1509 Dr. Suzanne Ebert of ADA Practice Transitions on Finding the Right Match in a New Practice : Dentistry Uncensored with Howard Farran
Is this a huge huge honor for me today to be podcasts. Everything dr suzanne marie either diaz who graduated from the university of louisville college of dentistry foaling. Gp are. she entered private practice. As an associate in saint augustine florida she started her solo private practice and ponte vedra beach florida. We're situated friends and family for eleven years upon the silver practice. She elected to continue to continue her care. Providing dental care to indigent populations becaming the dental director at a locally federally qualified health center under her tenure the clinics expanded ran efficiently and profitably while addressing real needs in the community including elder care. Special needs care yard diversion. Doctor also became heavily involved in florida dental association leadership where my classmates caesar sabato says just became the president-elect go caesar rising through the chairs of our local component and ultimately into the position of trustee for the florida dental association as adjunct faculty for the university of florida. She had the privilege of working directly with senior dental students as they rotated through our clinics. Dr ebert considers herself a clinical dennis. I and his unwavering in her desire to protect private practice dentistry. She's a vocal advocate of having a strong association to lead the dental profession to the issues facing today. Dr ebert is currently the vice president of dental practice and relationship management for the ada business innovation groups. So she did her gp. Our university of florida her d. m. d. university of louisville louisville. Right mobile you have to put a bunch of marbles in your mouth i our. Oh my gosh. You won't believe this. If i tell you i mean this. You can't make this stuff up so my dad. I learned everything from my dad had five. Sonic drive-in in wichita but he wanted to go global so he went north. Put one abilene. Kansas nebraska went south down to texas and for east. It was it was louisville. So i was always the summer between every high school year. I was always on the opening crew of new restaurant. So i spent a summer in louisville and that was so damn cool. My gosh the only bad thing i did there was when we first pulled in. We saw our first tobacco filled. So i wanted to jump out and pull a couple take back home. You know to save as souvenirs and evidently you can. You can do that in iowa. Corn farms but You you can't pull a tobacco plant out of the ground. And i learned that at about fourteen years old by got shot but my gosh. I wonder if you It to start this out. If you could just go back in time to win you graduated from louisville. What the hell are they supposed to do. They graduated in the middle of a pandemic. Now the class of twenty twenty i. I'm doing this podcast. I don't really care about a bunch of fifty eight year old fat bald dentists who have six grandchildren and debt free and money. I'm i'm worried about these kids coming out of school with four hundred thousand dollars in student loans. The you're in this Doing a lot in the practice transitions. Let me tell you how bad that is. Dental always had we've always had free classified ads and we've always had about a thousand. Dennis selling their practice listed and about five thousand jobs. Now it's two thousand dentists. Saying i'm done i'm outta here and only one thousand jobs so these kids are coming out of school. The only people hiring or dso's which is why trying to podcast all the dso's here in arizona. So many young kids saying who owns nbc to do that guy. So i you know i did dr. V my gosh What advice would you give him. Well what you're talking about is one of the main reasons. I got into this role at eight practice transitions. I worked with senior dental students for six. And a half years. They rotated in two week rotations through my clinics and when they would come into the clinic i would always ask. So what are you gonna do next year. And the ones that weren't going into a residency and weren't going into a family practice that they already had established. They had no idea what to do. So the common response was. I have absolutely no options. I'm just gonna go. Work in the dea. So and i said well you actually do have some options. Let's go over those options. And i think what resonated the most with me was towards the end of that six and a half years. I noticed that. I kept hearing the same thing over again. I know i'm going to hate my first year in practice. You're graduating with four hundred thousand dollars in student debt. And you're telling me that it's okay for you to hate your first year in practice. That doesn't make any sense to me. So let's go over. What your your options really are. you do. Have some private practice options. You just need to go looking for them. You have to have a place where you can land. That's going to help you develop the skill. Set that you wanna develop so find a place that shares the way you want to practice. Find a dentist that you really respect you. Respect what they're doing both clinically. You respect the way they treat their staff. You respect the way they interact with their community. If you can find that how great would it be to go in and be an associate within that practice and potentially take it over someday. I'm hoping that some of them took my advice. I actually a couple that did and they were very successful at it. And when i heard about ada practice transitions. I thought this is an opportunity for me to make a difference in many young dentist lives and help them to find a place where they can be personally and financially successful. This group that you're talking about right. Now that's graduating howard. I can't even imagine how they are feeling as they're entering this either last year of dental school or they graduated and twenty twenty we all know that their clinical time was cut short and even the class now the schools have slowed down to the in order to follow the proper procedures and they are not getting the clinical skills that they would normally get so what we're trying to really promote is this whole idea of mentor ship and like you said many of these docs especially in. Maybe some smaller markets are saying. I'm done. I don't wanna go back to the office. Fulltime i am. I just don't want to deal with this anymore. And i'm ready to sell. So why not explore some new options for this group. Why not explore the options of true mentorship. The doctor the owner is may be backing away. And they're backing away at an accelerated rate and that younger doc is coming in and really taking over the entire practice but it's a delayed sale opportunity. Where maybe the sale doesn't happen for about two years. It really is the best of both worlds as long as both the incoming doctor and the owner doctor are really prepared to follow this through all the way to the end. And that's again one of the things that we really emphasize here. At eight hundred practice transitions and that is spell out. Everything in the beginning. Make sure that your ultimate goals are in alignment so that you can lay them out very clearly and on paper and then follow through. That is why. I asked you to come on the show. You didn't ask me Because the has a practice transition. And where i i became known it Was your article that. I post on town. What went wrong. Might transition fell through after months of planning by susan ebert vice president dental practice and relationship management So for my homies. The lucky ones are just commuting to work for an hour The poor bastard drawn a treadmill right now so Try to distract him. So they don't realize they're on a treadmill for an hour They can't read this but tell them about your blog. What went wrong. How did your transition full through after months of planning. And why did this motivate you to go help the ada Start this Eighty-eight practice transitions. Well there are a number of wh- what went wrong out there. Unfortunately i have my own personal. What went wrong. And then we have the one that you're referencing. I believe in the blog post and that is where a an incoming doctor or potential buyer was looking at a certain practice. They really wanted this practice and the owner didn't quite have everything in order so for about six months. This owner was trying to pull information from his accountant and from his books. And all of this is going on right before the pandemic hit the incoming doctor potential buyer got cold feet is really what ended up happening and thought that the practice now. It's not wealth run. It's not got what it takes to support them in their goal of personal and financial success and it just didn't work out could this have been avoided absolutely if the owner had had all of that paperwork in order ready to hand off to that potential buyer and a nice little package said. Okay here you go. That would've made this thing much easier. The financing would have gone through a lot faster and everybody would have had a successful transition so again one of the things that we really emphasize. And let me just say this did. This was not with one of my clients because what we emphasize is. Here's your list of