133: The State of Dentistry with Howard Farran, Founder of Dentaltown - Part 1

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This is part one in my interview with Howard Ferrand, owner, founder of Dental Town. It's a fascinating interview. We talk about AI, we talk about the state of the dental industry, we talk about corporate dentistry and all things going on. We're going to do this one in two episodes. This is part one. Enjoy. Welcome, everybody, to another episode of the Dental Boardroom podcast. I have a YouTube unique and special guest, somebody that I learned about probably within the first few weeks of getting into dental way back in 2009 or 10, and that is Howard Ferrand, founder of Dental Town. Welcome to the Dental Boardroom podcast, Howard.

Hey, Wes. I've been a fan of you ever since you entered dentistry too. So this is. We should start a mutual admiration club.

I love it. A little bromance club going on.

Yeah, Bromance club.

Well, what you create on Dental Town is phenomenal. I don't think that there's a single central sort of communication platform or, or town center, so to speak, online where you have more of a gathering than what's on Dental Town. And I don't need to go into too much of a background. You were formerly a dentist, converted into sort of tech, into Dental Town, and at some point you made that your full time thing and the rest is history. Why don't you give us a some insight? What are you seeing from your perch as the founder and overseer of this huge marketplace of content and threads and communication? What are you seeing on Dental Town right now? And maybe what are some exciting things you have coming out on your roadmap before we dive into how the dental industry is doing?

Well, you're right. I am a dentist. I graduated in 87. Did I graduate dental school before you were born?

Nope. Nope. I'm 78. I'm 78.

Y. Oh, oh, okay, okay. So you were born, you were, you were alive and. But yeah, you know, I got out of school in 87 and I, I retired at 60. I sold my. Today's dental office. I really, I really. The main problem with me is I, it just got harder and harder to see. I mean, everybody's different. My back was fine, neck was fine, but you know, I had loops and lights and starting about 55, I mean, I, I just couldn't see. And so I, I, you know, that treat other people like you want to be treated. And I, you know, when I was doing a root canal one day and I said, would you really want you doing a root canal on you? And I thought, no, I'm out of here. And so if you're, if you're, if you're gonna go have brain surgery or a bypass, you might. You might ID the doctor and say, can you still see? But if you got readers. But. So I retired and it was really fun for about half a year. I mean, I went and spent two months with mom in Kansas. I went to Texas where four of my eight grandchildren live, and stayed with them two months. And in Arizona, I had spent two months in, you know, Apache Junction, where two other grandkids, and two months in a good year or another two. And. And then I was retired and I just, like. It's like, what am I gonna do? People kept saying, well, you should travel. It's like, dude, I've lectured in 50 countries five or more times. Like, seen it all, I've done it all. And then out of nowhere, Chat GDP came out. I had nothing to do with Chad gp. And I got four sons. One of them's a programmer. And he came over and this is about 20. It was two years ago September, and he came over and he said, dad and he download the app. And it was. It was like 1998 all over again when, when the Internet came out. I mean, and I, I remember getting tingly when AOL said, you've got mail. And I'm like, oh, my God. And I was on this Yahoo group with Mike Bar and Rude ZX within Adonis. You'd open up your. You'd open up your email and you'd be like 100 emails of people talking about root canals. And it was love at first sight for me. And then I had the same feeling with this AI. And Dental Town was, you know, everybody on that team had been with me for 25 or 30 years. My. My first assistant, Jan, saved me 30 years. Everybody on the Dental Town team, you know, they were. They, they were rock stars, you know, for 25 years. But this was a whole new deal. So I, I basically set up a whole new AI team. And I was so dumb. I thought all my dreams on Dental Town, it take us like six months to implement this. Here we are 26 months later. And, and with, you know, and it just. The project just keep getting bigger and bigger and bigger. We haven't really. We haven't released anything. I can't believe we haven't released anything in 26 months. We've been on this thing, but I keep saying we're about two months away. But, you know, I just. I just wanted to. I mean, I think AI is so huge, and we're sitting on 10 million posts where 10 million questions where a dentist said, you know, how do you find an MB2 and all this knowledge and all this wealth and so we're just redoing the whole thing. And it's going to be so, so exciting because I, I think the most exciting thing is like my relationship with Chat GP is I'll show you, Wes. I have this little Even when my phone's off, I got the new phone, the new iPhone. See, see that's got that wedge.

I do that.

That's Chat gp. That's like my, my, my best friend and same thing.

There's mine right there. Oh yeah.

Oh my gosh, there's mine right there.

