The Best Practices Show with Kirk Behrendt

How Many Days Are You Working for Free?

Episode #570 with Dr. Barrett Straub

Every dentist is working some days for free. If you don't like the sound of that, don't miss this episode! Kirk Behrendt brings back Dr. Barrett Straub, CEO of ACT, to explain what it means to work for free, how it’s not always a bad thing, and how you can track your numbers with ACT’s Effort Quotient and PPO Roadmap. To start aligning your practice and your life, listen to Episode 570 of The Best Practices Show! 

Episode Resources:

• Dr. Straub’s email: [email protected] 
• Dr. Straub’s Facebook: https://www.facebook.com/barrett.d.straub
• Dr. Straub’s social media: @bstraub10
• Subscribe to the Best Practices Show Podcast
•  Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

ACT’s PPO Roadmap: https://www.actdental.com/free-resources/ppo-roadmap 

Main Takeaways:

Follow the money in your practice.

Understand the effort gap and the energy gap.

Make incremental progress. Success isn't overnight.

Doing more and adding more isn't always the solution.

Your goal isn't to drop all PPOs, but to shrink the effort gap. 

Quotes:

“[If you're asked how many days you're working for free,] most people hearing that would say, ‘I'm not working for free any day. We’re charging for our dentistry.’ But in many cases, you're not on some of the days. We find that just about every dentist is working some portion of their month for free. Meaning, there's no revenue coming in for zero to three days, maybe if you're a fee-for-service. We’ve seen up to seven to ten days for some practices that are heavily in PPOs. And the whole idea is that we want to minimize the amount of time we’re working for free. We love write-offs. We love being charitable. We want you to keep doing that. But we want you to know, and your team to know, how many days are you actually working for free. And my guess is, most dentists don't know.” (2:19—3:07) -Dr. Straub

“There are gaps in every dentist’s practice where money is leaving. And that doesn't mean it’s all bad. It just means that it is getting harder, and harder, and harder for dentists to know and follow the money through their practice. So, if you start at the top with gross production, there is the first gap. We call it the effort gap. And that is the gap between your gross production and your net production. And so, that's the one we’re going to focus on today. That's the one we have been focusing on with our PPO Roadmap. It’s very, very important. And that's the difference between the dentistry you produce and the dentistry that you can actually collect on. So, your net production is your maximum collectible amount. So, we see practices producing $2 million writing off, the national average is 42-ish percent of write-offs if you're participating with PPOs. So, you could produce $2 million of dentistry but have a net production of $1.2 million. And you can only collect on that. So, you might have an $800,000, $600,000 effort gap. That's huge.” (4:14—5:34) -Dr. Straub

“One of the challenges, one of the pain points, one of the realities that we see — and I've experienced this. We all have — is we all graduate from dental school with some assumptions, with some thoughts of how we need to practice dentistry, ‘Well, everyone else is doing it, so we have to do it that way.’ And what a lot of people find themselves in is we get out, we go into private practice, we have to be contracted with X, Y, and Z insurances. And we get 15 years out of school, and we're like, ‘I am working really hard, and I thought I'd be making more.’ And that realization, that's what these gaps are for, is for a dentist one day out of school or 50 years out of school be able to follow the money in their practice.” (6:33—7:24) -Dr. Straub

“You're going to hear us talk about getting out of PPOs. And we’re actually not ever going to say like, ‘Every dentist needs to get out of PPOs.’ We’re more of the mind that, ‘Let's track the numbers. Let's know what our effort gap is. And then, let's make some decisions to shrink that gap to where we’re most comfortable.’ So, we see our top-performing, fee-for-service practices in the five, six, seven percent write-off range, and most of that coming from charitable, or what I call elective, write-offs. Mrs. Jones has fallen on hard times. I want to give her this dentistry for free because I can. That's fun. That's a great write-off. That's where you're impacting lives to give away dentistry. That's awesome.” (7:24—8:13) -Dr. Straub

“Our highest PPO practices, yeah, they're upwards of 40%, 42%, 43%, even 50%. That's a lot. They're working really, really hard to have the same collectible amount or less than some fee-for-service. Now, we have tons of practices in the middle. So, you don't have to be either/or. We have lots of practices that have gone through our PPO Roadmap and lowered their worst PPO-performing contracts. Instead of 40%, now they're sitting in 25% and they're feeling really good. Maybe they drop one more, and they're sitting in 18%, 15%. And maybe they’ll never go lower, because going from 40% down to 20%, that's a lot of profitability that you just put in your pocket.” (8:14—9:02) Dr. Straub

“The older you get, the less you have of this very valuable thing called time. So, what you realize is it’s not so much the money, but you're giving away days, and days, and days, and days, and days of your life that you never get back. You never get them back.” (9:49—10:05) -Kirk

“You've got the effort gap at the top, gross production, to actual net production. Then, you've got another gap in there, which is net production, collectible production, your actual collections percentage, which I think should be crazy high. And so, you're losing money there. Then, you've got your overhead percentage down to your net profit. And you've called it out best. Most dental accountants look at the bottom line of a P&L statement and go, ‘You're doing good! Wow, there's $274,000 in here! You're doing great!’ And you're like, ‘But I don't have any money.’ And then, there's one other gap that falls below that, which is cash that goes out that you don't see on a P&L statement like loan payments, like taxes. And so, you've got to be cognizant of these gaps so that you can play with these dials and enjoy your life. Otherwise, your only goal or plan is just more, more, more, more, more, more, more.” (11:07—12:03) -Kirk

“If you're a practice owner, the thing you're worrying about most is, ‘Of my gross production, how much do I actually get to put in my bank account?’ And you're going to realize soon that there are these gaps where money goes out. And as long as you know that, you can make some improvements. The alternative solution has always been, do more, do more, do more. And every time you do more, add a practice, add an op, add a team member, add more capacity, start working Fridays, Saturdays — we’re not saying that's always bad. We’re just saying that adds complexity. And complexity adds more effort, and effort adds energy, and more effort can add more stress. And we’re saying, before you make any of those decisions, know what your gaps are.” (13:45—14:34) -Dr. Straub

“If you truly graduated from dental school and said, ‘I can't wait to work six days a week,’ then go nuts. But no one’s said that.” (14:59—15:12) -Dr. Straub

“You have a life, and you have a practice. And if they're not aligned, you will always default, and your practice will make your life worse off. But if they are aligned and you say, ‘I'm only doing this dental practice thing to have a great life,’ then you get to design your practice. And that may mean not working Fridays, not working Saturdays, not working nights. And that's awesome — if that's what you want to do — which is what I want to do, and you want to do, and most of our clients want to do.” (15:15—15:42) -Dr. Straub

“You have your gross production. That's your one, true master fee. That means everything you've done, you build it out correctly. You then wrote off, whether it’s a PPO write-off, whether it’s an elective, charitable write-off — when you do those six veneers on your mom, actually bill it out and write it all off. You can't put zero in the ledger.” (15:52—16:14) -Dr. Straub

“Simple math, if you have a 25% write-off, you're working one week out of your four of each month for free. You're working until that second Monday before you're even making any revenue in order to pay your team. And now, you have the overhead, so now you're going to pay your team for a while. And you just hope that there are some days left in a month where you, doctor, get some. And for most of us, in most of our careers, we didn't really know those gaps. But where the gaps are going to come in is we’re going to know, our clients will know, exactly what our write-offs are, what those gaps are, how many days they're working for free, and not to beat themselves up.” (17:32—18:11) -Dr. Straub

“What happens when you're more profitable, when you have more money? Does your life get better? Do you get more charitable with your team? Do you have less stress and you have more smiles? Everything gets better.” (18:28—18:40) -Dr. Straub

“At the end of the day, it’s not money. Money allows freedom. That's really what it does. When you make enough money, you go, ‘I'm good.’” (19:06—19:12) -Kirk

“If you are part of PPOs, what we want you to do is bill your true, one master fee. Write it off, what the contracted amount is, just so you know. So, then you know in X, Y, Z PPO plan how much per month, per year are you writing off for that plan. You do that for all your plans. You do that for your membership plan. And you do that for your elective, charitable care, guaranteed services. You set it up so that you charge your full fee, write it off, and just start tracking the numbers. Nothing more.” (19:27—19:58) Dr. Straub

“We don't ever want to say it’s bad to have associates, or partners, or multiple practices — no. However, you have to go in with the knowledge of, ‘Where are my gaps? Why am I adding this capacity? Would it be more intelligent to shrink our gaps before we do that?’ We’re always going to say yes. But just this concept that there are some intangibles. There's stress. There's blood pressure. There's heart rate. There's more blood being given on some practices than others for the same potential collections.” (22:52—23:23) -Dr. Straub

“You're not really creating any more value unless you're getting, essentially, time back. Why would you add six more ops if it doesn't give you six more days?” (23:40—23:50) -Kirk

“Somehow, the message is getting across to young dentists and graduates that the way to a predictable, great life is multiple practices as quick as humanly possible. And once that happens, they will have more time. And I was in those shoes. When I graduated from dental school, I remember saying, ‘I'm going to own five practices. I'm going to run the business. I'm going to get out of the ops.’ And I soon realized, ‘Holy cow. Running this one practice is super hard, and I don't have it figured out.’ I would rather the mindset be, yeah, if you want to do that, go nuts. But get your first practice tight. Get it predictable. Then, use the franchise theory on those best practices. I think it’s opposite to say like, ‘I'm only going to get that life predictability once I have enough practices and enough associates and enough doctors and enough hygienists where I can take time off.’ Again, the more complex, you're going to have less time off.” (24:46—25:42) -Dr. Straub

“I would've originally said maximize your net production with minimal effort. So, we say effort equals time, which I love. Then, it becomes, maximize your net production or the amount you can collect with the least amount of time.” (27:04—27:21) -Dr. Straub

“There's no dentist out there flying from city to city on Fridays going, ‘I built an amazing fee-for-service practice. I work 162 days a year. I came all the way here to show you how you can do the same.’ Because any dentist that has ever done that is not speaking at state meetings anywhere. They're on a boat, or at a golf course, or at a curling tournament on the weekend, or you have a camp way up north. You are not thinking about, ‘How am I going to spread the message?’” (28:00—28:31) -Kirk

“The Effort Quotient is basically saying, how many days per month are you working for free? So, there are four numbers you have to pull. One is, how much did you write off last month to all your PPOs combined? That is the contracted fee, the difference between your one true fee and your contracted fee. So, all your PPOs, how much did you write off to all of them? Number two, elective write-offs, your charitable, your guaranteed service, all the stuff that you have some control over, you're not contractually obligated. That's number two. Those are dollar values. So, dollar values for all three of these. The third is your collections gap. So, if your collections was 95%, then I want you to put a...

Dental Insurance Independence

Episode #569 with Dr. Mark Murphy

Is insurance getting in the way of you and your patients? Do you want to get rid of it altogether? Well, stop right there! To help you avoid a disastrous outcome, Kirk Behrendt brings back Dr. Mark Murphy, Chief Growth Officer from ProSomnus, to provide five steps for a smoother transition into insurance independence. Always look before you leap! To learn the smart way to move away from insurance, listen to Episode 569 of The Best Practices Show!

Episode Resources:

• Dr. Murphy’s email: [email protected] 
• Dr. Murphy’s email: [email protected] 
• Dr. Murphy’s social media: @mtmurphydds
• Funktional Sleep: www.funktionalsleep.com
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Main Takeaways:

Take time to do the math.

Identify your value proposition.

Share your value proposition with patients.

Write the dreaded letter and do it strategically.

Communicate your letter to each one of your patients.

Quotes:

“We are free to choose however we want to practice, wherever we want to practice, whenever we want to practice. This is still maybe the greatest profession ever invented. We get to do whatever it is we want to do, work on whom we want, build the team that we want, do the kind of dentistry we want, and accept the kind of reimbursement models that we want. And I don't care about the economy. I don't care about insurance reimbursement, or availability or no availability of good employee bases. It might take a little longer in some locations, no doubt. It might be harder out in the middle of nowhere land to go nonpar, to live in that kind of world. It might be harder to do comprehensive care. But I've seen practices still accomplish that. If they're willing to work that path, and chase that dream, and make that their vision, it'll become their reality. We are free to choose however we want to do dentistry, whoever we want to be, and what for. And you can't do that in too many other things. It is incredible.” (5:41—6:34)

“I'm from the Detroit metropolitan area. And so, my joke is, Frank Sinatra said it a ton, if we can do it here, we can do it anywhere. In the last decade, we were the only state to lose population. The city of Detroit itself lost 25% of its population. We’re as insurance-ridden as anybody else. We had the deepest, darkest economic woes of anybody. And yet, dentistry survived. And guess what? Guess who survived the best? Dentists who were extremely insurance dependent? I think not. In fact, it was dentists who were more insurance independent. The less that you were feeding from the hind teat that we might call insurance, the more you were dependent on that, the more you were dependent on whatever happened in the economy. And the less dependent you were on that, the freer you were to practice the way you wanted.” (7:50—8:37)

“Someone will say, ‘I can't [be insurance independent]. I have too much debt.’ I'd say, ‘Oh, wait a minute. I think what you said was you can't do that now. That's correct. You probably can't do that now.’ So, when you say, ‘I had this dream. I went to dental school. I had these visions of how I practice. And then, I got saddled with $300,000 and $400,000 worth of debt. I got out. I bought this practice. I inherited the staff that isn't very motivated. They're not alive. They can't see the future well.’ And you say to yourself, ‘I can't get to my dream.’ I would say, stop! There's a comma in that sentence. By the end of the year. Maybe by the end of next year. But guess what? If you start that sentence with, ‘In five years, my practice can be . . .’ then, it starts to become a believable path.” (9:01—9:39)

“Where I wouldn't start is to say, ‘I'm fed up with insurance. I don't like it anymore. I'm going to cut my ties. The umbilical cord is clipped, and I'm off on my own,’ without knowing what risk that carries, without knowing what financial barriers were in your way, without knowing how your team felt — because you can't get there by yourself — without knowing how your patients really felt about that, without knowing whether you've really built a conversation with them, that they understood the value difference of seeing you versus seeing a participating or PPO dentist. If you don't do that, man, the risk is high.” (10:43—11:14)

“The mistake that most of us have made is trying to leave insurance without the right kind of preparation, the right kind of steps in place, the right kind of risk analysis so that we can plan and mitigate appropriately. We don't do that because we didn't go to business school. And so, we don't think in terms of some of the skillsets that we need to make those kinds of decisions.” (11:14—11:33)

“Dentistry has given up 22% of their average income over the last 11 years. That's the ADA statistics, two percent per year over 11 years. You can see those graphs. Now, if you took away 22% from somebody tomorrow, they would throw open the sash and scream, ‘I'm mad as hell!’ But if you took two points a year every year for 10 to 12 years, it’s like putting a frog in warm water and bringing him up to a boil. They never jump out. That's what's been happening to us because reimbursements are going down, debt is going up, and the business model for dentistry is getting more and more challenging. And so, what we’re going to see is more people — that's why you said we’ve had such demand on it, more people saying, ‘How do I get rid of insurance? How do I move in that direction?’ So, the first thing I'd say is, don't jump out of the pot and into the fire.” (11:55—12:37)

“There are steps. There's a sequence. There's a planning system you can utilize to do that, and it’s very simple. When we look at it, we look at it in five steps. The first thing that's most important is you really have to do the math. It’s really simple. You have to do the math. And the math is, what percentage of your patients have what kind of insurance? What kind of write-offs are you taking? You put that into a pretty simple algorithm. Anyone can do this themselves. It’s not easy, but you can do it yourself. If half your patients were PPO and half your patients were fee-for-service and you're collecting your full fee, you might be making 30% off your cash patients and 10% off your PPO patients. So, your blended take, if you will — and that's the wrong way to look at a business. I understand that. We could go into a whole different discussion on that — is you're netting 20%. So, you have to figure out, is it Delta? Is it Blue Cross? Is it one of the Aetnas? Is it a Cigna PPO? There are so many different things. And so, you have to categorize each of those, look at how many patients, how many dollars, how much write-off. Do the analysis and figure out, what's my risk of leaving that group of patients behind? How many of those patients would have to come with me in the new world where I wasn't going to participate with that discounted fee schedule for me to come out whole?” (13:01—14:15)

