The Dental Billing Podcast

Part 1: The Future of Dentistry and Dental Billing with Howard Farran DDS

• Ericka Aguilar • Season 10 • Episode 7

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Legendary dental expert and Founder of Dental Town Howard Farran joins me, Ericka Aguilar, for a compelling exploration of the future of dentistry, challenging the conventional norms that govern the industry. We embark on a fascinating journey through Howard's personal story, from Kansas to Arizona, navigating the complex economic barriers and education demands that define the profession. Together, we unravel the financial intricacies of being a dentist, contrasting the roles of general practitioners, specialists, and practice owners while scrutinizing the implications of operating within a cartel system.

The digital age is upon us, and AI is set to redefine the landscape of dental practices. We dissect the inefficiencies plaguing current practice management software and uncover how AI innovations, like the pioneering dental AI chatbot, promise to streamline operations and unlock new levels of efficiency. Drawing from a wealth of experience, the conversation paints a vivid picture of how AI can transform the way dental practices operate, enhancing both user experience and operational effectiveness, setting a new benchmark for the industry.

As we navigate the evolving business dynamics and global challenges in dentistry, the conversation broadens to encompass healthcare access in America. We shine a light on the disparities in dental and women's health services, particularly in rural areas, and consider the potential of international specialists to bridge these gaps. Our discussion also highlights the pivotal role of Dental Service Organizations in capital formation and their strategic influence in the market. Through it all, we stress the importance of ensuring quality and integrity by having industry-specific professionals at the helm, safeguarding the core values of dentistry amid shifting economic and regulatory environments.

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Want to know what your fee should be for D4346? Send Ericka an email to ericka@dentalbillingdoneright.com


Speaker 1:

Hey there, thanks for tuning in to the Dental Billing Podcast. I'm your host, erika Aguilar. Welcome back to another episode and for those of you that are new to my podcast, thank you for tuning in. Today's episode comes with an explicit language label. I want to give you fair warning because, although my guest today is a legend in dentistry, he's also known to drop a couple of F-bombs, and I want to keep this conversation as authentic as possible. But I also know that a lot of my listeners listen on the way to work, on the way to dropping off the kids, and wanted to just give you a heads up on the way to dropping off the kids and wanted to just give you a heads up.

Speaker 1:

This is probably not an episode that you want the kids to listen in on. It's all dental related, but if you've ever seen Howard live, you know that he does not hold back in anything opinion, religion, politics it's all mixed in there. This is a fun episode and what you guys may not know is that Howard and I go back about 20 years. At some point during the podcast we forget that we're recording an episode. So forgive us, we are just getting lost in our dental conversation, like we always do, even though most of the time we have a hard rule of no dental talk when we are talking on the weekend in a late night chat. With that being said, I just wanted to give you fair warning. I hope you enjoy this episode as much as we had recording it.

Speaker 1:

Okay, howard, I just wanted to take a moment, take an opportunity to talk to you about the future of dentistry and my perspective as billing is evolving more and more. I just wanted the listeners to hear what your opinion is of the future of dentistry, but before we do that, can you tell the listeners who you are? Like I can't believe there's still people out there that don't know who you are. Can you tell the listeners who you are? And a little bit about Dentaltown.

Speaker 2:

Yeah, I'm a dentist. I went to University of Missouri, kansas City, graduated in 87. My God, that was a long time ago and went out to Phoenix, arizona, because it just had better demographics, better macros. I did a bunch of research on dentist to population ratio. I was in Wichita, kansas, and it was going down every year and I found an area out here that had a dentist for every 6,000 people. So I moved 1,000 miles and I think I got here. It was Ahwatuke, was just annexed by Phoenix and it was 25,000 people and today it's like 90,000 people. So obviously demographics.

