Very Dental: Is the Grass Actually Greener? with Dr. Gary Holtzclaw

[00:00:01] [SPEAKER_02]: This is a production of the Very Dental Podcast Network. This is the Very Dental Podcast.

[00:00:17] [SPEAKER_02]: Welcome to the Very Dental Podcast, where you'll find entertaining and relevant conversations with visionaries, clinicians, and your friends in the dental space.

[00:00:26] [SPEAKER_02]: Now, here's your host, Dr. Alan Mead.

[00:00:29] [SPEAKER_02]: Very Dental people, welcome to another episode of the Very Dental Podcast. I'm your host, Dr. Alan Mead, joining me as a co-host who he's co-hosted several times now. We got Dr. Gary Holtzclaw. Gary, how are you doing?

[00:00:40] [SPEAKER_01]: You're doing great, man. Glad to be back.

[00:00:42] [SPEAKER_02]: Gary is in South Carolina. It has been very hot here for the last couple weeks, so it must be like, it must be crazy. How's your weather?

[00:00:53] [SPEAKER_02]: Oh, you've got a hurricane coming too. Oh, that's right.

[00:00:57] [SPEAKER_01]: Yeah, mid to high 90s most days, humid as anything. We are three hours from the coast, so I appreciate your thoughts and prayers, but save them for my friends down by the beach.

[00:01:05] [SPEAKER_01]: Okay, so they're way away from the water.

[00:01:07] [SPEAKER_02]: Yeah, a lot less.

[00:01:10] [SPEAKER_02]: Okay.

[00:01:11] [SPEAKER_02]: So, Gary, I have a question for you.

[00:01:13] [SPEAKER_02]: I was thinking, I've been talking about informed consent, and I've always been kind of fascinated by the concept, you know, dentistry and medicine are very different.

[00:01:24] [SPEAKER_02]: I'm not exactly sure why they're so different. I think maybe just the inception of it, but I want you to think about what you might tell a new dentist or maybe even a dental student, maybe even an early dental student about the concept of providing services that are wants-based versus needs-based.

[00:01:47] [SPEAKER_02]: And you could even go back before dental school. Because I was talking to someone, I said, you know, one of the problems, especially in dental school, was that everything that we were taught to do is sort of needs-based.

[00:02:00] [SPEAKER_02]: In a lot of cases, it is we're telling patients about conditions that they don't realize that they have. You know, the classic thing, if gum disease hurt, if it had pain associated with it on the regular, or, you know, if decay hurt prior to getting to the pulp kind of thing, maybe we would be in a better shape.

[00:02:19] [SPEAKER_02]: But on some level, we're destined to be asking patients about treatments that they don't realize that they need. So we're bringing it up to their attention. That sucks. I just feel like it sucks. And so there's, on some level, the dentists that practice more wants-based stuff, whether that's cosmetics or implants or, you know, orthodontics or whatever, patients typically are coming into your office with something they want.

[00:02:44] [SPEAKER_02]: So delve into that. Have you ever thought about that before?

[00:02:49] [SPEAKER_01]: Yeah, a little bit. I remember we started doing clear aligners again, like seven years ago or so. So we like sent an email out when we started. And I was amazed at how many people responded to the email. Like had it been for cleanings in five years or pro fees or, you know, anything other than like, I broke a cusp, all this tooth, now I need to see you. And it's just, it's so easy to sell. You almost have to, like with informed consent, you almost have to slow them down and go over it. Like they just want to do it. And it's the same people a lot of times that tell you they don't have like $500 for a crown.

[00:03:19] [SPEAKER_01]: But now they have like a couple grand for Invisalign.

[00:03:23] [SPEAKER_02]: Yeah.

[00:03:23] [SPEAKER_01]: Yeah.

[00:03:24] [SPEAKER_02]: And of course, I don't do any, I don't do any ortho or Invisalign or anything like that. Everyone tells me I'm crazy. I probably am. But it is funny because my mindset, I've been doing this for long enough.

[00:03:33] [SPEAKER_02]: My mindset might be broken, but I feel like something that younger dentists could take into account in their training is that, I mean, there's always that pushing the boulder uphill when the condition is something the patient doesn't understand necessarily that you're having to explain.

[00:03:54] [SPEAKER_02]: And I mean, we talk about communication stuff all the time on the podcast and good informed consent involves communication.

[00:04:00] [SPEAKER_02]: But I've always thought to myself, you know, specialists kind of have it good because first off, if they've been sent from their regular dentist, they're already primed to go in there knowing they need something.

[00:04:12] [SPEAKER_02]: And frankly, knowing probably they have to spend something. That's the other thing about dentistry is that the stuff that's needs-based is they have budgeted $0 for needs-based care because they don't want it.

[00:04:23] [SPEAKER_02]: They don't want it. There's nothing, no one wants to come in and have a crown done on a back tooth that's about to break or having to, no one wants that.

[00:04:30] [SPEAKER_02]: They feel like they might need that. I guess if it's hurting when they're biting on it, they might want it then.

[00:04:36] [SPEAKER_02]: But the reality is a lot of the stuff that I feel like I've been doing for the last 22 years is just not wants-based.

[00:04:43] [SPEAKER_02]: And so, you know, let the needs-based or it's needs-based, not wants-based.

[00:04:48] [SPEAKER_02]: And I'm just like, I do feel like a lot of people have sort of understood this and have just pushed their practices into the wants-based section, which would be like implants, Invisalign and ortho, cosmetics, that sort of thing.

[00:05:03] [SPEAKER_02]: And I think they're probably smart to do it.

[00:05:05] [SPEAKER_02]: But on the other hand, human beings probably are in a position where there's needs-based stuff.

[00:05:10] [SPEAKER_02]: So there's got to be some of us slogging in that spot too.

[00:05:13] [SPEAKER_02]: I just, I sometimes struggle with that.

[00:05:15] [SPEAKER_02]: I'm like, man, if you wanted an easier way, you didn't have to feel like you had to sell so much.

[00:05:19] [SPEAKER_02]: Although all those people have to do a ton of marketing too though.

[00:05:22] [SPEAKER_02]: Like, I guess not all of them, but a lot of them, especially since the Invisalign providers are, there's a lot of them.

[00:05:29] [SPEAKER_02]: So it's like needs-based stuff, you probably don't have to market as much.

[00:05:34] [SPEAKER_02]: I do great fillings.

[00:05:36] [SPEAKER_02]: You know, it's, I mean, it's, those are the kinds of things when you have a relationship in a recall-based practice like mine,

[00:05:42] [SPEAKER_02]: where you don't, you don't have to market that stuff very much.

[00:05:44] [SPEAKER_02]: It's very interesting.

[00:05:45] [SPEAKER_02]: I just have, I thought about that a lot lately.

[00:05:47] [SPEAKER_02]: So I'm curious, like, have you ever, have you ever thought maybe I need to go into something where, where it's, you know,

[00:05:52] [SPEAKER_02]: if, if maybe I should just stop doing what I'm doing, do something totally different.

[00:05:56] [SPEAKER_02]: And if, if you've thought about that, what were you going to do?

[00:06:00] [SPEAKER_01]: I could see me one day.

[00:06:01] [SPEAKER_01]: Well, I, the one time I could see myself having like a day, a week of sleep.

[00:06:05] [SPEAKER_01]: Cause you know, I took Kent Smith's class and got a little hooked and then took Aaron Elliott's class and got really hooked.

[00:06:11] [SPEAKER_01]: We talked about that on my first podcast about me getting too into it.

[00:06:16] [SPEAKER_01]: I never would want to do it full time because after 17 years, I have such a relationship with the people that are my patients and I don't want to get rid of them.

[00:06:22] [SPEAKER_01]: Like, I don't want to just pass them on to someone else, but I will say I like having some sleep and having some implants and having some aligners because it,

[00:06:31] [SPEAKER_01]: not the implants as much cause they're often nervous, but the other two, they never say they hate the dentist.

[00:06:35] [SPEAKER_01]: Yeah.

[00:06:36] [SPEAKER_01]: They're happy to see you.

[00:06:37] [SPEAKER_01]: And I get time with someone that there's like no risk of like needles.

[00:06:41] [SPEAKER_00]: Yeah.

[00:06:41] [SPEAKER_01]: There's no risk of drills.

[00:06:42] [SPEAKER_01]: Any drilling is outside the mouth.

[00:06:44] [SPEAKER_01]: That's really, so it's, it is a nice break for me, but I don't think I ever want to get, I mean,

[00:06:49] [SPEAKER_01]: I think if I was early in my career and I didn't have such a relationship with these people, maybe,

[00:06:53] [SPEAKER_01]: but probably not because I formed relationships pretty quickly with people.

[00:06:56] [SPEAKER_01]: Yeah.

[00:06:56] [SPEAKER_02]: When I get up in my head, when I get up in my head about, about, you know, the things that are harder or more of a slog or whatever in my practice,

[00:07:05] [SPEAKER_02]: what brings me back is literally a patient sitting in my chair that I go, God, I really like this guy.

[00:07:10] [SPEAKER_02]: We've, we've, you know, we've hit it off for a hundred years.

[00:07:12] [SPEAKER_02]: I've known this guy for, for so long or this, you know, I talk with a mom who's got all of her kids come here.

[00:07:19] [SPEAKER_02]: I've known him forever.

[00:07:20] [SPEAKER_02]: I do have, I have legitimate like affection for these people and I would miss that.

[00:07:25] [SPEAKER_02]: And those aren't, you know, if you're marketing for procedures, if you're, if you're the cosmetic guy or you're the all on,

[00:07:31] [SPEAKER_02]: all on four guy or you're the, you know, you don't necessarily get to form that relationship like you might with,

[00:07:37] [SPEAKER_02]: with someone who's kind of coming on a recall basis.

[00:07:41] [SPEAKER_02]: And, and it is, it's a funny thing because so many of us have hygiene driven practices because why do you have,

[00:07:48] [SPEAKER_02]: why, why do you have a hygiene driven practice, Gary?

[00:07:50] [SPEAKER_02]: Why do you have, I'm going to answer it too, but why do you have that?

[00:07:54] [SPEAKER_01]: I do because I bought a practice that was hygiene driven and I came from dental school where I only needed to do very basic things.

[00:08:00] [SPEAKER_01]: And I went to a dentist growing up that was hygiene based.

[00:08:03] [SPEAKER_01]: So he just kind of kept it going, but yeah, it becomes,

[00:08:06] [SPEAKER_01]: it becomes the machine that there are times that you feel like it owns you.

[00:08:10] [SPEAKER_01]: Like I have two days a week, there are three hygiene checks and it's just,

[00:08:13] [SPEAKER_01]: they never can, no matter how hard they try, they don't get lined up.

[00:08:15] [SPEAKER_01]: And I get home and wife's like, how'd they go?

[00:08:18] [SPEAKER_01]: And I'm like, I don't remember much other than hygiene checks.

[00:08:20] [SPEAKER_02]: Like they just kept coming.

[00:08:21] [SPEAKER_02]: That's true.

[00:08:22] [SPEAKER_02]: And I don't have, I've never had three.

[00:08:23] [SPEAKER_02]: I have two some days and that's, that's a lot.

[00:08:27] [SPEAKER_02]: I was doing some, we had a last second cancellation on one of our hygienists.

[00:08:32] [SPEAKER_02]: So they threw a bunch of hygiene over into my schedule.

[00:08:34] [SPEAKER_02]: That was a lot of hygiene that day.

