Building Wealth in Dentistry: Round Table Panel for Saving, Investing, and Practice Growth | Ep. 7

You know, the number one step in building wealth is in saving. And I was saving up to 50% of my income. Yeah, 50%. 50% that was my goal, 50% of the income.

I think endodontic programs should make an attempt to see if they can get some type of exposure for their residents with the ENT guys because as you start to do more and more endo, you realize ENT and endo, you're up in the sinus, you're in these places, there's a lot of overlap.

Goals and visions in life are directed by people around us and other people. And often in the world of social media, that ends up being people that really have no business telling us how to live because they really haven't figured it out themselves. But they are the loudest, you know, voices out there, and they tend to influence us. That's why they're influencers, right?

Yeah. The biggest, the biggest thing for me in my perspective is I think, um, the way a lot of people seem to be so successful is they, they really hone in on one thing and one subject matter, and they become a true expert at that thing. And they, they, uh, focus their time, their energy, their resources, their human capital, their everything they have on that thing, and they grow it.

So that's not something that you want to put all of your nest egg into early on, 'cause the chances are you're going to lose it. But that's what excites me. I think that's what I think. This is a generational. Is this off? No, it's not. We're not. We haven't said, well, I didn't, I didn't say goodbye yet. Oh, sorry. I know.

[Music]

Welcome to the P podcast, where we talk about all things dentistry and non-dentistry from a generational perspective. I'm joined today with my co-hosts, Dr. Ann Koch and Dr. Parsa Shahidi. Thank you so much for joining me.

Wow. Absolutely. What a week, huh?

Oh, it's been a crazy week. Sounds like it. Sounds like you're talking from the perspective of an investor.

Oh, believe me. I mean, there's a lot we can get into. Oh my gosh. I wonder, uh, I wonder how you guys are feeling with the, uh, we'll call it a little bit of a tank of of the markets here.

Well, I do have a thing that I call the Nasseh theorem. So, it's whatever Dr. Nasseh does, I would like recommend to do the opposite. Wow. So, so if Ali's, if Ali's buying stock, to me, that's an incredibly strong sell signal. Forget candlesticks, all that stuff. I'm going by the Nasseh theorem.

I'm somewhat of a good investor, but I tend to carry a cloud over my head. And every time something goes wrong, I call Annie. So, I've been associated with. I need to see some historical data there, but all I can say is if you look at it every day, it makes you go crazy. So, it's probably better to let the market correct itself, right?

I, I totally agree with you. And that's coming from a person who used to work at a trading house a couple of days a week. And, uh, especially like late '80s, early '90s, when day trading and other things was rocking and rolling. And I'll never forget. And there's an expression, what do you call a person who holds on to a losing investment? What's that? An investor. Because when we were, when we were seriously trading stocks, right, if you, if you had a stock go down a quarter, you were out of it. It's, it's like you had to just leave it behind, behind you, and go. It's like being a quarterback in football. If you throw an interception, that's not ideal, but it can't prevent you from throwing another pass. Same thing with trading stocks. If, if, okay, I lost an eighth of a point, I lost a quarter on a thousand shares, whatever. That's past. Go on to the next, the next purchase.

So, something unique about this, you don't know. Parsa, she's also been a trader on Wall Street and done a whole bunch of stuff, including like commercial fishing. I mean, your portfolio of things to do. Talk about experiences. You know, your generation is always interested about having experiences. I think Annie was there, done that ahead of time, having lived in Japan.

The one, the one thing I did learn, Parsa, especially as I got, uh, a little bit older and got a little bit more money. Uh, I, I have a professional investment team. And I, I don't drive them nuts. People are on the phone five times a day. I don't, uh, I have confidence in them. And it's kind of like, what goes down comes up. What goes up comes down. Yeah.

Um, and so to me, I, at this point, in these kind of dips and craters, even it goes down to 8 to 10%, I don't do it. But years ago, uh, I had my resources in a group in New York, and I realized they could not buy a stock at 20 and sell it at 25. They just continually held on to stocks, and I thought that was not a good thing. So, right before the crash, I guess what was that, Ali? 2008, 2007. I just took every penny I had out of the account. And during that crash, uh, we had a lot of dental friends who lost 60% of their resources. Wow. And I ended up only losing about 6%, which was, I went total cash. But I think if you have a good advisor, just look at the sports page, or look at investors who had invested with Bernie Madoff. Oh my gosh. Yeah. Right. You know what Bernie, you know what Bernie's promise was? You know what his promise was for a return? 10%. So what? So when I hear people having worked in the industry for a while talking about how they're making crazy numbers, that's to me so much BS. Yeah. You know, generally hit or miss. Somebody can have a stock or something go, but it's really tough for a manager to have a return like that on a consistent level. So Bernie sucked, you know, had all these people jump at him, but his thing was a guaranteed 10%.

What would you say? Uh, you know, I think it's a good thing for young people to hear, too, right? So I, I had a lot of experiences through all schooling with my friends, my colleagues, my classmates trying to day trade, whether it's crypto, whether it's, you know, just Robin Hood. And as we build out our careers, like it's actually a great, great thing to know.

What was your first intuition in terms of how to invest your money once you started making that? That's a whole other conversation for the audience. I'm sure everyone wants to know how to make money. But how do you, how do you think about where to put your money to let it grow as an endodontist or as a dentist or a specialist? You don't know what scared was unless you were in the '90s and you were shorting Amazon. Yeah. Yeah. You don't want to do that. Yeah.

It, because and again, you know, what's interesting, stocks generally incrementally go up like a stairs, but when they go down, they drop down. And everybody's driving the market down, selling. And, you know, the whole thing has changed because with all the computers and you have, you know, buy and sell signals coming in and stuff like that. But I thought trading, I mean, I really mean active trading was incredibly exhilarating. But I also think it's a young person's sport. At least for me, it's like, why are there no 50-year-old, you know, race car drivers? There's a certain point where it's a little bit too much up and down. And, um, so for me, I think for people who are really getting established as a professional, I would recommend that they find a really good financial advisor through recommendations from other friends and let those people handle it.

Would you, would you want to have somebody who's a financial advisor do a root canal? Of course not. Absolutely. So why would, why would I as an endodontist want to manage all the different options that you have, uh, in terms of investing strategies? That's my take.

No, I mean, Annie's right. But it's interesting because it's almost like a dichotomy. I'm, I'm more of, you know, what she said in terms of people who sell, um, you know, as soon as the stock goes up, is they're called investors. And that's true because that's essentially the opposite mentality as a trader, right? You could either be a trader or an investor, right? Traders, they want to cash out quickly, make a little bit of money, and so on. But that actually accumulates a lot more risk because that requires proper timing. So, whatever theory you use to time the market that way, it better be good. But nobody really has a good system. It all ends up being the same idea as gambling. That's why a lot of traders end up losing money in the long run because unless you have this robust kind of a mathematics program or something that is just using some some kind of a little edge so you can beat the market a tiny bit, it's going to be very difficult to make money as a trader, per se. Right? That's why investors are the rule, just like Warren Buffett and all these other people, because they believe in the long run, the market's going to go up, and therefore, if you hold, you will do well.

