In recent years, the concept of dental support organizations (DSOs) has continued to evolve and enlarge in the United States despite controversy. It is estimated that there are at least 1,000 DSOs, emerging DSOs and large-group practices in the USA with many others planning to start. The largest three DSOs are Aspen, Heartland and Pacific...
Ideation & The COVID Era Zoom with Dr. Gary Glassman and Post-Interview Discussion
This show opens with a discussion of the emerging popularity of teledentistry; how can it be incorporated into your practice? Next, Ruddle welcomes a special guest endodontist via Zoom, Dr. Gary Glassman, to inspire clinicians in their dental practices and beyond, and to give us a new perspective on DSOs. After, Ruddle adds insight on DSOs and extra dental costs in the COVID-19 era. Stay tuned for the close of the show where the Demotivators will inspire you with a kick in the pants and some ridicule!
Show Content & Timecodes00:09 - INTRO: Teledentistry 05:06 - SEGMENT 1: Zoom with Dr. Gary Glassman 38:04 - SEGMENT 2: Post-Interview Discussion 45:26 - CLOSE: Demotivators
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Welcome to The Ruddle Show. I’m Lisette, and this is my dad, Cliff Ruddle. We have a great show for you today. I really like the whole color scheme that we have going on here with the graphics and the lights.
Yeah. It reminds me of the old expression, “Carpe Diem”.
So, we’re going to start off talking about teledentistry. By the end of last year, it was reported that about 23 percent of dental professionals had incorporated teledentistry into their practice, to some extent, and another 11 percent plan to do so in the near future. So, this new model for oral healthcare is fast becoming a reality. Obviously, you can’t get your teeth cleaned by Zoom. But in what way can teledentistry be helpful?
Well, as we’ve said in previous shows, and we even had a COVID special, we can immediately screen COVID-positive patients or COVID-negative patients by using teledentistry. Consultations can a lot of times be done, if they’re focused. In other words, we’re not doing a general full-mouth examination in teledentistry. It’s more of a process to focus on a specific problem. So, we can do it for that. If you are a general dentist, and you maybe wanted to make a referral, you could do this all on teledentistry, by saving the patient a visit to an office, which could put them at risk.
And that kind of comes into that thing of nonmaleficence. Nonmaleficence is “Do no harm”. So, if you can save them from actually entering a risk area, that would be good. You can – you can do pain management. You can find out how bad the pain is, can they be seen at another time, or does it really need to be taken care of right away. So, probably the groups of people that come to mind are people that have a hard time taking time off work. That would be a category. Another one would be people who have caregiving responsibilities, like professional people. They have a hard time taking time off and scheduling. Some people are – they have a trouble with travel. There’s travel barriers. So, all these three categories can be used to help in teledentistry and take care of people.
Okay. Well, I know that dental insurance companies are starting to get onboard with this, and that’s necessary, to develop fee structures. The states leading the charge right now are Pennsylvania, Washington, Florida, and Arizona. And that primarily has to do with favorable coverage in those states. So, I guess you have to figure out how you want to charge for something like that, because probably some things shouldn’t be charged for, just like maybe a post-treatment follow-up. But then, what do you charge for?
Well, the main thing I’ve understood from doing a little bit of journalistic work on it, is you really need to treat a virtual patient exactly like a physical patient. And if you keep that as your guideline, then you won’t get into trouble. In other words, we see patients, we quote fees, don’t we? And we have frank discussions and concerns are addressed, that kind of thing. Just because you’re on the phone, and they’re somewhere away, you still have to discuss fees, because another thing to do with beneficence is “Do good.” Well, in beneficence, if you can save them a trip into your office, you’ve saved them maybe an exposure. So, anyway, those are kind of the things you should think about, as keeping them exactly like the physical patient.
And it sounds to me like communication’s absolutely crucial, because if they’re just assuming that they’re not being charged for a teledentistry appointment, then – and then they are surprised, that’s going to cause a problem.
You know, Lisa, probably another final comment from me would be, before teledentistry, did you charge them, when you called in a prescription? So, probably think back to how it was before – pre-COVID, and then think about, are you doing something now different? It should probably be just about the same.
Okay. Well, I first heard about teledentistry from Dr. Gary Glassman, when he was a special guest on our show, one of our COVID shows, last year.
And he was talking about teledentistry. And he happens to be a guest on our show today. So, maybe we’ll learn a little bit more from him. Let’s get started.
SEGMENT 1: Zoom with Dr. Gary Glassman
So, today we are joined by a special guest endodontist, Dr. Gary Glassman, from Toronto, Ontario, Canada. And Dr. Glassman is on staff at the University of Toronto and also maintains a private practice there. He has published numerous articles, lectured globally on endodontics, and is the Endodontic Editor for both Inside Dentistry and Oral Health Journal and is the Chief Dental Officer for a dental support organization, dentalcorp. So, we’re very honored to have Dr. Glassman on our show today, to share a little bit about himself, tell us some of the secrets of success, and then also give us a new perspective on DSOs. So, welcome, Dr. Glassman.
Thank you! It’s great to be here, and thanks for inviting me.
