EP 69: The Threats to Your Ideal Dental Vision & a Covid-19 Update

In this episode of the Double Your Production Podcast, Dr. John and Wendy are providing another update on the latest Covid-19 science and information from leading governing bodies.

They’re sharing how dental offices around the country are handling the current challenges, and how to thrive in this unprecedented environment.

For more updates from Wendy and Dr. John, follow The Team Training Institute on Facebook.

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, or in the trenches, know exactly what you’re going through. And now your leaders, the stars of the podcast, Dr. John Meis and and Wendy Briggs.

Hey, everybody. Welcome to the Double Your Production weekly update. I'm Dr. John Meese. I'm here with Wendy Briggs. How are you doing, Wendy?

I'm great Dr. John, good to be here.

Good to be with you. Lots of stuff happening. We've been kind of pounding on some of the regulatory bodies and some of the recommendations they've made, and thankfully some of those are starting to turn, aren't they?

Absolutely. So a few weeks ago, we talked about how the recommendation to wait 15 minutes to let the aerosol settle before we clean a room, in our opinion, was not science-based, was not fact-based. And last week, what happened, Dr. John?

Well, I hear that they rescinded that order because it made absolutely no sense at all. So as much as I bark at recommendations that aren't very well thought through, you do have to give credit to the organizations that do make those changes in their recommendations when they learn something better. Because that's hard for people in a high visibility position to do. It makes them look like they're waffling, and it causes confusion in the marketplace. And so I'm always super proud of them when they do change something that wasn't very well thought through to begin with, so good for them.

Yeah. And as more and more people came out and said, "This doesn't make any sense," same that we did. We reviewed a couple of studies that showed sometimes it can take hours if there really is an aerosol issue, but then you were sharing-- we were chatting a little bit ago, and you said on NPR this morning, they came out and said-- they had a specialist who said it's not in the aerosol at all. So again, this is a novel virus, we don't know very much about it. But as we are learning more, things change. And that can be a good thing and also incredibly frustrating.

This epidemiologist that I heard this morning was saying that face masks really are the things that people should be wearing-- I'm sorry, face shields, not face masks, are what people could be should be wearing because it's better protection against spray and splatter, which is now very well known to be the vast, vast majority of the way that the disease is spread. She was saying, "Don't worry about airborne spread," which is aerosols, "don't worry about that. The infection rate on that is extraordinarily low. It's sprayed splatter."

So as we learn more, hopefully, the recommendations will become more consistent and not be changing so wildly, and we don't end up in a situation where you have one group of people saying, "Well, the science is clear. This is going to kill you if you do this and the other scientists saying, "Well, the science is clear. You have to do this or you're going to die." That puts clinicians and the public really in a bad spot because they don't really have necessarily all the information to make a good decision. And right now it has become such a political issue that you feel one way if you're in one party and another way in another party. Well, the science is never going to overcome that, so yeah.

It's unfortunate. People are doing their best. I traveled last week because I know you have as well, and I'm on my flight and everybody's wearing masks and just like the photo of Dr. Fauci himself wearing the mask, they're touching their faces nonstop. I had a guy, literally, you can't make this stuff up - and I just looked around after it happened and I was dumbfounded - he took his mask off of his nose, sneezed, and then put it back on. That's not how this works. That's not how any of this works

And if you don't have a spare mask, that's a bad spot to be in after a sneeze because yeah.

And so I'm like, "Gosh people are trying their best, but they-- so I think [FDA SHIELD?] makes a lot of sense because it would probably alleviate some of the stupidity.

People trying their best and just not-- yeah. And they just don't know, or they don't know, or they're not used to wearing masks. In dentistry, we have an advantage there, right? Because we've worn masks for decades, and so we understand proper etiquette when people take off their masks. We saw a guy kiss his wife goodbye through the mask at the airport, and I'm going, "Good heavens. I don't know if this is helping any of us."

No, it does seem kind of crazy. I was speaking to a group of practices last Friday, and the rule was we're going to wear masks. Other than the person speaking, we're going to wear masks. I'm really trying to keep everybody engaged with keeping their mask on. It was really tough, and it's hard. It really is. And that's with professionals that wear them all the time. You often see people with the mask exposing their nose or sometimes exposing their mouth. Oh, gosh.

Walking through the store and taking it off, all of those things. But again, I'm delighted. We're still hearing record reports of practices that are opening [back up?], and the patients are delighted that they are able to get some of their [inaudible] taken care of. And those that have kind of followed our 100-day plan and the process that we've taught along the way are continuing to reach out with emails of success stories and wins, and they're super proud of their team. And they're really grateful that they're working again, and so there's a lot of good news happening as well.

