Very Dental: Planned Obsolescence & Subscription Hell with Dr. Brian Baliwas

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

[00:00:17] 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] Now, here's your host, Dr. Alan Mead. Very Dental people, welcome to another episode of the Very Dental Podcast.

[00:00:33] Joining me today as co-host, a guy that you probably have seen on Instagram, if not other places.

[00:00:40] Actually, he's been on the Very Clinical show multiple times. Dr. Brian Baliwas. Brian, how are you?

[00:00:45] I am doing well. It's Friday. The sun is out. The tsunami did not hit San Francisco like everybody thought so. So, I'm alive and well.

[00:00:54] Yeah. So, Brian, I mean, I've met him in person a couple times. He spoke at Voice of Dentistry a couple, three years ago. I don't know. It's been a while.

[00:01:04] And he got to sit down with the guys on Very Clinical. This is actually the first time I think I've talked to you on the podcast.

[00:01:11] And I feel like, okay, so for people that don't know him, first off, where have you been?

[00:01:18] But also, like, I was aware of Brian. I mean, it's got to be seven, eight, nine years. I don't know exactly. Instagram is my social media. It's where I go for social media. I use Facebook because I kind of have to.

[00:01:33] But, like, if I, when my brain goes into neutral and I have a smartphone in my hand, Instagram is my thing. And I think it's because it's an overwhelmingly visual medium and you can literally, you're, you can be sort of half engaged and it really, it really speaks to me that way.

[00:01:49] I don't put out much content on Instagram compared to consuming it.

[00:01:55] And maybe that's a mistake. But Brian has been basically Dentistry's, like, leading, as far as I'm concerned, sort of a leading influencer. I've seen him forever. He puts really interesting, you know, from anywhere from really good clinical stuff to really funny.

[00:02:10] Like, he's kind of got a, he's like born to meme a little bit. I mean, he's, but SF Dental Nerd is his handle. I'll put that in the show notes. If you've not followed him, first off, I don't believe you.

[00:02:22] But secondly, you got to, because he's got great stuff. And one of the reasons that I've reached out to him recently was, was a topic that he's been talking about a lot.

[00:02:30] And I'm hoping we get to it a little later because first, his dog Zylo is an adorable little lady. I've seen her a lot on the end. And we, it was really funny. We were sort of talking about a model that we've both kicked around or thought about the emergency dentistry and how, how it can't really be.

[00:02:47] First off, you need to have the right population, but also like, you know, you can't, it can't be like a regular insurance kind of bread and butter practice. It's a specialty thing because it's after hours and it's when people are their asses on fire. So it's, it's gotta be a different. And he was then telling me about Zylo's insurance. I want you to tell me about Zylo's insurance, Brian. I want to know everything.

[00:03:08] It's funny. Cause I tried turning this into a post and by the way, people couldn't see this because obviously they're listening, but I was shaking my head every time, every time you, you said I was the leading influencer and whatnot. I just feel like I'm just a guy who posts his opinion, maybe a little too much online and, and somehow drew a following.

[00:03:27] But Instagram, Instagram was, we should talk about it sometime. Instagram was definitely a, like you don't even do Facebook, right? You're just Instagram. And do you do TikTok?

[00:03:35] Yeah, I do not. I just don't have the dance skills to get up there.

[00:03:39] No, you don't. None of us really do.

[00:03:42] No, I think you just gotta be true to yourself and do what's right, but you should definitely be on social media somewhere.

[00:03:47] But yeah, no Zylo, I was going to post about this. We were talking about insurance and you had made the comment that you said, you know, I just don't think that would work in today's world with dental insurance.

[00:03:58] And I said, you know what? Zylo has insurance. We have this company called Healthy Paws for her.

[00:04:07] I think we pay $90 a month, you know, just to kind of give you numbers and she gets coverage and the coverage is very well explained.

[00:04:16] They tell us that they don't pay for exams. They pay a certain percentage for medications.

[00:04:22] They pay a certain percentage of this type of treatment and then they pay a certain percentage for this other type of treatment.

[00:04:29] And so anything diagnostic, you know, they don't pay for in terms of exams, but they will pay for x-rays to a certain percentage.

[00:04:35] And it's very clear.

[00:04:38] If I go to the vet and I get, you know, just call it a checkup. She gets some vaccines and whatnot.

[00:04:43] At the end of the visit, I get an invoice. I actually pay for her appointment in full.

[00:04:48] And all I have to do is get on the Healthy Paws app.

[00:04:51] I take a screenshot of the invoice that was emailed to me. So I'm not even downloading it or anything.

[00:04:56] I'm just taking a screenshot. I go to new claim on the app. I upload a picture of the claim.

[00:05:03] And in 24 hours, sometimes sooner, I get an EOB emailed to me, which I'll talk about in a second.

[00:05:11] And then I get a direct deposit of that payment straight to my bank.

[00:05:18] It used to be a check and then they opened up direct deposit.

[00:05:20] So now I just get paid like two days.

[00:05:22] Yeah.

[00:05:23] That EOB is so awesome. It tells you how much you've paid into the plan already.

[00:05:27] It shows you what your benefits are.

[00:05:29] It has an explanation of what was done and why or why they did not cover it.

[00:05:34] It's super clear, you know?

[00:05:37] And again, I just wonder why we can't do that in dentistry.

[00:05:41] Instead, you know, I'm just to give everybody context on the, I say fee for service, but we do,

[00:05:48] I would say I'm fee for service for certain dental insurances that won't pay us directly.

[00:05:52] Yeah.

[00:05:53] But we still send claims and have patients pay estimated co-pays and they pay the difference

[00:05:59] plus or minus at the end.

[00:06:01] So what's wild is, you know, our patients get an EOB and they have no idea what's going on.

[00:06:09] That EOB might as well, you should choose the language you want them to print it in.

[00:06:12] It being a language that you don't understand.

[00:06:15] Like I, I like the way Mandarin looks on a piece of paper.

[00:06:18] So that's what I would choose personally.

[00:06:20] Cause no, I mean, we're dealing with this right now, actually with a, with a health insurance

[00:06:24] company and you know what comes, you know, it's very clear that they send you on paper

[00:06:30] the bill when they won't pay for stuff.

[00:06:32] That is very clear.

[00:06:33] That number just beautifully easy to read $27,000 for a surgery for my kid back in spring

[00:06:40] break in March 2024, actually.

[00:06:42] So yeah, that's the whole.

[00:06:43] The other thing that's really clear that they put on there is this is how much you'd save

[00:06:48] if you see an in-network dentist.

[00:06:50] Yeah.

[00:06:50] And it's wild, but yeah, it's, you know, they use words and actually it's not just them.

[00:06:54] It's us as well.

[00:06:55] We're guilty of this.

[00:06:56] They use words like prophylaxis and D0110.

[00:07:01] And what's crazy is how many times have you had a patient call and they're like, I don't

[00:07:05] know what this is.

[00:07:07] It's like, Oh, that's your cleaning.

[00:07:09] Yeah.

[00:07:10] I, I, I'll go one step further.

[00:07:12] I don't know what it is either.

[00:07:13] I don't know what the numbers I've been bothered to do.

[00:07:15] Like, I know what, if you tell me what it's a one surface, blah, blah, but I don't even,

[00:07:19] I don't pay attention to that stuff either.

[00:07:21] And I probably should.

[00:07:22] I just, I sort of, I sort of reject it out of hand because it's like, I don't want to play

[00:07:28] in that.

[00:07:28] I don't want to play with that either.

[00:07:30] Why can't, why do they do that to the patient?

[00:07:34] I get it.

[00:07:35] If a computer or, or a certain coding standard, but why, why can't they explain in English?

[00:07:41] You know, what's interesting is it comes the problem.

[00:07:44] This is just my opinion.

[00:07:45] Again, I'm not an expert in this.

[00:07:46] I think the problem is dentistry isn't medical and it also isn't not medical.

[00:07:54] So what ends up happening is if you get a surgery, you know, like a, like a hand surgery,

[00:07:59] for example, and you get your bill and you look at the reimbursements, they're billing

[00:08:03] everything.

[00:08:04] It's like, we use 16 two by twos.

[00:08:07] We use this suture.

[00:08:08] We use this, this, this, and it all is billed.

[00:08:11] And each one they're getting paid a little bit for it.

[00:08:14] Yeah.

