Dr. James:
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Dr. James:
Yo, what’s up everybody. Welcome back to the the Dentists Who Invest podcast with myself, james martin. I am really, really really looking forward to this episode today with. Some of you may remember, sonja, from way back in the day when we did a 32 stories event on the facebook group. Holy moly, that seems like so long ago. Sonia, how are you?
Sonia:
very well, very well, thank you. It does seem like a long time ago, middle of lockdown, doesn.
Dr. James:
Doesn’t it, you know? But yeah, yeah, that’s crazy really. Actually, I’m just having a little bit of a reflective moment on that, but seriously, that actually feels like so long ago, but actually, really, if we think about it, it was probably about 12 months ago, which is a blink of an eye really. We have welcomed Sonia back today because we are all ears, as dentists, to learn about how we can be more profitable, which is, of course, the point of Dentist who Invest. It’s not just about investing in the financial sense, but also investing in yourself, because that is one of the easiest ways that you can, of course, create wealth.
Dr. James:
So Sonia is here to talk today, first of all, about her journey, because everybody needs a reminder, because it’s a really interesting one, and you know what? It’s a journey about entrepreneurship, and it’s a journey about stepping outside your comfort zone. So I’d love to hear about that. And then what I’d also love to hear about is how we can be more profitable with aligners in our practice. As a self-confessed individual and dentist who never undertook it upon himself to do any aligners whatsoever, today is a school day for me.
Dr. James:
let me say that yeah so I’m gonna tell us about your story.
Sonia:
What an intro and welcome back to um to our offices. So we’re in obviously london after james has just rolled out of another speaker event that’s why I’m all buzzed yeah and I don’t know if you remember last time you came to visit us here, um, you bumped into our neighbors, the sidemen, who are the biggest YouTubers in Europe, and I don’t think you knew at the time who they were, but you were handing out your business card and offering them dental services and it was just an amazing amazing hustle Really liked it.
Dr. James:
Thank you, you made an impression. It’s nice to be appreciated. But you know what? Yeah, sonia, for the people who don’t know you, which there will be some off on the podcast today, given that when the group, when you appeared on the group originally, it was very much in a nascent stage, and it’s it’s growing since then yeah maybe it might be nice to tell us a little bit about yourself and your journey into where you are today. I won’t spoil it. I’m going to let you start from the start and not jump in.
Sonia:
Yeah, fair enough. Yeah Well, the journey from 32 Stories is also, it feels, like a long time ago and a lot has changed in the world, but also in the business. So yeah, for those who don’t know, I’m Sonia Shamosky. I’m a doctor by background. So I grew up in the Netherlands and came over to the UK, to Oxford, to study, study medicine, completed my degree and practiced for four years in the NHS, primarily in ophthalmology and trauma and A&E. I was running an educational business at the same time, so in the tutoring space. So I always had an eye on the entrepreneurial side. I think I loved medicine, I love my degree, but for various reasons I don’t think it was exactly the right career for me. We can probably talk about that. But I moved into management consultancy. So I went to the Boston Consulting Group, which, for those of you who don’t know, it’s a it’s a strategy consulting house, um, that where you you go into companies and you advise them on on all sorts of strategic things. So I was working in healthcare, but also in other areas, and from there I went into a company called digital ventures, which is essentially an incubator for startups. So I was working there on what is now the world’s largest haemophilia app for patients, so allowing them to, to monitor their treatments and um and then into what is now 32 co.
Sonia:
You know, dentistry is going through some turbulent times, right. You’ve got people who are trying to sell their practices and trying to bump up their profits to to basically get a higher valuation. But they don’t have to do that, so they need to be. They need to basically get a higher valuation, but they don’t have to do that, so they need to be pushing through higher ticket items. You’ve got people who are really struggling to retain dentists, attract dentists. You’ve got a cost of living crisis. There’s just an awful lot happening and from our perspective, there are there are so many uh agencies trying to get a piece of the clear align or the orthodontic pie, because there is so much money in it and there’s so much demand for it that I certainly wouldn’t I’d be worried as a dentist that basically they’re coming after my lunch and that I’m sort of napping I’ve been been caught napping right.
Sonia:
They’re asleep at the wheel, as it were, because now what you’re also seeing is the big corporates going closer and closer and closer to the patient. So you’ve got the likes of Strauman, for example, very well-known, very well-respected implant brand who have said publicly their CEO said in their latest investor presentation we want to get closer to the patient. So what does that mean? That means they’re buying essentially these sort of semi-direct consumer smile shops which are on the high streets, which are directly competing with dentists for their clear aligner business. So, dr Smile plus Dent, you know how long is it and this is not trivial how long is it before they start to open implant shops? And you know as much as Straman is a hugely respected brand. I’m not sure how many implantologists would want to work for an implant shop on the high street. I don’t know.
