The Best Practices Show with Kirk Behrendt

An Answer to the Great Resignation

Episode #530 with Dr. Steven Kupferman

If you're tired of experiencing the Great Resignation, there is a solution — you just need to be open to it. To tell you about virtual assistants and how it changed his practice, Kirk Behrendt brings in Dr. Steven Kupferman, co-founder and CEO of MedVA, a company that provides qualified virtual assistants specifically for doctors. Is your in-house staff overwhelmed? Are things not getting done? A virtual assistant can help! To learn more about MedVA and how they can support your practice, listen to Episode 530 of The Best Practices Show!

Episode Resources:

• Dr. Kupferman’s website: https://la-coms.com
• Dr. Kupferman’s email: [email protected] 
• MedVA: https://medva.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:

The White Coat Investor: https://www.whitecoatinvestor.com

Kolbe: https://www.kolbe.com

Main Takeaways:

Virtual assistants can do almost anything your in-person employees do.

Your front desk person may benefit from having a virtual assistant.

Figure out which tasks you can outsource to virtual assistants.

Having virtual assistants will improve in-house staff retention.

There is no language barrier hiring MedVA assistants.

Quotes:

“You go back and forth in your mind, ‘Can I do this? Can I not do this? Are they going to be able to do this? Are they not going to be able to do this? How are they going to help me? Is it worth the money? Security — I'm not going to meet them. Who are they?’ But sometimes, you've got to take a leap of faith and try something out. You won't know whether it’s effective or not until you actually try it. And that's what happened with me. I had this incredible first virtual assistant, who still works for me to this day, who was so dedicated. He, to this day, is one of the best employees I've ever had.” (5:36—6:18)

“The great thing about a virtual assistant is everything is recorded. You can record your training sessions with them, and then that institutional memory gets passed on very easily. So, once I started to get things under control, the easiest things to give them were things like getting benefits and revenue cycle stuff. That has become, in my mind, something that should not be done by taking up real estate in your office. That's a job that should be done remotely from start to finish. That was really where things got started, and that's the easiest way to really get into the virtual assistant space, is to have them do revenue cycle, benefits verification, and things like that.” (7:46—8:33)

“[Insurance companies] are often hampered by the Great Resignation, more so than the dental offices. And so, they don't have people to answer phones. Most of their work is also done offshore. Sometimes, you can wait 15 minutes just to get somebody on Delta Dental or somebody on some other payer. So, 15 minutes is a good day, I think, for benefits verification — unless you're using some sort of online portal, which, oftentimes, you don't really trust anyway, or more offices don't trust, especially if you're doing a big case of some sort. So, 15 minutes is par, I think, for benefits verification. And it could be longer. That's what we’ve seen. And so, that's what we’ve done. We've utilized our offshore team to do that exclusively, and that's been fantastic.” (8:58—9:54)

“I went from there to accounting, bookkeeping, marketing, HR, scribing, letters, notes, and reports. And the tasks are endless. I mean, obviously, they can't be a dental assistant. They can't be a medical assistant. They can't take blood pressures and vital signs, and suction for you, and choose the shade of composite that you're going to be using that day. But everything else that's running in the practice can almost all be done virtually.” (11:25—12:04)

“The people that are running your practice, they don't like to do mundane tasks. That's what burns them out. And so, what you end up doing when you're utilizing virtual staff, you can really promote the people that are there, move them to higher-level tasks, do more to retain them, pay more to retain them, while putting these other tasks of, for example, sitting on the phone waiting for Delta Dental to answer, have somebody else doing that so that they can greet patients, which I think a lot of people who are in your office love to do. They love the patient interaction, even though they're not caring for the patient, or suctioning, or making a temporary crown. They love the patient interaction, the administrative staff. You want to keep them as long as possible, retain them, and using virtual assistants allows you to do that.” (12:53—13:47)

“The first language in the Philippines is English. They have Tagalog, which is their language. But everybody learns English from day one in school, so that is the official language of the Philippines. So, language is not a barrier. Now, they use different words for different things, just like they do in the UK, for example, or in Australia. But language is not a barrier at all.” (14:10—14:34)

“[The Philippines is] a healthcare-oriented country. They care for people. That's what Filipinos are known to do. In many other countries, they employ people from the Philippines to care for people. So, they are healthcare-centered. Everything there is healthcare centered. And so, the virtual assistants that I have are generally in the healthcare field to begin with, before we even do any training for them on U.S. healthcare. They're healthcare-trained at the outset, whether they're nurses, or therapists, or physical therapists, or whatever it may be, dental assistants or dentists. They're already healthcare-trained professionals. That's what they do in that country. Those are their main industries.” (14:45—15:30)

“All the other marketing stuff, making brochures and taking out ads, or whatever else you're doing for marketing, can be done remotely, of course. Visiting offices is harder. Bringing cookies or asking offices is a little harder. But if you think out of the box a little bit and you get a DoorDash account, and you call, or you use companies — there are companies that will deliver lunch to businesses. Forget medical or dental businesses. Deliver lunch and have a virtual lunch meeting. There are companies that do that on a day-to-day basis now. And they’ve taken off during the pandemic because it’s much easier to have a company send lunch to 10 people and then meet on Zoom, especially in high-traffic areas like California, New York, Chicago, and all those other places. So, marketing is easy if you think out of the box a little bit.” (18:13—19:10)

“[This concept of virtual assistants is] really new, and I think a lot of people, generally, are hesitant to try something new. Most dentists have a smaller operation and they don't need it — they don't feel that they need it because they’ve got one person working up front, and maybe one in the back, or two in the back, or three in the back, and they don't know that the person up front is overwhelmed and holding things together on their own, and that they could use a little help and add $10 an hour, $15 an hour, whatever it is. They can use that help. So, I think that that's probably where people get it wrong, is you think everybody is doing fine until they leave, and they say, ‘Gosh, I'm working too hard,’ or, ‘I'm resigning.’ I think that that's where a lot of people get it wrong, thinking that it’s not for them, or that, ‘I can't do this.’” (21:14—22:16)

“The simplest things like hygiene recall and getting patients in that have treatment plans that are not completed that the person upfront doesn't have time to do, and all these little tasks that you have on your mind, your email and your inbox, pass them off. [Virtual assistants will] get it done.” (25:09—25:28)

“I've always struggled with the transmission of institutional information along the way. I started with one employee in 2009. And the things that I discussed with the employee are gone, the goals that I had. The information that had gone from employee to employee is a game of telephone, and it doesn't always translate. But if you're having your first session with a virtual assistant, that's all recorded. You can record it all, and you can tell them everything. And then they’ll remember it, they’ll watch it, they’ll share it with the next virtual assistant. And all that becomes much more scalable rather than handing them an employee manual or whatever book you have, your standard operating procedure book or whatever it happens to be in your practice.” (26:07—26:59)

“I think that the real innovation is that these are people who are really working for you. You're not as much outsourcing them as you are hiring people who are working remotely. They happen to be in the Philippines, but they're going to be people who are working specifically for you. I think outsourcing where you sign up with an agency and they're answering your calls, or you're faxing them or emailing information to work on, and they're working on stuff for you and stuff for somebody else, to me, that's not an ideal situation. I think the real ideal situation is to find a company that is going to provide people that are working specifically for you. They are your employees. You tell them what your hours are, what you want them doing for you, specifically, and they're working specifically for you. And you take care of them like any other employee.” (30:11—31:01)

Snippets:

0:00 Introduction.

1:37 Dr. Kupferman’s background.

3:19 Why he started MedVA.

5:21 Resistance to having virtual assistants.

6:53 Training virtual assistants.

8:34 The best place to start utilizing virtual assistants.

9:59 How MedVA grew and evolved.

12:11 Things he learned from outsourcing.

13:49 Is there a language barrier with virtual assistants?

15:30 Scalability and marketing.

19:11 Ways to manage virtual assistants.

20:59 What people get wrong about virtual assistants.

22:16 Virtual assistants help get things done.

23:22 How it works and where to start.

25:29 Scalability in training virtual assistants.

28:26 More about MedVA.

29:59 Last thoughts.

Dr. Steven Kupferman Bio:

Dr. Steven Kupferman, Co-Founder and Chief Executive Officer of MedVA, holds M.D. and D.M.D. degrees from the David Geffen School of Medicine at UCLA and from Harvard School of Dental Medicine, respectively. He brings nearly two decades of experience in the healthcare industry. He is the founding physician of LACOMS, Los Angeles’s premier Oral and Maxillofacial Surgery Center, where he first pioneered the use of Virtual Assistants to optimize the management of his practice while simultaneously improving the quality of patient care. Dr. Kupferman and his wife, Danielle, reside in Los Angeles with their four children. 

Why Trust Requires Rules in Your Practice

Episode #529 with Heather Crockett

Without trust, you don't have a team. Building that trust is hard work, and Kirk Behrendt brings back Heather Crockett, one of ACT’s amazing coaches, to share tips and advice for getting started. Before anything else, you need to establish some rules! Once you do, everything else will become a lot easier. To learn why you need rules to build trust as a leader, listen to Episode 529 of The Best Practices Show!

Episode Resources:

• Heather’s email: [email protected] 
• Heather’s Facebook: https://www.facebook.com/heather.r.crockett
• Heather’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:

Books by Patrick Lencioni: https://www.tablegroup.com/books

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

Brené Brown: https://brenebrown.com

How Should a Company Share Its Values? | Q+A by Simon Sinek: https://www.youtube.com/watch?v=5yE541BY-1c

Books by Simon Sinek: https://simonsinek.com/books

DiSC: https://www.thediscpersonalitytest.com

Main Takeaways:

Everyone needs a good set of rules.

Building trust with your team requires hard work.

Understand predictive trust versus vulnerability-based trust.

Once you establish rules, you will attract people who like those rules.

If you're having a hard time establishing rules, hire a coach to help you.

Quotes:

“The issue is trusting one another on a deeper level than just predictive trust. Predictive trust, when we delineate between predictive trust and a different kind of trust that’s a vulnerability-based trust, our predictive trust is, I know that my husband is going to take the trash out because he’s so great at doing that every Friday morning before the trash guy comes. I know that Chris is going to show up to my meeting on time because that's who she is. She’s going to show up on time, every single time. Those are predictive-based trust type of behaviors. What we are going to dive into today, we’re going to talk about vulnerability-based trust and what that looks like.” (2:20—3:05) -Heather

“Vulnerability-based trust is the ability to open up and be honest with one another on a team to say, ‘Hey, I made a mistake. I did something wrong. I need your help. I'm stuck. I'm still learning.’ So, it’s taking the ego out of it and using our out-loud voices, bringing our ideas and our thoughts and our opinions to the table and putting it out there and saying it out loud, being honest with one another in a timely fashion.” (3:15—3:46) -Heather

“Vulnerability-based trust requires rules in your family, in your business. And one of the rules is you've got to have rules around behaviors — and that is core values.” (6:11—6:20) -Kirk

“I was at ADA SmileCon, and Brené Brown spoke. It’s one of the best lectures I've ever heard. I was moved. I was riveted. She said to a room of thousands of people, ‘Y'all got to have a set of rules. How many of you have a set of rules called values?’ And I was shocked by the number of hands that went up. There were so few hands, it was frightening. And she said, ‘You've got to have some rules, some behaviors.’ And what I didn't do as a leader is I didn't have a set of rules and behaviors.” (6:23—6:56) -Kirk

“Simon Sinek did a short speech on why values should be written. It’s fantastic. He says values are verbs. You should never have “trust” or something like that as a value because values have to be actionable.” (7:06—7:21) -Kirk

“It goes back to our favorite equation of E - R = C. I can't trust you and know that you are going to behave a certain way, especially around the verbs of the core values, until we have those core values set in place. Especially as we put together our strategy and our process as laid out in Traction as well. So, as the leader of the business, you need to have those things set in place before you can start embarking on the pathway of that vulnerability-based trust. We need to have these rules in place. We need to agree that, ‘This is how we’re going to behave in our meetings. This is what we’re going to do in our meeting. These are the behaviors that we’re going to embody on a weekly, daily, hourly basis, our core values. This is really what is expected.’ And once we lay that foundation, then we can start moving into the vulnerability-based trust concept.” (8:14—9:13) -Heather

“How this applies to your dental practice is this: if you're listening and you follow Lencioni’s work, and you know how important trust is in a business, my encouragement is to start with rules. And if you can't establish rules, that’s why you hire a coach.” (10:53—11:09) -Kirk

“It takes some time, but once you start establishing the rules, you start living by the rules. You start attracting other people that like the behaviors like core values. They go, ‘This is awesome! This is why I work here.’” (11:42—11:51) -Kirk

“Accountability happens with accounting. Accountability is not saying, ‘Hey, I trust you.’ No. We agreed that this is going to happen in seven days, and it happens the way you agreed.” (12:24—12:35) -Kirk

“We use the DiSC assessment. So, people take their quick DiSC assessment and they figure out if they're a D, I, S, or C. And our S’s — and there are a lot of S’s in dentistry because S’s are steadiness. They're nurturing, they're naturally humble, they're genuine and authentic, and they're very caring — very caring to the point that, oftentimes, they have something to say, and they choose not to say it because they want to spare the other person or other people their feelings. They don't want to rock the boat. They don't want to create or cause any conflict. They don't want to hurt anyone’s feelings — which is admirable, to a degree. The problem is, oftentimes, when we don't share out loud some of our thoughts, feelings, and opinions — notice, I said some. Some of our thoughts, feelings, and opinions, because sometimes we can overshare — the problem is, especially as we are talking as a team and we don't share those ideas and thoughts, we are actually doing the team more harm than we are if we’re quiet. So, if we stay quiet, we’re doing the team more harm than if we shared that idea and that thought in the first place.” (13:04—14:18) -Heather

