EP25: Strategies to Increase Patient Flow; with John Christiansen

Podcast

John Christiansen of Chrisad gives us a glimpse into the science behind dental marketing with strategies that are working for TODAY’S consumer. John claims there is no magic bullet for marketing, but gives incredible real life examples into the market today. How to increase your profitability with just a few simple steps. You won’t want to miss this episode!

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“EP25: Strategies to Increase Patient Flow; with John Christiansen” Transcript:

S1 00:00:02.268 [music] Welcome to the Double Your Production Podcast with the Team Training Institute. The one place designed for dentists and their staff, who want to grow their practices by following in the footsteps of those that have done it, who are in the trenches, who know exactly what you’re going through. And now your leaders, the stars of the podcast, Dr. John Meis and Wendy Briggs. [music]

S2 00:00:27.921 Well, the episode of the W production podcast. I’m really thrilled to be on the line here with one of my mentors, a person who really opened my eyes into the dental consumer, John Christiansen of Chrisad. Hey John, how you doing?

S3 00:00:44.529 Doing great, John. Good to see you, man.

S2 00:00:46.192 Good to see you too. So first of all, not everybody’s familiar with Chrisad. Do you want to let everybody know kind of what Chrisad does, and why it’s so unique?

S3 00:00:57.331 Yeah, sure John. I mean, after I got out of University of California undergrad, I went off to law school. And then got a specialized master’s degree in marketing and advertising from Northwestern. And basically started a business in 1980, and pretty quickly just began only working with dentists. So I had the opportunity to have, you know– Began research into what the consumer — the dental consumer — has been thinking, and what they want, and what they don’t want, what their hierarchical needs are, and so forth and so on. And for almost forty years now. So everything we do is based on statistical data and real life, real time experiences that are successful, versus the ones that are not. There’s no guesswork, there’s no intuition or anything like that. It’s science. It’s really the way marketing should always be handled, which is everything’s done by–

S3 00:01:51.639 You know, we’re at the point now where in the last decade, decade and a half, we’ve been able to get into more– Not only conduct massive amounts of studies into what the consumer wants, and what they’re aware of, and what they’re worried about regarding dentists, but now we’re able to actually get into the computers digitally, and sometimes manually. And we’re able to figure out what’s the flow as a patient. Are they growing? Are they not growing? What causes them to grow? Conducting twenty, thirty thousand secret shopper calls a year. And we overlay them with what’s being said on the phone, or how fast the market grows, and things like that.

S3 00:02:28.732 So it’s pretty cool, the kind of– This well nailed down. Everything we do is prescriptive, it’s exacting, it’s scientifically 100% certain to work, and it never doesn’t. Our guys are up around 6 billion dollars this last year. The guy who– Yeah, got a billion bucks over the last couple of years. And so we put all of this together. And not that I can suggest that it’s some sort of a master plan of mine, because it wasn’t, but we ended up having potentially the largest dental practice in the world with our combined clients. And we’re able to get data out of this not only real time, but we have treadline datas. We can predict what’s going to happen in the future based on what’s been happening gradually in the past. It’s not intuition, it’s not doctors’ impressions, it’s not staff impressions, it’s actual patient statements and patient behavioral data, overlaid with everything. So it’s pretty cool. And it’s really– It’s exciting. You know, I’m 65 years old now, and I’m still doing this. And I’m really excited about it, because it’s so much fun. It’s a lot of fun. So, it’s all research, John. It’s all research, no guesswork. You know–

S2 00:03:38.568 Yeah, it’s one of the things that really stood out to me when we first started working together. Because you had an insight into the dental consumer. And really, you were kind of consumer-focused at the time. You’ve expanded, and now understand what goes on in practices to a higher level, because you’ve gotten smarter and smarter. But really your insight into the dental consumer just totally blew my mind. Because what I was expecting and what was real were opposite. And frankly, what I wanted and what was real were opposite.

S3 00:04:11.324 [laughter] Yeah. I mean, I’ve mentioned it to you before, but it’s the case that– I hate to tell your listeners on this, but I’m not Santa Clause here. I’m not here to tell you what you want to hear, I’m here to tell you what you need to hear. And some of the things I’m going to tell you, you’re not going to be real happy about. And you’re not going to be the– It’s not going to win me any sort of popularity contest. But it’s what’s going to save your butt, and get you growing, and keep you in good shape as these ridiculous occurrences that are now occurring continue into the future. It’s a new world, and it’s a changing world, and you have to know what it’s all about in order to succeed. So I’m happy to help. And you know, there’s no secrets here. I’m happy to tell you guys anything. Because basically, if you take a look at what’s gone on over the decades we’ve done this, we’ll find something in the marketplace, and we’ll make a change in a practice, and we’ll take these guys up to 70, 80, 100 million dollars or something like that. And everybody goes, “Oh, what did those guys do?” So that eventually I’ll do it anywhere. But it’s better to be at the head of the tiger rather than the tail of the tiger. You know what’s going on.

S2 00:05:21.773 So, you always do a great job of taking a lot of information and packing it into a handful of slides that are so meaningful. And so you’ve got a presentation up here, and so I’m just sitting here excited to see it. So–

S3 00:05:36.723 Yeah I’ll show you some stuff.

