Money talk is over, for now.
I struggle to think about how "tough" I have it when $150,000 is more than 95% of the world.
And here I am complaining about how it is not enough.
It is what it is.
Did anyone pick up the AGD Impact this month?
Great article on "For Goodness Sake". Well yours truely was quoted because my father and my staff and I do the Dentistry From the Heart (the day of free dentistry).
The cover of the magazine shows off my dad and I and some volunteers with our first patient.
Don't I look good in black?
I sarted watching No Country for Old Men last night. DUDE!! This movie is messed up. Who thought of this movie? There is some messed up dudes in Hollywood.
But I did watch Dead Man Walking again this week. Have you seen this? This is an AWESOME movie. I know it has Susan Sarandon and Sean Penn and is directed by Tim Robbins (the three amigos of liberalism. "Not that there is anything wrong with that") but it is a must watch. This movie is in my top three of movies of all times. So go and watch it, you will not be disappointed.
Okay back on task.
Now I don't know about you but I love the AGD Impact's "What's Hot and What's Getting Hotter" by Howard Glazer.
I eat it up. I love getting my CRA and seeing if what I have is something the critics like and I can do a self evaluation if I indeed have the best products.
But I wanted to give a product list a different spin.
I want to give you a like of items in dentistry that, I think, are must haves.
I call them my Top 10, but it is more like 15 items (my top 15 doesn't have the same ring as top 10).
Now I do not pick items that are expensive or are showy. I pick items that I NEED. I pick items that are practicle. Items I can't live without.
Not items that make me the most money or make me the most efficient.
Here is the start of the top 10, I mean 15 (you see what I mean).
NUMERO UNO is LOUPES
Dude, you need to have loupes.
I know all the excuses...
They are too expensive.
I tried them once and I couldn't get use to them.
They give me headaches.
They are too heavy.
BS.
Loupes will make you a better dentist. That is the only thing we should be worried about...they will make you a better dentist.
Stop with the excuses... buy loupes, wear loupes.
Is it a pain in the ass to get use to them? Yes.
Are they expensive? Yes.
Do I poke people in the lip with my needle because the field of vision is so small? None of your business.
Can I see my imperfections more with loupes? Yes.
Do I do better dentistry because of them? Yes.
#2
Caries Detector
Actually, I use Caries Finder.
If you don't know, this is a liquid dye that you put on teeth to indicate decay. You can cut a preparation for a MOD resin, and when you think you are all done with getting the decay out you check yourself. I take a microbrush and dip it in the liquid and put it on the tooth. You rinse it and whatever stains red is decay. Whatever is decay you take out. See it is simple.
The least I can do for my patients is make sure all the decay is out of the tooth or teeth I am working on.
I use this stuff for everything... fillings, onlays, crowns, build-ups, primary teeth.
No one is leaving with decay in a tooth.
Are there issues with this stuff? There could be (and let me explain). Lets say you are in a deep caries control and it is near the pulp. Well you are using a RED dye. This could cause an issue when you are trying to distinquish between the stained dentin and the pulp.
That is why Ultradent came out with a green Caries Detector.
But over all this is definitely a product that I can't live without.
It makes me a better dentist.
I use it so much I can't work without it. I have to have it in my room at all times.
If I volunteer at a clinic somewhere I bring my own just in case they don't have it.
Get it and make it part of your tray.
Number 3.
SEPTOCAINE
At about 4 years into my practicing dentistry, I felt like I was using my patients as pin cushions.
I mean I was poking them like there was no tomorrow.
I was working on kids that wouldn't get numb.
I was hurting people.
Now I still hurt it is not as often.
In the maxilla, it is all Septo all the time.
Now in the lower, I know what you are thinking...Tell me he doesn't do it....Don't tell me he does blocks with Septocaine.
YES I DO. I GIVE BLOCKS WITH SEPTOCAINE. There I said it.
I know what you think...I know there is more chance of parathesia with it.
But not according to Dr. Stanley Malamed, who is the authority on drugs, and he says this is not the case.
He says there is no study that says this. In fact he did his own study and it says that Septocaine is not more likely to cause parathesia than any other anesthetic.
Soooo, I do it.
I have had one instance in the last 6 years with it. The tip of someones tongue got numb and the last I checked it is getting better.
But the good about this anesthetic is profound anesthesia.
Getting patients numb on the first try, not the sixth. This is good.
Kids getting numb on infiltrations on the lower. This is good.
Great stuff.
#4
A camera.
I am not talking about an intraoral camera, yet.
I am talking about a 35mm tooth camera.
This is something I don't have to have. But it is something that I love having.
I take pictures of my work. Not all my work. But some cases.
A couple of things it does for me...
I can see my work. I evaluate if the results were as good as I thought.
Sometimes they are and sometimes they are not. But I can certainly learn from the ladder.
I can get great before and after stuff.
From fillings to full mouth reconstructions.
I can create a picture book of my work.
I have taken my pictures of my work and sent them to Walgreens and had a photo albumn make out of them. I have the book in my waiting area so patients can see what is available. Done by me.
This gets patients thinking...wow, this stuff is available to ME, not just the people on T.V.
And last one for the day is the ELECTROSURGE.
I call this the poor man's lazer.
I have one in all my rooms. I use it all the time.
I don't know how to explain it but it is something I would recommend having.
Class V below the gum line... bust it out.
Crown prep and you can't get it to stop bleeding... bust it out.
That root tip that you are taking out that has been completely covered with tissue...Uncover it with the Electrosurge.
Operculum...I leave the make of Zoro.
Any tissue in the way... Z
I have a bunch more so we will talk more about them next week.
Listen I am going to have to talk about the AGD's annual meeting in Orlando.
July 16-20th in my backyard.
I am going to have to devote a blog on places and restaraunts I love. I will have to tell you where to go and what to eat.
I have to tell you the speakers that are a CAN'T MISS.
My teacher and friend Dr. Gremillion is one of the guys doing a Wake-up call breakfast (social event, and so is Dr. Glazer, who I mentioned earlier).
If you haven't registered, do not delay. Maybe I will have a pool party or something.
In the pool that I can't afford.
Have a great weekend.
Sunday is my sons 9th Birthday. It is amazing watch your son grow up.
It is the best.
Speaking of son, we just found out there is going to be a fourth Gammichia baby. We haven't told anyone yet. So you all are the first to know.
We heard the heatbeat yesterday, so it is official.
I guess now $150,000 really isn't going to be enough.
Talk to you Monday,
john
Friday, May 30, 2008
Wednesday, May 28, 2008
My final thoughts on money
I hope you enjoyed my breakdown on my finances last week.
I still shake my head when I think about money and its affect on the way we practice.
Before I get started...
I just finished a book called Brushko. It was copywrited in 1978 so it is not new or anything.
Very good.
Now I am reading a book called The Shack. This is a book going around that is getting a lot of exposure and a lot of people at my church keep talking about it. So I am reading it. I will let you know.
Growing up I was never a big reader but I felt like I was missing something. My freshman year of dental school I started to read. I real all the time.
But, as you know, I am also a movie buff...
I watched the movie No Reservations this weekend. Not bad. In fact, I liked it.
Money,
So you saw my budget. I told you my wife and I fought a lot about money. I think every couple does.
I remember like it was yesterday when I read a story about Warren Moon. He is a professional football player and was making millions of dollars a year when he was arrested for hitting his wife when they were arguing about the credit card bill.
It doesn't matter how much you make...
I find anyway that the more you make the more you spend.
You don't have to be a Bible thumping Christian to appreciate this but the Bible has more instructions about money than it does any other subject in the whole book. It has thousands of verses about money.
One that always sticks with me is...
No one can serve two masters. Either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve both God and money. (Matthew 6:24. I looked it up).
What do you think He is saying? Don't you think He knew what we were going to thing about money?
Don't you think He knew my wife would love purses? Don't you think He knew it was going to be tough when your friends roll up in a fat Mercedes to the study club? Didn't He know you were going to feel inferior as a person or as a dentist?
I went to a party with a bunch of dentists the other week. I roll up in my very comfortable
F-150. I love it, my kids love it. "Daddy can we go in the truck?!!"
But when I rolled up and an orthodontist and his wife get out a CL (the really nice slanty shaped one, I don't know the numbers) Mercedes and I have to walk by another dentist's car (a current model 7 series BMW). I walk threw the garage of the party giver and there is a Lexus and a Mercedes in the garage. Last dude coming to the party rolls up in a S550 Mercedes.
I feel like a dud. I shouldn't. I start saying to myself, "Man, they must be in some serious debt", trying to make myself feel a little bit better. I stop looking at the man and starting looking at the car. This is not right.
But you know who they call when they need a truck? (Although this doesn't help me at all. I get to drive their car for a day and feel even smaller.)
I continue to stand by the fact that even if I had that kind of money, I would not buy that kind of car. Because you lose all perspective. You have to get it washed all the time. You hate it when your kids are in it because they might mess up the interior.
I don't have anything that I hold on to that tightly.
If I ding my truck, I don't care. If the kids leave a crayon on the seat over the weekend and it melts, I pick it up and give them a lecture. I don't get mad about it or lose my cool.
I think if I spend that kind of money on something there is no way I will not Worship it (please refer to Mathew 6).
It is the same about my house. I love my house. It is a great house. But someone is always going to have a bigger house than mine. In a nicer area, with nicer furniture.
Lastly about the cars. If I have one (a fat car) I fear that I would make people feel the way I feel when a fat car rolls up. I feel like I am making someone else feel smaller than they are. We should have worth in our families, the way we love, our kids. Not in our stuff.
I try really hard to live under my means. I have been in a position of debt and it is not fun.
Going to work is a lot different debt free as oppose to going to work needed a certain number to pay your bills.
If someone comes to me and has an issue, I do not turn into a salesman. I turn into an educator and let them make a decision. Now if they make a decision that I am not comfortable with, I now have the ability to say, "Maybe this is not the practice for you. Maybe you should look for a dentist that wouldn't mind extracting that tooth." I let this patient walk out of my office. I don't even charge them for the exam.
Now imagine going to work and having debt hanging over your head all day.
I am not saying young dentist who have $200,000 in school debt and a $500,000 new office debt have any other choice but...
If that is not you then you have a choice to make.
Remember when I told you in the last blog about, "what does your check book say about you?"
Well in my budget I made some tough choices.
I have priorities.
I tithe...this is a line item that doesn't have to be there. And it may not be in your budget.
I save for the future...again, I don't have to do this.
Insurance...I don't have to have a $2.2 million life insurance policy on me. But I know if I get "accidentally" pushed down a flight of stairs and die my wife and kids will be taken care of for a long time (Guys take note, if I die, my wife will be available and really really rich).
I send my kids to a private school.
I have no consumer debt.
I pay all off all my loans as fast as I can.
All the above are things that are important to my wife and I. Could I knock a couple of those things out and get a fat car? YES.
Could I buy a bigger house? YES (but don't forget a bigger house means a bigger tax bill. It means bigger electric. It means bigger lawn and pool bills. It means bigger everything)
But I don't have my worth in things.
But I choose to live this way.
I am not telling you this stuff to make you feel crappy if you have a fat car.
I am not telling you this to make you feel bad if you are in debt.
I am telling you this to let you know it is okay to not have a fat car. It is okay to be the millionaire next door.
It is okay to live within your means.
It is fun to come to work. It is freeing.
Sometimes you can't help but feel small but I have to get over myself.
I have a family that loves me. I am a good dentist. I have a handful of patients that like me (that have nicer cars than me) and that is where I get my worth.
I could go on rambling for pages and pages.
The Millionaire Next Door says, "It is not what you spend it is what you save."
It is not cool. It is not showy. It is not as fun.
But it is what it is.
It is okay.
See you on Friday,
john
I have been reading my AGD's General Dentistry magazine and it it chalked full of great articles. I am getting good material for next week.
I still shake my head when I think about money and its affect on the way we practice.
Before I get started...
I just finished a book called Brushko. It was copywrited in 1978 so it is not new or anything.
Very good.
Now I am reading a book called The Shack. This is a book going around that is getting a lot of exposure and a lot of people at my church keep talking about it. So I am reading it. I will let you know.