“It’s never this simple. But in the simpler example I've just described, 30% return on my investment from half my population, 10% from the other, the blended result is I get to keep 20% of a $1 million practice. I'm making a couple bills a year. Life is great. The risk-weighted analysis is pretty simple in that case. If I took a look at that 10% population and I went to full-fee on them, I didn't participate in that fee schedule reduction, two-thirds of them could leave. Two-thirds of them could leave, and I'd be able to retain 30% on the diminished population. And what would my practice look like? Let me think. Same dollars in my pocket at the end of the year. Same net. I'd see fewer patients. I would do fewer procedures. I would work fewer hours. Who doesn't like that so far?” (14:17—15:02)

“We don't do the math and realize that in that, again, oversimplified version, we would only need to keep one-third of that population of patients. And I don't know too many dentists who have such a poor relationship with their patients that a third of them wouldn't stay. So, the first thing is you have to understand the math. Now, if it’s 90% you have to keep, the risk is higher. If it’s 33%, it’s lower. So, we really have to understand the risk of a population of patients. And it’s usually not one singularity, it’s a blend of Delta, Blue Cross, Cigna this, and PPO this. We have to put that together and understand so that maybe you decide you're going to leave these couple of PPOs first. Then, you're going to look at leaving these couple of PPOs. And if you haven't gotten hurt too bad there, then I'm going to go after Blue Cross and Delta. There's a way of mitigating that risk and managing that risk. But first, you have to do the math.” (15:03—15:51)

“I want to know your full production before you have any insurance write-offs or other kinds of write-offs. I want to know your full production, and then your insurance write-offs separated off from the total write-offs because I want to know how much are you really giving away to the insurance companies, and then how much do you choose to give away personally, or you lose in accounts receivable that you don't collect. We want to put those in different buckets. I want to see what the bucket is. So, if you have a $1 million practice and you're writing off $200,000 to the insurance companies, you have $1 million in production, and $750,000 in collection, and $700,000 of that is from the insurance, and the other $50,000 is from other, then I start to get a picture of how much you're writing off for insurance.” (16:14—16:52)

“I want to know how many patients have insurance that is being written off, and then, categorically, which ones. And if we've got a good dentist who can really dive into their data and dive into their software, I'd like you to take a look at those major procedures that you do and figure out what's the average percentage write-off for your Delta patients, for your Blue Cross patients, for your Cigna this, for your Aetna that, because you might have varying ones. And the risk-weighted analysis might lead us to say we should take a look at these couple of insurance relationships, PPOs, whatever they are first, and other ones later because these don't seem to be as bad. And so, we might parse them out in groups. That means it’s going to take me longer because you'll see that there's a six-month cycle to this kind of information flow. But I need to know how many patients, how many insurances.” (16:53—17:43)

“I also need to know what your P&L looks like because your P&L is going to tell me, overall, based on that production model and whatever the mix of insurances and collection is, how do you get to net out what you net out. And I don't want the P&L that says, ‘Here’s what I'm going to pay taxes on.’ I couldn’t care less about that. I want the P&L that says, ‘Here’s what I really make in total compensation.’ That's a different number. That's, how much do I pay myself, how much do I pay into my retirement plan, I've got my kids’ cell phones, an extra car, whatever else is going on in your life, all good by me. I'm sure you've got that all figured out with your accountant. But what is your real, total compensation on that practice revenue? Because that's what I'm going to use as the standard to say, ‘This mix of insurances gets us to this number. How does a different mix maybe get us there? How many patients do we need to keep?’” (17:43—18:28)

“Step number two is identifying a value proposition. It could be creating a value proposition for your practice. There are likely some things that you do in your practice with your team for your patients that are different, better, innovative, more comfortable, more convenient, or something than someone around you does. If there isn't, we’ve got to go find some of those and add them to your mix of services.” (19:52—20:17)

“We do a couple of business things called a KJ analysis or an RWW, a Real-Win-Worth analysis. We look through that list and you line them up to say, ‘Which ones carry the most value? Which ones are the easiest to talk about? Which ones have the best real value to us to explain to patients that they're in a different place?’ And we want to do that, why? Because down the road, we’re going to have a conversation with that patient about why they might want to stay in this practice instead of going to another practice when it costs them a little bit more money to stay here. And if they don't really understand that value proposition, then they're more likely to leave. So, I want to mitigate the risk by my second step, identifying the value propositions that we can incorporate into patient conversations on a daily basis.” (21:13—21:57)

“If we have patients that are there for the wrong reasons, it’s challenging to elevate the value proposition in their mind. But if we have patients of record that have come to know, love, and trust us, and understand who and what we are, then the identification or the ownership of the value proposition is strong. Now, step three takes us to sharing that with the patients. It doesn't matter if I've got this stuff. I've got it on the shelf. Maybe I make exquisite provisionals and I polish them up in such a way that the gum doesn't stick to them. I leave proximal contacts. I let tissue heal for three or four weeks before we take an impression. I mount cases in our articulator and show that to patients. I polish composites and put anatomy in them. But if I don't explain to the patient that, ‘Take a look at this restoration,’ and they go, ‘Oh, man. It looks just like a tooth. I can't even see it,’ well, honestly, I'd humble brag and say, ‘If you'd come in to see me five, six, seven years ago, I probably would've done one like you have on this tooth over here. But what we have found is if we spend a few more minutes polishing and reshaping these like this, two really cool things happen. Number one, they last longer. Number two, those little nooks and crannies I put in there so that it looks like a tooth, they help the tooth chew like a tooth. They're supposed to be in there, those little nooks and crannies. And if I leave it like this one over here, it doesn't work as well.’ That's a value proposition conversation I just had with a patient to help them understand why my filling is a little bit better than the average or someone else’s filling. So, when I ask them to pay a little bit more, they're more likely. Guaranteed? Nope. More likely. Why not guaranteed? People are still people. They're just more likely. I want to keep more of those patients. I want to move the needle a little bit in my favor for retention of that body of patients. And so, it’s not just having a value proposition and identifying it — I've got to share it.” (25:47—27:26)

“Your value proposition might not be doing better dentistry. Your value proposition might be, ‘We have a more harmonious team.’ You care more about people. You give back to your community. They could all be behavioral things. There's probably going to be a mix of some clinical things and a mix of some behavioral things, some environmental things. And that's your mix of who and what you are as a value proposition. Communicating it to them is what's critical.” (29:52—30:17)

“I'm so embarrassed. I've got to tell you one of the worst things I've ever done. I graduated in 1981, and we had a lot of General Motors, Ford, and Chrysler patients out here, and OEMs. Great insurance. Ninety percent, $1,200 or $1,500 for the coverage per year. Back then, my crown fee was $300. So, the worst thing I've ever done for dentistry is, those patients who’d come in and I'd say, ‘You need this crown, this crown, this crown, this crown, and this crown,’ and they'd say, ‘Does my insurance cover it?’ And I'd say, ‘Hell yes. Knock yourself out.’ And some doctors would waive that 10% copay. We didn't do that, but some did. But when $1,200 or $1,500 allowed you to do four or five crowns, we taught those patients to become insurance dependent. We taught them to think like it was an entitlement and like it was a third party evaluating the necessity of this treatment plan. Fast-forward to today and it’s, for me, 35 years later, they pay the same amount. We forgot to adjust that puppy for inflation. We made a lot of mistakes, and it still covers $1,200 and $1,500. And now, that covers one crown and two cleanings a year, and not too well.” (34:57—36:00)

“We’ve created this own world for ourselves. That's actually good news, if you're sitting in my skin. I say that's great news. If we've created this, we could create something else. That means we’ve got to spend some time, effort, and energy unlearning for people about this entitlement program and what insurance is and what it isn't. Now, the trouble is, the ADA is not going to do that for us. Your local state dental society isn't going to do this for us. No manufacturer is going to put on a multi-million-dollar ad campaign. We have to do that mano a mano, womano a womano, one person to one person conversations, face to face, and that's how we’re going to win.” (36:02—36:33)

“Moving away from insurance is not mechanical. You can do the math, but it’s behavioral. You and your team — not you. You and your team. In fact, your team, then you, if you can help it — have to own the value proposition that you're going to share with the patient. If you think that's a good idea, and you sit in your upper echelon and look down on your team and tell them what they're going to do, they will nod and they will smile for two or three days of the first week, an hour-and-a-half for two of the second week. But they will wear you down, and they will win. They will win the day. It’s about engaging your team with good leadership skills, about painting a picture of a preferred future that they might want to enjoy along with you. It’s about sharing that pie when it grows. Because if we end up with fewer patients but we end up making more money doing more of the dentistry that fulfills us, and helping more of our patients have healthy mouths, we should all win. It isn't for me to make more money. We should all win. Patients should win, my team should win, and I should win.” (36:45—37:44)

“When I went nonpar in 1991, it took me forever to get there. When I consult with people now and I talk to them about doing it, it took me forever to get there. Why? Well, because I knew I wanted to go there right away. I was scared. I knew I wanted to go there, but my team wasn't ready. And I...

Risks and Benefits with Patients

Episode #568 with Dr. Lee Brady

Every dental procedure has risks and benefits. How well are you communicating them to your patients? If you're unsure or don't know how to get started, don't miss this episode! To empower you with risk communication, Kirk Behrendt brings back Dr. Lee Brady, director of education for the Pankey Institute and founder of Restorative Nation. She shares her insight for managing patients’ expectations, reducing fears around procedures, and helping patients take ownership over their decisions. To learn how to advocate for patients through your communication skills, listen to Episode 568 of the Best Practices Show!

Episode Resources:

• Dr. Brady’s website: https://leeannbrady.com
• Dr. Brady’s Facebook: https://www.facebook.com/drleebrady
• Dr. Brady’s social media: @drleebrady
• Restorative Nation: https://restorativenation.com
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Main Takeaways:

Learn how to communicate risks and benefits.

Be mindful of what constitutes a risk for your patients.

You have the gift of time. Slow down your conversations.

Focus on risks and benefits that are most relevant for patients.

Advocate for your patients by giving them information and education.

Quotes:

“I think about all of my communications with my patients as being about risks and benefits. It’s the core of patient communication. And often, as dentists, we do think of that as a technical thing, like one procedure has certain technical risks over another one. But I actually think it’s a much bigger conversation than that because, for my patients, they think of the cost of one procedure over the other. One might be a risk or a benefit. A common one is how long it takes for a procedure to get done. So, with implants, we want all of our patients to do implants. And sometimes, they still ask about doing what we would call an old-fashioned bridge. Well, one of the benefits to a bridge is, chop, chop, you're all done in three to six weeks, where implant dentistry sometimes takes six to nine months. To us, we go, ‘Well, that's a no-brainer.’ We want the best thing, technically. To a patient, that may be a tipping point decision.” (3:26—4:24)

“Some people consider any surgical procedure a risk, no matter how much we tell them it’s easy and straightforward. Or the discomfort. There are a whole range of things that we can put in our risks and benefits box that actually are more tied to the logistics of the dentistry for the patient, or the emotional side of it for the patient, than they are about the stuff we learned in dental school.” (4:27—4:50)

“For me, if I need an informed consent, that says to me that I don't trust that patient, or I don't think they trust me, that there's something inherently not right about our relationship. And then, the question I ask myself is, ‘Should I be doing significant dentistry on a patient that I'm not in relationship with, where we don't have that really solid foundation?’ So, it’s a different way of looking at it. But I kind of grew up at the Pankey Institute, and a lot of what I learned there was about patient communication and individualized care, and that piece of it.” (5:18—5:57)

“Every patient that I talk to, we discuss risks and benefits of, not every possible technical solution, but the ones that would be relevant to them, the ones they're most interested in. We go through the technical risks and benefits, the time, the money, the procedures. And then, I document that in their chart that we had that conversation. But I don't have them sign it that I documented it. With that said, I don't do really complex surgical procedures in my practice. I can see where in some practices, depending on the types of procedures that you do, you could totally make a different choice. And that would be okay with me. I think you've got to do what makes you feel comfortable. If having them sign a form makes you feel more comfortable than not having the form then, by golly, you should be doing that. In my case, the form makes me more uncomfortable, so I don't do it. I think that's the great thing about dentistry. We get to make those choices.” (6:32—7:33)

“I tell people all the time, you can have anything you want. The reality of it is, you can pretty much have anything you want around how you could practice dentistry. And whatever you design, now you have to ask yourself, ‘What am I going to have to do to get it? What are the costs of doing it?’ And often, the cost is you're going to produce less if you work fewer days a week. Or sometimes, it’s funny, you don't. You think that'll be the cost, and the reality is you produce just as much, or you produce more because you're more focused on the days you're in your office. Or if you're actually having a good time, you're enjoying yourself more, you're going to be more productive. But it’s always a give-and-take. It’s always about, there's stuff on both sides of the scale. You've just got to say, ‘Am I willing to give this up to have this?’ But it’s a gift in dentistry that we get to do that. We get to design our lives.” (12:51—13:49)

“That's success, when a patient comes in and they have ownership around the choices they made for themselves based on the options we give them. It wasn't at all about what I'd said. The part to celebrate was that he got, ‘I chose to do this, and I knew what the outcome might potentially be. So, now I'll go back, and I'll make a different choice.’ It’s hearing that somebody has that kind of ownership that makes me want to celebrate, that I'm actually getting better at communication. I'm actually learning how to do this better. It’s taken a lot of decades, but I'm getting there.” (16:07—16:51)

“If I don't do a comprehensive exam, however you define that, if I don't look for all the risk factors — and I don't know what all the risk factors are that the patient has, whether that's technical risk factors, or I get to know them and it’s something that's going on in their lives right now, or whatever it is. But if I don't own those risk factors, I certainly can't have a conversation with them about that. So, it always starts there. And I tell dentists this all the time, and I actually believe this, any time I have one of those uh-oh moments in my dental practice, what I know is there was a risk factor someplace that I didn't uncover on the front end, and it cropped its head up and it showed up in my life.” (17:59—18:53)

“One new learning for me this morning was, this is a patient who’s at the very end of a three-and-a-half, almost four-year treatment plan. Guess when we discussed fees? Three-and-a-half to four years ago. You have all these big, glorious conversations about your treatment plan, and here’s what everything is going to cost, and you lay it all out. And so, one of the things that I realized this morning is, when you start to do this kind of dentistry that spans some time, because it’s interdisciplinary or it’s very complicated, one of the risk factors is — and there are two. I think there are two pieces of this puzzle. One could be that you get to the very end of a treatment plan, and your teeth are looking good, and they're feeling good, and you sometimes forget why you were doing all this in the first place. So, it’s possible that the value proposition, for him, isn't quite what it once was for these last little steps.” (19:39—20:44)

“I wonder if we need to do, not really a new case presentation or a new consult, but for these long cases, if periodically we need to schedule a check-in. The patient and I check in together and catch up, like, ‘Here’s what we’ve gotten accomplished, and here’s what's still ahead of us. Let's talk about the logistics for what's ahead of us, what's still to come,’ so instead of there being a four-year gap between the execution of some pieces in the conversations about that, it’s closer in time so that it doesn't get lost someplace. So, those are risks and benefits. There are big benefits to doing complex dentistry and interdisciplinary care at a dental level and at a patient level. And one of the risks is you can't remember those conversations, always, for four years.” (20:57—21:56)

“One of the pieces of this that took me a long time to get is that they're not my teeth. They're actually the patients’ teeth. It’s the patients’ health, and they are the patients’ choices. And I love that word, that my job is to be their advocate. At a beginning level, my job is to help the patient have the information that they need to be able to successfully make their own choices.” (23:01—23:33)

“I always hesitate to use the words “information” or “education” because sometimes I think we put way too much stock in it in dentistry. And I'm really clear that having the information does not move someone to action or change someone’s behavior. However, if you don't have the information, you have no option for changing your behavior or for making another choice. So, there's a level at which the information is foundational. So, the patient does need to understand the current conditions that are going on in their mouth. The patient needs to understand what their choices are. And in my case, I would say they need to understand the risks and benefits of those different choices, including choosing to do nothing. There's a certain set of risks and benefits to choosing no treatment. And then, once the patient has that, then my job is to support them in that choice. And then, ultimately, the third piece of it is if I'm actually the right person to execute the treatment they choose. Then, my job is to now put my technical hat on and actually execute that care or the phases of the care that would fall into my purview. But, exactly, it’s the patients’ choices. I think that's a better way to think about it for the patient. And I also think it's a better way to think about it for us as the caregiver, as the practitioner.” (23:35—25:05)

