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Are You Addicted to “The New Patient Fix?” – Episode 143

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Learn how to maximize profit for each patient who comes through your door. In this episode of Dentist Money™ Reese interviews Dr. Rich Madow, co-founder of The Madow Center for Dental Practice Success, host of TBSE (The Best Seminar Ever), successful author, highly-entertaining speaker, and award-winning composer. Reese and Rich offer practical solutions to many of the issues you face as a practice owner, from how to increase profits to how to ensure your team works well together. We promise a good time—and some great insight into what it takes to run a successful practice.




Reese: Welcome to the Dentist Money™ Show, where we help dentists make smart financial decisions. I’m your host, Reese Harper, here with a guest who I have been excited about interviewing for several months now, and we finally got him to carve out a few minutes from his schedule. As you know from the introduction, Dr. Rich Madow. Rich, welcome to the show.


Dr. Madow: Reese, it is my pleasure to be here! Thanks so much for having me on your show.


Reese: You and I could spend the next hour about Bob Dylan, but we are going to pivot today and actually talk about something our listeners really want to listen to, which is dentistry, and money, and how to find a way to improve their practices. You have been a huge inspiration to dentists all over the country for decades, man! Decades is probably a little strong, but at least a few, right?


Dr. Madow: No, decades is accurate, actually!


Reese: I’m can’t believe I’m saying that about a guy who looks so young. Every time I’m with you, I’m surprised that you and I look the same age, and you have been in the business for a lot longer than I have.


Dr. Madow: Come on, stop the flattery! But I do have a great time hanging out with you, Reese. You are a really cool guy. Super smart. Really motivated. And I congratulate anybody who gets involved with you and Dentist Advisors and listens to your podcast; you’re a guy to be with.


Reese: Well thanks, man. I’m serious about your aging, though! I think it is the music that probably keeps you young. I always look at your bio pictures on the emails, and then I meet you in person, and they really do look very similar. So I’m always surprised that the picture you took ten years ago… I feel like I’m talking to the same guy.


Dr. Madow: Oh, thanks!


Reese: So, anyway. Yeah, congrats on just keeping your energy up over the years and adding a lot of value. I just feel like you are aging well, and it is just cool to be hanging out with someone who has done so much over so many years.


Dr. Madow: Hey. I moisturize, what can I say? (laughs)


Reese: Well, here is the kind of thesis that I thought would be really cool to kind of throw at you, which is, let’s assume that of all the interactions that you have had over the years, we will try to present a case here for our listeners to put themselves in the shoes of a dentist that is about to receive a visit from Dr. Rich Madow. You are going to walk in, and you are going to visit a practice, and you are going to observe what you see. And I want you to kind of highlight what you assume you are going to see, right? Generically, maybe, across practices, if we looked at all the things that really stand out that are opportunities of improvement for people to be more profitable, to earn more money, to have a better overall practice and better lifestyle, what are some of these things that you are going to see, right? And I think I want to start with that and just have you kind of say some things that come to mind right off the bat.


Dr. Madow: Sure! It’s a great question. It’s a really interesting question, because ironically, in our coaching, we stress that every practice is different. It is not cookie cutter. Every practice needs an individual analysis and prescription to improve in the best way possible. But that being said, as you know and as I know, there are some commonalities that we see in just about every practice where significant improvement can be made. Great question! I will start with one that I thought of right off the bat. It is a term that I think Dave and I may have even create years ago, and that is the million-dollar file cabinet. In practically every practice we visit or our coaches visit, we see what we call the million-dollar file cabinet, and it is funny, because everybody is hung up on new patients. I think, as you know, the number one request or complaint from dental practices is, “we need more new patients! We need more new patients! That’s gonna solve everything! If only.” Yet we find that just about every practice has so much treatment that has been diagnosed that has been recommended to patients that has never been performed, and that is why we call it the million-dollar file cabinet. If you didn’t get one more new patient for the next five years, sitting in your charts there is probably millions of dollars of treatment to be done. And to go along with that, most practices have what we call a huge back door, meaning they get new patients and what happens to them? Some of them stick to the practice, but most leave, and they don’t know why, and they never have their hygiene appointment coming up, and they are not in contact with the practice. So, the new patient fix is just not right! Sure, we love new patients; practices need new patients; new patients are responsible for a significant percentage of treatment done every year. But if only you could concentrate on the treatment that has already been diagnosed and the patients who are already in the practice. And it is much more efficient! It is much less costly to do those things. So, that is something we see just about everywhere.


