Interview of Dr. Mark Hyman
by Michael C. DiTolla, DDS, FAGD
I finally got the chance to catch up with Dr. Mark
Hyman, a dentist I met some 15 years ago at a lecture
I was giving in his home state. Mark started
lecturing not long after that, and if you are looking
for a lecture that you and your staff will love, you
owe it to yourself to get out there and attend one
of his. Mark does not charge insanely high fees,
and he is not the only dentist in a 200-mile radius;
he is just one of the dentists who makes talking
to patients effortless. Whether discussing treatment
options or fees, he communicates in such a
confident manner that patients know he has their
best interests at heart. Mark has a great story, and
I hope you enjoy reading it as much as I enjoyed
listening to him tell it.
Dr. Michael DiTolla: Hello Mark! I know you have lectured at
nearly every major dental meeting, but for the dentists who
haven't had a chance to see you before, I want you to explain
a little bit about your past. Just kind of take me through that
and how you got to where you are today, because you've got a
fantastic practice, and I've always liked the fact that you're not
doing it in Beverly Hills or some rich suburb in Florida. You're
doing it in Greensboro, N.C. So walk our readers through it, if
you would.
Dr. Mark Hyman: I'd be glad to, Mike. Again, it's a pleasure
talking to you and reconnecting.
My journey through dentistry was checkered to say the
least. I started dental school at UNC School of Dentistry in
1980. I was president of my freshman dental class, while
coaching intramural football, and playing basketball and
soccer. Midterms came and I got creamed. The first week
back, spring semester of freshman year of dental school,
I quit school because I knew I was a failure and I would
never be a dentist. And I was walking through the halls of
the UNC School of Dentistry and ran into a young professor,
Dr. Ron Strauss, who saved my life. He said: "It's OK, Mark.
Being a dental student is nothing like being a dentist. So
give it another hour. Give it a day. See how you do." I'd
gone to the dean to tell him I was going to quit, and he
said, "Great!"
MD: (laughs) He didn't put up a fight? He didn't try to talk you
out of it?
MH: Not even a bit. He told me to go back to class, come
back at halftime, and he'd sign me out. Then I ran into
Dr. Strauss, had a decent morning, went back to tell the
dean I wasn't going to quit, and he acted disappointed.
And I muddled my way through the spring of my first year
of dental school, started in patient care that summer, and
caught fire! So I basically went from worst to first. I finished
dental school in three-and-a-half years. By the end of my
junior year, I'd finished basically all of my requirements.
MD: So was it coming in contact with patients that lit your fire?
Was it the book classes you didn't like? Or how do you explain
that kind of sudden metamorphosis?
MH: You know, I think the pure basic science — anatomy,
histology, physiology, biochemistry — wasn't my passion.
It was the people part of dentistry. And there were a lot
of people, a lot of classmates of mine, who were certainly
more talented. There were many of them that had a superior
academic background. But my big turn-on was the people
part. Once I got one-on-one with patients, things exploded.
MD: That's funny, because that is the exact opposite of my story.
I went to University of the Pacific, and when we started with all
the academic classes, I did really well because I'm able to memorize
and spit out facts. And I thought: Dental school is easy. I
can't believe everybody thinks this is hard. In fact, this is easier
than college. And then when we got to the clinical classes, that's
where my grades plummeted in a disastrous fashion. I ended
up in remedial operative and it took a long time for me to come
around to that part of dentistry. So it turns out you and I had
kind of exactly opposite experiences in dental school.
MH: But we both ended up doing well, so that's kind of
cool.
MD: Thankfully when you go to dental school, 99 percent of
your classmates end up being dentists. Of the people I know
who went to film school, 99 percent aren't doing anything
related to making films! So dental school got better for you after
that point?
MH: Yeah, and having graduated dental school in three-and-a-half years,
I went over to Israel to work on a kibbutz
from January to April in 1984, prior to my classmates' graduation
in May. I grew a beard and grew my hair long. You
know, I did more dentistry in my first week there than I'd
done in three-and-a-half years of dental school. And I loved
it. It was a very profitable trip, Mike, because my last week
there I met my wife.
MD: Wow, hold on. I was raised Catholic, so you're going to
have to define "kibbutz" for me.
MH: A kibbutz is a cooperative farming community. It was
how the land of Israel was settled back at the turn of the
century. Little cooperative farms were placed around the
borders of the country. It was a way to settle the wilderness.
The children all lived in the children's house, and the
men protected them at night. And the kids were taught together.
The kibbutz movement was really a wonderful thing
at the time.
MD: So you went over there and became ...
MH: The kibbutz dentist.
MD: The dentist. Did they have a dentist before you?
MH: They had a one-room dental chair where people would
rotate through, and I worked there three days a week. And
then I worked up at the Lebanese border, in a development
town with North African immigrants, a couple days a week.
That was during 1984. I worked at a children's dental clinic.
I walked out of the clinic one day and there were tanks rolling
by my dental office as they were heading into Lebanon.
I was this kid — I'd lovingly call myself a redneck Jew in
Greensboro, N.C. — and to look out of my dental clinic one
day and see tanks rolling by was distinctive.
MD: So while the other students were finishing up their clinical
requirements at school, it sounds like you crammed about a
year's worth of private practice into those four months.
MH: It was pretty unbelievable, Mike. And then I came back
and did the two-year oral medicine general practice residency
program at UNC Hospital at Chapel Hill. So June 30,
1986, I finished my residency, and July 1, I bought a private
practice in Greensboro and got started. I bought a 10-year-old
practice from a wonderful man who was just not enjoying
private practice. At the time, we had two-and-a-half
employees. The receptionist quit six weeks after I started. I
had to fire the hygienist. And I was left with one employee.