documents you need to get in order. Have them ready. Have them ready to pass off. Make sure that your entirely ready for your transition whether you are an owner or you are a potential buyer. If you're a potential buyer make sure your financing is lined up. Make sure that you know exactly what you can and cannot afford. Make sure that your personal finances are one hundred percent solid. Make sure that you know what your credit score is. Talk to the banks first hand. Make sure that you have a couple of different banks that you're working with find the best deal. All of those things are so important to making sure that your transition successful. I don't wanna be that guy. I never forget when i watched the The movie documentary. Whatever on sesame street the two most famous characters are big bird and oscar and I had four kids. Watch all this turns out by the same guy. And he ruled sesame street forever then got beaten out by elmo later on the little red one and just why oscar. The grouch was so popular. Just kids love oskar i mean. It's a guy living in trash can. In fact they rejected the idea. I said well we can't have a man living in a trash can. This is that that's not right but because it reminded them of their grandpa some old grouchy in during this last election. How many how many times did some two year old watches grandpa yelling at the tv whether he was for this team or that team. I don't wanna be that guy. But i'm that guy me. My four kids have turned into six grandkids and i just think it was so much better in the eighties. When if you bought a practice the seller would finance. I mean the baby. You wouldn't just give your baby up to the highest bidder and then leave and never hear your baby me. He built his practice zone hands or his patients. He wanted to good guy and You would go in there. And he'd say okay. I'll salty for this Seven years Terms ten percent interest and And then that dentist say that bought the practice. It's really great because the guy selling has skin in the game so when he's working on a patient and he says oh my god. I really messed up on this patient. mrs ebert. And she's really mad then he would call you. You had a relationship with you. It was just much better. And now it's through a third person Banker and it's like. Just take the money and run. I i just i just think it should go back to that way. But that's not the way it is. And i know i'm oscar. The grouch need to shut the hell up but does the ada practice transitions. Do you have the bank source that you can always that they can default to if they don't have a personal banker ones One wants to do the deal can if they go through you. Can you always find him a banker that will do it. We can most certainly point them in the right direction And help them to understand what the terms are and we can also give them the incoming doctors kind of a list. Go to list of things that they need to have in order before they start this process. But i'd like to go back to your previous comment cross grouch. Oscar had a wife. But i might be that white shirt you like cookies absolutely and i love baking them for migrant children. I must say let me. Just tell you that what we wanted to do is bring some more of that idea of having the dentists participants participants in this process. That's what we want. That's our ultimate goal. We want our docs to talk to each other. We want them to have an open dialogue. About what their futures. Hold whether you're retiring or whether you're buying a practice you need to be able to provide continuity of care for those patients. And i think mourn worn now than ever if a practice is going to be successful. There has to be compatible philosophy of care. That's transferred from the owner to the buyer the buyer the owner. It has to be compatible. Everybody has to be able to work towards the ultimate goal of providing a great experience for those patients. And that's what makes a successful transition when i'm talking about personal and financial success. I'm talking about it for boats docks. I'm talking about it for the owner doc. Who can transfer out of that practice and understand that their patients and their staff and their communities are going to be taken care of because as you said. This is their legacy. It's their baby sometimes. It's a family legacy where their grandfather father started the practice for the incoming doctor. The new buyer. I mean come on. They have to be able to relate to that staff they have to be able to relate to those patients and if they can continue to provide a great experience or at least consistent experience for those patients the patients are going to stay and that has to be something that needs to be taken into consideration this going through a third party where you just need at the end of the sign. The contracts to me is ridiculous. There's no place for that. in dentistry. We are a relationship driven business and we need to make sure that we're taking our patients considerations count i know These are challenging times that you talked in your in your own bio says. Dr uber considers herself a clinical dennis. I and is unwavering and her desire to protect private practice dentistry. And the just like your parents. I mean you can't win or lose when kids upset and crying and hurt him when this pandemic broke out the first thing i told the president. Ada is a trust me. You're going to be the whipping boy for this. I mean they're you know when you when dennis close down for two months. They're not happy and when they're not happy they don't think the nicest sweetest things to say about their parents their mom and dad you. You've all seen that in your own family So but how can you say that And your desire to protect private practice dentistry if the fastest growing format in dentistry. Dso's in fact of those We had five thousand help wanted ads and it dropped down to one thousand. It was only eso's and and I think this pandemic has been the best thing for the brand of dso's Because a lot of dentists just didn't want to fight a pandemic head on. And i'm an arizona which is ground zero for dso's because governor ducey Pass a law that if you got an active license anywhere in the united states it's good in arizona and it was actually triggered because registered nurses. They were actually recruiting an ireland and it was easier to get an irish nurse a green card and flyer to zona to become a registered nurse into find one in oklahoma who didn't want to pass the boards whatever whatever but eighteen point six percent of arizona. Dennis worked for so and then yesterday out of nowhere. Bob fontana of aspen dental management. Just acquired clear choice. I mean th the these geysers steamroller but Is it politically correct or incorrect. For you to say that you are like me where you I want my grandchildren to go to a dentist and the dentist is working for an insurance company and some nba. Stalin them that he can do this or can't do that then. My granddaughter needs a dentist and she goes to another dentist and it's owned by wall street and they want profit dollars. I mean where's my grandchild getting go when she needs a dentist and i'm not talking about the my four grandchildren that are boys. I'm talking about my girls Evelyn and you know. We're evelyn taylor gonna go. If all the dentists sold out their means of production they no longer can work with their hands. And by the way every time there's an economic downturn the the people that come out on top are always the ones that owns their means of production because of there's runaway inflation because of your twenty three trillion dollars debt. They just raise their prices. But you know who's first to go is extra employees when their sales go down so when you sell out your means a production and go become an employee. That's all great when everything's good but trust me when things are bad you want to own your means of production but i'm just wondering how that works. Ada who like say during pandemic. they're not going to be able to do anything right. But how are you allowed to support. Unwavering support for private practice when the fastest growing business models. Dso well we can find places for these dentists to go number one. Let's think about some of the smaller markets. Let's talk about those for a second. The dso's aren't going to the smaller towns. Great point they. They're not real no absolutely not. They're not going there and think about how great some of those practices are you have patients who wants to be there because your potentially the only denison town you have a very low purchase price from an existing doctor who selling the practice. What does that equal to. Gosh you have a payback on that loan sometimes as little as a year and a half to two years and you can be the full owner no debt on that practice you have a lower cost of living in those smaller towns you can live like a king or queen and guess. What if you wanna travel. You can travel even if you're not next to a major airport go by playing because you have in many cases unlimited income potential in those smaller towns. So let's talk about all of those small town dinosaur there and the wonderful opportunity that exists for some of these docks who are sick of the hustle and bustle and the marketing costs. That are involved with trying to stay