004: Building Comfort Dental to $500M/year and 175+ Practices | Dr. Rick Kushner

1989, the original practice has grown to a 4-doc partnership. Same concept, same format we're using now in 175 practices and 500 doctors around the country, 10 states, 11 states. But this is the first office and I'm buddies with Howard. And I'm thinking I'm going to sell out of this first practice, and we can go back and revisit that history if that's what you want to do. I don't know what you want to do, but I'm telling a Howard Farand story. And I said, I think I can go do this again. And I took Anna Kadat, still with us, threatening to retire. I'm begging her not to. My favorite partner of all, of all. Dr. Anna Kadat. She said, he knows. She says, uh, well, I'm going with you. So we're in Arvada, Colorado, and we go— I take Anna, we go to Westminster in 1987, I think, give or take a couple of years, because I'm elderly and a lot of years. That's about right. And we grow same concept, same practice management systems. We learned it for the previous 10 years in Arvada. We put it in place in Westminster with a different name. Arvada was called Supreme Dental. Westminster, Colorado was called Premier Dental. We grow that in 1991 to 3 years. We grow that to 4 partners, sell 2 more partnerships in the 3 years. Took 10 years the first time, took 3 years the next time. Now I'm thinking I might have something that can function. These systems are good enough without me being a practicing partner. And that's where Dr. Bloss comes in and his former— he's retired— former partner who spent his whole career with us, but he's retired, Dr. Neil Norton, without me. And I'm telling this story to Howard. And I said, and I'm going to change the names. The guys will agree, the gals will agree, all 3 of them, to Comfort Dental. Howard says, whoa, timeout, call a lawyer, that's a franchise. And he was right. And the rest is history. Ask him about that.

That's amazing. That's awesome. Yeah, he's really nice. I, I emailed him just first When I first started this, and he was super excited to just hop on a call with me. So I really appreciate it, especially because I'm sure he's so busy. Same with you. I really appreciate you coming on.

I guess, you know, a little bit about me from Howard, or tell me about you.

Yeah, so I'm just a D2 at Maryland. I have been trying— I've been interested in learning the business side of things because I'm sure, as you know, they don't teach any of this in dental school. So I've been trying to do it just by talking to people that really understand it. And it's been really great. I only started this a month or so ago and I've already learned a ton, but I listened to your episode with him and I thought it was really awesome, like your whole story. So I just kind of wanna dive in a little bit more about that and then maybe a little more specifically how, what dental students and younger dentists can do to advance our careers.

I probably did a lot of what you're doing. I listened to others, of course. I'm a contrarian. So one of the things I said when I listened to real dentists as I was a kid is, look at what they're doing and they're only mediocre, and don't do that. There was a lot of that in my history. I'm a contrarian. I did it my way. But let me tell you something. That's the only thing you mentioned in the email to Howard. So I kind of thought about that for A few minutes. Let me tell you something that'll make you feel better. Maybe worse. In the '70s at Marquette, and I'm not going to disparage Marquette, I've supported them for many years. They did the job. I passed my boards. But in the '70s, we had one semester, one hour. So that's 12 hours of a practice management course. I can't— I tell you the man's name if he's with us still. He's in his 90s at least. I can't remember his name. We loved him to death. We had him 1 hour a week for about 12 weeks. He taught us absolutely nothing about practice management, but he was fun and he dressed cool and he gave us all A's. So don't think this is a new phenomenon. That you need to learn practice management. Now, in our system— am I talking too much, or do you want to talk more?

No, I love it. I'm listening.

In our system, we don't care if the fresh grad, or even a recent or later, longer graduated dentist is proficient in practice management because we are. And we rarely— it does happen and sometimes it works out great, but we rarely open a new— all we do are new locations. We don't buy existing practices. We're not a DSO. As I told you in the opening story, we're a franchise. We rarely open a new office with fresh graduates. They're typically going to be a third or a fourth in an existing office who has the practice management knowledge, and they'll mentor those. Same thing, if I could just stray a little bit. We don't necessarily care. We take fresh graduates and later grad and earlier graduates. Earlier is the right term. I'm sorry. Willy-nilly. We didn't used to want to take— I didn't used to want to take fresh graduates. And then a couple snuck in, and they're absolute superstars from day one. Dental schools are in a terrible bind, and I don't need to defend them. I went to Marquette. I told you I supported them my whole career. They did the job. Colorado didn't have a dental— I'm from Colorado. Colorado didn't have a dental school at that time. It does now. A good one. Again, they're in a horrible crunch with expenses, with tuition, so they take on grad students who can increase that income but take away your procedures. So you don't get the endos that I got decades ago because there's an endo resident or or 5 endo residents paying huge tuition, maybe more than you, so they can possibly hold your horrible debt down. They're in a horrible crunch. We don't care about that either at Comfort Dental because you're gonna get an entire dental school's worth of reps your first week or 2 in any one of our offices with mentor or mentors. on board. Would we love it more if you had 50 extractions and couple of dozen endos? Oh yeah, but we'll get you there. Is that where you were headed?

