AME: The Generalist's Curse

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[00:00:57] [SPEAKER_00]: That's www.3ddentist.com

[00:01:05] [SPEAKER_00]: This is a production of the Very Dental Podcast Network.

[00:01:14] [SPEAKER_00]: Alan Mee is a dentist with too much time on his hands and too much recording equipment in his basement.

[00:01:20] [SPEAKER_00]: Armed with an obsession to bring entertaining and informative content to the dental world

[00:01:25] [SPEAKER_00]: in a way that's never been done before, I give you the Alan Mee Experience.

[00:01:33] [SPEAKER_00]: Well, hello and welcome to another episode of the Alan Mee Experience.

[00:01:37] [SPEAKER_00]: I'm your host Dr. Alan Mee.

[00:01:39] [SPEAKER_00]: I'm a dentist, a podcaster, and the field announcer of the Dow High Charger Marching Band.

[00:01:47] [SPEAKER_00]: Yes, it's true.

[00:01:49] [SPEAKER_00]: My first game is tonight.

[00:01:51] [SPEAKER_00]: Long story here.

[00:01:56] [SPEAKER_00]: So, I am a marching band guy and my son, I've talked about a million times,

[00:02:01] [SPEAKER_00]: Sean, my oldest, is a sousaphone player, so he's a marching tuba player.

[00:02:05] [SPEAKER_00]: And I am sort of a marching band fanatic in his high school,

[00:02:09] [SPEAKER_00]: which is the same high school that I actually went to 30-some years ago.

[00:02:13] [SPEAKER_00]: It has a really good marching band.

[00:02:15] [SPEAKER_00]: They didn't have a good marching band.

[00:02:17] [SPEAKER_00]: They didn't have... it was fine, but it wasn't very big when I was there,

[00:02:20] [SPEAKER_00]: but it's huge now.

[00:02:21] [SPEAKER_00]: They got 186 kids marching.

[00:02:23] [SPEAKER_00]: They sound amazing.

[00:02:25] [SPEAKER_00]: And I just love the marching band.

[00:02:28] [SPEAKER_00]: So, I went to Miami University in Oxford, Ohio for undergrad.

[00:02:35] [SPEAKER_00]: And although there is another marching band in Ohio that's probably a little better known,

[00:02:41] [SPEAKER_00]: the Ohio State Marching Band is fantastic.

[00:02:44] [SPEAKER_00]: But honestly, Miami has a very, very good marching band, always has.

[00:02:49] [SPEAKER_00]: And I had a great four years marching at Miami University.

[00:02:53] [SPEAKER_00]: And one of the cool things about Miami was they had a guy who was a separate announcer

[00:02:59] [SPEAKER_00]: from the football announcer who had this great big voice.

[00:03:02] [SPEAKER_00]: And you could tell he must have been like from the music department or drama or whatever.

[00:03:08] [SPEAKER_00]: He definitely had a level of excitement for the marching band that probably the other announcers don't have.

[00:03:14] [SPEAKER_00]: If you can imagine, an announcer who has to announce the game probably figures

[00:03:19] [SPEAKER_00]: announcing for the marching band is just like one more thing where I just have excitement for the marching band.

[00:03:25] [SPEAKER_00]: So, I suggested last year to the director, I said,

[00:03:28] [SPEAKER_00]: Hey, we used to have a guy in college who was like the voice of the Miami University Marching Band.

[00:03:34] [SPEAKER_00]: He had a great voice and he did all the announcing and it was a separate guy,

[00:03:37] [SPEAKER_00]: so it was kind of a cool thing.

[00:03:39] [SPEAKER_00]: I said, Hey, if you want me to, I'll do that for the marching band and it'll be cool.

[00:03:44] [SPEAKER_00]: I can have a different voice and be really dramatic for the marching band because I feel like that'd be really cool.

[00:03:50] [SPEAKER_00]: And he thought, Yeah, that's a good idea.

[00:03:51] [SPEAKER_00]: And then didn't – he didn't really say anything about it.

[00:03:54] [SPEAKER_00]: At the time, I didn't – I was like, Well, you know, he's sort of lukewarm about it.

[00:03:58] [SPEAKER_00]: Whatever, we'll talk about it.

[00:03:59] [SPEAKER_00]: Well, the first football game is today.

[00:04:02] [SPEAKER_00]: It's Friday, September 6th when I'm recording this.

[00:04:04] [SPEAKER_00]: The first football game is today.

