Very Clinical: 8 Columns of Hygiene* with Dr. Lance Timmerman

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[00:01:20] [SPEAKER_01]: Welcome to the Very Clinical Podcast. In about the time it takes to do an MO on three,

[00:01:26] [SPEAKER_01]: we will entertain and amaze you with tips and tricks on regular daily dentistry.

[00:01:31] [SPEAKER_02]: Here's Kevin and Zach. What is up, Very Clinical listeners? Welcome back to yet another episode of

[00:01:37] [SPEAKER_02]: the Very Clinical Podcast. I'm Zach Miners coming to you from Kansas City, Missouri

[00:01:41] [SPEAKER_02]: with me as always by trustee co-host, Dr. Kevin Hairfriar. Kevin, what is happening

[00:01:46] [SPEAKER_02]: in Cleveland, Ohio? Still raining, my friend. Still? It's still raining. Still delayed.

[00:01:52] [SPEAKER_04]: Lightning, thunder, the whole works, which is going to be our bit for tonight. Welcome,

[00:01:58] [SPEAKER_04]: Lance Timmerman. You're still in Seattle, correct? I am. Yeah. Is it raining there? Because,

[00:02:05] [SPEAKER_00]: you know, reputation wise. It was earlier. Actually sideways rain. We inhale. We usually

[00:02:11] [SPEAKER_00]: don't get that. Usually it's just kind of a drizzle on little mist. That's what we had

[00:02:16] [SPEAKER_02]: about an hour ago sideways. It actually rained here today in Kansas City as well,

[00:02:20] [SPEAKER_02]: just to, you know, triple down on this whole thing. So our listeners don't know this,

[00:02:25] [SPEAKER_04]: we had to cancel a podcast because I had no power from weather. So this is tonight's bit,

[00:02:32] [SPEAKER_04]: or today's bit whenever you're listening to this. What is the worst weather you've experienced

[00:02:40] [SPEAKER_04]: at your home or wherever? I'll go first since I've thought of this. This will give

[00:02:44] [SPEAKER_04]: you time to think. In 1994, I was going to go, my friend had his mother in town and

[00:02:52] [SPEAKER_04]: we were going to go for ice cream. And he came over to pick me up, pick us up. And

[00:02:59] [SPEAKER_04]: we got a little bit down the road and I was like, hey, like clouds look really bad.

[00:03:07] [SPEAKER_04]: Like maybe we should wait on this. And Ted is a jolly old sort and he's like, oh,

[00:03:15] [SPEAKER_04]: it'll be fine. And then like a minute later, all heck broke loose. Lightning,

[00:03:21] [SPEAKER_04]: thunder. I remember lightning hitting a telephone pole like right in front of us. And Ted said,

[00:03:30] [SPEAKER_04]: I remember he kind of chuckled nervously and was like, let's go back. So we went back to my

[00:03:37] [SPEAKER_04]: house and literally like the Wizard of Oz opened the side door and it like flew off

[00:03:45] [SPEAKER_04]: because the wind was so bad. We went down in the basement. It was

[00:03:50] [SPEAKER_04]: categorized as a tornado. This was 1994. That was the most, one of the most scared I've ever

[00:03:59] [SPEAKER_04]: been in my life. We were safe in the basement and after a little while we came upstairs.

[00:04:04] [SPEAKER_04]: I just remember like real estate signs flying by and debris. It was insane. And then,

[00:04:12] [SPEAKER_04]: you know, lost power for five days, lost power to the office for three days.

[00:04:18] [SPEAKER_04]: Drove around the neighborhood, be a tree through someone's roof on one street and

[00:04:23] [SPEAKER_04]: the next street looked like nothing happened at all. It was pretty bad. And the reason I bring

[00:04:28] [SPEAKER_04]: that up is the reason we canceled it was really similar to that. That really hit Cleveland

[00:04:35] [SPEAKER_04]: hard or East side of Cleveland hard. And it really reminded me of that period of time.

[00:04:44] [SPEAKER_04]: Being out without power for five days is pretty awesome. You still wake up in the morning,

[00:04:48] [SPEAKER_04]: go in the bathroom and flick the light switch and nothing happens.

[00:04:51] [SPEAKER_02]: Oh yeah. What about you Lance? Do you have a weather story?