[00:08:36] [SPEAKER_02]: That was, that was me doing hygiene, doing the exams on those patients,

[00:08:40] [SPEAKER_02]: doing some restorative in between there and doing hygiene checks in another room.

[00:08:43] [SPEAKER_02]: I'm like, wow, that's a lot.

[00:08:44] [SPEAKER_02]: So the people who do multiple hygiene checks every hour,

[00:08:47] [SPEAKER_02]: I have tons of respect for because the thing is,

[00:08:51] [SPEAKER_02]: I probably take too long with my hygiene exams in some cases,

[00:08:55] [SPEAKER_02]: particularly going back to what we just talked about for the patients that I have

[00:08:58] [SPEAKER_02]: actual affection for.

[00:08:59] [SPEAKER_02]: Like I, you know, I do the hygiene check,

[00:09:01] [SPEAKER_02]: but we also talk about soccer or, or, you know,

[00:09:03] [SPEAKER_02]: my son starting band camp or whatever, you know,

[00:09:07] [SPEAKER_02]: there's always something.

[00:09:07] [SPEAKER_02]: And I do have to say that is something that as much as I like to come across as being,

[00:09:14] [SPEAKER_02]: not liking to be around people or being alone,

[00:09:16] [SPEAKER_02]: I do have a lot of, like you say, the relationship sort of happened organically.

[00:09:20] [SPEAKER_02]: I mean, unless you're a complete sociopath and you can't,

[00:09:22] [SPEAKER_02]: that's going to happen, especially if they've come to you first.

[00:09:25] [SPEAKER_02]: So I've, I mean, when you think about it,

[00:09:27] [SPEAKER_02]: some of these patients I've known for, okay, I bought the practice in 1998.

[00:09:30] [SPEAKER_02]: So we're, we're approaching 26 years.

[00:09:33] [SPEAKER_02]: I may have known some of these patients.

[00:09:34] [SPEAKER_02]: Some of them are still here that we're here in the beginning.

[00:09:36] [SPEAKER_02]: That's crazy.

[00:09:37] [SPEAKER_02]: That's like the first 26 years of my life was basically birth to graduating dental school.

[00:09:43] [SPEAKER_02]: Just to get, so I've known these people are really long time.

[00:09:46] [SPEAKER_02]: Some of them, it does.

[00:09:47] [SPEAKER_02]: It's a, it's just an interesting concept.

[00:09:49] [SPEAKER_02]: And you know what?

[00:09:50] [SPEAKER_02]: A lot of these people, if I were, if I were the Invisalign guy,

[00:09:52] [SPEAKER_02]: or if I was, you know, if I was just doing veneers or something like that,

[00:09:55] [SPEAKER_02]: not that there's anything really like that around here,

[00:09:57] [SPEAKER_02]: I might not have met these people because they were here because

[00:09:59] [SPEAKER_02]: they came, got their teeth cleaned every six months before I ever showed up.

[00:10:03] [SPEAKER_02]: You know, I agree.

[00:10:05] [SPEAKER_02]: I think that model is around because it's always been around.

[00:10:09] [SPEAKER_02]: I don't know.

[00:10:09] [SPEAKER_02]: Do you think that could ever change?

[00:10:11] [SPEAKER_02]: Could you, could you see dentistry moving into a less hygiene driven thing?

[00:10:17] [SPEAKER_01]: I think we can, it could.

[00:10:19] [SPEAKER_01]: Actually, I told you about my friend.

[00:10:22] [SPEAKER_01]: He could not find a hygienist.

[00:10:24] [SPEAKER_01]: Like just could not.

[00:10:25] [SPEAKER_01]: He went through like, he's supposed to have two since COVID.

[00:10:28] [SPEAKER_01]: It was like he had one and then he'd have weeks without it.

[00:10:30] [SPEAKER_01]: He just don't, his favorite two things in the world to do are root canals and extractions.

[00:10:34] [SPEAKER_01]: And he has turned himself into a dental ER.

[00:10:37] [SPEAKER_01]: Like he's up there on Saturdays.

[00:10:39] [SPEAKER_01]: Sometimes he never comes into 10 or 11.

[00:10:41] [SPEAKER_01]: He might be there till eight at night.

[00:10:43] [SPEAKER_01]: He might be gone at noon.

[00:10:45] [SPEAKER_01]: And all the, you know, all his, it's mostly endos.

[00:10:48] [SPEAKER_01]: That's what he prefers to do.

[00:10:49] [SPEAKER_01]: So he's made himself almost like a, not an endodontist, but like he practices, his days

[00:10:53] [SPEAKER_01]: are similar to endodontist minus their apicos and the retreatments.

[00:10:58] [SPEAKER_01]: But then you add in the fact that, you know, he's charging higher fees than I do because

[00:11:03] [SPEAKER_01]: it's all, you know, emergency things.

[00:11:05] [SPEAKER_01]: People are in pain.

[00:11:07] [SPEAKER_01]: But it's, I don't think every dentist could do that, but I have noticed these younger dentists,

[00:11:11] [SPEAKER_01]: they have a lot clearer vision coming out of school what they want to do.

[00:11:14] [SPEAKER_01]: Like I've, I think I've talked to you about that.

[00:11:15] [SPEAKER_01]: Like I have friends that started startups and they were like spear trained when they bought

[00:11:19] [SPEAKER_01]: their office.

[00:11:20] [SPEAKER_01]: So they knew from day one, they were going to be like occlusion veneers and cosmetics or

[00:11:24] [SPEAKER_01]: another friend that wanted to convert his office to implant only as fast as possible.

[00:11:29] [SPEAKER_01]: When I feel like my generation, your generation, like even if we specialize a little bit, it's,

[00:11:33] [SPEAKER_01]: we still have the hygiene model.

[00:11:34] [SPEAKER_01]: We still have the fillings and the crowns and you just never get out of it.

[00:11:38] [SPEAKER_02]: I actually wonder too for younger dentists, cause I, I constantly, all I ever talk about

[00:11:41] [SPEAKER_02]: is all the debt they're going into and all this stuff.

[00:11:43] [SPEAKER_02]: But I will say the resources that they have available to them, um, you know, I'm happy

[00:11:51] [SPEAKER_02]: to say podcasts, but, but podcasts and social media and all that stuff.

[00:11:55] [SPEAKER_02]: And, and frankly, uh, Muhammad who does the student podcast, he has a much, much clearer

[00:12:00] [SPEAKER_02]: focus of what dentistry is going to look like when he gets out than I ever did.

[00:12:05] [SPEAKER_02]: I mean, in my, I grew up with it.

[00:12:07] [SPEAKER_02]: My dad was a dentist.

[00:12:08] [SPEAKER_02]: I mean, I grew up in a dental office.

[00:12:09] [SPEAKER_02]: I still didn't know anything.

[00:12:10] [SPEAKER_02]: I didn't know anything about how the business, no anything about the model.

[00:12:13] [SPEAKER_02]: I didn't know.

[00:12:14] [SPEAKER_02]: I just saw that dad liked what he did and he did a little of everything.

[00:12:18] [SPEAKER_02]: And so I guess I thought that's what you did.

[00:12:21] [SPEAKER_02]: And it is interesting for all the influences that a dental student could have that are outside

[00:12:25] [SPEAKER_02]: of the dental school and outside of my dad per se, I do agree.

[00:12:30] [SPEAKER_02]: And it'd be very interesting to know what percentage of dental students are affected

[00:12:35] [SPEAKER_02]: by those kinds of influences.

[00:12:36] [SPEAKER_02]: In other words, how many of them are like me and they're just keeping their head down

[00:12:40] [SPEAKER_02]: trying to get out on time versus how many of them are actually paying attention to,

[00:12:43] [SPEAKER_02]: and they have to know the opportunities that you and I had when we got out of dental school.

[00:12:49] [SPEAKER_02]: I mean, I had, I had my class.

[00:12:52] [SPEAKER_02]: I think everyone was going to associate for a couple of years and then buy a practice.

[00:12:55] [SPEAKER_02]: There might've been a few that stayed around.

[00:12:57] [SPEAKER_02]: I was in Minneapolis.

[00:12:58] [SPEAKER_02]: So it was like there, there was actually group practices.

[00:13:01] [SPEAKER_02]: Technically, I suppose it's a DSO, you know, they're, but they're all like Metro Dental

[00:13:06] [SPEAKER_02]: and Park Dental.

[00:13:07] [SPEAKER_02]: They were sort of, they're sort of a branded DSO.

[00:13:11] [SPEAKER_02]: So, and a lot of people work for them, at least for a while.

[00:13:13] [SPEAKER_02]: Some of them still do where they, you know, they, I don't know if they're part owners or

[00:13:18] [SPEAKER_02]: anything like that, but it's a large group practices.

[00:13:20] [SPEAKER_02]: But that was mostly a big city thing.

[00:13:22] [SPEAKER_02]: Most people were planning on going back and eventually buying a practice, I think, in a

[00:13:27] [SPEAKER_02]: lot of cases.

[00:13:27] [SPEAKER_02]: And that's just not, this is not what people are looking at necessarily.

[00:13:30] [SPEAKER_02]: Some maybe, I'm not saying it can't happen, but I feel like it's very different.

[00:13:34] [SPEAKER_02]: Like, I don't feel like I'm that old, except I really am.

[00:13:38] [SPEAKER_02]: I mean, having graduated in the nineties, in the late nineties makes me old, I think.

[00:13:43] [SPEAKER_02]: And it is just the way things work now.

[00:13:46] [SPEAKER_02]: And also what stuff costs now.

[00:13:49] [SPEAKER_02]: It's just like, I can't get my old man brain around a lot of it.

[00:13:53] [SPEAKER_02]: So I think that's the struggle.

[00:13:54] [SPEAKER_02]: When you talk to younger dentists or when you're seeing, are most of them figuring that

[00:13:57] [SPEAKER_02]: they're going to, I mean, you're saying that people did a startup.

[00:14:02] [SPEAKER_02]: Can you imagine doing it?

[00:14:02] [SPEAKER_02]: I can't imagine doing a startup when it was brand new.

[00:14:05] [SPEAKER_02]: Although I do think personality type has a lot to do with it too.

[00:14:09] [SPEAKER_01]: But I mean, no, I was a man.

[00:14:13] [SPEAKER_01]: I was out of school for one procedure.

[00:14:15] [SPEAKER_01]: So like I could have done a startup because I had no idea what I even wanted.

[00:14:19] [SPEAKER_01]: Yeah.

[00:14:20] [SPEAKER_01]: Like my joke was I bought an office and kept it the same because I'm like, the only other

[00:14:24] [SPEAKER_01]: thing I know is dental school.

[00:14:25] [SPEAKER_01]: I don't think I can create a dental school here.

[00:14:28] [SPEAKER_01]: So got my first lab bill.

[00:14:29] [SPEAKER_01]: I was like, well, that costs more than what dental school charge.

[00:14:31] [SPEAKER_01]: So that's not going to work.

[00:14:32] [SPEAKER_01]: But it's, it's just one of those things where I don't think you needed a clear vision.

[00:14:37] [SPEAKER_01]: They kind of taught you in school, like a little bit of business you got that you could

[00:14:40] [SPEAKER_01]: just like hang a shingle and you wouldn't go bankrupt.

[00:14:42] [SPEAKER_01]: That was basically the way it was taught.

[00:14:43] [SPEAKER_01]: Like you can't go bankrupt.

[00:14:44] [SPEAKER_01]: It can't happen.

[00:14:45] [SPEAKER_01]: And like when I bought my office, I had, there was one thing I could have bought really

[00:14:49] [SPEAKER_01]: like a pan or maybe CAD cam was around, but not like it is now that would have been more

[00:14:54] [SPEAKER_01]: than 20,000.

