March 31, 2025 • 19 mins
One bad case can haunt you longer than a bad hire. But what’s really more unpredictable — the patient in the chair or people in your practice? This episode debates what causes more stress: clinical work or the business of running a dental practice. The DPH coaches share their experiences on both sides of dentistry and how they reduce stress in clinical procedures and day-to-day operations. This is a practical listen for building more confidence and predictability into your day!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Paul Etchison (00:02):
Where are you more comfortable Doing clinical
work or dealing with the demandsof the business?
Today, we're debating whichside of dentistry is truly more
unpredictable.
Is it the procedures, thepatients or trying to keep your
practice just running smoothly?
And what can we do to make bothsides better so that we can
have less stress and a littlebit more joy?
I am joined today with my DPHcoaches and we've got plenty to
(00:25):
say about this one.
Let's get into it.
You are listening to DentalPractice Heroes, where we help
you create and scale your dentalpractice so that you are no
longer tied to the chair.
I'm Dr Paul Etcheson, author oftwo books on dental practice
management, dental coach andowner of a $6 million group
practice in the suburbs ofChicago.
I want to teach you how to growand systematize your dental
practice so you can spend lesstime practicing and more time
(00:48):
enjoying a life that you love.
Let's get started.
Welcome back to the DentalPractice Heroes podcast.
Thank you so much for spendingpart of your day with us.
I'm here, dr Paul Edgison isyour host, and I'm joined by my
co-host and coaches, dr StephenMarkowitz and Dr Henry Ernt,
(01:10):
both owning large practices.
Steve, owning many practicessix practices, six practices.
Steve.
As of today, that's the numberSix practices and Henry and I
both are owning a large practice, but we are all dentists that
have pulled ourselves outclinically to focus more on the
business aspect.
But we do still do someclinical and today we kind of
(01:31):
want to talk about man.
Does clinical dentistry suck?
Because I think you canresonate with yeah, it kind of
does.
Let's pull it apart because Ihave some opinions, but I want
to hear from you first, steve.
I mean, does clinical dentistryjust suck?
Steve Markowitz (01:47):
I think, paul, you wanted conflict.
So I think clinical dentistryis freaking awesome.
The problem is, you just see somany people, like you could see
.
In our organization we did over80,000 visits last year Wow.
In our organization we did over80,000 visits last year Wow.
If we were 99.9% perfect, we'restill going to have I don't
(02:11):
know the math, but a lot ofthings that didn't go right, and
the human body is unpredictable.
There are things that we maynot have seen as clearly as we
had hoped, and it sucks to dealwith complications, but if we
help or try to help enoughpeople, there will be something
that doesn't go how we expectand then we got to clean it up
(02:34):
and make it right and that sucks.
So, yeah, there are some partsof clinical dentistry that
aren't predictable, but there'salso a way and a method for us
to not put ourselves in thatposition or try to limit the
number of times we put ourselvesin that position.
Paul Etchison (02:50):
Well, you being an owner.
You got six practices managinga lot of people.
Do you find that clinicaldentistry is more predictable
than the people side?
Steve Markowitz (03:01):
We'll try to turn this around on me.
That's the question I was goingto ask you.
You're the one here on everysingle podcast that's saying
clinical dentistry sucks.
I'm saying it doesn't because Inever said that.
Henry Ernst (03:11):
I've never heard.
Steve Markowitz (03:12):
I've never heard him say that Steve watch
it Way more predictable way morepredictable than how a tooth
and bond is going to formtogether.
It's again, it's not widgets,but we're closer to widgets than
people with feelings andemotions and trying to predict
how someone's going to respondto honest feedback.
(03:34):
People suck, and I say thatfrom the most loving place.
Predicting how someone is goingto respond in a situation is
winning the lottery.
There are so many ways forpeople to respond to certain
situations.
Again, I think that's part ofthe beauty of what we get to do
as owners and leaders is trulyinfluence and grow people.
(03:57):
I love that part, but to saythat it's as predictable as
clinical dentistry is wild to me.
Paul Etchison (04:06):
Well, I feel like there's like I don't know who
said this to me at some point,but somebody said you know, I
have some days where I run mybusiness and I have some days
where I'm seeing patients.
I never had a bad day runningmy business.
And I was just like, yes, thatis so true.
And I feel like for me, likeyou know, yeah, people are
unpredictable.
But at the same time, man, Ijust find the clinical dentistry
(04:27):
so much more unpredictable.
I feel like I can do everythingright and something still
unexpected happens.