Yeah, that's awesome. I'm curious about when you were starting out with your model, why you didn't decide to go sort of the current or traditional DSO model where you, uh, didn't give out equity. Like, I feel like your guys' model is so different where the Doctors are partner doctors. You take Medicaid, like you keep fees low. Was there a, like, a decision that you had to make to get to that point, or was it just always from day one?

No, I got a great answer. I was a complete and total genius from day one and had this plan completely. No, the absolute opposite. It was trial and error and an evolution in every sense. But you asked a great question, and I don't even know if Howard asked that question or anything similar to that. But I'd like to go through it with you. I don't know how many minutes you want to spend here, but—

However many you're willing.

I did— oh no, I, I'm too old to sit here too long. But as much as you're paying me, I got to sit here. I was busy early on, doing well, uh, the usual court— DSOs didn't exist back then. This is the late '70s, early '80s, doing extremely well. I've got a consultant in. I can revisit that if you'd like. There's some practice management knowledge there, but it's a little controversial. But I did the traditional thing and I took on an associate. And again, I'm guessing you'll forgive me because it's decades ago. And I want to say a year, year and a half into Scratch start practice, which isn't done anymore. Asked me to revisit that. Again, a reason why practice management education in dental school— stop whining about it. We'll take care of that for at least the Comfort Dental. We will. But I took on an associate, a good one, and he lasted maybe a year. And then he, and I paid him, I don't know, 30% of collections, whatever the deal was back then. And he went on and opened his own practice and became successful. So I did it again. And this is a woman this time, went on and opened it after another year, went on and opened her own practice and was successful. I did. I was so stupid that I took on a 3rd associate. Now, this is a 3, 4-year period. I have good relationships with these people. They're all alive still to this day. Went on and opened his own practice after a year or two with me. And now each time I'm back to a solo doc with a 2-doc or more volume. Now, after being an idiot for 3 times, I decided, hmm, maybe if I sell Part of the practice, they'll stay. And that was Dr. Bruce Eirich, partner number one, happened to be a childhood buddy, still part of the ownership management team, might be in the building right now, retired from clinical practice as our our age at that ilk, still here. The next one, Roy Martin sold him a third. And this is 1985 or something. Still here. Also part of the management ownership team. Might be in the building. The next partner, the 4th, was Tom Plum, classmate of mine. Can't say he's still here because he retired. Spent his entire career here as an owner-partner. The next one bought me out. I'd already told you the story out of Arvada, and I went and opened with Annika Dodd in Westminster. She was a foreign-trained dentist who got her license. She was my assistant in Arvada. I didn't make that clear. Bill Oldershaw just retired, spent his whole career, and I could give you the first 10 or 15 before we even lost a partner. But those first 3, I was 0 for 3. You got the point?

Yeah.

So the other thing I was getting at was practice management. Nobody's gonna— none of your classmates are gonna— are you gonna open your own scratch-start practice?

Probably not.

I'm not trying to put you on the spot, but I wouldn't pick on you. You're a wonderful kid, but probably not. Uh, you're gonna— well, actually, if you're gonna buy into an existing practice, tell me if I'm wrong, You're gonna ask him or her to stick around and mentor you until you got it.

Yep.

But then the DSOs can pay more than you can pay, so he won't sell it to you anyway. He'll sell to a DSO and you'll go work for a DSO. That's the way life is right now. We're in a mess. Comfort Dental's future is immensely bright, but the profession is in a mess. Sorry for you and your watchers.

That's why we're talking to people like you.

So what else can I— is that, is that the stuff you want?

Yeah, like the scratch start thing. How come you said that that's what you guys do now?

