Friday, February 26, 2010

Thinking of the Future

Hey guys.
The week....its over.
Most of you by the time you read this will be done with work.
And the week will be over. Take a deep breath, relax, and read.
Speaking of reading, my birthday was last week and my wife bought me (or as the bread winner in the family says, "I bought me") an Amazon Kindle.
This is basically an ipod for books. Now instead of buying a book and then reading it, the new thing now is to download the book (I think it costs about $6 a book) and you download it.
The technology on this thing is INK. They try to make what you are reading exactly like reading a book.
I think this is the way things are going. I mean think of what this means. If you could download could also download magazines, text books, newspapers.
It is about the size of a medium sized paper back book and about half the width.
My sister bought me a gift certificate to Amazon for my birthday. So when I am done with my present printed book (how old fashion) I will buy my first virtual book.
I will let you know how it goes.
Oh and the thing hold up to like 300 books. I am sure next year it will hold 30,000.

Okay Noah had his first T-ball game and he was awarded the game ball. I told you.
The kid has got some skills.
Luke turned in his science project yesterday. I think I got (I mean Luke got) an "A".
I think all the parents are going drinking tonight.

Madison is in the regional spelling bee today.
She is the kind of girl that is tough on herself. You know the one that always says, "I am going to lose." I use to think that she knew she was smart and was just looking for attention. But how many times can you tell her that she is smart. It is not that I am worried, this is just something that I am keeping an eye on.

Okay enough about me....
How is the practice going? I don't know about mine. We have had a good (not great) couple of months. I don't want to get all excited because we just had a meeting with our financial adviser and we went over last years numbers. Not so good.
I will tell you later about how the numbers added up (can you say subtracted up).
I wanted to tell you about the my future.
If you didn't read Wednesday's blog, here the Reader's Digest version.
Two dentist practice. One dentist is going to retire in about 3 years.
I have been in kahoots with a dental student about coming in and being my associate/partner.
Now I am thinking about how this is going to go. I want to start planning.
I know that some of my father's patients will leave after he retires. But I don't think this number will be huge, say like if a new guy came in and bought another guys office.
Let me give a bit of background on our practice. My father has been working two and half to three days a week for about three years now. I have been really trying to move in on his patients. More so than I ever had. On the days that he isn't working, it could be vacation, it could be sick days or just a day that he isn't here and I am. When his patients are getting their teeth cleaned and they need an exam, this is my chance to get them comfortable with me.
I come in and joke around. I come in and really turn on the charm.
Because I might only get a couple more chances to be face to face with them before my dad might not be here anymore.
I am not saying I want him out of here because I really don't. First, I love working with him.
But two, if he stays then those patients that like him and him only will not leave our practice.
But more and more his patients are being put in front of me. If it because they can only come in on a day that he is not here or if they need something say on an emergency and I am the only one here. They get to think see that they are still in good hands even after the old guy leaves.

Now just brainstorming one day I let my mind wander. There is a dentist about a mile and a half away from our office. Now this is not a short mile and a half. He might as well be in another state because I never see him. I never hear about him, I never see any of his patients that are disgruntled. I have been in Apopka for almost 15 years and I have seen him twice.
Once to welcome me here and at a study club meeting one time.

He is a guy that kind of flies under the radar. He has been in the same location for 30 years.
I didn't know much about his office or what he has got going on over there. I don't know much about him but I do know he is a family guy and a very nice guy.
So one day I called him up and asked if he would talk to me.
Remember I don't know anything, but I wanted to find out.

So I went to his office. It is a weird experience. I know him, he knows me but....
I was greeted at the front desk and he came out immediately and took me to his office.
And we just talked. He is a big Gator fan and we talked about sports for a bit.
Then I we talked about the economy and the state of dentistry for a bit.
We talked about our mutual respect for each other.
We talked about our families. This was all about me finding out information about where he was at.
This is what I found out. He is 56 years old.
He has been in this one location for 30 years.
He has two daughters and one is married and one is engaged.
And he has been married to the same wife for about 33 years.
Oh and his wife is his receptionist.

I asked him to show me around the office.
If he had 900 I would be surprised. He has 2 dental operatories and one hygiene room.
And a small sterilization room. That was it.

I just told him about my situation. I told him about my father. I told him about Drew.
I told him that at my office I am looking at 4 open operatories 3 days a week.
I told him that those rooms could be his.
I told him then everything would be cheaper.
I said we could maybe have a lab tech in our office. Things would be consolidated.
My thought process was that we would work together and after a couple of years, maybe 5, I would buy him out. Or I would let him work at my office rent free and then I would assume his patients (and a little cash).
I didn't tell him that because I didn't want it to sound like a hostile take over.

At the end of the day it didn't sound like he wanted to make any moves and I didn't think he was going to jump and say, "What an awesome idea, lets do it."
I did however want to plant a seed and I think I did that.
He said, "That is something to think about."
See progress.

Man the future looks good, but right now I am such a hard time seeing into my crystal ball.
I am writing this blog under duress. I have to be at my, I mean, Luke's award ceremony in about 5 minutes.

So I have to go.
Have a great weekend.

Wednesday, February 24, 2010

Thinking of the Future

Hey all,

Hope you all are doing well.
I really liked Monday's blog. Man it makes make me feel better when I am not alone in my struggles. I think this is what this blog is all about.

I finished Walk-On: Life at the end of the bench. It was pretty good. Nothing great. But a good perspective on how hard it is to Walk On to a Division I basketball team and how you get treated.
I am now reading Three Cups of Tea. A book about a guy who gets lost trying to climb K2 in the mountains of Pakistan. He is helped by the natives and this leads to a lifelong journey to build schools in that region. At least this is what I think.
It has gotten rave reviews from everyone that has read it so I will let you know.

I watched a couple of movies this weekend.
Revolutionary Road with Leonardo DiCaprio and Kate Winslet. Wow this movie was sooooo depressing. I found myself say out loud, "Please make this movie end soon."
And my wife is say, "We have to see this movie to the end."
Then we watched GI Joe. I know what you are thinking, but my wife and I really thought it was okay. The critics hated it. So I guess our expectations were so wasn't half bad.