[00:08:14] The thing is we have all these codes, but when's the last time you did a crown and you, you

[00:08:19] know, I, we, we break it up some, a little bit because we do build up and crown, but when's

[00:08:24] the last time you were like impression and, uh, you know, anesthesia and this and that,

[00:08:33] and, and not, I'm not saying I want to do that.

[00:08:36] I'm just saying that's where all these.

[00:08:38] That's why we have, I got, and I have a theory now that you say that I have a theory.

[00:08:42] Uh, first off, one of the reasons that we don't use that code is that in dentistry, whether

[00:08:48] we like it or not, we kind of have to talk to the patient about what stuff is going to

[00:08:51] cost before we do it.

[00:08:53] And just, if you don't believe me, if you think that's, if you think that's just silly

[00:08:57] talk, I can do work and not tell the patient what it's going to cost.

[00:09:00] See how they feel when they get the bill after they're, there's something that they were

[00:09:08] $27,000 bill for the surgery that your emergency surgery, that your kid have six months later

[00:09:14] after the, your insurance, they haven't contacted insurance.

[00:09:18] You know, like that's how it is.

[00:09:19] They never talk about money in medicine.

[00:09:20] Three different bills too.

[00:09:21] It's like, you get another one.

[00:09:22] It's like, oh, well, this one's for the doctor.

[00:09:24] It's like, you couldn't include him on that first bill.

[00:09:26] It is.

[00:09:26] It is.

[00:09:27] That's a great point.

[00:09:28] I mean, the whole thing is medicine.

[00:09:31] Everyone, first off, medicine is a human right.

[00:09:33] Just to ask them, they'll tell you, but, but I mean, you can't have,

[00:09:38] nothing that is a service provided by someone else can be a human right.

[00:09:42] Can't be because someone, no one's working for free people.

[00:09:47] No one's working for free.

[00:09:48] But in any case, they look at this.

[00:09:49] If I have health insurance, they say I have healthcare.

[00:09:52] You hear that all the time.

[00:09:54] You don't have healthcare until a doctor is suturing your ass up.

[00:09:58] You don't have healthcare.

[00:09:59] Healthcare is the thing that is being administered.

[00:10:02] Health insurance is supposed to help cover this.

[00:10:05] And it's not really insurance, but dentistry is even less insurance.

[00:10:08] The bottom line is that medical insurance is maybe closer to actual insurance where you're

[00:10:14] covering an unpredictable bad thing that happened, right?

[00:10:18] And that's what healthy pause covers too.

[00:10:20] My guess is that healthy pause is not there for, uh, you know, vaccinations and exams,

[00:10:26] but it is there for when my dog eats a sock and it has to be surgically removed.

[00:10:30] Like that helps.

[00:10:32] They'll help with the super dumb, expensive stuff.

[00:10:34] That's rarely happens except for a dog.

[00:10:37] That's as dumb as mine.

[00:10:38] But like the reality is that's, that's what, you know, I have car insurance.

[00:10:43] Okay.

[00:10:43] This is great.

[00:10:44] This is a great example.

[00:10:45] I have car insurance and we're required to have car insurance.

[00:10:47] And, and if you look at your car insurance, you'll find it is, it's really expensive.

[00:10:53] It's really expensive.

[00:10:54] I, you don't even, I don't even, it's auto deducted.

[00:10:56] So I don't see it very often, but I'm like, God, we're paying out the nose for that.

[00:11:00] And then, okay.

[00:11:01] So I, I, uh, I go to this restaurant.

[00:11:03] They had a, it used to have a, uh, a lamppost in the parking lot and clearly they took the

[00:11:08] lamppost up, but they had those four bolts that you bolt the thing down into the parking

[00:11:12] lot.

[00:11:12] They're sticking up.

[00:11:12] They're probably eight inches off the ground, maybe 10 inches off the ground, but I, I

[00:11:16] didn't see it.

[00:11:17] And I crunched up my, my front end of my car on the thing.

[00:11:19] Like, Oh man, you know?

[00:11:21] So I brought it to the body shop and he gives me a quote in the quotes, like 2,500 bucks.

[00:11:26] He says, if you don't want to use insurance, I'll do it for 2,000 bucks, which first off,

[00:11:29] I'm sure in whatever world is probably insurance fraud to say that.

[00:11:32] But he says, the reality is my, my deductible was like a thousand bucks.

[00:11:36] So I would have been saving a thousand bucks or something like that.

[00:11:41] But the reality is like, yeah, but your, your insurance is going to go up 30% for like,

[00:11:47] so you better not shoot your wad on the, on the $2,000 crunched up front bumper.

[00:11:52] You got to wait for that.

[00:11:53] You got to total that baby for that.

[00:11:54] And I'm thinking to myself, but I'm paying out the nose for the insurance.

[00:11:56] But if I use it, I'm going to pay out the nose more.

[00:11:59] I mean, this is everyone, this is the most obvious thing in the world.

[00:12:01] Everyone knows this stuff.

[00:12:02] So I ended up not using my insurance.

[00:12:04] We didn't, you know, the insurance has no idea that I crunched my bumper up.

[00:12:08] So all of a sudden that's actual insurance.

[00:12:10] That's insurance.

[00:12:11] I'm making a choice as to whether or not, how catastrophic does it need to be for me

[00:12:16] to fall back on the insurance?

[00:12:18] Exactly.

[00:12:18] And, but medical patients feel like as long as I've got this premium, then the, I, you

[00:12:23] know, the, the, the world is my oyster.

[00:12:24] I get, I get whatever medical stuff I want.

[00:12:27] And that I don't, I think that's not realistic.

[00:12:30] And then, and the worst than that, they think if they have dental insurance, that it's the

[00:12:34] same kind of insurance as medical insurance, which of course is hilarious because I would

[00:12:38] love to have like a knee replacement where they cover $1,500 a year.

[00:12:44] And then you got to come back next year and get the other half of the knee replacement

[00:12:48] done or whatever, like dental insurance.

[00:12:50] It's crazy.

[00:12:51] Yeah.

[00:12:51] Like Kyle Stanley speaks on that quite a bit, how, you know, in dentistry, we, we, you

[00:12:57] know, a crown fails, I say fails, you know, maybe a patient doesn't take care of it.

[00:13:02] You get an open margin, something happens and we end up doing a redo and it's often at

[00:13:08] some offices free.

[00:13:10] Yeah.

[00:13:10] And in medical, those are revisions, you know, like where, where, what are you paying

[00:13:15] for?

[00:13:16] Are you paying for a result or are you paying for the treatment for the care?

[00:13:20] So yeah, kind of interesting stuff.

[00:13:22] It is.

[00:13:23] But what I like about Zylo situation is that they have made it effortless on your part to,

[00:13:29] to take advantage of the benefit that you're paying for.

[00:13:32] But you also realize that it's not there to pay for the entire whatever.

[00:13:36] Like, like when you saw it, when Zylo, Zylo's last appointment, she got a service done, you

[00:13:42] paid for it.

[00:13:43] And then they gave you, uh, they gave you the invoice.

[00:13:46] You literally took a picture, sent it to them in their app.

[00:13:49] And then it came back in your account about how much did they cover for like, was it a

[00:13:52] typical, was it a typical kind of appointment?

[00:13:55] Yeah.

[00:13:56] I think it's a typical appointment, but here's the thing.

[00:13:58] I don't know exactly how much they, they covered.

[00:14:01] I could pull it up, but it was no surprise because I know what my coverage covers and

[00:14:09] they explained it really well.

[00:14:11] I mean, I get these emails, I'm looking at one right now and it's like, Hey, you know,

[00:14:15] and so funny, they update you.

[00:14:17] Hey, thanks.

[00:14:17] You just submitted your claim.

[00:14:19] Hey, your claims in, you know, it's like, they just don't, they keep you in the loop.

[00:14:23] Everything's super like claim it status in process claim status completed claim.

[00:14:30] Number this, we received your documentation.

[00:14:32] I mean, it's just awesome.

[00:14:35] I just feel like, I feel like I'm actually getting taken care of.

[00:14:39] Yeah.

[00:14:40] And part of it, I wonder is like, you've chosen to have this coverage for your dog.

[00:14:44] You're paying for it.

[00:14:45] You are the consumer and also the person paying for it.

[00:14:49] I wonder if the fact that most dental benefits are paid for by an employer, the employer doesn't

[00:14:55] really use the service.

[00:14:57] It's the patient.

[00:14:58] It's, I mean, it's a hot mess.