Growing up I was never a big reader but I felt like I was missing something. My freshman year of dental school I started to read. I real all the time.
But, as you know, I am also a movie buff...
I watched the movie No Reservations this weekend. Not bad. In fact, I liked it.
Money,
So you saw my budget. I told you my wife and I fought a lot about money. I think every couple does.
I remember like it was yesterday when I read a story about Warren Moon. He is a professional football player and was making millions of dollars a year when he was arrested for hitting his wife when they were arguing about the credit card bill.
It doesn't matter how much you make...
I find anyway that the more you make the more you spend.
You don't have to be a Bible thumping Christian to appreciate this but the Bible has more instructions about money than it does any other subject in the whole book. It has thousands of verses about money.
One that always sticks with me is...
No one can serve two masters. Either he will hate the one and love the other, or he will be devoted to the one and despise the other. You cannot serve both God and money. (Matthew 6:24. I looked it up).
What do you think He is saying? Don't you think He knew what we were going to thing about money?
Don't you think He knew my wife would love purses? Don't you think He knew it was going to be tough when your friends roll up in a fat Mercedes to the study club? Didn't He know you were going to feel inferior as a person or as a dentist?
I went to a party with a bunch of dentists the other week. I roll up in my very comfortable
F-150. I love it, my kids love it. "Daddy can we go in the truck?!!"
But when I rolled up and an orthodontist and his wife get out a CL (the really nice slanty shaped one, I don't know the numbers) Mercedes and I have to walk by another dentist's car (a current model 7 series BMW). I walk threw the garage of the party giver and there is a Lexus and a Mercedes in the garage. Last dude coming to the party rolls up in a S550 Mercedes.
I feel like a dud. I shouldn't. I start saying to myself, "Man, they must be in some serious debt", trying to make myself feel a little bit better. I stop looking at the man and starting looking at the car. This is not right.
But you know who they call when they need a truck? (Although this doesn't help me at all. I get to drive their car for a day and feel even smaller.)
I continue to stand by the fact that even if I had that kind of money, I would not buy that kind of car. Because you lose all perspective. You have to get it washed all the time. You hate it when your kids are in it because they might mess up the interior.
I don't have anything that I hold on to that tightly.
If I ding my truck, I don't care. If the kids leave a crayon on the seat over the weekend and it melts, I pick it up and give them a lecture. I don't get mad about it or lose my cool.
I think if I spend that kind of money on something there is no way I will not Worship it (please refer to Mathew 6).
It is the same about my house. I love my house. It is a great house. But someone is always going to have a bigger house than mine. In a nicer area, with nicer furniture.
Lastly about the cars. If I have one (a fat car) I fear that I would make people feel the way I feel when a fat car rolls up. I feel like I am making someone else feel smaller than they are. We should have worth in our families, the way we love, our kids. Not in our stuff.
I try really hard to live under my means. I have been in a position of debt and it is not fun.
Going to work is a lot different debt free as oppose to going to work needed a certain number to pay your bills.
If someone comes to me and has an issue, I do not turn into a salesman. I turn into an educator and let them make a decision. Now if they make a decision that I am not comfortable with, I now have the ability to say, "Maybe this is not the practice for you. Maybe you should look for a dentist that wouldn't mind extracting that tooth." I let this patient walk out of my office. I don't even charge them for the exam.
Now imagine going to work and having debt hanging over your head all day.
I am not saying young dentist who have $200,000 in school debt and a $500,000 new office debt have any other choice but...
If that is not you then you have a choice to make.
Remember when I told you in the last blog about, "what does your check book say about you?"
Well in my budget I made some tough choices.
I have priorities.
I tithe...this is a line item that doesn't have to be there. And it may not be in your budget.
I save for the future...again, I don't have to do this.
Insurance...I don't have to have a $2.2 million life insurance policy on me. But I know if I get "accidentally" pushed down a flight of stairs and die my wife and kids will be taken care of for a long time (Guys take note, if I die, my wife will be available and really really rich).
I send my kids to a private school.
I have no consumer debt.
I pay all off all my loans as fast as I can.
All the above are things that are important to my wife and I. Could I knock a couple of those things out and get a fat car? YES.
Could I buy a bigger house? YES (but don't forget a bigger house means a bigger tax bill. It means bigger electric. It means bigger lawn and pool bills. It means bigger everything)
But I don't have my worth in things.
But I choose to live this way.
I am not telling you this stuff to make you feel crappy if you have a fat car.
I am not telling you this to make you feel bad if you are in debt.
I am telling you this to let you know it is okay to not have a fat car. It is okay to be the millionaire next door.
It is okay to live within your means.
It is fun to come to work. It is freeing.
Sometimes you can't help but feel small but I have to get over myself.
I have a family that loves me. I am a good dentist. I have a handful of patients that like me (that have nicer cars than me) and that is where I get my worth.
I could go on rambling for pages and pages.
The Millionaire Next Door says, "It is not what you spend it is what you save."
It is not cool. It is not showy. It is not as fun.
But it is what it is.
It is okay.
See you on Friday,
john
I have been reading my AGD's General Dentistry magazine and it it chalked full of great articles. I am getting good material for next week.
Friday, May 23, 2008
Cash Money II
David Cook, David Cook, David Cook.
OMG!! 95 million votes and 10 of them were mine. Yes I said it. I voted. And when Simon and all the others started talking about how great the other David was, I voted more.
He won by 12 million votes. He won by 25% it wasn't even close.
Susie, do not mess with me...I know talent.
Okay, focus. MONEY.
Where were we....we were talking about our budget. We are down to a ridiculous amount of money and we have only paid like 5 bills.
Lets get going. We are down to $38,000 dollars with most of the fix expenses.
So now I broke down some of the other random once a year expenses.
$38,000
Miscellaneous
Real estate tax 3,500
Financial advice 1,600
Termite bond 500
Home owners association 200
-----------------------------------------------
32,100
I know there is probably more stuff but this is what I could think about off the top of my head.
I pay for financial advice because I don't know doo doo about prime rates or if prime plus a point is good. Or if I pay 3 points and only pay this percentage rate for the loan.
Or if I should pay down my mortgage or my student loan first. Or blah, blah, blah. I can try to keep my dentistry under control and let this guy pick the best malpractice insurance for me. Or read the fine print on my flood insurance.
Termite bond...just try to do without it in Florida.
Now lets go over the once a month bills
$31,100
Cable 25 For basic cable (because I can't afford the good
stuff. You laugh but I am about to show you)
Pest Control 30 For the inside of your house, ie roaches, big ones
Weed Control 60 Can't do without it in Florida
Pool Chemicals 15
Alarm 25
Telephone 120
home
cell
Electric 175 I laugh at $175 now
Water and trash 50
Kids college fund 250 This is for 2 kids, I am hoping one of the
three doesn't make it.
=============================================
22,100
Now we have 22,100 left.
This breaks down into $1842 a month.
Well lets eat. $1842
What are our non fixed costs.
Gas (before the hike) $175
Food (2 adults, 2 kids) 450
Man is it going fast
How about Entertainment?
Going to dinner with the family
or the friends or just with the wife.
What about just going to a Magic game
(just so you know, lower bowl tickets
distal to the foul line are $100 a piece)
or a Gator game. How about the movies?
How about a concert? $300
Do you bring your lunch to work?
You are a doctor...you have money to
eat out everyday, don't you?
$10-15 per day. $250-375
Miscellaneous
How about presents?
You get invited to a wedding. Your
daughters birthday (don't mind the
party with the bounce house and the
clown). How about Christmas?
Easter? $150-1000
-----------------------------------------------------------------------
+517 to -458
Don't forget you are the big doctor now. You get invited to everything. One time I got invited to a wedding and I had no idea who these people were. My wife was a friend of a friend of the bride.
So if you get invited to a wedding you are screwed. You either have to go and bring a gift or if you don't go you still are required (by some unwritten law) to send a gift.
I get invited to about 5 high school graduations a year and about 3 college graduations a year.
At Christmas time the list of people that we buy for is ridiculous. I have cousins coming out the woodwork.
I get asked to sponsor band, theaters, walk-a-thons, relays, water polo, EVERYTHING. This has to come out of the budget.
Don't get me wrong. I love that people think of me. I am blessed beyond belief and I like giving. But....
We make $150,000 a year and on a good month we have $500 left over (and on a bad month we are flat broke).
Now what have we NOT talked about?
Cars,
who has money for a car payment. Let alone have money for a Mercedes or a sports car.
For the record, I have a 7 year old Ford F-150 truck. I love it. But I do get to feeling a little small when I roll up to a study club and I have the only American made car there. The parking lot looks like a luxury car dealership.
Boats.
What? Are you kidding me? Some of these boats I see are so sweet but...$40,000 for a boat. I can't even afford my truck and mini-van.
Jewelry.
Where is the BLING BLING?
Rolex, Tag, Rado, Raymond Weil. Don't tell me you don't notice people's wrist.
Dude you make $150,000, you can afford a cool watch. OH NO YOU CAN'T (and it sucks).
How about a vacation?
You are just scrapping by, you can't take time off.
What about fine art in the house?
Garage sales dude.
But the most troubling thing for me was....
I had no money to buy a practice.
How on earth was I suppose to save up to buy the one thing that might help me move up in the earning bracket?
Very depressing. I am sorry.
So trust me there was some serious fight at the Gammichia house about money.
Honey we make ONE HUNDRED AND FIFTY THOUSAND DOLLARS, what do you mean we don't have any money.
"You went to the stupid Magic game with your stupid friends and now we don't have any stupid money!"
"Well you had to go and buy that stupid purse. Like you need another stupid purse"
Have you been there?
I am laughing just thinking about it.
I have a lot of thought on this but let me stop there.
I will sum it all up next week. Like I want to talk about priorities. And how if you look at my checkbook you can see what kind of guy I am.
If you look at the things I refuse to get into debt over, you can see my character.
I want to talk to you about debt and how going to work with debt is different than going to work debt free.
Imagine life without debt. I can but it takes discipline people.
I have to stop. We will get into some tough talk next week.
Memorial Day on Monday.
It is a special day for me (not because I have lost anyone in the armed services) because I love this country.
I thank God for all the men and woman who paid the ultimate sacrifice for MY freedom.
Have a great weekend,
I might or might not be able to write on Monday.
I am going to Miami for family stuff and a Marlins game.
Then we have a graduation party on Monday (see what I mean) afternoon.
john
OMG!! 95 million votes and 10 of them were mine. Yes I said it. I voted. And when Simon and all the others started talking about how great the other David was, I voted more.
He won by 12 million votes. He won by 25% it wasn't even close.
Susie, do not mess with me...I know talent.
Okay, focus. MONEY.
Where were we....we were talking about our budget. We are down to a ridiculous amount of money and we have only paid like 5 bills.
Lets get going. We are down to $38,000 dollars with most of the fix expenses.
So now I broke down some of the other random once a year expenses.
$38,000
Miscellaneous
Real estate tax 3,500
Financial advice 1,600
Termite bond 500
Home owners association 200
-----------------------------------------------
32,100
I know there is probably more stuff but this is what I could think about off the top of my head.
I pay for financial advice because I don't know doo doo about prime rates or if prime plus a point is good. Or if I pay 3 points and only pay this percentage rate for the loan.
Or if I should pay down my mortgage or my student loan first. Or blah, blah, blah. I can try to keep my dentistry under control and let this guy pick the best malpractice insurance for me. Or read the fine print on my flood insurance.
Termite bond...just try to do without it in Florida.
Now lets go over the once a month bills
$31,100
Cable 25 For basic cable (because I can't afford the good
stuff. You laugh but I am about to show you)
Pest Control 30 For the inside of your house, ie roaches, big ones
Weed Control 60 Can't do without it in Florida
Pool Chemicals 15
Alarm 25
Telephone 120
home
cell
Electric 175 I laugh at $175 now
Water and trash 50
Kids college fund 250 This is for 2 kids, I am hoping one of the
three doesn't make it.
=============================================
22,100
Now we have 22,100 left.
This breaks down into $1842 a month.
