The Business Skills Dentists Never Learn In School

We sit down with Howard Faran to talk about why dentists can be great clinicians yet still feel stuck financially. We focus on the basics that change everything: trust, access, insurance maths, and building a practice that improves margins instead of chasing volume. 
• Howard’s background from franchise business to dentistry and an MBA 
• Why business education is missing from healthcare and dentistry 
• The real cost of PPO discounts compared with patient acquisition costs 
• Practice growth through mergers and acquisitions and buying retiring practices 
• Trust as a competitive advantage and why staff turnover hurts DSOs 
• Why scaling locations fails without systems and why margins matter more 
• Patient access, opening hours, and treating dentistry like a real service business 
• Mentorship for new graduates and choosing workplaces based on culture 
• Burnout as a symptom of low-margin work and misaligned incentives 
• AI in dentistry as a tool for speed, quality, lower costs, and better decisions 

If you require any help, don't hesitate to reach out to the Samera team at www.samera.co.uk. We are all here to help you!

Thank you,

The Samera Team

Transcript

Welcome And Guest Introduction

Speaker 2 0:15

Well, good hello everybody. And and today my name is Arun Mehra. And on the Dental Business Guide, I'm really, really delighted to have Howard Faran here from the USA, with all his world, worldwide expert being a dentist, running businesses, running clinics, and uh very well known in the US dental sector. Hi, Howard. How are you today?

Speaker 0:36

Very good, Arun. It's an honor to be on your show.

Howard’s Origin Story In Business

Speaker 2 0:39

Thank you. Thank you so much. And uh Howard, maybe for listeners today, maybe just give us a potted history of your background so they know the wealth of experience that you have and what you're what you've done in the past, what you're doing today. That'll be really, really helpful for everyone.

Why Dentistry Needs Practice Management

Speaker 0:53

You know, I was born in Wichita, Kansas, which is literally the center of the United States. And I was born in 1962. And uh we were I had five sisters, and we were very, very poor. And my dad saved up all his money for about 10 years and bought a restaurant franchise called Sonic Drive-Ins. It's one of those um you drive up and park in a stall and a car hop, and rollerblades rolls out and gives you the hamburger frying the coke. And he went from making about $11,000 a year to $60,000 a year, and it just blew our family's mind. I mean, we, you know, six-fold income. And then ended up buying another franchise every year for nine years in a row. And uh we eventually, after about five restaurants, moved to from the poorest part of town to the richest part of town. My next door neighbor was Kenny Anderson, the valedictorian dentist from Creighton University. And so I spent my uh childhood either going to work with my dad, who was the love of my life and taught me all the business I know, and then with Kenny Anderson going to the dental office. And and I just thought that was mind-blowing. I mean, back then, you know, we didn't have all these cell phones and computers and technology gadgets, and uh, he had an X-ray, and then we'd go into the dark room and develop it, and then he'd do a root canal, and and he had a one-person uh crown guy that made all of his gold crowns, and for me, it was just love at first sight. So, in the seventh grade, I wrote my dental school letter how to be a dentist. They told me to go to high school and take science classes, and when I got out of dental school, I realized that um my background in business was severely lacking in dentistry, and so I never thought it was appropriate for a general dentist to talk about root canals, endodontists should do that, or orthodontists should talk ortho. And um, but I saw this huge need for practice management. And later I went back and got my MBA, master's in business administration from Arizona State University, and um business is um uh it's not nearly as complex as endodontics or you know, I think I think it all unfords a hell of a lot harder than reading a statement of income, a statement of cash flow, and a balance sheet. But um, I love uh the dentists love their craft and I love helping them kind of understanding you know the basics of business. And um, you know, it's it's severely lacking healthcare. And you got to remember, healthcare is the fastest growing part of all the global economies. It's gone from in the United States, healthcare was one percent of the GDP in 1990, and by 2000 it was 12 of GDP, and now at 2026, it's 17 of the GDP, and you would expect that because when you're like really, really poor, you don't care about pollution and dirty water and dirty air, but when you get rich, you want luxury items like clean air, clean water, world peace, and you don't want to die. And every every day that you live, you bit up the price of the remaining days. And it was the Mayo brothers who were the first ones to realize in the United States that you know, back then, before Mayo Clinic, you know, when grandma got old and she had cancer and died, they'd give her, you know, they keep her comfortable, they give her little bottles, had morphine and opium and things like that, and they keep her comfortable and they died. It was the mayo brothers said, dude, she she'd sell her farm for a million dollars and give it all to you if you could keep her from dying for another year. So that high end of the market, Mayo Clinic, and then um, you know, um that high-end market. Uh, so so dentists are still struggling with that. You still see, you know, like in America, everybody before they die has bought a new car. And the the average new car in the United States is 50,000, and yet most dentists will retire, and they never sold one case for $50,000. And then it took a DSO, it took ClearChoice, who started rolling out these all-in-fours, and before that, nobody in the public knew what an all-on-four was. The dentists weren't recommending it. I remember when ClearCoice came to town, all the oral surgeons and peridonits got their feathers ruffled, but they started doing all this television advertising, and the next thing you know, everybody's patient was coming in and saying, Hey, can you do an all-in-for? I saw this 30-minute infomercial on TV, and they were taking someone like me. And it's like, dude, the last time they came into your office with a loose denture, you relined it for $500 for $300. Did you even suggest all on four $25,000 arms? So between just basic business and practice management and things like that, I mean, um, I I I think the average dentist um is leaving probably half their income on the table. Um, and and it's fun to coach them and it's fun to show them, you know, another another world, like like fast food. And um, and um dentistry's got a long way to go.