afloat in some of these larger markets in the urban areas. Let's talk about the way how nice it is to raise a family in an area where you don't have to worry about them walking outside the door. Think about all those advantages. There's a wonderful opportunity out there for these younger. Docs if they would just open their minds to exploring them. That was that was brilliant. You to shade me if there ever was a touche on this show you save me. Because it's obvious they they will not go to rural. So that's were half of america. Is i mean. I was born in wichita kansas You know i. I'm i'm familiar with The fly over states You know you watch the news and everything only happens on the coast right and in fact over here in arizona were so jealous of florida. I mean we're the florida of the west. How come no one ever talks about arizona. We're just as crazy as florida. Which by the way only seems crazy because they have the only transparent criminal justice data so all journalists can Mine their data. Where other states they mine. The data But yeah they're not going to roll. Because the millennials you know they. They're getting married a decade later than they were in in the nineteen forties. You know it's gone from you. Know basically You know like sixteen to seventeen all the way to twenty six twenty seven. They're single they have. They like their their star bucks and mocha's and whatever they do and they're not going to rule and the these dso's. I mean you go back ten years. A lot of them You know that had time to get to five hundred offices on any given day. They could have twenty rural practices. Not staff with a dentist and they're done and so so you're right so half of america you just said brilliantly is never going to go dsl and in the The the half living in the metro. They're certainly not going to take the whole market so independent practice as the The advantage but i was but i was wondering about this about another question about the ada. This space was really branded. You know fifty years ago. I don't wanna say. I wanna make alan thornburgh. Fill to too old but you know. Apcoa and associates afc coast and for allan f. to lemberg and he started this a gazillion years ago and he had a a model that was very efficient but the lawyers didn't like and that was he didn't want to have to lawyers fighting over the price so he said look. We're going to get this done. We're going to have his lawyer represent both parties and get it done. Every attorney will tell you well then who's representing you. You have to have the lawyer representing you and alan was like. Forget it you know. You can't get to dennis to agree on anything. You can't get to dennis to agree. On a bonding agent How the hell you gonna get them to agree on financial terms. But what i makes me wonder. Is we know how. Allen started it dual representation. Let's get her done. So what was the ada. What did you think. What did you guys have that you thought was so unique to practice. Transitions and valuation. This deal where you thought you guys at the could have a unique valuable approach this. We're well how were you seeing it. Well one of the most important things that we're approaching this a little bit differently. Instead of talking i the valuation. What we're talking about. I is are the dennis compatible. And i've talked about that a little bit before but that's where we start we start with. Is this the right place for you. If it's the right place then let's start talking about the other details that go into it so we start with an online profile. It's pretty extensive. And we've been called the match dot com for dentists. I'm kinda sorta okay with that. But i prefer master matchmakers because we behind the scenes go through and up these profiles and we matched them up on the philosophy of care so we only put together dentists who have the ability to communicate with each other and then we act as facilitators for that conversation. We're not negotiating for the dennis. We expect and this is what i talked about earlier. We expect dentist to take ownership of this process. Because then it's going to be successful. We found that most of our owner docs wanted to. They want somebody who's going to continue their legacy. That's what they want so they have to be involved in the process if they wanna have success there so we give the dentists buried. Concrete things to discuss we give them toolkits and worksheets and guides discussion guides. And we're there facilitators for that conversation. So they may not be able to agree onto on the bonding agent. And that's okay but you know what they're having no problem really agreeing on the purchase price. They're not having a problem at green. How to handle the accounts receivable. They're not having that problem because they already have a relationship with each other. Because another thing about denis's. They're not very confrontational star advantage you. Dennis aren't very confrontational. Dennis are computational in certain situations but in one on one they're generally not one on one. I i love him. But my god when when it's eleven o'clock at night and they're drinking and they're behind a screen and they don't have that one hundred million years of bio- biological evolution where you have more muscles in your face then you do blow. You know your your your hips and core. I mean I mean that's why emojis became so serious. Because you know if the person was joking at this that the typos go up on dental town. I can just read the posts until you Was his early morning sober on coffee or is this drunk bastard. Eleven o'clock you know barking at the moon and the typos. Goff to deal. So that is the weird thing about social media people. Forget that there's a human being sitting on the other side. And what's funny is all all call dennis on their own bullshitting you day of the week Because i'm not here to be their friend. I'm the hair to be their grandfather to tell him. You know this is real world but my gosh they on dental town when they get bad real yelp review. They almost have a complete meltdown. You know it's like you have to walk them off the legends like dude three posts ago. You said this company's product was a bunch of shit. I mean i mean my you know what what what's with. How can this patient said this. You're almost jump out the window but then you just call the dental company a piece of shit. I mean you know so. I still think we're evolving through this social media thing and and it just really really helps. I wish everybody had donald town would be transparent and put the real name and face. The only reason we can't do that is because the mother of my mother. Dennis role a christian and she Scorn lee told me howard if you do that where are my dentist when they need to ask a stupid question. If you're ended honest you're not gonna post a failed route down. First of all your referrals will be held against. She goes if you take away their place to privately. Ask a stupid question You're you're it's a disservice dentistry so You know since rela will probably outlive me by a decade All good clean living That's the way it is but they just Dennis are great in the face and behind the monitor. Sometimes you need to be taken out to the woodshed You know Just crease times but So match me that profile. I've seen that on the so so her website is ada practice transitions dot com and you create a free profile I can't actually create a profile because the last one i filled out was on plenty of fish and i got denied. They said dude. You're awale get the hell off here lose fifty pounds So i'll have all this trauma if i fill out a new profile again but the ones i've seen go south. This is were the ones i've seen. Go south i mean in a nutshell Dr i'm presents all these amazing cases knees every friday's doing some big five times thousand dollar case or whatever and the new guy looks at the big cases. I can do all that skill. Oh yeah sure you can but can you sell it. It's one hundred times harder. South a twenty five thousand dollar ks than it is to do. All the individual crowns and bridges and house and all that kind of stuff can't sell it so they'll buy some practice that's doing like one point four and they'll pay like one point two and at the end of the first year that thing didn't even do eight hundred so i mean so they didn't have the skill set so then what's the opposite of that or though by practice where doctored all of his own molar indo at thousand bucks a piece. But doc doesn't like endo wall did you back out every damn root canal out of the cells. Did you just pay for the right to do canals for them out. So then you flip that around. Where's the biggest value. I mean mike vitale. And i used to laugher butts off forever of how this one of our friends bought this practice from this old guy. All he did was amalgams. He didn't do he just patched everything. There's young didn't even know it just walks into this four day week. Practice from the seventy seven year old guy sal and who'd made all these emo dbl's for like forty years and on any given random day three or four those who just break into a million pieces and come in and he would just numb them up and do a crown and he was doing four crowns every single day. Monday through thursday unlimited. And just like my god. I mean any paid this practice. I