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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1056 New Grad Tips & Tricks with Dr. Trent Orth & Layla Orth : Dentistry Uncensored with Howard Farran

1056 New Grad Tips & Tricks with Dr. Trent Orth & Layla Orth : Dentistry Uncensored with Howard Farran

6/10/2018 2:44:08 PM   |   Comments: 0   |   Views: 276

1056 New Grad Tips & Tricks with Dr. Trent Orth & Layla Orth : Dentistry Uncensored with Howard Farran

Trent Orth is a 2018 graduate from the University of Alberta in Edmonton, Alberta. He also received his Bachelors of Medical Science from the University of Alberta.

VIDEO - DUwHF #1056 - Trent & Layla

AUDIO - DUwHF #1056 - Trent & Layla

Howard: It is just a huge honour for me today to be podcast interviewing Trent Orth and his lovely wife Layla, who just graduated from dental school in April and basically after you graduate you get six weeks off to get your license and all that so you decided to come down to Phoenix where 10% of the population is Canadian. Did you know that?

Trent: Really? 

Howard: Oh yeah. It's 10%. When you talk to any realtors in any given year, 10% of the houses flip in all the largest cities in the United States and in Phoenix it's 10% Canadian. 

Trent: Snowbirds. 

Howard: Yeah. Snowbirds. And then whenever the Canadian dollar goes up and the US dollar goes down, they start unloading into houses here. So how's the dollar? How's the Canadian/US dollar trading right now? 

Trent: Poorly to my knowledge. 

Howard: What is it, like seventy cents? 

Trent: Seventy-five?

Layla:  Yeah.

Howard: Seventy-five cents to a dollar.

Layla:  Something like that. 

Trent: I haven't checked in a while, but it's something like that. So anytime we come down here, I'm always thinking if we're going to buy something how much is it really going to cost? So it feels expensive. 

Howard: So your dad is a dentist and so first of all, I like doing a variety show. The guy before you was the vice president of 3Shape selling oral scanners. We have specialists on, we have old people like me on that have already done it thirty years looking back, but I think a lot of people want to know what you're thinking just coming out. You just graduated from dental school and your father is a dentist. So you're second-generation dentist. Were there any other dentist in the family? 

Trent: No. 

Howard: Yeah, so tell us about your journey and what does it feel like to have just graduated from dental school? 

Trent: It feels good. It feels weird now that I don't have any more school to do, but it feels really good. So, I did eight years of school total so I did four years of school before dental school, four years of dental school, and right out of high school I did a year, then I went on an LDS mission, actually to Arizona. 

Howard: Really, LDS mission to Arizona?

Trent: Yeah so I was down here for a couple of years, then I went back and did three more years of school and then went into dental school. 

Howard: So where was your mission in Arizona? 

Trent: So technically it was the Tempe mission. So the boundaries of that it included Ahwatukee, you're in Ahwatukee right? 

Howard: Right, we're in Ahwatukee. It's actually Phoenix, Arizona. So Phoenix is a million people and at the bottom of it is the largest city park in America. It goes from 48th Street down to zero to 51st Avenue - it's a hundred street long park and south of that is this little sliver of land where eighty-five thousand people live. So it's about less than 10% of the population and it was Ahwatukee but they annexed us pretty much right when I got here thirty years ago. So it is Phoenix, Arizona. But if you ask anybody in Ahwatukee, do you live in Phoenix? They say no, I live in Ahwatukee so it's kind of the identity. 

Trent: So the mission that I was in it went down to Yuma and it also went up to St John's Arizona area too. So kind of right across the state. 

Howard: So Tempe to Yuma to St John's? 

Trent: Yes, and you went to ASU too right? 

Howard: Yeah.

Trent: So, I was on ASU as well. I was a missionary on ASU. I don't know what year you went there or if the LDS Institute building was there?

Howard: It was '98 - '98/'99 for me. 

Trent: Okay. So they have a huge LDS institute building there now and I spent a lot of time there as well.

Howard: My favourite Mormon missionaries, is I've lectured in fifty countries and what's really neat is if you go there as a tourist, you stay at a resort, you do all the tourist trap stuff, you hear all the tourist stories, that's baloney. But I get picked up by dentists that are bringing in and you get to really learn about the country and I always tell them I don't want to stay in a Marriott. I've stayed in a thousand Marriotts. I want to say in your house because it's so cool to be in their home. what does a refrigerator look like in Rio de Janeiro versus Warsaw, Poland. I'll never forget when I opened up [Marchind Delucky’s 00:04:24] refrigerator in Poland and it was just sausages! You hear all these things about Polish people loving sausages but it was like white, grey and then they had different fruits. It's basically you just ate sausages and tomatoes and all these different dishes. But what's so cool is you can spot a Mormon missionary a block away - they got white shirt, a tie on a bicycle whatever, and they're young and they just got out of college. And I remember in so many third world countries – I love economics, I love macroeconomics and I’d say, “So why do you think they're poor?” We all live on the same planet and it looks like in Costa Rica you could grow anything, we're in Jamaica or wherever and their fresh, bright eyed, bushy tailed insights are just amazing because you don't realize that fifty-five years of reading all the books and the press you get really brainwashed and jaded and you eventually drink the Kool-Aid and they’ve talked to some twenty-year-old baby who just left home and is knocking on all these doors and hearing their problems. And it was just amazing, just amazing, but the economists are right because what they continually tell me, and I've talked to them in a dozen different countries, is that the economists always say if you don't have rule of law and you have lying, cheating, stealing, corruption, nepotism, it just is poverty. And every one of them would say the same thing. They'd say, well, it's a breakdown of the government and the family and when everybody's lying, cheating and stealing and even the police are stealing and taking bribes and then the family, there's no dads home raising the kids. How do you become a productive society? And it's really refreshing to hear all those views. So how jaded are you just walking out of dental school now? 

Trent: What do you mean? 

Howard: No, I'm just teasing. So, what does it feel like?  What does dentistry look like to you? One of the questions I always ask in economics is, they ask parents for their level of optimism. Do you think your children will be able to have a life as greater or greater than yours? Do you see the consumer confidence index is one of the greatest predictors of the economy because if you look forward and think it's dark clouds in the skies, then you don't want to go buy a house, a car. If you're afraid of losing your job, you don't want to spend money eating out for lunch. You want to take a lunch pail and save money. So do you think that you can have a dental office and career as great or greater than your father? 

Trent: Honestly, I don't know what to expect coming out of school. I think, for one, when I talk to my dad about what his student loans were like when he came out of dental school, obviously they were a lot less. But then when I talk to my friends who went to school,  I have some friends that went to Midwestern down here, and I talk to them about their student loans and it makes me feel really lucky. 

Howard: So what was the price of Midwestern? What is that about? 

Trent: I think it's something like it's almost a hundred grand a year or something like that.

Howard: So they're coming out $400,000 in debt.

Trent: Yeah something like that, maybe a little bit less, maybe something like seventy. You know, that's US dollars too so... 

Howard: So how much student loans are you going to have? 

Trent: So right now walking out of school, some of that was from living and everything too, but now we're sitting at $170,000 Canadian, which is something like a hundred and thirty five or a hundred and thirty five US. 

Howard: So just a really nice car. 

Trent: Yeah I guess so. 

Howard: So you bought a Porsche and it's invisible! By the way, here's your Porsche, take it and put it in your pocket. So you bought a Porsche and didn't get the car – you bought it, they stole it. But are you optimistic about Calgary, Alberta, Canada, which is just north of Montana? 