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And every. Everywhere I'm at, I mean, like, you know, like you'll be in a car and someone will say, I can't believe how. What's the population of Phoenix? Yes, well, well, let's, let's get the answer. And, and I, I want them to have that type of relationship with Dental Town, where instead of searching for a thread, they can just hit that widget and say, how do you find an MB2? And then boom, there's dental town and there's a five, six biggest threads on how to find an MB2. And, and it's going to be, it's going to be super exciting. And the other thing that was causing me, I, I had also retired from my, my podcast Dentistry and Sensor, we'd done like 1700 shows and, and I just retired from it all. But, but what really got me back in is all the emails and, and text messages. The dentistry split in two and the young ones are not happy and they're, they, you know, they started pushing back on me and saying, well, you're an old man. You graduated in 87. I mean, that was 40 years ago. And, and life was easy and dentistry was easy. And now we got DSOs and we're coming out of school with $500,000 in student loans and, and, and they're just not happy. And they started saying, I don't want to listen to an old man like you. I want to listen to somebody who's surviving all this stuff. So I thought, okay, I need to get back in on the podcast and I need to get back on Dental Town and I need to start addressing this Dentistry, it's split into markets. And first of all, I want to address some of their complaints. First of all, dentistry is still the best damn decision you can make. I mean, right now, programmers have been almost completely automated, you know, for the last two years of Chad gp. Everybody said, oh my God, you got to go to college and you got to become a Python full stack software developer. Okay, that's been completely automated. I mean, AWS is automated just with Kiro. I mean, Kiro alone. I mean, I remember when we started this project two years ago, I said, well, you know, someday Chad GP is going to be writing the code and my developer just like yeah, right. And then after about a year they're like, you know, it writes about 85% of the code, but you still got to go back and edit all. And now they're on Kiro, which, which is what Bezos launched with aws. He's been working on that for five years. And now the programmer's like, son of a. Now my programmers are telling their friends at ASU that are study via programmers to change careers. So, so, you know, if it's like the greatest mathematician alive today, even if you brought back Sir Isaac Newton and Einstein, it's still AI right now because it's so quantitative. But you know what's going to be really hard to, for AI to do is the soft stuff. Like, like when you call a dental office and you have AI answer the phone, it's a nightmare. Hell, they didn't even like the push button stuff. You know, humans talking to humans isn't going away. And no one's going to go to a dentist that's an ATM machine and a robot and have some R2D2 come in there and start jacking with your mouth. I mean, you know, you know what AI is not going to do is replace the, the soft stuff, the human stuff. And AI answering the phone has been nothing short of a disaster on Dental Town. I can't find one thread on Dental Town where switching to AI, you know, because, because they, they start thinking, oh my God, if I had AI, I can just buy some software and I don't have to have all these people answering the phone. Yeah, if it was that easy, you'd be hearing about it in other places. I mean, it's just not working. But AI is, is coming, like, take, take oral surgery. My gosh, Yomi now has placed 40,000 implants. I remember a couple years ago when they passed 20, I remember two years before that when they were trying to get, you know, when they were just talking about, hey, we got an oral surgeon to buy. I mean, oral surgeons are not going to be replaced by an AI robot named Yomi. But oral surgeons with Yomi are going to replace the oral surgeons without it. I mean, I see oral surgeons in the future running three, four bays of yomis and they're doing all the soft stuff and answering all the questions and making you feel relaxed. But when it comes down to surgery time, do you want a primate with 10 fingers and 10 toes who can only see 50 microns, where when you do the lab work, you can always tell if the dentist was right handed because everything's leaning towards the right or left handed. And, and I'll give you an example. The facial biopsy stuff out there in Beverly Hills where all the beautiful people like you live. My gosh, they, they, you know, if you, if you have a big bio, if you have a big biopsy like on your nose and you're good looking, you know, if you're like me, they just chop your nose off and send it to the lab. They wouldn't care. But if they were good looking with all your hair and all that stuff, you know, they'd want to. So they cut a little and then they go freeze it and look under the slides and come out and cut a little more. And it could be a three and a half hour biopsy if it was a big one on your nose and you did not want anybody to notice this scar at all. Well, now a robot, it sees at 1 micron, so it's looking down there. It doesn't need a scalpel. It can tell the difference between a cell that's cancerous and a cell that's not. And the hand is steady, there's no shaking. I mean that yomi goes in there, it's like a thickness of a pencil. I, I mean we're not going to be able to compete with AI it's the dent like oral radiologist. Well, you still need to be an oral radiologist. But an oral radiologist with AI is going to have 10 times the productivity and, or, and where are they going to get that productivity from an oral radiologist who doesn't use AI I'll give you two examples of. @ the gym, every morning I go to OES and there's two other old grandpas in there that I work out with. And one of them is a architect and one's a lawyer. And the architect told me like downtown Phoenix. You won't believe this but you know, they'll buy a city block and build a 40 story apartment complex and it'll have, when it's filled up, it'll have 20,000 people in it. I mean, I mean you go to, you go to Douglas, Arizona has 19,000 people and it's all spread out city, you know, big old, big old city. I mean that's one city block. And the architects say, you know, that's, that used to be a million dollar contract in a year for me. They would come in and they tell me what they're doing. And then we go look up the land and the soil and run the test. And I'd have eight or nine guys on a draft Board and that was a million dollar year long contract, sometimes two or three million dollars. Now he said we, we hired a draftsman with an architect with had a degree in computer science and was on Python. And now you come in and you'd say hi, I'm Wes and I'm going to build this part apartment complex. So I bought this pad. They the, the, your voice activated. The AI looks up the pad. They already got all, where all the pipes and wires and, and everything. They got satellite pictures of it. They know the ground, they know everything about it. You tell me that it's going to hold 20, 000 people 40 stories tall and it's saying well Wes, did you want those apartments at 8 foot ceilings? Because this would be your electric bill at 8 foot. Did you want it at 10 foot? Here's your electric bill 12 foot and, and you're talking it out and what is the color? And when you're done with that hour, hour and a half, meet greet meat about your project, it's done, it's all designed, it's done. And then if you come back and say we decided we're not going to go cheap PVC pipe, we want the expensive copper one keystroke done. I mean it's great. The lawyer, this lawyer has nine people in his law firm and they said, you know when they're getting their next lawyer, instead of looking at GPA and all this stuff, they're just going to look for someone who had an undergraduate degree that had a degree in computer science or computer engineer something with a full stack software developer. And they got one same thing that guy set up. He said, you come into me, you couldn't get in for two weeks. You come in, we talk, yak for an hour and then I got all these books behind me in a library. Then I look all this stuff up and two weeks later you come in and he says, now this kid, he just records it all as you're talking. It's prompting like the best follow up questions. It's looking up all the statutes in Arizona, the United States, all the other countries and then going back in time to get a full feeling of how, you know, people deal with this type of issue. And by the time the 30 minute conversation's over, the lawsuit's done, it's all written up. If it needs to have a court date, they've already emailed the, I mean it's crazy. And that's where dentistry is going to go with AI. I mean AI is not going away. It's going to be as big as the industrial revolution. And, and remember when that, when they came out with the steam engine, it took seven. You know the first application was so big and bulky was just a pump water out of flooded coal mines. And then it got smaller and smaller and it fit on a ship and disrupted shipping. And then when it got to America they built canals and railroads and it took 75 years for that thing to actually get hooked up to an assembly line. 75 years. AI is, I mean they are invest, I mean look at the Mag 7. I mean they're investing billions of dollars a day, billions of dollars a week. They're building one gigab data center. A gigawatt is a nuclear power plant. So these gigawatt, these 1 gigawatt plants take a full time nuclear reactor 24 hours a day. It's, it's not going away. But back to dentistry. You know these young kids, they got a lot of student loan debt. But I'm going to push back on that. I graduated with $87,000 in student loans. In 87, which in real and constant dollars is 250. So I had half your debt. As far as the supply and demand, the supply and demand of dentists per thousand Americans is the same in 87 as it is in 25. The big hurdle is you got a big old bottleneck of all these old boomer dentists who are all getting ready for their dirt nap. And so the supply is going to, it's going to, it's going to fall off. I mean you can look at the Christmas tree kind of like when you look at like countries like China and Korea and Japan where they got, they're getting a big top with elderly and hardly any replacement kids. And the world, the earth population. When I was in dental school, when I was in high school, one of the biggest, most popular books I think it came out in and when I was in high school, the population bomb. And it had a grenade on the COVID that looked like planet Earth. And we were going to overpopulate until we starved to death and all this kind of stuff. Well, now we know for a fact we're in the third year of a global population contraction. The global population is contracting. Everybody's got a smartphone. And you know what, you know the, the people who are going to have five, six, seven kids besides Mormons and Catholics, is, is people start getting an iPhone, they say hey, I want a new car. I don't want a kid. I, I wanna, I wanna go to Hawaii. I don't want a kid. And they realize that kids cost money and money matters, incentives matter. They're saying, like, my mom had seven kids, I had four, and then my kids are all having two. And so, you know, the, the contraction is real. So I, I, I, I, the dentistry is solid. It's not going anywhere. It's a great profession. And, and what would you have rather gone into dental school? Would you rather been an architect? That's going to be AI automated. I mean, everything's going to be, you're a dentist. And another thing is when I was a kid, you know that if you had seven kids, only the ugliest kid whose teeth were so crooked they look like they could eat corn on the cob to a chain link fence, only that kid got braces because you figured if you didn't, he had, you have to join the priesthood or become a nun. No one's going to marry this goofball. And now every kid gets braces in school and then they get them again when they're 30. And then if they get divorced at 40 or 45, they're back in for, I mean, everybody gets ortho, everybody's getting it several times whiter, brighter, bleaching teeth. You just, you, you know, you can't lose a tooth and go, I mean, if you ask a one, what would your wife do if she lost her front tooth? How much money would she pay to get that tooth back? If it was going to cost a million dollars, Wes, she would make you, she, she'd make you donate your liver and both kidneys. She'd get that tooth back in. I mean, it would emotionally shut her down to be missing her tooth. Whereas back 40 years ago, you know, just, just, it added character. And so dentistry's rock and roll. But here's the deal. Corporate dentistry is a real thing and they're getting, they're amassing a lot of capital and they're scaling, in fact, I, I gotta tell you, you know.