Sonia:
Dent Supply same thing, big and well-respected corporate dental brand. They acquired a DIY clear liner company called Bite for a billion dollars, famously, two, three years ago now. They’ve also just announced that in Scotland they’re going to be opening up small shops, small studios, which are going to again directly compete with dentists. You know it is a problem. It’s moving fast and if you are, if you said to me like would you be surprised if, in five to ten years time, um, all of these corporates actually own dentistry? And we’ve got salary dentists now. You’ve got pressure on wages, you’ve got them, given very little choice in the devices that they use, in the treatments that they offer. They’re just sort of in this corporate body just churning away. I wouldn’t be surprised unless dentists do something to address their profitability and actually take control and actually not just maybe think about doing something like clear aligners, actually go and do it, because there’s an existential threat to them having, on the one side, real direct consumer brands stealing their patients and on the other side, these corporate manufacturers setting up competing shops on the high street. I’m sorry, invisalign did it as well. Align tech did it. They set up um shops on the high street. Now they were sued by Smile Direct Club because they had an agreement that they wouldn’t do that. In the last couple of weeks actually, that agreement has now lapped. So let’s see whether Align do the same thing and start setting up shops.
Sonia:
But dentists are being squeezed from all sides and they need to do something to ensure that they aren’t, you know, just going to be salary Joes in 10 years time, especially for the younger guys and gals out there who went into dentistry, because it provides them independence and, you know, clinical autonomy and a right to work when you want to and earn as much as you want to. So it’s, it’s real. People need to think about this, and the the journey to that is is a convoluted one, but essentially what we’re trying to do is to help general clinicians provide more specialized treatments for their patients. So when you think about healthcare, not just in the UK but globally the ability for a generalist to provide something that is outside of what is normally considered general care so general dentistry in this case means that patients get greater access to treatment, but also clinicians can make more money, and the space where I think there’s an enormous amount of potential for clinicians is in orthodontics. So the orthodontic market has changed over the last 10, 15 years beyond recognition, and we will probably dive into the reasons for that.
Sonia:
But for us, the people who haven’t participated as much as they can and probably should are the general dentists, and the reasons for that are sometimes obvious and sometimes not, but it’s to do with the level of confidence in providing specialized treatments, the amount of training in dental school and just the access to good support and good training team.
Sonia:
Now that spans across three continents, that operates in multiple geographies, that has at its core really the desire and the mission to help general clinicians add clear aligners to their portfolio, but doing it properly, for want of a better word really thinking about the, the clinical rigor that’s required to provide good orthodontic care.
Sonia:
And how do you do that in a way that’s accessible to to any dentist so that they can a provide more treatments for their patients but be also make more money, and and that’s obviously what your listeners are really interested in. So you know I won’t dwell too much on what 32Co are doing. We will spend some time probably exploring that as we go, but in essence, what we do is we provide dentists with a platform to get all of their training in orthodontics for free, get access to specialist orthodontists, one-to-one to guide them on their orthodontic cases, and then a marketplace of clear aligners so that they never overpay for their aligners. And that is where really the profit margins come in and where it becomes a really attractive treatment to be able to offer to your patients.
Sonia:
So, that’s it in a nutshell.
Dr. James:
That’s awesome and you know what we’ll get into the technical aligner talk in just a minute. And, as I say self-confessed, I’m not someone who’s ever actually undertaken aligners on a patient, but I’m really interested to hear how they can be implemented more effective on the practice, in your practice, in any practice, because I’ve spent enough time on dental forums to know that there’s a lot of dentists mentioning that they’re not actually as profitable as everybody thinks they are, unless you take steps to improve your workflow, which we will touch on. Can we just quickly sidetrack for two seconds and touch upon something that you said earlier, something that is a little close to my heart and also I want the audience to hear as well? You know, when you were in medicine and you felt you had this, you understood. There was a point where you thought, okay, this is all right, but it’s not quite my calling in life. Did you purposefully take steps to leave medicine or was it more of an evolution? Real quick guys.
Dr. James:
I’ve put together a special report for dentists entitled the seven costly and potentially disastrous mistakes that dentists make whenever it comes to their finances. Most of the time, dentists are going through these issues and they don’t even necessarily realize that they’re happening until they have their eyes opened, and that is the purpose of this report. You can go ahead and receive your free report by heading on over to wwwdentistoinvestcom. Forward slash podcast report or, alternatively, you can download it using the link in the description. This report details these seven most common issues. However, most importantly, it also shows you how to fix them. I’m really looking forward to hearing your thoughts it’s a good question.
Sonia:
Actually, I think I went. I went into the degree that I went into for the science. So the the degree that I did was a very scientific degree and I don’t think, if I’m honest, that I thought too much about what followed after that. It was very clear to me when I went into medicine that I had, you know, an entrepreneurial drive that just wasn’t being satisfied In medicine. I couldn’t see it being satisfied. So I did take steps early. I mean, I built a company while I was still studying and I really enjoyed it. So for me, I think the evolutionary part of it was the acceptance. And it’s a big, it’s a big commitment to go into any healthcare degree and then, you know, extricate yourself from it. There’s a lot of disappointment from from family members and from friends that you have to consider and be on the wrong end of that no, I don’t think.
Sonia:
I don’t think I was. I think my parents understood that it just wasn’t right for me. But I will say that for me, I don’t regret a single second in medicine. I think it taught me a huge amount and it allowed me to do what we’re doing today as a team. I mean, our team is very clinical and that’s why I think that core desire to provide really rigorous ethical care is at the heart of what we do.