Noah has his first T-ball game today. Noah took his first batting practice last week and let me tell you, he impressed. He was hitting the ball out of the infield. Now that is a big deal when you are 2'8".
So I heard one of the other kid say to an opposing player, "Oh yeah, well we have Noah Gammichia on our team."
I love that kid.

I have so much to talk about (like Luke's Science project is due today. The parents are only supposed to do 10% of the work. YEAH RIGHT), but I think I will get right into the topic du jour.

The Future
I have been thinking about the future a lot lately.
Here is what I know....
We have a two dentist practice.
My dad is 65 and says he has about 3 years left in him. He is presently working 2 and a half days a week.
His practice, I would say, is not growing. I am not saying it is dying but it is not growing. He has put in his time. He has done all the Rotary he is going to do. He has been to his last Chamber luncheon.
He is not marketing himself that much. I mean people still talk about him, but this is not an active thing.
And that is okay, but it is a reality.

I know this. I have known this for a bunch of years.
A couple of years back things were going great here. So much so that we, my dad and I, hired an associate, thinking that she would come in and flourish.
The thought process was that while she was flourishing my dad would start to fade away.
Sounds like a good plan right?

Well about two months after she came on board the economy hit the pooper. As great as Dr. A was with our patients and regardless of how much EVERYONE liked her, we couldn't keep her. There wasn't enough patients for my father and I so there sure wasn't enough for three dentists.
So that door closed.
So my father and I continued to do our thing and not worry about the future too much.

One thing I did do at that point was plant some seeds. What I mean by that is that I would have future dentist cycle through this office "observing".
One of them was a patient. His family has been patients of ours since I was in high school. This kid's older brother was my younger brother's best friend in high school and college.
We will call him Drew. Drew had an interest in dentistry when he was in high school, and his mom asked if he could shadow here. I said, "Anytime!"

So Drew came in and loved it and to be honest with you my staff like him.
Next thing you know he is in his last couple of years of undergrad and is still shadowing. Next thing you know he is asking me how to apply to dental school.
So after I wrote him a recommendation for dental school I started to think of the possibilities.

I was thinking to myself, "He is going to be finished in a couple of years. He is from a great family. He is from this area. This could be perfect."
So after he was accepted to dental school and before he started, I took him out to dinner.
I told him that I thought it would be awesome if he would consider joining our practice when he was done with school. I didn't want to put any pressure on him but I wanted him to know that I thought he would be a great fit here. And we left it at that.

So it has been a year since that conversation and he was hooked. He loves our practice. He wants to be a part of it in a huge way.
I told him that as much as I want him here I wanted him to keep his options open. I mean he doesn't know much about being a general dentist. I told him there is a possibility that he would want to specialize and I didn't want to hold him back from that.
He agreed, but he still tells me he wants to be a part of what we have.

Okay well that is that.
So here we are again. A two dentist practice.
One full time dentist and a part time dentist.
Drew will be ready in a little over three years.

Here is my dilemma. Dentists usually have patients that are around their age. My practice is no different.
I mean, I have patients of all ages but the core of my patients are my age. I might see my core's kids and their parents, but my core patients are still my age.
So my father's core is all in their 60s and 70s. This is not a patient pool that is ripe for a rookie dentist.
So you would think that I would take all my father's patients and Drew would take all the kids of the practice.
Is that enough for Drew? Probably not.
He is going to have to create his own niche, but I want to have the practice humming when he gets here.
Not so easy in this economy.

I started to not just think about the future last week, but I did something about it.
I will tell you about it on Friday. T-ball game in 45 minutes...have to go.

Have a great Wednesday,

Monday, February 22, 2010

Survivor - Business Owner

Day-by-day, hour-by-hour, minute-by-minute. . .how often do you gauge the success of your practice??

I have hit an unexpected challenge as a business owner; what is the end-goal. Remember, I started this practice 3 1/2 years ago, from scratch. My first patient was 9/11/2006 - a denture patient. My second patient was on 9/12/2006 - a comprehensive new patient exam (the 1st of many in that first 6 months) on an old friend. On 9/13/2006 I had 3 patients including the first of many emergency patients. I had 2 employees and 3 chairs. My goals were simple, see at least 1 patient a day - everyday we were open. Every month was a new record and my goals were pure survival goals (make payroll, pay the bank, find some money to bring home when you can).

That survival mindset is a powerful thing. It forces you into a constant evaluation of the practice systems. I could tell you at any given moment where every dime of the money was coming from and exactly where it was going. Often times the money that was coming in had gone out the day before.

So where are we 40 months later?

On 2/18/10 we saw 18 patients and produced as much in that day as we did in the entire month of September 2006. Instead of seeing 50 - 60 new patients a month we are seeing 25 - 35. I have 5 employees (including 2 hygienists). We have grown, by any economic measure, we are a success. We grew in 2009 even in the midst of the "Great Recession". All of that is awesome in the abstract.

So why am I still in survival mode?

I have never, ever worked in another general dental office. My dad is an Orthodontist so I have lots of experience with their schedule and the ups and down of that occupation. But nothing in the generalist arena. Now that is great in one sense, I have no "brain damage", I have no prejudices about how something should or shouldn't be done. At the same time, I don't have anything to gauge the health of the practice by. Yes, I can look at the numbers and compare them, I can look at overhead percentages and see that we are within the appropriate ranges. But what about the down time?

A business owner in survival mode is looking at the patients scheduled in the next hour, the next day, the next week. A business owner with time to sit in his office on Monday morning has time to watch the schedule open up as the messages are played at the front desk. And that business owner who is in survival mode starts to stress, yea verily, to panic because his day dropped $600 (even though it would have been in the top 20 best days for 2008).

Do you catch the irony? A business owner in survival mode doesn't recognize when basic survival is no longer the goal. I am no longer a hunter-gatherer. I have a pantry at home full of food that I can choose not to eat. I don't have to concentrate solely on where my next meal is coming from - I can look longer term.

But I can't!!

It is time to move my practice analysis out 1 level. It is time to move to a month-by-month analysis, isn't it?

This year, I finally set out some goals for each month and the year that I felt were statistically valid. I had a couple of "real years" (2008 & 2009) which I could use to gauge some trends in the practice and felt like I could realistically set a goal that is reachable with an expected growth (my practice is not done growing, I don't know when it will be but that is another blog altogether).