[00:04:06] [SPEAKER_00]: And I hadn't heard anything or I hadn't heard anything official apparently.

[00:04:09] [SPEAKER_00]: And, I mean, like I always go and catch the last half an hour of their rehearsals on Wednesday evenings and stuff.

[00:04:15] [SPEAKER_00]: So I'm always kind of around.

[00:04:16] [SPEAKER_00]: I'm a bit of a pest of a band parent.

[00:04:19] [SPEAKER_00]: We volunteer a lot and stuff.

[00:04:21] [SPEAKER_00]: And never once has he said anything about it.

[00:04:24] [SPEAKER_00]: And apparently he just assumed I was going to do it and I never –

[00:04:28] [SPEAKER_00]: so in my email yesterday, I got the scripts that he wants me to read for halftime and for pregame.

[00:04:36] [SPEAKER_00]: And I'm like, Man, did you send this to everybody?

[00:04:38] [SPEAKER_00]: I didn't know.

[00:04:39] [SPEAKER_00]: And I finally emailed him.

[00:04:39] [SPEAKER_00]: I'm like, So do you want me to do this?

[00:04:41] [SPEAKER_00]: He's like, Yeah, I thought we had determined that – so he just assumed I was going to do it last year.

[00:04:46] [SPEAKER_00]: But I haven't rehearsed with them yet at all.

[00:04:48] [SPEAKER_00]: I was like, Oh my God, that's great.

[00:04:49] [SPEAKER_00]: But I don't want to like – I don't want to read my lines at the wrong time.

[00:04:53] [SPEAKER_00]: You know what I'm saying?

[00:04:53] [SPEAKER_00]: So anyhow, I will go to the rehearsal before the football game and learn when I'm supposed to read my lines.

[00:05:00] [SPEAKER_00]: And I will – I'll let you know if it is a horrible crash and burn or if it's fun.

[00:05:04] [SPEAKER_00]: I think it will be fun.

[00:05:05] [SPEAKER_00]: It will be cool.

[00:05:05] [SPEAKER_00]: And I love watching the march.

[00:05:07] [SPEAKER_00]: So it's just definitely my sweet spot.

[00:05:09] [SPEAKER_00]: So that is an interesting thing that happened quite quickly for me.

[00:05:14] [SPEAKER_00]: So here you go.

[00:05:15] [SPEAKER_00]: I will be announcing at the football game tonight and we'll see how it goes.

[00:05:20] [SPEAKER_00]: I have a really great topic for today.

[00:05:22] [SPEAKER_00]: I got a message from one of our listeners from – and she's in the Very Dental Podcast Group too.

[00:05:29] [SPEAKER_00]: Dr. Rupal Bhakta sent me this message.

[00:05:31] [SPEAKER_00]: She said, Hey, Alan, I can't remember if you've done an Alan Mead Experience topic on this.

[00:05:37] [SPEAKER_00]: Whenever I look at my local Facebook or Nextdoor pages, there's so much love for the local orthodontists.

[00:05:42] [SPEAKER_00]: They perform miracles.

[00:05:44] [SPEAKER_00]: But whenever there's a recommendation for a dentist or a pediatric dentist, the amount of vitriol hurled at offices, including mine, is astounding.

[00:05:51] [SPEAKER_00]: Think of everything a patient has ever said about a dentist and these things are – they say it out loud in public forums.

[00:05:57] [SPEAKER_00]: It made me think about is there any other group of dentists that gets as much hate as the generalists like dentists, general dentists and pediatric dentists?

[00:06:06] [SPEAKER_00]: Do patients generally love the specialists because they solve specific problems?

[00:06:11] [SPEAKER_00]: So this is something I have thought about a lot.

[00:06:13] [SPEAKER_00]: I've told – in many, many cases, I have to say that for young people still in dental school or young dentists, there is a little bit of magic in specializing.

[00:06:26] [SPEAKER_00]: And I don't necessarily mean like becoming a board-certified specialist of some sort, but there is some magic in doing specific things.

[00:06:35] [SPEAKER_00]: If you can – if you find something that you love like crazy and become known for it, it solves a lot of problems.

[00:06:42] [SPEAKER_00]: I'm a general dentist and there are times that I'm very irritated by the fact that I'm a general dentist.

[00:06:48] [SPEAKER_00]: And so we have to – we see all comers essentially.

[00:06:54] [SPEAKER_00]: And there are times when I'm like, man, I'd really like to focus on doing things that I like to do or I'm – like get really good at one or two things and be known for it.