Reese: Yeah, I think that is critical, man! And for whatever reason, that is not a natural tendency that most dentists have to look into their current customer base and say— like in business terms, they would say, “how are you going to monetize your current assets? How are you going to monetize your current book of business? How are you going to take what you already have and earn more money from it? It is a common business strategy in a lot of industries, and it is something that is stressed, but I think that particularly in dentistry, for some reason… I don’t know if it is just not as exciting, I don’t know if it feels like it is harder work, or if people just are thinking about it. It just doesn’t seem to me like it is the number one place people look for growth.


Dr. Madow: I agree, and I love the business analogy, because as you know, as a businessman, it is something that businesses talk about. What is our customer acquisition cost? And when they start analyzing that, as you know, they will always find, “well, geez! It costs us a lot of money to find a new customer,” or in our case, a new patient, and we better do everything we can to service that customer and to get the maximum profit we can out of them. Yet in dental practices, it is the question that people always ask: how many new patients do you get per month? And if somebody said 60 new patients per month, it’s like, “wow, congratulations! That is amazing.” Yet, you know, 50 of them are saying no to treatment, ten of them are leaving, (laughs) and you are left with net zero. Because it is tough! When you think, “well, I’ve already told this patient they need two implants and two implant-supported crowns, and they haven’t said yes. They’re not ready, so, shoot! Let’s move onto the next person.” That seems to be the attitude.


Reese: So, just to go a teeny step deeper then, if I am going to be looking into my file cabinet, my fictional file cabinet, here, and I am going to be trying to monetize or improve the revenue I can get from my current customer base, or current patient base, where is the lowest hanging fruit that you would start with, and maybe what are the first things that would be the most obvious kind of second steps?


Dr. Madow: Yeah, great question! Well, I will answer it a little bit indirectly. The lowest hanging fruit is not to have the million-dollar file cabinet in your practice. The lowest hanging fruit is to improve your treatment planning skills and your patient relation skills so people say yes to their treatment! Then you just avoid the whole thing all together, right? This is not the easiest way to go, but it eliminates a lot of steps. And it is something that I find all the time as well. Dentists take these highfalutin treatment plan presentation courses, and they learn how to be a salesperson. And you know, when a patient comes into a dental practice, they don’t call and say, “hey. I know I need four quads of scaling and root planing and two implants and three root canals.” They say, “I’m overdue for a cleaning. I chipped a tooth. I’m having some pain.” And then, if that is how they enter the practice, and the dentist takes some course that tells them, “well what you need to do is have this four-hour exam and then bring them back with their whole family for the treatment plan presentation and throw a sheet of paper in front of them that says, you need $12,000 worth of treatment,” and that is working against human nature, then that is what causes the million-dollar file cabinet. So, the first thing to do— and obviously, we don’t have enough time to get to cover that in the podcast— is to up your treatment planning skills. Work with human nature. Learn how to become the patient’s trusted friend and advisor and not just somebody who is selling them a bundle of goods.


Reese: Okay. I’m going to advocate for this based on my own experience in financial planning and some other business experience I have had. It is easier in many cases to find ways to incrementally and continuously across your entire business introduce incremental steps toward accepting more treatment or incremental steps towards new services rather than big jumps. That is just a general principle I believe in, and that has worked really well for us over the years as we have just moved people towards accepting better and better optimal outcomes. Maybe the $12,000 treatment is the optimal outcome for that patient, but a lot of times, it is just a big jump for them to make mentally, and it is scary, and it usually doesn’t result in high conversion rates, right? High conversion is not likely to happen when you are jumping people from a comprehensive exam to a very very large treatment presentation.


