Send Me Every Patient, The Philosophy Behind Comfort Dental with Dr Rick Kushner

Every time I went to these lectures, I heard something about, well, you don't want that kind of patient anyway. Well, we don't take that insurance. Well, we don't— every time. We don't take Medicaid. We wouldn't be in that neighborhood. And every time I'm thinking, that doesn't sit right with me. Send me the patient, any patient, all patients. I'll work with her, see if we can find a way to move forward, even if it's just a partial treatment plan or a simple emergency visit. Send me everything. And also get your fees up there. Get your fees up there. And I'm looking around and I'm thinking, I think I'll lower my fees. It makes a difference. Welcome to the Comfort Dental Podcast. Get a peek behind the mask with real people and real conversations.

So I couldn't be more excited to get to be with Dr. Rick Kushner of Comfort Dental. The reason why this is so exciting for me, Dr. Kushner—

No, it isn't.

Is because I, like probably a lot of people, didn't know much about Comfort Dental except that it had a pretty distinct brand. It looked very well done, which made me think it's corporate and it's similar to every other corporate expression. I had no idea. And then what happens is I start talking to Comfort Dental dentists, and the only way I can express it is that they have this energy about them that's like, this is the greatest kept secret in dentistry, and we don't know why everyone isn't doing it. Which leads me back to you, the one that started it all.

I haven't heard the term greatest kept secret In dentistry. But the answer to your question, the underlying answer to your question, is our doctors have to invest significantly, and then they are owner partners in their own practice. That weeds them out pretty healthily. So that's the answer to that. But I, we, you know, we're approaching, uh, half a billion in annual collection dollars. That's not a secret and that's not hidden, but it is a continuous challenge for us to recruit new partners. Additionally, kind of a sidelight, we don't— we have done it and it has worked, but we don't like to open new practices. We only open de novo, as they call it, scratch start new practices. We don't like, and we do 2 or 3 or 4 at a time, maybe in a big year, 5 to 7 a year. And we don't like to do it with fresh graduates. We don't like to do it with new Comfort Dental partners. We like to do it with seasoned Comfort Dental partners that have done it before. That ensures a quicker upstart.

Because you understand the mentorship model is important. Where did I— from my perspective, dentistry is one of the hardest professions simply because you have a healthcare professional that has to be clinically up to speed all the time, but then also needs to understand the art of business and the marketplace and how everything's changing.

I think I can kind of circle that and still give you a good answer with, uh, an example of a recruiting meeting. And we talked a little earlier, they're filled with probably mostly fresh or near fresh graduates, and then maybe 40%, uh, existing dentists who are considering that career change that you talked about. I stand up 15 minutes or so, and one of the things I ask is, are any of you interested in being associates? I said, maybe you've heard that we're a partnership organization, but we do take associates and it's okay to raise your hand. And then a bunch of them raise their hands. Then I say something like, uh, When you're an associate getting the percentage that your partner owners have agreed to pay you at the end of the month, be sure you know what your production collection would've meant to you in income if you were a partner.

Hmm.

Because I'm sure you will find that if you were a partner, you would've handled your practice buy-in debt, you would've handled your student debt, and there would still be extra dollars. In your pocket. That's why we accept associates, because you're going to turn into a partner anyway. We'd like to do it sooner. The other thing I talked to them about is some of you feel like, and I don't badmouth, I don't want to badmouth dental schools, believe me, they're up against it. That's another topic. But some of you feel like you didn't get enough procedures. In dental school, call 'em reps. John Elway threw about a billion passes. He got to be pretty good at it. Comfort Dental does, you know, about a billion fillings. They got to be pretty good at it, although the rest of the profession doesn't think so. But that's another whole story. So I'm talking to potential partners, mostly young, fresh, relatively fresh graduates. And I said, some of you believe you didn't get enough procedures. In dental school. You're right. Some of you believe you didn't get enough endos, root canals, enough extractions, enough third molar surgeries. You're right. Some of you got close to zero of those. First of all, your dental schools are up against it. This is not a criticism of your dental schools. I don't know how this is sustainable to begin with. But they need, in order to try to hold your debt down, they're not doing a very good job, but they're trying to hold your debt down. They need to attract grad students in endodontics, root canal therapy, in oral surgery, and they need to give them procedures. And that comes out of your procedure list. Now, you're in the right place. We'll give you Wherever you go at Comfort Dental, we'll give you a whole dental school's worth of procedures in your first few weeks if you're willing and able to be mentored. And if you don't want to do endo or you don't want to do, uh, third molar surgery, there's likely a partner in your, in your practice that will do that. So the patient doesn't have to leave and you still get to share in that. Now, your income will suffer for that. I'm not advocating that, but it can work. However, if you're willing to be mentored, you'll have it all down in a few weeks anyway.

Okay. So that model, it just, it works like the way you see things so clearly, but like you, you started this and it didn't, it didn't exist. Like the idea of the lean and mean philosophy, the idea of let's have a mentorship model. Let's get someone to not be an employee, but buy in. So there's, there's that equity.