mean when you know the average frogs right now is about seven fifty back in the day this was like two hundred eighty five thousand dollar practices just a know nothing bottom to your practice and it was just the biggest cash cow of all time. And that's what you need to do. So you go find a practice. And he says i do a dollar a year and then you look at the numbers. Say oh will you refer out all your root canals. Which i can do or are. I can extract teather. I can do dentures. Or i'm going to add him. This liner something. So if you're make sure you're paying for dental services that you can do and don't be buying the right to do dental services that you can't do. It's a so obvious but since the buyer didn't have skin in the game he didn't carry took the money and run. And i just i just don't think it's right. Well that's one of the reasons that we have a full clinical evaluation sheet. So we encourage the docks you look at the charts. We as part of the profile we actually ask about referral patterns. And that's one of the first things that we look at when we're saying. Is this going to be a good fit an often. What we're looking for is an incoming doctor who can provide services that the owner doc is now providing And we absolutely have a nice little checklist. You know that advises the incoming doctor how to evaluate the operations of the practice and then they can take that and put that into their own skill. Set and figure out whether this is something. That's going to work for them. Obviously if a practice is doing forty percent. Ip stations and this incoming doctor is not doing ibiza. dacians that's going to be an instant hit to the bottom line so that's one of those big red flags pops up shea. Happy thought about this. Let's take a closer look and see if this is the right place for you. Now we can evaluate a lot of that behind the scenes so we can immediately discount some of those things and say. Hey you know you might want to take a look at this practice but here are the things that you're going to want to evaluate a little bit more closely to see if this is the right place for you. If everything else is lining up properly again it comes back to these doctors communicating and really taking the time to evaluate. I is at a fee right. Does that work out yes great. Now let's talk about the operations of the practice before we invest a whole ton of money and accountants and lawyers and everything else. Let's just find out whether the operations fit. And i can come in and be successful in your practice if i can. Yes now i want to see all the numbers. I need to make sure that. I have all the information that i need. So that i can make an offer on your practice so guiding them through this process will alleviate a lot of those things that you're talking about so how much of this i mean You know. I i use. I look at it like having dental partner buying a practice. I mean the the best analogy is your parents marriage or marriage things like that. You know you don't you don't go meet somebody on a first date and marry them But you know So what percent of these again. My main concern is these kids. Come out of school. How many of these kids out of school. How long would be Dating period of they said well. I want to own practice. I fill out a profile. And and yeah. I would like to really think about buying this whole bands practice in this small town in kansas But but i don't want to commit to anything like that. I mean how. Have you met you. I wanna date. How long is that a good strategy to get an associate's job. And how long would it eating period be before i'm the seller and said you know. Let's kind of start writing a prenuptial. Let's let's start heading down the road towards marriage pre-nup needs to be in place fairly quickly because what we don't want to see happen and this is what we see happen. All too often is the associate comes into the practice with the understanding that there's going to be a transfer of ownership okay now. This doesn't work. This can work in either direction the owner then decides that. Hey you know what. I kind of like the way things are going. Yeah you will will do an ownership transfer in a couple of years. Yeah i think. I'm gonna retire next year. Maybe the year after that. Maybe the year after that all the sudden. It's ten years down the road. so that's one scenario. The other scenario is the associate comes in the owner. Thinks that yeah. We're going to transfer ownership and i'm going to retire in three years or five years but then the associate says hey. I kind of like being an associate this practice. I don't think i want to own now. The owner says. I don't know what to do. I'm i'm high and dry was counting on this. So what we encourage people to do is consider all of these things up front and again. We're talking about understanding your long term goals and by understanding what you're looking for out of your transition. You can help to avoid a lot of these problems. But if you don't get it in writing in plan for the future in writing than you are just opening yourself up to one of these scenarios so we encourage people as an associate coming into a practice especially a new grad. We have the conversation up front and say okay dr owner. What are your plans here. Are you willing to put those plans in writing. You're not committing to anything. You're just putting your plans in writing. dr incoming. Are you looking to eventually had ownership in this practice. The can you see yourself in that practice. If those two things are a yes and they've met and they've evaluated operations and they've made the decision they yes we want to give this a try great. Let's drop in associated contract within that contract. Let's have a six month review clause at that six month period. You're gonna talk again about this whole ownership thing and at one year in you want to make a decision and that decision has to be dr. Incoming argue going to buy this practice if you are. Here's how we're going to lay it out where either gonna do staged by in order to complete buy in. I'm going to be your associate. There are a number of different options at that point but make that decision and put it in writing and then when it is in writing after that one year. Make sure that there are. There's a penalty for an exit at that point. Ever come into play but if it does at least you have it you know. I grew up on judge wapner. And i'm sure you remember Judge wapner and i don't know how you could grow up listening to judge wapner on have your damn receipt. I mean people would always say some well blah blah blah blah. And he says. Okay show me. I mean i mean in fact watching judge wapner. Mike glove box. I used to just that was just a trash can for receipts and sure enough. You know once a year you'd have to dig through all that trash because you actually needed a damn receipt. And so you know you go talk to dennis in your lunch and at dinner. And he says he wants to sell next year and then like say. It goes the next year the next year the next year and what i think is that people don't understand how much money it takes to retire to maintain doctors a lifestyle and when they get close to pulling the trigger and they think well my cars old and the wife wants to do this only and then their kids might need something and one thing about life after another and it just they just keep kicking the can down the road Is it more that you also talked about the associate who doesn't want to pull the trigger. Works is more is at eighty twenty at fifty fifty do see more seller staying on longer than they realized or. Do you see more kids not wanting to pull the trigger. I would say that it's sixty forty towards the owners. Sixty forty john towards the owner staying being the problem there. Yeah the owners are. They can be a little bit challenging. Sometimes because they're not sure what to do and what we do for them. Is we make sure from the outset that we had a conversation to say. Hey you know. Have you really thought this all the way through. What are your plans for retirement. Do you have the financial wherewithal to continue down this path. Now have you explored other options. I mean once you retired from your dental practice there are other ways to stay involved in dentistry and make some money. There's so many other options out there. Do you want to stay on as an associate to the owner. The new owner. That's always an option. So there are ways to navigate this but every single doctor has their own agenda. And it's our job to figure out what that agenda is and again. I think that's where our profile has a lot of value. It helps people to start thinking about. What really are my long long-term goals how can i achieve them. And the way that makes the most sense. Yeah and My guy this The these Financing terms might talk to bankers. They say well. One of their problems is they had all these rules of thumb. They had all these metrics. These metrics are actually written down in their banks and and a you know based on the purchase practices to trailing twelve months. But you've been closed. You were closed down two months and that's a big donut. I mean two months at a twelve. I mean you just too divided by twelve hell. You were close sixteen point six six six percent of the month so a lot of these cars are kicking the