Speaker 2 5:52

Do you so do you do you see that? Um is it a lack of confidence in their ability, or do you see it they just haven't been trained in it? You mentioned that they're they're leaving money on the table. What's what's your view on that?

Speaker 6:05

Well, what I mostly see is if your mom and dad owned a farm, you grew up in free enterprise and they do well. But if your dad worked on an assembly line and your mom stayed home and made cookies, you really have never you've you've never seen this. I I I I think it's your childhood. I think if your mom and dad own their own restaurant, their own farm, their own business, and you were sitting at the dinner table every night, you get it, you understand it, you live it, you know.

Insurance Math PPOs And Profit

Speaker 2 6:30

But I I I kind of tend to agree. I I'm I'm I'm I'm a I'm an accountant, a product of a of engineers of parents. But my wife is a dentist, and she grew up in a in a in a retail environment where in Asian families in the UK where they have to work hard, and the parents worked seven days a week, long hours each day in the shop. She would go to the shop, see how they're selling products, how they're selling textiles. So, like you, um, you she she she's a she's a great sales lady, a great uh communicator, and just like yourself, you learn that skill, you pick that skill up, I suppose, through osmosis, seeing your dad do it. And it's kind of very natural in you now to be able to share that to to other dentists. How how interesting. Okay, so so now what's what's going on in the US market? What are what are the issues that currently uh dentists are facing, apart from obviously not being able to sell as much, uh, in particular um economically wise, but then the the the world of DSOs. What what's your view on this?

Mergers And Buying Local Practices

Trust Turnover And The DSO Problem

Speaker 7:30

Well, first of all, to be serious, I I think the dentists are doing great. I mean, when you live in the richest country in the world or any first world, there's about 20 first world countries. If you live in a first world country and you're a doctor of dental surgery, I mean, you know, I think the average one is making over 175. They're always making anywhere you go around the world, they're making in the top 10%, a lot of them in the top 5%. So if you live in a first world country and just by going to school, you're in the top 10% income. If you it if you got a bad attitude with that, it's all you, buddy. I mean, you beat nine out of every 10 people and you're still bitching and complaining. Number two, you work inside. I mean, I'm in Arizona. I mean, it it's tough when you're a roofer at construction and roads and bridges, and we work inside, and um, we have air conditioner, we have a break room. I mean, look at a dentist's hands. You look at a dentist's hands, you can tell they've never worked a day in their life. So, so that that's all good. But the human condition, the fear of missing out, the the the the way the human condition is, they always want to do better. Yeah, or I'd hope they always want to do better, and uh, and there's always been uh problems or challenges. I remember when I got out of school in 1987, it was HMOs called Capitation, where instead of the insurance paying a percent of it, they said, Look, we're just gonna give you the monthly premium, and then you do whatever you want. But they but the monthly premium was twenty dollars a month per individual, and then they decided to give us um 11. And it's like, whoa, whoa, whoa, whoa, whoa, where'd the other nine dollars go? I mean, I was loving your theory, transferring the risk from the insurer to the annual dentist, but I I noticed that half the money disappeared like that. So, so and and then there was PPOs, which PPOs, insurance companies, I mean, it just comes down to simple math. I mean, if you sign up for a big dental insurance PPO, um, it's just a volume discount. I mean, if you want to go out and get a hundred patients one at a time, you should know exactly what your marketing costs are per head. What does it cost you to get not someone dial and call the office, but for a butt in the chair? I mean, does that cost you $50 a patient, $100? So if you're paying $200 a patient to get them in your chair with new patients, you got 100 patients, that's $20,000. So then when a PPO comes and says, Well, we're gonna give you a hundred patients, so we want a discount, and you just have to look at that discount versus how much it would cost you to get each one of those individually. And and there's another great thing where mergers and acquisitions. If you go to Wall Street, MA activity is a huge part of a growing bull market, mergers and acquisitions, and then you go to the dentist. And I mean, I how many times have I seen this? A dentist will go to a small town and it's got five dentists. And every time one of the dentists goes to retire and sells practice, instead of selling to some new young energetic young buck that you got to compete with your whole life, they just buy the practice, roll it into theirs, and then the dentist, when he retires, they they they they never run out of money, so they always want to stay a day or two. And after five years, he got the one guy, and and after 25 years, that town with five dental dentists is now one dental office, and this guy's doing three, four, five million dollars a year and taking home a million dollars a year, and the only thing he did was mergers and acquisitions, and and almost every dentist will go to the grave and not even be able to do the math. Like, okay, the guy across the street selling his practice, he's he's 65 years old, he's 70 years old, he's got 1200 patients. Can you evaluate what it's worth? Uh, what do you want to break it down in just people who've come in in the last 18 months? Well, what if that's a thousand? What if what if you're paying $200 a head and he's got a thousand? So now, you know, so there's some money there, you know. Why don't why don't you just buy it? And then if you buy it, it's third person endorsement. If if I go up to you and I say, Hi, Arun, I'm Howard Fred, and I'm all that, and uh, you know, I'm I'm just a great guy, you're gonna think, ah, he's an egomaniac. But if somebody else walks up to you and says, Hey, see that guy over there? That's a great dentist. Well, if you sell me your practice and you tell your patients that you know that it's like giving your baby up for adoption, you had to pick the parent very carefully, and there's no one you trust more. In fact, he even works on me, and he's my dentist, and I'm gonna sell him my practice. And what's really cool is if you really need to see me, I mean, even though I'm retired, I mean, I could always pop in or I can talk to you, or whatever, whatever, whatever. And then what you find out as soon as he sells his practice and pays taxes and travels around the world and this and that, then he realizes he wants a new car or he wants new furniture, or she wants to give money to her kids, and they always seem to um, in fact, there's a um a thread that I started on uh dental town. Um, dentists that reached a hundred years old are still practicing in their 90s. And I mean, there's literally, I mean, you just get on Chat GDP, then there's a hundred dentists still practicing in their 90s. I knew one, George Ruey in St. Joe, Missouri. I think he practiced till he was 92. So just just keeping a balance between you know the the human, um, you know, what we we sell, um, we we we're we're not transparent in what we sell because of the asymmetry information. I know what a bottled water is. Um, I know uh when I go by uh an iPhone, I I know what an iPhone is, but if I go into your office and you tell me I need four cavities, that's asymmetry. And and that's why the courts have said that when a dentist gets sued, um, the dentist is guilty until proven innocent by himself for the diagnosis, the treatment plan, and the treatment? Because how is the patient supposed to protect themselves in this asymmetrical relationship? So, so just being open and transparent and just simple human business things like like when you look at trust, you know, that's one of the things that DSOs have a hard time on because they have such massive staff turnover. How does a DSO who can only keep their average doctor one year compete with some old man across the street? Like, like, like, you know, I I had staff with me that had been with me from 10 to 30 years. Um, you just you just can't compete with that. So, you know, DSOs have their advantages, they brought scale to the business and and they're learning. They they still got you know, um, they're they're getting better, you know, it's two steps forward, one step back. They're getting better, better, better. Um, but um, I think right now in the United States, four out of five dentists work for themselves. So this it's the 80-20 year old. Okay, so 20% are DSOs. I mean, what are you gonna focus on the DSOs, the insurance, the American Dental Association, the World Health Organization, and the war in Iran? I mean, what does that have to do with your dental office today? It's all you, buddy, and um, and you you can you can double your net income by doing very basic, obvious things.

