Friday, February 29, 2008

I have been thinking a lot about this. I have come to a conclusion... it is not CERAC I have a problem with.

Okay let me tell you about this meeting. It was a presentation that was going to demonstrate CERAC.

Let me back track to about 3 years ago. I went to an all day meeting put on by Patterson to introduce the CERAC. The dude spent the whole day (8 hours) talking about how great the machine was and how much money you can make with this machine. He answered every one's questions about money. What perplexed me is there was almost NO clinical photos. An all day lecture about dentistry and no teeth pictures. There wasn't any talk about how this benefits his patients. There was a lot of talk about how it is only one appointment, (which, don't get me wrong, I think is a HUGE benefit) but time is not something that moves me to make any decision. But that paled in comparison to the money talk.
So I left there with a bit of a bad taste in my mouth.
Since then I have dabbled on Dentaltown. I was a voyeur in the CERAC threads and my opinion really changed. There are some guys that are masters of CERAC. My faith in my fellow man was restored.
I didn't care what they were charging, they were spending time and working to make a product better for their patients. Their was no talk about how much money they were raking in. Only talk about improving their care. There was a lot of pride in their work.
Am I babbling here? Am I making sense? I work hard everyday to improve my product and be fair to my patients. I feel like if I do this well, I will make money. And it really turns me off to hear people talk about my profession as JUST a means to an end. Not a career of treating people and helping them with their dental needs.
Now back to the meeting.
They talk about how doing CERAC was the best decision they ever made. Then they started to show some of the before and afters. I was not impressed.

I was sitting next to a guy that I know that has a CERAC machine (This guy is my friend, I openly talk to him about this). As the dentist is presenting I asked him how is the insurance accepting these. He says that the insurance is only paying on 3/4 crowns and crowns, so you have to charge out everything as one of those. Hmmm?
I asked him how much to do a restoration. He says that everything is the same price regardless of the procedure, $800. Hmmm?
He also says he doesn't do many fillings anymore? Hmmm?
The dentist was doing MOD fillings with CERAC. The dentist was doing OL fillings with CERAC.
I was thinking to myself, "What is wrong with just doing a filling?" and I had some visions of an $800 charge and a little insurance fraud to go with that.
I don't have any problem with doing fillings with CERAC. But are people charging filling prices for fillings?
A different friend was telling me he worked for a dentist that would do CERAC fillings and charge $300 for them. I think this is fair. You are doing a filling that is indirect. You have overhead. A price a bit more than my price for a filling, I have no problem with this.
My problem is everyone thinking this is standard of care. If you are removing a old small DO amalgam, a FILLING is the standard of care. Have we gone away from this and no one has told me?
Now I have showed you some of my work. I can count on two hands how many of my filling I have replaced. I have been doing fillings at this office for 13 years. I have done over 10,000 fillings and have replaced just a few (I understand other people might be replacing them, but...). That is a pretty good clinical study.
I can tell you from a bunch of conversations I have had with other dentists, and the anti CERAC world, the sediment is there is a lot of over treatment going on.
The dentist is told in order to pay for the machine they have to do 13-20 restorations a month. Now don't you think there is a lot of counting going on in some offices?
I may be different, in fact I know I am different, but I don't know how many crowns I do in a month. I have never counted. But I can tell you sometimes I do 15 in a day but I can also tell you I have done 1 in a week. I am a general family dentist so my schedule can look very different day to day. Somedays I will do 3 New Patient exams, a couple of fillings on a child. The next day I could do 3 root canals. The next day I could see an elderly lady that has all sorts of root caries and then see her daughter to do 4 fillings on. I do what comes in. Somedays my production will be $15000 (pretty rare) somedays it will be $1500. I don't really count.
I try to make it so my overhead is not so high so I don't look at the schedule and say, "Damn! only 2 crowns today." (Don't get me wrong, I have some days that the schedule gets me down but it usually isn't about money).
Now, some of the users of CERAC misuese it and ruin it for the good guys. And I know the guys that are doing it right are cringing when people have this opinion about something they love and are passionate about.
They also realize that some dentists are using it for financial gain first and then patient second.
Then at the end of the lecture some guys around me are talking to each other, "Are you going to get one?", "I don't know. Are you going to get one?"
What!!? Did you guys just see the same presentation I did?
I find myself doing a lot more all porcelain onlays and 3/4 crowns qutie frankly, I love doing them. So I start thinking to myself, if I am doing 15 crowns a month by myself or if me and my partner are is are doing 15 together then we would definitely be thinking about a CERAC machine.

I am excited about maybe having a CERAC machine someday. But I can assure you it will not change the way I see teeth. They will still be white not green.

Have a great weekend,
Rest on Sunday,
john

Thursday, February 28, 2008

No this is not the CERAC blog

Okay before tomorrows blog, which is still up in the air, I wanted to lay some ground work.
Just so you all know, I have done my research on the CERAC machine and every scientist says the product is great.
They all say the material that comes out of the machine is top notch.
To let you know I have been pleasantly suprised at the data. Superior product from a superior machine, made from a superior company (I have a bunch of their machines in my office).
I am not trying to backtrack.
I was just a little hot after that study club.

I however do not want to write a blog that is that is offensive. I have tried that and it has not worked out for me.
I am still thinking about it...
Talk to you tomorrow, Maybe.
john

Wednesday, February 27, 2008

I hate being ripped off.

Okay I went to a CERAC study club last night and I am not happy. Fridays blog is going to be on my opinion of CERAC.

It is going to take me a couple of days to calm down and I don't want to say things I might regret (that is growth, baby). I also want to write about this, today's topic, because I was hot about it on Monday and I have sinced calmed down enough to write about it.

Today's topic is about getting ripped off.

You know if you go to a place of business, it can be anything, like a mechanic, a specialty store, Disney? Have you ever left a store and really felt a pit in your stomach because you just think you have been ripped off in the highest degree.