Thank you. Let me go back there. Uh, the model, fast forward to recent years and today for sure, is we have the best blending of the old and the new. We have dentists wholly own practice. I cannot own a practice as a franchisor. I cannot own a practice. I own none of the practices whatsoever. So we have ownership. In their own business, partner ownership in their own business, no solo practices. And also taking advantage of the economies of scale that the DSOs have showed us how to do and the discounts and all of that that comes with the discount discounts we get, our docs get on supplies. Unbelievable. It's a little embarrassing to let that news out to the regular dental population. But the start, and I thought you were going to ask me about how I got into dental school and all that stuff. I don't know that. You might, or you might not. I don't know how interesting it is, but I was a successful solo dentist from day one. Can't explain it. Most of it came naturally to me. You'll get it outta me throughout this interview. But as tradition dictated, when I got busy and I was busy, You take on an associate. And I did that 3 times. You think I'm so smart. Each one stayed 6 to 12 months, did very, very well, learned what I had to share, and moved on. No bad blood whatsoever. I'm still friendly. They're all still alive. I'm still friendly with all 3 of them. Moved on to open their own practices because that's what we did back then. I'm thinking, here I am left holding the bag, so to speak, with the 2-doctor practice, which I took on an associate because it was getting too big for me to handle by myself. And here I am back to one doc trying to handle a 2-doc practice. So I thought, I wonder if maybe I sold a half partnership He, back then it was all he, now it's he and she. And I, I need to add, in case I say he too much, uh, we're approaching 50% females and they're fantastic. And having said that, I do need to add, cuz it's a fact, the ladies' careers, average careers are shorter with more and longer interruptions. Other than that, they're among the greatest, they're among the average, and they're among the weaker. Just like the bin. Having said that, maybe if I sell half, maybe he'll stay. And I did. And it's Dr. Eirik, and he's still here. He's my corporate partner. He paid $65,000 for that partnership in about 1979. He was, he went to a different dental school. I went back to Marquette in the Midwest. Jesuit school, Milwaukee, Wisconsin. And my local dental school, University of Colorado, now a great school, uh, it didn't open till the next year and he got into that. So he was a year behind me and then had to do a couple years in the military. Uh, we, we have a similar background there, but he stayed longer. And then, so it's 1980, '81. Forgive me, I'm elderly. But I've been through the 3 associates, sold him. He's still here. Then we went to 3, then we went to 4. I worked, I call it shoulder to shoulder. If it's you and I, we might pass at 1:30 when the shift changes, but that's shoulder to shoulder. Sometimes we're there together. I worked shoulder to shoulder. And I've given this some thought, but I want to say, With a dozen or so, 10 to 12 of our earlier partners. And unless they've retired, they're all still here. And then I couldn't work shoulder to shoulder. We got too big. And passing on these wonderful concepts to dental school brainwashed brains became more and more difficult. To this day, that is our battle to continue to pass on these concepts and what we are and what we were and why we do this and so on and so forth. So after about 10 years of practice, we've grown the original practice to 4 docs. I sell out of the first office. And I just lecture. I'm lecturing these concepts to dentists all over the country, um, 30 or 40 dates, full-day dates a year. And I was going back to practice then the other half of the week, killing myself, obviously. But then I did take some time off from practice and just lectured. Word got out and I started hearing, you know how dentists are. Backbiting, jealous, miserable, attacking people. Why would I listen to you? You don't even practice anymore. So I thought, okay, I'll go open another one. And again, shoulder to shoulder with Anna and Fred and Jerry in Westminster. We didn't compete with the other, and in fact, we called it something else. There was no Comfort Dental. Same thing happened, except I sold partnerships from day one. And it was more successful faster than the original one because we didn't make all those other mistakes. And we took all patients and we can come back to that. We, I have some real strong opinions about the way the elitist portion of the profession thinks, which is 95% of them or maybe more, and the way we think. Here's spectrum, the rest of the profession, us. Anyway, after the success of the second office in just a few years, we're to 1991. So this is 14 years in the 2 practices. I've heard, yeah, you're a superstar. No, we, we're not questioning that, but will your concept work without you? So the 3rd office, North Denver, Neil Norton, who retired, stayed with me for whatever it was, 36 years. Uh, and Mike Bloss opened North Denver. And I pulled some shifts and did some specialty things, did a little ortho shoulder to shoulder with them as well. And that's, and it worked. It worked. All of our success is based on doctor caliber. We have no inferior locations. We have no inferior demographics. We have only stupendous and magnificent locations. If there's a weaker Comfort Dental office, it's due to doctor caliber. So I give Doctors Norton and Blosst, of course, much of the credit for, for their office. And they went to 4 partners. The rest is history because we knew we could do it. The next step, kind of important to tell, and then the rest is history. After the success of the 3rd office, we opened 3 at a time, all at once. All with new partners, and two of the new partners lied. I told you about this earlier. They lied about when they graduated because they were fresh graduates and they were superstars, and it changed my thinking. Well, we have to have experienced docs. We got superstar fresh graduates too, and they're all successful, and they're all still there. And we have we've added on to the space. We've relocated one, and bup bup bup bup bup. But they're all still there, and they're all monsters. I'm coming back to that. So I'm sitting, having a drink and sitting around and Howard Fran lectures and I lecture and we bump into each other and we're kind of good buddies for a long, long, long time. And between the second and third office, I want to change, I want to call the third office Comfort Dental and I want to change the other two offices. To Comfort Dental as well. And Howard jumps out of his chair, said, whoa, whoa, whoa, whoa, whoa. Call a lawyer. That's called a franchise, and you better franchise before you get in trouble. And I did, and he was right. So I, I've credited him for '91, whatever that is, 37 years now. I've credited Howard for making sure I was on the straight and narrow. And in the meantime, we've got a full-time lawyer. He's, he's now a corporate partner, uh, Greg Bears. We've had him for 25 or so years, and he spends tons of his time in the 10 states. Everyone's got a little different tweak, and we learn that we need to tweak this and we do it. And some of our partners bring this to our attention and we do it, and we're constantly tweaking things. So, because we're the only, only In the US, and I assume the world, but the only large franchise dentistry, they're all DS, which you, what we call DSOs now. Where was I gonna go next? You're not even asking questions.