Speaker 2:

And it's same thing with franchises. That's why, you know, you pay so much money for a franchise because, like in a restaurant, like you know, 97, 98% of restaurant franchises are still in business in five years, whereas when you open up your own restaurant, 40 to 60% are bankrupt in two to three years. I mean that's interesting. Why is that? Well, I mean it's got a very low economic barrier to entry. I mean, to be a dentist, you got to go to college for eight years and it's a very high economic barrier to entry. It's like anybody could set up a gas, propane, electricity generating station, but to build a nuclear power plant. You need $10 billion, you need 10 years. I mean so economic barrier entries.

Speaker 2:

Warren Buffett and Charlie Munger called them the protective moat around your business. Anybody can start a restaurant, anyone can start a dry cleaner, anyone can start a Chinese restaurant. But to build a protective mode around that a franchise or a patent or a brand like Coca-Cola or something like that is very hard to do. And dentistry not only is to have an eight-year protective mode around it, but you got to get an undergraduate degree and a dental degree. It also then operates under a cartel to, where the United States government is in bed with you and they won't let anyone come here from Germany or Japan, where they build Toyotas and Mercedes-Benz, to open up a dental office. When they get here, they say oh, we don't respect your school. From Germany, where you make Mercedes-Benz and Volvo. You got to go back to the you know University of Iowa for four years and go to dental school all over again, and it's such a you know these people are married, they got kids, they've been practicing dentistry, so you get that protective mode and that's why in the 20 richest countries in the world, health care is bankrupting every country because everybody feels entitled to pay grandma. You know she can't work anymore and she's sick and everybody wants to pay her bills. It's the right thing to do, but when you operate it under a cartel it ends up costing five, 10 times more.

Speaker 2:

You know, in the United States in 1900, healthcare was 1% of the GDP and then the government got involved and they fired all the doctors and closed down all the schools and opened up 50 state boards and said that only a state board can license a medical school or a dental school and when you come out of that school, only they can give you a license. So they became and there's no jury and you can't sue them. So they became the judge, jury and the executioner. And by the end of the century, healthcare costs had rose from 1% to 14%, and now it's all the way up to 17%, as these countries are. You know, united States is $32 trillion in debt. How much that is Medicaid and Medicare.

Speaker 2:

So, with these cartel conditions, that's why the average dental specialist in 2023 made $244,000 a year, whereas the general practitioners made $191,000. Dentists who own their own practice made 260 000. Dentists who were employees made 183. That's why oral surgeons average 334 thousand a year period. I mean, you'd have to sell drugs to make 334 000 a year. I mean, what the hell could your brother or sister do to just someday be making $334,000 a year? It has to be something incredibly legal and that's what the cartel does and that's why periodontists make $211,000, endodontists $266,000, pediatric dentistry $284,000, orthodontists $243,000, prosthodontists $214,000.

Speaker 2:

So you can see from the macro that you knowistry is headed. You know it's a lot smarter to specialize. I mean, you know when I got out of school that eight specialties now they have 12 oral surgery, endo perio, pediatric dentistry, ortho, prosthodontics, dental anesthesiology, oral facial pain, oral medicine, oral path or radiology and then dental public health. But there's so much information that to be a jack of all trades that is going down in reality and it's going down in income and then specialty is going higher and then putting more things under one roof. Like the most successful DSO of all time is when oral surgeons and prosthodontists and laboratory technicians all got under one roof called Clear Choice.

Speaker 2:

When I was a little kid and went to grandma's house for a week every summer in Parsons, kansas, they didn't even have groceries under one roof. We had to go to a meat man, the butcher. We had to go to the baker, we had to go to the vegetable store and then we went to the hardware store for canned goods and candy. And now you know, I hell, I buy all my clothes where I buy my eggs and butter at Walmart.

Speaker 1:

I mean you know, it's all under one roof.

Speaker 2:

So clear choice was obviously the clearest choice for DSOs. It's been sold twice. It's down by Aspen Dental because Aspen Dental knew they could feed all these patients into this process and that been a uh, a real good deal. And then the other um, sorry, I gotta plug this in. And then the other, um, um, great.