Because we can get to— we're not going to pay the equity for his or her 30 years. When we can just equip and supply the office and get there without paying for that within like 2 months. We'll see 200 new patients a month in month 1 in any of our locations.

It's crazy.

Yeah, it is. The downside, downside, you already said it. Fees are a little lower. Medicaid acceptance, typically we don't mandate it. They may tons of decisions on their own. We don't mandate that, but they take it because our overheads are low and it can be profitable. So you got to work a little harder, a little faster, and it's tough. It's not the style of practice that we all dreamed about. Now, an immensely talented dentist, he or she— and I'm talking the top 5% in talent, skill People skills and clinical skills, they can be successful in any style of practice they choose. Comfort dental makes up for the mediocre and the weaker. We make the weaker mediocre. We make the mediocre good. We make the good superstars because of volume and practice management systems and marketing and all of those things. So it's not— I feel bad. What I really want is all you and your classmates to— but we don't have that many openings. You might, you might not realize, but no, we don't have that many openings. But it's not the market you think it is. You're lamenting a lack of practice management education. And in our world, we're going to give it to you. You don't need it. Get reps. Use your valuable school time to get reps. That'll help you faster in our system. Yeah.

Yeah. That's what I saw. A recent thing from the ADA where you're talking about how it's— the field's looking different recently, where in 2010 the average dentist was making $267,000 and now the average dentist is at $207,000. But you said recently that your average dentist is making $400,000. So how are you guys so much higher than everyone else? Is it just because you get everyone reps in?

We're now over 5— we're now over 5— we're now over $500,000. It's crazy. I think I read a similar article, and I know that average dentist income has decreased. And again, I'm not going to say bad things about the ADA. I'm a lifetime member. I'm still a member. I'm a lifetime member of the ADA, the CDA, the local societies, and all of that stuff. But their purpose is to promote the profession. I do not believe those figures. I would say the average is closer to 150, not 200. I hope I'm wrong. And how do we get there? Do more, do it faster. And in fact, let me—

Lower overhead.

Lower overhead. Lower overhead. Let me read something for you. I'm reading so I don't leave it out.

Yeah.

Years ago, we were trying to— I probably did this on Howard's podcast, so you may have heard this, but I don't remember. We were trying to figure out how to interview someone like you and figure out across the table if you were going to be successful or not. And to this day, we have no clue. Talking to you, I mean, I would predict you'd be an immense success, a million-dollar netter in our system because of what you're doing right now. That's what I would predict. But honestly, I have no clue. So we went to a business consultant expert in California that California has nothing to do with it. That's where we found and said, "We want you to evaluate these not." Not 500 docs like we have now, but maybe 200, because this was a number of years ago, in these categories and find out which of these categories makes them successful in our style of practice at Comfort Dental. Categories are— I call— we call them the Sensational 7. We use them to this day. Likability, simple enough. I don't need to explain that. It's important. All of these are important, by the way. But when I'm finished listing them, I'm going to give you the 2 that stand head and shoulders above all the rest, and going to shock you. Clinical speed efficiency. You know what that is? How fast can you do the crown? Can you do the endo? Can you do the implant in 45 minutes instead of 3 hours at 45 minutes? And when you get the reps of a comfort dental doc, you can. It's like I always tell John the John Elway story. He was our— he's our hero, the quarterback, the old Bronco quarterback. How many passes do you think he threw? You think that made him pretty good?

Yeah.

Okay, clinical speed and efficiency, clinical quality. It's important. Of course, you can't be remaking everything. Work ethic. Are you willing to work hard? Very simple. Organizational skills, kind of management skills. Leadership, character. Leadership, how good you do in front of other people. Character, I got them in the same category. Character, how good you do when nobody's watching. And the last one, and it's important, confrontational tolerance. This one's misunderstood. Makes people think that I want to fight with everybody about everything. Not at all. I just want to confront the issue, discuss it, and find a solution. Now, there were 7 of those. I'm not going to put you on the spot. They're all important. The 2 that stood head and shoulders in our system Likability is important. Wasn't it? Clinical speed? Yes. Clinical quality? Important? Not on the list. Work ethic? Yes.

Oh.

Clinical speed and work ethic are the 2 most important characteristics of the Sensational 7, even though they are all important. And if I did that in Howard's podcast, I love doing that. I probably did, but I apologize to you.