Like, (not the same but I am setting the stage for my story) if you went to the mechanic. This is kind of different for me because I don't know anything about cars. They would say you need a new sphitzer valve (Fletch reference) and I look and he says see here you need to replace that. Then he looks up the part in the book and it says $50 and then he looks up how long the book says it will take, 1 hour, that is $150. So your bill is $200 to change the sphitzer valve. Now this doesn't tick me off that much because I don't know what the heck they are doing. I don't know a thing about cars. So I trust my guy and pay his bill. Even though I wish it wasn't so much.
Or (again, not the same but I am getting there) if you go to Disney with the family. It is 110 degrees and you can't wait any longer (you put it off as long as you can because you know what is coming) because you are starting to get dizzy. You go to the counter and your worst fears have come true...5 drink, $35 dollars. Ouch. I again don't blame Disney. It is not really price gauging. You get this awesome Dumbo cup that can sit in your cabinet for 5 years. But Disney has other stuff mixed in with the drink. They have the cart, they have cups, they have characters walking around while you are drinking your drink, it is part of the whole drinking experience.
I understand I am going to get it...I take it like a man and move on.

Now the thing that gets me is my local pool store. I have an automatic pool sweeper. (One thing that gets me is that the material the pool sweep is made of breaks down in pool water, figure that. I pay almost $600 for this thing and he tells me I will probably get three years out of it. What!!?!). This things drives around the pool and cleans up all the leaves at the bottom of the pool. Now every 4 minutes or so the thing automatically backs up. The reason for this is that if it gets stuck on a step it is not stuck there until the end of the day. So it has a valve on it that kicks it back. Pretty cool huh?
The valve I have has a hole in it. It needs to be replaced, no problem. Let me just run up to the Pool store and buy a replacement valve. My wife was out so I called her to go and get it.
She came home with it and said, "you know this thing was $65 don't you?" I said, "WHAT?!"
So I went on eBay and looked it up. $32 dollars BUY NOW and $5 dollars shipping. That is $65 compared to $37.

Now this makes my blood boil.
Now I am not talking about buying something that has service attached to it.
I am not talking trusting this guy more than I trust someone else. I am buying a product, not a service.
Now I am also not talking about, I could get it online for $25 and he sells it for $29. Of course I understand what it cost to own a shop, I understand what it cost to run a business. I don't understand sticking it to your loyal customers.
That is 100% more. That is highway robbery. Now if I didn't go to eBay and find this out, I would of never known he was ripping me off.
Am I being a baby? Do you say, "this is a capitalist society, and he can do what he wants"?

I have a small business and recognize that I have the trust of my patients. Are things expensive? Yes. Are they fair? Yes. If my service and products are better than the average guy can't I be a little more expensive? If I choose to have more staff than the next person in order to have a better experience for my patient isn't it okay if I charge more? If I choose to have better equipment more technology to serve the patient better, isn't it okay to be a little bit more expensive than the next?

But when it comes to someone buying a product here, it is different. (We don't make it a habit of selling products here, like Sonicares or whitening products, it is not a huge part of our practice)
When we do sell them products, we sell it to them for LESS than they can buy it at the store. We buy a Sonicare toothbrush for lets say $75 (because I don't really know) and the store sells it for $140, I sell it to my patients for about $99. I mean we pay the tax and may make $5 on the deal, which is enough for our troubles. This is not a money making thing. We sell the bleaching material at cost. I mean we have already made the money off of them for the bleaching.

I hate getting ripped off. I don't know why it rubs me so much but it does. Sometimes when you are buying a product you are not comparing two of the same things. This time I am comparing an apple to an apple. One apple was $65 and one apple was $37.
It wrong, just wrong.

Monday, February 25, 2008

Calgon, take me away.

We have quarterly meetings with our financial consultant. We go over everything that happended in the last quarter.

Let me preface this by saying my father and I don't know crap about money. We are pretty good at making it and really good at spending it but all the stuff in between we have always relied on other people to do it.
The first 10 years I have worked here we had an office manager that did everything.
So I became less and less interested in that part of the practice. We sat down once a week and she told us all the line items. In the same weekly meeting she told us what was in the bank. We asked her questions about the pulse of the front desk, i.e. accounts receivables, is hygeine schedule staying busy...things like this.
Our office manager retired and this all went away. Now we were in trouble because neither my father or I knew how to write a check.
So we had two choices... hire someone else or we had to learn the system (learn the system, I laugh out loud just thinking about it).
So we hired someone. He has an accounting mind and he runs a couple of small business like ours. I think in a week he goes to three offices. He has a box in an office and one day a week he pays the bills, payroll, takes care of our complicated health insurance plan, 401k plan and other financial issues that might come up.
So now we are back to the present.
We are having a sit down with our financial consultant. In the meeting is our accountant dude, me and my father and two people from our advisors.
Before the meeting our guy sends over all the things that are pertanant information
to the meeting. Where has our money has gone. How much we have, account receivables, new purchases, things we have thrown away (for depriating assest), anything you can think off.
Now between the 5 of us we hash out or business for about 2 hours.
Mostly I listen. But lately I have been getting more and more of the questions. Now it has become apparent that this might be a passing of the torch kind of thing. At the office the torch has definitely been passed. I make the bulk of the decisions and my father will step in when he sees me flouder like a fish out the water. Or when I have a breakdown in our office (usually involving a lot of F-Bombs) I plead with him to help me. And he does.
Now back to the financial decisions....Let me say one more thing...
Decisions... is it me or do we dentists have to make 10000 decisions a day.
Can I buy new instruments? The sterilizer is not working should I call the tech? Distilled water is so expensive should be buy a distiller? Yes, then what distiller should we buy the $399 one or the $599 one? Do you want the green microbrushes or the red? Do you like these cotton rolls or these? Ms. Jones just lost her job do you still want to charge her full price? The curing light in room three is losing power what do you want to do? Do you like the Colgate toothbrushes because the Crest rep was in today?
Should I try to save #31 with a crown lengthing and post and core and crown or should he just get an implant? And so on and so.