Sonia:
So I couldn’t do that if I had not gone through that process of working in the NHS, feeling what it’s actually like to have patients in front of you, being worried about risk and litigation and messing up. Basically, I don’t think you can teach that. So it was an absolutely necessary um step in my career, as was everything else, and I don’t regret a second of it. Um. But I think if people are thinking about alternative careers which is, I think, what you’re alluding to I don’t think there’s a right way to do it. Um, I think the advice would be to do something. Don’t do nothing, do something, uh, whatever that is, it’s not going to come find you.
Dr. James:
Yeah, you know, and here’s the way I look at it. We’re going to jump straight back to profitable, profitable aligners in just a minute. But I just wanted to touch upon this because this is something that’s close to me as well and there’s so many dentists reach out to me and they say James, I want to change, but I’m doing six days a week in dentistry and I’m like listen, you’ve got 168 hours in the week. If you’re spending 167 of those hours doing dentistry, right, that leaves one hour left over to eat, sleep, drink, see your family and also find your passion in life. So you’re kind of up against it a little bit. So I think the very first step is to accept that you’re not going to see the remuneration in your pocket from your side gig or your passion immediately. In fact, if anything, you’re going to take a hit, but you have to generate the time from somewhere and just go and do something.
Sonia:
Yeah.
Dr. James:
You know, there’s a beauty in action and just seeing where things fall into place.
Sonia:
Yeah, completely agree. It, yeah, completely agree.
Dr. James:
It’s really easy to think in highly technical terms and looking for specific outcomes and guarantees. The only thing that’s a guarantee is if you don’t change anything, then it will continue. And you know what? If dentistry is your passion and your calling and all of those things, that’s fine. But if you feel like you’ve got more, you have to take positive action towards making that happen. And how that looks is you take some time out, you do less dentistry because you cannot generate more time.
Sonia:
You have to proactively make the space in your life and how can you?
Sonia:
be too busy for that. Yeah, yeah, anyway, I think it’s. I think it’s good advice, but I will maybe I’ll say something controversial, which is that I don’t always think the grass is greener, and I speak to a lot of clinicians of all flavors. You know, we we have a lot of dentists who work with us and who apply for jobs to work with us, and they have frustrations.
Sonia:
Um, I have um doctors who contact me all the time saying how did you get out and what did you do, and I and I do sometimes say to them look, the grass isn’t always greener. When I left to go into consulting, I was working much harder than I was as a doctor and it really took a moment to say um turns out that doctoring wasn’t the problem here. There were great things about being a medic, and I know people who actually went back from consulting into doctoring and thoroughly enjoyed it for the new wisdom that they’d acquired about what it’s like in the outside world. So I think don’t be too hasty in um in leaving if you haven’t explored also how you can make what you’re currently doing more enjoyable for yourself yeah, 100.
Dr. James:
Yeah, no guarantees either way. And I suppose if you’ve got an itch, just scratch it. Yeah, I suppose that’s the best way of putting it in a nutshell, isn’t it? And you know what? It’s the things that you’ll find out along the way that are the beautiful part. And even if you go back to dentistry and think, actually, I have a whole new appreciation, how for this now? Because it isn’t so bad after all, because that other stuff was something I really didn’t like, at least you’ve learned that lesson. It puts the wind in your sails. Yeah, anywho, let’s talk about profitable aligners. So what are the things that you see most often in dental practices about regarding aligners and them not being executed as profitably as you could be? If you could just go in, wave your magic wand into dental practices and say change this, this, this and this, what would those things be?
Sonia:
Yeah, I think the first thing is people not providing clear aligners.
Dr. James:
And I’m not being facetious.
Sonia:
I think if you look at the numbers, there are people who have made clear aligners a really profitable and big part of their practice, but there are far more people who haven’t touched it and there are various reasons for that, related to confidence and related to the perceived demand in the area. But I think all of that can be overcome. There is plenty of patient demand. I mean, the market has grown 20% every year for the last five years and there are people who are profiting from that and it’s not always the dentists. So the first step for us is to sort of acknowledge that clear aligners are a part of the future of dentistry, whether you like it or not, and you don’t have to be an expert in orthodontics to get started at all. It’s just about recognizing that now, when people think about dentistry, they are not thinking about necessarily their NHS treatment and getting their fillings done, certainly not the younger population. They’re thinking about how do I get an amazing smile? And whether you agree with that’s correct or not, that is what’s happening. And so if you are a practice offering clear aligners and really making it a part of your cell, you will attract patients in. So it’s a lead generation tool If you then get people in the chair and you find out that actually clear aligners are not the right answer for them. Maybe they just wanted a bit of whitening Actually, maybe they needed some fillings. They haven’t been to the dentist in years. You’ve brought that patient into your practice, so you don’t have to become a master in orthodontics to start offering clear aligners and see the benefits from a lead generation perspective. The second benefit of having it even in your portfolio of skills is that it’s an upselling tool as well. So patients come in saying I want straight teeth. It’s a completely natural segue into whitening and intercomposite bonding and actually into a potentially lifelong relationship with that patient, because they are going to be with you and seeing you for months and months and it’s rare in other areas of dentistry that you would get that. So, in terms of profitability, if you’re thinking from a practice perspective, every associate in your practice should be able to offer clear aligners and do it safely. And that’s what 32Co is about is doing it safely, doing it properly and doing it profitably. But if you’re not, you are going to be missing out in the next five to ten years. It’s not about shallow Ashanta. You don’t, unfortunately, have a choice to start doing this sort of treatment. Now, once you are doing it, the way to make it profitable is essentially to become an expert in the workflow, but also to get your pricing right the workflow, but also to get your pricing right. So you know, I talk a lot about the evolution of the clear aligner market because I think it’s important for people to understand where the clear aligner industry came from, how we have got to where it is today and therefore how pricing and patient demand is impacted by that.