Speaker 2:

One is like when I got out of school, orthodontists were like 10 000 and the second biggest specialty was like oral surgeons of 5 000 and now pediatric dentists just place, just just top orthodontists. There's now, you know, there's almost there's more pediatric dentists and orthodontists. And whenever they open together, I mean any mom educated enough to take her kid to a child specialist is going to say his little, his little baby Erica is going to need braces when she grows up. And and are you going to write her a form and tell her to make another appointment? Go down the street, fill out another chart. Or you say, well, let's just have the orthodontist come on in. And so I call that one plus one equals three. You got a pediatric dentist, that's one. You got an orthodontist, that's one. But you put them together, they equal three. Just like oral surgeon, just like Clear Choice oral surgeon plus frost dentist was laboratory technician. That was more like one plus one plus one equals five. So you got all that going on.

Speaker 2:

And then you got, and then we're in the middle of the AI revolution. And you know, the industrial revolution started, you know, 200 years ago with the little combustion engine pumping water out of flooded coal mines. And they just kept making that engine faster, easier, higher quality, cheaper and smaller and it finally fit on a ship and that disrupted the entire shipping industry. And then, when I got here, they built canals for it and railroads. And then the telegraph came out and that was the phone line and it was the internet, and you have all these massive disruptive forces. But I think the biggest disruptive force is right now is going to be AI. Biggest disruptive force is right now is going to be AI. I mean, it's just beyond huge. In fact, this is Monday. A week ago, monday, china had their deep seat come out and the market yeah, I mean the market fell a trillion dollars, I think 600 billion of it was Nvidia, and so this is going to be a very disruptive thing and what I think it's going to do is it's going to change it where you know, like right now, if I decided this is Monday and I decide, okay, when I get off work Friday, I want to take a couple of the grandkids to Disneyland, my God, I'd have to start texting and I'd have to get on the phone and I'd have to call Disneyland and see if they got. I'd have to call all this stuff and now right around the corner there are AI agents where I will just tell my phone yeah, I want to go to Disneyland, tell my Arizona kids that grandpa's got to get some rooms at the Disneyland hotel and get some tickets, and get 10 tickets and then text and email Zach and Greg and Eric and tell them you know that what the plans are and that's it, and they'll do it. They will actually they'll. They'll do the whole damn thing and they'll come back with your plane tickets, your itinerary or hotel rooms, your tickets.

Speaker 2:

And I think where it's going to change in dentistry is, you know, when you go to these dental conferences where they bring in people like yourself, erica, these key opinion leaders and influencers in practice management, and they'll bring you out there and they'll show you all their new things that they're programming and all their new reports. And I've been in these so many times I've been to Effingham, illinois, what is that? That's the one owned by Patterson. Or go to Provo and see the Dentrix ones or whatever, and you'll be up there with all these practice management people and the room I'll just say the room. Okay, what percent of these reports when you go into a dental office have never been ran one time? Go to the report generator. No one's ever ran it one time and everybody agrees it's like 85% and they still. Every year.

Speaker 2:

They just keep putting in more buttons and more features and it's just a pardon my French, it's a clusterfuck of stupidity. I mean, when you go into the Hyatt Regency or the Hilton or a five-star resort, they open up the screen. They only have like seven questions and they're going to do them in order the name, the credit card, this and that they get everything. They need a streamlined process when you return. You know a $50,000 car to Hertz rental car. A guy walks out there with a Palm Pilot and just asks like five, six questions mileage, this that checks you out, gives you the receipt and then you go into a dental office and you open up Dentrix and 47 million buttons pop up and 85% of them have never been used.