S2 00:05:38.131 Great.

S3 00:05:38.666 I’ll show you, hopefully. A lot of it’s pretty new, but you know, essentially it’s a new world. And if you do what worked yesterday, it’s not going to work anymore. And the average dentist in the United States is down, according to dental economics, pretty close to 10%. Our average client. And they don’t do what we ask them to do. But our average client is up about 21-22%. You know, the 32, 31% swing in that deal. And our guys are really kicking butt. Doing really really well. So the first– You know, the golden rule of marketing and advertising is pretty important to understand, which is that you got to do unto others the way they want to have done unto them. And it took me forever to figure that out. And it’s actually– It wasn’t until I was up at Northwestern that I figured that out. Because the senior professor there, who’s a dear buddy of mine now, writes more books on marketing than anybody in the world. He essentially just: “What’s the benefit? What’s the benefit? What’s the benefit? What’s the benefit? What’s the benefit?” And it’s not the benefit to me or you, it’s the benefit to the consumer. You’ve got to find out what they want, and give them what they want. And hierarchically present it as we not only configure our advertising communications. But we have to remember that the configuration of the office is also a marketing communication.

S3 00:06:54.602 It’s a way that phone calls to the office– Everything that the consumer perceives has to be optimized. If it’s not optimized, then it’s like a waste of an opportunity. And we’ve got guys to do these things properly, or they’re in their marketplace point of evolution. It’s just, the statistics are ridiculous. We’ve built the largest practices, most profitable per chair. We have a number of guys now that are running at over a million dollars per chair per year, collectible money. Pie in the sky money. But it’s not how many offices you have, it’s how many chairs you have, and how filled those chairs are. Because you can have a bunch of offices, but if they’re only filled 30, 40 hours a week, it’s sort of a waste of time. You’ve got to have– You know, our most productive offices fill up 110 hours a week. Our most productive office I think, in the United States right now, is Hawaii. It’s opened up 110, 120 hours a week, on 10 chairs running at 12 million. Great, phenomenal, extraordinarily profitable. A lot of guys want to keep opening up all these offices and think that’s going to do something. But really it’s the number of chairs. The marketplace doesn’t saturate out. We have some marketplaces where we’ll have 50%, 55% of the overall local population come to our practices. And we think it can go even higher than that. The average practice with two hygienists, 220 or 215 hygiene appointments a month, basically they’re seeing 2400 patients a year out of 100,000. They’ve got 2, 3% of the marketplace. It’s all upside. So you want to build a bunch of offices and keep it in one place.

S3 00:08:43.461 I’ve got one pretty close to San Francisco airport that’s running around 12 million now, on 18 chairs. And they’re adding 20 chairs, so they’re going to be probably in the neighborhood of around 30 million in one location. But it’s more profitable if you don’t have a lot of offices. The whole thing is about efficiencies and math and so forth. And I talked about this research, this is the most recent. And we’ve got to do some new stuff here pretty quick, because this is a couple years old. But I can’t show you in this short presentation the timeline or the trend lines of how these have evolved. But essentially, the marketplace has evolved from the early 1980s when I first conducted this research. All they cared about then is just “Is this going to hurt or not?” Now they’re sitting there going, “Holy lord, is this guy honest? Is this place honest? Are they ripping me off? Are they telling me things that I’ve got that I don’t really have?” I mean, it’s a whole different world now. And the stuff that we want them to be concerned about, they’re not concerned about. And all this type of stuff is corroborated by their behavior over these decades. They’re just not– Increasingly now, we’re able to watch what they do, and of course have that correspond to what they say they want.

S3 00:09:55.179 With the secret shoppers, we get everything pretty well nailed down. But generally speaking, it’s stuff that the marketplace wants to shove on into the marketplace, into the patient– I’m sorry. Generally speaking, the items that the dentist tends to want to present to the public, in terms of the configuration of their office and their academic background, things like that, the public either doesn’t care about, or actually it bothers them sometimes. The spa thing for instance, and I mentioned the laser. You know, this is always tested to the point– They’re so low that it could be interpreted as meaning is actually negative to the [inaudible] they don’t want that, they suspect that’s a fraud, or whatever. So we just basically configure everything. What they say on the phone, the way their practice is configured. Everything. To kind of give the customer what they want. But what they want here, in this graph, is going to be changing when we conduct the study. It’s pretty– You know, in another– Probably a few months.

S3 00:10:56.328 Here is really important stuff. And this is every bit of data we can put together now, that shows this to be the case. That the marketplace– You know, they’re basically saying, “Man, I don’t trust these guys no more. You know, I remember a night in 2008, where I got laid off and it was really a rough time. And now they want me to take off work for a cleaning, when I don’t even know whether I need one or not. I don’t trust these guys anyhow.” So they’re basically saying they’re not going to take off work anymore, particularly for cleanings. They’ve demonstrated to take off work for restorative care, once the doctor convinces them that it needs to be done, and the relationship is built between the doctor and the patient. But it’s true that cleaning is this ridiculously huge opportunity for practices, which is not really fully understood by everybody. Where you have this annuity. The cumulatively always growing annuity gets managed right. Always growing annuity are the patients that are constantly– Not only new patients, but referring patients. And we’ve got data to show — and I don’t have the staff to show you guys, but — for every 100 hygiene appointments that’s added per month per practice, new patient flow goes up almost 27 new patients per month. No other additional marketing, no nothing. Because the patient trusts you. They come back, and they tell everybody at work, and so forth and so on. And this study was done a couple of years ago. 85% said they preferred primetime hygiene. But 79% of that same sample were appointed during the middle of the day, middle of the week. So it’s like, you’re just kicking them out of the practice.