What I want to do? I want to hear about corporate dentistry. I want to share a few thoughts though, before we pivot into that subject, because you're going into a. Well, that could take a little bit of thought and time into that. Can I just comment on a couple of this thread about AI and the state of dentistry? Not too long ago, about two weeks ago, I was in San Francisco and they had this really, really cool museum called the Computer History Museum, and it's in South Bay. And I went there, I took my daughter, we were college campus hopping and we looked at the origin of the computer and the evolution of computer technology over time and the span that we have covered, the innovation that has occurred since those 80s and 90s, that era is just phenomenal. And there's this thing called Moore's law, which maybe you've heard of. And Moore's law states that the number of transistors on an integrated circuit doubles approximately every two years. So processing speed, storage capacity, everything gets doubling every two years. And when he said that in 1965, this was somebody named Gordon Moore, very few people believed him. But you know what? It proved to be completely true. And, and it kept going. And he said it would go for 10 years and it sort of kept going. And I think we're going to see that in AI as well. Think about how far we've come in just two to three years of AI. I mean, they're even talking now about putting these AI data centers, these compute sort of centers in space in order to have more room for it. And so it doesn't consume as many earth resources. It's not sort of this loud construction project on everybody's street corner. Because the amount of invested money that these big companies, these MAG7 especially, are investing into these data centers in order to have compute power is unbelievable. And their capex spend, their spend on capital improvements or capital like these data centers is unbelievably high. And it's one of the first times where the stock price is moving up or down, not based on profits, but based on how much money they're spending on AI and AI development and.

These centers.

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That's I mean, how often is a, is a business evaluated by how much they're spending rather than by how much they're making? That's how much of a nuanced, unusual place we're at right now. And then when you talked about Dental Town having all this data, the millions and millions of threads and data going back, you know what that reminded me of, Howard? It reminded me of Reddit and how Reddit is a key data source for these AI LLMs, these large language models and their data sets. So much of that is coming from companies like Reddit because it's the depth of topics covered and threads on these topics. You just don't find this anywhere else. You've got the same thing, but dental specific. I didn't think about that comparison until you kind of brought that up. But I love this idea. I go into Dental Town and there's sort of an AI chat search at the top and I can type in whatever I want. I'm thinking about buying this practice. It's got four ops, it's doing 1.2 million. Here's some of the issues I'm running into. What are your thoughts and what should I be aware of as I approach this, this acquisition? And it'll just come up with some really, really helpful subjects there. And it can be on, I would think anything, given the, the, the number of topics covered on dentaltown, I think that's such an opportunity that you got and I say keep at it. I think that's great. The other thing I'll, you know, for me, I'm kind of thinking of the same thing as well. I want to be able to plug in our clients QuickBooks data set, plug in our personal financial planning software, plug in their tax returns, plug in our own sort of notes and meeting dialogue, and then feed into this thing.

