The Top Challenges Facing Dentists Today

Chris Pistorius (00:01):

Hey, everyone. It’s Chris Pistorius again with the Dental And Orthodontic Marketing Podcast. We’re all about finding great ideas, unique ideas, and things to help dental practice owners. Today is going to be no different. I’ve got a great guest, Dr. Paul Goodman a.k.a Dr. Nacho is with us today.

Chris Pistorius (00:23):

Dr. Nacho, thanks so much for joining us today.

Dr. Paul Goodman (00:26):

Love being here. Thanks for having me on. I love you guys. Love when people do stuff like this, get more stories out there on how dentists can do you better. Honored to be here.

Chris Pistorius (00:33):

Absolutely. Awesome. Well, hey. You’re a busy guy. All right. We talked before we hit the record button here. You’re running this Dental Nachos that we’re going to talk about in a second. You’re a current dental practice owner. You’re practicing. You’re a practice broker as well. How do you find the time to do all of this, possibly and get sleep still?

Dr. Paul Goodman (00:55):

Thanks for sharing that. Well, you have to work your whole life to create unique opportunities, unique timing. I practice six to eight days a month. I do dental practice brokering, Dental Nachos speaking the other days of the month.

Dr. Paul Goodman (01:08):

I was practicing as a full-time dentist. I always wanted to have a collaborative dental office. What’s unique about us is we have two locations with nine dentists working there. So we can always have a musical chairs of dentists. Someone can cover for me.

Dr. Paul Goodman (01:20):

One of the challenging parts, which I talk about, is being a solo practice owner can have a lot of upside, but also can have a lot of restrictions on your time when you’re the only person doing it. So the first thing I did was to create ability to replace myself in the practice with associates and other dentists there.

Dr. Paul Goodman (01:36):

I sleep more than people think. I just am like a friendly tornado, operate on double speed when I’m awake. So it’s not always easy to be around me.

Chris Pistorius (01:44):

Yeah. Well, that’s incredible. Always stay busy. I think that’s a good thing, right?

Dr. Paul Goodman (01:49):

Yeah, for sure.

Chris Pistorius (01:50):

Tell me about this Dental Nacho stuff. Obviously, I know a little bit about what’s going on there, but somebody that’s never heard of it or doesn’t know what it’s all about, tell us all about it, please.

Dr. Paul Goodman (01:59):

It’s a common thing. You wear this shirt around, people will stop you. I was getting money at the ATM. Do they call it the ATM? The guy who is the security guard said, “What is Dental Nacho?” Really, it’s like a Mister Rogers’ Neighborhood for dentists, where dentists could come together, talk, share, discuss spicy topics.

Dr. Paul Goodman (02:16):

Mr. Rogers is one of my heroes. Mr. Rogers … I’m a kid of the ’80s. I’m 43. He was talking about gun control, racism, things that we’re talking about now 30 years ago. That show is not just for kids. If you watch Won’t You Be My Neighbor, an amazing show about him.

Dr. Paul Goodman (02:33):

I wanted to create an environment where dentists would feel safe sharing, but we also could discuss the challenges that are facing our industry, causing us to have problems with our morale, challenges with money.

Dr. Paul Goodman (02:44):

I think one of the popular term now, Chris, is gaslighting. I think the public says, “Oh, my dentist always seems happy.” I say, “Well, that’s just a fake face they put on for you when you’re there, because we’re doing full contact arts and crafts on people who don’t want to be there.” So it can be a much more stressful job than what the patients see.

Chris Pistorius (03:03):

Right. So it’s kind of a … Dental Nachos, you almost think of a safe place for dentists, right?

Dr. Paul Goodman (03:08):

Yeah. But we can have spicy conversations. We also do a lot of things, in-person events, live streamed events, CE courses. The pandemic has created an opportunity for us to do things like we’re doing now. Also a community for dentists to care just as much about each other as they do about their crown preps, which I think is important.