And I feel, with people, I justfor me, it's been much easier
to the more I communicate withmy team and address the issues.
They just work, henry, likewhat's your experience man?
Like business or clinical?
Like what's more predictable?
Henry Ernst (04:45):
Oh, I am 100% business.
So I disagree with you, steve,and maybe it comes from my
personality, because, for thoseof you guys who know what a
Colby score is, I'm that goldengoose as far as Colby scores
goes.
I'm a mediator.
I'm in the middle of everything.
I'm not great at everything,I'm not bad at anything, so I
just find it, my natural aura isjust a mediator.
(05:07):
So I feel like if I coachpeople, I can I don't want to
say control them, but I knowwhere they're going to go one
way or the other.
Dentistry is a great profession.
We take care of people, we helppeople but things happen that
you have no control over, andthat's the problem we discussed
in previous podcasts, whereyounger dentists are so freaked
out because they expecteverything to go perfectly and
(05:27):
it doesn't.
And mentally, as a dentist,especially as a younger dentist,
you got to deal with this.
You got to learn how tocompartmentalize and understand
that.
Like you said, steve, which Iagree with, you see tons and
tons of patients.
Our office has 18 operatories,five dentists.
We see, like you know, a couplehundred people new every month.
We've got like 18,000 activepatients.
(05:49):
When 1% or a half a percent ofstuff goes wrong.
It feels like it's like an80-20 rule, but like all you
care about is the 20 and all youknow about is the 20, because
I'm sure we could swap storieshere and like what's the worst
stuff you ever happened?
And we remember stuff and itlingers with you and it eats you
.
And that's the problem withclinical dentistry, where in the
business model, all right,somebody really pisses me off
(06:10):
there.
All right, they're gone, bringon somebody else, let's coach
somebody else, whereas you'remarried to that tooth, that
something happened bad, and it'slike you're married to that
person.
You just hear their calls andthis and that, and how are you
going to get rid of this?
Paul Etchison (06:23):
But what I'm thinking about is that there's a
lot of dentists that spend alot of time on clinical and they
don't spend time on thebusiness and they're very
uncomfortable having thosedifficult conversations with
their team.
And I'm starting to wonder well, maybe that's a very
uncomfortable area for them,maybe they're the people that
says that I think clinical isway more predictable.
But then you got you Steve.
(06:44):
You got a team of gosh.
What like 150 people orsomething like that.
How big is your team?
150.
So if you hated the people part, you wouldn't have been like oh
, let's have more people.
Steve Markowitz (06:55):
What I hear most is that people don't love
to have the difficultconversations.
But I bet if I were to ask yourteam both of you guys is.
But I bet if I were to ask yourteam both of you guys is Dr
Ernst and Dr Etchison good athaving difficult conversations?
They would say 100%, they areamazing at having difficult
conversations.
But if I bet, if I gave yousome truth serum, those
conversations that you're havingaren't even difficult for you.
(07:16):
No, no.
So the business part of theconversation, or the difficult
part, isn't actually challengingfor you.
So if you were to go in andhave a difficult conversation
with an assistant, you may notfind that conversation that
difficult.
But if I were to go in and wewere to start negotiating
something that was reallyimportant to you, that was
really high stakes, I guaranteeboth of you would suck at that
(07:39):
conversation, and I do too.
I guarantee both of you wouldsuck at that conversation and I
do too.
So when every time people tellme that I'm great at having
difficult conversations, I go.
You've never seen me in adifficult conversation because
I'm just as shitty as you, and Ithink that's the level of
business challenges that we'retrying to overcome.
Yes, they are very predictableat a certain spot.
But, paul, let's switch seatsfor a sec.
(08:02):
I would love for you to comesit in my seat and tell me which
one is more difficult the DO onnumber 29 or running 150 plus
person organization?
I guarantee at first it wouldbe this.
You would take the DO on 29every single time.
So as we grow in our businessor as we take on new challenges,
(08:24):
clinically that is what's goingto be the least predictable,
because we're not as sound inwhat we're doing.
If all you did was a crown onnumber five, that was root canal
, I guarantee you would not havea lot of complications and you
would think that is very, veryeasy.
Henry Ernst (08:43):
But that's not how dentistry is.
That's not how dentistry isn'tthat perfect number five root
canal.
You got all kinds of shitthat's coming to you Left, right
, center, forward.
It's all different.
Steve Markowitz (08:51):
That's because your scope of practice, henry,
is so unique.
But if all you did was breadand butter dentistry, you would
sleep like a baby.
Henry Ernst (08:59):
I would be so bored as hell You'd be sleeping in
the chair.