Now with the advent of me taking on the financial decisions it becomes, "Should we change to Bank of America because you can earn a half of a percentage point more in interest? Do you want to go with a high deductible medical insurance plan (a health saving plan) because it will save you on premiums? Yes, well then what plan do you want to go with, the $1100, $1700, the $2100, or the $2500? Yes, then do you want to fund your employees accounts? Yes, then how much.
Do you want the employees to be paid every week or every other week? Yes then do you....
Are you fricking kidding me?
What do I pay all you people for? Someone else make a decision.
We are at a meeting with 3 financial people and two dentists and all the financial people keep asking the dentist what they want to do with their money.
If I wanted to make all the financial decisions I would be paying you three.
Did I tell you I don't know CRAP about money?
So after the meeting the head financial dude and I are left in the room. He starts getting on me (he really does care about me and my office and I really love him and he likes me, I think) about being a poor manager. I told him I am not a micro manager. (I am not a detail person and I understand my limitations. I put people in charge of something I trust it is going to be done.)
He says, "I am not asking you to mirco manage, I am asking you to manage". Ouch.
He looks at the office and sees the money part. I look at it and I see about 15 parts that I am in charge of.
Now I can see how easy it is for dentist to sell their offices to a mangement company. Look I will pay you a million dollars and all you have to do is the dentistry. SOLD.
I will never do this but I am understanding how difficult it is to running all aspects of this machine.
But he says, "just manage".
I took this to heart. I am trying to see up things here that are not micromanaging but checking the systems.
I am having monthly meeting with the front desk people. I am having monthly staff meetings. I am asking for more details in the sheet of account receivables.
But then we go to the financial meetings and he says, "How is it going? Did you find out about X?" I have had 6 meetings since our last meeting and I forgot to ask about X.
It is a process, I am growing. I might be growing intolerant but I am growing none the less.

See you Wednesday,
john

Friday, February 22, 2008

Just when you thought it was slowing down.

What a day, yesterday.

(I tried hard to make this blog visual, and have lots of pictures but my camera and computer are driving my bonkers. You know when you are doing something and it is working and then you try to do it again and it doesn't work. You want to pick up something very valuable and throw it down to the ground and stomp on it. I was able to get two in...I will continue to work on it. Wish me luck. I might be in the market for a new camera and montior soon. Don't forget to double click on the pictures and you will be able to see the detail)

I have had a couple of patients walk in this week that I think I have to tell you about.

First, an 81 year old woman comes into my office for a New Patient Exam. Now when someone is later in life I usually alter my treatment plan so to be as fair as possible. Meaning, I usually will not treatment plan a full mouth reconstruction on someone this late in life. I know all you neigh sayers will disagree, but I treat all mature people like I would want my mother to be treated. I want them to be as comfortable as possible with as little work as possible.
You might say, “Well, you never know she might live to be 100.” There are very healthy 81, you know the ones that still do aerobics and play tennis and then there is the smoking, watch TV with a couple of glasses of wine, 81 (not that I have a problem with smoking and wine). This woman happens to be the latter.
But she had some needs that couldn’t be ignored.
On the top she has 2 and 5-12. #5 and 6 are broken down to the gum line. #10 has a 12mm pocket on the mesial, due to a root fracture. #’s 11 and 12 are abutments to a 3 unit cantilever bridge.
So she has #2, 7, 8, 9, 11 and 12.
I thought about regular partials but she didn’t want any wires showing. Iwill come back to the bottom in a minute.

On lower she has 21-29. 23, 24, 25 and 26 all had deep (apically) caries . Good occlusion, good perio, no TMD.
Money is not an issue.
So I am able to do any type of treatment but remember my philosophy about my mother or in this case my grandmother (well, maybe your grandmother, my grandmother was mean as a snake).

I am NOT going to suggest implants so don’t even think about it. In the discussion appointment her and her husband were saying stuff like, “remember Bob down the street, who had all that work and the next year was in that nursing home?”
So this is what I decided to do.
Remember, this is MY blog. I am up for constructive criticism but not mean spirited jabs.
On the top I decided to remove 5, 6 and 10 then just do a traditional partial. I can get retention on #3 and #13 (which is a cantilever). Now I am going to have an issue with retention on #7. I will put a lingual clasp and hope for the best. I could do some sort of precision attachment but that would involve prepping for a couple of crowns and adding $2600 to the treatment plan.
Now on the lower, I have decided to extract her incisors. Then do crowns on the remaining teeth (21, 22, 27, 28, and 29) connecting them with a hadar bar and then adding ERA attachments on the distals of #21 and #28. So the lower will be real solid. A lot of work but I didn’t think I had much of a choice. If I have to do work I want it to be excellent.
All this to tell you that this little mature lady is going to have $13,000 worth of work.
$13,000, now that is a lot of coin. I keep going over it in my mind. Should I do the ERA's on top. Is that too much work on the lower? I guess that is what conscientious dentist should do. This is how I make myself feel better.
She is starting in a couple of weeks. I will let you know how it goes. I will take lots of pictures. As you can see I am still having trouble figuring out how to put pictures on the blog. Today I got two in and it won't let me do anymore.



Patient #2 is a 66 year old retired physician from Puerto Rico. His family was poor, so as a child he had no dental care. His college roommate became a dentist. So in the middle of his life he had a reconsturction done.
All his teeth are crowns. He has a bride from #2 to #10. Abutments on #2, 4, 6, 8, and 10. #11 is broken off below the gum line.
#4 has through and through decay .
The lower has a bridge from 19-31. Abutments on #20, 22, 23,24,25,26,27, 30 and 31. Get this, the abutments on #30 and 31 are on a huge blade implant .
On the lower he has through and through decay on #27 . He recently had two root canal done on #23 and 24 and they accessed the canals through the INCISAL. So he has these two giant holes on the incisal part of these teeth.
His bite stinks. So because he doesn’t have upper left teeth and he doesn’t occlude on the right he postures end to end.
Wow, let’s marinate on this for a second. Basically he needs another reconstruction Gammichia style.
He is going to need either a new bridge from 2-10 and then he needs implants on 11-14(maybe an implant bridge, so at least 2 implants).
Then he needs to have the lower redone. That is crowns on 20-27. Then implants for teeth #19 and I don’t know what we are going to do with those blade implants. I guess I can use them. Cutting this thing out would be a huge undertaking.
So that is 20 G’s (no not gagillion) without even doing the implants, which he will need at least 3, which is about 10 G’s more.
The problem with this guy is I don’t think he knows it is coming. You know the patients that come in just wanting a cleaning.
Like me at the mechanic. Yesterday, my battery light goes on in my truck. I tell him I have a dead battery. He says do you want the electric systems test for $39. I say, "No, I have a dead battery." So he puts a ridiculously expensive battery in my truck and off I go. It takes a bit but about 2 miles down the road the light comes back on. I am just like my patients.
So this guys comes in and recognizes he has a need but I don’t know if he knows he has a $30,000 need.
I can fix this guy but what is he going to say when I tell him it is going to cost him a Escalade to do it.
He comes in all smiles and leaves in a pool of sweat.
I know he must know that this kind of work takes a long time, because he had it done in the past. But like I said he had it done by his friend, so I am pretty sure it was done at a reduced rate if anything at all.
He is coming back for a discussion appointment in a couple of weeks. I will let you know how it goes.