[00:07:04] [SPEAKER_00]: Like the classic example I think about is we've had Rob Ritter and Chris Ramsey on the show a bunch of times.

[00:07:11] [SPEAKER_00]: Ritter and Ramsey, they're in Jupiter, Florida, and they are known for being the cosmetic dentists in Jupiter, Florida.

[00:07:20] [SPEAKER_00]: And as you've heard on episodes before, they basically treatment plan patients in a take it or leave it kind of way.

[00:07:27] [SPEAKER_00]: In other words, they're not going to fix the chip on your incisal of number seven.

[00:07:32] [SPEAKER_00]: They're going to look at your occlusion and look at all your worn teeth and suggest a fix that will take care of that.

[00:07:38] [SPEAKER_00]: And in a lot of cases, they prep a lot of teeth.

[00:07:40] [SPEAKER_00]: They do a lot of full mouth rehabs and they do it amazingly.

[00:07:42] [SPEAKER_00]: Don't get me wrong.

[00:07:43] [SPEAKER_00]: But the other thing is they're set up in such a way that people seek them out because they're the guys who do this stuff.

[00:07:49] [SPEAKER_00]: So being a specialist has some advantages that way for sure.

[00:07:54] [SPEAKER_00]: So for starters, the things that people say about dentists in public are next level.

[00:08:00] [SPEAKER_00]: It is amazing to me what patients say about their dentists and frankly, in saying the things about their dentist,

[00:08:09] [SPEAKER_00]: what they understand or don't understand about dentistry, their teeth, all of it.

[00:08:14] [SPEAKER_00]: It's amazing to me.

[00:08:15] [SPEAKER_00]: And I'm going to refer you in the show notes, there will be a link to we've talked about a bunch.

[00:08:21] [SPEAKER_00]: Matt Iglesias on Substack, he wrote a post earlier this year called Dentists are Bad.

[00:08:26] [SPEAKER_00]: And the post itself was bad enough and I will refer you to an episode that I recorded with Paul Springs about that.

[00:08:35] [SPEAKER_00]: But more than that, the comment section is amazing because what's really funny is when anyone brings –

[00:08:41] [SPEAKER_00]: I feel like in social situations, everyone sort of has a few stories locked and loaded and ready to go in case a subject comes up.

[00:08:50] [SPEAKER_00]: I think people – I think everyone's got their dentist story.

[00:08:53] [SPEAKER_00]: In some cases, I'm sure they're very positive things.

[00:08:55] [SPEAKER_00]: But in a lot of cases, if you've been done wrong by a dentist, you've got that story locked and loaded and ready to go if anyone wants to hear about it, including other dentists.

[00:09:04] [SPEAKER_00]: It's just a true thing.

[00:09:06] [SPEAKER_00]: And so the comment section of this Substack article are all the horrible experiences people had with dentists.

[00:09:12] [SPEAKER_00]: And every time I read them, I'm like, man, I don't know what actually happened here.

[00:09:17] [SPEAKER_00]: I have a suspicion I know what happened here.

[00:09:19] [SPEAKER_00]: The dentist is at fault.

[00:09:20] [SPEAKER_00]: The patient is clueless, whatever.

[00:09:21] [SPEAKER_00]: But the bottom line is that most of the time, you're not looking at specialists.

[00:09:26] [SPEAKER_00]: It is mostly general dentists.

[00:09:28] [SPEAKER_00]: I have tons of thoughts about this.

[00:09:29] [SPEAKER_00]: So the comments are next level.

[00:09:33] [SPEAKER_00]: If you want to like lose your faith in humanity, go check it out.

[00:09:37] [SPEAKER_00]: I'll link it in the show notes if you want to see it.

[00:09:39] [SPEAKER_00]: It will make you feel worse about everyone.

[00:09:43] [SPEAKER_00]: Just say that.

[00:09:44] [SPEAKER_00]: So I think dentists are probably the least sympathetic healthcare professionals for a few reasons.

[00:09:49] [SPEAKER_00]: First off, we do surgery on awake people.

[00:09:53] [SPEAKER_00]: What we're doing is no less complicated than a lot of other surgeries that people are put to sleep for.

[00:10:00] [SPEAKER_00]: But we're asking people to open their mouth willingly, let us give them shots in their mouth,

[00:10:06] [SPEAKER_00]: and make horrible sounds and spray a bunch of water and all this stuff and do terrible things to them that other medical specialties don't do.