[00:14:55] [SPEAKER_01]: And I look, I look at my office a couple weeks ago.

[00:14:56] [SPEAKER_01]: I have like some of it bought used, but I have like seven or eight pieces of equipment

[00:15:01] [SPEAKER_01]: that are over $20,000, like two scanners, three mills, a CBCT, 3D print.

[00:15:06] [SPEAKER_01]: Like I have a sprint race system and it all just, well, that's more 15, but still it all

[00:15:11] [SPEAKER_01]: adds up.

[00:15:12] [SPEAKER_01]: And you just, it's so hard to run an office these days.

[00:15:14] [SPEAKER_01]: Even a dental chair, an x-ray machine and some cabinets are going to run you so much

[00:15:18] [SPEAKER_01]: more than it did 17 years ago.

[00:15:20] [SPEAKER_02]: No, that's exactly right.

[00:15:21] [SPEAKER_02]: It's funny because, well, the other thing is when I bought a practice, I didn't know

[00:15:24] [SPEAKER_02]: anything.

[00:15:25] [SPEAKER_02]: I mean, my dad had a practice and was running a practice and, and, and I suspect he tried,

[00:15:30] [SPEAKER_02]: he probably tried to explain, but I, like, I didn't, I knew so little about running a business

[00:15:36] [SPEAKER_02]: and what I was going to have to do that.

[00:15:40] [SPEAKER_02]: I mean, it's a, I feel like looking back, I'm like, I can't believe they let me do that.

[00:15:44] [SPEAKER_02]: Someone loaned me money to do this.

[00:15:46] [SPEAKER_02]: I didn't know anything.

[00:15:47] [SPEAKER_02]: I think, like, I think people about going in with a business plan and stuff like that.

[00:15:50] [SPEAKER_02]: My, my, my plan is to buy the practice and be a dentist.

[00:15:53] [SPEAKER_02]: That's no, it's a, and they did.

[00:15:55] [SPEAKER_02]: Although I wasn't, I was going to say, I bought my practice for a steal.

[00:15:58] [SPEAKER_02]: Looking back, if you, if you looked back at my history, I might seem more savvy than

[00:16:02] [SPEAKER_02]: I was.

[00:16:02] [SPEAKER_02]: I was just clueless walking into it.

[00:16:04] [SPEAKER_02]: Basically.

[00:16:05] [SPEAKER_02]: It's amazing.

[00:16:05] [SPEAKER_02]: I don't think you get away with that as easily now as you did then.

[00:16:09] [SPEAKER_02]: I mean, you could, I, I got away with being just stupid about everything.

[00:16:12] [SPEAKER_02]: Shoot.

[00:16:13] [SPEAKER_02]: I'm still stupid about everything.

[00:16:14] [SPEAKER_02]: Like so many, so many of the things that these people are doing.

[00:16:17] [SPEAKER_02]: I'm like, I'm just scared thinking about it.

[00:16:20] [SPEAKER_02]: Like, like a startup.

[00:16:21] [SPEAKER_02]: Oh my God.

[00:16:22] [SPEAKER_02]: I mean, there are times when I have the little thing in my brain.

[00:16:25] [SPEAKER_02]: I'm like, okay, that's it.

[00:16:26] [SPEAKER_02]: I'm so tired.

[00:16:27] [SPEAKER_02]: One of the things that I bought a practice that's 26, 27 miles from home.

[00:16:31] [SPEAKER_02]: So I've got a, you know, I got a 40 minute drive one way, two times a day.

[00:16:36] [SPEAKER_02]: And I, I occasionally will calculate the number of hours I've lost to my commute.

[00:16:40] [SPEAKER_02]: And mind you, the commute sometimes is a little bit of a peaceful place to, to kind of unwind

[00:16:46] [SPEAKER_02]: before you get home and all that stuff.

[00:16:47] [SPEAKER_02]: So there's not, there, there's advantages to that.

[00:16:49] [SPEAKER_02]: But when you think about the time that you lose, you know, better than an hour and 20 minutes a day

[00:16:54] [SPEAKER_02]: for as many days as you go to the office, you're just like, wow, that adds up over 26 years.

[00:16:58] [SPEAKER_02]: I mean, that's a, it's a lot of time.

[00:17:03] [SPEAKER_02]: Although I live out in the country.

[00:17:04] [SPEAKER_02]: So if you're going to have a practice in town one way or the other,

[00:17:07] [SPEAKER_02]: short of me having a practice just down my driveway next to the horse barn, uh, where

[00:17:12] [SPEAKER_02]: I can walk to it, I'm going to be, I'm going to have some kind of a community anyway.

[00:17:16] [SPEAKER_02]: You cut it.

[00:17:16] [SPEAKER_02]: I've thought about, man, I should, I should just start something up here so I wouldn't

[00:17:20] [SPEAKER_02]: have to drive so far.

[00:17:21] [SPEAKER_02]: And then I think about the fact that, oh my God, I, I'd have to do a startup that I

[00:17:25] [SPEAKER_02]: have to figure out.

[00:17:26] [SPEAKER_02]: Like, I mean, I, I had patients when I, when I bought the practice, there were the same

[00:17:31] [SPEAKER_02]: patients that were there before I got there.

[00:17:32] [SPEAKER_02]: Lots of them were here before I ever got here and I very much appreciate them.

[00:17:35] [SPEAKER_02]: And a lot of them are still here.

[00:17:38] [SPEAKER_02]: I'm just the idea of a startup.

[00:17:40] [SPEAKER_02]: I mean, obviously there's people that know how to do it and can help you with that, but

[00:17:43] [SPEAKER_02]: it just seems like really over.

[00:17:44] [SPEAKER_02]: What if they don't come?

[00:17:46] [SPEAKER_02]: I mean, geez.

[00:17:47] [SPEAKER_02]: So I, I don't know.

[00:17:48] [SPEAKER_02]: I just, I got a lot of respect for people that are looking at these different models

[00:17:51] [SPEAKER_02]: and everything.

[00:17:53] [SPEAKER_02]: Um, I don't know.

[00:17:54] [SPEAKER_02]: So I, there are times if, if someone held a gun to my head and said, okay, you have to

[00:17:58] [SPEAKER_02]: do a startup and you have to pick a different kind of model.

[00:18:01] [SPEAKER_02]: I would love to do a model without hygiene, not because I dislike hygiene.

[00:18:06] [SPEAKER_02]: I love my hygienists.

[00:18:07] [SPEAKER_02]: And frankly, seeing hygiene patients is what keeps me busy, but doing something specific,

[00:18:13] [SPEAKER_02]: like I oftentimes think about it and everyone wants to throw up, but like if I could get

[00:18:18] [SPEAKER_02]: really good and comfortable with smile design and composite veneers, which is a kind of an

[00:18:24] [SPEAKER_02]: instant, instant, uh, cosmetic fix.

[00:18:26] [SPEAKER_02]: And if that's all you did, that would be kind of awesome because there's low overhead.

[00:18:32] [SPEAKER_02]: And, and I mean, it's one of these things where if you're good at that, it's a skill

[00:18:35] [SPEAKER_02]: sets you can carry with you.

[00:18:36] [SPEAKER_02]: You don't, you don't necessarily need to rely on the lab to do this stuff.

[00:18:38] [SPEAKER_02]: And I do enjoy doing that stuff.

[00:18:40] [SPEAKER_02]: I don't do enough of it to make it efficient or predictable.

[00:18:44] [SPEAKER_02]: Like I think if you did all of that, you could, that's the one thing about specialization

[00:18:48] [SPEAKER_02]: that I just love the idea of is what you do.

[00:18:50] [SPEAKER_02]: You do this and you're not, you're not spread thin because you and I are both do a lot

[00:18:54] [SPEAKER_02]: of different things and sometimes I don't do very much of it at once.

[00:19:00] [SPEAKER_02]: Like I'll get a glut of endo, but then there's, there's times where I'll go weeks without

[00:19:03] [SPEAKER_02]: doing any endo.

[00:19:04] [SPEAKER_02]: Um, we, have you run into that where you, where you're sometimes relearning the procedures

[00:19:08] [SPEAKER_02]: that you know how to do just cause you don't, you don't do them very often.

[00:19:11] [SPEAKER_01]: Yes.

[00:19:11] [SPEAKER_01]: I've done it with endos mine too.

[00:19:13] [SPEAKER_01]: I've started and stopped actually bought the comment system that Kevin using.

[00:19:17] [SPEAKER_01]: I was going to take his class and it got canceled.

[00:19:19] [SPEAKER_01]: So I've actually been messing around with some tooth blocks they sent me with that.

[00:19:24] [SPEAKER_01]: And you know, it's just, it's one of the things for some reason.

[00:19:26] [SPEAKER_02]: Come to your office and you can just do some endo on him.

[00:19:29] [SPEAKER_02]: I feel like that'd be a really good hands-on solution.

[00:19:31] [SPEAKER_02]: Kevin, we'll get on that.

[00:19:32] [SPEAKER_02]: We'll figure that out.

[00:19:33] [SPEAKER_02]: We'll figure what tooth Kevin wants some endo on and we'll just do that.

[00:19:37] [SPEAKER_02]: Yeah.

[00:19:38] [SPEAKER_02]: Works for me.

[00:19:38] [SPEAKER_02]: Yeah.

[00:19:38] [SPEAKER_02]: I'll do it for free.

[00:19:40] [SPEAKER_02]: I won't even charge you, Kevin, just because you're helping out.

[00:19:42] [SPEAKER_02]: I won't even charge you, Kevin.

[00:19:43] [SPEAKER_02]: Thanks.

[00:19:43] [SPEAKER_02]: I appreciate that.

[00:19:45] [SPEAKER_02]: Kevin's the man.

[00:19:45] [SPEAKER_02]: What can I say?

[00:19:46] [SPEAKER_02]: I think that Kevin's got a lot of CE teaching in his future, but I can't necessarily say

[00:19:51] [SPEAKER_02]: anything about that.

[00:19:52] [SPEAKER_02]: But I think it's not just going to be endo.

[00:19:54] [SPEAKER_02]: He might end up like half living in North Carolina, but we don't know about that for sure.

[00:19:58] [SPEAKER_02]: So you, okay.

[00:19:59] [SPEAKER_02]: So you do the endo thing where you start and stop.

[00:20:01] [SPEAKER_02]: I do that all the time too.

[00:20:04] [SPEAKER_01]: Yeah.

[00:20:04] [SPEAKER_01]: For me, endo has to be something where it just, I got to have the time in my schedule

[00:20:08] [SPEAKER_01]: to do it because I'm not the person yet that just opens up teeth on the fly.

[00:20:12] [SPEAKER_01]: Like I've never been that person is one.

[00:20:13] [SPEAKER_01]: So if I'm booked out three, four weeks and they're hurting, a lot of times I send endo

[00:20:18] [SPEAKER_01]: I know I can do out just because I'm like, I don't want them waiting through.

[00:20:21] [SPEAKER_01]: We can try the antibiotic.

[00:20:22] [SPEAKER_01]: It may or may not work.

[00:20:23] [SPEAKER_02]: Can you get an endo in quickly?

[00:20:26] [SPEAKER_02]: Like if, or am I with your specialist?

[00:20:29] [SPEAKER_02]: I can't, man.

[00:20:29] [SPEAKER_02]: It takes me forever to get someone in.

[00:20:32] [SPEAKER_01]: Well, if I can usually do it within two weeks.

