Since 2004, Angela Golden has been helping dental practices improve their success, and increase the value of their dental practices with her customizable consulting plans. With over 25 years of dental experience in both private practice and corporate dental offices, she understands the needs of your dental practice.
Angela started her career in the dental industry in 1992, in a small rural town in Northern Nevada. Over the years, she has utilized her skills as a Dental Hygienist, Dental Assistant, Office Manager, Insurance Specialist, Collections Manager, and Multi-Practice Regional Manager.
She has attained the ability to grasp new ideas and integrate them into desired results. Angela has implemented several pragmatic management systems into all aspects of dental practices. She is a dynamic, results-oriented problem solver and experienced in providing project management, consulting and marketing services in the dental field. Angela is passionate about the links between oral health and systemic health. She enjoys teaching other health care professionals and community the importance of oral health and how oral health contributes to such a wide variety of systemic disease.
Angela is an affiliate member of the American Association of Dental Consultants and an active member of the Speaking and Consulting Network , American Academy of Dental Office Managers, American Dental Hygiene Association and served on the 2006 Editorial Advisory Board for The Coding Institute’s Strategies for Success in Dental Practice Management.
In her spare time, Angela helps in fundraising efforts for the Northern Nevada Dental Health Program, Adopt a Vet Dental Program and Oral Cancer Awareness as well as spending time with her children and granddaughter.
VIDEO - DUwHF #986 - Angela Golden
AUDIO - DUwHF #986 - Angela Golden
Listen on iTunes
Howard: It is just a huge honor for me today to be podcast interviewing Angela Golden all the way from Reno, Nevada. Since 2004, Angela has been helping dental practices improve their success and increase the value of their dental practice with her customizable consulting plans with over twenty-five years of dental experience in both private practice and corporate dental offices. She understands the needs of your dental practice.
Angela started her career in dentistry in 1992 in a small rural town in northern Nevada. Over the years, she has utilized her skills as a dental hygienist, dental assistant, office manager, insurance specialist, collection manager and multi-practice regional manager. She has attained the ability to grasp new ideas and integrate them into desired results. Angela has implemented several pragmatic management systems into all aspects of dental practices. She used a dynamic, result-orientated, problem solver and experience in providing project management, consulting and marketing services in dental field.
Angela is passionate about the links between oral health and systemic health. She enjoys teaching other healthcare professionals and community the importance of oral health and how oral health contributes to such a wide variety of systemic diseases. She's an affiliate of the American Association of Dental Consultants and an active member of the Speaking and Consulting Network, American Academy of Dental Office Managers, American Dental Hygiene Association and served on the 2006 Editorial Advisory Board for The Coding Institute’s Strategies for Success in Dental Practice Management.
In her spare time, Angela helps in fundraising efforts for the Northern Nevada Dental Hygiene Program, Adopt a Vet Dental Program and Oral Cancer Awareness as well as spending time where her children and granddaughter.
You don't look old enough to have a granddaughter. I got four grandkids. You got one, too?
Angela: I have one, yeah. She's almost two years old.
Howard: You know what? A grandchild is your reward for not killing all four of your children when you knew you should have.
That's why I was telling my oldest son when he made me a little Taylor, I said, “Okay, now we're even.”
So we first met, gosh darn, in 2000 in the Caribbean in Grand Cayman. We were both listening to Linda Miles. So dentistry it’s really changed over the years. I mean, thirty years ago I got out of school. My dental office in Phoenix turned thirty last September 11, ‘87 and I would submit a crown for a thousand dollars at Delta, they'd pay half. If I sent him a root canal filling, whatever my fee was, they paid 80%. Whatever my fee was for cleaning exams and X-rays, they paid a 100%. Now they're sending me the fees and I'm doing crowns and root canals and fillings for 42% less money than I did three decades ago. But every time the earth goes around the sun, the staff all want a raise.
So what type of problems are you dealing with today in Reno?
Angela: Well, I'll tell you,Delta Dental is a huge problem for everybody I think. Especially now that they're not grandfathering onto Delta Dental Premier as they used to. So all of the new associates are having to go to the PPO plan and it's ridiculous the fees that they pay, in my opinion. A lot of practices are steering away from Delta completely because of they just can't make money. They can't be profitable. The one way they can is by doing assisted hygiene, but that's not fair to the hygienists as well as the patients. We can't provide the best quality care. So dental insurance has not changed since, I think, 1970 and unless we all fight against it, we're not going to see a change. We can't let the insurance companies dictate what we do in dentistry.
Howard: See that's what Delta—and calling them a nonprofit is what a joke. I mean, they do billions of dollars a year because Delta, Medicare, Medicaid and in my opinion, I don't want to get political, but the entire Democratic party, they never wanted to help poor people. They want to control poor people. Like if you look at the trillions of dollars they spend on public housing, well that's how you manage people. When you put them in a government house, they break out all the windows and put graffiti on it. If they would have bought them each a trailer and put them in a trailer park where they own the trailer, they would have painted it, planted flowers. Delta, Medicare, Medicaid, they don't see them helping poor and subsidizing them. They want to control the fee.
Like Delta, Medicare, Medicaid, whatever, Universal Acceptance has said, “Hey, we'll pay a hundred dollars’ worth of filling, but if you go to Angela, she might charge a hundred and twenty, Howard might charge a hundred and fifty. Here's the list of all the dentists that'll do it for that fee, nothing out of pocket.” But if you're a consumer who makes complex decisions, decides they don't want a low-cost Chevy, they want to pay more for a Pontiac or an (unclear 05:15) or a Cadillac like cigarettes. All the poor people buy Marlboro at ten dollars a pack and they could buy Lucky Strike for five. So Delta would say, “Oh no, you have to smoke Lucky Strike. You're not capable of taking five-dollar subsidy and applying it to a pack of Marlboro at ten.” I mean they don't want to subsidize them and help them make complex decisions, they want to control them and that's where dentists should draw the line.