Trent: Yeah, I think so. Coming out of school, I talked to a lot of dentists. Everyone still says you can do well. A lot of my friends that are dentists, that have been out for I guess zero to five years or something like that, they say you don't really have anything to worry about. But I just don't know what to expect because I've also talked to dentists that have a really hard time that come out and  they've worked for different dentists and they were promised things out of school from these dental offices and then they get there and it's nothing that they were promised. So we feel like in my situation... 

Howard: They were promised from employers or corporate dentistry? 

Trent: I don't know if it was a corporate office or if it was like a solo dentist but they were promised you'll come out of school, you'll be busy four or five days a week, and they moved their families to certain places and they get there and they're not busy. They're working a couple of days a week and they're less busy than they were at their old jobs. But I think given the situation that I will be coming out, I'll be working for my dad, I feel like it will be a better situation that I'll actually have a good mentor, which is something that's really important to me at least the first few years coming out. So I feel really lucky that I think I'll have a really good mentor. Me and my dad, we have a really good relationship. I like the way that he views dentistry and practices dentistry, so I'm excited to learn from him. So I'm pretty optimistic about at least learning hopefully how to run a business and also learning more about dealing with patients, more about different procedures. But as far as the market goes, I don't know what to expect. And you know, like I said before, my dad's downtown Calgary, it's an area that there's been a little bit of a recession in Alberta so a lot of people have lost their jobs so he's lost quite a few patients I think too. So I don't know what to expect with that. But, like I said, I'm optimistic. 

Howard: So demographics matter, they matter huge and if you look at Calgary or Alberta is where the tar sands are and when you go to Saudi Arabia, you don't even have to drop a thousand feet and you have oil ready to go into the barrel. I think Saudi Arabia's average barrel they have $4 into it by the time it goes to the refinery. But to extract it out of the sands is a very expensive process. So when oil was basically trading at $100 a barrel, the state was booming, but then it dropped all the way down to very low. I love these charts where they don't have that. So in 2008 it was $145 a barrel. And then by 2009, that was when the economic collapse was. So 2008, Lehman's day was 2009, so it was at $145 a barrel and it dropped all the way down to $30 a barrel. But at $30 a barrel it's been trending up, up, up and now it's past seventy-five headed towards $100. So do you think that's sustainable, do you think that price is going to last? 

Trent: I hope so. 

Howard: Well all the big brains on Wall Street think is, but at $70  are they starting to rehire? Well, first of all, when it was $130 companies have no incentive to work smarter. They just throw money away. So when oil collapsed, what was really great about the tar pits is they started to have to think we don't have the luxury of just wasting money. So they really squeezed their cost out. So the oil wouldn't even have to go back up to that high again, but the economy came back. I would be bullish on oil until the last drop. I mean people always talk about wind and solar and all this crap like that. Wind and solar is not even 1% of the United States' electricity.  We're still 20% nuclear powered and so when you look at electric cars and driverless cars, man, that's going to be ten years away before you have a solar-powered windmill-fed electric car to take you the grocery store. So right now it's oil and gas. 

Trent: Yeah, well that's a big thing. That's what Alberta is known for - its oil and gas and that's what the economy... 

Howard: And then agriculture too? 

Trent: Yeah, I mean farming is a big thing in some areas of Alberta.

Howard: What is it mostly - small grains? 

Trent: I have no idea. Do you know? 

Howard: Were you born there too? 

Layla:  No, I'm from BC. 

Howard: Vancouver, British Columbia. 

Layla:  That area. Yeah. 

Howard: So was it a cultural adjustment going that far inland? Because Vancouver, British Columbia, that's like the coolest city. I think it's the coolest city in North America. It's that or San Francisco. 

Layla:  It's pretty cool, yeah. 

Howard: Oh my God. It is so cool. 

Layla:  I was born in Vancouver and then I grew up on the island and central BC. 

Howard: Vancouver island?

Layla:  So Kelowna, have you heard of Kelowna, BC? It's kind of like, they call it the Hawaii of Canada. Everyone goes there for summer vacation. 

Howard: So you left for love, huh? 

Layla:  No, I actually left to go to Calgary. I was done school and I went to Calgary to work and then we met five years later and that's why I stayed. I was actually going to move back to Vancouver. I had planned to give it another six months in Calgary and then move back. 

Howard: So what work do you do now? 

Layla:  I'm a massage therapist and I have a small online business. 

Howard: Nice. well you're online now, sell something to my homies. What do you sell online? 

Layla: I actually just have a vintage shop online, clothing mostly. 

Howard: So, how many kids did your father have? 

Trent: Five. 

Howard: Did any of them go into dentistry or were you the only one? 

Trent: No, two brothers, two sisters. My two brothers are both business owners, so I have a brother who owns a concrete company in Calgary and the other one owns a cell phone company in Calgary too. 

Howard: When are you going to start? So, you're going to get your license, how many weeks until you get your license? 

Trent: We officially graduate, we walk the stage on June 9th and then June 11th is the first day I'll work. So I'll get my license, I think it's on June 7th is officially when I can go and register for it and get it. 

Howard: And when you go work with your dad, are you going to have a written contract?

Trent: No.

Howard: That that's your first mistake. When you guys got married, did you have a prenuptial? 

Trent: No.

Howard: That was your first mistake and this will be your second big mistake. No, I get it. you're in love. You want to live forever and that's great and romantic and that works half the time, but when you go work for your father you know, I've seen this rodeo several times. Say your dad dies and then you say I'm going to buy this practice for this amount of money, then your five siblings are like hell no, it's worth more than that and we each get 20%. And so then you go work for your dad and you have a falling out for whatever reason, and then you go across the street and set up and now your dad says no you can't set up across the street from me. You've just got to get it in writing because it's so important. When they say marriage fails a third, a third, a third on money, sex and substance abuse, it's really not even about those three. It's about they didn't talk about those three. Like take substance abuse. You come home from work – I know you're LDS, you don't drink – but you come home, you get married, you drink a beer after work every night and it drifts into two, then to three. Next thing you know it's six at night and a twelve-pack and she just leaves him, but they should've communicated way back then.

Same thing with money. I mean, how many of these dental offices don't even have a budget for the year?  100% of the Fortune 500 has a budget somewhere between Thanksgiving and MLK day, January 15th, for the whole year. I deal with these companies all the time. And then you go into a dental office. What's your budget for the year? I don't know. What do you spend on advertising? I don't know. What do you spend on labour? They don't have a budget. So when you go into a marriage, the importance of sitting down and talking about money. And then for monkeys, when you actually sit down and look at this, like you say I get a Starbucks every morning, but it's not on QuickBooks Pro. It's not itemized. When you sit back and then you guys look at each other and say, we spent two grand at Starbucks last year and then you start looking at all these expenses. So with your father, I just can't tell you enough.  I know you love your dad and my dad was my idol but my gosh, get a contract, get it in writing. Get an exit price, what happens if he dies? Then here's another thing. Let's say your dad has been working there. He's sixty-three?

Trent: Yeah.

Howard: So he's been working there and let’s say his practice is worth a dollar. Sixty-three is old dude, I'm fifty-five, I mean at fifty-five, you can't see as good as when you were forty-five. So he's slowing down, then here comes a thirty-year old energetic whippersnapper who's bouncing off the walls and squeezing in same-day dentistry and working through lunch and you build that practice from a dollar in value to three and then your dad dies and then your siblings value it at three. You're like, wait, I built two of that three. So to give a purchase price… Do you plan on partnering with him or do you feel like dating him for a year first? 