[00:10:14] [SPEAKER_00]: And let's be honest, man.

[00:10:15] [SPEAKER_00]: If your dog's teeth are getting cleaned, they're asleep.

[00:10:20] [SPEAKER_00]: So we're asking people to do a lot.

[00:10:22] [SPEAKER_00]: Dentistry is not the most pleasant thing to have done.

[00:10:24] [SPEAKER_00]: And a lot of people are perfectly fine being worked on in the dental chair and do fine.

[00:10:28] [SPEAKER_00]: But a lot of people don't.

[00:10:30] [SPEAKER_00]: And on some level, when you think about it, we are doing surgery on awake people.

[00:10:34] [SPEAKER_00]: And so, of course, they kind of hate us.

[00:10:36] [SPEAKER_00]: Most people don't look forward to coming into the dental office for that.

[00:10:39] [SPEAKER_00]: I don't hate them for that.

[00:10:40] [SPEAKER_00]: I get it.

[00:10:41] [SPEAKER_00]: And the other thing is we talk about money because the way dental benefits, you know, insurance if you want to call it that, but the way dental benefits are set up, no matter what the patient's need is, they have a fixed amount.

[00:10:57] [SPEAKER_00]: They basically have a fixed crappy coupon to spend towards dentistry.

[00:11:01] [SPEAKER_00]: And the reality is in a lot of cases, many of the things that we treat would probably be better treated if we were to do more teeth, more treatment, more ideal treatment.

[00:11:12] [SPEAKER_00]: It would probably last longer and that costs a lot more than anyone's dental benefits are going to cover.

[00:11:17] [SPEAKER_00]: And frankly, most normal people I think don't come into a general dentist's office or a pediatric dentist's office for that matter with the idea that they're going to have to shell out a whole bunch of money.

[00:11:28] [SPEAKER_00]: Like that's sort of the curse of being the generalist a little bit.

[00:11:33] [SPEAKER_00]: They are – we have to talk about money and we do surgery on our way people.

[00:11:38] [SPEAKER_00]: I think that's pretty much it.

[00:11:40] [SPEAKER_00]: And no one – I guess finally too, the money thing.

[00:11:43] [SPEAKER_00]: No one has a budget for dentistry because no one really understands their needs until they go in and see a dentist, a generalist.

[00:11:54] [SPEAKER_00]: So this all comes together.

[00:11:56] [SPEAKER_00]: So I think the curse of the generalist is something like this.

[00:12:01] [SPEAKER_00]: As much as we want to believe the services that we give are super valuable and highly – most patients perceive us as technicians.

[00:12:10] [SPEAKER_00]: The joke about not being a real doctor, I think most patients probably look at dentists differently than doctors.

[00:12:17] [SPEAKER_00]: And maybe because most of us are in a private practice or a private office kind of situation versus maybe more hospital or that sort of thing.

[00:12:26] [SPEAKER_00]: And since we're doing procedures, we seem more like physicians that do procedures whether that's a surgeon or a dermatologist.

[00:12:36] [SPEAKER_00]: So it's – a lot of our stuff is procedure-based and so we're sort of stuck in between this.

[00:12:40] [SPEAKER_00]: Are we like family practice physicians or are we more like surgeons?

[00:12:44] [SPEAKER_00]: We're kind of stuck in the middle a little bit.

[00:12:47] [SPEAKER_00]: But on some level, I think patients look at us more like technicians and that's maybe fair.

[00:12:52] [SPEAKER_00]: I don't try and disabuse people of what they believe too much because I don't think there's a lot – I don't think there's a lot I can say that's going to make someone believe something differently.

[00:13:02] [SPEAKER_00]: But whatever.

[00:13:03] [SPEAKER_00]: I think that's one of the problems.

[00:13:04] [SPEAKER_00]: We talk about money and we ask people to pay for care and that's something that physicians don't do.

[00:13:11] [SPEAKER_00]: I think the tradition and the understanding that most regular patients have is that they're going to go into – they're going to have a dentist.

[00:13:20] [SPEAKER_00]: And they go to their dentist every six months to get their teeth polished.

[00:13:24] [SPEAKER_00]: And what they hope is that the dentist is going to come in in the last five minutes of that appointment and pat them on the shoulder and tell them everything looked great or they're going to tell them they've got three cavities.

[00:13:35] [SPEAKER_00]: They need to see that sort of thing.

