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Dentists Who Invest

Profitability Secrets with Asad Rahman

Full Transcript

Dr James: 

Facebook.

Asad: 

I’m yet to find some software that does lives on Instagram and Facebook at the same time. But you know what, as I was talking just now, we literally just went live. So if anybody heard me say that and can help me out, I’d be super grateful.

Dr James: 

Anyway, back to the matter at hand.

Asad: 

Guys, we thought we would go live today, myself and Dr Asa Ramon and the reason that we decided to go live was, well, we were going to shoot a podcast and we thought, hey, why not have some more fun with it? Why not as much fun as we possibly can and invite an audience along to witness as well? Asad is here today to talk about profitability in our practice, profitability hacks and actually Asad has an amazing, amazing, amazing CV whenever it comes to this stuff because of his clinical experience and his role. Well, I’ll not, I’ll not. I’ll not take the words out of Asad’s mouth. Asad will do a lot better job describing to me. But put it like this Asad is in a really unique place to be able to offer dentists help whenever it comes to maximizing their profitability from clinical dentistry. But, of course, that starts with doing the best job that you can, from the patient first and serving to the highest standard, which we’ll cover in just a minute. But before we do, asad, how are you today?

Dr James: 

Very good, james. Hi everybody, how are you?

Asad: 

Amazing, amazing, amazing. I think the audience are doing just fine. But you know what? Let me confirm that in just two seconds, whenever I get the live up on my screen or my phone, asad, to see if we’ve got any questions, because, guys, I want everybody to know who is watching the day that if you wish to pop a question in the chat for Asad to help you with or for myself to help you, feel completely free to do that. There’s a live and interactive Q&A on the profitability side of our clinical dentistry. But, asad, just before we jump into that, can I just say one thing You’re looking mighty fine and mighty sharp for a flipping Wednesday morning. Do you usually wear a blazer and sit, or have you treated us today?

Dr James: 

Well, I work from home quite a lot. So, yeah, this is my usual attire, but I made an effort for you, james.

Asad: 

Oh, I feel flatter. And look at me, I just threw this old rag on as well. I feel embarrassed.

Dr James: 

Anyway.

Asad: 

Asad, there’ll be lots of people in the audience who have yet to meet you. I wonder if you’re able to do a little bit of a bio about yourself, because we know each other and some people in the audience ensure do know you. Of course, what we mean is everybody else as well, so we can be super inclusive and give everybody a little bit of context and what have you in the background?

Dr James: 

So I’m the clinician engagement lead at Portman Dentex. I work with the rest of the clinical team, the director’s dentistry chief clinical officer. In Dentex now we have approximately 400 dental practices and our aim is obviously to provide high quality dentistry and my role I’ve previously been a clinical lead and now in this new role is really to work with dentists, either one to one or with groups of dentists at practice level, and help them develop their skills, utilise the best dentistry and obviously ultimately that leads to maximising profitability. Personally, I have a clinical interest, a special interest in endodontics, after doing lots of previous postgraduate degrees, and I’m currently studying an MBA, which is my fifth degree at the moment, so a business degree to really kind of formalise my business qualifications in this role that I now do, which is heavily business based. So I’ve got a lot of experience over the past year, a few years, obviously working with dentists, going on to honour groups dentists help increase their profitability practices and then also on a personal level with my own clinical work and how I implemented, starting off, obviously, as we all do, as a general dentist and moving towards a special interest in endodontics. So, yeah, lovely to be here.

Asad: 

Hey, man, man, lovely to have you. Thanks so much. And do you know what name of the game today is? Talk about profitability, offer a clinical dentistry, ASAD. And you know, here’s the thing, everybody who listens to the podcast and listens and spends some time in the Facebook group, they kind of know my take on it. Do you know what I mean? So I’m not going to take too much airtime today, and they know why I personally believe that it should be a priority for all the reasons that we spoke about on the podcast before. But of course it starts with, as I was saying, doing the best job that possible can from the patient first. It’s only when you give way more value than you can expect, to receive more in return. It actually means you can do a better job, in my opinion, have more time and also more money to reinvest myself. Anyway, there’s a whole host of reasons and I just really, really, really came close to delving into the reasons why I think it’s important Personally, the reasons that I share with the community, with dentistry and Vest, but you know what. Enough about me. What I’m curious to know is why, in your opinion, is this something important and something that’s worth talking about?