[00:14:59] There's, there's a lot of middlemen between you and your patient.

[00:15:01] If you're, if you're dealing with insurance and it's, it's, it's a, and, and none of the

[00:15:05] insurance really cares to make it easy for anyone like, like, like healthy pause does, you

[00:15:11] know, it's a weird thing.

[00:15:13] Not to get political.

[00:15:14] It's, it's very similar to taxes.

[00:15:15] You know, most, a majority of, of Americans, the taxes automatically get deducted from your

[00:15:21] paycheck.

[00:15:21] So you never see it.

[00:15:22] You don't really feel the impact of, oh my gosh, like I'm paying so much in taxes or I

[00:15:27] can't believe what they're spending my tax money on.

[00:15:30] If they reverse that and they made it very clear.

[00:15:34] And at the end of, you know, come April, instead you had to write a check one.

[00:15:39] I feel like most people couldn't budget their finances enough to actually make that payment.

[00:15:43] But two, people would be very, it would be very transparent.

[00:15:48] What's going on with in dental insurance.

[00:15:51] I feel like they do that on purpose.

[00:15:53] They make things kind of cloudy to kind of show people that like, Hey, we're not actually

[00:15:57] providing you much in coverage at all.

[00:16:00] And then what's interesting is then that anger, that frustration gets transferred to

[00:16:04] the dentist.

[00:16:04] Yep.

[00:16:05] You know, transparency is for brave people.

[00:16:10] Transparency is for people that, that are, that are willing to, to have you take a look

[00:16:13] at what's going on.

[00:16:14] And of course the, the less they look at the, the, what the insurance is, is, you know, the,

[00:16:19] the better, I will say healthy pause sounds transparent.

[00:16:22] They seem to not, they are perfectly okay with you knowing exactly what's going on.

[00:16:26] And I'll bet they don't have a lot of complaints either.

[00:16:29] You can't see this, but it's funny.

[00:16:32] Like I've got all these claims approved for payment, approved for payment, applied to your

[00:16:35] deductible.

[00:16:36] I got a claim denied, you know, and you look at it, it's like explanation of benefits.

[00:16:42] I just click on that and I know what this is for.

[00:16:45] I think it's for some medication that I, you know, set.

[00:16:48] Yep.

[00:16:49] They just didn't cover that medication.

[00:16:52] Totally cool.

[00:16:53] It's explained.

[00:16:54] It says why it's crazy.

[00:16:56] I mean, we should be able to do this, but again, it would be too transparent, be too

[00:17:00] brave.

[00:17:01] Yeah.

[00:17:02] And I think the model would collapse.

[00:17:04] Yeah, it would.

[00:17:05] I take, I take medications and some of these medications I've been on for a bunch of years.

[00:17:09] And what's super funny is like, I, this, the insurance policy that I pay out the nose for

[00:17:18] some years they cover it.

[00:17:19] Some years they don't.

[00:17:21] Some years they cover, they cover it for half the year.

[00:17:24] So every time I go up there, I'm, I'm, you know, I'm getting my wallet out because sometimes

[00:17:28] it is a $0 copay.

[00:17:30] And I've had sometimes where it's been two, 300 bucks.

[00:17:32] And it's like, I'm literally rolling the dice and I'm not, I, and I have, there's a part

[00:17:37] of me that just goes, this is more trouble than I want to deal with, whatever.

[00:17:40] But it is, I mean, there's no transparency.

[00:17:42] I don't have any idea.

[00:17:43] And I'm sure that if I called someone and waited on, on the phone for 45 minutes, maybe

[00:17:47] someone would give me, who knows?

[00:17:49] It's just like, yeah.

[00:17:50] Transparency is for the brave and these people are not brave.

[00:17:53] They're hoping that you won't call, which is what happens with me.

[00:17:55] I'm not going to spend that time.

[00:17:57] So it's, it's frustrating.

[00:17:58] I mean, it's, it's fascinating though, that, that somehow insurance for your dog is just

[00:18:04] like on, on all levels better than everything, medical, dental, everything we've got like in,

[00:18:10] in there.

[00:18:10] Yeah, it's, it's, it's a little sad.

[00:18:12] And I, I, I too am sort of, I'm out of network with all, but like one insurance.

[00:18:18] I still feel like one of the best things we do in my office is no one leaves wondering

[00:18:25] what the treatment we're proposing is going to cost.

[00:18:28] And in some cases, because we're so open about that, they don't choose the treatment,

[00:18:33] which is also a win because no one wants to be providing treatment that people aren't

[00:18:38] going to pay for.

[00:18:39] Totally.

[00:18:39] But, you know, like who wants to, it's there too.

[00:18:42] If they get to do with it, what they want, you know, if it's in, and so on some level,

[00:18:46] you have to be okay with that.

[00:18:47] That's, and that also frees you up to treatment plan for what's best for the patient too.

[00:18:52] And I mean, I struggle with that because we're heavily insurance area where I am, but in any

[00:18:55] case, that's, that's neither here nor there.

[00:18:57] I feel like, I feel like you're on the right track.

[00:18:59] I appreciate too, that like the, the fee for service concept is awesome.

[00:19:05] I do think, and this is, I want to take, get your take on this.

[00:19:07] I don't hate patients for wanting to use their benefits.

[00:19:11] You know, I don't hate them for it because they're not even there.

[00:19:14] It's a benefit of their job.

[00:19:15] It's like part of their pay.

[00:19:16] So I can't hate them for that.

[00:19:18] What do you think about that?

[00:19:19] There's this misconception that I, as a, again, in quotes, fee for service.

[00:19:24] Yeah.

[00:19:24] Dentist in San Francisco that, that I'm also, that I'm also anti-network.

[00:19:29] This is the, the bane of today's society, which is if you believe one thing, then you

[00:19:34] prepackage all your beliefs into now we assume that you believe all these other things.

[00:19:38] Look, I would be a network.

[00:19:39] I think it's great.

[00:19:40] Why they send you patients.

[00:19:42] Being in network makes sense if it fits your fee schedule.

[00:19:45] But we as dentists are terrible, typically terrible business people.

[00:19:50] Your fee should be based off of what you're actually spending, what it costs you to provide

[00:19:56] that service, what you feel you deserve to be paid.

[00:20:00] And so when we actually broke down all our procedures, here's how we do this.

[00:20:06] It just didn't make sense to get paid that little for our area.

[00:20:10] Now there are some areas that pay more and it makes more sense based off of what things

[00:20:16] cost in that area to provide that care.

[00:20:18] There are some plans that will actually, um, I've heard of people going, wow, you know,

[00:20:23] the insurance actually does some research and goes, Alan's been placing really good crowns.

[00:20:27] And we noticed that the replacement rate at his office is really, you know, it's far out

[00:20:32] there.

[00:20:32] We don't mind paying you more knowing that you're delivering better work.

[00:20:37] Now that's rare.

[00:20:38] I was just going to say that.

[00:20:40] That sounds too good to be true.

[00:20:42] Rare, but I've, I've definitely had people who've negotiated that and they've gotten it.

[00:20:46] So I'm not anti in network.

[00:20:49] I'm anti people not getting paid what they need to get paid to do good work.

[00:20:56] So if they're paying you lowered reimbursements and you go, man, I really need these patients

[00:21:02] though, or my patients are going to leave or whatever, like you just need to be in network.

[00:21:08] You're now auditing going, okay, well, what do I need to do on my end?

[00:21:12] Time wise, material wise, lab cost wise to make this work.

[00:21:16] And again, I actually think that's kind of a fun project.

[00:21:19] I love the challenge of trying to provide solid dentistry economically, efficiently.

[00:21:25] That's awesome.

[00:21:26] The problem is there are also some people who go beyond that where now it's like, great,

[00:21:33] I'm going to do four crown 15 minute crown prep.

[00:21:36] And, and I'm going to do X, Y, and Z.

[00:21:39] And I'm getting my lab work shipped in from overseas.

[00:21:42] I'm paying for $15 PFMs.

[00:21:45] The other thing that's kind of wild that's happening in this area is we'll get people who

[00:21:49] they're like, look, I really got to see somebody in network.

[00:21:52] And it's typically somebody who's in their early twenties.

[00:21:55] They just got their first job.

[00:21:56] And us again, being transparent, I go, look, John, I totally get that.

[00:22:02] You should just start in your career.

[00:22:04] I understand that, you know, our thousand dollar, whatever difference in what this would cost

[00:22:09] you makes a huge difference.