No, I love it hearing that. That's really interesting. Do you think that— because with work ethic, do you think that's innate, or do you think that you've seen dentists come in and they develop it? Because clinical speed is obviously something that develops, but do you think the work ethic part is more innate?

I agree with what you said. I never quite thought of it that way, and I think you can learn clinical efficiency, clinical speed. And work ethic is more inbred. I, I agree with the way you put that.

Yeah.

It just seems to be there or not be there. Uh, a lot of, a lot of young dentists these days with DSOs— and you don't have to be a practice manager in DSO, your original issue, your original issue, you don't. You got business suits that are doing that for you. You know how they sell the DSO? All you have to do is the dentistry. Boy, I would turn tail and run. I might run my ass out of there so fast. But that doesn't exist anymore. So anyway, where was I?

Yeah, yeah, that's— I was just asking about the, the two. And then I also had something about the confrontational tolerance. That's also something I feel like you have to build. I'm thinking right now, I'm definitely not good at that. So how would you recommend improving that skill?

I would disagree with you. You know who you're talking to? You're doing pretty good. Okay. Okay. I'm the biggest asshole in the profession and you're doing just great. All right. Can I use asshole on your podcast?

Sorry?

Can I use asshole on your podcast?

Yeah, of course. That's perfect. I was curious, so do you think that your system, or if you had to start over in 2026, do you think you could do it the same way or do it faster? do you think the landscape's just so different now?

Uh, I absolutely believe it's more appropriate today than it ever was. We have captured, and we're hanging on, and we will forever, the best of both worlds. Ownership. You're— you— we don't collect your collections. We don't tell you what supplies to buy. We get you a good deal on supplies, you know, in your lab. And I go through all the stuff we We save money. The savings, by the way, the DSOs and us, even though we're not a DSO, but we get those deals too, or better ones. It's unbelievable compared to being in private practice by yourself. So we, uh, where was I? What was the question?

Yeah, I was just saying, do you think that if you had to start over in 2026—

Oh, the best of both worlds. We're maintaining the private practice concept. They're all owner partners in their own practice. 99%. We have a few associates that we hope are working towards partnership. And then on the other side of it, the DSO advantage, the economies of scale. We got them both. Yeah, you have to buy in. You have to buy in. But you're going to average $500,000. We're approaching, in 175 offices, we're approaching $500 million in collect— half a billion dollars. And you know what? Dentists are the biggest jealous conspirators out there. You don't think— come for dental, they're a bunch of hacks. That's what dentists— Did you know, Jackson, that if I make more money than you, you're a better dentist than me? That's a law. That's what they think out there.

That's crazy.

Half a billion dollars and they think we remake it all. So that's the battle I fought for my entire career, and I'll continue to fight it. In fact, when they told me that'll never work, well, all they did was motivate me. Yeah. Yeah.

That's what I, I hear dentists make jokes like, if a dentist is faster than me, then they're unethical. If they're slower than me, then I'm better than them. And it is, it is crazy. I've seen some of the pessimistic dentists out there even just posting saying, you know, I'm trying to learn some, some of these things. And there's dentists in comments like, why are you focused on this right now? You know, get those crown preps faster. I'm like, well, I'm doing my crown preps in lab for a couple hours a day, and then I can come home and work on this too, I guess. But I guess not according to some of these guys.

But you're getting paid, right? Is this— is there income in this?

Well, not yet. I just started it.

Well, I mean, I worked, I worked 6 or 8 jobs through undergrad and they don't do that anymore. I did that and dental school and they were all, and you asked, well, was it innate or business sense? Well, I listened and I learned, but I also worked 6 or 8 different jobs. They were all businesses. Even if it's selling hardware or garden tractors at Sears, it's all business of some type. I did all that. So I just considered this was— you got a job.

Rick came from a very blue-collar background, which I think really promoted his success. He did not work. Your dad was— was he a shoe salesman? Was that what it was?

My dad was a shoe salesman. Started with nothing, ended with nothing. God love him. He's a wonderful guy. When he passed, I got a raise. Think about that. Yeah.

So how did that motivate you? And I've like, you from, uh, Colorado, right? And you've stayed there this whole time. So how is it like you decided you wanted to stay in your hometown or home state and not want to move somewhere else like LA or New York?