If I did crowns and fillingsall day long, I would be just a
miserable soul, and that's awhole different conversation.
Yeah, I totally agree, henry.
Paul Etchison (09:14):
Now you say the business part is more.
I'm with you there, henry.
I think the business part ismore predictable.
Steve, I just wonder, like,what advice would you have for
someone who thinks the clinicalpart is less predictable than
the business part?
Steve Markowitz (09:28):
Yeah, I would do two things.
One, I would reduce yourservice mix until you feel like
it is it is more predictable.
So if the root canals orextractions or things that those
are the pain points, I wouldnot stop doing them, but find
cases that you know are going togo smoothly and gain confidence
(09:49):
in that part of your servicemix.
And then step two and this is atreatment plan philosophy part
I would treatment plan as worstcase scenario and that means if
there's a chance that that toothis not savable, don't try and
save it.
If there's a chance that thattooth needs a root canal, it
needs a root canal.
(10:09):
Create opportunities to setexpectations with your patients
so you can beat them and theunknown is what is causing you
stress or making it lesspredictable and make those
unknowns known to you.
Paul Etchison (10:23):
And Henry, would you say, I'll ask you the
opposite question is for someonewho finds the business very
unpredictable what advice wouldyou have for that?
Henry Ernst (10:48):
look at it like clinical is unpredictable and
I'm so nervous about clinical.
I think clinical has likereally really high ceilings, but
it also has really really lowfloors.
Here I do so much stuff I dowisdom teeth, I do sedation, I
do implants so I like that andthat makes me happy.
But there's a low ceiling.
Like one time when I was ayounger dentist maybe a couple
of years in I had a patient whoI removed and you always
remember these things, you neverforget them, right who I
(11:09):
removed a wisdom tooth on.
Everything went fine and dandy,no thought of anything, and she
ended up being numb for likefive months and you know what
happened during those fivemonths, like when I woke up in
the morning I would think aboutit, I'd be on like a vacation or
doing something happy, likethrowing a ball with one of my
kids, and in the back of my headit would just come there.
(11:32):
So that's what I mean by it.
There are some lows that youhave to learn how to deal with
and it can come like in thatcase everything was.
It wasn't a challenging case, Iwas younger, it wasn't a big
deal, but look at that floorthere.
It was like it took over yourlife and maybe as I've gotten
older too, as I really reallyfeel comfortable and it's about
what you feel comfortable in Ifeel comfortable in
uncomfortable conversations,right, because I live in that
world.
(11:52):
So you have to do what's inyour comfort zone.
So not just the expectations of, like the procedure mix or this
or that, but look at youruncomfort zone and maybe try to
analyze.
I was a young dentist too in myearly career and I said to
myself man, I'm having so manyproblems with patients and I
practice in Boca Raton, florida,for those of you who don't know
, patients are really pains inthe asses down there and I
(12:15):
literally made like a list ofall the patients that are my
aggravation patients and I foundlike things that were very
similar.
So I said to myself you knowwhat?
You made this point before,steve, from now on, when I see
these people, I'm going to bequick to maybe not be so quick
to treat a plan and rush into amarriage with them.
I'm going to walk the line.
Paul Etchison (12:34):
I think it's funny that you're making a list
of your worst patients, Likeit's like, what is this guy
making this list for?
What's this list for?
I'm scared now.
What are you going to do withthis?
Steve Markowitz (12:45):
No, it's a mental list.
Everyone has it.
It's just your Rolodex ofthings that didn't go perfect,
the things that randomly, 10years later, you wake up in the
middle of the night and be likewhy did I not torque that
abutment?
Screw in all the way.
Or why did I take on that casewhere everyone has that Rolodex
of patients that keep them up atnight?
Henry Ernst (13:05):
Give us one of those things, mr Clinical Steve,
like, give us one of thosethings that happened really
shitty, that kept you up forfive months.
Steve Markowitz (13:12):
Oh okay, the first angled abutment channel
that I got.
I didn't even know it was anangled abutment channel.
I tried the screw in on mydriver and I thought it fit.
I put it in.
I started hand torquing it andI went to torque.
I I put it in, I started handtorquing it and I went to torque
.
I couldn't get it to engage andI called the lab and they were
like that was an angled screw.
What the hell is an angledscrew?
(13:34):
I didn't even know what thatwas and I didn't have the right
driver and I couldn't untorqueit.
So it just sat there and then,like six months later, I tried
to open it up and I couldn't.