A data set that answers a lot of their questions like can I deduct my car in my corporation? Or can I deduct travel in my corporation? Tell me about the research and development, tax credit, all of those things. Or they could say, how much have I paid to Patterson over the past three years and what does that change look like? Or how has my labor cost changed over time? And because it would pull from all of these data sources, they would log into practice CFO's online account and have their own AI chatbot and can have their own data practice CFO specific data set to answer those questions, just like you would use on ChatGPT. Now here's the thing. I don't think any of this ultimately dispenses with the human involvement, at least not yet. Because I think that this AI tool, this incredible resource, will help professionals curate what is the best possible outcome. I know with me, there's taxes and accounting and debt and cash flow and labor costs and personal financial planning goals and personal taxes and insurance. And all this stuff sort of weaves together. This is what we do at practice CFO is we weave all of these different technical areas into a very customized financial roadmap for a doctor that is very nuanced to their perspective on life and money and what they want to accomplish with it. And it's so personal. There's a lot of soft elements to it that I think when it comes to dentistry or when it comes to financial advice, there's still a huge need for somebody to curate everything coming out of AI and all the data to create a very specific applied outcome for, for the customer or, or for the client or for the patient. So I'm excited for all of that. All right, let's dive in now to, let's dive into.

You know, one other comment on, on the AI Howard. I did a AI in dentistry series about three or four months ago and I interviewed eight CFOs and salespeople from these big AI companies like perhaps Pearl and Overjet and others. And one of the things I got out of that was.

There is a race by these companies to build the biggest data set. It's like an arms race. Whoever can get.

The biggest data set inside of their custom LLM ends up kind of being the winner. Sort of like Google was the first with the search and Amazon was kind of the first with an online marketplace trying to get almost first to market with a really large data set. So which company has the largest data set of radiograph analysis inside of it? That one typically is going to win because it's going to give the best sort of analysis of a given radiograph of a patient. And that's what I'm noticing right now is this arms race to get the most data. So what a lot of these application layers over AI, these sort of softwares built on AI are trying to do is just get that data set. They're willing to take a loss. It requires a lot of investor money because they're essentially giving a lot of stuff away at a low cost or free in the beginning just to get the data. Once they have the data, then they can start to monetize that better by charging more for their services, which I expect in about three years or so you're gonna see costs go up on a lot of these AI based applications. Once you have clear winners coming out, just like in the dot com era you had clear winners eventually emerge out of that like Amazon. And those are the ones that are gonna really monetize the fact that they had the data, they had the depth and they're the ones who are gonna be the winners out of this. So it'll be interesting to see how this all unfolds over the next few years. And I'm really excited to see what's gonna happen there on Dental Town with your.

AI. Well, the one thing you got to remember is, you know, we, we lived through this with the, the dot com deal. I mean how, how old were you in 94 to 2000? How old were you in.

2000? In 2000 I was.

22. Yeah. So you live, you live through this. And, and, and, and back then from 94 to 2000, the, the Four Horsemen, like we had the Magnificent Seven. The Four Horsemen were Microsoft and intel and Oracle and Dell. And look, look at Intel. I mean that's how early we are in the game where Nvidia has the biggest market cap of 5 trillion. Nvidia is not going to help make any. All the value is going to be the companies built on Nvidia chips. We're so early in this, this game. If it's a baseball game, we're in inning one where the intel, the Nvidia chip is still the big player with, with the highest market. I, I live in Phoenix with an intel plant. I'm on my page. I remember when intel was the biggest rock star in the world. Buy the whole company for 90 billion in the US government, about 10% of it. Nvidia is, is not even gonna. In fact, in 2000 after the crash, the biggest companies that, that made the most money like, like, like Facebook wasn't even born till 2004. The market crashed in 2000. The, the, the big companies. And as far as the race, the reason everybody's investing so fast is behind the scenes, everybody knows that, you know, if China gets his first or America gets his first, it's going to be a winner take all. I mean, I mean because right now it's chat gp, it's a large language model, but it's headed very fast. To artificial intelligence. And, and then, and then the, the, the programming chips. Right now in Nvidia everybody knows that when the the ran on quantum computing, in fact there won't even be any passwords because quantum computing can compete so fast that all your passwords would be hacked. The entire Internet would be transparent to whoever owned that quantum computing network. And I, that's why IBM zooms while it's getting so much money, the government is funding so much quantum computer researching. Because who, if whoever gets quantum computing and AGI, it's a winner take all Globe. I mean you, you could not look at the asymmetry warfare between big old huge Russia versus little bitty old Ukraine. You know that the high tech company is holding off the lion and, and also back to the outer space. Well yeah, the cooling is everything on these centers. So in outer space it's 2.7 Kelvin above zero and you have unlimited solar. And if you could drop all that data down on a fiber optic cable, that would be the way. But, but back to, but back to dentistry, we're seeing it diverge into two we're seeing corporate and we're seeing private practice. And those markets are differentiating corporate. You know those guys are using AI. Those guys have better practice management software. They can have someone full time in accounting like you. The only way an individual can compete back with those guys is, is to have someone like you for the individual. And, but corporate, you know, they, I mean when they can come into your neighborhood and carpet bomb Google Ads. But, but the one thing I want to say about DSOs is I think DSOs are exciting and sexy. I just think it's got a very big branding issue. Crazy. Everybody thinks when you talk about dso, they're thinking about Rick Workman's Heartland with a thousand locations or thing in Pacific Dental Services with Stephen L. Thorn and his thousand locations and Aspen, they think of these big old thousands. But there's 2800 DSOs and almost all of them, standard deviation two are between four and nine locations and that's where all the section is, is because let's go back to that, let's go back to a small city like you know, say, say some small city of a, of a hundred thousand and you got a, and you got a dental office on the south side. I mean, I mean how are, you know if you sit there and go to a north side, east side, west side and you go to four locations now you can carpet bomb that area with low cost radio ads, low cost television ads, billboards and with four locations you can have a full time marketing director, a full time insurance coordinator, a full time cpa. I mean, you can have a full time Python programmer, you know, analyzing your data. You're big enough to scale and that's where all the sexiness is happening. And, and every time I meet a dentist, let's take it home. Three or four or $5 million a year, they own between four and nine. Now we don't start counting until four because three is when they all die. If you're a real go getter, ambitious dentist, and you want to have a satellite location, you can muscle both. And then you decide, oh yeah, I'm going to go to the third one. And that's a breaking point where if you don't have the systems in place, you break at three, you end up having to contract. You sell off number three, you, you get, you, you fold all the way back down. And when you look at all the greatest companies in the world, like McDonald's, they spent 19 years on their first 10 restaurants. Chick fil A, I mean these companies, all the great ones, spend a decade on prototype number one, getting the right people, the right team, the right systems. And then when it buds from one to two, they sit there for another year and understanding the systems and then that two, maybe two years later, buds into four. So now they spent 10 years on a prototype and another four years budding to two locations and budding to four locations. And those guys are crushing it.

