Dr. Steffany Mohan, DDS, Iowa Shares Her Views on Dental Entrepreneurship: Howard Speaks Podcast #140
Steffany Mohan, DDS has been practicing dentistry for over 22 years. She is the owner of Plaza Dental Group - one of the most successful dental practices in the state of Iowa. Due to her passion for mentoring and guiding others, she has built and acquired several dental practices to help them thrive in the dentistry business. Dr. Steffany Mohan is helping patients improve their confidence in their smile through robust dental services. She is curious to learn new things and stays up-to-date with the latest dental news and technologies.
In this podcast, Steffany Mohan shares her views about the dentistry business, its economics, and how it feels to be an entrepreneur.
Watch the full video:
Howard: It's a huge honor for me today to be interviewing an idol of mine, a mentor of mine, Steffany Mohan. I swear to god, you've been crushing it. I'm born and raised in Kansas, I went to Omaha Berna Grad Kansas City, then I moved out here to Phoenix when I was 24 in 1987 and I love people that are crushing it in Kansas, Nebraska, Iowa. So many dentists always have this excuse in their head, like they'll go to [inaudible 00:00:34] and say "Yeah, but they're in [inaudible 00:00:36] Florida." You'll show them something that some guy is doing and they'll say," Yeah but he's in Beverley Hills." Ziv's in Beverley Hills, Dorfin's in Beverley Hills. I'm in Parsons, Kansas. You're in something smaller than Parsons, Kansas and you're just crushing it. You're crushing it in what I call the real world. America's 330 million people. Whenever you go to another country they only know the towns like New York city or LA and they never heard of Kansas or Iowa or whatever. How do you make it? How does a small town girl like you make it in a small town Iowa?
Steffany: I think it's easier. I think it's easier than ... I mean I can't imagine living in California or New York. People haven't discovered yet how great it is to live in Iowa. It's a wonderful place to live. I think it's so much easier because people still live here but not that many dentists live here so I think it's great. I think you go to live where everybody doesn't want to live and there's still people to take care of there.
Howard: Now Iowa has a dental school, though.
Steffany: We do, it's a couple of hours away from me.
Howard: What city is that in?
Steffany: Iowa City.
Howard: Iowa City and how big is your class?
Steffany: About 75.
Howard: I don't want to point out the obvious but I'm going to have to point out the obvious because I get this question a lot and the only reason I'm asking you is because you're a leader and I'm not in any, way, shape to answer this question. I get this question at least once every 2 to 3 weeks, by a young female dentists and she'll say it's not fair. When male dentists tell an all female staff to do something, they jump, they go "Blah blah blah." When I tell them the exact same thing, I was this guy's associate for 3 years and he'd say, "Yeah, get me a cup coffee and call my wife and do this and send this." When he's gone, she buys writings, he doesn't, they all wrap totally differently. Is that just her imagine or do ... because you've got to admit, what percent of the employees in dentistry are women?
Howard: 99%. My question to you Steffany, you've been leading in office for 19 years, do you think a 99% employee base in dentistry reacts to a differently to a male dentist versus a female dentist?
Steffany: First of all, I think that they're right. It's not fair.
Howard: So you believe it exists?
Steffany: Yes but, I think that it's also bologne that lives in your head so ... I was raised to believe that life wasn't fair or I was told life wasn't fair, I'm sure you were too. I'm not sure that our young people coming out of dental school were raised to think that life isn't fair. I never thought anything about it, it was a minor blip for me. I think that, sure, do they react differently to me than they do male dentists? Absolutely. Does it get better the older that I get? Yeah, but that's me actually. That's my confidence, that's my way of dealing with people, that's the way that I respond to them, more so than how they respond to me. If I don't feel like I'm worthy of being their boss or being their leader, that's my issue. That's not their issue. [crosstalk 00:03:58] I think in some ways, it's actually easier because I think that we understand each other more. We're moms, we understand that we some of the same issues sometimes. I could be on their level but still be their leader. Those aren't mutually exclusive.
Howard: You're qualified to speak on so many subjects but I want you to ... if I asked one thousand million dentists alive today, what's the most stressful part of being in dentistry, they're not going to say getting a block, they're not going to say ... they're always going to say dealing with staff.
Steffany: Yeah, every time.
Howard: Since 99% of all the employees are women and since you're a woman dentist and a very successful leader, what insight could you give ... there's about 7000 viewers listening to each one of my podcasts and I assume 5000 of them are men. What advice, being a woman dentist ... what advice, pearls or anything on how men could effectively better communicate with an all-female staff?
Steffany: Oh, men? I don't know. I don't understand women any better than men do.
Howard: Do you see any mistakes in men trying to be leaders and not understanding ... seeing low-hanging fruit?
Steffany: I think a couple of different things. Always be straight forward and honest with women even though they're probably not always going to be straight forward with you. Women have a way of ... you have to meet them on their level. You have to understand that life is hard for some women. They weren't raised the way that everybody else was raised. Maybe they're not the ... I mean, women are great, right, but they need to be re-assured a lot more than men. Even me, I need more re-assurance than my husband does. It's really important to make sure that you're communicating with them and don't just assume ... and that's any relationship. You don't want to just assume that everybody's okay. I don't know how men are supposed to relate to women easier, that's a good question.
Howard: It is because, I was the only boy. My brother wasn't born until I was 17. My parents were catholic and didn't believe in birth control or maybe it was a little accident. My mom would dress me in blue jeans and iron patches on the outside. I had no curfew, I had to be home when the street light's gone. She put my sisters in dresses and if they soiled their dress, they'd get in trouble. We lived about 100 yards from the Kansas river and I could swim in it, fish in it, whatever. They couldn't go within 10 feet of the edge. Even at 10 years, I thought this was batshit crazy. What is my weener going to do, in the middle of the river, that my sisters are going to drown because they're missing, you know.