Paul Etchison (13:48):
That still haunts me to this day, when I've had
issues with cases like I'mthinking about this one.
It was an adult with acrossbite and I'm like you know,
you go to the Invisalign courseand they go yeah, we can fix
the crossbites, watch this.
And then you try it At least me.
I've tried out a number ofpatients and it doesn't work.
I can't jump a crossbite withInvisalign.
I mean maybe certain ones youcan, but I just not going to get
(14:09):
that level of expansion.
I've always ended up having toput on braces or something fixed
to at least get the crossbitejumped.
And so we went to an expanderand I told her turn this thing,
you know one, turn twice a weekand I'll see you back in six
weeks.
She turned it twice a day.
And when she came back in sixweeks it was like the molars and
(14:30):
the posterior teeth were like45 degrees out and I backed it
up and when I was like takingthat thing off I'm like we've
got to get this thing off I waslike scared I was going to rip
the teeth out of her head andwhat was?
I lost so much sleep over that,thinking all these teeth are
going to need endo, all of themare going to have like a big
(14:52):
like gingival defect frompushing out the bone, and I lost
so much sleep over it.
Now everything worked out greatand the case ended up finishing
perfect.
But contrast that to whenthere's a lot of chaos at my
practice and there's stuff goingon in the business.
I find if with stuff's going onin the business, I can dive into
it and the more I spend moreenergy in it I can resolve it.
(15:15):
You know it might take a day ortwo of more conversations, but
it's just we're X amount ofconversations away from fixing
it With the clinical stuff.
It takes time and you got tohave the patience and there's
nothing you can do, like you, Ifeel.
That's where I feel like thatbecomes unpredictable.
I've lost the control.
It's out of my control.
Henry Ernst (15:33):
So I think the example I said about the floor,
the floor is so low, so thatcase you're talking about, you
lost sleep over it, right?
Yeah, like business wise.
I'll give you an example thatjust came into my mind.
You know, I work two days aweek in my practice now.
So I work one week like Monday,tuesday, the alternate week
like Thursday, friday, sosometimes there's like 11 days
in a row where I'm not here atall.
And so when I came back to work,like after being off for a
(15:56):
while, there was one of our teammembers, a dental assistant,
that missed her doctor's morninghuddle.
We have our doctors meet witheach assistants and she was late
.
And apparently she had beenlate for a while and maybe like
nobody doesn't say anything whensubstitute teacher, when I'm
not here.
So I've found her and I madethe you know the choice to make
have a difficult conversation,tell her why this is not good,
(16:19):
can't be late, you can't do thisanymore.
And I was really blunt becauseit's been a while.
I said if you can't come timethe next time you come late,
just turn around and go back.
We can't come on time.
The next time you come late,just turn around and go back.
We can't have that here.
So you know what happened thatnext day, that later that day
she quit, and you know what?
That was great, because now wegot rid of that little bit of
cancer and I handled thatbusiness stuff and it didn't
bother me one bit.
(16:40):
But that wisdom tooth that tookfive months, which resolved,
and everything.
I couldn't do anything about itat that point.
I had to just wait and in yourcase you could fix what you fix.
But I think that's the pointthat I was trying to make is
that there is a floor that youdon't have control over
sometimes.
Yeah, and did your patient.
Paul Etchison (16:57):
They eventually got their feeling back.
Henry Ernst (16:59):
Yeah, I'd have them come back every once in a while
and I do all this stuff you'resupposed to do and all of a
sudden they came back and theysaid I'm feeling tingling.
And I went to my office backdoor and I think I went outside
and I was like, thank you God,tingling and you know.
And then, like you know, acouple of weeks later came back.
But that was really stressfuland you know, for listeners out
(17:23):
there, this stuff happens toanybody and everybody and you
just have to find a way to livewith it and learn how to deal
with the stresses of dentistrywhen you're playing ball with
your son.
Don't let that get in your head.
Enjoy that time, because youcan't live like that.
Paul Etchison (17:35):
Yeah, I think that's.
The moral of the story is thatyou've got to stay within your
comfort level and also but we doneed to be challenged and we
need to grow.
So we need to have realisticexpectations but at the same
time, we need to grow.
So we need to have realisticexpectations but at the same
time, we need to grow and if wehave something that's really
finding it unpredictable, that'sprobably an indication to us
that that's something we need alittle help with, need to get a
(17:58):
little bit better, more skilled,more proficient with.
So if you're listening and youare thinking about having a
practice where you can work lessdays and make more money, you
should talk to some of our DPHcoaches, dr Steve and Dr Henry.