I know. I'm like, I'm just like, uh, I'm trying to take it all in because you're so humble about the fact that like, okay, you know, this person helped me out here. This person helped me here. But just cataloging your story, Where your model worked without you? And that was the moment of, this is scalable, whatever philosophy and systems and understanding I, I've built into it, it works.

Big watershed moment when we realized the concept can work, uh, with motivated docs willing to be mentored and then willing to mentor beyond. Uh, could be done without me being, my term, shoulder to shoulder. And again, I did pull shifts in the, I think all 6 of those offices. I've seen patients in all 6 of those original offices, but not a regular partner. It sounds critical of the profession, and I think it's a wonderful profession. I've battled it for 50 years. Literally.

So that's what I, that's what I am curious about though. Like for real, like how is it that you are a dentist? It's like the whole, remember the brand FUBU? It was for us, by us. You're one of them. You're a dentist. And yet this entire time you've been kind of on your own getting thrown at eggs and, and like—

Literally, by the way, Sean, I went and listened to all the Brilliant lecture and brilliant minds. And I learned tons from a dozen or more, all men at the time. Every time I went to these lectures, I heard something about, well, you don't want that kind of patient anyway. Well, we don't take that insurance. Well, we don't— every time. We don't take Medicaid. We wouldn't be in that neighborhood. And every time I'm thinking, that doesn't sit right with me. Send me the patient, any patient, all patients. I'll work with her, see if we can find a way to move forward, even if it's just a partial treatment plan or a simple emergency visit. Send me everything. And also get your fees up there. Get your fees up there. And I'm looking around and I'm thinking, I think I'll lower my fees. It makes a difference. Uh, okay.

This is where I need to interject. So the modern-day practice is largely built in a way that caters toward affluent individuals, and it's left behind those that can't afford care because they don't have systems efficiency, economies of scale, and a model that allows Those that are less fortunate to be seen.

Without question, Sean, I would go so far as to say it's worse now than it ever was. There are more middle income and below percentage-wise population than there was in the '70s and '80s. It's worse than ever. We can't, we don't, we don't require our, our practices to take Medicaid. It's their option. 98% of them take it. We kill on it. It limits us every which way, but we know it going in and we do what we can.

I think it does make sense that it shades like who you are and where you came from must shade this perspective of like no one else seemed to care.

You judge. You ask the other partners that you've talked— I've seen, like I told you, I've seen 6 or 8 of them. I don't think I've seen them all. You ask them all what led them to dentistry. And back in school, uh, I had an older brother and myself. Uh, we don't have any education in the family whatsoever. My brother went to junior college. He was the first one that went to college. Didn't finish. We just lost him this past year recently. Worked with our lab, ran our lab, by the way, for 20 years. My parents, I think, went to the 8th grade. I think they might've finished the 8th grade. And I was a good student, so I had some, I was blessed with some intelligence. Side story on how smart I thought I was. You know, I had a good public high school in suburban Denver, Colorado. I was, I had like a 3.8 or so, and I might get these numbers wrong because I haven't paid attention for many, many years, but I think a perfect SAT was 1600 and I got a 1280, which in my high school put me in the top 5%. I thought, wow, that's really good. So I applied to Stanford and Princeton. Princeton didn't even respond. And Stanford sent me a letter back. Gee, Rick, we appreciate your application here, but we turn down every year 200 4.0s and perfect 1600s. So I said, thank you. I went to the Air Force Academy for a brief— there's something in there. But anyway, my parents, Hard workers. My dad was a shoe salesman. Mom worked at Target. Uh, when I got into the 9th grade and I had 24-hour sports to keep me in school while she could work her full day, uh, they encouraged me, uh, to dentistry and extended family, aunts and uncles. And I thought about why did they select dentistry? But I agreed. Help people, of course, but have your own autonomy. Set your own schedule, work your own hours, be successful, help people. Much more freedom than medicine. So way back in high school, they mentioned it and we were poor and that's all they knew. They didn't know financial analysts. They didn't know real estate developers, but they knew the neighborhood dentist. To this day, I have no idea how they paid for it, and I'm convinced he gave it to 'em. They saw me for free. So there was that encouragement, and I didn't know I was poor.

I was going to say, when did you, when did that—

That occurred to me later in adult life. And I'm going to tell you why I didn't know I was poor. I had, uh, I had 2 baseball mitts and 2 bicycles. I had a 3-speed that was $80 and I rebuilt a children's tiny bike with the banana seats that we had then. I had 2 bikes and 2 mitts. Who thinks they're poor? But we rode the bus until I was in the 5th or 6th grade, and then we got our first used car. So that's how they encouraged me to dentistry. Now, there are a couple of stories about hand-eye coordination. They used to have us carve, you know this, they used to have us carve a sculpture as part of our, uh, application to dental school. They don't do that anymore.

Because everything was analog.

For wax-ups. Back then, back then we, oh, I did a bazillion wax-ups. Yes. I don't, I'm not criticizing that. Our docs, whatever they throw at 'em, they'll figure out how to do it. But how I got into dentistry, I went to the Air Force Academy. I I left after a semester and, uh, again, on good blood. I was a, I was a tremendous cadet and they, I had to fight 'em to get out. Uh, one of the, one of the traditional events they had was taking an M1 rifle apart with your hands and putting it back together. For time. We had what, 250 cadets in our— all guys then, back then, all guys. Women weren't in yet. Uh, 250 in my squadron. I was number one. I wasn't number one in grades, but I put that— took that thing apart and put it back together.