They can own a small town. And those are the ones that there's so much money being poured to. DSOs. They love the Rick Workman's of the world because that's their liquidity. That's your exit strategy. I mean, if you got four dental offices and, and you're doing $10 million a year, who are you going to sell that to? Some kid that just graduated from dental school with $500,000 of student loans? No. Rick Workman's the only one who's going to fly into your town in a jet. I've seen it. And.

He'Ll write you a check. He's the liquidity master. I mean that, that guy is absolutely the smartest man in dentistry on when it comes to the business of dentistry. I mean, I mean, but, but everybody looks at that guy and thinks that that's, you know, that's the threat. That the threat is that in every small town, in every city, half of that market is going to differentiate into these DSOs between four and nine locations. It's not the Rick Workman's of The world or the Aspen or all that stuff that you got. And what I love about Aspen the most, Aspen is really high on my list. They're the only one that intentionally went after the Medicaid, Medicare market. All the other DSOs and all the dentists on dental town, they all want to go to a 60,000 median household income or more. And when you go up to Scottsdale, not only is there a dentist on every corner, but all the houses are big and take up a lot of land. And then you go to South Phoenix where you know that same acre of land has, you know, a 9 plex on it with, you know, 10 families living in there and, and the density is high and they're on Medicare. And dentists just don't know how. Dennis only know how to do Ruth Chris. They can't get in their skull that McDonald's makes a incredible amount of money. And like take Rick Workman at Comfort Dental. He's got a hundred locations at Comfort Dental. And that guy's got a jet and those guys are his doctors are making bank because like, like, like you say you have a Medicare clinic. You know, if, if you got two cars and one's a used car and one's a news car, the dentists are going to try to sell a new Mercedes Benz. And while getting paid for a used car, I mean, I don't care if you want to just break it down into a Ford Escort or a Ford Taurus. I mean one is, you know, twice as much as the other one. And they'll go in there and they'll say, well you know, you gotta do, you know, they won't do amalgam, they won't do extractions, they won't do flipper. Aspen Dental goes in there. I lost my uncle who got free dentistry for me, I lost into Aspen. You know why? Because he coming to my office and he has a drop off his removable and then I send it to a lab and then he gets it back at the end of the day. And he said, all the old guys I golf with, they go to Aspen and you drop it off there and the guy fixes it right there and you, you leave with your teeth. I, I don't, I don't want to waste the whole day without my teeth. And you know the, so you know, Aspen's focus and, and if you can't make money on Medicare, then you need to call up McDonald's and Taco Bell and Arby's and tell them they all need to shut down. They, because the Mexican Taco Bell can't compete with Macao's. When I go to Taco Bell, I get two tacos for a dollar. And then when I go to Macayo, two tacos, rice and beans and a plate. I mean, that, that, that's 15, 16, you know, it's 20 bucks to eat a lunch. In my call, they don't understand market differentiation. And the other thing I can't understand is the bad attitude these kids come out of school. First of all, let me address some of the bullshit they talk about the $500,000 student loans. Okay, well, there's two dental schools in my backyard at still in Mesa, Arizona, and Midwestern in Glendale. Drive through that car lot, you couldn't count the Teslas in the parking lot, you couldn't count the $70,000 cars. And then on vacation, they go on cruises, they go skiing. I mean, they live like rock stars. A lot of them get married, have stay home wives. They have one kid walking and one in the oven before they graduate. Then they're like, oh, $500,000. And then I tell them, well, okay, live below means go back and live with your parents. You know, they would love it. You got a kid, they got a grandkid. Go back and live with your parents until you get all that paid off. And what do they do? They say, no, I'm not doing that. Next thing I know, they're talking about buying a house in Gilbert. And it's more than their student loans. They were all whining about their $500,000 student loans. Now they're buying a $550,000 house in Queen Creek. I mean, so, you know, that's all emotional. The bottom line is, the bottom line is if you go, when you get out of school, I mean, you got to do your reps and you've only done like what, you know, 15 canals of endo. 15 canals of units of removal. You need to go work for someone and learn clinical dentistry. And there's no better place. I did. When I got out of school, I came to Arizona and Ed Silker had one of the first DSOs out here. It's called Sunshine Dental. And he had four locations, north, south, east, west. They were open from 10:00am to 10:00pm it took four months for them to build out my office in Ahwatuki and get it up and running. So for four months I work 10am to 10pm seven days a week. And my guy, I was doing my. To get out of, um, Casey Dental School, you had to do 50amalgams. You had to do, I think.