Well lets eat. $1842
What are our non fixed costs.
Gas (before the hike) $175
Food (2 adults, 2 kids) 450
Man is it going fast
How about Entertainment?
Going to dinner with the family
or the friends or just with the wife.
What about just going to a Magic game
(just so you know, lower bowl tickets
distal to the foul line are $100 a piece)
or a Gator game. How about the movies?
How about a concert? $300
Do you bring your lunch to work?
You are a doctor...you have money to
eat out everyday, don't you?
$10-15 per day. $250-375
Miscellaneous
How about presents?
You get invited to a wedding. Your
daughters birthday (don't mind the
party with the bounce house and the
clown). How about Christmas?
Easter? $150-1000
-----------------------------------------------------------------------
+517 to -458
Don't forget you are the big doctor now. You get invited to everything. One time I got invited to a wedding and I had no idea who these people were. My wife was a friend of a friend of the bride.
So if you get invited to a wedding you are screwed. You either have to go and bring a gift or if you don't go you still are required (by some unwritten law) to send a gift.
I get invited to about 5 high school graduations a year and about 3 college graduations a year.
At Christmas time the list of people that we buy for is ridiculous. I have cousins coming out the woodwork.
I get asked to sponsor band, theaters, walk-a-thons, relays, water polo, EVERYTHING. This has to come out of the budget.
Don't get me wrong. I love that people think of me. I am blessed beyond belief and I like giving. But....
We make $150,000 a year and on a good month we have $500 left over (and on a bad month we are flat broke).
Now what have we NOT talked about?
Cars,
who has money for a car payment. Let alone have money for a Mercedes or a sports car.
For the record, I have a 7 year old Ford F-150 truck. I love it. But I do get to feeling a little small when I roll up to a study club and I have the only American made car there. The parking lot looks like a luxury car dealership.
Boats.
What? Are you kidding me? Some of these boats I see are so sweet but...$40,000 for a boat. I can't even afford my truck and mini-van.
Jewelry.
Where is the BLING BLING?
Rolex, Tag, Rado, Raymond Weil. Don't tell me you don't notice people's wrist.
Dude you make $150,000, you can afford a cool watch. OH NO YOU CAN'T (and it sucks).
How about a vacation?
You are just scrapping by, you can't take time off.
What about fine art in the house?
Garage sales dude.
But the most troubling thing for me was....
I had no money to buy a practice.
How on earth was I suppose to save up to buy the one thing that might help me move up in the earning bracket?
Very depressing. I am sorry.
So trust me there was some serious fight at the Gammichia house about money.
Honey we make ONE HUNDRED AND FIFTY THOUSAND DOLLARS, what do you mean we don't have any money.
"You went to the stupid Magic game with your stupid friends and now we don't have any stupid money!"
"Well you had to go and buy that stupid purse. Like you need another stupid purse"
Have you been there?
I am laughing just thinking about it.
I have a lot of thought on this but let me stop there.
I will sum it all up next week. Like I want to talk about priorities. And how if you look at my checkbook you can see what kind of guy I am.
If you look at the things I refuse to get into debt over, you can see my character.
I want to talk to you about debt and how going to work with debt is different than going to work debt free.
Imagine life without debt. I can but it takes discipline people.
I have to stop. We will get into some tough talk next week.
Memorial Day on Monday.
It is a special day for me (not because I have lost anyone in the armed services) because I love this country.
I thank God for all the men and woman who paid the ultimate sacrifice for MY freedom.
Have a great weekend,
I might or might not be able to write on Monday.
I am going to Miami for family stuff and a Marlins game.
Then we have a graduation party on Monday (see what I mean) afternoon.
john
Wednesday, May 21, 2008
Cash Money
I give a lecture to young dentist and the part that really wakes them up is the money part of the lecture.
I am going to give you a piece of it. It may take a day or two.
Before I start I want to tell you a couple of things.
I watched two movies this weekend...
1) Good Luck Chuck
and
2) In the Land of Woman
Good luck Chuck was pretty funny. I don't really like Dane Cook but it was a decent concept. I somehow reserved the unedited version and there was too much frontal nudity (I can't believe I just said that). But it was suppose to be a romantic comedy and I was watching with my wife and she kept looking at me (you know with that look, REAL NICE JOHN, YOU PIG).
In the Land of Woman...it was okay. Nothing special. But Melanie Griffin is in it and apparently she just had botox in her upper lip or had a lip job because I could not stop staring at how bad her lip looked. Don't agents tell their clients anything anymore, "like your lips look ridiculous".
OH, and lastly...David Cook is head and shoulders better than "no range" David Arquelleta.
I think David Cooks body of work is so much better. I think he has more talent, I think he is much more marketable. I think David Arquelleta is a good singer and he is spot on all the time. I think all his songs sound the same and I wouldn't buy he album for a million dollars.
Randy says he could sing the phone book, well it would sound exactly like all the other songs he sings.
Okay to the topic of the day...
The part of the lecture is called "why $150,000 is not enough."
Where this came from is the fact that when I was 5 years out of school I was making good money and I still felt like I was swimming up stream.
Here were my thought on the whole thing.
When I was in dental school my dad was giving me $800 a month. This is $9600 for the year.
This is how it broke down.
Rent $175
Electric 80
Cable 40
Phone 75
School stuff 100
Beer the rest
I mean when my dad was telling me I might make $60-70,000 my first year out, I thought I would live like Donald Trump.
I had everything I needed with $9600 imagine how high on the hog I would be living with 7 times that.
But here I, five years later, was with 15 times that and still struggling.
So I started to put all I spent on paper.
Lets start with all the big stuff
Total $150,000
Taxes (28%) 30,000
-------------------------------------------------
$120,000
Now this is something that I was not accustomed to. Just so you know 28% is really $42,000 but I know I didn't pay that much so I just made it $30,000. That figure still might be a little high also. But work with me. I couldn't find my W2.
Now I realized why my dad always sweated tax time. I don't have a problem with taxes but this is something that blind sided me.
$120,000
Tithe 15,000
--------------------------------------------------
$105,000
The first class I took out of dental school was Crown Ministry. This is a Bible study on money.
I tithe. So it is a budget item.
As an aside, tithing is the only place in the Bible that God tells us to challenge Him.
He says, go ahead and do it and I will bless you. So my wife and I take 10% of our money and it is an automatic withdrawl from my paycheck to our TITHE account. (I have increased the percentage about 4 times, if I never get it in my checking account then I don't miss it)
$105,000
Mortgage 27,000
--------------------------------------------------
$78,000
Okay I was 1 year out of school. I didn't have any money for a down payment. So I needed a second mortgage to pay the down payment.
I bought a modest home that cost $176,000 (in 1996). It was 2300 square feet and very comfortable for my wife and I.
3 big bills and I am at about half of my money.
I am sweating just writing this.
$78,000
Insurance 14,000
----------------------------------------------------
$64,000
I was not a partner so I was responsible for most of my insurance.
Life, disability, home, cars, umbrella policies, flood, medical.
I think insurance is the biggest racket, but you have to have it.
I even have more now but this is a big benefit to partnership.
$64,000
Student Loans 6,600
------------------------------------------------------
$58,000
I owed $38,000 at the time. It was a five year repayment. I know some of you are way higher.
In retrospect, I feel really blessed to have my family pay for most of my education.
$58,000
Kids Tuition 8,000
---------------------------------------------------
$50,000
This was for one kid (who was my nephew, this is a long story, maybe I will tell you about this later) who was in elementary school and for one pre-K kid.
Now I laugh at $8,000, in two year I will have my third kid in private school and I think it is going to cost me $19,000. I tell my wife not to tell me how much school costs, I don't want to know. This will be for a 5th, 3rd and a kindergartner. Middle school and high school are more.
OH JOY.
$50,000
Retirement 12,500
--------------------------------------------------
$38,000
$12,500 was the max you use to be able to put in a 401k. Remember the book The Millionaire Next Door, it says "pay yourself first".
WOW!!!
We just finished the big bills and we are at $38k.
Just remember we haven't eaten yet or filled our cars up with gas. Speaking of our cars....I haven't talked about a car payment yet.
I will finish on Friday. Isn't this fun to watch your money go so fast.
I have spent $112,000 in 5 minutes.
I am in full body sweat now.
Have a great night,
Talk to you on Friday.
john
I am going to give you a piece of it. It may take a day or two.
Before I start I want to tell you a couple of things.
I watched two movies this weekend...
1) Good Luck Chuck
and
2) In the Land of Woman
Good luck Chuck was pretty funny. I don't really like Dane Cook but it was a decent concept. I somehow reserved the unedited version and there was too much frontal nudity (I can't believe I just said that). But it was suppose to be a romantic comedy and I was watching with my wife and she kept looking at me (you know with that look, REAL NICE JOHN, YOU PIG).
In the Land of Woman...it was okay. Nothing special. But Melanie Griffin is in it and apparently she just had botox in her upper lip or had a lip job because I could not stop staring at how bad her lip looked. Don't agents tell their clients anything anymore, "like your lips look ridiculous".
OH, and lastly...David Cook is head and shoulders better than "no range" David Arquelleta.
I think David Cooks body of work is so much better. I think he has more talent, I think he is much more marketable. I think David Arquelleta is a good singer and he is spot on all the time. I think all his songs sound the same and I wouldn't buy he album for a million dollars.
Randy says he could sing the phone book, well it would sound exactly like all the other songs he sings.
Okay to the topic of the day...
The part of the lecture is called "why $150,000 is not enough."
Where this came from is the fact that when I was 5 years out of school I was making good money and I still felt like I was swimming up stream.
Here were my thought on the whole thing.
When I was in dental school my dad was giving me $800 a month. This is $9600 for the year.
This is how it broke down.
Rent $175
Electric 80
Cable 40
Phone 75
School stuff 100
Beer the rest
I mean when my dad was telling me I might make $60-70,000 my first year out, I thought I would live like Donald Trump.
I had everything I needed with $9600 imagine how high on the hog I would be living with 7 times that.
But here I, five years later, was with 15 times that and still struggling.
So I started to put all I spent on paper.
Lets start with all the big stuff
Total $150,000
Taxes (28%) 30,000
-------------------------------------------------
$120,000
Now this is something that I was not accustomed to. Just so you know 28% is really $42,000 but I know I didn't pay that much so I just made it $30,000. That figure still might be a little high also. But work with me. I couldn't find my W2.
Now I realized why my dad always sweated tax time. I don't have a problem with taxes but this is something that blind sided me.
$120,000
Tithe 15,000
--------------------------------------------------
$105,000
The first class I took out of dental school was Crown Ministry. This is a Bible study on money.
I tithe. So it is a budget item.
As an aside, tithing is the only place in the Bible that God tells us to challenge Him.
He says, go ahead and do it and I will bless you. So my wife and I take 10% of our money and it is an automatic withdrawl from my paycheck to our TITHE account. (I have increased the percentage about 4 times, if I never get it in my checking account then I don't miss it)
$105,000
Mortgage 27,000
--------------------------------------------------
$78,000
Okay I was 1 year out of school. I didn't have any money for a down payment. So I needed a second mortgage to pay the down payment.
I bought a modest home that cost $176,000 (in 1996). It was 2300 square feet and very comfortable for my wife and I.
3 big bills and I am at about half of my money.
I am sweating just writing this.
$78,000
Insurance 14,000
----------------------------------------------------
$64,000
I was not a partner so I was responsible for most of my insurance.
Life, disability, home, cars, umbrella policies, flood, medical.
I think insurance is the biggest racket, but you have to have it.
I even have more now but this is a big benefit to partnership.
$64,000
Student Loans 6,600
------------------------------------------------------
$58,000
I owed $38,000 at the time. It was a five year repayment. I know some of you are way higher.
In retrospect, I feel really blessed to have my family pay for most of my education.
$58,000
Kids Tuition 8,000
---------------------------------------------------
$50,000
This was for one kid (who was my nephew, this is a long story, maybe I will tell you about this later) who was in elementary school and for one pre-K kid.
Now I laugh at $8,000, in two year I will have my third kid in private school and I think it is going to cost me $19,000. I tell my wife not to tell me how much school costs, I don't want to know. This will be for a 5th, 3rd and a kindergartner. Middle school and high school are more.