It was one of those classic "don't-you-just-love-it-when-this-happens"
moments.
And then I lovingly say God smiled upon me, because I
stumbled into a Linda Miles seminar. Linda took me under
her wing and was amazing, and she has been a dear friend
ever since. So I had people looking after me early on. Drs.
Cathy and John Jameson have been tremendous influences
on my life.
I started going to the Pankey Institute in 1990. I went every
January for six years until I finished the curriculum at
Pankey. And that was one of the most liberating things I
ever did in my education dentally, because I stopped doing
single-tooth dentistry. Basically when I bought my practice,
it kind of doubled and doubled, and doubled and doubled.
And I had no clue what I was doing. Patients were saying
yes to me for whatever I was suggesting to them, but I
didn't know how to treatment plan, and didn't really know
how to do a complete comprehensive exam. I didn't know
how to study a panorex or a full-mouth series or study models,
and then deliver to the patient what they really wanted
for their health. So Pankey got me to slow down and work
comprehensively. It was the single most important thing I
did in my dental education to that point.
MD: So you mentioned that list, and it sounds like it includes
clinical and practice management mentors that really are in
a large way responsible for the success that you've had. But the
point I want to bring up is, it sounds like you went and sought
these people out and really kind of attached yourself to them.
MH: I did. I sought them. And they were very gracious in
their caring for me. At my sixth Pankey course, Dr. Irwin
Becker asked me to be a teaching assistant at Pankey. And
when I got called to his office, I felt like I was being called
to the principal's office. I thought I had really screwed
something up. And he said I certainly had a long way to go,
but he thought I had potential to help teach there. So that
was a great experience for me. Dr. Strauss, who saved my
life in dental school in 1980, asked me to come speak to the
freshman class and tell my story. And that's really when my
seminar career started. I was so nervous, Mike. I had diarrhea
and nausea and vomiting for the month before I was
going back to teach at Chapel Hill.
MD: Wow, that's quite the weight-loss plan! At least your suit
would fit well.
MH: The funny part of that is, I worked the morning of the
lecture. I was supposed to speak in the afternoon. I was out
of gas, ran to the gas station, filled up my car, jumped back
in my car, and my pants split from bellybutton to tush. And
I'm like, what do you do? I'm already late, and I would be
later if I went home and changed. I figured there was going
to be a podium I could hide behind with my ripped pants.
But instead I ran home, changed, got back to Chapel Hill,
and there was a little metal folding chair on the stage — and
nothing else! I would have been mooning Miami. But I was
so nervous, and the moment I started, it was like an out-of-body
experience. I just told my story and the crowd went
wild. Afterward, Dr. Strauss said: "You had a magic moment
there. You don't get many of those." And I thought, I don't
know what that was, but I want more of that.
So now I'm an adjunct professor at Chapel Hill. I teach the
freshman Intro to Private Practice class, and have for the
past 21 years. I also teach at the Advanced Education in
General Dentistry residence. I did a talk for the seniors for
many years. I'm a keynote speaker at Parents' Day. I teach
at Bowman Gray School of Medicine, their dental residence.
So I got to do little talks. Dr. Keith Phillips, who is one of
my heroes in dentistry, gave me some of his time at a couple
of major dental meetings.
But my big break was in 1999. I had the opportunity to
speak at the CDA (California Dental Association). In preparation
for that, I got involved with the Dale Carnegie Training® organization, which was transformational. I took the
12-week How to Win Friends and Influence People course,
which I think is the finest thing I did post-dental school
in my life — education wise, outside of dentistry. Along
with that I took their two-day High-Impact Presentations
course, where they do eight three-minute videos of you.
They film you, and you look at yourself, and your hands
are in your pockets, and you're scratching your head on the
first video. And by the eighth one, you're outside yourself
— really bringing it! So then I went to speak in Anaheim,
and from that one two-hour gig, the next year I went from
five seminars a year to 20. So from that one seminar I got
ADA, AGD, Chicago Midwinter, Yankee, Hinman, Greater
New York, FNDC — everybody. So it was amazing, just
transformational.
MD: You have a real gift for speaking. Our readers should
bring their teams to hear you speak the next time you are in
their town. It's a real treat. How was your practice doing during
those years?
MH: So I started in private practice in 1986. And in 1998,
another thing happened. I got really angry that I couldn't
figure out how to solve people's problems more effectively.
One of my favorite patients was in. I did a quadrant of
partial crowns, and the provisionals broke three times. His
wife came in not long after that — they've always said yes
to any treatment I recommended — and the wife looks at
me and says she couldn't get her work done because she
couldn't come in five or six times like her husband did. It
was heartbreaking. And that's when I looked into CEREC®
(Sirona Dental Systems; Charlotte, N.C.). So I was probably
the second CEREC user in North Carolina. I was the first
one in my area. Everybody told me not to do it. They told
me not to buy CEREC, that it's too expensive. No one believed
in it. This was the CEREC 2. My accountant told me
not to do it. My colleagues told me not to do it. The staff
was upset. And I told my father about it and he, in his wonderful
wisdom, said: "Son, why would you do it that way?
People are used to coming in for two visits." So I thanked
him, and I bought it.
MD: Well, at least you had the decency to ask them for their
advice before you ignored it!