Sonia:
So, as you probably know, invisalign was invented in Stanford in 1997. I actually spoke to the founder of Invisalign, zia Chisti, the other week. Fascinating guy, an entrepreneur in its truest sense. He was literally in a garage in Stanford and designed this device that he thought could move teeth. He did not come from a dental background. He built something that really worked and worked and fought tooth and nail for it to be accepted by the dental and orthodontic community as a device that actually worked and struggled to get investment. And the first VC that invested in Mizline took a healthy chunk. And that’s how the VC world works and it’s in many ways a real example of a success story in venture capital because they went public in 2001. And then, obviously, were built into a business that was very profitable for its shareholders thereafter.
Sonia:
But we’re now in 2017. All the patents have expired. A lot of patents have expired, and it’s meant the whole market has opened up. So the monopoly is over, the party is over. Anyone can now use that technology to make a 3D printed aligner using the same 3D printers, using the same plastics, using the same treatment planning technicians in the two big hubs, costa Rica and Pakistan, where all the clear aligner industries were sort of born, and that has created a commodity environment, right. So when things go off patent traditionally or what should happen is that there’s a bit of turbulence in the market. New players come in, you get competition, you get price reduction and you get a fight for an improved quality of service. That’s what should happen in an efficient market.
Sonia:
But what dentists are seeing now is that, despite the commoditization of the aligner, the fact that anyone can make it, they haven’t seen their lab bills go down. In fact, the trend has been upwards on the lab bill side, bill side, and so the question, the question is, how is? How is that happening? Why is that happening and why can dentists? Why are dentists not benefiting from what should be a healthy amount of competition in the manufacturer space, and how can we help dentists actually get on top of that and and take advantage of um of a kind of a healthy price reduction in the manufacturer side?
Sonia:
So to make your clear aligners more profitable, you need to find a way to pay less for your lab bills, and that means not being tied into one particular brand. That means having choice, and that means making some decisions about which brand you want to work with, so that they’re looking for your business, as opposed to you being beholden to one brand. One of the things that we do is that it’s to try and put the dentist at the centre of the decision-making process, and not one or other brands, because we know that they’re essentially all the same materials. The second thing that you can do is to think about your clear aligner workflow, and this is something we spend a lot of time working on.
Dr. James:
Can I just jump in here for two seconds. When it comes to workflow, this is a stat that flipping blew my mind. Okay, I came across someone recently. He’s a dentist. Okay, does invisalign, only invisalign, right? His gross is 1.5 million. That is his gross as a dentist. That is insane and it’s because every single aspect of the workflow that doesn’t have to be him. He has thought about it down to a T and he has delegated. He earns a lot, but he works for it. This guy sees a hundred patients a day and he works 12 hours a day, but he loves it. That’s where he’d rather spend his time. He’s totally happy to do that. So I just wanted to throw that out there before we jumped into workflow, to show everybody what was possible, because if you would have asked me before I met this guy, I would have said that was not possible. Yes, but yes. Back to workflow.
Sonia:
Yeah, I mean, this is what happens when you have high value items or high value treatments that you’re doing regularly and more regularly and remember it’s a virtuous cycle you start doing a couple of aligner cases here and there. You then get patients telling their friends because they’re a walking advertisement for the six months to a year that they’re wearing these things. Oh, where did you get them? I went to see dr james. He’s awesome. You should go and see him. You know these. These numbers rack up it’s three thousand pounds here, four thousand pounds there. But if you’re spending you know 10 hours of chair time on that patient, then suddenly it’s not looking as attractive. So how do you figure out how to have an, create an efficient workflow? And for us that’s about firstly making sure that you get the treatment plan right. So a lot of the problems that we certainly see is dentists who complain about just endless refinements. So when you’re doing your treatment plan, the sort of simulation comes back. It sort of looks okay, you’re not really sure, Technician’s sort of done it, and you press go and you get your you know 14 aligners and then you get to the end of treatment and you’re nowhere near what you want it to be and your patient’s unhappy and you’re going for refinement. And then you’re going for refinement and it just kills your profitability because you’re using so much chair time to deal with that patient. So for us the most important thing is get your treatment plan right from the beginning. Really think about how those teeth are going to move, what is realistic, what isn’t Consent your patient for that? And that’s why we have orthodontists working with the dentist to say look, I’ve done thousands of these cases that isn’t going to move like that. Let’s move that tooth like this. Consent your patient, this isn’t going to happen. And you’ve got yourself a treatment plan that’s predictable and is actually going to work, so that you don’t have the unexpected chair time that comes later down the line. So that’s actually a huge part of it.
Sonia:
Now, when you get over that hurdle, then you can start to think about do I need a TCO?
