Very Dental: Can Patients Actually Understand? with Dr. Bart Schultz

[00:00:00] In an effort to save you money, our friends at Krazy Dental have used a lot of coupons for a lot of different things. They've decided that instead of using coupons, they're just going to give everyone the best price across the board, no coupons necessary.

[00:00:12] But if you're one of those people that just loves to use coupons, we've got you covered. The coupon VERYDENTAL10 will work one more time, so go use it at Krazy Dental for 10% off of their already insanely low prices. Still itching for coupons?

[00:00:26] For July 2024, you can get free shipping on every order using the coupon VERYSHIP. All one word, VERYSHIP. Either way, Krazy Dental has you covered. Go check them out at KrazyDental.com. This is a production of The Very Dental Podcast Network. This is The Very Dental Podcast.

[00:00:55] Welcome to The Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians, and your friends in the dental space. Now here's your host and benevolent leader, Dr. Alan Mead. Very Dental people, welcome to another episode of The Very Dental Podcast. I'm your host, Alan Mead.

[00:01:14] Sometimes I say Dr. Alan Mead, and then sometimes I get criticized for saying Dr. Alan Mead because I'm flouting my doctor credentials to a bunch of other doctors. So then I'll just say Alan Mead. Understand, I took that criticism to heart, people.

[00:01:32] I am a doctor, but I'm not going to brag about being a doctor. I'm just, you know, just the way I am. Joining me, he's been on a bunch of times. My best friend from dental school, Dr. Bart Schultz. Bart, how are you doing? Yeah, very good, Al.

[00:01:44] Thanks for having me. I did say Dr. Bart Schultz because I feel like the audience needs to know that you have credentials. By now, if they think I don't have credentials, then they clearly don't care because they've been listening for a while. But I feel like the cred...

[00:01:58] Do you think it's important to be introduced as doctor in front of other doctors and dental professionals? I'm not technically a doctor. I just slept at a Holiday Inn last night. Yeah. You know, technically we're not doctors.

[00:02:12] This will bring in some bad comments, but PhDs are really doctors. Medical doctors and dentists kind of have their, you know, kind of a glorified master's degree. But it's a doctorate level. I remember we were hooded. Do you remember that we were hooded?

[00:02:26] I remember being de-hooded or hooded. Well, I remember there was controversy because the hooding ceremony, we had to pick what instructors, what professors we wanted to hood us. I remember we had Dr. Rich Nadeau and I can't remember who... It was probably Dr. Ziegler.

[00:02:47] Yeah, it was Dr. Ziegler. Okay. So, I mean, and they, you know, took the purple like little thing. They call it a hood, but it wasn't really a hood. It was like a little collar thing. I very barely remember that actually. It's funny. I don't remember.

[00:03:03] But I do remember that the hygiene graduates at the same time were super pissed that they didn't get to have a hooding ceremony. Oh boy. But it wasn't a doctorate thing. Like a doctorate is when you get the hood.

[00:03:15] I've worked really long and hard for that stupid hood. I'm getting my hood. There was lots of abuse. Yeah. There was lots of abuse for getting the DDS degree. Yeah, yeah. I mean, nowadays, you listen to recent graduates and it doesn't sound like there's nearly as much abuse.

[00:03:32] Although I think it depends on the institution. Does everyone always say that, you know, what I did walking to school uphill both ways? Yeah. Or two 50 year old. Are you 50? You're 50. If you're not 50, you're 50 like in a few days or something.

[00:03:45] I am not 50 nor will I ever be 50. He's not crossing that line. That's not happening. I need reading glasses and I refuse to participate. So I just put my glasses on my forehead. Yeah. Well, I mean, there's a funny thing about that too though because you remember when

[00:04:04] you first started, like soon after we had our hooding ceremony and we got our licenses, you had yours earlier than I did because I was a super senior. They liked me so much they wanted me to stick around for a little while. That was free too.

[00:04:17] They didn't charge you. Yeah, that cost nothing. It's just a bonus. Total bonus. Yeah. So we got our licenses and then we went to work in like probably the first day we worked. You're not old enough to be a dentist, are you?

[00:04:32] Because we had the baby face thing going. That's why, you know, it's just a matter of, I just remember feeling everyone treated you like you were very young. You were too young. You couldn't possibly know what you're doing.

[00:04:44] And to be perfectly honest, I didn't know what I was doing. So that is probably real too. It takes time. It does. But now that we're 50, do you think we're, what do you think? Are we on the end of our career?

[00:04:58] Are we like just hitting our mid-career stride? Where are we at 50 years old? I think we're three years into this. The glide slope into the ground. I think age and what you want out of your career is a little bit of a mindset.

[00:05:14] You know, I practiced for a year and a half in Northern Wisconsin with an older doctor that hopefully is not listening to this because he's still alive, but they were barbaric. One of the things, I mean, this dentist, one of them glued teeth separating the roots.

[00:05:34] Putting the teeth back into other patients' mouths from the tooth extraction. He collected teeth from extractions and then he could use them as Pontex is what you're saying. Yeah. And you know what I mean? I think that seemed unreasonable to a new recent graduate.

