1654 Comfort Dental CEO Dr. Rick Kushner's Fantastic Five Keys to Great Practice Management

So this podcast is 7 years old and I've been trying to get my buddy Rick on for 8. And, uh, I want him on the show a year before I even knew I was gonna have a show. Uh, Rick, thank you. Thank you for finally coming on the show. Um, you're everyone— you're, you're, you're the biggest legend I know in practice management because while You have so many experts who talk a good game, and if they went in 100 different offices in 100 different cities, they give the same advice to 100 different people. And you have 100 different offices. You're the real deal. You are doing this all day. And the reason I—

I looked it up.

You looked what up?

150, excluding Washington, but I'll come back to that.

150 offices excluding Washington?

11 more in Washington, but I'll clear that up.

Yeah. And—

It's your show. I'll try to remember.

Oh, no, no. It's your show today. This is Dentistry Uncensored. Who's more uncensored in dentistry, you or me?

Did you know—

He evaded the answer.

If you make more money than me, I'm a better dentist.

If I make more money than you?

Yeah.

I'm a better dentist. Or if I make more money Than you, you're a better dentist. That's a law. Think about it. Why would he say that?

Because the—

The next dentist is going to criticize your work.

Yeah, yeah, yeah. Because you just become a big target. Yeah. And if you don't have—

For a lifetime, but it's all good.

And if you don't have 3 arrows in your back, you're not a pioneer. 3.

Yeah.

A lot of people say, oh, I'm a real pioneer. I'm like, really? Who's the biggest enemy in your life? Oh, you don't have one? Yeah, you're not a pioneer. Because if you're a pioneer, you're infringing on someone's territory, and they're gonna come back and fight. But here's, here's, um, I retired, uh, during the pandemic. I sold my practice. I, you know, I, um, I completely retired, but I'm coming back to this show every once in a while only for dentists who have a message for these young kids. Every email I get from a kid is the same sad email. I'm $300,000 to $500,000 in debt. I'm working for a DSO. I hate it. Um, they get a different job every year. I mean, if a dentist has been out of school 5 years, they've had 5 different jobs and they don't know what to do. And I say, well, have you ever thought about being an American and just open up your own business? And, and, um, I want you to talk to that person today. So you were the biggest legend in my practice, Dr. Angela, because when I opened up, I bought your Mean and Lean tapes. And, um, it was so amazing. I can remember I listened to them. It was 3, 6— it was 6 hours hygiene, overhead, and group. So 12 hours. And of course, I did it on one Sunday, 18 hours. And that was back when you had number 2 pencils.

Pretty good memory. I don't know if you had to look that up.

But no, no, and, and I had it, you know, back then it was number 2 pencil and a rainbow tablet, you know, no computer, no laptop, no smartphones. And, um, I probably wrote an inch of notes, and it was the only thing our team read and studied and, and focused. And all I— all we try to be is you. And I feel like I was, um, um, kind of like, um, everything I didn't agree with you on early on, 10 years later I thought he was right, he was right. And some of the things that took like 10 years, you actually made me feel really stupid. I'm like, why did it take 10 years?

10 years.

And one of the biggest threads on dentistry, if not the biggest thread, is Rick Kushner's group practice. It's 14 pages long. I think there's 700-some posts on your group practice deal. So I don't even know where to begin with you, but let's just begin. Let's begin with our focus. That kid, she's 30 years old, $500,000 student loans, working at half any of them, you know, And she's miserable.

Well, of course my answer is buy a Comfort Dental partnership, but we'll, I'm sure we'll get to that. But I have to, I kept telling myself on the way over here, it's Howard's show. It's Howard's show. It's Howard's show. It's not your show, Rick. It's Howard's show.

Not today.

Comfort Dental. It wasn't Comfort Dental. So I just want to do a little history because I have to credit you and I do it all the time and I've done it to you. And I do it all the time. Uh, we were lecturing together, I don't know, 35 years ago, we were lecturing together, or I think we might've been in my golden house. We were drinking beer after doing some work and just talking a little business. And I told you, uh, I had the first office and they sold through 4 partnerships, and then I sold out and just lectured. 1985, '87 through '89. And if I get some of these dates wrong, it's because I'm elderly. And then I thought, uh, and the, the doctors at the lectures were starting, I started to hear the murmurs. Well, you don't even practice anymore. You know, what the F could you know? You don't even practice anymore. So I thought, well, I'll go do it again. So went to a different suburb, didn't call it the same name, but it's an important point when I credit you for what, you know, I'm going to do. And I did it over again and sold for— through 4 partnerships. So that's, uh, from 1977, actually. So that's now a 10 to 11 year period. And I'm still lecturing, of course. And I'm starting to think. Maybe I don't have to be. Maybe these concepts are so sound and so good that just someone that accepts the concepts and are willing to work with them can do this, and I don't have to be a practicing partner. And we came up with the third name, that was Comfort Dental. Remember a little bit? This time I'm going to do it without being a practicing partner, just guide these guys. And that's of course, Dr. Norton and Dr. Blass. Norton just retired. Blass is still with me, still on my ownership management team. You want me to talk less and let you talk since it's your show?

No, no, not at all.

Just stop me if you have to. And it takes off just as good, maybe even a little better if I look up the old numbers than the ones I open without me being a practitioner. Now I'm thinking I got something. And I talked to you and I tell you that story. And I said, I think I can recruit 6 doctors because we always open with 2, only de novo starts, only scratch starts. And we always open with 2 so we can cover 66 hours. And I want to go find 3 more locations. And I think we should change the names of the original 2. We like Comfort Dental the best. It was Supreme Dental, it was Premier Dental, and then it was Comfort Dental. And of the 3, we like the name Comfort Dental the best and call the next 3 Comfort Dental as well. Now there'll be 6 and do the whole deal. And you said, uh, excuse me, just a minute. Sounds to me like you're describing a franchise. I'm just a dumb dentist who knows a lot about dental practice management. Oh, remind me to talk about Dolores Woloszczek because I was going to take credit for all these concepts. Dolores Woloszczek. Anyway, you said you better call a franchise attorney, and we did, and you were right. And we've been enfranchised ever since, thanks to you. Honestly, we'd have stumbled into it eventually, but you had it right away. We got it taken care of cheaply right away. What was the original question? I wanted— no, I wanted to credit you because I always do for that foundational support. Uh, if I'm allowed to talk to these young folks, of course we want them to buy a Comfort Dental Partnership because we believe we've captured the best of both worlds. The original ownership practicing, managing doc. You know how they sell the DSO? By the way, we love DSOs. I love DSOs. It's 2 great resources for us, and I'll come back to that, and I'm totally sincere. You know how they sell the DSO?

Minorities.

You don't have to do anything but the dentistry to attract them. We're trying to get them to manage dental practices, and they're being sold from the DSO that you don't have to do anything but the dentistry. We'll take care of everything else, which you and I both had You and I both had our days when we said, we've all said it because it's so difficult. If I could just do the dentistry, this profession would be fine. And then we moved on.

We figured it out.

So Comfort Dental, we want them to own and manage and still like the DSO, take advantage of the economies of scale, which I could talk about. By the way, uh, I was going to give you some statistics and I will. But it's—I'm making it my show, so I apologize. Oh no no!

I'm loving it. I'm loving it.

We're gonna crack.

Do you have headphones for her? You don't have an extra one. Here here, Cindy. You can come sit on.

Well, let me just let me just bring you up to date. Gross collections, total offices, and and I I've said this once already, so let me just. Clear this up, total honesty. Excluding Washington, 150. I'm excluding Washington. There are 11 Comfort Dental offices in Washington. Washington state franchise law is different than every other one, and they're on a licensing agreement. They pay a flat licensing fee every year. They're branded like Comfort Dental offices. They market like Comfort Dental offices. Their genesis is like a Comfort Dental office, but I cannot call them my franchise because they are not. They are under a licensing agreement. So I do not include the 11— and there's some good ones— the 11 Washington offices in these stats. Gross collections, $391 million in '23 in 150 offices. That's GP offices, 125 specialty offices, 25. And oh, by the way, just over half of those offices, 81 of them are in Colorado. That's a 9.2% increase over 2022. Of that 391 or so, 330 are GPs and the balance is specialty collections. Total DDSs, again not counting Washington, 475. Average income, we crack the $400,000 net income number for the first time in '23. We crack $400,000. Now, depending on who you read— I'm sorry, crack $400 million? $400,000 per doc net income.

Okay. Oh my gosh.

And we're just approaching $400 million in collections. I want to say that to these youngsters because, you know, I'd go back.