Dr. Madow: Yeah, I totally agree. And I always give kind of a silly, real-life analogy. I say, “how would you feel if you walked into an expensive clothing store like Nordstrom, and you are looking at a shirt that is a high-priced shirt? It’s 300 bucks. And you finally get up the nerve to buy it, and you’ve never done anything like this before, and you go up to the nice clerk and say, I’d like to purchase this shirt, and they say to you, oh no. You can’t purchase that shirt unless you agree to get your next five years worth of clothing here. That will be $12,000. Yes or no?” Well, that is what it feels like to a patient when they come to a dental practice and they say they chipped a tooth, or have pain, or they’re overdue for a cleaning, or they got new insurance, and they get this big treatment plan presented to them. It is very high pressure. Even though the treatment is probably the right thing!


Reese: Even though it’s likely a good decision. It is just to big of a jump, right?


Dr. Madow: Yeah.

Reese: Okay. So, let’s go to maybe another thing that might come to mind besides this million-dollar file cabinet, which is super insightful.


Dr. Madow: Sure. Along the same lines, patients obviously cannot get dentistry performed unless they can afford it, so you have to have a lot of financing options. And I think most dental practices are onto that. They know how to do it. They obviously will take cash or check (laughs), who wouldn’t, right? Credit cards are everywhere. Just about every dental practice takes third-party financing such as CareCredit. CareCredit is our favorite, but there are some other options out there as well for third-party financing. And when you are talking about large cases, that is the best option for many people. Because Americans, we love to pay for things by the month! You pay for your car by the month, and your home by the month. That big screen tv that you can’t afford to watch the big game, you’re paying for that by the month! So obviously, we have to have these options in dentistry. But I find that financing is presented all wrong. And here is the typical thing— and again, you might find this exaggerated, but these are things we hear all the time. Somebody will be at the front desk, which is a horrible place to do it anyway, because everyone can hear, you know? How embarrassing (laughs). And this person is talking to the patient saying, “well, you have cash, check, chard card?” And the patient is saying, “no, can’t do that, can’t do that, can’t do that. I just maxed out my chard cards in Disney World.” And they say, “okay, well we’ve got a great thing for you. It’s called CareCredit. It’s a third-party financing company. You’ve gotta fill out this long form, and it’s going to ask you all kinds of personal questions, so we’ll learn about your income, and your job history, and your prison record, and then if you’re approved, well, you know, we can maybe go ahead. But if you’re not approved, you’re a loser, we’ll be making fun of you.” And the patients just don’t know what to do with it, and they say, “no, I don’t want to go ahead with that.” Here is something else that, Reese, you have probably learned about dental people, and I feel like I’m doing this now: we just love to talk. And if there is like a millisecond of silence we get uncomfortable. We feel the need to keep talking, keep talking, keep talking. But just imagine if instead of going through that whole spiel, somebody— the financial coordinator or front desk person, whatever you want to call them— just looked the patient in the eye and said something simple like, “your treatment will be $2,400 dollars, and we’d love to offer you twelve months interest free. That would be just $200 a month. Is that something you would like to take advantage of?” And then just shut up. What does every patient do? They’ll nod their head and say, “yeah! That sounds great. That’s something I’d like to hear more about.” That is the entire presentation! “We’ve got a great option for you, twelve months interest free. That’s just $200 a month. Is that something you’d like to take advantage of?” And then just be quiet, and wait for them to say yes, and then you can explain how the whole thing works.


Reese: Yeah. I think that is good insight. It is funny how sometimes it is a nuance sometimes in communication that completely changes the outcome. I know that the example you have presented is sometimes more than a nuance, but sometimes that nuance of silence, and of just waiting, of giving someone a simple, easy-to-accept solution and just waiting for them to make a choice… sometimes we get in our own way talking over people, and almost making the choice for them. We are planting question marks in their mind by over-communicating, you know? And I think that is valid.