Steffany: I grew up with a dad that threw me in the river. [crosstalk 00:06:54] He didn't want there to be barriers to where I could go and what I could do. I was a huge tomboy, I think I leave my hair long so I could not be a tomboy anymore. I think my dad purposely moved us into neighborhoods with only guys. I only played with boys when I was a kid. It was just the way it was. I never wore a dress, I had really short hair. I was just raised to be a tomboy.
Howard: I can't imagine you a tomboy. Let me ask you another question.
Steffany: You'll have to pay big for the pictures.
Howard: You're always on television, you're like a media star in Iowa. How many dentists are there in Iowa? 1500? Steffany: Yeah, I think.
Howard: 1500 dentists. Why are you the one that's always on. Is that because you're hot or was it networking or did a PR firm get you that spot or?
Steffany: I just accidentally lucked into it. I did Randy Elvarez's wellness hour and I shot his 30 minute commercials that he does, which are really, really powerful with patients, especially that haven't been in for a long time, really fearful patients. What I ended up doing is putting those on a couple of different TV stations in my market and finding out that it wasn't as expensive as I thought it would be. Certain markets are not that expensive. If I tried to go to New York or LA or even Phoenix, I'm sure it would be much much more expensive. Advertising on TV in my market is not that bad.
Howard: Be specific, how much was it to produce at Randy Elvarez and how much does it cost to air it?
Steffany: Producing Randy's show is different but to air it would be $200-300 for a 30 minute spot.
Howard: When you went to Randy's, did you make 1 deal?
Steffany: I made 2. I made an implant and a six month smiles.
Howard: Implant and were they both the same length?
Steffany: Yeah, they were both 30 minutes.
Howard: You're saying that it cost about $300 to run it?
Howard: A dollar a minute?
Steffany: Not what you' would think, you'd think it would be a lot more than that.
Howard: Every time you run a $300, 30 minute infomercial on implant and six month smiles, do you usually get a patient or do you get 2 or 3 or?
Steffany: There first time I ran one 30 minute, I got 10 phone calls within a half hour.
Steffany: Yeah, I know. It was crazy. We consistently get quite a bit from that but that got me into the TV world and I go on to the morning show and I talk. I love to educate people ... I want people to keep their teeth for their lifetime just like every dentist hopefully. It's really fun to talk about simple things that people can do to keep their teeth and to not have trouble, spend too much money and all that. It's fun for me to go on TV.
Howard: The only television station that will let me come on is the blind television network. That's the only one. How many years ago did you do Randy Elvarez?
Steffany: I think it's been about 2 or 3.
Howard: You thought that was a good return on investment?
Steffany: I loved it. I thought it was great. Randy's so professional.
Howard: Are you friends with him?
Steffany: Yeah. He's great.
Howard: Tell him I want to do a podcast with him and talk about that. I also want to ask you this, I got out of school in '87. It Kan C&C in Missouri. I remember the instructors in the lunch room, at the bar after class, talking about these two oral surgeon guys placing implants. They were doing blades, bars and they all called them butchers, quacks, these guys should have their licenses taken away and they were nuts. Some of the real famous implantologists back in '87, '88, '89 got their license taken away because of a failed case. Now I'm 52 years old and now there's 274 companies selling dental implants. I want to ask you ... I'm sure you didn't place an implant in dental school, tell us your journey to dental implantology and how has that affected your practice?
Steffany: I graduated from University of Iowa in 1996 and when I graduated, our senior year, Noble came in and let us put all the pieces and parts for prosthetics together on a desktop. Essentially, they told us at the time that we'd never be good enough or smart enough dentists to put in an implant. We just leave that to the surgeons. That's Noble's platform to this day. It's changed recently. Oral surgeons were the people that placed implants, all of a sudden periodontists and endodontists were replacing them. It was a realm of the specialists. What happened to me is I met a couple of people on the way and that's what's so great about meeting amazing people like yourself in dentistry. It makes you think differently and you learn that, "Oh, wow. You mean what I was told 20 years ago isn't necessarily true today. I had placed a few implants along the way and then I met Todd Shatkin and started placing some mini implants. What I realized is, minis are great for dentures but it's not something I want to do for regular or crown, bridge or full mouth cases. I love Todd, he's one of my good friends. Along the way, I met Brady Frank and Brady is such a revolutionary in the field of implants because he said not only should general dentists be doing this but otherwise, the field of implantology isn't going to get much bigger because general dentists don't understand what patients should or shouldn't have an implant. You can refer as much as you want to the surgeon but a lot of times the patient doesn't trust the surgeon, they trust you. They come to your practice and they want you to do the treatment. They like you, they know you, they want you to do it. I had been placing some implants before I met Brady but when I met Brady it threw jet fuel on what I was doing. To throw on top of it not only is he an amazing educator, he also was able to bring the cost down. Instead of breaking open a sterile package for an implant that's $400, it's $120.
Howard: With Brady Frank?
Steffany: Yeah, then it brings the cost of implants way, way down.
Howard: What kind of implant is he using?
Steffany: It's osteoready.
Howard: Oh, osteoready. Is he the owner of that?
Steffany: He's the owner of that.
Howard: Where's that out of?
Steffany: It's of Seattle.
Howard: Can you call him ... can you fix us up?
Steffany: Yeah, he's one of the coolest guys you'll ever meet.
Howard: I thought you were the coolest guy I'll ever meet. Yeah, set up. He's out of Seattle, huh?
Steffany: I was only a tomboy for 12 years and now I'm not.
Howard: Now you're the coolest chick I'll ever meet. If you could send us both an e-mail or set that up I'd love that. Go ahead.
Steffany: The way that it changed my practice is that what I was able to do is bring a simple one-unit crown implant to a patient that maybe wouldn't have been able to do it before. Now, it's the same as an endo and a crown where as it's heroic to try and save the tooth. An implant at least saves the space and lets you place something there without having to hope that the tooth doesn't fail. Implants fail too sometimes, sure, it's a much more predictable service for the patient so that they can actually feel good about what they're paying for, everybody wins.