[00:22:10] Go off.

[00:22:11] And, uh, I support you in your quest to try and find somebody who's in network.

[00:22:16] You know, here's the pros and cons.

[00:22:17] Here's what to look for.

[00:22:19] Go off.

[00:22:20] What's crazy is these patients sometimes come back and they go, Hey, I just wanted to, um,

[00:22:25] get the crown with you.

[00:22:26] And I go, what happened?

[00:22:28] And so either one, they had a not so great experience or what's happening more and more

[00:22:32] is two.

[00:22:33] They show me their, their proposed treatment plan at that in network office.

[00:22:39] I'm just going to throw out random numbers that are the round to make sense of this.

[00:22:43] Let's say a crown at my office is $2,000.

[00:22:47] They go, Oh, that's too much.

[00:22:48] I've got to go see an in-network dentist.

[00:22:50] They go see an in-network dentist.

[00:22:51] And all of a sudden you look at their bill and their crown is call it $800.

[00:22:56] But then all of a sudden there's like a, you know, an added fee for a post that I didn't

[00:23:05] think the tooth needed.

[00:23:06] I thought it was a buildup.

[00:23:08] Fine.

[00:23:08] That's a difference in philosophy.

[00:23:10] Great.

[00:23:10] But now all of a sudden there's also a $700 charge for a materials upgrade.

[00:23:16] That crown is only for a PFM.

[00:23:18] But if you want a white tooth colored crown, you've got to pay an extra $700.

[00:23:23] Okay.

[00:23:24] And then all of a sudden it also says that they need gingivectomy or, or laser troughing

[00:23:29] around this number three crown.

[00:23:32] Is that to aid in your impression or scan?

[00:23:35] Which I'll be honest, I do sometimes too.

[00:23:37] I'll pop out a laser and cut some tissue.

[00:23:39] Am I charging for it?

[00:23:41] I don't think I am.

[00:23:43] Long story short, we get a lot of patients come back and go, this is pretty much the

[00:23:46] same thing, but, but you didn't say I needed all these add ons.

[00:23:49] Like, do I need these?

[00:23:51] And I'm like, those are all included.

[00:23:53] You know, we see it a lot with, with our, our clear aligner treatments where, you know,

[00:23:59] we throw out a clear aligner price.

[00:24:00] You know, I think I'm going to go with Dr.

[00:24:02] So-and-so and go, okay, that's totally cool.

[00:24:04] And then they come back and they're getting charged for refinement scans.

[00:24:07] They're getting charged for each of the visits.

[00:24:10] Oh, an attachment pops off.

[00:24:12] It's a, it's another charge for this.

[00:24:14] Oh, you lost a tray.

[00:24:15] Here's another charge.

[00:24:16] Oh, and your retainers at the end.

[00:24:18] That's an extra charge there too.

[00:24:20] Versus having an all encompassing transparent.

[00:24:22] Hey, this is your treatment and it covers all of that.

[00:24:26] Yeah.

[00:24:28] We were talking about codes earlier.

[00:24:30] Yeah.

[00:24:30] Like that's the funny thing.

[00:24:31] Like I, we don't, we don't do that.

[00:24:34] We don't like, I, I, and I know that's exactly true.

[00:24:37] And I think in some cases, the best part is, is like, they give all these different codes,

[00:24:42] a gingivectomy code and a, and a, uh, core buildup or, uh, you know, there's a million

[00:24:47] codes you could send to the insurance company and everyone knows that the insurance company

[00:24:51] doesn't pay on any of those codes.

[00:24:52] So then you're, then all of a sudden the $800 crown, uh, they're paying out the nose for the

[00:24:58] stuff that the insurance company doesn't cover.

[00:25:00] And, and the dentist office knows that it doesn't cover it.

[00:25:03] And it's, it's a, it's a, it's a manipulation to, to, because what they're, they're there,

[00:25:07] it's the transparency thing.

[00:25:09] And they're just not being open about what they need to get paid for whatever, but they're

[00:25:12] going to get it.

[00:25:13] They're just not going to, they're going to get you in by saying the crown is 800 bucks.

[00:25:16] Well, you know what patients hate more than anything is that I do can't stand that.

[00:25:22] It drives me nuts when you like, as soon as, as soon as you say, I'm going to do this

[00:25:25] and then there's added fees and all you're just like, give me a break.

[00:25:28] Like I, I, I mean, I've forever, I've always been sort of a, let's, let's talk about what

[00:25:32] it, what the top line, what it's going to cost.

[00:25:34] But yeah, that's ridiculous.

[00:25:35] I'll bet.

[00:25:36] And my understanding is in California, that is a hot mess.

[00:25:39] Like, cause so often, particularly like in, I guess in LA, everyone takes insurance and

[00:25:44] everything.

[00:25:44] There's a million plans.

[00:25:45] And there's, and so it's like a race to the bottom.

[00:25:47] And so then the strategy is how do you get your feet to the point where you can, you can,

[00:25:51] you know, break even kind of thing.

[00:25:53] Yeah.

[00:25:53] Yeah.

[00:25:53] It's definitely a race to the bottom.

[00:25:54] It's also, um, it's, it's crazy to me what we as dentists treat as a loss leader at our

[00:26:02] practice.

[00:26:03] You know, if you were to, if you were to like actually calculate out and Adam and I were

[00:26:07] really surprised.

[00:26:08] We did this exercise probably a little late.

[00:26:10] I mean, we should have done this earlier, but we were like, like, let's break down a

[00:26:13] procedure.

[00:26:14] Let's look at our fixed costs, our rent, you know, our staffing, what it costs for, to, to

[00:26:21] turn over a room even like, what are all the barriers costs and the sterilization.

[00:26:25] And then in the, in the procedure, what does it cost for this?

[00:26:29] One of the costs that many people forget the cost of instruments, meaning how often is this,

[00:26:34] how many uses am I getting out of said instrument or whatever?

[00:26:38] Then you divide that by all.

[00:26:41] And so now you have a cost for the, the, the replacement of all the stuff.

[00:26:44] Yeah.

[00:26:45] You add all that up.

[00:26:46] You're like, Oh man, there were a bunch of procedures where we were going, we need to

[00:26:49] decide now, are we not going to do this anymore?

[00:26:54] Or are we going to do it?

[00:26:56] And it's just something that we break even.

[00:26:58] It's a lot.

[00:26:58] It's a, it's a service we provide.

[00:27:00] Or are we going to do it out of the goodness of our hearts and know that every time we do

[00:27:04] this, we lose $30.

[00:27:05] Yeah.

[00:27:06] Which I, again, like I, we do pro bono things for many patients, but like you do it systematically

[00:27:14] where every time you do this procedure, you lose this much money.

[00:27:17] It's wild.

[00:27:18] And so if you're taking that prophy that's getting paid, I'm not even going to throw out

[00:27:24] numbers because I don't want to get in trouble, but, but, but you're like, are you actually

[00:27:28] making money off your hygiene?

[00:27:29] And I would argue some people aren't, but it's a way for them to keep patients in the

[00:27:34] door so that they can find dentistry to do.

[00:27:36] Okay.

[00:27:37] So hygiene, like God love them.

[00:27:39] I think hygiene is hygiene is great, but I will say this.

[00:27:43] We've patient patients have an expectation that you have hygiene.

[00:27:48] Like patients, how do patients, when patients say they go to the dentist, what do they really

[00:27:51] mean?

[00:27:52] I think probably in a majority of cases, they mean they're going to get their teeth cleaned.

[00:27:55] Totally.

[00:27:55] My favorite thing is when the patient comes in, they have their teeth cleaned and then

[00:28:00] they sneak out before you can do an exam or the dentist even walks in the door.

[00:28:03] And let's, let's be honest.

[00:28:04] I mean, it's nice to have polished shiny teeth and it's nice to have, have plaque and, and

[00:28:09] tartar removed off your teeth.

[00:28:11] But the reality is if we're, if we're talking about a model that is preventive, which I'm

[00:28:17] not, I'm not convinced that dentistry is really preventive anymore at this point.

[00:28:20] But if we're talking about that, the reality is, is let, let as many sets of eyes that know

[00:28:25] what they're looking at, look at your teeth as often as you can.

[00:28:28] So if we have to treat stuff, we can treat small things instead of big things.

[00:28:32] But I, you know, the patients love to, if, if given a chance, especially if they're paying

[00:28:37] out of pocket or if they're, you know, they'd love to sneak out before I even get into the

[00:28:40] room and get the, well, the patient didn't really want an exam this time.