This was all yesterday. Just when you thought it was slowing down

Thursday, February 21, 2008

What, no Wednesday blog?

Sorry, Sorry, Sorry.
Yesterday was my birthday (39)and I have been busier than a one armed paper hanger.
From work my wife and I went straight to the Gator basketball game, which they squeeked out.
I have no excuse but I promise I am already working on Fridays blog (that is a bold face lie).
Talk to you tomorrow.
john

Monday, February 18, 2008

Call my therapist

I had a pretty good day yesterday.
So good that I am changing topics for the day.

I think most dentists are cut out of the same mold. I remember in my first year of dental school we had this professor who wasn’t a dentist but either a sociologist or a psychologist, but part of his class was to profile me and my classmates and anyone else that came through our school. And as it turns out, we were pretty much all wired the same. We are all perfectionists, people pleases, yes men, and all pretty much approval sucks.
Basically, we all want to be liked.
I think I try create all these systems in my life for people to like me and I put up all these walls just so people won’t dislike me. I treat people a certain way; I drive a certain way, practice dentistry a certain way, write a certain way… so people will like me.
(In a way, I can identify with Stuart Smalley).
Now it is easy in the office to hide this because I can say I want to have a successful business. I can say to my front office, “Did Ms. Williams come back for her second appointment?” (The first appointment at our office is always a New Patient Exam; basically it is an appointment that is just about me and them. They don’t get a cleaning; it is just an hour and a half with just me.) So the second appointment is a pretty good measurement. I would think to myself, if they come back for the second appointment, they LIKE ME!!
Now, in the back of my head I know this is crazy. There are a hundred things they may have stopped them from coming back. Too far to drive, the coffee was cold, the administrative staff was not friendly, it hurt to take the x-rays, they didn’t like the color schemes, it turns out we didn’t take their insurance…to name a few. But to me it is a direct hit to the ego.
OH! And yes, most dentists have egos.
So, when they don’t come back, I create diversions, “Oh, I didn’t like her anyway”, or “It must have been something the front desk did” or “She probably couldn’t afford me anyway”.
You see...It is crazy.
At the beginning of my career, it was really bad. I was a mess most of the time. (Well, I am still a mess most of the time, but I hide it better). I was new to this thing called dentistry and when something went wrong, or when someone called to have their x-rays transferred…call my therapist.
Can you imagine having a practice where when you went in the morning thinking, “If I don’t get a 100% today, it will be deemed a failure”? I know I am not the only one (remember we are all basically the same). And when I was a younger dentist this is the way I felt. Now, I can’t imagine why our suicide rate is so high. Dentistry is a hard profession to master. It is very hard to get 100% during the day, so to people that are wired to want 100%, this is a deadly (no pun intended) combination.
(A painful memory is when I was out of school for about 4 years and was having one of those months. I asked my wife if she could handle me going back to school because I don’t think I am cut out for general dentistry.)

I started to look at the big picture; I have a wife that loves me. I have children that think I walk on water (they are still young, what can I say), I have a great staff that believes in what we are doing, I have great friends, I have thousands of patients that call me their dentist, people at church think I am walking the walk, and my neighbors think that I am a good neighbor.
The overwhelming majority of people that I am around like me. So you see I still want people to like me, but I don’t NEED everyone to like me. I still am an approval suck but it is under control.
Do I piss people off? Sure. Do people leave my practice because they don’t like me? Yes. Do I hurt my patients (of course, I try hard not to)? Yes. Do I occasionally leave a filling too high? Yes. Do I obdurate the MB canal .5mm too short sometimes? Yes.
I am a flawed individual. I am not perfect (my therapist says I should keep saying this) I can’t do it. So I try my best and that is going to have to be good enough.
I can’t be everything to everyone. So I try to live by the motto…I can strive for perfection and settle for excellence. I know this sounds corny but it is true.

Back to yesterday.
We got up and got ready for church. It is always a good day when I don’t cuss before church. When we got to church everyone was smiling. Last week I had a church member that came to the office for a New Patient Exam. In the same week he came back for a cleaning (a prophylactic experience). I forgot to tell you, when someone come to my office for the first time, they always get a hand written letter by me welcoming them to the practice and telling them thank you for choosing our place. He came up to me at church and said, “Thank you, for the letter, it was a great touch.” That made me feel great.
Then after church we went to Five Guys burgers, by the way if you have never eaten there you are missing out, it is awesome. The place was filled with people we know.
A woman came to me that we know (not a patient) and said, “I know someone that just started coming to your office and she LOVES IT. She told me about an experience she had at your office and told me how great it is.” Aw man, twice in one day.
Then there was a family in there eating that had just switch dentists, to me, after a long relationship with another dentist. They just love the poop out of me. From the eight year old to the mother (seven kids) it’s a big lovefest. Then the father says to me, “Everyone in the family loves you so much that I made an appointment for myself next week.” At this point I am flying high. My head is so big; I could hardly fit it in the restaurant.
Then I saw him. He looked familiar. I stared and tried to light the candle of thought that lit his name (Pearl Jam rules). And it hit me. He WAS a patient. I haven’t seen him in about 4 years. Then the thoughts came, “I wonder why he doesn’t come to our office anymore? What did we do to upset him? What doesn’t he like about me?”
But then I caught myself and let it go.
This is a big step for me. Letting it go. Then my 4 year old slapped me back to right now when he needed me. “I gotta go pooppy. Will you wipe me?”
"Honey, where are you?"