Well, I have a little bit to say, but you’re our featured guest. So, Gary, you know I’m – I’m not a man of few words. So, I have to be – really zip it up today. But I’m really excited to have you here, absolutely delighted! And we could talk about so many things and kill the entire segment. But maybe just to get right to it, because time is forcefully restrictive, why are you here today, and what would be your intentions for our audience, when you’re completed with this interview?
Well, one of the things I’d really like to impart upon the docs that are watching, and whoever is watching, that there is a world beyond endodontics, and there’s a world beyond dentistry. And I know I’m speaking to an audience of successful practitioners, which is a very important part of who I am. And – but beyond being a clinician, I want to share the bigger picture, the bigger picture of who I am and what I do and perhaps, spark some ideation in the listeners, about how they, too, can expand beyond clinical practice.
Okay. Well, before we get into all of the professional aspects of what you do, tell us a little bit about Gary Glassman, the person.
Well, I’m a family man, to be – to spark it all off. Lita and I have five kids, all ranging from the age of 24 to 30, and two of them are in business with Lita, my wife, who’s in the pharmacological consulting business. One is a kinesiologist, the other one is pregnant right now, waiting for her first baby. I’m going to be a grandfather. That’s fantastic news. And my son – my other son, he works for UberEATS. He’s in the Sales Department and just is killing it, right now, because of, of course, all the home delivery. So, we spend a lot of time with the family. We spend a lot of time together, up at the lake house. We do some camping.
I’m a big outdoorsman. I’ve done that since I was a little kid, and I’ve sort of carried it on, into adult life. I love canoe tripping, camping, hiking. And I have a passion for wine, as you know, Cliff and Lisette. I – so much, that I bought my own vineyard in Mendoza, Argentina. So, that’s a great – that’s a great hobby of mine, and I’ve learned a lot, doing that. So, with all those things, I guess the key message here is bringing balance to your life, and this is sorta the life balance that I bring to the rest of what I do, which is, obviously, more work.
So, which is harder? Growing grapes or making a good root canal?
[laughs] Yeah. You know, it’s interesting, because when you do a root canal, you have things mostly [with emphasis] under your control. With growing grapes, you’re at the mercy of Mother Nature, unfortunately. And if the wind blows the wrong way, or you don’t get the proper rain, then you don’t get a great harvest for the wine. So, I would say that root canal, you have a little more control, although you are at the mercy of Mother Nature, many times as well.
How involved are you in running the vineyard?
I’m – I’m not day-to-day, because we have a man down there, obviously, because I’m in Toronto. It’s in Mendoza. And I have a couple partners, Steve Jones, who was in the dental business – is in the dental business, who you know. He’s one of my partners. And we have a couple Argentinians that run the day-to-day. So, I go down there, hopefully once a year, for the harvest. I’m going to miss this year, unfortunately. We have four hectares. We have two and a half hectares of Malbec, a hectare and a half of Chardonnay. We harvest the Chardonnay in February, which I’ve missed, and we harvest the Malbec in April. So, I try to get down there at least once a year, to help with the harvest and watch the vinification process be initiated.
That sounds really interesting. Okay. So, you’ve been in clinical practice for 34 years. And why don’t you just tell us some of the things you’ve learned over the years that maybe are key to your success.
I think the secret to successful practice, whether you’re practicing, whether you’re a mentor, whether you’re an educator, and I’ll sum it up all in one word. You need to be relevant. And I think the relevancy is really, really important. You need to be on top of your game. You need to be able to be the best you can be. I think that, with education, you need to stay up on everything, so people want you to be – to educate them and to come to your programs, to come to your courses. And of course, be the best that you can possibly be.
You know, in our practice, we really are patient centric, which all practices should be. So, we connect to our patients as people and not just a root canal, sitting there and getting the treatment done. And I think that’s important to have a successful practice. Pay attention to your patients, not only while they’re in the chair, but also follow-up care is important, too. So, I try to connect to my patients on a different level. They aren’t just a root canal. They’re a whole person. So, at night, I come back with a list from my staff of all my patients that I have. I either call them, if they’ve had a surgical procedure done, or I text every single patient at night, to see how they’re doing.
And that’s something they’re not used to, you know? And I often get those remarks. “Wow, this is great.” And I say to them, “You know, if you’ve been really happy with your treatment, give me a nice Google review.” In this era of social media, everyone’s lookin’ at Google reviews. Whether they’re relevant or not is one thing, but I think that’s – it’s important to be able to share that with your patients and share that with your colleagues.
When I get a new referral, which is quite frequently, usually from my courses that I give, I appreciate them, I recognize them as colleagues, and I give each patient – each new referring dentist a handwritten note and a nice referral package, which explains who we are, what our referral process is, that we’re always available, 24/7, 7 days a week, for them and their patients. Because of course, as an endodontist, you’re an emergency practice. And if you wanna build a practice successfully, you have to be available, and you need to see those emergencies. Because it needs to be no hassle, not only for the patient, but also for the referring dentist.