Howard: You're the one that opened the cost Pandora's box, I'm going to ask you a simple question. If you send one of the 31 million edentulist people to a dentist or a prosos, oral surgeon whatever. They don't see Chevy, Pontiac, Cadillac, they just get a treatment plan. 6 implants and a 12 year fix upstairs. 6 units and 12 downstairs and it's $50,000. Steffany, let me ask you this question. What percent of the 31 million Americans can not afford a $50,000 alternative to their denture?
Howard: You're in Iowa. You're not in Beverly Hills, you're not in Wall Street.
Steffany: The strange thing enough, the farmers here have way more money than the people in Beverley Hills. Howard: In Kansas, if you had a Mercedes-Benz, you bought it in cash. In Phoenix or Scottsdale, you have a Mercedes-Benz, you're leasing it.
Steffany: It's true. Don't judge a book by it's cover.
Howard: My Lexus is a 2004, 110,000 miles on it and I don't know anybody who owns a new Lexus that's not leasing it.
Steffany: I know. People don't do that here. If you don't have cash of a check to pay for it, you don't do that here.
Howard: Explain market segmenting because you're in Iowa. Grandma comes in with a denture. Do you offer two price points, Chevy Cadillac, Chevy Pontiac, Buick Cadlliac. What do you have to offer?
Steffany: I think the major mistake dentists make is they don't ask what they want first. They don't ask their budget, they don't ask what they're really thinking. Are they willing to spend $50,000? Sure, in some cases they are. Most of the time, no. Most of the time they either can't or won't because they're too practical to do it. You have to find what they really want. Do they want something that snaps in, screws in, what do they really want? You can work from there. Usually we'll give them a couple of different options. It's fixed hybrid, snap-in overdentures.
Howard: Point-blank ask them?
Howard: You'd say, "Howard, what's your budget?"
Steffany: What'd you think you're going to spend on something like this. What'd you think it would cost.
Howard: What do they say?
Steffany: Sometimes they say that's why "I'm here, I want you to tell me. Well I want to the oral surgeon, the prosthodontist and they said it would cost $30,000, I was hoping I could get it for less." That happens to me every single day. Which is great.
Howard: I don't think the prosthodontists have ever heard of a Chevy, a Pontiac, a Buick.
Steffany: They'll say, "Me, me, me. I'll do it for less than $30,000. Of course." If you're putting in $400 implants every single spot, you can't do it for less.
Howard: Steffany, you wear some hats in my mind. You're on television, you're amazing on so many levels. I want you to address this. A lot of these dentists listen to you. They see you and they see an entrepreneur. They see so many liked businesses. You like the game of business. My question to you is, why do you think you like the game of business and do you think that's something you were born with? Talk to 7,000 dentists right now and they say "I don't want to run reports on dentrics. I don't want to talk to my accountant. I hate everything about the business. I just want to go in there and work and take care of my patients." How does a person like that become an entrepreneur?
Steffany: Your dad was a business owner, right?
Howard: He owned 9 cinema drive-ins.
Steffany: My dad was a business owner. I think part of it is your mindset, yeah you're born with it. My dad was a veterinarian. I worked in his practice from the time I was 10. Maybe even a little younger. I had to clean cat and dog cages which was kind of gross. I grew up in my dad's business. I knew it wasn't a 9-5, 5 day a week job. It was a 24/7 thing. I never questioned it was going to be more, as a business owner.
Howard: In Iowa, was it a vet for dogs and cats or farm animals?
Steffany: Both when I was really young, mostly dogs and cats when I was older. I think a lot of people have unrealistic expectations. He told me to go be something easy like a dentist.
Howard: Your husband's an internist?
Steffany: My husband is a general surgeon.
Howard: Your dad was a vet, your husband's a general surgeon.
Steffany: My brother's a physician.
Howard: Which 3 of those, now that you've seen them all, was the best move?
Steffany: Dentist. My husband loves being a surgeon but the biggest thing for him is with the changes with the affordable care act, it's not something that's going to be feasible in the future, I don't think.
Howard: If he said to you "Yeah Steffany but you're going to get eaten alive by corporate dentistry."
Steffany: If you can't beat them, join them.
Howard: What does that mean? [crosstalk 00:20:21]. Do you think what the affordable healthcare act is to physicians, corporate dentistry is to dentists?
Steffany: Yeah, in some regards. The difference is there's such a big difference in corporate dentistry. There are people out there that are doing it pretty well. There are people out there that are slaughtering the field of dentistry. There are people that have no business.
Howard: Can you drop names?
Steffany: No. I still try to be popular.
Howard: I'm trying to get you to. My benchmark on this change is just one question, "How long do you keep your average dentist?" Those changes you're talking about, their average dentist doesn't even work for them for 1 year. Are you shitting me? You're a dental office and [crosstalk 00:21:06]
Steffany: You're making them violate their ethics on a daily basis.
Howard: The ADA should be publicly posting the corporate dentistries and how long the average dentist stays there. Imagine if Walgreens couldn't keep a pharmacist because the pharmacists felt morally out.
Steffany: Dentistry will be pharmacy at some point in time.
Howard: You believe that?
Steffany: I do. I think it'll be 50 years but I think it will absolutely be big big operations. I don't think it's feasible for dentistry to stay small mom and pop. Look at Walmart, Walgreens, look at industries ... big business buys out small business.
Howard: Especially with dentist's love of technology. "You've got to have a Cerec, CBCT, a laser."
Steffany: They're disliked for running their businesses. If they run their business, people wouldn't be able to come along and say, "I'll buy you and I'll pay you $250,000 a year. That's twice as much as you're making."
Howard: Every time a dentist goes out there and says, "You've got to have CBCT, you're just guaranteeing corporate dentistry because the scales of economy, that's only going to work in a grey practice."
Steffany: There are 5 dentists in my practice. I'm the sole owner. There's only so much. People cater to us so much more than they would at a one doctor practice. We get so many more perks than a single doctor practice. We get benefits.