Speaker 2 14:50

Correct, correct. And but going back to you mentioned the quite the point about DSOs and that the they struggle, as you said, turnover as staff as high. How how have you seen them improve that trust element? Or have they improved that trust element? Or or um do many dentists who go and join them only join them out of a last resort because they don't want to own their own practice, um, or they've got big debts and they just want a job. What's what's your thought on that?

Why Multi-Location Scaling Often Fails

Speaker 15:16

Well, the the first thing I I want to say about um employment, I just want to talk about employment. First of all, the um the DSOs are basically just group practice multi-location. That that's all it is. And when you look at group practice multi-location, there's about 2,800 of them in the United States, and the average one is between four and nine locations. And the reason we start counting it at four is good because the third location is where everyone dies. That's the cemetery. You're a real go-getter, so you you have an office, so you decide you're gonna put another office on the other side of town, and you're such a go-getter, you've got you've gone north, you've gone south, you decide you're gonna go east, and you put a third one over there, and that's when you realize that you can't be three places at the same time, you don't have the systems, and that's where you die. So if you come out of the third and and add a west location, now you had north, south, east, west, that's where ground zero and four to nine is where almost all but maybe a hundred live. And scale brings you some things, but I I have huge issues with four locations. I I think it's insane because I've had the blessings and opportunity. I I've lectured in 50 plus countries, um, um, taking my boys. You you go to places like um um Cambodia, and um, you know, they you the biggest building downtown is a dental hospital. I don't know why anybody needs two locations. I mean, when people say they're gonna have three locations, I'm like, well, what happened to the first one? I mean, I've seen dentists come out of school and just get an area the size of your garage to park your car, put in one opitory, here's their office number. They have no overhead and they have no employees, and someone comes in with a toothache and they do a root canal build-up and crown for $2,000. They don't even have $500 of overhead, and they just made $1,500 in a day. And so, what I don't understand about employment is you know, the whole time you were in high school coming into my office, you said you wanted to be a dentist just like me. When you were in um college, you wanted me to write letters to get you into dental school because you want to be a dentist just like me, and and then and then you come out of dental school, and then out of nowhere, you say, Well, I'm not ready. It's like, what do you mean you're not ready? You've been ready since the seventh grade. You've been you've been in my office twice a year for 20 years. Well, what do you what do you mean you're not ready? Well, I think I need some more practice and I need to pay down some of my student loans, and I think I'm gonna wait till I get married and have a baby and get a car and a truck. And it's like it's like you're ready right now. Go open up your practice right now. You know, I mean, you only need you only need one chair, and then and then what you want to grow. Yeah, I look at all these key performance indicators and new patients, and all you know, there's a hundred KPIs, and I think every one of them ought to just be thrown in the trash. I I want to grow margins, not locations. The biggest problem with DSOs is if you go to a DSO convention, it's hard not to laugh because when you meet someone, he cannot go one minute without telling you how many locations they have. Like, like I have 10 locations, well, I got 20. Well, Room's got 30. It's like, what is a location? I I don't, I mean, is that a unit of cash? Can I buy a cup of coffee or for you a cup of tea with a location or two locations?