S2 00:12:33.863 And dentists wonder why they have cancellation and failure problem, you know? You’ve got to give them something they want.

S3 00:12:40.500 Yeah. You may as well just ask them to turn around and kick them in the butt. [laughter] Because it’s horrible, but they’re not going to come back. Maybe a couple of decades ago. But there’s a lot of problems these days in the marketplace. It’s just– Here’s some data to show– This was done in late 2016, where we went through — at this point I think we had 1,500 offices — and we just looked at who did well. So the guys who have 50, 60 convenient hours per month, on average have production of $467,000 a month, and they had 274 new patients. Well, when you juxtapose that with the guy that has 0-10 convenient hours per month, those guys– You know, the flow doesn’t come from an ad you put out, and certainly not from a website or something like that. It comes from people who come into your place and go, “Oh my gosh, this is a spectacular office. We love this place.” From here, our internal research department picked up recently is that something in the neighborhood of around 14% of weekend patients have insurance maximums above $3000. And 6.83% of them have $5000 maximums or higher. And I’m like, “Whoa!” I didn’t think it was that high.

S2 00:14:04.982 I didn’t either.

S3 00:14:06.407 Yeah, I didn’t. Basically it’s led us to the opportunity here in the marketplace by the blinders that– Or, the [inaudible] you put on the marketplace. Does that make sense?

S2 00:14:14.867 No, absolutely. Yeah.

S3 00:14:16.625 Yeah, if you only have 9-5 hours Monday through Friday, you’re going to define your marketplace as being a bunch of guys from around here that are retired or unemployed. Because that’s all that’s going to come in. Their insurance competition levels are going to be lower. Whereas if you have– And we have a lot of practices play with this, where they have– They’re open– They only work a few days a week: Saturday, Sunday, and Monday. They do the restorative on Monday, they have all hygiene Saturday, all hygiene Sunday. They define the marketplace as being a bunch of guys with high max insurance, and then they accept a lot, and do really really well.

S3 00:14:47.233 So this study we conducted just recently, this was– Oh god, this was a lot of practices we studied here, that shows the full opportunity. The key to understand this kind of governor that goes on to practices is Detroit in 2008, versus 2009. We grew our practices after they shut down GM, and we grew our practices after they shut down Chrysler. And because we basically– You know, they were whining to me, and we had a meeting at one of those Marriotts out there in Detroit, and I said, “You guys better– It’s going to get pretty nasty. You’ve got to start listening to what we say.” They kind of got a little bit more [inaudible] and go, “Oh my god, we’re [inaudible] unemployment here!” That means you [inaudible] and that’s how we’ve grown. I think we’ve grown 11%, 11.5% every year between 2000 [inaudible] and 2013 essentially. So [inaudible] we’ve come and [inaudible] “Do you guys want to have dinner with us?” [inaudible] We had one guy triple during that time, in [inaudible]. He did really well. It’s just giving the customer what they want and understanding who they are. And not getting into the marketplace, but going after it.

S3 00:16:12.711 Now, during that period of time in Michigan, and also in areas in other parts of the United States where people were losing their insurance like crazy, we re-instituted our program of disseminating individual dental hygienists. Essentially, private contracts between the practice and the patient, that looks like insurance to the patient, but really is just a private contract. Insurance guys hated this, by the way. They really hated it. But there’s nothing they can do about it, if it’s just between the practice and the patient. So that’s another reason we got guys up real well. This is– It’s pretty obvious. But if you ask about insurance over the phone, you’re going to do a lot better. I mean, if you never ask about insurance over the phone, you’re going to do a lot better than practices that usually ask patients for insurance over the phone. This is the same amount of marketing, same everything. This is guys that– What is it? They only added 50 hygiene appointments a month. No, they’ve all had 50 hygiene appointments a month, but they had bad phones. They only got 71 new patients a month. Whereas if they had good phones, 104, 103 new patients a month. All things being equal. It’s a pretty major sample size. Same sample here, where they add 50 hygiene appointments a month in either case, but guys with perfect phones, who say the right things about insurance, get them in right away, and so forth and so on, grow 30% quicker than those that didn’t. So it’s just– We know.