[00:05:50] What kind of graft would that be? It's not autologous. Autologous is your own tissue. Xenograft? It's a xenograft. An autograft. An autograft. Yeah. Xenograft I think is an animal graft. Okay. So an autograft is someone else's tooth basically cut off and used as a Pontex. Yeah.

[00:06:12] I mean, a couple of years ago there was a machine they were selling to grind up teeth. Teeth into bone graft. Bones. Yeah. I'm not sure that was required that they were the patient's own teeth, but I don't know. I didn't mention that part. Yeah. I wasn't interested.

[00:06:29] Well, I'm not going to lie to you. I have a few times, particularly on the lower anterior where if I'm taking a periodontally involved tooth out and I'm in a splint, I will literally cut that tooth. I'll cut the root right off the tooth.

[00:06:42] I'll seal it up with composite and I've used that as a ... But I will say this, it is the patient's tooth. It's a great one. I'll give them that one. It actually is a pretty good treatment.

[00:06:50] It'll last that bugger and those things will last for longer than you need them to. If I didn't use it that way, I would use it in the patient's Essex, which is better than a composite. Yeah. Well, shade match anyhow. You'd assume. Yeah.

[00:07:04] Particularly if they're cigarette smokers, they get that just about perfect, that shade match. But again, it was the patient. So a youthful dentist next to ... The other thing in this practice I noticed that boy, the amalgams were really dark, black in color.

[00:07:22] And I thought, wow, we should set up a program for polishing amalgams because I know that doesn't really get done in the profession very often, but these were really black and scuzzy and rough.

[00:07:33] And then I realized they were using Miracle Mix, which I think is really a temporary material. Yeah. Miracle Mix was ... It was amalgam. I remember one of our classmates went to a practice where they were using Miracle Mix for a core material.

[00:07:50] And the people liked it because it's very radio-opaque, because it's glass ionomer with amalgam particles mixed into it. Yeah. From other people's teeth probably. Other people's amalgams. They were using this as really what I would say is a permanent restoration.

[00:08:03] And of course, the Miracle Mix was worn way below the occlusal table. And my thought is I learned a lot. Gosh, GC still has a website for it, Miracle Mix. Of course, yeah. It's metal reinforced crown and core buildup. Silver alloy reinforced glass ionomer restorative.

[00:08:21] Amalgams from Chinese children's pedo teeth. Maybe. But what's horrifying about ... Well, I mean, what's interesting is it is supposed to be a core material. It's not supposed to be a restorative material, but they probably wore the same way that glass

[00:08:32] ionomer wears as a restorative material, which is really quickly. These patients, most of them needed probably an indirect restoration to really make the tooth healthy. And I think someone came in with a broken tooth, you'd slap some of this material in

[00:08:46] place just to stabilize things so you get them back. And patients might not move on with care. But I think sometimes dentistry, even today, we're afraid to have conversations with patients about what they should do and what they can do.

[00:09:03] And then we're stuck with this difficult process of watching these people kind of struggle. You and I talk about something, and I'm not sure if we've talked about it on the podcast before. I think it'd be a good thing to talk about.

[00:09:18] I got a couple of topics in my brain, but along those lines, how often ... I mean, you do a lot of really complex treatment plans, treatment plans that have a lot of maybe steps

[00:09:29] to them, phases to them, where you're removing a lot of teeth, grafting, waiting for healing implants, this sort of thing. And it has to be phased out over time. Or even if it's not phased out over time, there's a surgical part of it and then a restorative

[00:09:46] part of it or what have you. And you've told me multiple times that the patient that you put beautiful grafts in and they're healing great and they're doing great, you've spent a lot of time with them, sometimes sedated, maybe sometimes not.

[00:10:00] But you're moving on to maybe the implant placement stage or whatever, and the patient sits down in the chair, they're happy to see you, and they say, What am I here for? What am I here for now? What am I here for now?

[00:10:11] And that's gotta ... every time it happens to me, it's gotta really happen to you, especially when you've taken a lot of time to phase this stuff out, doing a lot of big treatment plans.

[00:10:19] It's gotta just be like a knife in the heart on some level when the patient just has no idea what they're there for whatsoever. They must trust you because they're there. That's good, I guess. I think it's even simple things of a couple crowns.

[00:10:33] I often say to patients, this is the treatment we're doing today, and then I'll say, is this something you don't want to do today? I say it because I want them to be able to really buy in and have me out.

[00:10:44] So I've had some medical things that I've talked about with you before, but I mean, I think I have a pretty proactive view of the things that the doctors are doing for me. I'm paying attention to the things they're telling me.

[00:10:56] I'm listening, and I'm not the smartest guy, but I also pay attention to a lot of things. I don't know. I mean, if someone was telling me to do these things to my teeth and it might be four or five or $2,000, I guess I would listen.