See you Wednesday.
john

Aly...I have those burs you were looking for. Can you email me so I can send you the #s and the pictures. I am a Jgammichia@aol.com

Friday, February 15, 2008

Im frustrated

I”m frustrated.

Okay I have an axe to grind (one of many axes) and I will try to make it short.
I use to be a CE junkie. When I got out of school (okay, kicked out of school) I couldn’t get enough. I saw everyone. Linda Miles, Pankey, Nash, Jamison, Bertolotti, Brucia, Christiansen, I went to Dental Boot Kamp, I saw Buchannan, Kanka. You name it I saw it.
I felt like I was really adding to my already fine University of Florida (Go Gators) fine dental education.
I was loving every minute of it.
But lately I have been trying to hone my CE to what is happening in my practice right now. This the issue that is getting me more and more frustrated.

For instance, I started to do more veneers. But I was getting some sensitivity after cementation. Not a lot but enough for me to be concerned. So I made up my mind that I would pay to fly to a meeting that I thought would introduce me to the most people that knew about the most about cements. So I went to the biggest, I decided to go to ADA meeting.
Well it turned out everyone that knew anything about cements was there.
If they weren’t there speaking they were there endorsing a product.
I signed up for a bunch of lectures and I was so excited that I would put an end to this problem once and for all.
Well I went and saw a lecture and he was all into 4th generation bonding. (Just a biomaterials review… 4th generation is etch then prime then bond, 5th is etch then prime and bond together. 6th generation self etching primer then bond and 7th generation is etch prime and bond all in one).
So the guy I saw in a lecture was a 4th generation guy. “Okay” I said to myself maybe this is where cements are going.
I was excited because I thought I found what I was looking for. I was going to a lecture the next day to confirm what I learned today.
Not exactly. In fact, just the opposite. This guy was a 6th generation guy. I was starting to get a little discouraged, but still keeping my head up. I went to the exhibit floor. I felt like if I could talk to a couple of these guys and they agreed with one of the lectures that would be okay. Maybe one of the lecturers was on the moon.
So off to the floor, and it was awesome because the gurus were everywhere. It was like a who’s who of dentistry. So after I fought through the crowds I was able to talk to some of these people.
They all had strong opinions and they all were very passionate but they all disagreed. Some of the gurus would go as far as saying that that other guy doesn’t know what he is talking about.
It turns out they all endorse a product (Except Brucia, kudos to him). And the products are inherently different. They all were endorsing very different products. All generations.
So I spent all this money to go to the biggest meeting in the world and came back more frustrated then when I left. I left thinking the guys that I have been following for the last 10 years might not be all that great. I was doubting myself and my profession.
I was pissed and disillusioned. I read all these articles about veneers and how great they are and how it is changing peoples lives. I want to be a part of it but I can’t go all the way until I know with a lot of confidence that the patient is going to be better off than they were before. Not just prettier but better.
I couldn’t seem to find an unbiased opinion. I could find an opinion that didn’t have a money trail hanging off of it.

So I found an answer in the most unsuspecting place. My dental school.
I stunk at a lot of subjects (mostly because parting got in the way of my studying) but the subject I felt the most inadequate at was biomaterials. I never could figure out what the heck they were saying. In two ways… The first way is because all the professors were from far away countries. Second if they were speaking perfect English I still couldn’t understand the concepts. Elasticity, fracture, MP, and all the other terms.
I just couldn’t grab the concepts like I do now.
I was at my whit’s end so I picked up the phone.
I called Dr. Soderholm and explained to him my problems.
And, you know, what I was pleasantly surprised to understand him and understand the concepts he was talking about. Both moral victories for me.
From “hello” he was great (I guess you can say, “he had me at Hello”). He was happy to help me. I think he is stuck in a lab or administering clinical trials so much that he doesn’t get to much interaction with the outside dentist. He gets to talk to University dentists but maybe not the regular guy in Apopka, FL.
He was gracious and excited about the opportunity to help.
He talked to me about all the products why they work and don’t work and why some of the “gurus” liked some of the products.
He stayed on the phone as long as I needed. He wanted me to call him once I made a decision. He wanted to know what decision I made and why. Then he wanted to know if it was working for me.
I don’t know the moral of this story… I am still frustrated with the guru’s and the way money can influence people. Though, I did find an answer to my immediate need.
I don’t have a solution to this problem…I have Reality and I have CRA but sometimes I have some suspicions there.
But I know sometimes the answers you may be looking for could be in a place where you have already been.

Have a great weekend,
John

Wednesday, February 13, 2008

Airline Travel, Easy Right?

Ok, back to my return flight home.

I get to the airport right on time, the standard 2 hours before. The flight before mine was very late. Chicago is having a brutal winter and the temps are dropping so planes are having issues because of the cold. I set my laptop up next to an outlet and watch a movie. I love being prepared, I brought Netflix movies, my ipod and food (okay my wife is a big part of this). At this point the earlier flight has not taken off and the gate is filling up with people, and it is becoming apparent that my flight is going to be late. I don’t care, I am suppose to get into Orlando at 11:30, what is the difference if I get in at 11:30pm or 1am, no one is going to be up (no lovin’ either way).
I have these awesome headphones and while I am watching my movie I can’t hear anything except my movie, it is great.
Flight before ours has left.
So the gate is starting to fill up and I notice they are starting to board about 90 minutes late. Remember, I am totally calm and in no rush. Typical boarding, everyone pushing through the door just to wait in a line in the jet way. Hurry and wait, be rude and sigh when someone else slows you down. Only to wait in the plane.
Okay so we finally push back from the gate. Our plane then gets in line to take off (hurry and wait), it appears like we are almost ready, we make the turn and then the pilot comes on the speaker. You are going to love this…
APPARENTLY, the pilot has had too many flying hours and he tells us that we have to go back to the gate and see if there is another pilot that could fly plane. WHAT?!!! Are you fricking kidding me? Isn’t anyone keeping track of this stuff. I am no genius but this seems like a pretty simple computer program for a multi-billion dollar company. I flew from Phoenix to Newark, that’s 5. Then I flew to Chicago, that 3 more. EASY.
I digress.
So we taxi on back to the gate only to tell us that now the flight has been cancelled. WHAT?!!!
They say, “Please exit the plane in an orderly fashion and see the nearest customer service representative.”