So we set these goals and then in January blew right by the 1st one, we beat the goal by 10%. Great! But hold on, that doesn't mean my goals have changed for the rest of the year. Each month still has its own independent goal that I have set. I am not changing those goals just because we had 1 good month. But it is in the back of your head now; not only should be seek to reach these monthly goals, we should seek to surpass them by 10% or MORE.


That is survival mode kicking in. Gather, gather, gather, more, more, more. I should be excited when we hit our monthly goal - and we did again in February. But today, instead of being 10% over our goal, we have had some patients reschedule into March, so we are only 5% over our goal - and I'm stressed.

That is INSANITY!!! I AM 5% OVER MY GOAL FOR THE MONTH (12% OVER MY GOAL 2 MONTHS INTO 2010) AND I AM STRESSED???? As my 5-year-old said one time, "what the heck is going on in there."

I am past the point of being stressed over having some open time on my schedule - aren't I? Is this normal? In 2020 will I still be fretting over whether I can pay a bill that is due March 15th - yeah, I have a bill due in 3 weeks that is consuming my thoughts because it is a biggie. Yes, we have had the cash flow to pay that bill for the past couple of months, but will it last? Do I need to go back into survival mode? The survivalist business owner would put everything else on hold to make sure the vital bills are paid. I don't want to do that. I have all my bills paid as of today. Do you know how rare that is for me? I have no past due bills of any sort. I am bringing money home on a schedule for the past 6 weeks (and that is the 1st time I have done that in 40 m0nths). So why the difficulty sleeping? Why the hesitation to pay a bill before its actual due date?

When does the confidence kick in?

What do you use to evaluate your month?

What do you do when you have downtime? Is is stressful for you? If not, why?

Ahh, the voices are asking so many questions today. I must get them quiet, hopefully it is a good NYT Crossword puzzle today [well while waiting on approval to post the blog I finished the NYT puzzle good one today and my first sub-4 minute solve, now I just have to do payroll].

Have a great day.


Thursday, February 18, 2010

Dentistry from the Heart Conclusion

Noah said two Noah-isms this week that I have to tell you about.
First, before church on Sunday he says, "Dad, I can't wait to go to heaven."
I said, "Really, Noah, why?"
He looks at me like I am kinda stupid and says, "So I can be a Superhero"
And second, yesterday we were watching the movie SpyMate and one scene took place in Japan.
They were going to a hotel and got checked into their room. So they left their car with a valet, got their bags taken from a porter, got checked in the hotel by the guy behind the counter. And after he saw the third or fourth guy that helped this family he says, "Man that guy is everywhere." I am laughing so hard writing this because you see he thought all the Japanese guys were the same actor (because to him they all looked the same...if I have to explain it to you, it loses its effect).
Man that is good stuff.
And you can't laugh because he is dead serious. But the adults just look at each other and it is everything they can do not to just lose it.

Okay Dentistry from the Heart

6 am and it is dark out and our parking lot is full with people.
The line of people begins to move outside of the parking lot.
This was the last time I actually went outside.
It was a glorious day. So many things to tell you that it is hard to start. But one thing that I got out of the day was people's ability to serve exceeded my expectations.
I am telling you people were tired. People were on empty, and they still were smiling. They saw the need and found another gear. I was moved by my staff that was here at 5 am and still dancing and laughing at 4 pm. I was moved by some dentists that showed up and said, "I am here. I will stay as long as you need me and you can use me how ever you want."
We worked with two middle-aged woman who saw the sign and came in the office and said that they wanted to help. They had no dental experience. They were not even patients. They just wanted to help.
I was inspired by the companies that wanted in.
Patterson gave all the supplies. CAPTEK sent us a check to cover the cost of the incidental. And it was a nice check.
Chilis sent over a bunch of food for lunch.
There is a guy from my church that owns a nursery (plants). He heard about what we do, and he wanted to get involved. I asked him if he would be interested in putting something together for the volunteers. He was so into what we were doing that he put together 40 baskets of 8 flowers.
(I put in a photo a volunteer holding one of these baskets).
And the list goes on. We had an oral surgeon come that every year he starts the day off with, "John, thank you so much for having me."
Some of the jobs this day are not what you call glamorous. We have a sterilization room that is about 8x10. Usually it is big enough for what we do on a day-to-day basis. But for DFTH it is tight. We have a Statim and an autoclave with some ultrasonic cleaners. On DFTH we borrow an industrial-sized Statim and a regular-sized one. So now the room is packed with sterilizers, and then we put three people in the room just cranking equipment out all day. It gets really hot and the fumes are enough to get you a bit high.
But the women that were in there brought a boom box, put up a sign that said, CLUB STERILE and they dance all day long.
We had 5 pre-dental students here that want to be dentists. They are from the local Pre-ASDA chapter at UCF. They were our runner boys. They threw out trash. They vacuumed the floors.
What can I say, it was awesome.
About noon time we had a patient that is a DJ come, and he brought his van and speakers and cranked it up for about 5 hours. He brings a microphone and entertains.
The 7-11 manager from across the street brought over Hot Dog and Drink coupons just to keep the spirit of giving alive.
As far as the people, well the stories can be overwhelming sometimes. A woman from an hour away slept in her car just to get a filling done and to have her 8-year-old daughter checked out.
We saw lots of multiple extraction cases. The oral surgeon stayed until 2pm, and he had taken out 75 teeth.
We saw 125 people on Friday. Even though the number was down slightly from last year, I know we did more dentistry than last year. We worked about an hour and a half more than last year. I want to say that we did about $60,000 to $70,000 in dentistry in one day. WOW.
The patients were very thankful for all of our work. They kind of formed a community out in the rain and the cold. They came in and left with smiles on their faces (on the way out it was a crooked smile but a smile none the less).
I think everyone got something out of it.
You always hear people say when they come back from a mission trip that they went to change the people of X but it turns out the people of X changed me.
Well I think in this case we were both changed.
I think on all fronts our eyes were opened. The patient's eyes were opened to the caring nature of our profession and the dentists and the volunteers eyes were opened to the need that is out there and the joy of giving a little piece of themselves.

God was definitely smiling on Apopka last Friday.

Talk to you next week,
Have a great weekend.

Wednesday, February 17, 2010

Dentistry from the Heart

Friday was Dentistry from the Heart.