Dr. Madow: It’s so true. And another example of that, going back to our first topic when we talk about effective treatment planning— dentists, we do this too. I’m flashing back to this day. It wasn’t that long ago where I was in a dental practice, and I think when we visit a practice, or when Dave and I or there, or one of our coaches are there, everybody is on their best behavior, you know? They are all nervous they are going to do something wrong, so they are trying to perform at their peak. And I remember, I was in this treatment room, and the dentist is presenting treatment, I think the patient needed some endo. And they were holding up the x-ray, you know, a big beautiful monitor, showing it to the patient, as if the patient knows how to read x-rays anyway, and saying something like, “well, as you can see, there is a radial opacity at the apical root tip of tooth number 30,” and the patients, what are they doing? They’re sitting there going, “uh huh. Uh huh. Uh huh!” (laughs) meanwhile, they are thinking like, “what the heck is this guy talking about, and how much is he going to cost me?” I mean, I always say you need to speak in language that a fifth grader can understand, because if a fifth grader can understand it, then a PhD can understand it as well; you have everybody covered. And if somebody wants to ask more questions, they will. But we speak this crazy language of dentist terminology, and it is our language, and sometimes we forget that other people don’t understand it. I mean, simple terms, you know? A periodontal disease, or crown margin, or composite restoration. Patients have no idea what we are talking about, and we just confuse them.


Reese: Okay. That is good insight, man! As a patient, I know that based on the types of words you use with me and the way you communicate with me, I will either be more or less receptive to treatment. Because either I will know or not know what you’re talking about. And I want to know! But I don’t want to feel dumb, and I don’t want to feel intimidated by it, and I definitely don’t want to feel like you are having to dumb it down too much for me, because then it makes me feel even more stupid as a patient, you know? I just want you to figure out how to communicate with me in a way that is approachable, and I think you can spend a whole career and never figure it out. I certainly haven’t figured it out. And I’m still trying to figure out, how do we best present ideas and concepts? I just think in dentistry, one of the reasons people don’t accept treatment is because a lot of times they are kind of confused about what the treatment actually is doing in their mouth, and they don’t really know why they need to, and a lot of it has to do with some of the terminology we use.


Dr. Madow: I think it’s true. And again, back to communication. I think people don’t accept treatment because they are confused, they think they can’t afford it, and also on some level— and I hate to say it, but they think the dentist is trying to pull an over on them, or over-treat, or the dentist has their Porsche payment due, and the kids have got to enter Harvard, and there is just not that trust level. And that takes time, and it takes great communication skills to get somebody to trust you and to honor you.


Reese: Oh, there are so many similarities here, it is driving me nuts. But you can imagine how many people look at financial planners and they feel the same thing. “You’re just trying to confuse me so you can sell me something,” or “you’re just trying to get me to do this.” They feel intimidated. As any kind of technical service provider, accountant, attorney, especially a dentist, and a financial advisor, or whatever technical trade you have, the more you can make your language, like Rich said, fifth grade accessible, you will see a dramatic increase in your revenue. I guarantee it! Talking to you, Rich, I always feel like no matter— I mean, you are an intelligent guy. You have a ton of experience; you have a very large business; you have been entrepreneurial in a lot of different ways. But I never feel like, when I’m talking to you, that you are talking over me, or talking in words that I wouldn’t understand, or trying to talk in ways that make you seem or feel sophisticated. You are an accessible Bob Dylan type of guy, which I like!


Dr. Madow: Well, thank you so much! And you are as well.


Reese: I think that is a skill that you are trying! You are consciously doing that; I can sense it.


Dr. Madow: Well it is a good lesson for dentists, because let’s face it. Anybody in any profession— whether you are a dentist, or a money guy, a plumber, a computer expert, a car mechanic— you can talk over your clients’, or your customers’, or your patients’ heads if you want to. But why would you want to? I mean, it doesn’t make you look smart. I think in my life, and yours too, Reese, we have met many super intelligent people. And I think the people that really rise to the top are the ones who can simplify things and make other people want to hear what they have to say. You know, anybody can confuse anyone else if they try hard enough or if they are not thinking, “what is the good of that?”


Reese: If you want to make friends— and this example that I was giving that you did in the restaurant, right? If you want to make friends, and you want to be accessible to people, and grow, and have trust, just bring your language level down to a point where it is hyper-accessible, especially in a technical career. And I don’t know, I was thinking about that today, and this communication bug has obviously got me on one this morning.


