are public and then there are some private ones that I share too. There's probably about thirty or so on there and I'm making more. 

Howard: Well, you got fifteen YouTube deals. You can even search the question of the name of your YouTube channel. I mean I can tell you so many dentists and dental consultants and all that who YouTube channel exploded just by answering questions with their existing YouTube information. 

Jeff: Cool.

Howard: Yeah, so what else can they find on your website? 

Jeff: Well, they could also find a contact me. So if they want to do a practice strategy session and talk to me we'll do that same analysis where I'll have them pull the numbers for the past year. We'll look at their case acceptance rate. Talk about how they're doing and see if there's anything they can improve on. 

Howard: How much money is it for my homies to call you just to talk to you to see if we're a fit?

Jeff: Zero.

Howard: To see whether we were on Tinder, I swipe right or swipe left. Which one is you want to date her? Is that swipe right? Right, if you want her. Left if you want her. So you're saying if they call you the consultations free? 

Jeff: Yeah.

Howard: They're all driving to work alone listening to this podcast. They're wondering if you're a fit. What is the typical dentist calling you and asking? What does that initial phone call usually sound like? 

Jeff: They usually know that their case acceptance needs some help, but they just don't know what to do about it. And they're not making their production and collection goals. Even if somebody's case acceptance is poor. If they've got so many new patients coming out of their nose, it doesn't matter then they're not the right fit for me. So my typical client is aware that their case acceptance is poor. They know they need to be producing and collecting more and they're leaving money on the table and they want a fast fix, so that's why they're calling me. 

Howard: Nice. So Tom, what do you have to say on this? What are your thoughts? You're just sitting there, taking all this in or are you just showing up to be pretty? 

Thomas: No, I'll take the other side. It's been a tremendous career boost to me to be able to sit there and, you know you and I were trained at a time where we were told by professors and that, know your staff. Have your answers right now and tell the patient what they need. And that was such a change for me to be able to sit there and talk to patients. Show them what's going on there. Tell them what the consequences are and ask them questions and boom, they're engaged and that's been fun. That's been fun to see, well, how they're willing to proceed and move forward with very little effort. You and I were trained to talk. Talk, talk, talk, talk, talk, talk, talk and that was a change for me. So a paradigm shift if you will, so that's been fun to watch. The less talk the better and patients they know you have a degree on the wall. You're a smart guy or lady whatever and you can sit there, and like I said, you and I were trained to be the smartest man in the room and it doesn't fly. You sit there and you'll get a lot of, "Well I need to talk to my wife or I need to go home and feed the dog," or whatever. They'll have any excuse under the sun to leave, but if you have them emotionally engaged, they're not leaving. 

Howard: And a lot of dentists will tell me they'll say, "Well, I don't have the personality to talk to patients and I'm shy. I'm introvert and I'm just not cut out to do that." And that's why I wrote an article a couple of months ago called, Doc Hollywood. I mean it when you start studying behind the scenes of Clint Eastwood, Humphrey Bogart, Marlon Brando, Laurence Olivia, or Katharine Hepburn, Cary Grant, Charlie Chaplin, Henry Fonda, a lot these people aren't like the people they played and they're an act. I mean from Orson Welles to Clark Gable, Johnny Depp, I mean Elizabeth Taylor. So you can go to work and pretend you like people like to communicate and like to sell. I mean some of these movie stars play ax murderers. I mean who was that, Kathy Bateman. Was it Kathy Bateman in The Shining that beat that beat that guys knees?

Jeff: [inaudible 01:00:25] 

Howard: I mean she was a sociopath, but in real life she's not a sociopath, but when she shows up on Hollywood and they say, "Take one," she's beating that poor man's knees and who was the guy in The Shining and ... oh Anthony Hopkins. I mean if Anthony Hopkins was really like that someone needs to put him in jail or shoot him.

Jeff: Right.

Howard: So if Anthony Hopkins can play, what was that sick movie he was in?

Jeff: Silence of the Lambs.

Howard: Yes, Silence of the Lambs. If Anthony Hopkins can play Silence of the Lambs, doc, you can pretend you have a personality and talk to patients and get some treatment plan acceptance because if you don't, you're not a good doctor. When two out of three people leave your operatory with an infection and have no idea, no plan on getting it, but they're going to go buy the next iPhone. They're signed up for Netflix and Spotify and they're going to go to Disneyland. And they're going to fly Southwest Airlines to go to their cousin's first communion. They're going to do everything. They're going to spend all their money anyway. 