Actually, you know, it's funny because just yesterday, I had a patient who was, ever read that book by Michael Lewis called Flash Boys? No, but I've heard. I have to read it. I've heard about it. My patient was the guy in that in the group in the Citadel, the Flash. Oh my gosh. And he still had, they have now, they've kind of retired. They sold all of the stuff, and now they have like this one robust math program that they're using to do that same exact thing. They do billions of transactions per day with NASDAQ and, you know, and so on and and nice. And they get tiny fractions, like a fraction of a penny on each transaction, and that adds up. Volume. Yeah. They pay thousands and thousands of dollars in transaction fees, but at the end of it, they make some money. So unless you have that kind of a competitive edge, the idea to me, the way I look at it is that especially if you're young, you should even be a bigger investor. So the real question comes down to as to how much of your earning you should really save. And that's really the the theory as to what would it be. And if you really have a very, you know, if you're driven by spending your money, then you're going to have a lesser and lesser amount of it. You could save, right? So, I mean, traditionally, the average American like has a negative savings because they're spending more, right? Exactly. So, I think profession, it's great advice. You know, I, I was with, uh, it was a hedge fund right outside of Boston, and there were like 13 of us quote amateur traders. And I rearranged their trading page. I found a way at the time that they could get about a half a second advance. And it was the market was very different, uh, the way it opened up. It had a thing called the island on the NASDAQ stocks that would open up an hour before. So I rearranged the trading page. For some reason, that kind of crazy stuff makes sense to me. But of all the people trading, I was the only one who made it to a year. Oh wow. Uh, everybody else blew up. Yeah. And, and, and it was really crazy because I mean, one time there was a person, it was actually a physician, a specialist. And I'm watching this person trade, and I realized whether this guy realized it was real money or not, he just dropped $150,000. So I actually said to the guy who was the trading floor boss, you better go speak to Dr. So and so. I said, uh, you don't look at other people's terminals, but this guy just dropped $150,000. Yeah. And, uh, and he shouldn't have a terminal. That's a lot in one day. One last funny story was that I would actually do some research, even though trading is more a rhythm. And when you were trading, you would have a day like when Martha Stewart on the media came on. I must have traded at the same, the opening day, 60 times up and down. I was always ahead of the trend, up, going up, shorting it, going up. And in those years, if you were taking a short position on a new stock, you had to just be even at the end of the day. But you get into a rhythm. And there were other times where I just couldn't figure anything out. I'd close the terminal down at lunchtime because it was just going deeper and deeper. And again, that's kind of getting a rhythm and a breathing to how you were trading. But it gets pretty frenetic. And I think that's really, really a younger person's game to me. And but as Ali said, once I started getting, uh, some considerable funds, it's like, no, now it's time for a professional, not for an amateur to do it. So I think his recommendation about getting being conservative and having a professional thing, I, I totally agree with you. Yeah.

So I personally, actually, I, my portfolio is half and half. Half of it is professionally managed by people, the Goldman Sachs, and then the other half, I manage myself. Right. I tend to have actually a better return that they do, but it's because I take more risks. Right. They're more conservative because they want to make sure they don't lose my capital because that's, they've been instructed to make sure. So I can then gamble on the other side a little bit more. So that's the key thing. Once you have enough, then absolutely. You always want the, the most important concept of investment, as Annie would tell you, is basically having a portfolio that is as diversified as possible. Yeah. Because if you have multiple different segments and sectors of the economy, then at any point in time, there's about four or five different main sectors, and you know, real estate, and, you know, and obviously stocks and bonds, and, you know, and businesses, and, and things like that, owning a business, as well as, uh, few different, you know, modes of, uh, moving around money. So at any one point, whether it's gold and cash, all of these things, at any point in time, it's almost like an amplifier. Something is up, something is down. You can balance it out a little bit. I think Ali's got the right idea. I, I see trading for people like who are professional, like, you know, dentists and physicians and things, make it's like gambling. It's money that you can afford to lose. Don't do it if you can't afford to lose the money.

I wonder, Dr. Nasseh, Dr. Koch, like I think, so I have a really important question that I think the audience wants to know, and we really keep going back to this because people want to know how do they earn more, how do they gain wealth, how do they, you know, actually save? So I'm going to ask you guys for a few pieces of advice that, you know, up-and-coming dentists or specialists in the dental space and the healthcare space can actually, what can they do to take care of their financial future? And I think coming from you guys, that'll mean a lot. But before, before you guys give me that advice, what I, what I want to say is, I look at it like in a few different ways. I, the first thing to being a successful investor, like Dr. Nasseh said, you know, I do 50% and then the professionals at Goldman do the other. I think in order to be good at that other 50% on your own, you have to, you know, it requires a few things. One is being super aware of the the world's current events, the politics. Some people only look at the business side or the trading patterns, the S&P, and they ignore all the trends that actually cause the the markets to fluctuate. Second of all, they don't care and they offsource. And I think like any, in anything in life, if you're not actually aware of what's going on, you don't actually believe in what's happening, someone can take advantage of you somewhere. So, it's better to be ahead of it and know yourself. But then there's this other theory, which is like a lot of people invest money into real estate because it's safe and you get 7 to 10% every year, or over time. And then there's the Vanguard S&P, or you can invest in yourself. And so like a lot of people put their money into starting new businesses, and, you know, they've earned money through practicing endodontics or dentistry, and then they kickstart new businesses or put money into new, you know, as an angel investor. I think that's kind of a trend happening, and I see personally, that's where I want to put my money in. And I know we can, this is so generational. Why, what's wrong with that? What do you?

Yeah, I mean, it's, it's so, so it's a question of risk, right? It comes down to risk. Ultimately, all investment is a balance of the type of risk you want to take or not. I mean, ultimately, you can take all your money and go to Vegas and put like all of it in, you know, any number on a roulette table and start to to make money or not. But the real question here is, what is a sustainable type of a risk strategy that will always give you a certain rate of return that is kind of on par with the amount of risk you're willing to take? Now, early on, when you're younger, I totally agree that you could take more risk, but you could take more risk with a portion of your portfolio, not with your entire portfolio. Now, angel investing to me is one of those things that is like, once you already have a ton of money, then you could, you could because that's the ratio of risk is really high in those type of VC and, and, you know, so that's not something that you want to put all of your nest egg into early on, 'cause the chances are you're going to lose it.

That's what excites me. I think. This is a generational. This. Yeah, it's totally generational. I, I did the, you know, investor thing, the angel thing for a while, and I ended up losing, you know, a significant amount of money, and that was a mistake because I did it more as a personal thing to some different people I know who were building companies. And of course, even nowadays, um, it changes so much. Angel investing for, if you're starting out a company and you're looking for an angel, it's become much more difficult with angels. Years ago, you could get a, you could get like a return, you pre-arranged a return. Then it got to the point where angels weren't investing with you unless they got, you know, warrants. And then it went to the point now where angels now want equity. And when you're building a company, I'm sure, as you've probably learned, your whole thing is hold on as much equity as you can. So the whole angel investing thing in the last 15 years, in my opinion at least, has really changed. It was a lot easier working with angels 20 years ago. And again, when I'm talking angels, I'm I'm not, I'm talking, you know, not like seed funding, but you know, 50 to $200,000, that range, okay? You could, you could find some angels, and it was pretty easy working with them. At least the friends I speak to and in my experience, that type of angel has flown away. And now the angels that are on the scene want not warrants, they want equity. And then that gets the, when you're starting a company, the, the one of the main rules, keep equity as much equity as they can, because the further you go down, the next thing you know, you're working for somebody else. Okay. I'm sure you've heard many stories about that where people have been far too generous carving out equity as they're building, uh, their company. Part of the reason that money's gone is because the, um, it's been milked, right? Just way too many ideas that were really didn't merit, and there was a kind of a golden age of it where people made a lot of money that way through VC and all that stuff. But some of those ideas were gone. And now, as a lot of the government funding that used to be used for these types of ideas, kind of dried up, even in the medical industry, you see people are going and very quickly to go into the market with their companies, and these companies are basically just promises and ideas that are going public with nothing. And therefore, there's the failure rate has gone up in that sense. So people, the investors have become very savvy, and they're kind of like, you know, I don't want to lose my money either. So that's understandable. I can't recommend anything for anybody because I, right now, I'm a dinosaur in terms of that thing. There's been so much, think of, you know, AI, think of all these other things with, you know, computers, how that's changed the trading game. Years ago, you could actually communicate with the specialists at the New York Exchange and you could even see how they were, how they were working different stock prices and stuff. So to me, I, I think it's the game is entirely, entirely different now in terms of especially working with the two different markets. Go with a professional.