S3 00:17:57.858 Now, this is probably one of the most important — and I don’t know if you ever saw this before, John — but this is one of the important breakthroughs. A decade or so ago, we– You know, I barely got through chemistry when I was in high school, and couldn’t take it in college. And all my buddies went off to med school and dental school. They would have hated it. I felt like such a dummy. So I would listen to these guys over in– And these are dear, dear, wonderful practitioners. Dear friends of ours. Still our clients. And they would call up, “Oh, John, we keep 97.3% of our patients. You know, we’re doing fantastic.” But I sort of was noticing that they would have 1 or 2 hygienists year over year over year over year over year. And we’d give them 1,000 or 2,000 new patients a year. And it kind of– Not being the brightest guy, I guess, I go, “What the hell is going on here? Where are these guys going?” And I couldn’t figure it out. So basically, I started looking into it, and looking into it. And what those guys were doing is: they were doing the math properly, but they were applying the wrong formula. They were counting the number of people who they knew had left. Or they knew who had said, “I’m not going to stay in this practice anymore.” And who they knew were definitively not going to come back. So they sit there, and they use that as a measurement. Where they completely disregarded the gross number of patients that had come into their practice over the last 1, 2, 3, 4, 5 years, and counted whether they came back or not.

S3 00:19:33.134 So, we started looking at the math of these things. And I know — I mean, we all know — not everybody is actually– We know that about 20– Only about 25 or 30% of Americans come back twice a year. By the way, those are your best patients. But any sort of cumulative retention needs to be addressed, and understood, and practiced. Because it’s the cumulative retention that causes a practice to grow. So, and this also took us decades to figure out. And I just– It’s crazy, John. But it’s essentially: If you don’t have the appointments that they want in order for them to come back to, and create appointment into them, they’re massively less likely to make it back. And the hygienists all tend to want to shove them into the middle of the day, middle of the week, when they want to work. Away from quantifying documents. And by doing that, basically you’re ejecting the patients from the practice. You’re just kicking them out. Put them in the middle of the day, middle of the week.

S3 00:20:33.351 So, by cumulatively and proactively adding these hygiene appointments over time, you’ll have the opportunity to recoup cumulatively your once-new patients. But if you look at — and we’re able to look at many hundreds at once now — you look at these guys. And they think they’re — even the smartest of them — they’ll think they’re retaining 80, 90% of their patient base. But we’ll go through, and we’ll run a search of all the new patients they had over the last 3 years, and see how many of them have been in the practice in the last 1 year. And it’s commonly in the 30%, 20% range. Because they don’t proactively add this. Now the heart of this, we think, is practitioners not being super sophisticated business persons. And not to slam them, they weren’t trained in this, they just don’t know. But they don’t want to spend the money to add a hygienist if their current hygienist is not full. Well, the average production per hygiene check in the United States of our 1,400 practices in the United States is around $770 per hygiene check. So, in almost every market in the United States or Canada, you can hire a hygienist for $400, $500 a shift. At a minimum. So even if that hygienist sees one patient during that entire shift, it’s still a profitable method. But their failure to take this kind of a leap of faith in investment, that’s back to the biggest problem we run into still on a day by day basis. And once people figure this out, oh my gosh, it’s ridiculous. You know, we have a– I think we have a number of hundreds of — probably not 200 — but over a hundred practices that have grown by over a million bucks this year. And even they are miserly with regards to making this investment. They’re at 100 or 200 months over, year over, a month or a year or earlier. Month to month.

S2 00:22:34.878 We are amazed at how easy it is to look at the wrong numbers, to be watching the wrong numbers. Worrying about the cost of a hygienist who doesn’t have a patient, instead of worrying about when they do have a patient, all the care that’s required.

S3 00:22:51.387 And we love these guys, man. Some of these guys are my best friends. And I don’t know what the hell it is about my personality, or lack thereof, but I’ll just stick with them forever until they get it. And I run this data, and I’ve got hundreds of other ways to explain it to them. But usually just once I show them the number of patients, who are good people, who didn’t come back in the last year, who’ve been new patients for the last five years, “Oh, what’s going on here?” But some of these guys get into a level of complacency, because they grow so well, they become so prosperous and personally wealthy that they stop to look at the nuts and bolts. They don’t want to ruffle the feather of their staff, and so forth and so on. But this is the key to success right here, understanding the cumulative value of the once-new patient. So I mean, if I had a practice right now– And in fact, we’re probably going to open up some practices here pretty soon ourselves, just to play with some of these ideas. And the investment boys of the world want me to open up thousands of them. It’s not difficult to do, but essentially I will add the number of prime– If I get 50 new patients in January, I will add 50 new primetime hygiene appointments unfilled 6 months later. And I’ll staff it, and I’ll make sure it’s pre-appointed into. I won’t allow– I’ll have a device in the computers that will burn their fingers if they try to put a wealthy working patient into an appointment middle of the day, middle of the week. Because there’s just– If you kick them out of the practice, it’s unethical. It’s bad business. They don’t get it. They don’t get preventative care that would have kept them from having pain, and suffering, and high expense. So you want them to be able to come back. It’s unethical to kick them out of the practice by throwing them in the middle of the day, middle of the week. And this is not anecdotal statements, this is the maximum amount of data that proves this, so– But understanding this, John, is just the heart and soul of the whole deal.

S3 00:24:53.217 This sort of a concept, which a couple of our great staff here at the company were able to communicate, is that if you’ve got 75 open chairs, but you’re seeing 225 patients, you’ve got a 75% fill rate. Or 70% fill rate. Still doing 112,000 a month. Well, you double that with 450 in patients. Seeing 150 open chairs, who cares? You just doubled your production. So there’s that reluctancy to invest in hygiene when it’s empty, but obviously to anybody listening to this, the middle of the day, middle of the week’s a dead deal. And there’s just no point in even going for that unless they’re retired or unemployed. And even the weekends you’re not going to fill 100%, and even the evenings you’re not going to fill 100%, but even at half full, it’s extremely extremely profitable. Understanding that it’s okay to not– One of our fastest growing practices in– Go on John, I’m sorry.