these loans upstairs and saying well. I'm good with this loan. I wanna go. Everybody wants to pull the trigger. But our bank has this metric and it's not accounting for two donuts in the month of march and april now that march and april is now seven eight months ago is starting to change or they getting new metrics. Are you seen some of these deals. Starting to break loose from the What what do they call it alone. Guys the banker at underwriters the underwriters and the underwriters. I'm there like actuaries. They don't have enough personality to become an account timing. These people are numbers driven. So are the underwriters are they. They got some post corona metrics now or they still pre corona trying to figure that out so that has absolutely been a challenge which is why we're encouraging our owners to go back and start considering taking on seller note at least for a small percentage of the loan. Dental offices are back to about seventy eight percent at this point maybe close to closer to eighty from the latest data latest research. That came out. So we're getting there. We're getting back to one hundred percent. I don't know how long it's going to be before we get there. So that by itself is reducing. The banks Tolerance to loan one hundred percent of the practice value. So if the owner is kinda dead set this is my number. And i'm not budging on it. Then they may have start being more willing to do some seller assist on the financing. And that's something that we're just having to make real really very clear and i'm going to go back and just kinda let chan on this. The smaller market practices are doing much better overall. At least from what i can see. They are now hiring associates again. They are at a hundred percent production. And they're doing just fine. But i mean i. I know i'm going to be politically correct. Not talking about Sacks violence rock and roll i kind of stuff but it seems like the only people that will go to a small town is when they come out of school and they're married if you've already got your wife and your kid you don't need the bar scene in scottsdale and my gosh and who usually comes out of dental school most likely married with one kid walking and one in the oven. I know i don't want okay i. I started school with two children so really dirty so it's were one and two when i started dental school. Yes sir i. I had owned a business prior to my starting dental school Yeah that was. That was a journey into went through four years of dental school so they were five and six. When i graduated which is why when i graduated i looked at my husband and i said okay. We're in louisville kentucky which is kind of gray in the winter. And i said they're gonna go north. Where winter is winter or we're going to go south where we don't have to worry about it. He says there's no way we're going north instead. Okay yes we're going south. So that's how ended up in florida. Yeah and it's at. Mississippi river is everybody east of it goes to florida and everyone west of the goes to arizona and you need to realize human behavior because something like that you just think whatever. It's not really deal. No it's really a deal. And like when i've been in all with two for thirty two years and you have an interstate and there's a whole nother city on the other side and people just that interstate. It might as well be a wall one hundred miles high when you look at your date of your patients. In fact they'll drive from five miles west into my practice and almost no one drives from one mile east into the practice. Humans don't cross rivers and interstates and and all these things and you really got to get into. I'm going to ask you to politically incorrect questions. some people say and and i know expertise to comment on this even though i grew up. Five sisters and bleed barbie dolls. I was twelve that one of the things changing industry. The most of the demographics from basically being all boys club to now have one and a half boys and a lot of people are saying that is driving and dso's because to thirty two out of every three of their employees. Dennis are female. You're a female. Do you think women are more likely to want to say I'd rather just beat employing and concentrate on my family or do you think that's just a a bad rap. I think that's a bad rap for a number of reasons number one if you want to be a hands on mother if you want to be there for your child at their at their Goodness it was a mommy and me tea tasting party. If you wanna be their last minute for your kids you need to own your own practice. You need to have the ability to control your own schedule. You can grow that practice in whatever direction you want. You take the reins you take ownership of it. Most of the dennis who graduate from dental school are still interested ownership. And that's like sixty or percent. Believe at last check. Oh i haven't seen any numbers on that. Where where did you get that number from. Hp oh not me howard to dental town dot com or downtown. I i've seen that number. So it's two out of three women. Women are total student. I'm talking about total students but the class sizes are fifty fifty. So i just know from my experience in talking with female dennis. I will tell you a lot of ago into it with the idea that okay. I can't own my own practice. Because i want to be a hands on mother. I want to be a hands on wife. I want to have that opportunity. What i see is that i have more and more women coming onto our service. Where saying. I need to own my own practice because i wanna be a hands on mother. I wanna have that opportunity to be there for my family. And i want to have control over how i treat my patients so women i have to disagree with you about your Feeling or your thought that women are not interested in ownership. It's not been my experience and it certainly isn't with the dennis that i've been talking to on a very regular basis that that's awesome. I love to see it when women on their own practice. I actually love it the most when they get divorced and have to pay some punk eight thousand dollars a month alimony for ten years. How does that feel you like that is so awesome to see women dentists just pitching about alimony site. Yeah i know it's a racket. Why don't you get rid of it. Used to be an all male staying. And i'm just loving these women to if you're paying ten thousand dollars a month to some bomb Email me howard at ten dental dot com. And i'll bring you on the show and talk about it because because that's what's gonna make your body change. is a total total racket but Yeah i i go back to my class. There are twenty women dennison their those twenty women their average practice was significantly bigger and more successful and those girls pretty much all them already retired now and i got a lot of classmates that are really pissed off the they passed sixty and now they're in a pandemic and they did they can't retire mostly because of alimony and things like that and i am. I just think these these are strange time. I wanted to see another very very politically incorrect question. I told you the beginning. That That when your kids are in a bad spot. They're not going to be real friendly. They're they're they're they're in a bad mood. Their their kids are tired. They need to nap the they need a better situation. And there's a big old threat on dental town said a quit the ada and it's all based on the fact that the that we had to close down for two months and you know it was a novell virus. That's what all the experts are saying. You know we had a. We're all in this together. One species is all we got. But what would your spin on all those people that are really pissed off and by the way those people were extremely happy when it was the Joshua tran osowski. Dm d- president new hampshire dental society. Said don't close the door for two months in march. And they won't do it again and everybody's on dental dongo. Yeah joshua you go joshua so the new hampshire dental cy. I mean they're they're in the process. I mean it was on. It was on their their newspaper. So the new hampshire saying they're. They're not doing it again. What's going to happen if the government Well first of all do you think we'll talk about the issue. Does just talk about the whole issue because it's a big blight and it is and it's really too bad. Well i take that. Maybe it's not too bad. Dennis are giving the american dental association way more credit enabled to establish federal policy than they deserve the. Ada did not shutdown dental offices. That is not the way this works. The state's shut down the dental offices. There were some states that never shut down the dental offices. Wet what the aba did is what the bay went to bat and said hey these are essential workers. The aba is the one who who lobbied to get dennis designated as essential workers so now that they are essential workers. They can't shut down and less. The state says essential workers are shut down which they're not gonna do so. The ada is trying to protect the dennis and doing whatever they can do that. I have i admit freely. I was one of those people who sat my office for eleven years. Thirteen years paid my dental and paid my dental association. Dues didn't have any clue what the american dental association did for me. Just paid my dues. I was one of those