Chris Pistorius (03:28):

Yeah, absolutely. You just mentioned [inaudible 00:03:31], you talk about some of the top challenges in dentistry now. That certainly changes from month to month, as we’ve seen from the recent COVID stuff. Other than COVID, or maybe you could include COVID into this, what do you think are some of the top challenges facing dentists today?

Dr. Paul Goodman (03:46):

I talk about the Ds destroying the life of dentists. Dentistry’s great. Technology, great. Stuff we can do on patients, great. Working inside of our operatories has gotten more fun, probably a little bit easier, and we can do amazing things. When you step outside the operatory, morale and life of dentists, problems.

Dr. Paul Goodman (04:03):

Here’s one. Declining insurance reimbursement. I will use this example. Imagine if they said, “You’re going to exercise every day. You’re going to eat right. And every year, you’re going to gain five pounds.” That would hurt your morale. That’s what’s happening with insurance reimbursement for dentists. We’re being paid less than we were years ago, even though our business costs more to run.

Dr. Paul Goodman (04:21):

Our newest dentists, dental school costs has gone up two to three times as much without dentists making more money. So dental student debt affects the industry, not just the new dentists, it affects all of us. It affects decisions in where they work. It affects so many things. So both dental student debt and declining insurance reimbursement, I think, are two of the biggest challenges.

Dr. Paul Goodman (04:41):

Also, the pandemic has caused many hurdles for team members. Some of them couldn’t come back to work. We have to put together a whole football team to get our job done, right?

Dr. Paul Goodman (04:50):

I had a chiropractor as a patient. I said, “That must have been a relaxing job. It’s just you and the table. As long as the table shows up, you can do your job.” But I don’t know if you’ve been in a dental office. We’ve got assistants, hygienist, front desk. That can be fun. But if one person’s missing, I’m a big sports fan, we don’t always have a bench. That can really impact your ability to deliver care.

Chris Pistorius (05:11):

Yeah. That’s awesome. It’s kind of like the next man up philosophy of football perhaps, right?

Dr. Paul Goodman (05:15):

Yes. Yeah. But we have no next man or [crosstalk 00:05:18]. You turn back and we got nobody.

Chris Pistorius (05:21):

Yeah.

Dr. Paul Goodman (05:22):

That’s part of the challenges.

Chris Pistorius (05:23):

Yeah. Well, let’s dive into that a little bit. It seems like a hot topic. I ask this in almost every interview I do. It’s great to get different ideas here. But hiring and firing, and especially hiring and retaining employees, that next man up strategy we were talking about, in your opinion, you’ve been around, you know this stuff, what’s the best way to find great employees that are going to stick around?

Dr. Paul Goodman (05:48):

First thing I always share is always be looking for team members, even when you don’t need a team member. Always just be alert. I have a two children that live in my house. Apparently, it’s still illegal to leave them home alone. So we need baby sitters. So I’m always looking for extra babysitters.

Dr. Paul Goodman (06:04):

Life happens. Dental team members, it’s not an easy job. You’re working shoulder to shoulder with people who don’t want to be there, in a high stress environment. With the pandemic, sometimes people couldn’t come back to work because of their children. Sometimes people just get burnt out of the industry. So one strategy is always be looking, even when you don’t need anyone.

Dr. Paul Goodman (06:20):

Number two strategy is stay connected in your community, both dental and outside of dental, because there’s positions you can train people off the proverbial street.

Dr. Paul Goodman (06:28):

Three, stay connected with people who are connectors, like equipment reps, like marketing companies like you, so that you can leverage that. Oftentimes people shout out, “I need a hygienist,” but they don’t have any relationships at that time. There’s great services out there. Some of them are sponsors of our group. But they’re not magicians.

Dr. Paul Goodman (06:48):

Those are the three things I would say is always be looking, even when you don’t have a need in your office, for good team members.

Chris Pistorius (06:54):

Yeah. I think that’s great advice. In your experience, I’ve heard lately more of dental practice owners and managers really hiring people with no experience in dental. The thought behind that is, number one, there’s more of them available, right?

Dr. Paul Goodman (07:10):

For sure.