Speaker 2:

Girl's eyes glasses over, and then the one thing you want to know for sure is like well, you know, I'm spending $300 a head on a new patient. Did you find out? You know who referred her? Or did she see her advertisement? Or? Oh, she forgot that part is she was snowed. So there's not even a place to can you imagine how nice it'd be if you open up Dentrix and you could just go to settings and it said the Erica Aguilar setting or you know, or Sandy Pardue or Linda Miles or whatever, and you click one button and it shuts off 85% of all the bullshit that just clutter.

Speaker 2:

But it's going to get better because now it's going to be AI. So now Dennis is going to just sit there on his smartphone and hopefully the you know, the practice management app has a smartphone extension. You know, because you know, like most websites, like we redid the whole Dentaltown website. So the Dentaltown website is the same as the app. It's called a stack development and hopefully these things are stack developed. And then you could just ask it what is my overhead? Do I have any outstanding insurance claims? Do I need any? You know, you could just ask it. And we built the first dental AI chatbot. We don't think we're going to release it and I know, poor Eric, I've been telling you it's going to go. What we did is eventually.

Speaker 1:

And you have asked me to keep my mouth shut and I have, and I have been dying to see this thing.

Speaker 2:

Well, you know it's funny because the first insight came from my son, ryan. He has a degree in programming from NAU and from Oregon State and all this stuff. And you know he was telling me you know you got to get, you got to check out this chat GDP, you got to check out AI. And what I realized after I got chat GDP and started checking this out, that Dentaltown was 25 years old. We had the Foran Report, Dentaltown, Hygiene Town, ortho Town. We had magazines for a quarter of a century with thousands of articles. We had, you know, millions and millions of posts on Dental Town by a quarter million members for 25 years. I think they'd asked 7 million different questions with all these answers, and then I'd done like 1,600 podcasts and had all the transcripts to that. Yeah, and then we looked at the research and you know I wanted to download all 70,000 of the Library of Congress, you know PubMed, all the dental research articles, and that wasn't available. So we just hacked into that and scraped it. And so I put all that in one chat model and holy moly, because, like even in your expertise of insurance billing and all that stuff, I mean all that stuff's been discussed at length and the only way artificial intelligence works, I mean, there's zero intelligence. It's just, you know, we did math on our fingers and we did it with rocks, and then we did pencil and paper and then we got calculators. These are just massively high-speed calculators. I mean, if I say to you, erica, mary had a little Lamb, yeah, so when you're everything, everybody chat GDP, it's always going to be lamb. But if it's just dentistry, it might be. Mary had a little molar, mary had a little blockage in her mesial buccal canal and it seems like when I ask these questions on big, large language models, it's more mary had a little lamb. And when I ask it on just all dental information, it just seems tighter, it seems more specialized, it seems more up there.

Speaker 2:

Um, but we, what we're trying to do is we're trying to put lipstick on a pig. And for several months we, you know, kept trying to do all these things. But that website, it was so damn old and and we had it on our own servers. And you know instagram. You know mark zuckerberg, whose dad's been on my show several times. You've met ed um, um, you know, um, ed zucker. Mark zuckerberg doesn't even host instagram. He puts it on aws amazon Services because they're just a powerhouse and we knew we need to get on AWS and quit using servers and go serverless architect. And so we just decided you know, ryan spent probably a year trying to put lipstick on an old pig and then we finally realized we need to take that pig out behind the barn and just shoot them and then and just rewrite seriously every single line of code, and to do that I hired 10 programmers and 10 AI programmers and it's just been the most amazing journey ever.

Speaker 2:

And and I think you know my, my mission is when I, when I retired from dentistry, I did not sell my dental practice to a DSO, because I'm thinking about my eight grandchildren. I mean I don't want my grandchildren to go to some DSO where you know the office manager is running eight different locations. And it's kind of like if you're a young dentist looking for a job, I mean, look at McDonald's and look at Chick-fil-A. These guys are genius. I mean Ray Kroc, he only gave you one location. He wouldn't give you a franchise unless you were married, had children, went to church. I'm saying because he knew if you're married to a stay-at-home mom and you got your family all taken care of and you're providing for all those people. You're going to be focused and I'm only going to let you get your money out of one location. So you're just going to let you get your money out of one location. So you're just going to work your ass off on one location.