[00:11:13] Dentistry's complicated that it's sometimes hard for people to understand what we do. Maybe medicine's the same way, but they embrace getting their knees done or their back surgery that may not get better pain wise. I don't know. You're right. I spend that time.

[00:11:33] What's frustrating to me is that a patient, even though you've sat down, you've had... I just did a podcast a couple of weeks ago about this or last week about the big talker, the guy who comes in and he's a big talker about getting stuff done right.

[00:11:50] He can't do it right this second, but he knows... This is the person that you've had multiple consults with, and over the years, you've put together multiple big treatment plans that they've never really followed through with and that sort of thing.

[00:12:00] I sometimes think to myself, they have no idea what I'm proposing. I have literally explained it to them in as small a words and as few words as possible, and they really don't know what we're doing. Sometimes I think they just...

[00:12:14] It's like when someone says you've had a... We tell them they've had a root canal and they translate that into, they don't have a root of their tooth anymore. And I mean, I understand what you're saying. It's not my tooth anymore. Yeah. Yeah, exactly.

[00:12:27] I understand on some level, I don't know how important it is for the patient to thoroughly understand what treatment is going on for the treatment to work, but it would be nice for them to understand what we've done for them in a lot of cases so that...

[00:12:47] I don't even know how to say it. I think the... My question is, do they not care or do they really not understand or is it a little of both? I don't use the term root canal because technically they have a root canal or multiple root canals.

[00:13:03] I use the term tooth disinfection. So I try... That's a much... I like that better too. I say, the tooth has an infective process from trauma, decay, whatever it is. We're going to remove that infective process by removing that dead dying tissue. I think they...

[00:13:22] And so I say, you really need a tooth disinfection and then I kind of do the air quotes, a root canal. Oh boy, I'm really nervous. Listen, you're going to do great. We're going to make you feel comfortable with sedation discussion or just using good anesthesia,

[00:13:38] you're going to be comfortable. And I think once they understand what you're doing, I think they feel more comfortable. Now, I'm not sure they remember in a month or two weeks when they come in because I think they hear, well, $1,500, insurance will be 300. Okay. Yeah. No, that's right.

[00:14:01] They don't want to seem dumb or... And I don't think they're dumb. I think Americans don't pay attention to anything now. It's overload. I also think that it might be because they trust you, they trust the person enough that

[00:14:24] they're like, okay, this is what he says I need. I'm going to go ahead and do that. I trust that he does it. And I think that's good, but I do like patients to have an idea of what's going on.

[00:14:33] One nice thing about crowns, like the regular workflow of a crown or an omelet or something like that where you prepare the tooth, they're in a temporary and they have to come back a second time. They kind of get that.

[00:14:45] In other words, what I'm putting in here, I'm going to replace this temporary with the final one, because it sort of makes sense. It's easier for them to make sense of that particular procedure. And honestly, maybe a filling isn't so hard.

[00:14:56] You take out the rotten part, you stick a new part in there, it looks like a tooth. And that maybe is all they need to know. But like an implant or a root canal, a bridge. Oh man, a bridge.

[00:15:07] That's like brain surgery to try and explain in some cases without some kind of a model or whatever to show them. And typically I... Oh man, this is the thing about being 50. I got no time. I got no patience for that.

[00:15:22] I will generally let my assistant do that. That's probably a fault of mine. I know you are much better about that than I am. In those consults, I am so itching for my... I want my hygienist.

[00:15:33] It's the only time in the world I want my hygienist to come tell me that I have an exam that I have to do. I've got to the point that we try to do a consultation or even the complicated case where we've done

[00:15:43] the initial consultation to do their phase one or their box one if you're a spear guy or gal. And we've got the disease eliminated and now we're moving on to maybe an implant or even some crowns.

[00:15:56] I even like to do a second and third consultation almost yearly to kind of bring them back up to speed of where we are because they've kind of forgotten that this was a couple year process.

[00:16:08] This is where all on four, which I don't know that I agree with terminal dentition and removing a bunch of bone, but this is where that's easier for them is that they're in and they're out and they're done and they've moved on and they've got a nice result.

[00:16:22] I wonder about force control and paraphrasing. Okay, so here's the thing about that. Okay, so this is send hate mail to there's no chance. No, there's no chance that an all on four patient understands how much bone you're going to be taking away.

[00:16:39] And I doubt they have that consultation that way. I think they tell them you're going to be done happy and we're going to get your teeth tomorrow. What they tell you is you have teeth in the same day that you have surgery, which sounds pretty great.

[00:16:48] And maybe the patient wouldn't care how much bone you're taking away. But I do feel like I feel like we're obliged to explain what kind of stuff we're doing. I really do.

[00:16:56] And I have a lot of friends who do a lot of that stuff, and I've always wondered, like, how does the informed consent go? And I'm not sure that they I mean, you'll see these guys showing pictures of basically

[00:17:07] an entire alveolus of the upper sitting on a tray, and they think that's really cool. And like, man, if a patient saw that, holy shit, we're certainly shifting gears. But all on four was really designed for the mandible. Yeah. You know that because he didn't want to graph.