“One of the things that I thought in the beginning when I started to learn about a different way to practice, I really had this picture in my head of, ‘I'm going to do these new patient appointments that take two hours or longer. And then, the patient is going to go away, and I'm going to sit down, and I'm going to spend an extended period of time reviewing all their records. And then, the patient is going to come back, and we’re going to spend however much time together talking about all of this. And then, of course, they're going to absolutely want to do everything I recommend. And then, it'll all move forward.’ And first of all, my experience is that model actually doesn't work that way, always. Some patients, it works great. They're ready to make a decision at that first consult or treatment planning. Some people aren't. They need time to process.” (26:01—26:53)

“In dental school, unfortunately, we were taught, ‘Do an exam. Present the treatment plan. The patient says yes.’ You know what? That model works awesome for some procedures. Like, if you said, ‘What percentage of the time does that model work when they need a simple occlusal filling?’ I'm hoping the numbers are reasonably high. If I said, ‘In the average practice, how often does that model work if they need a single crown?’ I'd also expect your numbers to be reasonably high. I can remember a time in my practice where for scaling and root planing your numbers wouldn't have been really high because, at that point, the general public wasn't very knowledgeable about gingivitis and periodontitis. Today, when you tell somebody that they need a deeper cleaning, or whatever language you use, my guess is your numbers are pretty high because people start with a base understanding and a base desire. I mean, the reality is, if they're in our practices, they care about their teeth.” (27:37—28:40)

“One of the things I think we forget in dentistry is we have the gift of time. We have the gift of time. We get the opportunity to see the same patients over, and over, and over over an extended period of time. So, the whole conversation does not have to happen in one appointment. This conversation can be an evolution. I actually think it’s better that way. I actually think it works better if you don't ask the patient to eat the whole elephant in one appointment. Give them a chance to get some information, go home, experience some things for themselves, come back, and then deepen that. So, you're right, you have to spend a little bit more time. But that time could be divided up over a pretty big number of appointments.” (29:02—29:54)

“If you're going to be with the patient and have a conversation with a patient, for that conversation, however long it is, 60 seconds, 120 seconds, five minutes, can you be fully present with that person and actually, in that conversation, get the most out of it so that when that one minute, two minutes, or five minutes is over, the patient has a different level of ownership and understanding about whatever it was you talked about, even if it was one tooth or one old filling? And if the answer is yes, then we’ve moved the ball forward. If the answer is no, in truth, to me, you wasted two or five minutes that could've been super important in your relationship with that patient.” (29:57—30:42)

“What does dentistry need to look like for you to love it, for you to really be empowered and engaged? I know dentists who have come to my practice, and they’ve observed in my practice, who walk away and go, ‘I could never do this this way.’ And I'm like, ‘You know what? That's awesome learning. That was worth you standing here for however many hours, seeing how I do it, to walk away and go, this does not fit my personality. It doesn't fit my philosophy.’ I happen to have a dentist that's a super good friend that I've known forever. He sees probably three to four times the number of patients on any given day than I do. And he does it because he loves it that way.” (31:44—32:25)

“If you're going to try to change your practice, change it slowly. Do not derail a high-speed train because it will not get you to the outcome you want.” (33:08—33:19)

“When you pull up to the office, if you actually have to sit in your car for a minute to get yourself prepared to go in, my intuition is there's something about what's happening in your practice that you might want to evaluate and say, ‘Could I do it differently?’ so that you're not sitting in the parking lot going, ‘Okay, I can do this.’” (34:41—35:02)

Snippets:

0:00 Introduction.

3:06 Risks and benefits, explained.

5:01 Why Dr. Brady rarely does informed consent.

7:36 What Dr. Brady learned after returning to dentistry.

13:51 Get better at communicating with patients.

17:17 Risks around not remembering fees.

22:39 Your job is to advocate for your patients.

25:34 Slow down your conversations.

30:49 Have it your way.

35:34 More about Dr. Brady’s online courses and Restorative Nation.

Dr. Lee Ann Brady Bio:

Dr. Lee Ann Brady lives in Phoenix, Arizona, with her husband, Kelly, and three children, Sarah, Jenna, and Kyle. She owns Desert Sun Smiles Dental Care, a private restorative practice in Glendale, Arizona. Outside of her private practice, Dr. Brady is the Director of Education for The Pankey Institute, recognized for hands-on education programs focused on occlusion and restorative dentistry. She is the founder and lead curator of Restorative Nation, a supportive learning community for dentists.

In 2010, she was recognized by Dental Products Report as one of the “Top 25 Woman Dentists in the U.S.” in the category of dental educators. In 2005, she joined the non-profit Pankey Institute as their first female resident faculty member. Within a year, she was promoted to Clinical Director, and held this position until November of 2008. In 2008, she was asked to join Dr. Frank Spear in the formation of Spear Education and the expansion of his curriculum. As the Executive VP of Clinical Education at Spear Education, she managed the development and delivery of all programs in addition to her teaching responsibilities. In 2011, she left Spear Education to focus more on patient care and hands-on education.

Dr. Brady earned her D.M.D. degree from the University of Florida College of Dentistry. Being a lifelong learner, she dedicates countless hours to studying and understanding occlusion, restorative dentistry, and dental materials performance. She enjoys researching and teaching these clinical disciplines, as well as patient communications, case acceptance, and team development. She is passionate about solving complex cases, understanding the needs and concerns of her patients, facilitating the success of colleagues, and helping dentists find balance in their lives. 

Howard’s Best Advice for a Successful Career in Dentistry

Episode #567 with Dr. Howard Farran

An A in dental school is an A in dental school. Without learning about business, you won't have a successful practice. To help you think better about the business side of dentistry, Kirk Behrendt brings in Dr. Howard Farran, founder and owner of Dentaltown, to offer some of his best advice for a successful career in dentistry. To hear Dr. Farran’s insights and to learn what dental school never taught you, listen to Episode 567 of The Best Practices Show!

Episode Resources:

• Dr. Farran’s website: https://www.howardfarran.com
• Dr. Farran’s Facebook: https://www.facebook.com/HowardFarran
• Dr. Farran’s social media: @howardfarran
• Dentaltown: https://www.dentaltown.com
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Uncomplicate Business: All It Takes Is People , Time, And Money by Dr. Howard Farran: https://www.barnesandnoble.com/w/uncomplicate-business-howard-farran/1120331563

Main Takeaways:

Your practice is a business. Learn about business.

Learn about demographics before starting your practice.

There's no “good” time to start your business. Just start now.

Audit the people, especially the dentists, you choose to be around.

You're not a doctor of everything. Learn to delegate things you're bad at.

Spend and invest wisely! Bad spending habits will be the source of your stress.

Quotes:

“If you get an A in business and you're a horrible dentist, you'll be a millionaire. If you're the best dentist in Kansas City and you don't know anything about business, you're going to have a very miserable career. You have to learn business when you live in capitalism, especially somewhere like the United States.” (4:45—5:01)

“Demographics is the most important thing [to learn]. I'd say in the last ten years, every time I see a kid come out of school and they do $1 million the first year and put $350,000 take-home, they always went to a town of 5,000 and they're the only dentist. A lot of them went to a town of 2,500. But you see in Arizona, where we have two schools, every kid thinks that if they go to North Scottsdale where all the rich people live, that's where they would make the most money. And in 2008, when we had the economic collapse, I think Arizona had like 74 or 76 dental offices go under. Half of them were in North Scottsdale. And when I opened up in Phoenix, Arizona, the town south of me, Maricopa, which is a 30-minute drive, did not have a dentist for the first seven years I opened. And then, there's a town next to it called Florence, which didn't get one for seven years. I'd have all these faces, ‘It took me an hour to get here. It took me 30 minutes.’ And so, these kids don't understand demographics. You go to any major city, there are all these medical dental buildings. They seduce these young, dumb, green kids who don't know any better and say, ‘We’ll do your buildout for free, and we’ll give you six months’ free rent.’ Well, why do you think they're doing that? Because they have a horrible, horrible, horrible location that only you would rent. No Starbucks would go there. If a Starbucks or a mani-pedi — if something retail would not go in your location, then why the hell are you going there?” (7:52—9:28)

“You don't do mani-pedis and hair. But you clean teeth, whiten teeth — it’s basically the same thing. It really is. As far as a business, it’s hair, nails, teeth, gums. [Patients] don't go to the dental office because they're worried about P. gingivalis and anaerobic bacteria. They go because they want whiter, brighter, sexier teeth, and they want their nails done and their hair done. You're on the third floor of a medical dental building in an area that has a dentist for every 500 people, and you think you're going to solve this massive nightmare demographic problem with a Facebook Ad? Are you out of your mind?” (9:29—10:04)

“Business in three words is supply and demand. Why are you going to create a supply of something where there's no demand?” (10:57—11:03)

“It took me four months and ten days to open up [my practice]. I see these kids now, and they're like, ‘Well, I need more training,’ so they go do a residency. And then, they go to the Navy. Then, they go work for some corporate dental chain. And the bottom line is, they're just fear-driven. There's no “good” time to have a child, and there's no “good” time to start a business.” (11:32—11:54)

“The reason that banks are loaning to these kids, I mean, 99.5% of the loans get approved because dentistry is so non-competitive. The only reason you fail on a bank loan is a personal failure of getting your license taken away. And it’s usually drugs. So, if you can look in the mirror and say, ‘I can stay clean. I'm not going to lose my license,’ from whatever drug you're on — you're only going to fail if you get addicted to something. So, if that's not your problem, borrow the money and get in.” (13:03—13:36)

“The markets have changed over the years, but I like acquisition better than de novo. De novo is when you open up a store from scratch. I like acquisition better because look at what happens. Let's say you go to a town, and let's say there are 5,000 people and there are five dentists there. If you open up a dental office, now there are six dentists there. If you go in and buy an old man out, now, there are still five. When you purchase, you eliminate a supplier and you're not adding supply to the standard demand equation. So, I like acquisition better.” (13:38—14:18)

“Half of America lives in 147 towns. The other half lives in 19,008 towns. And many of these states — take Iowa, for instance. If you go to Iowa, they’ll give you a list of 20 towns. If you go there, the state of Iowa will give you $100,000, and Delta Dental of Iowa will give you another $100,000. So, you're complaining about your $300,000 student loans, and you can pay off two-thirds of it. So, then you go to this town. Then, you go down to the mayor, and it’s a town of 5,000. They’ve got like eight empty buildings on 1st Street and Main, and they’ll say, ‘Do you want one of these buildings?’ They’ll give you the building. So, now, you own the land and the building. You've got $100,000 from Delta and $100,000 from Iowa. And those small towns, they think a really great job is $10 an hour. I mean, they'd kill for $10 an hour. So, now, your number-one cost of labor, which is 28%, is now your lowest cost. You have no competitors. You don't have to do all these PPOs. And it’s crazy good.” (14:24—15:26)

“It’s all trust because we sell the invisible. These young dentists will go in there and they’ll buy this practice. They’ll see all these old ladies who are 60 years old that have been there for 30 years, and they got a raise every time the earth went around the sun, and he thinks his labor cost is too high. So, he says, ‘You know what? I'm going to fire these five 60-year-old women and replace them with five 20-year-olds for half the money.’ And then, what does that town of 5,000 think? ‘Oh my god. When old man McGregor left, all them good ladies, they didn't even stay for 30 days. That guy is a disaster.’ And then, you're going to try to change your brand on Facebook, and Twitter, and Pinterest, and all this bullshit where it’s just noise — they don't trust you.” (18:07—18:54)

“The dentists that unleash their staff to communicate, and diagnose, and get out the intraoral camera and show the X-ray, and all that stuff, they have a far higher treatment plan acceptance. I can't tell you how many dental offices I've been in where the dentist blames it on exogenous factors like the economy, and Obama, and Trump, and “build the wall”, and the Chinese, and all this crap. And I'm like, ‘Okay. I've heard all your noise. But you collect $750,000 and take home $145,000 on the same number of patients, 1,800, as the guy next door. He’s got 1,800 patients in the same damn town, and he’s collecting $1.4 million and taking home $400,000. You both have the same president, the same country, all the exogenous variables.” (19:46—20:32)

“You're a summary of your five best dentist friends in your dental office. At home, you're a summary of your five best friends who are out of the dental office. And when you join the Academy of General Dentistry and when you're going to those AGD meetings, those other five dentists who become your friends, they're CE junkies. They're on a quest to learn everything. No little detail is going to be missed. So, now, you're with five guys who are gunners. They're just going for it. They want to learn implants, ortho, endo, perio, and ped. They want to learn it all. So, now, your five best friends are getting their FAGD, their MAGD, and then they're calling you up saying, ‘Hey, are you going to that course on Saturday?’ And you're like, ‘What course?’ It reminded me of when I was in the dorm and you tell a friend, ‘Are you ready for that test tomorrow?’ And they're like, ‘What test tomorrow?’ I'm like, ‘God, are you out of your mind? We have a test at 8:00 tomorrow.’ So, if you hang around with people who know there's a test tomorrow, who know there's a CE course, who are telling you to go do this, you're a much better dentist.” (22:17—23:18)

“Really, really, really audit your dentist friends. That's why I like Dentaltown. I mean, who are these dentists that after 5:00, half of them want to go home, watch ESPN, drink beer, and say they hope their dental office burns down and they collect the insurance policy. And then, the other half are on Dentaltown arguing about the best bonding, root canals, whatever, till 3:00 in the morning. You need to feed off that energy.” (23:43—24:08)

“Look at sports. You watch the Super Bowl or a basketball game, the coach is totally engaged, walking up and down the field, yelling in plays. He’s totally in with his team. As they come off the field, he hugs them, and all this stuff. You go into dentistry, the dentist gets done with the root canal, walks in his office, and shuts the door. I would check out my patient and talk to them, and then greet the next one in the waiting room, super engaged. I'm in the game the whole time. I'm pacing the floor. When they say, ‘Okay, I've got to greet the next patient,’ I'll say, ‘Do you want me to go get them?’ Because I like to go out in the waiting room and shake their hand, talk to the next people, and make them laugh or whatever. But you're totally engaged, and you feed off that.” (25:22—26:07)

“Half the dental offices in America, the dentist is the last person to get to work. He shows up 10 minutes late. This patient is in the room at 8:00, and he walks in at nine after, and sits down with his Starbucks coffee. And then, when he’s done at 4:30, he’s like, ‘Well, can you make the temporary?’ And he goes home. When you're the last there and the first to leave — take the offices where the dentist is there first, and he stopped by Safeway and got a dozen donuts. He's in there first, and he’s the life of the party, and greeting them, and listening to them, and also making them feel safe. You go to most staff meetings, the doctor does all the talking because the staff is not even engaged, and they live in fear. In fact, if somebody wasn't going to go to the staff meeting, it should be the dentist. Or the dentist should go and not talk, because you need your team to talk. You need them to tell you — communication, communication, communication.” (26:12—27:08)

“If you had an A+ team and you did horrible dentistry, you'll have a $1 million practice. If you're the best dentist in Kansas City and your team is miserable, you'll be miserable your whole life. It’s all HR. It’s 80% people. It’s people management. It’s quarterly reviews. You go on Dentaltown, and people say all these things like, ‘I can't believe my hygienist . . .’ They're always griping about their hygienist, or their staff, or whatever. And the problem with gossip and griping is it’s misdirected.” (27:10—27:44)

“The worst thing in HR is not realizing that you have a toxic person in there that comes to work. Their glass is half empty. It’s not the man in the mirror; it’s everyone else’s fault. They have this super bad attitude.” (28:30—28:43)

“Look what they do with players. Not only is the coach walking up and down the basketball court, the football field, and all this stuff. At the end of the season, what percent of the teams trade players? All of them! They're like, ‘You know what? You were a B. But I'm looking for a B+. I'm looking for an A-.’ And then, look at dentistry. Ethel has hated her job for a decade. You go to the dental office, and there's a glass wall. You have to knock on the glass wall, and she slides it open and hands you a chart. Doesn't even make eye contact. And she’ll have her job in healthcare for a decade. I mean, that's just crazy.” (31:45—32:21)