Uh, we now live in other places as well, but this is still home base and it was just home. It just seemed like I'm in Milwaukee, Wisconsin, which again, still many friends there for 4 years at Marquette. Loved it. Nice town. I wasn't going to open in Milwaukee, Wisconsin when I had, at that time, a lifetime, 2 and a half decades of family, friends, acquaintances that watched me play baseball and went to school with me and blah, blah, blah, blah. It just seemed crazy not to go. So I went to the next suburb over from where I went to high school. It was just seemed like the logical choice and it was a good choice. It wasn't a great location. It was not. The original solo practice was not a great location. Every one since is.

What made that one not a great location?

Uh, just kind of an office building with other, not dentists, but other businesses in it. No big signage out front, no big visibility. Visibility, including signage, traffic count, residential density. Those are things that make a comfort dental office work.

Yeah. And I'm sure you have people doing that now when you were building. So you're the pioneer of like the lean and mean strategy. Was your corporate side, were you building that the same way where you wanted just a few people that were really grinding, or did you maybe do that a different way?

You asked a different question and I'll give you the same answer for the different question. It was an evolution in every sense. It was an evolution in every sense. And I still, I'm still very involved in bookkeeping and very involved in site selection. And I communicate with new partners, but my, my junior part— junior, they're old men— but my, my minority partners are much more involved with the individual partner candidates than I am. But I'm available. I'm available if they want me. And in our organizational meetings, our recruitment meetings, you would call them, I talk for 10 or 15 minutes and say, I'm upstairs if you want me. And very few take advantage. Very few take advantage of that.

Wow.

I'm still involved. I'm lucky. I'm lucky to have an office here in our conference room right now in our corporate building to come back to from the resorts where I usually am. And get aggravated.

Yeah, I was gonna say, what motivates you to keep going now at this point? Do you just love doing it?

Yes, there, there's a lot of financial still going on, and it's all very, very, very good. I could take it with me, but then the way I answer that— we're straying here, uh, for the last 30 years I've been able to Take time off and play golf with my wife 3 days in a row. So what am I going to do if I retire? Play 4 days in a row with my wife? Now we can't even play 3 days in a row. Now we play 9 holes a couple times a week. So no, I'm thrilled to have it. I'm thrilled to have it.

That's awesome.

Business. My son is an MBA and he's our CFO, so he handles the money and development. There's another minority corporate owner who's a lawyer. We have an in-house full-time lawyer and 20 other lawyers. You can imagine, use your imagination on that stuff. Every, for example, every state regulation for a franchise is different. And we have to, we find something we're doing a little off-kilter, we got to fix it. Constant, constant, constant.

Yeah. For golf, sorry, sidetrack here. What's like your favorite course you played? I've been gotten really into golf the past couple years, so that's been my thing.

They're probably in Arizona. A good 10 or 15 of them in Arizona. We spent 30 years at a place called Desert Mountain. It's north Scottsdale. But you would probably call it Carefree or Cave Creek because it's real far north. And then Paradise Valley, there's 10 or 15 courses within 10 minutes. But we can't— we just physically, we aged out. You have a handicap?

Like at 24, but then dental school started. So now I'm back probably way up. I haven't been able to get down.

You visit me in Colorado. Or in Arizona, and I'll take Cindy and I'll take you out. We'll have a ball.

I would love that.

I was a 10. I'm 74 years old coming up. I was a 10 for like 25 years. Now I'm approaching 17. That's what happens. I can't, I can't see my golf ball, Jackson.

You'd still be giving me strokes.

I'm putting it. I can see it. That's about it.

There you go. Yeah, I started the golf club at the dental school last year. So we do a tournament with the students versus faculty and alumni. So it's the Floor Rider Cup, but the alumni were kicking our butts. They won it last year.

They should.

Yeah, they should.

That sounds like a good event.

Yeah, it's a good time.

Your relationship with the faculty is good?

Yeah, the faculty's been great here. A lot of them, some of them come in part-time, but I think the faculty here has been really good.

That wasn't historically. That wasn't always the case. That that culture has changed once again. We got to get that big tuition. Let's not blow them off. But and then again, does anybody have any concern that the profession will have lots of foreigners? We do comfort dental. We do. And they're wonderful, and maybe it's a good thing. But I don't know if you're, if you're from a, a third world, what we used to call a third world country. I don't know if we still do. Maybe living in the US with $400,000 in debt, but netting $100,000 after the debt. Maybe that's attractive. Maybe that works. And American men and women, not so much.

Yeah.