Trent: We're just going to see how it goes for a couple of years, probably a year or two years and then see what we want to do. I don't even know for sure if I'm going to necessarily buy his practice or not, I don't know. 

Layla:  But he is looking to sell. 

Trent: Yeah, he's looking to retire in the next few years. So ideally I would love to buy his practice and if everything goes well do that. But we haven't agreed to anything, we've just kind of said let's see how it goes for a year. He's really willing to be a mentor to me. That's what he said to me. 

Howard: Well your dad, your mom, your siblings, everybody will sigh with relief if you get clear and transparent. You know transparency is top. Everybody says governments need to be transparent. There needs to be checks and balances. We don't have a king. We have checks and balances between an executive branch, a congressional branch, a judicial branch, and you need to be transparent. All through time an absolute power corrupts absolutely and then when you don't know what they're doing in the back room, the next thing you know, they invade Poland or something. So to get transparent with what's going on, what are the numbers, let's get a contract, it just means everything. And then you guys can get a game plan, then you don't have to pull the cord, it's just if we do this, here's what we're going to do. 

Trent: Yeah. 

Howard: But it's all in writing 100%. And then the other thing in dentistry is we sell the invisible. I just can't say that enough. I mean, I know what an iPhone is. I get the brand. I know what a Hershey's chocolate bar is. Bottled water, you know all these things. But when your engine light comes on – I grew up with five sisters, I played Barbie dolls till I was twelve – and I pull into a garage and I don't even know what lifters are, spark plugs... You know they always say your blah blah – they might as well just speak Greek! I'm sitting there analysing this guy and I go to (Brulek? 00:20:03) because he's been across the street from me twenty years. I know his wife and kids go to the same school mine does. I know he's a good guy. So when he's saying wah, wah, wah, wah, wah, wah, wah, wah, wah, I'm just like cut the shit, how much is it when I get my car back? And he says I have to keep it till Monday and it'll be $1,100. Fine. So it's trust. So when they come into your dental office and you say you have four cavities, what are they supposed to do? Google four cavities. I mean they don't know. So having your dad, he's has been there how long? 

Trent: He's been in the downtown area for thirty years. 

Howard: Oh my God. And then you’re marketing as second generation and then your dad was there thirty years and he sold it to his son and embellish the story – you're his only son, you know, and it's a game of trust so when they walk in there, then your marketing, serving Calgary since what year was that? 

Trent: He graduated in '82, then they moved to Calgary in '88. So I would assume he's been in the downtown area since somewhere around '88. 

Howard: So all of your marketing – serving Calgary since 1988, second generation. And then the other thing is how long have the staff been there? How many staffers he got? 

Trent: Two hygienists, two assistants and then two front end. 

Howard: So, two, two and two. And how long would you say they've been there on average? 

Trent: His friend and receptionist, his office manager, she's been there I don't know how long honestly, maybe fifteen or twenty years or something like that. And then he's had a couple of hygienists that are pretty long-term too. I think between five and ten years. 

Howard: So that's the whole game in dentistry because when you start telling someone they need an MO and a DO and an MOD they don't even know what you're talking about, but when they say you guys have been here since 1988, it's second generation, they've seen all these faces for five, ten, twenty years, then they accept treatment. And that's why you see things when someone comes into your office from advertising, they'll spend a dollar, when they're sent in by trust, they spend $3. And then you ask the dentists well what is your case acceptance rate? They have no idea. They don't measure that stuff. And then you say, well what is your case acceptance rate of a new patient from advertising versus a new patient referred word of mouth. They don't know any of that stuff.  And then you say, what do you know? And they go, oh, I'm going to go see Gordon on Good Friday in Scottsdale and learn about all the bonding agents. And they all work. I mean if you're 3M and you sell a billion dollars’ worth a year, if you're IV Clear and you sell a billion dollars’ worth a year… There are five companies that sell a billion dollars’ worth of stuff a year in dentistry. Do you think you can sell a billion dollars’ worth of stuff if it doesn't work? 

Trent: Yeah. You've got to be doing something right. 

Howard: Dentists have got eight years of college, they are the most anally retentive, paralysis-by-analysis, they over-analyse everything and the lower the stakes, the more they'll focus on it. Like they want to go see Gordon talk for like forty days and forty nights on bonding agents from companies that all sell a billion dollars’ worth a year. Then you ask them any question about their business, they don't know the answer. And you say you have two brothers that are in business. 

Trent: Yeah.

Howard: So now you've got to trust a think tank, your wife owns her own business and how much business did you learn in your eight years of college? 

Trent: Pretty close to zero, I'd say. I took some economics classes but that's it. 

Howard: By the way, have you heard of my thirty-day dental MBA? 

Trent: I have, yeah. 

Howard: Have you listened to any of it? 

Trent: Oh yeah, I just finished your book. A business made simple. What's it called? 

Howard: Uncomplicate Business. I went with that word because when I type ‘uncomplicate’ the red squiggly line comes underneath it, so it's not a word. So I dropped in Amazon and there's no book that says uncomplicate. So I said that's my word. In fact, my next one's going to be Think in Abundancy. And abundancy isn't a word either. Abundance is a word but not abundancy. It's part of my born-in-a-barn from Kansas lingo. But I put that thirty-day dental MBA, it's for free on iTunes, it's not on the Dentistry Uncensored, it's a separate iTunes show. It's on YouTube, they say I look much better on iTunes than YouTube and so she listed on YouTube. You have to turn your phone upside down.  

Trent: It's on Dentaltown too isn't it?

Howard: Yeah, it's on Dentaltown too. So, you're at a fork in the road and you've got to take both forks. You come out of school, you've got to take the road of clinical dentistry and then you've got to take the road of the business of dentistry and I really recommend that your spouse gets heavily involved with that because it's a huge communication role.  People say, like the wife here, how much do you charge for a crown? A thousand dollars. And then you'll come home, and you'll say I did five crowns today, I did four yesterday, I did three... So she's like five crowns, that's  five thousand. She doesn't realize that in America the fee they quote – all the people calling the phone, how much is a crown?  – they say a thousand dollars and then like 98.5% of dentists take Delta and it's a PPO and in the adjusted production they might only be getting seven hundred for a crown. So the wife hears a thousand, but you're only getting seven hundred, overheads 65% and the margins... She's saying hell, if he's got $5,000 a day, let's go to Maui this weekend. I mean let's just kick back tomorrow. So, you have to see that and by the way, I always ask what do you not like the most about your business? Oh, I don't like all the PPOs, well what do you want to build? Because only half of America has dental insurance. You say I want to build the cash market. Okay, so you want to build the cash market, but 95% of all the crowns you did was at a PPO price of seven hundred and everybody with cash you say it's $1000. So that's an economic barrier to entry. I mean, everybody knows if you want more of something, lower the price, if you want less of something raise the price, have the government tax it and regulate it. I mean like San Diego – San Diego used to be the tuna capital of the world. All tuna, biggest tuna, cannery. 