“The one thing dentists have a problem with is they're a Doctor of Dental Surgery, but they often think they're a doctor of everything. And so many times in a business, like, the dad was really good at planting and harvesting corn or wheat or small grains. But it was mom at the kitchen table that was really good on a calculator, and worked with the accountant and the IRS, and paid the bills. If I go into a dental office and the average team members, their morale is low and the turnover is high, I'll say, ‘Who’s been doing all the hiring?’ And they say, ‘The dentist.’ I say, ‘Okay. Well, you suck at it. You're not intuitive at it. This is not your skill.’” (33:22—34:01)

“Some of these dental office teams, they're all bowlers and like country music. Other teams, they're all line dancers. They all have their flavors. They all have their chemistry. You build up this corporate culture. And when the culture is bad — the fish rots from the head first. And the dentist is the head — capital, Latin, head. When that culture is dysfunctional, that's yours, buddy. You own that culture.” (36:10—36:37)

“I want the dentists there first, leave last. I want them to focus on HR. I want them in between patients. I'd like to go in most dental offices and take their private door down because you always see staff standing outside the door, waiting for the emperor with no clothes to walk out. Take that door down. Get engaged. If you nail the HR — I've been doing this for 30 years. When I walk into an office, I can smell success in 30 seconds. It’s fun, it’s energy, everybody is smiling, and you feel it.” (38:28—39:02)

“Hire slow, fire quickly, and get rid of toxic people.” (46:09—46:12)

“A lot of these dentists think that they're going to have a $1 million practice if they buy $1 million of technology. If they have a CBCT and a CAD/CAM and a laser, everybody is going to be super impressed with that. I don't see any evidence of that. In fact, I see the opposite of that. Whenever I see a dentist collecting $1 million and taking home $350,000, they almost never do ortho, Invisalign, place implants — they don't do any of that shit. They’ve got two or three full-time hygienists that have been there for a decade, a bunch of long-term staff doing a bunch of restorative dentistry. Their overhead is low, and they make mint. And instead of putting all their money in CAD/CAM, CBCTs, and laser, they're putting more money in labor. Because those girls that have been there 10, 15 years make more money. But I see so many people that get out of school with $350,000 in debt, and they think the secret is to buy $150,000 CAD/CAM, $100,000 CBCT, and fly out to the Dominican Republic to learn how to place implants. They keep spending all this money.” (47:54—48:57)

“The average dental office collects $675,000. But everybody who has a $1 million practice puts their money into consultants.” (50:07—50:14)

“If you can triple the trust, you'll triple your treatment plan presentation. And remember, if all your bills cost $1 and you do $1 worth of dentistry a month, your overhead is 100%. Don't change any of your bills and do $2, and now your overhead is 50%. The number-one cause of overhead is treatment plan acceptance. If you double your treatment planning — and the national data is scary. For every 100 cavities diagnosed, we drill, fill, and bill 38. So, we’re only doing — and I believe this. When you tell three people they have a cavity each, dentistry is doing one. One of those people wouldn't do it if you gave them a golden egg, because the sapien is a crazy monkey. But the better treatment plan presenters with more trust in the office, long-term staff, they get the middle third. And that's the difference between doing $750,000 and taking home $140,000, and doing $1.5 million and taking home $350,000, is getting that middle guy to do it.” (56:47—57:48)

“Again, it’s trust. It’s treatment plan presentation. If you want to buy technology, get intraoral cameras. Get digital radiography. Get 60-inch monitors so when I put that camera in the mouth, that cavity looks like you could go stick your foot in it. And when mom’s looking at that, then start talking about hair, nails, and teeth like, ‘I could smell that cavity.’ And she’s like, ‘Oh my gawd! Oh my god! You can smell it? Oh my gawd! Oh my gawd, do it right now!’ They care more about beauty than they do an anaerobic bacterial infection in a rock in their head.” (59:09—59:49)

“If you're going to invest money, the millionaires invest it in income-producing assets. Poor people spend all their money on consumption. A fool and money will soon be parted. If you're going to part with your money, you'd better buy something — if I'm going to spend a dollar, it better make me a nickel a year in perpetuity. Because I can buy a tax-free bond. I can buy a government bond. Every time I buy a government bond for a dollar, it'll get me a nickel till the end of the government. I can die, and that bond will still be giving me a nickel. You want to have a dollar? Then you need to buy $20 of these bonds. And if I can spend a dollar on something that’ll get me a nickel every year till the end of time, why are you buying a boat, a jet ski, a condo, and a BMW? It’s just dumb. Quit spending money.” (1:05:01—1:05:54)

“If buying a laser or a CAD/CAM or a CBCT makes you run 20 red lights on the way to work, it makes you be the first one there, it’s a boys-and-their-toys — if buying it lights your fire,

The Keys to Effective Morning Huddles

Episode #566 with Kirk Behrendt & Robyn Theisen

Do you dread morning huddles? Do you even have them in your office? If you've never done them, stopped doing them, or don't want to have them, it’s time to make a change! A huddle is more than just a huddle, and Kirk Behrendt brings back Robyn Theisen, one of ACT’s amazing coaches, to help you have effective morning huddles that you can't live without. Huddles are the most important part of your day! To learn the right way to do them, listen to Episode 566 of The Best Practices Show!

Episode Resources:

• Robyn’s email: [email protected] 
• Robyn’s social media: @actdental
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Dental Intel: https://www.dentalintel.com

Main Takeaways:

Make morning huddles the most important thing of your day.

Establish a time where all team members can be present. 

Start and end your morning huddles on time. 

Huddles don't all need to be 30 minutes. 

Be prepared and be engaged. 

Remove all distractions. 

Quotes:

“[A morning huddle is] an opportunity to all get together at the beginning of the day, start with something positive, and kick off a great day together. It’s also an opportunity for us to identify areas that, ‘What do we have going on today? How can we serve our patients best? How can we make this flow best for our team? And then, for tomorrow, what opportunities do we have, and how do we use today to fill those opportunities and maximize the time we have?’” (2:05— -Robyn 

“Depending on who you're listening to, many people agree that teams that do huddles produce, on average, about 17% more — I don't know why 17%. I've heard that so many times — than teams that don't.” (2:36— -Kirk

“[A morning huddle] gives us an opportunity to focus, to fine-tune our day, and know exactly what opportunities we have and how we’re going to maximize them.” (2:54—3:01) -Robyn

“I hear so often from team members, ‘We get there, and then the doctor shows up late,’ or, ‘Everybody is talking during it,’ or, ‘We read off the schedule. I can read everything that we’re talking about. It’s right on the schedule. They're not focusing on the right things.’” (4:32—4:49) -Robyn 

“The first [step] is identifying the time. Ten to 15 minutes, when you get into the rhythm, is all you really need. Obviously, morning is when most people do it. I have teams that prefer to do it, if they don't have a team that comes in at the beginning of the day, they may do it over lunch. They may decide that they all end the day at the same time, so that's where they do it. It’s about establishing a time that everybody can be there and doing it.” (5:29—5:51) -Robyn 

“A missing component when people talk about leadership is predictability. You have to be consistent as a leader. If you're a father, you have to be consistent. If you're a mother, you have to be consistent. If you're a leader, you have to be incredibly consistent. People start to believe in you when they know what's going to happen — in a good way, not a bad way.” (6:13—6:32) Kirk

“If the doctor doesn't show up on time, [the team starts] to believe that too, that there isn't value [in the huddle] and that it’s not important.” (6:35—6:40) -Robyn

“I know what you're thinking. ‘Kirk, you don't understand. I've got a lot going on. I had to talk to the periodontist. It’s crazy at my house. I had two kids that were sick this morning.’ And so, you come in with your cape and you go, ‘I own the business, so I don't need to really be here. Just tell me what's going on, and you guys get started without me.’ The second you start thinking like that, we all see your behavior as, ‘He or she doesn't care.’ So, you have to make it important.” (6:43—7:11) -Kirk

“Along with having [a morning huddle] is starting and ending on time. So, the point is to be consistent with what time you start. End on time so that you're not late with your patients or getting your day started late. So, having [a huddle], and being on time. The second piece that I would say is, when you get to the meeting, you're at work. It’s time to go. There's no eating. There's no putting on makeup. There are no cell phones. It’s time to get to work and be prepared for the day. So, no disruptions.” (7:23—7:50) -Robyn

“Start on time and end on time. That's critical. Even if the huddle is terrible, start with that.” (7:52—7:56) -Kirk

“We had a great coach years ago, and he made us do our meetings at like 12:03 and 10:35. And I'm like, ‘Why?’ He goes, ‘Because 12:03 is 12:03. It is not 12:05.’ And I've never forgotten how specific that is. When you're not on time for anything, it screams, ‘I don't care.’ So, if you're going to want people to be on time, which is an important component of your practice — you could actually build a dental practice just by being on time. You could. Think about that. And it starts with a huddle. So, you have to be prepared.” (8:00—8:31) -Kirk

“When the meeting goes — bam. There's no food. I don't mind coffee. But if you're going to do a huddle, a team meeting, anything — and don't do it over lunch because I'm starving. When I'm hangry, I can't think. I've got to eat too. So, make sure you set up some rules. Remember, the thing is you've got to set up some rules.” (9:19—9:37) -Kirk

“To me, [putting makeup on at work is] the same thing as — when you arrive at the office, when you punch in, it’s not to surf the internet. You're punching in because it’s time to work. And so, that means coming prepared, being ready to go, because we’re walking out of the meeting and we’re going straight to our patients. So, being prepared for the workday and being ready to go, that's when we start our workday.” (9:47—10:05) -Robyn 

“We talked about predictability, being on time, and starting on time. A big part of that is coming prepared. So, it’s being specific about what each person or each department is bringing to the meeting. And I like to tell my teams, if you can read it on the schedule — I can read that. I'm looking for things that aren't on the schedule. And so often, I see that business team members are the ones that are preparing for hygienists, for assistants. And I find it very important for every person to be auditing their charts and coming prepared with their schedule, because the more that you put into researching and knowing exactly what's happening in your day, the better results you're going to get from the information that you've researched.” (10:17—11:02) -Robyn

“You have to have the admin team members [at the huddle]. Non-negotiable. I think it’s really important. Remember, one of the things you have to do in a business is you teach people how to treat you. I get it that Mrs. Finelli is early for the appointment. She loves coming early, chatting with everybody. She probably brought some muffins or whatever. But putting a sign up there in the front saying, ‘Hey, we’re back meeting. We’ll be with you in a minute,’ she will get that.” (12:22—12:48) -Kirk

“Even saying to [a patient], ‘Gosh, it’s great to see you. We’re going to go have our meeting to prepare so we can give you the best experience possible today. We’ll be back with you shortly.’ That's really what we’re trying to do for the day, is prepare for the patient so that they have the best experience with us.” (12:51—13:05) -Robyn

“[A huddle] doesn't always have to be 15 or 30 minutes. We’ve seen huddles that are really well done in eight minutes.” (13:08—13:15) -Kirk

“There is the perception that [a huddle] has to take so long, and for bigger teams that they can't get through it. It’s really about coming prepared and having each person know their role, and you can efficiently go through it no matter how many people you have. It’s about coming prepared and knowing exactly what each person’s role is for the meeting.” (13:21—13:38) -Robyn 

“One thing that I've had success with is having meeting buddies. So, if there are people that come in late, it’s their responsibility to find their meeting buddy and find out exactly what happened and be prepared for that meeting buddy to give their information the day before. So, they're giving that meeting buddy their information to give at the morning meeting, and then finding them when they come in so that they can find out what's going on for the day and what was at the meeting.” (14:09—14:33) -Robyn 

“Here’s how dentists’ brains work. And this is how your brain works, if you're listening. You're always thinking in terms of exceptions. So, when Robyn and I are talking concepts, you're thinking about the one team member this is not going to work for, or you have three patients that aren't going to go for this, or you've got a partner or associate that this isn't going to work for. Stop thinking like that. Start thinking globally like, “This would be important for all of us to be on the same page.’” (14:35—14:59) -Kirk

“If you're going to build a dental practice with all these moving pieces — I don't care if you have four team members or 400 team members — you have to decide, how well do you want this thing to run? And I would caution you to not bypass the huddle because you've got team members coming in at every — you're going to lose 17%, if not more, of your production because you decided not to do that.” (15:18—15:44) -Kirk

“If you have a dental practice and you run it, I would make the huddle the most important thing of the day. Period. And think better about it.” (15:46—15:55) -Kirk

“I am a big fan of Dental Intel. We use it at ACT, and I know many of our offices have it, especially their Morning [Huddle] and the way that it is set up. One of the things that I like the most about it is that it looks at three days, yesterday, today, and tomorrow. I think that yesterday can be overlooked by many team members, and the importance, and I think there are some specific things with looking at yesterday that can help us to capitalize on opportunities. What I mean by that is I know in many morning meetings teams will look at, for example, ‘Who are we going to ask for reviews from today?’ And so, when we start with yesterday, now I can go back to those team members and say, ‘How did it go with asking for those reviews?’ So, there's an accountability piece to it, and it’s a way to identify the opportunity. So, if we didn't ask, or we weren't successful with getting the reviews, what do we need to do to change that? If we’re focusing on collections and we need to get our collection percentage up to be able to review, ‘Here’s what we said we would do today,’ then tomorrow, we’re going to say, ‘Did we actually do that?’ And so, it’s an opportunity to reflect on those things, and have some accountability with our teams, and identify opportunities to improve or celebrate the win.” (17:31—18:45) -Robyn

“You do have to talk about the loss. But when something goes well, the huddle is the perfect opportunity to go, ‘Hey, whatever you guys did at 1:00 and how you put those appointments together, that was freaking amazing.’ You're going to positively reinforce that. What you want to do is you want to give voice or energy to that because where your energy goes and where your brain is, that's what you create more of.” (18:52—19:18) -Kirk

“What gets measured gets improved. But what gets measured and reported on exponentially improves. And [hygiene reappointment percentage is] a wonderful one just to put in the “yesterday” thing. My hygiene reappointment percentage for yesterday was 95%. Boom. And you're going to see, once you start putting that in the morning huddle, it’s going to go up. Because if I'm a hygienist in a dental practice and I'm at 72%, I'm not going to report 72% today, 71% today. I'm going to feel some pressure, in a good way, to up my game.” (20:03—20:36) -Kirk

“Numbers don't have to be viewed as negative. To me, they're not subjective. They're black and white. So, if a hygienist is at 70%, what we really need to identify is, why does that keep happening? And if somebody else is getting 90%, what are they doing that the other hygienist isn't, and how do we change that system so we all get the result we’re looking for?” (20:46—21:06) -Robyn 

“I am a big fan, and I know at ACT we’re a big fan, of block scheduling and scheduling to goal or looking for opportunities and being productive. And so, in Dental Intel, looking at today and tomorrow, there are opportunities to at look to know, ‘Have we scheduled to goal? Do we have openings in the next two days? And if so, what are the opportunities that are coming in today that we can fill into those holes, or how do we direct them?’ So, if the business team members come with, ‘Here’s the next rock that we have in the doctor’s schedule,’ or, ‘Here’s our next new patient opening in hygiene,’ we can identify those people coming in today who can fit into those, because our best opportunity to do it is with the people that are in front of us, not the ones we have to call on the phone.” (21:14—21:54) -Robyn

“[People with balances is] something that I would say the admin team comes prepared with. They're looking for people who have balances, do we have treatment plans assigned? So, we know all of those people that are coming in. And I know Ariel recommends talking to those patients before they even go back for their treatment, and we’ve identified it so we know exactly who those people are and can make sure that we get those balances. If we aren't able to collect the balance before they go back, now, all of our assistants and our hygienists also know those people have got to stop by and see the business team before they leave today.” (22:17—22:44) -Robyn

“I heard a statistic that it takes up to 17 touches to get in touch with somebody once they’ve left your office. So, if we can identify those people in terms of next schedule hygiene appointment — is everyone leaving with a hygiene appointment? Is there unscheduled treatment that needs to go on? Are there balances that we need to collect? We have a greater opportunity doing that today than we do trying to catch them once they leave.” (22:52—23:14) -Robyn