S2 00:26:00.304 I was going to say, in most markets if you open evening hours, they fill up, and they fill up forever. So, you have to schedule a little different, because you’re going to have more cancels and fails and a bit more convenient times. But in most places it’s still just such a big winner, and just back–

S3 00:26:21.948 Oh god. Oh. You know, probably my favorite practice in the world now is my buddy Declan Devereux — and I hope doesn’t mind me using his name — in Honolulu. I’m so proud of him. He had a bankrupt rights file opposite Honolulu. By the way, brightest man I’ll ever meet, ever. And so he took over the lease, but it was 20– I can’t remember. 25,000 or 29,000 a month. But this huge place, by Ala Moana Center. And when I got to him, he was doing 90,000 a month with two doctors. And I went, “Oh my god.” So he was listening to all these people who didn’t know what they were talking about. And he was on the way to bankruptcy court. So, fortunately, one of his buddies in another part of Honolulu was a client of ours for probably 5, 6, 7 years. And he had grown by tenfold, and so he tended to want to listen to us. He was kind of at, “Necessity is the mother of invention” type thing. So he listened to us, and did exactly what we said, and at some point– And he grew a million bucks a year, two million bucks a year, for a number of years. But eventually, about 4 years ago, he reconfigured the practice to be more like an airline, or a restaurant, or a hospital schedule, where you have three shifts. There’s a Saturday, there’s– In fact, I might even have it. Can I? How do I go ahead on this thing?

S2 00:27:44.931 Uh–

S3 00:27:45.674 Maybe I– Oh, here it is, here. There’s his schedule, there. So basically, you had three shifts. You had a Monday, Tuesday, Wednesday shift. A Thursday, Friday, Saturday shift. And then a Sunday shift. The blue is all hygiene, the gold is restorative, and the white is shut down. So, this staff voted him the best place to work in Hawaii. Because they only work three days a week, and they work when they want to work. He doesn’t care, as long as the schedule is filled. They can work all three days– All seven days a week if they want to. They don’t got to work any days, if they don’t want to. It’s set up like a, you know– Pretty flexible, pretty cool. And he pays the hygienist by the patient. Most guys that are going over well do these days, so they have an incentive to see more patients per hour, and with the assistants and so forth. And it’s ridiculous. It’s ridiculous. It’s heartwarming for me to see this. It’s great great scheduling. Give the customer what they want. But the big rub is, staff will sabotage the schedules, they’ll trust that we watch them. It’s 20, 30,000 secret shopper calls. We’ll be able to see that they have 10 Saturday appointments open, and the receptionist will say, “Well there’s no appointments available,” or whatever. It’s pretty common. We have false patients being put into evenings. It’s, you know– Trust me, we– All day long, it’s all we ever see. But if you get at configuration of practice in hours, and a management system keeps the staff happy — ethically correct, because the staff makes a lot of money — staff’s happy, staff gets a lot of time with their family. Which we want, in fact. So, like in a normal case here, these guys get 4 days off every week. They spend more time with their families than a 9 to 5 worker. So this is a great way to give the patients what they want, but keep the staff happy. Everything has to be integrated and optimized. Staff has to be happy, otherwise you can piss off the whole thing. They’ll screw the practice. I mean, doctors think they got everything handled, but trust me. We see what goes on. They’ll get them. In fact, by the way, that’s a good Saturday hygiene schedule.

S2 00:29:56.377 Wow.

S3 00:29:56.643 Long as they do it– That’s a pedo practice in Florida, and he only sees restorative between 9 to noon Monday through Thursday. But he just doesn’t want nothing to interrupt this checkbook. That’s what you want to have, is real heavy Saturdays and Sundays. If you can look at Saturdays, it’s all hygiene. And that doesn’t mean don’t do restorative, if it breaks out, then you do restorative. You know, or do restorative later. But usually you’ll bring them back Monday at 10 o’clock. If you build a case properly, tell them their head– They’re going to die — and hopefully you’re not lying, because they’re going to bleed to death or whatever — they’ll come back Monday to get the work done. You don’t want to interrupt Saturday, Sunday, or evening hygiene, or morning hygiene, with restorative. Because they won’t take off work. This took us three decades to figure out. They won’t take off work for hygiene, but they will take off work for the restorative care that’s found in hygiene. So it’s a big deal to build that relationship, and get that annuity of wealthier people flowing in and back through your practice. Stimulating referral.

S3 00:31:03.244 And as I said earlier, some of these practices actually– It’s rare these days they’ll let me do it, but I say: Don’t spend any money on marketing. Just add a bunch of hygiene. The problem this practice has is that I think they’re getting 400 new patients a month, and we filled up all their hygiene slots, 120 hours a week. And so he added– He took out two doctors’ chairs and turned them into operatory, so that’s going to be an operatory practice. Which should do about 12 million I hope. When people understand this stuff, it’s almost like you owe it to the public to be able to expand your capacities with multiple chairs. Such as — continually — such as to recapture the once new patients. To give them the level of care that’s going to keep them out of pain, keep them out of suffering, you know? But in the meantime, it’s great business for the practice owner. I firmly believe that practice managers should be paid massively in proportion to growth in business. And a lot of our guys do. In our company, we pay our great managers $2,000 a year raise for every percentage that our company grows. We pretty regularly grow 10% a year. We have never had a down quarter since we’ve opened. But hey, that’s the right way to do things. Don’t be cheap, pay a lot of money. You know, it’s just crazy.