Sonia:
Do I need someone in the practice who’s going to be doing that first kind of consultation to get the patient excited to save my chair time? It works incredibly well. So we have a sort of part of the team that just focuses on supporting our dentists on their practice growth and really looking at those things that make an enormous difference, even though they’re very small things to implement, and we’ve seen huge success from basic things like well, why don’t you, why are you doing sort of NHS work mixed with private, just bits and bobs here and there. You’re sort of switching context, switching constantly. Why not just have a dedicated block or a full day where all you’re doing is this sort of treatment? You can increase your efficiency enormously by doing it that way. So these are some of the sort of tips and tricks, but in the main, I would say you know, get your lab bills low and get your treatment plan right, and then you will actually see an enormous increase in your profitability.
Dr. James:
Let’s talk about what we’ve done is. We’ve talked about the actual chair a lot and what the dentist does. Let’s zoom out. Let’s talk about front of house. How can front of house contribute towards making big pardon, clearer liners in general more affordable and not sorry? Well, affordable is part of the equation, I suppose, but profitable is what we’re here to talk about. Yeah, really, how can they contribute?
Sonia:
so front of house are a really important part of of the patient’s journey from the minute they walk in. So you know, michelle, who, who runs our practice growth. It’s like she has. She has this story that she always tells when she walks into a new practice. She’s like if I’m going to spend several thousand pounds on my teeth, I want to walk into a practice that looks clean, smells nice, is tidy and where I’m greeted by someone who’s smiling at me and who’s actually interested in seeing me today, not with the head bow behind a computer. They may seem like trivial things, but, um, they can really make a big difference. So she talks about keeping the windows clean. She talks about what does the hand, the handle on the door feel like? Is it clean? Because why would you spend four grand on a treatment in somewhere that looks untidy and unprofessional? So that’s one thing that front of house can do smile and keep everything nice and tidy which sounds super obvious, but it’s still under done.
Dr. James:
It’s understated its importance, right. So at the minute I’m reading how to win friends and influence people I should have read that book so long ago, by the way. I feel like I would have learned more from it being younger, but there’s still the odd gem in there and things that made you make you tweak what you do going forwards, and there’s a whole chapter in that book called how someone’s name is like the best thing you know, you know the most beautiful thing, the most beautiful sign to their ears, right? So why don’t we use our patients names when they’re in the practice? It works and it sounds so obvious, but we still don’t do it. Yeah, so these are the things that we’re here to talk about and, like I say that what you just said, it you can never do it too much, you know, and that’s why, even though, yes, nothing, yeah, and it’s free and it’s free. So, yeah, whilst it’s, yeah, of course, it’s an important thing to do and every you know there might be some people think listening to this and thinking, oh well, obviously.
Sonia:
However, yeah, we still don’t do it enough yeah, and I think it’s easy when you you know you can go on a course and you can read a book and they can say we’ll just get a tco and get a, get a crm that can fire out. You know emails in a sequence and that that might be all right for some practice but for for others, that’s maybe not the first step that you take. Maybe just start with the things that are easy to do, which is train your team to smile at patients, to talk to them. You know, we now offer whitening, we now offer clear aligners. You know, if you’re interested, book in with Dr James. He’s got slots in his diary. Make sure you’ve got posters lying around that they can pick up and peruse while they’re waiting in the waiting room. These are things that we help with and they’re simple things to do but potentially impactful, especially when you’re just starting out providing this treatment.
Dr. James:
You know what as well. If because we always have to be truthful, of course if anybody at your front desk has a story, a genuine story, about how someone they knew went to see dr smith, dr james, dr whoever, and had a really positive treatment outcome, why aren’t we sharing those with the patients when they come to the front desk Saying things like oh, you’ll love Dr James, he did Invisalign to my aunt, the results are stunning, they look beautiful. Just sharing that sort of stuff that makes a huge difference. That primes the patient. The patient’s ready to go because there’s rapport built before you’ve even set foot in the room and there’s nothing more powerful than a referral effectively, which is what that is. Yeah, you know, we don’t think about referrals in that sense, but effectively, what the receptionist has, he or she has just done is referred that patient into the room.
Sonia:
Yeah, by a word of mouth yeah, and the same with the with your nursing team as well. You know the conversations that you were describing those three questions. It doesn’t have to be the dentist, you know the nurse can have a chatty conversation with the patient and talk about oh, is there anything you want to do? Are you going on holiday? That’s nice. You’re getting married? It’s just rapport building. That, I think, is especially in a busy NHS practice. It’s understandable that it doesn’t come naturally, but it’s something that people are going to have to work towards to make a practice profitable 100%.
Dr. James:
I’m going to chuck something in there as well. That somebody taught me a while ago and it just popped into my head just when you were talking, and this is how to generate conversations along the lines of more cosmetic treatments, or certainly not the functional ones, which your gdp would traditionally do. Three questions, every single new patient exam. These are the three questions that you say. You say hello, mrs smith, feel free, have a seat. All the regular things that you might say to a patient when it comes to the patient being in the chair, just before you look in their mouth. First, question any issues with your teeth. Second, question anything you dislike about your teeth.