[00:04:59] [SPEAKER_00]: I mean, barely. I mean, one nice, Seattle is one where we're very moderate. So the summers

[00:05:05] [SPEAKER_00]: never get that hot. The winters never get that cold. We don't have really extreme weather,

[00:05:11] [SPEAKER_00]: but occasionally we'll get some snow storms will come in. So there was a time where

[00:05:20] [SPEAKER_00]: it's a little bit more common of to have ice in Portland because the way that

[00:05:25] [SPEAKER_00]: Portland has this river, the Columbia River comes through and allows Eastern Washington

[00:05:30] [SPEAKER_00]: or Eastern Oregon cold air to come through this little valley and hit the moisture from

[00:05:36] [SPEAKER_00]: the coast. So we dealt with ice quite a bit. And one time that did happen here in Seattle

[00:05:45] [SPEAKER_00]: that was very similar to the Portland stuff that I'd experienced that it had snowed

[00:05:53] [SPEAKER_00]: and then it came through and iced over. And it got cold enough that,

[00:06:01] [SPEAKER_00]: and this is early in my career. So I was trying to, I had a four wheel drive car with

[00:06:06] [SPEAKER_00]: chains and studs and whatever I needed to do, wherever I wanted to go. My excuse was to ski,

[00:06:10] [SPEAKER_00]: but I learned, this is when I learned that just because I can get to the office doesn't

[00:06:16] [SPEAKER_00]: mean the patients can. So why the hell did I bust my ass to get all the way to the office?

[00:06:20] [SPEAKER_00]: And I got all the way to the office just in time for Holly, my wife, to call and chew me out for

[00:06:26] [SPEAKER_00]: leaving. And I couldn't really understand what she was yelling at me for because of the sound

[00:06:31] [SPEAKER_00]: of a burst pipe that was in the wall that there was just one little spot of insulation

[00:06:37] [SPEAKER_00]: in the crawl space that had a gap and that gap is where it froze and burst. But we didn't,

[00:06:46] [SPEAKER_00]: young couple, new homers didn't know how to turn water off. And so where there's a master thing.

[00:06:54] [SPEAKER_00]: And the one that was in the house had frozen, so we couldn't turn it off there.

[00:06:59] [SPEAKER_00]: And luckily we had a neighbor who's very handy, who was in the cul-de-sac that was able

[00:07:04] [SPEAKER_00]: to take a shovel and bust through the ice to the thing that's on the front yard by the driveway

[00:07:09] [SPEAKER_00]: to turn off the water at the street level and was able to turn off the water there.

[00:07:14] [SPEAKER_00]: But it was covered with ice, so it wasn't an easy thing. Fun times.

[00:07:20] [SPEAKER_00]: That was probably the most extreme weather just because of that. Nothing like a tornado though.

[00:07:26] [SPEAKER_02]: I think you got me there. Mine also involves ice. In 2002, there was a massive,

[00:07:33] [SPEAKER_02]: it was my first year of practicing, a massive ice storm. It was a full,

[00:07:39] [SPEAKER_02]: like seven day city shutdown event. Wow. Seven days.

[00:07:43] [SPEAKER_02]: Yeah, yeah. I didn't see a patient for an entire, which at the time felt like a

[00:07:50] [SPEAKER_02]: financial disaster. It was wild. But yeah, full seven, I was lucky.

[00:07:57] [SPEAKER_02]: I had power. I was living in an apartment at the time and

[00:08:00] [SPEAKER_02]: a lot of people came over that had lost. It was a major event. Now, since Lance started

[00:08:05] [SPEAKER_02]: talking about ice, I will also say I've been involved in a whiteout while driving

[00:08:10] [SPEAKER_02]: away from the ski slopes. A real genuine whiteout. That's scary as hell.

[00:08:17] [SPEAKER_02]: Very scary. You can't stop because someone's going to

[00:08:20] [SPEAKER_02]: run into you. I mean, we're talking driving probably two to five miles per hour for

[00:08:27] [SPEAKER_02]: well over an hour. It was nuts of just like your hands just gripped to the wheel and

[00:08:33] [SPEAKER_02]: just hoping. So those are my two weather stories. Scary, scary.

[00:08:38] [SPEAKER_03]: All right. Well, let's hope for some sunshine.

[00:08:41] [SPEAKER_00]: Yeah. Fingers crossed.

[00:08:42] [SPEAKER_02]: Absolutely. Okay, Lance, we're going to talk about the business of practicing dentistry.

[00:08:49] [SPEAKER_02]: And I'm guessing over the years you've probably changed your mind on a thing or two.