And then the California legislature decided that the canning plant wasn't environmentally friendly, so they outlawed it. So San Diego went from the tuna capital of the world to there's no place even clean the tuna. So instead of working with business where they say, well, you know, this is ugly, but if we just ban it, well all it's going to do is move down to Tijuana. So how does that save the environment? So, everybody in California loses their job and then you just move it across an invisible line. So when government works with the business to say how can we try to clean up this process? Because when you just do the California thing and close it down, it just pops up on the other side of the wall, the invisible wall that Trump's building in Tijuana. So, you guys both getting on the same page, communication, seeing the books. Does your dad use a CPA? 

Trent: An accountant, yeah. 

Howard: And does that accountant specialize in dentistry? 

Trent: Yeah.

Howard: Really? 

Trent: Yeah. I think the accountant that he works with, he's been with for quite a while. I'm quite positive that he works with a lot of dentists. And I've talked to quite a few accountants too that specialize in working with dentist as well. So the U of A, the university I went to, is pretty good about that at least. They bring a lot of the accountants that work specifically with dentists to the school and they have them come and talk to us. They have different vendor fairs with different financial people or accountants or insurance people that specialize with dentists, 

Howard: You know, if you were going blind, you'd want someone who specializes in ophthalmology. If it was just your retina falling off, you'd want somebody who only specializes in retinas in ophthalmology. And when a dentist switches to someone who only does dentistry, oh my God, I mean just on average their overhead drops 5% because it's not just the math, it's the art. Because you know what you know, but we don't know what we don't know, and a lot of things are going on. Right now, I'm sitting here thinking when I graduated high school in 1980, the economy fell to the ground, interest rates were 20%, unemployment, inflation were double digit and then it got better. Then I graduated in '87, May of '87, then October '87 was Black Monday. The market lost five hundred points in an hour. And then it was really good from '87 all the way to March of 2000. That was about the longest stretch, is it thirteen years? And then boom, the Internet bubble popped, and it wasn't just the Internet bubble, it was really the Y2K bubble because all those cells were going up because everybody wanted to redo all their computers before the Y2K thing. So at Y2K, everybody was done, so sales stop January, February and March just collapsed. And then the next one was just this last one in 2008. So now it's 2018, it's been a decade. So in my walnut brain, I know humans are crazy and they make very bad decisions. And the reason there's a business cycle is because people make mal investments, whether it be in agriculture, real estate, stocks, bonds, cryptocurrency, whatever. So about every ten years there's this massive correction because we're all crazy and we don't know what we don't know. 

It's the same thing with that CPA who specialized in dentistry. After they've done this ten, twenty, thirty years, they know this works and this doesn't work, but they always can't explain that on a statement to income, a balance sheet, and a statement of cash flow. So getting someone who just only does dentistry and then when you go to those meetings, some of those people – what's the big one in Dallas, Texas, the Accounting firm in Dallas? Cain Watters. Yes, Cain Watters out of Dallas, they only do dentistry. But they have a rule when they do their year-end report. If they want you in there for a day, you have to bring your spouse and if you say, I don't want to bring my spouse, they discontinue you as a client because they've been doing this for thirty years. They know what happens when the dentist is going this way, the spouse in the other room. And they're like, no, we don't want to work that way. So, you've got to be very transparent with the personal budget, the dental budget with your dad, with legal, all those kinds of things. So what are you passionate about in clinical? What did you do in dental school that you said, man, I could do this. I mean your last name is Orth. Why aren't you in Ortho school? You're second generation, not reading your last name. 

Trent: My wife wishes I was, I think. My wife wants me to specialise somewhere so we can live somewhere cool for a couple of years. But I don't know. So far part of the reason I got into dentistry is because my dad was always coming home and he was talking about these different technologies he was learning about. How excited he was about the CE he was learning about and when I started looking into that – I'm kind of a techie guy, a little bit of a nerdy guy – so that was part of the reason why I was attracted to it because it seemed like there was so much cool stuff you could learn and so much cool stuff you could implement. So as far as dental school goes, we weren't exposed to that much of the interesting technology out there. We did some cad cam stuff, which I thought was really cool. I'm looking forward to learning more about cad cam when I get out in private practice. 

Howard: Does your dad have a cad cam? 

Trent: Yeah. 

Howard: What does he have? 

Trent: He has a Cerec. 

Howard: Does he use it? 

Trent: Yeah. 

Howard: How often does he use it? 

Trent: I think he uses it, the times that I've been in the office, he uses it every day. 

Howard: Everyday, that's awesome and does he like it? 

Trent: Yeah, he really likes it. So for him, I know that he feels it was a really good investment for him. 

Howard: Does he do all the scanning, milling, staining, lasing? He does it all himself? 

Trent: I'm not sure what his assistants are doing. Is that what you mean, if his assistants are doing part of it or not? I'm not sure what parts his assistants do and what parts he does, but when I have seen him do it, I've seen him do the scanning and then obviously the crown insertion too. 

Howard: But not all of the stuff in between? 

Trent: Yeah. I'm not sure if he's doing that or if he has an assistant that's helping him do that too. 

Howard: Because that's where I think it goes incredibly wrong. 

Trent: When the dentist is doing all the steps? 

Howard: Yeah, when you buy this expensive machine to become a lab tech. Dude, you don't even have to go to dental school to be a lab tech. If you want to be a lab tech, cut your income and go be a lab tech, but if you turn your assistant into a high tech job, that's the way it would work.

Trent: I'm not sure, maybe they're scanning too. The ones that I've seen is the ones that I've watched him do, a few that he said were more complicated cases where he was scanning and ones when they start getting really deep subgingivally then it's a harder scans. 

Howard: So where does the name Orth come from? 

Trent: It's a German name. 

Howard: Orth is German and does it mean something? 

Trent: I don't know. I can't remember. I've looked it up before. I don't know why I'm looking at you, but... 

Howard: Did you take his name and you didn't Google it first? 

Layla:  No

Howard: I mean my gosh, definition orth. It just says ortho - a straight rectangular upright, combining form, denoting substitution, add two adjacent carbon atoms and a benzene ring. Yeah, they don't have Orth, but it's German. Greek is orthos, so orthos in Greek means straight, right? So you're on the straight and narrow path, is that what it is? You're straight and right. Are you right wing and straight?

Trent: I guess so, yeah. 

Howard: So you are an Orth. 

Trent: And there's also Australian Orths too, but we're not related to the Australian Orths. So I have a cousin who's an Orth. He just went to dental school in Australia and he met some Australian Orths too, but they're not related. Maybe really distantly I guess, but they're not the German Orths. 

Howard:Yeah. So are you thinking about Grad School? 

Trent: I don't know seriously I'm thinking about it. Right now, I'm just enjoying being done with school. So my plan has always just been to work for a few years and see how much I'm liking it. If there's something I really desire to go back to school and do then I would consider it, but at this point I'm not really thinking about it too seriously. 

Howard: You know, another thing I love bringing new grads on because I like to talk to people at all different phases of their journey and a lot of older dentist like me or DSOs are looking to employ the youth and you've got to look at the associate turnover in private practice and the DSO space – the turnover is insane. And then combine that with the fact that millennials, their turnover is insane. So like in our generation, my mom's brother got a job at Mobil Oil when he was sixteen and he retired when he was sixty-five. He had one job from sixteen years old in Parsons, Kansas till he was sixty-five and they moved him around the world. And you look at the greatest companies to work for, fastest growing, most tech thing – Facebook, Apple, Amazon, Netflix, Google – their average millennial only stays one to two years. So then when you go into dentistry, a lot of people say, everybody that works for these DSOs quit after a year or two. Do they quit after a year or two in private practice? So the reason I like to keep beating at [inaudible 00:36:16] they always say, and he's already said it three times, they are attracted to mentors. It's why Heartland has the slowest turnover rate with associates because they just have all this continuing education that you can get on – five year tracts a year, FAGD, or become an implantologist or starting to work. So if you get a job at Heartland, you say well my end goal is I really want to learn to place implants. Great. We'll give you all the hours and CE you need.  So they're staying and learning and that's what Facebook does.