35 extractions, 15 canals of endo, 15 canals of room. I was doing that every week. And I was in there in a group practice. So when I pulled out a tooth and I couldn't get all the way out, this guy named Nick Gidwani, my savior, he come over and he'd show me how to get it out. And in that four months, and Nick, Nick bailed me out of so many teeth, I, I, I could get all my teeth out. And I was doing so many feelings. So you need to get your reps in and it's either going to be a mentor like I had a mentor like Nick Gidwani, where he actually showed me how to do, you know, dentistry and extractions at a whole nother level and then, or the business, I mean, I was listening to Ed Silker, you know, he was on four lane intersections, he was doing billboards, he had four locations, he was doing direct mail. And that guy was teaching me the business of dentistry. And then I meet guys that worked for Heartland for a year or pds and they're just like, oh, I can't hate working for dsl, I just hate it. I said, okay, well you've been working for Stephen Thorne. He's got a thousand offices. Sit down and show me how to check out a patient on the, the software. Oh, I, I don't know how. Oh, you just, you just want to sit and whine in bits. I mean, you know, the opportunity to work at Heartland for Rick Workman. He owns a thousand offices. I mean, and furthermore, look how many studs I know that worked for him for a year or two and finally got all the skill sets and they could, they could treat a toothache. I mean, the big money is not in cleanings, fillings, exams and X rays where delta dental is going to pay you about a nickel more than your cost. It's going to be in a toothache where dentistry started with Pierre Fashard over 200 years ago. I'm going to come give you a coin because I'm in pain. And you're either going to do a root canal and a crown for $22,000 plus, or you're going to pull the tooth and place an implant for another two, 3,000 plus. I mean, those are the big money. And then they, and then they come out of a year or two working and they, they, they know how to do endo, they know, they know how to treat a toothache. And if you say, oh, well, I don't want to, I don't want to do toothaches. I just want to do cleanings, exams, X rays, fillings, bleaching, bonding, veneers and Invisalign. Okay, man, that, that, you can do that too. You know, it's called being orthodontist, but you know, that's your. Now you're competing with orthodontists where when you see that Invisalign patient, you know, you're scheduling a half hour to see it and the orthodontist is scheduling 15 minutes to see it. So they're seeing four patients an hour for 50% overhead and, or maybe 60 and you're, you're doing two patients an hour. So I don't know, it works there. But they, they learn dentistry and then what do they do? They leave with like the best assistant, the best office manager, and they go set up a practice and they, they, they, they, they, they got great demographics. They do a million dollars the first year. And the biggest hidden valley is those DSOs. They can't go to those small towns because when you come out of school, you're a prime mating age and you want to go find a mate in Phoenix, Arizona in a 5 million person metro. Or do you want to go down to Eloy with 30,000 people and find your mate there? So if they come out of school, they're in prime mating, breeding, marrying age. And it's very hard to attract associates down in rural. In fact, when those DSOs went rural, they said that 10% of their rural stores did not have a DOC in the box on any given day. That's how hard it was. So they're staying all in the urban area, they're all staying in the 60,000 median household income more. They're going to kick your butt in marketing, advertising, negotiate better supplies, all that kind of stuff. But where they cannot compete is the human relationship. I mean, I saw that in Phoenix, Arizona. They come in from big box dso. We got, you know, half a dozen of them here. And they'd say, well, this Dr. West, I went in there and he told me I had three fillings. And I came back and I did two on the right and then I came back to have west do the other one on the left. And now west doesn't even work there anymore. And this doctor New guy says that I got two other cavities on the left and that the one that was done on the right, one of them needs to be redone because it wasn't done right. So I'm like, oh yeah. So I'm doing that and then I go back there again and now that guy's not even there. I mean, you know when you can't keep your doctor, you know these DSOs, I mean, I mean, you would be shocked at how short of a career. Talk to any dentist that's been out of school for five years and ask them how many jobs they've had and they're going to say five. So if you can't retain your doctor, you're not going to build a relationship. And, and the, the. I think my secret for my today's dental is that I would come in and tell them they need this and I'd leave. Well, Jan's been there for three decades. I remember when I left my, my, when I sold my dental office, the new hygienist that we just hired had been there nine years. It's called relationships. It's like they want to go where everybody knows their name and they're not going to let a robot treat them, they're not going to let R2D2 treat them, and they're not going to go to a dental office where every time they walk in there, there's someone different. And the other thing, the DSOs are really you. You can just spot it. A DSO. I mean, I mean, you know, there's two types of DSOs. And you, you know, when you go into McDonald's, you know the, the movie, the Founder? What's the Founder? My, my dad had nine sonic drive ins and I went to hamburger conventions. I actually listened to Ray Kroc lecture when I was 10 years old and he was telling me about how the most important thing in the restaurant was the woman's bathroom because they're going to get off that interstate and she knows the filling station is going to look like a camel, just uses it. She knows if she goes to 7 11, they're going to be liars. They're going to lie to their teeth and say we don't have a bathroom. It's like, what do you, do you have a catheter out of your kidney? I mean, come on. And then they're going to go to McDonald's and mama's going to know, oh my God, they have the best bathrooms in the world. And we're going to clean the women's bathroom every hour on the hour. It's gonna have toilet paper ever. It's gonna be checked every hour. And he, and he said, I remember him saying this when I was 9 or 10 years old. He said, men's bathroom, you don't even have to clean it how those boys will pee on the truck. They'll pee on the tire of their own 150 of their own F150. They'll pee on a tree. They'll write their name. And so mama's a squatter. And when she knows you got the cleanest bathroom on the intersection while she's squatting, Daddy Bear and baby Bear going to be ordering our delicious salty french fries and our delicious Coca Cola. He just knew the people business. And you go into. But here was his trick. He would not hire you. And this didn't make the movie. And I thought it was sad unless you were married to a stay home woman with a couple of kids. And then he was only going to sell you one franchise. He said, that man will just. He's modern day slavery because he's not feeding his mouth, he's feeding four mouths. And those children and Mama Bear wake. Well, Chick Fil a took it a step further and said, hell, we won't even hire people that would work on Sunday. We're going to get Christian men that are married stay home wives and they have family values where it's against their heart and soul to work on the Sabbath. And the average Chick Fil a is doing 5 million a year. McDonald's doing 3 million year. And then you go to, then you go to Burger King. They'll sell you 10 locations. And that office manager is running down to 10 locations. The owner doesn't even go in there. And you know, he, maybe he retired from the NBA and he had $10 million. So he thought how I'll just buy 10, 10 Burger Kings, Subway, same thing. Eight or nine locations. When you walk into that DSO and you're out of school, first thing when they show you the office, you say, oh, you're the office manager. Yeah. How many offices you run? And if they say 2, 3, 4, 5 run. How many? Just run. Don't even listen. And when she said, oh, this is my only location. Oh, how long you been here? What to, to everybody in the office has only been here two years or three. Or has everybody in the office been here 10 or 20 years? And when you meet the assistant, how long you been here? I'll be, be 17 years this November. Look at the, the, the dentist. Is, is he on wife number three? Is he on wife number four? If he's on wife number four and no one's worked in his office two years more run. You need a mentorship and either how to run the business or clinical dentistry and, and, and that, that's why Rick Workman is getting these people to go to Heartland because he's saying, what, what is your goal? You stay with me five years, you'll get your fellowship, the agd. Do you want to do blood and guts and learn how to do implants and endo or do you want to do soft and pretty cosmetic dentistry, bleaching? And he's, he's trapping him down saying, give me five years, your life and you'll be able to treat any toothache with a root canal or an implant, whatever. But you know, so you're either getting clinical dentistry, it's like the med schools, you know, it's all the med schools are moving their hospital from where the university is to where the big city is because they say, look, we're running a med school, we need more primates. We, we, we, we can't operate in a town of 30,000. We need to be in downtown big city so that we get that one out of a thousand, that one out of ten thousand, that one out of a hundred thousand, one out of a million diseases. And so get your right attitude, you're in the right profession. I mean it is so easy to crush a dentistry and just find out what your decisions are. But DSOs are going to beat you in anything that can scale.