people after. I sold my practice and i had to do to some health things a hell health issues. I went to work at a federally qualified health center. Because i really love dentistry. And i'm really have a passion for serving people and everybody deserves to have access to care. At that point. I started getting involved with the dental association. I started getting involved in lobbying. I started getting. I started seeing the things that they actually did. And i was very impressed. I was impressed enough to spend a lot of time with the florida dental association and by the way have to have that shoutout to caesar to go but come on. The american dental association did not shut dentistry down. The american dental association did everything they could to get dentist back up and running that gave them they talked to the national leadership and said hey you know let's get policies in place so that you feel comfortable in your state allowing these dentist to come back to work it. American dental associated did everything they could and they had to be conscious up the climate as it existed in that moment nobody knew what to do in those first couple of months. They did the best they could That is a Well well well said. I mean Yeah the the. And furthermore the centers for disease control that floated the idea i. The centers for disease control wanted To go in the end in the world health organization and again it was a novel virus. I mean it was a brand new virus so people didn't really Know what to do and Do you think there's I saw But i love the irony of dennis. I mean Gordon was always telling me about that He said my. Gosh you know i remember. One time. he was out here in scottsdale. He had like five hundred thousand people and he was showing this case. I think was about an clear liners and immediately the whole world The four by custom extraction was an atrocity and the collusion and the everything he was trying to teach just drifted in a whole another direction. Because my home he's got eight years of college. i mean they got easing math applied. Math is physics applied physics biology chemistry applied chemistry biology. I mean they got their masters and all the tools to tackle any subject. And like this mask thing. I thought i was talking to well. Why would you be against a mask ballsy. Because if they want to force me to wear a mass dude cigarettes kill four hundred thousand americans a year. You stop selling cigarettes all where the masks. But i'm not gonna wear a mask while that dummy over there. Is smoking a cigarette. So you know. Kim god that's just that's the way dentists. Thank i mean. Obviously tobacco is gonna kill more people during the pandemic in america. The coronavirus i mean. Can we agree on that. Yeah so i have to wear a mask inside a store that sells cigarettes rally. So you know so but then the the the opposite side of that is never let better be the enemy. Never let best be the enemy of better so yeah but k making them wear a mask. Imagine if you took their tobacco way you're in florida. What would happen to florida is there is no skull chewing tobacco to be sold anywhere in the state of florida or even worse. Think about kentucky. Oh it'd be. It'd be an uprising. I mean they would march to the capitol and it'd be over so i love the way dennis think about this stuff but i i think i really think i've been a big. I've been watching the emergency room numbers ever since i've The days available that eight and a half percent of all the tooth aches. Our emergency room visits or dont'a genyk origin in my state of arizona. And my gosh just makes me feel bad. I mean what is wrong with dentistry where were responsible for. Not triaging and taking care of eight and a half percent of the load at the hospitals and by the way in thirty two years. I've seen some bizarre stuff. I had a patient one time. Walk in with a two foot by one and a half foot. Ray of the side and a script for penn vk and pirka because of of a swelling and infection. I'm like they just irradiated. Your whole upper towards i mean just crazy but so if the pandemic breaks out and the hospitals are overloaded. You'd have to be insane to even think about shutting down the dental offices if you knew they would triage and keep patients out of the emergency room but they have no history of that. I mean i got ten years date in arizona. Where the i mean if you said well we gotta keep open because we want to overload the emergency like dude. You've been doing it for ten years. What's going to all the sudden. Make you start giving your cell phone number to your patients and and being able to go in. After hours or their held their close. Friday saturday and sunday their close three out of seven weeks. In fact the average dentist is only open thirty two hours a week and there's one hundred and sixty hours a week. They're not even open their closed. Eighty one percent of the time and the emergency rooms always open. So how do you. How do you look at that scenario. It's funny that you should bring up e. r. diversion. It was one of the things that i was pretty passionate about here in florida when i was the dental director for the f. Uhc and i will tell you that after beating my head against a brick wall for a very long number of years. We finally got the hospital to give us a bouchier system for we got one hundred dollars from the hospital for the patients that we would see from the emergency room. We ended up hall. Gosh i wish. I had all the data in front of me but we saved the hospital in one year over five hundred thousand dollars just by seeing their patients for them and giving them the opportunity to come to one of the federally qualified health centers. That's kind of an easy answer. But why are the real problem is the hospitals. Aren't recognizing that the dentist needs to be their partners in this. There are a number of dentists like me out there who went into who are been beating their heads against a brick wall Jane grover is kind of the head of that whole thing over the ada the diversion programs and she's got so many different plans to be able to handle some of that overload and it's the hospitals that are really kind of the the hold up there. The dennis are more than willing to be active participants in this. We'll hey tell. Gene share wants to come on and talk about it. I wish you talk about because you would have to be absolutely out of your mind to think that the ten year track record of it being eight and a half percent That human behavior doesn't change that overnight. It's like it's like when they started the no smoking campaign when they started it. I mean america. The government started this problem when they start giving us six million troops overseas. They start lashing. I'm a pack. A day will when they came back from war to guess what they were addicted to nicotine so to me when the government sued them and wanted. This law seems like dude. You started the whole smoking epidemic. And based on the fact that the journalist are and there's no journalists in the united states. I mean reading on chomsky's book manufacturing consent. It's been when they say they're not biased. I mean come on lately someone say oh so. You're not by really they all cry. They all bawling on tv when democrat loses. And they're not biased. How out of your flip mind are you. I mean i mean i mean they they. They can't even compose themselves there. I mean if you're a journalist bowling on television quit your job today. Because i don't want to get to know you or your bullshit. I just wanna know the fax. The government started the deal. Which is a ge you know. All these lawyers want to sue ge for all these chemicals dumped in the river they were all made during world war two and there's a ton of letters written to the president of the united states and the five star general saying well. If we make all this stuff what are we do with this and there. It isn't litter just dump it in the potomac. You're in the middle of a war. You're getting bombed from hiroshima tanaka saw. I mean it's a horrible thing going on and no one was carrying about the tadpoles and the potomac at that time so it's a nice luxury fifty years later To sit there and say we want you to clean it all up and all this stuff. People are complex. These are very very strange times. I can't believe we went over an hour. But yeah i. I'd like to have jingu over on if she's headed the diversion american dental association. Because we're still going to have this problem in ten years. I know my home say. They're closed friday. Saturday sunday they specifically did not wanna be a physician at a hospital in work. Those hours i mean hell. California had to pass a law. That medical doctor residencies could not work over a hundred hours a week because they were falling asleep during surgery. Have you ever even heard of one dentist. Since peer for shard that ever worked one hundred hours in one week. Yeah california's to write a wall to ban that with physician. My my homeys They went to the medical school country club dentistry thing and they're not working evenings and weekends and if i was going to start i have been in small towns. I have walked into the urgent care. I've walked in there with my grandchildren. And i talked to the guy in baz romney's yeah there and i said well what are some came out