Dentistry Worldwide: ‘The key nowadays is to have as little debt as possible’

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World series interview with Dr Duy Nguyen, Pacifica, US

Dr Duy Nguyen describes how dental marketing is changing where he lives in Pacifica, United States. He talks to Somnowell Marketing’s Founder Loran Simon about how dentistry and marketing is changing in the United States.

Why did you become a dentist?

Dr Duy Nguyen: I went through a series of life experiences – that’s how I kind of wound up doing dentistry. 

When I first decided I wanted to go into something healthcare-related, I didn’t know what I wanted to do. I ended up working at a hospital for a while, not doing research or anything. I was working with patients in a lung department. 

We would treat patients every day. I saw maybe about eight to 10 patients a day, and we’d do spirometry – it’s like a breathing test. 

Working at the hospital was difficult because half the day was paperwork and then half the day was treating the patients. I found I liked treating the patients more and I liked the patients that came back regularly. I had patients that came back maybe every three to six months. The day went by really quickly when we saw patients and the day went by really slowly when I was just doing paperwork. I didn’t like the bureaucracy of the hospital either. 

So I found out that I kind of liked something that maybe I can own myself, where I can just do procedures all day long, with minimal paperwork. And that’s how I kind of found dentistry to work out for me. The day goes by really quickly, and there’s a form of artistry to it, too.

In the beginning, I didn’t see it that way, but now that I’ve become a lot better at doing dentistry, the artistry has come out. Now that I’ve got a lot better with my hands, skills, I see that it really is an art form and I enjoy it even more. That’s how I ended up becoming a dentist.

What are the biggest marketing challenges that you face and how do you deal with them?

Dr Duy Nguyen: I think the hardest part about doing marketing is there’s no blueprint for it. It’s really regional. Because I talk to my buddies who are in Texas or in the Midwest – or on the East Coast – they all give me a different scenario on what they think works for them. And it’s really, really regional. 

For instance, there’s something called Zocdoc and it works really well over in the East Coast. Here in the West Coast it doesn’t seem to work that well. I tried it, maybe got maybe a few patients a month. Yelp here in the West Coast seems to work really well.

As far as mailers, that’s the one other thing that is still kind of analogue that a lot of dentists do. It’s extremely expensive and hit or miss. You can throw tens of thousands of dollars into mailers and not get any kind of return. They’ve done studies on it – you get about a half a percentage return point on mailers. It’s like a shot in the dark. You throw the dart at the board and hope it hits, and if it doesn’t, then you move on. I think that’s the most difficult part of it. You can go to lectures about marketing, but that might not work in your area. It is really regional.

Marketing has changed considerably, what does this mean for dentists? Is it easier or harder?

Dr Duy Nguyen: I think it’s made quite a quick shift toward digital. I pretty much only do digital marketing nowadays. 

You have to be pretty tech savvy to know all the stuff. A long time ago when I opened the office someone asked me, “Do you have a Facebook page yet for your office?” I said, “That’s silly, why would I need a Facebook page for a dental office? Who wants to look at my dental office on Facebook?” And they said, “No, you have to have it.” I said, “Okay,” 

I opened it and then I didn’t know how to manage it. And to this day I probably still don’t… I under-manage it. I hardly look at it. But some people really, really succeed with their Facebook dental page, right? I don’t know how they do it. I don’t have the time to manage it. 

So dentistry is like a convenience thing. People like that they can just go to the dental offices, make an appointment really easily. If an office doesn’t have parking they sometimes don’t even want to go there. 

I’ve found that making things very convenient for them works, like enabling them to make their own online appointments – which is one of the big things I have in my office. You can just go on our website and click a button and then you can make your own appointments. You don’t even have to talk to anybody. Seems to work really, really well, and it fills in all the holes in our schedule as well. 

We outsource all that stuff, obviously, because we don’t have the capability to do all that digital stuff. But there wasn’t a blueprint for it. I had to kind of discover all this stuff myself and read through countless forms and what’s worked for people digitally, and then contact those people and get it implemented.

It really is going digital. The analogue stuff probably works as well, but it’s so costly. For a small business owner, I can’t just throw tens of thousands of dollars out the door.

What role does cosmetic dentistry play in your practice today and what do you think the future holds?

Dr Duy Nguyen: Well, I think that’s a multi-faceted question, because there’s still the bread and butter cosmetic dentistry that we all think of, such as veneers and anterior crowns, things like that, and whitening. 

That’s the simple stuff, but it’s become a lot more complex nowadays, where literally people are coming in with little or no teeth, and we’re taking all the teeth out and putting in four to six implants and then fixing a denture to it. And that stuff is not easy. That’s not something you can just do on your own, under one roof, you need a whole team of people. 