“Not having the right people in the right seats, that's probably the toughest one of all time. Like, ‘Okay, we’re going to do this.’ Well, the person who’s going to do this really isn't the person that should be doing this. And so, if you can't make these decisions, you know they're holding you back. And they're holding you back in a big way.” (14:43—15:02) -Kirk

“One of the things is not calling out the truth. And when you can step into rules, you have behaviors, you’ve got the right people in the right seats, you can start to go to the second layer of the pyramid, which is conflict. Lencioni’s whole thing of starting with trust and then getting to conflict, you can't get to conflict unless you have trust.” (15:46—16:06) -Kirk

“As we work our way up the pyramid and we have that accountability piece, that peer-to-peer accountability gets much easier when we trust each other. When it comes from a place of, I'm not saying anything because I need Kirk to share a login with me and I'm afraid that Kirk’s going to say he can't get that done for me, or I don't want to rock the boat, I don't want to hurt his feelings like, ‘I can't believe you haven't done that for me. I've asked you to do it a couple of times for weeks,’ whatever it is, coming from a place of understanding, that we’re doing this for the betterment of the entire team, and there are no personal attacks attached to it. And I think that's one of the biggest hurdles for a lot of these team members to get over.” (16:50—17:32) -Heather

“Everybody wants the results, but nobody wants to do the hard work that gains the results.” (18:21—18:26) -Kirk

“There are three selves: the self you want to be, who others think you are, and who you really are. And there's the lowest amount of stress or energy when all of those three get as close as possible.” (19:47—20:05) -Kirk

“Work doesn't have to be a four-letter word. It can be a fun word.” (20:53—20:56) -Kirk

“We always say as goes the leader, so goes the team. So, the leader has to go first. And you can bring it and be transparent. Once you introduce this concept to your team, you, as the leader, need to go first and lead by example to say, ‘Okay, guys. Spoiler alert, I'm about to be vulnerable. I screwed this up. I made a mistake and I need your help.’ And that's okay.” (21:13—21:38) -Heather

“Patrick Lencioni talks a lot about, ‘Don't let them see you sweat.’ Why would we do that? Why would we not want our team to see us sweat? It’s really okay for them to see that we’re struggling with something.” (21:38—21:53) -Heather

“All change processes start with the first step, which is telling the truth, which can include being vulnerable.” (23:14—23:23) -Kirk

“We can, as leaders, have a mixture of that humility and the confidence. That's what really makes an amazing leader. Not only do they have that humility, but they also come in with a confident front as well. And they're developing other leaders in that same way. So, let them see you sweat in the way that you are, in fact, telling the truth and being honest.” (24:36—25:00) -Heather

“Get over yourself and be first. Go first. Be vulnerable with your team. Find that level, that in-between area, of where you need to be vulnerable and where you need to be confident.” (27:49—28:00) -Heather

Snippets:

0:00 Introduction.

1:45 Why this is an important topic.

3:05 Vulnerability-based trust, defined.

3:47 Kirk’s journey.

8:00 The importance of having rules in place.

9:14 Having rules lead to trust.

10:56 How this applies to a dental practice.

12:50 Roadblocks of having vulnerability-based trust.

18:01 Results require hard work.

21:02 Let them see you sweat a little.

23:09 Change starts with telling the truth.

24:11 Embrace the rules first.

27:33 Last thoughts.  

Heather Crockett Bio:

Heather Crockett is a Lead Practice Coach who finds joy in not only improving practices but improving the lives of those she coaches as well. With over 20 years of combined experience in assisting, office management, and clinical dental hygiene, her awareness supports many aspects of the practice setting.

Heather received her dental hygiene degree from the Utah College of Dental Hygiene in 2008. Networking in the dental community comes easy to her, and she loves to connect with like-minded colleagues on social media. Heather enjoys both attending and presenting continuing education to expand her knowledge and learn from her friends and colleagues.

She enjoys hanging out with her husband, three sons, and their dog, Moki, scrolling through social media, watching football, and traveling. 

Occlusion with Your Patients’ Growth & Development

Episode #528 with Dr. Curt Ringhofer

Countless people are affected by temporomandibular joint disorders. Fortunately, you have the opportunity to correct it. If you want to be a valuable resource for your TMD patients, don't miss today’s episode! Kirk Behrendt brings in Dr. Curt Ringhofer, an instructor from the Chicago Study Club, to talk about recognizing, diagnosing, and treating growth deficiencies early so you can set patients up for proper growth and development. To learn more, and to find out how to join the Chicago Study Club, listen to Episode 528 of The Best Practices Show!

Episode Resources:

• Dr. Ringhofer’s email: [email protected] 
• Dr. Ringhofer’s office number: (708) 349-0022
• Chicago Study Club: https://chicagostudyclub.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:

The Bruxism Triad by Dr. Jeff Rouse: https://c1-preview.prosites.com/temp2bngb078h1/wy/docs/Dr.%20Jeff%20Rouse%20-%20Inside%20Dentistry%20Bruxism%20Triad%20Article.pdf

Finding Connor Deegan: https://www.aapmd.org/aapmd-blog/finding-connor-deegan-video

Main Takeaways:

Find the Connor Deegans in your practice.

Set young patients up for proper growth and development.

Recognize, diagnose, and treat growth deficiencies as early as possible.

There are more TMJ patients than you might think, and they will seek you out.

Remember that what we know today about occlusion may be wrong tomorrow.

Quotes:

“If we set people up for success, in any aspect of life, we’re setting them up in a way that they can grow. And it’s no different in growth and development. If we notice that there's a growth defect, whether it’s at the maxillary level or the mandibular level, we’re setting them up to grow properly. And when we set them up to grow properly, it’s going to affect the airway. And we all have heard the stories from Jeff Rouse — and airway seems to be the sexy topic nowadays — and the effects it can have on not only development of kids, but as we get older, there's more diabetes and heart disease.” (5:55—6:37)

“I read an article not too long ago that the highest incident of airway-disordered sleep is from about three to eight years old. Well, that's when the brain is developing. And if we’re suffocating the brain of oxygen, it’s not able to develop as well. And a lot of that has to do with the exoskeleton, which I learned from Mark Piper, that if we can grow the exoskeleton, now we don't encroach on the airway and kids can sleep better.” (6:37—7:08)

“What I've learned from Dr. Piper and Dr. McKee is that we have imaging to back up when there's lack of growth at the joint level. You have less projection of the mandible, which then gives you a smaller airway size. And so, if you can back that up with actual science and facts, it’s hard to dispute that. But I think maybe, then, the dominoes start to fall. If you have a smaller mandible, the tongue is encroaching on the airway. So, now, you become an open-mouth posture, which causes a narrow maxilla because the tongue is not occupying the mouth and advancing the premaxilla and widening the maxilla. So, what came first? Quite frankly, I don't really care. I think we need to diagnose it all, and then treat it as necessary.” (10:25—11:14)

“Jeff Rouse wrote an article on the bruxism triad. People with airway-disordered sleep are going to grind their teeth more. I always saw those kids with all that wear on their teeth, and I thought it was occlusion. Going through The Dawson Academy, I thought, ‘Oh, okay. The teeth don't match up. They're not in centric relation.’ Well, Dr. Rouse — really credit him for bringing that to the forefront — showed that, no, that could be an airway issue, and we need to look past the second molars, and are there enlarged tonsils and adenoids and things that are inhibiting the children from sleeping well.” (11:42—12:19)

“Did you ever read the article, Finding Connor Deegan? It’s about a kid who grew up in Chicago, and his mom wouldn't accept the fact that he had ADHD. Making a long story short, when he would test, he was testing cognitively gifted. But they kept saying he had ADHD. And it turned out he had an airway problem. They went through and they expanded his arches, took his tonsils and adenoids out — and the mom was adamant. Now, he’s an A and B student. And he doesn't have the stigmatism of having attention-deficit disorder.” (13:03—13:42)

“Talking to some of the physicians at that pulmonology group I work at, their hands are tied because they have about 15 minutes to talk to each patient. In dentistry, we’re lucky. I have a fee-for-service practice, so I can sit and talk to patients as long as I need to get that diagnosis and find out their history. And when I'm evaluating someone for growth or temporomandibular joint disorders, or any new patient, for that matter, the first thing I'm doing is sitting in my consultation room to find out what they want. And then, we go into the treatment room and we take a look. Because you can almost get as much, if not more information, by talking to the person rather than just looking in their mouth.” (13:49—14:34)

“One of the things that you'll hear when you're sending a young kid to an orthodontist and they have that Class II bite, or the discrepancy between the upper and lower jaw, is you hear a lot of reasons why. And my favorite one is, ‘Oh, they’ve got the upper jaw of the father and the lower jaw of the mom.’ And it’s like, no — this is a growth deficiency. And when you get the images, they have an anterior displaced disc, which disrupts the growth center sitting on top of the condyle, so then you can't get that projection of the mandible. Because when we think about growth, the maxilla is going to grow first, and then the mandible follows.” (16:44—17:27)

“Dr. Piper talked about the first permanent molars, which are the smart molars. And if we all visualize, what happens is as the maxilla is growing, the mesial inclines of the maxillary first molar interdigitate with the distal inclines of the lower, causing distraction osteogenesis of the condyles. I think of it like nature’s Herbst appliance. It’s causing the mandible to come forward. But if we lose the ability for the condyle to grow, what happens is then, if you clench the teeth together, it can hold the maxilla back from growing as well. So, that really doesn't ever hold true. Because I'll be at meetings and orthodontists get a little uncomfortable because they're like, ‘Well, some kids grow and some kids don't, and we’ve just got to try it.’ And I'm like, ‘No, we don't have to try. We can image and find out where the disc is.’” (17:28—18:20)

“The other [misconception] you hear is, ‘They have an anterior tongue thrust.’ Well, the question becomes, was the tongue there that caused the bite to open, or were they pushing their tongue forward because their airway was constricted, so they had an open-mouth posture where the tongue didn't occupy the roof of the mouth, so now we can't advance the premaxilla and expand the arch? So, I think that's where people get confused.” (18:21—18:50)

“One thing I heard Pete say when he was speaking one time, he goes, ‘If you're going to quote me, quote me on when I said it because things are going to change and I'm going to be proven wrong if I said something 10 years ago.’ And I love that line because it’s 100% true. What we’re talking about today could be wrong tomorrow, for all we know.” (19:19—19:39)

“There was a study club that I was involved with with [Dr. Piper], and it was about how the mandible gets ignored. There was so much out there that the temporomandibular joint is really a growth center that helps everything else develop. And it’s like the red-headed stepchild, if you will. Nobody wants to talk about it because we’ve got implant dentistry, we’ve got esthetics, and now airway seems to be the one. But there are so many people that are affected by temporomandibular joint disorders. And whether it’s from pain — and those are the easy ones. It’s the occlusal discrepancies that make it the most difficult. The vast majority of Class II patients have some type of growth deficiency at the joint level because their mandible didn't project. And when you think back to the most difficult cases, it’s the ones where the upper and lower teeth don't match together. They don't line up correctly. And those are the ones where we can't develop an occlusal relationship.” (21:06—21:14)

“We think of occlusion as the static relationship between the upper and lower teeth. But it’s the dynamic relationship that really gives us difficulty. We can get the patient to grind right and left and get everything adjusted perfectly. And as soon as they start chewing, you get that elliptical movement, things start to go haywire. And it’s the ones that go haywire, the Class IIs. And if we can diagnose those patients ahead of time, whether they accept treatment to correct it or manage it, whatever they do, they're taking ownership of it. And it’s not the dentistry I gave them, it’s their skeletal relationship. It’s their condition of their body. So, they're assuming the risk with us. And we’re not writing checks back because of dentistry that didn't work.” (22:14—23:01)

“Jim and I practice a half-hour from each other, and we are both busy. There is more of this out there than people — and they seek you out. I've never, in a million years, thought I would have a practice that dentists are referring to me. And, at first, it was a little uncomfortable because I didn't know what to do after I diagnosed them. But to speak to the point that these patients are crazy, they're not crazy. They just don't know where to go, and they’ve never gotten an answer. Because what did we learn in dental school? Give them a splint and, hopefully, they got better. But we were just hoping. Where, now, we can understand what the anatomy is. Is it structurally intact? Is it structurally altered? Is there an anterior displaced disc? Is there inflammation in the joint? All the different aspects that we would do for dentistry, no different than periodontal disease. We need to figure out why is there gingival inflammation, because it can come from plaque and calculus, it can come from a poor restoration. We need to figure out the why before we can figure out the how. And then, the patient needs to accept the risk with us. And that's really where I think people seek us out.” (23:52—25:03)

“If you have a Class II patient that is evaluated in the seated condylar position, so not MIP, by manual leaf gauge, anterior deprogrammer, whatever camp you came from and however you're going to get that patient to centric relation, or what we’ll call the fully seated condylar position, evaluate the anterior teeth. And if you have greater than a two-millimeter discrepancy in the horizontal or vertical dimension, or midline discrepancy, those are the patients that we need to start to think there's a loss of dimension or a lack of growth at the joint level. And we need to evaluate that because, especially in growing kids, if they can't grow, we’re setting them up for failure. And that's a concept that Dr. Piper taught me, called the rule of twos. And where it came from was the disc thickness is two millimeters. So, if you have a two-millimeter anterior open bite in any of those three dimensions, that could be an issue of a disc displacement.” (26:52—27:59)

Snippets:

0:00 Introduction.

