Payman takes a trip across the pond this week to chat with UK-born Upen Patel, who practices in Sacramento, California.
They explore the differences between UK and US healthcare, education and culture, and Upen chats about his experiences at some of the US’ top training academies.
Payman and Upen also talk about the challenges of funding dental school, Upen’s love of squash, and much more.
In This Episode
01.24 – Moving to the US
05.58 – UK Vs US schooling
08.39 – Funds and finance
17.59 – Next steps
21.23 – US associates
24.38 – Coping with COVID
28.42 – Safety nets
31.34 – Practice purchase
33.12 – Specialisms
36.33 – The team and US models
44.08 – Postgraduate training
56.01 – Fees, pricing and positioning
01.05.43 – Black box thinking
01.19.19 – Missing the UK
01.21.33 – Squash
01.23.41 – Fantasy dinner party
01.24.27 – Last days and legacy
About Upen Patel
Upen gained his DDS from the University of the Pacific School of Dentistry in San Francisco, US, in 2005.
As one of the course’s youngest ever graduates, Upen earned the Outstanding Achievement Award from the university’s Academy of Restorative Dentistry.
Depen then completed a residency in advanced education in general dentistry at PACIFIC University, where he graduated as valedictorian with the highest honour in his class. He is now a member of the university’s faculty.
He is a member of the Academy of General Dentistry and a fellow of the International Congress of Oral Implantologists.
[00:00:00] Yeah. I mean, I’d say more competition, but to be honest, I’ve never been worried about competition. I think there’s enough patience for everyone. It’s just what kind of patient you want to treat and also personality wise, who get along with as many patients I wouldn’t get along with. And that’s fine. They don’t see me, but there’s a certain demographic I really get along with and I know what my niche niches. But yes, I would say I would say fair market value around average for the whole country at the highest percentile, let’s call 1800 for a crown.
[00:00:32] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts Payman, Langroudi and Prav Solanki.
[00:00:49] It gives me great pleasure to welcome Dr. Patel onto the podcast opens. Dentists who qualified in the US but grew up in the UK a bit different to what some people want to do than where they qualify in the UK and then want to move over to the US. And actually did his A-levels in the UK and then and then moved and then started his undergrad training in in the US in Europe, in San Francisco.
[00:01:16] That’s correct. A specific San Francisco.
[00:01:19] Yeah. Lovely to have you with.
[00:01:22] Pleasure’s mine.
[00:01:24] So open. You know, the reason I wanted to do this podcast was to get for people kind of a contrast on the American system compared to the UK system. I know you’ve never worked in the UK system, but just, you know, your your answers to questions will enlighten people. But just tell me about the move itself. What what happened that made you move?
[00:01:46] Absolutely. So back in 1997, I just finished my GCSEs and every year my mom’s side of the family live in California. Every year we would go for summer holidays to the US. And, you know, I thought nothing of it. I was just I’m just visiting my cousins and but you know, they were probably always talking about my uncles or my mom. You know, you should move out here and move out here when when you’re ready. And then eventually they got a green card and they decided to wait till I finished. I was secondary school in England, so I finished A-levels. I did the usual stuff, you know, it was a pure maths, mechanics, physics, chemistry, biology, all the usual stuff. Back then I didn’t know anything. I was so young. Knowing now the difference between the UK and the US, I had no idea what I wanted to do and when I was 18 I just thought, Oh, I’m supposed to be a doctor or a pharmacist or something. So I just took those subjects and then I applied to pharmacy schools in England at King’s College. Queen Mary Westfield, I think was called in and some random place. I think it was Bristol. I don’t remember anymore. I just knew I wanted to live in London and that was that. And then my mum was like, You know, we’re going to move to America. I’m like, Oh, okay, so how do I do that? Suppose you have to take SATs, you go do these exams. I’m like, I just finished all this stuff. I don’t want to do any more. And then then I basically went through the American application process to become a pharmacist in America. I did all that and I got in.
[00:03:10] Here. Yeah, yeah. You just it just like UCAS form kind of stuff. But they have America similar things. So I did all that and then to basically I got into the universities in England, but I had to decide. So then basically I went, I came to America and when I, when I landed in America, I thought I was going to be a pharmacist. Day one is different here. You do for you as undergrad, pre pharmacy, pre dental or and then you go to professional school. So that was the best thing that ever happened because when I came here, apart from the cost of education is completely different. And that was a big shock to I did not understand that, which is fine. I mean, there’s a difference in the way things are done in the education system versus us versus England. But yeah, I came to school, I mean college, and they’re like, Yeah, you’re taking chemistry in biology. I’m like, I did all this, but what? What do you mean? So I first two years, I was so easy in college, I had a good time. I literally took A-levels again. And then you take organic chemistry, physiology, all this stuff. So you can take all the prerequisites to to go to pre-med pre pre farm. So what happened was I was taking all these classes. I was like top of the class. It was like everyone was like, Oh, the British student, you know, can you, can you talk like the way you talk and all this kind of stuff, you know? And it was easy to make friends and it was easy. It’s like but it was just I wasn’t used to the culture either. I missed all the sports in England. I missed just the places I used to hang out. And it was a big culture shock coming here because I wasn’t in New York City. I was in a small town in California for the university. So it was very hot too, like 110 degrees and all the time.