Did you know you were gifted with— With—

I'm trying to tell you, that's kind of when I— I was a good baseball player and a Pretty good basketball player until they all got so tall. Decent football player. I didn't know to that level. No. Another event, when I think about these things, another thing young dentists don't do or dental students don't do is work a part-time job or 10 like I did. One of the things I did, was I worked at, at Sears in a huge suburb in Milwaukee selling hardware. It has nothing to do with the story. And then later fencing and garden tractors. And the store had a contest with an original video game called Atari—

Pong.

Pong. Made by Atari.

Yep.

I'm not, I'm not that far off. Pong. And we had a contest and the winner got one and I won. And there's 100 employees in Sears. So I kind of knew I had something there. So I left the Air Force Academy, went and did pre-dent. And again, I, my scores were good. I got in, had a good recommendation, got in, uh, after 3 years. And the way my my mind works. I was kind of conservative then, but I said, hmm, I gotta go a year early. Someday I'm gonna make $1 million a year. If I go a year later, it's gonna cost me $1 million. Seems so simple to me.

Who thinks like that? Like, like it's, it was, it was common sense to you.

Get this over with. Dentistry or dental school was a means to an end. I, I mean, I had good grades and in fact, Another thing that goes to who I was and am, uh, I completed all my credentials, all my procedures, all my required procedures by the 4th year, uh, mid-semester holidays. And in Marquette at that time, there was a preceptorship, an internship in a private dental office in northern Wisconsin. And I, I love to tell this story because I'm now working on My relationship, good loving relationship with the 4th generation of that family. We lost the old man, of course, but his son was an oral surgeon. He's retired and his children and his grandchildren. Anyway, I spent a month in, in their home and in his dental office as a senior dental student. So I kind of knew going in a lot of stuff, but I knew. I didn't know enough. Uh, listening to all the people going through the, uh, the failed associateships, failed associateships. You last a year, you, you leave me holding the bag. I would've done the same thing. So no criticism intended. And, and then I decided I'm still not quite getting as much as I need on the practice management side. And I'm taking clinical courses and learning all that stuff too. I, I learned, uh, I learned how to diagnose the simple ortho cases that I could possibly do as well as an orthodontist. And I did that for a while and I did some IV sedation and I tried lots of different things, all kinds of CE. And then I did a practice management, uh, in-house consultation company. You're not gonna know. Psycom became PBP, and the woman was middle-aged and her name was Dolores Walashek. And if she's still with us, she'd be at least in her 90s. And I've looked her up and I can't find her. So if anybody watches this and has ever heard, I've tried to reach out to her. Uh, she either initiated or cemented the initial interview, the 4 or 5 questions that we mandate. And you've talked to the doctors and they take— Find out why they're here. Primary concern. Uh, are you having any pain? Do your gums bleed? Are you happy with your smile? Have you lost any teeth? If so, were they replaced? If not, why not? What kind of a budget do we have to work with? You know, I just did that in about 21 seconds. We left out their answer. I'm talking 2, 3 minutes, and I'd like that done in just a tiny private consultation away from the clinical setting.

Mm-hmm.

And then I'll say, you wanna come with me? We'll go take a look, see what we got. That's initial interview. Dolores Waliszczuk, I don't wanna get this wrong, but I believe she initiated that. But the best thing she did, and I didn't do it and I don't advocate it, we went through all these practice management things. Many of these concepts are still ingrained in Comfort Dental today. And she said, and then when you complete your treatment plan, you're not going to believe this, hand the patient 2 or 3 business cards of neighboring dentists who can maintain it from now on. She knew I was always going to be a new patient magnet, and she wanted me stressing the new. I didn't do it. But I got the point. And again, stemming from that, we have hygienists and we do tons of hygiene, and you can come back every 6 months, every year, whatever is recommended. And of course, we'd love to see you. But there's an old Rick saying, show me a practice with multiple hygienists and I'll show you an 80% overhead. It's a loss leader in the profession. We don't make money on hygiene. And that goes on to this day. And I said, I take all the credit anybody wants to give me for this. When I'm lecturing 30, 40 years ago, I said, gang, guys, again, probably all guys. I'm in front of, you know, A.D. Dennis. You mark my words, people in business suits are going to come and look at your business with your 80% overheads. Your lousy practice management, and they're gonna think, hmm, we can do it at a 60% overhead. Give him his same 20% and we'll pocket the other 20%. And now you have a country full of DSOs.

You saw that?

I saw it coming as clear as day. Wow. As clear as day. So our overheads average under 50% to this day. Now, the profession, the Elitist part of the profession wants shorter schedules, fewer hours, bigger fees, and only the right kind of patient. And we have longer schedules. We're open Saturdays. We're open evenings. We're covering that office 66 hours, not 36 or 40 or 30 or 24. And we've got discounts and So on and so forth. Boom, 50% overhead. So that's a big, that's a big factor.

You know, there's something about new or modern that I think this is like a trap where a lot of people think, oh, just because something is new, it must be right or it must be a better way. And I find that those people that are really, they have wisdom, can actually go, yeah, but this might be simple, but it's, it's right. And you somehow found the things that made sense and you hung onto them and you like, I don't know. I feel like there's such a simplicity.

Well, that, um, that's certainly fair. I appreciate it. I hope it's true. When I'm being a smartass and I don't want to be in, in this venue, But I would say I just looked at what all the other dentists were doing and did the opposite. I mean, and I was mostly serious. No such thing as the wrong kind of patient. Are you kidding me? So that's kind of the, the story. DSOs, I mentioned them and I mentioned them in a negative light, and I don't mean that. They bring— some of the big ones are heavy marketers. Not all of them, but some of them are heavy marketers. They bring patients into the profession. Some of them think they're too expensive, some of these patients, and they might try Comfort Dental. We get 100 times more patient flow from a DSO than the, than the reverse. And the same thing with partner candidates. Many of them, none, we've, I, we occasionally, we lose a partner mostly to now in this many years retirement, but I've never lost one to a DSO.