Okay. So let's stop right there. Yeah. I mean, you always tell me you're $300,000 to $500,000 in debt and then this is what they do. And I'm talking about just the ones I know. Totally. I'm talking about just the children of the dentists I know in this valley in Phoenix. Phoenix has 4 million people. Here's what they do. They'll sit there and all they do is whine about $300,000 to $500,000 student loans. So they go become an employee somewhere and they're miserable.

Correct.

But then they go buy a $300,000 to $500,000 home in Gilbert, and it's like, well, whoa, whoa, whoa, whoa, whoa, what? What? Why would you buy— and then they're driving a course, you know, they got a wife and they each have a $70,000 Toyota Tundra or something. And it's, um, and then they're miserable. And he just said his doctor's coming up on $400,000 net income. And you know what I tell all these kids? I know your dad. Your wife's pregnant. God, they would give anything if you moved in their basement. Go live in their basement for free and get a job and start paying off student loans and paying off debt money. But they they increase their personal consumption. They start getting married, dropping babies, buying houses and cars while they're an employee. And I I remember I had this problem in Ahwatukee. We're across from Guadalupe Indian Reservation. All these boys would come over and they'd have these hot little you know lowriders and And they'd want me to come out and see it. And I'd put my arm around him. I said, how much have you got into this car? And he's like, ah, $30 grand. I said, you're doing it to pick up the girls. And those girls, you know, when they say they want a boyfriend with benefits, they're talking dental benefits. They're not talking about a lowrider.

It's funny.

You could have spent $30,000, gone to DeVry Institute and gone from pushing a weed eater to working at Intel or Motorola.

Our partners pay it off early, but I could top your story and I hate to do— I apologize for that. I've said it for decades when it was $60,000 or $80,000 in debt, but now I'll update it. I used to tell them, and I'll just bring it to current numbers because I use the same numbers. Dental schools hate driving them $400,000 to $500,000 in debt too. They're at their wit's end as well. But I'll come back to that. But I used to tell the young dentists in my groups, And I'll just update it to today's numbers. If you're going to spend 8 years of your life post-high school getting this degree, driving yourself $500,000 in— let's do the numbers. For 8 years, you're going to earn nothing and you're going to drive yourself $500,000 in debt. You should have sold cars. Car salesmen have always been able to make $100 grand a year. Now they make $200 grand a year, actually, but we'll use $100 grand a year. So you didn't make $100 grand a year for 8 years. You drove yourself $500,000 in debt. That's $1.3 million you'll never catch. And you want to take a $100,000 job, $150,000 job. You never catch the car salesman. You should have sold cars. Maybe that makes sense. Or average. And somebody says, well, how about the median? The median is just around $400 grand too, by the way. A little more number-wise, I think the young people— some, there are some young Docs out there that like numbers.

I, I need you to go back and clear up one thing because I, I know my homie's head and she's sitting there thinking, I hate working for these DSOs, and you just said you love them. So that triggered her. So clear that up for her. Why do you love the, the person, the thing she's trying to— she's trying to get out of hell.

There's a couple— she's the reason. Uh, there's a couple of, uh, opportunities That we love through DSOs. I wish they would market and brand even more so they could introduce themselves to even more dental patients. Our mission is to treat the underserved. So if they attract— if they help us attract more patients, and some of them maybe can't afford the fees at the DSO and maybe can't afford The inconvenience of the hours. And we've got those other, those 2 things. So some of those patients will filter towards us, but we also get 8 to 10 dentist recruits per year from DSOs who want to make more money. Now, can the reverse happen? Sure, but not nearly as often. If we're getting a doc from a DSO, That's a doc that wants to earn more, wants to do better. If they get one from us, that's a doc that couldn't cut it at Comfort Dental.

You know, I like numbers too. We both love numbers. And I always think, uh, the, the 2 Ricks of dentistry are Kushner and Workman. I mean, I love both.

He's a good old friend of mine too, like you.

Good man. And so many— he's got, he's got as many arrows in his back as you do. And, um, He, um, I think he's number one because his average DSO— because I think his average doctor stays with him over 2 years, and the average DSO, I think it's less than one. Um, do you— have you seen that? I mean, is that a— I mean, they don't—

Wow, I, I, I didn't think it was that bad.

Yeah.

Uh, we can't get him to retire. Gold Rolex, you know that story? As an aside, and I'm joking, but 30 years ago I had 12 partners, 15 partners, and I had to open my big mouth and say, if you make 10 years, I'll buy you the stainless Rolex. And oh, by the way, if you make 25 years, thinking I'm now spending— I'll buy you the gold one. I'm now spending between $300,000 and $400,000 a year on Rolexes. They'll get to 22, 23 years and they'll stick around till they get to 25 gold. And we joke about it, but we love it.

Um, you also said something I want to come back to, um, that you, you focused on, you know, on the underserved. And I think of all the DSOs, I think Aspen focuses on the underserved. I think the rest of them are all going after the same suburban market, $60,000 median household income. They have dental insurance, you know, the suburban market. They're not— no one's in the rural because they can't get a young graduate to go sit in Eloy, Arizona, because the young graduate is prime mating time. And if there's 4 million people in the Phoenix Valley, that's where you're probably gonna find—

Let me jump all over that. Not again, not to top you. You mentioned those 2 COVID months. I'm going to sound like I'm promoting Medicaid. I didn't know Aspen would be considered— I don't know. I didn't know Aspen takes Medicaid. I don't think so, but I don't know. So I apologize. Those 2 months that you're talking about in Medicaid or in COVID, we went to half. And then we went in the next month, we went to—

Half.

100%. And then we increased 8%, 10%, like I just told you, per year. How did we do that? People fell into Medicaid during COVID that didn't used to have it. Most— we don't mandate it. I can't mandate it. Most of our docs take Medicaid. During COVID hundreds of thousands of people that had no insurance at all Fell into Medicaid, we got busier. I'm not trying to sell the rest of dental work because they can't manage 2 or 50%. By the way, our overheads averaged 45% in '23. Uh, average 45%. That's how we can make Medicaid work. While we're on the Medicaid subject, it just You kind of led me there with serving the underserved. Again, I don't mandate that we take— they just— our overheads are 45%. We make it work. We make it work. We just in Ohio, and I met with the governor in Colorado personally, they had some money. What can we do for Medicaid? What can we do for you and Medicaid? Because we're about it in Colorado. And I said, well, we'd love bigger fees, but honestly, We'd love a bigger limit. We just do more dentistry for these folks. Went from $1,000 to $1,500. The fees essentially stayed the same.

You got that through the governor?

And we got that through. So we're busier than ever. Again, I sound like I'm promoting Medicaid and I don't think dentists should.

Well, you can promote it. Can I show you my favorite slide I stole from you and I've used? I haven't used it a lot just to—

You have my permission.

I haven't used it every lecture, just Every lecture, every lecture since day one. I think this slide was in my first lecture. He's got this—

It's absolutely from Lean and Mean Practice Management.

So 4 doctors are making $25,000 a year. One has 80% overhead, so he has to do $125,000 in fillings. One has 65% overhead, so she's got to do $71,500 dentistry. One's got 50% overhead, so obviously she just has to do 50 to make 25. And the lowest one is 40% overhead. So they got to do $41,000. Rick, I think the average overhead when I got out of school was 65%, and it's just been drifting up ever since. I mean, these docs, and when they tell you their overhead, I mean, when you go and actually look at the numbers, it's even worse than what they tell you.

Well, at the DSOs, of course, they don't even know. But let me come back to that. Let me jump on you. Let me jump on you again. We caused DSOs. I guess they're public enemy number one. Not to us. We love it. Introducing ourselves to more folks. Do more marketing. Do more branding. But we caused it. Not me, but the profession. Business people looked at us 20, 30 years ago. I warned them 20, 30, 35 years ago. They looked at us, our hygiene-heavy practices with 80% overheads, and they said, these guys are morons. They're willing to work for 20% from my slide. Let's let them work for 20%. We can do it for 20 or 30% less overhead, keep the difference, do the management, and let them continue to work for their 20% if they're so stupid. And you know what? They were right. And they did it. Back to Medicaid. I think I should make the point in my attempt to sell the world on Medicaid, and that's not at all what I want to do. In Colorado, a family of 4 that earns $90,000 a year— that's real money— they qualify for Medicaid. $90,000 a year. And maybe they'll lose their Medicaid and get a different job. They're still our patients. Maybe their family and their neighbors don't have Medicaid, have something else. Maybe they'll refer them. They're still our patients.

Just one insert to our international viewers. Um, Medicare is our federal government insurance for all the elderly people. Medicaid is different in all 50 states and it's for the poor. So he's talking about a state-sponsored insurance program for the less advantaged.