[00:17:23] He didn't want to graph. I think one is more cleansable. The upper, I think, is because it's simpler and faster. But I mean, I think teeth should be in the back. I think having posterior teeth where we generate lots of force makes sense.

[00:17:35] But I'm not here to knock all on four. I'd say that their consultations offer a solution quickly. My sometimes treatment plans take longer, which adds more complexity of just patients remembering what we're doing.

[00:17:48] But that might also require more and multiple bone graphs to do the things that they want to do. When you place a bunch of bone graph material into the sinus area, does their head get heavier? I don't know.

[00:18:01] So what I really want to know is if you did like the right side and you just pounded in a bunch of graph material on the right side, does their head lean until you can get the other one done? Is there like... I'm curious.

[00:18:13] We make a foot lift for them. Exactly. I'm sorry, Doc, but without my lift, I can't walk in a straight line. I've done hundreds, more than 500 sinus graphs. I find it very, very predictable, easy, simple to get lots of bone and really...

[00:18:33] Is it shocking how much bone you can get in that sinus sometimes? I remember watching you do one and I'm like, it doesn't stop. It's not stopping. There's more. There's more. I kind of think with a CT scan evaluation, but I kind of think eight to 10 millimeters of...

[00:18:48] Excuse me, eight to 10 cc's of maybe four. If you're doing a multiple implants, four to 10 cc's of bone per side. Whatever you push up there, you're going to get a little bit of regression back.

[00:19:02] My goal is I'd like someone to have a 12 to 15 millimeter implant in the posterior. Basically right up to the eyeballs basically. Yes. That's what I'm looking for. I mean, but I'm not afraid of a sinus graph. I think it's a really predictable, easy procedure.

[00:19:17] It works really well and it is kind of a, as Mitch Day would say, if anyone remembers Mitch Day, Dr. Day, shout out to you wherever you are. Finesse, panache, Elon. Elon, yeah, that's right. You know the very first time I met Mitch Day, I was a sophomore.

[00:19:35] As a sophomore. God, I could have been a junior, but I think I was a sophomore. Remember when they would send us down in the oral surgery department to assist the seniors that were going through the rotation?

[00:19:48] And at one point, they were taking wisdom teeth out on someone, upper whizzies. Whoever was doing the surgery, I've told this story on the podcast, it's just too good not to tell. Whoever was doing the surgery was having a really hard time, two upper wisdom teeth.

[00:20:03] So you got to know that for an oral surgeon who is taking out a lot of wisdom teeth, you give a relatively straightforward upper wisdom teeth and that is literally like, that's the easiest thing they could ever do. In microseconds. Exactly.

[00:20:18] So Mitch gets in there and he asks, this is so horrible. I shouldn't have, it's too late before I used his name. He asks which corner of the room, and I didn't know what he was asking. He said, this way or this way?

[00:20:34] And I pointed to a corner of the room not knowing. He popped the tooth out and it did, it went flying to the corner of the room. It was all like, I was just observing. I wasn't even assisting. I was just observing.

[00:20:47] It was all I could do to not reach out to try and grab it like as a reflex because he popped the thing off. Of course, he was showing off for everyone in the room for sure, but that's, you got

[00:20:53] to figure oral surgeons could probably do that all day long. Dr. Day was an excellent instructor at dental school. He was fantastic. He made you feel confident and good. I mean, he's a guy that should be teaching dental school. He scared me.

[00:21:05] He scared the hell out of me. But then again, everyone scared me. I was just scared. I was just walking around scared constantly. So that was kind of where I was with all that. He was not happy with, he's the one I had to tell him.

[00:21:17] Remember when I burned my hand? I was working at the coffee shop and I was steamed. It was like my first day or second day at the coffee shop. I was steaming some apple cider. It was fall. So it was probably one. Is that a thing?

[00:21:31] Was that just your creation or is that something you do at a coffee shop? No, no, no. That's how you, they want hot apple cider. So you'd put it in the steamer and of course I over steamed it and I burned my hand.

[00:21:39] It ran right over the thing, burned my hand. Burned it pretty bad actually. I couldn't sleep except I literally went to sleep with a bag of frozen corn in my hand. It's the only way I could sleep because it hurts so bad.

[00:21:50] So I go in, that's my first three days of oral surgery rotation or something like that. I have to explain to Mitch Day that I'm not going to be able to really participate because I burned my hand at the coffee shop.

[00:22:02] He didn't suffer fools really and I was the fool at that time. I remember feeling pretty terrible about that actually. So yeah, that was maybe not the best choice I ever made working in the coffee shop at that point but that was a whole other thing.

[00:22:17] You had the best job though when you were, well you had a couple of jobs in dental school. You drove a tow truck if I remember correctly. You drove a tow truck in Minneapolis, St. Paul area in the winter time? I did.

[00:22:28] I towed for people for an Amoco gas stations or Amoco gas stations that AAA people would call it and so I never towed someone who was parking in the wrong place. I did loss prevention in arts. That was the worst job ever.