Okay. So there's one thing that I just keep catching from you that strikes me as very interesting. You carry such honor for the profession. Despite the fact that you have not been honored by the profession.

Yeah, it's a, it's a, it's a conundrum. It's a contradiction. Yeah, it is.

Where, where does that come from?

The 500 Comfort Dental partners that proved me right.

But you don't have this chip on your shoulder that you're combative against the—

No.

Even when you mention the elite, you're still doing it in a way that's honoring.

I have tons, I have tons of friends in dentistry outside of Comfort Dental. I really do. I appreciate them. I know you can, I always try to say this when I'm berating the profession. If you're immensely talented, you can pull off that 5% elite practice. You could pull it off, but you could pull off anything when you're that talented. But the rest of, so Comfort Dental makes weak docs average. They make average docs. Way above average, and they make above average docs earning 7 figures. 7 figures. Let's talk about debt and DSOs, uh, and dental schools. We talked for the last 5 years or so about $400,000, $500,000, $600,000 debt and how at Comfort Dental, Our docs pretty much all pay that off early. So this is the right place for you. I'm now hearing, I read something this morning, I think Howard authored it. Don't quote me on that, but you can quote me on, we're now dealing with $700,000 to $800,000. And by the time the interest is in, it's $1 million. That's not sustainable. That's not sustainable. Can't happen. You can't go $700,000, $800,000 in debt and then take a job for $100,000 to $200,000 a year. I used to tell them again, 30, 40 years ago, don't take 8 years outta your life and not work another career and then go into debt for this and then make $100,000. I used $100,000 back then. I used that number 40 years ago. I said, if you're going to do that, Sell cars.

But Dr. Kushner, it's a guarantee.

No, it isn't. Let me tell you about the bankruptcies. So, I mean, sell cars. The car salesman makes $100 grand and he, again, he, now it's she for sure, but she earned money for those 8 years while you were going into debt. You can never catch the car salesman. The way I, that's the way I deal with them then. Some of them catch on, but my team, my, my corporate team, they kind of protect me a little bit. They kind of don't ask me to do all that much anymore, but I go listen to 'em. My gosh, they're giving the same presentation. They are. They're using the same lean and mean stuff. You know, just talk about elite dentists. John, did you know that if, uh, I'm a comfort dental dentist, and you're not. And I make $500,000 a year, and you make $200,000 a year. You're a better dentist than me. Oh yeah, they're just a bunch of hacks. Am I am I surprising you? Because I was the hack. Well, they've been told.

You can't do this.

Your patients won't do that. So Comfort Dental, we take plans nobody else wants to take. Right. We work hours nobody else wants to work.

They're not, they're not willing. Nobody wants, they're not willing to, but they want to get paid the half a million.

And again, only the extreme, only the extremely talented. I'm not saying it's impossible, but we take 'em all. We take all can— all partner candidates too, and they don't all work out, but they almost all do.

I, I don't understand how a dentist can be viewed as inferior if the other dentist is doing 3 times as much work.

That's how the elitist mind works in dentistry. Well, he makes more money than me, so I've got to be a better clinician.

You know, I've heard stories of dentists that Because they're waiting on those ideal patients and the bigger treatment options, they're in their office playing video games until their staff comes by and lets them know that they're needed.

Yep.

Could you picture a comfort dental doc having time to play a video game?

I hope they're in their office at the end of the shift, uh, tallying up treatment plans and making care calls. Fantastic 5. They've talked, they talk about the Fantastic 5. Initial interview in a, in a private setting, a clinical exam talkover technique. Uh, the simplest one even patients can understand is don't say caries, say decay.

Hmm.

While you're talking across the patient to your assistant who's inputting or charting or whatever she's doing. Uh, financial arrangements done by the doctor. Unless it's $80, but I don't want this $4 million business run by a high school graduate. If you're lucky, she's a high school graduate. There would, you know, we have some that aren't even that yet. Wonderful workers, but no, I want the doctor presenting.

So maybe, maybe you can explain this to me. So you have a dentist that has to bet on themselves in order to get through dental school. Uh, assume the debt of dental school and then all of a sudden somehow it's attractive for them to get a guarantee, very low guarantee.

You know what?

Instead of, instead of an employer where they can own and have a talk, like what's going on?

The catch, what's the catch at Comfort Dental? It's hard work.

Hmm.

It's hard work. So many of them come outta, come outta dental school and they complain, well, I never got any practice, man. You know what? I didn't either in 1977. I didn't get any practice management advice. I can teach you that in 3 hours. No, they come out and they love the DSOs. And again, I'm thrilled with DSOs. I don't know how they're gonna do it. I mean, let me come back to that. But they tell them, all you have to do is the dentistry. We'll take care of everything else. And I tell them, You gotta do the dentistry and everything else. Different, different, different mindset. But the students like that. DSOs I've read recently, it's in all of our literature. Maybe you think I'm obsessed with it, but that's all we ever read. You look at it, you'll see it too. They're now doing de novo starts. They're doing scratch starts. Um, good luck with that. Um, they're running out of the market. They've bought up all the private practices. And, uh, they're also tired of dealing with the 40-year curmudgeon who still wants to do things the way he's always done things while he works back. The selling dentist works back for a few years. And I, putting, putting rookies in a scrap— I told, already told you, we don't even like to do that at Comfort Dental. Putting rookies in a scratch start in a de novo, not sustainable.

So is that the reason why you haven't gone the PE route and just said, hey, let's just buy 2,000 practices in the next 18 months?