They are fantastic and we'rehelping people and we're taking
on clients.
So if you're interested inworking with a coach, check out
dentalpracticeheroescom.
Thank you so much for listeningand we'll talk to you next time
(18:18):
.
Where are you more comfortable Doing clinical
work or dealing with the demandsof the business?
Today, we're debating whichside of dentistry is truly more
unpredictable.
Is it the procedures, thepatients or trying to keep your
practice just running smoothly?
And what can we do to make bothsides better so that we can
have less stress and a littlebit more joy?
I am joined today with my DPHcoaches and we've got plenty to
(00:25):
say about this one.
Let's get into it.
You are listening to DentalPractice Heroes, where we help
you create and scale your dentalpractice so that you are no
longer tied to the chair.
I'm Dr Paul Etcheson, author oftwo books on dental practice
management, dental coach andowner of a $6 million group
practice in the suburbs ofChicago.
I want to teach you how to growand systematize your dental
practice so you can spend lesstime practicing and more time
(00:48):
enjoying a life that you love.
Let's get started.
Welcome back to the DentalPractice Heroes podcast.
Thank you so much for spendingpart of your day with us.
I'm here, dr Paul Edgison isyour host, and I'm joined by my
co-host and coaches, dr StephenMarkowitz and Dr Henry Ernt,
(01:10):
both owning large practices.
Steve, owning many practicessix practices, six practices.
Steve.
As of today, that's the numberSix practices and Henry and I
both are owning a large practice, but we are all dentists that
have pulled ourselves outclinically to focus more on the
business aspect.
But we do still do someclinical and today we kind of
(01:31):
want to talk about man.
Does clinical dentistry suck?
Because I think you canresonate with yeah, it kind of
does.
Let's pull it apart because Ihave some opinions, but I want
to hear from you first, steve.
I mean, does clinical dentistryjust suck?
Steve Markowitz (01:47):
I think, paul, you wanted conflict.
So I think clinical dentistryis freaking awesome.
The problem is, you just see somany people, like you could see
.
In our organization we did over80,000 visits last year Wow.
In our organization we did over80,000 visits last year Wow.
If we were 99.9% perfect, we'restill going to have I don't
(02:11):
know the math, but a lot ofthings that didn't go right, and
the human body is unpredictable.
There are things that we maynot have seen as clearly as we
had hoped, and it sucks to dealwith complications, but if we
help or try to help enoughpeople, there will be something
that doesn't go how we expectand then we got to clean it up
(02:34):
and make it right and that sucks.
So, yeah, there are some partsof clinical dentistry that
aren't predictable, but there'salso a way and a method for us
to not put ourselves in thatposition or try to limit the
number of times we put ourselvesin that position.
Paul Etchison (02:50):
Well, you being an owner.
You got six practices managinga lot of people.
Do you find that clinicaldentistry is more predictable
than the people side?
Steve Markowitz (03:01):
We'll try to turn this around on me.
That's the question I was goingto ask you.
You're the one here on everysingle podcast that's saying
clinical dentistry sucks.
I'm saying it doesn't because Inever said that.
Henry Ernst (03:11):
I've never heard.
Steve Markowitz (03:12):
I've never heard him say that Steve watch
it Way more predictable way morepredictable than how a tooth
and bond is going to formtogether.
It's again, it's not widgets,but we're closer to widgets than
people with feelings andemotions and trying to predict
how someone's going to respondto honest feedback.
(03:34):
People suck, and I say thatfrom the most loving place.
Predicting how someone is goingto respond in a situation is
winning the lottery.
There are so many ways forpeople to respond to certain
situations.
Again, I think that's part ofthe beauty of what we get to do
as owners and leaders is trulyinfluence and grow people.
(03:57):
I love that part, but to saythat it's as predictable as
clinical dentistry is wild to me.
Paul Etchison (04:06):
Well, I feel like there's like I don't know who
said this to me at some point,but somebody said you know, I
have some days where I run mybusiness and I have some days
where I'm seeing patients.
I never had a bad day runningmy business.
And I was just like, yes, thatis so true.
And I feel like for me, likeyou know, yeah, people are
unpredictable.
But at the same time, man, Ijust find the clinical dentistry
(04:27):
so much more unpredictable.
I feel like I can do everythingright and something still
unexpected happens.
And I feel, with people, I justfor me, it's been much easier
to the more I communicate withmy team and address the issues.
They just work, henry, likewhat's your experience man?
Like business or clinical?
Like what's more predictable?
Henry Ernst (04:45):
Oh, I am 100% business.