Howard: What if I made this for an analogy. You said in 50 years [crosstalk 00:22:41]. They've got to get a new name for corporate because every dentist that's told me they're hate corporate, they're in corporate. I'm like, "Dude, you're an LLC."
Steffany: We have to do apples to oranges. There are some in corporate dentistry that have no business in being in dentistry at all. There are some that are doing pretty well.
Howard: What about this analogy, because nobody can predict the future. Who knows. Who guessed last month that China's stock market would fall 30% this month. It' has fell the same level that we did in 1929.
Steffany: I was in China a year ago.
Howard: If the market drops 20%, it's a bare market. It dropped 30%. In a month. No one knows the future. My son Greg Farran always reminds me that lawyers went corporate before any physician. 2 decades they've stabilized that 50% work for big firms and 50% stayed solo. Greg thinks that dentistry's going to do the same. Half will be in corporate and half will be in solo
Steffany: I can see that.
Howard: I think the biggest wrong with dentist positions lawyers is it's like hurting cats. The largest employer in the world, Walmart, has the highest percentage of people that don't have a high school education. When you start getting to law firms and you can't get 2 lawyers to agree its Tuesday, a lot of them can't work in a group.
Steffany: I think you're probably right that there may be a certain point. I'm just afraid that a small practice can't compete long-term. If they do it really well of course they can. Anybody that does business very well, they'll be fine. Medicine did the same thing where as 10-15 years ago, there were just a tiny percentage of physicians that worked for hospitals and now it's 50%. 50% of physicians work for the hospital.
Howard: Back to that question and I know I interrupted you as you tried to answer it. How can you, as a leader, motivate a younger kid dentist to get more interested in entrepreneur-ism in business and running the dentrics reports and getting interested in marketing. Would you say if you just don't like it you need to work for someone like me, you or a chain? Or do you think it'd be nurtured.
Steffany: If you don't want to have 12 books beside your bedside table that have to do with business and economics ... if you don't have that and you don't want that and you don't want to do that instead of watching Big Bang Theory then you really should be a workery dentist. If you're not interested in the business side of dentistry, you should go work for somebody else. Otherwise, it's going to become increasingly hard for you to make a living as an owner for dentist.
Howard: If you're not passionate about it, you're never going to be good about at it.
Steffany: I think people have been able to do it for a long time because it hasn't been as sophisticated and now sophisticated companies are moving into dentistry and taking over where there has been disinterest in running the business before. If you're really not interested in running a business, be honest to yourself and go work for somebody else. It's not going to work long-term.
Howard: Steffany, you and I have another thing in common. That is, we both have dentists working for us and neither of us were interested in a partnership. I'll tell you my reason first and I want to tell you why we aren't partners. I always figured, when you get married you have great sex, you have children, you spend evenings and holidays and that fails 50% of the time. Really, you want to marry a dentist, no sex or children involved, no weekends or holiday, you're going to marry a damn dentist? Also I can just give you the name of hundreds of dentists that say the divorce break up with their partner was worse than their divorce break up with their lover, how come you don't have any partners?
Steffany: I haven't found anybody yet that's as passionate about the business side as I have. I don't know anybody else that has 12 books by their bedside table. I don't. My husband is exactly the same way, he doesn't want anything to do with business at all. He's a shareholder in his multi-specialty group but he doesn't want to ... he goes to meetings and participates but he has never educated himself on the business side of medicine. That's all I ever wanted to do. I wanted to become educated so that I could take care of my patients on the clinical side but I also wanted to make sure that my kids would be fed and that my business was not going to go under. That was really important. I also was really curios about it. If the curiosity isn't there, the passion, you're toast.
Howard: Do you have any specialists in your practice?
Steffany: I don't. I'm teaching my docs to do implants.
Howard: You teach them yourself?
Steffany: I do a lot of mentoring. We do a lot. Tomorrow, we have 25 implants that we're placing. My 2 newer docs will place 25 implants tomorrow with me over their shoulder. Howard: I'm going to go right to specifics. There's 274 implant companies. How many systems did you have to buy? What is some young dentist out of school saying "Steff, I've only got enough money for 1 system, I don't want to do 3."
Steffany: I'm really lucky. I only bought 3 before I settled on one. I've had people come to my courses and they say, "Oh my gosh, I've got like 8." We'll see I'm half as good as you.
Howard: No you're half as dumb as I am. I had to go through 6 before I found one that worked and you found it in 3. [crosstalk 00:28:48]
Steffany: I needed something that was minimally invasive procedure, I needed something that was economical because when you're getting your feet wet with implants, you're going to waste a few because you picked the wrong size or you don't get high enough torque or it's not the right situation. Every time I broke open a $400 implant package, I wanted to vomit. I knew it was $400 out of pocket if I screwed it up. Then it makes you not want to do the implant procedure because it makes you think I screw it up I'm out $400. I can't charge that to the patient because they know I screwed up and I can't help it. The basics of the whole thing is, I needed a more economical implant. You know as well as I do, the screw design is almost identical across the board. There's minor differences in how they actually function and how they're placed. By-in-large, the titanium screw with the SLA coating is the same.
Howard: Okay, a lot of people don't know what the SLA coating means.
Steffany: Basically, you sand blast it so it makes the surface rougher so it integrates better is essentially what it is.
Howard: The feedback I get on these deals is, she didn't say what brand, what CE, how do you do a composite but the person doesn't want to tell you what kind. [crosstalk 00:30:14]
Steffany: The biggest problem with the 274 implant systems is the education. You could go to 50 courses and never place an implant. The reason I love osteoready systems is because it's a system that teachers you to go home and place your first implant right away. Without 2,000 hours of implant CE. Most people that come to the courses already have it. You don't have to know every single thing to put in an immediate implant. You take out a root that's the same size as the screw you're going to put in and you place the implant immediately.
Howard: You chose, your friend, Brady Frank's system?
Steffany: I did.
Howard: What's the training? Does he do all that in Seattle or does he do it across the country?