There really is. A lot of our practices that have been following our 100-day plan are going to have-- had a record month. If they're open all May, they're going to have a record month in June as well because the patient demand is there, so patients are wanting to come in. Prepare yourself for that. It may not last, but for right now, the patient demand is really fantastic.

Delighted with that. Well, Doctor John, our topic today I think is really interesting because it covers a lot of things that we just talked about with kind of what we've been through over the last few months. But there was another survey online for dentists, and the dentists were asked, "What do you see as the greatest threat to fulfilling your vision for your life and your future on your desired timetable?" And the answers to this were pretty interesting, right?

So the two top responses-- the ones that got most votes were PPO insurance and the downward pressure on profits, and the second one was inability to save enough to ever retire. So I thought both of us really kind of feed each other, feed into one another pretty clearly, and especially given where everybody is. We've talked on a few of our previous live episodes about this general feeling amongst dentists that now is the time to cut insurance. Get rid of all the PPO plans. We can't afford to take the write-offs. And some of these feelings and thoughts-- and sadly, some practices are taking advice from dentists who mean well, but maybe don't have very much data or enough data to support that thinking.

I thought it would be good if we talked through some of that, maybe some of the myths about dental insurance, number one. And then number two, really talking about what we are seeing practices do to increase the valuation of their practice which then impacts their retirement, right? A lot of people don't understand it. A lot of people may not really be thinking for dentistry, especially, a lot of your quality of life from retirement comes from how your practice is valued and the end-game that you helped doctors [think?] through so well. So I thought that might make a really interesting topic that's timely as well with some of the stresses of people have on their cashflow at the moment?

Well, let's start with a PPO because I think that one leads into the other discussion. And deciding whether to be a PPO provider really is a broad question. It is a question of number one, what practice style do you want to have? Are you the kind of guy that's going to be a one-doctor office who's just going to kind of chug along the whole time-- more interested in not scaling anything but just interested in being just a one-doctor practice. Okay. Well, if that's it, maybe going the fee for service route makes sense.

The reason people take PPOs is because of patient demand, right? Patients want to use their insurance. [Wendy?] and a group of hundreds really of healthcare professionals, of dental care professionals-- we ask them, "Who goes to a primary care provider that's not on your insurance plan?" And in a group of a few hundred, there's always three, four, five. But everybody else-- and these are people that have income that's higher than the national average. These are people who're well educated. These are people who're health-minded. And they want to use their insurance.

So we have to understand that in the general public, most people want to use their insurance. Not everybody has insurance. They don't care. Some people have insurance, and they don't care-- but not very many. So if we're going to go the fee for service route, then we lose that patient demand that we get from people who have PPOs who are PPO participants and PPOs that [inaudible] provided [inaudible]. And so the question isn't really do I want write-offs or not. Nobody wants write-offs. The question is, "Can we drive enough patient demand so that we can stay nearly as productive as we are with PPOs so that our income doesn't drop?" So that's really the question is can you drive enough patient demand without [going?] PPOs? It's not a, "Oh, I wish," or "I want." That's kind of thinking-- that's not really mature thinking. The real thinking is, "Can I drive enough patient demand?"

Right. And I think a lot of practices, especially in this time, we're kind of fat and happy, right? We've got all these pent-up demand. One of our practices this morning had 1,000 patients that they were trying to schedule from a 10-week time period. So right now, we've got incredible demand. And so maybe it may feel like, "Oh, this is a good time to eliminate these plans and to at least cut out the worst plan." However, what's going to happen three or four months from now? Unless you've been strategically planning, six months from the shutdown, we got nobody in the schedule, right

So that's one of the things that we talked about is making sure your schedule forecasting and some of those things that are really going to be vital to see you through-- but it could be that right after the shutdown, there is a time where keeping the schedule full is a challenge. We meet doctors all the time that said, "For the last 20 years, [it's?] been fee for service. But now, it's a struggle, right? I'm not growing. I'm declining. My practice is in the negative of every month when you look at [attrition?]." And so again, what we wanted to avoid is that situation where we're in this slow decline. And when it happens slowly, sometimes people don't notice it enough to make a change, right? And so the sad thing that-- we run into doctors that's been going for two or three or four years, and they really don't have a practice to reignite or patients to reengage because the downward spiral's gone on for too long.