[00:13:36] [SPEAKER_00]: So they look at the dentist from the hygiene visit, from the recall visit.

[00:13:41] [SPEAKER_00]: A lot of times they look at the dentist as the guy who checks the box of how is everything going and do I have problems.

[00:13:50] [SPEAKER_00]: And I mean if you pay attention to modern culture, that's the joke.

[00:13:56] [SPEAKER_00]: Like, oh man, when the dentist comes in, what's he going to find?

[00:13:59] [SPEAKER_00]: I hope he doesn't find anything.

[00:14:00] [SPEAKER_00]: So the reality is a lot of dental problems don't hurt and a lot of dental problems are hard for a patient to see.

[00:14:06] [SPEAKER_00]: On some level, it's our responsibility to help patients understand their dental problems.

[00:14:11] [SPEAKER_00]: But go back and read those comments in the comment section of Matt Iglesias' article and you will see that they probably don't understand their condition very well.

[00:14:22] [SPEAKER_00]: We have not done an awesome job or they haven't been listening or whatever.

[00:14:25] [SPEAKER_00]: So in a lot of cases, I think they think we make a lot of stuff up.

[00:14:27] [SPEAKER_00]: But it's the bottom line.

[00:14:28] [SPEAKER_00]: And that's so frustrating because for all they know, we do because it's very hard to see this stuff.

[00:14:34] [SPEAKER_00]: And as I've heard recently on a podcast, as soon as you start showing them their x-rays, you're dead.

[00:14:40] [SPEAKER_00]: You're asking them to look at x-rays that – you look at x-rays all day.

[00:14:44] [SPEAKER_00]: They never look at x-rays.

[00:14:45] [SPEAKER_00]: So it's difficult.

[00:14:46] [SPEAKER_00]: Probably photography, if it's a visual thing that they can actually see, photography of some sort is going to help.

[00:14:52] [SPEAKER_00]: But the reality is that they a lot of times come into their hygiene visit, their recall visit, and they're not having any problems.

[00:15:01] [SPEAKER_00]: And so you come in at the last five minutes and point out all the problems.

[00:15:04] [SPEAKER_00]: That's I think what a patient perceives in a lot of cases.

[00:15:07] [SPEAKER_00]: That's what general dentists do.

[00:15:09] [SPEAKER_00]: We run an office that has a hygiene program and a recall program.

[00:15:13] [SPEAKER_00]: And we're the guys that come in at the end of the appointment and tell you bad news and tell you what's wrong.

[00:15:18] [SPEAKER_00]: And then you have to decide if you believe us or not.

[00:15:20] [SPEAKER_00]: That's kind of what it is.

[00:15:20] [SPEAKER_00]: I think this paints with a broad brush because obviously many of us are good at treating emergencies, getting patients out of pain.

[00:15:28] [SPEAKER_00]: A lot of us can do amazing cosmetics and replace teeth.

[00:15:32] [SPEAKER_00]: There's a lot of good stuff.

[00:15:33] [SPEAKER_00]: But the reality is a lot of patients come in not thinking they have any problems.

[00:15:37] [SPEAKER_00]: And we have to be the guys that tell them that they have problems.

[00:15:41] [SPEAKER_00]: So my hot take on this is that generalists are still the folks who come in after the hygienist cleans our teeth and either tells us that we're doing a great job or shows us the problems.

[00:15:50] [SPEAKER_00]: That I think is one of the curses, one of the big curses of the generalists.

[00:15:56] [SPEAKER_00]: Much of the time it's different with specialists in a few reasons.

[00:16:03] [SPEAKER_00]: So, I mean I refer to a lot of specialists.

[00:16:06] [SPEAKER_00]: I don't do any orthodontics in my office.

[00:16:08] [SPEAKER_00]: I do limited endodontics in my office.

[00:16:11] [SPEAKER_00]: I do limited surgery in my office.

[00:16:13] [SPEAKER_00]: And frankly, I don't do a ton of periodontal procedures in my office either.

[00:16:16] [SPEAKER_00]: We do scaling and replaning.

[00:16:17] [SPEAKER_00]: We do kind of basic periodontal therapy.

[00:16:21] [SPEAKER_00]: But we don't do the real complex stuff.

[00:16:23] [SPEAKER_00]: I don't really graft.

[00:16:24] [SPEAKER_00]: There's a lot of stuff we refer out.