Speaker 2 18:45

That's absolutely so true, though, because you're right, it's such an ego thing. But if if you you're right, if you if you're even if you have like two locations, if your margins are huge, okay, what are you worrying about? I don't need 20 locations. I can have two locations that make you a lot more money. So I was talking to someone in um who's based in Croatia who runs dental clinics Croatia um last week, and uh his his minimum size of his clinics of like must be about 20 chairs in each clinic, so he's absolutely maximizing his profitability in that space. Everything's in one place, it's much, much easier. So he doesn't need to have um hundreds of small clinics, he just has like 10 20 chair clinics, and as you said, that's where the margin really becomes very attractive for anyone else who wants to buy it in the future as well. So you're very right there, Howard, is that they beat their chest, they get excited, and um, I've got 20, I've got 30, I've got 50, I've got 100. But the reality is it's uh it's goes back to profitability, correct?

Access Hours And Patient Service

Speaker 19:47

Yeah, and when you fly into Cambodia, you notice that the tallest building in town says dental hospital, and it has an emergency room. The first four or five floors are all emergencies, general dentists, and then you have 12 specialties, oral surgeon, orthodontics, oral path. He's got them all. And I podcast and have interviewed him in his office on the top of that building, and I've I've done podcasts on the top of dental hospitals around Asia two or three times. And then when I go into the United States, I see these dentists go into a small town with five dentists, they buy out all the retirees over the next 20 years, and they got one location doing five million a year. I know a dentist in um Bakersville, one location doing 20 to 30 million a year. I know a pediatric dentist in the northeast doing 20 million locations. Oh I never knew why you have one location. You say, Well, I want two rents instead of one. I want two locations. I don't want I mean, I there's an office in Portland that has 96 chairs. Why do you need a second location? So the location thing is insane. Like in Phoenix, Arizona, um, you know, you you know, um, when you go to a hospital, you don't need to make an appointment. But see, for dentists, I gotta make an appointment. But for a hospital, I don't have to make an appointment. Uh, and you know, if you're having a toothache, just go to the emergency room. It's open 24 hours a day, seven days a week. And that's what a real doctor is. You know, if you fall on your bicycle on a Sunday and break your leg, an ambulance will pick you up and take you to a real hospital where the real doctors work 24 hours a day, seven days a week. But if you fell off that bike and broke your front tooth in downtown London, how easy would it be to find a dentist on a Sunday with your front tooth knocked out?

Speaker 2 21:30

Really, it'd be so difficult. I'll be honest with you. It's so difficult.

Speaker 21:34

Yeah, they're not doctors, they're they're they're dermatologists, they're ophthalmologists, they're dentists, they're Monday through Friday. They say they have banking hours, it's like my bank's open with ATM machines 24 hours a day, seven days a week. I can deposit money, I can get money out. Um, so uh and that's why group practice is better because group practice, you're available more for your patients.

Speaker 2 21:57

Absolutely. One of one of the bugbears of my wife, I remember she when she was working for a practice many years ago, she said uh uh it come at it'd be it reached one o'clock, one p.m. at lunchtime. The the front door would close, a sign would go up, uh we say close for lunch. Okay, the phone's still ringing, this patient. Queuing up outside, but um wanting to get in and get their pain sorted out. But the the practice owner just closed up and that was it. Okay. And then at two o'clock, those patients came in. And when she opened up her clinic, was she said that was one of the bugbears I really hated is that we have to be accessible to everybody, we have to be open. Um, the phone shouldn't be ringing, it should be picked up within two rings. Um, and we need to make sure those patients are seen. So it's that commerciality, which I think maybe you've got definitely got, and my wife maybe have as well. That needs to be combined with the clinical side of things. But so many people don't have that commerciality, commercial reality, um to to build their business.