Now it is 10pm Chicago time and they have put us all on a 6am flight (I am pretty sure they just made up a flight and we just used the same plane, just a new flight crew that was on call, same gate and same plane).
They are going to put us all up in the Airport Westin. Now this is the only airport hotel that you have to get in a bus and drive (what seemed like) 10 miles to get to.
So if you thought people where rude before…now it is not even subtle. Now I am in a full on haul ass mode to get the hotel shuttle. I just want to get to a bed and away from people. The shuttle comes and people are running to it. I give the guy my carry-on bag to put in the back and he puts it in the bus, but by this time the inside of the shuttle is full. It holds 14 people and they have to shuttle 200 people to the hotel. So people started to jam on this shuttle. By the time we left there were at least 35 people in this thing. You know where it says “no is allowed past the white line”, well we had 7 grown men in front of the white line. Me being one of them. I was the one leaning on the door. Yes the door that swung out.
So I finally get to the hotel. I think it is 11pm. Of course you can’t just jump into bed. You are all jazzed up. So I take a shower, do some work and then get into bed. 12 midnight. I have a 4:15am wake up call.
We all get back to the plane in the morning. Just so you know at 4:30am you don’t have to get to the airport 2 hours early. We were the only people there. I mean there was about 50 TSA employees for about 10 customers. So, again I wait. I brought two movies so I start another one. Boarding is on time and goes as planned. Then we wait and wait. Now it is past the departure time by 15 minutes. Then the pilot comes on the intercom (I am not making this stuff up, it really happened) and the car that pushes back the plane (what do you call it the pusher backer) did not start because outside it is 3 decrees. Now we are in O’Hare international airport. I am looking out my window and I do not see another plane, 75 gates and we are the only plane. What do they only have one pusher backer? It is the second largest airport in the WORLD. Some how it takes ONE HOUR to push us back. I could only laugh. I am flying solo. Imagine the parents of the 3 kids going to Disney for the first time.
At 11am we finally arrive in Orlando (71 degrees, by the way), in one piece.
I get home at 11:45, exhausted.
Instantly, changing from world traveler to dad and husband. I like this a lot better.
Oh, airplane travel.
Easy, right?


Talk to you later this week
John

Monday, February 11, 2008

Airline Travel, aint it grand?

Oh airline travel.

I told you after Dentistry from the Heart (Which went great, by the way, everyone was great. My staff really took ownership of it. They worked so hard. The volunteers were awesome. The patients were even great. We saw about 100 patients and about 200 teeth. And we sent 35 people away. God was smiling on us on Friday) I had to jump on a plane. I was heading to Chicago for one day.
Plans were to get into Chicago about 10pm. I would have a couple beers with some friends and my brother, then go to bed. Next day, I would be in meetings all day until about 5pm. I had an 8 o’clock flight back home. Home at 11pm. Easy, right?
An aside on airline flying, I get to fly a good bit, I and I find people are at their worst when they are in airports. Everyone is in a rush and they don’t care who they run over to get to where they are going. People’s good graces go by the way side because “I have to get to where I am going.”
It is hard to be in a plane. People are used to their space and when you put people in a combustible situation they can either be more gracious or they can become idiots. I find people usually lean toward the ladder.
Boarding the plane. No, even before boarding there is this tension in the security. Hurry, hurry, I only have 2 hours to wait for my flight. Hurry. Why do I always rush through the security? People are trying to schlep 3 kids to Disney World, trust me I know how difficult this is, and I am saying, in my head, “COME ON.” And I only have two hours to go 200 yards.
Then we get to the gate and wait. Then finally the airline gatekeeper says, “Okay lets board section #1.” At this point why does every person that is going to be on the plane jam to the gate? Is it better to sit in a stuffy plane being smooshed in a tiny seat or hanging out in the airport with air conditioning and electric jacks? Is the plane going to leave without them?
What about the late guy, “Final call for Mr. Smith, this is the fourth and final call for passenger Smith.” Who the heck is this guy? Where is he? I get to my gate 90 minutes before boarding and this Smith guy just strolls on up 10 minutes after the plane is suppose to leave. The whole plane is ready to go and they call for this guy four and five times.
My favorite is, on arrival, when the plane comes into the gate, everyone jumps up. Where are they going? I was in row 25 and the plane dinged and everyone around me jumped up. It was 15 minutes before the plane emptied to the 25th row. Then when it was time for me to jump up the people behind kept pushing up and wouldn’t let me out. See what I mean, people turn into idiots.
Then everyone practically runs (me included) to the next thing which is the baggage claim. You know you do it to. Get the hell out of my way I have to get to baggage claim. Now what happens when you get to the baggage claim? Your bags are waiting for you when you get there right? NO WAY. You wait and feel like a huge idiot because you just worked up a sweat getting there.
You get off the plane and call your ride and say “I will be right there as soon as I get my bags”. Well inevitably it takes your bags about 30 minutes to come out and your ride has to circle around the airport about 10 times.

As you probably can tell my flight coming home was a colossal disaster. But after I wrote the story it was a blog that was too long. You will have to wait unit Wednesday to read about it. A cliff hanger….

Talk to you later this week
John

Something totally unrelated that my son said. I told you I laugh at them all the time.
We say things that we understand but if it is never explained to them they are free to interpret.
I am still laughing about this one. We went to a BBQ in our neighborhood and were on our way home.
We saw a house for sale and I told my wife they wanted 700 Gs for that house. Now Luke my 8 year old says, “G, what is that?”. So I go into G is for Grand. And Grand means 1000.
So he says “OH!! All this time I thought “G” meant Gajillion. I thought that house was for sale for 700 gajillion dollars. My wife and I about peed our pants. Kids, aren’t they great.