I thought California Medicare was completely insane. They were shocked that so many dentists didn’t take Medicare, so they barely raised the prices, just barely raised them and got a whole bunch more people to sign up. They don't realize that if it was just a subsidy, everybody would sign up and then they get out of a list and say you know. They've never ever, ever, ever been about helping poor people. They only want to control poor people. They want to own them, control them, but don't get me started on that. You're going to make me have a stroke right here on my own podcast.
Angela: The other thing about dental insurance is they don’t look at the benefits at how dentistry's going to affect the rest of the body so instead of preventing strokes and heart attacks and everything like that, they’re not looking at the full picture. Dental insurances are only looking at what they want to look at and you're right, it's not fair.
Howard: If Delta Dental owned smartphones, they'd force everyone to have a Samsung and if you’re poor and said, “Well, can I take that and apply it to Angela’s practice and upgrade to an iPhone?” They’ll go, “No, there will not be iPhones. We’re Delta Dental, we’re Medicare, we’re Medicaid, we're smarter than you, you're a Neanderthal. You only get a Samsung” and then they think that’s intelligent. But that's where the battle line needs to be, that's where the war needs to be and now what Delta is doing is if you don't sign up for their PPO, then they send the money to the patient knowing that so many of them are just going to cash it and never come back.
Angela: They claim bankruptcy and then you don't get the money anyway.
Howard: Yeah, there needs to be a war because if all the dentists worked for Delta, then where do the patients go when they need a dentist? I mean when my granddaughter, if she's got a disease, I want to take her to a doctor that looks at me and tells her what she needs. I don't want that doctor to be some employee, some HMO that withholds all these choices for me because they've already made the decision that me spending money on an iPhone and a house and car is more important than my granddaughter when they don't realize I'd get my granddaughter, both my kidneys, my liver and every dime I've ever made. I just can't stand it when other people make decisions on behalf of me because they think they're smarter than me.
Angela: Yeah, I totally agree with you 100%.
Howard: And that's where the battle line was with Obamacare. It was about massive regulation controller price instead of just helping poor people get into the innovative fee-for-service system that is so abundant in America.
Angela: I wish that if we had more fee-for-service dentists but it's hard to get patients that way and that's why I’ve seen people turning away Delta Dental patients because they just can't make it a profit. Some of the insurance companies that I negotiated with like Aetna, Cigna, I am seeing better results, but you can't negotiate with Delta, they're just (inaudible 09:08).
Howard: They’re monopolistic, they're abusive and one of these days they're going to be pushed into a corner. I mean, it's an abusive system but you used to also work for a DSO?
Angela: I did.
Howard: Which one did you work for?
Angela: Pacific Dental.
Howard: Oh, Stephen Thorne! I tell my homeys all the time, they always want to buy a laser or a cad cam, a CBC, they want to learn how to place implants. The number one return on investment is always a practice management consultant and a lot of these kids will work for a couple of years for Pacific or Heartland or (unclear 09:47), when they said they didn't like it, they quit and I said, “Yeah, but Stephen Thorne, I mean he manages five hundred offices.” I mean, Rick Workman manages eight hundred offices. Surely, you learn a massive amount of business.
I mean, if that company could run five hundred and most of my dental friends can't even run one, did you learn a lot of sophisticated management systems from a company that manages five hundred? Did you learn more new things to do or more things not to do? What was your journey like at Pacific?
Angela: Honestly, I learned more things not to do here in Reno. At the time, they were just building their practices up right now. Just a few years ago they started with one, I think they have four or five here now. In my opinion, I like to treat the patient and I didn't feel like that was what we were doing so I didn't feel like it was a good system.
Howard: What did you feel like they were just mainly trying to do?
Angela: Up-selling everything and like I said, I'm not the kind of consultant that is big—I want to take care of our patients. That's my top priority and so sometimes I feel like a lot of upselling, especially on scaling root planings that for patients who could get by on maybe doing appropriate with inflammation and then going forward or into (unclear 11:23) and then reevaluating that. That was one of the things I saw.
Howard: Yeah, I imagine. But one thing that I really respect about Pacific is when he started Pacific, he bought a practice management system where he owned the code and then he hired his own programmers and they've been programming on top of that layers and layers and layers for twenty years. What I respect most about Steven Thorn is the guy knows his cost. I mean when somebody leaves and had a cleaning exam and X-ray, he knows if he made $3 or if he lost $3 and I feel one of the biggest pitfalls of dentists is that their Dentrix and Eaglesoft doesn't merge with their QuickBooks or Peachtree or Microsoft Great Plains accounting, they're calling it Microsoft GP.
So these dentists have a schizophrenia system and every time I've ever seen a dentist walk out of an office he said, “Hey, you just did a hygiene exam, the lady just had a cleaning (unclear 12:27) exam. Did you make seven dollars, fourteen cents? After tax, you lose twelve bucks.” He says, “I don't know, but I'm thinking about adding in other hygienist,” It's like, “Dude, I could sit down and do the math with you and prove to you that by your fifth full time hygienist, you’d declare bankruptcy.”
So that's why I think there's such a huge market of dental consultants. I mean, there's been a swath of dental consultants the whole thirty years mainly because the management information system is so bad. I mean, if you compared it to the Hyatt Regency or Hertz Rent a Car, you would start crying.
Angela: Well and talking about Stephen Thorne, he has the systems in place for every single detail and that's where practices are lacking. A lot of the newer software that are coming out, like Dental Intel and Practice By Numbers, those kinds of systems pull all the information from Dentrix which helps the consultants tremendously and I'm sorry, but it's so hard to pull reports from Eaglesoft or Dentrix to see where your profitability is because you have to print fifteen different reports to find one answer.
Howard: Yeah and then you hear the owner of Dentrix, Henry Schein, Stan Bergman. Next time he's doing a conference called the Wall Street, listen to him. “Oh, the profits sales, net income, return on investment,” I mean, it's like I'm sitting there wanting to scream on the call saying, “Hey, how come none of your customers can have any of those numbers?” I mean, his entire conference call is completely impossible on his own practice. In fact, they’re called Dentrix. A management information system would be like calling me a Calvin Klein model.