That's correct. And the fee structure is so low that the DSOs— I'm gonna say certainly most— and nearly all other privately practicing dentists, they simply cannot Except these patients. I get that. I get that. Back to dental students. Not only are they driven $400,000 to $500,000 in debt, they're graduating without having done endos and extractions while in dental school because dental schools have their backs against the wall. They can't charge dental students more. They have to take their residents. And they're foreign-trained docs, and they take those specialty services from the undergrads. Now, this is okay with us at Comfort Dental. We'll mentor them and we'll, we'll teach them. I tell them, don't worry about it. If you're willing, in 2 weeks at a Comfort Dental office, you'll get an entire dental school education. Worth of reps. We'll teach you your endos. We'll teach you your extractions. There'll be a mentor at your side in your Comfort Dental office. But if they're unwilling, no, I don't do endos, I don't do extractions, that dentist is in trouble no matter where he or she goes. I need to mention new patient numbers, uh, 220,000 last year. In the 150 Comfort Dental offices, 220,000 new patients. Our annual marketing budget for these 150 offices is $5 million. That's nothing. That's 1.3% of overhead. We marketed for 220,000 new patients for $5 million. That's 1.3% of our overhead. We have our own lab. I mentioned economies of scale. Our doctors use our own lab. The lab last year collected $22, just over $22 million. That's an 8.5% increase over the previous year. And that's 5.9% of overhead. I tell, I tell you this because you kept some of these old slides. Our lab percentage of overhead, 5.9%. In old lean and mean practice management, I allowed 10, if you remember. We're at 5.9 with our own lab. So these are some of the economies of scale. I'm embarrassed to tell you the discounts we get on dental supplies. Our deals that our office does for the docs, and they comply with a vendor list. It's extensive, but the deals are embarrassing. Our requirement Is that it's win-win. We need to get a little piece of it, a rebate. My office, my office, a little rebate, little reimbursement, but the doctors have to get a better deal than they could get on their own. Win-win. The lab is that way. Everything we buy is that way. Real estate is that way. These are the things that we provide for the franchisees, but they collect from their own patients. They file their own claims. They do all of that. We don't touch them. We don't teach them clinical dentistry from my office. Their partners do. Remember, we open with 2 docs, go to 4, 5, 6. They mentor them. Uh, I can go further and ramble on and on and on, but it's your show.

Okay, well, I want to stop you in the fact that whenever I talk to docs about overhead, um, they're Yeah. Lab and supplies can be a problem, but it's labor that's a nightmare. I mean, I mean, you routinely see labor at 30%. Now, Rick, how can you have 50% overhead if you have 30% labor?

You can't. And you are correct. And it's tough for us right now. It's tough. We're going to get through this, of course, but it is tough. And our goal has always been 20% and we're, we're not, We're 22, 23%. Okay, then still staying at the 45% level because of all this other stuff.

But tell me what that number includes. Is that FICA match, insurance, uniforms?

Not uniforms, not uniforms. That would be under supplies.

Would that be FICA matching, health insurance, any benefits?

And we struggle, we struggle. How intimate do you want me to get? My office supports and provides all the other overhead categories from rent to lab to supplies to marketing, blah, blah, blah, blah, blah, blah, blah, except salaries. And that's the one they miss on. They handle that entirely themselves. And I'm sympathetic, especially right now. It's tough, but that's cyclic. We're going to get through that.

So labor has gone up because of the pandemic and the—

of course, I understand all that. Labor shortages. I understand all that.

How high has some of your laborers got? I mean, what would you say the average labor was before pandemic? What do you think it is now?

Oh, it's been 17, 18, 19, and it's probably mid to low 20s in several instances right now. But—

Mid to low— what's mid to low 20s?

22, 23, 24%. Yeah, that's where they're missing.

And it used to be 17, 18, 19?

Yes. Yeah, I'm guessing. I don't see all of that every week, every month. I do not. Yeah, they'll give us their total monthly nets and we'll know what their overall is, but they— I won't see a breakdown.

Back to marketing. Um, my gosh, there are— most dentists think, you know, my overhead would be perfect if I got 10 more new patients a month. I've already paid the rent, mortgage, equipment build-out, computer, insurance, malpractice. I paid everything and I got 3 more days of the month and my schedule is empty. If, you know, they, they always think if they got 10 more new patients, they, they could significantly Because it's nothing within that after you're in the profit zone. So what works for marketing? What does not work for marketing?

Boy, you must be reading my notes. Well, we like to talk about a thing called the Fantastic 5 because it's social media. We've, we had a commercial on an NFL football game, but let me talk about the Fantastic 5. You'll get your 10 more new patients if you just do it. Then we work with our own doctors on these things. I want you to do it. There's 5 of them now. I want you doing a short 2, 3, 4-minute initial interview with every new patient away from clinical. How long has it been since you saw the dentist? What drove you in here? You having any pain? You satisfied with your smile? Do your gums give you any trouble? Are you missing any teeth? If so, were they replaced? If not, why not? How'd you lose those teeth? Take some hand notes. You could do it on a pad. They can do it on a pad and pay attention. Doctor number 2, doctor-driven financial arrangements. Doctors talk money. Doctors talk money. Comfort dental doctors talk money. We don't turn our multimillion-dollar businesses over to the high school graduate up front If you're lucky, she's a high school graduate these days. We're not even sure anymore. You already talked about staff issues. Our doctors do the financial arrangements. Third one on this list is a handwritten thank you or welcome note after— handwritten, signed by the doctor, handwritten. We have, we have data, we have computers, we understand all that, but it has always stood out And it always will. And I send a handwritten welcome thank you note to every potential Comfort Dental doctor recruit. And I do 5 or 10 a day to this day. Here's a tough one, and then I'll get to the best one. Patient exit interview. Patient wants records transferred, wants to leave the practice. Contact the patient, ask if they'll drop by. And chat for 5 or 10 minutes. So you can ask, what did I do wrong to make you want to leave my practice? The best case scenario typically is you'll get a phone call. You might get to talk to them on the phone. Maybe you'll get to text them. Patient exit interview. And here's the one that's so mandatory. A post-op care call or text, these days text, but a phone call is even better. And my criterion was always if you got an injection and even if it was occlusal restoration back in the day, You know, occlusal amalgams, you go back to amalgams. You got to make a post-op care call. Now, none of that costs any real hardcore marketing dollars. None of it. Just about a commitment. And woven throughout all of that now is a clinical exam talkover technique, and all roads in the appointment flowchart at Comfort Dental point Point to the initial complete exam, not hygiene. Remind me to tell the Dolores Woloszek story. So woven through all of that is a clinical exam talkover technique, talking across the patient who's listening to your assistant who's charting using terminology that the patient can understand. Decay instead of caries, that type of thing. Missing tooth number X, never replaced. Bleeding points, not hemorrhage, bleeding point terminology that the patient got to present this. I've gotten through so many thousands of these. And then I sit the patient up and say, we're developing the x-rays. Do you have any questions about what we've recommended so far? I haven't recommended a thing so far. And they say, no, I'm ready to go.

The American Endodontic Association is trying to change root canal to endodontic therapy.

And again, woven through is the nonclinical diagnosis or CP. Nonclinical, nonclinical. Just don't be technical. I gotta talk about hygiene. Okay. So we can turn off some more young people when they realize how old we are. I opened a traditional dental practice in 1977, solo practice, and I was doing really well. I got busy really fast and the patients liked me. And I was getting into these things like the Fantastic 5 that I just Delineated for you. And I wanted to know more. And I went to the lunch meetings with the dentists in the neighborhood, and they weren't doing as well as I was, and they had been there 10, 15, 20 years. So there were no resources there. I hadn't gotten into attending lectures that early. And again, it's 1978. I've been there a year. There's a company I believe called Psychom, and it used to be called PBP, and both names have disappeared. I can't find them. But I paid $4,500 for a week of a consultant to come in and teach me practice management in about 1978. And I take credit for like the Fantastic Five. I take credit for that. I can't because Dolores Waliszek, where are you? She would be if she's with us. I have looked for her. She'd be in her 90s. I would love to talk with her again and see if she can remember who I was and what we have become with the foundation that she laid for me in about 1978. So she went through all these things and she taught me about initial interview and she taught me about complete examination and she taught me Taught me about resisting first visit hygiene. The prophy ought to come dead last in the treatment plan, not first. And I know how tough it is. Oh, I just want a cleaning, doc. Oh, well, I just want to examine all your teeth. I'll do it for free if I need to, but I stray. So we spend a week doing all of this and she's recapping. And again, a lot of the Fantastic 5 and some of these things that I've been talking about. And she says, and when you've done your financial arrangements yourself, and when you've scheduled it out, 3 or 4 visits for $1,800, and it's paid for, and you did your prophy on the final visit along with the restorative that you were going to do on that visit, hand the patient the business cards of 3 good dentists in the neighborhood who can maintain this for them forever. Did you hear that? Did you hear what she said? I said, excuse me? She said, when you complete it, give them the business cards of 3 good dentists in the neighborhood who will maintain the treatment plan that you just completed Every 6 months with their pro fee. Now, she sensed that I was going to be a new patient magnet forever. And she didn't want me having that recall over. She said recall dentists are jumps. Her words, not mine.