Dr James: 

So, if I take my own personal journey, for example, I started off as we all do most UK graduates doing FD training and I was actually very lucky to have a fantastic FD trainer and I ended up staying in that practice for a few years. And what I started seeing over the years is once you start to build up trust with patients, once you’re able to patients trust you, once they know that you can service them and look after their dental health, you’re able to enhance the skills that you provide to patients. And then, from a kind of real personal experience, I had a situation where you know there was an issue where I had a patient and me, there was a clinical issue and I was sued. And when I kind of I’m a big believer in you know, learning, growing, moving forwards, and when you kind of extrapolate the issues around, that it comes back to really having time with patients, having the ability to connect with patients, build a rapport, and when you do all those things that communicate the right way, build a rapport with patients, inevitably you realise that you’re able to provide a better service. So you know, from my own perspective and from what I’ve seen across different practices in different dentists, it’s really important that we do that, as you’re saying build a connection with patients and then utilise those skills the right way and inevitably, when you do that, you’re able to charge appropriately.

Asad: 

Do you think lots of dentists hold the belief that the less they charge, the more they’re helping the patient and also the less likely they are to get sued?

Dr James: 

100%. So I mean I’ve seen that across lots of dentists and you know we may talk about mindsets etc. And dentists I find generally they’re in two different camps. So there’s exactly what you’re saying. The dentists that believe and at one point I was maybe in this camp where you believe that the kind of the value you charge you almost give the best you can but then the value you charge is limited because you, in your own kind of mind, you feel patients will not be willing to pay more than that. Now, on the other hand, what again my personal experience after you’ve done multiple postgraduate training, appropriate postgraduate training, and you’re trying to provide a service, the numbers just don’t add up if you’re trying to provide it on a certain level. So, from your own personal point of view, you’re thinking right. I want to be able to use X equipment, even if we just keep it to basics in terms of the cost you’re using. Now you may not be a practice owner, but even as an associate, I always say to people take into account, because somebody is paying for this for you to be able to provide this to patients. And even when you’re taking the basic costs, for example, you know that the kind of, if I talk about ENDO, all the files I’ve used, all the different arrogant systems I’ve used, etc. They’re not going to be cost-appropriate. So you don’t want to ever be in the position where certainly you’re losing money. So that has to be taken into account. And what I found over the years is when you’re appropriately trained and you’re providing an appropriate service so endodontic referrals, for example. I can’t remember in the last two, three years providing endodontic referrals that patients have ever questioned the charge. Again, these charges are set up fairly to take into account your costs and also your skill level and the service that you provide.

Asad: 

Yeah, 100%. So it starts with giving more value and it actually affords you the luxury to give more value to your patients as well. Exactly, which is a beautiful way of articulating it. Yeah, whereas if it’s this race to the bottom in terms of who can charge the cheapest wrap price, well, inevitably the dentist is going to suffer. Whether that’s going to be the materials that we use by the time that we’re able to give the patient, yeah, so here’s the thing If you want to take that one layer deeper. If we’re truly serious about doing the best job for the patient, which is literally the MO or it should be the MO of every single dentist up and down the country. There’s very few hard and fast rules. That’s a hard and fast rule right there. If you are a healthcare professional, you want to do the best to be patient right Exactly If that’s your MO, then actually inevitably cost is going to come into it at some level. Therefore, you need to confront your own limited abilities about pricing money in order to be the best clinician and do the best job for the patient 100% yeah. But anyway, this podcast is not about me. Anyway, so let’s go back to what you were saying just a second ago.

Dr James: 

As I, because we want to avail from your knowledge and experience on this, because you’re in an amazing place.