[00:16:27] [SPEAKER_00]: There's someone who's trained in a lot of these things would look at my office and go, God, you're leaving a lot on the table.

[00:16:30] [SPEAKER_00]: And you know what?

[00:16:31] [SPEAKER_00]: I am and that I still sleep well at night and that's fine.

[00:16:35] [SPEAKER_00]: But a lot of the time once a person makes it to a specialist, they've become aware of a problem or concern that they've decided that they want to address.

[00:16:45] [SPEAKER_00]: And in some cases, they know before they ever see a general dentist.

[00:16:52] [SPEAKER_00]: And in some cases, they might even self-refer to a specialist.

[00:16:55] [SPEAKER_00]: You know, like if someone's got crooked teeth, you know, they can just call an orthodontist office and say I've got crooked teeth.

[00:17:01] [SPEAKER_00]: I want a consultation.

[00:17:02] [SPEAKER_00]: They don't even have to go through a general dentist.

[00:17:04] [SPEAKER_00]: Like the reality is specialists, if someone has made it into a specialist's office, they already know that they have some kind of problem or concern or issue that they want to have treated.

[00:17:15] [SPEAKER_00]: And that in some cases, it's that your general dentist told you, oh, my God, your wisdom teeth are all messed up.

[00:17:22] [SPEAKER_00]: You need to have those out.

[00:17:23] [SPEAKER_00]: We send them in and they but or, oh, my gosh, your teeth are really crooked and I don't do ortho.

[00:17:27] [SPEAKER_00]: So I'm going to send you my friend here or or oh, you got an abscess tooth.

[00:17:30] [SPEAKER_00]: This is a much tougher tooth than I want to treat.

[00:17:32] [SPEAKER_00]: So I'm going to say like but they're getting to this specialist knowing that there's a problem.

[00:17:37] [SPEAKER_00]: And in a lot of cases, it was the general dentist that told them about this problem.

[00:17:40] [SPEAKER_00]: So, again, we get to be the bad news guys more so that, you know, if you go into an orthodontist's office, you're not surprised when they tell you that you have crooked teeth.

[00:17:50] [SPEAKER_00]: I mean, you got there for a reason.

[00:17:53] [SPEAKER_00]: And that's that's like the huge hurdle that specialists have.

[00:17:56] [SPEAKER_00]: And the other thing is, is if you made it into a specialist's office, you're probably at least interested in what kind of treatment they can they can provide you, which means you probably know that it's going to cost you something.

[00:18:08] [SPEAKER_00]: You know, like it's not going to be it's not going to be something that you don't know exactly how much it costs.

[00:18:14] [SPEAKER_00]: But you are obviously willing enough to hear what options you have if you're going to show up.

[00:18:19] [SPEAKER_00]: So on some level.

[00:18:21] [SPEAKER_00]: People who show up in the specialist's office are self-selecting, like if you refer someone for orthodontics or I don't know, prosthodontics or whatever, and they don't go to the specialist, they're self-selecting.

[00:18:33] [SPEAKER_00]: Like the specialist doesn't have to, in most cases, if I send someone to an endodontist, unless I'm not sure of the diagnosis myself, that's that's that can happen too.

[00:18:43] [SPEAKER_00]: But in a lot of cases, a patient shows up in the endodontist's office knowing they need to root canal.

[00:18:48] [SPEAKER_00]: And so and if they've shown up, they're probably going to do it.

[00:18:51] [SPEAKER_00]: Not always, but a lot of times, you know, so and that's a great thing for specialists.

[00:18:56] [SPEAKER_00]: And if you've got a tooth that's abscessed and you don't go to the I try and refer you and you don't go, that's one less person showing up in the specialist's office who might have a beef with them because they didn't bother to go.

[00:19:07] [SPEAKER_00]: They don't want a treatment.

[00:19:08] [SPEAKER_00]: So so I'm convinced that specialists kind of get a little bit of a free ride in the in the whole review space and the public talking about space.

[00:19:16] [SPEAKER_00]: Because if if a patient has made the effort to get into the specialist's office, they're at least willing to hear about their problem and what they might be able to solve.

[00:19:26] [SPEAKER_00]: And the other thing is there's a little bit of self-selection in if you went to a specialist.

[00:19:33] [SPEAKER_00]: You're you're kind of committing to some kind of treatment in that, in other words, that that is a decision you made and people like to think that they make good decisions.

[00:19:42] [SPEAKER_00]: So if you go to a specialist and and follow through with their treatment and they do it, they you think they don't do a good job.