Back to your question, which I think was an important one. Annie, the question he asked is, what is the advice for the younger doctors and dentists who are interested in building true wealth, right? I mean, that's really a critical part of it. How do you build true wealth? And it's just a, you know, just like the basic stock type of an advice, you know, you know, buy low and sell high, right? It's what's there to say. So you build wealth in my opinion primarily, however, by a simple advice that I give at the end of all my presentations to the residents around the country, and that is advice that was given to me by one of my professors, the Gdonski, that Annie knows, actually, as I was graduating. The Gdonski gave this piece of advice, and it's very simple. He said, as you graduate, make sure you live below your means. And that's a critical component of it because most, especially today and for the younger population, because everyone is living on social media and Instagram and TikTok and all these things, and the FOMO is strong with this generation. That's right. That's right. So people are worried about missing out. People are spending way too much money on having experiences and and buying things. Everyone's become a consumer. And, you know, there's not a problem with that as long as it's managed properly. But to a lot of extent, I feel like people have become slaves to the material, and as a result of that, they could never build proper wealth as long as the idea that they have is one of keeping up with the Joneses, which is historically, it's an an old thinking. But but you really have to go back and start to think that, you know, the number one step in building wealth is in saving. And and, you know, the way I managed to retire kind of early, a little bit on this side, is I took on that advice and I was saving up 50% of my my income. And that's really, yeah, 50%. 50% that was my goal to save 50% of the income. Yeah. Oh, absolutely. And that's how you can retire early. I mean, there's no magic to it. Is you do that, and then you save it, and then you invest it properly into the right channels.

Let me give you an example, person example. 1986, I evaluated many, many dental practices in Manhattan. What I was trying to do was a number of years ahead of it, trying to have like a direct dental insurance thing with Japanese companies in New York City. Right. So I went around and I went, every time I went in with an accountant, evaluating practices, and it was stunning to me. And the one thing I came away with is that as a group, dentists had cars that they owned that they really couldn't afford. Okay. And like, you know, you're you're driving, you know, a fancy Mercedes when you should be driving like a Ford, right? And I, I couldn't believe it. When you get into the Schedule C and you got into the real bowels of their practice, that they didn't have that much money. But I think one of the things was certainly at that time, people felt like, well, I'm a professional, I'm a doctor, I went to school for all these years, I have to have some kind of satisfaction. But at the end of the day, if you're not making that kind of income, now you're getting a little bit into a scar territory. And again, the one thing that I saw almost every case, these individuals had cars that they really couldn't afford. Yeah. Which I thought was really interesting. So the net result, after spending, uh, six figures with accountants, I didn't, I didn't take a note. I didn't do what I wanted to do. I also couldn't find the Japanese connection. But the one thing, even though I spent a lot of money with the accountants evaluating all these crazy practices, the one thing I did not do was get saddled with a big note. So for me, it was okay.

So, what are the? So we talked about, so live below your means. So what can you say, three things? What can they, what can young dentists and up-and-coming healthcare folks and professionals, or anyone do to build their wealth? So live below your means. Dr. is a style, the way you filter the world around you, right? So, but then obviously you have to increase the input. So work hard, right? So you can make the money, and then save more of it, and then use what you save judiciously by hiring the right things, obviously, get, get training yourself. You have to read a ton of, uh, books. The problem also is what I see also my young kid is that everybody, because of the social media and because of the fact that people have exposed to a highlight reel from people, they think that building wealth and becoming rich and having these things is a quick thing. Yeah. I said, you know, give me the, give me the, you know, get rich quick scheme so I could do this. And there's just no such. I mean, there occasionally there are, but it's not the rule. Obviously, those are the exceptions. Yeah. So, it's important to kind of understand that that, you know, true wealth is built with lots of, you know, sacrifice and hard work and knowledge, right? So, gain the knowledge, understand how the system works because the system basically follows game theory. There's a certain set of rules you follow, whether you're investing into the stock market, real estate, you know, bonds, and other vehicles. You have to understand how this thing works. But you should not have the expectation you're going to get rich very quick. Sure. Sure. Right. So that's the problem is that people are not willing to do that, and it's just, um, it's difficult.

I, I think Ali's advice is right on the right on the money there. And, you know, one of the things also, you know, for me, uh, never having any kids, it's a different thing. For me, young professionals with a family, my god, that's such a, that's a such a demand, is such a different game. I just heard something today that what percentage of Americans spend $36,000 a year on daycare? That's a lot of money for a family to spend on daycare a year. So, and the other thing is, if you know, if you have kids, you got to go on vacations. Um, you know, I went on very few vacations. Luckily, doing a lot of lecturing in in dentistry, I was many places that kind of were like a vacation to me. So when I was done, I didn't want to go on a ship or on a plane and go someplace. I was happy being home. But I, I think Dr. Nasseh's recommendations, Ali's recommendation about living below your means, as as best as you can, and I think it's much more complicated with a family, is is a really good tip. I happen to agree with that very much.

So I think, I think dentistry is one of those professions that people really, I mean, you, you can take a look around the country or internationally, and people are doing really well. I think there's a lot of great case studies and examples of people who have done exceptionally well financially in the space. And so, you know, the biggest, the biggest thing for me in my perspective is I think, um, the way a lot of people seem to be so successful is they, they really hone in on one thing and one subject matter, and they become a true expert at that thing. And they, they, uh, focus their time, their energy, their resources, their human capital, their everything they have on that thing, and they grow it. And when they, when they are good enough and they exit from that or they become successful financially from that one thing, then their wealth starts working for them. So in our field, that's, uh, the most important thing we can do, just say, as an endodontist or as a specialist, is to be good at what we do.

A big question that a lot of my colleagues have, and as we navigate this landscape, is what's the best outcome? Do we, you know, do we work for ourselves? Do we build out a practice? Do we build out a network of practices? Do we hop from practice to practice? Optimize our time and resources. What is the best path to earning the most?