And of course, if you work in a partnership, you need to be a good partner. You need to communicate. You need to share in the good, and of course, you need to share in the bad as well. And effective communication really is the key. And when you’re working on a patient, when you’re working on a task, I think everyone deserves the best you are, when you have your clinical hat on. So, I’d like to talk about being excellent in the moment and making sure that all external stimuli are sort of put to the side. Nobody can disturb you or distract you. When you’re working on that patient, you are working on that patient. So, being excellent in the moment is like a – is a term I really like to use, to bring focus onto the task at hand.
And Gary, before we went live today, I heard that you trudged into work by foot from across the street, and you had all this tight schedule, but yet you had Ruddle, and you had Lisette at 1:00 p.m., Toronto time, and you said there was a – a big emphasis on each patient, and time was like melting away. So, did you stay focused?
We stayed focused, man. I told my staff in the morning, I said, “I gotta be out by 12:00, Toronto time,” because I knew if I told them 12:00, I really had to be here – out by 12:30. And I knew if I said 12:00 noon, they would get me out as close to that as possible. So, they were excellent in the moment. They were focused. They knew what had to be done. They made sure every patient was seated on time. They made sure that I [with emphasis] was on time, because they’re like taskmasters, my assistants.
One of my assistants, Hannah, has been with me for over 20 years, and my other main assistant, Diane, has been with me for I’d say about 9 or 10 years, now. So, they know – they know what I’m thinking. They know what I need before I even need it. So, it’s nice to have that, in order to stay on time and to stay on schedule. So, I could be here, to tape The Ruddle Show!
Well, that’s awesome, and I appreciate you doing that. But go ahead – go ahead, Lisette.
Well, Dad, I – what he’s saying is what I’m – what I’m hearing is things that you also emphasize, all the time, like getting to know your patients, staying relevant, communication. It’s like those are, I think, very important things. And we actually try to deal with those a lot, on our show. What – what would you caution young clinicians to watch out for, especially now, in this time of COVID?
Yeah. I think – COVID or not, I think it’s important that young clinicians be focused, learn – be good – I always said – people say to me, “Why did you go into endodontics?” And I respond by saying “I wanted to be good at one thing. I wanted to be an expert in one thing. And I wanted to do it well, as best as I possibly could, and hopefully, as best as anyone that’s out there.” So, what I tell my mentees, because I do a lot of mentorship for younger dentists and younger endodontists, is, “Be good at one thing.” If – and I tell this to general dentists, too, who are looking to expand, doing more root canals.
And I say, “Be good at doing one canal,” as an example. “Be really good at doing single-canal teeth. And be excellent in that. And when you’re excellent in doing single-canal teeth, go to two-canal teeth. And be really excellent in that. And when you expand upon that, then, graduate to molars. Don’t all – don’t all of a sudden run, before you can walk.” And they sort of get it. They understand that. Because they’ll always ask, my dentists, “How can I do that molar root canal in one hour?”
And my response to them is, “I’d like you to do it better. And then, when you do it better, eventually, as you become familiar with the techniques and the technology, you will be faster at it. But don’t let that be the initiator of what you want to do. Be good and do one thing well. And then, expand your horizons into other areas, whether it's endo surgery, whether it’s implant reimplantation, or whatever have you, when you look at endodontics and all the procedures that are available for us.”
Well, for our audience today, they’re going to get a very good glimpse of a man who is continuously incessant on reinventing himself, and maybe that’s one reason you’re so excited about life.
Yeah. You know what? It’s nice. I mean, I’ve expanded my horizons into other areas of the profession, education, writing, being Chief Dental Officer for dentalcorp, which is Canada’s large dental support organization, which we’ll discuss. But especially in the times of COVID, it sort of feels like Groundhog Day. Every day is the same. And when you expand your horizons, it sort of brings a little mix into your life, so it doesn’t get boring. So, my education has morphed into the key opinion leaders for different companies, and that has allowed me to stay on top of my game and not only maintain my expertise in what I do, but also knowing that I can do better all the time.
And again, if I can give young dentists and older dentists alike a piece of advice, I would say, “Never rest on your laurels. There’s always something more you can do.” Steven Jobs said, in his address to Stanford University, “Stay hungry. Stay foolish. Don’t ever think you know everything. And always try to keep learning.”
I like what you were saying about, “Keep – get really good at doing one thing.” And we talk a lot about that, on our show. We both read Outliers, and maybe you have, too. But that 10,000 Rule, like “You’re not really proficient, until you’ve done it 10,000 times.” So, it’s a lot.
Right. So, I must be really proficient at root canals --
-- because at last count, I’ve done probably just south of 60,000 procedures, over my – over my career.
Keep working, Lisette. Keep working.
Keep working! [laughs]
Okay. Well, let’s talk a little bit about your passion for education, because I know that you give courses and lecture a lot. And that must be difficult now, in this time of COVID. You’re probably not doing a lot of traveling.
No, I’m doing zero traveling, but sort of – we pivoted, and we’re doing a lot of – I’m doing a lot of online programs. And that’s been very, very exciting, too. You know, I started giving two-hour programs where – working with Dentsply Sirona has been – has just been – has been a fantastic experience. So, what DS does is, they send out kits to the doctors, with 3D-printed teeth, pre-accessed, whatever they need for the treatment, whether we’re teaching ProTaper Gold or WaveOne Gold, or what have you. Usually, it’s ProTaper Gold, because everybody’s got a rotary handpiece. So, all they need is a rotary handpiece.