“We can look at opportunities, I think a great one is hygienists coming prepared with, ‘Who needs perio charting today?’ That's a great opportunity where that can really put a hygienist behind. So, if we can identify who those people are at the beginning, now the assistant or the admin team, or whoever can help out with that, has time to prepare and know exactly who can fill that in instead of when the patient comes in, now we’re trying to scramble to see who can help out. We’ve allowed the assistant or the business team member time to identify what their day looks like, who can help where, and be able to plan their day to accommodate.” (23:56—24:30) -Robyn  

“It’s an overlooked opportunity to really plan, review yesterday, celebrate the wins, identify areas that may go on our issues list to be able to figure it out as a team how we address them. We look at today and maximize the opportunity for today and the flow of the day to make sure that people have a great day, and patients have a great experience, and then identifying the opportunities for tomorrow so we can capitalize on any openings that we have or getting patients in in a timely manner. So, really identifying that, looking at those three days, and making it the best that we can make it.” (24:42—25:13) -Robyn

“We’re at an age where finding, keeping, and retaining great team members is harder than ever. There's no better way than for you to sit down, create a few giggles, fun stuff. Now, you don't want team members disrespecting you because you're giggling all the time, and nothing is happening. That's not good. But remember, team members that are great ones — nobody ever leaves a practice. They leave a person. So, if you have a great chairside assistant, or a great front desk person, or a great anybody in your practice, one of the greatest things you can do to keep them long term is to be engaged with them. And the huddle is a great place to do it.”  (25:44—26:25) -Kirk

“When you do your huddle — like, I want people to know I care. I care about you. And so, as a dentist, a huddle is more than a huddle. It’s the fulcrum. It’s the beginning of a great relationship that only gets better if you treat it and think about it the right way.” (26:33—26:50) -Kirk

“[Make] it fun. I know Dental Intel has the motivational minute at the end, and different fun videos. I have teams that bring in jokes or a motivational quote for the day. So, ways to make it fun, and get your day started on the right note, and set yourself up for a positive day.” (26:53—27:08) -Robyn 

“I'll throw in one more tip too. Do you guys get Google Reviews? I hope you do. You're going to get some great ones. What a great opportunity to say, ‘Hey, before we start the meeting, I've got to read this. It came in yesterday.’ Read it, and go, ‘Thank you, guys. That's who we are.’ Or when a patient brings in gifts, somebody brings in muffins and they say, ‘You've changed my life,’ what a great opportunity to share the story. Or share the story of the kids on the team members in the dental practice. Say, ‘Hey, I want to say congratulations to Lucy and her daughter. I saw that yesterday. That was so cool.’ You're going to show people you care. Again, is your practice relational, or is it transactional? The huddle tells us all.” (27:10—27:55) -Kirk

Snippets:

0:00 Introduction.

1:47 Why you should do morning huddles.

5:22 Establish a time for morning huddles.

7:20 Get rid of all disruptions.

10:12 Show up prepared and be engaged.

11:58 Admin team members need to participate.

13:06 Huddles don't have to be 30 minutes.

13:38 Arrange meeting buddies.

14:34 Make huddles the most important thing.

17:26 Use Dental Intel’s Morning Huddle feature.

18:46 Use huddles to reinforce positive behaviors.

19:53 What gets measured gets improved.

21:08 Look at today and tomorrow in Dental Intel.

21:56 Get aligned about patients and opportunities during huddles.

24:33 Last thoughts.

Robyn Theisen Bio:

Robyn Theisen brings an entire life and legacy of dental experience to the team and every team with which she works as the daughter and sister of dentists. With almost 20 years of experience in dentistry, her roles ranged from practice management...

Why You Need a Leadership Team

Episode #565 with Jenni Poulos

Whether you have a team of three or a team of 30, you need a leadership team. To reveal why you need one and what it can do for your practice, Kirk Behrendt brings back Jenni Poulos, one of ACT’s amazing coaches, with advice for building a great leadership team early in your career. Remember, you can't run a practice alone — and you were never meant to! To start creating a smarter, healthier, more aligned team, listen to Episode 565 of The Best Practices Show!

Episode Resources:

• Jenni’s email: [email protected] 
• Jenni’s Facebook: https://www.facebook.com/jenni.poulos
• Jenni’s social media: @actdental
• Subscribe to the Best Practices Show Podcast
•  Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Kolbe: https://www.kolbe.com

DiSC: https://www.thediscpersonalitytest.com

Myers-Briggs: https://www.themyersbriggs.com/en-US

Rocket Fuel by Gino Wickman and Mark C. Winters: https://benbellabooks.com/shop/rocket-fuel

Traction by Gino Wickman: https://benbellabooks.com/shop/traction

Main Takeaways:

You can’t be a solo leader. 

Find a mentor or coach early in your career.

A leadership team is not just for small practices.

Figure out who you are and your unique ability ASAP.

Be intentional and committed to creating a leadership team.

Having a leadership team will keep you aligned, smart, and healthy.

Quotes:

“I love Brené Brown, and one of my very favorite quotes of hers is, ‘You can't do it all alone. You were never meant to.’ And really, when you're running a practice any size, you need help. You need someone that you can bounce ideas off of. You need someone to work through the challenges. You need people to execute in their unique abilities so you can execute in yours. And having members of a leadership team that you trust that you can be vulnerable with, that can help you make tough decisions, live within your core purpose and your core values, is going to really elevate your practice, elevate your life, and take you to places you didn't know that you could go.” (2:06—2:54) -Jenni

“Having a leadership team does not mean run out and get a partner. That's not what we’re talking about. It may include that at one point in time. But sometimes people think, ‘Well, running a dental practice is lonely. I need somebody I can work with and bounce ideas off of, so I'm going to split my business in half and bring in another dentist.’ That's not the smartest thing. It’s not. If you're lonely, get a coach. It’s a lot cheaper.” (2:57—3:25) -Kirk

“The big elephant in the room, especially when I begin coaching and working with small docs and I say, ‘Hey, we need to get our leadership team going,’ they say, ‘I'm a group of five. I'm not going to have a leadership team. I'm a solo leader.’ It’s like, ‘No, you're not a solo leader. And you're not intended to be a solo leader.’ I will be a part of your leadership team. Or if it’s not me, if you don't have a coach, you need to find a mentor. You need to find someone that can be that thought partner with you that can help you make decisions, help you think outside the box, look at things in a different way. You have to bounce ideas off of someone, or else you're living inside of your head, which is a dangerous place to live all of the time. So, no matter how small [of a practice] you are, you need a leadership team.” (4:13—5:08) -Jenni

“As a coach, that's one of my favorite things to do, is to be a part of your leadership team, to be that person that you can bounce ideas off of, and think differently, and point things out in ways that maybe you wouldn't. That's what a great leadership team does. They challenge each other to look at things in a different way, to look outside the box, have a new perspective, maybe think about something that we didn't think about. And this is how we get to the best decisions for the practice.” (5:08—5:38) -Jenni

“The first thing you should do when you own a business is get a mentor or a coach. A mentor can save thousands and thousands and thousands of hours of your life. A coach can do exactly the same thing.” (5:43—5:55) -Kirk

“The other thing I didn't really do early in the process, which I'm going to encourage all of you guys to do, is figure out who the hell I was. I wish I would have taken every personality test under the sun, like the Kolbe, DiSC, Myers-Briggs, worked with an intense behavioral specialist, and figured that out by the time I was 30. And then, I would have gone all-chips-in on who I was.” (9:29—9:55) -Kirk

“You need to be thinking about priorities, the path, the vision, and where you're going. And a leadership team is going to help you get there.” (11:06—11:14) -Jenni

“There are three areas that you need to really excel in to kill it in your practice. You need to be aligned, you need to be smart, and you need to be healthy. An amazing leadership team is going to level you up in all of these areas because the alignment is going to come clear when you have someone that has these complementary strengths to you, and you can bounce ideas off of one another, and get really clear on where you're going and developing priorities and a path for your team that gets you to these goals.” (11:23—11:59) -Jenni

“An amazing leadership team is going to get you aligned, get you smart, and get you healthy.” (12:51—12:56) -Jenni

“Pete Dawson used to say making money was a byproduct. It’s the byproduct of doing the right thing with the right people for the right reasons, all that kind of stuff. And that is absolutely true. If you're a dentist and you want to make a lot of money, it should never be your goal. Your goal should be to do something great.” (13:01—13:16) -Kirk

“Being a great leader and being a great leadership team isn't about what you tell people. It’s about how you show up, how you support, how you grow the people around you, and how you grow great leaders. And when you're so in the weeds alone, it becomes frustrating and it’s hard to really be the type of leader that projects what they expect. When you're so in the weeds, it’s hard to project that amazing attitude, that smart, aligned attitude that you expect of your team. And when you can share in the responsibility, when you have people that you can bounce ideas off of, bounce frustrations off of, you can really project what you want. And as a great leader, you're in front pulling and leading and showing what you want. You're projecting the attitude. You're projecting the core values. You're projecting the work ethic that you want to see from your team. And that's going to elevate everyone around you, and they're going to want to work harder for you because they see you working hard for them.” (15:06—16:26) -Jenni

“People don't leave practices. People leave people. So, if you ever lose a great team member, they didn't say, ‘This place is messed up.’ They left a person. So, the leader has got to get better.” (16:44—16:54) -Kirk

“A great leader is this: it’s not somebody who is amazing, thoughtful, brilliant — no. A leader is consistent. What they do, ultimately, is grow other leaders that grow other leaders.” (17:02—17:13) -Kirk

“You can't just develop a leadership team and go, ‘Go!’ There are laws. You have to have bylaws. One of the most important bylaws that I screwed up a lot is you can't have workaround conversations. You can't have these sidebars. You can't agree to something and then have a sidebar and trump the other people on your leadership team. That's the fastest way to make them super angry at you and obliterate trust.” (18:14—18:39) -Kirk

“Because we have trust and vulnerability, we've been able to come to the table and say, ‘Whoa, we’ve agreed that we don't do this. We've agreed that we bring things to the table, and we discuss them.’ It allows us to work through those challenges and grow together. But absolutely, you have to be committed to one another, committed to the process, and you have to work at it. And when there are agreements, you have to honor them.” (18:49—19:18) -Jenni

“Vulnerability allows us to create these environments of psychological safety. And we’ve talked about this before, Google actually did a study on this with 40,000 teams. The most effective teams across all industries have environments of psychological safety. What that means is team members feel free to say, ‘I don't know. I need help. I made a mistake,’ and to ask questions without fear of repercussion from their teammates or their leaders. As a leader and as members of a leadership team, that begins with you guys practicing that together, and then modeling it for your team. And being vulnerable doesn't mean like this weepy, oh-my-gosh sob story. It's about being honest. It’s about saying, ‘I need help,’ about saying, ‘I don't know.’ And that is a tremendous strength that you need to learn and grow into. And when you can develop that, when you can develop that within your leadership team, your team will see that and they’ll begin to feel free to say, ‘I want to grow, and I need help to grow in this way. I'm uncertain and I need help here. I made a mistake and I want to get better.’ That's what you want from your team. You want them to say, ‘I want to be better, and I need help in this way to get better.’ When they start asking for help in that way, that's when the magic is going to start happening.” (20:36—22:19) -Jenni

“An effective leadership team, the meeting cadence and getting things done, it can't be haphazard. The one thing I would encourage you is that you really have to set aside time to say, ‘We’re going to be intentional about this. We’re going to sit down. We’re going to land the plane. We’re going to talk about the things that matter.’ Just as we talk so much about the importance of the team meeting, meeting with your team, calibrating with your team, this is also so important with leadership. And the bigger you get, the more intentional you need to be about this. Don't just think, ‘Oh, we’re going to fit in some time at our lunch,’ or, ‘We’re going to meet for a few minutes before.’ Because what happens? We see an emergency over lunch, or we’ve got to finish our chart notes, or life happens and we’re coming in late one day, or we have to leave early. Be intentional about creating this team and being committed to it, or it won't work for you.” (24:13—25:17) -Jenni

“Time is the new rich. I don't care how big your practice is, how many locations you have. I don't care how cool your practice is. All I care about is how much time you have. The person who has the ability to do what they want with their time is the richest person in the world. And that's the hugest benefit to building something that's worthwhile, more time.” (26:30—26:54) -Kirk

“Whether you're a practice of three or a practice of 30, this is a component that you need. Having a leadership team, be it two, five, ten people, it’s going to create that aligned, smart, and healthy practice. It’s going to bring outside perspectives, bring complementary strengths, and it’s going to let you share in the challenges and the joys in your practice. So, if you don't have one, commit to making it happen.” (27:30—28:00) -Jenni

“Even if your practice is really cool and you have an amazing leadership team, you've got to have a coach that coaches your leadership team. Our coach is going to be here next week. She’s a badass. She kind of scares me a little bit. I'm worried to see what's going to come out of her mouth. But she can say things I can't say. She can call me out in the middle of the room, and we use terms like “gloves off”. ‘Here they are, gloves off. Here’s the truth.’ And one of my favorite things she’s ever said to us is, ‘I can see ceilings you guys can't.’ And it’s so true. It’s amazing when somebody from the outside can take your leaders and make them healthier and think better in a way that there's more glue and more alignment.” (28:06—28:47) -Kirk

Snippets:

0:00 Introduction.

1:54 Why you need a leadership team.

2:56 Leadership teams aren't just for large practices.

5:39 Stop living in your head.

7:31 Figure out who you are and your unique ability.

11:01 Get your team aligned, smart, and healthy.

14:59 What it means to be a great leader.

18:11 Develop trust and vulnerability.

22:24 Be aligned at the top.

24:01 Invest in your leaders.

27:26 Last thoughts.

Jenni Poulos Bio: 

Jenni brings to dental teams a literal lifetime of experience in dentistry. As the daughter and sister of periodontists and a dental hygienist, she has been working in many facets of the dental world since she first held a summer job turning rooms and pouring models at the age of 12. Now, with over 10 years of experience in managing and leading a large periodontal practice, she has a firm grasp on what it takes to run a thriving business. Her passion for organizational health and culture has been a driving force behind her coaching career. She has witnessed firsthand how creating an aligned and engaged team will take a practice to levels of success that they never believed possible! 

If I Only Knew Then What I Know Now

Episode #564 with Dr. Colin Richman

Your health and your time are two of the most important resources you have. Once they’re gone, they’re gone! But it’s not too late to invest. To help you protect these assets, Kirk Behrendt brings back Dr. Colin Richman, assistant professor in the Department of Periodontics at the Medical College of Georgia, to share the lessons he wished he knew in his early years of practice. To hear about the best ways to prepare for your future, listen to Episode 564 of The Best Practices Show!

Episode Resources:

• Dr. Richman’s email: [email protected] 
• Dr. Richman’s cell phone number: (404) 784-7272
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

A Philosophy of the Practice of Dentistry by Dr. L.D. Pankey and Dr. William J. Davis: https://pankey.app.neoncrm.com/np/clients/pankey/product.jsp?product=86&catalogId=10&

Mayo Clinic Executive Health Program: https://www.mayoclinic.org/departments-centers/mayo-clinic-executive-health-program/sections/overview/ovc-20253196

Cleveland Clinic Executive Health Program: https://my.clevelandclinic.org/departments/executive-health

Cooper Clinic Executive Health Program: https://www.cooperaerobics.com/Cooper-Clinic/Executive-Health.aspx

Johns Hopkins Executive & Preventive Health Program: https://www.hopkinsmedicine.org/executive_health

Integrated Dental Seminars: https://www.integrateddentalseminars.net

Main Takeaways:

Balance your life.

Make smart investments.

Be proactive with your health.

Join an Executive Health Program.

Don't normalize your day-to-day stress.