The other thing that I see sometimes suggested by experts on Facebook groups is the, "Oh, just cut the cord just drop them all at once." Well, you just put a gun to your head. That is going to create a huge mass exodus of people out of your practice. If you're going to do this, pick one at a time that you want to get rid of. Take the one that you have the fewest lives and the fewest patients that have that and that's the worst pay or get rid of that one first, and slowly work your way up while you're strengthening your ability to get patient demand.

And if you come to that point where you've got enough demand and you don't need those PPO patients-- because remember, almost all of them will leave. I know you think that they won't, but all the data is clear. You don't take their insurance, they're moving on. They may not move on in the first month or six months or year, but they're moving on. The next time they have a procedure done, now they're really getting sensitive costs, and not all of them, but many of them. So you really have to be cautious about how you would go about stopping being a provider. It can be done, but it's not just a, "Oh, I wish. I want." It's, "No, this is a-- I'm going to take a new strategy. I'm going to have a new plan. Now we got new tactics on how to do that. We're going to do it over a period of time. We're not going to gamble. We're going to do it in a way that we know we're going to have the sustainability of our practice."

Right. And one thing that's really interesting is when we look at another mindset that's very common is people think, "Oh, the most productive practices have got to be [huge?] for service," right? They think that the most successful practices don't take anything. And we've seen the opposite, right? We've seen very successful practices that take a lot of insurance. And so just because you take insurance, I think another myth is that your quality of care has to go down. And we always argue that that's not true.

I've never understood that link, right? Quality care is clinical decisions by a doctor giving the patient what their options are and letting patient choose. That's clinical quality. Well, how much you get paid for it? Unless you don't have-- unless you're a doctor that doesn't have integrity and is going to somehow shortchange patients if the reimbursement is less. I mean I guess I don't see that dentistry, really. We have a super high, high integrity profession, and I just don't think that that happens very often. I'm not naive to think it couldn't happen, but I don't think it happens very often.

I would agree. And so the thing that we talk about in a lot of our live events and with our clients is the next dollar phenomenon is key. And you can do so much more with [inaudible] [dentistry?] and the next dollar phenomenon if you have good flow, right? So that's the advantage of the insurance companies is they're sending more patients your way which gives you more opportunities. And you always quote Heather when she says, "Would you rather--" How does it go again? Remind me.

Yeah, would you rather have 80% of something or 0% of nothing-- or 100% of nothing.

100% of nothing, right? So the whole key is even if it's a plan that's awful, I get it. We've been in the trenches. And sometimes you see the coverage and you groan because you know it's not great. But that's when the opportunity arises to help that patient value a higher level of dentistry and help them understand why they need the care, the urgency of the care, and doing more today is how you win, right? Even if there is a right off, that next dollar phenomenon helps drive profitability. So we love to see practices that understand how to leverage the benefits of insurance instead of focusing on all of the negatives, and certainly, we see highly successful practices that accept insurance in having evaluated now for purchase because then, in the mergers and acquisition side of dentistry, for now almost 10 years, having evaluated 150 practices or so, I can tell you that the idea that fee-for-service practices earn more is not true.

There are amazing exceptions. There are practices that are extremely well-run and do extremely well fee-for-service. There are just not very many of them. It's very, very difficult. You'd need a very charismatic doctor. You need a very, very top-notch team. You need a top-notch patient experience. It's just harder. So when we talk about the profitability of a practice, well, that now leads us into the second question, which was really not having enough money to retire. So two thoughts on that.

Number one. I was just watching a video by Gary Vaynerchuk, who's a best-selling author, and a thought leader, and a straight-talking guy. He's not everybody's cup of tea but I enjoy listening to him. And he said, "Well, the reason why people don't have enough money to retire is they spend too much." And there's some good truth to that. My approach has always been, well, if I want to retire and I want to spend more, I need to earn more, right? So I really just need to figure out-- all I have to do is figure out how to earn more, and that's relatively easy, right? That's what our whole company does. We just help people earn more. That way, they can have the lifestyle they want and be able to retire. Part of the retirement question is the valuation of your practice. And so most people have no idea how practices are bought and sold, and so that's how they get tripped up into, "Well, I don't want to take insurance. I don't want the write-offs. My practice will shrink a little bit. I won't make as much, but I don't have the headache of the insurance company. I don't have that feeling of getting screwed by the insurance company. I just don't want any of that."