[00:20:34] [SPEAKER_01]: Okay.

[00:20:35] [SPEAKER_01]: If that's where the emergency friend that of mine pays off, because I'll sometimes tell

[00:20:39] [SPEAKER_01]: people like, listen, he's not a specialist, but he can get his rule is he gets you in

[00:20:42] [SPEAKER_01]: a day or tomorrow.

[00:20:43] [SPEAKER_02]: I'm going to start with that to your friend.

[00:20:45] [SPEAKER_02]: It's a long drive, but he's really fast.

[00:20:48] [SPEAKER_02]: I'm telling you that.

[00:20:49] [SPEAKER_02]: I mean, I, I kind of love that because he's also, he doesn't have to drive demand because

[00:20:54] [SPEAKER_02]: toothaches always happen.

[00:20:56] [SPEAKER_02]: A toothache and a credit card is a really powerful, powerful driver for dentists.

[00:21:01] [SPEAKER_01]: You know?

[00:21:01] [SPEAKER_01]: And he, he also talked about that.

[00:21:02] [SPEAKER_01]: Like, you know, he's not a big SEO Google words guy, but no one is trying to buy like emergency

[00:21:08] [SPEAKER_01]: room dentistry.

[00:21:09] [SPEAKER_01]: Like they're buying implants and Invisalign and you might pay a good penny in Greenville

[00:21:13] [SPEAKER_01]: to get on the top of the sponsored page there.

[00:21:16] [SPEAKER_01]: But his joke was that you say, I want to just advertise root canal or just advertise

[00:21:21] [SPEAKER_01]: dental ER.

[00:21:22] [SPEAKER_02]: Yeah.

[00:21:22] [SPEAKER_01]: They're giving it to you on pennies on the dollar compared to what they're only charging.

[00:21:26] [SPEAKER_01]: So he immediately went to the top of Google without even trying just by changing his practice

[00:21:30] [SPEAKER_01]: name to like from Chapman dental to Chapman emergency dental.

[00:21:34] [SPEAKER_01]: Like it just put that word in there.

[00:21:35] [SPEAKER_02]: I love, I've always thought the emergency dental thing struck me as interesting that the

[00:21:39] [SPEAKER_02]: problems with it is I'm, I'm not, I'd have to up my endo game.

[00:21:43] [SPEAKER_02]: I think you can with reps.

[00:21:45] [SPEAKER_02]: I think you can, but in endos, when endo is good, it's like the best procedure ever.

[00:21:50] [SPEAKER_02]: But when it's tough, it's, it's a bit on the soul crushing side.

[00:21:54] [SPEAKER_02]: One of my last endo experiences was I kept missing the block.

[00:21:59] [SPEAKER_02]: I'm like, really?

[00:22:00] [SPEAKER_02]: I got, I got an hour and a half set aside or maybe even two hours set aside.

[00:22:04] [SPEAKER_02]: And I literally an hour into it, I didn't even have the rubber dam on because I kept

[00:22:07] [SPEAKER_02]: missing the block.

[00:22:07] [SPEAKER_02]: I'm like, wow, what does an endodontist do in this case?

[00:22:11] [SPEAKER_02]: And I don't miss blocks hardly ever.

[00:22:13] [SPEAKER_02]: So I don't know what the story was on.

[00:22:14] [SPEAKER_02]: It's just like, it was classic.

[00:22:15] [SPEAKER_02]: And I have a bit of, I have a bit of bad juju with endo.

[00:22:20] [SPEAKER_02]: I feel like, I feel like, and sometimes I feel like every tooth that I try and get into

[00:22:23] [SPEAKER_02]: is the one super weird anatomical one word, but I'm, I suspect I'm probably just being

[00:22:29] [SPEAKER_02]: dramatic.

[00:22:29] [SPEAKER_02]: That's probably not true, but that's one of the reasons I don't do more endo because

[00:22:32] [SPEAKER_02]: for me, I've never, even with a lot of practice and classes and everything, I've never found

[00:22:35] [SPEAKER_02]: it to be super predictable.

[00:22:37] [SPEAKER_02]: And so, like you said, it takes a long time for me.

[00:22:40] [SPEAKER_01]: You also hit on, you hit on another thing of what I like about mine and your model is that

[00:22:44] [SPEAKER_01]: when you miss the block, you probably have numbed this person before.

[00:22:48] [SPEAKER_01]: So they know that you're at least confident.

[00:22:49] [SPEAKER_01]: That's the hard thing about like his system.

[00:22:51] [SPEAKER_01]: One shot deal.

[00:22:52] [SPEAKER_01]: If you have a bad, yeah, you got like a one shot deal.

[00:22:54] [SPEAKER_01]: And if you miss it, it's like, I meet people in hygiene, at least they talk to me usually

[00:22:58] [SPEAKER_01]: before I, we don't take new patient emergencies anymore.

[00:23:01] [SPEAKER_01]: We just, you don't come through hygiene.

[00:23:02] [SPEAKER_01]: You just can't be a patient.

[00:23:04] [SPEAKER_01]: And it's one of those things where it does give you ability to screen people and be like,

[00:23:07] [SPEAKER_01]: okay, you barely made it through the pro fee.

[00:23:09] [SPEAKER_01]: We might need to give you some pills or nitrous to get you through the filling.

[00:23:13] [SPEAKER_01]: Like you're struggling with scaling.

[00:23:15] [SPEAKER_01]: And that's the part he doesn't get is they walk in and he has no idea if they're terrified

[00:23:19] [SPEAKER_01]: or if they're like going to fall asleep on them or if they're in the middle somewhere.

[00:23:22] [SPEAKER_02]: It's interesting too, because you almost have to assume that the patient that comes

[00:23:27] [SPEAKER_02]: into the toothache office is probably, is probably afraid and is probably, has probably put stuff

[00:23:32] [SPEAKER_02]: off, which let's be honest.

[00:23:33] [SPEAKER_02]: I mean, I have tons of patients like that in my office too.

[00:23:35] [SPEAKER_02]: I have patients that I like and consider long-term patients that still never frigging do anything.

[00:23:40] [SPEAKER_02]: I mean, that's, I have a, I just saw a patient, the last patient for lunch is one of those

[00:23:45] [SPEAKER_02]: people that comes in when the crowns that have been in their mouth for 25 years are falling

[00:23:50] [SPEAKER_02]: out and all they really want you to do is re-cement them.

[00:23:53] [SPEAKER_02]: And you're on some level, you're like, I don't really want to have the tough conversation about,

[00:23:59] [SPEAKER_02]: I'm not going to keep doing this for you for the rest of your life.

[00:24:02] [SPEAKER_02]: And the other thing is, is that you, they, they come in with full knowledge that, yeah,

[00:24:06] [SPEAKER_02]: this probably won't last very long. And then I checked, I checked the last time I'd worked on

[00:24:10] [SPEAKER_02]: this tooth that we worked on was several years ago. And it was another Hail Mary. Then I'm like,

[00:24:14] [SPEAKER_02]: God, they're not, they shouldn't even last that long for crying out loud. And they did.

[00:24:18] [SPEAKER_02]: And I'm just like, I'm not the guy who gets rid of those people. I should. Cause they,

[00:24:22] [SPEAKER_02]: that's just, I mean, it's a waste of my time, but it's also, I've known this person forever.

[00:24:26] [SPEAKER_02]: And I also know that, that she won't follow through with any kind of serious treatment. I mean,

[00:24:30] [SPEAKER_02]: it's like some of the crowns that we, some of the things we end up doing are things that I did

[00:24:34] [SPEAKER_02]: before. A lot of them are not, a lot of them have been, you know, I've been around longer than me.

[00:24:38] [SPEAKER_02]: So this person has literally spent almost no money on functional dentistry because they don't ever

[00:24:44] [SPEAKER_02]: do anything new. It's unreal at what people function on. And probably our model gives us

[00:24:51] [SPEAKER_02]: some leeway with, you know, whether or not we toss the crazy people like that or just keep them

[00:24:56] [SPEAKER_02]: around. So it's a good story on a podcast. I don't know. Yeah. Those are the good cement patients.

[00:25:02] [SPEAKER_01]: They'll say use the good cement. You know, like you got a bad cement. Use the good cement.

[00:25:06] [SPEAKER_02]: No, no, no. We need the good. No, actually no, I, I used the lousy cement, but now I'm going to go

[00:25:11] [SPEAKER_01]: get the good for the third time. Let me go get the golden box. We'll open the golden box that we

[00:25:16] [SPEAKER_02]: only use on the difficult. It should have their face on the label. The, the, the patient that only

[00:25:21] [SPEAKER_02]: comes in when, when things are wrong. That's, and you know, it is a funny thing in my model,

[00:25:26] [SPEAKER_02]: the patient that only comes in when things are a problem that irritates me, but like in your buddy's

[00:25:30] [SPEAKER_02]: model, that's the patient he's looking for, you know, of course that's, he's going to come in

[00:25:34] [SPEAKER_02]: because it hurts and that's why they show up. Right. That's the, it's an interesting thing.

[00:25:38] [SPEAKER_02]: And so he doesn't have hygiene. Does he have regular hours or does he just have like a calling,

[00:25:45] [SPEAKER_02]: like a calling system? I'm curious about this. It's, it's kind of developed into a little of both.

[00:25:51] [SPEAKER_01]: He, he never starts at like eight or nine just because like he has his business team will get there,

[00:25:56] [SPEAKER_01]: maybe eight or nine, start lining stuff up. He shows up somewhere between 10 and 11.

[00:26:00] [SPEAKER_01]: And he just kind of goes, but yeah, like once you, I think the rule now is if you haven't seen,

[00:26:06] [SPEAKER_01]: if you've seen him before, like you're repeating person, he'll even come up there on Saturday and

[00:26:09] [SPEAKER_01]: Sunday and put, you know, get you out of pain. New people, I think have to be Monday through Friday

[00:26:13] [SPEAKER_01]: and he's about to hire a third doc. So he's done this for like a year and a half and he's already

[00:26:19] [SPEAKER_02]: tripled it basically. Interesting. Yeah. How big of a, how big of a town do you think you have to be to do that?

[00:26:28] [SPEAKER_01]: Well, Greenville has over 300 dentists in it. I just know that when I was a district president with

[00:26:33] [SPEAKER_01]: an ADA. Um, so I, yeah, you can't do it in like where my parents grew up in Clinton that has like

[00:26:40] [SPEAKER_01]: two or three dentists total in it. Like that's not going to work there, but yeah, he can get like

[00:26:47] [SPEAKER_01]: referrals from people like me and a lot of our referrals to him. He thinks we're referring.

[00:26:50] [SPEAKER_01]: It's just people calling saying, Oh, this two is killing me. I want it out today.

[00:26:54] [SPEAKER_01]: And we're just like, well, we don't do that, but he does. So he's always thanking me for it. And I'm

[00:26:59] [SPEAKER_01]: like, dude, you gotta understand. I didn't really, I didn't really, yeah, kind of refer to it.

[00:27:03] [SPEAKER_02]: It's a referral as much as they came from your office, but this is someone that you couldn't

[00:27:07] [SPEAKER_02]: or didn't want to work into your schedule. And that's, that's, so he has a value for you that way.

[00:27:13] [SPEAKER_02]: I mean, like, yeah, I mean, that would be a valuable thing for, but he's, so it sounds

[00:27:18] [SPEAKER_02]: like he works a lot though where they're open a lot. Is that right? Are there hours pretty

[00:27:21] [SPEAKER_02]: wide?