So you know, if you work at Uber and all you're doing is driving cars or you're a programmer at Amazon and all you're doing is shipping and one of the reasons they keep you at Facebook because a millennial will say, well, I've been doing this for a year and I'm kind of bored, I'd like to learn this. Well, Facebook, they can move you to all these different tracks. They say, well go spend a year in virtual reality or now they're starting a crypt coin. So if you want to attract the young and retain them, they want mentors, they don't want silent owners, they don't want to be in there with two kids and Dumb and Dumber and one breaks off a root tip and the other one's like, I don't know. They want mentorship. 

Trent: I would say too, my class was right around forty people and I'd say almost all of them, that's exactly what they're looking for. They're looking to go somewhere to get experience where they're going to be able to do a lot of procedures, but also somewhere where the dentist that's working there is going to be able to work with them closely and be a good mentor to them. 

Howard: And another thing that the young kids overlook is, they need to learn business. You've already said you got zero business training in school and then they go work at Heartland and I say, “Well, tell me all that you learned from business?” “Oh I didn't learn anything.” It's like, okay so Rick Workman runs eight hundred offices and most dentists can barely run their one office that they're standing in the middle of forty hours a week. Really, there was nothing to learn from a company like Pacific where Seathorne’s running five hundred offices. So they take systems and systems and systems to do that so it's a great place to learn business. 

Trent: And part of the curriculum at the U of A where I went to school, we do have a couple of practice management courses, but yeah, I would say the general consensus is that we feel like we don't really learn much about...

Howard: And who would you say is the biggest practice management guru in Alberta, Canada. 

Trent: I'm not sure.

Howard: What about Canada in general? 

Trent: I'm not sure either. 

Howard: Email me and tell me who you think the number one Canadian homegrown local practice management consultant is. It would be interesting to hear because I do know countries are very different and within the United States, I don't even like the term United States of America because it makes no sense. I mean like no one refers to Europe as the EU, the European Union, because you can't compare anything with Germany and Greece. How do you compare Portugal to Sweden? Or Italy to Denmark. So the United States, how do you compare New Orleans to New York City? Or Anchorage, Alaska to San Francisco? I mean it's the United States. Even the Federal Reserve, when they started the Fed Bank because in the 1800s you kept having banking crisis after banking crisis, and the government really didn't want a central banker, but they didn't want to have a depression. How many depressions did they have in the 18th century, like three or four? So they started the Central Bank, but one of the things they did is they broke it up into twelve regional banks, the board of governors, like there's one in Minneapolis, there's one in Kansas City, there's one in San Francisco. And that's really what the United States is, I look at the Federal Reserve map and they got it about right. It's basically twelve countries flying under one flag. And, so I know in your area, advertising and marketing is still a very taboo subject. There's a dentist up there in Red Deer named (Yar Zuk? 00:40:32), a very good friend of mine and some of the saddest feedback I've ever gotten from my thirty-day dental MBA when I launched that in '98 back when it was on VCR –  have you ever even seen a VCR, have you ever even held in your hand, a VHS tape? 

Trent: I have, yeah. 

Howard: Really? When was that, your fifth birthday party? And dentists around the world, were doing this stuff and then they found it was illegal. I mean dentists in Hong Kong and places you wouldn't think, why are they so conservative? Like Romanians, why are they so conservative? But it’s just healthcare and business is very taboo and you are in a very taboo place. So having that inherent trust from your father handed down so that when the engine light comes on everybody … when my engine light comes on, I know it's the idiot light and I'm just hoping that the guy talking to me I can trust because I'm an idiot. I don't know what you're saying. I don't know how to verify it.  So how conservative is the lack of advertising in Alberta right now? 

Trent: Pretty conservative, I would say. I mean that's something we learn in school too. So there's the ADA&C, the Alberta Dental Association and College. 

Howard: What do you call that? 

Trent: ADA&C  

Howard: A D A N C 

Trent: And C.  

Howard: Oh, ampersand, and C, so Alberta Dental and... 

Trent: Alberta Dental Association and College. 

Howard: Oh so it’s ADA …

Trent: Yeah, and … 

Howard: So Alberta Dental Association and College. Okay.

Trent: Yeah, so that's the regulatory body that governs Alberta and they're the ones that enforce, I would say across Canada it seems like the strictest advertising guidelines and things like that. 

Howard: Why you think that is?

Trent: I think it's exactly what you said. I think they're worried about the prestige or the professionalism of dentistry going away. They're worried about it just being seen as I guess like a car salesman and I don't know what it's like in America, I assume it's a lot different. I know it's even a lot different between provinces in Canada, but I think that's probably what they're concerned about is that they don't want us to be viewed as anything other than a professional. And they don't want the trust of the patients to go away because they see all this. 

Howard: Which is really so funny because it's exactly they say they don't want to be a car salesman. No, you want to be a car salesman. The car people sell the average American from age sixteen to seventy-three a new car every five years. So the average American will buy thirteen new cars - I mean they sell seventeen, eighteen, nineteen million new cars a year and the Americans will finance over five years and they'll buy a new car and the mean average price for a new car in the United States is $33,500. And then you go to Alberta, Canada and say, Hey Albertans, how many of you sold one $33,000 treatment plan in your entire life? No one raised their hand, and it's like I don't want to be a used car salesman. They look at a mouth on fire, gum disease, cavities... Well the very worst one is this one. So let's just go to the shittiest tooth in your whole head and then your insurance - you start talking about false gods, I mean your insurance, why would you bring up the insurance? When you go buy an $800 iPhone, no one mentions insurance, when you go buy a new car thirteen times in America, no one mentions insurance, when you go buy a house, no one mentions insurance. You know who makes insurance what it is? It's the dentists who don't want to be a used car salesman. They're the first ones that bring it up. Well, I'll tell you Trent, you've got thirty-two shitty teeth, but this is the one you're playing to today. This is the one that's hurting and broke and your insurance, insurance, insurance in the name of the father, son and the holy insurance company will only give us a thousand dollars. So let's just treat this one tooth. And then next year, December 31st, when the new pagan ritual holiday comes out called dental insurance we'll get another thousand and you'll have sacred permission to proceed. So yeah, they should be car salesman. And when you look at a mouth, the people selling all the dentistry, they go in there like a new car. Could you imagine taking in your old car? And they say, well Trent, let's just replace your wheels and then next year we'll replace your engine and then next year we’ll reupholster your car and over the next five years you'll have a new car. 5% of dentists sell that average price of a new car once a week. They work Monday through Thursday to five, Friday they go onto that big case. It might be an all-on-four, which is a twenty five thousand an arch. They might be doing upper and lower, it's fifty. They might be taking out everything and replacing them with Empress glass veneers, bonding, whatever, but one out of twenty dentists – and if you don't believe this, what you do is you call CareCredit. Do they have CareCredit in Canada? 