Well, I think one of the things, and I'll let Ali talk about this in terms of having your your own practice. One of the things I was never afraid to put money back into my education. And I think people like Dr. Nasseh and I can talk about that, at a certain point in your practice, put money back into the practice. It's getting, you know, whatever type of technology that you need. So, if you need a cone beam, get a cone beam. If you need to have a second microscope or a third microscope, get the microscope. For me, uh, I had been doing pros and restorative dentistry and was trained in that. And at age 41, I decided to go back, spend a bunch of money, and become an endodontist. It's not, it's not just the money and the tuition that you're putting back into a program. It's two years of basically having no income, right? And I think that's very difficult for people with a family to do. Uh, fortunately, there were just two of us and and the spouse was working. But I think the, the thing for me is, don't, I like the idea of betting on yourself. And what I mean by betting on yourself is either with different training. So if you're, if you're a non-specialist and you're out there and you're 33 years old and you love doing, whether it's perio or surgery or endo, don't, don't be intimidated not applying to try to become a specialist, but you've got to consider the financial part. And again, everybody's different with the level of confidence. You know, I think a lot of people are okay making a bet on themselves that they're going to do it. How do you feel about that, Ali?

So I mean, the question of how do you build wealth, right? Is we first have to kind of define wealth, right? Because I think we can say which one of these ways can build better wealth, working for yourself, working for somebody else, and so on. We have to understand that the definition of wealth is a little bit different than definition of money, right? Historically been associated with. I mean, not to get too philosophical, I'll get back to to say which way you can make more money. Sure. You know, working for other people, but you should really go back into understanding what is wealth. And wealth is more than just money. It's essentially the, it's kind of living the good life. And the good life is defined different by different people. So, you know, somebody who has, whichever way they define their lives, not maybe by material things, they could be, I mean, Epicurus, one of my favorite philosophers of, you know, the Greek philosophers, had this thing that all you need in life to be happy is friends, freedom, and then analyze life. Right? So none of these are really that money. And he said that the happiest he was when he was just having some give him some good cheese in the company of friends, and I'll be happy. Right? So, so that's like real, that's real wealth. So, it's not necessarily living the life that is promoted on the social media and things like that, right? Yeah. Yeah. I mean, you know, so I feel like we just have to kind of have that real understanding first, because often times what becomes our goals and visions in life is directed by people around us and other people. And often in the world of social media, that ends up being people that really have no business telling us how to live because they really haven't figured it out themselves. Yeah, but they are the loudest, you know, voices out there, and they tend to influence us. That's why they're influencers, right? So having a deeper meaning in life, you can't be happy and be wealthy, you know, having tending to a beautiful garden, having a great family around you, all of that, you would be wealthy. The studies show that beyond a certain amount of money, people are not necessarily happier unless you're a pure capitalist and, you know, a true consumer, which how do you define, for example, and I think we can, I can define it. You can define it. What, what is it a combination of besides money, which is an obvious factor, right? So, I mean, money, a component, again, to, you know, for it's just, let's follow the Maslow's hierarchy of needs, right? I mean, you, you once you take care of your basic needs of your security and shelter and, you know, food and things like that, all of those additional wants that come on top of it are not necessarily going to make you, they're not solved per se by money. Those are solved by inner conflicts that we all have that we may have not figured out. Right. So, changing the subject here from your question, you know, you want to know how you can make money, and I'm like going on a whole different tangent here, but but I think it's like unless you understand that and then you decide that you just want to have money, right? And which is there's nothing wrong with that. Obviously, we live in a capitalist country. I totally believe in it and I'm a big fan of it myself. So, uh, but but I feel like you can't really begin to understand how you build wealth, right? Without really having understood this part of the definition of wealth, because otherwise you're just essentially, you're going to feel like you're just on a treadmill running and running and running, but you're just not going where you want to go. Yeah. Right. So once you've understood that, okay, so let's get off of this, what some people may think is a high horse, but once you understood that and you have a, you know, a full understanding of what you want to consider to be your the good life for you, um, then as far as dentistry is concerned, where you can be, in my opinion, you can make the most money, obviously, if you're just interested in making money, would be to scale what you do. I mean, as as endodontists, as general dentists, and things like that, everything we do is a kind of a one-on-one ratio with what our hands can produce, right? So in order for you to be able to do more, then you need to scale that beyond what you do yourself because you are the rate-limiting step when you're doing all the work yourself. But then as soon as you start to add additional work by bringing other people to work for you, obviously ownership would be a far better way to make money because in that sense, you're going to own the capital into what you build. So that becomes equity into the effort you make. So the sweat equity that you put in, the effort you put into it becomes part of the, um, value, part of the value, and that's where the difference is in the generationally speaking is that you may not want that sweat equity. I gave a talk recently, Annie, at or to the, um, to the biomedical engineering class and was talking about all the developments and things like that in in dentistry. The first question they asked at the very end of it, the question was, well, how do you balance your work in life? Work-life balance? How do you, how did you do your work-life balance? I don't think there's no work-life balance. That's so funny you say that. You guys know Dave Ramsey? He's really famous. So, he's a, you know, a huge, huge figure in in the finance and saving space. He's he's massive. And he said, by definition, anybody who's successful at something, there is no work-life balance. So, he said, you know, I had, he, you know, he had a bunch of kids, and he said, I, I didn't make the 77 sports they played, I didn't make all the games all year round, but I picked and chose a few, and I, by definition, was committed to my job, and I provided a great life. And I think, um, that's a great point. But, but I guess I'm wondering, well, let me just answer a question, and I'll answer it about how I would, how I would define wealth. To me, uh, it was never a dollar figure. It was when it, I got to a place where I could do whatever I wanted to do at whatever time I wanted. Right. Right. That to me was that. Okay, I think I've got that's financial retirement. Annie. Yeah. But I mean, but again, you know, you have to realize, I didn't even finish paying my education loans until I was late in my 40s. So, you know, think about it now. If you go to a private school for for four years, then a private dental school for four years, then a specialty for three years, that's a lot of indebtedness. And so, as Ali said, you have to, you figure a way to work. What are you doing? And, and at that time, the loans, uh, the, the rates on education loans were really low. So, they were the last things that you would pay off. But that's a long time, and you think about that into, you know, mid to late 40s before you finally wipe those loans off. But to me, it, the wealth thing is not so much a number. That number is different for different for people. But to me, it really was when I got to the point where I could do whatever I wanted to do, uh, at whatever time I wanted to do it. Yeah. Time. I think autonomy of time. I look at it the same way, Dr. Koch. Like, while I'm not there now, I hope to be. And I think that the time is it, you know, how you want to spend it, if you're able to do it that way, I think that's a big deal. But, you know, I think what people want to know, and I'd be curious to know what the audience thinks, how do people define wealth? And for those who are up and coming in the dental space, what do you think is really the key to becoming, uh, wealthy in dentistry? And so you talked about scale. I want to hear from both of you. There's a few different pathways to, uh, you know, working in this space, whether that's as a specialist or non-specialist. You can work for yourself, you can scale that, you can go practice to practice, you can go corporate. Let's get a little bit real here. What are the, what are the real ins and outs of this model?

I want to go first before Ali, because having been a director and having residents graduate and go out into the world, I feel really strongly about this. Most people, and it's totally understandable, when they graduate from a training program, be it endo, perio, surgery, whatever, you have a lot of debt, and all of a sudden it's like, I want to make it all back in the first year. Listen, don't be a hack. If you come out of school the first year and you're a hack cutting corners, by the end of three years, you're a serious hack. And so my whole thing is that when you came out of the endodontic program, concentrate on your technique. Speed comes to you naturally. But if you start cutting corners in the beginning, that all of a sudden going to become a huge swath. And it's really amazing, at least in endodontics, Parsa, how quickly the speed comes to you. So that first year to me, Ali, I think it's really about refining your clinical technique, incorporating speed into what you do. And then by year two and three, you start to make, I shouldn't say this, but I will. You start to make more money than you could have imagined. But that's working because you're doing good endo and you're you're making a patient base like Ali did. That's the key. But I've seen so many people the first year out of school cutting corners. They're taking every mole to 21 millimeters. Oh, it's calcified. All that kind of stuff just to crank out patients. I, I strongly advise against doing that. I strongly advise work in your technique, and your speed will come to you.