Speaker 2:

Dot every. I cross every T. Look at Chick-fil-A. They said not only you got to go on church on Sunday, we're not even going to be open on Sunday, it's the Sabbath baby. You're going to take the day off and get, do your mental health thing. And McDonald's is doing like 3 million a year and Chick-fil-A is at like 5 million location. They're just crushing.

Speaker 2:

Then look at subway subway man, if you want to buy eight franchises, they'll sell you 10. And and look at, look, the same thing with burger king. I mean people graduate from the nba and they go buy a dozen burger kings. And that's why when you order the french fries at burger king, I mean you never know what you're gonna get a tater tot, a half a onion ring. I mean there's no quality control. And it's the same thing in these DSOs.

Speaker 2:

Look for, you know, go in there and first question you ask is who's the office manager? How many locations do you do? Is this your only store? And then start asking around the staff how long has everybody been there? I mean, if the oldest person in this 10-year-old office has only been there for three years, ask where the other dentists are and go talk to the last dentist. This is why I think dentistry. You know I'm old school. I want an old school fee for service. If you are in a DSO, I want you to be a part owner. I want you to. You know, if the dentist has to do what the office manager says, then where is my little Taylor Marie, my first granddaughter, who turned 13 last month? Where the hell is she going to go to the dentist if all the dentists are working for office managers and publicly traded companies on Wall Street? So you know, I think they're going to get better.

Speaker 2:

You know, in healthcare, when these big management companies start out, it was always quality, it was, it was, it was gosh darn Mayo Clinic, the Mayo brothers. They kept seeing everybody. Just, you know, when grandma got sick, they just kept seeing everybody give her a bottle of codeine and morphine and and send her home and just make her feel good until she died. And the Mayo brothers was like well, wait a minute, man, she, she lives on a 60 acre wheat farm and and you know she's, you know she's retired, she, she had sold the farm for a million dollars. She truly does not want to die and that's it's her decision.

Speaker 2:

So they always went after the high end market and Scripps, cleveland Clinic, my gosh, the Sloan Ketter, feed Earring in New York, the Houston Interferon Clinic, I mean they just went to the top, whereas dentistry kind of went to the suburbs. I mean they all focused on the suburbs. You know 60,000 median household income or higher, you know that had insurance. They gave up on the rural. They didn't go rural because when humans graduate from dental school they're about 25 and they're horny little primates that want to find a mate and get married and they want to go to the big cities. No one wants to go to Eloy, arizona to look for a mate. They want to go to Phoenix where you know there's a million people in the city, 5 million in the Metro. So when they went rural, you know most of those DSOs had a, had a dock with a box with no dock and at 10% of the time they had they had empty, empty dock locations and that just didn't work. So dentistry. So I think the rural is going to be saved just by the mating patterns of primates.

Speaker 2:

But when you go into the big cities, you know I, I, I, you know, I, I, I'm an optimist. I think they're going to get better and they're going to focus on quality, and you know they'll get better in time. But quality to me is determined by staff turnover. And when, when you, when you can't keep your dentist, that's a huge, I mean that that's just horrible. So so my job is to, you know, I want to keep a family practice, I want to keep the dentist in charge of dentistry.

Speaker 2:

You know, I grew up in Wichita, kansas, where there's a big Boeing. Boeing was the biggest employer and Boeing, you know, when I was a little kid, the CEO of Boeing was always like one of the most respected aeronautical engineers in his field and when they talked people just weren't on, they listened. And then they got hit by Wall Street and actually moved the headquarters from Boeing where they make all the planes, which I was just a fuselage. And then they moved the headquarters to Washington DC, because that's where all the sales are to the Pentagon and the military and that's where all the money is. And then hell, it didn't even take 10 years. Their planes are falling out of the sky, doors are falling off. I mean the whole thing went to shit because a dentist wasn't running dentistry and aeronautical engineer was not running Boeing. Henry Ford was an engineer and and you know it just.