OH JOY.
$50,000
Retirement 12,500
--------------------------------------------------
$38,000
$12,500 was the max you use to be able to put in a 401k. Remember the book The Millionaire Next Door, it says "pay yourself first".
WOW!!!
We just finished the big bills and we are at $38k.
Just remember we haven't eaten yet or filled our cars up with gas. Speaking of our cars....I haven't talked about a car payment yet.
I will finish on Friday. Isn't this fun to watch your money go so fast.
I have spent $112,000 in 5 minutes.
I am in full body sweat now.
Have a great night,
Talk to you on Friday.
john
Wednesday, May 14, 2008
Tier Specialists
Here is the thing.
I have been so busy that I just couldn't do the blog.
I was going from 5:30am to 10pm every day and sat down on the couch at 10pm and just stared at my computer.
And the blog is not only thing in my life that I have let go.
I have half done projects all over the house. This weekend it all came to a head. I am going in a thousand different directions and going nowhere. Not that all these things don't bring me a lot of joy but when I can't do them to the level of excellence that I want I explode.
Just ask my wife.
For instance I sat at my computer for 2 and a half hours last night (yes on Sunday) and wrote up my charts from Wednesday through Friday.
But I have definitely missed you and I am sorry about last week.
I am back on track (for now).
Last week we were talking about Tiers. But once we have established ourselves in a particular level we can't forget one thing.
We are who we hang out with.
Specialists and Labs and other institutions that you deal with become a huge part of your identity.
Lets talk about specialists for a minute.
When I first got out of school the periodontist I used was my dad's periodontist.
It was just assumed that I was going to use this guy. So I did.
Well this lasted for awhile until I realized his style was not my style.
I mean I am working my badonkadonk off trying to create an environment that people like. I was trying to establish myself as a Tier III++ guy. I was going out of my way to raise the level of expectations of my patients. And I felt he wasn't.
I had to make a change.
So I was thinking what do I do now. I have people that need a periodontist and I don't think this guy is taking care of them well enough.
So my quest for a Tier III or Tier IV periodontist began.
Well I know a couple of guys but I don't know anything about how they roll. I have heard their names but don't know anything about them.
I found myself being my own private investigator.
I would stalk some of these guys (they were all men, there are not any woman periodontists in my area, so guys mean guys) at meetings.
I would listen to the way they spoke.
I have a big thing with EGO.
I have a big problem with people who think their poop doesn't stink. I have a big problem with people that think they know it all. I graduated 13 years ago (damn I am getting old) and I still learn every day. I might know stuff but I am learning new stuff.
I don't want to hear a guy speak that doesn't listen. I want a guy that is confident and compassionate.
I want a guy that is good but doesn't know it. Or knows he is good but is trying to get better.
I narrowed my search down to three.
Now I started to call their office (from my cell phone so they didn't know who was calling). I wanted to hear how they answered the phone. I wanted to feel like my patient feels when they call. I might ask a gum question to see how they handled it.
Then I would walk into their office unannounced. They don't know me from Adam and I wanted to see how they treated a stranger.
Now I have narrowed it down to 2.
So I sent them both a patient.
I found out when they were going and marked it down.
The day after their appointments I called the patient and we played a game of 20 questions.
How did he treat you?
Do you feel like you got ample time with him?
Did he and his staff explain everything to you?
Do you feel like you have a decent grasp of your perio situation?
Then I called the periodontist. You got to see Mr. Smith yesterday, how did it go?
Now I say these kind of things like it is an easy process. It is not. It is a pain in the tookas.
But in the end it all worked out.
I chose one about 10 years again and have not used another periodontist since.
He treats my patients like I do. (He is not nearly as good looking as I am but this is also what I am looking for).
I can call him anytime of the day (I can but I don't because I know he is busy) . I can ask any question I want. We go to CE together.
I consider him my friend. I would trust him with any patient, even my family.
But what I like best is he is real. His poop stinks.
I can constructively criticise him. Actually I think he would want me to do this, because if no one ever tells him he never knows.
Now once you think you have spent all your energy finding a new periodontist then what are you going to do about your lab.
I had a real problem with my father's ceramist.
Every time I would send him a case I would get a call. Now the call was not, "This is some awesome work" or "great prep" or "what an impression." It was always a lecture of some sort.
I don't mind some constructive criticism but enough is enough.
I had to change.
Now the PI thing starts all over. I have 5 ceramists come to my office. Then I show up at their lab unannounced (to see what the place looks like. Have you ever been to your lab? You must.)
I saw how they rolled.
I browse around the lab and see what there "everyday" crown looks like (not their show pieces they want you to see). I will look at the impressions of the other dentists they are using.
If the impressions suck then they are not asking the dentist to get better.
If they are not calling you and me and asking for another impression then they are not helping you and me get better at what we do.
I chose my ceramist about 10 years ago. I have not sent a crown anywhere else since then. (talk about loyalty....I guess I would be a terrible NBA player. Oh and I am 5'10 with heels on)
My ceramist and I go to CE together. I also consider him my friend.
Now I know all you older dentist are set in your ways. You may be saying I don't need to worry about this anymore. I have got my periodontist and everything is cool. IS IT?
I told you I am sending my perio people and all my crowns to the same person for a long time. This doesn't mean I am resting on my laurels.
I still call the office on my cell to see how they answer. I still occassionally call the patient to see how their first appointment went. I still show up there unannounced. I still go to my lab and look at all the impressions. I am still investigating.
I guess this PI's case is never closed.
Food for thought.
I am glad to be back. I hope you are.
See you Wednesday
john
I have been so busy that I just couldn't do the blog.
I was going from 5:30am to 10pm every day and sat down on the couch at 10pm and just stared at my computer.
And the blog is not only thing in my life that I have let go.
I have half done projects all over the house. This weekend it all came to a head. I am going in a thousand different directions and going nowhere. Not that all these things don't bring me a lot of joy but when I can't do them to the level of excellence that I want I explode.
Just ask my wife.
For instance I sat at my computer for 2 and a half hours last night (yes on Sunday) and wrote up my charts from Wednesday through Friday.
But I have definitely missed you and I am sorry about last week.
I am back on track (for now).
Last week we were talking about Tiers. But once we have established ourselves in a particular level we can't forget one thing.
We are who we hang out with.
Specialists and Labs and other institutions that you deal with become a huge part of your identity.
Lets talk about specialists for a minute.
When I first got out of school the periodontist I used was my dad's periodontist.
It was just assumed that I was going to use this guy. So I did.
Well this lasted for awhile until I realized his style was not my style.
I mean I am working my badonkadonk off trying to create an environment that people like. I was trying to establish myself as a Tier III++ guy. I was going out of my way to raise the level of expectations of my patients. And I felt he wasn't.
I had to make a change.
So I was thinking what do I do now. I have people that need a periodontist and I don't think this guy is taking care of them well enough.
So my quest for a Tier III or Tier IV periodontist began.
Well I know a couple of guys but I don't know anything about how they roll. I have heard their names but don't know anything about them.
I found myself being my own private investigator.
I would stalk some of these guys (they were all men, there are not any woman periodontists in my area, so guys mean guys) at meetings.
I would listen to the way they spoke.
I have a big thing with EGO.
I have a big problem with people who think their poop doesn't stink. I have a big problem with people that think they know it all. I graduated 13 years ago (damn I am getting old) and I still learn every day. I might know stuff but I am learning new stuff.
I don't want to hear a guy speak that doesn't listen. I want a guy that is confident and compassionate.
I want a guy that is good but doesn't know it. Or knows he is good but is trying to get better.
I narrowed my search down to three.
Now I started to call their office (from my cell phone so they didn't know who was calling). I wanted to hear how they answered the phone. I wanted to feel like my patient feels when they call. I might ask a gum question to see how they handled it.
Then I would walk into their office unannounced. They don't know me from Adam and I wanted to see how they treated a stranger.
Now I have narrowed it down to 2.
So I sent them both a patient.
I found out when they were going and marked it down.
The day after their appointments I called the patient and we played a game of 20 questions.
How did he treat you?
Do you feel like you got ample time with him?
Did he and his staff explain everything to you?
Do you feel like you have a decent grasp of your perio situation?
Then I called the periodontist. You got to see Mr. Smith yesterday, how did it go?
Now I say these kind of things like it is an easy process. It is not. It is a pain in the tookas.
But in the end it all worked out.
I chose one about 10 years again and have not used another periodontist since.
He treats my patients like I do. (He is not nearly as good looking as I am but this is also what I am looking for).
I can call him anytime of the day (I can but I don't because I know he is busy) . I can ask any question I want. We go to CE together.
I consider him my friend. I would trust him with any patient, even my family.
But what I like best is he is real. His poop stinks.
I can constructively criticise him. Actually I think he would want me to do this, because if no one ever tells him he never knows.
Now once you think you have spent all your energy finding a new periodontist then what are you going to do about your lab.
I had a real problem with my father's ceramist.
Every time I would send him a case I would get a call. Now the call was not, "This is some awesome work" or "great prep" or "what an impression." It was always a lecture of some sort.
I don't mind some constructive criticism but enough is enough.
I had to change.
Now the PI thing starts all over. I have 5 ceramists come to my office. Then I show up at their lab unannounced (to see what the place looks like. Have you ever been to your lab? You must.)
I saw how they rolled.
I browse around the lab and see what there "everyday" crown looks like (not their show pieces they want you to see). I will look at the impressions of the other dentists they are using.
If the impressions suck then they are not asking the dentist to get better.
If they are not calling you and me and asking for another impression then they are not helping you and me get better at what we do.
I chose my ceramist about 10 years ago. I have not sent a crown anywhere else since then. (talk about loyalty....I guess I would be a terrible NBA player. Oh and I am 5'10 with heels on)
My ceramist and I go to CE together. I also consider him my friend.
Now I know all you older dentist are set in your ways. You may be saying I don't need to worry about this anymore. I have got my periodontist and everything is cool. IS IT?
I told you I am sending my perio people and all my crowns to the same person for a long time. This doesn't mean I am resting on my laurels.
I still call the office on my cell to see how they answer. I still occassionally call the patient to see how their first appointment went. I still show up there unannounced. I still go to my lab and look at all the impressions. I am still investigating.
I guess this PI's case is never closed.
Food for thought.
I am glad to be back. I hope you are.
See you Wednesday
john
Monday, May 12, 2008
Tier Dentistry (con't)
We have been talking about Tiers in dentistry.
If you are just joining us, we talked about different levels of dental offices.
Basically, I was taught there are 4 tiers. From the clinic setting (McDonald's) to the boutique practices (Ruth's Chris).
As a small business owner I think of my office constantly.
I think of my patients and what they want. I think of my staff and if we are giving the customer a product that they will pay for.
I would say my clientele is middle class to upper middle class, who appreciate good service and for the most part care about their teeth.
Now this is a pretty big box. I have families. I have singles. I have young married with no kids. I have empty nesters. I have elderly. I would say I have this great mix of people because that is who I like to treat. Black, white, Christian, Jewish, Muslim, American and non-American. So I try now to exclude anyone. If they can afford it they can come (and sometimes if they can't afford it they can come anyway).
But what I am trying to say is the lines of the tiers are getting crossed.
I have been thinking a lot about this. Ruth's Chris is the top tier restaurant (I know, I know I talk about Ruth's Chris a lot. It is my favorite restaurant. I go every chance I get. The sweet potato casserole is AMAZING. Steaks come out on a plate that is 500 degrees with butter melted on top of them. OH MY GOSH. I am getting sidetracked).
So if you are the manager of a Tier IV restaurant or dental practice you are trying to cater to the people that can afford what you offer.
But this is where the lines are getting crossed.
What do these people look like? For me, who is the middle to upper middle class? For the Tier IV guy, who is the upper class?
So a couple of months ago I went to Ruth's Chris with my periodontist. My wife and I got their a bit early and took a seat at the bar. I started to people watch. I noticed something strange about some of the clientele. They were every walk of life.
Lets back track. 10 years ago, who went to Ruth's Chris? The rich.