MH: So I probably did a couple thousand units with the
CEREC 2. I got the CEREC 3D in 1994 — did a couple thousand
units with that. And now we have the CEREC AC unit.
I've also worked with CEREC Connect. I think it should be
whatever is appropriate for a practice. I don't think CAD/CAM dentistry is for every practice. I think CAD/CAM dentistry
is an idea whose time has come. And if someone
chooses not to mill in their office, if there's a lab that has
an expertise in receiving digital impressions and returning
quality dentistry, I think everybody wins. My understanding
from some of the top labs that I know of is that they can
deliver that care cheaper, and their remakes tumble. Does
that sound correct?
MD: Yes, absolutely. It's one of the things that we've noticed
as well. And the other thing I'm excited about is hopefully
being able to shrink the amount of time between the prep
appointment and the delivery appointment. Because certainly
I've noticed — we've got many CEREC units here at the lab
that I get the opportunity to use — that same-day dentistry
is preferable to two-week dentistry, mainly because of the
temporary, and all the things that shift around during
the two weeks while it's on. So, hopefully, one of the benefits
of the increase in digital dentistry will be a dentist prepping
a tooth, taking a digital impression, sending it to their
laboratory, and having it back in maybe 48 or 72 hours.
Because I honestly feel that the less amount of time the temporary
is in place, the better the chance that the cementation
appointment is going to go smoothly, quickly, and
perhaps without anesthesia for the patient. So while onehour
dentistry is certainly preferable to two-week dentistry,
I also think that three-day dentistry is probably preferable to two-week dentistry. So, yeah, we see a lot of benefit
to dental practices. And, like you said, not every practice is going
to want to mill their own restorations. But, certainly, digital
impressions are within the grasp of every dental practice.
MH: I definitely know my heroes in dentistry, like Dr. Gordon
Christensen, say that in five years everything is going to
be digital. I respect him a thousand percent, whether that's
accurate or not. Digital dentistry is an idea whose time has
come. So a word that I try to use with my patients and
with my audiences when I speak is the word "appropriate."
What's appropriate for your practice? What's appropriate for
your style and your temperament and your talent?
MD: How do you bring up one-appointment dentistry with the
patient? Do you kind of make the decision whether or not you
are going to mill the crown in-office before you mention it to
them? Is it something you offer to most patients? How do you
decide who might be a good candidate for a CEREC same-day
crown?
MH: Right. You know, taking a half-step back, one of the
great gifts I've had in dentistry that started in 1990 was
working with an intraoral camera. So from that, the urgency
has been created. We have eight operatories, Mike. We have
eight Digital Doc cameras. We take a picture of every patient,
every procedure. So while the patient is in the chair,
all of a sudden they are turned on and motivated. And they
want the care immediately. So when I have a captive audience,
when I have somebody with a broken body part, I can
create that sense of urgency to act, if we've got time in the
schedule. The way the team and I work, the way that they're
trained and the flexibility that they have, we can solve their
problem right on the spot. If we don't have the time in the
schedule, traditionally you would put on a temporary, put
on a Band-Aid with bondo and some composite if there's
a broken cusp, and they'd come back in how long, if ever?
You know, with digital dentistry now, I can do the preps,
scan them, and put on a quick provisional if we don't have
the time to run the whole thing.
For example, IPS e.max® (Ivoclar Vivadent; Amherst, N.Y.), I
think, is an amazing material that has taken the profession
by storm. With in-office dentistry, it's really hard to deliver a
quality e.max crown start to finish in less than two hours in
my hands. So if we need e.max as a material and someone
doesn't have enough time, you could scan them, mill them
in your chamber, or send them to your local lab and put on
a quick provisional, and end up with a superior product
without a traditional impression. So, if I can do them in the
same visit, Mike, I will. I have found with today's economy
the biggest premium for patients is time. No one's got the
time, and if they bothered to walk into your office, they're
ready to purchase some dentistry.
In our office we're huge believers in dental financing. We're
big CareCredit users. They've been phenomenal to work
with. We've worked with them for ages. I think last year we
put just under $400,000 on CareCredit.
MD: Yeah, I love CareCredit too. Most of the patients I see aren't
walking in with an extra $5,500 in their wallet earmarked for
some restorative dentistry.
MH: So we are very upfront with patients about asking
them how healthy they want to get. How fast they want
to get there. What their goals are for their health. We ask
them why they left their last dentist. We take the time during
our new patient experience to establish their values and
their needs. We can't be all things to all people, Mike, but
99 percent of the patients that come in love us, and they
send their friends and they pay their bills with appreciation.
When people ask me how I do this, I tell them I out-listen
the competition. It's pretty amazing to sit down in a consult
room with a new patient, and at the end of that visit I ask
them if they've ever had a dentist do that. Mike, it breaks
my heart: 99-plus percent of my new patients say they've
never had a doctor sit down and talk to them like this. So,
as I tell my audience, I haven't even examined them and
they've already said yes to me. So you want to know how
to improve your case acceptance and do more dentistry? My
answer is you out-listen the competition. You slow down a
bit and let the patient define how healthy they want to be
and how fast they want to get there.
MD: So walk me through that first appointment, if you could.
Tell me a little bit about it, how much time it takes, and maybe
the order of things. Maybe for the reader who doesn't really
even have a set first appointment that a new patient might go
through — you know, where it's just kind of seat-of-the-pants.
Walk me through that first appointment, starting with the
phone call from a patient with a broken cusp on #19.