1:47 Dr. Ringhofer’s background.

3:08 How he got Terry Bradshaw’s jersey.

5:17 Why growth and development in occlusion is an important topic.

7:10 How his practice has evolved.

8:35 Why aren't humans forming properly to breathe?

11:14 The bruxism triad.

12:19 Find the Connor Deegans in your practice.

14:35 Working with pulmonologists.

16:29 What most dentists get wrong.

20:17 The vision for his study club.

23:06 Myths around TMD patients.

25:25 What we can expect to learn in the future.

26:40 Last thoughts on growth and development in occlusion.

28:02 More about Chicago Study Club.

29:55 How to get in touch with Dr. Ringhofer and how to join the study club.

Dr. Curt Ringhofer Bio:

Dr. Curt W. Ringhofer graduated from the University of Illinois Dental School, and has committed himself to providing only the finest dental care. He and his team have continued to educate themselves, assuring that you will only receive the latest state-of-the-art, personalized care.

Dr. Ringhofer has pursued advanced dental education at the Dawson Center, The Kois Center, Misch International Implant Institute, and The Piper Clinic. He is also a member of two study clubs in which he meets with dentists from both the United States and Canada throughout the year. He lectures extensively throughout the country on TMD, Occlusion, and Sleep Apnea.

Dr. Ringhofer is a member of the American Dental Association, American Equilibrium Society, Academy of General Dentistry, American Academy of Restorative Dentistry, as well as a Fellow in the International Congress of Oral Implantology. 

Outperforming the Pack in the Age of Covid

Episode #527 with Dr. Grace Yum

Dentistry suffered during the pandemic. Yet, some practices were able to outperform and thrive. To share how they did it, Kirk Behrendt brings back Dr. Grace Yum, founder of Mommy Dentists in Business, who polled members of her MDIB community for their best practices. She found seven key points that helped them outperform during COVID-19, and you can use these tips to prepare for the future. To learn what successful practices did to outperform the rest, listen to Episode 527 of The Best Practices Show!

Episode Resources:

• Dr. Yum’s Facebook: https://www.facebook.com/profile.php?id=100075730122393
• Dr. Yum’s social media: @dr_mrs_boss_mom
• 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:

Mommy Dentists in Business Podcast: https://mommydibs.com/podcast

CEO Roundtable events: https://mommydibs.com/events/ceo-roundtable

Main Takeaways:

1) Adopt protocols quickly.

2) Call your patients individually.

3) Drop PPOs as soon as possible.

4) Run “lean and mean” with your team.

5) Be prepared to see emergency patients.

6) Do more elective dentistry. Some are low risk.

7) Build a great culture that your team wants to stay in.

Quotes:

“Looking back and polling the 10,000 [in the Mommy Dentists in Business community], I was able to harvest information, analytical data, on independent practices — not large DSOs — on what they did to financially do better than previous years. One might think, ‘Of course. We shut down. It was COVID-19. Nobody practiced for a couple months. Of course, numbers are going to go down. Of course, production is going to go down. Overhead went up,’ etc. However, there were many practices that outperformed what they did in previous years. And so, I wanted to know, ‘What did you do to outperform yourself?’ And hence, the word, outperformers. And I was able to collect a lot of information from everyone who was willing to share. Some did not want to share publicly on Facebook, so they sent me private messages or emails. And after filtering through all that data, I was able to come up with seven consistent points for action.” (5:11—6:29)

“Number one, COVID-19 protocols were adopted and set in place, in motion, fast. So, the practices that were able to prepare their teams and get those protocols in place and get everybody lined up early on so that when the states say, ‘Open,’ they're ready to go. Because a lot of states said emergencies only. You can only do emergencies. It depended on population density of your town because there are rural parts where COVID-19 didn't hit, and it was business as usual. So, it didn't affect them. But if you were in a very densely populated city where COVID-19 was rampant then, yeah, there were a lot of issues. So, practices who were able to say, ‘Okay, I've got protocols in place. My team is on board, and they're trained,’ and they were kept in the loop during quarantine, they were able to open their doors with confidence, with their team, confident, and quickly.” (9:58—11:04)

“Number two, offices or practices that called their patients individually rather than a mass email, they were able to fill the schedules quickly. The patients felt cared for and were less afraid. They had communication with their patients. The team handled all the questions with compassion, not saying, ‘Oh, you're ridiculous. Don't worry about it.’ No, they said, ‘We understand you're nervous. We understand you're scared. Let us answer your questions. We want to make sure you're comfortable coming in, and not afraid.’” (11:45—12:21)

“There are practices that did both, mass emailing and calling. And you know your patients. You know the ones that are going to be timid and ask you 50,000 questions, and you know the patient that's like, ‘I trust you blindly. Whatever you say, doc. I'm coming.’ So, you have to know your patient base and who you're really going to call.” (13:03—13:25)

“Number three, practices that dropped PPO insurances became more profitable. And that's obvious. You're not in-network anymore. You're going to get cash pay. Of course, it’s going to hike up your productivity and your income. Most doctors would be afraid to drop insurances. But the ones that did drop their PPO did see an increase in their profits because they communicated to the patient why they were dropping the PPO. They explained, ‘I can't see multiple patients at a time now. We can only do one at a time. The rise in cost of PPE, I am trying to keep you safe. I want you to feel comfortable being the only patient in the office and nobody else around, and we want you to know that we paid extra money for the PPE so that we’re all covered up, that you're going to be safe.’ Those patients completely understood and agreed to pay full price.” (13:27—14:31)

“Everyone who dropped [PPOs during COVID-19] were like, ‘This is the perfect time.’ They did it, and they were like, ‘I'm so glad I did it.’ It was the right time to drop the PPO. They were ready.” (14:54—15:07)

“Number four, practices that ran lean and mean, meaning they trimmed the extra fat, they saw their profits rise. So, they ran on a skeleton crew, but they were able to provide the same level of care because now, they're really doing one-on-one, not three ops filled. They were able to do the one-on-one care with a skeleton crew. They lowered their overhead, but then dropped insurances and increased their productivity as far as monetary wise. So, they were getting their profits up.” (15:20—15:58)

“This was the best time to drop toxic employees because you had to furlough. And then, you could bring back who you wanted to bring back. So, they realized, ‘Hey, this guy or girl is always giving everybody trouble. Keep them furloughed. I'm not going to call them until I really need them.’ And so, they said, ‘I'm going to pay for two assistants, and I'm going to drop insurances, and we’re going to run on a skeleton crew.’ One front desk and one back assistant. That's it . . . Why have all these extra hands when you don't need to?” (16:23—17:04)

“Number five, many doctors saw an increase in seeing emergency patients. There were a lot of broken fillings, clenching, and a lot of bruxism. And that's probably because a lot of parents were home with their kids. Everyone was stressed during COVID-19, not just dentists. Doctors reported an increase in broken restorations and, therefore, more dental work. And then, again, going back to what I stated in the beginning, the doctors that secured their PPE first, they were able to see the new patients because the dentists in their community that didn't have their PPE couldn't see patients. So, the ones that adopted the protocols early, got their air purifiers, got the N95 masks, got the gowns, got the face shields, they made patients feel comfortable. They were taking patients from other dentists in the community because they had everything. They were ready to roll. So, all of a sudden, their schedules are packed with emergencies because they had everything. And the minute they could practice again, they were on it.” (17:06—18:16)

“The sixth point, it’s going into what kind of dentistry we were doing. So, a lot of emergencies. But then, because everybody was doing Zoom calls, patients were looking for elective work. They're looking at themselves on camera and they're like, ‘Oh my god, my teeth are brown!’ They wanted veneers. They wanted whitening. They wanted Invisalign. They wanted cosmetic work. More and more people were self-conscious of what they looked like because of Zoom calls or Google Meet calls or Microsoft Team calls. Patients were seeking elective services alongside emergency services. So, that Invisalign case, that $7,000, $8,000 case, boom, they were like, ‘Sign me up. I'm in.’ And how easy is Invisalign? You're scanning a patient, and there were no aerosols, unless you're getting to the bonding buttons and stripping down. But initially, you're just scanning, come back, deliver your first set of trays. There is very low risk in Invisalign at the dental office.” (18:35—19:50)

“The last point that I'm going to leave you with is that doctors who provided a strong culture for their team also reported increase in profits. Because the doctors engaged their team members during quarantine, they leaned in, they said, ‘We’re going to be on WhatsApp. Is your family sick? Did you guys get COVID-19? I'm sending you dinner. Uber is coming over to drop off dinner. You guys need groceries? I'm going to give you guys grocery cards. You guys need this? I'm going to send you this.’ And the doctors who were like, ‘Hey, let's meet on Zoom. Let's check in. Let's talk about the protocols. Let's talk about the PPE. Let's talk about your fears. What are you worried about? What are you not worried about? What do you need?’ those doctors who showed true leadership and kept their team close reported higher numbers. So, that is really important, culture.” (20:29—21:29)

“A lot of this comes down to communication, basically. Communicating with your team, communicating with your patients, communicating with your distributor or manufacturer and getting supplies. If you had a good relationship with the person that you're ordering supplies with, you bet they're going to send you the box of N95s really fast. If you're that person’s favorite dentist and you treat that rep really well, oh yeah, they're going to send you what you need, and fast. If you're only ordering through websites and eBay and there's no person to talk to, good luck. You might be getting fake ones.” (21:32—22:11)

“Right now, the challenge is human capital crunch. People are having a hard time finding employees or team members. And so, they’ve learned, if you can keep your culture happy and people happy, you can maintain. But — I hate to say it — a lot of team members, they're going to leave you for that extra $5. It’s really hard to be pushed into a corner. But a lot of companies, including DSOs, ended up paying double what you normally pay for an hourly employee to keep them around. And now, it’s about building a better mousetrap in your company. It’s about retention. Because we all know, when you have turnover, it’s costly. It’s taking time, spending more money training a new person. You want to retain the good talent that you have because, chances are, they're going to get poached.” (22:42—23:42)

“Learn to communicate. And you need to be a people person. I'm not saying you need to be a pushover or a doormat — I'm not saying that. But you need to learn how to cultivate rapport. That will serve you well ten times over. You need to be likeable. Don't be a jerk. Nobody likes a jerk. Not your patient, not your rep, not your team members. I get it — you worked really hard and long to be a doctor. But stay humble. Don't be a hotshot, because nobody cares for a hotshot. And even if you practice long term, even 20 years out, you're still learning new things. You still make mistakes. And I know that you're going to think, ‘Oh, I'm a doctor. I have “doctor” on my scrub top.’ In 20 years, you're not going to even want to wear scrubs anymore.” (24:35—25:19)

“When you put out good energy and good karma, it comes back to you. It really does. So, I believe that as a young dentist, learn your skillset, learn your trade, learn from mentors, but be a good person. Do what's right for the patient. Do what's right for the team. And put yourself in the other person’s shoes. So, understand before you want to be understood.” (25:43—26:07)

“Keep learning. Keep going. Don't be discouraged. Day to day, it can be discouraging. But look for the positive in that day. Look for your why. Did you make a patient smile? Did you get someone to say, ‘Oh my gosh, I love the color of my teeth,’ or, ‘Oh my gosh, I can smile again’? Look for the reasons why you're in this in the first place, because that's going to keep you motivated and that's what's going to keep you coming. And guess what? The money will come.” (26:37—27:08)

Snippets:

0:00 Introduction.

2:00 Dr. Yum’s background.

3:45 Mommy Dentists in Business Podcast and website.

4:31 How her group became a hub for information.

9:47 Getting ahead during COVID-19: get protocols in place quickly.

11:45 Getting ahead during COVID-19: call patients individually.

13:26 Getting ahead during COVID-19: drop PPOs.  

15:18 Getting ahead during COVID-19: run lean and mean.

17:06 Getting ahead during COVID-19: see more emergency patients.

18:32 Getting ahead during COVID-19: do more elective dentistry.

20:29 Getting ahead during COVID-19: keep your team close.

22:12 Findings from her group after COVID-19.

24:11 Advice for dentists.

26:21 Last thoughts on outperforming during COVID-19.

27:11 About CEO Roundtable and future events.

Dr. Grace Yum Bio:

Dr. Grace Yum is a lifelong resident of the Chicago area, where she grew up in Glenview. She is a mother and a certified pediatric dentist — a certification achieved by only 5% of all dentists in the U.S. Dr. Yum is the former founder and practice owner of Yummy Dental & Orthodontics for Kids, and she is also the founder and CEO of Mommy Dentists in Business.

In addition to managing the MDIB community, Dr. Yum hosts her own podcast, Mommy Dentists in Business Podcast. With 11 complete seasons, Dr. Yum’s podcast has been in the iTunes top 100, was ranked number 3 of 15 of the top dental podcasts by Patterson Dental’s Off the Cusp publication, and has been downloaded nearly 80,000 times.