I mean, it's just complete insanity which is why myself, I've been on SoftDent for thirty years. I just switched to Open Dental because of Jordan Sparks that dentist in Oregon where he had the same problem with Dentrix, but he was trying to extract all the patients’ names and addresses so he could do a mailing card back when tooth bleaching was coming out and he was a little bit of a programmer himself; he noticed not only could he not do that, but people actually spent time building firewalls that make sure that he couldn't and then he called Dentrix. They said, “You can't do that, that's our data.” He said, “My patients are your data?” and he was so pissed off he started Open Dental and Open Dental is the only dental office software that doesn't advertise anywhere because they're growing.
Angela: Their company is so popular and it’s nice that they have their own versions of everything on there. It's so easy to use that anybody can just walk in and start using that programs, there's not all these hidden little places to post or places to put things.
Howard: Well, if someone was coming out of school, you're talking to a lot of kids right now. I mean, I always tell people please send me an email to email@example.com. Tell me who you are, what country you live in, how old you are. It's about 25% are still in dental kindergarten school and the rest are all under thirty, they're working on Aspen; they're working on all that stuff. If she was getting ready to open up her own office, what practice management information system when you tell her to go with?
Angela: I actually am really liking Curve Dental right now. I don't have any practices on it yet, but I have done a couple of demos with them and they have everything put together really well. Like I said, I don't have any practices on it yet, but the second one I would say would definitely be Open Dental.
Howard: So Curve Dental is out of Utah. In fact, it's up the street from Dentrix. Wasn't it started with ex-Dentrix employees?
Howard: Yeah. In fact, if you look at where Dentrix was started in Provo, Utah, there's about ten other companies now around them just doing everything they should have done thirty years ago. They created an entire that they call Silicon Valley for tech startups, now they're calling it Silicon Slopes in Utah because it's tech brands out there and it's amazing how many companies in Utah wouldn't even exist if Dentrix did what we were begging them to do. I mean, I went down to Dentrix twelve times; not once, not twice, twelve times and when you talk to them talk, I mean, it was like talking—yeah, I don't want to go there. I sort of got a (unclear 17:13) stroke but anyway. So why did you like Curve more than Open? Why was that your first go-to?
Angela: The charting made it really easy to—I like to demonstrate to a patient. If you're going to be selling dentistry, you need the patients to understand it. Their dental charting was amazing, the periodontal charting was amazing visual for the patients to see the depths of the periodontal pockets to see where the recession is and then their analytics, they have the most amazing analytics that pulls up instantly on (unclear 17:48). Instead of having go through so many reports, you can just click right on the analytics.
Howard: Dental Curve on Twitter is @DentistSoftware. Now they're cloud-based, aren't they?
Howard: Now was that a deciding factor in your picking them first?
Angela: I actually do think that cloud-based is the way to go. I know Soft dentists going cloud-based, Dentrix have a Dentrix Enterprise that's cloud-based; I do think it's going to be the way of the future and everybody needs to get up on it.
Howard: I’ll retweet their last (unclear 18:26) that said, “We share the love with our customers this month by making a fun change to the Curve Dental log-in. Making every day a celebration is a part of your work day is why we're a better fit to the modern progress.” And then they did oh my God, what is date today? The 12th? They have a Valentine's Day.” This Valentine's Day, we'd like to tell our customers we love working with them.” So I retweeted that and I also retweeted your last tweet, “Thank you so much for the 25,000 homies that follow me on Twitter.” That is just amazing. Your last tweet, you are @GoldenOpsReno; she's in Reno, Nevada. She's Golden Opportunities and at hdhhdh So I just retweeted that to my homies because they're driving to work right now, they're commuting and I tell them I'm not to text me are while they're driving.
So just to explain to them why you like the cloud, because what I don't understand is like you take a restaurant chain like McDonald’s with forty thousand locations and every damn location has a computer and software and servers and they got to be installing updates and all this stuff. You look at so many of these chains like do they not get that they could have a centralized IT department and all of those terminals can be cloud-based and people say, “Well, I don't like the cloud.” Well, when you get on Google, that's a cloud. When you get on Facebook, that's a cloud. LinkedIn, Pinterest, all your social media stays on that. All that stuff isn't in your iPhone, it's on the cloud. But why do you think it's slow to come to dentistry? Do you think there's actually a reason or just they're too busy learning how to place implants?
Angela: I just think that generally the IT people, everybody, you have to have a server, you have to have a server to hold all your X-rays and that's what’s been the belief to everybody, you have to have that server. Some doctors even believe that you can get hacked if you’re all cloud-based, which I don't know the statistics on that. I do know that we've had several dentists be hacked. Here in my Reno offices and in my JJJdd offices, I know several practices that have been hacked with the ransomware and whatnot and maybe none of those offices were cloud-based that was all through a server.
Howard: Well, I mean it's exactly the opposite. I mean if you're a cloud-based, you have a department, you have IT people, you have people that have college degrees in this stuff and they're on top of it twenty-four hours a day and then you have Dr. Cranston who's in there Monday through Thursday and then when his computer crashes you find out he was backing up his software to the D drive instead of the C drive and he doesn't even have a backup. My son got the ransomware in the laptop and we basically had to throw away his laptop.
Angela: Oh yeah. It's ridiculous.
Howard: It's crazy, crazy, crazy.
Angela: If a dentist gets hacked then you have to inform all of your patients that you've been hacked and their information was compromised and nobody wants that for their practice. So I think going cloud-based with all of the different servers and to the contrary, they're much better protected with that software than anything else.
Howard: But I do know on the Internet, I do know this. Two things I keep hearing dentists tell me about the Internet. Number one were these big CBCT files; loading them up on the cloud is like downloading a movie. I mean, they're big files. So I have heard a lot of people like oral surgeons say, “Did I take your CBCT on everyone, I can't do the cloud.”