school and would you give him some space for free for him to set up a dental office. So that at your triaging say oh. That's dental related. Just go down the hall. The last door turn laugh and he said hell. Yes and i've had other dentists that i'm couldn't get a loan or whatever they're going to small towns like eleven percent of the towns in the midwest. Dennis and they've actually gone to the mayor of that town. The mayor of the town says wall at downtown i remain. We only have one light in this town. They're six buildings boarded up. I'll give you a damn building and if you're going to set up a dental office there. We only have one bacon town. He'll give a signature loan and the only people that do it. How i can politically correct this. But they're mormon their lds. They have a family. They already have kids. They go to that small town. They're the only dentist town. They get a building for free. They get all they get a signature loan and the first year. They're they're doing a million to take it home. Four hundred. Everybody in that town thinks ten dollars an hour's the best job in the world so as labour's only always below twenty percent total costs their net. Income is always over fifty percent. But i get it some people say well. I'd rather die than live in a town But you're almost to driverless cars. I mean i'm in phoenix were. Google did their their pilot work for five years. We've had the driverless cars. We've all seen him in humans. When the biggest episodes they had problems at his people. Throwing rocks adam. You know my monkeys. They don't they. Don't like a car without a driver scared him and the throw rocks adam them all words down but and then what's another thing. That's totally irrational. Because when you're talking about something irrational irrational. Like a lot of you'll say well let's say there is a thousand people dying a day. You wouldn't close down the country for one thousand people a day at there's three hundred and thirty five million. I said well look plane flying. I mean i mean last year. Like only one guy died in a commercial airfli- on a southwest airlines flight or little piece fav engine cracked winona sectors had out. Most humans like may just compensate it. We'd just said all right. I don't want a window seat. I'll just move to the. I'll i'll row. I mean big deal or just sit in front of the problem solve but imagine if to fully loaded jumbo jets were falling out of the sky every day in america and killed the same number thousand but my my humans my homo sapiens. My monkeys who lost their tail saw two jumbo jets falls sky. How do you think you'd take him to close down all the airports eight seconds so when they don't see it firsthand if they can't feel it and sense it they just don't get it but i'm telling you if i was going to start. Dso it'd be emergency room. Eso and i and every hostile. I've talked to there. it's just culture. Why can they remove a tumor out of your brain. Do a bypass and amputate your diabetic foot. But they can't pull a first molar or do a root canal and makes zero sense. It's totally just culture. And and by the way there is some lack of culture in arizona. I was actually upset. Yes say walmart A lady was wearing her christmas pajamas to walmart before thanksgiving. You just don't do that. You don't wear your christmas pajamas to walmart till after thanksgiving house some class arizona. My god but One other thing i want to ask you about is Sometimes the hardest thing to do with the human. I mean satisfaction equals perception of what's happening minus water expected and the hardest thing to do with the human change your expectations and i'm trying to sell some of these kids. I know you sign up for dental school. Your dream job. All that kind of separate were in the middle of a once. A century pandemic. Maybe you should change your perception and get a job at. What do you call. F h cues that what they're called. Fqhc talk talk about that that maybe there's other alternatives and maybe there's other things you can do right now during a once in a century pandemic that. Maybe you weren't thinking about when you up for dental school. Well there's a big perception. There that public health ministry is inferior. That it's a poor working conditions. There are a lot of perceptions out there when you say the words public health. And i am going to admit to having had some of those perceptions tell you my practice was quite high end and i most of my patients were. Ceo's in their wives in pontypridd beach. When i went to the fqhc commitment at that point and at that moment was i am going to have this population. The exact same care that. I gave to my ceos and my wife's of the ceo's. And i am proud to say that. I would pit the dentistry that was done during my tenure there and goes on today because i know who took it over. I could put it against any dentist in the area because we paid attention to quality. We had some of the advantages of working at a public health. You have set working hours. There's little to no call. You have a guaranteed paycheck. You have the ability to provide care however you want to. As long as you're in the right situation there are a number of fqhc's that give their dentist pretty much free rein to do dentistry. However they want. I was sort pullback reconstructions. At the on homeless people the patients can are expected to pay a very small amount that small amount represents a huge chunk to them. It's an opportunity to change the way people think about every one of the most gratifying moments was when we finished with one young lady and she said my children since i started this process have brush their teeth twice a day and floss every day since i started this and they now are in a habit because that happened over. If it took a long time to get the treatment completed they have habits now that they can take with them so we're changing the mindset of an entire population. That's a pretty special thing and it's one heck of a of a moment for a dentist. Who just wants to help people so many opportunities exist out there like that. Don't discount does you have to search a little bit sometimes and you've got to find just the right situation for you and your needs but there are so many opportunities so i would encourage a lot of these younger down especially now who are really searching for something. Different and changing their perception go up to public health. There are a lot of advantages there and a lot of really great opportunities. And i just wanna say one thing about expectations. I mean i totally love anthropology because the teeth lasts longest and they always have the most evidence is dental relate. i love you obviously. All animals want their own nasa. I mean look at woodpeckers and they're beaten his beaker into that tree because he wants safety wants his own hole and you let your. I got four dogs. Let him out in the morning. They you know they go and mark their territory and this true you know i get that and you want to own your own place and a lot of you want to go back to that That small town and you own your own practice and you don't want to buy somebody else's okay. I get it. But there's this little thing he might not have heard about Cold wall street that is completely built on mergers and acquisitions which is why if you look at the five hundred publicly traded companies in the year two thousand already half of them don't even exist anymore when i got out of high school the average age of the p five hundred was the grandfather was over sixty Now that i'm almost sixty. The average age of fortune. Five hundred company isn't even a teenager and by the time you're as old as me the average company won't even be ten years old and you go into the small town and you want to set up your own practice. And there's some old guy selling so the town's got two thousand ten thousand people and there's ten dennis and this old guy selling you want to build your own so now there was ten. You build your own now. There's eleven and then old man sells to young kid. And now you're competing with a high energy doc in their twenties or thirties. That's just that's just not how wall street would would do it. They would buy out that old man. Because now gone from ten and every time i've ever found in matt a dentist collecting three or four million dollars. It's only that strategy. I've not seen another strategy. Why came here. There were eight dentist and about every five years. Some old guy retires and now the town only got three dentists and of the phi that i bought. Almost all of them stayed part time one day a week to sometimes two days a week and then something would happen in their life financially and they'd bump it up to four days a week and i mean they just own this town do mergers and acquisitions. That's what that's why Bob fontana just clear choice because he didn't have to go set up a whole chain of implants centers across the nation. He just buys it and by the way this is going to go on for ever. I just wanted on dental town under practice transitions It's a real active part. It's broken up into Associates corner future planning life after dentistry partnerships and associates practice acquisitions cells practice startups retirement planning and then life after retired dennis. Which by the way the most active dennis on dental