Absolutely. It goes back to having a philosophy before you start to working on your efficiency, right? So, you really need to have, and by that philosophy, I mean, what is your efficacy? What is what is it that you're trying to achieve? And then you can cut out the fat to be more efficient so you can maximize that output for, you know, our line of work. Obviously, you know, you, you could work in any of those settings that I said. As you said, time is the great equalizer. All of us have the same time, whether you know, whether you're Elon Musk or if you're the guy who's passed out on the street here. Everybody's got the same 24 hours. Just the question of how you spend that time and how you make the most out of it. And that's to that extent also is, I mean, you know, if, if, if you end up just working so that you can produce money, then it takes away from that idea that I was talking about, what is the good life for you? So you first have to define what is the good life for you, and then from there, you then need to engineer what would be the sustainable way that you could make that happen so that you can, um, and then there, there's obviously going to be some sacrifices, right? So the question then becomes, based on your personality, what you want, where that sacrifice should lie. Is it going to be on the side of your family? Should it be on the side of your work? Should it be on the side of your fame? Should it be on the side of your money? And all of these are factors you need to constantly keep in mind and constantly balance out to find out what is the right answer for you. So, but, but I think like one thing a lot of people wonder is like, when they leave a graduate program or they leave dental school, and they want to know, okay, I, I, if I, if I go work for a private practice that's owned by a 30-year career dentist or specialist, I'll probably learn a lot. I'll probably see less patients, but I have the support, I have the wisdom. And maybe there's even a path to partnership. Then you're presented with an offer from one of the big DSOs. I won't say their name. And there's a $50,000 sign bon sign-on bonus, and you're on track, you know, to make, you know, several hundred thousand, first year GP or whatever it is out of dental school, and you're really scratching your head wondering if this is the right move or not, and you have to put the, that ahead of your, you know, maybe some of your future goals. I guess that's the part that I think we want wisdom on and your advice on how should you evaluate that situation. Is there any downsides to working corporate and seeing a lot of patients, maybe at the risk of not being 100% quality? You know, those are the conversations.

Can I go first, please? Because I feel really strongly about that. And what I mean by that is in an endodontic training program, there are two things people

have to get a handle on before they graduate. I I think endodonic training programs everybody should try all different types of systems because what may work well in my hands may be a different technique in Dr. Nasi's hands and you know what an entirely different company's file may work best in your hands. So I think for everybody in dental school in endodonic training programs, you have to find a clinical technique that works for you. But the part that everybody misses is you also have to find a philosophical component that works for you. And that's what Ali was talking about a little bit on the sides there. You have to have not just a clinical technique that works for you, but also a philosophical viewpoint that works for you. And I think when you understand what's going to work for you, that's going to give you make the decision whether it's, you know, a private practice or a DSO a lot easier. But if you don't have some kind of philosophical component to where you're going, I think it becomes very difficult to make the correct decision.

Yeah. What's your perspective? What's your stickick? What's your angle? How do you, you know, totally how does it make sense to you? And then from there, you kind of uh work out the rest. So, you know, for me, for example, was kind of making it a patient-based type of a practice. for somebody else. It could be some some something else. You know, every everybody's going to have to find that thing first by which they define the value that they provide in the work that they do and then from there they'll get to work it out. But let's just go back directly to what you ask in terms of the working for somebody else or not. To me that the the question to to ask oneself and I can tell you for myself what I always tell people to ask me should I do this or that. I said, you know, you first have to decide where you want to live cuz that really helps a lot if if you know where you want to live, right? You have a lot of freedom. You can go different places. There's a lot of need in this country for different types of work, right? So, if you can go anywhere, you can go to a lot of places and get a lot of good opportunities and that's actually a good thing and you should go where you get the good opportunities whether that is going to be working for DSO or build your own. I think it also comes down to what you want to do at the end of the day. If you want ultimately to build your own, but you don't have any experience, you could work in somebody else's practice for a little while and gain some experiences through osmosis and through, you know, basically deliberate practice, asking the right questions, seeing how operations work and then transfer some of that uh knowledge into what you want to do later on yourself. But the sooner you get to do your own thing, the better off you are because again, it's all about time. Just like investment, the sooner you start to save money and invest, the better it is because the compound interest, you know, compounding the it's all a question of time. And the same thing and that's why the BMW 7 series that you drive when you're young, you know, will cost you two to three years of retirement, later retirement. So that's that's a key thing. You have to you have to look at it that way.

That's a tough one, but Exactly. Right. That's a great way. But but so you have to think of things like that in the same way. But uh in terms of what what to do, it really comes down to what is your ultimate goal. If you don't know what you want to do, and that's okay cuz I actually I didn't know when I graduate from school where I wanted to go and what I wanted to do and so on. And I did for a couple of years did work as an associate in different practices. And it was a great experience. In fact, I was in the prototypical DSO at the very beginning back in the early 90s. It was not a DSO. It was a group practice. It was like the largest dental group practice and they built many many offices and I worked in that and I ended up seeing so many different offices, so many different practices, different types of practices, working with different types of assistants and different operations and that really was helpful to me in terms of understanding my own vision as to what is best for me. So having that experience helped me hone in what do I want because many times I saw what I didn't want. Interesting. and that helped define what I do want. So, but did you know did you know going into that as you as you took that that position? Did you know that you wanted to own your own practice and and make it what it was? I mean, we're only a few blocks away, right? One of the most beautiful streets in Boston and what it turned out to be. Did you know that that was your goal in the end? No, I didn't actually. So, that's what I'm trying to say is that, you know, you you know, you can't plan all your life ahead of time because at some point some of that spontaneity is needed to kind of make it fun, right? Because if you know if you if you want to plan the whole thing too far ahead that takes away the fun but as I feel the whole process of growth is a process of self-discovery. You figure out more about yourself and what you want and you put yourself in these experiences and you hone in what your goal is and then it slowly but surely that image will emerge and you see what is it that you want to do and what makes sense to you and then that's where the execution is needed.