S3 00:32:33.000 When I got out of grad school in marketing, I didn’t know much about business. I probably read about, oh god, 10, 20 books a year just to figure out how to run a business. And they all dovetail into making sure you take care of the staff. Got to do that. Let me see what else I’ve got here for you. Ah, here’s an example, just as a– I’ll go through these. This is just a sampling of clients who had 100 hygiene appointments a month, have reasonably decent secret shopper parades, and you’ll see on average they grow by about 100 new patients a month. About a million dollars per year. And obviously they’ve got 100 hygiene appointments. But it’s the hygiene appointment addition that stimulates the new patient flow of increases, and stimulates the production. I’ll just go through a bunch. And we’re not hiding these guys’ names, we just didn’t have the time to call them up and say, “Hey, could we use this?” But these are real guys that are my– They’re clients and friends, for sometimes two or three decades. Many of these practices we started from nothing, like that one, and north of Miami. I mean, he really kicked butt last year. I’m so proud of him.

S2 00:33:46.462 How much, if you don’t mind–?

S3 00:33:48.668 Oh yeah, he went up by 600 new patients last year. And almost 2 and half million bucks. But this is what he– You’ve got to get out of the way of being a clinician, and understand what the marketplace is thinking, and what they want, and so forth and so on. This is a great practice in Long Island. “Oh, it can’t happen in Long Island.” You’ve heard that before, right? “Can’t happen in Long Island.” This is the largest practice now in Long Island. Didn’t used to be the largest one. It used to be one of the smallest. But you just got to give the customer what they want. Simple. Very very proud of these creative practices. These are– This is what life’s all about, is, you know– It’s just really fun. It’s just a lot of fun. These guys.

S2 00:34:30.752 Fantastic.

S3 00:34:31.354 This friend of mine– This guy is a 30 year client. Nicest guy in the world. Was killing himself. And we finally got him to– We wrote a book on how to grow your practice while getting out of the chair, called “How to Grow Your Practice While Sitting in the Bahamas.” And I started the principle about 22, 23 years ago, and with one or two guys who were brave enough to try it. Unfortunately, a couple of them got real sick and had to learn how to do it, while sitting in their hospital beds. But now we have about 300, 400 practices where the doctor has either gotten out of the chair, or the senior doctor barely works.

S3 00:35:11.225 One thing I didn’t know, and you probably know all too well, is that the human body is not really built to be a dentist into your 70s or 80, or even 50s. So you got to figure out a way to get somebody younger to do it for you. Spend time with your family. So that book– I had to go over to India last year, at the beginning of the year, and I think the flight was 40 hours round trip. And I didn’t get the updates to the Bahamas paper done in that period of time. Because there’s so much new information to be gleaned from these practices, that it actually succeeded. Or had troubles in order to watch out for. It’s really really– We’re very proud of that. Because a lot of these guys would have had to sell. You know, and let’s face it, you sell in 2000, and you’re 60 years old in 2017. You’re going to live another 35 years if you’re pretty well educated American. And take a look at what happens with inflation, and it’s not going to be a good life. You’re not going to have tax deductions. You’re going to get taxed on sale. And we’ve had hundreds of practices. We’ve had to come back, we had to start again after they sold thinking they were going to be able to retire, and they’re tired and– The Bahamas principles, or the Bahamas book — which any of your readers, or your viewers, are welcome to, I’ll give you a way to get to it — is basically, it’s a way by which they don’t have to sell. They can take more time off. They can will it to their wife. No, you don’t have to be a dentist to own a practice. And you know, will it to their kids or whatever. Maintain it like a McDonalds. But you got to have the right systems and so forth and so on to make it a great business. So this guy is out of the chair, thank goodness. Because he was not enjoying himself. John, I’m talking, man. Do you have any questions or anything like that for me?

S2 00:37:13.973 You’re doing great, John. You just, you get on a roll, man, and you are just– You are flying. So keep going. I’m loving it.