Chris Pistorius (07:10):

Number two is they’re finding that when they do that, yeah, there’s more training. They can teach them the dental side of it, but they’re finding that they’re not set in their ways, they’re totally coachable, and they wind up being better employees. Have you seen that? Do you have any experience with that?

Dr. Paul Goodman (07:25):

Oh yeah. We do that with a lot of things. There’s technical jobs that are hard to do that, some not legal, like hygiene. But sometimes your assistant team, depending on what they’re do, or your front desk team, and also just …

Dr. Paul Goodman (07:37):

This is an off topic, but why does somebody have to have the same career for 40 years? Is that a good thing? Meaning someone who’s a dental assistant, and an awesome dental assistant, aged 23 to 36, maybe they’re just burnt out, and they want to be a rep for a supply company. That’s totally cool.

Dr. Paul Goodman (07:53):

So I think we just need to be comfortable with this transitioning nature of the workforce, and be agile and flexible. You’ve said a good point. Get good training systems in your practice so that when you do bring somebody in, you’re not reinventing the wheel.

Dr. Paul Goodman (08:06):

Too often, dentists are held hostage in a way by this one team member who knows all these things. Also, I’ve had a great life, but I’ve also had some challenges. I’ve had unexpected events happen, illness, death, injury, or happy events. Somebody’s spouse has to move across the country because they got a great job as the VP of sales for something. Now, they’re gone. So I think dentists need to learn in school that putting your team together is something that’s never finished, and you should always be working on it.

Chris Pistorius (08:36):

Yeah. I’ve referenced this before, but are you familiar with a book called E-Myth Revisited?

Dr. Paul Goodman (08:42):

Oh, yeah. Am I familiar with it? It’s near me at all times. I have it right here.

Chris Pistorius (08:46):

Folks, this was not planned. I promise.

Dr. Paul Goodman (08:48):

Yeah, yeah.

Chris Pistorius (08:49):

I’m not promoting-

Dr. Paul Goodman (08:50):

These are my two favorite books. E-Myth and Checklist Manifesto. I have these at all times.

Chris Pistorius (08:55):

Perfect. This was not rehearsed. I promise. But you’ve said a couple of things that made me think you might be onto that. You talked about replacing yourself earlier, and then you talked a little bit just now about process, procedures.

Chris Pistorius (09:08):

Anybody watching or listening right now, this book, E-Myth Revisited, applies to you. It applies to almost any business. What it really talks about is what Dr. Nacho was just talking about, in the sense that you never know what’s going to happen, so you really need to have a really good book of process, procedures, something that somebody even off the street could come and just read the book and know how to do that job, right?

Dr. Paul Goodman (09:35):

[inaudible 00:09:35] paper still. We have ways for people to touch something and say, “These are the most eight important things from the Checklist Manifesto for each job.”

Dr. Paul Goodman (09:42):

I think management is repetition. One of my consultants told me that early on. It’s such a good point. I think dentists get frustrated where they need to learn to delegate tasks that they are able to give up. But some dentists will micromanage too many things and cause their stress level to rise.

Dr. Paul Goodman (09:58):

Really, it’s sitting down, going through the process of creating a system, creating supporting assets for it, whether it’s digital and paper, and then being patient enough [inaudible 00:10:09] to help people when they drop their nachos, or the nachos go off script.

Dr. Paul Goodman (10:14):

But what’s crazy, Chris, is, I say this all the time, dental school sets dentists up to be miserable, because they don’t talk about any of this. So they make you think that being technically competent is good.

Dr. Paul Goodman (10:26):

Everybody knows this experience. Everybody has in their background an amazing chef owned restaurant where the service stunk, the food took too long, you didn’t know if they’re open, but the food was amazing, but you stopped going there because the other stuff was a problem.

Dr. Paul Goodman (10:42):

Dentists are the people trying to make their pasta so well, while the other stuff they’re not planning. That’s part of the reason, I believe, why they’re so stressed out in private practice, because they don’t even know that this is a thing until they get there.

Chris Pistorius (10:53):

Right. Yeah. That all makes complete sense. I can’t say enough good things about that book, E-Myth Revisited.

