Very Dental Student: The Last Big City Before Nothing with Dr. Pete Stover

[00:00:00] In a perfect world, every aspect of your business should be organized and streamlined.

[00:00:03] But let's face it, maintaining order in the midst of a busy practice is easier said than done.

[00:00:08] It's those small oversights that can snowball into big challenges,

[00:00:12] running out of supplies, misplacing instruments, and worst of all,

[00:00:15] when your assistant has to leave chairside to retrieve something they forgot.

[00:00:18] So here's the solution. A lean clinical workflow. A systematic approach that brings order to the

[00:00:23] chaos, benefiting dental practices of all sizes. And now here's your host, Mohamed Abubasha. Hello, everybody. Welcome to another episode of the Very Dental Student podcast. I'm your host, Mohamed Abubasha.

[00:01:41] Today I am bringing on a guest, Dr. Pete Stover from Elk City, Oklahoma.

[00:01:46] Dr. Stover, you're just gonna pull teeth into amalgam. Well, that's part of it, but they also sent me to New Mexico to sit with an oral surgeon for a week to learn how to take out thirds and do pre-prosthetic surgeries and stuff like that. And I really kind of lit my fire. I already knew I liked surgery, but that was part of that.

[00:03:03] I didn't have to pay for that. That so fast, it was insane. So that's kinda how I got up and going. And been in the same building since 05,

[00:04:21] so coming up on 20 years here pretty quick.

[00:04:24] Yeah, that's awesome.

[00:04:25] There's a couple things I wanna talk about

[00:04:27] a little bit more. about it. Then there's TriVit. So the tribal, matter of fact, at the ODA in Tulsa last year, I happened to run across a Chickasaw recruiter and I asked him, I was like, yeah, hey, just out of curiosity, what's the going rate for you guys? And it was close to $200,000 for a new grad. And for every year experience, I think it went up 5,000. So I was, I had

[00:05:44] no idea where they would be now, but that's volunteer license. Well, when you're in the IHS, it's all within their system, so it's irrelevant of what state you're in. So I just fly to the reservation, do my thing, and come home, which is nice. And again, I've got an oral surgeon over my shoulder. They do a lecture, but the cool part is you get to do hands-on, losing a lot of bone, you know, any surgical experience like that is going to help you in your career. Yeah. I've definitely heard from people who are doing a lot of surgery. Like once you can do, once you can lay a good flap and do an atraumatic extraction and then like bone graft and re suture up, that's like, you pretty

[00:08:20] much have the surgical foundations down and then the implant placements, kind

[00:08:24] of the easy part once you have those skills.

[00:08:26] Yeah.

[00:08:28] Okay. I told him, I'm coming in, we're doing implants, we're doing these things. He just couldn't get on board with it. There was no ill feelings, but it was like, I'm going to come in and do things the way that I have a vision how I want to do things.

[00:09:40] That didn't work out.

[00:09:41] As soon as I could tell it wasn't going to work out, I was talk about this a little more. So in the build out, how many operatories did you build straight away? Did you leave some room for expansion? Yep. Or did you go ahead and make it a pretty... Yeah, the population of Elk City is about 10,000 and there are probably eight dentists, eight, eight or nine. But the weird thing is about 48% of my patients are from Elk City.

[00:12:24] It's we draw all the way into the panhandle of Texas, Southwest corner.

[00:13:25] I'm assuming like it's it's way more than 10,000 that you guys are actually so yeah It's probably like closer to 50 or maybe even a little bit more than that

[00:13:29] Yeah, probably if you added every little town and everybody that you know ends up coming here

[00:13:35] Yeah, that's awesome. Um have you ever so

[00:13:39] The whole the whole time you were there

[00:13:41] You know have you ever thought about expanding trying to add an associate or I?

[00:14:43] everybody out here has more patients than they get. And that's where I would love,

[00:14:45] like I would love to bring an associate on

[00:14:47] and kind of turn them loose with all the CEREC

[00:14:51] and all the toys and I could do way more surgery.

[00:14:53] But when you're running a busy, busy practice,

[00:14:56] it's really hard to book a sedation

[00:14:58] in the middle of your day,

[00:15:00] because you can't go check all the patients

[00:15:02] and stuff like that.

[00:15:03] And so, yeah, I definitely,

[00:15:05] I would love to get someone out

[00:15:07] and do like a. So yeah, there is no, the sky's the limit on that. As soon as your skills are booked and they're kind of the DSO model. And even when they leave, they come back pretty quickly normally because they know you, they like you, they trust you. So it was not a problem. When I started, I was in network with everybody, most everybody, right? Because I was just getting practice off the ground.

[00:17:42] But I realized real quick, but not as much. Yeah, like I said, you would think we'd have to be in network with everybody, and we saw very minimal effect. If anything, like I said, I'm doing less work, same money if not more. So yeah, you don't have to be afraid to go out of network. It's okay to get in with them when you get started, but as soon as you can, you need to start dropping them.