Speaker 2:

You know, I don't know, call me stupid, but I think you got to be a dentist or run a dental office or own a dental office and you know it can be ran like a business but it's still a sacred, sovereign profession. But I want to give this dentist more tools, because the dentist is. They're wearing way too many hats. I mean the DSOs are crushing it in capital formation, finding location, getting better deals on supplies and lab. But even on the lab and supplies, I mean, let's say lab, say your lab bills 10 and your supplies are 6, 16 how most of these dsos want 14 off the top. So they would have to give you free supplies and free lab to justify their existence. And they don't. And uh, where they do justify their existence is insurance control. When they buy a dental office, my God, they go right to Delta and Blue Cross and Blue Shield and they submit and they renegotiate their fees and they get it done. And they negotiate their fees differently than you do, because they have half a dozen attorneys show up at the meeting and when half a dozen attorneys show up at the insurance meeting, your fees get approved so they can buy a dental office and pay for it just by, you know, five years of higher fees.

Speaker 2:

And my individual can't do that. My individual, you know, he's got to do the marketing. These guys are on TV, they're on radio. I mean you know they're big things to go after. Now, personally, it doesn't bother me because I practice in Phoenix and I mean I love DSOs because they just were a continual source of new patients and they'd all come in with the same story.

Speaker 2:

Well, I went in there and it was for a free cleaning, free exam, everything free. And then they found four cavities that were $250 each for a thousand. So I thought, okay, well, it's all free and now I need a thousand dollars for the fillings. So I went in there to have them done on the right side, two on the right, two on the left. I went in there and the dentist had diagnosed he no longer works there. And then there's this new dentist and then she says that I don't have four cavities and I have three, or the other one said five. I mean it's just you're selling the invisible.

Speaker 2:

They don't know what a root canal is, they can't read the pano. I mean you could point to your two metal foramen and say they're bilateral jaw cancer lesions that need to be extracted. They wouldn't have any idea what you're talking about. That's why all the courts, the Supreme Court, your state board always says that, due to the asymmetry of information, dentists and physicians are guilty till proven innocent. So your exam is guilty, wrong till you prove different. Your x-rays, your diagnosis is a huge asymmetry of information. It's not like free trade. When you're buying a bottle of water or a pack of M&Ms or get a pack of gum at the store, I mean you know someone's getting in your mouth and telling you you need root canals and crowns and it's pretty serious stuff. And. But so I think the dentist, the dentist, it's their game to win.

Speaker 2:

But God, wouldn't it be nice to take AI to where the dentist gets to sit there and he sees that it's 11.24 and his one o'clock just canceled and sit there and hey AI, hey AI, can you find the 10 best patients that can fill that appointment in an hour and a half and send them a text and email and call them, and then you know that's your personal AI agent and it comes back 10 minutes. Yeah, your one o'clock has been filled by patient Erica Agliar, who needs an immediate upper denture, and you know it'd just be nice that you could just say, hey, do I have high overhead? And it could reach into your accounting software at QuickBooks Pro. It could reach into your Open Dental, which is open. I think that's where we'll have our first lock Dentrix hell.

Speaker 2:

The reason Open Dental started is because the guy that founded it had Dentrix and all he wanted to do is download his patient's addresses to print out on labels, to do a mailer for this new bleaching that had come out back in the day and they had put up. Not only could he not do it, his undergraduate degree is computer programming, so he could see that man, they spent a ton of time building all these firewalls. So he called Dentrix and said why can't I do this? And they said it's because it's their data. He's like, wow, and well, that's how YouTube does it. I mean, you upload a video on YouTube, you can't download it, you can't edit it. It's their property and it's their property and if you say take it down, you're at their mercy If you want to make a change.