Overhead Break-Even And Margin Thinking

Mentorship Jobs And Early Career Choices

Speaker 22:54

And they're not, and not only do they not have that commerciality retail uh deal, they're also are entitled. They're they're they're as bad as government employees. Like, we're taking lunch at 12. It's like, okay, well, when I got out of school, it was common to have overhead at 50 percent. So if you gross a dollar, you took home 50 cents. So, what do you how do you get 50 overhead? Well, you come into the morning and you work until you pay all your bills, and you don't go to lunch until you paid all your bills. And when you paid all your bills, then you go to lunch, then you come back and do it again. And they'll sit there and have a cancellation at 11, and they'll sit there for an hour, and the phone will ring, and they don't have any openings in the afternoon. They'll say, Well, I just broke my tooth. Sorry, I don't have any openings. Like, well, well, yeah, you got 12 to 1. You haven't paid your bills for the day, you're gonna close down at lunch. Then it doesn't even dawn on them that they haven't done anything. Like a fireman, when you go to a house and it's on fire, you can't say, Hey, a run, I'm sorry, it's lunchtime now. I gotta take a break, let all those people burn to death and die. I'm gonna go have a hamburger and some, or for you, it'd be fish and chips, and uh, you know, and um, so you know, they're they're they're very entitled. And um, how many dental office do you go into each day where you just ask the team, what do we have to do today to break even? I mean, you know, where you're open four days a week, there's four weeks in a month, you know, you're open 16 days a month. How many days a month do you have to work till you get in the profit zone? If you're if you're two-thirds overhead, I mean, if you have to work 10 or 11 days to pay all your bills, well, then hell, why don't you blow open a Friday and a Saturday at the end of the month because you're in the profit zone? They they just don't think about profit. And and then they say to me, they'll say things like, Well, I think I should add a hygienist, or I'm thinking about growing an associate, or I'm thinking about adding a second location. Hey, why don't you think about growing your margins? Because you just saw you're signed up with a PPO plan and you just did four fillings and that you charge $250 a piece, but the insurance is only giving you $125, and your overhead is 65%. So you just did four fillings and you lost $20 on each one of those fillings. That's $80. And you were in there working for an hour. Now, I don't know about you, but I'd rather take that hour and go spend $80 at a record store or or you know, or buy a CD ROM or a movie or a pair of tennis shoes. I mean, I I don't find it fun to do four MOD composites in an hour and then lose $80. And then I ask them, well, how many of these volume discount insurance plans do you participate in? I mean, and they'll say, Oh, I I'm I'm signed up with like like eight or nine. And it's like, okay, I got an MBA, but I I already figured out on your computer that you participate in 13. How do you think you participate in eight? And I've been here five minutes and I know the correct answer is 13. And this is why I love Dennis, because they're interested in their craft. I mean, I love it. They'll they'll debate a root canal and a bonding agent and implants on dental town until three in the morning and get mad at each other and you know, all this emotions, and you know damn well, 80% of those guys debating all this stuff, they don't know. They couldn't read the difference between a statement of income, a statement of cash flow, a balance sheet. They don't know what their overhead is, they don't know how many insurance plans there are, but then they'll say they're saying, Well, you know, I'm so successful, I don't want to have one full-time hot dentist, I want to have two and get me an associate. Then then they do all that and you come back a year later. Now their overhead's even higher. And then, as far as dentists getting out of school, I mean, you know, when you go into a hospital, there's some serious research. Like, you don't want to have a bypass at two o'clock in the morning because the best doctors are there during the day, and they're they're not gonna argue with and they say, Well, they're on call and all that. Come on, it's it's Christmas, it's new years, it's one o'clock. They're families, aren't they? So yeah, yeah, but but what but where do the people that come out of school? They need mentors and they go work at DSOs, and and you know, they go work at DSOs for money and they quit because they're not happy. They need a mentor, and with 12 different specialties, you can't be if you're uh just came out of dental school and you say, Well, I want a mentor that's gonna teach me how to do invisalign or place implants or do molarendum. Well, well, unless you find a 12-headed dentist, you need at least 12 mentors because there's 12 different specialties. What you really need is a mentor that loves dentistry. Um, you know, his you know, we when you go apply at a job, so many dentists will get on dental town, they say, Well, I applied at uh two offices. One was a DSO and one was a family product, and and what the DSO will pay me 25 of collection of uh collections, but they pay the lab bill. And this free enterprise private practice, he'll pay me 30, but I have to pay half the lab bill. Where should I go? And I'm like, is that how you got married? How much money do you make? What is your paycheck? What are your benefits? Will will you come with health insurance? I mean, I mean, this this is this is uh a marriage, and and and and when you when you're applying in a dental office, I'm gonna go through and meet everybody in there, and I'm gonna say, Oh, you work at the front, how long have you been here? And she says, Two years, and then I meet the dental and said, How long have you been here? And she says, One year, and I go meet the hygienist, and she's a temp. And I go to the office manager, and she's she's in charge of four different locations. Yeah, I mean, run, and then you go into another we when I sold my dental office, the new hygienist that we just hired, the new one, she'd been there 12 years. My assistant, when I retired, she quit too, and uh that that was 30 years. And when patients come in and they see the same person, the same location. This is like like when you go home for a family dinner. I mean, does every time you go home for a family dinner? Is your dad got a different wife, and your sisters all have different husbands, and you know, they traded their dogs in for cats? I mean, you the what what's what's neat about family is you know, I've been on this journey with five sisters and a brother and a mom and all these, you know, for for 63 years. That's what trust is. Does it look like a family practice, or does it look like McDentals? And and I love DSOs because they're open. Um, you know, the the the first uh um the first DSO that I'm aware of in uh Phoenix, Arizona was Sunshine Dental, uh by the late um oh my gosh, I forgot his name. I can't believe I forget I'm forgetting his name. And he was a mentor of mine, and he had Sunshine Dental, he had the north, south, east, west, but he was open seven days a week from 10 a.m. to 10 p.m. So everybody knew their hours, and everybody had their own family dentist, but everybody knew if it was after five, your dentist is unlisted and in voicemail, but you could go to Sunshine Dental and you could just walk in that place and they would see you. And when I got out of dental school, um I started um building out my practice, and I was young, I didn't the only thing I messed up on my new practices, I didn't have a penalty that you know he said he said he could knock it out in like 45 days, but I didn't have any penalties, so he ended up taking 120 days. If I would have had a thousand dollar a day refund for every day you're past your deal, like the big boys do when you're building a Walmart. Uh, I I I would have, but but other than that, I went and worked at um Sunshine Ed Silker was his name, Ed Silker, and he passed away uh a few years ago. And um I I I told Ed, I said, Well, I don't think you want to hire me because I'm gonna start my own practice. And he just started laughing. He goes, I'm not in competition with you, you're not in competition with me, you're only in competition with yourself. This patient can go anywhere in Arizona they want. Why do they want to go to see me? Because you're closed. Why do they want to see you? I he said, I don't care. But I worked for him 10 a.m. to 10 p.m. seven days a week for four months, and dental school, I was doing my dental school requirements, which is like 50 extractions. No, it was yeah, I think it was 54 fillings, 15, 15 extractions, 15 units of endo, 15 units in row. I was doing that every week, and it was in a group practice. So when I got stuck or couldn't do anything, there were two or three other dentists I would go to, and there's this one guy there named Nick Gidwani, and he could get me out of any. I learned I learned more in that four months at Sunshine Dental with Dr. Nick Gudwani and his wife Jetra than I did, I think, in two years of clinic in dental school, just because of the volume. And um, you know, if you want, uh you know, when I got out of school, about one in four dentists had a dentist in the family they could work for, and the only other jobs you could get was in the army, navy, air force, marine, Indian Health Service, public health, because the dentists don't hire them. So the dentists are very hypocritical, they complain about DSOs. Every dentist you hear complain about DSOs, and I say, Well, you know, she's got a job at a DSO in your city. Would you have hired her? No, so she's supposed to graduate from dental school and do what?