Dr. Madow: Yeah, it is interesting! And always do it with a sincere smile on your face, and mean it, and be patient. You know, because restaurants, gee, it’s that great kind of microcosms of how we treat other people. And I’m sure we have all overheard people at other tables who weren’t happy with their order just yelling at the poor server and putting them down, and saying, “how could you not know this?” and “I told you I was gluten free! Now I’m going to have diarrhea all night!” And it doesn’t get you anywhere. You know, it’s funny, I remember— I think it is Howard Farran who calls his anesthetics sleep juices. He says, “okay, we’re just gonna give you a little sleepy juice,” and like, what would a patient rather hear? “We’re about to inject 2% lidocaine with 1:100,000 epinephrine.” Nobody would want to hear that! “Let me give you a little sleepy juice!”


Reese: Dude, I love that! (laughs) I love it. Okay, so what is something else that you kind of see in the practice? We go into the practice, what is something else you assume you would see?


Dr. Madow: Yeah. Here is something that just came to mind. It really bugs me, too. It’s a team thing— and let’s face it. Teams run the practice; you need a great team. Dentists can almost step to the side and just do the dental treatment if they have a fantastic team. And one of the things I see, teams tend to get a little territorial, a little rivalrous, maybe, and the typical thing is that the back and the front don’t get along. The back meaning the clinical area, the front meaning the business area. They don’t appreciate one another, they don’t cover for one another… they think they they are the most important and that the other people are just there as  window dressing, or I don’t know what they think (laughs). But it’s really sad to see! And dental team members are so important, and they are such smart, hardworking people, and let’s face it. They have to do, you know, the scut work; they have to clean up after the patients, hold the patients’ hands, deal with the insurance companies, and deal with the things that the dentists shouldn’t be doing. And that work division is fair and suitable; it makes sense for a dental practice, but it can cause quite a bit of tension. And then when something doesn’t go right, the front blames it on the back, and the back blames it on the front. You see it in just about every single dental office!


Reese: Why do you think that happens? Because just yesterday, I was on our private Facebook group— a plug for that,, okay? If you go there, you can ask any financial question. Yesterday, one came in that I was reading through, and it was about an associate leaving, and I saw one about hygiene leaving, and then I saw one about the front and the back having kind of a heated discussion about a patient issue. I can tell, like, this is a real— I mean, I probably see as mean team posts as I do almost anything else. Why do you think it is such a challenge to get the teams to sort of gel and make people— because ultimately, what this results in that I highlighted is, it results in turnover, too, you know? And that is just like, the worst! I mean, it is really a big cost for a company.


Dr. Madow: Yeah, I think one of the big things about dental practices is that the job definitions are so clear and so segmented, you know, we have our hygienist and she is— and I am using female pronouns because it is 99% female, and yeah, that is changing, but just for the sake of this discussion— she is in that treatment room treating periodontal disease, and doing perio exams, and she is a producer, and this is her little kingdom or queendom. And then we have the dental assistant, and they can be the doctor’s pet, you know? They are there knee-to-knee with the dentist all day long. They’re in the trenches; they’re suctioning, spitting, slobbering, cleaning up puke… you know, they are like, in the OR. They’re in the midst of everything. And then the front desk is kind of clean, but they’re bringing the money in! And all these jobs are so different. And I think sometimes, we don’t even know what the other person is doing, or we don’t appreciate what the other person is doing. And it gets a little territorial, and then when something goes wrong in the practice, what is the first thing we do? We blame someone else. And then, if we form a little team, it is usually the front versus the back, because people love to have little cliques and little teams as well. So, why does it happen? Well, I’m not 100% sure, except for those reasons, but it happens.


Reese: Are there remedies here to kind of improve it?