Asad: 

You literally go to different practice before a living. You literally go to different practices and allow dentists to be more profitable, enhance their beliefs whenever it comes to these things and also give them practical tips on how that’s achievable. So you know what you talked about mindset just a second ago and you and I just scratched the surface just then with what we’ve said. What do you find are other limiting beliefs? How can we say that dentists hold whenever it comes to giving themselves permission, almost I suppose, to be as profitable as possible? What beliefs do you find hold dentists back from achieving? That Is a better way of saying it.

Dr James: 

Well, it can be the classic example of the two mindsets. So, as we all know, there’s people with kind of fixed mindsets or people who believe that any kind of talent or ability is innate and not learnable, and there’s people with kind of growth mindsets who think that you know your talent and abilities you can learn and improve on. And what I find with dentists in kind of certain camps, if it necessarily with people with fixed mindset, if I take a classic example of, you know, composite bonding, let’s say, lots of people will say this is just one example because it brings to mind A classic phrase oh, I’m not good at composite bonding, I’ll never be good at composite bonding because I’m not artistic. Now, that’s the fixed mindset. If you switch that into the growth mindset, it’s I’m not good at composite bonding because I haven’t done the whole host. There’s about 20, 30 different courses out there, masters out there, on aesthetic dentistry etc. Now if you go and do those appropriate training with the mindset that you can then implement that, you will be, let’s say, at a certain level of composite bonding where you’re better than the people who haven’t done that composite bonding. Now here strengths obviously come into it. So I’m not here to say everyone has, whoever has a growth mindset, is kind of thinking right, if I go, you know, when I was younger I wanted to be a footballer. And then you very quickly realize you haven’t got the strengths to be a footballer. So it’s not to say that, oh, I’m gonna go and play football, you know, 18 hours a day and eat well, et cetera, and become a footballer. It’s not that, it’s the simple fact that you’re giving yourself mission to at least attain that knowledge and have the understanding that you can move towards a certain direction and improve your level of skill. So that’s a classic example, I mean. And the other limiting factor which I find is sometimes dentists will go and actually do a course, but they won’t actually know how to implement that into their practice. So, yes, they may have gone and I know people who’ve done, for example, masters so three years and significant cost in implants but because a lot of these courses are kind of theory-led, you then need to supplement it with a mentor, et cetera. They don’t go and provide that. So they’re almost in the halfway house. They have the mindset they’d need to learn, but then they kind of just limit themselves because the rest of the cohort might be ahead of them or whatever, and they won’t go and implement that. So those are the two or three different positions I feel dentists find themselves in, which again comes down to the way they’re thinking about dentistry and what they’re providing. And do you know?

Asad: 

what I love about your answers and your philosophy on this. This comes from direct observation of countless clinicians up and down countless practices. I mean it’s not like you’re just reporting something that you’ve heard on a podcast or something like that. Once upon a time you’ve literally seen this with your own eyes, so it just adds a little bit of extra gravitas to what you’re saying. So certainly, mindset is a big part of it. It starts with as we way, as some people might say it sounds, it starts with believing that it’s achievable, because if you don’t believe it’s achievable, we’re never gonna go out with 100% conviction. And that’s what becoming the best at your job looks like. You have to really attack it. You have to really go for it. You have to really believe that you will be able to internalize this information, adopt it and become the best dentist that you possibly can. And it’s only until you mentally are aligned, your thoughts are aligned with that concept. Well, you’re always gonna leave some ability on the table. You’re never actually gonna quite fulfill your potential. In my opinion and here’s the thing, even if you objectively aren’t gonna be like the god of root canals or composite bonding, the point is that when you believe that you’ve got the greatest likelihood of becoming as good as you possibly be.

Dr James: 

That’s all it is.

Asad: 

It’s not like true or false. It’s just that it is most likely to give you the best outcome possible.