Also, Internet phone systems, VOIP voice over internet protocol. What these dentists didn't realize, they thought, “Oh my God, my internet, it's reliable, it's never gone down in ten, fifteen years.” Yeah, that's because you haven't had it on your business phones and they were saying that when they have voice over Internet phone system calls, the phones were going out five minutes one time in the morning and seven minutes out in the evening and they'd pull their hair out.
So maybe it's bleeding edge right now and at any minute, it could be leading edge. I know a lot of these Voice Over Internet Protocol phone companies are dumping tons of money into infrastructure to get that. We have that issue at Dentaltown where our Internet service provider, it does go down for an hour or two every single month. So then the obvious thing is we'll get another internet provider so we'll have two but to have all those T1 lines. I mean, it's so damn much money. It's like why I want to spend several thousand dollars extra a month out of my own back pocket just because I know it's going to go down for an hour every month and then in Phoenix you always got some (unclear 23:41) who went to on a tractor and they're going to cave there, they're putting in their crosses, they’re digging something and I'd say about every six months some guy with a backhoe takes out the whole damn cable. That is a nightmare.
So who's calling you now? Are you mostly consulting in Reno or are you going all around? You go anywhere or what's your territory?
Angela: Well, I like to stay closer to Reno and obviously, my kids all live up in Idaho. That's where I started my business that's in Idaho so I still have clients up there and I don't like to fly very much but I will do it.
Howard: How come you don't like to fly?
Angela: Oh well, I was in a plane crash when I was sixteen.
Howard: Small plane or a big one.
Angela: It was a big plane.
Howard: Wow! Tell me about that. What happened?
Angela: Well, are we were flying to Italy and it was my first time on a plane, my first time ever and my flight from Reno to San Francisco went great and then San Francisco to Milan was our next stop and our hydraulic systems went out. So we flew around Chicago area and crash landed at Chicago O'Hare and all I remember is blue foam everywhere and it was the scariest thing in my life.
Howard: Wow. That is crazy. So are you a big potato eater? J. R. Simplot was born in Idaho and he was what, he was the eighty-ninth richest man in the world? When he died, he had three point six billion in cash and lived to the age of ninety-nine when he was the oldest billionaire on Forbes400. You know what my favorite joke in the world is? Came from J. R. Simplot know what a chuckle. They always tell you if you want to get a bill passed, you have to hand your water bills to some corrupt politician and they asked J. R. Simplot, they said, “Well, have you ever thought about politics like being the governor of Idaho or a senator from Idaho?” And he says, “Why? I already own them all?”
Angela: Yes, so true. His children were actually patients of mine.
Howard: That man was, gosh, he was just a genius side. Do you know his story with McDonald’s?
Angela: I've heard it a few times. All of the French fries from McDonald’s are made by J. R. Simplot.
Howard: What it was when they started it, they started it down in California, the first time ten they were all in (unclear 26:17) and down there in that dry, arid deal and when the guy who took Ray Kroc who’s the one who took it from a regional player of ten stores to rolling out as a franchise. As they were rolling it out, the French fries didn’t taste the same and he thought the McDonald’s brothers were holding something back or they couldn't figure it out. But everyone wanted to know why they were greasy, soggy in Indiana and Illinois but they were that crunchy, dry, tasty, salty in Southern Cal and it was J. R. Simplot who said, “Dude, it's the conditions of the area, you're moving these potatoes to these wet, humid places.”
So what he did, the most genius thing he did, one idea made him a billionaire. He said,
“When we pull out those potatoes, we're just going to blanch deep fry them. We're going to cut them, dress them and just fry him in the three hundred and fifty oil.” He said, “I wanted the oil to where if you sprinkle water in there, the water pops out,” and he said, “We're just going to deep fry them for just ten seconds and that will lock everything in and then we'll put them in a bag and we’ll freeze them” and he invented frozen French fries and they were perfect and that's why McDonald’s has a consistent French fry around the world because they're all made in one place and just an amazing man. I mean, I was a freak genius.
So you mostly work in Idaho and Nevada. Why are clients calling you? What are their problems? How are you solving them? What are you seeing in the field these days? What problems do you see? What problems are you solving?
Angela: Well, it depends on the practices. Most of the practice like in Reno and Boise are kind of the smaller towns that have some rural areas that don't even have airports. But a lot of the problems I'm finding are that there's just not enough training for dental practices. They don't have the training that they really understand treatment planning. They don't understand the solutions that we can offer to our patients not only through just working on dentistry, but I really like to focus my patients on the oral systemic link especially with sleep apnea.
There are so many things out there now that dentistry is we’re ticking all of that into effect when we open to looking into somebody's mouth, we also have to remember to do the oral cancer screenings, checking the X-rays. There's so many practices that I see now that don't do a perio charting once a year or they don't take X-rays once a year or even every twenty-four months.
So I think it's just building the systems back into dentistry like we used to have. There are systems for everything and really trying to link I mean, when I go into my practice, one of the things I do is spend a day just learning what they're doing in the practice and sometimes I go in and they're not taking blood pressures, they're not looking at the patient as the whole body, which I'm very, very passionate about that and treating the patients. Making sure that we're giving them the information about periodontal disease and heart disease and diabetes.
In dental hygiene school, I became very, very passionate about the oral systemic link because my patients were my family, of course and my grandmother had a heart attack while I was in hygiene school. My uncle was very diabetic, ended up losing all of his teeth. He was my (unclear 30:08) patient and I became very passionate about that. So I did more research and found that we can detect the carotid artery on a Panorex and how much of what we do in dentistry, it can help treat other patients with diabetes, heart disease. That's something that I really want to focus on when I go into practices is helping them build their practice to the next level by treating the entire patient, not just the mouth.