Dr. Paul Goodman (11:01):

Yeah.

Chris Pistorius (11:01):

It talks about creating a business as a franchise. Even though you’re not going to be a franchise, there’s a lot of things that you can do to set your business up in that way. I totally see some parallels on how that could work, like you mentioned with dentistry.

Chris Pistorius (11:15):

I’m going to switch gears just a little bit here. You mentioned dental school. This was a topic I was talking with somebody the other day about, how in dental school, they teach you really well how to become a dentist, or in most cases, how to become a dentist, but they leave out a lot of the business aspect of this. Is that accurate?

Dr. Paul Goodman (11:34):

Yeah. It’s incredibly accurate, irresponsible, and maybe even borders on a scam, because here’s why. Dental school keeps raising their prices, they’re delivering less to the dental student, and they’re not training them to survive and thrive in the real world.

Dr. Paul Goodman (11:48):

Here’s an example. Dental school charges 500 or $600,000. That’s money, right? They charge it to the dental student. Yet when the dental student is in dental school, nobody teaches them how money works in dentistry, which is one of the most irresponsible things.

Dr. Paul Goodman (12:04):

I don’t know if I’m an economist, or I don’t know if I’m a business whiz, but I don’t think you can help anyone if your practice goes out of business. I don’t think you’d be doing dentistry on the streets.

Dr. Paul Goodman (12:13):

Keeping your dental office in business is more challenging than people think. They just give these cliches, “Dentists don’t fail.” “None of them go out of business.” But they have not looked to see what’s happening in our industry with declining insurance reimbursement, with challenges that people are having. So I just think we need to start to have these conversations in dental school, so they’re at least aware of these things.

Chris Pistorius (12:34):

Yeah. We see all it all the time too in marketing. Honestly, in all frankness, it’s probably helped our business, because these people come out of school, and they’re like, “All right. I know how to do dentistry, but how do I grow a practice?” Right?

Dr. Paul Goodman (12:48):

Yeah.

Chris Pistorius (12:48):

They don’t know much about marketing. Unfortunately, what happens, if they get in the wrong hands with the wrong people in terms of marketing, they can spend a ton of money and not get anything out of it. We see a lot of that, especially with some of the newer guys or girls coming out of school, and trying to figure out what they want to do with their practice.

Dr. Paul Goodman (13:07):

I agree with you, but I would encourage, and not really challenge … If a dentist is going to spend 5% on marketing, just as an example, and you took all the millions of dollars of revenue, it’s going to be like 0.6%. So your business has a huge pie that could grow for all companies if dentist says, “Hey. I’m at least going to spend $50,000 of my million on marketing,” because dentists are often very frugal, #dentistCheap, I’ve come up with that, on marketing. So I think, in the most positive way, there’s a huge pie for marketing companies to win if dentists get the message like, “Hey, I should be spending this money on marketing.”

Chris Pistorius (13:45):

Yeah. No, that totally makes sense. Especially, it’s so competitive now. Depending on the market you’re in, you’re getting a lot of pressure from corporate dentistry.

Dr. Paul Goodman (13:54):

Right.

Chris Pistorius (13:54):

So yeah, for sure. I want to talk a little bit more about new dentists. What’s your advice to somebody coming out of school, or maybe they’ve been an associate for a year or two, and they’re getting that itch to maybe have their own practice? Do you feel as though it’s smart right now go out and do your own thing?

Dr. Paul Goodman (14:11):

What they should do is go to someone who has a three-year-old, like me, [inaudible 00:14:15] and say, “I want to watch it for the next week, and see how I do,” because having a dental practice is like having a three-year-old that never grows up.

Dr. Paul Goodman (14:21):

But in all seriousness, I think that they need to develop their core with business leadership, team communication, nothing to do with crown preps, nothing to do with extracting teeth, and see if that’s the life that they want. I think one of the …

Dr. Paul Goodman (14:36):

If someone said to me, “Why are dentists have so many morale problems, stress problems, depression, death by suicide?” Here’s why. This is the answer. Dentistry is filled with conflict. You’re talking to people who don’t want to be there and don’t want to pay for it. You have team members who are challenging to deal with.