Well, I used to tell them another story. Uh, I told this lecturing around the country in the '80s. I said, what are you doing going to undergrad for 4 years and then dental school for 4 more years? 8 years you're earning nothing, and then you're going to graduate— and I used this number then— you're going to graduate and make $100 grand a year? I said, sell cars. Wow. You save the 8 years. They made $100 grand a year in the '80s and they didn't lose that 8 years. Now the car salesmen make more than the average dentist.

It's crazy.

Fact.

Yeah.

Drives me crazy. Not at Comfort Dental. Not at Comfort Dental. We're, we're cracking 500 av, and then we have to, we have to— somebody said, well, yeah, but what's the median? You know, that guy who said it'll never work. Well, what's the median? We actually compute the median. It's in the high 4s. So—

That's crazy. Has volume— like, are you able to negotiate rates a lot better too? That— is that another benefit of having a ton of practices?

And, and everything there is from real estate to dental supplies to lab. You mentioned lean and mean. Lean and mean allows your lab expense to be 10% of your gross collections. Salaries 20%, rent 5%, blah, blah. But specific to lab, it allows 10%. We have our own lab. Hello, labs that we have approved. Our overall system-wide lab expense is 5%. That's the kind of thing that can happen with an organization this size and this efficient. Now, when they miss, let me ask you a question. We have some influence over rent. We have Wonderful influence over supply costs. I told you about lab. Those are big ones. Marketing, we have influence. My office has influence over marketing. They all contribute to a huge marketing fund. Uh, if their overhead gets above 50% at Comfort Dental, which is wonderful in every other, every place else, and make me come back to the DSOs and how I predicted that would happen. But what— and I'll put you on the spot, Jackson— if their overhead creeps, Comfort Deli overhead creeps above 50%, what's the category that we don't have much any influence over that they're blowing?

Production?

The big one, salaries. Oh, they're paying too many and too much.

Oh, you guys don't have a say over the salaries at each location?

They hire their own, they fire their own, they pay their own along with everything else. There's a small royalty to my office. The rents come through us and we pay the rent or we own the building, some of them. But, uh, where was I? Where was I going, Mike, with the other—

You were talking about the—

when you say production, just, just in Comfort Dental, we calculate everything off collections because production is nothing. Nothing.

Okay.

That's practice management. Practice management is appointment control, control over overhead, control over collection policy. The policy is no statements being sent. None. Does it happen?

Yeah.

It does happen. So, oh, I know where I was going. And I'll let you go if you want to move on. Hopefully you have some homework to do. Uh, I predicted in the '80s, and it's on the record, believe me, with overheads in the '80s, in the 1980s, I predicted businessmen are going to look at this miserable operation practice management-wise and know instinctively that I can do it for 50 or 60% and have that 20 to 30% to the corporate office. And that's— and they did. And that's how the DSOs came to be. It's our fault. We were so horrible with our multi-hygienist practices, sending bazillions of statements and 80% overheads, that outside business people looked at us and said, they're idiots. We can do it better. And that's what happened. I think we ought to conclude on that.

Yeah, there we go. That's awesome.

I'm just too— I'm half serious. If you're good, I'm good. Okay.

Well, I just have one more thing I'll ask you about. So there was a dentist I've seen and he said that he started at Comfort Dental, I think, but now he just has his practice, but he still does the no hygiene model and everyone kind of called him crazy until COVID happened. All the hygienists started either dropping out or requesting these super high wages. And he had all these dentists every day saying, how do you practice with no hygiene? Like, so is that something that you've seen too, where dentists are starting to shift away from it in general?