[00:22:43] Not because you'd catch people or they'd get prosecuted but it was extremely boring watching people. When you did find someone, did you find people that were stealing stuff or trying to steal stuff? What were you supposed to do?

[00:23:01] So you had to really, if I remember this right, you had to know what they had taken, where it was on their body and you had to verify they didn't pay for it because some people

[00:23:10] actually shop by putting things in their pockets and when they get a professor, they pull it out and pay for it. My son does it. Sean likes to do that. Sean, don't put it in your pocket. Yeah. So most shoplifters I think don't steal like a candy.

[00:23:24] They steal expensive things like there was a time that some of the electrical outlet GFI components were a couple hundred dollars. That was always a place they would steal things. They would steal router bits. Lots of shoplifting happens from theft of workers, workers stealing it but drills and

[00:23:46] things like that. So you had to watch them and even then if you didn't really know, they didn't want you, Menards didn't really want you harassing people about this. That being said, I don't know that they do anything about shoplifting now. I think it's probably a career choice.

[00:24:06] It does make you wonder what, and I always, you know, we had someone else that I want to say one of our other classmates did the same thing. Like she was like a security guard or something if I remember correctly. I can't remember exactly but. I remember that.

[00:24:21] I don't remember who that was. I can, I remember who it was but I don't want to, I don't want to say any names because I can't remember exactly but I also am like having a job in dental school, I mean I didn't

[00:24:34] do anything till I was a senior because we had less classes, you know, it was all basically just clinical stuff at that point. But again, I didn't make enough money to make it even worth really doing.

[00:24:45] It's not like, I think I made six bucks an hour if I was lucky and tips. And sometimes they would require you to stay up late and clean like clothes. That was not a great choice. I did it on the weekends a lot.

[00:24:57] It wasn't as bad but on the other hand, you know what? Now there's no job you could get that would make a dent in anything. I mean like, well you get more loans because what's, you know, cost of living when you're

[00:25:09] talking a hundred grand a year or more in loans, what's, you know, what's beer money? Jeez. So, I mean you get more money for jobs in the Twin Cities now. I mean substantially more but you're right. I mean you're not going to earn 50,000 or 90,000.

[00:25:26] I'm not sure, you know, when we talk about tuition at U of M and I'm sure it's pretty standard around the country is, I don't know how you pay that money back. I don't know.

[00:25:38] Well, and I think your options coming out of school are different now than they were. I mean like there were a fair amount of people that went right into an associateship with the idea they were going to buy. There might have been some people that did startups.

[00:25:51] I know, I can think of three of us that bought within the first year. I know Todd Johnson did, I did and Paul Thomas did. Hot dog. Hot dog. Hot dog Johnson, yeah. PK Thomas. Yeah, I know.

[00:26:06] So all three of us did and I thought I was special. Like I thought I was the guy and I'm like, oh no, everyone else did too. So yeah, it was a lot of people. I don't think, I mean there is a few people.

[00:26:15] There are like I had a guest on the show a few weeks back, a guy who does a podcast all about practice ownership and there's some people who are really gotten into that kind of practice ownership.

[00:26:25] I will say, I'll bet it leans pretty heavily that they have military backing. Like they did the an armed forces thing where they got most of their tuition probably paid for I'm guessing. It's just a tough debt position to be in by any standard.

[00:26:41] So ROTC or whatever you want to call it for the military. So they pay your tuition off after four years of service. Does that work the same today with tuition? I think so. 400,000? I think it does.

[00:26:53] So why would you, why wouldn't you just, I mean that's what you do I feel like. I don't know if they have that much available anymore but geez, I don't know. That would make a lot more sense today than it did when tuition was 100,000 for four years.

[00:27:09] Yeah, no I agree. I agree. It's an interesting concept. So I wanted to, this is something I wanted to talk to you about. We talked about it a little bit before. So listeners, I'm going to try and find for the show notes a couple examples of this maybe

[00:27:25] on Instagram or Facebook. But it's one thing, the way that we market to potential patients is different. It's quite different than the way that dentists selling a service or a product to other dentists do.

[00:27:40] I feel like a lot of the marketing for courses or procedures or instruments or services or whatever, I mean it's very easy to appeal to a dentist's sense of financial well-being. Basically talking about how if you do this your profits will skyrocket.

[00:28:05] If you do this, what do the richest dentists you know do? Blah blah blah. There's no shortage of advertising that uses that kind of appeal to the average. Basically dentists like all people like to make money.

[00:28:20] And if you can say that by doing this your office will be way more profitable, your office will make more money, all this stuff. But some of the ads are really fucking gross. I'm sorry but some of the ads are super gross.

[00:28:34] It's a matter of, it's one thing to send that to a dentist. But I always wonder what would patients think about some of this stuff the way that we advertise to each other about this stuff?

[00:28:46] Because I mean on some level a patient, I think the patient is supposed to believe or we're supposed to let the patient believe or we're supposed to let the patient know that we have their best interests at heart.

[00:28:56] In that you know obviously in dentistry more so than in medicine we have to talk about money with patients for sure. So patients generally think that we are, we're money-grubbing bastards as it is I think I think on some level.