With the exception of the middle to upper middle class on a special occasion.
I would say this type of people are from 50-65.
They would dress a certain way.
They all kind of looked the same.
Now, rich is such a relative term. There are people that are rich that don't look it (ever read the Millionaire Next Door, it is a must read. But if you did read this book you would know that the vast majority of the rich do NOT eat at places like Ruth's Chris) and there are people that look rich that aren't.
They all dress different and they are all different ages.
Can you imagine 10 years ago walking into a Ruth's Chris being 25 years old wearing jeans and a t-shirt?
Well, this is what I saw while sitting there. These two plopped themselves next to us at the bar and ordered some red wine. Now when I was 25 the only bar I was plopping myself down at was the Purple Porpoise in Gainesville and I sure as hell wasn't ordering a MERLOT.
Now is this young person rich or is he using his parent's money? I guess Ruth's Chris doesn't care. I guess if it was my office I wouldn't care.
I read a statistic recently that said that 33% of all new Mercedes owners make less than $60,000 a year. WOW!!!
Lines are being crosses all over.
I have a neighbor that is days from bankruptcy, living in a real nice neighborhood (yes, if you are an avid reader, I have some screwed up neighbors. I fit right in don't you worry).
and she is driving a super sweet Lexus. Also the car is never unwashed. She is so upside down in everything she has. It is amazing how stupid people are.
I think about what a burden it is to drive an expensive car that you can't afford. Every time I see someone in an ESCALADE, my first thought is that car is that car nice. Then I think, man the person driving that car is cool. Then I think what it cost to drive that vehicle. I think that he or she could have two tricked out Expeditions for that price.
I am getting off the point.
Who is it that we are trying to get in our practice?
One quick story. There are a lot of professional golfers in Orlando. One of them was referred to my office. I had a patient that plays with this dude. My patient thought the two of us would get along because we were the same age, we are both diehard Gator fans.
He came in to get his teeth bleached. We talked like old pals, we had lots in common.
Now this guy at the time was in the top 10 on the money list. I think he made close to 5 million dollars that year.
I never saw him again. My friend told me a while later that he was a little chapped because I charged him.
$300 to a man that made $5,000,000.
On the flip side of this, I was seeing a man for a new patient exam. He was a huge grinder and he had ground his teeth down to bits. So I told him, "You need a lot of work and it is going to be very expensive (something like $40,000) to fix your teeth."
He said he would think about it and let me know. He drove away in his 12 year old Suburban.
I told myself, "Yeah, right".
He called in about 15 minutes and asked, "When can we start, I had to go home and find out how long it would take me to transfer money?"
Who are we trying to get to our office?
I have stopped trying to figure it out. I set up my practice in a way that I think people would like. I have set up my office in a way that if I was a patient I would like it.
I don't care if the people are rich. I don't care if they are well dressed. I don't care if they are 50-65 years old. I don't care who's money they use.
I just want them to appreciate what we are doing.
I want them to appreciate the staff.
I want them to want what we have to offer.
In the last week I have had two patients that were NOT rich getting work done. These are the kind of guys that are doing one filling a month because they can't afford to do the work all at once. But both of them on two separate occasions said to me, "I appreciate you."
Not "thank you" or "I appreciate it".
This is the stuff I work for, "I appreciate you" and they looked me in the eyes and shook my hand.
And I said,"It is my pleasure", because it really was.
Have a great day.
Talk to you on Wednesday,
john
If you are just joining us, we talked about different levels of dental offices.
Basically, I was taught there are 4 tiers. From the clinic setting (McDonald's) to the boutique practices (Ruth's Chris).
As a small business owner I think of my office constantly.
I think of my patients and what they want. I think of my staff and if we are giving the customer a product that they will pay for.
I would say my clientele is middle class to upper middle class, who appreciate good service and for the most part care about their teeth.
Now this is a pretty big box. I have families. I have singles. I have young married with no kids. I have empty nesters. I have elderly. I would say I have this great mix of people because that is who I like to treat. Black, white, Christian, Jewish, Muslim, American and non-American. So I try now to exclude anyone. If they can afford it they can come (and sometimes if they can't afford it they can come anyway).
But what I am trying to say is the lines of the tiers are getting crossed.
I have been thinking a lot about this. Ruth's Chris is the top tier restaurant (I know, I know I talk about Ruth's Chris a lot. It is my favorite restaurant. I go every chance I get. The sweet potato casserole is AMAZING. Steaks come out on a plate that is 500 degrees with butter melted on top of them. OH MY GOSH. I am getting sidetracked).
So if you are the manager of a Tier IV restaurant or dental practice you are trying to cater to the people that can afford what you offer.
But this is where the lines are getting crossed.
What do these people look like? For me, who is the middle to upper middle class? For the Tier IV guy, who is the upper class?
So a couple of months ago I went to Ruth's Chris with my periodontist. My wife and I got their a bit early and took a seat at the bar. I started to people watch. I noticed something strange about some of the clientele. They were every walk of life.
Lets back track. 10 years ago, who went to Ruth's Chris? The rich.
With the exception of the middle to upper middle class on a special occasion.
I would say this type of people are from 50-65.
They would dress a certain way.
They all kind of looked the same.
Now, rich is such a relative term. There are people that are rich that don't look it (ever read the Millionaire Next Door, it is a must read. But if you did read this book you would know that the vast majority of the rich do NOT eat at places like Ruth's Chris) and there are people that look rich that aren't.
They all dress different and they are all different ages.
Can you imagine 10 years ago walking into a Ruth's Chris being 25 years old wearing jeans and a t-shirt?
Well, this is what I saw while sitting there. These two plopped themselves next to us at the bar and ordered some red wine. Now when I was 25 the only bar I was plopping myself down at was the Purple Porpoise in Gainesville and I sure as hell wasn't ordering a MERLOT.
Now is this young person rich or is he using his parent's money? I guess Ruth's Chris doesn't care. I guess if it was my office I wouldn't care.
I read a statistic recently that said that 33% of all new Mercedes owners make less than $60,000 a year. WOW!!!
Lines are being crosses all over.
I have a neighbor that is days from bankruptcy, living in a real nice neighborhood (yes, if you are an avid reader, I have some screwed up neighbors. I fit right in don't you worry).
and she is driving a super sweet Lexus. Also the car is never unwashed. She is so upside down in everything she has. It is amazing how stupid people are.
I think about what a burden it is to drive an expensive car that you can't afford. Every time I see someone in an ESCALADE, my first thought is that car is that car nice. Then I think, man the person driving that car is cool. Then I think what it cost to drive that vehicle. I think that he or she could have two tricked out Expeditions for that price.
I am getting off the point.
Who is it that we are trying to get in our practice?
One quick story. There are a lot of professional golfers in Orlando. One of them was referred to my office. I had a patient that plays with this dude. My patient thought the two of us would get along because we were the same age, we are both diehard Gator fans.
He came in to get his teeth bleached. We talked like old pals, we had lots in common.
Now this guy at the time was in the top 10 on the money list. I think he made close to 5 million dollars that year.
I never saw him again. My friend told me a while later that he was a little chapped because I charged him.
$300 to a man that made $5,000,000.
On the flip side of this, I was seeing a man for a new patient exam. He was a huge grinder and he had ground his teeth down to bits. So I told him, "You need a lot of work and it is going to be very expensive (something like $40,000) to fix your teeth."
He said he would think about it and let me know. He drove away in his 12 year old Suburban.
I told myself, "Yeah, right".
He called in about 15 minutes and asked, "When can we start, I had to go home and find out how long it would take me to transfer money?"
Who are we trying to get to our office?
I have stopped trying to figure it out. I set up my practice in a way that I think people would like. I have set up my office in a way that if I was a patient I would like it.
I don't care if the people are rich. I don't care if they are well dressed. I don't care if they are 50-65 years old. I don't care who's money they use.
I just want them to appreciate what we are doing.
I want them to appreciate the staff.
I want them to want what we have to offer.
In the last week I have had two patients that were NOT rich getting work done. These are the kind of guys that are doing one filling a month because they can't afford to do the work all at once. But both of them on two separate occasions said to me, "I appreciate you."
Not "thank you" or "I appreciate it".
This is the stuff I work for, "I appreciate you" and they looked me in the eyes and shook my hand.
And I said,"It is my pleasure", because it really was.
Have a great day.
Talk to you on Wednesday,
john
Friday, May 9, 2008
Tier Dentistry
.
(This is what the patient sees when they walk into my office,
read on to see why this is relevant)
Thank you for the comments.
A man needs to feel loved sometimes.
I am sensitive, what can say.
Anyways, we have been talking about why someone would pay $40 dollars for a steak or $400 a night for a room.
And how someone can come to appreciate a great filling (that cost more).
The Pankey Institute explained it to me as Tier Dentistry (that means if this sucks or you don't understand it, blame it on the institute).
All the offices can be broken down into 4 tiers.
Let me explain.
Tier I
Is what we would refer to as a clinic. High volume of patients all for bottom basement prices.
This is the McDonald's of dental offices.
On the McDonald's sign it reads Billions and Billions served.
They aren't saying, "we have great beef". They are not saying, "Come get great service"
People understand they are not getting USDA beef or exquisite service, they are coming to eat.
Plain and simple they are eating and it is not at home.
The Tier I office might be a full HMO office. They get their patients from THE LIST. You know the list. They are every insurance list. They get the patients that are told by their insurance where they are to go.
This is a no frills office. There is not alot of character in this office. There isn't alot of service in this office. There isn't alot of relationship building.
But the patient is able to get care maybe for the first time. They are getting in the dentistry door. They are being introduced to dentistry.
They for the first time are addressing things they may not of ever known they needed addressing.
I am not saying anything bad about this office. It is what it is. It is serving people. Now to me as a higher tier dentist I am glad these people are in the door (because soon enough they may want more out of their dental care).
Tier II
I compare this to a Denny's. It is getting a little better. People sit down to eat. There is a menu. There is service.
The dental office is getting a little better. There maybe some character in the office. There may be a dentist that owns the place. Maybe the office has relationships with some a good lab. But maybe using products are good but not great. They maybe serving steak but it is still not USDA.
Patients are getting better care but may still be looking for something more.
Tier III
This office is a TGIFridays. Maybe a Bennigans.
The office has some character. The office has personality. They care about the plant (the way the office/restaurant looks and feels). The dentist does a lot of CE. The dentist is using a lab that is good. They are using specialists that are good.
There is good service. The team spends time talking about how to make things better.
The food they are serving is good to great. The steak is now USDA.
They care.
The issue with this tier is, to me, an identity problem. The problem can be from the dentist wanting to be an exclusive kind of dentist and/or the patient want a $40 steak for $25.
Tier IV
Is like a Ruth's Chris.
This place serves steak and they wouldn't dare serve just USDA.
This office is real nice. This office spends a lot of time on CE.
I would say it has patients that know they are in a Tier IV place and have some expectations (this also can be a problem. Patients with unattainable expectation). Great service, great plant, character.
Alot of "It would be my pleasure, sir."
And the patient comes in expecting to pay $40 for a $40 steak.
Tier IV is where I thought I wanted to be.
Don't think there aren't problems with every tier. In tier IV there is an issue with maintaining. If you are going to do comprehensive dentistry on EVERYONE then this is a really small niche of patients.
This is hard to maintain.
Now me, I am a Tier III dentist and I have a Tier III practice.
I do dabble in Tier IV dentistry but my home is III.
I don't want to be exclusive. I don't want to only treat a certain type of clientele. I want my place to be for everyone. I want to see families. I want to see CEO's and I want him or her to tell me about the newest acquisition of the company. I want to see Little Susie and I want her to tell me how she lost her first tooth. I want to see the college kid going to UCF and tell me about the latest keg party. I want to see people from my church.
I want to see people that say, "It is okay if I pay for that $11,000 treatment plan before we get started (and whip out cash). And I want to see the patient that can't afford me that still comes in (and I give them a discount). I want my patients to expect great service. I want my staff to say, "It was my pleasure".
So how do I do this.
But this is hard to do. I try to be everything to everyone and this is deadly combination.