Dr James: 

Exactly. Well, that goes to obviously one of my you know, corvalli key belief of mine is never not comparing yourself to somebody else, because so when we all qualify as dentists, let’s say there’s a certain standard we have to meet to qualify. Now, even within that, you know, you and I went to the same dental school. Well, there’s people of different abilities, even at that age or that kind of that set when you’ve just qualified as a dentist. Now that doesn’t mean that those people will always be the best at a certain thing, or best at dentistry because you’ve got your rest of your career. And a classic thing I say I read something a little while back do you know how long the average dentist works? So they did this study in America and they found the average dentist works for about 40.4 years. So and that’s in America where you’d think, right, they’re gonna make the money. And you know people have this perception of American dentists they’ll make the money and then they retire. But that’s in America now it’s not too far dissimilar to the UK, I’d say. So another classic thing of comparison is in my mind it just makes no sense that if I was two years qualified, even if I’ve gone and done a master’s in endodontics or three years qualified, or even gone trained as a specialist. It would be, in my mind, even insulting to the profession if I suddenly became the best in the world at it, because there’s somebody who spent 40 years doing this. There’s somebody who spent 40 years doing this to get to the so as another kind of thing. So we can’t get disheartened by that fact that you know it’s going to take us a long time. Each way along the journey we’ve got to obviously learn and improve. So if we’ve got that mindset, rather than being disheartened by the fact we’re never going to be as good as someone at the top, or thinking on the flip side, which is, you know, overconfidence, thinking we are the best at, you know, two or three years qualified, having appropriate understanding of what, where you are in the journey of dentistry, this long journey of 40 years or 30 years is very important.

Asad: 

And it kind of reminds me of a saying, what you’ve just said you can’t compare your chapter to, let’s say, to someone else’s chapter 20, it’s just. It’s just a math thing, it doesn’t make sense as talented as you could be a dentistry and as talented as they could be, there’s just no way that’s feasible with something that’s always been something ten times as long as you. So, yeah, food For thought on that one. Food for thought big time, but yes, anyway. So we’ve covered the mindset side of things, so important, and it’s actually the first step and stone to all other achievements, in my opinion, in life. So the mindset side of stuff is okay. How can we think, how can we achieve enhanced outcomes by analyzing our perspective on certain things and Modifying and enhancing it where necessary, merely to give us the greatest likelihood that we are going to become the best condition that Possibly can. So let’s shift gears slightly and move more towards the practical side of things, as in what things do you observe From your clinical experience? You’re going into all these clinics. What things do you observe frequently that dentists need to do better at, whenever it comes to the profitability side of things. So that can be. Do this procedure in this way, treat the plan, this procedure in this way or here. So you should orientate your diary, diary really practical, tangible stuff.

Dr James: 

Well, so I’ll start with that because that’s a key thing that I focus on with dentists diary zoning. So this Can be appropriate if you’re, let’s say, an NHS clinician or doing majority NHS and you wanting transition more towards private dentistry, or even if you’re a private dentist and you’re wanting to implement a new service. So we’re all stuck in our kind of day-to-day and and making that change and simply saying, right, so out here I’ll use the example of in this line. You know I don’t obviously focus in and onto myself, but again, having spoken to clinicians who go and do this in this line course or short term orthodontic course, they’re thinking, right, I’ve gone done this one day course, how do I then implement that? And big difference, I find there’s dentists who will Say, okay, I’ll just wait as and when patients come along, I’ll put these exist the same Short-term orthodontic patients into my existing diary and I’ll just make time for them. How it works. What you find with those dentists is because there’s no kind of zoning in the diary where they know they have to do short-term orthodontics. There’s no kind of planning or thinking that they want to slowly transition towards doing more short-term orthodontics. They never get there. On the other hand, the dentists that really are able to implement services. They’ll go in on the Monday morning They’ll be brave, let’s say and they’ll block off or add in an extra half a day when they’re not working. So if they work, you know, four days a week, they’ll add in an extra half a day or Make a set space for this new service. What they’ll then find is there’s a time pressure. They have to have to fill that space. They have to slowly implement this new service and by doing that, what they’ll find is, before you know it, they’re doing a day of short-term orthodontics, then a day and a half, then two days and then cutting back in on their diary because they’ve simply planned and Put a time pressure on themselves. That’s when I talk about diary utilization. It’s it’s very important you utilize your diary to the type of dentists you want to do and implement it quickly.