Steffany: There's some in Seattle, there's different locations across the country. There's one in Denver. There's lots of different places to go to learn how to do it. The gist of it is you'll go home and do it. You pay for your kit by putting implants in some of your actual patients. That's what's really sad. I have so many people that have come to my courses, they've taken 100s of hours of implant CE so they never felt confident enough to actually go and put a screw.
Howard: You're teaching this in your office too?
Steffany: Yeah, in Des Moines too.
Howard: One of my listeners right now could go to your office and do these in Iowa.
Howard: Well, tell us all about that.
Steffany: I'm also teaching in Denver, Seattle.
Howard: You teach at the osteoready with Brady Frank?
Howard: A listener can go to west Des Moines, Iowa. Is that suburb of Des Moines?
Howard: Let's talk about your course. Is it 1, 2 days?
Steffany: It's 2 days, it's over the shoulder. It's seeing how simple and straight-forward it can be. It's all for general dentists, obviously specialists can come too but they have different training so general dentists are very comfortable and confident after a few days that they're not going to kill somebody with them. That's a common though, they think that it's so complicated that they have to have all this training because they're going to really hurt somebody with it. Bone heals. People take a tooth out and the bone heals over.
Howard: What's the website, is that your DM smiles, your dental office website?
Steffany: The implant stuff would be osteoready.com.
Howard: How much is your 2 day course?
Steffany: It varies, it's a few thousand dollars, it's a regular implant course.
Howard: How much of that is lecture for the 2 days versus clinical?
Steffany: About half is lectures, half is clinical.
Howard: What you and Brady should do is ... you've never made an online CE course on dental town and Howard Goldstein has got 325 courses and we've 550,000 views. Half a million views. The best marketing that you can do ... you know why I'm really after you, you know how many complaints I get that podcasts and courses are all white males? I get that a lot and I'm so aware of this because I grew up with 5 sisters. My 50 employees, 43 of them are women. I have 2 male assistants, I have a male [inaudible 00:33:48] but it's 43/50 are women.
Steffany: You're just trying to keep testosterone around you any way you can.
Howard: I'm so sensitive to not having any podcasts/courses by women and I went to dental school. I was lecturing in dental school and I put the magazines out. This little 5" dentist came up to me and she said, "Nice editorial board, all men" and she flipped the magazine at me. It hit my mouth, nose and I was stunned and I felt so bad. I finally got Elizabeth Fleming in my backyard and I'm always on the hunt for women role models[crosstalk 00:34:32] I probably shouldn't say this on a podcast, I know this is totally inappropriate and off the record. You're in Iowa, which if you're listening from around the world, people listen to us on iTunes around the world. In the United States, where Steffany lives, is Iowa out of 50 states. The whole election starts in Iowa and everybody tries to win in Iowa because if you win in Iowa it sets the tone for the whole pace. I'm actually going to vote for Hillary. I have 5 sisters and I have a 3 year old granddaughter. My reward for not killing my 4 boys was a granddaughter. I don't want her to grow up and think all presidents are males. I don't really care which president I vote for because they all lie. They're all lying. George Bush said he was for smaller government and when he left 8 years later there was 27% more employees. You started with 100 and ended up with 127 and he campaigned on smaller government. Bill Clinton said he wouldn't pass NAFTA and the first thing he did in office is pass that. When it's all done and said, I don't want Taylor to grow up and think all presidents are male.
Steffany: I'm glad you said that because my 12 and 15 year old daughters are amazing. If you ask them today do you think you could be president they'd be like, "Sure, why couldn't I be?" They just know they could. Howard: Is that because of Margaret Thatcher, the iron lady, paving the way in Britain? Because the German president's a woman?
Steffany: I think they think if they wanted to, they could. Anything's possible for them. It is cool. Your granddaughter will rock the world, I guarantee you.
Howard: I wonder how many viewers I lost for the rest of my life by saying I'm going to vote for Hillary Clinton.
Steffany: It's early, it's possible you might change your mind.
Howard: She totally has my interest and if you could find me any other women that want to do a podcast [crosstalk 00:36:42]. Right now, have you surfed those 335 courses just, "Man, man, man, man." I would love to have a course by you. You know what has never been done on the internet? Is a complete continuum on how to place an implant. Everything on the internet is a one hour course and I don't think you can teach a kid in one hour, how to place an implant. I think it would take at least 3, 6, 8, 9.
Steffany: I could teach you how to do a simple one in an hour.
Howard: Well then make me that course.
Steffany: Now I promised in front of a bunch of people so I have to do it, right?
Howard: Your picture avatar on Brady Frank's, they're all going to watch yours anyway.
Steffany: That's interesting that you just said that because do you think that women dentists want to be lead by women? I do. I have some amazing women friends in dentistry that have been huge mentors for me. Lisa Germain, Sonny Lezee, some of these amazing women. But you're right, there aren't as many as there should be.
Howard: Let me podcast and interview them.
Steffany: Yeah, I will.
Howard: Send them to me because I need to be better at that.
Steffany: You want to surround yourself with women because you don't have enough, right?
Howard: There's a rumor flying around that Straumann says that for the first time ever, they sold more units of implants in America to general dentists than specialists. There's a rumor that the number has changed. Then, we have to overwhelming data that Korea has 20,000 and 3/4 dentists place an implant every month.
Steffany: 80% of general dentists in Europe place implants.
Howard: You're talking to 7000 people, probably 6000 have never placed one. Talk to that person.
Steffany: This is what's really great. Bone doesn't have nerve endings, it bleeds. Once you get past the soft tissue and everyone thinks you have to flap the soft tissue. If you have a molar site, the patient's missing about 19 or 30 which is about half of them. Lots of people missing 19 or 30. You have this much bone and you want to put an implant in that's half the size of the bone you have. What are you going to hit? You know where the nerve is because you're really conscious of where it is.
Howard: They're afraid of hitting the nerve?