Trent: I'm not sure 

Howard: It was owned by GE, now GE's in complete turmoil, they were way overexposed in the 2008 deal and they really haven't recovered. Immelt is going to go down – he followed Jack Wells. Never follow the greatest businessman in American history. You know, that's going to set you up for fault. But anyway, you go to CareCredit. What I love most about CareCredit is CareCredit will go in there and show you all the dentist offices in your city, county, state, and how much money they're financing. So they'll go to your offices and are like, “Well, you know, they don't have any money around here, it's a poor area, this is like Somalia and there's no money.”  And they'll say, really? Okay, well there's a dentist three blocks down and he finances $50,000 a month and you've done $500 a month for the last ten years. So really... Whenever we go on vacation and I see a dental office I always stop and go in. And so I went to San Diego last week and I saw a dental office in Maricopa, saw another one in (unsure 00:46:53) when I was visiting my mom at home in Wichita, I was just driving around, stopped at one in Derby, one in Rose Hill. And it was so funny, I was having lunch with this dentist in this really small town of like two thousand in Kansas and he says, well, there's just no money out here. Really? Because we're eating at a Mexican restaurant and I remember saying to him well, there's a Circle K over there, which is like a 7-Eleven. I said, how many cars and trucks in the parking lot? And he counted and said seven. And I said, and how much is each one? They were all seven Ford 150 or Ford 250 trucks that were between $50,000 and $100,000. So here you are in Rose Hill where there's no money and I'm looking at gosh darn $50,000 and $100,000 trucks. And then when we walked over there afterwards – they're Kansas, they're hillbillies, they're born in a barn and they're getting inside – I mean these F150s you can't even imagine because mama's big in Kansas and she's grabbing that old deal, she can barely get into the truck. I mean she has to lift her leg two and a half feet. And it's like so they've got a $100,000 for a fully decked Ford 250 and then this dentist has never sold one complete dental case his whole life because it's the dentist thinking with his brakes on. And that's what Alberta is. 

When you talk to people, they say, why is America Great? It's the biggest paradox in the world. Why is America the greatest country in the world? Because for five hundred years people voted with their feet and said, I'm tired of these other worlds. I'm going to come here. So then you say, so we should open back up Ellis island and let in unlimited immigration. Oh no, no, no, no, no. Kill it down. And then you say okay, well that doesn't make any sense. That's the dumbest. The only way you could get America's economy to grow three or four or 5% a year again, like it did for hundreds of years it was unlimited, just open up Ellis island. And then the second thing you say, so you like competition, do you think McDonald's should have a law that only McDonald’s can sell hamburgers?  Oh no man, I went Wendy's and Burger King and In-N-Out Burger and White Castle. I want all kinds of competition. And then what do they do? Every industry runs to Washington DC and tries to get trade protection for steel and aluminium and all this stuff like that. And then your dental society – oh we don't like competition, we don't like advertising, we don't like you to talk about prices. And then that doctor's wife's on the phone calling around shopping on price, ordering online to Amazon and they say when you order batteries on Amazon, when you're on voice Alexa, they won't even tell you the name brands. You'll say Amazon, I need triple-A batteries. And they'll say, well, Amazon's got a sixteen-pack and they wouldn't even say the brand because they're all knockoff generics. If you want to actually see the brand, you've got to go to or Amazon Prime and then you have to scroll down and then you'll find out that the two biggest brand names charge twice as much as all the knockoffs.  So here's these dental board's wives buying all the brand names, all the knockoffs. Millennials, by the way, if they're going to get credited for anything for their generation, I think the number one thing they're going to get credited for is the death of brands. When they want a triple-A battery, they don't need the little Duracell, they don't need the little icon, a battery's a battery's a battery. And so these dentists are hypocrites, they emigrated to Canada and they are against immigration, they want competition with everybody that serves them, but they don't want competition within their own. And they always make fun of people who sell stuff. But you know, the guy selling you the F150, he thinks it's the hottest truck in the world. And if you say to him, well, I'm thinking about getting a Toyota. Oh God, no, my God, no! And he's passionate. When you go into the Apple store, the guy working at the Apple genius bar, he can't wait to help me. He knows I'm a grandpa and blind and he's showing me all this stuff that, you know, your four-year-old granddaughter could figure out. But when dentists tell me they don't like to sell dentistry, it's like, yeah you hate dentistry. You only do it for a job. You ought to get out of dentistry. You shouldn't trade your life for money. That always leads to depression, disease, drinking, drugs, everything like that. You should only do things that you love. 

And I always tell my boys, the thing I'm most proud about professionally is I've never worked a day in my life. I worked with my dad at Sonic Drive-in from age ten to twenty. I mean, you go to work with your dad, your idol, you have free hamburgers, cheeseburgers, onion rings, there's a bunch of beautiful car hops running around as opposed to what? Go home with my Catholic mom and five sisters who are always either playing school or church or stations of the cross are saying the rosary. It was just a blast. When I got to dental school, I took all those courses because it was so fun to learn and whenever something didn't become fun anymore, I always moved onto something else. You know, I've been playing for fifty-five years. 

Trent: Well I hope I can say that too. 

Howard: Well you should because look at the laugh ratios. You look in middle school and high school and college. Everybody's laughing and having fun and you look at the little kids, at five years old, everything's funny. I mean I've read the studies that they laugh over three hundred times a day and then by the time you're forty, it's down to three times a day and you look at the happiest people in society, they're always in high school or college, single, no relationship, no job, no children. So it's like, no, no no, you've got to get married, have five kids like your dad and you've got to get a job. And then you're like, oh my God, this is horrible from like twenty-five to sixty-five. Then finally your kids leave home, you retire from your job and you're like, wow, what the hell is that? So what I tell people to do is just slow down. The stress of having five kids versus two, the stress of working five and a half days a week versus four. Just letting you know that well, you don't realize when you want to buy that Ford 150 truck, you don't realize how much blood, sweat, tears and guts you have to spend for that. So a life of minimalism. I can't believe dentists get a boat. My God. How many idiot friends do you have with a boat? All you've got to do is show up with some food and a case of beer and it's a free boat. Why do I need a cabin? Half the dentists I know in Arizona have a cabin. I can stay in a cabin for nothing. Why would you buy a cabin? And then people say, well, I really like San Diego, I think I'm going to buy a house. Dude, you're only going to go down there once a month for a week. For the money you're going to spend on that cabin, you could get a deluxe suite at the Marriott with room service overlooking the ocean and now you get to your cabin and the first three days you've got to clean and vacuum and the roof's leaking and you know, it's just... So a life of minimalism. Keep the smile on. 

Layla:  We like that. We like minimalism. 

Trent: Yeah I would agree.

Howard: So what questions do you have for me? You say “in your book you talk,  rather be with dentists around you, form relationships with them.” I'm glad you wrote that on your question. I guess I can talk about my next book, if I write one. I'm thinking abundancy and I know it's not a word. I'm thinking hope you know, optimism. The glass is half-full, getting fuller. When you go across the street, I would split the dentists. It depends on the place, I know I'm biased but I still think the south is far more warmer. The New Jersey in New York. I've lectured at both of those places a hundred times. If you think the nicest, sweetest, good old boy dentist that you're ever going to meet in your life is from New Jersey or New York, you probably have never left New Jersey or New York. I mean, they're just not. It's like the complete opposite end of the spectrum in Louisiana. But when you look across the street, if he thinks in abundance, he knows that what he's competing with is iPhones and Ford 150 trucks and trips to Disneyland and all that kind of stuff and he knows that a rising tide lifts all ships and working together and having fun and feeding off each other's ideas and you want to surround yourself with those. But the man who thinks in fear and scarcity, he's toxic and he's always going to drag you down and you're going to be a summary of the five people you hang around with the most. So we know the dentists I hang around with are within a mile of me.  My God, they would do anything for me. I could give them one of my patients, they would send them back. I have patients coming in and saying I'm going to sue that dentist because this didn't work out and I say calm down spanky and then I'll redo it for free. I say I'll redo it for free if you just knock it off, okay. You know just shut up. 