Asad: 

I Love that little tip, just then. That’s so good. That’s really practical as well, because next time somebody goes in the course, what we have to understand is you have to create the space almost so that it can be filled. We have to do it that way around, you know, because then again it gives you something to focus on like an objective, basically, because you’re like, oh crap, well, I’m actually gonna waste that day unless I fill it with this patient, you know. And that doesn’t mean, obviously, that we’re going all over a way to what we treat people or anything like that, but it just means that we’re that much more likely to be able to see those opportunities to help people.

Dr James: 

Yeah.

Asad: 

Zoning. I have a question actually, and I’m interested in your philosophy in this, because here’s what I see a lot. I see a lot of people you want to implement zoning, but they don’t really know where to start, and I know that you’ve given us a really, really, really good practical tip for People for dentists here in the position where they’ve recently done a course which has expanded their skills. What about just GDP? What about somebody who’s in a place where they haven’t actually done that recently, but they want to implement zoning. What’s the best strategy that you’ve ever come across on that front?

Dr James: 

so again, zoning it’s. It comes back to If I talk about clinician, who’s kind of mixed NHS, private, yes, back to the mindset when you’re in your NHS zone. You’ve, let’s say, you got ten. When I used to work on the answer you said five to ten minute checkup appointments and you’re going through you know 45, 50, 60 patients a day and you’ve got 20 minute, you know, restoration appointments etc. Now to then suddenly say within that same day You’re then going to add in a 40 minute private patient for a composite or whatever you know a Crown prep. An hour. It’s just. I don’t understand how you’re able to then flip from the mindset of just rushing, being quick, providing obviously a service but at a certain speed, to then going right the next hour. I’m gonna be a, I’m gonna do the best crown prep. I know you’re not in the right mental space, you know you might be tired, etc. You’ve got to take all this into account your nurses rushing around, he or she’s, you know, getting all the equipment ready before you know that our has cut down to 40 minutes, and then you just think, oh, I’ll just do my usual quick crown prep, not implement these new things I’ve learned on this crown prep course, for example. So then again, the thing about zoning that I say, if you’re a mixed clinician, have set time where you it’s a private zone Because you can almost and have it in an afternoon, because you can almost flip your mindset at lunchtime and go right the next three hours. I’m just focusing on, you know, providing my best industry at a certain level and when you’ve got your other zone, etc. You might be doing checkups in it or whatever You’re able to work at a certain Pace that you need to. So it’s important for your team as well to know. The other thing is when we link in reception and so you know your receptionist are key to implementing this with you, because you need to Implementing this with you, because you need them on board to implement diary zoning. So they need to know not to suddenly put oh, mr and Mrs Smith has rung up with an emergency, let’s just put them in this zone where there’s the gap. That zone is there for a certain for you to develop your skills and move a certain way. Yes, see that emergency in a different space, but utilize the zones correctly. So you need to have, obviously, reception on board. It’s not just dentists has decided, I’m gonna do zoning. The whole team needs to be on board with them towards that zoning.

Asad: 

Hell, yeah, mate, and you know what? Just one more thing that popped into my head on zoning whenever you were talking, just then. So let’s say you’ve got like private and let’s just say you’re doing some really simple zoning because I’ve seen people do simple zoning, unlike as complicated as you like with like 10 different zones. You know what I mean. So let’s keep it simple for today. So let’s talk about the mixed practice, for example, and let’s say that you’ve got an NHS dentist sorry, mixed dentist, rather and what they wanna do is create a little bit more space for private treatment and I noticed that you said just then that an afternoon could be an example of when you do that. Have you noticed that there’s better slots in terms of, how can we say, prime time slots that patients tend to gravitate towards, or private zoning, for example?