[00:04:51] Where did you go? Where did you go for the pre-med bit?
[00:04:54] So I went to Europe, also University Pacific, but they undergrad in Stockton. So it’s it’s inland from San Francisco about 2 hours, like not 120 miles. And so I thought I was going to be in like a New York kind of thing and all that kind of stuff. No, but it was a good thing because I studied I didn’t wasn’t distracted. I made lifelong friends. They still my friends. But what happened was all my friends were present and I was like, wait a minute, I’m getting better grades at the same grades as you guys, you know, nothing against pharmacy. But I just by the time I did some, what they call it, work experience and pharmacy dental stuff, I had time to do it. And also I think I had become a dentist. You know, all my friends are doing it. And plus, the dental school was in San Francisco. It wasn’t in Stockton. So I was like, I want to live in a big city. I want to become a dentist. And that’s how it happened. It was just stumbled upon it because my friends. They are doing it and none of my friends are preform. And I was like, I don’t want to be stuck here and get bored, you know? So that’s how it happened. And then if I stayed in London, I would have probably been a pharmacist, but maybe I would have changed mid-career. I mean, undergrad or university? I don’t know.
[00:05:58] You must have had buddies who did A-levels with you and then went to university here. What’s your impression of the difference between uni here and college there?
[00:06:09] So, you know, I don’t know if you went to a private school in England or public sight. My whole I was always in the private school, you know. So coming here was a big difference to always all boys, you know, in England, here, suddenly I’m in college. Oh, this is great. You know, everyone is like there’s a lot more girls.
[00:06:27] Did you go berserk?
[00:06:28] Well, it was it was fun. You know, I didn’t have to I didn’t have to worry about work so much. I mean I mean, studying so much because I kind of was repetition the first year or two, but then it got hard. But so British, I think three years, right? I think it’s three years and then you’re done and then you pretty much off in the workforce. I found that some of them, they went to Oxford, Cambridge, some of them went to UCL Kings. I found I found that they had a good time but it was over in a flash and of them had a hard time with that adapting straight away and then just being a professional and that’s it. You’re like here. I mean, technically you can be in college like eight years, nine years. And if you really do like undergrad masters, professional, you know, I mean, it’s just the cost of this stuff. You know, I did it a little bit different. You can go as fast as you want. So I finished undergrad in three years, you know, because I had all those UK classes, so I got credit for it and then I finished dental school in three years.
[00:07:20] Normally dental school’s for, but I went to Europe which has there’s no summer vacation. So I just kept going and that gave me an extra year. I did a residency like an advanced education, dental dentistry. So I was done in six years. I was done as a dentist, maybe similar to a UK dentist around 23, 24. So I had had a lot of time to process everything, but I had no guidance. None of my family members are doctors or dentists, so that was the first one. So in hindsight, if I could go back 20 years, it’s so much more I would have paid attention to and done, but I’ve done my own path and I’m happy with it. But I think I think UK again, I don’t know too much about what training is involved and an undergrad in dental school, but I find that we had all multiple choice in all our examinations. Any examination for anything is always multiple choice. I think UK is more essay based. From what I understood from when I was in A-levels, it was handwritten answers and maybe that’s the same way in professional school. I don’t know.
[00:08:19] We had some multiple choice, but the multiple choice was negative marking. Did you have that where if you get it wrong, you get a minus one?
[00:08:27] No, no, it’s just.
[00:08:29] It’s just multiple choice. It was like I’m not sure if they still do it, but there was a question of do I even answer the question? Because if you don’t answer the question, you got zero.
[00:08:38] You kind of guess it.
[00:08:39] If you get it wrong, you get minus one. I’m not sure if they still do that now. I know. Yeah, exactly. Yeah, exactly. So give me an idea of the costs. What are the kind of costs you’re looking at for undergrad and then professional school?
[00:08:52] So this is 20 years ago, so I’ll give you 20 years ago costs and I’ll give you 20, 22 costs because I do know those numbers. Yeah. So if you go and these are no I mean, no, no scholarship, nothing straight like full fee undergrad if you go to somewhere like maybe a state school but like a like a like UCLA or UC, that would be it’s not a private institution. It’s still not cheap, you know, versus a private school. Could be USC, Europe, NYU undergrad for you. I mean, you could be looking at almost 103 and 1000 just undergrad, you know, nowadays.
[00:09:27] Now pre-med bit.