We send them the kits, the 3D-printed teeth, the ProTaper Golds, the ProGliders, hand files, ProLube, a syringe with rubbing alcohol, because that’s best to use in 3D-printed, acrylic teeth, because it doesn’t release the – the files don’t stick to it and get pulled in all that much. And I go online, I give my lecture, I demonstrate under the microscope, using the same 3D-printed tooth. They follow along. I give the next segment of the lecture, demo, they follow along. So, it’s been very successful, these two-hour programs. So, sort of a pilot program that I’ve done. I’m doing it for the Pacific Dental Conference in a couple weeks, for the JDQ in Canada in Montreal, and also for the Ontario Dental Association. We’ve got that planned.
And I’ve also just developed my own three-day program, where we cover all aspects. It’s going to be 3 days, 20 CE credits, and I’m very excited for it. And we actually pilot that in a couple weeks, March 11th through 13th. So, I’m excited for that as well. And everything is sent to the doc. Again, all they need is a rotary handpiece. But I’m doing more now, in the – sort of the general realm of what I’ve coined “oral fitness.” And oral fitness I describe as having more than attractive teeth. It means taking an active role in maintaining the health of your teeth and gums, in the same way that you would exercise your heart and your muscles.
And it means taking a proactive daily look at your oral health and not just waiting till there’s a problem. We do know that oral health is directly related, and it can affect general health. So, you know what they say, “After all, an ounce of prevention is worth a pound of cure.” So, on my social media, especially my LinkedIn and my Facebook, I’m giving daily advice with respect to general dentistry as well and how we can take care of our oral health, not just endodontics. So, I’m excited to do that. Sort of branched off into that area as well, and it’s been very successful, and it’s got a lot of response from my followers.
Two questions, maybe three. I hope this doesn’t get us too far off script.
When you send out the kits, and they do the work, do the colleagues send the work that they’ve performed back to you, so you can evaluate it? And then, is there some kind of a feedback loop? Or do you share all together, you know, hold up the results, and everybody can see what everybody did?
Yeah. That’s a great question. So, we do many things. For the 2-hour courses that we give, and if it’s a small group, I don’t like to have more than 20, by their names, I will say, “Okay, John. Let me see what you’ve just done with your glide path. Just tilt your screen down, hold it up, and let me take a look at it.” And I can see it pretty nicely. “Great shape, you ledged here, you blocked yourself out. You can prevent it by doing this, that, and the other.” With my three-day course, we actually have a pre-learn program, and in the initial part of it, I’m actually partnering up with Steve Buchanan. He’s got a beautiful access program, online access program.
So, two weeks before the – my program, we send the kits out. It’s got all the 3D-printed teeth that need to be used, opaque, transparent. I’ve recorded a video. Steve’s recorded a video with my video inserted. They do the pre-learn, two weeks in advance, and at the time, they will take pictures of their accesses, of all the tooth types that we provided for them. They will send them in to me, one week before the program. I will look at them, I will put them in my keynote presentation, and I will review the ones that I think demonstrate what good looks like and what bad looks like.
And if it’s good, I’ll tell them why, and if it’s bad, or if there’s a problem, if there’s a ledge, there’s a blockage, I’ll explain to them why the access occurred this way, why you gouged the floor. You didn’t do your straight-line access properly. It’s too small, it’s too big. And we’ll take them through probably about an hour of that first three-hour to four-hour – we’ll call it day one, and we’ll take them through the accesses and through their pictures. But in that aspect, they’ll send them in, and I’ll just import them into my presentation. That’s a great question.
The second one is, do they all get a little shot of Flaneur?
Only the ones that do a really great job. Only the ones that do a really great job. We actually have two new wines coming out, which we’ll probably send them. We have a nice orange wine coming out, now, very trendy, apparently, where the – where the skins are in contact with the wine a little bit longer. So, they get this nice orange hue to it. So, ask Isaac. I’m sure he’s very familiar with the new orange wine that’s coming out.
So, maybe if they play the curve and get a nice pack in all three dimensions, they’d probably get that.
They’ll get a – they’ll get a snack pack of all the different wines we have, 100 percent.
That’s their reward.
I have one other question. So, when they send in their work, and you’re going over some things with them, do you reach out to each one of them, individually, and kind of do a little back and forth with them, before the course? Or is it all handled in the course, like in the class?
Yeah. I’ll do – I will contact directly with them, because I’ll have a week before the course, and discuss it with them, individually, actually ask them if I can present their tooth and present their name and if that’s okay. If they say no, no problem. I can do it anonymously. But yes, I will grade and evaluate each and every single access that they do, and then present the ones that demonstrate the factors that we just discussed, online, to the whole group.
Let’s talk a little bit about your role as Chief Dental Office for dentalcorp. Because, in the past, I know there’s been some mixed feelings about corporate dentistry and dental support organizations. So, what made you choose to be a leader of one of these organizations?