Dr. James:
Very careful with the language there. Okay, if you say hate, all right, it’s a negative word. Say like the word like is in there. They hear the word like, but actually you’re saying the opposite of like. It keeps it all positive. It’s crazy. Honestly, this is sales language, so to speak. So it’s a very refined process and actually not to go off too much on a tangent, but when you’re talking to patients, if you constantly use positive language, even if you’re saying the opposite, like, you don’t like that, right. As soon as people hear the word hate and things like that. It turns them off from the sales process. It’s massive, right, huge difference Anyway. So your three questions and even issues in itself. You know any issues or any pain or any problems? That’s such a negative word, are you with me?
Dr. James:
So, if you say any issues, what’s an issue? It could be a magazine, are you with?
Sonia:
me.
Dr. James:
You know, and this stuff really works. So, first one, any issues with your teeth, anything that you dislike about your teeth, anything that you’d like to change about your teeth See how many leads that generates for more cosmetic treatment. I just want to throw that out there to the either for anybody who’s listening. I believe I got that from a course a while ago and as soon as you do that, the number of queries that that generates for other treatment, only so you can serve someone. If you want to decline the treatment, that’s entirely up to you. But how do you know what someone is thinking until you basically put it on a platter for them to them to articulate their thoughts. And you wouldn’t believe the number of times people say no to the first day, then the third one, they’re like oh well, now that you mention it, how about this?
Sonia:
yeah, interesting, it’s completely on topic. I don’t think it’s going off topic at all. We we you know a lot of the dentists who come to us actually have never done clear aligners before, and it’s one of the big questions they have is how do I even start talking about this? It’s not so much about the mechanics of the orthodontics that is my first problem I just want to know how to discuss this treatment. I’m not experienced, so we obviously, as I mentioned, we run free training for anyone starting out on our starter course. We’ve got them running now.
Dr. James:
It’s a month-long training and one of the entire weeks is to do with how do you communicate with patients and how do you get them excited so, obviously, everything that we’re talking about today, let’s make it hyper contemporaneous and talk about direct to consumer clear aligners, the, the dark arts, the naughty stuff in dentistry. How do we overcome that as clinicians? Because you guys see this all the time and you, you know. Here’s the thing, right? You know, when patients think the only metric is price, they’ll think to themselves well, actually I’m getting the same thing for a third the price. So, again to go back to sales, we’ve got to build value, we’ve got to get them to understand why it’s safer, better in the long term and more predictable to go to the dentist. How do we work that in as part of our message?
Sonia:
Yeah, I think you’ve almost answered the question yourself there and firstly, having the conversation with the patient to say look, what are you unhappy with, before they’re tempted to go to a sort of DIY, unsupervised dentistry model. Because I agree with you, it’s not in the patient’s best interest to do teeth straightening without having a checkup, without having radiographs, without having a dentist they can ever actually meet or speak to, let alone the fact that when something goes wrong, what are you going to do? Who are you going to sue? Who are you going to go to? It just doesn’t. The model is the model I think is broken from both the patient’s perspective and actually also from an economic perspective. So again, to give you a bit of the history of Smart Direct Club and where it came from, it was again founded off the back of the patents expiring, so they were allowed to use the same technology as Invisalign had invented all those years ago and they came out with a model that was extremely innovative in a way, but nobody thought was going to work. How could you do dentistry from home? But through enormous marketing efforts and also with actually the help of Invisalign, who took an almost 20% stake in Smart Direct Club and were their manufacturer from the beginning. They’re not anymore because there was a big legal falling out, but they helped them get to the point where they were treating and marketing this as a completely safe thing to do from home. And, to be honest, the dental community was a bit slow to catch up and to sort of say what, what is even happening here, um, to try and to try and combat that. So, um, when your patients are coming to you and saying, look, I saw this advert on the TV and now there are lots of sort of copycat versions of it, but it’s the same model when they’re coming to you and saying, well, look, it says on the TV, I can get my teeth straightened from home. You know what’s wrong with that?
Sonia:
I think the first thing is to explain to them that in order for you to move teeth safely, you need to have your mouth needs to be stable as, as it were. You need to have a complete checkup to make sure the roots are healthy, you don’t have any caries. You need to have a clean. It all needs to be in ship shape condition for those teeth to move. You also need to have radiographs. You need to check for pathology. You need to check for the roots to make sure that you can actually move them safely, and none of that happens with these direct-to-consumer brands. So that’s the first thing to educate your patients on.
Sonia:
Second thing to educate them on is who’s designing your treatment? You’ve never met them. How are they supposed to know what you want? Two patients with the same mouth may want completely different things for themselves, right? They may have completely different priorities and there is no one-size-fits-all in orthodontics. So who’s’s designing a treatment? When you’re doing it professionally with a dentist, with me, um, well, with you, in this case you. I am going to work with you on that and with you know 32 co. There’s actually also going to be an orthodontist involved in the picture and we’re going to together come up with a plan to make sure that that outcome is going to be bang on for you. When you’re doing it with a direct consumer brand, I don’t know who’s making that plan. You’re never going to meet them. They’re never going to know. It’s just sort of one. You know a one size fits all answer.