Tuesday, February 5, 2008

Dentistry from the Heart

I wanted to tell you, in advance why I cannot write on Friday.
I have a lot going on from now until Friday that I wanted to tell you about.


I went to a lecture about 4 years ago. (The lecture was terrible but this was not the point of this blog).
One thing I did get out of the lecture was something called Dentistry from the Heart. A dentist got up on stage and told the audience about something he does for what appeared to be "marketing reasons". He opens up his office and he and his staff worked on people for free for the whole day.
Now, I don't really care what his motivations for doing it but I just thought that was a great idea. Taking one day and treating people for free is always a good thing.

About a month later I was asked to volunteer for a free dental day. They told me all about the kind of thing they do.
They say 3 previous weeks the patients come in and are screened. They have to bring in a W-2 form or some form of income verification. To see if they are poor enough to meet the standards of patients they want.
Now first of all, to me, the screening seems like too much work. Second of all, I don't want to help just the poor of the poor. The person that came to mind was the single mother of three, she makes $30,000 and now her tooth hurts. She probably doesn't fit in this poor of the poor box but she could benefit from a blessing just like the next person.

Our office decided to do this but to do things our way.
We decided to do our own Dentistry from the Heart.
In our Dentistry from the Heart there are no rules. Its first come first serve. No screening. No income verification.
Sure there are people that take advantage but.... If a person wants to wait four hours to have a tooth pulled, they meet our requirements.

This is how we do it.

We have 7 operatories in our office. We desire to have 6 rooms going at a time and the seventh room is a triage room.
We run two 4 hour shifts. 7am-11am, Lunch, then 12pm-4pm.
We were able to get 9 dentist and 3 oral surgeons to volunteer. This is a testament to the types of dentists we have in Orlando. Some of the staff of dentists come with the dentists. Some staff members come without their dentist. I have patients that volunteer. It is just a reminder of how I am blessed to work with a bunch of great people.
Now we wanted to make this a real community event. So we call up some of our patients that own restaraunts and they are more than happy to donate food to feed the volunteers.
So there will be breakfast for the early morning volunteers donated by Panera.
And the list goes on...All the dental supplies are donated by Patterson. All the toothbrushes and toothpaste donated by Colgate.
Lunch is then brought in, all donated. We all will be wearing donated T-shirts with the Dentistry from the Heart logo on the front and all the volunteers names on the back.
We start at 7am but because there is such a high demand people will come from far away and come very early, like 3am.
So we have a lot of people waiting a long time in the parking lot. So this year we are going to have rental chairs brought in so they will be more comfortable. While they wait, we are going to have a DJ come, who is also donating his services. Winn-Dixie (a local grocery store) is donating food to be grilled in the parking lot by one of our patients who is also bringing his grill.
Home Depot donated a couple of cases of water.
My staff has worked their butts off trying to make all this happen.
Doesn't it sound awesome.
But this is not the only thing. I read in the paper this weekend that there are 27 free dental days in Orlando in the month of February.
Are you kidding me? I am welling up just thinking about it.

My staff is getting here at 5am to set things up. Then we start cranking about 7 and go full on until the bell rings at 4pm. Then there is the clean up.
Then I have to get on a plane at 6:30 and be at my destination at 10pm.
So all that to tell you I won't have anytime to blog on Friday.

Have a great weekend.
See you next week
john

ps If you are interested in doing your own Dentistry from the Heart, email me. Jgammichia@aol.com and I will give you all our information and you can hit the ground running.

Sunday, February 3, 2008

Oh, thank heaven for 7-11

I have not worried about the economy until this week.

Before this week I only thought the people being affected by this downward trend is the housing industry. I would ask my title people (you know like titles when you buy a house) , "how's work?" and they would say, "what work."
I would think this was funny but it never registered to me that things might be tough outside of my own little island.
My plumber patients are asking me if we need a replumb job at the office.
My cabinet patients are telling me my cabinets could use an overhaul.
Humm.
But this particular thing that happened has changed my outlook on MY world.
I had a patient the other day and he is a regional manager for 7-11.
And like most people at his or her recall appointment, I ask, "How's work?".
I mean he works for 7-11.
7-11 has always been around and will always be around.
But he replied, "slow, real slow". I told him, "You work 7-11, for crying out loud".
He says most of his business comes from the home building teams. Plumbers, framers, concrete guys, irrigation dudes.
Those guys don't work, they don't come to 7-11.
If they don't come to 7-11 then they struggle.
Wow, I was taken aback.

I started to think about it and I was thinking about the trickle down and how the crappy housing industry affects us all. And if it hasn't hit you yet, I think you better, at least, think about it.

I was having a converstation with one of my front desk people.
Sometimes I work and I don't know how hard they have it up at the front.
I come to work the schedule is full, sometimes (okay, never) I don't think how hard it might of been to fill it.
But lately I have noticed holes in the hygiene schedule.
So this peeked my interest. So I said, "What gives?"
She says that when she is calling people to confirm she is hearing a lot of "We are going to have to put it off a bit because my husband lost his job". Or "lay-offs at work are coming next week, I am going to have to let you know, if I can reschedule or schedule at all."
Humm.
Now things are starting to come together. I spoke to another dentist about 2 months ago and he said he had to let his associate go because there was no work for him to do. I talked to one of our pastors and he said the giving at the church is at critical mass. People that use to give a ton are now not giving at all. (this is a theological discussion that we won't get into right now because there isn't enough memory on this computer to have it).
Then I noticed my schedule is filled with little things not big things. I have been noticing a lot of "fluff" in the schedule.
So for the first time this thing might be starting to hit the Gammichia office.

So much that I have had to have a conversation about it with my wife. Now you can understand how foreign this is to someone that has been working the last 12 years. I mean the economy has been pretty booming. Dentistry has been booming all of those years.
I have never faced a downward trend in the economy.
So having this converstation with my wife about what it would mean to our family if things started to slow down was kind of weird.
We implemented a bonus system about 7 years ago at our office. This was the first time I paid any attention to the production and how one year related to the previous year. This quarter compared to the same quarter last year, things like this.
For 7 years we have never failed to go up. The fourth quarter of last year was the first one that was not better than the year before. Humm.
We still made a profit but...this is the trend I am talking about.
So is this going to be a blip on the screen or a real flat line?
Heck if I know.
But at least I know there is a screen.
I'm just hoping it is not hooked up to a defibrillating machine.