So I disagree with you, steve,and maybe it comes from my
personality, because, for thoseof you guys who know what a
Colby score is, I'm that goldengoose as far as Colby scores
goes.
I'm a mediator.
I'm in the middle of everything.
I'm not great at everything,I'm not bad at anything, so I
just find it, my natural aura isjust a mediator.
(05:07):
So I feel like if I coachpeople, I can I don't want to
say control them, but I knowwhere they're going to go one
way or the other.
Dentistry is a great profession.
We take care of people, we helppeople but things happen that
you have no control over, andthat's the problem we discussed
in previous podcasts, whereyounger dentists are so freaked
out because they expecteverything to go perfectly and
(05:27):
it doesn't.
And mentally, as a dentist,especially as a younger dentist,
you got to deal with this.
You got to learn how tocompartmentalize and understand
that.
Like you said, steve, which Iagree with, you see tons and
tons of patients.
Our office has 18 operatories,five dentists.
We see, like you know, a couplehundred people new every month.
We've got like 18,000 activepatients.
(05:49):
When 1% or a half a percent ofstuff goes wrong.
It feels like it's like an80-20 rule, but like all you
care about is the 20 and all youknow about is the 20, because
I'm sure we could swap storieshere and like what's the worst
stuff you ever happened?
And we remember stuff and itlingers with you and it eats you
.
And that's the problem withclinical dentistry, where in the
business model, all right,somebody really pisses me off
(06:10):
there.
All right, they're gone, bringon somebody else, let's coach
somebody else, whereas you'remarried to that tooth, that
something happened bad, and it'slike you're married to that
person.
You just hear their calls andthis and that, and how are you
going to get rid of this?
Paul Etchison (06:23):
But what I'm thinking about is that there's a
lot of dentists that spend alot of time on clinical and they
don't spend time on thebusiness and they're very
uncomfortable having thosedifficult conversations with
their team.
And I'm starting to wonder well, maybe that's a very
uncomfortable area for them,maybe they're the people that
says that I think clinical isway more predictable.
But then you got you Steve.
(06:44):
You got a team of gosh.
What like 150 people orsomething like that.
How big is your team?
150.
So if you hated the people part, you wouldn't have been like oh
, let's have more people.
Steve Markowitz (06:55):
What I hear most is that people don't love
to have the difficultconversations.
But I bet if I were to ask yourteam both of you guys is.
But I bet if I were to ask yourteam both of you guys is Dr
Ernst and Dr Etchison good athaving difficult conversations?
They would say 100%, they areamazing at having difficult
conversations.
But if I bet, if I gave yousome truth serum, those
conversations that you're havingaren't even difficult for you.
(07:16):
No, no.
So the business part of theconversation, or the difficult
part, isn't actually challengingfor you.
So if you were to go in andhave a difficult conversation
with an assistant, you may notfind that conversation that
difficult.
But if I were to go in and wewere to start negotiating
something that was reallyimportant to you, that was
really high stakes, I guaranteeboth of you would suck at that
(07:39):
conversation, and I do too.
I guarantee both of you wouldsuck at that conversation and I
do too.
So when every time people tellme that I'm great at having
difficult conversations, I go.
You've never seen me in adifficult conversation because
I'm just as shitty as you, and Ithink that's the level of
business challenges that we'retrying to overcome.
Yes, they are very predictableat a certain spot.
But, paul, let's switch seatsfor a sec.
(08:02):
I would love for you to comesit in my seat and tell me which
one is more difficult the DO onnumber 29 or running 150 plus
person organization?
I guarantee at first it wouldbe this.
You would take the DO on 29every single time.
So as we grow in our businessor as we take on new challenges,
(08:24):
clinically that is what's goingto be the least predictable,
because we're not as sound inwhat we're doing.
If all you did was a crown onnumber five, that was root canal
, I guarantee you would not havea lot of complications and you
would think that is very, veryeasy.
Henry Ernst (08:43):
But that's not how dentistry is.
That's not how dentistry isn'tthat perfect number five root
canal.
You got all kinds of shitthat's coming to you Left, right
, center, forward.
It's all different.
Steve Markowitz (08:51):
That's because your scope of practice, henry,
is so unique.
But if all you did was breadand butter dentistry, you would
sleep like a baby.
Henry Ernst (08:59):
I would be so bored as hell You'd be sleeping in
the chair.
If I did crowns and fillingsall day long, I would be just a
miserable soul, and that's awhole different conversation.
Yeah, I totally agree, henry.
