Join us as Loran Simon, Founder of Somnowell Marketing and the Somnowell device, interviews dentists around the world and shines a light on dentistry and dental marketing in different countries. This interview is with Dr Duy Nguyen, from Pacific Manor Dental, based in Pacifica, United States. www.pacificmanordental.com.
Loran Simon: Why did you become a dentist?
Dr Duy Nguyen: Yes, 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 actually ended up working at a hospital for a while, not doing research or anything. I was working with patients in a lung department, and I wanted to know if I wanted to go through the medical route or not. 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. And working at the hospital was difficult because half the day was paperwork and then half the day was just treating the patients. And 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 and the day went by really quickly when we saw patients and the day went by really slowly when I was just doing paperwork. And also, 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 kinda found dentistry to work out for me. It was the mixture of just doing procedures all day long, 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 gotten a lot better at doing dentistry the artistry has come out. Now, I see… Now that I got a lot better with my hands, skills, I see that it really is a art form and now I enjoy it even more. That’s how I ended up becoming a dentist.
Loran Simon: 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 the marketing is there’s no blueprint for it. It’s really regional. ‘Cause I talk to my buddies who are in Texas or in the Midwest, or some are in the East Coast and 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 happens to work really, 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. Didn’t seem to work that well. Yelp here in the West Coast seems to work really, really well.
As far as mailers, that’s the one other thing that is still kinda analog that a lot of dentists do. Is extremely expensive, and is hit or miss. So you can throw tens of thousands of dollars into mailers and not get any kind of return. I think what the return that… They’ve done studies on it, and you get about a half a percentage return point on mailers, so you have to throw tens and tens of thousands of dollars toward mailers. It’s really regional, and so that’s the hard part about doing marketing is that, 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, but then you’re going to be probably throwing tens of thousands of dollars at something that didn’t work. I think that’s the most difficult part of it. And there’s no… You can go to lectures about marketing, but that might not work in your area. It is really, really regional.
Loran Simon: Marketing has changed considerably, what does this mean for dentists? Is it easier or harder?
Dr Duy Nguyen: Yeah. I think it’s made quite a quick shift toward digital. I pretty much only do digital marketing nowadays. And you have to be pretty tech savvy to know all the stuff. A long time ago when I opened the office someone told 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 Facebook on dental office?” 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. Just… I don’t have the time to manage it. But I have noticed that the… There’s certain things that makes… So dentistry is like a convenience thing.
People like that, you can just go to the dental offices, make your appointment really easily, and things as simple as parking. If an office doesn’t have parking they sometimes don’t even want to go there because it doesn’t have parking. I’ve found that making things very, very convenient for them, like making their own online appointments, which is one of the big things I have in my office, is that 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. There’s firms out there that help you do that kind of 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. Most of it is going digital. The analog stuff probably works as well, but the analog stuff is so costly. It’s just so costly that I’m not sure I’d wanna throw that kind of money out the door, and it might work, but it’s such a huge, huge resource. And for a small business owner, I can’t just throw tens of thousands of dollars out the door.
Loran Simon: 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 kind of 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 gotten a lot more complex nowadays, where literally just 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 fix 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 to do. It’s moved a lot toward that realm, and the bread and butter stuff I could do on my own under my own roof with little or no assistance, but those more complex cases where we’re talking about totally edentulous cases and just doing a whole makeover, has to be across different specialties. We have to talk to a oral surgeon, a periodontist, and it’s a lot of money, it’s a lot of work.
But that’s 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. Because those cases, 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 worth of work.
Loran Simon: From what we can see from the marketing side, there's a huge amount of demand for implants.
Dr Duy Nguyen: Right. It is, 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. Because 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 gotta find like a bunch of specialists that you’re comfortable working with. And as a business owner, a small business owner, when you 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 about searching and figuring out who works best with you. I’m pretty lucky, ’cause 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, pretty difficult.
Loran Simon: It sounds like you really need to have a good team in place. Whilst 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 gonna be seeing them for the rest of their life. If one thing goes wrong, you actually… You own these patients for life.
Loran Simon: How you manage the dual roles of being a respected dentist and business owner, what tips do you have for other dentists starting out?
Dr Duy Nguyen: Well, that’s a lot of things in there. So, just to manage the first part first, the how do I manage being a respected dentist and a business owner? Well, that’s nice, you just threw that I’m already respected in there, like…
Well, it’s quite difficult, actually. Especially if you’re in a small town versus a bigger town. So, I like to think of Pacific as a smaller town, there’s about 45,000 people here 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. And word spreads in a small town. And if someone doesn’t like you, they tell everyone in town about it. And when you open it, my situation is different, most people, some people take over offices, 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 just like, more just a dentist and I delegate. As you get busier, you have to find the right people to delegate the tasks ’cause you don’t have time to do all this stuff anymore. And I think that’s key. So, the staffing is probably the most difficult part of being the business owner. Because I’ll tell you now, the auxiliary people who work for a dental office, they stay at your office ’cause they like you. And a lot of times they don’t stay because they’re making a bazillion dollars or anything like that. So they like that they know they have a stable job and that they 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.
And so, working at a small office, that’s the most difficult part, is the staffing. So you have to keep these people happy and nowadays benefits is a must, vacation time is a must and sick leave is a must and healthcare and benefits, all that stuff is a must. Staffing is the most difficult part right now in owning a small office. Then I guess the third part of the question is, let me see if I answered that question earlier. What would it be? That’s the hardest part. So every now and then, sometimes I’m so focused on being a dentist, nowadays, I am. ‘Cause I have so many cases going on. If something comes up, like, for instance, just say, a computer blew out or something like that, I don’t have time to manage it anymore, so I just tell the front, go call somebody who can fix this and that, ’cause I just don’t have time to do these kinds of things anymore. So I think that’s key to being a busy office is delegation.