I think the best answer for that is we're too hands-on with, and we're splitting our portion of the pie. Only 5 or 6 or 7 ways. Uh, a better question, uh, the principles we practice together, uh, all in our 70s. How long are we going to do this? Matt and Heath bought out Neil Norton and they're a generation behind, and that's the direction we need to go. And we need women. And we need minorities and the usual things. And I don't have a plan for that. We're going to figure that out, but they do such a magnificent job and they were there from day one in their 70s, but it can't, I mean, time's going to get us. That's a fair question. I don't have a great answer for that till I die.

Why would anyone ever retire when they love what they're doing?

I love it. And I'm, I'm lucky to go back to have an office to go back to after playing 3 days of golf in a row with her, which I can come back to that and get aggravated. I'm lucky to go back to an office and get aggravated for another 3 days, but I'm bored now. We used to, we've recently relocated from a huge 7 golf course resort, 45 minutes north of here to PV. And because we used to play 18 holes 3, 4 days in a row, and now neither one of us, we play 9 holes every 3rd day or every 4th day, and that's enough for us. So I'm bored to death now. No, I'm not. My son's in, uh, granddaughter talking about it. Uh, she's only 15, 14. I haven't, uh, had any other family members. I have some Grandniece and nephews, all wonderful kids. Young, they're young men and women now. No dentists.

You know, the, the thing is, I've been in dentistry since I think 1997. So I was 13 when it just surrounded me. I got immersed in it and I just remember thinking, dentists are kind of interesting individuals. I don't necessarily get them. It took me a while to understand, and now almost all my friends are just dentists because I've been in this world. But what I hear so often is that dentists get burnt out. They get super jaded. They don't end up liking the situation that they're in because of how difficult dentistry is. And—

All true.

Who ultimately suffers? The patient. Because if the dentist isn't fully alive, present, engaged, and they're slowly going down this road of being depressed— not— I'm not even talking about potential suicidality. I'm just saying depressed, Everything's gray in their life, on meds, whatever. The patients are the ones that end up suffering because they don't get the best care. And then I'm talking to your Comfort Dental docs and there's vibrancy, there's enthusiasm, there's like this joy. And they almost feel like they're like missionaries that get to give the work that they would want to give and not even have to think about whether it's going to be profitable because there's so much money coming in.

Uh, yes. And our answer To the burnout is our schedule allows us to get our, you want to get your monthly, you want to get your weekly shifts in. You can do that in 2.5, 3, 3.5 days and then have 4 or 5 days off. If you get to a 4 or 5, we've got a couple of 6-doc practices and you're covering that same facility. One doc can be on vacation. All the time. In other words, once a month you take a week off. That's how we deal with that. And then they're, and you're right, they're so fantastic 5. I didn't finish, uh, patient exit interview. Patient wants to leave. We battle trying to get them to do this. Even our own docs, we continue battling them over the fantastic 5. And if I can do it off the top of my head, I'll do the I'll do the Sensational 7 for you. I think that might interest you. Anyway, patient exit interview. Call the patient, say, hey, what did I do wrong? Come on in, let's discuss it. Uh, I'll tell you over the phone. Well, tell me over the phone. Don't leave to save $50. I'll, I'll credit you the $50. Come on. I'm not sure that's being done as often. They're so new patient wealthy. They can move on. To be honest with you, it's true, but we don't need all this marketing if you did all of that a little better. And then the best one, care call. You got an injection, you got an occlusal restoration. I'm calling you. Back in the day, like I'm an old guy, I can say back in the day. Uh, I had a car phone, which was rare back then. I used to, and they were so quick. Hi, let's go. Wait, wait, wait.

What car were you driving? 'Cause like Jaguars, BMWs, they're the ones that had 'em, right?

I had a Cadillac Eldorado. That's what I remember at that time. But I got 'em in all my cars. I think I used to try to get my 12 Care Cars calls in before I got home. I had a 10-minute drive 'cause they were so quick. How hard is this? Uh, hi, it's Dr. K. Are you still numb? Any pain? Any problems? You know how to reach me if you need me. Bye. Boop. It's a killer. It's a killer. 9 times out of 10, the patient says, really? Nobody ever did this with my eye surgeries I told you about earlier. Uh, care call, but not from the doctor, from one of the staff. Second best, but still, still. Uh, we talked a lot about trying to recruit and how difficult it is to recruit people to invest in their own partnership when some of the world is telling them, oh, you could just do the dentistry. You only make $150 grand, but you can just do the dentistry. We'll do everything else for you. So 20 years ago at Comfort Dental, I might've only had 75 partners. I'm gonna say maybe 100. And we're touching 500 now. So we were 1/4, 1/5, and we were trying to assess— I can't remember the company's name. We were trying to assess which characteristics were most important in being a successful Comfort Dental dentist, not a successful dentist, Comfort Dental dentist.

Uh, dentist.

And I, I think I can come up with them. Uh, clinical quality, clinical speed, uh, organizational skills, leadership. Uh, sorry.

Likability.

It's actually at the top of the list. Uh, leadership, character. Uh, leadership's doing the right thing when people are looking. Character's doing the right thing when nobody's looking.

Um, work ethic.

Work ethic. That was 7. Uh, it's funny I left out work ethic because we hired an industrial commercial psychological firm from California. We evaluated all of our docs. In our opinion, 1 through 5, I think, their strength in those 7 categories. And then we showed the numbers and we shared all this with the firm and they put together all the data. And those things are all important. They're all important. I'm not, don't misunderstand. I've always, every time I tell this, I'm afraid this is going to be misinterpreted. There are, they're all important, and 2 are head and shoulders above the rest. Clinical efficiency, speed, and work ethic. At Comfort Dental, if you have those 2 things and you're not terrible at the other 5 things, you'll be successful. And we've lived with that for the next 20 years.