Dr. Yum has quietly become nationally recognized in her field. She has appeared and was featured on the TODAY Show on NBC, NBC Chicago as a repeat guest, Parents magazine, Parenting magazine, and Chicago Parent magazine. She has also appeared on many podcasts, with topics covering dentistry, work/life balance, and business tips for the working mom.

My 3 Biggest Pet Peeves in Dentistry

Episode #526 with Dr. Jeff Rouse

Aside from patients and insurance, there are numerous things about dentistry that can rile you up. Today, Kirk Behrendt brings back Dr. Jeff Rouse, one of ACT’s all-time favorites, to share three of his pet peeves in the dental space and the changes he would like to see in the future. If you're ever planning to meet Dr. Rouse, pay attention! To learn what not to say or do in his presence, listen to Episode 526 of The Best Practices Show!

Episode Resources:

• Dr. Rouse’s Facebook: https://www.facebook.com/jeff.rouse.58
• Dr. Rouse’s social media: @jeffreyrouse
• 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:

Spear Education: https://www.speareducation.com

Dr. Frank Spear, Dr. Gregg Kinzer, and Dr. Ricardo Mitrani’s treatment planning course (December 2-3, 2022): https://content.speareducation.com/2022-spear-live-art-of-treatment-planning

Main Takeaways:

Put in the effort.

Get rid of the defeatist mindset.

One course is not enough to improve.

Join a study club and be open to sharing your work.

Don't assign the value of an insurance company to patients.

Quotes:

“Whenever I saw Frank lecture, or Gregg — anybody lecture — I would always think, ‘I want to do that. That's cool. I want to be able to treat that.’ And, in fact, I'll even go back farther. In 1995, I saw John Kois lecture. And I said, ‘I want to do that. I can't do that right now. I'm going to figure out how to do that.’ I never, ever said I couldn't do those things because they weren't in my world. I just changed my world, and it started with me. I changed who I was and my confidence and competence to do the case.” (4:30—5:19)

“It’s such a defeatist attitude — and lazy attitude — to say, ‘Those case patients aren't in my world,’ because that's the easy way out. It’s not, ‘I'm going to go learn how to do it. I'm going to go find those patients. I'm going to figure out how to do that.’” (5:20—5:39)

“If you talk to dentists and they say they're burning out, it’s because they're not challenged. They're not getting any better. And if you don't get any better, I understand why you're burned out. I wouldn't want to do the same junk every day. You've got to be getting better. You've got to be putting some effort into this. You've got to have something that’s going to drive you to the next year, and the next 10 years. And so, for me, I'm more excited today than I've ever been to do dentistry. I love it. I love it right now more than at any other point in time in my 34 years.” (5:59—6:37)

“To take the easy route and just say, ‘Not in my practice,’ that drives me crazy.” (7:50—7:56)

“When I went back through and looked at all those people that we were doing very significant dental care on, you know what the common element was? They had been to a ton of other dentists and have been sitting in their hygiene program for years, getting exams that said, ‘Nothing is broken. Nothing is diseased. We’ll see you again in six months.’ So, when you're walking out of the room and you say to your buddy, ‘Those patients are in their practice, not in mine,’ no — they were in your practice for years. You just didn't bother to either learn how to diagnose it correctly or get them out of the hygiene operatory and actually have a more comprehensive view.” (10:43—11:29)

“Number one on my list of things that aggravate me is taking the easy way out and assuming that those people aren't in your practice, because they are there.” (13:13—13:24)

“What it really comes down to is when they're walking out of the room and saying, ‘Those aren't in my practice,’ it’s like they're saying your baby is ugly.” (19:42—19:49)

“I want everyone to have the joy that I get out of doing this kind of dentistry. I want everyone to experience that. It is so much fun. It is absolutely the best way of doing dentistry, in my opinion. And I want everyone to experience it so badly that when I hear them giving up that easily, it just kills me.” (20:02—20:23)

“You've got to put in the effort to get the benefit. And no one course is going to do that in treatment planning.” (20:48—20:57)

“You could take a course in some sort of software that you're going to use to plan implant placement. And you come home, and you use the software. That's not treatment planning. Treatment planning requires you to understand not only breadth of information but depth of that information. And an introduction like facially generated treatment planning at Spear gives you a taste of what is required in order to get there. But it has to be studied in more depth than that.” (21:36—22:22)

“In 1995, I saw John Kois. Went and heard Frank Spear lecture. If I had just gone, ‘Well, okay. I guess that's it,’ that would've been silly. No, I had to hear Vince Kokich lecture. I had to hear Dave Mathews on perio. I had to go travel all over the country to go to different courses. And I found certain people that all taught me the pieces that I needed to be able to synthesize that information. And then, working with Bill Robbins, all of his knowledge, my knowledge, all of that came together and I can start treatment planning at a higher level. But it took a few years. It was a handful of years involved in order to get to where I started feeling comfortable with it, to where those cases started coming around.” (22:25—23:23)

“To think you're going to go to one course and have it — actually, I heard it the other day. And it’s someone I'm really close to that took facially generated treatment planning. I said, ‘We’re doing this other thing,’ and she said, ‘Well, I already took that course.’ And I'm like, ‘Oh. So, you got it? That one course, you got it all?’ She’s like, ‘Well, no.’ I'm like, ‘There. You don't. You need more.’” (24:23—24:58)

“One course may teach you how to do a better composite. One course is not going to teach you how to be better at doing interdisciplinary dentistry. That requires continued work, continued learning. And the best thing to do is commit to learning it, and then find a group, usually a study club, that has specialists in it that you can continue to evolve your ability to treatment plan. And then, you've got to do it. You've got to make the photographs, and collect the data, and present cases to that group.” (25:03—25:40)

“I think that's one of the bigger issues in dentistry is that we don't have a coach watching us all the time and correcting us all the time because we tend to be loners. And our practices are usually alone.” (26:38—26:52)

“I was an associate in a practice for a while. And if we’re an associate, we tend to not share as much as we should. And so, I think being open to sharing — like I had a second ago, the associate here in the office was doing a case that is unfamiliar with implants and how to manage provisionals and such. And so, we sat down, and I trimmed some of it, and they trimmed the other part. And that's a quicker way to learn the lesson than doing it on your own and having it look like crap, or fail, or whatever, and then you have to go, ‘Okay. Well, next time I've got to do this differently,’ and then having to evolve that way.” (26:55—27:42)

“It’s a sematic issue, but it’s the truth: the patient isn't a Delta patient. The patient is a patient. The patient has Delta insurance. And they didn't go out and buy Delta insurance, their employer bought Delta insurance. And I'm using Delta as a generic term, not a specific. It happens to be one of the bigger ones that I hear about, but it could be any insurance. The person isn't a Delta person, meaning the values of the Delta Dental insurance of having cheaper care, or whatever it happens to be. That may or may not be the values of the patient. And yet, when they walk in, you go, ‘Yeah, that's a Delta patient.’ Well, we kind of give up on them. ‘Yeah, I treat a bunch of Delta patients.’ I'm like, ‘Okay. The patients, they have needs. Right?’ ‘Yeah, but they're Delta patients.’ I'm like, ‘Dude, that doesn't stop them from making a decision independent of Delta. There are all kinds of ways to work around that.’” (28:59—30:15)

“If a patient wants care, they can get care. If they want what we have to offer, then they can do it. Absolutely, they can do it. And so, assigning the value of the insurance company to the patient drives me crazy, because it’s not right. There’s a bias when they walk in the door as to how you're going to go about treating them. And I think you [should] offer them the solution that you would recommend for yourself or your family and see where you go from there. Give them a chance to say yes or no.” (30:29—31:22)

“If you don't ever begin the process, you'll never get there. You will always do the same thing.” (36:17—36:22)

Snippets:

0:00 Introduction.

2:05 Dr. Rouse’s background.

3:41 Pet peeve 1: the defeatist mindset.

6:38 Why he loves dentistry now more than ever.

13:24 The beauty of interdisciplinary dentistry.

20:24 Pet peeve 2: not putting in effort. 

25:48 No dentist is an island.

28:30 Pet peeve 3: “I treat a lot of Delta patients.”

31:24 Advice for dentists.

37:43 Pet peeve 4: Buffalo Bills fans.

39:37 More about Spear, Dr. Rouse’s courses, and how to get in touch.

Dr. Jeff Rouse Bio:

Dr. Jeff Rouse is recognized as a pioneer in the field of airway prosthodontics — the impact that a compromised airway has on the stomatognathic system. Along with fellow Spear Resident Faculty member, Dr. Greggory Kinzer, he developed the "Seattle Protocol" to recognize, control, and direct resolution of airway distress in a restorative dental practice.

Dr. Rouse maintains a private practice in San Antonio, Texas, and practices with Dr. Kinzer and Dr. Frank Spear in Seattle. He is also an adjunct assistant professor in the Department of Prosthodontics at The University of Texas Health Science Center at San Antonio. Among his dental accolades, he has written numerous journal articles, including a portion of the “Annual Review of Selected Dental Literature” published each summer in the Journal of Prosthetic Dentistry. Most recently, he co-wrote a textbook by Quintessence titled, Global Diagnosis: A New Vision of Dental Diagnosis and Treatment Planning.

After graduating from dental school in San Antonio, Dr. Rouse completed a two-year general practice residency at the University of Connecticut Health Science Center. He practiced family dentistry for 12 years before returning to school to earn his specialty certificate in prosthodontics from The University of Texas Health Science Center at San Antonio in 2004. He is a member of the American Academy of Restorative Dentistry and American College of Prosthodontists, and past president of the Southwest Academy of Restorative Dentistry.

I Dropped Delta & I'm Still Too Busy

Episode #525 with Dr. Kevin Groth

Do you and your team provide exceptional service for your patients? If you do — and you believe it — why are you accepting average or below-average fees? It’s time to make some changes, and today’s guest is here to help. Kirk Behrendt brings back Dr. Kevin Groth, who recently dropped Delta, to share his journey, what he’s learned, and advice for dentists looking to be free from PPOs. You deserve to get paid for the work you do! To learn how to get started, listen to Episode 525 of The Best Practices Show!

Episode Resources:

• Dr. Groth’s email: [email protected] 
• Dr. Groth’s Facebook: https://www.facebook.com/grothdental
• Dr. Groth’s phone number: (248) 229-9380
• Dr. Groth’s social media: @drkevingroth
• ACT’s PPO Roadmap: https://form.jotform.com/221648541900150
• 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:

You should get paid for the work you do.

PPOs mean working one out of every four days for free.

Do your homework and the prep work before dropping PPOs.

A few great patients will leave you, but don't take that personally.

Believe in yourself and your team. You can do this and be successful!

Quotes:

“At the beginning of the year, you always look back on the previous year. And I hate that because you look at the numbers and be like, ‘I wrote off that much money from doing the work but not getting paid for it?’ And that's what we’ve done the last couple years, to the point that I always bring my manager into the office and say, ‘This is crazy. Should we think about doing this? What do we do? I think it’s time to maybe think about dropping.’ And then, we get on with our busy week and we put it to the wayside.” (3:36—4:02)

“It became time to say, ‘Let's get paid for what we’re doing.’ Actually, I remember the day. It was a day where I did like three hours of posterior composites. And then, I realized, Delta, I had to write off like 55% of what I just did. And I worked so hard for those composites that it’s crazy to me.” (4:16—4:37)

“I'm not saying the write-off is 55% for everything. But those specific procedures that I did was close to that. And my hourly wage was less than what my hygienists were producing at that time. So, to me, it made no sense. And I'm like, ‘You know what? I'm too busy, too many patients, and I'm writing off so much. It’s time to make some changes here.’” (4:38—4:58)

“If someone is listening to this and they're thinking about [dropping PPOs], I would also look at your office and what you do as a practice. Are you separating yourself amongst the peers around you that make you stand out from a value aspect? Because patients see this as a monetary thing. If they don't value you, they're going to walk. And I think it’s an important thing to say, ‘Am I ready for this? Do I have the right team? Do I have the right technology? Do I have the right services? Do I have the right brand to make a pretty drastic change without going crazy or doing it the wrong way?’” (5:55—6:28)

“We looked at last year, and it was like, ‘Dang, we wrote off half a million dollars’ worth of work.’ And this is another thing, is we raised our fees last year to combat inflation. And yet, it didn't do anything besides make our collection percentage go down.” (6:51—7:09)

“Pick one out of four days, and those are the days you work for free.” (7:13—7:16)

“About 20% to 30% of Delta patients will probably leave you, according to the research. Some people say 10%. But also, if you lose 30% of those Delta patients, you're still going to net even. So, when I looked at that, I was like, ‘Okay. We can lose 300 patients out of the 950, and I can still be at 2,100 patients,’ which is still too many patients for me to occupy. So, why wouldn't I jump in and [drop Delta]?” (8:05—8:30)

“This is the best time you can drop Delta because everything is more expensive. If I dropped Delta two years ago, people would think it’s a money-hungry grab. But the reality is, everything is more expensive, so people anticipate this, saying, ‘Okay. I pay more for groceries. I pay more for gas. I pay more for my dentist visits. And that's okay because this is part of life and what we’re going through right now.’ And people that value you won't think twice about that. That's the key, is you've got to look at these things from those perspectives and say, ‘You know what? I can do this. I believe in myself and my team.’” (9:22—9:59)