And what tips do I have for other dentists starting out? Dude, get into as little debt as possible.
Loran Simon: Get into as little debt as possible?
Dr Duy Nguyen: Yes, I think that’s the key thing, ’cause it used to be… It used to be quite easy, actually, because schools cost so little.
Yes. So 20 to 30 years ago, you probably graduated with anywhere from $10,000-$25000 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. So you’re looking at… With no patients, you’re looking at already a million dollars of debt. So, the key is nowadays is to have as little debt as possible. It might mean you partner with somebody, and you cut the loan in half, or it might mean that you go in to a location where that is not so competitive and open an office with little overhead, and there is a need, and you know that patients will come in right away, 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 kind of nickel and diming the general dentist nowadays with their contracts. So, that’s also key, too. You have to know how to negotiate really, really well. So I was very lucky that my in-laws taught me how to negotiate really well. ‘Cause they told me that a lot of these people you see once and you never see them again, so you have to negotiate the hell out of it. ‘Cause a deal is a deal is a deal at the end, alright, so I learned to really negotiate my rent. I negotiate the hell out of everything. I negotiate my overhead. I negotiate everything. You have to keep your overhead low because as much as you’re producing if your overhead is not low you’re not taking home anything.
And lastly, I think the key thing is, you gotta treat your patients like how you want to be treated. There’s no kind of rule on how you want 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 that there’d be TV in the ceiling. I like there to be… I like to have somebody just 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 wanna be treated. And to be fair, some people don’t care about that stuff. They don’t… They go, “Okay, we’re just coming in for a cleaning and that’s good enough for me.” And if that’s okay with you and how you wanna 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.
Loran Simon: Excellent. Thank you. That's really great business advice.
Dr Duy Nguyen: Well, thank you.
Loran Simon: What do you think about the future of dentistry in the US?
Dr Duy Nguyen: I think it’s increasingly more difficult to be… Am I getting this question right? You’re talking about the future of dentistry in general?
Loran Simon: In general, yeah.
Dr Duy Nguyen: Oh, in general. Okay. Not for the individual?
Loran Simon: No, no. Just in general. I guess from a dentist's perspective as other dentists will be reading this, so for them to have an insight on where you think dentistry is going in the US. So what do you think major changes will be perhaps over the next five to 10 years? And new challenges that will be coming up?
Dr Duy Nguyen: Sure. I think we have a huge battle right now with the insurance companies. Right now, there’s multiple lawsuits going on right now with the insurance companies because they’re undermining… Just the fees and reimbursements. And that’s been a really, really big hassle. That’s one of the things that is kind of behind the 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 is a huge, huge hindrance to if we can keep our office open or not. And so I hope that the insurance companies and our so-called lobby groups, we have the associations that we all kinda belong to and they kinda 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 that’s going on right now. We’re moving away from just stone models to just doing completely digital.
I just purchased a digital scanning… A digital scanner, so we won’t be taking impressions any more. No more impressions. Can you believe that? It’s crazy.
For everyone. No more impressions. We can do full arch scans with the intraoral scanner. We’ve had the cone beam in our office for almost, almost two years now. In the past, we used to… A patient will come in and they’d like, they would ask me, “I’d like to get an implant done.” And they’d say, “Well, 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. ‘Cause 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. ‘Cause 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.
You don’t have to flap open somebody to figure out how much bone they have there. The technology is outrageous and it costs a lot of money but it’s… It is really, really quick. You get results really, really quickly. And I think that’s where we’re heading now. Everything is becoming digital. On the web, and also in the office. And I was always worried about the digital, ’cause especially with the impressions, things like that, and the CT. ‘Cause I didn’t know about the accuracy of it, so I always have this rule where you kinda… I wait about five years. And they get all these studies out and then see how the five year studies go, and see if the results really do match with what they’re claiming. And it’s exceeded my expectations. Digital impressions are better than analog 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.
Yeah, and there’s still a need for dentistry over in some of these rural areas. So 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, there’s a dental office, right? Which is absolutely insane. There’s too much competition here. And then there are spaces that has no competition where so ever. So I hope that the government helps incentivize people to go to these more underprivileged areas in that way and they can kinda make a deal with paying off some of these student loans as well. Because that’s a big problem in the future of dentistry too. Future students don’t have the money to open offices anymore. And they’re gonna go toward working at corporate offices. And that’s something I didn’t touch, either. All these corporate offices are just taking over small mom and pop shops nowadays, so there’s offices, I won’t name any of them, but there’s offices that disguise as mom and pop offices but they’re really corporate offices ’cause they use a… Doing business as names, so you don’t even know that they’re a corporate office and they take them over. So a lot of offices are going that route, where they’re, I don’t know if you’re familiar with this term “DSO”? It’s a corporate office disguised as…
Loran Simon: What does "DSO" stand for?
Dr Duy Nguyen: I can’t remember anymore. You have to look it up, but it’s where they hire dentists and they work under their philosophy as a corporate office.
And they never give the doctor more than 49% ownership of them, of that particular office. They still wanna call the shots. And they’re, I think it’s a sad thing where it’s going that route where most of the offices in the US are gonna be taken over by corporate offices. But, that’s also part of the future of dentistry, too, because these guys have negotiating power, because 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.
Loran Simon: 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 for the rest of your life and you don’t get to call any of the shots,” it’s become more of a dictatorship than more of a “we own this practice together” kinda thing.
Loran Simon: Thank you, that’s really, really fascinating. Thank you so much.