It’s moved a lot toward that realm, and the bread and butter stuff I can do on my own under my own roof with little or no assistance. But those are the more complex cases, where we’re talking about fully edentulous cases and doing a whole makeover. It has to be across different specialties. We have to talk to an oral surgeon, a periodontist, and it’s a lot of money, it’s a lot of work.

But the hardest part is communication between different offices and meeting the patients’ expectations. It’s moving toward doing more implant stuff, and I consider that more of the difficult cosmetic dentistry than the simple crowns and veneers nowadays. 

I’ve probably done only a handful of those cases, and they take years to complete. They take six months to a year just to get ready for it, and then it’ll take another six months to finish. You’re talking about over a year’s worth of work.

From what we can see on the marketing side, there's a huge amount of demand for implants.

Dr Duy Nguyen: Right. Just doing the work is half the job, but getting these patients to finance it is a whole other thing, because we’re talking about tens of thousands of dollars that they just can’t drop within six months or a year. We have to find financing plans for them and we have to make sure that they’re happy at the end and meeting their expectations at the end, too. 

If they throw $25,000 at you for an upper arch and they don’t like it, then what do you do? It’s a big mess. You’ve got to find like a bunch of specialists that you’re comfortable working with. And as a small business owner, when you’ve just open an office, you don’t know these people, and you don’t know what they’re capable of. So, it’s a lot of searching and figuring out who works best with you. 

I’m pretty lucky, because I knew some people already who were doing it and had a good relationship with them before I opened the office. But I can imagine if you don’t have any experience with that stuff that it could be pretty difficult.

It sounds like you really need to have a good team in place. While the rewards can be big for the patients, there's also a potential risk as well, which is quite significant.

Dr Duy Nguyen: It is. You own these patients for life. Because once they get this appliance in there, you’re going to be seeing them for the rest of their life. 

How do you manage the dual roles of being a respected dentist and business owner?

Dr Duy Nguyen: Well, it’s quite difficult, actually. Especially if you’re in a small town versus a bigger town. I like to think of Pacifica as a smaller town. There’s about 45,000 people in this town, so the word gets around pretty quickly. 

I built this office from scratch, so when I opened the doors I had zero patients, and then three and half years later we have around 1,600 – almost 2,000 patients at our office. If someone doesn’t like you, they tell everyone in town about it. 

My situation is different to most people. Most people take over other offices. I built mine from scratch, so I had to wear a lot of hats. I had to be the business owner and the dentist at the same time.

In the beginning, I had a lot more time being the business owner because I didn’t have that many patients, but now I’m more just a dentist and I delegate. As you get busier, you have to find the right people to delegate the tasks to because you don’t have time to do all this stuff anymore – and I think that’s key. 

Staffing is probably the most difficult part of being the business owner. I’ll tell you now, the auxiliary people who work for a dental office, they stay at your office because they like you. A lot of times they don’t stay because they’re making a bazillion dollars or anything like that. They like that they know they have a stable job and can come to work every day and they’re appreciated. Because they can easily just go and work for Uber and make probably about the same amount of money on their own time.

World series interview with Dr Duy Nguyen, Pacifica, US

So, working at a small office, the most difficult part is the staffing. You have to keep these people happy and nowadays benefits is a must, vacation time is a must and sick leave is a must. Healthcare and benefits – all that stuff is a must. 

I’m so focused on being a dentist, nowadays. I have so many cases going on. If something comes up for instance, like a computer blows out or something like that, I don’t have time to manage it anymore. I just tell the front, go call somebody who can fix this and that. So I think that’s key to being a busy office is delegation.

What tips do you have for other dentists starting out? Get into as little debt as possible?

Dr Duy Nguyen: Dude, get into as little debt as possible. Yes, I think that’s the key thing, because it used to be quite easy actually, because schools cost so little.

Twenty to 30 years ago, you probably graduated with anywhere from $10,000-$25,000 dollars in school debt, which is a drop in the bucket compared to what it is now, because we’re looking at a quarter million, half a million dollars in debt now, right, from school. 

And on top of that, if they wanted to open an office, they have to take on another half a million dollars. With no patients, you’re looking at already a million dollars of debt. 

So, the key nowadays is to have as little debt as possible. That might mean you partner with somebody and you cut the loan in half or it might mean that you go into a location that is not so competitive and open an office with little overhead. Or you can just take over an office that’s got cash flow already.

But the contracts nowadays in the US are quite difficult. All the insurance companies now are pretty much ‘nickel and diming’ the general dentist nowadays with their contracts. So, that’s also key. You have to know how to negotiate really well. 