Yeah. Right. So it makes a transfer from knowledge into execution. You've been doing your, you know, analysis. Now it's time for action, right? Then you do it. So that's that's perfectly fine. Some people, they start the dental school and they know exactly what they're going to do. They're going to go practice with their parents or like do this or do that. That's all clear. But for many people who don't know what they want to do and what the options are, there's nothing wrong with just kind of, you know, planning around. It's just as long as you're not stating in that persistent vegetative state. Right. Right. Right. And you're moving forward. Yeah. Dr. Cotch, have you have you thought about it? I mean, cuz you you said you never practiced. You never owned your own practice. How did you think about that? Well, I I was obviously working in the military then working there with a lot of different HMOs, PPOs, different practices jumping around, you know, doing work. And then got to the point I I got tired of having people tell me what to do. I'm going to be honest. I don't like people I don't I don't like people telling me what to do. Okay, I'm just being honest about that, right? Doesn't mean doesn't mean I'm not going to listen to suggestions, but that's different than no, you can't do this, you can't do that, that kind of stuff. And you know, Ali knows I'll tell you that when you go into different offices, my god, whatever you do, don't upset the assistants, right? And it's like we could get another dentist easily, more easily than we get the hygienist or assistant. So that gets to a point where I just I didn't want anybody else telling me what to do. The other thing that's really interesting is when I came out of endodonic training, I trained in Philadelphia and uh so what are you going to do? I go to Boston. Everybody without exception said you can't go to Boston. What? What do you mean I can't go to Boston? Well, there's too many endidonists you can't do to Boston. Don't don't buy that. If you're good, if you care, you can go anywhere. May not be easy. It may be much easier setting up an endodonic practice in Syracuse, New York or Madison, Wisconsin than Boston, but you can go where you want to go. So, what Ali says, and I think this is really important if you have a spouse or a significant other because when you're working and you're starting out, you're spending a lot of time at the office. And it's like even like the school thing, even though a school is a totally different situation, I tabulate it up all the time when I was at at at the school. What do you how how do you how many hours a week do you think I was at the school? Let's see. Um Oh, I'm going to flip the cards. 79 hours a week. I was going to say 80. Wow. Investment banking hours, Dr. C. And again, and I won't tell you what the uh what the uh re reimbursement was, but the point of the matter is you do it because you love what you're doing, but you're also building what you're doing. But you get to a point, as I said, for me, I I didn't really want people to tell me what to do. I felt confident my own abilities to do what I wanted to do. But I think the other thing that's really really important is if you're trying to be it's not just dentistry, but if you're trying to build some type of business and and you have a spouse or a significant other, if that's in an area or location that that makes your partner or spouse unhappy, boy, that makes for a really pretty miserable, right, existence.