[00:19:00] Yeah.

[00:19:01] I mean, that makes sense to me, just the mentioned that you had gotten into kind of the digital world really early. So talk to me about when you first, like, when did you first get a scanner? When did you first get a mill? When did you start kind of in the 3D world? Right. So in 2006, I got my first CEREC. It was a red cam and it would be like a, what

[00:20:25] came before a flip phone? The candy, the bag phone and now they're at the prime scan. The number of milling options evolved rapidly, and now there's so many materials. It's insane. The technology worked out great for me. I got to tell you, the one that really probably changed the game was a cone beam.

[00:21:42] I got a cone beam 10 printers, you know, just as they kept evolving. And so, and matter of fact, today we're printing a full arch hybrid for a patient I'm going to deliver tomorrow that we did the surgery today. I would have never imagined that was coming. So it's insane. So, you know, so most,

[00:23:04] you have to be careful when you start buying technology, especially as a, I mean, we're back doing analog workflow. Our school is doing a pretty good job of incorporating some digital, um, into the workflow, but it's, we're not really leveraging the efficiency of it. If that makes sense. They're teaching us how to use it, but not necessarily in an efficient way, in my opinion, um, cause I've seen, I've seen how it's used outside because

[00:24:21] I worked as a dental assistant and I know that it can be a lot more efficient.

[00:24:25] So a lot of people could get into that trap of like, Oh, well be able to like prep, prep a bunch of inlays and not have to do the filling, just, just turn the 3d printer on and just cement it that way. I feel like, I feel like that will eventually happen. Yeah. What are, what are your comments on that? I'm beta testing some softwares and stuff to do exactly that. Cause nothing is more painful than a quadrant of the MOD, MOD,

[00:25:42] or the I'd rather be shot in the foot.

[00:25:44] If I see that on schedule, I'm just like, oh goodness gracious.

[00:26:42] But however many layers, that's how long. And those things, they're so fast now,

[00:26:44] they're like 15 minutes.

[00:26:46] Yeah, so literally all that matters is the incisal,

[00:26:49] then like the incisal gingival height.

[00:26:51] That's all that matters on how long it's gonna take.

[00:26:53] Yeah. That's crazy to me.

[00:26:54] Yeah, and it prints them all at the same time.

[00:26:57] So it doesn't make sense to-

[00:26:57] You don't have to worry about open contacts or anything,

[00:27:00] because it's-

[00:27:01] One, no, because they're very accurate.

[00:27:03] Two, if one of them is open, what's it made out of?

[00:27:06] Composites made out of resin, so you could just- When you mill any material, you have to worry about it chipping. When you cut something thin, it starts chipping. I'm not going to say that is irrelevant in printing, but printing is additive. So you don't have to worry about it chipping. It will build that pretty thin beveled margin without any trouble.

[00:28:20] Yeah, you don't have to worry about anything like an overmill or anything like that when

[00:28:24] you're printing because it's not milling.

[00:28:27] Exactly. right now and I use them all day, every day, whether it's printing guides, models, aligners, restorations, bridges, hybrids. I mean, it's worth every penny. So yeah, you can get into an entire, like you have to buy the cure workflow that is fast and efficient and try not to use 28 burrs to prep a do You don't need them, you know, 332 around very real quick done that shouldn't take long at all

[00:31:05] Little things like

[00:32:02] So there are 20 birds sitting off to the side, right? You don't need it.

[00:32:03] I don't even know what they're called.

[00:32:05] Exactly, don't complicate it.

[00:32:07] You can do a lot with very few birds.

[00:32:10] And just simple things like hemostatic gel

[00:32:13] and packing a little cotton pellet in there goes a long way.

[00:32:16] So keeping things simple on that front as far as operatory,

[00:32:22] I would recommend, for example,

[00:32:24] and this is kind of a Marcostas thing,

[00:33:23] Okay, get a high-powered curing light. Some people are scared of them, then use them forever.

[00:33:25] So if I can cure it in five seconds and you would cure it in 20, add that up over a year.

[00:33:31] Those are all, be efficient.

[00:33:33] Look for the efficient ways to do things.

[00:33:36] And those little things will help you because if you can add five more fillings a week,

[00:33:41] we're not even talking in millions here, but all those little things will add up if you're

[00:33:45] that much more efficient that in the same amount of real quick, we do this and this every time. And matter of fact, once in a while I'll deviate and go, all right, I'm going to use something different. They're like, what? Because they know, like you do this every time, every time. And so being repetitive and predictable is good going to do here? You just already know what you do. Yep. Yeah. Well, once in, you know, like for a lot of times, you know, if we're really busy, I'll have the assistant, my assistant put the matrixes on and stuff like that, and I don't have to worry about it. They, they know exactly the way I do it.

[00:36:22] And if they have to do it, they do it the same way.