I have the education to do a full mouth reconstruction and I have the education to do a pulpotomy on #B.
I have a office that we just renovated. We have two different areas in the reception area. One with a couch and fancy chairs for the uppity folks
(double click on the image and make it bigger) and the other side has a TV and some toys. 
I have the ability to serve the Tier IV patient that likes the atmosphere in our office.
I don't have a problem with any tier. Just like I wouldn't have a problem going into a McDonald's or a Denny's. But I know what I am getting there.
I also know that my expectations change when I am getting a Ruth's Chris steak. I would say to myself that my water glass has been empty for about 5 minutes and I am noticing it.
I am rambling again. I am going to stop here.
Now that I have explained to you the tiers I want to explain to you my thoughts.
I think things have changed. The client has changed. Has the dentist changed?
I will try to get into it next week.
I did go to a study club yesterday that a years worth of blogs information came out of it.
I want to write about it soon because I will forget about it, so look for that.
Have a great weekend,
It was 93 degrees here today.
It has rained once in about 3 months here.
We have been doing a rain dances.
Lots of swimming and dead grass.
Peace out,
john
(This is what the patient sees when they walk into my office,
read on to see why this is relevant)
Thank you for the comments.
A man needs to feel loved sometimes.
I am sensitive, what can say.
Anyways, we have been talking about why someone would pay $40 dollars for a steak or $400 a night for a room.
And how someone can come to appreciate a great filling (that cost more).
The Pankey Institute explained it to me as Tier Dentistry (that means if this sucks or you don't understand it, blame it on the institute).
All the offices can be broken down into 4 tiers.
Let me explain.
Tier I
Is what we would refer to as a clinic. High volume of patients all for bottom basement prices.
This is the McDonald's of dental offices.
On the McDonald's sign it reads Billions and Billions served.
They aren't saying, "we have great beef". They are not saying, "Come get great service"
People understand they are not getting USDA beef or exquisite service, they are coming to eat.
Plain and simple they are eating and it is not at home.
The Tier I office might be a full HMO office. They get their patients from THE LIST. You know the list. They are every insurance list. They get the patients that are told by their insurance where they are to go.
This is a no frills office. There is not alot of character in this office. There isn't alot of service in this office. There isn't alot of relationship building.
But the patient is able to get care maybe for the first time. They are getting in the dentistry door. They are being introduced to dentistry.
They for the first time are addressing things they may not of ever known they needed addressing.
I am not saying anything bad about this office. It is what it is. It is serving people. Now to me as a higher tier dentist I am glad these people are in the door (because soon enough they may want more out of their dental care).
Tier II
I compare this to a Denny's. It is getting a little better. People sit down to eat. There is a menu. There is service.
The dental office is getting a little better. There maybe some character in the office. There may be a dentist that owns the place. Maybe the office has relationships with some a good lab. But maybe using products are good but not great. They maybe serving steak but it is still not USDA.
Patients are getting better care but may still be looking for something more.
Tier III
This office is a TGIFridays. Maybe a Bennigans.
The office has some character. The office has personality. They care about the plant (the way the office/restaurant looks and feels). The dentist does a lot of CE. The dentist is using a lab that is good. They are using specialists that are good.
There is good service. The team spends time talking about how to make things better.
The food they are serving is good to great. The steak is now USDA.
They care.
The issue with this tier is, to me, an identity problem. The problem can be from the dentist wanting to be an exclusive kind of dentist and/or the patient want a $40 steak for $25.
Tier IV
Is like a Ruth's Chris.
This place serves steak and they wouldn't dare serve just USDA.
This office is real nice. This office spends a lot of time on CE.
I would say it has patients that know they are in a Tier IV place and have some expectations (this also can be a problem. Patients with unattainable expectation). Great service, great plant, character.
Alot of "It would be my pleasure, sir."
And the patient comes in expecting to pay $40 for a $40 steak.
Tier IV is where I thought I wanted to be.
Don't think there aren't problems with every tier. In tier IV there is an issue with maintaining. If you are going to do comprehensive dentistry on EVERYONE then this is a really small niche of patients.
This is hard to maintain.
Now me, I am a Tier III dentist and I have a Tier III practice.
I do dabble in Tier IV dentistry but my home is III.
I don't want to be exclusive. I don't want to only treat a certain type of clientele. I want my place to be for everyone. I want to see families. I want to see CEO's and I want him or her to tell me about the newest acquisition of the company. I want to see Little Susie and I want her to tell me how she lost her first tooth. I want to see the college kid going to UCF and tell me about the latest keg party. I want to see people from my church.
I want to see people that say, "It is okay if I pay for that $11,000 treatment plan before we get started (and whip out cash). And I want to see the patient that can't afford me that still comes in (and I give them a discount). I want my patients to expect great service. I want my staff to say, "It was my pleasure".
So how do I do this.
But this is hard to do. I try to be everything to everyone and this is deadly combination.
I have the education to do a full mouth reconstruction and I have the education to do a pulpotomy on #B.
I have a office that we just renovated. We have two different areas in the reception area. One with a couch and fancy chairs for the uppity folks
(double click on the image and make it bigger) and the other side has a TV and some toys. 
I have the ability to serve the Tier IV patient that likes the atmosphere in our office.
I don't have a problem with any tier. Just like I wouldn't have a problem going into a McDonald's or a Denny's. But I know what I am getting there.
I also know that my expectations change when I am getting a Ruth's Chris steak. I would say to myself that my water glass has been empty for about 5 minutes and I am noticing it.
I am rambling again. I am going to stop here.
Now that I have explained to you the tiers I want to explain to you my thoughts.
I think things have changed. The client has changed. Has the dentist changed?
I will try to get into it next week.
I did go to a study club yesterday that a years worth of blogs information came out of it.
I want to write about it soon because I will forget about it, so look for that.
Have a great weekend,
It was 93 degrees here today.
It has rained once in about 3 months here.
We have been doing a rain dances.
Lots of swimming and dead grass.
Peace out,
john
Tuesday, May 6, 2008
Pride and Trust
Monday we were talking about Pride and what it means to you.
First, I saw the movie 21 and it was not very good. I read the book Bringing Down the House and it was much better. I give it a 4 out of 10.
I am a big Netflix guy and I watched one of the worst movies I have ever seen this weekend. It was called "Shoot'em up" with Clive Owen. I give it a -2 on a 0-10 scale.
Back to teeth.
On Monday I was saying that when I do a work that is better than average then I have no problems charging a fee that is more than average.
Only one problem, the patient doesn't know what is better than average work is.
If I do a filling and Joe Smoe does a filling. How does the patient know that mine is better?
They don't.
I, for instance, start this filling 10 years ago by taking tons of continuing education to know how to do this filling properly.
I have the best x-ray system to diagnose the decay better.
I have researched the best materials.
Then I buy and use the best materials.
I have a facility that is comfortable.
I have a staff that is trained to do this procedure better.
I use all the best tools.
I try to do the best filling I know how to.
Then I make myself available to them if there is ever a problem.
So what does the patient perceive as a good filling?
They may perceive a friendly staff. The may perceive a nice facility. They definitely perceive a good injection. They perceive comfort during the procedure and then they perceive comfort after.
And they perceive THE PRICE.
They don't understand materials. They don't understand technique. They don't recognize if someone takes off too much tooth structure. They don't understand why something would last longer by doing it better.
Did I mention they do understand price.
How many calls do we get.... How much do you charge for a crown? How much do you charge for a cleaning?
Cleaning that is a whole different blog. The patient doesn't know what a cleaning is. (I know you are not suppose to end a sentence with "is" but if the AGD wanted a Pulitzer Prize author, this dude would not be considered) So many of my patients come from a clinic setting practice that they were getting a free 20 minute cleanings.
This stuff drives me crazy. I work my ass off trying to be the best dentist I can be hiring the best people I can (hygienists) and they are getting away with this.
Then they tell the patient that they need a "deep cleaning" and they are going to have to pay for that.
So I ask if the dentist did a perio exam.
They say, "What do you mean?"
Did they take this probe and measure the depth of your gum pockets?
"Doc, I have no idea what you are talking about"
YEAH RIGHT, they NEED a deep cleaning. Don't get me started.
This is an idea of another blog. What clinics offer guys like and you? I think they have benefit to us and I will explain this soon.
Anyway, back to perception.
I think of ourselves a little like auto mechanics. Its a cash business and people have no idea what they are spending their money on. And, oh yeah it has to be done. This lends to huge trust factor.
It is funny when I bring my car in to the shop. The guy will tell me you have some carbon build up in your something and we need to do something with a something and then you a problem with the blah blah blah blah blah and blah blah blah $750. (See what I mean about the price.)
I say, "Well, Mike you have been my mechanic for years, I have no idea what you are talking about, no I don't want to see a picture of the carbon build up, so go ahead and do it. "
One time he actually showed me a photo of the carbon build up. I had no idea what I was looking at and if that was even my car. He was trying to inform me and educate me but...
I know, I know we are not like auto mechanics but it really comes down to trust.
Back to the perio thing a minute. In all my New Patient Exams I put my patients in our consultation room and we just talk. We start a relationship (as much as you can get in 15 minutes) and one of the things I talk about is gum disease. I explain to them that I am going to be doing a thorough gum exam. I explain this is what the gum disease looks like and this is how I examine for it.
It is like taking a intraoral photo of decay. This is taking the trust out of it (not that having trust in your care giver is bad) but you are involving them in the decision about them.
Then they know that if they have a bunch of 6mm pockets, they now know what that means. They understand what it means if they don't do anything and they understand why they need "deep cleanings". Then they know that after their deep cleanings they want those 6mm to become 3mm or less.
Back to fillings.
I suppose explaining is again key. But I am not going to spend half my day talking to people about what a filling is and how we do it. I am not going to go over what a good one looks like and what it means to use the best materials.
So it is going to have to come down to trust.
So if they come with a little trust in the office we all are a little better off. You know what I am saying...If they are referred to our office by someone the trust has started.
Imagine the conversation over some beers at your patients house. "If you are having that much trouble with your dentist, you should try mine. They are the best. All the stuff they have done for me has been great. And he is good looking to boot."
So they come in with some pre-conceived trust.
So we try at our office to have an internal marketing strategy. We do a terrible job at it but...
We try to send thank you letters to referrers. We try to send movie tickets. Dinner gift certificates, T-shirts...stuff like this (I have been try to get everyone on board to just send a $20 bill in the mail. I would love to get $20 in the mail, it would make me pay attention).
Have I answered my own question? Have we figured out what is going to make someone pay $50 more for my filling?
Well, why would someone pay $450 for a room at the Ritz when the Hilton down the road is $200 a night.
Why would someone pay $40 for a steak at Ruth's Chris when the Outback has a $18 Outback special (and it comes with a salad)?
Are the beds that much better at the Ritz? Is the meat that much better at Ruth's Chris?
Lets stop here.
Well, today I have been all over the board.
I am talking about fillings, then perio, then auto mechanics. Then I talk about internal marketing, then hotels.
Needless to say I don't have all the answers, so I babble.
I am going to take some of these and talk about them individually and maybe we can come up with something together.
If you have some clarity, please comment.
Talk to you Friday,
john
PS. Are you still reading?
Are you enjoying this stuff?
Have any ideas on topics?
Let me know by commenting or emailing me. Jgammichia@aol.com
First, I saw the movie 21 and it was not very good. I read the book Bringing Down the House and it was much better. I give it a 4 out of 10.
I am a big Netflix guy and I watched one of the worst movies I have ever seen this weekend. It was called "Shoot'em up" with Clive Owen. I give it a -2 on a 0-10 scale.
Back to teeth.
On Monday I was saying that when I do a work that is better than average then I have no problems charging a fee that is more than average.
Only one problem, the patient doesn't know what is better than average work is.
If I do a filling and Joe Smoe does a filling. How does the patient know that mine is better?
They don't.
I, for instance, start this filling 10 years ago by taking tons of continuing education to know how to do this filling properly.
I have the best x-ray system to diagnose the decay better.
I have researched the best materials.
Then I buy and use the best materials.
I have a facility that is comfortable.