And they're all going to be four to nine located. The DSOs that's going to get your butt. It's the one in the small town that, that's got four locations in a small town of a hundred thousand. Not the one off Heartland or the one off Pacific or the one off Aspen. That, that, that's not the one you should fear. You should fear the guy who was born in that town of a hundred thousand and he's got a north, south, east, west location. He don't have the employee turnover. He's doing partnerships, he's doing, you know, he's, I mean he's partnering with it because he's got a liquidity problem. You can't sell a 10 million dollar office, anyone other than Rick Workman, but you could sit there and go to your 10 dentists or your eight dentists that work in your four locations and sell a million dollar slice to each one of them. And you could do owner, carry financing. And then as far as the individual, you have to specialize in accounting. That's why I'm on your show, that's why I'm your big fan. Because these guys will go to their, their church and they'll, they'll ask the priest or they'll ask the temple. They'll say, well, who's a good accountant? And they'll say, oh, Bobby Joe, he's such a good man. And I'm sure he's a good man. He's, he's all a good man. But does he specialize in dentistry? I mean, the numbers are quantitative, but you need someone specialized in dentistry because there are markets where the, the, the people who specialize in like accounting will say, well, all I, you know, I don't know exactly how, but here's nine PPOs. And I know that when, when my clients drop these five PPOs, they net more money. And you know, and these are the good ones, these are the bad ones. I mean, you need to get someone like yourself that specializes in accounting, that specializes in retirement where you say, okay, I came into this thing, $500,000 in student loans, I'm going to go work, get a job. I mean, a mentor on how to run business. I mean, how do you keep all these employees and patients? Look at hygiene. I mean, if you get, if you go to an office that gets 30. Well, here, I'll give you the exact math. I mean, look, look at the, the hygiene math. It's clear. If that office is getting 20 new patients a month and keeping them, they would add another full time hygienist every four years. If they're getting 40 new patients a month, every two years, they have another hygienist. So you're telling me that old man's had that location for 30 years and has one hygienist four days a week? I mean, it just. Whoever comes in the front door is going out the back door. So, so who's built a dam and keeping their wives, their assistants, their hygienists, their receptionists, their patients. And they've built up to two full time hygienists and one who comes in half a day a week, a couple other days a week. And either you're going to mentor stuff, the soft stuff like how do you lead? How do you become a leader? How do you communicate your goals and values and have a successful office? And he might not even be that good of a clinical dentist. And then, and then, and then as far as CE, look at the advantage of CE. When I was getting my FAGD MAGD, I lived in Phoenix in 87, there was no dental schools. There was no fluoride in the water. I had to get on an airplane to every course to learn how to place implants to Carl Mish. I had to fly to Pittsburgh Seven three day weekends once a month. When I, when I went up to see Gordy, I had to fly to Provo. I'm going to Salt Lake, and then rent a car and drive to Provo every weekend for a year. He had 12 courses. And now with online, holy crap. There are 650 classes on dental Town. Half for free and the other half costs you less than the cab fare to go from the airport to the hotel you're staying at. I mean, with online learning, I mean, my God, you can learn all this sensory. If you have the right attitude and you're railing to hustle and you're ready. And my favorite story is Citibank. You know, Citibank? The reason that thing got so damn big was because he got a job at Citibank. And he just asked a simple question. He says, well, when my mama goes to the butcher and she writes a check, how does it actually get the money out of her account into this bank? And nobody knew the answer. And computers were coming out just like Chad. GDP came out. And nothing to do with you and me, AI, just here. And so he would go down the check clearinghouse and he would learn how the checks were clearing. And then he was realizing, oh, they got these computers now. You could really automate this. He got it. So he started automating departments, worked his way all the way up to the CEO. And Citigroup was the biggest bank ever. And his vice, his number two man was the guy at Chase. What's that guy's name of.

Chase? That I don't.

Know. Oh my God. Oh, my. Jamie Diamond. Oh, Jamie D. Jamie Dimon was. And then he, they got a pissing match with Jamie Diamond. He fired Jamie Diamond. So Jamie diamond left, and now Citigroup collapsed because that guy was old. And, and, and now Citibank made more net income than all the other banks in America combined last year. Because Jamie Dimon knews every step, every step of the way. And then I go into a dental office and I just say, okay, check out this patient. They don't even know how to use Dentrix. And they've been on it for 30 years. I mean, they're not even. Every time you walk into a dental office and I've been doing. I'll throw every one of my dentists under a bus right now saying this. I've been, I've lectured in every state a dozen times, 50 countries. And whenever I'm out and about, I don't go to Nordstrom's, I don't go shopping, I don't go get my nails done. I see dental offices. I walk in unannounced. I want to meet the dentist.

When I walk in.

There. We lost you there for a sec, but we're good. Keep.

Going. Nine times out of ten, when I walk into a dental office unannounced, where is the dentist? Where do I find the.

Dentist? The operatory.

Now? Hell no. They're always in their private office.