I was very lucky that my in-laws taught me how to negotiate really well. They told me that a lot of these people you will see once and you never see them again, so you have to negotiate the hell out of it. So I learned to really negotiate my rent. I negotiate the hell out of everything. I negotiate my overhead. You have to keep your overheads low, because as much as you’re producing, if your overhead is high you’re not taking home anything.

And lastly, I think the key thing is, you got to treat your patients how you want to be treated. There’s no rule on how to run your office. But every day I go in the office and I go, ‘Okay, I’d like this done to me and I’d like there to be coffee at the front. I like there to be TV in the ceiling. I like to have somebody walk me out the door every day and feel like I’m not just a number walking into the office’. And so that’s key to any office. 

You have to treat patients how you want to be treated. And to be fair, some people don’t care about that stuff. They go, “Okay, we’re just coming in for a clean and that’s good enough for me.” If that’s okay with you and how you want to run your office, that’s fine, but to me that’s not good enough. Because we have to be a little bit better than everyone else nowadays.

What do you think about the future of dentistry in the US from a dentist's perspective? What major changes will there be over the next five to 10 years?

Dr Duy Nguyen: I think we have a huge battle right now with the insurance companies. There’s multiple lawsuits going on. That’s been a really big hassle. 

That’s one thing that is behind doors that you don’t hear about. People think, ‘Okay, the future of dentistry is a bunch of implants; the future of dentistry is snore appliances’ or things like that, right? But to me, the insurance companies are a huge hindrance to whether we can keep our office open or not. 

I hope the insurance companies and our so-called lobby groups – we have the associations that we all belong to and they kind of negotiate with these insurance companies – I hope they meet somewhere in the middle. And that we can come to a compromise where we can still do what we love to do and still keep our doors open. 

As far as the future of dentistry with technology – that aspect – there’s tons of stuff going on right now. We’re moving away from just stone models to just doing completely digital.

I just purchased a digital scanner, so we won’t be taking impressions any more. No more impressions – can you believe that? It’s crazy. We can do full arch scans with the intraoral scanner. We’ve had the cone beam in our office for almost two years now. 

In the past, a patient will come in and they’d say, “I’d like to get an implant done. How much will it cost?” And then before I even tell them how much it costs I would tell them, “I don’t know if I can do it on you, because I don’t know if you have enough bone.” 

But now that I have this cone beam machine, in under five minutes, I can tell you if I can do an implant on you. I can see exactly how much bone there is. That’s the future of dentistry. It’s just so instantaneous. You can figure out what kind of treatment you can do and what you can’t do instantaneously.

And I think that’s where we’re heading now. Everything is becoming digital. On the web and also in the office. I was always worried about the digital, especially with the impressions, things like that, and the CT. I didn’t know about the accuracy of it, so I always have this rule where I wait about five years and then see how the five year studies go, and if the results really do match with what they’re claiming. 

It’s exceeded my expectations. Digital impressions are better than analogue impressions – the accuracy of it. Things fit even better and implants come in guided now, so I can do an implant in under five minutes, it’s absolutely insane.

There are some places that have no access to dentistry and then there’s places like, let’s say, San Francisco where every other block has a dental office, right? There’s too much competition here. 

Then there are spaces that have no competition where so ever. I hope that the government helps incentivise people to go to these more underprivileged areas and they can make a deal with paying off some of these student loans as well. That’s a big problem in the future of dentistry, too. Future students don’t have the money to open offices anymore. They’re going to go toward working at corporate offices and that’s something I didn’t touch, either. 

All of these corporate offices are taking over small mom and pop shops nowadays. There are offices that disguise as mom and pop offices, but they’re really corporate offices. Are you familiar with the term “DSO”? 

They hire dentists and they work under their philosophy as a corporate office… I think it’s a sad thing that it’s going that route where most of the offices in the US are going to be taken over by corporate offices. But, that’s also part of the future of dentistry, because these guys have negotiating power. When they own a few hundred offices, they can call Henry Schein or whatever and say, “I want 50% off on this particular product,” and Schein will be happy to give it to them because they own a few hundred offices.

It's the same in the UK, the corporates are taking over a lot of practices. There's a lot of consolidation going on with dental labs as well.

Dr Duy Nguyen: Yes, and that’s fine if they let the individual call some other shots. But when they say, ‘Hey, we own 51% no matter what’ and for the rest of your life you don’t get to call any of the shots. It’s become more of a dictatorship than: ‘We own this practice together’ kind of thing.

Loran Simon

Loran Simon

Loran Simon is the Founder of Somnowell, one of the UK’s leading oral appliances to help to cure snoring and sleep apnea. Over the past 10 years, Somnowell’s growth has been mainly achieved using the digital marketing services of Somnowell Marketing, an agency that Loran Simon also founded and manages. The agency consistently generates thousands of new patient enquiries for Somnowell’s network of dentists.

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