[00:28:42] And I'm just thinking to myself, I, for, for me, I like seeing them.

[00:28:46] I like seeing them every appointment, even if I'm not charging out a full on exam of

[00:28:50] it, because I don't know.

[00:28:52] I just feel like, yeah, totally.

[00:28:54] So on certain patients, stuff can get away from you pretty fast, but I think patients don't

[00:28:57] value that.

[00:28:58] They value that they, that they got to spend quality time with the, with the hygienist who

[00:29:02] treats them nicely and polishes their teeth.

[00:29:04] And, and I'm not, that's not to downplay the, the importance of hygiene, but I, I, what I'm

[00:29:09] saying is what patients perceive is probably, I mean, hygienists that take themselves serious

[00:29:14] as clinicians and stuff are, are great, but it's really hard to get the patient perception

[00:29:20] the same as the way the hygiene perceives what they're doing.

[00:29:23] In other words, I think the patients go in and they think, oh, it's nice to spend quality

[00:29:26] time.

[00:29:26] She asks about my kids.

[00:29:28] My teeth feel all smooth when I leave.

[00:29:29] And, you know, that's where it's, so we've kind of, and we've sold that as that's, that's

[00:29:34] the, that's what people go to the dentist for, you know?

[00:29:37] And I'm just like, what's interesting is we've been using different therapies and educational

[00:29:42] tools to kind of help climb that hill and fight that battle.

[00:29:48] The one thing that has really been effective for us is such an old school product.

[00:29:53] And it's something that I used to use when I was five and the dentist wanted to make sure

[00:29:58] I brush my teeth well.

[00:29:59] And it's disclosing agent.

[00:30:00] Disclosing agent.

[00:30:01] Yeah, exactly.

[00:30:01] And so interesting having patients, you know, and, and we're, we're really kind of going

[00:30:07] over the fact that we're not just cleaning plaque and tartar.

[00:30:10] We're cleaning biofilm and we're trying to reduce bacterial load.

[00:30:14] Now we can get into the argument.

[00:30:16] There's some people who get this done and it's like, they are also low risk and it's not really

[00:30:21] causing any issues anyway.

[00:30:23] Yeah.

[00:30:24] But I think it's a lot different framing it that way and having patients see it.

[00:30:29] Yeah.

[00:30:30] So I don't know.

[00:30:31] I, I, you're right.

[00:30:32] I think you have to see the difference.

[00:30:35] I, so do you, are you doing, uh, are you doing the guided biofilm stuff?

[00:30:38] Are you, are you, or is it something similar or something like that?

[00:30:41] Yeah.

[00:30:41] I'm, we, we have air polishers in the office.

[00:30:45] We're, we're definitely big believers in that.

[00:30:48] Um, some patients don't like it though.

[00:30:50] Like you said, they're kind of used to a certain way of having their teeth cleaned.

[00:30:55] Um, it's tough.

[00:30:56] And then the other big, I think the toughest thing of air polishing is really the retraction.

[00:31:00] Right now we're trying out a bunch of different retractors.

[00:31:03] Interesting.

[00:31:03] Um, so far the best one's been, um, zero scarred cause it has a little saliva.

[00:31:11] It hooks up to your saliva ejector and kind of helps, uh, with a little bit of that suction

[00:31:15] as well.

[00:31:15] And it frees up the other hand to use a mirror that has HVE on it.

[00:31:20] Um, I'm interested to hear all that stuff cause I'm, I, I haven't pulled the trigger on it,

[00:31:24] but like, here's the thing.

[00:31:26] Like I'm one of the guys that, that stalks the, the, the guy guided biofilm, you know,

[00:31:31] the EMS channels on Instagram and stuff, because let's be honest, it's dental porn to watch the,

[00:31:36] watch the purple and red stuff come off the teeth with it, with an air polisher.

[00:31:40] It's hard not to, it's hard not to, that's very satisfying in the same way that certain

[00:31:44] videos of, of wisdom teeth coming out are incredibly satisfying as a dentist.

[00:31:48] It's really satisfying to see that stuff clean off nicely.

[00:31:50] I'm so I'm, I'm sold on it.

[00:31:52] This is a good segue, um, to what you originally wanted to talk about, which is planned obsolescence,

[00:31:58] because if you're interested in buying an air polisher, one, they're expensive.

[00:32:04] Yep.

[00:32:05] And two right now, I don't think anybody's going to disagree with me.

[00:32:08] Anybody who owns one of these, that they're expensive to maintain.

[00:32:12] Mm hmm.

[00:32:12] And it's wild to me seeing the parts on this machine that are made of plastic.

[00:32:21] Mm hmm.

[00:32:21] That are completely downgraded.

[00:32:23] And actually, I'm not going to say her name, but she's somebody who's been air polishing

[00:32:26] for a while.

[00:32:27] She owns nine or 10 of these units.

[00:32:31] Mm hmm.

[00:32:31] She has multiple practices, um, in New York.

[00:32:36] And she showed me, because again, she's been buying these, these machines for a while.

[00:32:41] She showed me the differences in her early machines that don't break that her, her workhorses

[00:32:48] and the mission, the newer machines that she's bought, where she's like, look at these hoses,

[00:32:52] look at the internals.

[00:32:54] And it's all of a sudden you start seeing like things that were made out of metal are

[00:32:57] now being transitioned to plastic.

[00:32:59] And it's wild.

[00:33:00] She's like, I've sent this one in three times for repair.

[00:33:03] And what's crazy is a lot of these machines you have to send in for repair and you, they

[00:33:08] charge you for a loaner.

[00:33:09] Meaning, you know, now you've got your patients and your hygienist hooked on using this thing.

[00:33:14] Oh, you want to, you want to keep going?

[00:33:17] Well, you got to pay us X amount of dollars for a loaner.

[00:33:20] If you're, if you buy a Porsche and you've got that thing in service, typically they kind

[00:33:25] of give you a loaner, don't they?

[00:33:27] I'm not a Porsche owner, but somebody correct me if I'm wrong, like a luxury item.

[00:33:32] They, my parents, my parents have a, my mom has been God forever.

[00:33:36] She's been a Lexus and she buys, she buys new Lexus from, from the same mom.

[00:33:40] And guess what?

[00:33:41] Not only do they get a loaner that we're, they live in Midland, Michigan and the service

[00:33:46] place is down in Metro Detroit.

[00:33:47] So it's an hour and a half to two hours away.

[00:33:49] They drive up, pick her car up, bring it down, leave the loaner with her.

[00:33:52] And that's not an extra fee, but I mean, they're paying out the nose for the maintenance

[00:33:56] they're, they're paying out the nose for the car.

[00:33:57] They're doing all that stuff, but that's just part of the branding.

[00:34:00] And I think to myself, what I think of when I, when I hear you talk about this loaner thing

[00:34:04] for an air polisher, first off, I'm sort of enraged to even hear it, but it is, it is

[00:34:09] classic.

[00:34:10] I mean, this is, but I think everyone wants to get into that subscription model where they

[00:34:14] get to swipe your credit card.

[00:34:16] And everything is sort of pointing towards that, which is the closest that I'm pretty sure

[00:34:22] that if you like had a religious background, that is Satan's work.

[00:34:26] That is, that is, it's the worst.

[00:34:28] The whole swipe of like, like the, you know, that I'm talking about the classic thing.

[00:34:33] I think I probably pay for four different softwares that can text my patients and I'm too lazy

[00:34:39] to figure out which one we're using the best or whatever.

[00:34:41] So, so I get multiple swipes cause I'm too lazy.

[00:34:44] Guess what?

[00:34:44] They love me.

[00:34:45] They love me.

[00:34:47] And they'll never mention anything to me about it.

[00:34:48] Cause I might change what I do.

[00:34:49] So I think that model in the model of, it is funny too, because the subscription thing

[00:34:55] would technically make the planned obsolescence thing, not an issue, except it probably always

[00:35:00] thing is, I do.

[00:35:02] I, you know, I think it's overused.

[00:35:04] There are so many things that people sign up as subscription that doesn't make sense.

[00:35:08] Yep.

[00:35:09] When you sign up for a subscription of magazines, it kind of makes sense.

[00:35:12] Why?

[00:35:12] Cause each magazine is different every month.

[00:35:14] It's making sure it's, it's saying, Hey, you're into this.