Now, jumps?

Chumps.

Oh, chumps.

She said it, not me. I never did that. We do recall to this day, but she made the point, always stress the new. The low overhead is in the new, not in the recall.

I used to go to— did I interrupt? I don't want to interrupt.

No, no, that's the Dolores Walachek story. And I never did that, but I heard it. I heard it and I thought it through. And of course I never did that. And I don't know if her tongue was in her cheek or not, but she was not laughing. Recall dentists are chumps.

I remember me and my team and Lori and all that going down to Delta Dental of Arizona and showing them our overhead and telling them that you basically pay us just enough money to barely do the cleaning, exam, x-ray, and a filling. I don't need $1,000 to pull 4 wisdom teeth. I don't need $1,000 for a crown and a denture and a part. I said, you'd overpay me on all the big stuff. And then when I went to MBA school, there was 4 or 5 guys from hospitals in there. And he said, my God, we lose money on every procedure we do. So we have to do a $100,000 CABG, coronary artery bypass graft, 3 times a day. And then our hospital's in, in, in the pink or in the profit zone. And he goes, you know, a hip is $70,000 and an knee's $70,000. And We'll have to do 4 70s, but $300,000. And I said, that's dentistry. And I used to tell Ed, I said, Ed, I mean, when you pay your hygienist $40 an hour, you can't pay me $40 for a cleaning.

Well, but those back in the day, we get the point. No, we couldn't agree more.

I said, right. And then the hygienist, I always tell the Hygiene Association every time I have a lecture for them, your main deal should be going to all these insurance companies and saying, why does an endodontist You have $1,500 for a molar root canal. He's in there for an hour. I'm in there an hour and I don't even get— I get paid more per hour than my prophy fee. You know, that's, that's, uh, incentives matter.

Absolutely. No, no, couldn't agree more.

Uh, and I also want to say one thing about his Fabulous Five. Um, he says that when the patient gets there, he needs to meet the doctor first. I mean, that's actually the law. Um, you know, you can't set him in a hygiene room when she takes bite wings. That's, that's against the law. And I had this thrown in my face. I took one of my babies to the, um, emergency room because he was freaking out and he had some bump there and he thought it was cancer and all that. And I kept telling him, finally I just said, I'll take you to the ER right now. It's nothing. It's a little fat lipocell, whatever, whatever. So I took him in there, I'm filling out the paperwork, they bring him back and everything. By the time I get back there, that lady went and took a CAT scan on his lower ab. Well, he's a boy and he's got testicles down there. down there. And that's— and, and then when the doctor came in and said, that's a liposil, just like I said, and you took a CAT scan that included his testicles, and you— oh, I thought you wanted a CAT scan, or all these, all these things like that.

Start with the doctor.

And it's like, that was— I, I told that guy, I said, this would be a guaranteed lawsuit, a guaranteed board thing. I'm not going to do it because I'm a dentist. I know dentists do it routinely, but it's that first impression set in lead. You never get a second chance. And when— and You taught me that, where when they come in there, you meet the doctor first. Not in the operatory when they're upside down staring at you. You got to walk in there, touch the flesh, you know, how are you doing? Sorry about the Broncos this year. Maybe next year they'll make the playoffs. You know, think of something personal in their life or whatever. And, and then I gave them my card because of you that had my, um, my office number and my— my— back then it was a Motorola pager. Here's my Motorola pager.

Here's my page number.

Yes, I have erectile dysfunction. If I— if you owned a— if you owned a Motorola pager, in your life. You, you probably are bald, have ED, and all kinds of things. But, um, but yeah, um, and I would say, look, if you go— if, if I do something to upset you and you don't come back, well, if you don't tell me, you're harming the community. I said, if, if I see— if I do 100 fillings and no one, no one says anything's wrong, I think I'm the best filling doctor in the world. I need you to come back and say— I never— because they come into me and they'd say, um, And I'd always ask them, 'cause you— well, why did you leave your last dentist? Did you just move to Phoenix? They go, oh no, I've lived in Phoenix 10 years. Oh, you haven't been to the dentist 10 years? No, I've been to a couple dentists. Why did you not go back there? And she goes, well, you know, he did this filling, uh, it doesn't feel right and I haven't been able to eat on it. And then 6 months later they sent me a card for a recall. Like, are you kidding me? I went in there one time and I still can't eat on my tooth. I said, well, when you told the doctor, what did he say? She goes, I never told him nothing. I never went back. And I'm like, oh, Oh my God. So that's why you got to be calling these people and calling them after nights. I just had a surgery. I had a, uh, hernia. Um, quit doing squats. That's all I can say is when you, when you get in that squat rack and go down one of those times, you're gonna—

I still do them.

Oh my God, I felt like I was shot. And anyway, I had a hernia repair and nobody— I said, I'm, you know, no, no big deal, I had a hernia repair. But, um, that night I was wondering a couple of things, but I, I never saw He never called that night, or no contact. Yeah. And, um, and, and it's so funny how people, um— I, I had a lady the other day, just a neighbor, and she had a surgery. And I said, well, how'd it go? And she goes, oh, my doctor was so sweet. You know what he did? And she's like 800 years old, she can barely stand up. And she goes, he came by with a rose and gave me a kiss in the hospital that night. I thought, he's a millionaire. I know he's a millionaire. Yep. Um, they don't remember what you did, but they just remember how you feel.

Yeah. I don't know.

I don't know how good you were.

Um, I wasn't a very good dentist. I mean, within the standard of care, of course. And I want to talk about that, by the way, but they love me. Didn't know my filling maybe wasn't perfect, but it was within the standard of care. And if it wasn't, I did it over. And if I couldn't, I gave the money back. Let's talk about—

Let's talk about that. Cause I read that Walmart, Refunds one per— if you go buy a tent, take it out camping for 3 days, and bring it back with dirt and mud and all over it and say it's a tear, that, that no questions asked, they just have a return policy.

Um, I agree.

I think one of the reasons I was never sued is if you came in and said, I hate this denture, I give them their money back. And then, and a couple of times I would have the dad, her husband, come in and said, I really Like the way you handled that. That was, you know, and it's like, you know, just redo it.

And, uh, it should go without saying.

I gotta ask you a question on, um, I got— I have to, um, you have the largest thread on dentistry, Rick Kushner's group practice, and they had— and it's 17 pages long, and a lot of the questions are, um, on your overhead equipment, lasers, CAD/CAMs, all these Any, any of these items over $50 grand, what, what is a return on investment and what do you think is a toy?

I don't buy a laser in their buy-in. Uh, they've added panos in, in the latest technology in recent years. Their buy-in is around $300,000 per partner or $600,000 For the new office. They're all scratch starts. It includes 4 treatment rooms and panoramics and all the front office technology. But I'm not, I'm not a technologist. I'll just plead dumb. We have people for that, but I'm not, I'm not it.

And then here's another thing. Um, I know, um, you've triggered them when you talk about Medicare because they think, well, the Medicare fees How the hell could you make money on Medicare? And this was a big issue. This was with a big wow on my head. We would always talk about in school and all the lectures and talk about like fees. And Rick's the one who said, well, it's not the fees, it's the time. And what he would do— and I, and I've seen you do this back in the day where you present the whole treatment plan and, and you can do the whole treatment plan an hour or two. Well, if you do If you do $300, $400, $500 an hour, who cares if you're getting $1 for a filling? If you do the whole case and you— when they would say, well, my DSO or my PPO, I just want to come in here and get the free cleaning. And you'd say, well, that's not how it works. So, you know, this is your insurance and here's your whole case and it'll include— is that true?

I would probably say something like, If your exam and your radiographs aren't included and you're worried about how much that'll cost, just so I can convey to you the things that we see for down the line, I'll do that for free and we'll clean your teeth. And I'll note on the chart that you refused everything else, but I, I just need you informed and I need it on the chart. What we think you need. But you lead me to overtreatment, and I don't want to convey that at all. There's plenty—

No, no overtreatment.

I know, I know. But when I say complete case, well, I never did an implant. Of course, I'm too old and past that, but they do tons of them. I mean, they do good stuff, high-caliber, high-cost stuff. But when I talk about complete treatment plan, I don't want to convey to these young docs out there that these are big extravagant treatment plans. They are not. They are not. Overtreatment is a huge problem in the profession. A huge— ask the doctor, our buddy that we chatted with before the—

Yeah.