If you are reading this for the first time DFTH is a free day of dentistry that my office hosts.
It is the idea of a dentist in New Port Richey, FL.
I was at a lecture and heard the idea. He encouraged the audience to take it and run. And run we did.
This year marked the fifth year of Dentistry from the Heart Apopka style. A day in which we give away free dentistry.
We, my father, my staff and myself open all eight of our operatories, put a volunteer dentist in each one and do as much dentistry and help as many people as we can in one day.
We have limited it to just extractions and fillings simply because it becomes an efficiency thing. We feel we can see more patients in a day if we stick to things in our wheel house.
It is a pretty large undertaking and it is something that we start planning about 7 months in advance.
So sometime in August I put up a list of duties and my staff have an opportunity to sign up.
Dentist volunteers
Non-dentist volunteers
Marketing (you would hate to plan all of this and patients not show up)
Dental supplies
Gifts for the volunteers

About one month before the event the planning starts to get crazy. Everyday there is something going on that is related to DFTH.
If it is not a last letter to the volunteers reminding them of their commitment. Or a call to our supplier about material (By the way Patterson Dental donated all of the supplies). Putting the finishing touches on the T-shirts and having them delivered. The marketing is in full swing, tying up loose ends for all the gifts and food deliveries.

The last week is full on crazy.
The newspaper put in a blurb about it. The community sign has the last minute announcement and the calls start coming in. Well once we started fielding about 10 calls an hour we had to create an extension to send inquires to.
I was on a popular radio morning show on Thursday to tell people about the day.
This year was particularly crazy because of the weather. There was a very good chance it was going to rain and we were scrambling.
In addition to all the last minute things we do, this year we were trying to arrange for a tent to be delivered. A not so easy task. One because we are trying to have a tent ordered and delivered and installed the same day we call. And because, did you know you have to get a permit to put up a tent bigger than a 10x10? Well either did we.

Anyways things went pretty smooth. We knew the day was going to be huge.
And with large crowds comes strife. We found this out last year...."He butted in front of me" or "That person was standing in line and then 5 of his family members joined him 4 hours later."
It is really hard to please everyone, but we didn't want this to happen again so we brought in some muscle.
My assistant's husband is a retired police officer and chief of police. My front desk person has a son that is graduating from the police academy next week. And he brought one of his classmates.
And the three of them were "keeping the peace" all day.

So we tried to think of everything, and the more you do this kind of thing the better you get at it.
So I went to bed hoping we had thought of everything. We went to bed hoping we planned everything well.
In my mind I had to put the finishing touches on the planning and start to think about the 10 hours of work that we were going to do. It is like a wedding. You plan up until "the" day and when it is "the" day you realize you can't plan anymore. It is time to execute.

I wanted to get my mind right.
What I mean by this is I had to check myself. I constantly have to remind myself that it is not about ME.
My name is one door of the facility and I am on the radio and in the paper, but it isn't about me.
So many people have put work into this thing, so many people will volunteer, so many people will give money, so people will sit in the cold and the rain for 6-8 hours to have a tooth pulled.
It isn't about me.
I have to remind myself that this day should be a celebration of many people's hard work and desire to serve. And it should be about serving.
I had to prepare my mind for a TV camera or two walking through the office and people asking me for interviews.
I will have to tell a news person why "I" do this.
I have to think of words to say as to why and try to deflect all the attention off of myself.
Sometimes it is not so easy to put into words why you do something. And I had put into words how it is not just about me but it is about the hard work of my staff and all the volunteers and without them this day is nothing.

So on my ride into work on Friday (this year me and my staff started an hour earlier. They were here at 5am and I strolled in about 5:45am) I always give them a call. My staff member has excitement/psychosis in her voice, "Dr. John it is so crazy here, you better hurry."
This is literally music to my ears. Crazy is good.

To finish today's blog I want to leave you with a couple of things.
There were 100 (yes, I said ONE HUNDRED) people waiting in line at 6am. The first patient got here at 9pm the night before and slept in the walkway to the door.
I will tell you all about the actual day on Friday.

Have a great Wednesday,

Monday, February 15, 2010

We wish you a Merry President's Day

Happy President's Day.

I hope each of you woke up this morning excited to gather with friends and neighbors and sing songs celebrating the achievements of our great leaders. Leaders such as Millard Fillmore, James Polk, William Gates, Sammy Davis, etc. I know my kids love wrapping the Presidential pole and opening their presents. This year, we really went all out and got them the Presidential Press Release Hero game for the PS3. It is a lot like Guitar Hero/Rock Band, but it comes with a teleprompter - in expert mode, you have to "speak extemporaneously while looking like you are speaking off the cuff." They were very excited.

Yep, the sarcasm voices are screaming this morning.

I just flew in from Chicago (and boy are my arms tired). . . .

No, really, I did just get back in from Chicago. I spent a glorious few days in that fair city to attend the bi-annual Joint Council meetings for the Academy of General Dentistry. Now, I know what you are thinking, how can I get that lucky to get a trip to Chicago in February. I mean, come on, who doesn't grow up dreaming of going to Chicago in FEBRUARY.

I'll tell you, it was wall-to-wall honeymooners up there. Or I think they were honeymooners, I really couldn't tell; what with everyone wrapped up from head to toe in woolen burkahs trudging through the slushy streets and giving the 1 finger wave to the taxis trying to run them over. Ahhh, nothing like the twinkle of Michigan Avenue IN FEBRUARY.

Have I mentioned how much I enjoy traveling by myself and being away from my family. . .no, I haven't mentioned it. . .What about on Valentine's weekend? Still no, really. . .

Oh, yeah - it's because I hate it. I believe the technical term is called co-dependency, but I hate traveling away from my family. I would be an awful sales rep, and I admire those that do it (not that there's anything wrong with that). However, traveling Valentine's weekend, away from my Valentines was not the best for my psychology. And while we are on that subject, this is my 19th Valentine's Day with Susan - still haven't found a card that says everything I want it to.

OK, all that said, I'm in kind of a mood today.