Dr. Madow: You know, just like everything else, it is really important to know what other people do, and to appreciate what they do. I think this is going to sound like a little silly rule, but sometimes when I talk about team issues, I feel like I’m a Kindergarten teacher. I think it is really important to have this policy in your office, and in your life as well, and that is, don’t say anything about somebody else that you wouldn’t say if they were standing there right in front of you. And if you have a complaint, have a solution. It is really important that we are very open at our team meetings and that we bring up issues where we think things are not going well in the practice, but let’s also bring up a solution or an idea for an improvement when we do that. And a lot of times, they are the simplest things. But, you know, gossip, backstabbing, they take place in just about every dental practice. So, let’s make it a point that if we are going to say, “hey, Tammy didn’t sterilize the instruments, and now we’re running behind, and she’s such a jerk, and she’s lazy and she’s—” let’s not do it that way. Let’s just say something that you would say right in front of Tammy. “Hey Tammy, I had to do an endo in room three, and the instruments weren’t sterilized. I know you are super busy, but maybe we can come up with a system to make sure this doesn’t happen again.” I mean, how much nicer is that? Along the same lines— and this is really sad, but I would say we see this maybe in 50% of the practices, and that is, there is one team member who is just holding the doctor hostage, and the doctor is afraid of her, and she is just nasty, and she takes advantage of every rule at every opportunity, and she doesn’t get along with people. But maybe she is great clinically, or maybe she is fantastic with the insurance companies, or for whatever reason. For some reason, the doctor has given them chance after chance after chance, and they are afraid to give them their walking papers. And believe me, we are not the kinds of coaches that come in and start shaking things up and saying, “you’ve gotta fire this person.” We just don’t do it! But sometimes, it reaches the extreme where it has to be recommended, because you have given this person chance after chance after chance, and they just cannot improve, and they just keep bringing everyone down, and the patients sense it. And there are times when you have to give them what we would call a job opportunity elsewhere. But dentists are afraid to do it. And again, it is extreme, but when it has to be done, it has to be done. And I have never talked to a dentist in that situation that a month later didn’t say, “I can’t believe I waited this long.” They say it every single time. Or, you know, we also see the dentist who micromanages the team to death, and they are afraid to do anything, and that creates tension as well, and I think it is really important to train your team well, and then let them fly. Let them have a go at it. Let them know that it is okay to make mistakes, as long as you don’t kill anyone (laughs), right? But, “do things on your own! Be motivated. Be a self-starter. And if you do something wrong, well, we’re gonna accept that! Because you are trying to do your job better and better.”


Reese: That is so critical, man. That’s so critical. Yesterday afternoon, I had a team member who has only been here for a few months do something really creative that was helpful, and this person told me, they said, “sorry, I’ll stay in my lane.” They just mentioned that. Like, “sorry, I know I’m kinda getting outside of my lane here. I’ll stay in my lane.” And I was like, “what? Why do you feel that way?” It was really insightful for me to see that whatever had happened maybe in previous employment or life experience, or maybe it was something in our culture that was making that person who had just been here for only a few months feel like this creative great thing they did was like, outside of their job description for some reason, right? And I was like, “do not feel that way! There is not detailed lane for you! There is no limit to the value you could provide to our business. Please feel like you can take these liberties to try to improve things that are outside of your job description occasionally.” Of course there is a difference between not doing your primary job and just wandering around all day doing random projects, but I just feel like too many employees feel very restricted and scared that they might fail on trying something. It might make them look bad, or put their job in jeopardy, and that is a corporate culture thing. So, man, I tried to stamp that fire out as quick as I could, because I really felt like that is not part of our culture, but it was interesting to see someone new come in and for what— I know that that terminology, or that phrase “stay in my lane” wasn’t something I have ever said or something that our company has ever said, it is just that in business in general, I think there is a feeling of, “I don’t want to get outside of my area of expertise. I’ve gotta do my job and my narrow focus.” So, in a small dental practice, it is just not realistic, especially at the front desk and in the back. I mean, back and front, there are a lot of crossover, and you need people who are trying to help the ship move in the right direction, regardless of the task. So, that is my thought I don’t know if you feel anything around that area, but team is a big deal to me.


Dr. Madow: Absolutely. And you know, along the same lines— kind of a little bit on a tangent from that, but one of the things that really bothers me is when you go into a dental practice, and they are doing something, and it just doesn’t make sense. And you ask somebody, “why are you doing it this way?” And they say, “well that’s the way we’ve been doing it for the last ten years.” Like, come on.


Reese: (laughs) “so that’s great.”


Dr. Madow: That’s the reason not to do it that way!


Reese: (laughs) exactly! Yeah, that’s true. Anyway, okay, we don’t have a lot more time left, but let’s think of anything else. I know you have a few more things, I’m sure, coming to mind.


Dr. Madow: Okay, we will do one more thing, because this is a biggie. Something that we see in just about every dental office. How’s this. I guarantee you that if we took a second here and googled dentists— where are you, you are in South Jordan, Utah?


Reese: Yeah, I mean Salt Lake.