“I said, ‘Guys, we’re better than the average dentist. I think we all agree with that, right?’ ‘Yes.’ ‘Okay. Then why are we accepting fees that would be usual and customary in our area? It doesn't make any sense because what we provide is a service that goes above and beyond anything that's usual here. Nothing is usual. We’re extraordinary in how we do it. I know all of you believe in that. So, it’s time that we start looking at this, and it’s time to start thinking about these things. Because if I don't do this, then we’re going to have to make some changes internally, which I don't want to do. So, it’s either we make these changes that would be beneficial to everybody, or I start looking at things and saying we need to start cutting back here, here, here, and lower our bar to the lowest common denominator of the area.’” (10:00—10:48)

“The process of it is really getting yourself mentally on board, that this is the process that we’re going to go through. I believe that this was what's best for us, and I believe that this is something that is going to be better for our office to continue to provide the care that we’re doing without changing who we are as a business or an organization.” (11:33—11:52)

“[The reception to the Delta letter] was a mixed bag. We had some patients that dropped us right away. And we started making an Excel spreadsheet of this, saying, ‘Okay, here are the patients that left us for this.’ It was a handful. They didn't even give us a chance. Some people said, ‘It’s strictly financial. I'm sorry. I have to go somewhere else.’ Or maybe they were waiting for opportunities for us to change so they could leave, because maybe they moved further away, or whatever it may be. There was a combination of things that people left us for.” (14:17—14:43)

“I was actually surprised by the number of overwhelmingly positive reviews or feedback of the letter that we got. And people would want to talk to me. So, I'd be running three hygiene and seeing 15 patients a day, but then they'd be like, ‘Can we talk about this letter?’ And I'd be like, ‘I don't have time for this.’ But I guess you need to prepare for that. Know that you're going to have a five, 10-minute dialogue about Delta. And as long as you are confident in terms of how you deliver that message, people understand and say, ‘I get this is why you're doing this. I respect it. I understand that you are better than average, and we’re not going anywhere.’” (14:45—15:18)

“I also have an amazing, amazing front desk that has taken on the bulk of the phone calls and dialogues with these patients. So, I'm not putting a fresh 21-year-old up at the front desk to answer these phone calls. I have people that believe in who we are. They’ve been through the process with this office. They know what they're saying. And quite frankly, I gave them the autonomy to do whatever they need to do that is right to make this patient happy, or communicate how we need to. And at first, they were a little clunky in the dialogue. Like, you can try and script this as much as you can. The reality, you're going to evolve that script to the point where it’s going to get to a different position by the tenth phone call with somebody versus the first phone call.” (15:25—16:05)

“I think we’ve lost about 60, 70 patients so far, which is not too bad for 950. And of the 60, 70 patients, there might be five or six that I'm going to be missing. The rest were probably good weed-outs anyway. And it makes sense. If they don't value who we are, they were there for the financial component of things, because we took their insurance. And they left us because it wasn't aligning. But I don't want patients that don't value me. And to me, it’s like, if you don't value me and what we do and how we do things, why are we in this relationship?” (17:05—17:37)

“[Dropping Delta has] weeded out some of the dead weight. And I don't want to call people that. But at the same point, we all have those patients that you see on the schedule, and you're like, ‘Ugh. Gosh, I can't stand this person.’ Or they drive my front desk nuts, or there are always issues with the billing, or whatever it may be. Those people leave, and I'm like, ‘Good. Find some other office that you can do this to. Because, quite frankly, you probably shouldn't have been here all along.’ And this is a good reason to have them go.” (17:40—18:04)

“This is one I took from Zach [Sisler], is I will say, ‘My door is always open. You're always welcome back here.’ . . . And I don't tell that to everybody.” (18:08—18:20)

“It’s crazy, looking at the schedule. I look at the monthly report, or whatever it is, and I'm not writing off $3,500 a day. That's insane. That's so much work. You're talking about two crowns’ worth of work that you write off every day on that sheet. It’s like, this is crazy because I'm working so hard. And I'm sure everyone listening is working hard. You should get paid for what you do. I work hard. I go to these courses. I get a bunch of great labs, and materials, and all these things that I do to give my best to these patients. And yet, I can say that I'm writing off 30%, 40%, 50% of what that is. It’s not right.” (18:46—19:20)

“I hope that other people have a brand of some sort, and they believe in what they do, that they believe that they offer a service that goes above and beyond the usual and customary. Because if you do, then get paid for that.” (20:51—21:03)

“You have to be flexible. You have to keep a blind eye to that list and not get yourself so hung up on why people leave you because you don't know their life experience or circumstance that they're in. So, if they leave, I hope the best for them. I really do. And I'm going to miss several of those patients that left me. But it’s what's best for me. It’s what's best for my company. It’s what's best for our patients. It’s what's best for my team. That's what you've got to look at. It’s not the individual that leads you.” (23:34—24:04)

“[Even after dropping Delta,] I'm still busy. Still way too busy because I didn't lose enough people.” (24:16—24:21)

“People don't like surprises. So, if you can make it so they're not surprised and they know exactly what's coming, I think people are reasonable with it.” (25:28—25:37)

“We have a lot of patients that think Delta Dental is the best insurance. And they always say, ‘Well, I don't understand. I have the best insurance plan. Why don’t they cover this much?’ Well, that goes down the rabbit hole of what Delta Dental is and what insurance is in dentistry versus medical insurance. There's a huge difference with that, and they don't understand that. I've had patients that said, ‘Well, I don't get it. You're doing a write-off. Can't you write that off in taxes?’ It’s like, ‘That write-off is very different than what a governmental write-off is for taxes. You have to receive money in order to pay the taxes on that.’ And he goes, ‘It looks like you're getting taxed twice.’ I'm like, ‘Pretty much. I'm glad you understand this now.’” (25:42—26:22)

“People have called me disgusting . . . ‘This is disgusting. I can't believe that this is happening at this office. I've been a patient for decades. He’s disgusting.’ ‘Oh, okay. I'm sorry you feel that way.’ The paying upfront thing, ‘Doesn’t he have enough money? I don't understand. Is this practice struggling? Because he has to now get paid upfront. Is that a big change?’ I'm like, ‘No. That's because that's a Delta policy. You have to get paid upfront.’” (26:31—26:58)

“I had one guy, I saw his wife one time when I was right out of dental school. I don't even remember her anymore. And obviously, something didn't happen well. But I had seen him for nine more years. And I've treated him well for the nine years. And as soon as he got the Delta letter, he said, ‘This is the last time I'm coming here because you didn't call my wife back nine-and-a-half years ago.’ ‘But you've been a patient here for nine-and-a-half years, and you haven't had any issues with me, have you?’ ‘No.’ But you're going to find any excuse to leave. And if you want to say it’s your wife’s problem, no. It’s because of financials.” (27:03—27:41)

“Here’s a big caveat. Most of the time you have conflict in your practice with a patient, it’s because of finances. And that's what it comes down to. What's really the true problem here in those that have left my office is because it’s a financial thing. And I respect it. I understand. I know people are in different positions, no matter what it is. But if they value you enough, they will stick around.” (27:43—28:04)

“[What most people get wrong is] I don't think they believe in themselves. I don't think you believe or have the confidence that you could do something like this, and that you should be part of the system. You are just another fish going down the stream type of a thing. Stop that stream. That’s what I think people get wrong, where they get so hung up on who leaves you, or they don't believe that they should ask for this as the value of what they do. But I ask that value when I ask for somebody that's on a different insurance plan, and

How to Stay Healthy While Traveling

Episode #524 with Dr. Uche Odiatu

Traveling can take its toll. If you want to stay healthy while you're on the road, you need great habits and a positive mindset. To help you be your best no matter where you are, Kirk Behrendt brings back Dr. Uche Odiatu, the fitness guru, to share some simple tips you can try on your next trip or vacation. To learn the best secrets for before, during, and after your flight, listen to Episode 524 of The Best Practices Show!

Episode Resources:

• 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:

Brown University sleep study: https://www.brown.edu/news/2016-04-21/sleep https://www.cell.com/current-biology/pdfExtended/S0960-9822(16)30174-9

Dr. Andrew Huberman’s light study: https://hubermanlab.com/using-light-sunlight-blue-light-and-red-light-to-optimize-health

The Mind-Gut Connection by Dr. Emeran Mayer: https://emeranmayer.com/book

Jim Rohn: https://www.jimrohn.com

Albert Schweitzer: https://www.nobelprize.org/prizes/peace/1952/schweitzer/biographical

Dr. John Demartini: https://web.drdemartini.com/the-breakthrough-experience-houston-nov-2022

Chicago Midwinter: https://www.cds.org/midwinter-meeting

Main Takeaways:

A good travel experience starts with mindset.

Bring travel-friendly food that is good for your microbiome.

Hydration is key for overall health. Bring a water bottle with you.

Motion is lotion. Don't stay cramped on long flights or long commutes.

Adjust for sleep changes in new environments so you can still be well-rested.

Quotes:

“Many people lose it when they get away from home base. It’s drive-throughs, it’s fast-food, it’s airport food, and they show up a little worn around the edges, not their best.” (2:35—2:45)

“Almost all success, in any endeavor, starts with the mindset. People think, ‘I hate traveling. Ugh. I don't know why I booked such an early flight. Ugh. I can't stand it. I always write off the first day going anywhere. I always write off the day coming back.’ They start off already behind the eight ball. They're already defeated before they leave. So, I have a mantra. I say these words: I love travel. Travel loves me. I love travel. Travel loves me.” (4:39—5:02)

“I see all these people on Facebook complaining about their delay, their missed flights, their cancelled flights and, ‘Oh, look at me. I'm stuck with 17 people in this row. There's a guy vaping beside me and someone with a comfort dog.’ Well, that's your experience. A different way to experience it is, set the tone for enjoyment. I love travel. Travel loves me. And the universe, or a god, or the energy field somehow brings to you better experiences that will align with your expectation. Some people expect to be late. They expect to be tired. They expect to have someone [without] good hygiene beside them. They expect not to get upgraded. So, it starts with mindset. I love travel. Travel loves me. That's not a guarantee, but what I do is I stack the deck in favor of having a better travel experience. That's the way you start off — mindset.” (5:02—5:47)

“The day before, I bring stuff with me so I'm not always struggling for food. I bring something called miso soup. Miso soup is prepackaged. You just add hot water. So, even at an airline that doesn't serve food, like Southwest, I get a little cup. I can get hot water and mix up my miso soup inside. Miso soup is cheap. You can get four packets for about four, five, six dollars online. It’s a fermented food, great for the microbiome, which helps you have a better circadian rhythm change experience. I'll bring green tea with me. Coffee, sometimes . . . More coffee for me is like throwing dynamite on a napalm bomb. I don't need as much caffeine as most people, so green tea is good. A little bit less caffeine, tons of antioxidants. So, I bring my own.” (6:33—7:20)

“Traveling internationally, you can't bring nuts and seeds and fruit with you. That's not something unless you're traveling in your own country. I go across the border quite a bit, so I can't bring fruit. I can't bring nuts because customs will take it away. You can't bring seeds. Heaven forbid, if you threw an almond out and it grew into an almond bush in Arizona. So, that being said, miso soup and green tea is a must for me.” (7:33—7:53)

“I bring an empty container for water because you can't bring water, obviously, through security. But I do know once you get across, they now actually sell filtered water. So, it’s good for the environment [to bring your own bottle]. But also, now, instead of spending six dollars a bottle for some of these designer brands of water, I get filtered water at any number of different water fountains in the airport. So, that's a pretty good thing. Also, in the fitness room. Again, if people want to buy water, they can spend the five, six, seven, eight dollars, FIJI Water and Evian water. But the fitness room, it’s free. You get filtered water in the fitness room. I can fill this one liter or one quart bottle up. So, I bring an empty bottle with me. That allows me to stay hydrated, because dehydration is a big part of lacking good travel instruments.” (7:54—8:39)

“When I check in, I always ask, ‘Where is the fitness room?’ I love being on the same floor. They’ve shown, it’s called geographic success. Most dentists know about geographic success. Geographic success for most dentists is, you do a big case on a patient, and they move a week later, and now they're in Osaka, or now they're in Seattle. But geographic success, for me, when I check in, is I get to be on the same floor as their fitness facility, or very close. So, now, I can pop in and out a lot easier than if it’s in a different hotel tower. So, when I go in, I want to see if I can be in the same tower or on the same floor. And all I'm doing is stacking the deck in favor of being closer towards the gym.” (9:12—9:50)

“There was a study at Brown University. It was a study shown in Cell Reports, 2018. They’ve actually shown the first night in a new bed, anywhere, your brain, half of it stays hypervigilant. And you're thinking, how is that possible? Why would I? Well, at a certain level, you're used to sleeping in your own bed, your Sleep Number. You've got the king size. You've got the servants waving palms at the family. When you're in a new bedroom or a new hotel, what happens is your brain thinks, ‘Hey, there could be danger here.’ It’s a primitive, primordial failsafe feature that's part of our DNA. So, for the last million years, any time a caveman or cavewoman is in a new place to sleep, the brain stays hypervigilant, ‘There could be danger here.’ So, you might think you're sleeping, but you're not sleeping as deep as you would the second night.” (10:53—11:43)