I guess the there there's people listening who have aspirations to own a practice or currently own a practice and want to grow it. There's also people who want to find the right journey and path, you know, as an associate their whole career. Dr. Cotch, obviously, you're doing a million other things, too. So, I guess you're not the the typical example. Um, but a lot of people want to be an associate because they don't want to feel the pressure and and burden of it. I'm not one of those people, but Oh, dang. A huge portion of the population is. So what do they do to be successful? If if an associate comes to your practice, Dr. Nasa and Dr. Kotchel come to you too. Why do you how do you see them setting themselves apart or differentiating themselves compared to someone else? As an associate, what can they do to be success classes so they can you know talk about investment in yourself, right? That's what continuing your education is. I mean education itself is an investment in self, right? I mean that's the whole essence of it is that that's how you get the higher levels of skills that you make yourself irreplaceable right that's the key thing irreplaceability factor of an employee is what gives them the value the uniqueness and that allows you to be able to um perceive that value and pay them accordingly. So as a dentist associate, the key here is that what's so different about this particular dentist and it could also be it doesn't always have to be just a lot of C courses technically and educationally. Some you know personalitywise or something and some people could be very popular for that reason that's those are all important factors but ultimately it goes into again it goes back into trying to refine that vision of who you want to be and what is your goal. what is in your eyes the optimal dentist that you can be. Not just somebody who does fillings and and and crowns and, you know, scrapes calculus off teeth, but instead, you know, how do you see yourself as the kind of person that creates the kind of value that makes you irreplaceable? Whether you're working for yourself, it would be the same thing. And you know, on that side, when you're working for yourself, it's certain executive or managerial components on top of your clinical components. But as an associate working for somebody else then the key is how do you you know add value to the practice and those are the things that you can improve and you have it's you know it's just like the rest of life it's not just in dentistry and everything everything else you know it's a constant state of growth and learning and once you develop that then then whatever you do you're trying to apply more you you got to find out how can you be better you know that's the key thing how can you improve it's Annie would know that Kaizen Right? Kaizen is the the Japanese principle for Kaizen. It's the continuous and never ending improvement. Right? The Japanese believe in the industrial line that every tolerance can always be better, less error. I'm sorry, Annie. Go ahead. And I I just learned so much from living in Japan. Totally affected for me in terms of product development. Uh what I mean by that is that in Japanese society, Japanese culture, the more sophisticated something is, the more simple it is. And I think when you know for me in the dental world the worst thing is having engineers try to co-design something with you because engineers in my experience create products that try to impress other engineers. The thing for me is how is it going to be to the end user. Okay. And so for me if you're creating a product you have to realize the person who's maintaining that handpiece or maintaining that piece of equipment many times is 19 20 years old maybe a year two years of community college. So you can't make this incredibly incredibly challenging to maintain it. And also in terms of of using it, if you have uh a product idea and and you have something like four buttons, maybe get that down to two or one button. But to me, I think the genius is in taking an advanced concept, distilling it, precipitate out the core aspects of it, so for the end user, it becomes straightforward to use and maintain. Annie Para has an engineering degree, so we shouldn't give engineers too hard of a time. Oh yeah. But okay. So, but I won't take too much offense. No, but but don't you don't you agree on that? Yeah, of course. Yeah. No, I think it's funny because even as an engineer, I think about being a practice owner and I think a lot of people want to. And I'd like to know, by the way, the audience, what percentage of you guys are practice owners versus associates? We'd love to know versus students. That's a great thing. So, please leave your comments below. But Dr. Nas, I'll go to you with this. It's all about efficiency, right? You teach me that every day in the clinics. Uh Dr. Cotch talks about how you're the you're the king of efficiency. So what does a practice owner do to boost their efficiency and boost productivity? What do they do? So talking about the practice owner or somebody who's doing clinical because on what aspect of efficiency we're talking about about the practice as a whole or each operation each endodonic procedure because I think the practice let's talk about the if that's okay. I mean there's a whole operation. Yeah. Operations. So operation wise I mean you know that that's actually a pretty uh that's a long conversation because it's a multi- aspect uh type of a um approach. You have to understand that you know your operations is really as good as your communications right dental communication is a major part of the practice which means how do you I mean it goes back to management and leadership right how do you get people to do what you want them to do for in order to do that you need to have first a good vision of what is the kind of operation you want to run right what is efficiency to you what is the so you can be as efficient as possible but then as you increase speed you reach a point of diminishing returns in which the system falls apart. So as good as your system that you have right so you need to kind of figure out what is the kind of system you want to have and then be able to inspire motivate and then compel everyone under you know your supervision to do the uh the right things. So that's essentially what you want to do. So how can you increase the efficiency of the office is by understanding what is an efficient office to you and then discover where the inefficiencies are in the office obviously. So many inefficiencies are in my opinion generally at the level of the procedure. It's often times just fidgeting not really knowing where the end is. So you're not going from A to B in a straight line. You're just kind of meandering around. You don't know where Yeah. You're not having a good flow. You're not communicating well with your assistant. your system doesn't know exactly what you want. I always, you know, often times in my uh presentations I tell people that if you want to be more efficient, the first thing you need to do is to have to develop a mindset of efficiency. You have to think that it's important that you want to be efficient and efficiency means also to some extent that it's going to be stressful, right? Because anytime you apply time and work together, right, means you're pushing yourself and therefore it's going to be stressful. So you have to see what is your comfort level. What is that point at which your system is going to break down and you're going to start breaking files and ledging teeth and you know not waiting enough for anesthesia and you're going to end up being unproductive and doing worse. A good way to kind of figure out where you are, as I say in my in talks, is to film yourself from the moment you walk into the room to do a endodonic procedure or a filling or a crown or whatever you do until you leave the room and then later on sit with your assistant and watch it at the end of the day and then see where did you guys where were you guys inefficient and by inefficient I mean that you really didn't achieve anything by the time you spent there. Right? If the assistant had to get up and go get something from the other room, that's inefficiency. It's a waste of time, right? If you were just kind of like meandering, not wandering, you didn't know what you were doing, that's inefficiency. But if you spend a little bit of extra time talking to the patient in a way that try you try to build connection and you try to create a little bit of value, that's not inefficiency. That's could be a part of it. But it's question is when did you do that? Before you did the anesthesia or while the patient was getting numb, right? So that connection is important. But you just have to apply it correctly in the right sequence of events. So that's for the clinical part. But in terms of the other aspects of the operation, I feel that you know people waste a lot of time on the phone. They're not very good in terms of the um the assistant communication with the patient. All of these are a part of that vision that you need to communicate and coordinate everyone under your supervision to be able to do that. And to some extent at c certain scale you start that as a oneoff office scale right. Yeah. And then as soon as you start to scale things up then you would kind of be out of the picture. Then you rely on proper delegation. So the people you delegate the these tasks to have to understand your mission and vision in terms of efficiency and care. So it's you know all of these things whether you're running an office or you're running GE or some other math it's all the same set of principles of organizational behavior and organizational management that you need to do. It's this is a microcosm of it. As you get larger, it gets more and more difficult obviously in many ways and you need to have more hands on deck. But ultimately, it's about communication and and proper delegation. That can only be successful with uh proper delegation, which is trust and verify and make sure that things are done properly. And that starts by having the right team and then knowing how quickly you should get rid of people that are not good for the team. So, and you know, and that changes cuz based on the environment you're in. I mean, if there no assistance around, you know, you're going to have to see if you can train somebody who's a little bit not as good as opposed to hope you're going to get a better one. So, having a good system of training, having a good uh booklet that people can go back to and kind of reread and reorganize, having adequate number of meetings on regular basis so you can reorient everyone to the same direction because, you know, as they say, it takes multiple times to create a habit. Yeah. And you could communicate something once or twice. Never expect that once or twice of a communication of something is enough. That's where you know leaders have to be patient because people just don't grab things like that. So, is it worth it to have team meetings? I know a lot of practices do that where on Monday morning they go through their goals for the week for productivity patient. Is that something that you see in Edo? Every day ideally if you could start by Yeah. I mean ideally if you could start with some type of a huddle and and and and be able to just communicate at least your mission statement for the practice. What is your mission for for this office? How is everybody should be thinking about the patients and you know so on the customers if you will. All of those things will just reorient you correctly to your goal. Danny wants to say can I just add a couple of real world things here especially more towards recent graduates of endodonic programs. Um there's going to be a lot of graduates who go out and they'll work in a couple of different endodonic practices. Everyone is a little bit different in terms of equipment, but there's going to be a fair number of recent endodonic graduates who go into different general restorative practices and do the endo. That can get really inefficient and frustrating because they don't have anywhere near the equipment that you want to use and what you're comfortable using. So, when I went around, this was both uh endodonic practices and one or two restorative practices in the past. I actually had a big bag that I took my equipment with myself. So I came in, I had my, you know, my my back filling gun, a percher gun, I had a bunch of uh files sterilized in different bags, but I brought equipment in so that if I had to do a procedure in that office, be it an endodonic office or if it was a restorative practice, I had the equipment that I needed because if you don't have the equipment that you need, it gets very frustrating and it gets very inefficient for for the person doing the root canals, which is you. So, I think if you're a person who's going to spend a year, two years, or however long it may be, doing the have file, will travel, a great tip, and I I really learned this from one of my residents, right? They were working down in uh the South End and and over in the Chinatown area of Boston, and they had a bag, and when I saw the bag, I realized, my god, this is brilliant. So, I I adopted that very quickly. And any office I went to, if they didn't have the specific instrument that I wanted, I knew I had it in my bag. That took a lot of stress out of the day and it also added a great deal of efficiency to me in that office. Right. Right. I think it's all about systems like you guys said like you know my take on it maybe stemming from other experiences in my life having the right systems and you know patient first experience. I mean Dr. Dr. Nas, you talk about this all the time. Like in any business, it's a customer first experience. And if the patient feels like they get there, the front office is organized, they're picking up their phones, they're able to schedule, reschedule, cancel appointments, they get there, they take their pain medications, they're under the chair, they're in and out, they feel comfortable, and then they can get in touch with you after. That whole system, I think, creates efficiency. like so you might