[00:27:23] [SPEAKER_01]: Believe it or not, they tend to, I think on the average week, they're probably open four

[00:27:26] [SPEAKER_01]: days from like 11 to six. And then maybe like count another three hours every two weeks that

[00:27:33] [SPEAKER_01]: you're up there just kind of, you know, knocking out one to two people.

[00:27:36] [SPEAKER_02]: I'd be curious to know what the schedule looks like when he leaves at the end of the week for

[00:27:40] [SPEAKER_02]: the next week. In other words, are, is there mostly space or is, or in, and then can you take

[00:27:45] [SPEAKER_02]: calls over the weekend to line them up? It's an interesting thing.

[00:27:49] [SPEAKER_01]: Yeah. I don't know who manages is like after hour thing. If he sends that phone home with

[00:27:52] [SPEAKER_01]: like a business team is getting so much per day to answer the phone or what? Cause I'm sure it

[00:27:56] [SPEAKER_01]: rings like around the clock or goes to voicemail or whatever. Um, I don't know. I know that he

[00:28:02] [SPEAKER_01]: doesn't schedule anything new other than today. Like he won't even schedule tomorrow, but he does do

[00:28:07] [SPEAKER_01]: multi appointment endo a lot because it'll open a tooth up, those calcium hydroxide, get out of pain

[00:28:12] [SPEAKER_01]: and then get them set up later. So I know that he does schedule things two weeks out often for that,

[00:28:17] [SPEAKER_01]: but he's not doing anything like crowned bridge. He'll like, he'll, he'll resubmit a bridge for

[00:28:20] [SPEAKER_01]: you if it comes off, but he's not really built model. I don't, I don't think that, I don't think

[00:28:26] [SPEAKER_02]: we're big enough around here to pull it off. And the other thing is, is that I think I've always

[00:28:30] [SPEAKER_02]: thought unless you had multiple dentists and you'd have to have a lot of patients to make it,

[00:28:33] [SPEAKER_02]: make it work for multiple dentists. Although I guess what you say, he probably charges a premium

[00:28:39] [SPEAKER_02]: for, he does for the emergency aspect of it. So that's kind of interesting. And the other thing

[00:28:45] [SPEAKER_02]: is, does he take insurance? Is he, is he a insurance? Yes. I know. I think he, I don't

[00:28:49] [SPEAKER_01]: think he follows. I don't think he, he may give you a form to file. I might be wrong here. I need to

[00:28:54] [SPEAKER_01]: ask my business team this cause I, I barely know how we do insurance. No, I know. I don't know

[00:28:58] [SPEAKER_01]: either. But I think he more or less like, I know it was like a minimum of thing, like three or

[00:29:02] [SPEAKER_01]: $400 just to get in and it goes to a treatment if you do it, but you get there and decide,

[00:29:06] [SPEAKER_01]: no, I don't want to do anything. Then he just had a larger than normal limited exam.

[00:29:11] [SPEAKER_02]: Wow. And the other thing is I was like, when you're not filing insurance, it doesn't really

[00:29:15] [SPEAKER_02]: matter. Like, like whatever it is, it is. I mean, there was a time when we didn't have all these,

[00:29:21] [SPEAKER_02]: these codes that went with the, you know, you, you saw the patient and did what they needed kind

[00:29:25] [SPEAKER_02]: of thing. And I think honestly, my dad may have practiced at a point where there really wasn't

[00:29:28] [SPEAKER_02]: so much of a, it's just interesting. Like that model is interesting because it takes out

[00:29:33] [SPEAKER_02]: the hygiene thing. And, and a lot of us, like you said, have leaned into the hygiene driven

[00:29:40] [SPEAKER_02]: model because that's what we knew and that's what we bought and that's how it's been. I'm

[00:29:45] [SPEAKER_02]: not going to change that now. Um, and actually right now I have a relatively stable hygiene

[00:29:51] [SPEAKER_02]: situation, so I'm not singing the blues as much, but, but earlier this year we had turnover,

[00:29:56] [SPEAKER_02]: uh, and honestly, I will say now back and back, you know, in the, in 2020, 2021, you couldn't find,

[00:30:04] [SPEAKER_02]: you couldn't get any people to, to, um, apply. So if you had any applications, you were, you had

[00:30:10] [SPEAKER_02]: pretty slim pickings and you're paying them a lot more than you ever were. That's that part is true.

[00:30:14] [SPEAKER_02]: And I think that's just real. But, um, now I can, now I get some, uh, applications. I haven't had

[00:30:20] [SPEAKER_02]: as hard a time hiring. I think right now I just am so gun shy about hiring because it's been

[00:30:26] [SPEAKER_02]: part-time. My full-time person's been here for a good long time and I know what to expect from her.

[00:30:32] [SPEAKER_02]: And we now have a really solid part-time person there too, but we had a really solid part-time

[00:30:36] [SPEAKER_02]: person who up and left, like, like dropped it on me and out of the blue several times. That makes

[00:30:42] [SPEAKER_02]: me gun shy. I don't like to hire cause I don't, I want to make sure we got someone who's going to

[00:30:45] [SPEAKER_02]: stay for a while. Apparently I'm, I'm a creature of habit and like to just have things stay the same.

[00:30:49] [SPEAKER_02]: And so, so I haven't been thinking about a hygiene list situation, but it always crosses

[00:30:55] [SPEAKER_02]: my mind because I don't, if particularly in bigger cities where, where, you know, hygienists

[00:31:01] [SPEAKER_02]: are, are getting some of the things you hear about in Seattle and Chicago and in Los Angeles,

[00:31:05] [SPEAKER_02]: how much they pay a hygienist. I don't know how much, um, reimbursement they can get for that.

[00:31:10] [SPEAKER_02]: So at some point do they price themselves out of, out of the job? And if they do that,

[00:31:15] [SPEAKER_02]: what's the solution because patients expect it again in the same way that you and I have only

[00:31:19] [SPEAKER_02]: known this hygiene driven situation. A lot of times patients go to the dental office to see a

[00:31:24] [SPEAKER_02]: hygienist and Oh, by the way, I got to see the dentist too. I just wonder how that changes over

[00:31:27] [SPEAKER_01]: time. Have you thought about that at all? I have a little, um, we, we had a hysterectomy followed

[00:31:34] [SPEAKER_01]: by a maternity leave. So we went through about four of the last four or five of the last seven months

[00:31:40] [SPEAKER_01]: with a fill in hygiene. Okay. And it was horrible. Yeah. Like we had one, I had a fire because she

[00:31:48] [SPEAKER_01]: was impaired. I had one day we filled seven times, like you fill it and then they text you a week

[00:31:53] [SPEAKER_01]: later, like taking the kids to the zoo can't come. I mean, yeah. Finally got so bad that my main

[00:31:57] [SPEAKER_01]: hygienist looked at me and said like, just give me one of your assistants and I'll do all of you.

[00:32:01] [SPEAKER_01]: I'll just do assisted hygiene and knock it all out. We did find one and two that we really liked,

[00:32:05] [SPEAKER_01]: but it's just, it's very rough out there. And I don't think I realized how bad the shortage was

[00:32:10] [SPEAKER_01]: because I'm like you, like I don't hire a lot. Yeah. Yeah. Like my young, my newest employee has

[00:32:14] [SPEAKER_01]: been there a year. She's up front. My assistant's been here almost two rest of my teams all over

[00:32:19] [SPEAKER_01]: five and most of them are over 10 and one came with the bill. You know, she always joke. She came with

[00:32:25] [SPEAKER_01]: the building. So I just don't, I don't think I was as aware as my friends who kind of have a little

[00:32:29] [SPEAKER_01]: more turnover than me, but it, it is rough out there. I mean, the interview is always impressive.

[00:32:34] [SPEAKER_01]: I always ask them to write on their inner, like just on a piece of paper, like what is your asking

[00:32:38] [SPEAKER_01]: salary? Cause I hate to pay people under what they expect, but I've also told my team, like none of us

[00:32:44] [SPEAKER_01]: knows what we should be paying you right now. Like we all hear the number that you hear, but then when

[00:32:49] [SPEAKER_01]: I talk to my friends, no one's ever paid this number. So it's like, none of us knows anything. We don't

[00:32:55] [SPEAKER_01]: know what it should cost. We know what the break even point is. And you're right. There's a lot of

[00:32:58] [SPEAKER_01]: offices right now that are doing hygiene at a lot. You can't. Yeah. That's, that's the thing I've heard

[00:33:02] [SPEAKER_02]: that too. And I'm like, you know what? I'm not sure we need it that bad. I mean, I, I, I mean,

[00:33:08] [SPEAKER_02]: I think hygiene has a ton of value in a lot of ways, but, but you can't lose money on it. That

[00:33:13] [SPEAKER_02]: doesn't make any sense. If I were a hygiene patient and I knew that they were losing money on me,

[00:33:19] [SPEAKER_02]: I would be very wary of whatever they treat and plan on me. Cause cause if you're there and

[00:33:23] [SPEAKER_02]: they're losing money on you, they got to squeeze something out of you. I mean, you might need a

[00:33:28] [SPEAKER_02]: couple extra root canals that you were not having trouble with. Cause, cause you know what? We're

[00:33:32] [SPEAKER_02]: losing money here. I don't know. It seems, it seems crazy. I really do. Cause you know,

[00:33:36] [SPEAKER_01]: you'll pick your patients to go. I love my hygiene. If you should pay her more, you know,

[00:33:39] [SPEAKER_01]: it's always the whole, I don't think they realize that most of that money in hygiene isn't profit.

[00:33:44] [SPEAKER_01]: Like they, I think they think that most of that's still mine. No, no one. The other thing is,

[00:33:49] [SPEAKER_02]: I've always said this to you. You're like when, when you start justifying a fee to a patient or an

[00:33:54] [SPEAKER_02]: employee, you have lost them. You are the teacher from Charlie Brown. They are not hearing it.

[00:33:59] [SPEAKER_02]: This is not like, like the concept of, you know, the concept of, you know, this is how much we get

[00:34:04] [SPEAKER_02]: paid. And so I can't afford to pay you this. They, you've lost them. If you've made it to that part of

[00:34:09] [SPEAKER_02]: the conversation, you've already lost. There's no way anyone's hearing that. That's, that's the same

[00:34:13] [SPEAKER_02]: thing about, that's the same thing about if you work on a patient and you don't warn them that this

[00:34:18] [SPEAKER_02]: tooth might be in trouble and then it hurts, you've lost them. You've lost them. You lost them an

[00:34:21] [SPEAKER_02]: appointment ago. Just, you know, you just didn't, you didn't cover that stuff. So I feel like on some

[00:34:26] [SPEAKER_02]: level, yeah, it's, it's in right now we're doing okay here. We have not, our, our reimbursements

[00:34:33] [SPEAKER_02]: have not increased in forever, but we're still, you know, what it is is just, I'm just less

[00:34:37] [SPEAKER_02]: profitable, which is something that, you know, we shouldn't accept, but it is, it kind of is what

[00:34:42] [SPEAKER_02]: it is on some level. It's not, we were able to make it, make it work. And, and, and honestly,

[00:34:47] [SPEAKER_02]: the pain of having to do something different is just less than the pain of sticking with,

[00:34:53] [SPEAKER_02]: you know, or is greater than sticking with what I'm doing right now. So I haven't made any big

[00:34:57] [SPEAKER_02]: moves, but I am curious about how long hygiene will do that or, or, or what kind of solutions

[00:35:01] [SPEAKER_02]: there can be in there. I, you said you had some assisted hygiene. How did that work?