Quotes:

“I tell my residents, I tell my kids, I tell anyone who will listen to me, your career is a 40-year project. It’s not, ‘How much am I going to make next year?’ and, ‘Which potential employer is going to pay me a $10,000 sign-on bonus or $2,000 more a month?’ This is a 40-year project. And in hindsight, it’s not a dress rehearsal. So, as a young graduate about to enter this noble profession, I'll tell you as follows: balance your life. Look at Pankey’s Cross of Life. On the four pillars of what he talks about, profession, love, faith, and you, get everything in balance.” (14:16—15:20)

“Very, very, very few dentists ever go bankrupt. You all can be successful no matter what you do. Enjoy it. Enjoy the ethics of an ethical career, and be prepared. Be prepared for the serious things. Let some of the glamor, the glory, the cars, and the big houses be an aspiration for one day, but get everything into perspective. What is important is, run a decent practice. You don't have to have the biggest practice in town. You don't have to have the most number of zeros behind your name on the bank statement.” (15:24—16:10)

“Stop and smell the roses. There's a wonderful quote that is unfortunate. It takes a crisis to stop and smell the roses — which is what happened to me. I like to believe I was successful. I had a fabulous practice. I was lecturing all over the country. I was teaching. I was working with residents. I was on the school board. I was at every one of our kids’ games. But there was very little time for Colin, and there was [less] time for Colin as a husband.” (17:00—17:34)

“Recruiting as many patients as you can as your primary objective in life is not what we were put on this planet for. Very few reasonably ethical — I'm not talking of the best of the best — reasonably technical individuals do not land in trouble. They all make a decent living. Some have got an extra one or two zeros. I did very well. I had a lot of balance. We saved in our 401(k) from day one, so there's 40 years of saving. We had an IRA from day one. We did all of those things because I came from an immigrant family who fled the Holocaust with their lives, and that is where we grew up, in South Africa. So, we were taught, you save a decent amount of money as a priority. And we did. We had intelligent investments, not speculative investments; balanced investments, non-high-risk investments. And the magic of compound interest over 40 years, thank goodness, when the crisis came, money was not a problem. I could walk away and do whatever I wanted to do. And that's what I'm doing now. I'm having fun with dentistry as my hobby. I earn a few pennies, and that's fun. We could do that. So, balance is, remember you've got a family. Remember to be involved. Get off that cell phone and have dinner with your family.” (18:17—20:18)

“We’re not on this planet to see how many patients we can recruit, because then the problem is, what are you going to do with all these patients? I love these ads, ‘100 new patients a month.’ What are you going to do with those 100 patients a month? Are you going to examine them? Are you doing treatment? Are you going to drill-and-bill? So, that is part of balance. You are the driving force of the empire. You are responsible for those working under you, although that's changing in the corporate world. You are responsible for the well-being of your staff, the well-being of your family, the well-being of everything around you, and the well-being of the thousands of patients you are blessed to treat. You are the course. Look after yourself.” (20:26—21:19)

“Be proactive. And [looking after your health is] part of it. Set up a proper retirement plan. Make sure your wills and all your legal documents are up to date. Make sure you're accounting. Make sure everyone around you knows your wishes.” (25:17—25:31)

“I have always exercised, whether it was jogging around the neighborhood. Then, about eight years prior to the cardiac arrest, friends invited me to join their biking group. I'm not a great athlete. I don't have to get out there every day and run or do whatever, but exercising is a priority. We watched our weight. We watched our diet. As I mentioned, I knew we had a cardiac history, so diet was important. I was carrying a few extra pounds that, in hindsight, I didn't need to be carrying. But the important thing is, when they diagnosed me with high blood pressure and with what's known as heart failure five, six years ago, at that stage, treatment should've gone beyond tablets. And had I known about the Mayo Executive — I did not know about it. At that stage, most of us have very deliberate day-to-day activities. I would have gone for that Mayo Executive physical, or the Cleveland, or the Cooper, or whichever one you want. I chose Mayo, and I chose the main branch of Mayo because I think they're ranked as the number-one medical entity in the world. That's why I went there. It’s readily available, and it did not cost me a fortune.” (26:28—28:10)

“Balance it out. Exercise. Exercise with your kids. Spend time with them. Exercise doesn't mean you've got to break a vigorous sweat every time. Exercise means movement. Sign up with a gym. Give your staff, as a benefit, gym privileges. Look after your staff. I looked after my staff. It was part of the condition of the sale of the practice, I'm told, that they will be looked after at the same level that I had done for the past 30 years. And I still work with my successor in that. We help our patients to look after their mouths. What about the body that's attached to that mouth? And look after your own. Now, a real sidebar issue: how many dentists see their dentist twice a year, and floss every day, and all of that stuff? . . . That's a topic for another time. Look in the mirror. Am I doing what I'm saying, or saying what I'm doing?” (28:19—29:27)

“[One thing I would have done differently is] I would have gone to Mayo for an executive physical. Once they made a diagnosis many years ago, and I had a heart issue, and I was hospitalized, I would have gone to Mayo. I would’ve put more credence to, ‘We don't know why you're having a problem,’ as an unacceptable answer and I would've delved deeper. So, on a personal note, that is what I would have done differently.” (30:22—30:50)

“When I mentioned to my existing cardiologist — whom I haven't had a great relationship with in Atlanta — that I want to go to the Mayo Clinic and they're going to do this, that, and the other, he commented, ‘Well, you know, we can do all that here.’ And I thought to myself, I didn't say anything, ‘Then why didn't you?’ So, I think you've got to be proactive, and quizzing, and ‘Why does this happen?’ And when you talk about the Pankey cross balance of life, that's not a religious cross. That is the four pillars of balancing your life out and taking things seriously.” (32:04—32:53)

“Our lives are complex. Our lives are full, and we wear numerous hats without realizing it. We’re under intense stress without realizing it. And that stress becomes normalized, all the little sidebar crises that dentists have to get through their day, and to get through their week, and the individual crises of each staff person, and then the plumbing goes out, then the compressor packs up, then the crown didn't arrive on time. Every time that happens, it pulls on that heart muscle a little bit. And that becomes normal. One has got to put that in perspective. One has got to put that in perspective. The five percent of patients who don't pursue treatment — think of the 95% that do pursue treatment and the 80% of those that become part of your extended family. You can't make everyone happy. Most of us who are in the service businesses strive for 100% success. There's a balance. There's a serious balance there.” (33:18—34:38)

Snippets:

0:00 Introduction.

1:35 Dr. Richman’s background.

4:19 The event that shortened Dr. Richman’s career.

13:47 Stop and smell the roses.

17:44 What balance truly means.

22:25 Be proactive with your health.

25:43 Dr. Richman’s thoughts on exercise.

30:07 Things Dr. Richman would have done differently.

34:54 More about Dr. Richman and how to get in touch.

Dr. Colin Richman Bio:

Dr. Colin Richman was born in South Africa. He graduated from the University of Witwatersrand School of Dentistry and completed his residency in Periodontics at the University of Connecticut. He practiced general dentistry in London and Johannesburg, South Africa, for six years before entering his post-graduate residency program at the University of Connecticut. Following completion of his residency program, he and his wife moved to Atlanta, Georgia, where he held a faculty position at Emory University School of Dentistry until the school closed. He then entered private practice, limited to Periodontics and Implant Dentistry, for the past 27 years.

Dr. Richman is an assistant professor in the Department of Periodontics at the Medical College of Georgia and is affiliated with Perimeter Community College, Department of Oral Hygiene. He is very actively involved in Periodontally Accelerated Osteogenic Orthodontics (PAOO) and has been described as a pioneer in the emerging technology of PAOO.

Dr. Richman has delivered more than 200 continuing education programs both in the U.S. and abroad. He is the Director of the Seattle Study Club of Atlanta and belongs to numerous dental organizations. He is a Diplomate of the American Board of Periodontology and an Honorable Fellow of the Georgia Dental Association.

Dr. Richman is married to Maureen Richman and has two sons, Steven, who is a practicing tax attorney in Atlanta, and Peter, who is entering law school with a focus on cyber law. 

How To Make a Dentist’s Life Easier

Episode #563 with David Harris

Over your career as a dentist, the chances of being embezzled is about 70%. So, what can you do to lower that risk? To share some answers, Kirk Behrendt brings back David Harris, embezzlement expert and CEO of Prosperident, with four best practices to prevent embezzlers from stealing your time and money. Put systems in place so embezzlement doesn't happen to you! For tips to make life as a dentist a little bit easier, listen to Episode 563 of The Best Practices Show!

Episode Resources:

• Prosperident: https://www.prosperident.com
• Call Prosperident: (888) 398-2327
• David’s Facebook: https://www.facebook.com/davidharrisprosperident
• David’s social media: @davidharris9406
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

**Email David for a free copy of his Embezzlement Risk Self-Assessment Questionnaire: https://www.prosperident.com/contact-us

Prosperident’s Hall of Shame: https://www.prosperident.com/hall-of-shame

Dental Embezzlement: The Art of Theft and the Science of Control by David Harris: https://www.barnesandnoble.com/w/dental-embezzlement-david-harris/1134016570

Previous Best Practices Show episodes with David: https://www.youtube.com/results?search_query=act+dental+david+harris

Main Takeaways:

Prevention is better than the cure.

Check collections and deposits monthly.

Remember to check your day-end reports.

Track any financial discrepancies with a graph.

Learn to use your practice management software!

Your team doesn't need access to bank statements.

You should be delegating to your team, not abdicating.

Quotes:

“The chance that a dentist will be embezzled in his or her career is around 70% . . . So, it’s not a problem that affects a small corner of dentistry somewhere. The majority of dentists will be embezzled. Sometimes, it’s taking tens from the office, or a few thousand dollars, or maybe scrap gold from the gold jar. And sometimes, it’s over $1 million dollars.” (4:14—4:44)

“About half of those who get embezzled once will be embezzled again. And about half of those will be embezzled again.” (4:49—4:59)

“Most dental offices don't have really good control systems, and that means that people get away with things that shouldn't happen. And the goal is to improve. It’s just like dentistry. If I'm a patient and I go to my dentist and say, ‘Doctor, I want to spend the least money in my lifetime on my teeth.’ What the doctor is probably going to do is hand me a toothbrush and a can of dental floss and say, ‘Use those like you believe in them, and see my hygienist every six months. That will keep your lifetime outlay to the minimum, because what happens if you neglect those things is going to cost a lot more, and it’s going to be a lot more invasive.’ And I'll say exactly the same thing about embezzlement. Prevention is far, far, far cheaper and requires a lot less heart muscle than remediation.” (5:30—6:21)

“Let's talk first about how embezzlers think. If you're a dentist and I work for you, the first question I'm going to ask is, ‘Does [the doctor] know how much money should be in today’s bank deposit?’ It doesn't matter, to be clear, whether you make the bank deposit or I, your office manager, does. The first question is, does [the doctor] monitor how much the practice management software says was collected? And if the answer to that question is no, which is probably the case in 80% of practices, then stealing is incredibly easy for me. I mean, all I have to do is divert some of the deposit. I don't have to do anything exotic in the software. If you do monitor deposits against collections, I can still steal. But it’s a lot harder because now what I have to do is teach the software how to lie to you about how much money came in. It can be done, but that's a lot harder.” (6:32—7:26)

“Let's ask the really basic question: why do 80% of dentists not compare what the software says they collected versus what went into the bank? It’s a simple concept. The problem is that the practical application of it is a little bit tough. So, it’s the end of the day, today. It’s 5:00. You had a busy day. You’ve seen 20 patients. You got bit twice. You are really thinking about getting out the door. There's a report that appears from your practice management software, and you get the idea, ‘Okay. But before I go home, I really need to check this against the bank deposit.’ Here's the problem. A lot of the money that was collected today is going to arrive in your practice’s bank account either earlier than today or later than today. In other words, we have what we call timing differences. So, think about a patient who pays today by credit card. Your software captures that as a payment today, your practice management software. But that money doesn't get to your bank until probably two or three days from now. So, you actually have no way of comparing that amount in your software against the deposit in the bank today. You have to say to yourself, ‘Okay. I need to write that down on a piece of paper, put it in a spreadsheet or something, and then come back to it three days from now and see if that amount actually arrived.’” (7:27—8:54)

“Another complication is that a lot of payments go by electronic funds transfers into a doctor’s account. And when an insurance company pays by EFT, there's a timing difference but it’s actually in the opposite direction. So, what the insurance company does is they send out the money electronically, and they send the EOB, the explanation of benefits, by the U.S. Postal Service. Electronic funds transfer of money gets there in your bank account in about 30 minutes. The EOB, the explanation of benefits, might take four or five days to arrive, and then somebody in the practice opens it, and they might be too busy today to post it, so maybe it goes tomorrow. And again, what you're forcing the doctor to do is to go back into the electronic banking and try to find a deposit that might've happened four days ago, or it might've happened 34 days ago. So, trying to do all that at the end of the day when you're really thinking about getting out the door is a bit of a daunting problem, and it’s asking a lot of somebody at a moment in time when they probably don't want to do it. And the consequence is, as I say, most doctors have given up on this one.” (8:57—10:14)

“We have always had the tradition that [checking collections and deposits] should be done on a daily basis. And I'm probably going back to before your time, but if you think back to before computers, in the old pegboard system, there was really no such thing in pegboard as a monthly report. The whole focus of pegboard was today. And at the end of the day, the doctor got the report and the bank deposit, and lined one up against the other, and decided that all the money was there. So, we’ve continued, even though computerization has been around in practice management software for over three decades, that basic mentality of, ‘This is something we should check at the end of each day,’ is still there. I'm going to make a radical suggestion. Don't do that. Let's look at a month at a time instead of a day. And that means a couple of things. The first thing it means is that rather than doing this activity 20 times in a month, we do it once. So, that just got a lot easier. Even though we’re doing it for a bigger period of time, once is easier than 20. If you had to do a quadrant of fillings, you would logically try to do them all at once because it’s numbing once, and prepping once, and so on, rather than doing that four times for a quadrant.” (10:17—11:46)

“There are some other advantages [to checking collections and deposits once a month]. The second advantage is that a lot of those timing differences that I mentioned have now self-corrected. In other words, when you're looking at a whole month at a time, a credit card payment that is recorded in software on the sixth of the month and gets deposited to your bank on the tenth of the month, there's no longer a timing difference because you're looking at the month as a whole. So, now the timing differences you have to contend with when you look at a month are only the transactions that overlap the first day of the month and the previous month, or the last day of the month and the next month. So, the percentage of deposits, if you're looking at a single day, it’s really easy for 80% of the money you take in today to have a difference between the day it hits the bank account and the day when it hits your software. When you look at a month at a time, now you're probably talking about five or eight percent. So, the magnitude of the stuff that's difficult to resolve gets much smaller.” (11:56—13:07)

“Here’s the second trick people can do. So, we’re looking at a month at a time. When you look at your collections according to practice management software versus your deposits in the bank, you're probably going to end up with what I'd call a variance. In other words, this month, either you collected more according to your software than what went into your bank, or you collected less. So, let's take that number and see how we can resolve it. And there are a couple of things you could do. You can look in your previous month’s bank statement and try to find this stuff with a negative timing difference, or you can look in your online banking after the end of the month and try to find this stuff with a positive. So, you can try and track down the origin of the variance. That's the best answer, but it’s also a lot of work.” (13:09—14:05)

“The other thing you can do is you can create a graph and stick the variance on that graph. So, we’re having this conversation in April of 2023, which means we probably just did or are about to do this for March. So, let's say in March that the practice management software collections were greater than the bank by $2,200. What you do on a graph somewhere, and it can be up on your wall, if you'd like, or it could be on a spreadsheet or something like that, is you put a dot for March at $2,200. You do the same thing for April. You do the same thing for May. And if you're mathematical about it, you fit a regression line to those dots. If what you're looking at is timing differences, timing differences reverse. So, let's say on the last day of the month, a patient pays $4,000 by credit card. And let's keep it simple and let's assume that's the only timing difference for that month. What you're going to see at the end of that month, let's call it March, at the end of March, what you're going to see is practice management software is greater than bank deposits by $4,000. What you're going to see when you look at April is the reciprocal. In other words, in April, you have a $4,000 deposit and nothing in practice management software because the payment was recorded in March. So, the variance reversed, if what you're looking at is timing differences. When you plot your timing differences over time and you fit a line to them, what you get is something with a slope of zero, or pretty close. If you look at that line and it’s not zero, it’s increasing, for example, now you don't have timing differences anymore, it’s something else, like maybe embezzlement. But you know what? Putting that dot on a graph takes a whole lot less time than trying to go back and find the origin of that $4,000 variance and make sure that the money was deposited.” (14:06—16:20)

“If you're not doing a comparison between collections and deposits, you've made it so easy for [thieves]. I mean, the dumbest, laziest thief on the planet can steal in that framework. So, let's eliminate the bottom half, intellectually, of the people who want to steal from a dental practice. This one step [of checking collections and deposits] will rule out those people. Anybody who can't figure out how to crook your software now can't steal from you. And if what's involved is doing this once a month, and as I say, not having to actually track down the source of the variance but just plot it, that makes life so much easier. Can people still steal from you in that case? Yes. But now, what they have to do is trick the software, which is a lot harder and a lot more demanding.” (17:09— 18:00)