MH: First off, we try to differentiate between a true dental
emergency and an inconvenience. We see true emergencies
within an hour. I mean, immediately. It's how soon can you
get here? If the tooth has been broken for a month-and-a-half
and now their golf game got canceled so they want to
come in and I need to change my schedule to see them,
that's not a real emergency. We've got exceptional business
team members, and they have a script that they go through
to ask a bunch of questions to see if some patients are self-selecting
at that point. They ask a lot of the questions on
how long they've been in pain. Who referred them? We try
to find out why they left their last dentist, if there are other
radiographs at another office. What's the urgency to act? Do
they have a wedding coming up? Is this, again, a true emergency
or just an inconvenience?
MD: This is all done on the phone?
MH: It is. Then we'll e-mail them, or they'll go on our website
and download the health history, or we'll send them a
snail mail copy, so that is already filled out for the initial
office visit.
When they come in, our new patient experience is about
an hour and 20 minutes, and we don't clean teeth. We sit
down in the consultation room and talk for 5, 10, 20 minutes,
whatever is appropriate. We take a panorex. We take
a full series as well. If we think study models are needed at
that point, we'll take them, or do that at a second visit. We
do digital photography with a nice background. We have
two places in the office. One of our superstar hygienists
has become our treatment coordinator, and she coordinates
this visit. I meet with the patient first, and then she takes
the photography for me, the radiographs, the full-mouth
probing. We do a full-mouth tour with an intraoral camera,
where we kind of co-diagnose. Then I do a complete exam
— TMJ, occlusion and existing restorations. We go tooth-to-tooth
with the intraoral camera again to look at nuances.
And I'm real careful at that point, Mike, not to diagnose on
the spot. I try to let the patient do that for me, when we
put the broken body part up in front of them, and they say:
"My tooth is cracked. You need to fix it." And that's what
I found so liberating about the camera, about using the
technology. I don't ever say the word "need" to one of our
patients — you need a crown, you need to floss, you need
to do anything. I ask: "What do you want for your health?"
And particularly when you put the camera shot in front of
them, the verbal skill I use to close the deal is to just say
the word "Wow."
MD: (laughs) Exactly!
MH: And I don't speak. We put the picture up there and I'll
say "Wow." I point, and when they say: "My tooth is cracked.
You need to fix it," I'll ask how I can help them. How soon
they want to get this done. So, you know, it's a lot of fun to
practice like this. If the patients come in at the first visit and
say they don't want an exam or X-rays. If they say: "I don't
want this. I just want my front tooth pulled," I'm like: "That's
fine. It's just not what we do. Let me find you a good dentist
that will do that." Often at that point they'll say: "No, I want
you. No one has ever sat down and talked to me. I've never
seen an office that is this beautiful. I've never seen a staff
as well dressed. They're all smiling." We hire smiling faces,
Mike. The longest-term teammate that I have has been with
me 20 years. The average time people on the team have
been with me is at least 10 years.
MD: That's a common theme from the successful dentists that
I've talked to. The ability to attract and retain top-quality
employees is super difficult, but I don't know if there's anything
more worthwhile. You can go through all your levels of
Pankey and reach a level of clinical excellence. And you can
even do this kind of appointment that you've just described, the
co-diagnosis with the intraoral camera, tooth by tooth, and let
the patient kind of figure out for themselves what's going on as
you narrate it. But without the staff around you to pull this all
together, it's kind of all for naught, right? It's not going to be
dentistry that actually gets done.
MH: That is correct. If I could make the point: I think as a
profession, we do a lousy job training our teams and ourselves
because we're so busy with the urgent, unimportant
things in life. In our office we do a lunch-and-learn at least
once a month, where we have a manufacturer come in. We
do a ton of continuing education. We have staff meetings
out the wazoo. I love going to the Scottsdale Center in Arizona
to train for CEREC. I've been to Sirona's headquarters
in Charlotte, N.C. I've gone to every CEREC speaker around
the country. But we now have four dental assistants, and
to take everybody out of state, fly them, feed them, pay for
tuition; it just gets really expensive. To have them trained
in your office is amazing, and we've done that. So for our
office, for our temperament, I do the preps and walk out
of the room. The team packs the cord, scans, designs the
restoration, mills it, takes a pre-cementation radiograph. If
it's e.max, they cook it in the oven. Then I come back when
the tooth is etched and ready to roll.
MD: What a great way to practice! How fun is that?
MH: It's a hoot! I'm not doing anything that anybody
couldn't do if you are passionate about your dentistry and
care about your patients and teams. The last time I lost a
teammate to another dentist in my hometown was 20 years
ago. So I try to spoil them. The other striking piece of that,
Mike, is everybody that I have working with me now used
to work for another dentist. So it's not that they didn't have
the talent. I just saw that they didn't have the right fit, or
they weren't liberated like I have done for them. It's a great
way to practice, and it's a lot of fun. We're actually looking
for a partner to join us if you want to get back in private
practice or you know anybody.
MD: (laughs) Well, hopefully tens of thousands of dentists will
read this and so you'll get a few hundred e-mails and phone
calls.
MH: One would be nice.
MD: Have you ever been to Disneyland out here in Anaheim?
MH: Many times.
MD: There's a ride called the Jungle Cruise. If I had to work
on any ride at Disneyland, it would be the Jungle Cruise, because
it's the only ride there where the person working the ride
is telling jokes and having fun. So as you cruise around this
obviously fake jungle on this "tour," they are making bad puns, there's silly wordplay, but it always kind of seemed like fun.