Jeff: Yep.

Howard: So your job is to make sure they get all their teeth fixed so they have less money to spend on the bullshit they don't need.

Jeff: Right.

Thomas: I agree.

Howard: Yeah and you guys can do it. 

Jeff: Yep.

Howard: Yeah and I really wish you guys would start posting your YouTube videos on Dentaltown, answering questions. I can't believe we went five minutes past an hour. We're into five minutes over time. Is there anything I wasn't smart enough to ask or should've asked or...?

Jeff: No, I think you kind of hit on it all. You punched on the right points. You're familiar with this beast and how it kills dentists and it's really a simple fix.

Howard: And just let me give you a reality check, again docs listen to me. Spend all of your money on consultants and what will you do? You'll go to some institute for six weeks to learn TMJ and right now TMJ isn’t even one percent of your practice and heads up all your TMJ patients are fricking crazy. And then you're going to go spend all this money going to these cosmetic institutes to learn how to do upper ten veneers. Hey, here's an idea. "Did you know last year you didn't do any veneers? You're an idiot." And then you're going to go spend $50,000 to learn how to do all on four and guess what you’re going to spend the rest of your life doing all one none. You've never done an all on four. You're never going to do an all on four so go back to dentist school. Forget TMJ, forget crazy ladies, forget all that [nones? 01:04:07]. Go back and I want you to run a report on its supply and demand and your city might be very different than Kathmandu, Nepal. They'd be very different than Beijing. I've lectured in Vietnam, Cambodia so you're in this town, run out all the procedures you've done in the last ten years. That's your town. I wouldn't go to Childress, Texas and open up a Toyota Honda shop. I'd open up a Ford one fifty pickup truck shop. I mean these are your people. These are your town. If your people said, "Look, we don't buy nothing but Ford pickup trucks." Then be a Ford dealer.

Jeff: Right.

Howard: So in your town how many people are movie stars getting full mouth cosmetic dentistry and veneers? How many of them walk in there and give you a $50,000 for two arches or all on four? Get real. These are your people and it's just as easy to get rich at McDonald's as it is in owning a Roost Crisp and Roost Crisp works in some towns and McDonald's works in all towns. 

Jeff: Right.

Howard: Find out who your people are and then just get them. Look at all of your people who you already told them they have a disease and you didn't get it done because your house's not in order. You had the wrong people answer the phone. You don't know how to close the sale. You're not measuring any of the stuff and you can double or triple your practice. And my final thought is this, when I find a doc doing one and a half to three million a year taking home five hundred thousand to eight hundred thousand a year, they're almost always in the fly over states. They're almost always in some town you never heard of and what are they doing? 

Jeff: Right. 

Howard: They're doing everything right in their market. 

Jeff: Right.

Howard: So just get your damn house in order. Get poised for growth. Put money into your team. Get your house in order and then when you get filthy rich, I don't really give a shit if you buy a jet ski or a Cad/Cam. I don't care if you get a cabin or a boat. My recommendation would be to get a divorce and a new girlfriend, but that's a whole other story. That was a joke.

Jeff: Yeah.

Howard: But anyway gentlemen, thank you so much for coming on the show today and talking to my homies. I thoroughly enjoyed podcast. It was an honor to podcast you. I hope you both have a rocking hot day. 

Jeff: Thank you. You're welcome. You too.

Thomas: Thank you, Sir. 

Jeff: Hello, my name is Jeff Palmer, founder of the Case Acceptance Academy. I want to answer two questions for you today. Number one, how do you know you need our help? Number two, how do you get started? If you are a practice owner and you are asking yourself, "How do I get my practice more organized? How do I train my staff? How do I improve my case acceptance? How do I reach my goals?" If you are a practice owner and you are asking yourself any of those questions then we can definitely help you. Our purpose at The Case Acceptance Academy is to provide you with hyper effective and innovative case acceptance and administrative strategies, tactics in systems that result in stable, predictable growth and efficiency. I packaged this in such a way as to help make your business into a franchise model even if you never intend to sell or franchise. Where do you get started? If you go to and go to the free tools section, there's any number of tools there that you can use to engage with us before you ever talk to us or meet us. Just like patients they want to know more about you before they meet you. There's any number of resources available for free on our website so you can find out more about us, what we do, how we do it, and how we can help you. So I look forward to meeting you or hearing from you soon. I hope you found the video valuable and the information useful. Like the video, share it with your colleagues and friends. Comment on it if you wish or go to for more ways to engage with us.

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