Yeah. That’s a great question. I – I always thought – always think there’s always a better way. I never like when groups get stigmatized, in a negative way. And working with dentalcorp has been probably one of the most – other than teaching endodontics and the latest and greatest in technique and technology, which has been one of my greatest loves and passions in dentistry, in my career. But this has been unbelievable, because it allows me to work from the inside, to optimize patient care in corporate dentistry. And we’re really patient focused. So, my job as Chief Dental Officer is, I facilitate the companies’ continued growth ambitions, and I champion programs to support the practice community, so we can deliver optimal patient care.
So, my mantra has always been -- and I’ve imparted that in our doctors, where we got about 1,200 doctors, 800 associates, just south of 500 offices all across Canada. We have endo offices. We’ve got one in Montreal, one in Ottawa, two in downtown Toronto, and one in Mississauga, just outside of Toronto. And my mantra’s always been, and it continues to be, “Quality treatment, predictably successful outcomes, and optimal patient care.”
And as a DSO, you know, our four pillars are integrity, because we want to hold ourselves to the highest standard and always do what’s right. Innovation, which is the second pillar. Every day, we find new ways to enhance the patient experience, again, moving back into patient focus. Collaboration, it’s a family, it’s a network. We all connect with each other. And everyone has an – all the SLTs, the Senior Leadership Team, and those in the Support Center, we share our ambitions, our experiences. We unite with our challenges, which is nice, for that common goal. And our last one, of course, is excellence.
We strive on excellence – it’s nice for dentists to join our network for many reasons. Number one is, they can realize the equity in their practice and still practice how they want. We have a business model of autonomy, where we don’t tell them how to practice, we don’t tell them what products to use, we don’t tell them what techniques. I try to influence them in endodontics, because being a leader in our field, it’s nice to be able to show them what the latest and greatest in technique and technology, and as we move through the years, more good stuff comes, in order to increase the success rate of endo.
So, I do have influence on what they do, but they still have the opportunity to use whatever they choose. So, they realize the equity. They can practice how they want. If they don’t like doing the back end, if they don’t like doing the legals and the HR and the payables and the bookkeeping, we take that from them. That’s what a support center’s all about. And then, they can focus in on doing what they love best, which is dentistry. And once again, going back to “Be excellent in the moment,” they can focus in on their dentistry and not worry about all the extraneous stuff that they don’t like to do.
So, I’d like to follow up on these some 500 offices. They’ve now joined the group. Is there a certain complaint or a common complaint that is brought to you, that you need to deal with?
Yeah. Usually, the complaints come before they actually join, because when they join, they see what a positive experience it is. And of course, they’re wondering about, you know, “What if I don’t meet my numbers? What if I – do I have to fire my staff? Do I have to change what I’m doing? Am I going to be mandated to use a particular product or not?” And we always say, “No, you practice how you want.” And once they join the network, there’s very few complaints. Some of the complaints are, “Well, I wanna learn how to do more advanced endo.” You know, “I took your simple course, your basic course, and I wanna go into endo surgery, and I wanna do – I wanna start extracting wisdom teeth.”
Well, we have programs. We have an amazing [with emphasis] amount of programs for our dentists, ranging from every specialty you can think of, but not only for dentists. We have programs for assistants. We have programs for our hygienists. We have programs for our admin staff. Virtual learning, instructor-led training, self-paced programs, and we have conferences, every year. So, I hear very few complaints, once they’re – once they join. It’s always the trepidation of the unknown and the uncertainty of what they’re getting into and what they may have heard from other friends or people that have been in bad situations with DSOs of the past.
Gary, that reminds me of the patient that you ask them ten years later, “So, what do you think about endodontics,” or whatever, and they’ll be two answers. They’ll report the terrible pain they were in, before they got to the clinician. Or they’ll say, “I had a fabulous experience. I had a lot of pain, and Dr. Glassman took it out.”
Yeah. That’s probably the most rewarding thing. Patients come in – you know, one of the reasons I went into endodontics was not only because I love endodontics, but one of the reasons I went in is – rather than being a general dentist is, I wanted to – I wanted to meet lots of people. I wanted to see my patients, it’s almost like a one-and-done, and you have a moment to establish rapport with a patient, a moment to establish a relationship. And it’s interesting, over the years, how you can manage that. And that’s probably one of the – that’s one of the most rewarding things as well.
But just as you said, patients come in pain, they’re really nervous, they don’t know what to expect, especially if they’ve never had a root canal procedure, and they’ve got to pay all this money. So, once they leave, it’s like, “Wow! I just had a root canal! I can’t believe it! It was amazing! You got me out of pain, it didn’t take very long, and I’m happy to pay the money.” [laughs]
I wanted to go back a second to dentalcorp. I – I’d never heard of a dental support organization before my dad told me that you were going to be talking about it on our show. And so, then, I talked to him about it, and he was saying, “Oh, well, they can help, you know, with getting you the technology for your office, negotiate with vendors. They can do like a lot of the bookkeeping stuff for you. They – I mean, they offer CE.” And I’m like, “Well, why would anybody not [with emphasis] want to join?”