[00:35:17] We're just going to send it to you because we know you're going to buy it anyway.

[00:35:20] Okay.

[00:35:21] There is a, a light.

[00:35:24] I forget the name of it, but it detects oral cancer.

[00:35:27] You have somebody rinse.

[00:35:28] And I remember they came to your office and they're like, I was like, okay, how much does

[00:35:32] this thing cost?

[00:35:32] They go, well, it's, it's this much per month.

[00:35:34] I go, okay.

[00:35:35] For how many months?

[00:35:36] And they're like, oh no, it's a subscription.

[00:35:38] I go, you're having me subscribe to a piece of hardware.

[00:35:41] Yeah.

[00:35:42] Meaning what?

[00:35:43] Meaning that if it breaks, you replace it.

[00:35:45] They're like, oh yeah, totally.

[00:35:45] Like you, you know, you don't actually own it.

[00:35:47] You subscribe to use it and any upgrades to, you know, you'll get the newest one.

[00:35:52] And that just doesn't make sense.

[00:35:54] Like, what are you talking about?

[00:35:56] Like, I like to just try this subscription.

[00:35:58] When you hear the word subscription, just, just substitute the word rental and see how

[00:36:03] you feel about that.

[00:36:04] See, cause here's the thing, you know, maybe renting a composite light makes perfect sense.

[00:36:08] Maybe, or maybe not.

[00:36:10] I don't know.

[00:36:11] Maybe not.

[00:36:11] But, you know, and that's, see, this is where I think the free market kind of solves that.

[00:36:16] Cause I wish that other people, you know, if the government was in the way, guess what?

[00:36:20] We'd have a competitor and they'd go, that's dumb.

[00:36:22] You can buy it from us for this much, which is what's happening to the air polishers.

[00:36:27] And again, I don't want to speak on this yet because we're still in this trial phase,

[00:36:31] but we, we own an EMS, but we also just bought kind of a cheaper version.

[00:36:39] And that's what happens.

[00:36:41] You know, I have, I have, I have thoughts about this too, that I'm not the, I will say

[00:36:46] this, the EMS product is really well designed.

[00:36:48] Oh, it's like, I love the, I love the fact that it's hand pieces in the same way that

[00:36:52] we're used to having hand pieces and you don't have to, but on the other hand, that might

[00:36:55] be a, that might be a luxury.

[00:36:57] That's worth looking at.

[00:36:58] This is all, I love my EMS people, but also I'm not, I'm, I'm kind of brand agnostic on

[00:37:03] a lot of things.

[00:37:04] And for the same reason that you have always talked about it really and truly.

[00:37:08] I'm not going to say this about, this is not in regards to EMS.

[00:37:11] This is regards to just dental companies as a whole, as I approach, you know, I graduated

[00:37:16] in 2014.

[00:37:17] So now I'm going in past my decade.

[00:37:20] I used to want the best materials and the best things.

[00:37:24] So like you get out of school, it's like, well, bonding agent, what's the best?

[00:37:28] And what's crazy is as I started doing, as I go through my career, I realized that most

[00:37:34] of these major products work, you know, you're like, what's the best scanner?

[00:37:39] Most of the major ones work well.

[00:37:41] They have their, their little things that make them unique, but they all kind of work.

[00:37:46] What I'm looking for now, instead of what is the best, I'm looking for the company that

[00:37:50] has the best support.

[00:37:51] Meaning I know that they've got my back as a customer.

[00:37:56] You know what I mean?

[00:37:57] Like there's something about companies and now I'm not talking just dental, but companies

[00:38:01] as a whole that, that, that really value you and your loyalty to their brand and their

[00:38:06] service.

[00:38:07] But the moment you feel like somebody is taking advantage of you, it just is a huge turnoff.

[00:38:13] And that's just happening more and more with a lot of dental companies where I'm going,

[00:38:17] look like some of these companies are like billion dollar implant companies and I'm going

[00:38:24] really?

[00:38:24] And you're going to nickel and dime me for like this $40 screw.

[00:38:28] Like I'm so confused right now.

[00:38:30] Totally.

[00:38:31] That's in, and the other thing is like there's every, every, every year there's, or every,

[00:38:36] every few months, there's another one of these sorts of stories.

[00:38:38] It's kind of outrageous.

[00:38:39] And what's really funny about it is a lot of cases as dentists, we just suck it up.

[00:38:45] Outrage, you know, I, I mean, I, I have no, I have no concern saying about this.

[00:38:49] I mean, I don't, I, I don't do any aligners or ortho, so I can say this.

[00:38:54] I mean, uh, align makes it a really good product that a lot of people hate them for.

[00:39:01] Like, like, because, because of their, their limitations.

[00:39:04] I mean, you have their, uh, I was just laughing about, you can't sell, you know, like you can't

[00:39:08] sell an iTero to another person.

[00:39:10] Yeah.

[00:39:11] You're not allowed to do that.

[00:39:12] I'm thinking to myself, really?

[00:39:13] But first off, my first action is watch me, but second off, like the support aspect is

[00:39:18] important.

[00:39:19] And so that's, that's, that's part of the problem.

[00:39:21] And they've, they've taken the resale market.

[00:39:23] There is no resale market at some point.

[00:39:25] Did you say, I mean, if, if someone buys the practice, you're, they're allowed to somehow

[00:39:28] transfer it or something like that.

[00:39:29] They are, they are.

[00:39:30] So part of me wants to, for the sake of content, part of the,

[00:39:34] part of me wants to just set up a separate LLC and sell this thing to somebody else.

[00:39:39] And, and, you know, it's a, it's a patient chart of one and there'd be myself.

[00:39:43] And I would fly the thing personally to them and then get a cleaning from their office just

[00:39:48] so that it's official.

[00:39:49] Like you bought this practice and now you have me as a patient and you also own the scanner.

[00:39:54] So I don't stop.

[00:39:55] It's it.

[00:39:56] Okay.

[00:39:56] So I, I think the very best podcasts are the ones where the dog is in the room with

[00:40:00] him.

[00:40:04] I, I, okay.

[00:40:05] So I use, um, I use a medit.

[00:40:07] I use a medit.

[00:40:08] I 700, which is no longer new.

[00:40:10] It hasn't really been new for a couple of years.

[00:40:12] Um, what I, one of the things that is really cool about medit so far, so far, the software

[00:40:18] upgrades are all free.

[00:40:20] There's no, like, you don't pay any extra, you pay, you pay X dollars for cloud storage,

[00:40:24] which is, which is, I I've never, people got mad.

[00:40:26] They used to be 99 cents.

[00:40:28] And then I think they went to 20 bucks or 10 bucks a month or something.

[00:40:30] I'm like, I, I, I don't even want to worry about it, but, but, um, I'm hearing God medit.

[00:40:37] If you're listening, I'm hearing that they're that all this, and they have a software suite.

[00:40:42] They just continue to make different, interesting software.

[00:40:45] You can print mouth guards.

[00:40:46] You can, a lot of stuff that I don't actually do, but I, I maybe aspire to, but, um, they're

[00:40:51] going to make that like, that's all been included.

[00:40:53] And, and to me, that's part of one of the reasons you might want to look into a medit is

[00:40:57] because they have a lot of really cool things and they don't charge extra for it.

[00:41:00] But, but clearly they understand that the market, you know, the money and the, and the

[00:41:05] new, the new, the subscription fees are where it's at.

[00:41:08] So that may not stay that way is what I'm hearing.

[00:41:10] And it breaks my heart a little bit.

[00:41:11] Cause it's one of the reasons I, I kind of like men.

[00:41:13] I've had, I've had good luck with the, with the product.

[00:41:16] I've had really good service through CAD cam or for CAD Ray.

[00:41:19] But I mean, the reality is, is that like everyone kind of, they're all looking at these models

[00:41:25] and they're all trying to squeeze is my, the thing that's funny is I always feel like the

[00:41:29] dentists are always on the bottom of these things.

[00:41:31] No matter, no matter what, it's always the dentist that seems to get squeezed, you know,

[00:41:34] we get screwed.

[00:41:35] It's because we don't pay attention.

[00:41:37] Yeah.

[00:41:39] So just to give you a heads up, like it's tough because a lot of these things encompass

[00:41:43] software, right?

[00:41:45] So you think about like a 1985 BMW.

[00:41:48] They make parts for it, you know?

[00:41:50] And yes, there are some older cars where the manufacturer isn't making parts for it anymore.