Paul Etchison (09:14):
Now you say the business part is more.
I'm with you there, henry.
I think the business part ismore predictable.
Steve, I just wonder, like,what advice would you have for
someone who thinks the clinicalpart is less predictable than
the business part?
Steve Markowitz (09:28):
Yeah, I would do two things.
One, I would reduce yourservice mix until you feel like
it is it is more predictable.
So if the root canals orextractions or things that those
are the pain points, I wouldnot stop doing them, but find
cases that you know are going togo smoothly and gain confidence
(09:49):
in that part of your servicemix.
And then step two and this is atreatment plan philosophy part
I would treatment plan as worstcase scenario and that means if
there's a chance that that toothis not savable, don't try and
save it.
If there's a chance that thattooth needs a root canal, it
needs a root canal.
(10:09):
Create opportunities to setexpectations with your patients
so you can beat them and theunknown is what is causing you
stress or making it lesspredictable and make those
unknowns known to you.
Paul Etchison (10:23):
And Henry, would you say, I'll ask you the
opposite question is for someonewho finds the business very
unpredictable what advice wouldyou have for that?
Henry Ernst (10:48):
look at it like clinical is unpredictable and
I'm so nervous about clinical.
I think clinical has likereally really high ceilings, but
it also has really really lowfloors.
Here I do so much stuff I dowisdom teeth, I do sedation, I
do implants so I like that andthat makes me happy.
But there's a low ceiling.
Like one time when I was ayounger dentist maybe a couple
of years in I had a patient whoI removed and you always
remember these things, you neverforget them, right who I
(11:09):
removed a wisdom tooth on.
Everything went fine and dandy,no thought of anything, and she
ended up being numb for likefive months and you know what
happened during those fivemonths, like when I woke up in
the morning I would think aboutit, I'd be on like a vacation or
doing something happy, likethrowing a ball with one of my
kids, and in the back of my headit would just come there.
(11:32):
So that's what I mean by it.
There are some lows that youhave to learn how to deal with
and it can come like in thatcase everything was.
It wasn't a challenging case, Iwas younger, it wasn't a big
deal, but look at that floorthere.
It was like it took over yourlife and maybe as I've gotten
older too, as I really reallyfeel comfortable and it's about
what you feel comfortable in Ifeel comfortable in
uncomfortable conversations,right, because I live in that
world.
(11:52):
So you have to do what's inyour comfort zone.
So not just the expectations of, like the procedure mix or this
or that, but look at youruncomfort zone and maybe try to
analyze.
I was a young dentist too in myearly career and I said to
myself man, I'm having so manyproblems with patients and I
practice in Boca Raton, florida,for those of you who don't know
, patients are really pains inthe asses down there and I
(12:15):
literally made like a list ofall the patients that are my
aggravation patients and I foundlike things that were very
similar.
So I said to myself you knowwhat?
You made this point before,steve, from now on, when I see
these people, I'm going to bequick to maybe not be so quick
to treat a plan and rush into amarriage with them.
I'm going to walk the line.
Paul Etchison (12:34):
I think it's funny that you're making a list
of your worst patients, Likeit's like, what is this guy
making this list for?
What's this list for?
I'm scared now.
What are you going to do withthis?
Steve Markowitz (12:45):
No, it's a mental list.
Everyone has it.
It's just your Rolodex ofthings that didn't go perfect,
the things that randomly, 10years later, you wake up in the
middle of the night and be likewhy did I not torque that
abutment?
Screw in all the way.
Or why did I take on that casewhere everyone has that Rolodex
of patients that keep them up atnight?
Henry Ernst (13:05):
Give us one of those things, mr Clinical Steve,
like, give us one of thosethings that happened really
shitty, that kept you up forfive months.
Steve Markowitz (13:12):
Oh okay, the first angled abutment channel
that I got.
I didn't even know it was anangled abutment channel.
I tried the screw in on mydriver and I thought it fit.
I put it in.
I started hand torquing it andI went to torque.
I I put it in, I started handtorquing it and I went to torque
.
I couldn't get it to engage andI called the lab and they were
like that was an angled screw.
What the hell is an angledscrew?
(13:34):
I didn't even know what thatwas and I didn't have the right
driver and I couldn't untorqueit.
So it just sat there and then,like six months later, I tried
to open it up and I couldn't.
Paul Etchison (13:48):
That still haunts me to this day, when I've had
issues with cases like I'mthinking about this one.
It was an adult with acrossbite and I'm like you know,
you go to the Invisalign courseand they go yeah, we can fix
the crossbites, watch this.