Especially, I’m thinking like students out of endo school would – that seems like ideal for them, especially also – don’t you – you’re up on protocols and regulations. So, that might even be helpful in this time of COVID, on all the protocols that need to be followed. So, why would – I mean, I guess you’re saying, though, that – my dad said that it’s because you give up freedom. But now you’re saying that you really don’t give up any freedom.
No, you – you give up zero freedom for how you wanna work. But just like you said, we have – we get the best prices. So, how it benefits a doctor who comes out of school, not just the partners. I’m talkin’gabout – I’ll talk about the partners first, though. How it benefits them is, they’ll get their equity out. They’re bought at a – what their cash flow is, what their EBITA is, and if they – if they surpass that EBITA, which they got bought out, they fall into the bonus range. Not only do they get a percentage of what they collect with their own hands, but also, what they – the – sort of the bonus range as well, after that.
In addition, you can increase your EBITA very easily by taking part in our programs, because we do get better rates for products. We do take over your bookkeeping and your legals and all that. So, all those costs are out. And we have an incredible CE program. Where we look at the associates, we actually have a very structured Associate Development Program, which is great. So, a – the associate comes out of school and they’re automatically put into our Welcome Program, where they learn all about dentalcorp. They learn all about compliance, ethics, this, that, and the other. We teach them everything that they need to know on a Foundations Program.
And then, they’re enrolled in our – we call it their Practice Foundations Program, where they will learn online what endo looks like, what good endo looks like, prostho, extractions, treatment planning, patient experience, ethics, compliance, et cetera. And we have a great Compliance Department. If you get a complaint, I don’t call the Royal College of Dental Surgeons anymore. I call Julian Perez, who’s our VP of Risk and Compliance. And it’s amazing how we have all these internal things.
And we have what we call the network advantage. So, if you’re living in Vancouver, and you decide you wanna move to Toronto, whether you’re a dentist, assistant, a hygienist, or admin, we’ll find a place for you, in one of our practices. Whatever province or whatever city you move into, in Canada, we have a spot for you. We’re always in touch. I really like to call it a family, because that’s what the experience has been. It’s been – it’s been a family.
It sounds like Lise and I don’t have a lot to worry about, because we can just move north and join this family.
No problem. If you got yourself an Ontario license, you are more than welcome to come back in and start practicing again.
Well, thank you so much for coming on our show today. Do you have any final comments that you want to leave us with?
Well, you know, I think that we’re all fortunate with the lives that we live. And I think we’ve chosen a very rewarding path in our life. And as others, my goal, when I leave this fine earth, and one day I’m sure I will, I hope that I make a difference in people’s lives, not only with education, but with providing the best care possible, with all my patients.
You did say something about dying, and the last time I physically --
-- saw you, we were together in Vancouver, at the big meeting, right?
It was a year ago. It was a year ago. It was my last trip that I took, from the Pacific Dental Conference, and I remember coming back, and I got a phone call saying that there was one or two cases of COVID out of the thousands of people that were there, and you need to self-isolate for 14 days. So, I self-isolated for 14 days, and at the end of that 14th day, we got the call from our Royal College that all offices are shutting down, until we get a better grasp on this virus and what it means and all the uncertainty that lies around it. And we never closed down, because we’re an emergency practice.
So, we geared up with PPE. We had a lot of PPE saved up, since SARS. So, we had all the N95 masks and the gowns stored away for a possible problem in the future. So, we anticipated that and that there may be. So, we were – day one, we never shut down. As soon as I got out of isolation and quarantine, I started back on it, feet running on the ground, and we’ve never stopped. Of course, the protocols are, of course, a lot different. We see fewer patients, fewer – the flow is different. Our [laughs] – our reception area is completely different. We have virtual waiting rooms, where patients can stay in their cars or somewhere warm, until we’re ready for them, and their room is ready. Obviously, HEPA filtration units, enclosures in our operatories.
We treat every patient now as if they are COVID positive, and I think that’s the way to go. Just like we treat every patient that may have a communicable disease, you have to maintain the highest standards. So, not only do we keep our team safe, but we also gained the confidence in our patients, so they feel safe and have the confidence to come back and pay us a visit.
Well, I’m going to come back to what I was going to say about that last time I saw you and about death. Do you remember that part? [laughs]
I do. I do.
That’s – you said a very – I don’t know if it’s famous. It might’ve been in Yiddish, but I think it was your grandparents that told you, and if you don’t say it, I’m going to say it. So, I’m going to give you the chance to say the coaching about life and then death.
Okay. Tell me what – tell me what I said, because I – I wanna –
You said something about, “Be sure to die early, as late as possible.”
-- right. The secret to life – the secret to life is to die – what is it? The secret to life – okay. That’s what it is. “The secret to life is to die early, as late as you can.” Is that the – is that the quote? What I said was, “The secret to life is to die young, as late as you can.”
Thanks very much!
[laughs] That actually makes a little more sense [laughs].
All right, thank you.
That’s the – that’s the quote. I’m glad we got it right [laughs].