Friday, February 1, 2008

The weekends are awesome

This past weekend was so awesome. When you have kids every weekend is so rich.


I am going to tell you some stories and if it gets a little long I will start again on Monday.

On Fridays we usually like to just hang out. We have another family that has started to come over and just hang with us. They are a great family of 6 (four kids). So that is 4 adults and 7 kids, wow.

If it is cold, in Florida that is 55 degrees or lower, we get a duraflame log and have smores.

So the adults are out there enjoying the beautiful weather and each others company, and the kids are everywhere. They can play in the "playroom", they can play outside where we can see them or sometimes they will play in their rooms.

Then one of the boys came out, in a bit of a panic, and said "I can't get the zipper unzipped on the hamper". I was thinking, I am kicked back drinking wine, unwinding from a tough week, don't bother me kid. So I said, "It is no big deal, I will get it later"



He said, "Yeah, but Madison is in it".


OHHHH!! That is different.

I went in there and sure enough she was in the hamper, like one of those contortionists.

I rescued her from the perils of broken zippers. I am the hero.

Until the next day.

Basketball at 9am to 11am. But one thing I did not tell you is that we went to MONSTER TRUCKS on Saturday night.

Now this is a boys night. Noah, my 4 year old, everyday for a week would wake up from his nap and say, "Is today the day we are going to Monster trucks?" It is so cute.

Now if you have never been to monster trucks you will never understand. Trust me, you have to be there. It is so fun. The first year I went, I was bringing my nephew about 7 years ago, I went without a ticket. I did not realize since its inception it has been SOLD OUT.

I had to scalp tickets. Yes to monster trucks. 65,000 people (I almost said red-necks, see I am learning).

So for the people in my church it is a big day. One guy buys about 200 tickets, in the family section (there is actually a family section where there is no smoking and no drinking allowed) and gives them to people at his work and church and their families (you pay him if you can, and if you can't...have a great time, it is a ministry for him). So he goes to the stadium about 6 hours before it starts and sets up a tailgator. Tents, tables, grills, broilers and spends the day there. He makes hot dogs and slow cooks pork to make pulled pork.

So me and the boys get there about 4pm for the tailgator. Both boys are in shirts that say "Little guy" and I am wearing a shirt that says, "Big guy". They still love being around there daddy.

Back to my friend, he buys 5 parking spaces and him and all "our" peeps are parked around the tents. The trucks are all parked in a circle and the boys play football and tag and smear the queer in the middle of the trucks. This is a total testosterone thing. We have burping and passing gas contests (I almost said fart, growth is a good thing).

So the boys are having a ball and the dads are hanging out watching the boys act like idiots. When Noah comes to me and says, "I have to go to the bathroom". So I look around and tell him, "Lets just go pee by one of the trucks".

Now remember all of our people are around, everyone knows each other, right? Well...apparently not all the trucks were the people in our group.

So I have pulled Noahs pants down to pee (he is FOUR years old) and I hear, "hey don't pee on my truck."

I am fully engaged with Noah and am looking down to make sure he doesn't pee all over himself. As I am looking down I say, "Okay dude", thinking someone is messing with me.

So Noah is done peeing on this guy's tire and I get up with a smile on my face think someone in my group is messing with me. But some dude is looking at me and he is madder than a snake. And still have no idea what is going on so I walk by this guy and slowly realize this is the guy that was talking to me and this was his truck and he ain't messing around.

Now this is not a souped up Harley-Davidson truck or a Cadillac or anything like this...it is a Ford Explorer truck (this is the point where I would make fun of Ford Explorer trucks but not this time. You can't bait me into it). And his Ford Explorer truck has a "I love (heart) my truck" liscense plate on the front.

So I kind of gaze back at him and he has this stone face on. So I think this guys is going to punch me, so I think I better address this before I get sucker punched or something.

So I said, "Dude (this is how guys talk to each other), is this your truck?" And still with the stare, "Yes".

I said, "Dude, I am so sorry. I thought you were joking around. I thought you were a guy in my group."

He said, "I thought YOU were going to pee on my truck and I was going to come up all on you". Then she says, "I understand if the little guy has got to go but..." I could tell this guy was really pissed and was trying to be cool. I mean he does heart his truck.

Now the truck next to this one had about 12 kids in the back of it jumping up and down in it, rocking it back and forth. But the one truck in the whole place that didn't belong to someone in our group, I pick to pee on. I mean it was a four year old peeing on your TIRE, dude.



At 6:30 we begin to move to the stadium. It started at 7pm. It was four hours long. Let me tell you it is so awesome for the boys. They love every minute of it. I buy them every piece of candy you can imagine. This thing is a money making machine. They sell cotton candy, they sell french fries, funnel cakes, snow cones and adult candy as well... and beer.

I told them the one thing I would not buy was T-shirts with your favorite Monster Truck on it. This is going too far. They were ticked at me.

If you haven't been you can't imagine. I am going to let you see a quick video of it, just so you can have a little glimpse of what it is like. I took it with my little camera so the quality is not good.


Needless to say we all were pooped when we got home at 11:30. It is great to see your kids passed out in the back of the car on the way home. They gave it all they had.










video


The blog is getting kind of long so I must stop here. But I leave you with another "Noah". We have been going over letters with him. We are on the letter "C". The book has the letter and pictures of things that start with the letter "C". So there is three things on the page. Now he is so excited he is yelling the answers out. First a picute of a cat and he yells, "CAT". I said great. The second was a cow and try to form he yells, "COW". Then there was a picture of a cupcake and he yells out, "MUFFIN".


Now, I don't know if this was funny to you but I laughed so hard. I put them to bed and still couldn't stop laughing. It was a picture of a cupcake you know C...upcake. But he said Muffin. I am still laughing about it. Kids say the darndest things. Noah is so funny to me.


Hope you have a great weekend.


John


My wife and I have reviewed this blog and told me the kids would not be offended by this blog.


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