Speaker 2:

I mean, it's just arrogant people, arrogant abusive bullies do arrogant abusive bullying things but in the end it just forced them to be ran over from behind. Because if you're not doing it nicely and well and faster, easier, higher quality, lower cost and scalable, well then you're just noise until someone will run over you from behind. But I think the new noise now is going to be someone saying, yeah, my cash flow I mean I'm busy all month and where's my cash flow? And it says, well, you know your account receivables are at 30, 60, 90 days. Your insurance billing you know you have nine different fees scheduled with PPOs. Here's your overhead according to QuickBooks Pro. And you know your overhead on operatory is $118 an hour.

Speaker 2:

And you're just, you're losing money on these three plans, which you should drop, and these other three plans you should freeze. The only one you're making money on and continue to grow is this one, and you should. You know, blah, blah, blah. You know just, I think it's just going to be a revolution. That's what we're gearing up for. We got, you know, we started this project. It'd be a year ago, september 5th, and now we're into February. So September, october, november, december, january, so you know, so we're 17 months into this and six months into it I hired my second AI programmer and now, like, say, I'm 16 months into this, I have now I have 10. And when we get this thing up and we get the dental chat bot, I just think it's going to be one more tool that my homie can rely on to help him or her do dentistry faster, easier, higher quality, lower cost and scalable.

Speaker 1:

And your point of help right. So you want to empower the private practice. You want to empower that dentist, absolutely.

Speaker 2:

I mean I got an MBA from ASU and I love Wall Street and all that kind of stuff, but I mean I'm a dentist. Even when you retire, you're still a dentist. I mean, once you're a dentist, you're a dentist till you die. And I just, you know, I look at my four kids, I look at my eight grandkids and I just really obviously believe that dentistry should be ran by dentists. I don't think it should be ran by suppliers and Wall Street and I don't want some guy I mean look at Boeing. I don't want some guy with the MBA cutting costs and then, until your planes fall out of the sky, I mean, at the end of the day, there has to be a passion to want to build the best damn airplane in the world.

Speaker 2:

And at the end of the day, dentistry has got to be ran by people who really want to get you out of pain. I mean, you know, gb Black is the father of modern dentistry here for 100 years. But Pierre Fouchard started 200 years ago and he's trying to get these boys to. They're called dental surgeons and he tried to get them to quit being barbers and to quit practicing outside and quit cutting hair and he wrote a textbook and he said let's just really get serious about dentistry and dentistry. You know there's 8 billion people and anywhere I've gone in the world I've never met anyone who's never met a dentist. I mean you can go into the backwoods of any country. I mean I've been to 50 countries and no matter where you go, you know, in some jungles it might be a medicine man, in a lot of places it's somebody with a tackle box but they got fake denture teeth and they got, they got elevators and they got forceps and sometimes they got lidocaine or whatever the heck. But you know, you know there there's probably about a million dentists that are some variation of how they do it in your town and mine, and then there's probably about another million dentists. It's kind of like China. China's got a billion 400 million people and if you have four, five or six year degrees you're in the big urban areas and if you have a one, two or three year degree you got to go rural. And that's a very good segmentation, because kids want to do a nine-month program in the summer, then go to downtown Beijing and try to make big money on root canals and crowns and you know there has to be a market segment. Now in America people don't believe that, but it's insane. Like, look at your insurance. If you pay me $500 for a crown and another insurance pays me $1,000 for a Crown, well, that's two separate Crowns. I mean, don't tell me that you can give me $20,000 for a Ford Escort and $50,000 for a Ford Taurus, and they're both the exact same car and the boards are weird, like they have the specialist do all the judging of the general. So okay, so the ended on it's got 1500 bucks and he's got microscopes and spent an hour and a half and all this stuff. But you only gave me 800 and I had to pretty much do this thing in an hour and then it failed and now you're bringing in a guy who got twice as much money, twice as much time, twice as much equipment, twice as much time, twice as much equipment. And he's judging my root canal and then, or in the honest, he doesn't even sign up for Medicaid or Medicare or any of the low-cost DSOs or HMOs. So what are you saying? That if someone does Medicaid in Guadalupe that they're going to be judged? Their $500 root canal is going to be judged by some guy in Scottsdale that charged $1,800 and the insurance paid $1,500. I mean, so you know, there's always going to, whenever there's people involved, it's going to be disagreements and politics and all that kind of stuff. So it's a never ending battle. When all these 20 richest countries who, by the way I mean, think about it.