[00:41:56] But guess what?

[00:41:57] There's a, another company that makes a part that they know that they could sell or, and

[00:42:02] you can get your car up and running.

[00:42:04] The problem is, you know, and, and iTero has done this with their element, right?

[00:42:08] Like they don't, they no longer service that, that, that machine.

[00:42:12] I want to say that like one of their older ones, like it doesn't even, I don't think

[00:42:17] you can use it anymore.

[00:42:18] Yeah.

[00:42:19] Element two, the reason we ended up getting the upgrade in air quotes, you guys can't

[00:42:23] see that, but the upgrade last year to the 5D was our other one starts slowing down.

[00:42:29] Yeah.

[00:42:29] And I can't prove this, but I'm hoping that one day, if this is true, that, that an iTero

[00:42:35] employee comes forward and, and we read about it on Netflix, but I feel like they, they

[00:42:40] were, you know, they're pulling the Apple model, slowing down older, older machines so that

[00:42:45] people would buy new ones.

[00:42:46] Again, I can't prove that that's total speculation on my part, but there's no support for that.

[00:42:52] We have.

[00:42:53] Is there proof that Apple does that?

[00:42:55] Oh yeah.

[00:42:56] You can look that up.

[00:42:58] Yeah.

[00:42:58] They, they were actually slowing down.

[00:43:00] I think it came out.

[00:43:02] Am I wrong about that?

[00:43:03] I, I'm not, I'm sure that you're not wrong, but what's really funny is, is each time that

[00:43:08] I've upgraded, I, I use a Google pixel phone.

[00:43:11] I'm on the seven.

[00:43:12] So clearly they're going to be beating me up about it because the nine came out earlier

[00:43:16] this year.

[00:43:16] I feel like performance issues make it.

[00:43:19] And maybe, maybe that the hardware is, is not as good for the software.

[00:43:25] I mean, you know, there's, there's a, you could, there's a, there's a plausible story

[00:43:29] in there.

[00:43:29] I don't know enough to know that, but I will say that like, for instance, I couldn't hold

[00:43:32] the battery charge and maybe the batteries just get old over time too.

[00:43:35] That might be it.

[00:43:36] I just looked it up.

[00:43:38] Apple to start paying out 500 million in iPhone slow down lawsuits.

[00:43:42] If you're a part of the settlement back in 2020, you're about to get 65 bucks.

[00:43:46] Yeah.

[00:43:46] I mean, it's not a surprise and also know that, but I mean, that was a strategy.

[00:43:52] That was, I mean, so I want to know, I'd love to be a fly on the wall in those business

[00:43:56] meetings.

[00:43:57] You know what we can do to help with sales?

[00:43:59] Let's make it.

[00:44:00] And the other thing is, is this a product I already bought and only in the technology

[00:44:04] can they go in and alter performance of a product after you bought it and you, you're,

[00:44:09] you've been using it.

[00:44:10] That's like fricking crazy.

[00:44:11] I'm glad they can't do that with my mountain bike.

[00:44:13] Did you, did you, did you watch that documentary that I posted?

[00:44:17] I literally, I'm about two thirds of the way through the documentary.

[00:44:20] Brian sort of sold me.

[00:44:22] I'll, I'll, we'll put it in the show notes.

[00:44:23] It's called by now.

[00:44:25] It's a, uh, and it is, it's horrifying.

[00:44:27] I mean, it is a documentary and they are pushing a viewpoint.

[00:44:31] So I get it, but it is, it's kind of horrifying.

[00:44:33] It's about, it's about a lot of this stuff.

[00:44:35] It's about how, how they get you to buy more stuff, how stuff seems disposable, but it's

[00:44:41] not, you can't, I don't, it's the movie is full of amazing special effects, watching trash

[00:44:49] and old things fall out of tall buildings on of like, like basically the amount of junk

[00:44:54] that's being made.

[00:44:54] The fast fashion stuff makes me never want to buy clothes again in my entire life.

[00:44:59] Unfrigging believable.

[00:45:00] Yeah.

[00:45:00] It's, it's a, it's a hard watch to be honest.

[00:45:03] Yeah.

[00:45:03] I feel like, and that's the thing is I feel like I'm a part of that.

[00:45:06] What started this conversation too, as you had commented, I had a particle air abrasion

[00:45:11] unit in our lab go down.

[00:45:13] Yeah.

[00:45:14] And we were kind of bummed about it and we were totally down to just buy a new one.

[00:45:18] We looked it up at 350 bucks.

[00:45:20] And I, and the moment you decide that like, this is so me, the moment we decide we're going

[00:45:25] to throw something away, get a new one.

[00:45:26] I'm like, let me just take this thing apart.

[00:45:27] Let's see how this thing works.

[00:45:29] Yeah.

[00:45:29] So I take it apart and I see inside, do I still have it on my desk?

[00:45:33] Oh no.

[00:45:33] It's, it was a little hose and it was just torn and another hose was kinked.

[00:45:39] And I'm like, oh, I'm looking at this.

[00:45:43] It's two different screws to put this together in a spring and just two hoses.

[00:45:47] I call up the company.

[00:45:48] I'm like, Hey, you know, I just wanted to order a replacement parts for the internals

[00:45:52] of this thing.

[00:45:53] And they go, oh no, no.

[00:45:55] We sell the hose that's on the outside, but we don't sell those internal ones.

[00:45:59] And I'm like, don't you guys make this?

[00:46:01] Like you guys can't sell me the internals.

[00:46:03] They're like, no, we don't do that.

[00:46:04] I'm like, okay, well I could probably get these parts online somewhere.

[00:46:07] Can you do me a favor?

[00:46:08] Can you send me the manual on how to put this thing back together?

[00:46:11] Cause it is a little tricky.

[00:46:13] And they go, we don't provide that either.

[00:46:15] I go, you don't have a video or anything about how to put that in.

[00:46:18] I go, no.

[00:46:19] And they're like, look, if it's, if it's a new product, if you bought this within five

[00:46:22] years, you can send it in and we can repair it.

[00:46:25] And I go, well, this thing's like 10 plus years old.

[00:46:31] And I'm looking at your site now and you have the exact same one still in service.

[00:46:36] And forgive me if I'm wrong, but looking at this technology, it hasn't changed.

[00:46:41] It's a very mechanical thing.

[00:46:43] And they're like, sorry, we just don't repair that.

[00:46:46] If it's older than five years.

[00:46:48] And so out of spite, I canceled our order and I was like, I'm fixing this thing.

[00:46:54] So look, nobody can see this, but I've got it here.

[00:46:55] This is tubing.

[00:46:56] Yep.

[00:46:57] You could fix that thing for the rest of your life.

[00:47:00] That's it.

[00:47:00] And, and, and everybody, what's funny is the number one comment I got from a bunch of friends

[00:47:04] of mine.

[00:47:05] They're like, dude, it's 300 bucks.

[00:47:07] Like, what was your time worth?

[00:47:09] And I love, I love the people who saw that.

[00:47:12] I saw that.

[00:47:12] Well, you could have been seeing patients.

[00:47:13] I'm like, I could have been, that's for sure.

[00:47:15] Now there are, there are some offices in the world where we don't have unlimited patients

[00:47:19] sitting in our parking lot, ready to walk in and pay for my fucking air freezing

[00:47:24] unit.

[00:47:24] But I mean, I get it.

[00:47:25] But also, also I can afford anything.

[00:47:28] I just have to do another couple of crowns per month and I can afford anything, right?

[00:47:32] Like on some level, you have to realize that we're throwing stuff away all the time.

[00:47:36] And your point is, I get it.

[00:47:38] Stuff like that sticks in my craw.

[00:47:39] This is a, this is a great topper.

[00:47:41] We know we could go on forever on this.

[00:47:42] So I have a friend who, who, uh, you know, I have a bunch of microscopes in my office and,

[00:47:47] and you know that the, the story with, with, uh, with x-ray, um, with like a Dexis

[00:47:54] unit or a sensor, whatever, is that those things you put a warranty, they put a warranty

[00:47:58] on those.

[00:47:58] First off, you pay out the nose for them.

[00:48:00] And, and literally if it breaks in your office the next day, if you haven't bought the warranty,

[00:48:04] God help you.

[00:48:04] Or they give you like a limited six month warranty, whatever.

[00:48:07] Why do they, why do they want you to pay for the warranty?

[00:48:09] First off, it's a great, it's a great swipe on your credit card.