And then you try it At least me.
I've tried out a number ofpatients and it doesn't work.
I can't jump a crossbite withInvisalign.
I mean maybe certain ones youcan, but I just not going to get
(14:09):
that level of expansion.
I've always ended up having toput on braces or something fixed
to at least get the crossbitejumped.
And so we went to an expanderand I told her turn this thing,
you know one, turn twice a weekand I'll see you back in six
weeks.
She turned it twice a day.
And when she came back in sixweeks it was like the molars and
(14:30):
the posterior teeth were like45 degrees out and I backed it
up and when I was like takingthat thing off I'm like we've
got to get this thing off I waslike scared I was going to rip
the teeth out of her head andwhat was?
I lost so much sleep over that,thinking all these teeth are
going to need endo, all of themare going to have like a big
(14:52):
like gingival defect frompushing out the bone, and I lost
so much sleep over it.
Now everything worked out greatand the case ended up finishing
perfect.
But contrast that to whenthere's a lot of chaos at my
practice and there's stuff goingon in the business.
I find if with stuff's going onin the business, I can dive into
it and the more I spend moreenergy in it I can resolve it.
(15:15):
You know it might take a day ortwo of more conversations, but
it's just we're X amount ofconversations away from fixing
it With the clinical stuff.
It takes time and you got tohave the patience and there's
nothing you can do, like you, Ifeel.
That's where I feel like thatbecomes unpredictable.
I've lost the control.
It's out of my control.
Henry Ernst (15:33):
So I think the example I said about the floor,
the floor is so low, so thatcase you're talking about, you
lost sleep over it, right?
Yeah, like business wise.
I'll give you an example thatjust came into my mind.
You know, I work two days aweek in my practice now.
So I work one week like Monday,tuesday, the alternate week
like Thursday, friday, sosometimes there's like 11 days
in a row where I'm not here atall.
And so when I came back to work,like after being off for a
(15:56):
while, there was one of our teammembers, a dental assistant,
that missed her doctor's morninghuddle.
We have our doctors meet witheach assistants and she was late
.
And apparently she had beenlate for a while and maybe like
nobody doesn't say anything whensubstitute teacher, when I'm
not here.
So I've found her and I madethe you know the choice to make
have a difficult conversation,tell her why this is not good,
(16:19):
can't be late, you can't do thisanymore.
And I was really blunt becauseit's been a while.
I said if you can't come timethe next time you come late,
just turn around and go back.
We can't come on time.
The next time you come late,just turn around and go back.
We can't have that here.
So you know what happened thatnext day, that later that day
she quit, and you know what?
That was great, because now wegot rid of that little bit of
cancer and I handled thatbusiness stuff and it didn't
bother me one bit.
(16:40):
But that wisdom tooth that tookfive months, which resolved,
and everything.
I couldn't do anything about itat that point.
I had to just wait and in yourcase you could fix what you fix.
But I think that's the pointthat I was trying to make is
that there is a floor that youdon't have control over
sometimes.
Yeah, and did your patient.
Paul Etchison (16:57):
They eventually got their feeling back.
Henry Ernst (16:59):
Yeah, I'd have them come back every once in a while
and I do all this stuff you'resupposed to do and all of a
sudden they came back and theysaid I'm feeling tingling.
And I went to my office backdoor and I think I went outside
and I was like, thank you God,tingling and you know.
And then, like you know, acouple of weeks later came back.
But that was really stressfuland you know, for listeners out
(17:23):
there, this stuff happens toanybody and everybody and you
just have to find a way to livewith it and learn how to deal
with the stresses of dentistrywhen you're playing ball with
your son.
Don't let that get in your head.
Enjoy that time, because youcan't live like that.
Paul Etchison (17:35):
Yeah, I think that's.
The moral of the story is thatyou've got to stay within your
comfort level and also but we doneed to be challenged and we
need to grow.
So we need to have realisticexpectations but at the same
time, we need to grow.
So we need to have realisticexpectations but at the same
time, we need to grow and if wehave something that's really
finding it unpredictable, that'sprobably an indication to us
that that's something we need alittle help with, need to get a
(17:58):
little bit better, more skilled,more proficient with.
So if you're listening and youare thinking about having a
practice where you can work lessdays and make more money, you
should talk to some of our DPHcoaches, dr Steve and Dr Henry.
They are fantastic and we'rehelping people and we're taking
on clients.
So if you're interested inworking with a coach, check out
dentalpracticeheroescom.
Thank you so much for listeningand we'll talk to you next time
(18:18):
.
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