When I got my first intraoral camera and had the opportunity
to do an exam the way that you're talking about, tooth by tooth,
oftentimes I kind of felt like I was one of the boat directors on
the Jungle Cruise. And I felt like I was almost giving the patient
a tour of their mouth. And I found it to be a really enjoyable
process to kind of, as you've described, go tooth by tooth and
show them things that they had never seen before, and spend
the time to go over their entire mouth and all the posterior teeth
they can never see. They were really familiar with 6 through 11
from looking in the mirror and the rearview mirror of their car.
But to show them all their posterior teeth, they were the ones
who would start to ooh and ahh and bite down on the camera.
I'd have to take it out of their mouth so they didn't break another
tooth. So it got their interest into what's going on there, and
it created a sense of concern, so that when we got to the real
things that needed explanation — like the bridge of calculus
from 22 to 27, or the obvious perio conditions around a couple
of the teeth — it was real easy for me to have them engaged in
this conversation that we were having. So while it might sound
like more work to a dentist reading this to do an exam the way
you do, I find it to be a lot more enjoyable way to practice that
just happens to lead to a much higher case acceptance rate.
Would you agree with that?
MH: I agree completely. You know, at our age — we are a
similar vintage, except that I have better hair than you, but
that's about it — I think life is too short, and I don't want to
argue with patients. We have an expression in our practice:
There's no hostages. You don't have to be a patient here.
You don't have to work here. It's free will. This is America.
I'd rather see fewer new patients and thoroughly examine
them and listen to them because the result over the years
has been an extraordinary level of case acceptance. And
what's interesting, Mike, is these aren't just upper class people.
I've had people of very modest means accept extraordinary
treatment plans just because I took this time.
MD: Well, not only that, but because of the CareCredit as well.
People don't have $15,000 buried in their backyard while they
are waiting to meet the dentist who will redo their old crowns.
MH: CareCredit has been an unbelievable adjunct. The
camera creates that sense of urgency. We do have a lot of
technology in our office. We have eight operatories. We
have eight Isolites (Isolite Systems; Santa Barbara, Calif.),
which I think has been transformational for my career. We
have a Digital Doc camera in every operatory. I have the
two CEREC machines. I have three lasers. We use Discus
curing lights; we have two in each operatory. So I made
that investment in the equipment in the practice, so I can
work efficiently. I wish our profession did more of that and
looked big picture. I think one of the worst things we ever
did was make intraoral cameras portable, because you're a
2011 cutting-edge dentist in one room and you're 1950s in
the other.
MD: And the reality is it probably won't get carried from room
to room anyway.
MH: They're so affordable now, it's just a matter of how
many days does it take to pay for itself? Everybody that
has ever had to buy a camera on my advice says they easily
add $100 to $500 a day, so that's between $20,000 and
$100,000 a year. You almost want to say, well, why do you
care what the camera costs? If that was a stock, you would
pay five grand for it and within 12 months it would be
worth $100,000. Would you buy it?
MD: I would, and lots of it. Even my lululemon stock didn't do
that well this year!
Tell me a little bit about your hygiene department, your hygiene
philosophy. Maybe how the hygienist takes care of those people
who come in for a "cleaning," who have obvious periodontal
needs. And if you're comfortable, maybe about how the hygienists
are compensated, as well?
MH: Love to. Our hygienists are just outstanding. And, actually,
everyone in the office has gone through Dale Carnegie
Training courses now, which is a hint to your readers. We've
all gone to the Carnegie course, and we've had them come
in. They were already talented and charming before, but
this refined their people skills. So nobody gets in the first
day and gets their teeth cleaned. They've gone through the
new patient experience. They've had the full-mouth perioprobing,
so we have a diagnosis for what type of cleaning
they're going to get. Four of our eight operatories are dedicated to hygiene. So each hygiene room has a Cavitron®
(DENTSPLY; York, Pa.) and a Prophy-Jet® (DENTSPLY) that
shoots chlorhexidine. Every room has modern, state-of-art
equipment. Every hygiene room has an Isolite also. Do you
want to know how to double your hygiene productivity?
Have them pop an Isolite in and go to town. The time it
takes to do scaling and root planing is cut in half. And each
hygienist has her own intraoral camera, so nobody scales a
piece of tartar without a before-and-after shot. We have the
before shots, so they'll Cavitron that calculus bridge from
22 to 27, take an after shot, and print that out. That's your
business card for the day. So instead of thinking it's just a
cleaning, the patient thinks: This is disgusting. I'm infected,
and now you got the infection out of my mouth. When there
are quadrants of scaling and root planing, we try to do that
as efficiently. We try to do two quads at time, if that's appropriate
for the patient. You know, again, we always do
the before-and-after camera shots. We now have a hygiene
assistant that is dedicated to keeping our hygienists on task.
What I'll try to say to my audience, Mike, is: Why would a
doctor do a non-CEO procedure? Why would you spend
your time doing something that a well-trained teammate
could do for you?
MD: That's a good point. You rarely see dentists taking alginate
impressions for study models, for example.
MH: So, in the same vein for our hygienists, if they've got
a dedicated hygiene assistant that's setting up, cleaning up
the room, taking the radiographs, taking the panorex when
they're due, taking the full series when they're due, taking
impressions for whitening trays, the hygienists can focus
on their education, on their scaling, root planing, on their
hygiene-only duties. We have just kicked that into high gear,
and it's been amazing.
MD: The Carnegie training for the hygienists, is that mandatory?