[00:35:05] [SPEAKER_01]: We only never have to do it two days. Cause I finally found the two we liked and they took

[00:35:10] [SPEAKER_01]: the other like 18 days or so. Um, it went okay. I got to scale some teeth too. So I told her, I was like,

[00:35:16] [SPEAKER_01]: if I don't have a pain, like if mine finished early, like I'm grabbing your next one. And she was good

[00:35:20] [SPEAKER_01]: at like, they took the schedule, like printed it and they kind of wrote like hard or easy. So they

[00:35:25] [SPEAKER_01]: did let me have the privilege of like, whether it was kindness toward me or whether it was just,

[00:35:29] [SPEAKER_01]: you know, cause I always joke that there are moments where my team looks at me, like you are,

[00:35:33] [SPEAKER_01]: you go to so much CE, you're so smart, you're the doctor. And then it's like, they huddle up and

[00:35:38] [SPEAKER_01]: they're like, what are you going to do with the idiot over here? Like you can't be caping it by

[00:35:41] [SPEAKER_01]: himself. So I don't really, so in the middle is where I probably am, but it's funny how they're

[00:35:45] [SPEAKER_01]: like, well, we can't give a hard patient. He's never, it's like, I've never picked up a

[00:35:48] [SPEAKER_02]: scaler. I do. I do. It is funny. The team doesn't realize that we, we did a little training in,

[00:35:53] [SPEAKER_02]: in periodontal therapy. It's amazing how that happens. It's just because we don't lose the

[00:35:57] [SPEAKER_02]: majority of it in our office doesn't mean we're not familiar with it.

[00:36:01] [SPEAKER_01]: We, I'm never going to say that we get the level of like hygiene training that a hygienist

[00:36:05] [SPEAKER_01]: gets. I don't think some dentists, we get the ability to diagnose, we understand it, but we do

[00:36:08] [SPEAKER_01]: not have the repetitive skills. We don't have the reps that they got in hygiene school,

[00:36:12] [SPEAKER_01]: but I do think that they don't, when you hire a new grad sometimes, which I've done or recently

[00:36:19] [SPEAKER_01]: out, I think by the end of working with me, they're always surprised that the closest of

[00:36:24] [SPEAKER_01]: what we get to them is closer than what they get to us compared to everything outside hygiene.

[00:36:29] [SPEAKER_01]: Like, I don't think they realize sometimes you start explaining like how refractive lesions

[00:36:33] [SPEAKER_01]: happen and stuff like that. That doesn't, yeah, there's a lot of hygiene and there's some general

[00:36:38] [SPEAKER_01]: dentistry too, but there's a reason why you have to almost streamline them into like, okay,

[00:36:41] [SPEAKER_01]: this is when I cram. This is when it's cracked so bad you can't save it. This is what we're

[00:36:46] [SPEAKER_01]: looking for because you just can't teach all that and have the reps they need to be

[00:36:51] [SPEAKER_01]: competent at hygiene. It's just, yeah. So it's, I mean, you get good hygienists and you get along

[00:36:56] [SPEAKER_01]: with them and they're great. Like I have a great relationship like you do with my hygienists.

[00:37:00] [SPEAKER_01]: It is very toxic out there right now. I mean, not just on Facebook groups. It's just like,

[00:37:05] [SPEAKER_01]: you're talking to your friends now and the ones that never complained are miserable. And I think

[00:37:10] [SPEAKER_01]: that's part of the shortage thing right now is because we need to come together as a profession

[00:37:14] [SPEAKER_01]: and figure this out. Cause if not, the government is going to do it for us.

[00:37:17] [SPEAKER_02]: That's what you and I talk about.

[00:37:17] [SPEAKER_01]: But we're not willing, we're not willing to come together.

[00:37:20] [SPEAKER_02]: Let's just pretend in this dystopian universe that we're creating, that the government does end up

[00:37:26] [SPEAKER_02]: with some kind of a solution to make this work. What do you think would it look like? Would,

[00:37:30] [SPEAKER_02]: would they, would they just open more hygiene schools? Would they, I don't even know. I'm not sure.

[00:37:35] [SPEAKER_02]: Like right now we end up probably having more grads and we can handle around here. Anyhow. I don't even

[00:37:39] [SPEAKER_02]: know.

[00:37:42] [SPEAKER_01]: Well, I don't know. It, I don't think the government, when they make the rules, going to understand

[00:37:47] [SPEAKER_01]: what roles, cause you know, like, let's be honest, like how many of your patients come in

[00:37:51] [SPEAKER_01]: and think everyone that works with you is a nurse. Yeah, I know. Like they think they could draw

[00:37:54] [SPEAKER_01]: blood. They think they're like, you got some great nurses around here and they're getting,

[00:37:58] [SPEAKER_01]: they get confused with the whole, like, well, why can't Courtney come make my, you know,

[00:38:01] [SPEAKER_01]: why can't Courtney come assist or why can't Dominique go clean my teeth? And you're always

[00:38:05] [SPEAKER_01]: explaining like, this is an assistant, this is a hygienist, but I don't even know what they would

[00:38:10] [SPEAKER_01]: do. I just know that it would probably be based around your state and like where they are on the

[00:38:15] [SPEAKER_01]: blue to red scale. Yeah. You know, if they're more donkey or more elephant. Yeah. But one's going to look

[00:38:20] [SPEAKER_01]: at it more as maybe a public health thing. Like we need this to be able to provide dental care,

[00:38:24] [SPEAKER_01]: you know, cause that's always access to care thing. And I always tell like, we don't really know if we

[00:38:28] [SPEAKER_01]: have enough dentists and hygienists or if we just, it's gotten so expensive to do it that we priced

[00:38:32] [SPEAKER_02]: our way out of it. You're exactly right. We don't know. We don't know what the ideal number is because

[00:38:36] [SPEAKER_02]: first off, so many people don't seek care in the first place. And I think sometimes the government,

[00:38:42] [SPEAKER_02]: the government wants, makes the assumption that we need to have this level of, because everyone

[00:38:47] [SPEAKER_02]: needs to be able to seek care. And there's just people, there's, there are some people that are

[00:38:50] [SPEAKER_02]: never going to seek care. And there's some people that are going to be super regular and they

[00:38:54] [SPEAKER_02]: would never go without. And it's, it's one of those things where human beings are pretty

[00:38:58] [SPEAKER_02]: complicated that way in some, in some ways. So I don't know. I, I, I've thought about,

[00:39:05] [SPEAKER_02]: I've thought about streamlining hygiene in that, and you and I talked about this and I've,

[00:39:10] [SPEAKER_02]: I've done episodes about this. I still haven't pulled the trigger on any of it, but the, but

[00:39:14] [SPEAKER_02]: the GBT style where it's more biofilm therapy using, um, you know, where you start by removing

[00:39:21] [SPEAKER_02]: biofilm with, with, uh, um, the airflow kind of, you know, the, the, and then, and then you,

[00:39:27] [SPEAKER_02]: so it speeds everything up. You use, it speeds everything up and then you're doing less scaling

[00:39:31] [SPEAKER_02]: and more of that. And, you know, I gotta say, I'm convinced that it's probably a good thing.

[00:39:37] [SPEAKER_02]: I haven't tried to pull the trigger in my office yet. And it's, again, it's not because I don't think

[00:39:41] [SPEAKER_02]: it's a really good thing. It's because I'm just not very good with change and I, there's always

[00:39:44] [SPEAKER_02]: something more important in my brain or whatever, but I do think that that could make things because

[00:39:50] [SPEAKER_02]: I think that speeds things up or it can, uh, when most people, when you talk about it, they say,

[00:39:55] [SPEAKER_02]: yeah, it makes it faster. So I have more time to talk about treatment and health. And, and,

[00:40:00] [SPEAKER_02]: and I'm like, that is great. But also in places where you just don't have enough people to see

[00:40:05] [SPEAKER_02]: all the people that you need to see, you could have potentially shorter appointments, maybe give

[00:40:09] [SPEAKER_02]: different roles. I don't know. I just, I feel like that, that I'm not sure that the model that we

[00:40:14] [SPEAKER_02]: bought into necessarily works or fits anymore or moving forward. I am curious if there's people

[00:40:24] [SPEAKER_02]: listening to this that go, Oh, well, I use this model. I'm in a different model. I would love to

[00:40:27] [SPEAKER_02]: hear about that. You guys should go to the Facebook group and let's talk about it because

[00:40:29] [SPEAKER_02]: I do think most of us know the model that we do. And we assume that everyone else does that. And I'm

[00:40:35] [SPEAKER_02]: assuming Gary, your model and my model are probably relatively close because we are relatively

[00:40:40] [SPEAKER_02]: close in age. We bought similar kinds of practices that had that model in place. But the reality is

[00:40:44] [SPEAKER_02]: that's just what you and I know, you know, and I, it makes you wonder if, if there's,

[00:40:49] [SPEAKER_02]: if we're missing something, I don't know. I, I, and I do enjoy thinking about business models,

[00:40:55] [SPEAKER_02]: different ways to deliver this stuff. I never change anything, but I do like talking about it

[00:40:59] [SPEAKER_02]: and thinking about it, you know? And so if other people have ways they're doing things that,

[00:41:02] [SPEAKER_02]: that would be an improvement, I think it's worth talking about. Not that I would ever do it.

[00:41:06] [SPEAKER_02]: I probably wouldn't change anyhow, but I just, I love the concepts of it.

[00:41:09] [SPEAKER_02]: And you and I have talked about this on chat quite a bit. And I, and again, it's like,

[00:41:15] [SPEAKER_02]: you can talk about it without coming up with great solutions. There's a lot of talking to be

[00:41:19] [SPEAKER_02]: done. And sometimes the best thing is like your friend who is just like, he did it. He pulled

[00:41:24] [SPEAKER_02]: the trigger and did it. And he doesn't sound like he has with the emergency clinic. He doesn't have

[00:41:29] [SPEAKER_01]: regrets at all. No, only regret he has is he didn't do it from the start because he started with a

[00:41:34] [SPEAKER_01]: startup. Like he had probably, I don't know, I think probably six to eight years of

[00:41:38] [SPEAKER_01]: like me and you did just not liking it, not having it flow like you wanted it to. And it really took it

[00:41:45] [SPEAKER_01]: like him putting him doing hygiene for probably two months and having a job listing with competitive

[00:41:52] [SPEAKER_01]: pay and having no applicants come in before he said, I'm done. Like, okay, if I get rid of hygiene,

[00:41:58] [SPEAKER_01]: what do I lose? And then if I, what do I feel like I else can get rid of? And then can I make

[00:42:05] [SPEAKER_01]: myself busy with what's left? And he always took the most joy out of getting people in out of pain.