Steffany: They are. Stay 5 or 6mm away from the nerve. Huge companies have been built on the principle that you can place a place a short, wide implant in that space. If you want to place a 5 or 6mm wide implant that's 8mm long, what are you going to hit that's 8mm? Your nerve is 16mm down there. There's no way that you can hit the nerve. Sure, there is a way, please don't let me think that you're going to do willy-nilly whatever. Carefully measure, we're scientists, mathematicians, we know math and science, we can figure this out it's not a complicated formula. Take your x-ray, use your measuring tool on your software and find out how long that you have before the nerve. If you can't see take another view, take something else that makes it easier to find. It'd be like having a basketball hoop that's 10x the size that you need for the basketball to go through it. It's not a difficult procedure when you're talking about simple, straight forward ... people make it so much more complicated because we're told in dental school it's the realm of the specialists. Everybody that's placing an implant should be doing it only if you're trained for 4/5 years in residency to do it. Here's what happens. Oral surgeons that are your and my age are not far off age-wise. There are oral surgeons that are our age, what kind of implant training do they get in residency?
Howard: Hardly none.
Steffany: None, literally none.
Howard: In fact Steffany, when I was UMKC in '87, the two oral surgeons placing implants, all the instructors called them butchers and crazy, they should have their license taken away. They were doing blades and something else.
Steffany: It's only been 15-20 years that anyone has been placing implants.
Howard: It was quackery at UMKC for '84-'87. You ruined your reputation if you tried doing it.
Steffany: There's no person on the planet that more than 15-20 years ahead of you. Anybody that graduated from oral surgery residency or perio residency in the last 15 years, didn't get any different training than anybody else is going to get in the marketplace. [crosstalk 00:41:27]
Howard: If they go to, osteoready.com how much would the starter kit cost?
Steffany: Starter kit's $5000.
Howard: Does that come with any CE?
Steffany: It comes with the CE, it comes with the implants, it comes with all the drills that you need.
Howard: 5000 bucks, they can get the system, the 2 day hands-on course.
Steffany: You have to pay for the course separately because most people come and figure out if that's for them. For less than $10,000 you can get an implant system that's top of the line, that you can use tomorrow.
Howard: It's all fear.
Steffany: It's all fear.
Howard: The anthropologists, sociologists, my favorite [inaudible 00:42:14] the naked aid. Who's the guy, the hierarchical scale, Abroham Maslow. They said that fear is much greater than greed because if you're dying of thirst and you look at that pond and there's two crocodiles looking right at you, you ain't that thirst. The ten biggest plummets on Wall Street are much bigger than the ten largest single-day games. I'm going to throw a fear question at you. Steffany, you're saying just place the implant but don't you always have to bone-graft too and I don't know anything about bone grafting. Don't you have to bone-graft around it to do it right and I don't know bone grafting.
Steffany: This is what's really great about a GP common sense course, that everyone can follow. I honestly believe everybody that has a dental license can follow this, whether you're a year out of school or you're 30 years out of school or any place in between. If you choose a case that has enough bone and it has height/width bone, they're slam dunk. They're so simple, 5 minute procedures. They're really isn't anything that's super super simple about it. If you need bone grafting, you need sinus lifts, that kind of thing, choose the 80% of cases that are very simple and straight-forward, refer out the 20% that are complex. That's one of the things we teach in the 2 day course, we teach people how to decide between those 2. What's simple and straight-forward, what's difficult. If you have a huge spot of bone in-between 2 existing teeth and they have all their teeth except number 19, and you have this giant space for bone. You can put an implant right, smack-dab in the center of it. There's nothing hard about that. You know where the nerve is and you can avoid it. It's not that difficult and I know that sounds like over-simplification but it really is that simple. That's what's great about coming to the course, watching me place the implants, where I prove that it just is that simple.
Howard: I hope you comment on my "Howard Speaks" this month, it was on whether or not you need a surgical guide.
Steffany: A lot of cases you don't.
Howard: It was the most controversial Howard Speaks, I've written a monthly column since '94.
Steffany: I love that you don't mind being controversial. That's one of my favorite things about you.
Howard: My thinking on that is, when I was in dental school, I read so many articles. You should be nice to your patients. Really, is someone saying to not be nice? You should have a clean office. Really, is someone else saying there should be a dirty office? What I always do on mine is, I don't want to talk about what everybody agrees on, I always want to find where the controversy is. I want to throw the controversy at you and I hope you log on to my Howard Speaks because it's only got 50 comments, and you're either far-right or far-left. The deal is this, my problem with implantology lectures and instructors is that 90-95% of crowns are done one at a time, if you go to any crown and bridge course it's always about full mouth rehabs and how to open the bite, a face bow transfer. You go back to your office where the rubber meets the pavement and it's all single units. In implants, 95% are single units and the most commonly missing tooth is the first molar. You got a molar, a second bite, a second molar behind it and there's people out there saying you have to have a surgical guide on 100% of the cases. [crosstalk 00:45:44]
Steffany: What is wrong with you, that you can't hit that giant space between the two teeth?
Howard: I know and they're like, if you don't have a surgical guide you're a hack.
Steffany: That's crazy. [crosstalk 00:46:01]. Of course we're practical. We live in the real world, in a real practice, every day. I did dentistry this morning, I'm sure you did too.
Howard: I said if you have to have a surgical guide when you have a pre-molar in front, a molar behind, their heads in your crotch, you're looking straight down at it. If you can't nail that, you should just go home. They didn't like hearing that.
Steffany: They probably didn't. For complicated stuff, the surgical guide makes sense. For really simple straight-forward stuff, you're an idiot if you need one. Sorry but I'm channeling you.
Howard: What are the indications you need a surgical guide?
Steffany: I have CT in my office, if you really have a case that's super super difficult where you don't think you have enough bone and you don't know exactly where it's going to go, the soft tissue has overgrown a little bit. You really don't know how to hit the bone that's underneath the soft tissue then a surgical guide makes sense. If it's a straight-forward case which is 80% of the cases, it doesn't make any sense.