“Any time you sleep deeper, you're more lucid, better memory, more emotionally engaged, more EQ, emotional intelligence. It’s always profound.” (12:01—12:09)

“A better-rested brain has better connection to past associations, left and right brain coherence. You're more energetically ready for the day.” (12:21—12:30)

“If you're fit already, if you travel well-rested, if you love lecturing, if you are happy at home, if you travel well on the plane, you arrive hydrated, you have good nutritional status, you can actually weather the storm of going to a lobby bar and having a drink, do the entertaining, then go to the [hotel] room. But most people are sleep-deprived, continuously. They're challenged at home. Their work is challenging. They don't have good habits at home. They don't exercise. So, they're high-performance race cars that get regular fuel, regular oil, and they arrive behind the eight ball. But if you're already in fit shape, you can actually weather the storm of a lobby drink, with good intentions and not overdoing it.” (13:54—14:37)

“No matter what your age, your muscles have no idea how old you are.” (17:08—17:11)

“Andrew Huberman, a neuroscientist out of California, talks about early morning sun, before noon, awakens or helps reset your superchiasmatic nucleus and helps to reengage that primitive, caveman, prehistoric part of us that likes daylight first thing in the morning.” (17:59—18:14)

“Our muscles have no idea how old we are. The only thing they know is that we move a lot, which is youthful, or we sit a lot, which is accelerated aging. So, if you're a high mover, whether it’s step count or physical activity, your muscles, all they know is, ‘Kirk is a teenager. Kirk is youthful. Kirk is youthful.’ If you sit a lot, and you get up after watching three seasons of Sons of Anarchy, and all of a sudden you're like, ‘Whoa,’ you feel stiff — most people expect to be stiff and sore and clogged. But it doesn't have to be that way. The science says muscles have no idea how old we are.” (20:19—20:53)

“70% of our waking time is spent sitting. I often try and do my Zoom calls standing. So, that might be the next thing, to elevate our desks. I'm sitting in this room where I can get Wi-Fi today, but I'm all about standing more often. There’s an enzyme called LPL, lipoprotein lipase, and the gene for it is 10 times more active when you're standing. And lipoprotein lipase takes sugar and fat out of the bloodstream into the working muscles, and it’s about 100 calories more every three hours that you're using just by standing. So, I'm a firm believer in standing more. I alternate my standing and sitting when I'm working with patients. My re-care exams, I'd rather stand and do them and crank up the chair. So, I do my exams standing. It makes me look more energetic. I look more alive. I think differently when I'm standing. More oxygen to the brain. So, that being said, sitting is the new smoking.” (20:59—21:45)

“They’ve also said that motion is lotion. Arthritis, joint pain, and inflammation hits about 45 to 50 million Americans. Arthritis, stiff joints, inflamed joints. Well, cartilage has very little blood supply. What they need, though, to get increased circulation of good nutrition and take away the toxins, is good movement. Synovial fluid pumps harder when the joints are moving. So, motion is lotion means the more you move, the more greased your joints are. That's pretty powerful. Motion is lotion.” (21:45—22:20)

“No excuses when it comes to fitness. If I'm in the mood to work out and I think, ‘Oh, I have no shoes,’ or, ‘I only want carry-on. I don't want to fit shoes in,’ I'll go downstairs in black, shiny dress shoes. I'll go down in tuxedo pants and leather shoes. Who cares? I'll never see these people again. If anything, when you walk into a gym with shorts on and black dress shoes, the gym empties. ‘Who the heck is this freak?’ Now, I have all the equipment to myself. So, I'll work out in dress shoes. I'll work out in flip flops — which aren't the safest. I've never worked out in bare feet before, but I don't care. I'll never see these people again. What will people say? ‘Who are they? Who are they?’ So, I talk about it all the time — no excuses. I've gone to the gym in jeans and a tank top. Why not?” (22:43—23:22)

“They’ve actually shown a lot of circadian rhythm disruption is simply because our bacteria — which have no eyes, but they do have a consciousness — know we’re off our schedule. So, if normally you go to the bathroom first thing in the morning, guess what? Now, you're going to the bathroom at 2:00 in the morning. Your bacteria goes, ‘What are you doing? What's going on?’ Now, the bacteria is thinking, ‘Hey, do I make serotonin now? Do I help pump out these neurotransmitters? Or do I have this person still asleep?’ The person is awake. Usually, they're asleep at 2:00 a.m. Probiotics help bring harmony to the microbiome.” (23:55—24:28)

“People often overpromise what probiotics can do. Scientifically, they’ve shown probiotics can help with antibiotic disruption with the microbiome. After someone takes amoxicillin for 10 days, or penicillin for seven days, or clindamycin, which is one of the more challenging ones, antibiotics have also been shown to increase stability and diversity to the microbiome. It doesn't give you free range on pop, tequila, stay up all night and listen to Def Leppard. You've still got to do all the good habits. People often think, ‘Uche, I've tried probiotics for four days. It did nothing for me.’ Well, you hate your job. You're a shift worker. You don't exercise, and you eat Pop-Tarts. So, taking probiotics without doing the fundamentals is like throwing fertilizer on your driveway, and there's no seed or soil. You need seed and soil. The seed and soil is good sleep, loving your job, and a good diet. Then, probiotics can plus you.” (24:29—25:15)

“On the road, if you have a reasonably good diet, probiotics help to balance out the microbiome, which they’ve shown now is a big part of circadian rhythm disruption. But you're thinking, ‘Uche, the large intestine is far from the penial gland.’ Well, guess what? These bacteria are responsible for 40% of the 500,000 circulating metabolites in the body. This is actually from a gastroenterologist, Emeran Mayer, author of The Mind-Gut Connection. Your microbiome is responsible for 40% of the 500,000 circulating metabolites in your body. So, if they're feeling disrupted, unwell, if they're away from their time zone, if there's light-dark cycle disruption, guess what? Your mind is impacted. So, to have these microbiomes happy, you need a better functioning physiology and neurology.” (25:15—26:00)

“Sitting on a plane, anything in a confined space — so, say you didn't get the upgrade, you're not at the exit row, you're not in premium economy, so you're stuck in that smaller regular seat — crossing your legs makes it worse. You're already cramped, and now you're cutting off circulation. It doesn't mean you can't cross your legs. Just don't have them crossed for an extended period of time.” (27:02—27:20)

“I never get a window seat. I never get the middle seat. I always get the aisle. The only time I get a window seat is when I'm doing a red-eye [flight]. Because in a red-eye, I don't want to be disturbed. So, I make sure I have no liquids two hours before the red-eye. I have my noise-cancellation headphones. I have earplugs, orange glasses before I go, a sleep mask so I don't see all the lights and pings and the person moving next to me. Then, I'll sit at the window seat for the overnight flight. However, all of the flights, I want aisle. That way, I have more room. I can get up and down. I get up at least every 45 minutes to an hour.” (27:21—27:49)

“They’ve actually shown that we sleep best and deepest when it’s about 65, 66 degrees, which is a little chilly for some people. But having it at 71, 72, 73 at nighttime, we don't sleep well when it’s hot. Cooler is better.” (29:01—29:13)

“If you're on your own, or you have the agreement of your partner, 65 to 66 degrees has been shown by neuroscientists that you get the deepest sleep. Cold outside the room, warm under the covers. And they’ve shown people who have insomnia often have elevated body temperatures than people who sleep deeply.” (29:22—29:40)

“There are so many different hacks to be healthier. People think, ‘Oh, I don't like cold showers.’ You can still be healthy not taking cold showers. How about an infrared sauna? If that's your sticking point — if you're exercising, you're loving your job, loving your relationships, and eating healthy, an infrared sauna is not going to make or break you. I only do lukewarm showers. Big deal. Wim Hof, The Iceman, makes it sound like if you're not doing cold showers, you're going to die early. A lot of fitness fanatics make fitness sound so complicated.” (30:40—31:09)

“Elite experts always make it sound like, ‘You've got to do everything.’ Oh, really? Now, you've made the wagon so high, people are falling off the wagon all the time. My fitness, my nutrition, my wellness wagon is low. So, if I fall off, I can get back on easy. Because most of life is off balance. It’s not so perfect.” (31:15—31:31)

“They’ve even shown cold water on your face helps you sleep deeper. So, you don't have to immerse yourself in an ice bath. But if someone was very sick, or they were competing in a decathlon, or a LeBron James during the championships, then I would say dot the I’s and cross the T’s. But a cold shower, it’s called a hormetic effect. So, at the end of your shower, turn down the water a bit so it’s not so hot. Maybe make it warm. And for you, that could be your cold shower that day. So, don't think that you have to do everything perfectly to do this thing called a fit life.” (31:40—32:12)

“America’s business philosopher, Jim Rohn, said that when you're on vacation, think vacation. Don't think about the office. When you're at the office, don't think, ‘I really should take a vacation,’ that you're never really present.” (33:32—33:41)

“If you spend a lot of time doing work on vacation, you're definitely sapping the vibe of that vacation time. It’s not really vacation.” (33:52—33:58)

“Albert Schweitzer, the humanitarian anthropologist, said the best teacher is role modeling. So, instead of telling people what to do at home, and telling your friends, and having chats about BMI, organic food, keto, and paleo in the lobby bar, lecturing to your buddies, live it.” (34:41—34:55)

“One of the most successful diets ever that the AMA acknowledged, the American Medical Association, is the Mediterranean diet. It’s not just about food, it’s the fact that they don't argue at the dinner...

Selling a Specialty Practice

Episode #523 with Paul Sletten

Someday, you will sell your practice. If you own a specialty practice and don't know where to start, don't miss today’s episode! Kirk Behrendt brings back Paul Sletten, founder of the Sletten Group, to share his expertise and the key things you need to know for a successful transition. Whether you have a few years or a few decades left doing dentistry, it’s always the time to prepare for your exit. To start creating a plan that gives you peace of mind, listen to Episode 523 of The Best Practices Show!

Episode Resources:

• Paul’s email: [email protected] 
• The Sletten Group: https://theslettengroup.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:

Solo practice is not dead or dying.

Have a five-year transition plan in place.

Involve your team in your transition process.

Build and maintain a broad, healthy referral base.

Keep a healthy practice, and you will sell for top-dollar.

Quotes:

“Every transition has the fundamental basics in common with each other, but every one of them is unique because the practice culture is unique as an extension of the core values of the owner or owners.” (2:29—2:44)

“I have to go on record and apologize to all the specialists who have had to sit in dental meetings and try to interpret how it might apply to them when transition issues are discussed, because the seminars are almost all directed at the general dentist. That makes some sense because 80% of the population are general dentists. But the specialists get left out, and there are some really important things to talk about and discuss with them.” (2:48—3:24)

“When we talk about transitions, in general, every person thinking about transition has to put a plan together. And in putting that plan together, we've talked about their need to do it five years in advance of when they intend to implement it. And the reason for that is there are some things to understand.” (3:48—4:13)

“Our plan, when we work with a client, is to help them put the business plan together, and the timetable, and the action steps that lead to the actual transition. But they're also going to want to link that practice plan with their personal life plan. And that applies to all specialists as well.” (5:22—5:49)

“If you contrast what a pediatric practice does compared to an endodontic practice or an oral surgery practice, those two practices are unique. An endodontist or endodontist group of doctors, if it’s a group practice, they need a succession plan. What happens when Mary, who founded this practice 38 years ago, walks out the door, having retired? What do you lose? What walks out with her? And what are you going to need to do in terms of defining an ideal candidate profile for the young doctor that you're going to go out and recruit and bring into the practice to move into that practice culture? What other partners are going to have to step up in some areas where they hadn't been responsible before because Mary has always been the visionary and the keeper of the flame? So, succession planning is really, really important.” (5:50—7:01)

“[Endo and oral surgery] are heavily, heavily reliant on referrals. They work hard to build and retain referral relationships. And one of the cautionary tales that you hear if you listen to people who tried to retire and had a difficult time in getting their practice sold for what they thought it was worth, is that they had missed the point of understanding where they need to keep their referral base expanded in terms of the age range. So, if you are a 65-year-old endodontist in solo practice and you're getting ready to retire, there's a great chance that your entire referral base will be within 10 years of your age in either direction. And they're all getting ready to retire themselves. So, a discerning buyer candidate coming and looking at that situation will notice that, of course, because that's part of the fact-gathering that they will ask questions about when they're looking at whether they should be interested or not. And if you have a tight bunching of ages of the referral community that aligns with the seller’s age, you're going to have some problems.” (7:17—8:44)

“There are some changes in our society, of course, in that patients are living longer — much longer, in many, many cases — on the norm. And so, that isn't quite as much of an issue. It is an issue, but you've got to be sure and continue to meet people and continue to be intentionally visible. But one of the barriers or one of the things that block that kind of thinking is if you're a solo practice and you're going hard every day. You're not thinking about growing your patient base. And so, after a while, the practice even becomes a little bit stagnant. And it’s what the predictability is for whether the buyer is going to be able to afford to buy your practice and will it cash flow well. So, you've got to keep a really sharp eye on attrition in your referral base and be mindful of that. If you're in your 40s right now, keep that in mind as you go through the remainder of your career.” (10:34—11:54)