Now the meeting itself was great. If you are an AGD member, do you realize how many dentist volunteer leaders are working to ensure that the practice of dentistry remains prevention focused and generalist focused. The AGD dentists and staff that meet in Chicago at these meetings are some of my best friends but also some of the finest advocates for dentistry you could ever meet. We MEET. This is not a play-trip with lots of downtime. It is a 7:00 am to 5:00 pm discussion, often being continued over dinner. No fluff, no golf-outings, etc.

There are dozens of issues currently going on around the country that I could talk to you about for hours - but don't worry - I don't want this blog to become the propaganda wing of the AGD, it is about the daily grind of dentistry. But that is what I was doing last week so it is part of my daily grind today.

Last random thought - anyone watch the Olympics Opening Ceremony??

I watched it instead of taking a balmy walk around Chicago IN FEBRUARY.

I teared up (or is it tored up) during the parade of nations when the delegation from the Republic of Georgia entered. What an incredible display of national pride juxtaposed with personal grief. I thought the IOC and the Canadian's did nice job of trying to recognize the tragedy while still going on with the $33 million dollar show (and that's Canadian dollars).

For my money, nothing will ever surpass the China Opening Ceremony in terms of in-your-face pomp and chest-puffery. However, Canada did a nice job. The slam poetry and KD Lange were a little odd (was it just me or did "she" look like Chaz Bono and Truman Capote's love child). All the video technology has me thinking that in a decade or so the opening ceremonies will be entirely virtual; a nationalistic production of Avatar.

No real dental news or issues to report. I'm still working out from under the pile of mail and issues that arose from me not coming into the office for 5 straight days.

I'm going to put the voices back to bed.

Have a great day,


Monday, February 8, 2010

Facebook Marketing

Hey guys,

Okay maybe I was in one of those moods on Friday.

I went to do my research for my blog on Facebook, and I got side tracked.
My site, which I haven't even commented on since NOVEMBER, was full of meaningless stuff.

I just got a little annoyed.

Is there some good to it? Yes
Are there things on Facebook that are productive? Yes
Can we speak to a bunch of people at the same time? Can we show pictures of family? Can we communicate with people effectively? Yes, yes and yes.
So this still doesn't explain why when I go to my site I see loads and loads of dribble....okay I will just stop.

I will tell you how this thing started. I was at a study club meeting last week (it was on sleep entry coming soon) and marketing on Facebook came up.
You see Dentistry From the Heart is coming up on Friday (if you don't know about DFTH, see the end of the blog).
One of the dentists announced his volunteering on his Office Facebook account. Another dentist, who was a fan, said he was going to put this on his office Facebook account.
So we got to talking and no one else has this for their office.

Okay so have any of you done this? Anyone loving the results?

I did it.
I did it this week. I made A Soft Touch in Family Dental Care business page on Facebook.

Now what?

So my friend at Angulo Dental has a practice page. He puts pictures of his office. He puts pictures of his work on there.
He has fans....157 of them. Most of them might be friends like me and his specialists and his patients....who are already fans of him.
So is it something that is worthwhile? Is it a lot of work to have our "friends" look at our work?
Okay let's say it IS worth it.

Just like our websites are worth it.
But they all take work to maintain.
I made my website about two years ago, and I haven't done anything to it since. I have a person on my staff (kind of) in charge of the website. But unless you say to them, "What is new with the website?", it usually falls by the wayside for her too.

So if you don't do anything to your website or your Facebook account it will fizzle out.

Are we willing to put the time and energy into something with mild success?
It will be fun for a bit because it is new. You will put a picture up there and a couple of your "fans" will comment. "Dr. X your work is so good. You are such a good dentist."
Wow that makes you feel good. But does it make for real results? Results like people picking up the phone to call, or results like getting into their car and driving to your office.
Is it a feel good thing? Yes.
Does it strengthen the bond between you and your patients/friends? Probably.
But what is the cost reward?
I have to tell you I am not really a fan of getting random stuff from Facebook. I am glad to see an old classmate, but I don't know how I would feel about getting something like "Be a fan of Winter Park Urology".
I know I could press "ignore" but I don't know if they get a report of who doesn't want to be their friend. I start to feel bad because I like Winter Park Urology (we have shared a moment together), but I don't want to be a fan of their Facebook page.
Am I rambling? Don't answer that.

What I am trying to say is I don't think it is for me right now. I don't have time to update it. I don't have the time or energy to care about it. Maybe because I don't see the benefit.
Maybe you do.

Speaking of working. What IS working for you? I am going to write a series of blogs on how we are marketing ourselves: internal marketing,, External marketing, websites.
Is anyone paying Google or doing search engine optimization?

If you are doing something that is working, I would like to hear from you. If you are doing something or did something that didn't work, I would like to hear from you too.

Real quick I will give a brief synopsis of Dentistry from the Heart, this is the blurb I sent the local radio station.

Drs. Victor and John Gammichia and staff are hosting the 4th annual Dentistry from the Heart.
This is a day of free dentistry. We are just going to be doing ambulatory care...fillings and extractions.
Friday February 12th.
7am-4pm and we will see patients on a first-come, first-serve basis. We recommend patients getting here early because last year the first person came at 9pm the night before.

It will be a true community event.
15 volunteer dentists...general dentists, endodontists and an oral surgeon
25 nondentist volunteers (our staff members and our families, some of the other dentists staff members, old employees, patients and people from the community that heard about it and want to help).
Chili's, Sam's Club, Winn-Dixie and Dunkin' Donuts are working with us to feed our volunteers.
Uth Stuph has donated T-shirts.
Most of the dental supplies are donated by Patterson Dental, a local dental supply company.
We have a DJ donating his time to entertain the masses outside.
We have a local church that is bringing food and drinks for the waiting patients.
It is going to be great.

We saw 130 patients last year. We always want to improve.
But what we really want to do is improve people's lives.
We recognize this is a tough time for people and sometimes a nagging tooth problem might be something people are really suffering with.
Or maybe something broken in the front that a patient is self-conscience about or something wrong in the front that the patient feels is keeping him or her from getting a job.

So Friday's blog might just be a photo montage of the day.

Have a great Wednesday,

Who Dat

Congratulations to the New Orleans Saints and all their fans!!

I don't even want to know how long it takes for some of my friends in that part of the country to get back to work - Mardi Gras started a little early this year.