Or did you just happen to attract winners who are more
than happy to take it?
MH: I send everybody to Dale Carnegie. So is it mandatory?
It's part of the philosophy of this practice. People say:
"How do you hire these people?" I hire smiling faces. I hire
attitude over ability any day of the week. What I find is that
most of the predominantly women in dentistry whom I've
hired as teammates, they've just been dying to be cared for,
and nurtured, and supported, and educated, and liberated.
And that's what we do.
MD: They've been dying to have a career and not just a job?
MH: Yeah, and somebody to care about them. My philosophy
is I'll pay for any continuing education any teammate
wants to take inside or outside of dentistry. If their church
or synagogue has put on something special, of course I'll
pay for it. That has nothing to do with dentistry, but it
makes them a better-rounded person, and they've got more
interesting things to talk to our patients about.
MD: When was the last employee hired? Has there been anybody
hired recently? I know a lot of people have been there for
20 years.
MH: Actually, we just hired our fourth dental assistant.
MD: Like you said, people are always asking you where you
find all these winners, and you said you hire "smiling faces."
Tell me a little bit about the process of finding this new dental
assistant, and maybe the kind of things you ask in interviews.
Because dentists tell me all the time that hiring and, unfortunately,
firing is one of the things that they don't enjoy about
private practice.
MH: You know, what's interesting with my team as long
as they've been with me, they really did the hiring for me.
This young woman was interning with us from the local
community college. I really didn't have any intention of
hiring a fourth dental assistant. Her attitude was sensational.
She was the first one in the office every day. She almost
beat me to the office. And I never saw her doing anything
except setting up, cleaning up rooms, scrubbing instruments,
running around, saying, "How can I help?" And
her last day she brought these beautiful gifts for each of
the teammates and wrote me this gorgeous letter, saying
thanks for this opportunity. Would I please write her a
reference for employment? And I thought, to heck with
that, I'm going to hire her. Anybody that would go to
this trouble, show this level of commitment, whether I need her or not, I'll find a position for her. She's just been a joy.
MD: That's amazing. So you probably weren't entirely sure
whether you needed her or where you were going to put her,
but you knew she was a quality person and these don't come
around all that often.
MH: With that attitude, I'll find a position for her. What's
interesting is that one of our other assistants came in our office
the same way. She interned with us. She was top in her
class. And the joke is, the rest of the team said: "We want a
puppy. This is our puppy. We love her. Can we keep her?"
We didn't have a position at the time. She went to work
for another office. We had another woman follow a young
man out of town and, basically, they called this woman, and
about an hour later she was in our office working for us.
She has been sensational. And the same thing happened
with this young woman we just hired. She interned with us
and the team was like, can we keep her?
MD: You know, one of the things that we've learned here at
the laboratory over the years is that, in order to grow, we have
to be slightly overstaffed. If we see somebody or somebody
comes by who's a quality person like you talked about, or who
goes through our educational department, and we find that
this is somebody great, although we're not sure where we're
going to put them, we'll do the same thing and hire them. So
at any given time we may be slightly overstaffed by say, I don't
know, 20 people. Now we've got 2,000 total employees, so 20
people is not a huge amount. But do you feel like in order to
grow, you should be kind of slightly overstaffed, as opposed to
the dentist who maybe, in an effort to cut overhead, wants to be
slightly understaffed?
MH: I do, and I say that with an asterisk: If people are
standing around or they're not self-motivated, it brings the
whole team down.
MD: Right.
MH: But for us, for example, in North Carolina, you can
only have two hygienists per doctor.
MD: Really?
MH: Yes. That's the Dental Practice Act. We had a young
partner with us who left, and I was left with three hygienists
who were phenomenal. So what do you do? So I made
my longest-term hygienist, who had been with me for about
10 years, our treatment coordinator, which sounded crazy,
to take our number one producing hygienist off the production
line. And for six weeks on the job she added $52,000
of treatment that was directly attributed to her sitting down
with people and discussing elective treatment. Was that a
good move or not? Will they say you're nuts to have three
full-time hygienists?
The other thing is that people are allowed to take vacations.
Life happens. People get sick. I don't want a part-time, fill-in
agency person — no disrespect to them. But with our
system, we have people that are trained on our software,
trained on our cameras, with our verbal skills, with how
we do our financial arrangements, with our philosophy
and care. Our patients expect the level of patient care
and experience in our office, and not a commodity. They
don't expect just a cleaning. They expect you to know their
family, and love them and care about them. So, to your
point, to be slightly overstaffed lets people take vacations
without the practice having to run on three wheels for a
couple weeks.
MD: One of the slides that I showed at that last talk that you
saw me give was one of how, here at the laboratory, 2010 represented
the first year in which we actually did more all-ceramic
restorations than PFMs. This is truly striking because it's been
a long time coming with all-ceramics creeping up very slowly.
The PFM has always been the workhorse restoration in general
dentistry in the U.S., so it was really amazing to see all-ceramics
actually pass PFMs last year. And it's because of two
restorations: the one you mentioned earlier, IPS e.max from
Ivoclar Vivadent, and BruxZir® Solid Zirconia, the full-contour
zirconia restoration that we developed. I'm wondering, what
does the mix of restorations look like in your office? Are you still
doing a lot of PFMs, or are you doing more all-ceramics? What
are your current choices?
MH: We are doing probably 99 percent all-ceramic.
MD: (laughs) And one PFM a year?
MH: You know, I love gold, and nobody wants it. I think
I'm a typical dentist. I've got three gold onlays in my mouth.