[00:42:11] [SPEAKER_01]: Like that's what let, you know, made him want to drive to the office faster and go home, you know,

[00:42:14] [SPEAKER_01]: sorry, just be there longer. But I don't want that model because I don't want that much. I jokingly

[00:42:20] [SPEAKER_01]: call it secondhand anxiety. I don't want everyone to come in to be jacked up in pain because those,

[00:42:25] [SPEAKER_01]: you don't always joke when you meet someone in pain and then you see them in hygiene in a couple

[00:42:29] [SPEAKER_01]: of weeks, it's a different person. That's almost, it's a different person. You didn't meet that

[00:42:32] [SPEAKER_01]: person. You met them jacked up in pain and unable to talk. And also, you know, people in pain are way

[00:42:38] [SPEAKER_02]: harder to get numb because I'm convinced because of the higher, the higher catecholamines and stuff

[00:42:42] [SPEAKER_02]: like that. I swear to God, they're so much harder to get numb. And of course that's when they need to

[00:42:46] [SPEAKER_02]: be numb the most. It's just like, so you're, it's a, it's an interesting point. I, in the same way that like

[00:42:55] [SPEAKER_02]: God love those people that can work on kids all day, but I couldn't do it. So, you know,

[00:42:59] [SPEAKER_02]: there's a lot of models that'll work as long as you're willing to swallow that pill. Maybe the

[00:43:03] [SPEAKER_02]: emergency one is like that too. I'm not sure that I'd want to be seeing people in pain all day long

[00:43:07] [SPEAKER_02]: either. You might make their day, but it's, they're probably not, they're probably not their best selves

[00:43:13] [SPEAKER_02]: when they're in your office. I'm sure of that. That's interesting. And then you got about a pain

[00:43:19] [SPEAKER_01]: and then this has been hard for him because then they want you to be their dentist. And you have to

[00:43:23] [SPEAKER_01]: explain to him that like, well, if I'm your dentist, you're just going to be in pain all

[00:43:27] [SPEAKER_01]: the time. Like this is my model. Like, cause cause he had to like figure out it. Like, where do you

[00:43:32] [SPEAKER_01]: send them next? I mean, cause you know, he wanted to just like give me all of his original hygiene

[00:43:36] [SPEAKER_01]: patients. And I was like, I am not ready for an associate. I don't want to deal with it right

[00:43:39] [SPEAKER_01]: now with the hiring shortages issues and all that. I'm not taking on like 1100 people.

[00:43:45] [SPEAKER_01]: Like to be honest with you, we've turned off new patients to the end of the year anyway. Cause we

[00:43:48] [SPEAKER_01]: were, we got new patients booked out all the way through like November already.

[00:43:53] [SPEAKER_01]: So it's like, what do you do? But yeah, that's the tricky part for him now is figuring out.

[00:43:59] [SPEAKER_01]: It's almost like he needs to open a second office with a model he hated and just put an associate

[00:44:03] [SPEAKER_02]: over there. It's a good problem to have, but it's also, it's one of the things where you're

[00:44:07] [SPEAKER_02]: like, it's almost the opposite of what we're talking about. It was like, okay, so now you've

[00:44:10] [SPEAKER_02]: got the patient that wants you to be their dentist, but you don't do that. That's not what

[00:44:14] [SPEAKER_02]: you do. Like you're not going to do crowns and fillings and you're cause you do root

[00:44:18] [SPEAKER_02]: canals and extractions, baby. That's, that's your jam. And short of short of that, they got

[00:44:23] [SPEAKER_02]: to find someone who does that's wild. That is wild. It's almost like you're right. They need

[00:44:26] [SPEAKER_02]: another branch, a restorative branch over and over across the street.

[00:44:30] [SPEAKER_01]: I love how all of us out, like there's the other models and the specialists have it so much,

[00:44:34] [SPEAKER_01]: you know, it's like that model is the one you want to be. And like, you know, I always love

[00:44:37] [SPEAKER_01]: doing my CEREC. I love doing crown and bridge. And I always like, I knew I didn't want to be a

[00:44:41] [SPEAKER_01]: prosthodontist because of what they get is a lot of dentures and very complicated stuff.

[00:44:45] [SPEAKER_01]: But I cut, like I cover for my friends a lot. They cover for me, but also occasionally we cover

[00:44:49] [SPEAKER_01]: from a prosthodontist. And the joke's always when his emergency patient calls, it's like,

[00:44:54] [SPEAKER_01]: what's about to walk in? Like, it's not like crown off one of her 19. It's like a fixed hybrid

[00:44:59] [SPEAKER_01]: in three pieces. And you're like, I'm not even absolutely sure I'm qualified to temporarily

[00:45:03] [SPEAKER_02]: put this thing back together. I don't even know that I have the right tools for this. Yeah,

[00:45:06] [SPEAKER_02]: no, I get it. I get it. And it is interesting. It's like the grass is always greener. And I do

[00:45:11] [SPEAKER_02]: think dentists are probably, probably specific about this, these different models. We

[00:45:18] [SPEAKER_02]: probably talk like, like how often do you think, how often do you think a cardiac surgeon or an

[00:45:26] [SPEAKER_02]: orthopedic surgeon is worried about the model that they're doing? I suspect almost never because

[00:45:31] [SPEAKER_02]: they work within a hospital situation and their, whatever model their hospital has is what they

[00:45:35] [SPEAKER_01]: do. That's my guess. Well, I was thinking with your informed consent podcast a while back, like,

[00:45:40] [SPEAKER_01]: you know, we, so dental school has its strengths and its weaknesses, but my dental school did a

[00:45:43] [SPEAKER_01]: great job of making you understand that informed consent is you explaining stuff to people so they

[00:45:48] [SPEAKER_01]: understand it and they understand risk that can happen. Like if you do nothing, if you do the

[00:45:52] [SPEAKER_01]: treatment or the risk, but med schools probably are all connected to a hospital and they, they,

[00:45:58] [SPEAKER_01]: they grow up with that insurance driving decisions and all that from day one. And it's just one of

[00:46:04] [SPEAKER_01]: those things where they're probably never really taught informed consent like we are. And you're

[00:46:09] [SPEAKER_01]: right. You don't talk money ever. They just send you a bill later. I'm not convinced that dentists even

[00:46:13] [SPEAKER_02]: understand informed consent very well on some levels, but the reason that we have to, the reason

[00:46:18] [SPEAKER_02]: that we have to explain better is because we're asking people to pay for something upfront. We are,

[00:46:22] [SPEAKER_02]: we're, we're explaining what it's going to cost before we do it. And they never do that in medicine. So

[00:46:27] [SPEAKER_02]: the reality is I think informed consent is almost a check the box thing. And I, I mean, I'll, I'll link to

[00:46:34] [SPEAKER_02]: that informed consent if you didn't hear that one, because I was going over what happened to my

[00:46:37] [SPEAKER_02]: assistant, but also like I've had some weird informed consent situations where basically they

[00:46:44] [SPEAKER_02]: don't do it. They don't really, they don't really do it. If you aren't the person writing the check,

[00:46:49] [SPEAKER_02]: they're not particularly worried that you understand what's going on. And on some level,

[00:46:52] [SPEAKER_02]: maybe because we're asking them to pay in the data service or something like that, we are,

[00:46:57] [SPEAKER_02]: they're going to be less likely to be happy to go along with it unless they know part of the

[00:47:01] [SPEAKER_02]: financial stuff. So, but I mean, I honestly think any patient in any medical situation would make

[00:47:06] [SPEAKER_02]: better decisions if they knew there was new, the dollars attached to it, even if they're not paying

[00:47:10] [SPEAKER_02]: it, which they're not in a lot of cases in medicine, but it's just, it's a, that's a whole

[00:47:16] [SPEAKER_02]: other podcast. We probably should have talked about that too. I love talking about that, except I've

[00:47:19] [SPEAKER_02]: never once have I come up with a solution where I'm like, Oh, Hey, I've got it figured out. It's just,

[00:47:23] [SPEAKER_02]: it's just like the real solution is a need as little medical care as possible. That's,

[00:47:30] [SPEAKER_02]: that's the real solution. Spend as little time in a medical situation as you possibly can.

[00:47:34] [SPEAKER_02]: And I would not even say the same about dentistry because I think dentistry,

[00:47:38] [SPEAKER_02]: we cover ourselves in glory with informed consent compared to medicine. I really,

[00:47:41] [SPEAKER_02]: I really think we do because patients are making decisions from the right standpoint,

[00:47:46] [SPEAKER_02]: but you know, not only are they understanding what the procedure is typically, but also what

[00:47:50] [SPEAKER_02]: it's going to cost them, what it could cost. So.

[00:47:53] [SPEAKER_01]: I'm sure you've had this happen where you go through their options and you have any questions?

[00:47:57] [SPEAKER_01]: No. Yeah. Well, Casey's going to come in and talk money. Yeah.

[00:48:00] [SPEAKER_01]: And my joke is I'll be back after she talks money. Cause you'll probably have questions.

[00:48:04] [SPEAKER_01]: Like you don't have them now, but once you see you're going to owe $1,500,

[00:48:08] [SPEAKER_01]: then you're going to have a question about it because.

[00:48:11] [SPEAKER_02]: Yeah.

[00:48:11] [SPEAKER_02]: A hundred percent. That's a really good point.

[00:48:13] [SPEAKER_02]: And so at what point do you do the deep dive on informed consent? Cause it's,

[00:48:19] [SPEAKER_02]: it's there all of a sudden they're really listening when they have the dollar amount attached to it.

[00:48:25] [SPEAKER_02]: And I do think, I think that the cool thing is, is that I'm the person who talks money in my office

[00:48:30] [SPEAKER_02]: is also really good at explaining treatment too. Typically when I have to give bad news to people,

[00:48:35] [SPEAKER_02]: I walk out the door and let Shelly do it because I'm a giant wuss. I mean, I'll, I'll own it,

[00:48:39] [SPEAKER_02]: but I'm also like, I don't love that. It's pretty uncomfortable. I also don't love,

[00:48:43] [SPEAKER_02]: I don't love having to talk about money either. I'm kind of a wuss that way. It's one of the

[00:48:46] [SPEAKER_02]: reasons that I'm not very successful at anything. Cause I just, I just, I run away from pain

[00:48:50] [SPEAKER_01]: basically. So here we are. I'm weird in the, I don't talk. The consultant got me to not talk

[00:48:56] [SPEAKER_01]: about money because I'm really soft hearted and they put me on a charity budget. Cause I'll just

[00:49:01] [SPEAKER_01]: give things away. That's exactly so many dentists. But what's that? Yeah. Yeah. But what's weird

[00:49:05] [SPEAKER_01]: about me is that, or my office is if it's under about $3,000, I'm rarely involved, but if it gets

[00:49:11] [SPEAKER_01]: over like five, particularly almost 99% of what we do is closed financially by me. Like not the

[00:49:18] [SPEAKER_01]: care credit application, but the talking. And I do think there's a point with people where

[00:49:22] [SPEAKER_01]: you need to be willing to man up and talk about it. Cause those numbers get big enough where you

[00:49:28] [SPEAKER_01]: start talking about like, I know this is a major investment, you know, by any standards. Cause

[00:49:33] [SPEAKER_01]: I always say, you know, I love helping people, but as we moved to the new office and we're mostly

[00:49:37] [SPEAKER_01]: fee for service and we go up with fees as we need to, like a lot of the new patients that call and ask

[00:49:43] [SPEAKER_01]: what the new patient cleaning is, I'm not near the most expensive person in town, but I'm not near the

[00:49:47] [SPEAKER_01]: cheapest either. I'm just not seeing a lot of those people that probably needs them.

[00:49:51] [SPEAKER_01]: Most of my charity cases are like the single moms I have at my practice or people going through chemo

[00:49:56] [SPEAKER_01]: radiation or like someone's like, my sister doesn't have a dentist and she has all this going on.

[00:50:01] [SPEAKER_01]: I'm like, just send her my way. So I get, I get to screen people at least a little bit, but I don't

[00:50:08] [SPEAKER_01]: know. It's a bad thing because I like that it screens people to do the dentistry I want to do,

[00:50:12] [SPEAKER_01]: but I do feel like we are leaving a huge subset of the population that we've just priced ourself

[00:50:17] [SPEAKER_01]: out. Like that even if they want dentistry, they can't afford it. And if you're on those like local

[00:50:21] [SPEAKER_01]: Facebook groups, like they're horrible sometimes, but like ours is Simpsonville resident or fountain

[00:50:25] [SPEAKER_01]: residence. So many of those comments are like, Hey, I need three crowns. And you might know someone

[00:50:31] [SPEAKER_01]: that would do it for under like, this is all I've been saving for a year. This is all I've got.