Sonia:
And then the third thing and this is probably the thing that is most problematic for patients is when something goes wrong, when teeth don’t track, when you’re not happy with the result, where are you going to go? There have been so many records of complaints at these direct consumer companies. But because patients sign a non-disclosure agreement, very often when they sign up to treatment they can’t complain publicly about what the problem is. So they’re scrambling to get hold of support and you have to go into some of the forums to see how problematic it is and you feel very sorry for patients. You know it’s a really unpleasant situation to be in.
Sonia:
You’ve actually paid two, two and a half grand for this treatment. It’s not worked and you don’t know who to go to. And in the worst cases you know you were saying you lose that patient if they go elsewhere, if they go to a diy brand. Sometimes they come back to you with horrible issues with with their occlusion, because who knows who’s designed that treatment plan and then it’s up to you to try and fix it. Um, so, so that is probably. Those are probably the things to explain to your patient that there is a big difference between professional teeth straightening, doing it properly and doing it sort of at home. And I think most people care enough about their teeth that when those two things are weighed up next to each other. They think actually it’s probably worth doing it properly.
Dr. James:
Do you know what’s extra super cheeky and I’m sure that you’re really familiar, I’m sure that you’re aware, familiar with this as well when they send, when they send instructions to the dentist to make extractions on their behalf, with this as well, when they send, when they send instructions to the dentist to make extractions on their behalf, absolutely mad so if you look at the, if you read the consent forms for some of them, you will see that the consent that the patient signs is contingent on them confirming that they’ve been to their own dentist to get a dental checkup and that they’ve checked that the x-rays are fine.
Sonia:
Now what patient is able to check? Their own, you know pas or their opgs? You know who’s supposed to do that. So what they’re basically saying is your dentist should confirm that you don’t leave it so that they can go and have treatment elsewhere, which is crazy you provide in your practice boom, there we have it, and 32 co do things a little differently from the bigger aligners out there, I believe yeah.
Sonia:
So I think 32 co are. We’re not an aligner manufacturer. You know we sit on top of that layer. We are a platform that does three things. We provide all the training that you need for free, no matter what level you are, so the training is tailored to you. If you’re a complete beginner, you will get beginner training. If you’re very experienced, the training will be tailored to you. It’s delivered into your 32 co portal, which is an online portal which, again, is free to sign up to.
Sonia:
We provide, uh, you with an orthodontist, a specialist orthodontist, one-to-one to provide case guidance so that you get the best treatment outcomes every time you do a clear aligner case. And obviously that’s reassuring if you’re a complete novice, because you know that you’ve got an orthodontist there and we’ve got probably some of the top orthodontists in the country working with you and people that you would all recognize and people who have taught you in dental school, who are going to be on the other side of the treatment plan for you and talking, basically mentoring you through it. And then the third thing is we provide you with access to essentially a marketplace of the top manufacturers with all the same top materials, with choice on how you want your line of finish so that you have choice, but also so that you can get access to the best prices every time. And there’s no no one size fits all. You know we we don’t. In some ways we don’t have a dog in that fight. You know, our objective is to have a fair marketplace with a curated set of the best manufacturers, and then it’s up to you.
Sonia:
What you pick Doesn’t really bother us. And you know a lot of people ask us well, hold on, how are you guys making money? I think it’s a totally fair question. Your listeners are financially savvy. So the way that 32K make money is that we just take a service fee from every clear aligner case and, importantly, we take that on the manufacturer side. So again, we came back to this. At the beginning. We talked about the commoditization of clear aligners and the fact that there should be more competition and that the competition should help drive prices down for dentists and that they should benefit from that. That is literally what we’re doing and that’s what we’ve created.
Dr. James:
How would those implant shops work then?
Sonia:
I’m sort of I’m.
Sonia:
I have no idea that’s on their roadmap, but I’m thinking you know, if you read between the lines, when a ceo of a big company like that says we want to get closer to patients, uh, and they’ve already acquired shops that operate on the high street that do just clear lines, is it really the biggest leap of faith to assume that maybe they’re thinking about doing something with the implants? I am not for a second suggesting that, um, that they have or that it’s already on the table, but if this is the way corporate behavior is going, it’s just something to bear in mind. Imagine you’re, you know, a 24 year old grad and you’re emerging out and you know you kind of had a shit time during your degree because covid ruined a lot of it. And now you’re out there and you’re feeling pretty vulnerable because cost of living crisis, recession, hard to get your first job, um, the nhs is in turmoil, hard to get the support that you need really to get going.
Sonia:
And then also, we’re looking at these pressures coming from all sides like this is why we built the company. This is why we said, like, let’s focus on the clinician. We are about trying to empower you guys, or us as a clinical community, to say you can, you should be the center of dental care. It shouldn’t be the fact that corporates sweep in and take all of the work or that you disintermediate the dentist altogether with a DIY concept. If you upskill clinicians, you give them confidence and you give them access to well-priced devices, they can make decent money and they don’t have to worry too much about that. But if you stay standing still and you stay where you are and you’re sort of a bit unhappy and a bit miserable and doing bits of private here and there, you’re not going to survive cool.
Dr. James:
Thank you so much for those insight and tips. You know what? Let’s make it powerful, punchy and impactful for the people who may have just tuned in this very moment to this podcast. What would you say?
Sonia:
your top three are top three tips to make your practice profitable with clear aligners. Yeah, as I said, number one start offering them and make sure everyone in your practice can offer them safely and effectively. Make sure that you’re getting your lab bills at a fair price and make sure that you are making clear aligners also part of your day-to-day marketing of your practice, because it’s not just about providing the treatment itself.