“Everything is not drying up in the specialties. To me, it gets back to, what are you doing that keeps your practice healthy? What are you doing to continue to have a setting, a practice culture, that people thrive in and love to be part of? If you're doing that, you're not drying up. Now, if somebody goes to sleep at the wheel, that could happen, of course. But I don't see that as a generality.” (12:30—13:01)

“If you get around to staying in a solo practice, it’s more challenging at transition time if you haven't kept your referral base broad and in good, healthy condition like your practice is.” (14:49—15:11)

“A young endodontist is looking for a practice to own. He’s been an associate at three different practices over the last six years, and he is looking for something to buy that can be his own. And so, when we started with him, the first question we asked him is, ‘Do you know what you're looking for? Have you identified what would be an ideal setting for you? Where do you want to live? Where do you want to raise your kids? Where would you feel great practicing? What kind of practice do you want to have? What kind of a team do you want to put together? What are your thoughts? What are your money issues? What kind of school loan debt do you have? What size practice are you looking to buy?’ And the thing about endo practices is that they're so doggone profitable, it’s amazing. It’s not unusual to find one with 65% profit margin in tax. And they have the lowest overhead of anybody in dentistry.” (15:38—16:50)

“Your kids can learn a great deal and add some life skills themselves by watching mom or dad go through a transition. You see what it takes. You have to do a whole bunch of clarifying. Whether you're buying a practice and getting into practice and launching a career, or whether you're ready to get out, the planning skills are life skills that kids need to be exposed to intentionally. And there are great benefits that come when that happens.” (18:35—19:12)

“It’s important for people to understand that several of the loudest preachers out there saying that solo practice is dying or dead and comparing it to the dinosaurs, they're investors in DSOs.” (19:25—19:42)

“As we’re working with this young endodontist, we’re asking them all these questions as a couple. You need the input of both parties. They're both huge stakeholders. One will run the practice and be in the practice. The other might very well not be in the practice, but nonetheless, they're influencers. They need to make some decisions together.” (20:03—20:32)

“There are awesome practices available in smaller towns. I don't mean tiny towns like the one I grew up in with 2,500 people, I mean 50,000, 60,000, 75,000. There are unbelievably good lifestyles available in communities like that, and amazing practices. I strongly recommend people at least look at those. If they have proximity to a major city, that's even better. There are great lives to be lived in places like that as well, as an option.” (20:38—21:17)

“[For endo or oral surgery], I'll give you a big number and I'll give you a small number. A big number would be 45 to 50, to have a relationship with that many people. But you're going to make it or break it based on the dirty dozen. If you have 12 great referrers, you've got a career — as long as you nurture those relationships and pay close attention to them.” (21:41—22:12)

“By tailoring a schedule and your work commitment, your clinical time-at-the-chair commitment, then you can do all kinds of things with that that are creative and that will blend in beautifully with your lifestyle.” (24:11—24:25)

“There's a timetable that's in place from the time that a specialist makes a decision to transition — this is why you need a five-year plan. It, predictably, is going to take longer to recruit a specialist than a generalist. There are notable exceptions to what I've just said. But that's true, what I've just mentioned. It’s going to take longer. Let's say you're solo and you're going to do a search. You need to plan on taking two to three years. It can happen faster than that, and you need to be prepared if it does, and ready and flexible. But it could take that long, especially if you're taking the time to be really selective so that you leave your team and your referral doctors in a great place by bringing in a successor that they're going to relate to. That's a gift to all of them, and to the new person taking over the ownership.” (27:59—29:10)

“If you have a two-doctor partnership, your operating agreement for the partnership between the two partners should have a clause in it. The typical clause that you see, way more than half the time, is that the younger partner would have the first right of refusal to buy the practice on notification of your intent to retire. That's the wrong way to do it, in my opinion. I think you're way better off having language that requires the partner to buy it. It’s good for you because it ensures you, the seller, of not having to go through some steps that are, indeed, avoidable. And it's really good for the younger partner because it allows the younger partner to bring in an associate of their own choosing and move that person through a process where they eventually become an owner as well.” (29:48—30:54)

“Another common practice that I used to see 40-plus years ago when I started in the business was that you never tell the team until you've sold the practice. Both of those issues defy logic. There are a lot of people who are dental brokers clinging tightly to the notion that you shouldn't tell your team until you have the deal all finished. And what's the rationale behind that? Well, they’ll tell you that you run the risk of losing your team if you tell them that you're leaving. And I say you run a far greater risk of losing your team if you don't tell them. Once you've made your choice, your decision, why not invite your team to participate in the process actively? They should meet the candidates. You should get an idea from them what kind of personality and what kind of a skill set, attitudes, core beliefs, would fit in your practice culture. They're the ones who have the best insights to that.” (32:01—33:25)

“When somebody asks you, [‘How much longer do you intend to practice?’], they're really asking two questions. The question is, ‘How much longer are you going to be here, doc?’ The second question — the real question — is, ‘What will I have to do when you're not here anymore, doctor? Will I have to leave and find another practice?’ So, lean into it. Don't tap dance. Lean into it and say, ‘Well, I'm going to retire at some point in my career. And, by the way, when I do, what kind of person would you want in here? I'd love your input.’” (36:38—37:14)

“I've even heard things like periodontal practices don't sell for as much as they used to. Endodontic practices don't sell for as much as they used to. That's not true. If they are a great practice and it’s really a healthy practice, they sell for top-dollar. If they're in a desirable location, in a good suite, and where the owners have taken really great care of the referral community that supports them, they're selling for top-dollar.” (38:37—39:16)

Snippets:

0:00 Introduction.

1:57 Paul’s background.

3:34 Why succession planning is important.

7:04 Be cognizant of the age of your referral sources. 

11:59 Are specialties and solo practices drying up?

15:11 What to look for when buying an endo practice.

17:08 Planning skills are critical life skills.

20:00 Small-town practices can be great options.

21:18 How many referrers do you need in endo or oral surgery?

22:42 Tailor your schedule and work commitment.

24:44 Other important items to think about.

27:49 The timetable for a successful transition.

29:10 Advice for selling to a younger partner.

31:28 Tell your team about your transition plans.

37:20 Talk about what will change and what won't change.

38:24 Last thoughts on specialty transitions.

41:28 How to get in touch with Paul.

Paul Sletten Bio:

Paul D. Sletten founded the Sletten Group, Inc. in 1975 in Denver, Colorado. They are in their 48th year of business and have developed an international clientele, having assisted and completed transitions in all 50 states, six provinces in Canada, and two states in Australia. They continue to exclusively work with fee-for-service dentists and their teams around the country. 

It is exciting to see both people and practices grow, and to know they have had a hand in so many transitions brings them enormous joy. Their wide-ranging experiences allow them to bring what they have learned to each new client situation. This experience helps them know how to tailor their services to the unique needs of each client and to be able to offer multiple options to almost any client situation. Due to this ability to customize their services, the Sletten Group also works with all of the specialty practices in the dental industry. 

Paul has spoken at more than 285 dental meetings around the country. This...

Dr. Bob Skinner – ADA Meeting Chair at ADA SmileCon

Episode #522 with Dr. Bob Skinner

If you weren't at SmileCon 2022 — why not? It’s a great place to learn and have a good time. There are tons of CE, activities, and events you won't want to miss! To tell you all about it, Kirk Behrendt brings back Dr. Bob Skinner, the meeting chair of SmileCon 2022, to welcome you to this amazing event. To learn more and to register for SmileCon 2023, listen to Episode 522 of The Best Practices Show!

Episode Resources:

• Dr. Skinner’s website: https://skinnerdentistry.com
• Dr. Skinner’s Facebook: https://www.facebook.com/robertl.skinnerdds  
• 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:

SmileCon: https://www.ada.org/education/smilecon/smilecon-future-meetings

Main Takeaways:

Learn about SmileCon and its vision.

Save the date for SmileCon 2023!

Go to SmileCon 2023!

Quotes:

“We work on these a couple years out, so it’s not like we started thinking about this last week. There was a lot of preparation. We have the basic CE courses, because a lot of people like to come here to get CE. We’ve got phenomenal speakers. So, you can come here, you can have fun and see all the wow moments that we put in, but you can get a good education too. You can learn new techniques, new materials, new supplies, and new equipment. A lot of people like that. We’re always in a great destination.” (1:24—1:55)

“[The NASA mini museum is] one of the wow moments we have. They brought a mini museum from NASA. They brought the moon rock . . . One of the lounges has a little NASA mini museum. We had to pay to get it here from NASA about 30 miles away. I said, ‘I think we can swing that.’ We had to get a little security for it. And so, that's a wow moment. You can come see that and be part of NASA. Leland Melvin is going to be our keynote, an astronaut that went from the NFL to an astronaut. Think about that. You don't see that much. Super, super nice guy.” (3:16—3:56)

“We wanted to create some FOMO. Why aren't you here?” (4:13—4:16)

“Another vision we had was Street Fest. I thought, ‘We’re going to be in this building for two days. Let's get outside. It’s October. It’s in Houston. The weather is going to be great.’ So, we’re going to close the street down in front of the George R. Brown Convention Center. We’re going to have a stage set up and have a live band . . . We’re going to close the street and have food trucks come in, and you can go to different food trucks and get the cuisine of Houston. I've been down here six times in the last year-and-a-half. I've never had a bad meal. It’s phenomenal.” (6:57—7:33)

“Another thing that we’re starting today was a thing that I coined as Dental Olympics. We had an Olympian kick that off this morning. Texas has four dental schools. And I always thought, ‘Well, do they have a kumbaya moment?’ And the more I thought about it, I said, ‘You know what? They're competitors. They're trying to get the best students to go to their school.’ And I understand that. But I said, ‘There are times where you can compare, and get around a table and talk about what works at a school and what doesn't work at a school.’ And I visited with some of the deans who said, ‘Yeah, we need to do more of that.’ I said, ‘Why not do it at SmileCon?’” (7:36—8:16)

“My job [as a mentor], from here on out, is to make sure you're successful.” (11:03—11:05)

Snippets:

0:00 Introduction.

1:12 Dr. Skinner’s vision for SmileCon.  

4:37 Getting Brené Brown to speak at SmileCon.

6:38 Events happening at SmileCon.

7:36 Bringing schools together with Dental Olympics.  

10:33 What's next for Dr. Skinner.

Dr. Bob Skinner Bio:

Dr. Robert Skinner was born and raised in Fort Smith, Arkansas, and has always felt a special passion for this area. Although he had to leave to finish his education, he knew he would return here to establish his dental practice and raise his family. And that is exactly what he did. The patients he began treating are now bringing their children — and even their grandchildren — in to see him!

Having completed a bachelor’s and master’s degree from the University of Arkansas, he attended the LSU School of Dentistry and received his Doctor of Dental Surgery in 1986. During his dental education, he was involved in extensive research in the subjects of Oral Pathology, Cancer, and Endodontics.

His work garnered four NIH Grants, top awards at Table Clinics presented nationally and internationally, and produced three abstracts and seven journal articles. In 2012, the LSU School of Dentistry honored him with their Alumnus of the Year Award.

That same drive to learn still exists today and is the reason he attends so many continuing education courses each year. He has rarely missed a national, state, or local dental meeting/seminar and serves as a State Delegate in the American Dental Association’s House of Delegates.

Elected by his peers, he was honored to serve as the General Chairman of the ADA Annual Session 2009. In the same year, the Arkansas State Dental Association presented him with the Distinguished Service Award, one of the highest honors given. 

Dr. Marty Jablow, David Pleva, & Tim Caruso - at ADA SmileCon

Episode #521 with Dr. Marty Jablow, David Pleva, & Tim Caruso

Do you have pain in your wrists, neck, or back? Then you need to listen to today’s episode! To talk about this important but overlooked subject, Kirk Behrendt brings in three experts, Dr. Marty Jablow, David Pleva, and Tim Caruso, to help dentists and their team prevent and treat the physical suffering that comes with dentistry. From prophylactics to choosing a great mattress, they offer the best advice for recovering from long, stressful hours at the office. To start feeling recharged and pain-free today, listen to Episode 521 of The Best Practices Show!

Episode Resources:

• Dr. Jablow’s email: [email protected] 
• Dr. Jablow’s Facebook: https://www.facebook.com/jablow
• Dr. Jablow’s blog: https://dentechblog.blogspot.com
• Dr. Jablow’s social media: @martyjablow
• Tim’s email: [email protected] 
• David’s email: [email protected] 
• 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:

Raving Patients: https://www.facebook.com/groups/ravingpatient

Westin: https://www.westinstore.com

Main Takeaways:

Start taking care of your body ASAP.

Be mindful of your posture throughout the day.

Learn how to breathe properly and practice it daily.

Accommodate your body for aging and other changes.

Sometimes, it’s okay to ask patients to accommodate you.

Don't forget about your team members. They are suffering too.