Howard: Do you think they're very necessary when they're ... what if you're trying to put 2 or 3 implants. Do you think you have to have two guides they have to draw or don't even have to draw prosthetic-ally.
Steffany: Why were angle developments invented if everybody draws all the time?
Howard: But do you think surgical guides prevent having the need to angle developments?
Steffany: Maybe but with Curvis B and Curva Wilson, there's variations in that anyway so it's not like you're putting a picket fence in. There's differences in ... the roots don't all line up straight parallel. There's actually some variation in that. Most of the time, I don't think a surgical guide helps that much with that.
Howard: I feel like I'm spending too much time with your amazing mind on implantology and not enough time on the other 6 month smiles because when you said that your course teaches the 80-20 role, pick the 80% that don't need a sinus uplift, pick the easy ones. Ortho is a perfect 80% because 5% are class 3, which Jay Leno, orthodontists don't even want to do class 3. 15% are class 2, he doesn't have a chin, when he smiles his liver shows. But 80% of ortho is class 1 molar, class 1 canine. I just want to dress him up, make him look whiter, brighter, sexier, cleaner. Talk about 6 month smiles.
Steffany: 6 month smiles really fits that niche of the adult patient that either had ortho and had relapse or they have serious issues that they were never able to have braces when they were a kid and they always wanted their teeth to look a lot better. Or, pre-restorative cases. A lot of times you'll have a veneer case where the teeth are all over the place and you can't do veneers on that case. There's no way you can do a nice cosmetic case if the teeth are somewhat orthodontic-ally aligned. 6 month smiles fills the gap in between all of that. It does it because if you pool adult patients, at least 80% don't want to wear metal braces and they don't want to wear them for 2 years. The length of time is a huge issue and the metal braces is. I wouldn't wear metal braces and I'm not that vain, believe it or not. I wouldn't put metal braces back on. I had them for 3 years as a kid and I just don't want to do that again. If you told me you could put cosmetic braces on me and it would only take 6 months, I would agree to that. But I am not going to agree to something that's going to take a super long period of time and looks bad. That's what 6 month smiles is really about and again, it's cases where you wouldn't look at the patient as an orthodontic patient because it's too mild to send to the orthodontist because it's a silly, minor case. It's also something that [crosstalk 00:50:02] they can have a nicer smile.
Howard: Don't you think the orthodontist with ortho is the same problem as with oral surgeons an implants? If you go to an orthodontist, I have people going there and [crosstalk 00:50:14] here's two years of ortho maybe orthonatic surgery, they don't do market segmentation either. What surprised me is even orthodontists don't offer 6 month smiles.
Steffany: In my mind, would it be better to put 8 or 10 veneers on somebody or straighten their teeth that already look good? They're just not in the right place. We did way too much cosmetic dentistry for a long time when we really should have been doing more ortho.
Howard: You know why I knew that was bullshit to begin with? All these big cosmetic dentist names that were peeling off everyone's enamel for 10 upper veneers, made their own daughter get ortho and bleaching. Now that you've been out 2 decades ago, when we peeled all the enamel off and did 10 upper veneers, how many of those teeth died and needed root canal 10 or 20 years later.
Howard: What percent would you say?
Steffany: 40% or 50% maybe?
Howard: If you won't do this on my own 4 boys, you had 4 children too didn't you?
Steffany: I had 4 yeah. I have 2 boys and 2 girls so I got lucky.
Howard: I got a granddaughter, do you have a granddaughter?
Steffany: Not yet, I have teenagers so I'm still in purgatory.
Howard: That's amazing. I'm a firm believer if you wouldn't let your own kid do this, why are you selling it? I've also found out as I get older, you're talking about leadership that as you get older you have more confidence and it comes down to it, you become a leader because you exhume leadership more. So many girls that I let the tail wag the dog 20 years ago and put veneers on them, now I could have a fatherly talk to them and say, "Look, 2 years are going to by like this or 6 months or whatever." Let's just unravel these things. You just want to look cuter on your facebook selfie, let's unravel this for 6 months, let's do some bleaching, whitening and you're a pretty girl, this will be good. I don't want to shave down all the enamel off your teeth.
Steffany: We don't want to condemn them to a lifetime of maintenance, that's not fair.
Howard: I don't want to throw you under a bridge but dentaltown.com, no dentist practices solo again. There's kids out there all by themselves saying, "Well, Steff" ... by the way is Steff okay with you?
Steffany: Yes, of course.
Howard: I hear there's 6 month smiles, there's [inaudible 00:52:43] which was Ryan Swain? There's powerprox which was who? The guy that eats? That guy. He'll kill me if I don't remember his name. There's invisiline, clear correct. What would you tell those people that are driving to work right now, they're all alone, come on help me out I don't want to take 4 courses. What's the difference between 6 month smiles and [crosstalk 00:53:14]
Steffany: Invisiline moved their original course to a half day course. I did tons of invisiline for a long time, invisiline's great for patients that are super complaint but you can't predict who's going to be complaint straight out of the gate. I got tired of patients saying sure I'm wearing the trays, but nothing would move. I've done enough cases that I know if they were the aligners the teeth move. 6 month smiles is where you have automatic control. You know as well as I do that the 4 years in oral surgery residency or the 2 years in orthodontic residency, what they're really learning to do are the super complicated cases. They don't need 2 years to learn the simple cases, that's straight-forward and simple. It's tooth movement, force and how everything will respond to the force. That's not a difficult thing to learn, it's doing the super super complicated cases and finishing them so you don't yank their teeth out along the way. 6 month smiles has good science behind it and I think that's the difference, that's why it's grown into a real company because it really actually has the science behind it and it works really well.
Howard: I'm not giving up, I've got to find my buddy on powerprox or I'm going to feel [00:54:00]
Steffany: Is it Rick something?
Howard: Rick Depaul! I was having dinner with him and his wife. Back to invisiline no compliance, is this a bias of mine but to me little girls would do anything to do prettier and that little boy with the bogger out of his nose and that same shirt he's worn for 3 days, he ain't going to wear his aligners. I'm to the point now at 52 years old I'll tell mom, I'll do it on a young girl, I'm not doing it on your high school boy.