I have a staff that is trained to do this procedure better.
I use all the best tools.
I try to do the best filling I know how to.
Then I make myself available to them if there is ever a problem.
So what does the patient perceive as a good filling?
They may perceive a friendly staff. The may perceive a nice facility. They definitely perceive a good injection. They perceive comfort during the procedure and then they perceive comfort after.
And they perceive THE PRICE.
They don't understand materials. They don't understand technique. They don't recognize if someone takes off too much tooth structure. They don't understand why something would last longer by doing it better.
Did I mention they do understand price.
How many calls do we get.... How much do you charge for a crown? How much do you charge for a cleaning?
Cleaning that is a whole different blog. The patient doesn't know what a cleaning is. (I know you are not suppose to end a sentence with "is" but if the AGD wanted a Pulitzer Prize author, this dude would not be considered) So many of my patients come from a clinic setting practice that they were getting a free 20 minute cleanings.
This stuff drives me crazy. I work my ass off trying to be the best dentist I can be hiring the best people I can (hygienists) and they are getting away with this.
Then they tell the patient that they need a "deep cleaning" and they are going to have to pay for that.
So I ask if the dentist did a perio exam.
They say, "What do you mean?"
Did they take this probe and measure the depth of your gum pockets?
"Doc, I have no idea what you are talking about"
YEAH RIGHT, they NEED a deep cleaning. Don't get me started.
This is an idea of another blog. What clinics offer guys like and you? I think they have benefit to us and I will explain this soon.
Anyway, back to perception.
I think of ourselves a little like auto mechanics. Its a cash business and people have no idea what they are spending their money on. And, oh yeah it has to be done. This lends to huge trust factor.
It is funny when I bring my car in to the shop. The guy will tell me you have some carbon build up in your something and we need to do something with a something and then you a problem with the blah blah blah blah blah and blah blah blah $750. (See what I mean about the price.)
I say, "Well, Mike you have been my mechanic for years, I have no idea what you are talking about, no I don't want to see a picture of the carbon build up, so go ahead and do it. "
One time he actually showed me a photo of the carbon build up. I had no idea what I was looking at and if that was even my car. He was trying to inform me and educate me but...
I know, I know we are not like auto mechanics but it really comes down to trust.
Back to the perio thing a minute. In all my New Patient Exams I put my patients in our consultation room and we just talk. We start a relationship (as much as you can get in 15 minutes) and one of the things I talk about is gum disease. I explain to them that I am going to be doing a thorough gum exam. I explain this is what the gum disease looks like and this is how I examine for it.
It is like taking a intraoral photo of decay. This is taking the trust out of it (not that having trust in your care giver is bad) but you are involving them in the decision about them.
Then they know that if they have a bunch of 6mm pockets, they now know what that means. They understand what it means if they don't do anything and they understand why they need "deep cleanings". Then they know that after their deep cleanings they want those 6mm to become 3mm or less.
Back to fillings.
I suppose explaining is again key. But I am not going to spend half my day talking to people about what a filling is and how we do it. I am not going to go over what a good one looks like and what it means to use the best materials.
So it is going to have to come down to trust.
So if they come with a little trust in the office we all are a little better off. You know what I am saying...If they are referred to our office by someone the trust has started.
Imagine the conversation over some beers at your patients house. "If you are having that much trouble with your dentist, you should try mine. They are the best. All the stuff they have done for me has been great. And he is good looking to boot."
So they come in with some pre-conceived trust.
So we try at our office to have an internal marketing strategy. We do a terrible job at it but...
We try to send thank you letters to referrers. We try to send movie tickets. Dinner gift certificates, T-shirts...stuff like this (I have been try to get everyone on board to just send a $20 bill in the mail. I would love to get $20 in the mail, it would make me pay attention).
Have I answered my own question? Have we figured out what is going to make someone pay $50 more for my filling?
Well, why would someone pay $450 for a room at the Ritz when the Hilton down the road is $200 a night.
Why would someone pay $40 for a steak at Ruth's Chris when the Outback has a $18 Outback special (and it comes with a salad)?
Are the beds that much better at the Ritz? Is the meat that much better at Ruth's Chris?
Lets stop here.
Well, today I have been all over the board.
I am talking about fillings, then perio, then auto mechanics. Then I talk about internal marketing, then hotels.
Needless to say I don't have all the answers, so I babble.
I am going to take some of these and talk about them individually and maybe we can come up with something together.
If you have some clarity, please comment.
Talk to you Friday,
john
PS. Are you still reading?
Are you enjoying this stuff?
Have any ideas on topics?
Let me know by commenting or emailing me. Jgammichia@aol.com
Monday, May 5, 2008
Pride
I was a senior at the University of Florida (undergrad) and I had already been accepted to dental school, so I did what everyone does, I signed up for a blow off class. Ceramics.
Unbeknownst to me this was NOT a blow off class. These people take pottery very seriously.
I was in the ceramics lab more than I was studying for all my other classes and still pulling a low C.
But this is not what the blog is about. One night, I started home about 2am after working late on my final exam. I was taking a short cut through the higher level ceramics lab (instead of ashtrays, they are making dinnerware) when I came upon a trash can.
In this trash can was a very cool set of mugs (they might have been chalices but to a college student every thing that hold a liquid is a beer mug) and a matching pitcher.
I thought to myself, “Self, you have just scored some awesome fine china (if it is not plastic it is fine china)”.
So I started to dig into the trash can and gathering up my booty. When out from the senior ceramics lab came some dude screaming, “You can’t take that.”
I said, “The heck I can’t. It is in the trashcan and I am going to take it”
What he said has will affect the rest of my life.
He said, “What I meant was, I wish you would not take that stuff. You see I am the artist that made those. It is a big deal to me that they are not out in the world. If you turn those things over you will see that I have signed all of the “mugs” and the pitcher. (I indeed turned them over and saw his signature).
He continued, “I was not happy with the way they turned out and I wanted to throw them out. You see when I sign something, it has my name on it I want it to be good. Now people will associate the product with the maker. I don’t want people associating this product with me. Hence the trashcan.”
He said, “I will tell you what, I will trade you. I have some other stuff and if you give me the crappy ones I will GIVE you these that I really like.”
I thought the guy was totally off his rocker at the time. And at the time all I cared about was getting free fine china. So I made the trade.
I got the china but it was the lesson I learned from him that was the real jewel.
This guy was so adamant about not having work, that he was not proud of, out in the world. So much so that he would basically pay me not to take it.
So this is the motto I live by in my practice. Every thing that goes out of my office has my signature on it. Trust me this is not as easy as it sounds. It means redoing stuff. I means working harder on benign procedures.
And I try to make my staff feel the same way. Meaning, everything that THEY do has MY signature on it.
From sealants to bridges I make sure things are good (more like great) when they leave. I know I have talked about this before but I feel this strongly about this.
Imagine you are doing a root canal and you have a couple extra minutes in your schedule. So you go ahead and do the build-up. You tell the patient that you will bring them back for the crown next week
You throw something on there knowing they are coming back in a week.
Anyone ever used the thumb print method of build-ups.
What if you do a sloppy job on this build-up and they don’t come back?
This is what haunts me. I do something sloppy and they don’t come back.
So in order to not have this problem, I micro manage everything that goes out of here.
This is not always good either. My assistant says I am going to have an early heart attack because of it.
But I think better to be known as a perfectionist and die early than a slouch and be around for awhile.
Here is a build-up I did
.
How about kids teeth. Do you say, "Well they are going to come out in four years anyway."
NO WAY. Same thing.
Here is a quadrant on a kid. I did a sealant on the molar. I did a pulp and a big filling on the 2nd molar and a DO on the first molar.
Don't forget you can double click on the picture and it will go to life size.
Do you think this is easy? No.
Do you think this takes a lot of work? Yes.
Now you can take this to crowns and implants and bridges.
Well I think this work is above average so I charge above average prices.
I am going to pick this topic up, starting at pricing, on Wednesday.
I want to show you more photos too.
Hope you are having a great Monday.
I am going to see the movie 21 today.
I let you know how it is.
john
Unbeknownst to me this was NOT a blow off class. These people take pottery very seriously.
I was in the ceramics lab more than I was studying for all my other classes and still pulling a low C.
But this is not what the blog is about. One night, I started home about 2am after working late on my final exam. I was taking a short cut through the higher level ceramics lab (instead of ashtrays, they are making dinnerware) when I came upon a trash can.
In this trash can was a very cool set of mugs (they might have been chalices but to a college student every thing that hold a liquid is a beer mug) and a matching pitcher.
I thought to myself, “Self, you have just scored some awesome fine china (if it is not plastic it is fine china)”.
So I started to dig into the trash can and gathering up my booty. When out from the senior ceramics lab came some dude screaming, “You can’t take that.”
I said, “The heck I can’t. It is in the trashcan and I am going to take it”
What he said has will affect the rest of my life.
He said, “What I meant was, I wish you would not take that stuff. You see I am the artist that made those. It is a big deal to me that they are not out in the world. If you turn those things over you will see that I have signed all of the “mugs” and the pitcher. (I indeed turned them over and saw his signature).
He continued, “I was not happy with the way they turned out and I wanted to throw them out. You see when I sign something, it has my name on it I want it to be good. Now people will associate the product with the maker. I don’t want people associating this product with me. Hence the trashcan.”
He said, “I will tell you what, I will trade you. I have some other stuff and if you give me the crappy ones I will GIVE you these that I really like.”
I thought the guy was totally off his rocker at the time. And at the time all I cared about was getting free fine china. So I made the trade.
I got the china but it was the lesson I learned from him that was the real jewel.
This guy was so adamant about not having work, that he was not proud of, out in the world. So much so that he would basically pay me not to take it.
So this is the motto I live by in my practice. Every thing that goes out of my office has my signature on it. Trust me this is not as easy as it sounds. It means redoing stuff. I means working harder on benign procedures.
And I try to make my staff feel the same way. Meaning, everything that THEY do has MY signature on it.
From sealants to bridges I make sure things are good (more like great) when they leave. I know I have talked about this before but I feel this strongly about this.
Imagine you are doing a root canal and you have a couple extra minutes in your schedule. So you go ahead and do the build-up. You tell the patient that you will bring them back for the crown next week
You throw something on there knowing they are coming back in a week.
Anyone ever used the thumb print method of build-ups.
What if you do a sloppy job on this build-up and they don’t come back?
This is what haunts me. I do something sloppy and they don’t come back.
So in order to not have this problem, I micro manage everything that goes out of here.
This is not always good either. My assistant says I am going to have an early heart attack because of it.
But I think better to be known as a perfectionist and die early than a slouch and be around for awhile.
Here is a build-up I did
.
How about kids teeth. Do you say, "Well they are going to come out in four years anyway."
NO WAY. Same thing.
Here is a quadrant on a kid. I did a sealant on the molar. I did a pulp and a big filling on the 2nd molar and a DO on the first molar.
Don't forget you can double click on the picture and it will go to life size.
Do you think this is easy? No.
Do you think this takes a lot of work? Yes.
Now you can take this to crowns and implants and bridges.
Well I think this work is above average so I charge above average prices.
I am going to pick this topic up, starting at pricing, on Wednesday.
I want to show you more photos too.
Hope you are having a great Monday.
I am going to see the movie 21 today.
I let you know how it is.
john
Friday, May 2, 2008
The associate
I told you all me associate starts on Monday.
I want to tell you the story about the whole thing.
My dad is almost 64 years old. About a year ago I started talking to him about what he is thinking about doing about the big "R" word.
This is a great time for us, because we really are getting along great. He is loving practicing but sees that he has a lot of interests other than dentistry and realizes now that he has the money to take off whenever he wants.
But also this is a great time to bring someone else in.
We have the luxury of doing this on our time schedule.
So I asked him, "how much longer do you need to practice (moneywise)?" He said about 3 years.
I said, "Well, why don't we start looking for an associate now. I think it will take a long time to find one. And when we do find one it may take a long time to get him (I will tell you about the HIM thing later) going."
I told my supply rep. to spread the word that we were looking for someone.
I put an add in the local dental society newsletter.
It said something to this effect...