“This really basic control [of comparing collections and deposits], which, as I say, most people don't do because it looks too daunting, if we can make it as simple as getting a month-end summary report from your software, looking at your monthly deposits from your bank statement — and when you look at your deposits, just to point out something that may not occur to all the audience, you have to pull out any nonrevenue deposits. So, if you got PPP money back in the COVID-19 days, that was a deposit to your account, but it was not revenue in your practice management software. If you have multiple accounts and you're moving money back and forth, those are nonrevenue deposits. So, you have to screen that stuff out. But if you have none of those, every bank statement gives you a total for the total deposit, so you don't even have to add them up.” (18:04—18:55)

“The other advantage of looking at a month at a time is that what some thieves have done is if they think the doctor is looking at day-in stuff but doesn't look at month-end information, then they’ll come in on a Saturday or a Sunday when the practice is closed, and they’ll put through a bunch of transactions that they don't want the doctor to see. When you look at a month as a whole, you catch all those things. So, there's an advantage there as well. But the real advantage is, let's shut down those stupid, lazy thieves and let's make it so that anybody who pulls money out of the deposit and doesn't do something in software to cover it up will get caught.” (18:58—19:43)

“First of all, why would you have to [tell your team you're going to start verifying collections and deposits]? You get the bank statements, I'm hoping. And I really have an issue with any dentist who lets staff get that stuff first. Staff generally don't need access to your bank account. So, the banking side, you get already. There are some dentists who don't know how to print a month-end report from their software. And I would suggest that if you're listening and you are in that category, I have one word for you: learn.” (20:15—20:51)

“I'm going to say something that a lot of your audience won't like to hear, but it has to be said. Whatever reports you rely on as a practice owner from your software, print them yourself. As soon as you allow a staff member to print a report and hand it to you, you have given up control over the parameters used to generate that report, and it is really easy to hide stuff from you. So, I know there are doctors out there who would like to go their whole career without learning the first thing about their practice management software. That software is more important to your financial well-being than your handpiece is. And you all know your handpiece like it’s your child. You need to embrace your software with about the same amount of enthusiasm.” (21:00—21:49)

“If you don't know how to print reports in your software, there is somebody, somewhere, who can show you.” (21:50—21:55)

“What's involved here is getting bank statements that you already get anyway and learning how to print one, exactly one report, from your software. And assuming that you can climb those two mountains, you don't need to go to your office manager and say, ‘I'm going to start doing this.’ You might end up going to the office manager later with a question about discrepancies. And if they’ve never seen you ask that question before, they may wonder why or even how you got the information. But you can decide, at that point when you're likely facing a problem, how important secrecy is to you. But just to do this calculation, no, you don't need anybody’s help.” (22:15—23:01)

“Step number four happens when you start seeing variances that don't look like they're caused by timing, like somebody stealing your money. A typical thief will take between two and four percent of your collections. So, you have an office that's collecting $100,000 a month. That means we would expect a thief, once they get comfortable with their pattern, to be taking between $2,000 and $4,000 a month from you. So, when you're looking now at your variances each month between collections and deposits and you see that January was $2,000 and February was $2,300 in the same direction, and March was $1,700 and April was $3,500, when you start seeing that the variances are all on the same side of the origin on your graph, as I said, this isn't timing. So, now, you have a sleepless night. And what you do, hopefully, in the morning, is call Prosperident.” (23:24—24:37)

“When we investigate, our investigations are completely invisible to staff. We go to tremendous lengths to make sure that when a doctor calls us with unconfirmed suspicions — and sometimes, it’s been confirmed — but when it’s somebody who says, ‘I think Sally, my office manager, is stealing,’ our whole process is intricately planned so that Sally has no idea we’re on the job. And that's important.” (25:50—26:18)

“A dentist will call me, and they’ll say, ‘Yeah, I've been a bit negligent in my overseeing of my practice, and now I think that Sally, my office manager, is stealing.’ And what I say to that doctor, and I will say to the next one who calls me, is let's understand how unequal this battle really is. You are busy all day, every day, trying to do great dentistry for your patients. And that is your primary focus. And while you're spending that time doing that, Sally, your office manager, has the whole day to think about how to separate you from your money. And beyond that, your control systems are 100% visible to her because she’s the person who lives with and probably, in some cases, implemented those controls. So, Sally knows whether you compare the day-end report to the bank deposit. Sally knows whether you look at a day-end report at the end of the day, or you just throw it in your basket to get to when...

The Missing Ingredient to Team Trust

Episode #562 with Adriana Booth

Episode Resources:

• Adriana’s email: [email protected] 
• Adriana’s Facebook: https://www.facebook.com/adriana.booth
• Adriana’s social media: @adrimarieb
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Traction by Gino Wickman: https://benbellabooks.com/shop/traction

Main Takeaways:

Connection, conversation, communication, and core values lead to trust.

Your core values are the foundation to develop your team’s trust.

Have regular, scheduled check-ins with your team. 

Live your core values.

Quotes:

“At the root of it, we love people, and we love to help people. And I think that's most of us, especially in the dental field. We are there to help. We are there to serve. And when we think about that connection, when you truly get to know people and you're empathetic, sympathetic — to a point — and you know who they truly are and how they work, obviously, you are like the little birds of a feather. You kind of start to attract like-minded people. And all of a sudden, you'll end up with a team who have all these similarities and respect for one another. They have a connection. And what happens next is pretty easy. It’s that trust. We don't have to fight for trust, at that point.” (5:04—5:52) -Adriana

“I can't work for you as a dental assistant — and I'd be a terrible dental assistant — and I can't lean on the core values if I don't know the core values. And so, I think one of the things that you have to do in order to build something that's trustworthy, long term, very healthy, it’s got to be built on the right values. And you know this, your favorite people care about the same things that you care about. So, my question to you is, what do you care about as a dentist? And once you figure that out and put those out there, it’s your favorite thing, ever.” (6:35—7:04) -Kirk

“I worked recently with another one of our awesome coaches, Heather, and been putting together a lot of things with our core values. And just like we tell our clients, we have to keep it in front of you. That's why we put it on shirts. We put it on our water bottles. We have it on stickers. At any given time, when I walk into a practice that I'm coaching and if I ask the team, ‘Hey, tell me what your core values are again,’ and they don't know them, it’s a little bit of a heartbreak for me because I know, at that time, the doctor can't be that committed to their core values if his or her team doesn't know them by heart. And that's a big one.” (7:26—8:03) -Adriana

“I have a couple teams, I know their core values because I've been in enough meetings and enough conversations that they talk about them so much, I can even rattle off their core values. So, that's when I know that are living their core values. And they hire, fire, have conversations around them, tough conversations, fun conversations, they have projects, they do their social media around it because they truly are living it.” (8:06—8:33) -Adriana

“I'll give you the secret today of how to find the right people. It’s super simple. And I didn't come up with this. It’s actually from Gino Wickman, if you read the book, Traction. Finding the right people in your practice, they have two things — not 90. Two. They share your core values, and they get results. Period. When you create a team of people that, number one, share your core values, they're all-in on your values and they get results, you're killing it. And you don't even know why. If you're missing one of those two, you're miserable, and your brain is headed in that direction.” (8:39—9:15) -Kirk

“I'm not talking about the hallway drive-by conversations, the lunch time chats. It’s truly what we call here at ACT a check-in. We have a form. It is very structured. That's a thing that I always explain to my teams is, at ACT, yes, we might be a little off-the-cuff sometimes, and we like to customize everything for our clients. But at the same time, as much as we like fun and off-the-cuff, we really love structure because we want repeatable processes. So, we want to give each of your team members the same opportunity to check in with the doctor, owner, manager, their team lead, however we want to structure that, to have time, one-on-one, have goals, so we have a little bit of fun or fluff in there, so a little bit of personal connection, and we leave with priorities in what's next steps so that we have a follow-up. And we always leave with a next appointment scheduled, just like our patients.” (9:30—10:33) -Adriana

“Here’s my question to you, as a dentist. Do you love your team? And everyone goes, ‘Yes, I do.’ Well, what's the system, or what do you do that supports what you just said? And having a regular check-in — again, we didn't come up with this. We had a coach that made us do regular check-ins. And I thought they were kind of hokey at first. And now, I'm like, ‘This is the most important thing you could ever do.’” (10:50—11:10) -Kirk

“[At check-ins], we’re going to also mix [personal high, personal low, professional high, professional low, core values, and priorities] in with how can leadership help the team member. Because there might be something that me, as a team member, thinks of, and this just, I covet my time with Christina, who I do my check-ins with, and Kirk, because that is my time to say, ‘Hey, how could I improve? What do you see from the outside that I can do a little bit better? And I would like to work on X, Y, Z. Do you have any ideas for me? Do you have any resources?’ And that's exactly what your team members will do. So, it becomes this two-way conversation that is directed by the team member. A key ingredient is having it on the schedule, having a time block, making sure you're sticking to that time block, 15 minutes is pretty good, pretty common. Some will do 30, if they want to maybe grab a bite to eat in that time. And they’ll say, ‘Hey, how could I help you? How are you helping yourself?’ so that it’s not just you, as a team member, relying on your manager or your owner to do it for you. It’s a little bit more self-guided. You want to have that sheet printed. They fill it out and turn it in at least a day prior so you, as the manager or owner can review it, make your own notes, because you want to show that team member it’s valuable to you as well.” (11:36—13:04) -Adriana

“You don't have to have team members share all these intimate details. What you're giving is you're giving space to it . . . Team members can tell you whatever they want. But just by the fact that you've carved out 30 minutes, or 15 minutes to say, ‘This is our time together.’” (13:41—14:03) -Kirk

“You're changing the whole annual review conversation. Now, having a regular check-in, and you're talking about results and priorities, it makes it so easy for both of you, the employer and the employee, to talk about a raise, if that's on the board. Because somebody that's bringing big results, and we’ve talked about you're coaching them on a regular basis, and it’s a regular system, and they run the meeting, it’s powerful because now, it becomes a hugely healthy opportunity.” (14:08—14:40) -Kirk

“In a world where we hear dentists all the time say, ‘I can't find great people out there. Our practice is growing,’ and in the same breath, the dentist talks about the dentistry, and the patients, and how big it is, and a second location, and they can't even remember team members’ names. And I'm like, ‘Oh, you're forgetting the single-most important ingredient to how all this work, which is team members that trust you.’” (14:44—15:08) -Kirk

“I've just walked through this with a client who, she’s a great leader. She’s really team oriented. The beauty in [check-ins] was she said, ‘My team member came to me. And she had copies of the last year of her check-ins.’ And they only do check-ins about every other month. And she said, ‘Hey, I want to show you my timeline. These are the things you told me to work on. And, look. I've done all of these things.’ And she said, ‘Now, where do I go from here?’ She was sitting there ready for the, ‘I want more money,’ conversation. But it was the opposite. The team member is now so invested in that relationship, in the business, like, ‘How else can I help?’ And that's the key. Once we get on the same page with core values, we’re connected, they are bought in, they care about your business as much as you do, at this point, and then that ball will keep rolling.” (15:22—16:19) -Adriana

“If I'm a team member working for you, and you're the dentist, and you're sitting down with me and we’re talking about core values and results, you can see how this relationship changes. You change from the boss to someone’s coach. And you're all dreaming of that. We don't know how to do it until we have a system. So, we’re giving you the system today.” (16:21—16:41) -Kirk

“The missing ingredient to team trust is you've got to have core values, and you've got to have a system like a check-in. And look at your practice as a garden. It’s a beautiful garden. And the garden needs care. Weeds will come into the garden. If you don't weed the garden, the weeds take the garden. The garden also needs fertilizer. It needs water. It needs some good sunshine. So, it requires proactive care. And so, what we’re suggesting here is use the good care, which is all these things that we’ve mentioned, so that your team continues to grow, because it’s only going to get a little bit weirder for a while in the employment market.” (17:09—17:44) -Kirk

“Once you get good people, good people attract more good people. That's the key. And when your valued at your place of employment, it doesn't become a job. You want to be there. And you want good people to be there with you. You get really picky. You get really picky about who you work with, how they show up, how they behave, and you become invested in, now, as the owner, weight is off of your shoulders a little bit because your team is doing a lot of the, ‘We don't act like that her. Oh, no. No, no. We don't do that. This is how we behave. This is what we believe. Come on. Fall in line, or you're going to have to get off the bus.’” (17:56—18:38) -Adriana

“It gets picky on both sides of things. You get picky because you're attracting a higher quality team member. The team members also get picky about who comes into the fold too. They’ll chew up and spit somebody out who’s not playing along with the core values.” (18:42—18:55) -Kirk

“Core values are not feelings. They're not aspirational words like excellence and awesomeness. They're behaviors at the workplace that you've completely enforced that are true behaviors that you like to see, like all-in attitude, like we before me. And when you do that, you can see everybody starts to buy in to the behaviors and it becomes something super special.” (18:59—19:24) -Kirk

“I absolutely love [core values]. This is my favorite thing of all time because if I would've known about this in my 20s, that would've saved me a lot of stomach lining. And people often dismiss core values as, ‘Oh, that was way back in the ‘70s and the ‘80s.’ No. Look at any big brand today. No matter who it is, if they're strong and they have an incredible following and support structure and trust with team members, you're going to see it’s bound by core values.” (19:26—19:51) -Kirk

“Once you start seeing core values in your own practice, you'll go to the smallest store and you're waiting to cash out – usually, if there's even a human there, because we talked about AI is taking over, your self-checkout, you've got your virtual card, your Apple Pay – and you see their core values posted. And you're like, ‘What? They even have core values here? That's awesome!’” (19:57—20:21) -Adriana

“Human beings don't even absorb anything — they have to hear it seven times, seven different ways for them to even initially adopt it. And core values are like the bound structure — think about at home. Do you mention it one time to your kids? No! You become the CRO, chief repeating officer. There are things I've said in my house so many times that the walls could repeat it. But they're value-based things. Same thing applies in a great practice. Any great leader repeats the same things over and over. But they're the things that matter, not, ‘Did you do this? Did you do that?’ I'm not talking about micromanaging. I'm talking about, ‘We do this because. We behave this way. We are this kind of people. We believe this.’ And so, you can't do it once. And then, you've got to find different ways to make them come alive, whether they be medals, whether they be stories, whether they be Instagram posts. That's a game that we’re always trying to figure out, how do we do this? How do we bring it alive?” (20:45—21:44) -Kirk

“We’re huge proponents of two hours, weekly meetings. And that's a piece of that meeting rhythm that is very structured. We talk about the core values every single meeting. We rate them. How often are they showing up? How do they show up? How do they show up in our team and out to our community? And if we aren't doing that every single week on some level, I promise you, you're not living your core values, and they're not that important to you.” (21:47—22:16) -Adriana

“The more you lean into what we’ve talked about today, which is the secret ingredient — which is core values — the more you lean into it, I promise you, the less crazy stuff you deal with.” (22:20—22:29) -Kirk

“A few last ingredients that I would say is that connection. Connection is the key to long-lasting relationships, in general, but especially with your team members. Get connected. Do your check-ins. Build that value for the relationship and lean hard on your core values. It will totally change your practice and change your life.” (22:52—23:13) -Adriana

Snippets:

0:00 Introduction.

2:08 Adriana’s background.

2:57 Why this is an important topic for dentistry.

5:55 The missing ingredient to trust.

7:05 Live your core values.

8:35 Have regular check-ins.

10:34 The structure and logistics of check-ins.

14:40 Check-ins help your team be invested.

16:19 Attract great team members from core values.

18:55 Core values are everywhere.

20:21 You can't just tell team members once.

22:17 Last thoughts. 

Adriana Booth, BS, RDH Bio:

Adriana Booth is a Lead Practice Coach who partners with dentists and their teams to cultivate leadership skills, build practice growth, and streamline business practices. After spending over two decades in the dental industry working with top-notch dental teams, Adriana came to ACT to share her passion for professional growth, high-level training, and systems creation with our clients. As a dental hygienist with a love for connection, communication, and personal growth, helping a practice become successful is at the heart of her passion for dentistry.