Steffany: I've had high school boys that are pretty compliant.
Howard: Would you call those gay?
Steffany: Kind of, maybe, I don't know. They have to look me in the eye themselves and really say yes, I want this for myself, instead of mom or dad wants this for me.
Howard: It's that look, you can tell.
Steffany: I want to know if they're a good student. If they're a first born they're probably a rural following. I want to know the interaction between mom and dad and I want to see if they're respectful to mom and dad. If they roll their eyes to mom and dad I'm like Heck no, there is no way they're going to do anything mom or dad says and they're certainly not going to do what I say.
Howard: They have to have a look that they're into beauty.
Steffany: They do. They have to be far enough along. They can't be 12, 13 or 14 usually. They have to be far enough along that they want it for themselves I think.
Howard: What I like about 6 month smiles, I'm in control. If I bomb that up to your tooth, it's all me. If I have a gut feeling that it's going to be up to you and you're going to make me look bad, I don't want to do it. Do you do regular ortho?
Steffany: I don't do regular ortho, just invisiline and 6 month smiles. I charge $3700 plus $500 for retainers for 6 month smiles.
Howard: What are the retainers are they fixed bridge?
Steffany: We do fixed and a removable. We do a fixed 6 unit on the lower and then we do an essex.
Howard: For upper and lower?
Steffany: Upper and lower.
Steffany: I just don't want [crosstalk 00:56:50]
Howard: Are you still doing invisiline?
Steffany: A little bit but it's few and far in between, it's hard to get compliance. I've done [crosstalk 00:56:59]
Howard: It's expensive. The lab bills are expensive and I think that's what has brought in some knock-offs. What are those?
Steffany: There's simple 5 or something like that. There's several ... there's nothing as comprehensive as invisiline.
Howard: One thing you want to do in business is have a protective moat around it, like a patent. Dentistry has one because the schools ... anyone can open up a restaurant or a dry cleaner but you have got to go to 8 years of college to open up a dental office, that's a huge restrictive barrier of entry. I always think when these companies come out, they charge an arm and a leg, they're forcing a competitor.
Steffany: They actually still believe all dentists are wealthy beyond belief and the sheer numbers tell us otherwise. We're still regular people that have a regular income.
Howard: Steffany, talk to that person who's living in fear. What are they afraid of learning from 6 month smile or powerprox with Rick Depaul, what do you think is the fear factor and holding them back?
Steffany: I think the fear factor is that somebody else is going to find out that they're doing it and they're not going to be doing it perfectly. The great thing about ortho and putting brasckets and wires on a tooth is if you can move it one way, you can move it another way. If you move it some place where it doesn't belong you can move and fix it. It may take longer than 6 months or a certain period of time but you should always tell them longer than that anyway. 6 months for most people but for you it's 8 or 9. The fear is you're going to screw something up that you can't fix and the fact of the matter is if you can move the tooth one way you can move it the other.
Howard: What can me into ortho 28 years ago, 1970 you sent anyone to ortho they just pulled the 4 first [inaudible 00:59:02], that's all it was.
Steffany: Now everybody has sleep apnea.
Howard: [inaudible 00:59:07] and then they spend about 6 months straightening the teeth and then a year and a half where you picked these big old 10mm. What I didn't understand about needing space is, a lot people they'd say you need to pull 4 [inaudible 00:59:23], you might just need 5 or 6mm. I could sit there and take out the MOD amalgams and put them in direct composites with less contact. I could put a wedge in between the teeth and then go in there with [inaudible 00:59:39]. I could get all the space they needed just by removing the two surface amalgams and a little slenderizing I could do the case in 6 month, and their amalgams turn white.
Steffany: That's magic! We live in the real world where regular patients want what we have practically to offer.
Howard: You are going to have a lot of homework, you promised [crosstalk 01:00:11]
Steffany: I did promise you lots of things, I know.
Howard: You're going to build me some online CE course, how many online CE courses are you going to build us?
Steffany: At least 1 for sure.
Howard: You need to have 1 on ... you're an amazing leader and marketing person.
Steffany: I like that.
Howard: You're the Bono in U2, you're the front face. I have seen you on the news a dozen times because I follow you on Youtube. Every time you post on Youtube or Facebook, I see it. You also were going to post on this month's Howard Speaks because it's right or left, no in-between. Final question, we're in over-time it's 1 hour and 1 minute. 1 question us old guys have about women that I want you to answer. I only have 7 restorations in my mouth, they're all gold, how come every time I see a woman she's got 3 gold earrings, gold wings, watches, anchor, even a gold BB in their belly and then I'll say "Can I put a gold crown on number 2? It's way back in the mouth." They look at me like I'm from Pluto. Why is gold perfect on every part of a woman's body except her molars?
Steffany: Smoke and mirrors, Howard. It means that we want to appear that we have perfect teeth but [crosstalk 01:01:33]
Howard: You're saying gold symbolizes there used to be a flaw whereas a gold ring or a gold chain [crosstalk 01:01:42]
Steffany: In my mind, teeth are supposed to be white, even though you can put a gold crown on it, I feel teeth are supposed to be white. But my jewellery is supposed to be gold.
Howard: All mine are gold.
Steffany: Really women want diamonds honey not gold.
Howard: On that note, thanks for promising all the stuff you're going to do for me because I really want you to be on that list. [crosstalk 01:02:11] When I go to the general schools, they're 45% women and they don't want to log onto dental town and see the all man show. If you've got other leaders, bring them on. I want them to see women role models, I don't want them to think that they have to work Rick Workman or Steven Thorn, that they can be like you some day because a lot of them want to be like you.
Steffany: Thanks that's really nice. I appreciate everything you do for dentistry, you're amazing.
Howard: All right Steff thanks for giving me an hour of your life today.
Steffany: Take care. Howard: Bye bye.