Also, as part of that, uh, very non-clinical presentation, I just quote a total fee or 3 visits, it's $650 a visit. I'll offer no breakdown whatsoever unless I have to.

You know, the late Omar Reed, who, um, I always think when I hear the pandemic, that was the first, um—

Oh, really?

Casualty of the pandemic is I had to miss his funeral. I was so scared and I, I didn't know what to do. I mean, he's my buddy and people were flying in from all over the world and I'm like, people are flying. I mean, all these days I'm coming from England and Canada. I mean, they were coming from everywhere and I thought, That's probably not a good place to be during a pandemic. Yeah, I think I think I'm gonna have to set this one out. But he was the one who taught me present a case fee. Do not sit there and and say well to number one, to number two, to number three, to all a shopping list that they can take to dentist down the street.

Say we'll go the whole maybe I learned it from him grand. Maybe I learned it from him.

I want to say Dolores Walacek, but yeah, but but I'm but I'm no I'm I'm just saying that um two legends um you and him. Omer, Rick and Omer both.

Um, thank you for mentioning, you remember Earl Estep?

Absolutely.

That was a practical— I'm sorry.

He just passed away.

Oh, I didn't know that either.

Yeah.

And, uh, but that was a practical guy. That was— he taught us a lot.

Boy from Texas.

But back, yeah, but back in that, in the day, I heard too much of keep your fees up there, keep your fees up there, keep your fees up there. And I'm thinking there's too many patients that I'm missing out on because they can't afford it.

And here's the other thing, um, not to throw anybody under a bus, but I remember when I got out of school, it was very unsettling to me when I did go to these very high-end institutes and they would lecture about the A patient, B patient, C patient, D patient, how you just want A patients. And I'm like, okay, my entire family tree, according to your definition—

Are D patients.

Is D patients. Yeah. I mean, my mom and her 3 brothers didn't have one tooth when they got out of high school. I mean, they graduated from high school edentulous. And, and, and, and I thought to myself, well, would you rather own McDonald's or Ruth's Chris Steakhouse?

McDonald's.

Yeah. I mean, why do—

Well, thank you. Thank you for that. I mean, we, all these years together and not together and together, not together. I used to say it. I heard them talking about the right kind of patient and the wrong kind of patient. And I just wanted to slap the shit out of them. There is no such thing. Wrong kind of patient. What is that? Can't get it done? Maybe next year. Maybe next year. Again, we wanted to reach some of those younger dentists. And I, of course, want them to call us and ask about opportunities.

Where would they call? And I have no money from this. I'm not on a commission. Well, if you do get a partnership out of this, I at least get one.

But I get my $500,000 fee for this, right? The website, comfortdental.com.

Comfortdental.com.

Yeah, it's— we're easy to find.

I'm starting to see the DSO split just like McDonald's and Chick-fil-A versus Burger King and Subway on one deal. Nobody thought McDonald's $3 million average restaurant revenue would be surpassed by Chick-fil-A when they only got 1/10 the stores and they're closed on Sunday. And what is the answer why? Is because Ray Kroc knew— watch his show, The Founder. Um, he wanted each one of the franchisees to be married, kids, um, go to Sunday church, whatever, and give them one location in one town. And this is the only way they're going to feed their family. So they will give this location everything they've got and their stores were the best. And, um, Chick-fil-A said, not only are we going to do that, we want you to go to church on Sunday, but we're going to close down on Sunday because we think the Sabbath is that important. And then Burger King, you know, you come out of the NBA, you graduate from, um, um, the NFL or the NBA, and you say, you know, I'm gonna buy me a dozen Burger Kings or a dozen Subways, and, and they sell them to them, and they never run one of them. They never own any of them. And the same thing with office managers. Whenever I hear an office manager nightmare, I'm like, now who's your office manager, and does she only run your office? No, she runs 4 offices in Toledo. And I'm like, yeah, well, there's— you're, you're already Subway. And if you look at Subway, they've had more franchise lawsuits against the franchisee. All they do is stay in court all the time, and it's a shit show. And, um, you know, when you own your own office and everybody works in that office, you, you, you're gonna make it in this office. But, you know, if you're spread out and if you don't have any skin in the game, you know, when you're an employee, you don't have any skin in the game. Sometimes these dentists, um, they get upset and they just walk out, you know what I mean? And, and plus, uh, but anyway, um, so owner-operator seems to be the family business, family practice, family business, the family farm seems to be the bedrock of economic history.

Well, again, it's the closest thing to solo practice with all the advantages of a DSO. That's what we try to do. People, others have tried it. It's, it's never worked. It will never happen again. Comfort Dental will never happen again because nobody else will take the 45 years that it took. They want to do it next year. Nobody else will do that. I will do that without quitting. One more story and I'll get out of your hair. Oh, no pun intended.

Hey, I got hair. I got nose hair.

You got a lot down here. Uh, years ago, I want to say 20 years ago, uh, we had maybe 1/3 to 1/5 of the doctors that we have today. So let's say we had 100 to 150 doctors. And we hired an industrial psychology team from California. I can't remember who they are. And we wanted help understanding the characteristics that made some partners— Comfort Dental partners now. This is Comfort Dental stuff. I'm not saying this applies to everyone. I think it probably does, but this is my area of expertise. We wanted to find And we came up with 7 of them. We wanted to find the characteristics that made them successful, some more than others, so we could replicate the more successful ones and maybe not so much with the less successful ones. Because I can sit across the desk to this day with a young doc, maybe a fresh graduate, maybe even a little, a little more experienced. And when you see this list, when you hear this list, And I can't tell you which ones will be the big earners and which ones will be the low earners to this day until we observe them work for a period of time, and then we can. Now, it's— I call this the Sensational 7. It's old business, but it's still true to this day. And these are the 7 characteristics that My team, my ownership team came up with 20 or 25 years ago. And then this psychological testing service in California helped us organize the data to determine which were the important characteristics. In no particular— now they're all important. They're all important. In no particular order. These are the Sensational 7. Likability, no need for an explanation there. Clinical speed or efficiency, no need for an explanation there. Again, I'm listing it third, but in no particular order. Clinical quality. Next, work ethic. Next, organizational skills. Uh, That's self-explanatory. I became multitasking and, you know, organizing the operation of things. Next, this is listed 6th in my, in this, this handwritten list, leadership, character. Leadership's doing the right thing when other people's, other people are watching and character's doing the right thing when nobody's watching. And last, I'd listed it last, confrontational tolerance. Now that is misunderstood, and I do want to make a few comments about that. That implies to some that the doctor's willing to go fight over every little issue. That's not at all it. He's just willing to discuss tough issues instead of hand it over to the high school graduate up front. If you're lucky, she's a high school graduate up front so that I could just do the dentistry. No. Confrontation of tolerance. Okay. That's 7 of them. So We scored our 100 or 150 partners, however many, on a scale of 1 to 5 on each of those. And we discovered with the help of this company that they're all important. They're all important. Clinical quality is important. I don't mean to say it's not. There are 2 that are head and shoulders above all the rest. Clinical quality, just remember that standard of care. I mean, it— You know, it's a range. It's not just a point. Get it in there somewhere. That's, that's fine. The 2 that stood out and do to this day, head and shoulders for success at Comfort Dental. I'm not— I think that applies everywhere, but I'm only talking about Comfort Dental, are clinical speed efficiency. And, and this is the big one. Work ethic. The others are important, but not near as important as those 2. And we still to this day cannot sit and have a meeting and know that. They could be wonderful. They could be fantastic dentists. They could be immensely likable. If they don't have a work ethic, it's not going to work here.

Yeah. I say, um, You talk about your early mentors. The first— my mentor out here in Phoenix was Ed Silker. Do you remember Ed Silker?

I don't.

He had 4 Sunshine Dental offices, and I knew no one would hire me because I was opening up my own office here in the most southern part of Phoenix called Ahwatukee. And he said, I don't care, I don't care if you practice across the street from me, I'll hire you. And he, um, his— it was open 7 to 7, and he let me work 7 to 7, 7 days a week. That was his hours. And, um, then my office opened. I, I ran my office and then I'd leave my office to go back to him. I did my dental school requirements every week at his. It was like 54 fillings, 15 extractions, 5 endos.

Exactly.