Adriana has a B.S. in Dental Hygiene from West Liberty University/O’Hehir University. By being a member of Dental Entrepreneur Woman, the Academy of Dental Management Consultants, AADOM, and local dental study clubs, Adriana maintains strong relationships within the dental community. She enjoys fitness and outdoor activities, relaxing by the water with a good book, and at the top of her list, her Chesapeake Bay Retriever, Beau Duke. 

What Your Patient’s Gut Health is Telling You

Episode #561 with Dr. Uche Odiatu

There is more to gut health than probiotics, and it all starts in the mouth. Today, Kirk Behrendt brings back one of ACT’s favorite fitness gurus, Dr. Uche Odiatu, to talk about one of his favorite subjects: gut health. He passionately shares his knowledge about the microbiome, advice for engaging team members, and ways to talk to patients about this very important topic. A healthy mouth leads to a healthy gut! To learn how dentists and hygienists can help patients with whole-body health, listen to Episode 561 of The Best Practices Show! 

Episode Resources:

• Dr. Odiatu’s LinkedIn: https://ca.linkedin.com/in/druche
• Dr. Odiatu’s website: http://www.druche.com
• Dr. Odiatu’s Facebook: https://www.facebook.com/UcheOdiatu
• Dr. Odiatu’s social media: @fitspeakers
• Subscribe to the Best Practices Show Podcast
• Join ACT’s To The Top Study Club
• Join ACT’s Master Class
• See our Live Events Schedule here
• Get the Best Practices Magazine for Free!
• Write a Review on iTunes

Links Mentioned in This Episode:

Viome: https://www.viome.com

Main Takeaways:

Change your diet for better gut health.

Acknowledge the role of gut health on mental health.

Understand how antibiotic prescriptions affect gut health.

Learn how to engage your patients in gut health conversations.

Involve and empower your team so they learn more about gut health.

Quotes:

“If you want to be current, you've got to know about the microbiome because your patients are reading about it every night.” (3:49—3:54)

“The average Joe thinks, ‘Oh, I take a probiotic.’ There's much more to gut health than taking a probiotic, just like there's more to health than popping a vitamin pill.” (4:31—4:39)

“Gut health is elusive. It’s amorphous. You've got to think of how these gut florae became a part of us. When we’re born, basically, the womb is very sterile. When the baby comes through the birth canal, that's the first introduction to the microbiome, or the mother’s microbiome. However, if you were born by C-section, which is about one out of three kids, one out of three patients born now, they get more of a skin microbiome. They get more staph bacteria than lactobacillus and bifido. It takes about seven years for a C-section delivered baby to catch up to a vaginally delivered baby.” (4:40—5:18)

“Back 40 years ago, only one in 25 kids were born by C-section. Now, it’s one in three. So, when you talk about one in three, you're thinking about 30% of patients that are born without good, diverse, stable biome. And they do suffer from it. The Journal of Obstetrics and Gynecology has shown how they're more likely to have asthma, more likely to have metabolic syndrome, more likely to have food sensitivities. So, there are a lot of things going on. This all might sound, ‘Uche, as a dentist, how am I supposed to know these things?’ We know now that if people don't manage blood sugar well, guess what? They're also likely to have more bleeding upon probing, and loss of attachment. Diabetics lose teeth two to three times as much as a person who doesn't have diabetes. So, this is where the conversation goes. It’s really important to have a working knowledge, and you've got to read the books. You've got to listen to the podcasts. You can't be scared about it because these patients are Googling biome, gut, kombucha, and kimchi.” (5:19—6:16)

“In South Korea, the average adult eats 35 kilograms of kimchi a year. That's how much cheese the average North American eats a year, 35 kilograms of cheese in a year. So, kimchi, it’s very fermented. It’s got 20 times more probiotic qualities than other fermented foods like yogurt and fruit and vegetables. When you look at the obesity rate of South Korea, it’s about 10%. The obesity rate in North America is 35%. So, if you start looking at fermented foods and probiotic foods, you realize how it impacts metabolism, immunity, and how you look. So, I bring these things in eclectically when I talk. But ultimately, you've got to look current. You can't just think gut conversations just start with a probiotic. There's much more to it.” (6:21—7:12)

“The mouth is the gateway. And the number-one way to change and have a healthy gut is to change what you're eating. And who’s in charge of the eating apparatus? The dental industry. So, we are perfectly poised — there's never been a better time to talk gut health because we are in charge of the entrance to the GI tract. It all starts here.” (7:13—7:30)

“Hippocrates said, ‘Let food be your medicine, and medicine be your food.’ And Hippocrates also said, ‘All disease begins in the gut.’ He said that 2,300 years ago. And now, we realize the information about gut health, it’s true. (8:45—8:58)

“Right now, if your bacteria were fermenting fiber, which they love, and you were eating about 30 grams a day, as a man, 35 grams a day, your body is pumping out short-chain fatty acids. And they are the most anti-inflammatory agent your body makes. And every hygienist knows inflammation is key. Back in 2009, JADA said a lot of the destruction of periodontal disease comes from a hyper-inflamed host, a host that goes overboard, a weak immune system, burning out and causing bleeding and creating a lot of osteoclasts that are breaking down bone. Well, if your body has enough fiber and you're fermenting and making short-chain fatty acids, you now have a big bucket of water, anti-inflammation, and you can douse the flames easier. So, anyone who is eating fiber, anyone who is eating 30 grams a day for men and 25 grams a day for women, they can actually douse the flames of inflammation. They have a less likely chance of almost every modern disease, including gingivitis and periodontal disease.” (9:05—10:02)

“Right now, they're saying that 90% to 95% of North Americans aren't eating enough fiber. They literally have all these fires in their body, and they cannot douse the flames. So, if your bacteria aren't getting fermenting fiber, what happens if they can't ferment? They can't douse the flames of inflammation. So, the joints hurt, hair hurts, cognitive irritation, gut inflammation, psoriasis, eczema, ankylosing spondylitis, gingivitis, periodontal disease, all because the body is unable to make short-chain fatty acids. And this body is incredible. It has its own pharmacy. But you've got to give it the fuel, and that's where food comes in. Let food be your medicine, and medicine be your food.” (10:06—10:44)

“Dr. Paul [Tennenbauer], PhD in immunology, said if you are going to eat a meal that’s debauchery, if you have a cheat meal — again, pizza once a week, there are 21 meals a week. It’s basically one of the 21. So, it’s not so bad, one out of 21. If you give your bacteria what they want, they’ll let you have your cheat meal. But if you have a big meat meal with a lot of saturated fat and processed food, and you don't give them what they want, they will slow down digestion. You'll have gas. You'll have constipation. You'll have inflammation. But if you have a salad with your big steak, you have two sides, broccolini and asparagus or mushrooms, now you make your bacteria happy.” (11:20—12:00)

“Give your body a couple of fermented foods a day, and now you're giving them what they want. Now, they’ll let you digest that [not-as-healthy] food. They won't give you as much gas. They’ll douse the flames of inflammation around your joints. So, it’s like a tag team, back and forth”. (12:16—12:28)

“If you want to make your own pizza, you can have gluten-free bread. You can have whole grain bread. You can put real cheese on, feta cheese, goat cheese, instead of that spray-on orange cheese. You could put hormone-free meat. You can get free-range chicken. You can put broccoli on pizza, mushroom and broccoli on pizza, [if it isn’t] taboo for you. You can put peppers. You can put olives. You can make a pizza healthy. It’s not debauchery if you make your own.” (12:29—12:58)

“Only one out of 100 people are celiac. There are some people who are gluten-intolerant, but they're not gluten-allergic. Celiacs are definitely allergic to gluten. A lot of people eat poor-quality bread. Some people say, ‘Oh, I don't do gluten.’ Eat better quality bread, whole grain, sprouted bread. Sourdough bread is very much gut-friendly. Sourdough is a different kind of yeast. It’s a different way that bread is made. Sourdough is gut-friendly. Rye bread is gut-friendly. One-hundred percent whole grain bread is gut-friendly. White bread, the white bread that you can make into a snowball, not very gut-friendly. But for most Americans, guess what? That snowball, that white bread, is two to four grams a day for the average American. But again, very heavily processed.” (13:11—13:52)

“This is from Justin [Senebaugh]. Justin [Senebaugh] is a microbiologist out of California. Processed food is our downfall. The more processed food we eat, the more processed food the patient eats, the higher likelihood they're going to have an inflamed gut and chronic levels of inflammation, things that don't heal well. Peri-implantitis. We’re so good at putting out the fire and having good integration around the implant. But we don't talk to patients about — you do an implant on a shift worker, you do an implant on a sedentary person, you do an implant on a person who is depressed — one of the periodontists I heard lecture at the Dental Economics Conference last year in Nashville with Dr. Pam, he was saying that he was surprised how people who take antidepressants have a six percent higher chance of not accepting that implant than a person who doesn't take antidepressants, just because depression is an inflammatory condition. They have higher levels of C-reactive protein. So, start looking at the bigger picture. Start thinking A and B and C. There's much more to the body than one plus two. There are many ways of looking at it. The body is always synergistic in how it responds to what we do.” (13:54—14:59)

“Ninety-eight percent of bacteria in us are good. There are bacteria, archaea, eukaryotes. Everyone knows about H. pylori. But not all the H. pylori are bad. There are about three different strains. Only one causes a problem. The other two don't always cause a problem. E. coli, there are about 20 or more different strains of E. coli. They all live inside us. C. difficile is always hanging out. It’s like the Hell’s Angels in the parking lot called our gut. But guess what? If you don't have a lot of good, beneficial flora, now they get more parking spots. As soon as C. difficile gets more parking spots, guess what? Now, you've got quite the party. So, what happens is you've got to really feed the good ones and starve the bad ones.” (15:09—15:48)

“There are 42 trillion single-celled organisms in us, the same amount of cells of human origin in the body. But 85% of our human cells don't have a nucleus, and they don't have bacteria. So, that's why the gut bacteria actually outnumber the human origin ten to one. But species wise is sheer dominance. So, we have 21,000 human coding genes. You and I are 21,000 genes. But the sheer collective genetic footprint of the 10,000 to 20,000 species inside you is up to 100 million genes. So, who runs the show?” (15:58—16:32)

“The earth is 4.6 billion years old. There was zero life for a billion years. About 3.5 billion years ago, bacteria formed. These same bacteria are living inside us. A lot of immunologists and microbiologists joke around, we could just be the walking vehicles of bacteria to survive. Because when you're living, they're your friends. But when you die, within three days, your body decomposes by the same bacteria that helps you live. So, when the body decomposes, that's your bacteria now chowing down on you. So, think about it. They're ruthless. Most of us treat our bacteria bad our whole lives, starving our bacteria, not getting good sleep, not being physically active, poorly managed stress. So, now, you die. Three days later, the decomposing started. And it’s the same bacteria that — people always think the bacteria comes from the flies. No, it comes from the bacteria inside us. They're our friend, but now they're your foe.” (16:44—17:36)

“We think of the GI tract as it starts here and ends at the butt. So, there's up to about 26, 28 feet of it. So, that makes sense. The gut flora starts here. There are about 700 species in the mouth. Again, most of them, beneficial. Most bacteria in the mouth are part of your friends. So many dentists, though, don't know what's going on inside. We kind of know the bacteria that often produces or ferments and breaks down sugar and causes decay. We know that. But the other bacteria, we haven't analyzed them yet. They're so amorphous it’s hard to fully understand. So, that's why when people get an imbalance, all of a sudden, you get Candida, or you get thrush. You get a white tongue. So, if I get someone coming in at 50, 55, 60 with oral thrush, I know that Candida albicans is overgrowing. But we have it in our mouths all the time. When your beneficial flora is high and there's good sleep and a good immune system, the body can keep Candida at bay. But when someone has gone through a recent bout of antibiotics, or multiple bouts of antibiotics, if someone has stress, or if someone has dry mouth, or someone doesn't sleep very well, now they have Candida. And it manifests as millions, if not trillions, of bacteria multiplying and you get this white coating, which is basically Candida setting up condos on your tongue. It means that that's the body out of balance, and dry mouth sets that up.” (17:50—19:08)

“Dry mouth sets up the mouth out of balance. If the mouth is dry, someone is not going to digest food as well. So, when you think about digestion, people always think it starts in the stomach. But if someone has a dry mouth — think about it. Two-thirds of all prescription and over-the-counter medication causes dry mouth — two-thirds. As we get older, 55, 60-plus, dry mouth. People who mouth breathe, dry mouth. People who are anxious — think of all this post-pandemic stress — dry mouth. So, if you're chewing food with a dry mouth because of stress, age, anxiety, and side effects of maybe three, four, or five medications, now, I'm not even going to start the breakdown process. Digestion starts in the mouth. Actually, I should really say it starts when you're thinking about the food. But if you have a dry mouth, you start swallowing that food without it being touched with all the saliva to bring it into a liquid form. You don't have all the enzymes. And now, the stomach has to work harder to digest the food and absorb it. (19:08—19:58)

“You can eat a great diet with dry mouth, and now you're going to have nutritional deficiencies. That's what a lot of doctors don't understand. ‘Hey, your diet looks good. I wonder why you're lacking B-12 or you're lacking this nutrient.’ Well, what happens is, you're chewing your food too fast in a dry mouth because you're anxious, and you're sleep deprived, or you're mouth-breathing. Now, you're sending down food only partially broken down. The body is a miracle, but it can't work magic. And now, you become nutritionally deficient, simply because of a dry mouth. And that's why when I see a patient with dry mouth, I call that the sign of accelerated aging. I want to get their attention. ‘Accelerated aging.’ ‘What can I do?’ ‘Well, we’ve got to start getting you nose-breathing. How are you sleeping?’ So, all these conversations start with the dentist and hygienist.” (19:58—20:38)

“You've got to start talking the talk of total-body health. And now, as a dentist, I can talk dry mouth, and digestion, and absorption, and slowing down the aging process. ‘Just by having a fully functioning, fully restored mouth, I can actually help slow down aging. You know why? Because when you have a fully restored mouth with good saliva and good TMJ, now you can break down food. And literally, you have healthier lungs, heart, liver, and brain.’ So, it starts with us. This is where dentists have to start taking ownership. We are oral physicians. We are physicians of the mouth. I don't just do veneers. I'm a physician of the mouth. I'm looking at the big picture. ‘Let's see your meds. Let's talk about shift work,’ that kind of thing.” (20:38—21:17)

“People think of burnout as stress, ‘I'm not managing stress well.’ People are taking antidepressants. However, when you think of the gut, think of the bacteria as your — they're traveling with us from birth to grave. They don't have a brain, but they have a consciousness. So, when someone is stressed, mouth-breathing, when someone is stressed, poor sleep, when someone is stressed, eating comfort foods, when someone is stressed, muscular tension, your bacteria, they don't have a brain, have a consciousness. They sense you not moving. They sense your dry mouth. They sense the lack of nitric oxide. They sense the lack of rest. So, what happens when your bacteria senses it? Digestion slows. Any time you're in fight-or-flight, or angry, or upset, or frustrated, or irritated looking at the news, the body puts all the energy into the present moment because there is no gradient to stress. It's all or nothing. So, when you're angry, looking back at the guy honking the horn, you're watching the news on CNN, looking at FOX and all this stuff, what happens is your body goes into high alert into the present moment. It puts digestion on hold, so digestion slows. Any time you're anxious, digestion slows down. The minute digestion slows down, your body can no longer repair, recover, and grow. That's why stress can literally make you shorter.” (21:49—23:05)

“They talk about there are three reasons why kids will often not be as tall as other kids. So, 80% is genetic, family. But three negative impacts on childhood health is stress, infection, and food quality. So, 20% of your kids’ height is the amount of stress they had in that childhood home, how much immune system challenges, how sick they were, and the quality of the food. Twenty percent is a big impact. It’s one or two inches. And again, it’s the bacteria. Bacteria have a part to play.” (23:05—23:37)

“Your bacteria, they don’t know light or dark. But they do know when you’re horizontal. And some bacteria are most awake when you're dreaming. Many bacteria are very awake when you're dreaming. And dreaming is what sleep scientists have said now is when your body processes emotion or processes memory. So, if people are stressed, they literally grab the emotional dirt from today and drag it into...