[00:48:12] There's one thing.

[00:48:12] That's, I think that's more of it.

[00:48:13] But the other things, those things break all the damn time because they're carrying it

[00:48:17] around the office and they drop it.

[00:48:20] And so, so the reality is that probably makes sense to have a warranty as much as it chaps

[00:48:25] my ass to do it every single time.

[00:48:27] But I, I just, I, I pay for the warranty on the Dexis sensor cause it, cause they break.

[00:48:32] I've had them break.

[00:48:33] And so, but then I'm talking to a friend of mine who, who sells microscopes.

[00:48:38] He's like, well, we're thinking about putting a warranty or, you know, what do you think

[00:48:41] about a warranty for the microscope?

[00:48:43] I've owned four or five microscopes.

[00:48:45] They are lenses and lights.

[00:48:47] That's what they are.

[00:48:48] They're lenses and lights.

[00:48:49] And the reality is I'm not sure I could break it if I wanted to.

[00:48:52] Like I, like, like I will say this, the, uh, some of them have some cameras built into

[00:48:56] them and that's that technology I suppose probably could break, but like, that's a hard,

[00:49:02] that's a much harder thing to say.

[00:49:03] So they're trying to decide if it makes sense to have a warranty program where you do.

[00:49:06] And, and I know that everyone's kind of looking for that, that, that residual income

[00:49:12] residual, you know, like, Hey, and, and I think what's

[00:49:15] funny is like, there are products.

[00:49:16] I mean, another product that I, they don't, I don't know if they sell warranties on them,

[00:49:21] but like an electric hand piece, um, you use them all the time.

[00:49:25] They're going to break down.

[00:49:26] The question is, is that worth warranty?

[00:49:27] Like I have found that having a lot of them is a really good solution because they seem,

[00:49:33] you seem to get used less, but you know what?

[00:49:34] They're going to break.

[00:49:35] Like I'm not advocating this.

[00:49:39] I'm going to throw that up, but I know colleagues and friends who, instead of buying a $2,000 handpiece

[00:49:49] and if you ever have to get these things repaired, they're like, I'll be honest, $800 to $1,000

[00:49:54] to repair.

[00:49:55] Okay.

[00:49:55] They have handpieces now that are 200 bucks that you can get.

[00:50:01] Yeah.

[00:50:02] And if they break, they dispose of them.

[00:50:05] And again, now you're back in the disposable world, but that's the thing is look, I'm not

[00:50:10] saying things have to last forever, but if they don't, don't price them like that.

[00:50:15] Yeah.

[00:50:15] You know what I mean?

[00:50:16] No, that's exactly right.

[00:50:17] There's, there's, there's so much here.

[00:50:19] We could, we could dig in.

[00:50:20] And honestly, there's a ton of things I want to talk to you about that we're just not going

[00:50:24] to get time for because, because we can't, this is not the Joe Rogan podcast.

[00:50:28] We don't go for four hours.

[00:50:30] I suspect I probably could with you.

[00:50:32] So maybe we need to have you on again, but the, it is, all this stuff is particularly

[00:50:36] interesting for a practice owner.

[00:50:38] But if you are not a practice owner, listen hard, because if you become a practice owner,

[00:50:43] if you're looking at it, these are some of the dumb things that when you're driving

[00:50:47] home from work, this is the stuff that pisses you off.

[00:50:49] This is the stuff that stays in your brain, right?

[00:50:51] Yeah.

[00:50:51] And, and like you said, we go not to go back to that topic, but we were talking about how

[00:50:55] some people were like, well, is it worth your time to fix that?

[00:50:58] I want to follow those people around and go, oh, you're going to park your car.

[00:51:02] You know what?

[00:51:02] Just give me 50 bucks.

[00:51:03] I'll park it.

[00:51:04] You could be doing dentistry right now.

[00:51:06] You see them in line at Starbucks.

[00:51:08] I'm going to be like, dude, what are you doing here?

[00:51:12] Go cut a crown.

[00:51:13] Like your time's better spent than doing this.

[00:51:15] But, but these are the things that we think about.

[00:51:18] And as we go through our day, like being a practice owner, it bleeds into my personal

[00:51:24] life.

[00:51:25] So like it no longer is that nine to five.

[00:51:28] Like I'm fixing stuff or working on a protocol or doing this.

[00:51:34] Like I would argue that I actually work.

[00:51:36] I, I, I seek patients for eight hours of the day, but I'm probably working on the practice

[00:51:41] another six or seven.

[00:51:42] Yeah.

[00:51:43] Yeah.

[00:51:43] Yeah.

[00:51:44] No, it's I, and, and even the working, like it's too bad we can't be attorneys because they

[00:51:49] bill for that time that they're thinking about their, even if they're, you know what I'm

[00:51:53] saying?

[00:51:53] They, they bill for any time they're thinking about their clients.

[00:51:55] Unfortunately, if I'm thinking about whether or not I can find that MB2 at dinner and I'm

[00:52:00] not talking to my, my family because I'm so bothered by the fact that I can't bill for

[00:52:04] that time.

[00:52:05] I'm afraid I cannot bill for that time.

[00:52:07] I haven't found a way to do that yet.

[00:52:08] So, Oh my gosh, it's funny.

[00:52:10] Listen, Brian, this was great.

[00:52:11] I feel like you should probably, I mean, you are fantastic on Instagram.

[00:52:15] I love your stuff on Instagram.

[00:52:16] You should just, you should have a podcast because you, you just spout wisdom a lot.

[00:52:20] I don't, it's all experience.

[00:52:22] I appreciate the kind words, but honestly, I think that the way we combat some of the stuff

[00:52:26] that we talked about insurance, land obsolescence is Instagram.

[00:52:31] Meaning if you come up with a good idea, if you have a way of fixing something that broke,

[00:52:35] like everybody's so concerned about putting out this content that's going to go viral,

[00:52:40] right?

[00:52:40] Like, Oh, well, how do I hop on the latest trend?

[00:52:43] Don't worry about the trend.

[00:52:44] Like leave that to the people who are comfortable dancing and hopping on TikTok.

[00:52:47] But like if something breaks at your office and you're like, you know what?

[00:52:50] Like we've been fixing this this way for years without having to call repair person.

[00:52:56] You know what?

[00:52:56] There are a bunch of people who would appreciate you just recording you doing it.

[00:53:00] It doesn't need to be fancy.

[00:53:01] It doesn't need to be edited.

[00:53:02] It doesn't, you could just be you and throw that out there.

[00:53:07] Tag me in it.

[00:53:08] Tag Alan in it.

[00:53:09] Like let's get that out.

[00:53:10] And again, it's all about us kind of using this as a communication tool to better ourselves.

[00:53:17] And if you find something that you disagree with, that you don't like, you have a couple

[00:53:22] options.

[00:53:22] Some are better than others, but you can just ignore them or you can give constructive,

[00:53:28] respectful criticism and we can grow together in dialogue.

[00:53:30] So that's just my, my charge.

[00:53:32] Whenever somebody brings up Instagram, it's like, I'm fortunate.

[00:53:35] I'm thankful for all the followers I've had.

[00:53:38] And, and, you know, I hate the word influencer, but sure.

[00:53:42] Like I I'm, I'm thankful that, that, that I'm somehow pretend important in this pretend

[00:53:48] world of social media.

[00:53:49] But, but more importantly, I'm just thankful that, that I have the ability to connect with

[00:53:54] everyone on there and, and kind of get better together.

[00:53:57] Yeah.

[00:53:58] I'm here.

[00:53:58] That's a, that's a, I'm in brother.

[00:53:59] That's a good one.

[00:54:00] Brian, this was great.

[00:54:01] I, this will not be the last podcast we do for sure.

[00:54:03] I'm having too much fun with it, but thank you a ton for being on.

[00:54:06] And if you guys have any questions or comments, first off, you can go to SF dental nerd on,

[00:54:10] on Instagram and he's there all the time.

[00:54:12] You're not going to miss him, but I'll put all this stuff in the show notes.

[00:54:15] He's not on Facebook, so he won't be in the Facebook group.

[00:54:17] Uh, but we'll make sure we get them connected anyhow, which I think, frankly, strong stance.

[00:54:22] I'll give you that one for sure.

[00:54:24] Less is better when it comes to social media, but this was great, Brian.

[00:54:27] I really appreciate it.

[00:54:28] And we'll talk to you again soon.

[00:54:29] Awesome.