Dr. Madow: Okay. So let’s just say we googled dentists Salt Lake City, Utah, and took a dentist you have never heard of, called their office during normal business hours pretending to be a patient that wanted to come in. Say you are asking a typical question. How much is a cleaning? Do you take my insurance? Do you see kids? Whatever it is. Those are the kinds of questions that potential new patients ask. We just did a random call to a random dental office during normal business hours. I guarantee you one of two things will happen. Thing number one is, the phone will not be answered, and you get some kind of voicemail saying something like, “if you’re hearing this message during normal office hours, it means we’re busy treating other patients.” Ugh! Okay, this is a new patient that wants to come to your practice for some reason, out of a thousand gazillion dental practices in Salt Lake City— there is one every five feet, right? They chose your practice, and they are going to call to try to make an appointment, and they hear a recording like that? Or one that says, “we’re currently at lunch.” Click. They’re going to hang up, and probably never call back again.


Reese: That was your window, yeah.


Dr. Madow: Right. The other thing that would happen is, they’ll call and they’ll ask a question like, “how much is a cleaning? Do you see kids? Do you take my insurance?” engage in a nice conversation with the person at the front desk, but never make the appointment. And then, what happens? Again, we talked earlier about the new patient fix. We’re spending money on marketing; we’re doing internal marketing; we’re asking for referrals. But a patient like that calls, and there is no record ever made of that call. So, the dentist just assumes that their phone is not ringing, because everybody says, “well, track your referral sources. When a new patient schedules, find out how they found out about your practice.” And we all know that is essential, but you don’t track the calls when the people don’t make the appointments, and they probably outnumber the others ones about five to one. So, wow. That is such an issue.


Reese: Such a good point.


Dr. Madow: Yeah, I mean, the bottom line is at the end of any call, you have to say to the patient, “we would love to see you as a new patient in our practice! We can see you tomorrow at 2:30 PM. If that is not convenient for you, we have Thursday at 11:00 AM. Which works best for you?” And not just, “would you like to make an appointment?” but offer specific appointment times at the end of every call. It’s a must-do.


Reese: I spend a lot of time in dental practices, and I hear front desk conversations all the time, and I’m just surprised at how little work has been done in that area, but you can’t— I mean, the truth is, man, there is just not a lot of training! There is training, but people don’t come into these jobs with the background. They need coaching; they need consulting; they need content to learn; they need continuing education. And it is no shame in it.


Dr. Madow: Well when somebody calls a dental practice, they are calling because they know that we can help them get healthier, you know? We can help them keep their teeth and have a beautiful smile, and everything we do in our dental practice is great! It’s beneficial. We’re not ripping people off. But then, if the front desk person isn’t trained to get that person in the appointment book, you are having them lose that opportunity to really get something great in their lives! And you should feel ashamed about that; you should feel like you are not helping people the correct way.


Reese: Now, if I was a dentist, the inherent motivation here is, you know that 90% of the population is not properly following total oral hygiene care throughout their life, you know? You know that is the case. I mean, statistically, we know that the majority of the population neglects oral hygiene to a pretty significant degree, and it has massive health effects in their day-to-day life, in their longevity, in their mortality rates… I mean, it’s a significant value you’re providing, and you don’t have to have any apology or shame or discomfort about being aggressive in scheduling patients for treatment, because you are helping them do something that they would not do without you. And I feel like once you find something in your life that you are that passionate about— I finally found that for myself in building the right kind of fee-only fiduciary planning practice that let me have confidence selling this, because I believe that what I’m doing is saving people’s lives! It is improving relationships; it is improving longevity and mortality; it is making people live happier during their life, and while they are working; they have more confidence. Oral hygiene is a significant issue, and I want my dentists to be proactively reaching out to me, because otherwise, I will neglect it! It is not something that is inherently part of my routine, and I need that accountability. I want it, and I just think sometimes dentists feel embarrassed to be too aggressive, just like my team might feel that way if I wasn’t motivating them to see the value of what we’re doing, so… just believe in what you’re providing once you have found that! You are lucky in dentistry to have that from day one, unlike myself, who had to go through a journey to get here.