Speaker 2 32:18

Do what and do what? Just sit there, wait.

COVID Lesson Dentistry Is Margin

Speaker 32:21

And your office, there's 168 hours in a week, and your office is open 32 hours. That means it's closed 81% of the week. Four out of five hours a week. Your dental office, your build out, your construction, your insurance, your supply, everything lays idle four out of every five hours, and you couldn't hire this for I mean, I mean, look at a hospital. What what if what if you just said, what if you just said, uh, yeah, just we close at five and we get here at eight in the morning and just come in here, especially if you're a man, a man, Dennis, you come in here and uh just just for walk-ins emergencies. Because if you had one broken tooth, it'd be a thousand dollar crown. You had one toothache, it'd be a root canal build-up crown. And it wouldn't matter if you took four hours to do a molar root canal build-up, CADCAM, Serach crown, four hours or Glidewell's new I.O. digital deal or whatever. You don't need any. We we we saw that in COVID. In COVID, our corrupt government um told the dental office we had to we had to shut down for for safety, but all every everybody that gives money to politicians, Walmart, Costco, all the big locations, they were all open. And um, and dentists were sneaking into their office because someone they knew had a toothache, and then they get on dental and they go, Oh my god, I can't believe it. I I drove into my office, I had my assistant meet me there. We did a root canal bill on the ground, $2,500. I told her we're not open, we can't be open, no insurance, paying cash. She she she paid me $2,500, and I only had to pay an assistant for two hours. Um, she makes twenty dollars an hour, but I gave her just a hundred, I gave her a Benjamin, I gave her a hundred dollar bill, and I I made $2,400. So so dentistry is not a game of volume, it's a game of margin. But everybody wants to talk about you know anything but a margin, just grow your margins. You don't need to grow your locations, you don't need to grow your hygiene department, you don't need to grow your so you just grow your margins and you have your fixed cost of a dental office. Find out why it doesn't produce any money 80% of the week, and just uh just relax, have fun, and don't do things you don't like to do for money, or it leads to depression and burnout and disease. All these people that are burned out in dentistry, it's because they're doing things they hate to do for money, and that's just a bad recipe. Now, just have fun. If you hate Florendo, send it to us.

Speaker 2 34:55

Absolutely. So I I know I've taken up quite a lot of your time already, but just to it's a it's it's a it's a very great point. And you said that grow your margins, not your locations, and that's um a very valid point for any uh kind of budding young dentist out there, and there are many dentists thinking about opening at multiple locations. But if you if you had to give like your wisdom to young dentists there today through your experience, what would be what would be the top three things you would uh advise them to do?

Speaker 35:27

Keep remembering your initial dream. What made you want to be a dentist just like your dentist? Well, what was it? It was he had his own office, it was your mom was a dentist, she loved it. Um, she got to pick her staff, she didn't work with people she hated, she didn't have a boss, she didn't she didn't go to school eight years to live under somebody's thumb and be bossed around and told what to do, who wasn't even a dentist. I mean, I can't believe that instead of opening up their own office, they'll go work for a DSO that's not even owned by a dentist. Really?

Speaker 1 36:03

Yeah, really?