Speaker 2:

Erica, I graduated from high school in 1980 and that was the worst economy I'd ever seen. So I've been in five bad times. I was born in 62. That was the Cuban Missile Crisis, the year of the flash crash, but I do not remember that at one years old. And then I graduated from high school in 80. That was the worst economy I'd ever seen. Interest rates were 20 and a half percent. Paul Volcker shut the thing down to break inflation and then I got a school in 87, right before Black Monday. Then there was Y2K in 2000. Then there was Lehman's in 2008. And now you know we have a $32 trillion deficit and you know all the global stock markets, from China to India they're all flat.

Speaker 2:

But look at me in high school from 80 to 2025, in 45 years, you've told me that the economy has grown maybe one and a half to 3%. Okay, well, that's what inflation was. So that was flat. And then you told me communism was so bad because it was all centrally planned government. Okay, those governments like China and Russia. They pay for about a third of the economy.

Speaker 2:

I'm in America where the state and the city state and fed is 50% of the economy and they funded that with $33 trillion of debt. I mean the last four years, I mean every year. They just keep adding another $2 trillion. $2 trillion. And ours, as they say, it's growing because it's like you know, it's basically, you know, growing the same rate as inflation and a lot of the every country, these big Medicaid bills with socialized medicine, all 20 of them countries. There's no, the government took all the money. They don't, they regulate it to death or there's no growth. All the big growth is in Asia, china, vietnam, countries like that, and these countries, they're all coming to a grinding halt because of government debt, which is mostly healthcare and military. And when you run healthcare like a cartel I mean look at Denmark, think of all the dentists in Japan, or the doctors in Japan or New Zealand or Australia or whatever might want to move to your country and be a doctor and they have to go to school again, so they're not going to do it.

Speaker 2:

Um, you know the eu um had an eu deal where if you're licensed in um one country in dentistry, you could practice in another, and that that really left a bad taste in your mouth because, um, a bunch of people came from two or three uh countries. Um, and everybody came, moved into england and said they came from that country with a degree, and it was just a paper degree, it was a diploma meal. But I think now with computers and and websites and and uh, all that kind of stuff, you you could authenticate and and schools can be accredited. I mean they and a lot of these schools in poor countries, a lot of people haven't thought out the math Like you go to America. I mean, you know most of these dentists will apply to a dozen different schools. But if you just take the number of people applying to the number of seats, you know there's only really three or four people applying for every seat in dental school, maybe five or six in med school, probably about 30 to one for veterinary. That is actually the hardest thing to get into. But I've lectured at dental schools in India that had 50 seats and would get 50,000 applications and they wouldn't even look at an application if the child had ever made one B in their entire life. And they could strip it down to like 10,000 applications where they made an A on everything since they were born. And so the doctors in India and Pakistan and all these amazing countries.

Speaker 2:

Then I come to America. 30,000 towns, 15,000 of them don't have any of the specialties in dentistry no, oral surgery, endodontics, periodontist, pediatrician. Look at healthcare. You talk about women's rights and women's healthcare rights. Man, when you got 15,000 towns that don't even have an OBGYN and if you opened up Ellis Island and said, hey, are you an OBGYN in Asia? Come to America. I I mean just putting that person in each one of those towns is going to move the needle on health care. Now who's going to pay for it? Well, you know, you know when you, when you run.

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Ericka Aguilar

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