The kids and I watched the game at a friend's house (they have kids my kids' ages so it lets me watch the game). Momma is stuck in Baltimore for only another few hours (hopefully) so the kids got a surprise extra day with dad. You can read that as you will - probably any interpretation of it is an accurate summary of the weekend ;)

Busy weekend for me doing the 3 kid single parent thing. Karate, soccer, basketball, church, clean the house, super bowl. . .all-in-all a good weekend.

Now, the lawyer in me is requiring that I place a disclaimer in the blog this week. Given all the hoopla over the phrase "Who Dat" and the NFL's laser-like focus on protecting its brand. I must emphasize:

when I say "who dat" I am using it in the common vernacular reflecting the Cajun/French heritage of the indigenous peoples of the lower Mississippi valley.
And by the New Orleans Saints, I mean not the professional sports franchise that is a member of the National Football League. Rather I mean the fine people of the great state of Louisiana who have been canonized and beatified by Papal decree after meeting the requirements laid out by Pope John the XV in the 10th century. And by super bowl, I do not mean the trademarked name of the championship game played between the top 2 teams in said National Football League; I refer to that event as the final game of the NFL season which, to the best of my knowledge, is not a trademarked phrase. However, should said phrase be later found to be trademarked or otherwise encumbered by some claim of ownership or artistic licensure, I hereby agree to refer to said game by whatever phrase is legally permissible at the time. In no way is the AGD, Dr. John Gammichia or any reader of this blog liable for my reference to the game and my descriptions of plays or commentary of the game is entirely a work of fiction and any similarity to plays, players or broadcasts of said fictional game is entirely coincidental.

Whew, that took me a good 7 minutes to compose - and I bill in 1/10 of an hour increments so that was billed at 12 minutes at a rate of $100/hour because I like you guys and am giving you my discount rate - so please remit $20 to the AGD Advocacy Fund in honor of that awesome legal paragraph.

OK, now that the legal particulars are out of the way. I thought it was a good game. Brees played good, Manning played good. The defenses played good. The Who played good. The commercials were 'meh'. Oh, and anyone see the really controversial Tebow ad???? OOOOO a guy joking around with his mom. It just dripped of political conservatism. Right after the ad I felt this strange urge to go out and buy a gun and join the Tea Party Movement.

Seriously, if the media hadn't played up the ad as being anti-abortion would anyone have even noticed?? I'm betting the Focus on the Family website got tons of hits over that ad. Apparently the adage is true, there is no such thing as bad press.

Dental topic, dental topic, dental topic. . .how 'bout dealing with patients that have insurance and trying to explain how insurance doesn't cover everything. Isn't that fun. Let's take a for instance using a fictional insurance company, let's call it Triangle. Now, Triangle Dental Insurance Company has separate companies in all 50 states. Then within each state is has a couple of different master plans. Then each of those master plans can be personalized to suit the employer that is buying the plan. This leaves the dentist with around 200,000,000 different coverage tables.

Now, said dentist sets up his practice focused on treating the patient, not on doing only what an individual insurance company allows. Accordingly, he takes routine x-rays 1 time per year on healthy adults and every 6 months on minors. More frequently based on caries risk. Fluoride is dispensed routinely to children and as needed to teenagers and adults based on caries risk.

Most of the time this is not an issue because most insurance companies pay for these treatments at this frequency. Then you get the outlier that apparently changed its policy to x-rays every 2 years and no flouride. Patient comes in that is a caries risk and you take radiographs and place fluoride because there are some incipient lesions that you might be able to remineralize. 2 months later the patient's parent calls upset because the insurance company says that the fluoride isn't covered and you have to justify your treatment.

I don't mind patients questioning what we do, it is my job to educate patients.

What I don't like is having to defend against an assumption that if it isn't covered it isn't needed. I know, it is an age-old problem, but I'm curious how your offices handle it. If you read this blog and are not a dentist, how would you like this to be explained to you?

That's all for now, the voices miss Susan and are ready for her to get home safely.

Have a great week.


Friday, February 5, 2010


Hey all,

Will you be my "friend"?

Facebook, it is so crazy.
I go on Facebook and I see what is on my Homepage.

"don't go to sleep with a frown in your pocket"

Gavin became a fan of We can find 1,000,000 people who DO believe in Evolution before June.

Tony G and Emerson T are now friends

Paula D became a fan of 4 Rivers Smokehouse.

Johannes G "There is no more terrible instant of enlightenment than the one in which you discover your father is a man with human flesh." Frank Herbert

I just became a fan of Angulo Dental who....

We are a small dental office committed to making dentistry not scary anymore. Serving metro Orlando since fall of 2001. Many smiles and lives have been changed over the last 8 years. It's what we do.

This is my friend Jorge who started a fan page for his office.

Facebook is becoming sooooo huge that this is the way people are communicating.
Friends are reuniting. People can find groups that they can support. Old flings are rekindled. Marriages are breaking up. All the good stuff. People are spending precious time (and most people are doing it at WORK) updating and redoing and putting pictures on their Facebook account.

Julia W became a fan of Nancy's Italian Ice.

I have to admit I rarely go to my facebook page. I rarely update anything and when I do go on there I am so surprised at all the crap I find.
I am just going to come out and say it.
I have to tell you that I think Facebook is soooo stupid. I am sorry to all the students and people under 30 that I have just wickedly offended.
I just don't get it. Now I know I am old. I know you might have a tough time teaching this dog new tricks. Someone please tell me what they see in Facebook.
Have I seen pictures of people I haven't seen in awhile? Yes
Have I talked to my old high school classmates? Yes
But when I say "yes", I am talking like 3 sentences, and then I go back to my busy life.
I have a hard enough time talking to the friends I have now. When I say friends, I mean real friends...not virtual Facebook friends.
And what the hell is this farm thing. People keep talking about building their farm, and "I can't wait to get home to my farm". I didn't even bother to look it up. I don't care.

Teresa D became a fan of Hu-Friedy Mfg. Co., Inc.

I also think Facebook is kind of dangerous for us middle-aged people.
We are in our lives and we think back on all the "Golden" years. So when was that? High School and college and dental school.
We had no cares in the world. We could study and party like rock stars. Man I will tell you I was so cool in those days. I was living it up on daddy's dime (dad, if you happen to come across this somehow, I love you and I was at the library all those times, I swear).
LIFE WAS VERY GOOD. I didn't have a care in the world. I didn't have this extra tire around my waist, and I for sure didn't have all this back hair.
But now when you really look at your life, it is much different because we didn't have kids to feed, bills to pay, soccer games, baseball games, church, doctors appointments, car payments, PTA meetings, Parent/teacher conferences, dental conferences....real exciting (can you just hear my sarcasm).