[00:36:24] Cause they've seen me do it a bazillion times.

[00:37:27] Wasted movements in here did I change burrs 12 times to shave that one low corner? Is there one bird that could do the whole thing?

[00:37:32] So yeah, don't be afraid to time yourself and see hey, can I get more efficient?

[00:37:35] Don't get corners, but can I do this more efficiently?

[00:37:41] That's that's your secret because let's say you do have to accept every PPO in the world to get started What's the only one way you can make more money?

[00:37:43] Do more procedures. Yeah, and what's the I've been focusing on just kind of like, just from my own desires is just be fast. So I'm glad to hear. And your patients will appreciate it. Do you want your mouth open here an hour, and he moved furniture for this lady to make sure she wouldn't leave me like a bad review on Google. Yeah, that's a crazy story. That's definitely a really funny one though. Yeah, I don't know what application that would have in our field.

[00:40:23] Well, you got it done too fast.

[00:40:26] Are you paying me by the hour? And so I did a continuum down there and cadaver sinus lifts and all that kind of stuff. And so that's kind of what I did then. If I was getting out today and I knew implants was where I wanted to be, I would either A, find a mentor or B, I would go to one of these really good programs like 3D dentist, CSI,

[00:41:41] Pathway, all fantastic.

[00:41:42] And they can get your clinical speed up there quickly and help you understand. find this entire thing before I ever numb the patient. That's a game changer. Once you can already know where you're going before you get there versus, you know, back when we did this before and you flap it all open and look for bone and then figure out a way to get teeth on it. That is a very inefficient, unpredictable way to do it. Yeah.

[00:43:00] I mean, now with the guided surgeries,

[00:43:02] you can even like do an immediate implant placement

[00:43:05] without really doing much of a flap or anything really. with a cone beam, and I learned how close I was to stupid things that I should have never been close to that I would have never done with a cone beam. And in my lectures when I teach, I show my cases where I was like, that's a millimeter away from a lawsuit. You know, that's too brave, too sure of myself.

[00:44:20] Not all of these are still in the mouth 15 years later,

[00:44:24] but I should never be that close to a vital structure molar endo without a cone beam. I'll do an anterior or something like that, but you know, my staff knows if we're doing endo on three, there's about a 75% chance there's an MB2. Give me the cone beam, let me know where it starts, and then I'll find it in half the time. You know? So yeah, it's a given. It's automatic. Molar endo for sure, usually you

[00:45:40] can pre-molar something. Just take one. It'll be fine.

[00:45:43] Yeah. Yeah. I agree with that wholeheartedly for sure. you know, like, that was just barely starting, but maybe it was the angle, and they come back, maybe they don't show up for their six months, and a year later, I'm like, oh gosh, that little thing that I probably should have treated got big in a hurry, and I hate it, I feel terrible every time, but we're human, it happens.

[00:47:01] So I would not have my pride hurt to have someone,

[00:47:06] have an AI just zip through and scan my x-rays and be able to diagnose all the caries and do all of this before I even get to the appointment. And sometimes it takes me like a while to get through it. Whereas I wish I could have like just something I could toggle on and off to just make me, just kind of train my eyes faster to be able to just catch what I'm looking for. I don't want to be completely dependent on it, but just something there that I can just verify

[00:48:25] that what I'm seeing is actually what I'm seeing. helpful thing. Yep. Any advice you have for somebody who's interested specifically in going rural, so not necessarily here in Oklahoma, just anywhere, what advice would you give them? Would you advise them to go ahead and look for an office that they could maybe associate in first?

[00:49:44] What do you think would just be the best route to get into that?

[00:49:48] Right.

[00:50:45] go here look trough trough pop pop that's invaluable so and then if you get plugged in with a good mentor associate who's ending their career you know now

[00:50:51] start talking about man maybe I want to buy this thing because one thing that's

[00:50:55] nice is the way you evaluate practices has changed it's from when I graduated

[00:51:01] to now it's changed multiple times so you, if you're like, man, I want to be the Invisalign veneer king of Western Oklahoma, call those guys. Go work for them. Learn what they do. And then when they phase out, you just take over and you're a haydoc at the football game

[00:52:21] and you just hit the ground running.

[00:52:22] There's no, I say learning curve, there everybody, but a lot of people are like that. So just the, the idea of being rural, setting your own fees, not having to worry so much about, you know, if Delta is doing low, lowering their fees every year, you don't have to worry about that because you're out of network

[00:53:41] anyway. Um, and then also just and still have a lot of friends. Dr. Haney was one of my mentors. He's still there. Love Dr. Haney. So I'm around the school. But yeah, if you have questions or even want to pick my brain, man, I'd love to, you know, just email me and I'll be as much help as I can be, you know?

[00:55:03] Yeah, absolutely.

[00:55:04] Thank you for, you know, just offering for the listeners to reach out that way.