SEGMENT 2: Post-Interview Discussion
[music playing] Well, that was a fun and informative interview. Great having Gary on the show. We’ve worked with Gary for many years, publishing endodontic articles for Oral Health Journal. But this was the first time that I had the opportunity to talk with him, face to face.
That was really good, because it’s one of those long-distance relationships you’ve maintained for a long, long time. Yeah. I like Gary as a person, for many, many reasons. And my opinion has been developed over decades. We’ve had dinners around the world together. We’ve lectured at the same venues together. We’ve hung out together, and we’ve talked about shop together. In fact, I’m so impressed with Gary, that I’ve started an international education initiative, and I’ve identified him as one of like six people to help me spearhead that project. I think everybody could see that he’s a remarkable guy.
Yeah. He’s a good speaker, too. And one of his secrets to success, he said, was to stay relevant. And it sounds like he’s done a pretty good adapting in the COVID era, with the teledentistry and giving courses virtually. I know a lot of dentists are being hard hit right now by COVID. So, dealing with the costs, both obvious and hidden, is troublesome to a lot of people.
Yeah. In fact, there’s a lot of discussion going on, in different chat rooms, and just conversations that occur, about who actually pays for this. And of course, some dentists are already – you know, there’s the leaders, the early adapters. But they’re – they’re charging for PPE stuff, but they can either put it inside their fee, so it’s kind of covered up and not really obvious to a patient. Or it can be a separate surcharge, which has caused some discussion among patients.
I know some patients have seen this PPE surcharge on their bills and been quite irate about it.
Yeah. Chad Gehani, he’s our Past President of the ADA, he had a really good recommendation. And they’re lobbying, right now, with the insurance companies. But he would like to have – there’s two choices, either every single fee has a certain percent added to it, to cover this. So, it’s just automatically there. Or, there’s a separate fee per patient, just for PPE.
And obviously, PPE – and maybe installing the air filtration in your office, those are obvious costs. But Gary also talked about patients delaying treatment during this time, and now, all of a sudden, he’s overwhelmed with patients that have some pretty serious problems that might not have been so serious, if they would’ve gotten to the dentist earlier. Also, I guess, they’re – dentists are seeing less patients during the day, even. So --
Yeah. It’s – you heard him make a comment, how they’re busier now than perhaps he’s ever been, because a lot of people, if it didn’t really hurt, and they weren’t aware of any big, underlying problem, they waited. Well, waiting is just waiting for a time bomb [laughs] to go off. And so, everything’s much more expensive for them and more time consuming for doctors to treat successfully. So, yeah. Then, there’s a lot of emotional toll, because you’re wearing this gear, all day long.
And many dentists tell me on phone calls and emails that, when they tear that stuff off, at the end of the day – I’ll never forget. I saw a little clip of Marco Martignoni, in Rome [laughs], taking this stuff off, and all of a sudden, after about – I’m exaggerating. After about an hour, it seemed like, finally --
-- this guy emerged, and it was Dr. Marco Martignoni! But anyway, it’s exhausting. It’s tiring. You don’t breathe as well, and you got a lot of gear on you.
I imagine it’s probably pretty hot, too. You might have to have the air conditioner [laughs] cranked up, in your office.
And there’s problems with staff, because sometimes staff have concerns with children at home, with schooling, and they have to Zoom. And so, there’s a lot of issues financially, mentally, physically, that COVID has brought to us.
And it’s not just the dentists that have had a problem. It’s also like corporate dentistry and vendors, like Dentsply. I mean, I guess there’s less salespeople going into the offices, now.
[laughs] I’m laughing, because everybody talks about “I was out for so many months!” Or “I only saw certain kinds of patients.’” “We triaged!” “We did all this stuff.” They don’t seem to realize that the people that give us all the tools, the supplies, the armamentarium that allow us to practice; they also had serious losses. It was in the billions of dollars.
Yeah. Because I guess – oh, I got [laughs] another leg cramp. Oh, dear! [laughs] Okay. Well, I also like the perspective that Gary gave us on DSOs.
Way to soldier up!
You know, a lot of – I think that a DSO would be a good way to go, nowadays, especially if you’re a young dentist. I – we found an article that Dr. Gordon Christensen wrote, a couple years ago, in Dentaltown, and we’ll have that article in our Show Notes. But he lists all the pros and cons of DSOs. And a lot of the pros, Gary actually mentioned, already, the enhancement of a work-life balance was one.
Yeah. Well, if you just want to come into dentistry, and you just wanna be a dentist --
-- and help people, then, all of a sudden, if you can get rid of all the other stuff, the hiring, the firing, the insurance, the regulations. I mean, it’s an amazing job to be an owner today and run an office. So, young dentists, if they have enormous amount of debt, most of them do, this is a good way to get your feet wet, to get started in an operation. I would just say, select a really good DSO. Do you homework. If you’re a dentist, don’t just join – I won’t drop names, because there’s some that are not so important. They’re not that – I would say, professional. But then, you talk to things like Heartland, and you see what they’ve done in the United States. You see what Gary’s doing with dentalcorp. This could be a really good thing and a new future for many young dentists.