Dr. James:
It’s about generating leads for all the other types of treatments that you provide in your practice well, knowledge is power really, and it’s actually got a parallel there with the reason that I started dentistry invest because if you can invest yourself and you understand how to do it, in a diy sense you, the individual, participate by investing your own money then what it means is you don’t pay somebody else to invest it in your behalf and hence give them the percentage. Typically, your ifa fee is about one to three percent in the uk, which doesn’t sound like much. Everybody’s happy to hand that over, but it’s not so much what you pay the ifa versus the gains that you lose out on yeah as your portfolio grows through time because, remember, it doesn’t grow linearly, it grows exponentially.
Dr. James:
So 1% to 2% over 20 years affects your portfolio by reducing it by one third. That’s a huge amount of money. That is a massive amount of money. Let’s put that into real terms. If you would have got $2 million after 20 years of investing let’s say that you can achieve that through investing consistently in an ISA. However you want to do it, let’s just pull that number out of the air Then at the end of that two years, you would actually only in fact, have $1.2 million. So what’s your IFA bill? $800k, roughly, yeah, which is a huge amount. $700k, $800k, something like that. One third. That’s a huge amount of money to be given to someone else. But the thing about that is that actually pushes your retirement further down the line. But the problem is most people get there and they think it’s not the 2 million they could have had, it’s the 1.2 million they do have and they’re like, oh, that looks great, fantastic. But there’s no appreciation for how much that could have been. Yeah, if. For how much that could have been. Yeah, if they would have done it in a diy sense, done it themselves. But of course, the knowledge comes in at that point. Having said that, when you do really know what you’re doing, you can write it on the back of a postcard how to appreciate your capital in the markets, how you realize that, as in how you withdraw it for the mark from the markets. There’s a little bit more to it, but I’m just throwing that out there, and one thing which I’m going to touch upon just before we part ways today to everybody who’s listening we are going to.
Dr. James:
Obviously, everything we talked about today was how to generate more money in your practice, and here’s a really powerful model for looking at wealth creation. Actually, there’s only really two ways, in essence, that you can ever become rich. Number one is build wealth. Number two is create wealth. So when people come to me and they say, hey, james, what I’d ideally like to do is have more money tomorrow and become more wealthy, how do I invest to do that? I’m like no, no, no, no. That actually fits in more in the build wealth aspect proportion, or put yep, well, the half of wealth that we were just talking about then. Because how build wealth looks is you invest your money and then it grows up and up and up over time, but typically that takes decades, particularly when you’re investing using the methods that fa is using the market, which there is a lot of power in. Understanding how those work yourself, you’ll certainly expedite your journey to become wealthy, but it’s still in the time frame of decades.
Dr. James:
So if you don’t like what you do and you don’t like being a dentist, understand that that’s what would be necessary to do. You’d have to work in that job for quite a while in order to achieve wealth. So what we’ve just talked about today is the other side of the sphere of the two things that we just talked about just then, which is create wealth. What are literally the things that are gonna put more money in your hands tomorrow? And there’s actually four things when we’re talking about dentists.
Dr. James:
Number one, which is we touched a little bit upon today, is sales. The better you are at sales, the more money you can generate in a smaller amount of time. But you’ve got to do it ethically. All we’re talking about is charging appropriately, charging appropriately for a value. Most dentists value is up high, but what they charge is actually not the same. It’s not at that level. It has to be pushed up higher. That’s sales If someone is really good at something and they’re really passionate about something they don’t need to sell. If someone wants to tell me about the tastiest pizza they’ve ever had, my mouth would be watering. They probably just sold that pizza to me, but they weren’t even trying to sell you with me. Yeah, but how does someone know how good that pizza is unless you tell them?
Dr. James:
yeah that’s what we’re getting at. Sales is number one. Business we touched upon that today with workflows and also how to implement aligners into your practice. Business is number two. The other one is spending reviewing, which is to say, just have one eye on the money that’s going out, because if you make a million in a day, you can spend a million in a day if you’re not careful, if you really put your mind to it. Yeah, so we’ve got those three.
Dr. James:
And then number four is accountancy. So if you have an understanding of accountancy and you’re a private dentist, you’re yet to invest in a living company, circumstances permitting, because there’s a few caveats to this and I should be careful then there is a massive tax saving. That is there likely. So, yeah, that is all I wanted to say, just to round things up. Today, sonia, you’ve been super generous with your time. Everything that we’ve said today fits into the create wealth portion, which of course, ties in with Dentist who Invest, which is the point of the platform. Sonia, you’ve been super generous with your time. Thank you so much. We hope to see you on Dentist who Invest sometime soon.
Dr. James:
Again, podcast. Please hit follow or subscribe so you can stay up to date with information on new podcasts which are released weekly. Please also feel free to leave a positive review so others can learn about this podcast and benefit from it. I would also encourage any fans of the podcast to sign up to the free facebook community from which the podcast originated. Please search dentists who invest on facebook and hit join to become part of a community of thousands of other dentists interested in improving their finances, well-being and investing knowledge. Looking forward to seeing you on there.