[00:29:09] And I mean like you have to go to great lengths to let them know that you're not or to let them know. But the reality is when they see an ad like this or if they were to ever see something like this what would they think?

[00:29:20] Do you know what I'm, does that make sense what I'm saying or am I just talking in circles? No I don't think you're talking in circles but I mean the question might be as I look

[00:29:27] at this and say okay let's talk about being more proficient at taking wisdom teeth or surgical extractions. Lots of dentists, general dentists don't take out wisdom teeth. Lots of dentists refer that out which is fine. I don't refer a lot of surgery out.

[00:29:44] I have trained and practiced and learned and I think I do a very effective if not maybe a better job now. I mean that's an opinion but the question is do they need the wisdom teeth removed?

[00:29:58] You're selling them a service that they benefit or need or should have. I don't like to use the word need but should have. So if I do that and I do it in a way that makes it better I think you know patients

[00:30:10] don't want to go to someone else. You have a better understanding of your insurance, you have a better relationship. If you can do the care and do really well at it I think and by the way I think patients should have this care.

[00:30:25] Extractions or wisdom teeth may be debatable but how about a crown? If you become better at it so does the house need the new roof or are you just putting a new roof because insurance will pay for it? I mean so I see it both ways.

[00:30:39] I mean certainly going to Spear is a moneymaker for Spear in many ways. They do well. I think the things that Spear teaches you is a way not to necessarily prep a crown a certain way but to diagnose and have conversations with patients and show them the possibility.

[00:31:00] Spear is not all about veneers. I don't think LAVI is all about veneers. I think you treat people as a person individually so I'm less hung up on it. Now I will say that I mean the world of marketing now is all about profitability.

[00:31:16] Maybe the reality is these companies that promise you more revenue do they guarantee you more revenue? No of course not. Your ability to implement those things has probably more to do with you and your communication skills with people if you're going to be successful.

[00:31:31] Here's the other thing though. Some of it like on some level I know Spear has done some marketing that talks about you know make you not only will you enjoy working more it'll be more profitable and that seems

[00:31:41] less gross to me I think than in some cases it's just a matter of when it's a business practice versus you know adding new procedures or adding a new way to look at things or whatever.

[00:31:52] When I started my evolution of jaw TMJ type pain and sleep I took a bunch of courses through the AACP American Academy of Cranial Facial Pain great great organizations by the way. Anyone who's doing that should be a member because they're the people kind of speaking

[00:32:07] out for people who want to do this but most of the people I was taking the courses with were talking about how they were in roller skates all day, they hated dentistry, they

[00:32:15] wanted to get out of dentistry, oh I just want to do something else and I'm thinking God I don't really hate dentistry I really enjoy what I do. I want to offer this facet to me but I don't want to stop doing crowns or implants I don't

[00:32:27] want to give that up and I looked and I heard their stories and again hate mail goes to Bart Schultz but it seemed that a lot of them were you know working for multiple insurance companies and running their tails off that way.

[00:32:42] That would be challenging to see 86 patients a day and trying to see multiple patients I'm definitely not built that way and if I had to practice dentistry that way I would definitely look for a different solution.

[00:32:54] I think you don't have to practice dentistry that way and that's a scary endeavor but maybe that's a different podcast. Well what's interesting too is that there's a level of profitability too like when you

[00:33:05] run like that mind you if you're running that way because you take a lot of insurance that's one thing but I mean if you're seeing a ton of patients and you have no downtime because

[00:33:13] you're seeing a ton of patients you're you know that's that's a way to make money there's no two ways about that it's harder on your body and it's harder on your soul maybe but it's a like I don't I don't run that way.

[00:33:21] I have to tell you that there was a time in my career where I did run two chairs all the time and I always had multiple hygienists and everything like that and I was taking a lot of drugs. Yeah yeah.

[00:33:33] What's it what's interesting is I feel like I slowed that down after I got out of treatment and I don't remember if that was like a requirement by my therapist or not but but I run pretty

[00:33:43] slow now compared to how I used to and maybe there's a correlation there I don't know. It might be something to look at after 20 years. Joy and stomach lining are important and valuable and somewhat irreplaceable so I mean and again what what do you need?

[00:33:56] Do you need the $300,000 wakeboard boat? Maybe and if it brings you joy you should you should have it but I don't know that society's weird now. It is it is and I have to tell you that there is something that there's something about

[00:34:13] like I feel I feel weird that I don't need that much like like on some level I in comparison I make as little at this as anyone you know or anyone listening this I guarantee you I'm

[00:34:23] not throwing numbers out there but I make my production is tiny in my but I also I also don't have debt like a lot of people do whether that student loans that or building giant

[00:34:34] building debt or whatever and so on I don't need that much because I don't have I'm not that far in debt and I'm not that in and I kind of like that on some level but and that's

[00:34:43] just been I've had an aversion to debt from the very beginning and I think that was I've told you this before it's because I because of the practice that I bought like I didn't