[00:08:54] [SPEAKER_02]: I have. The question is, could you even limit it to one or two?

[00:08:58] [SPEAKER_00]: Yeah, that's the thing. Who do I hate the most?

[00:09:01] [SPEAKER_00]: Yeah. So many.

[00:09:08] [SPEAKER_00]: Yeah, from the business standpoint that I changed my mind, I thought in dental school and early on

[00:09:16] [SPEAKER_00]: and watching my friends do things the way they did, I thought the way to success was

[00:09:21] [SPEAKER_00]: a big practice, big staff, lots of hygiene columns. And when you hate everyone, having

[00:09:30] [SPEAKER_00]: a lot of staff is not great. And over the years, I've also helped friends that were

[00:09:37] [SPEAKER_00]: shorthanded and I have a friend who is every practice that he has, he runs a DSO so that

[00:09:42] [SPEAKER_00]: they'll kind of have the same formula. And it's always four columns of hygiene

[00:09:46] [SPEAKER_00]: and three columns for the doctor to run between. And I decided that was terrible

[00:09:55] [SPEAKER_00]: and I don't want anything to do with it. And I'd gone to lunch with a periodontist,

[00:10:00] [SPEAKER_00]: my favorite people. And he was telling me that as he grew his practice, and one year

[00:10:07] [SPEAKER_00]: they had someone who retired or quit or something like that. And as he was,

[00:10:13] [SPEAKER_00]: it was like his third assistant or something like that. And they decided not to replace

[00:10:18] [SPEAKER_00]: and that year they generated $40,000 less in revenue or something like that. But that was

[00:10:26] [SPEAKER_00]: exactly her paycheck. And he's like, so having someone and all I did the extra effort that goes

[00:10:32] [SPEAKER_00]: is involved to it was just to pay her paycheck. It didn't affect his bottom line at all.

[00:10:39] [SPEAKER_00]: And so he said, you know, it's important to figure out the math that where is the sweet spot

[00:10:46] [SPEAKER_00]: of productivity and your take home. Because my friends that have four columns,

[00:10:53] [SPEAKER_00]: actually do you guys have four columns of hygiene? No, I should make sure I'm not.

[00:10:58] [SPEAKER_04]: I have eight.

[00:11:03] [SPEAKER_00]: I mean, I have friends who do the choir here. They love it. And they love their

[00:11:08] [SPEAKER_00]: their all that it's like to them, it's passive income. Well, COVID really

[00:11:11] [SPEAKER_00]: shined a light on on that suddenly, the overhead to pay these hygienists, these double their rate.

[00:11:19] [SPEAKER_00]: I mean, the going rate for a new grad in Seattle, I know it's regional and everything,

[00:11:23] [SPEAKER_00]: but in Seattle, they're looking at $75 to $80 an hour, just to start fresh,

[00:11:27] [SPEAKER_02]: not knowing how to do anything. Did you say $75 to $80 an hour?

[00:11:32] [SPEAKER_02]: Yes. Does Delta even pay that for a pro?

[00:11:37] [SPEAKER_00]: Not even close. No, it's it's ridiculous. And but these they want the $80 an hour,

[00:11:42] [SPEAKER_00]: but they also want a dedicated assistant and two chairs to bounce between. And I'm like,

[00:11:48] [SPEAKER_00]: wait, you haven't even graduated yet. And you're making these demands.

[00:11:51] [SPEAKER_00]: So I bought me an airflow, an EMS airflow and fired by hygienist. And we do it

[00:11:58] [SPEAKER_00]: ourselves. You know, my assistants, we they can we in Washington, they can coronal polish

[00:12:02] [SPEAKER_00]: well and airflow coronally, even if you're not trying to, you're going to go four millimeters

[00:12:06] [SPEAKER_00]: sub gingival anyway. So, you know, it's what is an EMS? Is that a is that a Pisa? Or is

[00:12:12] [SPEAKER_04]: this something different? No, it's, it's really cool. Go ahead and explain it.