Three Rules For Young Dentists

Speaker 36:04

You're working, you work for a guy who's not a dentist. I mean, that's isn't that kind of I mean, why why why didn't you just quit dental school at the end of third year and say, Oh, I've had enough. I had enough. I don't even I don't even need dental instructors anymore. I mean, after three years, I'm ready to work for someone that's not even a dentist, and and and then and then you're an employee and office manager says stuff to you like I've seen them in these DSOs where they show the x-rays, you have eight patients come down the recall today and they get their FMX, and wherever there's a big MOD amalgam filling, they call it a crown opportunity, and they say, Now, today you're gonna see 38 crown opportunities. Now, you know, we expect you to, you know, at least do four. And it's like, well, when you go to the doctor, tell your doctor that I'm expecting that he sees at least three patients with an STD and starting you for gonorrhea and syphilis and chlamydia because that's our goal today. That's what we're gonna say. That that's our goal. I mean, I mean, just just just remember your dream. Why did you want to be a dentist? And you and you went from I can't wait to be a dentist, I hope I get in dental school. Will you help me get in dental school? To now you keep saying, Now I'm not ready. I graduated, I have my license, I'm completely legally, educationally, trained, and ready to go. And then you keep saying not now instead of saying I'm afraid. Don't say not now, say I'm scared. And that that that that that's fine, but you know, you're only gonna be scared if you got some big payment to make. But if your only overhead is you, and I've seen this in Singapore the most. Singapore has the most solo practicing dentists who don't even have an employee. Maybe his daughter after high school at 2 30 will stop by and help dad out. Sometimes the wife will stop by and answer phones, or if he's got a big case, she'll come by and such and they have like no overhead, and they only do like $300,000 a year, but they take home 200. They love their job, there's no stress, they don't do anything they don't like to do for money, they're more likely to smile. You you can find 10 dentists smiling in Singapore for every one in New York City, and it's all it's all this mass production. We got to have six chairs, and we got to have two hygienists in five locations, and they just they just ruined the whole thing. And I'll tell you what, you come back 10,000 years from now, there's still gonna be solo practicing dentists because when I break my tooth, I got to go to a human. I don't know how to fix this, and you're going to touch me and give me a shot and operate on my tooth. Well, that that's weird. I mean, I I can go to a store and I can just buy a phone and not even touch you, not even shake your hand. I can go buy a bottle of water, which in the United States costs more than gasoline. Can you believe that? Bottled water per liter costs more than gasoline. Everybody's worried about the price of gas from the air. It's like, why don't you worry about the price of water, you moron? And and and just just have fun.

Speaker 2 39:11

So, okay, so remember remember your dream, remember your dream is your top top one. What are the other two?