[00:34:55] go into big debt for it but also the practice I bought sort of trained me to not not expect too much of patience and I mean literally it's I it was a great deal and taught me a

[00:35:05] bunch of bad habits that continue to to gall me this day up to this day but but I'm like I do have to say though you don't like if you can build a life where you don't need

[00:35:15] that much it's kind of great actually like I just I just had a week off because my assistant took a week off I'm like okay so I'm not gonna work it was it was not even I didn't go anywhere

[00:35:24] great I rode my bike a lot and not much else you you recharged your battery though and that is much not as much I would have liked yeah weather maybe but still well I mean there's

[00:35:35] a what brings you joy I like to woodwork and I there was this router mechanism table that I really wanted and drove to the Twin Cities and went to this woodworking show and boy I

[00:35:47] really wanted this I didn't buy it I was like I don't really need it and then I drove to Milwaukee we had a family reunion a couple weeks later and the woodworking show is traveling around the country

[00:35:56] and was in Milwaukee and I bought it and I was like okay it's meant to be yeah and no kidding it sat in my garage unopened for like seven months yeah and and and maybe there's some

[00:36:09] things that I think about like you know boy it's the want it's the want that really we really yes excite us yeah you know and I try to teach my children that we want everything and I think

[00:36:21] your wants you should pay for with cash and your needs and you only need a little bit you can borrow and and maybe you know and does does all the extra things bring you happiness and if it

[00:36:33] does great do it you know and and maybe that curbs some of the things in life I mean I enjoyed dentistry there's some of the difficult patients and some of the BS of the world and the dynamics

[00:36:45] that that frustrate me but I don't think I would want to give up dentistry there are days you and I talk about lets us buy a coffee shop yeah my assumption on in a coffee shop would be riddled

[00:36:56] with craziness it's probably a bunch of assholes that come in and don't like you'll make a coffee for him and they'll they'll complain about it too I mean I don't know I edit I have to say that like

[00:37:06] I can talk a pretty good game about patients driving me but I don't know man my patients are relatively normal my team is relatively normal I have compared to a lot of what I see in social

[00:37:17] and just hear about I feel like I'm I'm I'm blessed like I have I have very little of that kind of thing it doesn't mean I don't get burnt out on it and all that stuff either but I definitely

[00:37:26] feel like I have a pretty a pretty pretty easy go of it we remember the worst of the worst yeah right we do remember the difficult patient that was frustrated about money and and truthfully that's

[00:37:39] not very many people and so we kind of make our decisions in life of what we should do based on the the obscure things that we kind of remember and that's probably not how we should do things

[00:37:50] no that's right my dad always says that it's like you can you know you can do a procedure 99 times perfectly in the one time it goes wrong is the time you're gonna remember and that's exactly

[00:37:58] right that's that's kind of in the in the one the one patient that's snarky to you or the way and like that is that is very real that's probably it's probably human I mean like real to the point

[00:38:10] where I think everyone probably does that so I bought my daughter a shirt and it says sarcasm is my love language my daughter's 15 years old and in her sarcasm is so witty and so sharp that huh

[00:38:24] you know I I love my children dearly I'd like to murder my son weekly my daughter don't have that problem but but her sarcasm is challenging and and maybe the people snarkiness isn't their

[00:38:35] snarky maybe it's just their weird witty sense of humor and yeah and maybe you and I mmm I'm uncomfortable because they're mad at me but maybe they're not so and maybe we should learn to

[00:38:46] compartmentalize about things of you know things are out of control that's hard yeah we care that's a good thing that's a good aspect to have in life right mm-hmm it's something you were saying like

[00:39:00] your router how it was the there was a certain thrill of of the of the want there's a certain thrill of I mean like like you were thinking about it a lot when it was something that you

[00:39:12] wanted that it was there was an anticipation aspect to I didn't want it I needed it at that point I need it I can't live without it I'm notorious for for having lots of wants and I'm

[00:39:23] better now about about not falling into that than I used to be man I used to just I'd go to you remember you were there I'd go to the midwinter and I'd buy stuff it didn't help that I was I

[00:39:33] was kind of I think you I think you bought I think you bought a Sam articulator and sold it for like $14 that was I was sober as a judge then I was that was long after I that was long after I I got

[00:39:45] clean I I bought an articulator I think it might have been even at spear and now I got it before that I got it for it it's beer I just didn't use it and so I sold it and of course what happens

[00:39:56] now I'd like to have a back you know now I wish I hadn't sold it but I wasn't using it in the Sam articulators Sam trees like a piece of art artwork yeah yeah I mean they're all it was really

[00:40:06] nice it's really it's really good and that's what they use its beer and also but of course I'd sold it I sold it for I'm sure I'm sure $14 my ass on it exactly cuz I do that all the time for everything

[00:40:15] I but yeah the midwinter was the best was what stuff would show up weeks later that I hadn't remembered I'd ordered but it was something I had to have while I was there I was not in a great

[00:40:26] mindset but now I'm finding myself that that shelf is not as full as it used to be and also like when I buy stuff like the main things that I've bought lately are like I use like crazy my the mountain