Ric Crowder became a fan of 5,000,000 People Strong For A "That's what she said" button.

When you look at your life, sometimes it looks kind of boring. People my age always want to think back to those times and say, "What have I become?" "What ever happened to that kid that used to drink beer and go skinny dipping with his friends at his girlfriend's lake house (dad again, I swear there was parent supervision like I told you). I am not saying my life now isn't great. Because it is, but some people my age would probably not love their life like I do.

So what do we do we go on Facebook and try to rekindle our first love. We try to see how she or he is doing (I say we but I don't mean me. I will get to my personal policies later). Remembering how much fun we had with that other person. Not remembering that person probably didn't shower every day or that his mommy did his laundry and had to wake them for school every day. Who cares about that, we had so much fun in high school 15 YEARS AGO.

Kirk S became a fan of Bruce O'Donoghue.

I know, I know, everyone doesn't go on Facebook to "hook up" with old flings. I know that we all want to see how our old classmates are doing. Yeah the guys you didn't like 20 years ago, let's see how they are doing today. Or let's see where so and so lives...Oh he is married, I thought for sure that guy would never get married. Well I get there is a lid for every jar.
Am I really out of it or are all of you on Facebook all the time?
I did a soft survey at the office today, staff and patients.

Al N Most of us want to be judged based on our "intentions" rather than our we offer the same level of grace and understanding to others that we expect for ourselves???

And people go on this site. My assistant, hygienist, and first patient go on EVERY DAY. What?!!
They claim they are going to see what their family is up to. My front desk person and second patient go on once a week.
I don't know how many friends I have on Facebook, but it is something like 250. If I sat on Facebook and watched all the stuff coming in from just 250 people. It is so stupid. I am sorry I can't.

Rhonda put her contact in wrong.
Steve says "TGIF"
Lynette says they hate it when Facebook changes their format.
Chuck just bought a pig for his farm.

Are we really serious about this?

But this blog was supposed to be about Marketing on Facebook. But as I went to my Homepage and looked for stuff to write about things just kept coming in. I just scratch my head.
A couple of dentists posted stuff, and I am thinking to myself, "it is Friday, probably their day off and they are either at work doing paperwork and on Facebook or at home (which is even worse) on Facebook.

My friends are trying to market their practices on Facebook.
Tell me how you use Facebook?
Are you on it all the time? Tell me your approximate age.
What do you use Facebook for? Is it productive?
And if you think I am way off base I want to know that too.
Maybe I am missing something. Enlighten me, but don't be mean.

I almost forgot my rule of Facebook is I don't "Friend" any of my old girlfriends. Really I try not to "Friend" women period. I know it is stupid, but out of respect to my wife and I know not everyone has pure intentions. Look people at church have affairs too. I just don't want to put myself in tough situations.
I will get a "Friend request" from a woman, and I don't know who they are, so I ignore it.
Then a week later I will get a "friend request" from the same woman and this time it is with a message, "Are you going to be my friend or what?"....ignore again.
If I don't know you, and I don't know where you know me I usually never check my Facebook account so why do you want me as a friend anyway?

Please enlighten me,
I will follow up on Wednesday.
Have a great weekend

Wednesday, February 3, 2010

Bill Strupp

Hi all,

Real quick before I get into it. I finished The Last Lecturer and I have to say I was disappointed. I didn't like it for a lot of reasons. I will tell you real quick. How can you have a lecture basically about dying and not talk about what happens to you when you die.
Maybe I am saying this wrong. The book was about his life. It was about how he dreamed things when he was a kid and how he made them all happen as an adult. He talked about all his successes in life. He talked about how he and bunch of students that have hit the big time.
Not once did he talk about heaven. It was sad really. I kept thinking to myself, "What good is it for a man to gain the whole world and forfeit his soul." HE IS GOING TO DIE. Who cares that you were able to work at NASA for a summer? Who cares that you worked for Disney working on the first virtual experience ride. WHO CARES. YOU ARE GOING TO DIE. The Bible says, "Your works are like filthy rags to me." It is really sad.
I'm thinking about it, and I don't think I have like a book in a long time. Maybe it is me.
I started to read a book called Beyond Belief: Finding the strength to come back. This is an autobiography of Josh Hamilton. He is the baseball player that is a crack addict. He was the one that hit the 28 home runs in the home run derby.
It is an easy read because he uses very easy words. He talks about how when he was a senior in high school his English teacher told him that if he would sign 12 baseballs for him he would give him an A and he wouldn't have to do any work. Hence the easy words.
I saw a great movie this weekend on was called A Perfect Getaway. Worth the rent.

Topic of the day,
I now have a new favorite lecturer and his name is Bill Strupp.
You know I have had some issues with some lecturers in the past. You know my big thing is identifying with the guy. A lecturer is typically either a guy that gives a lecturer and then goes behind the curtain never to be seen again or is he like Bill Strupp.
Let me give you a for instance, or two. He starts off the lecture by telling you that he has big time ADHD so he is going to move fast. He says, "so if you have a question just ask it." He goes on to say to yell "QUESTION". He wanted to answer your questions and was happy to do it...imagine that.
He also tells us before the lecture starts that he has rented a room on the water across the street at the local yacht club. He says, "I will have all the beer and wine you can drink and all the shrimp you can eat." He went on to say that his wife made the cocktail sauce herself.
The course was $1300. I counted 255 people in the audience. That is like $330,000 (for a two day course....damn.)
So I think they could afford to buy the cocktail sauce? Yeah, but that is the kind of people they seemed to be.
So immediately my guard went down. If you want to know why my guard is up so high please see my blog on Frank Spear. and