Howard: Yeah, it’s amazing. There's still a lot of dentists who think correlation versus cause and effect like my coffee pot didn't turn on because the sun come up; that's a correlation not cause. In fact, my favorite chart and I just posted it yesterday, was if you plot the number of Ikea stores in a country and number of Nobel prizes won, it's a perfect line and so if a country wants to have more Nobel prizes, they should open up more Ikea stores. But the data, I don't believe it's correlation anymore. I believe it's cause and effect. I mean, they got great research that women with gum disease have three times the rate of breast cancer. It's an inflammatory disease.
In America, they always talk about truth, liberty and justice, but it's really money is the answer, what's the question and the most expensive thing these health insurance companies have is a premature baby and when you drop a frog at one pound, it's a million bucks. They know that the number one preventable thing they could do is what they got any of these pregnant girls on their plan, they want them to have a cleaning. They could knock out the gingivitis and the perio because when the body's inflamed, something's doing something to say maybe this isn't a good time.
I'll give you another example of that where it took them thirty years to figure out but everybody knew was happening. Do you remember when girls reach menarche, the age kept going lower and lower and lower and it finally got to where in the United States and France, 10% of girls were reaching menarche at age ten and they just knew it was all the hormones in the milk and the beef and all that. So America didn't do anything because the Americans owned by lobbyists and they didn't want it. But France actually did the right thing and banned all the hormonals in their foods because they knew that was from and it continued to drop and drop and drop regardless. And finally it was an evolutionary biologist who said, “Well, you're just looking at these twenty rich countries, let's look at all the countries.” So he started looking all the countries and he said, “Is menarche raising anywhere?” and they found out, yeah, in Ethiopia, in Somalia, in Eretria, it was actually going up and then they immediately realized evolutionary biology that if a woman has a really rich, amazing diet, that would be the best time to get fertile and drop an egg and make a baby and the reverse of that is true.
If your mouth has gum disease and inflammation and the body thinks maybe this isn't a good time to grow a frog, let’s not do this, this isn't a good time, but there's something in there. And I listened to the past executive director of The American Dental Association for like ten years, way back in the day, I think it was in the eighties. I think his name was Brennan and I mean he showed a whole presentation for a day on this link between gingivitis and low weight term babies. So I think that's going to be a big deal.
But when you're talking about staff training, I mean there's another way to look at that. I mean, not only do all staff and dentists need continuing training all day, every day. I mean, I always say every day humans need to brush, floss, take a bath, get motivation, get new information. I mean, they're humans. That's how you manage humans. It's like the Christmas bonus; once a year doesn't motivate your staff in July. I mean your staff pays their bills monthly. So if you pay your rent, car payment, your house payment, phone payment monthly, the only bonus that's going to make them think in that month is the bonus they get that month. They're not thinking about the end of the year. But the biggest problem in dentistry is the staff turnover. I mean, you go into the offices where when everybody only works there two to three years, you can't really get any traction.
Angela: No. That's a huge problem in all over the country. I believe that the job hunters, they find a dentist and they work there for a year and then they jump over because they're going to get a dollar an hour raise or, I have a bonus system in my practices that I put into place that it's based on each individual person's accountability and what they do in their actual position. So the assistants get bonused on how much treatment they're doing in a day and the hygienists get bonused on how much treatment and helping the dentist diagnose a treatment with intraoral cameras and sharing in the responsibility of the practice. So it's not just the dentist being held accountable for everything, that's not fair to dentists. I believe that everybody in the office needs to be held accountable for each of their positions and the only way we can do that (inaudible 35:41) properly.
Of course, my business name is Golden Opportunities and so for like a bonus system is called Golden Opportunities Accountability Levels and that's where I go in and we really evaluate how well treatment coordination is going, how well the hygiene scheduling is going, how well follow-up calls made what I call treatment auditing because everybody needs to be held liable for that. Otherwise, your practice is just going to go down the tubes and like you said in your book, Howard. The quote I think it was, “You have to create opportunities in your practices with your staff by helping the patients, you're going to create more opportunities with your staff and that's going to just flourish for everybody.” So that there isn't that much staff turnover, so that the staff is really held accountable and likes to come to work because they're helping people.
Howard: Well said. So your territory is mainly Idaho and Nevada. Just those two states?
Angela: Yeah and I go to Utah, also.
Howard: You go to Utah? So how many dentists are in Idaho or Nevada or Utah? Do you know the numbers on those three states?
Angela: There is close to five hundred and fifty here in Nevada or northern Nevada, I should say. There is eight hundred and twenty something in Idaho and that was my last year's count so I don’t think that includes Las Vegas. Close to a thousand in Las Vegas.
Howard: Okay and how many in Utah?
Angela: There's probably fifteen hundred, I would say.
Howard: And so if some kid was coming out and they were thinking about going to Utah, Idaho, Nevada. My question is, do demographics matter? Do small town rural dentists in those three states do better than the big town Denison, Reno, Vegas and Salt Lake City?
Angela: Yeah. I totally 100% believe that rural dentists do better. Like I said, I have several practices that are in rural Nevada. They're mining towns. In rural cities or towns, I guess you would say, they don't have to contract with every dental insurance company out there to get patients which is a huge benefit. So there's more fee-for-service in rural areas because there's not as many dentists in those areas. So let's say one of my towns. Let's say Elko, there's maybe twenty dentists in all of Elko, but there's a population of over thirty-five thousand people.
Howard: Where is that? Idaho or Nevada?
Angela: That's in Nevada.
Howard: and what are they mining?
Howard: That's your name! So you're just being biased because you're Golden and you love gold. I would raise my daughter in Nevada but I'd never raised a daughter in Idaho.
Angela: I know that joke.
Howard: I don't want her whole life saying, where are you from and she says Idaho. Bad joke. But anyway and I'll tell you in like right here, I'm in Phoenix, Arizona, but everybody in this area, if you say, where are you from? They will say Ahwatukee because that's the way it is. But I have friends that commute forty minutes in the morning north to Scottsdale (unclear 39:26) all day long and then I have other friends who are more lazy who commute forty miles out of town and go to Maricopa and Eloy and just clean up.