AI And The Future Of Dentistry

Final Thoughts And Goodbye

Speaker 39:16

Work for yourself. Okay, just work for yourself. You're a doctor of dental surgery, and you work in a first world country, and now your best idea is to be somebody's employee. Why don't you get a tattoo that just says, I want to be your bitch? I mean, I mean, I mean, really. I thought I thought when you got your doctorate, you were introducing everybody. Hi, I'm Dr. Ferran. And then the minute you graduate, now you're like, Hi, I'm Megan's bitch. Yeah, I just get she's a she ain't a dentist. The owner of the clinic ain't a dentist. I just do what I'm told. I went to school eight years to get a job I hate, and and then and then they're confused when they start drinking too much alcohol, start smoking pod, so saying they're burned out, saying they want to get into another business, they they want to be a day trader and they start buying stocks. It's like, dude, what happened to your dream? It got killed by your fear. I didn't have any fear when I got out of school because I knew I knew the break-even point was almost. I mean, I mean, when you go, when you go to McDonald's, and I know you're on the British pound, but but I mean, what's the most money as an American I could spend on myself at McDonald's? 20 bucks. Is there anything in dentistry that cheap? What can I buy in the dental? I mean, the x-ray would be 50, the exam would be 100, the filling would be 250. I mean, I mean, gosh darn, you need one customer who needs one filling, and you just made 400. I mean, when you were in dental school, how what did you have to do to earn 400? Work a whole week at your part-time retail job to make 400. Now you can do that in an hour, and that you're in the profit zone. Now, not if you have six chairs and four assistants and three people answering the phone. You just need to open your own dental office and maybe get one employee and and then grow that to where someday you say, you know what, Arun, we we need another chair. So, and then one day you may need four, and then one day you need may need eight, and one day you may need 80 chairs, you may need 800 chairs and go buy the tallest building in downtown your city and put dental hospital, and that's your whole marketing budget. Everybody knows that's a hospital, and hospitals you don't need to have an appointment, they have an emergency room, and I mean, just um, just just have fun. And I'll tell you what, and and then here's the third deal: never give someone money who you don't like to be with. Okay, when you when you uh mean when you drive into work and you see your receptionist car out there and you're just like, yeah, or your hygienist saying, Ah, you know how many dentists tell me that they they hate their assistant or they hate their. I'm like, what do you mean you hate your assistant? How in the hell can you hate your assistant? And furthermore, why are you paying someone you don't like to work with? I mean, when I would drive to work, I was sitting there thinking the whole way, I wonder if Jan won her softball game last night. I wonder what Chris and her husband Martin did last night. I wonder, you know, and and and the first 10 minutes just walking around, fist bumping people saying what up and what up, and then and then when you have that type of relationship, they can tell you, um, you know, they can come in there and they say, Okay, Dr. Fran, you got a hygiene check, but you're running 10 minutes behind. I'm gonna stand behind you with a frying pan. And if you're in there longer than five minutes, I'm gonna knock you out. I mean, I mean, if she can't tell you what she's really thinking, and and and and what what is gossip? You know, gossip's like, I'm gonna bitch to you about Howard because I don't have the trust to go tell Howard myself. So just just stay true to yourself, you know, work for yourself and work with people who if there were no patients, you you would you would you would you would just love. I mean, I mean, I I think the and same thing with fam with patients. When when they're toxic, that's what 12 specialists are for. I mean, when they come in and they're telling you the last three dentists screwed up their denture and this and that, and every and you just look at this person, like, okay, this lady's crazy. They're called prostodontists. Send your crazy denture patients to a prostodontist. If they say, Well, I don't know why I want to have a denture here, you charge a thousand dollars an arch. I mean, I'm looking at an ad in Phoenix, denture world will do the whole office for $250. I'll say, Well, what's what's keeping you? Do you need a ride? I mean, I'll drive you to denture world. I mean, I mean, how do you do you need a map quest? I mean, I mean, it's like it's like, don't treat people you don't like, don't work with people you don't like, don't do procedures you don't like, stay true to yourself, work with a bunch of friends and family and have fun. And you're gonna be a rich doctor in a first world country. And let me tell you something a rich dentist in second or third world countries or developing countries uh are still in the top 10%. I mean, I care i i've i i've i I've uh you know I've lectured in Somalia Ethiopia uh all uh Tanzania South Africa and and when they're they're always in the top in education and income and if they're doing those things that they're working for themselves that they like what they're doing if they love their team they're all smiles and giggles and you stay in their house and because I didn't like to stay in hotels I didn't think I could really get the experience of Poland if I'm sleeping in a holiday inn I wanted to see how a Polish family talked and aid and their kids and and you see all the cultural differences and and um and uh some of it's uh really eye-opening I remember getting a big old argument with a dentist in Brazil I was staying at his house and he was he told me that his son was so smart that when he grows up he's gonna be a dentist and then he told me his daughter was so pretty that when she grew up she was going to marry a dentist and I'm like whoa whoa whoa what the hell where the hell did that come from well your boy's good looking he's got a he's good looking why don't you tell him to be some girl dentist boy I mean so you learn all these culture things and let me tell you something about economics I notice the people are all the same the dentists are all the same but man when you're sitting in that house and you're in a very poor developing country all they talk about is soccer everybody watches soccer they're all having fun they love it but man if you're someone's house in Iran or Lebanon or Korea or Japan or Germany it's business they talk about the business of dentistry and I swear I'm not senile I'm not crazy but when I'm in those underdeveloped countries talking to the same group dentist um business is usually the um it's not on their mind it's not in their home and if you spend all your time watching soccer I bet you you have a great life yeah but you might not have a very big growing profitable business so again I think if you were little but maybe they've got it right maybe they have it right isn't it and they're enjoying their life and that's that's the bottom line isn't it it's as you said it's about enjoying your life um stay true to yourself and have fun correct absolutely well Howard I think you've shared some real pearls of wisdom here today um I appreciate especially those last three points um of have a dream and remember why you went into dentistry that's the number one number two work for yourself I think that's a very valid point okay I think it's when you when you studied so hard why shouldn't you work for yourself why should you be someone else's employee if you if you have that don't let fear overcome overcome that and then the last point um never give money to someone that you don't want to to be with you why why why hang out or work with people you don't like that's pointless so I think you've really shared some really great insights there of your experience um of your career um I really appreciate your uh time and uh uh kind of your your consideration to to be here today um any last comments to to to our listeners today from your side i think i think that um these are the best times in dentistry um i think the new thing that's come out lately is artificial intelligence and i think artificial intelligence is gonna make it so much easier to learn dentistry to understand dentistry i i mean i mean there's and look at all the misinformation there the first thing they said was and when ai came out that the first people that would lose their job were um well oral and maxillofacial radiologists because ai is better with images than it is with large language model text and what so what so they they said that they always live in fear and they hate change and and what happened in in a in radiology it's expanding why yeah because the task was reading the x-ray the purpose of why you went to school was explaining to the patient and the referring dentist what the disease was and that's where you are socializing and and and now that you can read 10 times as many x-rays make it quicker you you so on the same eight hour day you're reading twice as many x-rays so your your your overhead's the same so the price is going down and now dentists who never could um afford an oral radiologist to review every panel they get now a lot of dentists are just saying I just automatically send every pano to an oral radiologist and then people in poor countries are now having oral radiologists read them from India and Pakistan and L and so so AI it's not going to destroy the world it's not going to take over the world i mean hell held the longest lasting and and then when they say it's gonna take all the jobs look look at your car how many people work in the car industry how many people are making in factories for the 30 000 different parts that the car manufacturing plant just assembles nobody makes a car in the world they only assemble a car made from 30 000 well if robots if robots become as common as cars there's gonna be that many people building robots selling robots maintening robots repairing robots you're gonna have you know if there's three million people working in the auto industry in the United States and everybody that has a car is a robot there's gonna be three million people working on robots it's gonna be like the internet you know when when the internet came out for me it was in 1994 and they said it was going to do all these things and no one believed it well 30 years later most of what it did I didn't even see coming it's like it just keeps getting better and better and better and better. It's the same thing with AI you're the human it's all about you and AI is going to make you read your your books better you'll be able to you'll be able to get your financial sheets back from your accountant and then just scan them into AI and say talk to me am I doing good I mean I mean AI AI is a big big thing and I get focused on AI because I think it's gonna make every dental office run faster easier higher quality lower in cost and increase patient satisfaction correct amazing well thank you so much today Howard okay um for your time contribution your wise words experience really appreciate Thank you joining us on our podcast today thank you all right it was an honor to be on your program or any everyone do it again let me know absolutely all right see you later thank you