Dr James: 

So again, my experience of that is having worked with a lot of clinicians is the more complicated you make the zone, the less likely it is to be adhered by reception, because they’re let’s be honest, reception are under pressure, they’re on the end of the phone to this patient who needs to be booked in at a certain time. So that’s why I always prefer wider, even in my diary, longer slots for certain things. So when I have my, I still do a bit of general dentistry and then my endo slots. They’re kind of really longer slots, again giving the patient a certain availability. Right, we can see you from 12 to five or, if you wanna do an evening slot, five to seven, whatever. But having longer slots is always better. The more kind of smaller slots you make, it just it doesn’t work with the whole team kind of having to go on board.

Asad: 

Love that and you know. Whenever it comes to, let’s say, the private slots, for example, have you noticed that there’s a certain time of day that it’s better to have those slots at, in terms of them being more likely to be filled?

Dr James: 

No, again, not necessarily. So that’s something. Obviously we analyze diary utilization et cetera a lot, but so not necessarily that there’s kind of certain time periods that are better. So again, if you talk about that private example, having a morning private slot and an evening private slot, maybe on different days, or even just having a whole day this is my private day et cetera, but what you’ll slowly be able to do is, if you’re wanting to go that way, increase your private dentistry, cut down your NHS, or if you want everything a status quo, it stays a status quo, but you’re giving each patient the correct service that they want, with a fair service for everyone, and it works well.

Asad: 

That’s cool. Listen, I’m so glad that I asked that question because I know that that answer that you’ve just given us will be from data as well, because I have no doubt that that’s a parameter that you’ve measured as well, and it doesn’t make any difference. That’s knowledge in and of itself. That’s valuable. Yeah, Cool, man, All right, well, awesome, you know what? I am very keen for us to talk about the profitability side of the dentists, because I know that that’s your forte and actually, if memory serves me right, however many episodes of Dennis Universe podcast we’ve done, I think it’s 215, something along those lines. We’ve never actually talked about specifically that. Yeah, it baffles me a bit because I know how we’ve done this, but I know that.

Dr James: 

Yeah, well, I think it’s not just as you say yourself in your episodes, but a lot of people felt appreciate that when ended on Tix has done correctly and right. There’s lots of little things but for me personally, you know, I laugh and joke and say I’m just seeing the patient once and then never again. That’s my aim. I just want to see that patient once for that one tooth and then never again. But if you’re talking specifically about costs et cetera and you want to get into the nitty gritty, then yes, I was saying earlier there’s certain equipments that I’ll use which may be different to kind of a general procedure, you know as doing a retreatment yesterday in certain different files, techniques et cetera and that you’re using. But from an associate point of view, the first thing I’ve got to remember is there’s no lab costs. So if you do a RizLine or you do a composite bonding, you’re getting stents made or you’re doing implant work, first thing is there’s lab costs in, and adontics obviously is not a lab cost. You have to take into account the files. So certain practices choose to obviously take that small file cost, you know, 30, 40 pounds or whatever, pass that to the patient or build it into the cost, Again, not necessarily coming away from the associate. So from a profitability point of view, you know, as you’re talking about your podcast, in my mind it’s a quite profitable procedure. And then if you take into time, for example, the hour and a half procedure, an hour and 15 hour and a half procedures, so the amount you can do in a day, you know you can kind of utilize that your day well to implement a lot of adontics into your day. But that starts again from. It was my passion, so I have always, out of all of dentistry, I’ve always loved adontics, and that then goes into me wanting to do my further training, et cetera. Because you have to. Whatever kind of service you provide, we all know as dentists the appropriate level of training we need to provide certain services. So go out, you know, achieve that, and then the rest, I think, just falls into place with a bit of tips and tricks on diary utilization, preventing new services, et cetera, here and there. Oh, beautiful, okay, cool.

Asad: 

So I love the philosophy for things you’re talking about as well, and not because it’s about making as much money as possible? Definitely not about that. It’s only about serving the patient with a high standard, being remunerated to a standard that is fair. Fair, because we’re giving them such high value and then using that to have the lifestyle that we want and love and adore and enjoy. Whether that be a little bit less dentistry, whether that be a little bit more dentistry, horse for courses.