Quotes:

“Bury [bad reviews] with good ones. That's really the thing. I'm lucky. We get really good reviews. We’ve got a lot of them. You can use companies to get them. There's a Facebook Group Dr. Len Tau runs, which is Raving Patients. You might want to get in that and some of the stuff there. With that, you have to remember that we’re all going to get bad reviews. My office gets an occasional one-star review. But most of them are not about treatment. A lot of it is strictly about money. And you know what? People will dismiss some of that stuff. But some of them have legitimate complaints. And you know what? You need to address them. But unfortunately, you cannot address them in public. Be very careful what you say. There are HIPAA violations and things like that. So, if you do have one, reach out to people who may be able to help you craft a very nice response that will keep you within lines of HIPAA. And with that, do the best you can.” (1:06—2:12) -Dr. Jablow

“My office, we’ve got 400, 500 reviews. We’re a 4.9. So, we’re not perfect. We’ve got one-star reviews, two-star reviews. If you get a one-star review that says nothing, that's fine. I mean, it’s dismissed. So, with that, bury them with good ones. Everybody is going to have a bad one. We’ve all been to a restaurant and had a bad meal, or bad service. It doesn't mean I don't always go back. It’s the consistency in that. So, do the best you can. Address real issues in real ways but be careful doing so.” (2:15—2:54) -Dr. Jablow

“If you ever get a negative review, the best thing you can ever do is call the patient right away — like, immediately — and not be equipped with an agenda. Just say, ‘Listen. I care, and I noticed. Tell me.’ And then, at the end, say thank you. A lot of times, that's a good start.” (3:29—3:47) -Kirk

“Sometimes, you can negotiate them taking [negative reviews] down. Again, if it’s real, then you've got to fix something. That's really the important part. If it’s a real problem, fix it. Admit to the error. That's always the case. If it’s the crazy person, well, thank God, you're not treating them anymore.” (3:48—4:09) -Dr. Jablow

“Crazy people don't know they're crazy. So, don't try to reason with crazy people. If they have this long history of being unhappy, you're not going to change that.” (4:11—4:21) -Kirk

“Don't necessarily take [negative reviews] personal. It may be directed at you, but don't take it that personal way. It makes it more difficult for you to deal with it on a non-emotional level.” (4:25—4:36) -Dr. Jablow

“Everybody has their own, what I call, issues. None of us sit the way we’re supposed to. I always say, even for my patients, the thing I really want to invent has already been invented but no one will pay me for it, which is to sit up straight. And so, I always said to the patients, ‘You sit in front of your computer monitor, and all you're doing is slouching.’ So, I want a broom handle with two suction cups. You get the idea. And you can't come in. That would solve a whole bunch of neck pain, TMJ pain, all of that stuff. But you have to first get the patient to understand that posture matters.” (8:24—9:06) -Dr. Jablow

“Whether it’s a patient or the dentist, if you don't understand that your posture can be a problem, is contributing to your problem, you're never going to accept the solution, just like everything else in dentistry.” (9:08—9:19) -Dr. Jablow

“Dental professionals will do anything on the planet to make sure that the patient is comfortable, to their own detriment. They're doing gymnastics and cartwheels, and they keep asking, ‘Are you okay? Are you okay? Are you okay?’ And the patient is only in the chair for one hour. And so, if you would say, ‘Can you turn your head? Can you scooch over? Can you open your mouth bigger for a little bit longer? We’ll be done sooner, and you'll feel fine.’ But the dental professionals are there for 12 hours, sometimes longer. And they're suffering.” (9:40—10:14) -Tim

“I make the mistakes that [Tim] is talking about. There are times that it is easier for me to move than it is to move the patient. And if I can do that for a short period of time — and I'm lucky. I've been doing this a long time, and I've got the gray hair to prove it . . . But with that, you have to sit there and go, ‘Okay, what are my physical limitations?’ I remember when I had hurt my back — and it had nothing to do with dentistry — I couldn't do an extraction for a week. I compensated for it in different ways. And you have to understand that. But there are always what I call the cheat. You know what? It is easier for me to turn than the patient. Or I'll stand up and do something because it’s easier. And as long as I can keep that small, that's great. But when it starts getting to be too much time and my back starts to hurt from it, then I have to be able to say to the patient, ‘You're going to have to help me.’” (10:30—11:35) -Dr. Jablow

“One of the big things that we see is that patients will do all the exercises we give them. But posture, if you don't watch posture — it’s the key to everything. I'll have patients back in my clinic all the time saying, ‘I do the exercises, but they don't help.’ But then, you look at them, and they sit slouched, and they're not watching their posture enough.” (11:41—11:58) -David

“Exercise is like flossing.” (12:05—12:06) -Tim

“I always say, ‘What's the hardest exercise that you've been doing?’ And they go, ‘Um . . . Um . . . Um . . .’ They can't show you what the exercise is, which leads us to believe that they're not actually doing the exercise. So, same when I go and I'm bleeding to death on my bib in the dental office and they say, ‘Have you been flossing?’ and I say, ‘Um . . . Um . . . Um . . .’” (12:13—12:35) -Tim

“There's something that says 90-something percent of households in the United States have floss in them. So, everybody pretty much has it. Using it is a completely different thing. And what you're saying is true. I can do all the exercises, but I can't compensate for the fact that I may have an issue that I'm not addressing.” (12:44—13:06) -Dr. Jablow

“It’s kind of like breathing. You can control it. But when you stop thinking about it, you then lose control over it. So, you need something to remind yourself all the time that you're slipping into something that's not healthy.” (13:13—13:26) -Dr. Jablow

“I have a quote in one of the talks that I give. Dr. [Balanky], and I can't remember where he worked out of, but the quote said, ‘When the exception presents itself,’ so, those are the people that you have to accommodate, ‘treat them exceptionally. But that's not what your daily routine should be.’ So, being mindful.” (14:02—14:20) -Tim

“Everyone has their musculoskeletal complaints. We do a little survey. I think the male dentists have more lower back pain. The female dentists have more upper back and neck pain. And the hygienists and the assistants are their wrists and their hands, generically, what we see. The other thing that we see is when the new equipment is purchased — and no offense to the dentist to my right — they get the new chair, and the staff gets the old, broken chairs. They don't get a new one too. So, sometimes, that’s an issue, where ergonomics comes into play. The staff is accommodating to the broken equipment that they have to make use with during the course of the working day, to their detriment as well. Like, the seat pan is loose, so I have to sit askew in order to balance the seat pan in order to treat the patient. Or assistants can't see because the dentist’s back of the head is in the way.” (14:43—15:41) -Tim

“Or the chair is placed at a different level. I watch, sometimes, where I have to say to the patients, ‘Can you turn to your left so that my assistant isn't reaching so far, or having to stand, or do something different?’ Again, asking the patient to accommodate. Sometimes, as a dentist, you're going to have to accommodate too for your own assistant. It’s a give-and-take.” (15:42—16:06) -Dr. Jablow

“One of the assistants asked me yesterday, ‘Well, I really can't ask my boss that.’ And I'm like, ‘Well, shouldn't you have a working relationship? There's no “I” in team. Hey, doc. Can I get a peek?’ They can take a look and see what they need to do. And equipment for assistants, just thinking about it, the archaic belly bars, the new assistant programs are using saddle seats because then they could physically get closer, get higher, turn and move a whole lot easier and maintain a better posture. Because if that belly bar is there, typically, they're hanging on to it for dear life so that they don't fall on top of somebody.” (16:09—16:47) -Tim

“People accessory-breathe. Accessory breathe means they're shrugging their shoulders and using their neck musculature in order to breathe when you should be using your diaphragm. Like, all the stuff from your belly button up, your diaphragm should be working when you breathe, but your shoulders shouldn't go anywhere near your neck, and your chest shouldn't move. If you're a singer, you sing from your diaphragm. If you talk to singers, they got it. So, if you put one hand on your chest and one hand on your belly, if you're breathing properly, the hand on your chest shouldn't go anywhere. But your belly should move when you breathe in and breathe out.” (17:44—18:20) -Tim

“A little more oxygen in you is good, and it relaxes you. You're not going to be as stiff. So, you can do [breathing and exercises] in between patients. You can do it when you can. They talk about getting to a traffic light and tucking your stomach in for 10 or 20 seconds as a way to try and work on your gut. Some of this stuff is easy. You just have to know from these guys what to do, and then be serious about instituting it and incorporating it into your day.” (19:01—19:33) -Dr. Jablow

“More of it is trying to teach you what you need to do. Because you can come to us three times a week, and we do our stuff in the clinic, and you feel better. But if you keep falling apart at home, you're never going to get better. So, our goal is to teach you the correct exercise to treat yourself. And you'll start monitoring, ‘I'm getting stiff. I need to do my exercises. I'm starting to have pain. I need to do my exercises.’ So, our focus is on getting you to take control of your own symptoms. That's where it’s all at, at this point, is you become a self-treater. Because if you want me to do it, we’re never going to get anywhere. You have to take responsibility and treat yourself.” (21:35—22:07) -David

“I can think of this lady who had back pain with sciatica, and she wanted to go back to play tennis. And this is a long time ago when [David and I] worked in the clinic in Oak Park together. So, we got rid of her sciatica. I got rid of her back pain. She was playing tennis. And she came in one day with this piece of paper in her hand. And I said, ‘Hey, how are you doing?’ And she goes, ‘Oh, I'm great. I'm doing my exercises. I'm playing tennis.’ She goes, ‘But I want to talk to you about this.’ And I'm like, ‘What is it?’ It was our bill. And I said, ‘Is there something wrong?’ And she said, ‘Well, it’s the bill.’ And I said, ‘This is what we charge everybody. We didn't charge you more or less than anybody else. Did we not accomplish the goal of you getting back to doing what you wanted to do?’ ‘Yeah, you did. You did. But you never touched me.’ I didn't have to lay hands on her to get her back to doing all those things. And so, I said, ‘Well, I'm really sorry but this is what it costs, whether I touched you or not.’ I learned something after that. So, now, when someone comes to my clinic, I put my hand on their shoulder when they come in, and I go, ‘How are you doing?’ And then, we have no problem with that ever again.” (22:14—23:27) -Tim

“We get that too in dentistry. If you don't actually touch them, you just do the exam, sometimes they go, ‘But the doctor didn't do anything,’ because the treatment is what you're paying for, not the knowledge to get you there.” (23:30—23:45) -Dr. Jablow

“Typically, when we look at massages, they don't provide long-term relief. People come to us and say they feel better, temporarily. And all you're doing is relaxing these muscles. But if you still have a problem there, as soon as the brain recognizes, ‘Wait a minute. There's still an issue there,’ they're going to tell that muscle to spasm again to not move that joint. So, it’s kind of like relaxing a little bit. But until you address the problem, it’s never going to be fixed. That's our goal, is to fix that problem so you don't have to rely on other things to get you back to where you need to be. And sometimes, it’s just a matter of doing simple exercises every couple of hours.” (24:24—24:57) -David

“One of the basic things we do is talk about retraction for necks. So, between patients, you're doing this, walking down the hallway. You're sitting with the patient, and you're getting stiff and sore. You do a couple of those, and go back in. Sometimes, they're really basic things that can get you through your day. But people tend to not do that. Now, they're in pain again. And now, we start the whole cycle again.” (24:57—25:15) -David

“We all love a nice massage. But if my two fingers are numb in my hand, or I have raging sciatica down my leg, that's probably not going to get rid of that. Now, once we get it where it’s under control and manageable, and you want to go for a massage, or you want to go for something else, that's perfectly fine. And it’s great if you can do it. Or get the [massage] gun out and relax my shoulders a little bit. That's fine. The issue that we see as clinicians is people will start with their trainer, or someone who doesn't know how to care for medical conditions trying to manage that, to their detriment, where they make it worse.” (25:18—26:00) -Tim

“The human body can only be subjected to so much.” (27:09—27:11) -Dr. Jablow

“Everyone’s body reacts differently to the stresses put on it. And we all have about the same parts, give or take. But everyone responds to the stresses put on that at different rates . . . As a dentist, sometimes the procedures that are pretty benign, the patients are flying out of the chair and their response to that is way overblown compared to how you think it should be. And it’s the same with people with back pain and neck pain where it shouldn't be a 10 out of 10, but it is, for some people.” (27:29—28:05) -Tim

“For dentistry, if you guys beat yourself up all day for 10 hours, whatever it happens to be, and you don't go home, and you don't rest enough at night to recharge the batteries and let your body recover from the stresses you put on it, and you go back and do it again, do it again, do it again, do it again, four days in a row, five days in a row, and you're out of balance, physically, bad things happen.” (28:08—28:32) -Tim

“There are things I'm going to be able to do when I'm younger. But now, when I get older, there are things I'm going to have to make accommodations for. And we need to know that.” (30:12—30:20) -Dr. Jablow

“The last two days, we’ve seen a good number of students [with pain in] their shoulders, their necks. And some of it is the equipment they're using and their programs. It is what it is. That's what they have to use. But making them more mindful. Or the loupes that they're using. They're all set in an office — they're not in their office, they're set in the exhibit hall or wherever they buy their loupes, and the focal length isn't enough, and they're dropping their heads to focus, even though it’s supposed to make things easier for them to see and visualize.” (31:16—31:50) -Tim

“We’re getting measured for a new set of loupes. And they have all my measurements, so they know what they are. But the reality is, I'm leaning in more. And I know I am. Why? Because my eyesight has changed too. And we don't always change our loupes because the magnification works. But the rest of it isn't, so I'm leaning in more. So, again, you have to always think about all these little pieces of the puzzle that may change exactly what we’re doing, even if you don't think anything changed. That's the reality.” (31:54—32:26) -Dr. Jablow

“Get your iPod, put on your comfy clothes, take your comfy pillow, and go to the Back to Bed store and tell them you're going to be there for a little while, and lay on their beds. It annoys the heck out of the sales guys. And you need to find one that's comfortable there where you lay on it and you go,...