Dr. Paul Goodman (14:54):

If conflict is fighting fires, a firefighter knows they’ve signed up to fight fires. A dentist in the real world has no idea how much conflict they have to deal with. As a practice owner, you have to deal with quite a bit daily. It’s all personality driven. Are you the type of personality that will do this?

Dr. Paul Goodman (15:11):

Buying a practice can be the key to financial success, can be the key to making flexible decisions, but you know what? Here’s a problem, Chris. What’s your spouse’s job? Because if your spouse has a job where he or she might move across the country, you buy a practice, you’ve got a big problem. Because if she gets a promotion, or she has to live her dream, what are you going to do with your practice? Dentistry …

Dr. Paul Goodman (15:31):

I have two daughters. What this pandemic has taught me is I will encourage them to do what they want in life, but I will guide them. I will tell them that if they have a job where the only way they can make money is by physically being in front of somebody, it’s a very risky job. Dentistry, hairstylist, restaurant server. Because what this pandemic has taught us is dentistry’s not portable.

Dr. Paul Goodman (15:55):

There’s great points. Everyone’s going to need a dentist. Doesn’t mean it’s [inaudible 00:15:58] But just sharing that owning a dental practice can be an anchor to that geographic region, you just want to make sure that’s where you’re going to be.

Chris Pistorius (16:06):

Yeah. That’s a great point. COVID has definitely shown us that. We see the people, the businesses that have been impacted the most, dentistry, anything in person, entertainment, arts, things like that.

Dr. Paul Goodman (16:17):

Right.

Chris Pistorius (16:18):

That’s an excellent point, for sure.

Dr. Paul Goodman (16:20):

Thanks.

Chris Pistorius (16:21):

When we talk about somebody going to buy a new practice, or they’ve made the decision, “Yeah. I want to do this. I want to own a practice,” tell me … You did this. What was your thought process in terms of, do I start from scratch and build my own, or do I go out and look for a book of business and maybe buy one from somebody that’s retiring?

Dr. Paul Goodman (16:42):

It’s such a good question. Most of the time, buying a good acquisition is going to … You’re going to buy cash flow. You’re going to buy systems. So most of the time, that’s what dentists do.

Dr. Paul Goodman (16:52):

But startups, and we work with startup consultants, we respond to startup consultants, give you the opportunity to create your own brand from scratch, but it also means you likely will need to go where there’s a need for a dentist.

Dr. Paul Goodman (17:07):

In my area of New Jersey, we have a one dentist to every thousand people. Very competitive. If someone came into my town and wanted to do a startup, it would be very difficult for them to survive, not because they’re not a great dentist, not because I wouldn’t be nice to them, just because when there’s a free pizza, and there’s nine people, and there’s eight slices, there’s going to be a problem.

Dr. Paul Goodman (17:29):

There’s a really interesting thing happening where there’s massive opportunity, where you can be in a ratio of one to 3001, one to 4,000. But I say this in the most diplomatic way. They’re not often areas where people are clamoring to move to, and they might not be able to bring their spouse there. So I think …

Dr. Paul Goodman (17:48):

I don’t know. There was this movie, Doc Hollywood, back in the day, with Michael J. Fox. He got stranded [inaudible 00:17:53]. I believe that’s going to happen. There’s going to be towns that have no dentists. Dentists are shutting their doors, and no one’s replacing them, because up until about the 1990s, most dentists returned to where they lived to practice, me included. [inaudible 00:18:06].

Dr. Paul Goodman (18:07):

Now, we have all these cool people, 50/50 men and women, more women, people from other countries. It’s awesome for the field. But from a business perspective, are people going to go to the middle of Pennsylvania to buy a dental practice if they’re not from the middle of Pennsylvania? Spoiler alert, they are not.

Chris Pistorius (18:24):

Right.