S3 00:37:20.587 [laughter] Yeah if I’m not making something that’s clear, or you go, “Wait a second, John!” My experience is not this. But there’s a lot of guys right now that are wasting an awful lot of money thinking there’s a magic bullet in terms of marketing and media that’s going to get them some sort of magic results, something like that. Well first of all let me tell you, if there was something magic out there, I’d buy it. Or I’d copy it. Or whatever it is, I’d sell it. But when I got out of grad school, just shy of 40 years ago, there was the three major networks, and then there’s the independent networks now. Turned into FOX, and– There was just broadcast channels and– God, I was just thirsting like crazy to be able to put together advertisements on the tv that were just beautiful and compel people to act and so forth. And the newspapers were so spectacular at that point, oh my gosh it was wonderful. But I took, as suggested in our graduate studies, I took a fairly scientific approach to comparing the relative efficiencies of media, and what to use and what not to use. And as I pretty rapidly became a dental-only type of a business in the early 80s, I go, “Wait a minute, how do we get these patients to get in? What media makes sense?” And so all my dreams of having these glorious tv commercials and wonderful magazine or newspaper ads evaporated. It didn’t make any sense. Because wait a minute, we’ve got a radius– We eventually found a radius of about 30,000 people, in 100,000 population. They’re not going to go much further to go to a dentist. They’re not going to be far from work or from where they live. But it’s easier to hit them where they live. So we go, “Wait a minute, I got to have a good site on it.” Because we paid for it once. And it depletes, it decreases in its per impression cost every day that it goes down. So you get a prim impression cost many digits less than a penny after about five years. Which is about $5,000 site. And we’ve got a– I think I’ll show you — we’ve got a, oh god, a banner that we put up that cost $350, but it’s been demonstrated to grow a practice by a million dollars a year. Just efficient media.

S3 00:39:47.033 But all the sexy stuff, it isn’t making a whole lot of sense. And we run about 3, 4 hundred websites out of this company. Because we– They ask us to do a little bit. And it’s got to be there, but it’s not a driving force. It’s a dormant media, it’s not an active media. It’s a past route. In fact we’ve got the interns right now, a couple of rooms over, they’re basically trying to find the positive search terms that occur, and when they occur, and so forth and so on. So you want to have active media that reaches out and grab people. Stuff that you can’t rely on a website to cause much, even if it’s top of Google. I used to own the top of Google in the United States and ran a lot of data through it, and–

S3 00:40:28.817 You know, in a very telling example in New Jersey, we had a practice that was getting 5 new patients a month, had to have secret shoppers, and we got them 1,000 hits a month on their website. But after it went to 1,000 hits a month, they still had 5 new patients a month. Had a still crappy practice with $50,000 a month. No difference whatsoever, no data, the needle didn’t move at all. So you’ve got to understand what these things are going on. Here’s the math. I mean, sexy stuff– I shouldn’t use the word stupid, but sexy stuff can be really not a very good investment. And even if you believe Zuckerberg’s numbers on Facebook — which I don’t believe, because there’s no overseeing monitor — and even if you believe everybody saw every one of those placements– And believe me, we’ve placed these things, but we’ve never seen a difference. And it’s only 30% of locals that are exposed to it every year. Whereas a banner, or a side sign, can sometimes have 100,000, 200,000 people see it every day for up to millions of investment. So we do that right. Direct mail sounds, “Oh my god, is this guy Fred Flintstone?” Well it’s still the only way to reach the local marketplace. And if you say the right things in those fliers, holy lord. Kick butt.

S3 00:41:43.442 Now here’s some of the fliers and so forth. You know, everything’s got to be integrated and optimized. Since the research came up basically suggesting that the marketplace doesn’t trust dentists anymore, a lot of the imagery that we use has been shifted to more high credibility historical visuals. You see in these logos here, and so forth. Everything has to be exactly the same. You want to sort of build an image in the mind of the public: This is the dental office where you need to go. Remember that when you’re doing your marketing, you’re also marketing to your existing patients, to refer and come back. You can’t trace marketing, obviously. Except for bottom line increases and new patient flow, hygiene flows, and of course production. Because if you’re telling them procedures that they need to have done, or that they didn’t otherwise know that they were going to have done, and you can tell them about it and they come in because of it. They may not say they come in because of it, we just want to see the numbers go up. They’re clean practices. They always go up. This is not– We call cards. “Oh my god, don’t you want to digitally hit them?” Well you got to digitally hit them, but you also got to hit them in the regular mail too, and then remind them that cleaning’s going to be nothing. You’ll notice we do $0 cleanings. Where legal, we don’t charge co-pays for exams, cleanings, and X-rays. Because we want to not put any barriers for patients to get in the door. Remove all barriers, completed barriers. Don’t make them take off work. They think it’s going to– They pay $25 to go to get a cleaning at your office, and their coworkers don’t, they think that restorative is more expensive in their office.

S3 00:43:21.330 This is not our best website, but a good example. We actually are scheduling online directly through our websites now. And this is interesting. Every week and a half we’re getting about 1,000 appointments. Directly into our clients’ schedule. Not spammable, not losable. Directly into their schedules. And they’re making the appointments at ridiculously high levels. But here’s this whole thing about causation: We don’t really know that those appointments wouldn’t have been made otherwise, through the phone or walking in. But about 40% of them, in a study we just did, the appointments were made during hours other than when the office was open. So we think there’s a lot of appointments that are being made using this media, or using this conduit, that wouldn’t have otherwise been made. That’s a really really effective banner right there. Oh my gosh. This is a staff– We knew it anyway, but the guy kept staffs, and he can see year over year what’s happened to the ridiculous growth. The banner is really the only variable. He added another hygienist. So–

S2 00:44:29.084 So John, when you said 0% with insurance where legal, where would the listeners go to find out if that’s legal in their locale?