When they get done. I mean, I mean, you know, they just go back to their office and shut the door. They don't check out the patient meet and greet, push the flesh with the next patient coming in. They. If, if the girls are all busy, they can't sit down and say, well, here, let me check you out. They're not mastering the system. Same thing with hygiene. You know, they'll sit there and someone call up, want to get their teeth clean. Well, my God, you got an assistant. She can go set up the room. She can seat the patient, she can take the X rays. Then you go in there, you got assistant, you can probe, and then you can scale. And then when you're done, your assistant can jump over and polish and floss and fluoride treatment and. And dismiss the patient checking out. You have dentists that haven't done one cleaning in the last 10 years. That is lazy, lazy, lazy. And same thing with the hustle. I hated lunch because, I don't know, maybe my body's different than you, but if I go to lunch and I go eat some tacos for lunch, whatever, I come back and get a sleepy wave. I'd rather do a toothache during lunch. I'd rather do a cleaning during lunch. Everybody knew at the morning meeting that, hey, which dental assistant is going to go through my lunch with me if they need it? And it was always, always the assistants that had kids that needed to leave at the closing time with kids, and then the assistants that didn't have any kids, they'd always say, no, I'm going to lunch, and you can stay late, blah, blah, blah, blah. But I, I was the first one there when they got there. I went there and unlocked the door. I was, I was, you know, there. I was the last one to leave. I would do cleanings. I did cleanings all the time. When you got. When I go into a dental office right now. Before COVID when I got out of school, it was routine to see offices with 50% overhead. By the time it was 2000, it was routine. Everyone was 65% overhead in the, in the urban. After Covid, I see, 80% all the time. And what do they got? They got way too many staff. The dentist lives in this private office. He hasn't done a cleaning, he doesn't know how to load an autoclave and he can't check out a patient. There's no hustle. So when you're coming out of school and you got $500,000 of student loans and you got a wife, a pregnant wife with a kid at home, and that's your dental office, well, hustle. And same thing with associates. I would never ever hire a single associate. They were always up there at 3 o' clock trying to cancel their rescheduled last patient because they wanted to get to the gym, workout and go to the barge and look all pretty for the girls. I always wanted a Mormon. I said, come on, we're next to Gilbert. 10% of this town's Mormon. I want a Mormon with a stay home wife, with at least. She's got to be at least pregnant or one kid already walking those guys, I go to them and say, hey, I got a toothache. Can I squeeze it in for lunch? They're like, oh, thank you Jesus. Thank you for that opportunity. I mean, I remember sometimes we, I remember a dozen times we close at 7 and at like 6:30 someone called the toothache and they'd say, well, they're not even going to get there until seven. And they say, I wait and then they can walk in. And they would, they would do the whole root canal build up in Crown Prep, $2,500 and they wouldn't even lead till nine. And they thought they were lucky. They thought, they thought it was a gift from God because they were, you know, these were big producers. Incentives matter. Chick Fil a figured it out. McDonald's figured out. You figured out when you get an associate, get someone so damn hungry that they'll murder a grizzly bear and eat him with his bare hands. And you're going to be making money and learn all the systems from ground up. And I'll tell you what, if you're going to stay in one place and you're going to build relationships with the patients, they're going to stay with you. They're not going to change. And the other thing is, last but not least half of America doesn't have dental insurance. Why is the whole world focused on dental insurance when half of them don't even have insurance? And when they do have insurance, only going to pay $1,000. And when you look at them in the eyes and say, well, you know, I know you have insurance and that's good for a thousand. So you know, look, you know, you came in to reline your denture and we can reline it and that's $175 an arch. We can make you a new denture and that's going to be about 750 arch, that's 1500. Or we can place two implants down there so that lowered entrance snaps in and that's, that's, that's a 5,000. Well, or we can put four implants down there and the teeth will snap in and they don't even come out. And that's 25,000. So you got to help me out. You could do nothing. We could do a reline, we could do a new denture. We could do two snap on implants. We could do four where you don't even take it out. And at least, at least, at least 1 in 10 pick the $25,000 arch1.1 out of 10. In fact, the biggest gold mine for implantologists is these little denture clinics. Like there'll be some trailer in the old retired part of town. It's called denture world. And they've been doing Relines for 20, 30 years. And they end up going to sell that. No dentist even looks at it. No one even takes it serious. I cannot believe to you how many people that I went to, to Carl Mish's, got my fellowship, the missions to with or got my diplomat in. And I say, no, no, dumbass, you're going to go buy that thing. They got a 30 year brand recognition. Every day 20, 25 people are coming in there for reliance. They go in there and they say, well, these people are poor. They don't have any money. Really, dumbass, go go look at the car they're driving. They just bought an F for $90,000. They have the money if they want it, and then they go in there and that $300,000 a year denture mill is now doing $10 million a year because they're presenting treatment. And that's the thing that dentists got to learn to do more than anything is, yeah, diagnosing and treatment planning. That's a skill. And if you're a young kid, you need to go find a periodontist that you can go take your cases with. It's going to take a periodontist that you refer your period implants to. It's going to take them two years to teach you how to diagnose and treatment plan and, and present dentistry. And then once you get the confidence where you can start presenting treatment, money falls out of the sky whether they have insurance or not. So dentistry is your game to lose. It's all going to come down to your attitude. And if you want to get out of violin and whine about your student loans and whine about dentistry is overcrowded. When you got the same supply demand ratio as I did in 87, and you got the biggest, heaviest, top of all the dentists or boomers at the top, and, and they're all going to be taking a dirt nap in the next 10 years and the market's all yours and you can learn from the DSOs. Create your own DSO. You should open, you should go to rural, you should go set up an office in an area where one day you set up an area where you realize one day you're going to need four locations because that might give you the incentive to sit there and say, yeah, this is my office and it's prototype number one and I'm going to perfect this system so amazing and I'm going to have such an amazing team that in 10 years we're going to pull a chick fil A and we're going to turn into two locations. I mean, Sam Walton opened up his first Walmart when in 62, when I was born. He'd already spent 20 years working for his competitor for 20 years before him and his wife Helen figured out what they were going to do. And then they opened up one in 62 and in 10 years they only had like 12 locations. And then by the time he died, he was open up 40 Walmarts a month. You spend all your time in prototype number one. You perfect all the systems, you perfect it all at it. Worst case scenario, now you got a million dollar practice and you're taking home 350. And, and then upside, someday that might turn into two, that might butt into four and you'll have a $10 million show going on and you'll be making bank.