[00:19:49] [SPEAKER_00]: Yeah, you might give him a bad review.

[00:19:50] [SPEAKER_00]: But the reality is a lot of times you're kind of predisposed to like what they're offering because maybe your general dentist sent you there and you figure your general dentist isn't going to send you to someone that they don't trust and think would do good treatment for you.

[00:20:03] [SPEAKER_00]: There's just specialists have less hurdles and less barriers to get through to treat the patient for a lot of reasons.

[00:20:08] [SPEAKER_00]: And I think that is the same reason that they get so much love publicly in, you know, say Facebook groups or reviews or whatever.

[00:20:15] [SPEAKER_00]: And I'm not going to say that, you know, I'm not going to say that all specialists have fantastic reviews, but but her point is well taken.

[00:20:24] [SPEAKER_00]: And on some level, I think the specialist kind of kind of get that free ride a little bit and good for them, I guess.

[00:20:29] [SPEAKER_00]: It's they've they've gone through extra training and they put.

[00:20:31] [SPEAKER_00]: But it goes back to what I've said to younger dentists.

[00:20:38] [SPEAKER_00]: If you if you OK, let's just say around here around in the mid-Michigan area, if you wanted to never have to market and have more patients than you can possibly handle, possibly handle, go to a pediatric dentistry residency, become a pediatric dentist.

[00:20:54] [SPEAKER_00]: You will you will write your own ticket because there's so few around here.

[00:20:58] [SPEAKER_00]: They're so hard to get into that there.

[00:21:01] [SPEAKER_00]: I mean, the demand, the supply is way, way smaller than any demand we have.

[00:21:06] [SPEAKER_00]: We always have more demand than supply.

[00:21:08] [SPEAKER_00]: I will say this. We do not have the we are even even in my area of central Michigan, I would say we are the demand for generalist offices, a general dentist offices, not pediatric office, but general offices is it's oversupplied.

[00:21:25] [SPEAKER_00]: Like I do not have people beating down my door.

[00:21:29] [SPEAKER_00]: I don't do a lot of marketing.

[00:21:30] [SPEAKER_00]: I mean, so I think I think you can you can adjust those things with marketing.

[00:21:33] [SPEAKER_00]: But the reality is it's not like I'm the only dentist around.

[00:21:35] [SPEAKER_00]: And so, you know, I'm the only show out there.

[00:21:38] [SPEAKER_00]: That's where I look at bigger markets and see that you can kind of develop a niche by becoming the guy that everyone who wants their smile redone go to or or become a specialist in an area that needs those specialties.

[00:21:52] [SPEAKER_00]: And you will never have to worry about having a lot of patients.

[00:21:55] [SPEAKER_00]: And and those people probably don't worry about bad reviews anyhow, because what do they care?

[00:22:00] [SPEAKER_00]: They're still the only game in town.

[00:22:01] [SPEAKER_00]: So I think I think there's a lot to what she was suggesting.

[00:22:05] [SPEAKER_00]: And specializing, like I said, doesn't necessarily mean you went to a residency.

[00:22:10] [SPEAKER_00]: You may specialize in.

[00:22:13] [SPEAKER_00]: I don't know, you may specialize in in anterior bonding, let's say, you know, I could see in my in my mind, I love doing I love doing anterior composite veneers.

[00:22:24] [SPEAKER_00]: I think it's fun.

[00:22:24] [SPEAKER_00]: And I think if I did enough of them, took enough training and got enough coaching from someone like Dennis Hartley or Jason Smithson or whatever, I think I could probably provide a product that that's really good.

[00:22:35] [SPEAKER_00]: I like doing that.

[00:22:36] [SPEAKER_00]: I don't think there's enough demand around me to be that specialized, you know, to do that kind of thing.

[00:22:42] [SPEAKER_00]: I don't around me.

[00:22:44] [SPEAKER_00]: A lot of people market as cosmetic dentists, but I don't think any any of my colleagues around me are cosmetic only dentist.

[00:22:51] [SPEAKER_00]: We definitely don't have anyone that just does all on force.

[00:22:55] [SPEAKER_00]: All on force are really interesting space.

[00:22:58] [SPEAKER_00]: I have lots to say about that.

[00:23:00] [SPEAKER_00]: Good, bad and ugly.

[00:23:01] [SPEAKER_00]: But right now, I mean, the patients in my practice that need an all on four and I'm not gonna lie to you, there are there.