Well, there is a hygienist shortage and we have very few. It's true that we have, I don't know, maybe 20 in the organization for years and years and years. I lectured on how to make money in hygiene, and it's a 2-chair, uh, 1 hygienist, 1 assistant model, and 2 patients per hour, not 1. And that's, that's profitable. Well, we can't find the 2 hygienists. I mean, we can't find the hygienists at all. We don't want to use up 2 chairs, uh, Again, show me a multi-hygienist office, I'll show you an 80% overhead. Now, incumbent in that, you need to be diagnosing perio. 2/3 of our patients need more than a simple prophy. If you got a hygienist to pay, all of those go into her chair. Usually it's a she, uh, because we got to keep that busy. That's a bad decision. But the doctor's doing the perio. And in Colorado, and now nearly every state. This has evolved over the years. This is where I said a while back, this is a touchy subject because it pissed people off and it'll make them mad at me and I'll have to fight with them. But almost every state now allows dental assistants or a certain level of a dental assistant to do a rubber cup. And that's important. Now, I don't want that individual doing the scale. I want the hygienist or the doctor doing that. But the rest of it, the floss and the oral hygiene instructions and the rubber cup, that can be done without a hygienist or certainly without a doctor. So yes, it's a factor. I'll tell you one more story. Maybe it'll be a final one. I did mention a consultant. I don't advocate this. I mentioned a consultant back when I was your age. I was doing pretty good going through the process that I told you about a half hour ago. A few years into practice, and I hired— it's called PBP back then. I don't know if it exists anymore. A 1-week, maybe 3 days. You could look that up. Consultant. Her name is Dolores Waliszczak. I remember her name. Wrote an article about her. Always tell the story when I think of it. She was wonderful. She was a middle-aged woman. I say older lady now. So if she's still with us, and I've looked her up and I can't find her because I'd love to speak with her. So if she's still with us, she's in her 90s. And she watches what I'm doing, some of the stuff I'm talking to you about. And she teaches me about appointment control and complete exam. And complete the treatment plan on every patient, and limit first visit starts, relieve pain and infection only, and back for a complete exam, and do the complete exam. And she saw how well I was doing in the sensational seven, how good I was at all seven of those things. And after three days or a week, however long she was there, he says, "You got all that? You got all that? You got all that?" I said, yeah, I do. She says, you're doing great at this and this and this and this. I'd like to see you doing more in this and this and this. And then she tells me, and I quote, and when you complete the treatment plan, you're not going to believe this, Jackson. And when you complete the treatment plan, hand the patient 3 business cards of other dentists in the area who can maintain it for you. She was serious. I never did that, but recall dentistry is high, high loss leader, high overhead dentistry. New patient dentistry, so she said, always emphasize. She sensed that I would always attract the new, and I did not need recall patients whose treatment was completed. I didn't need to do another filling every 3 years when I could do 8 fillings on every new patient right now. Yeah, I never did that and I don't advocate that, but I believe in the concept.

Yeah, that's really interesting. You would never think that, but—

You will never hear that anywhere else.

No.

All right, 80% overhead and they like their DSOs. Yeah, I'm being facetious.

Well, that's a— sorry, one more question. Do you— what do you think of, uh, yeah.

I'm just kidding.

I'm just kidding. The treatment coordinators, are you big on the doctor presenting the treatment, or do you guys have treatment coordinators come in and explain it?

I don't even know what the hell a treatment coordinator is. No, we want— now, if it's, if it's a prophy and 2 occlusal restorations, of course the dental assistant could do that. But if it's of any significance whatsoever, no, I want the doctor doing it. And it's of— if it's of any size, and, you know, in my day, maybe $1,200. Now it might be $3,200, whatever. I want it done in a setting away from the clinical setting. And it goes along with the initial interview, which we would like started in a private consultation room, not in the dental chair. That's all lean and mean stuff. And by the way, I told myself I was going to tell you this. It's not expensive. We have reconfigured, Dr. Bloss has reconfigured and updated all of that original stuff that is still appropriate and eliminated, you know, the new technology, which I've admitted, that's, that's his thing. That's not me. But that stuff is all available. I'll get you a link to that so you can go through all the Lean and Mean. I mean, it's, it's dozens of hours. Yeah. Yeah. But that's, those Lean and Mean basics are all available. And all of our— hopefully, hopefully we beg all of our docs to refer to that stuff. Yeah.

Awesome. Well, that'll be great. Thank you so much. And thank you again for coming on and taking some time to talk to me. I think that—

My pleasure. Come out and see us. You know how to reach me?

Yeah.

Yeah. You know, email stuff.

Yeah, I definitely will. I'd love to.

Where are you from?

I'm in Maryland. I'm from Maryland also.

Maryland. The closest we can get to you is Ohio, and that's far. Yeah, you'll probably stay in Maryland.

If you're ever in DC, I'm not sure if you'd ever be there before.

I've, I've been every— I've been in all 50 states many, many times.

Okay. All right.

I lectured in all of them.

Wow.

Thank you, buddy. Good luck to you. You're doing great. Proud of you.

Thank you so much. Have a good one.

Bye. My pleasure.