And the same thing with learning implants. Like why do you want to fly from Canada to a thousand miles away to learn how to place implants when there's a periodontist or an oral surgeon in Alberta that have placed five thousand implants? And then when you place an implant and you totally screw it up, if that guy was a jerk or you didn't know him or whatever and that patient went to the board or the attorney or whatever, it could steamroll into something. But when you send it to your buddy, he's the guy on the board and he just fixes it. So when you go knock on the doors, you're going to tell it's a character trait and they probably have had it their whole life. Remember in dental school there were people who would do anything to help you pass the test? And then there were people who wanted you to fail because they were gunners and they're called gunners because you just wish you could get a gun and line them all against the wall and shoot them all because they're just mental midgets! And so, you want to find out who are the gunners that would throw you under a bus so that they could get ahead 1% and who thinks in abundance. 

And then sometimes your friends change over time.  You know, when you're single, your friends are single, then you get married and all your single friends go away. Now you're all a bunch of married couples and then you start dropping frogs, the crowd keeps splitting. Another way to do it is don't buy your supplies online, buy them through a rep because the rep can't wrap sixty thousand items, but they can tell you who's fun and cool and then you tell them all about you and yourself and your wife and dog and cat and whatever. And they start finding the dentists that are like that. The next thing you know, you've got a really good buddy who's an endodontist who will let you sit down in a chair and when you’ve got three hours open on Tuesday to go watch a molar endo, and periodontists and oral surgeons. And the orthodontist, I beat up the orthodontists the most because I think of all the nine specialties they think in fear and scarcity the most. There's no doubt about it and I just don't see anything they say or do with paediatric dentists, oral surgeons and endodontists, they're just a completely different breed of cat. 

So that's why I always like to remind them that when I go around the world and I see Derek Mahoney in Sydney, when he saw clear liners come out from Invisalign, he said, I know these guys are to do it, and I know that they know how to do it, and I know after they do it for three or four years, half of them are going to quit doing it. So he started to deal where every Thursday at the end of the day bring Invisalign cases and I'll help you. Oh, so what does he have now? He grew his office from a little one orthodontist office to now in Sydney, he's got north, south, east, west, and in each one of his offices, he has four orthodontists associates. He's doing like, it's something crazy like $50 million dollars a year. 

So you go around to all these countries. I've seen it in Cambodia, I've seen it in Indonesia, I've seen it in Tokyo, I've seen in Hong Kong, Singapore, London, Paris where these guys think in abundance. And so a guy like you comes and knocks on his door and says I want to learn clear liners – come on down, because even if you do all your clear liners, you're not going to do your class twos, you're not going to do your class threes, you're not going to do open bites, long faces and this guy is going to be working on diagnosing the treatment plan because in healthcare you want to get an A in the diagnosis of the dream plan. It's okay if you get a C on everything else, but what's really horrible is when you get an A on the root canal and an F on the diagnosis because it was the tooth next to it. You never want to do perfect treatment on the wrong diagnosis. And so, they start really working with you on diagnosis. So now you go back and you see all this work though. So now when you see this kid sucking its thumb at five years old and all this, and so you see a lot. So as you start doing ortho and someone's mentoring you, now you start diagnosing and referring a ton of ortho while you're doing a bunch of ortho, and it's back to that – when you think in abundance, everyone's glass gets fuller and when you think in fear and scarcity, just like a trade war, you know if this country really wanted to go back to nationalism and knock off free trade, you couldn't imagine how fast this economy could contract. I mean, you've got to think in hope and abundance. 

America can grow its economy while the rest of the world grows their economy. It's not like for us to grow, you got to go down. Like for your exports to go up, China's exports don't have to go down. There's a reason they export so much more than we do. Why don't you work on that? And one of the reasons our exports are so slow, again it's lack of immigration. People say I don't like when I call the company and the call centre’s in India. Oh, so you mean you want to open up Ellis island so those people in India can come here and answer the phone right here in America? Oh no, no, no. I'm against immigration. And then you say, why is that? Well I don't like foreigners. Well go talk to a native American Indian about immigration. You know, you think you were born here. You came here – there were twenty million native American Indians and the European imperialist settlers, it wasn't the government, it was the settlers. They exterminated nineteen out of twenty million American Indians. They did it in Canada, they did it in Australia. Wherever European settlers went, the first thing they did is cleared the land of the indigenous people. And if you don't want to accept that or believe that you're crazy but find the dentists who think in abundance, just go knock on the door, pretend like you're running for mayor. 

Trent: Yeah, that's one thing I really liked about the book because I've thought about that. It seems like everywhere I drive now there's so many dentists. And I think because I am a dentist I notice it a lot more, but I really liked that part about the book. And that's one thing that was kind of concerning for me because you know, I did my dental school in Edmonton, which is three hours north of Calgary, you get to know a lot of the specialists that come in and work with the students at the school and I always felt jealous about my classmates that were staying in Edmonton because now they had all these good relationships and a lot of them. Like a lot of the oral surgeons say come I'll teach you how to do wisdom teeth or come shadow me anytime, if you have any questions my door is always open. So that was a big thing for me moving to Calgary. How do I form those same relationships with the specialists that are there or even the other dentists that are there?  

Howard: Is your dad introvert or extrovert. He's been there thirty years. He probably knows who all the... 

Trent: Yeah, I'm sure he has a lot of... I know he has the certain specialists that he refers with. I know he's a part of different study clubs. 

Howard: Some of those specialists they'll refer to for thirty years have a very dysfunctional relationship and they're not even aware of it. You'll find a dentist says I've used the same CPA for thirty years. Okay, great. Well here's a blank sheet of paper. Just write down the three different accounting statements. Doesn't know. Yeah, dude, it's a statement of income, a P&L, it's a balance sheet, it's a statement of cash flow. Tell me the difference between a statement of cash flow and a P&L. So this guy, even if he's your friend, right? He's your friend but he's kept you completely in the dark. You're somewhere between Stevie Wonder and Ray Charles. You're somewhere between blind and deaf and our dad. And so if your referral relationship is a friend that doesn't want you to grow and learn, because I want you to send me all your root canals so I'm not even going to help you on any endo or talk about technique or call you up and say, dude, why did you send me this, it's a bite customer with one root. Why aren't you doing this? Well, I'm just not quite sure. We'll then come over here on Friday, I'll schedule a patient on my day off Saturday and you can be my assistant. 

Trent: Yeah. So moving to Calgary, that's a big thing for me too is not only having a mentor as my dad, but also trying to figure out what type of specialists or dentists I can call. 

Howard: And then there's another category which is funny because where did our hockey team, Phoenix Coyotes, did that come from Alberta or where did that come from? Ryan? Where'd Phoenix Coyotes come from? 

Trent: I don't think they came from Alberta because we have the Flames and the Warriors there. 

Off camera: I'll Google it.

Howard: That's why God made Google. And by the way I think it's so funny how everybody's focusing on Facebook and privacy issues and all that kind of stuff. If the humans are on it, it was Mark Twain that said, whenever you agree with public opinion, you're on the wrong side of the fence or something like that. And Facebook knows all your data, where you post all your greatest hits, your greatest photo. What is that? 