tan are the ones that retired because they sold their practice. But i mean they didn't own a restaurant. I mean when you own a restaurant. Your personal identity isn't a baker but a dentist they. They sell their dental office. Everybody so-called them docks so go to the ce events. I mean. I can't tell you how many times i'm lecturing and i find out the guy sitting in the front row sold five years ago but he's a dentist so just final question. I know we went into overtime and you got better things to do than yak with me all day but for that old man. That's planning on selling his practice and retiring sooner rather than later. He's not on instagram. He's not on snapchat and he wants a return on like real estate. It's a fact that if you go fix up your home in arizona and put it in a brand new swimming pool you're not gonna get that swing pool back out of the purchase price on the swimming pool and so docs thinking i you know. I would not want to invest a dollar fixing up this old thing to sell. If i didn't at least get the dollar back at a bare minimum and it'd be nice maybe get a bucket and quarter a buck and a half. Is there any advice. You have to old senile dentists who are thinking about laying down their drone retiring of what they could do to increase the value of their practice. In the eyes of young millennials. Yes and i will make this short and sweet. The one thing that the new generation of dennis seems to value as the number one indicator of whether they will or will not fit into a practice as far as technology goes is digital radiography. They all seem that seems to be the number one determinant of whether they will even look at a practice. It could have. If you don't even have that then you better be a really good area and you better have some kind of other draws that these docs can can look too. you know. that's so funny because my oldest grandchild Turned thirteen and he asked you day What this room was for. And i had to tell him. It was a dark room and he said well. What does the dr grow. I'd explain to him how it started off. We were dipping them in liquids and then when the eighty two thousand came out and automated the dipping man that was the greatest thing in the world. I i still think the two thousand was the greatest thing that ever happened dentistry. And and the cbc t is a bunch of crap compared to win the pano that software upload and they put are on the right side and al on the left and all your patients could see the right and the last thing anybody could read. Is that right side. Hell yeah homie. I mean that. So i'll take the right left pair now in the two thousand but So you're saying digital radiography I agree and and you guys all i want to say. Is this At the end of the day you know peer for chard was the first one that got the barber surgeons to give up cutting hair. And let's do this teeth thing full-time than one hundred years later we had. jv black. and then when i got out of school actually met a dentist who practice outside in saint joe missouri and when i asked him what was the greatest thing about the great depression he said well you know because he graduated in twenty seven. I said oh man that must suck as twenty nine. Wasn't a good year and he goes well. Twenty nine wasn't a good year for wall street but we didn't know about that. I mean that was wall street all the way till thirty two to trickle down to the mid west and we. We suffered the depression thirty to thirty six. But he says best damn vein have dentistry because We never afford to go inside but when everything went bankrupt and boarded up and closed up. Finally the mayors. Like we'll just on board these things and let these guys go inside hell's winter outside and here's a boarded up building. You can still do that today. In twenty twenty every small town. I've ever driven through has boarded up buildings. And and what. Dr rue telling me that when they moved inside they all kind of had a pack among cells that they were going to give up the barbara side. They were just going to go in and do straight standup dentistry. And you wanna get your haircut. You can go somewhere else. I mean so you know. There's just think outside the box but the bottom line is i. Don't care if you're a. Dso private practice a dental insurance company. A dental manufa. I don't care who you are. you're a top line. Those are all the numerator and they're all divided by one denominator the patient. And if you don't keep one eye on the patient and one. I in cost than eight billion. Humans are not going to have the freedom to afford to go to the dentist and you only became a dentist to help your patient and the whole industry starts when a human gives a dentist a dollar to fix something in their mouth and it's all about the patient and the value chain work so well together at intel and motorola whenever you're dealing talking with somebody higher up in another industry the whole value chain courts each other dates each other shares in for me everything they can because they know if they don't get out their computer faster better smaller cheaper higher quality they all lose and in dentistry. It's all about the patient. And i don't really care what docs thinks about a dsl or delta dental or the ada. I wouldn't do all your polcies divided by the patient. Do they make dentistry faster better. Easier lower cost higher quality. It's all about the patient and every dennis. I know that keeps one eye on the patient and one iron cost and drowns out all the noise from the dysfunctional value chain. They do very well in dentistry and on that note. Thank you so much for coming on the show. that jane grover whose a d. m. d. n. a. m. p. h. a. Dds massive level. If she can talk about how. Dentists can do their job without having to rely on an emergency room. Who's really sick of her crap. I mean to emerge and tell tell the head. Er guy you're a dentist and he'll roll his eyes so the next time you're winding well yeah. Some people don't think dennis are real doctors. Well nobody in the emergency room. Thinks you're a real doctor and took. I'm going to interrupt you howard. I have done that the entire time right on. But i'm good interrupt you because it's not the er docs. They are more than willing to embrace. It's the c. suite guys. They're the ones who aren't giving us the opportunities that we need to be able to have in order to come in and treat those patients find its hospital administrators. It's the insurance people. They don't they. Don't see this as a value add enough. I literally had a hospital administrator. Tell me yeah. That's that's about eight percent. That's not enough for austin best that kind of money in this while. They are the ones. When i went and talked with the er folks. They're all about it. Oh yes let's do this. Let's do this. Let's do this. When i go up and i talked to the hospital administrators in the ceo's and then they get the insurance companies involved. That's when things break down because there find a charge thirty thousand dollars literally saw guy come in like you with a bill for thirty thousand dollars because he had to have a cat scan and a pet scan for an infected second more. So so you're saying it's the it's the ceo. The chief financial officer the chief opera the ceo. The chief information on if you're saying people are saying. I mean obviously if you have eight and a half percent of americans i mean. Half of america goes to walmart in any given week or month if half american went to walmart. Eight and a half percent of them wanted tonight him. What's the chance walmart would carry it. A hundred percent and they'd make twelve and a half percent net income on it So you're saying it's the c. Suite hospital executives. Don't aren't doing this right. That's been my experience. And i did it for six. And a half years pounding the pavement. I went and i talked. Legislators i talked to the i. I talked to the hospital administrators. I talked to the cfo's and it took a long time of me. Feeding down a lot of doors in order to get any funding. And i just said let let me send my way. Send them my way. I'll take care of them so interesting. Well thank you for that point susan. Seriously thank you so much for taking your time. You're more than wonderful. So if someone wants to contact you just go to ada practice transitions dot com or how they follow up of. They got specific. If they have a specific question they can always email me ebert. S e rt s at ada dot org or they can just go to our website and e mail adapt ada a t at What is that okay now. I just had a blank. Go ahead and just i. E mail us at adapt at eighty eight dot org so you were trying to think of what A website or no. Just if they have questions they can go to the website. Ada practice transition dot com. And there's a contact us form. Oh contact contact us at eight hundred eighty eight. Pt at eighty dollars. Okay let me see if i can find. Sounds too good to save some. Okay contact us. Yeah you just go there. Go to asia. Practice transition dot com. They got a contact she questions. The email is eight. P t at eighty dot org ada at eighty dot org and again. Thank you so much for coming on the show day. It was just an honored podcast. You thank you so much cowardice and honored to be here at truly was all right. Good luck with those grandkids. Thank you you too.