Dr James: 

The point is that you get to choose Love.

Asad: 

that, okay, cool. So listen, thank you for that and let’s go. You know what you know. I think you probably have some really good knowledge in your head in this specific animal body right now. Say, if we were to go right into the clinical side of endodontics, like you know there’s. Like you know what I was intrigued by when you said about certain materials that are out there. They’re you know, they’re good and they permit you to be as profitable as possible, like, for example, like I’m going to give you an example on that one, or what I should imagine you might say you might say okay, spend a little bit more on this thing, because actually it means that your retreatments go down by a huge amount and therefore you make more money overall and you do a better job for patients. Because if you have this pure austerity mindset, you’re not going to be using the best materials. Build, your rates could be higher as well. So stuff like that. I’m sure certain you know some amazing things on that front. Any tips?

Dr James: 

Well, yes, I mean one of the biggest things and I was a talk with one of my friends who’s an endodontic specialist in Sheffield on Monday and a lot of people who do endo will agree that irrigation itself, so irrigation is the key part. So this is really getting clinical now. But, irrigation is the key part of endodontics. So a lot of people worry about what file system they’re using, what you know, how they’re shaping the canal, what obturation they’re using. But it’s ultimately it’s about removing bacteria, so it’s irrigation. So you want to be first tip is using the correct solution. So it’s got to be sodium hypochlorite. You know, above 1%. I’ve known, you know, certain clinicians who have gone and got the kind of cheapest hypochlorite out there. Get it, you know, get it from a dental brand. Yes, it costs a bit more but you’re getting a certain percentage. You know it’s safe for patients, you know you’re. You know you’re having less incidences with it, etc. And then the second thing is actively moving that arrogant around. So again, this is where it gets released on a spectrum, because you’ve got machines in the States, for example, which are about 50, 60,000 pounds, which some endodontists use. So they’ll access a tooth and stick this thing on top of a tooth and it will actively irrigate the tooth for an hour. You can, obviously, and pump the arrogant in and, you know, suck up the old arrogant, not practical. On the other hand, you’ve got dentists who will just put arrogant in a tooth for about 10 seconds. So you’ve got a real spectrum Now the halfway house after, and again, lots of studies show this is the best method of active irrigation, which is vital, you know, in improving success rates, is to use something like an endo activator. So it’s about 250, 300 pounds on the market, really easy to use so anyone can use it, so it doesn’t require any further training, you know it’s. You simply put it into the canal and it pressed the on button and that one tip will reduce your kind of failures a lot. So by spending 200, 300 pounds on this one piece of equipment, reduce your failures a lot.

Asad: 

I totally geek out on this stuff. Can we go one layer deeper in terms of leakiness? Is that all right, yeah?

Dr James: 

all I want to know is because I used to use an endo activator when I was yeah, what’s your protocol when you’re an endo activator?

Asad: 

So irrigation protocol yeah, irrigate all of that stuff.

Dr James: 

Yeah. So the whole irrigation protocol, obviously using irrigate after each you know filing of the canal, making sure. So again, another key part of irrigation, make sure there’s patency. So using hand filing to make sure there’s patency, using your after every instrumentation, more irrigate. So it’s almost like again when you’ve got your nurse and you’ve got your 400 dentistry, you’ve got they know you’re, you know irrigating, then you’re putting that down, they’re moving the suction away, you’re filing, they’re then going back in, so that it’s just the constant repetitions of that. The more you get in, the better. Again, time wise, the longer you put the arrogant in, the better. But that’s where you have to be practical and that’s where I come down to the hour and a half mark. If a bookendos for an hour and a half, because that gives you sufficient time over technically, if you access the tooth you know LA Rubber Dam access the tooth within, let’s say, 15, 20 minutes, you’ve then you know you’ve got about 50 minutes to an hour off irrigation time. So that’s important. The penultimate rinse is with the EDTA. That’s just to remove any debris and and really it goes back to you. We get taught this at dental school and what I found about training, you know postgraduate training is. We learn a certain thing in dental school. We then go into the real world and we have to because we have to work at a certain speed. In the UK we cut corners. We then get confused why things fail. We then think, oh, that’s failed because I’m not good at that. But when you go into postgraduate training and realize if you just go back to what you’re taught at dental school and do things the right way, things don’t fail. You know, you don’t get a long end or you don’t get a short end, or things work well. So it’s sometimes about going back to basics. That is the key. We all know how long we should be irrigating. We all know what should be irrigating with. Use the correct stuff, do it the right way and you’ll have less failures.