Yeah. I mean, just also the – there’s mentors that you can look up to and follow in the DSO. There are – they – the CE that they provide. There’s all the administrative stuff they handle. It seems – I guess the number-one drawback would be, maybe people feel like they’re losing freedom. But Gary pointed out that that’s actually not the case in his DSO.
Yeah. You could say, “Well, I’m a dentist! I wanted to be an owner, my whole life!” But maybe being an owner, you never thought that meant all the peripheral stuff to doing the mechanical procedures that comprise clinical dentistry.
Yeah. I – from what he was describing, I felt like if I was a dentist, graduating from dental school, that I would – that would be my first goal, to join up with a DSO, so that I could kind of get – figure out how things work, kind of.
Yeah. You just don’t get a lot of this in dental school. So, it lets you start practicing, you see patients, you have staff, you learn how to be nice to people, and you just focus on your practice.
Yeah. Well, that was a great interview. I hope we can have him back again, in the future.
We’ll have him back, because there’s a lot he can share with our group that will be forward thinking.
So, thank you, Dr. Glassman, for coming on our show, and we hope to have you back, soon.
So, we’re going to close our show with some more demotivators. And for those of you who do not know what demotivators are, they’re these cards that are meant to inspire, but they inspire with a little bit of tough love.
So, I’m going to read one, and then, my dad will tell you what it means to him. So, the first one we’re going to do is called Burnout, and it has a picture that’s kind of interesting, because it has a match that’s on fire. But then, when it burns down, it’s going to light all of these matches on fire, and it’s going to be an explosion. So, here’s what it says. It says, “Burnout: Attitudes are contagious. Mine might kill you.”
Oh, my! Well, I think to just take the easy way out, let’s look back at the interview with Gary Glassman. And he talked about that work-balance thing, you know?
Yeah. And so, he’s got the grapes, and he’s down there in Argentina. We didn’t even talk about his missionary work, you know, at the – in Jamaica. And then, of course, he’s – he likes to kayak, and he likes to do all these things. Well, when he comes back to the office, that gives him renewal. So, balancing this work and life is really important. And then, it helps your attitude. And when you have a great attitude, it’s infectious.
And – yeah. And apparently, a bad attitude is also infectious [laughs].
Bad attitude, you’re going to take the whole staff down. Just prepare to sink.
Okay. The next one is Hazards.
And this one has – I guess the golf ball might’ve gone into the water.
So, this one says, “There is an island of opportunity in the middle of every difficulty. Miss that, though, and you’re pretty much doomed.”
Well, going back over my life, I really like that Chinese thing. You know, the word “crisis” in Chinese, is two characters. One character is “danger” and the other character is “opportunity.” So, within every danger, there’s enormous opportunity. But if you – what was the last part of that? You mess that up, and what?
And then, you’re pretty much doomed.
Yeah. So, you’re in a tough case, you know, and you’re working around curvatures and stuff, you have a real opportunity there, don’t you?
Yeah. And there – yeah. I guess that’s – that’s true. But then, also, we can even think about this time of COVID, you know, the opportunities that Gary talked about, like with teledentistry, DSOs, giving virtual courses. So --
That was really good. What you just said, those three things were really good.
-- I kind of think of it as like when one door closes, another door opens. So, if you’re standing in that room, and the door is closed, and you just keep staring at the door that’s closed, and you don’t look around for the open door, then you’re just going to be there, for a long time [laughs].
Okay. The next one is called Risks. And it has a picture of --
-- yeah. But it looks like it might be sort of like a – there – I don’t know if it’s working well, or not. Anyway, it says, “If you never try anything new, you’ll miss out on many of life’s great disappointments.”
Oh, that’s easy. So, you look at a preoperative film, and the x-ray shows roots that are long, they’re really narrow canals, and there’s a lot of curvature and recurvature. So, you must absolutely get into that case and start working, so you can break an instrument and have all that great disappointment.
Okay [laughs]. Yes!
You don’t want to miss out on a broken file. Come on!
Well, yeah. I guess you learn a lot from disappointments as well.
Well, you learn more from your errors than you ever do from your successes.
Well, that’s our show for today. And thank you for that insight on the Demotivators. And we’ll see you next time, on The Ruddle Show.
The content presented in this show is made available in an effort to share opinions and information. Note the opinions expressed by Dr. Cliff Ruddle are his opinions only and are based on over 40 years of endodontic practice and product development, direct personal observation, fellow colleague reports, and/or information gathered from online sources. Any opinions expressed by the hosts and/or guests reflect their opinions and are not necessarily the views of The Ruddle Show. While we have taken every precaution to ensure that the content of this material is both current and accurate, errors can occur. The Ruddle Show, Advanced Endodontics, and its hosts/guests assume no responsibility or liability for any errors or omissions. Any reproduction of show content is strictly forbidden.
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Moving with the Cheese & Delving Deeper
A Better Understanding of Change & File Brushing
The Dark Side & Post Removal
Industry Payments to Academics & Removing a Screw Post
Special Guest Presentation by Dr. Don Tyndall
Controversies & Iatrogenic Events
Sharing Knowledge Pros/Cons & Type II Transportations
To Be Determined
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To Be Determined