I love working with it. It's ugly. Basically we're doing IPS
e.max on the molars and IPS Empress® (Ivoclar Vivadent)
pre-molars forward.
MD: It's funny how when you're going around with an intraoral
camera in a patient's mouth, anytime you see gold, you
can just stop and ask them who the dentist is in their family,
and they look at you like you're clairvoyant.
MH: It's amazing, isn't it? Again, we love gold, but I find that
virtually nobody wants it. If we need strength, these e.max
restorations — I know it's early, but I think you can stand
on them and they don't break.
MD: Yeah, we're four years into it. Gordon, who I look up
to like you do, typically says we need five years to see what's
going on. But, we see the fracture rates here in the laboratory,
and we can tell that it's doing fine. It's holding its own against
PFM. Now, there are certain things that need to be taken
into consideration. If a dentist were to say to me: "Hey look, I'm going to prep this molar, and by the way, I'm going to underprep
it like I usually do, and give you guys less than a millimeter
of occlusion reduction ..."
MH: Not gonna work.
MD: Then, yeah, I don't even want a PFM. Then I do want a
cast metal crown of some sort. But, in that case, if it starts
getting thinner and thinner, I'd feel better with a BruxZir
crown than an e.max crown, because it is stronger, even
though it's not quite as esthetic. But yeah, given close to ideal
reduction, e.max is doing just fine, whether it's cemented or
bonded into place.
Another number that we've seen here at the laboratory that
has slowed down and hasn't really recovered since the recession
has been porcelain veneers. I came out of LVI back in
1995 thinking I was going to have an all-veneer practice,
and it didn't really turn out that way. When you look at the
number of veneers that we do compared to other restorations,
you can see that it's probably not a huge driver in a dentist's
monthly production. Do you find yourself doing a lot of veneers,
or do you find yourself being more productive with other
indirect restorations?
MH: It's a mix. You know, we have two full-mouth rehab
cases going right now, and those are tough. It's a lot of work
and a lot of time. They sound really sexy when you go to a
course and see the superstars doing them, and they're really
hard to deliver in an exquisite fashion. Here in Greensboro,
my hometown, our three biggest employers were furniture,
textiles and tobacco. So you have a clue of how those industries
have been doing.
But we're still doing well. We're successful because of our
systems, because of the people, and because we're giving
the patients what is appropriate. We're offering them the
chance at comprehensive dentistry at a pace that's comfortable
for them. So, people still shock me and say yes.
Sometimes it takes them longer to do the entire case. They
may break it up. Again, having the dental financing is a
big thing. And sometimes the limit of what they can afford
is not going to be appropriate. I think one of the worse
restorations is to veneer 6 through 11, and then you've
got black buccal corridors going posteriorly. So I'll virtually
do two-for-one to go ahead and add the premolars,
just so it will look right. You don't want to end up with
headlights.
MD: Yes, exactly. Where teeth 6 through 11 look nice, but it
looks like they forgot to put their partial in because you can't
see their bicuspids or molars.
MH: Exactly. I'd rather do four, eight or 10 anterior teeth
than six.
MD: For me it's either four or eight. You can't stop on the cuspids.
It never works. Did you say something about having
microscopes in the operatory? I have stuck with loupes even
though the microscopes are out there.
MH: We don't have microscopes, but we pretty much have
everything else. We have lasers. We have the DIAGNOdent®
(KaVo; Charlotte, N.C.). We have digital radiography in
every room. And again, I'll invest in my patients' health.
That's where I see digital dentistry going. I see that as a
tremendous opportunity for bread-and-butter dentists to
partner with their labs, if they don't choose to have the
milling chamber, and the labs are set up so they can turn
that around promptly.
MD: What do you think about the fact that the numbers I've
seen show that still less than 50 percent of dentists have made
the investment in digital radiography?
MH: I think that is criminal, Mike. When we invested in digital
radiography, I was so embarrassed by how much I had
missed. Crowns that I thought looked fine with my regular
Kodak film, now with a digital radiograph, I was appalled
at how much I had missed. There is a learning curve with
it. But I don't know anyone that has invested in digital radiography
for whom it hasn't paid for itself in a year or less.
MD: Yeah, you never hear stories about people investing in the
system and then giving it back. You won't find a lot of barely
used digital radiography systems on eBay.
MH: Digital radiography is an idea whose time has come.
Our challenge is that many of our colleagues aren't farsighted.
They're scarcity-minded instead of abundance-minded.
And that's too bad. When I've been able to speak at meetings
around the country, I hope people find me a liberation
speaker, as opposed to being a motivational speaker. I hope
I help them let go of things that are holding them back. I
have never heard people regret it when they've added technology
that set them free.
MD: How do you feel about talking money to patients? Will you
do it?
MH: Absolutely, I'm pleased to! I think for the bigger cases
that we, as a profession, need to re-grow our spinal column,
and man and woman up. And say: We believe in this. This
is an investment worth doing. An investment to secure this
tooth, whatever your crown fee is.
I'll often say, before that, to the patient: "Besides money, is
there anything keeping you from getting this done?" They'll
say it's just the cash flow. If they say: "Well, how much is it?"
It's typical in dentistry to say: "Well so-and-so discusses that
in our office," and you run out of the operatory. I think you
put the picture up in front of them on the camera and say: "It's an investment to keep this." One of my favorite things
is to break it down to what it is per day.
MD: (laughs) Wait, what? Not even monthly? You're going per
day?