[00:12:16] [SPEAKER_00]: Yeah, it's the EMS. There's different versions out there. I'm just a big proponent. I love

[00:12:21] [SPEAKER_00]: that. It's a Swiss company, EMS, guided biofilm therapy. And the it's a sprays

[00:12:28] [SPEAKER_00]: water and it's got a little powder that's basically like baking soda, slightly sweet taste

[00:12:35] [SPEAKER_00]: that just a normal protocol you do a disclosing solution. I like the GC

[00:12:39] [SPEAKER_00]: disclosing solution. It's got three different shades. So the the tartar is teal and the

[00:12:44] [SPEAKER_00]: fresh stuff is pink. And you can tell kind of the how long it has been since they've had a

[00:12:49] [SPEAKER_00]: cleaning. Anyway, you just go through it. And really within a few minutes, you've power washed

[00:12:54] [SPEAKER_00]: all the pink. And then if there's anything left over this, this device does have a piezo on

[00:13:01] [SPEAKER_00]: on the other side. So you put one handle down and grab the other to get the little

[00:13:05] [SPEAKER_00]: tenacious. Well, I guess, well, since I don't have a hygienist that that's saved for me

[00:13:08] [SPEAKER_00]: for my exam. Yep. I come in and do the exam and, and chisel what's what's necessary.

[00:13:13] [SPEAKER_00]: So when I see these tick tocks of these hygienists laughing at high dentists saying,

[00:13:18] [SPEAKER_00]: I can, I can do hygiene too. And, you know, they're so superior to us.

[00:13:21] [SPEAKER_00]: I think we do as good a job as those laughing hygienists and in half the time. And so, yeah,

[00:13:31] [SPEAKER_00]: I used to think that the key to success was a hygiene driven practice. But as we've evolved

[00:13:36] [SPEAKER_00]: to a more because I got the EMS originally to just be able to power wash these zirconia arches.

[00:13:41] [SPEAKER_00]: Well, we do it was designed for teeth. So why not do that on my teeth people?

[00:13:47] [SPEAKER_02]: Right. So, so basically, if I'm if I'm hearing you right, it's it's that like,

[00:13:53] [SPEAKER_02]: you know, there's there's nothing wrong with a smaller staff seeing less people for maybe

[00:13:58] [SPEAKER_02]: more higher value items than a, you know, a rat race. Yeah. Well, and I learned early on,

[00:14:05] [SPEAKER_00]: I'm I'm a big enough asshole that I can't have a big staff.

[00:14:11] [SPEAKER_04]: Yeah, we heard you did have a big staff and now you don't.

[00:14:14] [SPEAKER_04]: But the it's interesting because I like we only have two columns of hygiene. I don't want any

[00:14:25] [SPEAKER_04]: more. I don't understand how you can. That's not my jam at all. And I'm trying to see

[00:14:34] [SPEAKER_04]: less patients per day, but produce more. So do more. So and I heard a comedian. I want to

[00:14:42] [SPEAKER_04]: don't remember their name, but I would attribute it to them. If you like to play golf, really,

[00:14:48] [SPEAKER_04]: the goal of golf is to play less golf. Sure. Right. Right. Sure. The least amount of golf you

[00:14:55] [SPEAKER_04]: play, the better your score. So sure. I would like to do the I would like to do less dentistry,

[00:15:03] [SPEAKER_04]: but do more or win or whatever. I don't know what the analogy is there. But yeah, I'm trying

[00:15:08] [SPEAKER_00]: to do more with less every day. Yeah, my ideal day, single patient. Yeah, just go and do all

[00:15:17] [SPEAKER_00]: in X no hygiene. Just saw them get let them go. Go home. I love it. Right on. All right.

[00:15:25] [SPEAKER_02]: Very good. Very good. I say that is a good thing to change your mind on for sure. I don't

[00:15:31] [SPEAKER_02]: also have friends that run the four columns and it sounds really exhausting. It sounds really

[00:15:38] [SPEAKER_02]: exhausting. Sounds like something I never want to do. Yeah. Kevin, you've added an associate.

[00:15:43] [SPEAKER_02]: Do you add a hollow column of hygiene? No, no. Still just two, two for two, two docs,

[00:15:50] [SPEAKER_04]: two columns. Yeah, we the 3d way is to produce out of one column and we have an assistant

[00:15:57] [SPEAKER_04]: column for Invisalign checks and stuff like that. But one column, one doctor, you just sit there

[00:16:04] [SPEAKER_02]: and produce and nice it. Very good. All right. Next time we will find out if Lance has changed

[00:16:13] [SPEAKER_02]: his mind on anything in life. Who knows? Maybe he has maybe he hasn't. All right,

[00:16:19] [SPEAKER_04]: Kevin, any final thoughts? No rock on Lance. I'm digging what you're saying. Super. Right.

[00:16:26] [SPEAKER_02]: Thank you for joining us, Lance. And we will see you next Tuesday.