It's like most dentist wake up in the morning at a one person per two thousand per patient ratio and then they drive an hour and get out of their car when it's one dentist for five hundred. But if they would have drove the other way, they could have driven to a place that's one out of thirty-five hundred or one out of six thousand. In fact, I'll tell you this. When you drive from Phoenix to LA, the border town is Blythe, right? They don't have a dentist.
Howard: So you could work Monday through Thursday, four ten- hour days, it'd be like shooting fish out of the barrel and then probably be so damn rich, you could have a condo on the ocean in LA and one in Scottsdale and every other week drive and spend Friday, Saturday, Sunday like a rock star in one of those three places and I know dentists who do that. I know dentists in Bakersville who makes so damn much money. He works four tens Monday to Thursday, then gets in his own private airplane and flies to Orange County and then hangs out there for three days. But everybody in Newport Beach would if you say, “Well, you want to practice in Bakersville?” They'd say, “I'd rather go to hell” and then you'd got to tell them that Bakersville is hell. It is hell, don't say I’d rather go to hell Bakersville is hell. What's that?
Angela: Rural areas are, I mean, that’s where people work so there’s still people that live there. I know, let's say Hamilton, Montana, it's a beautiful country, beautiful places to hunt and fish and do that kind of thing but there's very few dentists and northern Idaho, it’s the same way. Coeur d'Alene is a beautiful place, but there's some places that they just can't draw dentists to and I don't understand that.
Howard: Coeur d'Alene is the worst Ironman course in the world, though. I've done Ironman three times but the bike is the longest part, it's hundred and twelve miles. But in Coeur d'Alene that's just straight up and down mountains the whole way.
Angela: Do you go up the end-point also?
Howard: Oh my god, you don't ever want to do a bicycling trip in Idaho unless it's called a Harley Davidson. And then there's another thing I don’t understand where these kids, they come out of school, a lot of them are in love with one of their classmates and they're going to have a couple of babies, but they still want to go to downtown Salt Lake or Phoenix or whatever. It’s like “Well, why don't you just go rural for five years, make your babies?” If you want a big city baby, well that doesn't start till they're six, seven, eight, nine, ten and then you could sell that million-dollar practice to someone, you could build it up and sell it.
Angela: It’s funny because I actually have one of my practices listed on Dentaltown for sale that's in rural Nevada and everybody that I've had contact, I mean this is a majorly, very profitable practice fee-for-service and beautiful office. But everybody's like, “Oh no, I don't want to live way up there. There's a two-hour drive to go shopping.” Well yeah, it is (inaudible 42:43) okay with it.
Howard: The most amazing thing you just said is that no matter where you are in America, every consultant says if you're two hours away from a major airport, you're going to crush it. I mean, that's about how far you have to get away. And then the other thing that people don't realize is that two-hour drive is about to be dead because I'm here in Phoenix where Google started their driverless car program called Waymo and so for all year I've been seeing all these Waymo cars driving around.
So once it’s a driverless car, you're not going to pay thirty, fifty thousand dollars this fancy Honda Accord and all these bells and whistles because you're not going to be driving. It's going to be like a box on wheels and you and the wife can go in there, you might just have a bed and a big screen and say, “We're going to go watch a movie on our two-hour commute to town.” Or after work you're tired and you're two hours going down and you go, you get in your bed, you fall asleep, you wake up two hours later, ding, ding, ding, ding, you are now here in the big city.
So once cars go driverless, I don't think anybody's going to care about the commute. It's the same way with me on an international flight, it’s like people saying, “Dude, how do you lecture in India and Vietnam and (unclear 43:47)? I mean these are fifteen-hour flights.” Well, if you're in first class, the thing lays completely flat like a bed. Well, if you're laying down completely flat in a bed, you don't know you're in an aluminum tube going five hundred and fifty miles an hour across the ocean. I mean, you just go to bed and you wake up and you’re four thousand miles further than when you went to sleep.
I also think this, here's my big prediction. You can't get any work done at home because all your kids are saying, dad, dad, dad, dad, dad. You can't get any work done at work because you're sitting in a cubicle and everybody's come by and telling you what they did last night and they're moving and how's the wife. But you have to be there for the meetings. So I think what's going to happen these commutes are going to be great. You're going to leave your house, kiss the kids goodbye, get in a box, do all your email for a two-hour driverless commute to work. Then get out, do all the meetings you have to do, find out what needs to be done and then get back in your car uninterrupted, do your work two hours back home and I think everyone is going to be a lot happier. I mean, I feel so sorry for people in cubicles where they do everything so you can't bother them. They put a sign in, “Please don't disturb.” They put on the headphones, they do everything to go away and you see some guy tapping on the shoulder. “Oh dude, you got to go see that movie. Black Panther was awesome, I saw it with my dog” and it's like you know.
Anyway so demographics matter. If you don't think demographics matter, what I suggest you do is graduate from dental school, go set up your practice in Syria, Afghanistan or Somalia and then after, I don't know what six months or a year, you might start thinking maybe demographics do matter. So how do you slow down staff turnover?
Angela: Well, treating your staff like they are your family. I mean, you're with them. Most dentists are with their staff more than they’re with their own wife and kids and I feel like treating your staff really, really well and giving them rewards and letting them know that they're appreciated is going to be a huge deal. Making them be a part of you and then part of your dream and then part of your team, you have to bring them into your whole life. Some of the most successful practices that I've ever had actually do their dental meetings at the doctor's home because that's where they get to know each other and are more relaxed and going out and doing things, having a cocktail after work with your staff or something, making them feel appreciated.
Howard: Cocktails, I thought you were in Idaho, Nevada, Utah, that’s Mormon country, you've never seen a cocktail before.
Angela: Oh, yeah.
Howard: But the problem is that you're hard-wired at birth that all you want to do to survive long enough to reproduce and to survive, you need to control your environment. So a lot of these dentists are very controlling and it just anti-biology to delegate. Do you see that a lot or do you work with that?