spend an extra minute or two finding something or the assistant does and you might chat for a couple extra minutes but in totality it's such a systematic approach that you're highly efficient and I think I think that's something that we learn uh you know in residency I mean we don't have our own personal assistant we do everything from A to Z we set up read the notes we uh write the notes obviously we go through all the imaging ourselves we take the images the x-rays the CBCT we do the procedure we we clean up we give posttop instruction instructions. We walk into the front desk so we learn how to be efficient uh in order to learn and also make our Harvard clinic productive. But I think it's it's sort of a big thing that people want to know about. And I I guess for me as I think about the next steps, it's you know I I I hope to learn as much as possible on a path to having my own practice. But I guess the biggest question is if I know that's what my end goal is, you know, what is the value in even spending a few years working in different practices to be able to ultimately get there knowing that that's what I want to do anyway. So I guess it's food for thought and with the with some of the audience telling us where what they're doing, whether they work for someone else or work in uh their own private practice, I think this will all be very useful and I'm I'm excited to see what they say. One of the things um many many many many uh restorative or general dental practices uh they actually have a tub or or they have basically you know a cart that's basically the endodonic component. So it's amazing. I've been in so many offices where they've had a tub that's where all the endodonic stuff is right. So if if you're in an office that's not a specialty office and you're doing endodonics spend some time to get your endodonic stuff organized. I used to even tell these different people uh have a trauma kit, right? And the trauma kit would involve fishing line for creating a splint. I would tell them, you know, use 40 pound test, you can use pink line, have some resin material there that you can tack it onto the adjacent teeth so that if somebody comes in and they've got a young person, a kid, and the tooth has been somewhat, you know, uh luxated, uh if not, but let's say luxated, you have the ability to very quickly, seamlessly, efficiently put that splint on. So I I think it is and I think efficiency o goes back to being organized for sure. I mean and that and that's kind of a um personality type of the kinds of people you're going to end up hiring, right? Because you're going to have to compensate for your probably what you're missing yourself by having the proper delegation of things. I mean, you know, Annie knows I'm not the most organized person, but I I've organized chaos operating my you not organized. No, but I get things uh done anyway. I could find all that matter a needle. But I think that might not be a bad idea at some point in the future to have someone who is like a large practice manager, something like that to kind of come talk about see how do you coordinate a uh you know a number of staff together and what would be a good some of the best practices for people in the DS. Yeah. I mean large practice numbers because these are like the organizational behavior we're talking about at the level of the you know because it's very different in different industries right I mean if you're dealing in a a large uh retail group is one thing if you're working a big network of engineers working in cubicles is one different thing if you're working in a dental office it would be a different thing but the question here is that how do you make people gel how do you create that thing I mean in a small practice it's easier as I said because you could be on top of it But once you start to scale up, things start to get out of control and then you need to have those catalytic mechanisms that kind of holds things together from flying apart. Yeah. Yeah. I think I mean DSOs excel at that. So yeah, that's it's the endodonic perceived itself is not the difficulty, it's personnel management and efficiency. That's the challenge. I have a question for you Parsa. as a person who've gone has gone into endodonic training right from dental school and I don't know whether you're working moonlighting outside of the school right now but what I'd like to talk about and and especially get Ali's take on this because he's so centrally located and has such a wonderful reputation. I'd like to talk about basically referrals and working with other specialists and physicians if you have any recommendations to that. I mean, I'm from the point I've never hesitated uh calling any physician. And luckily for me, in my entire career, anytime I ever had to call a physician on a patient, it was nothing but a professional conversation. So, I I never had any hesitation doing that. And also, in terms of referring to a periodonist or a surgeon, to me, I've always had really good relationships. And the biggest thing for me that worked for me was being totally honest. A couple of times I had just enormous, enormously difficult patients. These people had a lot of other issues going on and the tooth didn't need to have a root canal. The tooth needed to be extracted. When I made those referrals, I called up my friends who were the oral surgeons and said, "Listen, there's a patient coming over and this is a difficult patient." Afterwards, I had one person said to me, "If they ever sent another patient like that to them, they would kill me." But these were these were people who couldn't help. They were just difficult people. But I think I think being honest and this is especially for non-speists. If you're referring a case to your local endidonist uh who's going to help you out, be honest. If you broke an instrument in a miso buckaroo, tell them because they're going to find out anyway. If the patient really is a management nightmare, give us a heads up. It benefits everybody. So I think there there really is an art to working with specialists both other dental specialists and medical specialists and I was wondering Olly in all your years working there on copy square what's your take on the whole referral business well I mean it's you know if we think of ourselves as islands that's always going to be a problem we have to think of ourselves as teams and if we think of ourselves as teams then you are really as strong as every link in your chain right so every member of your team is support of you. And that's why having a good referral network and having that proper relationship that is based on good communication to talk about situations in which things are not going the right way and you know that will just going to create a lot of uh great outcomes for yourself as as you know as as as a business uh person but also as uh for the patient in terms of what they're expecting. So you know as in our line of work the number the types of referrals that we send out to um physician colleagues as since you were asking about physician colleagues you know we work primarily with neurologists and and um ENTs orangologists because of sinus issues and things like that that's very important to have a good strong network since you see a lot of neuropathic pains neurological issues on top you know our job as endodonists is to rule out endodonic sources but that doesn't mean everybody who is coming to is necessarily knows that they have endodonic sources. And that's really what makes a good endodonist is somebody who's able to rule that out and know that look this got to be seen by somebody else as opposed to do a full mouth of root canals on everybody that you see just as that has pain in the you know in the facial area to be able to to triage that. with other people in your team. Again, I mean, you know, I always say as you know that I always say that the number one source of your success in your practice is going to be your case selection and your treatment planning. And number two, I have as your communication skills, communication ability that that goes with communication with your patient in terms of managing their expectations, your communication with your staff to keep them happy to be a good leader because I mean that's just leadership, right? and then communications with your referring sources. And if you can manage all of that, you'd be taking your first step towards building wealth. Make it full circle to the beginning. Full circle. Full circle. It's a good point. I mean, I think uh you talk about this all the time when you when you teach us, Dr. Nipet, I think personality matters a lot. Like I think if and we do this, we we for implants, we think about periodonists, oral surgeons. I think the person that I would feel most comfortable setting my patients would be someone who has a true grasp on patient management and can really make them feel comfortable because you know just today saw a patient who had been kind of tossed around from practice to practice two really big active infections in incredible amount of bone loss and felt like they were hopeless they thought implants were expensive they didn't know what they were going to do they had number eight n compromised and they left feeling a little bit more comfortable and stressfree and I think if a provider's exceptional clinically and they just don't know how to be kind and effective in their communication to make the patient feel better, then they're really not doing their job. So, I think when I think about who I would refer to, it would have to be someone I feel comfortable in their uh personality. Well, do you know what the first question a general dentist asks a patient after they've sent them to a specialist and when they see him again? What's that? You know what the first question always is? Always. What's that? How did you like Dr. Nasi? How do you like that? They don't ask well did you know was the gut perure a millimeter from the apical terminus or was it 2 millime or what technique? No. How did you like Dr. Nas or Dr. Cotch? That's the first question that's always asked. Sure. That makes sense. Yeah. And then people will judge you based on the peak and valley they're experienced under your care. So your job as the kind of communicator with clinical skills obviously is to manage that peak and valley. Yeah. So through the way you run the office, the efficiency concepts of, you know, how the front desk answers the phone from that moment on, you going to build that brand of that experience because people begin and initiate that experience with that first phone call, right? That's why it's so important to have the right experience with that. I mean nowadays, I wonder what's going to happen because now there's a lot of AI infiltrating the the phone conversation. I don't know how that's going to end up, but that's going to be for the better or for the worse. What do you think? Is it going to be better for the worse? for probably for the better. I can't tell you how many times I've called a doctor's office or an airline and been superbly disappointed about the of the response I get. I mean, I I think that's a stigma. You see it in like SNL skits. You see it on social media like sometimes the front desk people at doctors or healthcare offices, they're not the friendliest. And I really think it makes a difference. If someone gets there or they're on the phone and their experience is pleasant and uplifting, even a dire situation, you know, I think your experience is immediately, you know, elevated, elevated to the point where a lot has to be bad to change your mind. I think with AI, I think it has to be better because you take away a lot of that negativity and that human bias. Someone has a bad day, they pick up the phone, they're not in the mood to hear a patient complain about their 15-minute scheduling conflict, it's not going to translate. And AI is we're building human intelligence and emotional intelligence. So I'm not so worried about the robotic monotone of AI anymore. You know what I mean? So that is so true. It's a lot of upside. Lot of unless the person answering the phone is not Grock AI fun mode. You're I've heard that. I've heard that it can get pretty pretty spicy. Oh, it sure can. Yeah, that's that's Annie. That's the X platforms AI Gro and it's got a couple of different modes and one of them is the fun mode and can get pretty rowdy. Yeah, that's right. So that's interesting. So that's terrific. I mean we could talk about this stuff for a long long time but I think it's been um kind of long in the tooth at this point. So this is fun and this is extemporaneous and uh I like it posh you would be interested when I was running the program I had an externship with ENT and a couple I don't think you did it but a couple of of Yeah Manny did it. I didn't do it. No. Yeah. Yeah. It was really good and eventually it stopped. But I think where I'm going with this, um, I think endidonic programs should make an attempt to see if they can get some type of exposure for their residents with the ENT guys. I think if you speak with Dr. Alvaro, I think Matty thinks it was one of the best learning experience of his three years because as you start to do more more and more endo, you realize ENT and endo, you're up in the sinus, you're in these places, there's a lot of overlap. But I think I think that's the thing that I'd love to see more endonic programs do is have some exposure working with the ENT people. Yeah. I mean 30 40% of sinositis unilaterally is actually origin. So knowing that is a great um uh thing and to be able something like that. Right. Perfect. Well, it was fun. Let's do this again uh soon and we should get more into this practice stuff and we should probably bring some other people in. I think that could add a lot of value for our viewers and so on and that would be great. Well, terrific. Great to see everybody. Ali, I know you're heading off on a couple of weeks travel around the world. So, safe travels, be smart, be safe. I'll try. I'll be at the ID and also traveling to China. Great to see you. Thank you both, Dr. Nasseh, Dr. Koch. Thanks again. Pleasure. And we'll see you in the next one. [Music]