[00:40:39] bike the you know that's where they apply use it all the time and so on some level that's super gratifying that I bought something that could have been could have been the thing that sat in my

[00:40:48] garage unused it could have been that thing and it wasn't so that was pretty great like it wasn't really a gamble I was riding a lot everything like that but but lo and behold I'm it that is

[00:40:57] a there's something like the gratitude for having something that you wanted and that you actually use that's a big deal like what a funny thing to get all excited about but like I do use that damn

[00:41:09] bike all the time I love it it's fantastic and so it was a good buy it was really expensive and it was totally worth it and did I want it yeah I never even had that much anticipation for it I

[00:41:18] walked into the store not knowing it was gonna be there and lo and behold I freaking bought it it was almost an impulse buy difficult today as you probably can't get bikes is easy exactly exactly

[00:41:28] the right now in this particular time during the the pandemic with this all this crazy like supply chain stuff I was lucky to get a damn bike so you know though so the the void in our lives that we

[00:41:39] look to fill I mean and this is maybe in our practice or in our relationship with our spouses and you know whatever it is I is it is it the consumerism or that I need to do implants I need

[00:41:51] to make more because I got a fit in or match up to the Joneses yeah do I gotta buy my kid another new iPhone because I got a match but the Joneses I mean another horse trailer another horse trailer

[00:42:01] right you know who doesn't need six horse trailers and I don't know exactly you know so um that's that's maybe the things what brings us joy and brings us happiness I never went to Panky I did

[00:42:14] lots of Dawson courses and but the cross of life you know good you know work family God and play I kind of think about those things I'm not perfect I have a lot of faults but I but I try to think

[00:42:26] about you know there's this balance of things we should we should do and and I think that fills some of the voids in our in our life that we're looking for and yeah you I don't think your bikes

[00:42:36] really expensive because you seem to use it daily yeah no that's that's like honestly it's one of the only purchases I've ever made like that you know that I felt like was it was a good buy and

[00:42:48] I'm grateful to have it I'm grateful to have the time literally to use it when I can like having that week off boy I wrote a lot this week heard a lot this week my father passed away this past

[00:42:58] this past month and I had done his dentistry I don't know 15 years ago maybe 20 years ago I did bunch of implants full mouth rehab crowns bridges veneers and the end of his life he had some

[00:43:11] paralysis a stroke and eating was was challenging just swallowing and I felt good about doing his dentistry because had he been left in the condition that patients can to go to he would have he

[00:43:24] probably choked to death a long time ago yeah and and he enjoyed food yeah right up to the last he really did so the $50,000 of dentistry if I bring this around $50,000 dentistry that last someone's

[00:43:36] 20 years and they get to enjoy things it's really not that expensive no it's not if you break it down for a 20 30 or 40 years your bike whatever it is is is insignificant it it's like buying a

[00:43:47] season's back to this past the ski hill right and you know you use it 46 times it's not really that much money no it's nothing that's just it it's the it's the roll of the dice as to whether or

[00:43:56] not you'll use it but still it's actually really it's a point well taken so I mean honestly for someone who wants to take something home with that try and make the purchase like my bike instead of

[00:44:06] like your router and I sometimes it's hard to know like or the Sam articulator maybe hard to know what kind of purchase is gonna be but it is funny cuz honestly dentists overwhelmingly are really

[00:44:19] high earners like like I can't believe I'm saying this but we just buy expensive stuff man like we kind of a lot of us kind of Ken you know and kind of a lot of them kind of do like I always love how

[00:44:33] you like you you drive the used the most used car I know I kind of do too but you have what you have a you went to Arizona to get your car I had I bought it in Arizona and yeah it was probably a

[00:44:45] cartel cocaine chip I bought it in Ali had it shipped in Arizona but I paid cash compartment in it Wow where that came from what's all this white powder things is white

[00:44:57] powder in the windows are tinted a hundred percent but I paid cash you know and and it's a it's a but you also didn't buy it brand-new either I know I'd like actually I'd like a Tundra I have kind

[00:45:11] of fallen in love with these Tundras these Toyotas and but it's easy not to buy one of those because there are none yeah there's no new vehicles there's no new cars anywhere exactly I

[00:45:20] know I mean I look at cars as a tool yeah it's a piece of equipment that that I use and you know I don't fault someone who's a car person who's got a really fancy car I don't really fault that

[00:45:30] but but it's just not my thing Alan I have a mutual friend who who cars are his thing and buys lots of new cars and that's his that's his deal I think it's crazy but he likes it so you know

[00:45:45] what brings you joy do it I've pissed away money on a lot of other stuff to you so there you go you know that's sort of story well I tell you what Bart this was good I think I think let's

[00:45:54] leave it go we'll do this again sometime soon we got we got your microphone figured out so we can we can we can do this again but this was good I didn't know exactly where it was gonna go and I

[00:46:02] think it went I went okay place so thanks for being on Bart we'll talk to you soon thanks for having me