Dr. Madow: The amazing thing is how many team members and dentists don’t even believe in the treatment that they are presenting. And that really affects everything. It is just amazing. Well, if the team doesn’t believe in the dentist’s actual clinical dental abilities, then that’s a humongous problem. But also, you know, periodontal treatment. Periodontal disease affects, what, 75% of the U.S. adult population? And dentists are afraid to present it because they don’t really believe in it; they just think it is easier to do a cleaning, and get the patient on their way, and… wow.


Reese: That is doing a disservice to the patient. You are not giving them the full scope of options that would maximize their health, right? I meant you don’t have to sell it, you just have to present things honestly and transparently and give people the option to select the optimal treatment. Don’t assume that they don’t want to hear about it, or don’t assume that they don’t want to pay for it, or don’t assume they don’t want that treatment. If you don’t present them with that option, they’ll never know. We have to do the same thing. I mean, people don’t like the amount of work involved in comprehensive financial planning; it is a pain; people don’t like it. But when we present them with all of the consequences of neglecting details in all of their financial areas, you would be surprised at how many people are so appreciative and grateful in implementing a much higher level of patient care in finances than you would ever have done by just making assumptions about your customers. Don’t make assumptions about your patients; let them choose the level of care that they want, right?


Dr. Madow: And amazingly, some people might actually want the best that you have to offer! (laughs) it’s amazing. But you have to believe in it, and if you don’t believe in it, it shows through. It shows through in the way you talk, in your body language, and everything. And if you are not enthusiastic about it and communicating well, nobody will say yes to it. Which kind of brings us way back to the beginning when we talked about the million-dollar file cabinet.


Reese: Oh yeah. And creating a practice that you really believe in! I mean, I think— Richard, you have a lot of experience in this area, but getting someone to have a practice that reflects the type of dentistry that they really believe in and want to do, that’s part of it. I mean, not every dentist is going to have an identical philosophy on treatment, or presentation, or cases. They are not going to all have identical philosophies, but if you don’t have one that you are passionate about, that is going to really affect your overall profitability and growth, and satisfaction with your job.


Dr. Madow: I totally agree. And if you love having a blue-collar practice where you do a lot of extractions and things like that, well that is great! If you love it, you’re helping people.


Reese: I just finished a book— well I haven’t read the last chapter yet— it’s by Ray Dalio, who is kind of a famous billionaire guy from your neck of the woods, actually. His book is called Principles, and kind of the main takeaway from the book I got was, do meaningful work with people you really love, you know? And I think that is what drives the work that you do, and drives what I do. I think that if you can do work that you love and are passionate about with people that you really love and care about, I mean… that’s what life is all about. And however much money you make, it won’t ever compensate for not working with people you love doing something meaningful that you love, you know? And I think that is kind of your goal as a coach, and one of the goals I have as a financial advisor, and I just hope everyone feels like they have gotten some value out of this. I know both Rich and I do care about our audiences, and want to make sure you guys have the ability to make positive decisions in your life, so… Rich, how do people get in touch with you the best way, personally, if they want to reach out?


Dr. Madow: Oh, fantastic! Our website is There is only one “d” in Madow; a lot of people try to put a second “d” in there. You can reach out to me personally through email; it’s The website for our big annual seminar is; that stands for The Best Seminar Ever. Check out our podcast, The Dental Practice Fixers, on iTunes or Spotify or Stitcher, anywhere you can listen to podcasts. It sounds like enough homework for people (laughs).


Reese: That sounds like a lot, man. I was just booking my flight this morning to TBSE, man! That is November— is it 8th and 9th, or 9th and 10th?


Dr. Madow: Well now you’re asking a tough question (laughs). Whatever the first—


Reese: It’s a Friday and Saturday, alright?


Dr. Madow: Yeah. Reese, we are so happy. You are going to be on the TBSE stage, and we are really really excited about that, so thanks for doing that.


Reese: Yeah, man! I’m excited; it’s going to be a really cool event. We look forward to it, and if you want more information, it will be in the show notes. Thanks again, Rich! I really appreciate all you do for the industry. You are a good influence on dentists everywhere, and on me, and I really appreciate all you do. We will look forward to having you again on the show soon.


Dr. Madow: Sounds great! Thanks so much, Reese.


Income, Practice Management

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