So I think that's the reason why maybe recruiting is hard is because People don't want to have that work ethic. I feel like there's an old school aspect that you've taken with, with you to Comfort Dental of, I don't mind working hard. I came, I saw my parents work hard. I'm going to work hard. There's nothing wrong with working hard. And a lot of dentists today, like you said, they don't come from that generation. It's almost like this entitlement. You worked really hard. You have this massive debt. And now, I don't know, dentistry should be sort of— easy and you're just gonna make a ton of money.

I like your analysis. I haven't thought of it exactly that way, but it makes complete sense to me. Boy, when they make it though at Comfort Dental, they sure spend it. Yeah.

I don't think Jeremy's struggling right now. I think he's enjoying—

Uh, he came— is Jeremy the junior?

Yes.

Yes. He came before his dad.

Mm-hmm.

He, I don't know how much you know about him. Yeah.

And he told, and he got his dad to go.

His dad was a traditional practitioner in Utah. And he sold out, but he recruited dad and he's just about as good. And that, this is an area where they are so monstrous. I rented their Pueblo location for them. We do all the rents and then we, they know we mark it up 3 to 5% because we get 10% off because of our experience in real estate, blah, blah, blah, blah, blah. And they rent from us. They outgrew the old place. 20 years, maybe. And they went and found a location twice as big. And they did the renovation on their expense. I helped them. And I would never have done this location. It's just traffic count is not there. Residential density is not there, but it doesn't make any difference. And they've already increased. They moved on their own about 3 months ago. And yes, he's a true superstar. He's not, he's maybe top 5. He's not number 1. We have maybe 10 at 7 figures.

Does that surprise people when they hear that?

Because— I don't use that. I don't use that in front of recruits because I don't want them to think that's any kind of a guarantee or a promise.

No, but it, it—

we give 'em the average. We give 'em the average.

It ruins the narrative arc over Comfort Dental. That somehow you can't get the time.

They don't believe us. They don't believe us. They don't believe we do what we say we do. Or, and this might be more of a reality than the other one, they don't think they can do what we say we do. That's another barrier. So the braggadocio, that, that, I, this is a two-edged sword.

But they also want their name on the sign. Is that the biggest thing? I mean, they're not getting at the DSO, are they?

They're not opening solo practices either. They're not opening traditional practices either. They're going to work for DSOs.

Um, but everyone thinks Comfort Dental is a DSO. Why are they wrong?

Because they own their own partnerships. The DSO is, you know, private equity, uh, businessmen and women. Stock. The doctor may get to buy stock. Maybe that makes him think, or she, that they're owners, but they don't do any management. The, uh, front office staff filing claims, chasing down collections, that's all done by employees of the DSO.

So if someone would have told you, you're 2, 3 years into practice, hey, Dr. Kushner, someday you're going to be responsible for coming up with a model that is going to be so disruptive that allows every Everyone to get care. Doesn't matter where they come from. Doesn't matter what insurance they have. Like, talk about a contribution to dentistry. You've, you've gotta be proud.

Thank you. We do not eschew any communities. We're in some upper middle income neighborhoods, but far more lower middle in, and we don't stay away from low income. And they're some of our biggest practices cuz there are more people. And nobody will care for them. We don't discuss caliber of patient. This one, the average case is gonna be $850. This one, it's gonna be $2,800. We'll have to see 3 more patients. They all work. It all works.

Are you concerned with the future of dentistry, the way that the elite model kind of is proliferating?

Yeah, we talked, we talked most of this Session, we talked about recruiting sensational seven hardworking people. You know, we talked about how difficult that is and how that's our biggest struggle. And they're going to stop going to dental school, period, when they're facing eight hundred thousand dollars debt and a hundred dollar, hundred thousand dollar, hundred fifty thousand dollar a year job. The ADA claims average general dentist income is $192,000, I believe, something like that. I don't believe it. I understand the ADA is about promoting the profession, but I don't believe it's that high. I just don't. And they don't know ours. They don't survey us. I think they don't. You say, why don't more people listen to you? I think they know the answer and they don't like it. Well, why, why wouldn't all these ex— I know things about doctors and patients and practices. I, I mean, trends. What I told you about women, I'll get criticized for that. I was just told you they're wonderful. We're working towards 50%. And then I gave you those statistics. They don't want to hear that. Not because, you know, it's the truth. I think you need to know that and just expect it and take what you can out of that. And again, we got some magnificent women. If you're from Pakistan and you can make $100,000 a year in the United States, dental school might be a little more desirable. So do you want to? Pakistani dental force. I, maybe we do. We have some minorities, we have some foreigners, and they're honestly, they're fantastic. No, no Pakistanis. I think that's why I used it, 'cause I can't think of a Pakistani.

Dr. Kushner, where do you feel like you're most misunderstood when it comes to your contribution?

I think They probably would accuse me of being all about money. And I was trying to find a better way, an easier way for me and my partner, my initial 3 partners, mostly lecturing, pass on this information and get away from the chairside for a while. Wasn't all about make the most money. It was never about that. It was never about stopping practice. Uh, you know, we all have our bad moments. Oh, I gotta get home before this kills me. We've all had those moments, but we show up the next day. And I saw my last patient in 2002. So I worked even a semi-regular schedule for 25 years. And then now you don't want me, now you don't want me working on you.

So, so if there's a dentist that's listening right now, they're not in Comfort Dental, they've been 8 years, 10 years in practice in some capacity. And they don't like the profession, they feel trapped, but they kind of have to stay in it because they've invested in that DDS or DMD at the end of their name. What would be like a natural first step to maybe see if some of what you're saying, because it might sound too good to be true.