MH: I'll say, you know, for three bucks a day over a year,
you get to keep this tooth the rest of your life.
MD: That's awesome! What is that — three bucks per day times
365 days — that's over a thousand bucks, almost eleven hundred?
MH: Roughly. You know, it's a cup of Starbucks a day to
keep this tooth.
MD: I like that.
MH: It's going to Redbox a couple times. I mean, come on.
Don't tell me you can't do this.
MD: Will you actually say that?
MH: Depending.
MD: Right, depending on the rapport that you have with that
particular patient.
MH: If they're a Duke fan, all bets are off. I'll say anything
to piss them off.
MD: (laughs) How about on the bigger cases? How about somebody
who does have a need for, say, 10 crowns or something
like that? Is it the same kind of discussion, or is it a little bit
different?
MH: Interestingly, once the urgency has been created, I find
those cases easier.
MD: Really?
MH: Because I think people have been hesitant, dentists
have been hesitant, to show them comprehensively how to
solve their problem. One of the great things our treatment
coordinator does is she does the imaging after she takes her
digital photographs. So we do a digital case presentation,
where we have Photoshopped their smile, and show them a
before-and-after of their teeth. And then three or four other
patients have given us permission to share their before-and-afters.
So they see other people who had similar problems,
from all walks of life, who have chosen to do this.
MD: Wow, that's impressive. Obviously that's another good example
of somebody taking some training courses and becoming
adept at putting together those types of presentations with
Photoshop and things like that.
So to wrap this up, Mark, if I'm a dentist out there reading this,
and my practice isn't really where I want it to be, or where I
thought it would be when I came out of school, and I like what
I'm doing, but I'm not doing as much of the things that I want
to do, give me some advice and tell me what you think the first
couple steps would be in terms of what I might do to sharpen
my clinical skills, and what I might do to be able to kind of get
my practice running a little more like yours?
MH: Right. I think one of the greatest expressions I ever
heard, Mike, was three words: Success leaves clues. So what
have other highly successful dentists done? And, to me,
they've invested aggressively in their dental education, and
they've invested aggressively in their people skills — like a
Dale Carnegie type of thing. As an office, we spend a lot of
time reading success literature. If I read a book that I like,
I buy a dozen copies and give it out to everybody in the
office. So, as an office, together we've read "The 7 Habits
of Highly Effective People," "Good to Great," "Raving Fans,"
"Who Moved My Cheese?"
MD: And they're all happy to do it?
MH: Well, we do it because at the next staff meeting we're
going to talk about it. Where else have they ever worked in
dentistry where somebody handed them a book and said,
"This is because I care about you." Another book we did
was "The Millionaire Next Door." How many dentists have
given their teammates "The Millionaire Next Door" because
they said, "I want you to be a millionaire?"
MD: Yeah, more typically I think they hand them the Henry
Schein catalog and the Patterson Dental catalog and ask them
to find the cheapest cotton rolls.
MH: So I think part of it is our dental colleagues need to
have a career conference with themselves, and just decide.
This work is too hard, Mike, to not love what we do, and to
not be with teammates that we love. So a big thing for me
was also working with consultants. Like I said, Linda Miles
was a huge influence. Naomi Rhode was. And working with
John and Cathy Jameson has been a singular ongoing relationship
for us and for the team. These folks have seen it
all and done it all. And it's wonderful. A lot of times they'll
say the same thing I've been saying, but it's good to get the
affirmation from a third party. So again, I invest aggressively
in myself, aggressively in my team, and I try to keep a balance
in my life with my wife and with my kids. You know,
there's no perfection. I'm not a perfect dentist. I'm not a
perfect father. Not a perfect son ...
MD: Or lover, from what I've heard.
MH: Or brother. The lover, I try hard.
MD: (laughs) Yoda said there is no try...
MH: I'm very humbled by where dentistry has brought me
and by the privilege of speaking like I have. I love being
able to share my story with people and try to inspire them
and liberate them. It was like hearing you years ago at the
Holiday Dental Conference. I thought you were sensational.
You had that real high-tech communication on the overhead
projector. And now the whole world is digital and computers.
But the bottom line is, Mike, you can buy all this equipment,
it doesn't create a relationship with your patients. If
you deliver commodity care, you're not going to thrive in
today's dentistry, in today's economy.
MD: How dare you? That overhead projector was state of the
art!
MH: Take the time to be a part of your patients' lives and
make a difference in their lives, and you will thrive beyond
anything you've ever dreamed of. That has been my experience.
MD: Well, that's fantastic, Mark. I think that's a perfect place
to go out. I've never interviewed a successful dentist who, when
I asked them how they got to where they are, said they were
born this way, that they've been doing this since they were 4 or
5. Everybody goes into dentistry for a different reason. But it's
about looking and finding somebody who's doing it the way
you'd like to do it, and then following them and attaching your
wagon to them. And you're right: Success leaves clues. And a lot
of people are willing to give you those clues because they know
they should share it with somebody else as it was kind of freely
given to them.
I want to thank you for your time, and thank you for sharing
your world with our readers.
MH: A pleasure, Mike. If anyone wants to get in touch with
me, they can call me at the office, 336-282-8850, or go on
our website, www.tarheeldentist.com, and zip me an e-mail
and let me know how I can help them.
MD: That's fantastic, Mark. You're the first interview we've
done where somebody has actually offered to have people call
them at the office and ask them questions.
MH: It would be my pleasure.
MD: If anybody had any questions about whether you meant
everything you said during the interview, I think you answered
them right there.