Angela: Oh, yes. Dentists and hygienists are very, very OCD and so letting go of reins and delegating something to somebody else is kind of out of our norm; we don't like to do that. So I try to get the dentist to understand if they do let go of the reins a little bit, they're going to be a lot more profitable because they'll have more time to do what they like to do. Dentists come to work, they are in the patient's mouth all day long.
Like you wrote about many times, they're high suicide rates. The stress that they're under and then having a business on top of it to run is a whole another stress level. I can't even imagine how some dentists don't delegate things can even handle it. That's probably why they have such a high suicide rate, but I just feel like I have to train the doctors as well. You don't have to kind of conform them to letting go of the reins and saying, “Yes, you can trust me to help you.”
Some dentists have let their staff takes over everything and those are the ones that I see that they are not checking their day sheets, there's no systems in place to check on embezzlement and that's a huge problem in dentistry right now is there's so many dentists being embezzled. I just don't know how Mr. Harris handles all the embezzlement that he has on his plate.
Howard: Yeah and it's not just that, it’s spouses up there embezzling. It's like you're a woman dentist, your husband's upfront and he's done but then he started saying, “Well, hell, I can sell five thousand a month, you wouldn't even know it.” Another thing is when there's a two family members in there. So your assistant wants to hire your sister to work up front. Now you have two cats from a different tribe. I mean, there's so much that’s going on.
I have to tell you that thirty years ago when everything was paper, check, pegboard, there wasn't that many ways to embezzle. But today with everything digital and paperless, credit card terminals. I mean, they invent a new way to steal every single day. In fact, some of these office managers are so good at it they should seriously think about politics because they’re such master stealers.
So here's another thing that I see all the time. You go into a medical dental building, there's four dentists and three of them, three people coming with a cavity. They have about a one-third treatment plan acceptance and then there's that one office, three people coming into the cavity, two people get the cavity done. The difference between a one-third treatment plan acceptance rate is your average $750,000 office where they're taking home a $175,000 a year. But when you get two out of three people to say, “Yeah, I need to get my cavity done.” Now you're at a one and a half million-dollar office and you're taking home $300,000 here.
What do you think the key is between having a one-third treatment plan acceptance rate versus a two-thirds? We can guarantee a one-third aren't going to get it out. I mean, some of my favorite patients come to the office in a wheelchair with an oxygen tube in their nose and they're out smoking by my front door. I mean, I love them. I mean, there's diabetics in my practice that drink a two-liter bottle of pop every single day. I mean, people are people are people.
I'll never forget the first patient I ever saw that had a trach from oral cancer. Truman Medical Center (unclear 50:54) under Brett Ferguson, Charlie White walked out of there, someone in her family snuck her up cigarettes and she was in there smoking through her trachea. And I said, god dang, I love people because my foreign families. I mean, we're all from Wichita, Parsons, Kansas, Nevada, Missouri. I mean, we're born in a barn type people, I get it. I get that one out of three are ever going to make a great decision about almost anything, but how do you go from one out of three? That's the low hanging fruit that says, “Oh, you're a dentist. You say, I've got a cavity. Hey, I should probably get that done.” But how do you get that middle third? How do you get that one in the middle to go with you instead of going home?
Angela: You know what, I think it's all in the way you treat your patients. Some of my practices have paraffin hand wax, some of them have neck pillows or little massage rollers; making the experience unbelievable for the patient is going to build trust for your patient. If they trust you, they're going to probably get their dental work done because they do trust you and I think that going that extra mile and giving the patient, making them feel like a human, not just walking in there, open your mouth, you have a cavity and walk out, explain it to them. I can do this cavity here, you have this cavity and show them a picture of it. Show them what it looks like in their mouth. Treat him like a human being. That's the number one way to win patients over is by treating them like a human being and I think that that's a lot of times we forget that our patients are humans. They are people and they have feelings and they just want to feel pampered and cared for and they want to know that somebody is actually listening to them.
Howard: Yeah and there was a big study, a big medical malpractice company wanting to know why it was always the same doctors getting sued over and over and over. So they were trying to prove that maybe they went to a bad school or they didn't have enough continuing education and once they found out that the only thing different with them is they were assholes. Their patients didn't like him and I also think it's very weird how in these smaller offices, the dentist will numb up the patient and then he'll leave the room and he'll go sit in his office for ten minutes and it's like, god dang, that was the only time that mattered. “Hey, how's the dog, Angela? How's the kid telling me? How old is that granddaughter?” Blah, blah.
I mean, that's the only point that matters and they leave the room and when I know that my receptionist is mad at me because I added an extra filling or ran overtime or whatever and I know she's ready to slap me, I always dismiss the patient and walk up there and just say, “How are you, Valerie?” And she was like, “Actually, Angela’s pretty pissed. She had an appointment at 10 o’clock, Howie. What time is it? It's 10:20, why are you twenty minutes late for Angela?” Then I own it and I'm out there, “Angela, I'm so sorry,” whatever, whatever. But that's the only stuff that matters. Your doctor’s saying if they got an A in calculus that everybody will honor them and always be their patient.
Angela: They don’t care. Patients don't even know what school you went to most of the time or they don't know anything. They just know you're a dentist or you're a hygienist and they don't know even what you're supposed to be doing; they just want to be taken care of. I know when I go to the doctor, if we're at the dentist for that matter, if I went to a practice and the doctor didn't actually talk to me and find out my concerns then that would really bother me. I think I'd feel like they should treat me as a human being, too.
Howard: And another thing I want the young kids to know. When they get out of school, they’re always going to hear all these shocking stories about how bad this other dentist was and a lot of them are going to believe it. I'll give you some instances like I've been a dentist for thirty years. Do you know how many times people have told me, “You know he had to put his knee on my chest!” Okay well, I've never met one dentist ever on earth that ever lived in this life or the one before that put their knee on a chest. How many patients have told me that in thirty years? A hundred. So when they tell you all this bat shit, crazy stuff, don't side with the crazy person. When the other person is a doctor of dental surgery, you’ve got to get accepted into college, dental school, start a business. I mean, I'm baking the other dentist is probably ten times more normal than this crazy person with crazy eyes telling you this crazy story.