S3 00:44:41.105 Well it’s a constitutional issue. And I can’t act as a lawyer. But basically, we have around 1,400 offices in the United States that don’t charge co-pays for exams, cleanings, and X-rays. And it’s been around 14 years now. And we’ve never had a problem whatsoever. Our lawyers say it’s a gray area of the law. Insurance companies don’t seem to want to go after it, because they’re afraid of countersues that would expose what’s really going on, which they’re really, really ripping off the public. So basically, it’s a way by which you could have more patients in your chair to diagnose more restorative care. See, they know what a cleaning is supposed to cost, but they don’t know what restorative care is supposed to cost. Because of course, restorative care occurs once every 8 or 9 years, whereas cleaning should occur once a year, twice a year. So it’s a commodity. So if the war is won or lost on the basis of whether they can get in for a cleaning or not without taking off work or school, and whether they’re paying for it or not. I can tell you– And I can’t tell you that we could advise this, because we’d have to advise and not do it, because it’s a breach of contract. But I can tell you the vast vast majority of our clients that have contracts with insurances don’t charge the patient exam, cleaning or X-ray. Exam, cleaning, or X-ray co-pays in direct conflict of what the insurance contract says. They don’t believe the insurance contracts are enforceable. Business interference, racketeering, restorative trade, things like that. But again, I can’t act as a lawyer, I can only tell you what other people–

S2 00:46:14.925 No, that’s fascinating.

S3 00:46:17.238 Yeah, it’s interesting stuff. But yeah, the insurance companies find practices left and right, right? I mean, it looks like VCs. It’s not VCs. VCs get their money from insurance companies. And now they’re lately just coming right out, trying to– They don’t like people who interfere with their game. Guys like me. Because we increase utilization like crazy, and that draws against their insurance premiums, and they don’t like that. Makes them very upset. So they try to buy me out for ridiculous sums of money. We’ve got a friend of ours that has a company that optimizes insurance per plan, and they don’t like him either. They try to buy him out. Blatantly try to buy him out. Take him off the playing field. Because it’s a pain in the butt. But in the last 14 years, all they’ve really done is they’ve just raised the premiums to the public, to offset the fact that utilization rates are going up. You know, honestly all I care about is that the public is cared for, our clients are doing well. And honestly the blessing of where we’re at is that by way of our work, the public is much healthier than they would have otherwise been, as a result of having this level of preventative care. And we only got 16, 1700 practices around the world, mostly in the United States. But I’m telling you, we’ll go off to see our clients in Australia, there’ll be copies of our practices in Australia. There are practices in Spain, there are copies of ours everywhere in the world. These practices are doing the same thing. So it’s having a macro effect of helping the public worldwide have a better life. If there’s something in the world to be proud of and happy about and enthusiastic about, that’s it.

S2 00:47:59.055 Yeah. Fantastic. Well, John, this has been eye-opening and fascinating, like you always are. You have such a good methodology for looking at data, following data, tracking the trends, and identifying strategies that are really successful. So I appreciate so much you sharing all of this with our listeners. We often will promise something on our site that would be an add-on to what’s covered in this. So is there anything you can think of that would be a good add-on?

S3 00:48:42.819 Well you asked earlier, John, what’s the one little bit of advice I could give a practice that would make it so they could, after watching what we’re talking about here, change their lives. And honestly — and I don’t stand to benefit from anything except for telling the truth — is they’ve reconfigured their hours to maybe work fewer hours a week. Maybe work weekends, and then maybe three days a week, or something like that. And all hygiene Saturdays, all hygiene Sundays. You know, swallow the protocols that we’ve scientifically configured for the phones to be handled. Which is: Don’t ask about insurance, offer them all sorts of appointments and don’t make them take off work, tell them their insurance works well. Where they are comfortable legally doing so, not charging that co-pay for exams, cleanings, or X-rays. Properly create appointing, and monitoring it closely so that you benefit from the cumulative rewards of retaining your patients. Rewards and trust. Just average production for patients. Ridiculous. Working maybe less hours. I mean, just follow that advice. Most practices in the world don’t need to spend a penny on marketing. And they’re getting past around 45 or so, and they want to learn how to not work, or see patients as they get older, but make more money. I mean, I’ll give your guys our Bahamas book. You can read it. And we have it in an audiotape too, if they can’t read, which many of our clients can’t because of how much they work. But they’ll just give it to– I’ll make sure you guys get it, John.

S2 00:50:34.674 Okay.

S3 00:50:37.434 But I don’t know, I mean, the writing’s on the wall.

S2 00:50:40.209 Yeah. No, that’s–

S3 00:50:41.025 Count the patients, count the– Count the new patients.

S2 00:50:45.494 Yeah. Yeah. Well, I’m sure all of the listeners can really understand why I was so excited to have John be on our podcast today, because he is a brilliant guy who has really revolutionized the industry and the consumerization of dentistry. And so thank you so much, John, for being with us.

S3 00:51:06.656 Thanks John. Hope you come out and visit us sometime too, it’s really cool what we’re doing here. It’s really neat.

S2 00:51:11.901 I’m the kind of guy who just shows up, so now that I have an invitation–

S3 00:51:14.982 Well then show up! Just show up! It’d be great to see you. Take care, man.

S2 00:51:18.603 Yeah, sounds good. Thanks John.

S3 00:51:21.053 Thanks John. Bye bye. [music]

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