Well, we have, we have these recruiting meetings and we call PPoD, potential partner opportunity discussions. It used to be a legal requirement for franchise. I don't, I think I learned that it's not legal, but It works so good. Uh, there's a lecture that 15 minutes that I said, I, there's a half-day lecture, there's a visit to the lab and then visit to any offices you want. And then that evening in the, we have a penthouse at the Four Seasons in downtown Denver. We fly them in, by the way, and put them up in hotels. And it might be a 50, 60 doc event. And we do that 3, 4, 5 times a year. And then we entertain them at the penthouse. If they want to drink, they can drink. If they don't, we'll feed them. They can ask their personal questions. The selling doctors show up. They can have personal discussions. And if they want to come back and visit, we, we have no restrictions whatsoever. Sure. Come on in here. We're doing 2 crowns here. Doing implants. Implants. I never did an implant. It wasn't perfected enough for me to go learn. It was, they were kind of They were kind of old school awkward. I thought they were, I thought they were too vicious, to be honest with you, but not now. Not now. And those students aren't getting implants in dental school. Now ours can teach it. They, we, we'll, we provide lots of CE. We provide lots of continuing education at no cost. Our relationships with the companies that sponsor the CE. Long answer for a short question. If you're used to seeing 15 new patients a month and now you're going to see, your practice is going to see, you know, 300, you're going to see 75. You can't transfer that same style of practice to our, you'll fail. You'll fail. They're typically when they, when you know, the economics is, you know, if you have a few new patients, they're all big cases. We would all love that, but you better be talented. You better be extremely talented. I've watched our number one guy. He's at Cherry Creek. Cherry Creek is kind of an upscale neighborhood, by the way, but it, it, it, it treats a lot. It's Colorado. It treats a lot of, uh, other neighborhoods. I've watched him. I, I, lots of perio. I diagnosis lots of, uh, gum disease. I know that complete treatment plan, initial interview, care calls. I've watched him and I don't understand it. And he's number one and he has been. We call the, uh, award, we call it the Million Dollar Club. We call it the Joel Stett Award. It's, you know, it's like Mickey Mantle.

I— So it's named after him.

We named the award after the guy who's been number one for 20 years. Wow. He talked about, he, I was joking, but I hope he takes me seriously. He said, hey, who's gonna retire outta your office? He, I'm just on the phone. We're, we're close. We're real good friends. I said, I don't, I told him what I told you. I don't, we don't talk about it. They're so good at what they do, and I don't know if you could take the pay cut. And he kind of, he kind of said, oh, maybe, maybe I better back off. But we make more. We, you know, we make more than all of them, of course, but we, we're supposed to. That's why they won't retire. They make too much money.

So I think something makes sense to me, and that is people see Comfort Dental again, they see the fact that it's beautifully cohesive and aligned in its branding at every location. And because the exterior looks like it's the same, they assume that the doctors working inside must be homogenous and must just be the same. And yet every dentist I've talked to has their own autonomy. And it's— I can tell by the way that they choose to practice. They want to be more implant specialty. They're Dr. Nguyen and they want to go more of the You know, associate route where he's actually passively making money, not having to work as much. I see every single doctor's individual expression of dentistry being able to be supported in your model.

Absolutely. Different personalities, different styles within the, within the same concept. Absolutely true.

Yeah. But from the outsider, they go, no, it's probably, you just then have to become this.

Now, aside from hard work, Yeah, there are some, sometimes somebody will adjust a clinical schedule. Well, we're going to leave at 6:30 today instead of 7:30. It's a good practice. We won't say anything. Fine. We'll just, you know, we'll note it and we'll log it and we're not obtrusive. We work to not be obtrusive, especially if they're successful. Leave them alone. Uh, I had another thought and it, it's, it escaped the senior in me.

I, I just wanna say thank you, Dr. Kushner, because you have been under fire for a long time, which is crazy.

I was under fire for a long time when I was out there more. My docs honestly love me. You know, somebody's in trouble and needs $15,000. I'll take care of you. Uh, they know that and they don't take advantage of it. If you are one of our partners and we got wind that the guy down the street told a patient something bad about you, uh, I'd go to bat for you. I would still do that. They don't bother me with it, or maybe it doesn't happen as much anymore.

Is that the Italian in you?

Yeah. Yeah. Yeah.

Forget about it.

Yeah. Uh, one, one final comment. You mentioned different personalities, different autonomies, which of course, and they own their own practices more often than you would think. A patient might have a personality conflict or might not agree with the treatment plan with a, even with a comfort dental doc. I would start by saying, Comfort Dental Doc screwed up, but he'll leave that Comfort Dental and go to another Comfort Dental all the time. All the time. Yeah, I'll just go to the one down the street. It's only another few blocks. That's not true, but we separate them. We're at a, we're trying to end.

Ooh.

I can't believe that. We're at a—

Time flies when you're having fun.

We're at another crossroads on my end of the deal, my team's end of the deal, that we didn't really expect. Because who thinks you're going to last 40 years or 50 years? Our facilities are wearing down, so we're renovating and we help. And some of the renovations have turned out good. We thought there's a, there's a wonderful practice in Lakewood. And I thought, oh, we're going to have to relocate them because this thing just— we did a renovation, turned out magnificent. So, but sometimes teardowns and sometimes rebuilds and sometimes relocations just because we wore out the facility. Something you don't really see. 40 years ago. Well, thank you so much. I hope it goes over. I hope somebody watches it. Like I said, I don't know who watches these things.

Thank you so much for letting me interview you today.

Thank you for listening. You can learn more about Comfort Dental at comfortdental.com.