Implants and dentures. I was like, like getting another UMKC dental degree. And by the way, I'm embarrassed to say UMKC dental because you went to Marquette and this guy gave them a million bucks. He rebuilt their whole damn deal. And, uh, you, uh, uh, I, I'd never forget that. Every time I see those millions, I just think, well, my mentor, Rick Kushner, he gave Mark a million. That was so damn cool. And, um, but, um, but yeah, the work ethic thing is amazing. Like I had, like after the pandemic, um, I can name, oh, 4 dentists in this town that were whining to me in person that, well, I didn't even get to do a pulpotomy or a chrome silver crown. I said, oh my God, you're so lucky. You just ran into me. Because I know a Medicare pedo clinic in South Phoenix where all the poor people live, and another one on the west side, and they'll hire you. This is the day rate. And they go, I'm not gonna go do pulpotomies all day for $250 a day or something like that. I mean, oh well, the— how much did the dental school pay you a day to go there? And weren't you just bitching about $500,000 of student loans at 18 still, and you never did one pulpotomy? And now when you have— and I looked at, uh, several there was these PPO fees and some of the other— or HMO fees. And some of the other dentists said Sunshine wouldn't see those patients. And I said, well, I'll see every patient. Number one, that kid needs a dentist. I need the experience. I mean, and I, you know, it's just not afraid of work. And the only successful farmers are the ones that sunup to sundown, they're just walking around fixing shit on their farm 24 hours a day, 7 days a week. It's that work ethic. Some people like to work and some don't.

Well, that's a very, very good list. They're all important. Uh, but you can be mediocre in the other 5. If you're strong, you'll be in the top 10% at Comfort Dental.

And I want, and I want to say something about your confrontational tolerance, because it's another question on here. Um, they say half the marriages fail. A lot of people say marriages fail because, um, money, sex, finance, drugs, alcohol, booze, whatever. And that's actually not even true. It's that you guys aren't communicating about it.

And that's a— it's as good a word. Communication.

You gotta talk about challenging deals and people don't want to come home to their wife and talk money. And I remember when my mom and dad had to pay the bills every month, God, we'd hide upstairs and they'd just yell and scream. And then mom would unscrew light bulbs and say, we're not using electricity. I mean, just crazy shit. And it's like that, none of that needed to happen. We just all needed to talk. We just needed to communicate about uncomfortable subjects. And everybody wants to talk about fun stuff like, um, the Super Bowl in 2 weeks. They don't want to talk about overhead. They don't want to talk about, um, but, but I want to ask, I want to stay on topic to this thread, which I've been asking you to post on for almost— oh my, when did this thread start? Oh my God. It started in 2006. What is the year again? Is it 2024? Is it 2024?

It is.

Um, but anyway, they say, oh, so marriages fail. They say half the marriages fail. So what happens if me and, um, Cindy, um, buy a partnership at Comfort and a year later we want a divorce? We don't want to work together anymore. Does that ever come up? Is that ever an issue? How do you, how do you solve that?

My answer, of course it does. My answer to that is, and I've got the answer and I've said it a thousand times, and I'm saying sometimes it doesn't work. You and I don't need to love each other at Comfort Dental. We just both need to commit to the same system. There's a big difference. I worked with some partners. I use his name when I'm telling the story back home, but he's a strange, strange bird. I almost killed him once.

Yeah.

And then I thought, and then I thought, no, he shows up for his shifts. He's a decent dentist. He's a decent earner. He's committed. I don't have to go out and have a beer with him. That's my answer. But one of you would have to decide, well, which one of us is moving on? We marked your practice and—

Well, I'll pretend this is a pencil. It reminds me of what you just said was what Milton Friedman said about, um, about, um, international trade and globalization. He says, you only got 2 choices, war and kill each other. Or globalization, because when you make a pencil, the rubber's coming from, you know, Vietnam, the metal's coming from Brazil.

The wood from—

He did that pencil and like 23 countries are involved in making this, countries, and all of them hate each other. They've been to war with each other, but you know what? But we're just making a pencil. It's okay if you have a different religion, live in a different continent and eat food differently and everything, but we're right here at a pencil factory. We're at Comfort Dental. We're treating patients. We don't have To love each other. We just have to be committed to making the most awesome pencil on earth.

It's a great analogy. That's a great analogy.

And that's why it's scary that we're deglobalizing. Everybody's moving the, you know, offshoring and moving back. And if nobody needs— remember Frank Zappa and his song? He said, um, there'll never be a nuclear war because there's too much real estate involved. And you get rid of all, all the economic reasons why we need to work together. Then shit, why not just shoot each other?

Well, you're over my head. You're too smart for me.

I can't follow that. But um, oh my gosh!

Um, but that's our story in a short period of time.

I I know you have time limits on this, and yeah, I have a I have a time limit for all ordinary people, but not you. And uh, but but we will wrap this up because they do like shorter stuff, and I I admit that when I see um before I went and saw an hour and a half when I went and saw Napoleon, and you you said, "I want to refresh on Napoleon." You see like a 17-minute YouTube video on Napoleon and one that's 1 hour and 50 minutes. I, I do the 17-minute one, but, but can you do the, the 17-minute one on the difference between mean and lean overhead, mean and lean group, and, um, I had 3—

Uh, sure. I had 3. You guys called them 6 hours. I guess when we, when we, when we taped them or put them on a thumb drive, they were 6 hours apiece. I did 3 8-hour lectures for, I don't know, sweetie, 20 years. And the first one was Lean and Mean Practice Management. And its thrust was collection policy, appointment control, and overhead control. It had 3 big sections and that's really the foundation of everything. And I didn't do much on hygiene, but it, It was good stuff. Uh, you show me a multi-hygienist office and I'll show you an 85% overhead. So we learned there's only one way this can work. We, and in Colorado at the time, it was a little more rare. I think it's pretty much everywhere, but I won't be the expert on— it's very dependent on the assistant being legally allowed to handle some of the polishing and the flossing. The non-scale procedures. And it's a 2-person team. It's a hygienist and an assistant utilizing 2 treatment rooms. That can be immensely profitable. And that's what that presentation was. And the group partnership is the stuff I've been talking about today.

Okay. But back to that. I mean, think about this. I mean, dentist, do you want to go get your new patient and set them and clean up the room and then go get the patient, seat them, and you have an assistant do all that?

Insanity.

What are you paying hygienists up in Colorado?

Easily, we can't find enough of them, of course, but they're making $90,000, $100,000 a year.

Yeah, so let's say that your hygienist makes $90,000 a year. I mean, do you have to go to college 4 years to set up the room and then go seat the patient in the room?

She should have an assistant.

And take the bitewings? I mean, it's just common sense that the dentist has an assistant but the hygienist doesn't. And when The hygienist has 2, um, assistants, works 2 rooms. Yeah, hygienists don't want to work that hard.

No, I— we had, we had some hard-working, we had some hard-working hygienists.

Yeah, yeah, yeah. Well, I, I don't think the dentist work— I, I, I hate throwing my homies under the bus, but I gotta tell you something, homie. Um, you know, I, I've lectured in 50 countries, many of them multiple times, and whenever you go on a cruise and get there, all the tourists that go to all this stuff I go looking for dental offices and I've got, and I post them and, oh my gosh, I got, I got interviews and podcasts with dentists from, I think 50 countries. I did 4 in Japan, everywhere. I love this stuff because it's one herd of 8 billion people, one disease, one bacteria or a couple or whatever. And they, um, you know, they love an architect, how every toilet and window, you know, how The, the buildings are all different. Well, the dentistry is all different, and, and I, I, I loved, um, watching it, and I, I, I just, um, love that stuff and, um, seeing how they do. I forgot where I was going at this point.

That never happens to me.

Where was I going with that point? Oh, the, the hygienists. Um, Singapore, every dentist is just one employee. The only guy in the dental office does everything. Yeah, but the thing is, when I go into every dental office around the world, where's the dentist? Where do I always find the dentist 9 times out of 10?

Private office.

Private office. It's like, what are the odds that I never catch you? And they got assistants doing all this, the hygiene, everybody's doing everything, and this labor's up to here. Then I go into your offices where the labor's down to here, and all your dentists Do your dentists do pro fees?

Yes.

What, you know what percent of dentists would find that an insult? You imagine if Rick Workman told his new recruits, oh yeah, you'll have to occasionally do a cleaning. He'd lose them right there. It's like, you can't do a cleaning?

Let me expand on that. You're talking about a simple pro fee. Half to 60% of our new patients haven't seen the dentist in 3 years. Lots of those folks need more than a simple prophy. They need SRP. So our docs do tons and tons of scaling and root planing, and that's profitable. And then turn it over to the assistant for polish. So when I say they do a prophy, yeah, okay. But—

But a lot of your dentists also, I mean, I learned this from you and I did, I'd say, okay, well, You know, like, like when I had a, um, you know, I mean, imagine getting 4 wisdom teeth. Would you want them pulled one at a time, 4 times, or would you want them all 4? And then dentist— and then the dentist will be in a, in a medical dental building, and the oral surgeon numbs up the whole mouth all day long for 40 years. And this dentist over here is right side, left side. And then he's having the hygienist do the scaling and root planing. It's like, man, numb up all 4 quads. Do the scaling and root planing, knock out the 3 fillings and a crown, have the— and then polish, scaling. But what you taught me is that, man, I'm fast. I mean, my nickname in dental school was Fast Fingers, Faran. And it's like, I'd rather just have you for an hour and a half or 2 hours, knock it all out. And you look at those fees, hourly fees, you're in the profit zone. All you need to know is your overhead per hour. And, and if you know your, your overhead per hour and you can double that, you have 50% overhead.