Ryan: Winnipeg, they joined the NHL in 1979 as the Winnipeg Jets.

Howard: The Winnipeg Jets. So on Facebook you're saying, here's our five-year anniversary and we're in love, but Google is God. That's where you pray for help, divorce attorney, top five signs, you're getting a divorce, or your spouse is cheating on you. So Google has been sitting there the whole time with her lips shut because Holy Moly, they have your truth serum. Facebook was the yearbook picture at Harvard. Facebook's your greatest hits album. Google is your truth serum. There's people out there googling all kinds of stuff and now they're doing voice, so once you do a voice search, you've given them permission to turn on their microphone whenever they want and they're already solving murder cases with Alexa because they're going back on people who you're a suspect and then they'll go get your audio files. It was crazy. I was in my first jury duty deal and I had to go there for three weeks and it blew my mind. They were asking you a question, they were saying, “Hey Trent, you know this girl named Layla?” “No, never heard of her.” Three seconds later, here's six audio phone calls of you talking to her. “Did you know that they were doing drugs?” “No, oh really, well here's all your texts you sent her.” And what was really freaky they're like, “Well, six years ago, this is what you said.” And I'm like, they've got every conversation you've ever had. So transparency is dead, but Facebook would be the tip of the iceberg, Google would be what sunk the Titanic. So I can't believe we already went an hour and ten minutes because I keep babbling. Any other questions you have? 

Trent: I don't think so. No. Thank you for having me today. 

Howard: And if you're a homie in Canada, I'm bringing it and I wanted to tell you one thing. The reason I was going on this sport, I got lost on a tangent with this, when hockey teams move from Winnipeg Jets to deal, that's business. The NFL, if they could get the star player from another team with a better deal, they'll steal them. They're always stealing and all that kind of stuff and it's taboo in dentistry, but it's really good business. One way you get your mentor and make a lot of money is, let's say you work Monday through Thursday, say you do four ten-hour days and then Friday you load up all your molars, molar endo, or all your implants or all your Invisalign, then you go to that three hour drive away because see you drive three hours from - you're in Calgary and three hours away is Edmonton?

Trent: Yeah.

Howard: Yeah, so in Edmonton, there's Mormon dentists who have five kids at home and a stay-at-home wife and it's competitive and they want more money. And they're like, “Well, why don't you do this? Why don't you drive three hours and then I'll split it with you fifty/fifty.” So then they'll come down and you've loaded up your six implant cases for the week, maybe they're all individual, maybe it's an All on 4 that you and your dad combined no way you could do. And now he’s in there doing an All on 4 for twenty-five thousand an arch, but the four implants may be he’s charging fifteen hundred a piece. So he's getting three thousand, you're getting three thousand, but you're watching in your own deal. And that is one of the fastest growing business models in the United States. 

And like I say, I don't know the dental insurance market in Canada, but in the United States, the insurance companies have a much higher fee schedule. So all these corporate dental offices, and by the way when we talk about corporate, 80% of corporate dentistry is I'd say twenty offices. It's kind of like the press, all they talk about is the Fortune 500. The Fortune 500 doesn't employ 15% of America. The number one employer, that employs 80% of America, has a small business administration, twenty-five employees or less, doing a million dollars a year and a dental office is exactly that small business. It could be a wheat farmer, a dairy farmer, a clothing shop. That's America. And so when these insurance companies, and so it'll be like a group practice and there will be three dentists in there and they're billing their molar endo and they're only paying him six fifty for a molar endo. But they have an endodontist come in and the same damn insurance company will pay them twelve hundred for a molar endo. So shit, I'll do it for six hundred, but if I have an endodontist come in, I can bill twelve hundred. I split it with him, I get my six hundred, didn't even do the damn molar root canal. And then you look at one of the reasons these big Heartlands are expanding so much and some of these other changes because they can buy your dental office and let's say they finance it over five years, just the fact that they can go back to the insurance companies and negotiate higher fees – the difference between the fee you are getting and the higher fee over the next five years was what they paid for your dental office. And then a lot of these people will buy a dental office where they get critical mass, they’ll say, “Okay, I'm going to buy your dental office in San Diego.” Well we already have five dental offices in San Diego. And we went and found endodontists in other markets that are busy enough or hungry enough. And by the way, when you come out of school and you're an endodontist, why do you want to go buy land and a building and build a dental office to go another million dollars in debt when you could go to Calgary or Edmonton and find the five biggest offices in town and say, “I'll come and do your molar endo and I'll split it fifty/fifty.” 

So now you come out of school, you got your student loans, and then if you're smart, you're going to move back in with mom and dad, live for free and now you're going into these offices getting 50%, so your overhead is zero and that is the fastest growing business model and you see it first in the most competitive markets like in California where their best idea was to open up another dental school. If five weren't enough, they thought, you know what, we're going to double down on dumb and we're going to open up our sixth dental school. Phoenix is like that. When I got out of school thirty years ago, Arizona didn't have a dental school or fluoridated water. Now it's got fluoridated water, AT Still in Mesa, Midwestern in Glendale. They're dumping out two hundred eighteen dentists a year and then our adjacent states, like Nevada, didn't have a dental school. Now they got two. New Mexico didn't have a dental school, now they've got one so that's going to make a change. That's why dental income has been dropping about thirty-eight hundred a year since 2009. But it's still at one seventy-four, which is three and a half times the average combined average household in America so no-one's going to cry you a river over that, but it's a plus for the insurance companies and it's a plus for the consumer. So as it gets competitive, they're going to rural markets that are smaller, they may be more likely to open up evenings and weekends. The insurance companies are getting far more participation, but as insurance becomes a bigger and bigger game, you really have to start dissecting that fee schedules. And if they're hell bent on paying the specialist, thirty, forty, 50% more for the same procedure then a lot of times the best business decision to make is to have the specialists come into your office. So then you get a mentor in your deal. You have a relationship. It's a fifty/fifty relationship. You get to go in there and observe and then if you start doing something and something goes wrong, you got a buddy that's coming in once a week that can do this kind of stuff. So with that any final questions? 

Trent: No I don't think so.

Howard: How about you, Layla?

Layla:  I'm good. Thanks for all your help. I know that Trent has said a lot of good things about you and you've helped him a lot just with your book and your podcasts and stuff. 

Howard: Well, if he was a true fan he'd cut his hair just like mine. 

Trent: That's the next step. 

Howard: We were talking about your name is Layla because, she probably doesn't remember this song came out before she was born, but when she said her name was Layla, you guys don't know it was one of the greatest songs when I was a kid. The song was inspired by Eric Clapton's love for Patty Boyd, the wife of his friend and fellow musician, George Harrison of the Beatles and Clapton and Boyd would eventually marry. And when Layla was first released, it was not successful. And you said your mother named you after that song? 

Layla:  My dad, it was one of his favourite songs. 

Howard: Oh my God, Eric Clapton is just one of the greatest musicians and I only have one Eric Clapton joke and it's so bad. Ryan shall I do my Eric Clapton joke or is it just too bad. 

Ryan: It's way too bad. 

Howard: Thank you, Ryan for that, saving your dad from himself. Tell your father that I said what a great job, he raised a fine son. Best of luck to you. You guys are married three years. I hope you make it a hundred and three years. And Godspeed guys. 

Trent: Thank you.

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