Asad: 

And you know what? Excuse me, just to add to what you were just saying, just to bring it full circle back to what we were saying at the start, put it like this if you’re doing Bantu, nhs root canals all day long, you only have somewhat of time, usually realistically to be able to donate, to be able to give to that procedure, right. Therefore, your success rates are ultimately going to be limited to a degree with me. So actually it’s not until you step outside of that zone and you give yourself a little bit more time to do it properly, properly, until you actually hit the true potential of what you can achieve in terms of success rates for your root canals, right. But in reality, actually, naturally, when you give someone a little bit more time, well, there’s overheads with the practice and what have you as well. So the remunerary it actually starts with asking someone for a fair remuneration level to give them the time that they need so that you can actually get a true perspective on how good you can really, you really are and how good you really can be. But that’s how people don’t see that the price thing limits them. Sometimes One has to ask this is the thing right, but you have to take that leap. You have to take that leap of faith in the first place, which never happens unless we talk about the stuff and explore it.

Dr James: 

Exactly, and I mean the leap of faith that you’re mentioning. So when? So I’ll go back to when I was an NHS clinician, about three or four years, and I actually would spend an hour and a half on my endos. So out of all the things that you’re rushing around trying to fit lots of patients in, fit your emergencies in, et cetera, fit your restorative treatment in, the one thing that I would spend my time on was endodontics, because I always had a vision and a passion for that. I would take my career towards endodontics. So it goes back to having that kind of overall vision and plan for your career, or a certain five year path in your career. And if you know that, you know we talked about Invisalign earlier and you know that, so you’re not then going to be worried and say, okay, for the first six months this half a day in my diary might be empty or might only have two patients, because you know longer term you’re gonna have five days filled with that If that’s the way you want to go and you want to continuously learn and develop. So it’s almost like you’re in the zone. You’re in this kind of continuous day to day movement, taking a step back and thinking about the future and your overall vision is so important and, like I was saying earlier about implementing that. You’re saying implementing action comes first and then the results come later. So you have to take the action first and then the results follow from that. Then the remuneration follows. So initially I’m doing endos for an hour and a half for Van2, which was, you know, three UDAs at the time Doesn’t matter, I’m learning, I’m learning, I’m learning, and then you can make the transition.

Asad: 

Love that. It’s about seeing the bigger picture, the bigger picture yeah. Big time, man, big time. Well, listen, I thought there were some gems in there for sure today, and I’m sure everybody listening and watching on the Dennis C Invest Facebook group what was about from that? So I want to thank the person for giving up your time. I pleasure this beautiful Wednesday and I’m sure we’ll have you back on the podcast even soon, because I reckon we’re just scratching the surface whenever it comes to this stuff.

Dr James: 

Yes, anytime, James, anytime.

Asad: 

Okay, well, I’m looking forward to that already. Asad, if anybody who has listened to the podcast will watch on the Facebook group today wants to get in touch with you, how are they best off finding you?

Dr James: 

So I’m on Instagram just Dr Asad Rahman and LinkedIn as well, dr Asad Rahman. So always happy for people to reach out. I’ve done a few podcasts before people reached out, so always happy to help people with their overall vision for the career, how to develop for the implement new services, et cetera. Always happy to help.

Asad: 

Love it dead. All right, well, as I say, listen. Thanks so much for your time today, asad. I’m sure you and I will speak again very soon.

Dr James: 

Yeah, nice being to James, Thanks.