I love humans. I mean, I would not have wanted to be born on earth the only human on earth that’d have been extremely weird and confusing and so the humans make it all great, but they're the source of all the stress, trouble. Sounds like you're at work and need to go. Is that your doc? Is that a dentist that just walked by?
Angela: Oh yeah, he just walked by. He just waved to me.
Howard: You should've brought him on the show!
Angela: Yeah, I should have.
Howard: So for a close, how much do you cost? How do they find out more information? Your website is Golden ODC, Opportunities Dental Consulting. Your email’s info@goldenOCD.com. So basically you prefer to work in Nevada, Idaho, Utah. What are your charge? Is it a contract, is it a daily rate, a monthly rate? How does it work?
Angela: You know what, I don’t have a have sub key, I base everything on what the needs are for the practice in the practice for instance, if I'm doing a practice startup or if I’m just training. So everything is based on what you actually need. I don't do a lot of the year contracts, things like a lot of consultants do. I'm very one-on-one with my clients.
Howard: So you have no contracts?
Angela: I do not have contracts.
Howard: But I bet you didn't say that to your husband, Mr. Golden. I bet you made him sign a contract.
Angela: I did!
Howard: You make everybody not sign a contract. So the fee, it just depends?
Angela: It just depends, honestly, on how much time I'm spending in the practice or what the practice that will be based on how I do my fees.
Howard: Here’s the most common question that everyone asks me from dental kindergarten: Howard, what implants do you recommend? I say, “You know what, the better question is, have you ever been an auditor or inspected by the state board of OSHA?” Do you know what your true total account receivables is? How many accounts have credit balances? Do you know why? Does your scheduling coordinator know how to effectively communicate with patients to schedule needed treatment? Do you know how many active patients you have? How many active patients are falling through the cracks? Do you have a written hygiene policy or perio program? Do you have only one person in charge of all financial assets of the practice? Do you have a compliance coordinating practice? When did you last reform an audit of all systems in your practices and you know what, your bone cell, your osteocyte it doesn't give a shit if that titanium implant was made by Nobel Biocare or Straumann or Implants Direct. It came out of some mine in Utah, right?
Angela: Well and it's so funny that you bring up the auditing. I think I actually I saw it, you posted it about the dentist in UNLV who was using abutments. I don't know how many times I've gone through practice audits with the state of Nevada or OSHA or even insurance companies do audits. I'm doing one next week with an insurance company. There's so many things to be looking at in your practice that dentists don't really know until they get the phone call or OSHA walks through the door or they get a letter in the mail saying, “Hey, we're coming into your practice and we're going to look at everything” and that's where dentists really need to know.
Howard: And some of it just oversight. I hear there was a good old boy in Oklahoma who just didn't know that his autoclave had died, but they just kept using it. Then back in the day when I was little and got out of school, the Centers for Disease Control, they were aware of clusters and they could go there with hand in pencil and figure out that everybody in this cluster ate at this restaurant or the number one thing in common is they went to this dentist, but now they can take that infection and go through the DNA and sequence it and say, “Oh, you caught this from Howard, not Tom” and the ramifications. I mean, it's like a criminal deal. I mean, there's so many hats to wear that the dentist have to delegate, they have to slow down the staff turnover and my final note is nobody ever got a gold medal in the Olympics who didn't have a coach and you look at these gold medals now. They’ve got their sport coach, they've got a nutrition coach, they’ve got a therapist, they’ve got a personal trainer, they've got sports psychologist so they keep their head in the game.
I've always thought the best dental consultants in the world were part armchair psychologist, trying to get their head back in the game, you know what I mean? If you're burned out, fried, then your mind's not in it. So these guys get a gold medalist, they might have five to ten coaches and then the dentist thinks, “Well, I'm a doctor. I mean obviously I know everything. How could anybody know anything more than me if I'm a doctor?
Kids, I'm going to tell you a thousand times, by the time you get to my age, every practice doing two, three, four, five million didn't use one consultant, they used a half dozen consultants over thirty years. And if you think a laser or a cad/cam or learning how to place implants is more important than calling Angela, you're just going to learn a lot of shit the hard way and it's going to cost you a ton of money.
Angela: Howard, I really appreciate you saying that. There are so many great consultants out there and even I learn every day from different consultants and I don’t have a coach; I use you guys. I have your book here that I read. I have all kinds of books from David Moffat, Linda Miles, Louis (unclear 01:01:24), they are all wonderful people and we all need to learn from each other. Not one person has every solution and that's where I think I'm lucky that I have had the experiences of being in every position except for the dentist. So I do understand and relate to the staff and that has helped me in consulting drastically because the staff really relates to us.
Howard: One last thing, I'll never forget, this happened to me several times in my life where in my journey in the eighties and early nineties, what am I friends with like the most perfect practice in the world? One was Drums Smith in Lafayette, Louisiana. One was what was that guy's name in Wichita? Anyway and I said, “Why would you get a consultant?” I said, “You have a perfect practice.” He goes, “Buddy, that's why I have a consultant. I've never given a consultant a dollar where I didn't get that dollar back twice in that single calendar year” and what you're seeing—was it Landry in Wichita? Yeah, Dr. Landry, your sister-in-law Joyce used to work for him. And he says, “What you're seeing is twenty, thirty years of a consultant fixing up the hygiene department, a consultant fixing up this or sales or this or marketing or website.” He says, “If there's one person that thinks they can come in here and just tweak it a little better, I'm buying it right now.”
So thank you for all that you do for dentistry. Thank you so much for giving me an hour of your life coming on the show today.
Angela: Thank you so much, Howard.
Howard: And how old is your granddaughter?
Howard: Is that your only one?
Howard: Then I bet that's one lucky, spoiled rotten granddaughter.
Angela: Oh, I love her to death.
Howard: I hope you have a rocking hot day, Angela. Thank you so much for coming on the show today.
Angela: Thank you so much, Howard. I appreciate it.