[00:50:36] [SPEAKER_01]: And it just breaks your heart. But then sometimes you look at that number and you want to comment

[00:50:39] [SPEAKER_01]: as a dentist, but you're going to sound money hungry and be like, you're not even covering the

[00:50:42] [SPEAKER_02]: lab costs. I won't ever comment because it's, I'll never come out looking right on that. But

[00:50:47] [SPEAKER_02]: that's the reality is, and I can't, Oh my God. I think I probably recorded on, um, guy,

[00:50:55] [SPEAKER_02]: Matt Iglesias, who's like a, uh, he's kind of a political commentator. He's, he's, he's pretty

[00:51:00] [SPEAKER_02]: left. He's on, he's a liberal. I enjoy listening or reading his, his stuff. And he had a, he had a,

[00:51:05] [SPEAKER_02]: uh, a column or whatever he called dentists are bad. And basically he just riffed riffed on how

[00:51:11] [SPEAKER_02]: so money hungry. And also in the, the, the, the column was bad. He was wrong in a lot of ways,

[00:51:19] [SPEAKER_02]: but worse than that was I, I subjected myself to the comments for a little while. Don't ever do

[00:51:24] [SPEAKER_02]: that. Don't ever do that. Cause the people are telling the worst stories about people that these

[00:51:29] [SPEAKER_02]: are not even human beings to them. It's just not worth, I'm convinced that I keep thinking to

[00:51:34] [SPEAKER_02]: myself someday I'm going to make a podcast that goes towards people and, and explain that dentists

[00:51:39] [SPEAKER_02]: are human beings. And, and that, you know, dentistry is 99% of dentistry is, is preventable

[00:51:44] [SPEAKER_02]: if you know what to do. And, and I mean, I'm, I'm convinced that would be of a good service,

[00:51:48] [SPEAKER_02]: but no one wants to hear that. No one, like I want to do it, but I, but everyone says you're

[00:51:52] [SPEAKER_02]: crazy. No one wants to hear that. And it's true. It's like human nature is such that you don't want

[00:51:55] [SPEAKER_02]: to be told that your problems are yours. You don't want, you know, uh, it's, there's,

[00:52:02] [SPEAKER_02]: I don't know. It's a really tough, it's a tough sell. You're exactly right. So yeah,

[00:52:05] [SPEAKER_02]: never read the comments on anything if you're a dentist and never assume that if dentists are

[00:52:09] [SPEAKER_02]: covered in media in general, that it's going to be a fair shake. Cause it's not, it never is.

[00:52:13] [SPEAKER_02]: Um, you know, of all the dentists that I know, I think most of them are pretty great people. And

[00:52:18] [SPEAKER_02]: frankly, if you read about us in, in any kind of media, we're all the worst ogres in the world.

[00:52:25] [SPEAKER_01]: It's pretty bad. Well, I think one thing that medicine's done because of medical insurance is

[00:52:30] [SPEAKER_01]: there's this belief with patients will believe both sides of this, which is that healthcare

[00:52:33] [SPEAKER_01]: is cheaper than dental care. They'll also believe that they also understand that the hospital will

[00:52:38] [SPEAKER_01]: turn you into the collections and bankrupt you basically. So it's weird to me because I have

[00:52:42] [SPEAKER_01]: all those comments, like on those residence pages, they'll say stuff like, man, I just wish dentistry

[00:52:46] [SPEAKER_01]: was the cheapest medicine. And I'm like, the cheapest things in this country, if you don't have

[00:52:50] [SPEAKER_01]: insurance is dentistry, maybe optometry, you know, and then maybe veterinarian services,

[00:52:56] [SPEAKER_01]: because we all take money from you. Like you're just usually a lot of people have vision.

[00:52:59] [SPEAKER_01]: You know, chiropractic coverage too. It's one of those things where if you, if it's

[00:53:03] [SPEAKER_01]: over in medical, you may only owe $20, but they're going to bill, you know, $600 for 15 minutes

[00:53:09] [SPEAKER_01]: and then hope to get a hundred for it. Like it's just insanity. When you look at the EOBs,

[00:53:13] [SPEAKER_01]: when they come in.

[00:53:14] [SPEAKER_02]: Toothbrushes and toothpaste are way less expensive than monster. Also, that's something that's

[00:53:18] [SPEAKER_02]: interesting. That's a, people don't think about that, but it's like opportunity cost,

[00:53:22] [SPEAKER_02]: baby. And I'm not, I'm, I'm one to talk. I, I, I don't have the healthiest dietary

[00:53:28] [SPEAKER_02]: habits all the time either, but, but you can't disconnect, uh, people's experience with

[00:53:33] [SPEAKER_02]: dental problems from, from lifestyle stuff, but they don't want to hear that. No one wants

[00:53:38] [SPEAKER_02]: to hear that. No one wants to hear that. And, and I don't know that you can push that on

[00:53:43] [SPEAKER_02]: people. They're going to, you know, their problems are not their own. I think physicians probably

[00:53:47] [SPEAKER_02]: deal with that on some level too. But the other thing that's funny is I think people think

[00:53:50] [SPEAKER_02]: physicians are all really great people and they're not money hungry ogres like dentists.

[00:53:55] [SPEAKER_02]: And I'm like, the reason they can think that is because your doctor's office is never going

[00:53:58] [SPEAKER_02]: to talk about money. They may well bankrupt you, but they're never going to talk about

[00:54:01] [SPEAKER_02]: money. So it's interesting.

[00:54:03] [SPEAKER_01]: And you also, you also sent a check to a hospital name that that money's been taken and given

[00:54:08] [SPEAKER_01]: to the doctor. You're not writing it with like, you know, I don't know my, my name, you

[00:54:13] [SPEAKER_01]: know, my stamp literally just has my name, even though my practice is something that just

[00:54:15] [SPEAKER_01]: says S Gary Holtzclaw Jr. You know, it's funny too, cause you can see the difference in

[00:54:20] [SPEAKER_01]: like customer service and like ophthalmology or chiropractic or vet or like how my team

[00:54:24] [SPEAKER_01]: talks on the phone. I went and got blood war a couple weeks ago and you know, not surprisingly

[00:54:28] [SPEAKER_01]: being overweight, I'm getting borderline triglycerides. They're going to medicate me if I'm not better

[00:54:32] [SPEAKER_01]: in six months. So the doctor is my fourth doctor in four years. They keep leaving the state

[00:54:37] [SPEAKER_01]: and I like this one a lot. Hopefully she lives here. She has kids and they're in school here.

[00:54:41] [SPEAKER_01]: So hopefully, but she said, my nurse will call you and tell you the results. Well, I'm sure

[00:54:45] [SPEAKER_01]: this is not how she meant it, but the nurse called and said, Hey Samuel, which is always

[00:54:54] [SPEAKER_01]: that you're going to try glycerides are high. If you could eat better, be less obese and

[00:54:59] [SPEAKER_01]: work out. Um, we're going to see, we're going to see, we're going to see in six months and

[00:55:05] [SPEAKER_01]: please call back since you didn't answer and schedule that appointment. And I'm thinking

[00:55:08] [SPEAKER_01]: if I ever heard my team talk to someone and use the words less obese or something, it'd be

[00:55:13] [SPEAKER_02]: like, it'd be better to hear that from a recording, like literally a recorded voice

[00:55:17] [SPEAKER_02]: than just, just cause I mean, then you know that no one actually put any effort into it,

[00:55:21] [SPEAKER_02]: but a human being on the other, that makes you kind of hate. And I'm sure she had like

[00:55:25] [SPEAKER_01]: 600 people to call. You were the fourth person on a list. Exactly. No, exactly. Yeah. But

[00:55:30] [SPEAKER_01]: it was just, I've never had less empathy or emotion in a phone call. It was like a robot. Just

[00:55:34] [SPEAKER_02]: if you could be less obese, that's going to motivate you to change your lifestyle too, for

[00:55:38] [SPEAKER_02]: sure. Just that, that totally bored and uninterested call is going to turn you. That was

[00:55:43] [SPEAKER_01]: the, that was the energy and empathy and passion I needed to push me onto the bicycle. What

[00:55:48] [SPEAKER_02]: keeps me, what keeps, what's going to help me with medicine, medical stuff is wanting to

[00:55:51] [SPEAKER_02]: be in medical offices less and less if I can avoid it for sure. There's no doubt about

[00:55:55] [SPEAKER_02]: that, Gary. Okay. So this was interesting. Clearly the grass is greener on the other side.

[00:56:00] [SPEAKER_02]: I love talking about different models of dentistry, but also kind of the stuff we're dealing with.

[00:56:03] [SPEAKER_02]: I got to go back and see patients. This is middle of the day for me and I got a patient in the

[00:56:07] [SPEAKER_02]: chair, so I got to run. This was awesome though. I really appreciate you being on. Yeah, man.

[00:56:12] [SPEAKER_02]: Glad to be here and we'll do it again soon. And if you guys are not members of the Facebook,

[00:56:17] [SPEAKER_02]: whatever you need to go do that, uh, go to Facebook, uh, search very dental and there's

[00:56:21] [SPEAKER_02]: five passwords that I'll take. Uh, I never got any feedback from people about me opening up the

[00:56:27] [SPEAKER_02]: very dental Facebook group to non podcast listeners. I didn't Gary, what's your feedback? You want to

[00:56:32] [SPEAKER_02]: keep it, you want to keep it small or go crazy? Like I'd rather, I'd rather it be slightly smaller

[00:56:37] [SPEAKER_01]: than your first Facebook group where dump your fires every day. But it's funny because most of my life,

[00:56:43] [SPEAKER_02]: I like to be peaceful, but occasionally an occasional dumpster fire was kind of fun. I don't

[00:56:47] [SPEAKER_02]: know. I mean, and the other thing is I was only sitting on the sideline just pouring gas on stuff.

[00:56:51] [SPEAKER_01]: I never actually see the difference is you were the, you were the admin. So I would sign in and

[00:56:55] [SPEAKER_01]: then have like 640 comments to figure out what happened. No, I know. Cause they all have to

[00:56:59] [SPEAKER_01]: became a dumpster fire, like on comment number seven, not in the original post. And I, what the,

[00:57:04] [SPEAKER_02]: the pride I had was that I was the one who got to announce that I got to deem it a dumpster

[00:57:09] [SPEAKER_02]: fire. I was the one who put the little, the little gif up there to make it an actual dumpster. It was

[00:57:13] [SPEAKER_02]: so good. Oh my gosh. I miss those days. But if you don't want that very dental Facebook group is

[00:57:17] [SPEAKER_02]: very, very bustle and very calm, uh, five passwords you need to give me a one. You don't

[00:57:22] [SPEAKER_02]: have to give me all of them. One of them is fine. Timmerman, Papa Randy, Lipscomb, McWethy or

[00:57:28] [SPEAKER_02]: Hornbrook. I can't believe I can continue to remember this. I can't remember a phone number,

[00:57:31] [SPEAKER_02]: but I can remember those five. So one of those five will get you in and we'll talk about good stuff.

[00:57:35] [SPEAKER_02]: Like what Gary and I talked about. Gary, thank you again for being on and we'll catch you again soon.