Yep.

And, um, but breaking it up into, well, we're gonna do the right side, then the left side, then you're gonna come into the hygiene, she's gonna do the right side, the left side, you're basically gonna come in every Wednesday for a year. I mean, God, just, I mean, this is America. Just pull up, get her done. And back to that advertising, what's the big implant, um, What's the big implant, um, company that's, uh, that the consumer implant company?

That's Implant Dent. We use them.

The one that advertises all the time on TV? ClearChoice? ClearChoice. Oh my God, when they started advertising things, and that their, their big founder was right out by you in Colorado, um, when they started advertising out here, oh, every patient's coming and asking about implants. And I'd be sitting— every time I'm sitting here at home and I see infomercial on them and they got all— I mean, but the more they advertise, they, they, they raised the, the, the water for every boat in the harbor.

That's what I'm talking about with DSOs. Yeah, yeah.

And DSOs are doing it too. And, and the, the— my, my, um, I, I love the DSOs because number one, I like competition. I think whenever you take competition out— I remember when I was a little kid Um, I don't know if you remember, but, uh, Japan and Germany were kind of naughty during World War II, so we wouldn't buy their cars. And so GM had 50% of the market and Ford and Chrysler had the rest, and they sucked. And then they said, okay, we'll let you sell your cars here, and they had to get their act together. And now Toyota has 20% of the US market and GM only has 30%. And, um, did you know that this city of Phoenix Um, if you fell off a bicycle on Sunday morning and broke your front tooth off, you could get a fireman to pick you up. You could go to a hospital. They'd be staffed 24 hours a day. There's no dentist.

No dentists.

It wasn't until DSOs came where my fellow man in Phoenix, 4 million people, can see a dentist on Sunday. They start— it's competition number 2. When I got out of school, um, about a quarter of the class, their dad was a dentist, so they had a job. The rest had to go to the Army, Navy, Air Force, Marines, or something like that. And now they can get jobs at Army, Navy, Air Force, Marines, and go work for their dad. They can do all this stuff, but now they got a gazillion jobs. Um, I think Rick Workman is one of the greatest men I've ever met. I mean, and he's so ethical, great friend, moral. And I mean, he's just a great guy. I mean, he's like— he reminds me of Chick-fil-A. I mean, you know, he's just a— yeah, really. I mean, he's just the, the all-American boy. And, um, people want to throw him under a bridge, yet, yet they'll go on vacation for a week and their patients are just left to dry. And he's leaving his patients in a group practice that can still take care of them. I like competition. I like all that. But the one thing that does concern me is when healthcare started to do that, they focused first on quality. All the big change were Mayo Clinic, uh, Scripps, Cleveland Clinic, Houston, um, um, you know, all the big brands and hospitals were, were only the very best. There was no big brand hospital said we're faster, easier, more efficient. And, um, and Aspen, I'd like to ask, I lost my own family member to Aspen because I'd have to take, reline his dentures at 8 o'clock, send it to the lab and see it at 5 o'clock. He'd go to Aspen, 2 blocks from his house.

They do it down the hall.

Right there. I think Aspen, Target, we're going after Medicaid. We're going after poor, all that. Everyone else is going after suburban insurance, Delta, $60,000 median household income with benefits, indemnity insurance. And I would like to see, um, we start— where's the Mayo Clinic of Dentistry? Where's the Cleveland Clinic of Dentistry? Where? But you go to like, um, in Asia, in Asia, every one of those towns has like a 10-story building downtown. And it's like oral surgery, orthodontics, endo, perio, pedo, blah, general dentistry. And they're open 24 hours a day, 7 days a week. So if you're in Malaysia or Cambodia and it's 2 o'clock in the morning and your tooth explodes, you go to the dental hospital and that's what they're called. Dental hospitals. Like America doesn't even have a dental hospital.

Interesting.

And, um, and that's why I like going around the world to see how other people do it. And I want to tell you this, I cannot tell you how many dentists I've had this conversation with. They were at Witzen, they're going to all these different institutes, all this advice, and it just wasn't working. Their overhead was 70, 80%. They were working, they were stressed, all that. And they got mean and lean hygiene group and, uh, and, um, practice management and just said, yeah, their overhead went to 50%. They went to 4 days a week. And that's the last thing I want to talk to you about. Um, the shifts. Do you really think when you say your doctor's coming around $400,000 a year, how many hours and shifts are they working for that? Is that 7 days a week?

It's, it's 6 days a week, 11 6-hour shifts for a 66-hour work week. If you and I— For the whole office? Yes.

But the dentist working there making $400, does he work? He doesn't work all those 11 shifts.

Typically he or she will work 5 or 6 6-hour shifts.

5 or 6?

5 or 6 6-hour clinical shifts. So you might have a 12-hour day and then 2 or 3 6-hour shifts in addition to that. If the 3 of us, we have to cover 11 shifts, And a 3-doc partnership works really nicely at Comfort Dental. We'll get the 11 shifts covered easy. That's just 3, 3, and 3, 4, and 4. And then we'll double up on the PM shifts and the Saturday shift. That's a typical 3-doc model. But we open with just 2 of us. So we got to cover 66 hours, 36 for you. 30 for me and then vice versa. So we want to get to that third partner real quickly. Yeah. Because that gets to be a bit of a grind covering all the shifts with just 2 of us.

Cindy, what questions should I have asked your husband that I didn't ask? Since you are the brains of the whole operation since day one, I don't care what Rick says. Gordon Christian's secret is Rela Christian. Rick's secret is Cindy Kushner.

No, let me help her. You might've asked me, what do I do these days? And we kind of started there because I'm a little bored. I can't play as much golf as I would like because it's just fatiguing now at my age.

How old are you?

71, closer to 72.

You look great.

Thank you. And so she'll say, why don't you go write some more? And I go back to Beach Boys. First of all, I already wrote them all. And secondly, it's not that easy.

What he means by Beach Boys, we're talking about where some of our most famous musicians, when you hear them go on tour, they say, man, I've played the same, the same 10 songs for—

I got to play for 65 years of my life. I got to play the same 12 songs. And some of those— every night.

Some of those extremely famous musicians, I've heard them in interviews say, sometimes in the middle of a song, I forget where I'm at because I've played it so many times. I'm thinking of something else. Sure. I'm just reaping Muscle memory reflex thing that I'm like, am I on the 3rd refrain or the 4th?

So, so to finish, to finish up, I'm still the majority owner. We're probably totally privately held. And my minority partners, 5, 5 are, are dentists that worked their whole careers at Comfort Dental. And nowhere else. And there's one, there's, there's 3 more. There's a full, full in-house attorney. He's a minority partner. My son Paul is an MBA. He's the CFO. And my nephew, 50-year-old nephew, is the lab manager. He's worked at the lab for 25 years. So what do I do? I do lots of bookkeeping, honestly. We have no secretary. We have no secretary help. At the corporate office. And I help with, I help with marketing and I do lots of recruiting. I help with recruiting and, uh, they protect me by handling all the other bullshit so that I'm not bothered with it, frankly.

Okay. So your Mean and Lean tapes, I think, are more valid today than when you taped them 20 years ago.

Oh, thank you. Thank you so much for saying that.

My 30-Day Dental MBA was filmed in 1998. And anybody who goes through them all tells me it's kind of like trigonometry or geometry, you know, It doesn't matter how old your geometry book is. They're not changing a right angle. But those kids, I hear them talk about, um, whenever they hear advice from someone our age, they go, ah, Rick and Howard, they graduated in the golden years. They don't, they don't have no idea what they're talking about.

I heard they were before us.

Yeah. Yeah. Yeah. So, so the, the bottom line, the bottom line is what do you say to that? Those kids on social media who just think, well, I'm not listening to someone who's a dinosaur. I want to listen to someone who's 30.

You're 500 grand in debt and you're going to work for 100 grand. What are you, nuts? That's what I say.