Father and son practice looking for an associate. The practice is fully digital and excited about the opportunity to have someone join our family.
We work in a great community and have a great staff. In anyone is looking for a place to call home and become part of this practice and community and is looking for a career not a job, please call John blah, blah, blah.
I thought I would lay it on the line with the ad. I wanted people to know what they were getting into.
I can say that my ideal was something like this. I didn't want a new grad but I wanted someone younger than me. Not that I don't love new grads and there spunk. I remember how hard it was coming right out of school and how little I knew about real life dentistry. For some reason I thought it would be a male. I always thought my partner would love sports and I would come to work and we would talk about the game. We would talk about our next trip to whatever sporting event.
I hope this doesn't sound like I am being a sexist because I am not. I just had this mindset. I go to study clubs and me and the dudes (in the study club it is 8 to 1 guy to girl) talk about teeth and the latest game and what games so and so went to. We talk about stats and stuff like that.
I thought coming to work with an associate would be more of the same.
So the resumes started to come in. Dental students, residence, associates, displaced dentists. All women and NO men.
I interviewed about 11 women and zero men.
I thought about this alot. Why no men?
Do they not want to partner with two other dudes? Are they opening up there own places more than woman?
Do women appreciate associateships more than men?
Do they want to be with other dentists so they can have a family and still have a place to work?
I don't know the answers but I didn't dare ask one of them.
I did have two guys that I knew in town that I talked to about it.
One guy is a big Gator fan and is real unhappy with his associateship, he came by just to see how the magic happens here and we talked for a little bit. Then I never heard from him again. (I guess there was not much magic).
The other guy goes to my church. He is also unhappy in his present situation. We did a lot of talking and he says that my office was too far for him (10 miles from his house. I hear my BS meter going off).
That was it for the men.
So I started to change my mindset. What would it be like working with a woman?
I never really thought about it, but it was becoming more and more evident that it was going to be a woman. I started to warm up to it (it not her...that is how rumors get started).
Also, my staff is convinced that some mothers would prefer a woman dentist for their kids. And some people would prefer to have a woman dentist for themselves (I guess I could agree with them. If that is true, good. Then my patients will have that choice. Old, young, girl or boy).
The way I handled the resumes was, the people that said they were interested I first talked to them on the phone. I kind of felt them out for the kind of thing they were looking for.
Then if I enjoyed talking to them on the phone I would ask them for their email address. I had about 40 questions that I emailed to them and told them I wanted them to think about before we talked in person.
They were questions that were going to tell them about our practice and get them thinking outside the box a bit.
Like, How would you classify your management style?
What part of school did you love? (I was thinking if they loved the first two years of school and didn't like the second two, then we are not going to jive).
I asked them if they are passionate about dentistry.
What do they love and hate about dentistry?
How do you deal with conflict?
Things like this.
I interviewed at my office about 8 people.
To say the least I was very impressed. The problem I was having was they are very smart. I don't know if you have got this by now that I am not an intellectual. I am relationship kind of guy. I am a tooth kind of guy not a sum cum laude kind of guy. YouknowwhatIsayin?
Can my associate be smarter than me? I guess they are going to have to be.
As an aside, I was telling my wife about the process. When I told her they were all woman her ears poked up. What do you mean they are all women? Honey I don't know, they are the only ones that are responding to the ad.
As you can imagine my wife would rather me not spend alone time with another woman. I mean she realizes as a partner there might be many times that me and this dentist would have to spend a bunch of time together after work and stuff like that.
I have always been cautious of spending alone time with woman, other than my wife.
But at the office it is almost impossible. I stay after hours to do my work. So does some of my staff. Then all but one goes home. Then it is me and her for 20 minutes or so.
I always thought that the less you put yourself in bad situations the better.
Back to the search...
I narrowed it down to two.
Now up until then my father wasn't involved. So I told him, I have the top two and now I want him to get involved.
So we were going to have both candidates to our house for dinner with everyone"s spouse (at different times. Can you say CAT FIGHT?)
They were both super. But one stood out.
It was time to pull the trigger.
I mean to me, this is a big deal. I don't like change and this is a BIG change.
I called her and we made a start date.
By the way, my wife really like her as well. She was impressed by her and the way she carried herself. I guess it is a woman thing...I wouldn't understand.
Now, we have an associate. What the hell do we do now?
We have a practice that is doing well. We do not have a practice that is bursting at the seems.
I am very busy. We live in a town that is really growing. They are putting in commerce all over the place. For instance, there is a Home Depot 200 yards down the street and they are building a Lowes across the street from Home Depot.
There is a neighborhood across the street from us that has 600 homes in it. The neighborhood our practice is in front of has over 2000 homes in it. There is only two dentists on this side of town and we are one of them.
But we don't market ourselves. I don't have time. I haven't even been to a school in 8 years.
There are probably 10 elementary schools within a five mile radius of our office.
My thought process is that she starts at 2 days a week (she has another gig three days a week). My thought process is that I will give her all the new kids.
Now if she could build like I did it would look like this. See the kids and do a great job. The kids have parents and grandparents. The parents have neighbors and the parents have bosses and colleagues. And so on and so on.
So she has a couple of things on the books but really what I have her doing is going to a bunch of schools. This is the last month of school so I say hit them hard now and have a real busy summer.
You know, just getting yourself out there. Letting people know you exist.
Maybe Rotary, maybe Chamber of Commerce.
Junior League, stuff like this.
I thought about getting a website.
Stuff like this.
Just something going on in my life that I thought you should know about.
I could tell you all the ins and outs (like the other job she has is 5 miles away and she hasn't told her present boss about me or that she lives about 700 yards from our practice).
but it would really be way too long.
Have a great weekend,
I don't know about you but in Florida we are in our pool everyday.
Be jealous, be very jealous.
john
I want to tell you the story about the whole thing.
My dad is almost 64 years old. About a year ago I started talking to him about what he is thinking about doing about the big "R" word.
This is a great time for us, because we really are getting along great. He is loving practicing but sees that he has a lot of interests other than dentistry and realizes now that he has the money to take off whenever he wants.
But also this is a great time to bring someone else in.
We have the luxury of doing this on our time schedule.
So I asked him, "how much longer do you need to practice (moneywise)?" He said about 3 years.
I said, "Well, why don't we start looking for an associate now. I think it will take a long time to find one. And when we do find one it may take a long time to get him (I will tell you about the HIM thing later) going."
I told my supply rep. to spread the word that we were looking for someone.
I put an add in the local dental society newsletter.
It said something to this effect...
Father and son practice looking for an associate. The practice is fully digital and excited about the opportunity to have someone join our family.
We work in a great community and have a great staff. In anyone is looking for a place to call home and become part of this practice and community and is looking for a career not a job, please call John blah, blah, blah.
I thought I would lay it on the line with the ad. I wanted people to know what they were getting into.
I can say that my ideal was something like this. I didn't want a new grad but I wanted someone younger than me. Not that I don't love new grads and there spunk. I remember how hard it was coming right out of school and how little I knew about real life dentistry. For some reason I thought it would be a male. I always thought my partner would love sports and I would come to work and we would talk about the game. We would talk about our next trip to whatever sporting event.
I hope this doesn't sound like I am being a sexist because I am not. I just had this mindset. I go to study clubs and me and the dudes (in the study club it is 8 to 1 guy to girl) talk about teeth and the latest game and what games so and so went to. We talk about stats and stuff like that.
I thought coming to work with an associate would be more of the same.
So the resumes started to come in. Dental students, residence, associates, displaced dentists. All women and NO men.
I interviewed about 11 women and zero men.
I thought about this alot. Why no men?
Do they not want to partner with two other dudes? Are they opening up there own places more than woman?
Do women appreciate associateships more than men?
Do they want to be with other dentists so they can have a family and still have a place to work?
I don't know the answers but I didn't dare ask one of them.
I did have two guys that I knew in town that I talked to about it.
One guy is a big Gator fan and is real unhappy with his associateship, he came by just to see how the magic happens here and we talked for a little bit. Then I never heard from him again. (I guess there was not much magic).
The other guy goes to my church. He is also unhappy in his present situation. We did a lot of talking and he says that my office was too far for him (10 miles from his house. I hear my BS meter going off).
That was it for the men.
So I started to change my mindset. What would it be like working with a woman?
I never really thought about it, but it was becoming more and more evident that it was going to be a woman. I started to warm up to it (it not her...that is how rumors get started).
Also, my staff is convinced that some mothers would prefer a woman dentist for their kids. And some people would prefer to have a woman dentist for themselves (I guess I could agree with them. If that is true, good. Then my patients will have that choice. Old, young, girl or boy).
The way I handled the resumes was, the people that said they were interested I first talked to them on the phone. I kind of felt them out for the kind of thing they were looking for.
Then if I enjoyed talking to them on the phone I would ask them for their email address. I had about 40 questions that I emailed to them and told them I wanted them to think about before we talked in person.
They were questions that were going to tell them about our practice and get them thinking outside the box a bit.
Like, How would you classify your management style?
What part of school did you love? (I was thinking if they loved the first two years of school and didn't like the second two, then we are not going to jive).
I asked them if they are passionate about dentistry.
What do they love and hate about dentistry?
How do you deal with conflict?
Things like this.
I interviewed at my office about 8 people.
To say the least I was very impressed. The problem I was having was they are very smart. I don't know if you have got this by now that I am not an intellectual. I am relationship kind of guy. I am a tooth kind of guy not a sum cum laude kind of guy. YouknowwhatIsayin?
Can my associate be smarter than me? I guess they are going to have to be.
As an aside, I was telling my wife about the process. When I told her they were all woman her ears poked up. What do you mean they are all women? Honey I don't know, they are the only ones that are responding to the ad.
As you can imagine my wife would rather me not spend alone time with another woman. I mean she realizes as a partner there might be many times that me and this dentist would have to spend a bunch of time together after work and stuff like that.
I have always been cautious of spending alone time with woman, other than my wife.
But at the office it is almost impossible. I stay after hours to do my work. So does some of my staff. Then all but one goes home. Then it is me and her for 20 minutes or so.
I always thought that the less you put yourself in bad situations the better.
Back to the search...
I narrowed it down to two.
Now up until then my father wasn't involved. So I told him, I have the top two and now I want him to get involved.
So we were going to have both candidates to our house for dinner with everyone"s spouse (at different times. Can you say CAT FIGHT?)
They were both super. But one stood out.
It was time to pull the trigger.
I mean to me, this is a big deal. I don't like change and this is a BIG change.
I called her and we made a start date.
By the way, my wife really like her as well. She was impressed by her and the way she carried herself. I guess it is a woman thing...I wouldn't understand.
Now, we have an associate. What the hell do we do now?
We have a practice that is doing well. We do not have a practice that is bursting at the seems.
I am very busy. We live in a town that is really growing. They are putting in commerce all over the place. For instance, there is a Home Depot 200 yards down the street and they are building a Lowes across the street from Home Depot.
There is a neighborhood across the street from us that has 600 homes in it. The neighborhood our practice is in front of has over 2000 homes in it. There is only two dentists on this side of town and we are one of them.
But we don't market ourselves. I don't have time. I haven't even been to a school in 8 years.
There are probably 10 elementary schools within a five mile radius of our office.
My thought process is that she starts at 2 days a week (she has another gig three days a week). My thought process is that I will give her all the new kids.
Now if she could build like I did it would look like this. See the kids and do a great job. The kids have parents and grandparents. The parents have neighbors and the parents have bosses and colleagues. And so on and so on.
So she has a couple of things on the books but really what I have her doing is going to a bunch of schools. This is the last month of school so I say hit them hard now and have a real busy summer.
You know, just getting yourself out there. Letting people know you exist.
Maybe Rotary, maybe Chamber of Commerce.
Junior League, stuff like this.
I thought about getting a website.
Stuff like this.
Just something going on in my life that I thought you should know about.
I could tell you all the ins and outs (like the other job she has is 5 miles away and she hasn't told her present boss about me or that she lives about 700 yards from our practice).
but it would really be way too long.
Have a great weekend,
I don't know about you but in Florida we are in our pool everyday.
Be jealous, be very jealous.
john