And so the problem with that is the revenue of their practice very rarely stays the same. It usually goes down. Profitability usually goes down, as well. They may have a little better piece of mind with the mindset that they had, but they're certainly not in a better position. So that profitability of your practice, that is how your practice is going to be valued someday, right? The more profitable it is, the more it's worth. And so these decisions-- and it's not dollar for dollar. It's three and a half or four times, right? So you take your profitability times three and a half, four. For an individual practice, your evaluation is going to be somewhere around there. And so doctors get into this idea that, "My profitability doesn't matter because I'm going to just--" They think of it more like a house. It's an asset, and the agent's going to tell me what I can sell it for and that's what it goes for. They think it's out of their control. It's not out of your control. The profitability is in your control and that's the main driver of the value of your practice.

And one of the common mistakes that we see in-- That would be another interesting podcast is mistakes that we see in preparing for the endgame or the transition time in your practice. But one of the mistakes that I see most often is doctors wait too long to really start thinking that way, so they're not able to increase the profitability and really focus on that. So at a minimum, I say, five years before you see that data - that's a bare minimum- it's time to start thinking about things you can do.

We have so many success stories. I'm thinking of one group practice. A partnership get practice in Pennsylvania. They approached us three and a half years before, and they ended up partnering with a larger DSO. And so we had really three years to really focus in on the profitability and we got [hygiene?] up right away. Hygiene drove the success. As hygiene goes, well rest, the practice often can follow. And I remember getting an email from this doctor after they had finalized the sale and said, "I cannot say enough about the help that you and Dr. John gave us and what that actually meant. You made a world of difference in us being able to sell our practice for a much higher multiple". Because of the profitability that they had worked on. Right. So it does take some effort, but it's really not that lengthy of a timeframe. So if you are getting toward the end and you're thinking gosh, I just don't have enough cash to retire, before you pull the trigger on the sale, get some work in now and it can make a huge difference.

I mean, it can be a seven-figure difference on a single provider practice. It can be a seven-figure difference. So really be thoughtful of that. And five years of planning, six is even better. And you can really drive the value of your practice dramatically. So.

And I think sometimes it's a little bit overwhelming because there's a fear that it's all going to be so much work for the doctor. And doctors, when they're nearing the end, they're kind of checked out a little bit. Some check out already. They're almost ready to retire, even though they're still working in the practice. So keep in mind that a lot of things that we teach are very much team driven. So even if that sounds like [you're?] at the end, and you're thinking, gosh, I don't know if I have the energy to do that, five or six years of really hitting it hard. A lot of what we teach is a team-driven approach. So that might bring some peace of mind as well.

Yeah, it really shouldn't be any harder on the doctor. It really shouldn't. Everything should be more efficient, more effective. And the doctors should be just doing dentistry all day, and not worrying about all the things the doctor is generally worried about, just focusing on the handful of things that are doctor stuff. And the team driven practices is certainly the one that's going to drive the big jumps in profitability.

Yeah, I might also add, Dr. John, there's probably a lot of people stressed about cash flow at the moment. We're kind of in a unique tail end of a really unprecedented time. And so that's one of the main things that we're focusing on with our practices is how to actually get the cash flow cranking back again and pad up that savings. So if your savings has [dwindled?] in the last few months, recognize you're not alone. But there's some easy things that that we can work on to help replenish that. And of course, obviously, our goal is to do what's right for the patient, the right reasons every time, and focus on things that are great for the team and also great for the practice. So that win, win, win. That's what we're looking for.

Right. A lot of practices right now have a cash crunch that they're feeling. A lot of practices have false [calf's?] confidence because of the PPP loans. And so one of the exercises that we went through our CEO group, that's our highest level members. So these are the smartest guys in any room. One of the exercises that I took them through is the cash confidence dividend is, how do you structure your cash? How do you make sure you have enough working capital so that you can go through the bumps without worrying about it, without losing any sleep at night, without getting that panic feeling that oh my gosh, am I going to run out money? And so many practices had that feeling and had many sleepless weeks or months. And some still are.

Right. That's a terrible place to be, right. So I heard you mentioned at one time, there's a really interesting statistic that only 4% of the population can retire at the same quality of life or the same lifestyle that they have while they were working. And that's really sad. I would like to think that dentists performed at a higher number than that. But didn't you say that dentists are right there, it's about 4%.

That's right. The general population and dentists are no different. And so that goes back to Gary Vaynerchuk is watch your spending. And if you're not on track for retirement, that means you should be spending less or hiring TTI will help you earn more so you don't have to cut back your lifestyle you know it. But you can't have one without the other really.

I absolutely agree. We always say there's got to be a return on that investment. So we're super proud of the return on investment we're able to help our practices get and that's why we have this sucess stories to share, which is super exciting. Well, great job, Dr. John.

You too, Wendy.

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