Yeah. And my gosh, I'll tell you what, you know, you know what, my, my, the best view I could think of, um, it's kind of like, look at when the USSR fell apart. The USSR collapsed. It was, um, the Berlin Wall came down, blah, blah, blah, blah. And, uh, Poland said, we're just divorcing communism. And we know America's got the better system. And they went 100% full American. And the Russians thought, well, yeah, we don't want to go that far. We still want to do, you know, and they just meddle with it, meddle with it, meddle with it. And it's the same thing on this overhead stuff. You guys, you just, you just can't divorce yourself from your ideology and say, okay, this guy's making $400,000 a year. Hundreds of doctors doing this. And they also say that the old people say that about the millennials. They say, well, the millennials are like this. And they've been saying that. I've met— there's 2 million dentists. I've met them. Their people are all the same. Your patients are all the same. You think you're, you're as unique as, you know, all the Nike tennis shoes you wear. You know what I mean? I mean—

Howard, the dirty little secret at Comfort Dental is It's really hard work. Yeah, it's really hard work. And we have these arguments. Well, what's wrong with that kid? Why won't he? And sometimes we just flat out conclude he believes us that we're doing this. Some of them don't, by the way. He doesn't believe he can do it.

Well, what's the failure rate of dentists who want to join you? I mean, if she's listening to you and you say that the franchise fee is $300,000.

For a new, for a new half partnership, it's about $300,000. Yes.

What would it be if they go into an existing practice and buy half?

Could be $400,000 or $500,000. Yeah.

And what do you recommend, an existing partnership or a de novo?

A fresh graduate is not likely to get a new office.

Oh, okay. I did not know that.

He or she needs, he or she needs the mentoring of an existing. I stand up in front of them and I say, if you can manage, buy the cheapest partnership On our— we have a list of available partnerships. Buy the cheapest one. But if you can't and you need that mentoring and you need their support to hold this overhead at 42%, you're going to pay a little more for your partnership. Then you can learn it. And in 5 years, sell that one out and we'll let you open a new one.

So how could a dentist buy a new one? Do they have to have 5 years experience or 10, or is it—

Honest to goodness, I can't think of a new one that opened that didn't have both veterans, Comfort Dental veterans. They sell out of an existing successful Comfort Dental and they open a new one because they want to get that third and that fourth partnership. And they get almost all that money. We get a little piece of it.

And back to, back to new patients. Um, I noticed your Comfort Dentals around here, they're all freestanding buildings. Uh, you can see them from 4-lane intersections. Um, you said you had an ad during the NFL game. Um, do you do direct mail? What, what, what is your— how would you—

It's, it's almost all social media now. It's all— we have a, we have a, we changed companies about a year or two, a year or two ago.

Facebook or—

I'm sorry.

Is it— when you say social media, is that mostly Facebook or, I mean, I can't think it'd be Twitter or LinkedIn or—

No, it's, uh, Fubo. Uh, streaming. It's on streaming TV, not network TV. And there are image ads. They're, they're big time. Hours, affordable fees. Hours, affordable fees. Where's my, where's my Care Day video?

Oh, the one you sent me? I, I sent it to him and he's gonna splice it in.

Uh, but we pay it.

We pay a, a marketing company So what would you say to a dentist who's thinking about retiring and selling his practice to retire? I mean, we both retired now. It's a big transition.

Uh, the DSOs are wonderful for that. That's an avenue that they've never had before because there's nobody else going to buy it. Now, you mentioned telling a graduating dentist to open his or her own. Not so sure.

Because it's risk. Whereas if you buy an existing—

The way I tell that story, and I would never argue with you, but I stand up in front of 50 dental students and somebody did this to us in the '70s and said, how many of you are going to open your own practice? And we had 138 in our class at Marquette and we all raised our hand. I can ask the same question to 50 or 60 juniors, 3rd and 4th years, and nobody raises their hand. And I'm not gonna argue with him. I'm trying to sell a Comfort Dental opportunity in the first place. And in the second place, I'm not sure they're—

If you're gonna start a new one, you're in the unknown. You need demographics and you need to have— you need to be a good business person. But if you buy an existing, you've eliminated all that. It doesn't matter what the dentist-to-population ratio is if you're buying an office that's already working.

And they better buy all my materials. And memorize them. Oh, Medicaid credentials.

You have to come over before we end this podcast. You got to come over. Seriously. And I can't tell you how many dentists were trying to get a hold of him like me and got a hold of you and you answered our questions. Hundreds. Hundreds all the time. And I, I do, I think we wouldn't know who Gordon Christian was if he wouldn't married Rella. And I don't think we'd know who Rick was if he didn't marry Cindy. I do.

Well, can I finish with what— What I was going to say is it's not that easy to open up a practice. We do it for our dentists.

We do the building permits.

We do the equipment. We do the credentialing. We do the staff hiring. We do the marketing. We do the site selection. We do the office design. We do the equipment purchase. We do, you know, all the stuff.

But all that was covered in dental school. They should know all of that.

They know none of that. Let me finish. He's got to stop. I was— here's a story I tell. Yeah, it's going to sound pretentious, but I don't care. It was here 3, 4, 5 years ago out in Cave Creek. I had my Bentley, one of my Bentleys at the gas station. And a young man pulls up in a truck and it says such and such landscape architect. He's a landscape architect. It was obvious. He says, hey sir, how you doing? I said, hi, nice to see you. He says, tell me what you did to be successful. And I, I was kind of proud of how Quick, I responded, and I said, "Sure, go to school or training till they call you something." It can be. I don't. It doesn't have to be doctor, lawyer, or dentist, or it can be landscape architect. It can be sales manager. It can be car salesman. It can blah blah blah. Two, get off your ass every morning and go do it for twenty-five years. And 3, marry my wife.

Nice.

Because I always come up— you live through it too— with a harebrained idea, and she'd roll her eyes and say, okay, let's go, every time. Yeah, and some of them worked.

But hey, um, thank you for all that you guys did for me and my family and my boys. And, um, not only what you did for me and my family, but what you've done for so many dentists, Rick, you have so many fans. I mean, hell, every partner got a Rolex watch. I mean, you took a strange dentist and made him a blood brother and, uh, you're a— he's just a good guy. Um, you're the biggest heart. That's another thing. Uh, you have the biggest heart. I mean, I just think you're just one of the most wonderful people I ever met. Thank you so much for coming on the show.

Thank you.

Any patient can come to Comfort Dental on Care Day. If you feel you need our services, we're here for you.

In 10 states, we have over 140 offices and just under 400 doctors participating in Care Day today, with hundreds of staff members as well. We take first-come, first-served on this day. Many of these patients don't have insurance. This might be the very first time they've seen a dentist all year.

We don't ask if they have insurance or anything like that. We just ask them what they want, what they need, and we provide that service for them.

So no cost. On Care Day, we do cleanings, we do extractions, we do emergency treatment, we do fillings.

Anybody that comes in with any sort of need that we can accomplish in a day, that's what we want to do for them today.

This is actually a day that we look forward to all year.

So I've been with Comfort Dental for about 4 months.

I heard about Care Day right when I got here. I'm excited to be able to partake in that today and help the community out. We get to do free treatment for people that don't have dental home, that need care, and it's the right time of year to be giving people treatment for free. So not everybody can afford dental services, and today's a really good day for us to give back for those that can't. It means a lot to us in that regard, especially at this time of year.

time of the year. Our staff and the people we employ here, they really care.

We're very appreciative that they're open today to take care of our people that have bad teeth and can't afford to go to the dentist and get them fixed.

So this is a very good thing that Comfort Dental does.

Thank you. So I've been coming here for a couple of years now, and it's a really big help. You know, I don't have no insurance, and it helps. I appreciate them very much that they do this every year.

We're currently at the Green Valley Ranch office, very busy. We've seen at least 15 patients already this morning. We have a total of about 37 signed up right now to be seen, and so very busy, very active, everybody's moving.

So we got a lot going on. I got a lot of patients waiting for me. I think all 6 chairs are full, and we got about 10 or 15 people in the lobby waiting for treatment. We're expecting another busload of patients We had a bus or 2 of people coming in here around 10:30, 11 o'clock. We had a bunch of little kids come through. One of our busiest Care Days for sure. We've got a lot of people to see, but at the same time, everybody's really festive and having a good time, and so that really makes a work environment about as good as it gets. Care Day was a huge success this year. In our office, we more than doubled the number of patients we saw this year. Pretty incredible. I used to be terrified of dentists until I came here. Every Christmas they do Care Day and it's free, so hop on down and get one service for free. Here for the free care.

Important to take care of your teeth.

Very excited to come and get some work done. Service is a big part of who we are as dentists, and today we get to be that.

I think what Care Day says about Comfort Dental is the we're committed to those underserved patients in our communities, and we really truly want to help those who are in need.

Care Day is the center of Comfort Dental, and everything that Comfort Dental is revolves around Care Day, and so we stick to that every year.

So this is our 38th Care Day since 1984, and this is a tradition that we're going to continue on for years to come.