So my guard is down and he says, "why should you listen to me?" He says, "Not because I am the founding father of such and such or that I am a member of the muckity muck club. No, it is because I have done 48,000 units of crown and bridge."
Damn that is impressive. I started to count up what I have done and it is not even a 3000.
Okay so now he has my guard down and he has told me his real credentials.
Now I can listen.
So I start to listen and it is like I am listening to my friend. He is talking in a way that is not like, "I was talking to the president of this company and we came up with a formula that we think is going to work". It was more like this is what works in my hand.
Now, not everything he says I agree with. Not everything he says I am going to do.
But when he says he is working with something and it is working for him....I believe him.
He does his dentistry like I would do mine.
You know the expression, "I don't care how much you know until I know how much you care."
Well this resonated with me. I could tell he really cared about his patients. Sometimes when he was telling us about a case it became more about the patient's story instead of the dentistry.
Oh, remember the happy hour thing at the yacht club? All the patients that he showed in the slide presentation, he invited.
So you saw his patients roaming around the happy hour.
I have to tell you he restored my opinion about CE guys.
Here is the kicker for him. I imagine he is doing pretty good for himself. Let's say his overhead on his lecture is 80%. I mean is he really making $66,000 for the weekend. Damn.
So then he goes on to tell us that he now has a partner. A 31-year-old dentist from Kentucky.
They meet and greet the patients together (even though they are all coming in to see Dr. Strupp) and they treatment plan together. Dr. Strupp does most of the closing and when it is time to work...the young partner starts the work.
The kid numbs them up, the kid removes all the old dentistry, the kid removes all the decay, the kid does all the build-ups (Dr. Strupp is really into building up), the kid does the initial prepping and then ol' Bill comes in and does a "fine-tuning" of the preps.
He didn't push a single product in the whole two days. His material was good. His delivery was refreshing. I liked him.
I e-mailed him yesterday, and he e-mailed me back in about an hour.
His lecture was about complex cases. All he talked about was full mouth reconstructions.
That is great for him, and it is great to learn about it for the 2 or 3 I might see in a year.
But ever since I have been back, two days now, I have heard "I hope I am not getting x-rays today because they really aren't in the budget."
So my clientele are just regular people. My peeps are being hit hard by the economic down turn. Some of my patients can't afford x-rays and you know what...I am still honored to be their dentist, and if I have to put an IRM in that hole for a couple of months for them to afford the filling I will.
So I loved hearing Dr. Strupp, but it is what it is. When I do do another large case I will be more equipped, but for now it is going to be "No, Mrs. Jones it is okay for us to wait on your x-rays this time."

Have a great Wednesday

Monday, February 1, 2010

The Climb

OK, the long expected plunge photos are here. I know each of you spent the weekend waiting anxiously to see these pictures - sorry I'm not better looking ;) Also as a shout out to my peeps at headquarters, I am wearing my AGD Foundation shirt.

Yes, I did it. I ran a 5K in the snow and then jumped into a lake - and along the way helped Special Olympics of Kansas by raising $620 (thanks to all who donated). It was a cold day, "the sea was angry my friend", 24 degree air temperature at plunge time. The water was a balmy 27 degrees. Now someone with more physics knowledge than me is going to have to explain how water can get below the freezing point - but I can tell you it was cold ("I WAS IN THE POOL"). It felt every bit of 27degrees.

Now, permit me if you will, a bit of midwestern boasting. There are 2 plunges in the Kansas City metropolitan area so a total of approximately 2,000 people jumped into 27degree water when it was 24 degrees outside. No one got hurt and nothing got cancelled. In Maryland, they had a plunge with 15,000 people on the same day but they cancelled it because the water was 36 degrees and the air temperature 29 and people were getting hypothermia. I'm not saying we're tougher, I'm just sayin. . .well, come on, my daughter plunged last year and the water was 33 degrees.

Come on Maryland, that close to D.C. and you can't stand a little cold water in your face. Or maybe the recent election results have been enough of a cold water plunge for that area of the country. (btw, if you are taking that seriously at all, lighten-up).

Now for the sappy dental-related thoughts from the weekend.

You might not be able to tell from looking at my pictures, but I love to run. I also love to eat but that is another story.

As a business owner, running is my release. It gives me long stretches of time to clear my head and think only about the next step. Now when you run you become intimately familiar with the slope of the terrain upon which you are running. You notice the slightest shift in slope, you find elevation changes that are too subtle for a car passenger to notice but that require you to push just a little harder.

On Saturday, before the plunge, I "ran" in the 5K race. I finished in 33 minutes but the key is that I finished. I set a goal and I saw it through. It really was no different from when I ran 39 miles last January in the Disney Goofy Challenge - I set a goal and I saw it through. Each of those races had the exact same issue, I had to start running by putting one foot in front of the other. Then I had to keep running, period.

Now for the sappy part. I am an artist at heart. I am a musician and music affects my moods remarkably. I use music throughout the day for motivation or for introspection. I have certain music I listen to when I have a stack of bills to pay and certain music I will listen to when I have a difficult case coming up. I also listen to music when I run, not loud, just background noise that actually helps me to focus on the task at hand.

In the race on Saturday I was listening to my daughter's ipod. Now, she is 11 and has excellent taste in music but I am going to use her as the excuse for why I was listening to Miley Cyrus' song "The Climb" in the last 3/4 mile of the race as I was ascending the last little hill of the course. Now, if you haven't heard that song - go out and get it. It is a great song and that young lady is remarkably talented. The lyrics to the chorus say "there's always gonna be another mountain, I'm always gonna want to make it move, there's always gonna be an uphill battle. . .doesn't matter how fast I get there, doesn't matter what's waiting on the other side, it's the climb."

Oh yeah, 38-year-old husky guy plodding up a hill with tears in his eyes as he is reflecting on the climb involved in starting a business. We set goals, we go to seminars on practice management, we go to wealth seminars and retirement planning seminars but the truth is there is no shortcut - starting a business and keeping it going is a mountain that cannot be moved, it must be ascended. During that ascent you are going to notice every change in the slope. It will be easier at times and more challenging at times. You may slide backwards at times. There will always be those who chose not to climb the mountain who drive by and say, "that doesn't look hard but I don't want to climb it when I can drive around the mountain". And that's fine but don't dare try to tell me what the slope feels like when you are in the car, get out and try it yourself.

Ultimately, we climb not because of what is at the top - I can't even see the top. We climb because we want to see if we can.

And so we start.

We put one foot in front of the other and we keep moving. . .

have a great week,



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The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.