Dr. Paul Goodman (18:25):

So it’s a very unique challenge. Some of it comes with massive opportunity, but some it comes with massive risk. The first thing I say to a dentist when they’re getting a job, which is what we help them do, “Are you geographically flexible?” If they say yes, I say, “You can earn twice what most dentists make, but you’re going to go to Omaha, Nebraska. You’re going to go to Fargo, North Dakota. Is that okay with you?”

Dr. Paul Goodman (18:46):

Nobody … This is what they should tell dental school applicants, Chris, because they’re really not being …. They’re not showing them the true picture of private practice dentistry before they go to school.

Chris Pistorius (18:58):

Right. Yeah. I think that’s a great point, and you’re right. People used to go to school, they’d come back, go to their hometown, set up shop, and they’d be there. That trend certainly is changing.

Dr. Paul Goodman (19:11):

Sure.

Chris Pistorius (19:11):

That’s very interesting. We’re going to wrap it up here, but what kind of parting words or nuggets of wisdom could you share with folks that are watching right now?

Dr. Paul Goodman (19:22):

What I would say is if you’re a dentist watching, just do one thing to be kinder to a dentist near you. Call them up on the phone and do something that was normal when you were a teenager, but now I know you’re all weird. Say, “Hey, do you want to go get lunch and just talk?” I know it’s going to be weird. Just say, “I’d love to get to know you.” I believe dentists getting to know each other, being kinder, sharing more, is the key to a successful industry.

Dr. Paul Goodman (19:45):

I’m a huge Game of Thrones fan, so if someone’s listening to Game of Thrones, they’re going to get it, this is like when they didn’t think the White Walkers were coming, but they were coming. They were. I’m telling you, the White Walkers are coming for dentistry. Dental insurance reimbursement, dental student debt.

Dr. Paul Goodman (19:59):

I work with DSOs. DSOs a very interesting mix. That’s corporate dentistry. Corporate dentistry is doing things to push the field forward, but also doing things that limit opportunities for private practitioners, because a great practice will often be bought by a DSO before it gets on the open market. That’s something that’s been … Our dental ancestors have let them in, so now we have to deal with that.

Dr. Paul Goodman (20:22):

So I would encourage you, reach out to a dentist in your town, talk to them more, go to more in-person CE, be that kind of friend that you needed when you were in dental school. That’s what I hope people would do.

Chris Pistorius (20:33):

Yeah. That’s great. That’s a great analogy with the White Walkers. I like that.

Dr. Paul Goodman (20:37):

Yeah, right.

Chris Pistorius (20:37):

What if somebody’s watching this, and they’re like, “I need some help [crosstalk 00:20:42] Dr. Goodman’s talking about here,” what’s the best way to reach out to you guys and learn more about your program?

Dr. Paul Goodman (20:49):

Thanks so much for letting me share that. dentalnachos.com. I’ve tried to create like an ESPN version of what we do, from buying practices, CE, events. You go to dentalnachos.com.

Dr. Paul Goodman (20:59):

One of my best friends in life, I brought him. It’s my phone. You could just text nachos to (215) 543-6454. If you text nachos to (215) 543-6454, one of my idols is Gary Vaynerchuk, Gary V, and I got the same community text platform that he has. It’s been a great way to connect with people, because you text in, and you’re texting me. We can have a conversation. Ask me a question. I really love it.

Dr. Paul Goodman (21:24):

Thanks so much for letting me share that.

Chris Pistorius (21:25):

Nice. Yeah. I’ll make sure we put that information below the post and everywhere that this is going to be broadcast.

Dr. Paul Goodman (21:31):

Awesome.

Chris Pistorius (21:32):

Hey, Dr. Goodman, seriously, thanks so much for your time. I know how busy you are. This has been really fun and a lot of really good information. I appreciate you being with us today.

Dr. Paul Goodman (21:41):

Thanks, Chris. I really appreciate it.

Chris Pistorius (21:43):

Sure thing.

Chris Pistorius (21:43):

Thank you to everybody that’s watched this episode of the Dental And Orthodontic Marketing Podcast. Please be sure to check in with us next week for another great show. Thanks again.