[00:23:07] [SPEAKER_00]: Every practice probably has these people that are kind of kind of terminal dentition.

[00:23:11] [SPEAKER_00]: And I right now have to refer down to the Metro Detroit area and supposedly Grand Rapids area now.

[00:23:17] [SPEAKER_00]: And this is still this clear choice, man.

[00:23:19] [SPEAKER_00]: This is the big the big company ones.

[00:23:21] [SPEAKER_00]: We don't have anyone.

[00:23:22] [SPEAKER_00]: Now, there's a couple people down in Metro Detroit that are not corporate per se.

[00:23:27] [SPEAKER_00]: But that is still that's a long that's a long haul from where I am for people to do that.

[00:23:31] [SPEAKER_00]: I've sent some people there and I've had some people very happy that they did it.

[00:23:34] [SPEAKER_00]: But that's a big commitment.

[00:23:36] [SPEAKER_00]: You show up in an all on four office referred by your dentist because they don't want to do an all on four on you.

[00:23:43] [SPEAKER_00]: Hopefully your dentist has explained that this is there's going to be a pretty significant cost for this.

[00:23:47] [SPEAKER_00]: Most of them handle financing just fine.

[00:23:50] [SPEAKER_00]: But, you know, that's something that if you're going to drive two and a half hours, you're probably going to listen to what they have to say.

[00:23:56] [SPEAKER_00]: And you may well go ahead with the treatment just for that reason.

[00:23:59] [SPEAKER_00]: So I I think that specializing in a certain procedure has some value as much as I love my hygienist and as much as I love the patients that I've seen for 20 some years.

[00:24:12] [SPEAKER_00]: In some ways, the recall driven practice that you know, that sends recall patients into the generalist schedule.

[00:24:20] [SPEAKER_00]: That's that's that's when people walk in and they don't they think they're having no problems and you got to give them the bad news.

[00:24:25] [SPEAKER_00]: It's sort of a weird it's a weird thing.

[00:24:27] [SPEAKER_00]: Dentistry has been dealing with forever, but I do believe that's why that's why the specialists get so much love.

[00:24:32] [SPEAKER_00]: And I think it's worth worth a thought.

[00:24:35] [SPEAKER_00]: So thank you for the note.

[00:24:37] [SPEAKER_00]: RuPaul, that was a good it was a good question.

[00:24:39] [SPEAKER_00]: I think a lot of people run into that.

[00:24:40] [SPEAKER_00]: If you guys have any questions or comments or want to want to talk more about this, we can do this in the Very Dental Facebook group.

[00:24:45] [SPEAKER_00]: If you're not a member, go to Facebook and search Very Dental and then request an invite.

[00:24:49] [SPEAKER_00]: You're going to give me one of five passwords.

[00:24:53] [SPEAKER_00]: Papa Randy, Hornbrook, Timmerman, Lipscomb, or McQuethie.

[00:24:58] [SPEAKER_00]: Any of those five will get you in.

[00:25:00] [SPEAKER_00]: And it's a small group.

[00:25:02] [SPEAKER_00]: It's a very tight group.

[00:25:03] [SPEAKER_00]: It's a there's no garbage fires.

[00:25:05] [SPEAKER_00]: Sometimes I miss the garbage fires.

[00:25:07] [SPEAKER_00]: Not gonna lie to you, but there's no garbage fires there.

[00:25:09] [SPEAKER_00]: They're all people that are listeners to the podcast.

[00:25:10] [SPEAKER_00]: You already know a bit about them.

[00:25:12] [SPEAKER_00]: If they if they slog through the podcasts, they are they are people that already are a certain kind of person.

[00:25:18] [SPEAKER_00]: I really enjoy doing this.

[00:25:19] [SPEAKER_00]: I hope you guys are enjoying it.

[00:25:20] [SPEAKER_00]: Let me know to give me give me some reviews or send me messages or something.

[00:25:24] [SPEAKER_00]: Just let me know how the podcast is going for you.

[00:25:26] [SPEAKER_00]: We have a lot of cool content coming up and I'm hoping to do some traveling to be able to interview people in person coming up in the next few months, too.

[00:25:32] [SPEAKER_00]: So everything's cool.

[00:25:35] [SPEAKER_00]: Really enjoy doing this stuff.

[00:25:36] [SPEAKER_00]: And I hope you guys listen.

[00:25:38] [SPEAKER_00]: Tell a friend and we'll catch you next episode.