[00:09:28] Yeah, yeah. Nowadays yeah. I mean, back then maybe, I don’t know, 100,000 just for undergrad. I mean, that’s maybe 150, but I’m gonna say 100 and then dental school, medical, dental school is more expensive than medical. More expensive than pharmacy. I think veterinary school is more than dental because I think that’s the only other one that could be similar. But dental school back then was 250,000. Now I know it’s pushing FI 400 to 500 just for dental school. And then if you have residency, some of them, some residencies, you’re paid a stipend, some you’re not. So if you go to Endo, Ortho and or Ortho Perio, some of those could be 250 or so now. So you could be $1,000,000 for 8 to 10 years of school age, $30 million of debt, you know, and oh, man, that’s that’s a it’s a big deal. Then you’re trying to buy a practise for 500,000 or a million with building. I mean, it adds up quick. If you don’t understand finance, I mean, you could easily take 500,000 and invest in a couple of real estate and you don’t have to go to school technically, you know, I mean, it depends. It depends, you know, what location you’re at. So you really have to like this profession in this country if you’re going to spend this kind of money. And most people still don’t know that. That’s what I mean. I’ve noticed some people, they think, oh, it’s easy money, you know, just got a. In a bunch of offices and just get going. And there’s plenty of people that are very good at business. That’s fine. They’re good at that. But you know, I don’t know what it’s like in London if there’s a tuition. I mean, England’s sorry, or Great Britain. If there’s tuition, there is tuition.
[00:10:54] But it’s it’s it’s capped. I think it’s capped at nine, £10,000 a year. Okay. And that’s kind of that’s kind of new. When I went through dental school, it was free and there was even there was even money they used to pay people. If I mean, it was means tested. Yeah, it was. It wasn’t even a loan. It was actually it was it was a grant. It was called. And it was means means tested. So I don’t know. I didn’t get it. I don’t know how much you had to earn to get it, how little you had to learn to get it. But but the government would not only give you pay you your your university, but would also give you money to live as well. And, you know and you know that that that wonderful notion that that where you come from shouldn’t affect your your opportunity for for education. That used to be a thing over here. And I bet you think it still is a thing with the cost compared to yours. Yeah. So what do you do about getting that cash? Did you did your parents pay? Did you get a loan?
[00:11:52] What happened? No, you just get a loan. They have federal grants, private loans. So. And then that includes money for living costs and things of that. But if you live in a city like San Francisco, in New York or L.A., I think your rent is going to be you might and you start going out a lot and stuff like that. You probably gonna go a little over, but you know, it was 100% loan. But if I ran out of money, you know, my parents, it didn’t come from medical or any like professional background. They similar to, I think a lot of my age group in England. They, they grew up in Zambia and Kenya. They moved to London in the seventies and they had a shop, you know, newsagent. So they worked like 24 hours. I mean, sorry, seven days a week, almost like 12, 13, 14 hours a day. I think it’s similar to Proud Dad from what I understand from the Cos. But yeah, so they gave me extra money if I ran out because I needed it for food or just rent but I wouldn’t, I wouldn’t like extravagantly spend it. No. Because I know I had to pay it back. So I mean the loan money. So back then though it wasn’t nowadays it’s very bad interest rates for loans. It could be like five, six, seven, 8%. Right back then I think it was like you could get 1 to 3% for a for a government loan and private loans might have been 5 to 6% if you don’t if they don’t cover enough.
[00:13:06] So two questions. Number one, what was your parent’s plan regarding work? Were they planning to open a shop in America as well?
[00:13:16] No, I think when they came here, my uncles, they had some history with some business here and some real estate and hotel or motel. So I think a lot of Indians say either go into that category or the agent versus us versus England. But yeah, they got a motel area. It wasn’t the best location, to be honest. They did their best. They got quite badly hurt in the recession in 28, 2008. But you know, they don’t live an extravagant lifestyle, so they’re fine. I’m around. So if they need anything, I got them. You know, I’m fine as a dentist now. So they came here and they they gave me the opportunity.
[00:14:00] The opportunity to to do whatever I wanted.
[00:14:03] We were at a conference in San Diego, the OECD, last year.
[00:14:08] Oh, yeah.
[00:14:09] In, in the same conference hall was a it was I think, I can’t remember the exact name but it was like a it was kind of the Asian Hotel Owners Association.
[00:14:18] Okay. Yeah, yeah.
[00:14:20] And there was a bunch of happy guys walking around and we bumped into some of them in a bar afterwards. And one of them was, there was a couple who they were dentists, but they’d bought a bunch of motels as well. And they were telling us about the business model and how there’s a couple of guys who own hundreds of motels and. Oh, yeah, like any other business. Right. There’s no, there’s always a couple of guys.
[00:14:44] Yeah, it’s real estate basically. And they got in early and you know, and they have a big connexion. So my parents, a small time they had one and just to pay the bills and get by and you know, they’re content. But yeah, you can it’s just like opening multiple dental offices and selling it for multiple of them and stuff like that. That’s what it is. Or just hang on to more and more and more. Then a big marriott will come over and take everything from you if you really want to. But this, this is never ending. So why would you sell it? You would just keep growing, you know, and then sell it, maybe a portion of it. If you don’t want to deal with a headache.
[00:15:15] I don’t mean to pry, but just give me this. Like, what was when you qualified? What was your monthly payment for your loans that you had? Like, how did that what kind of amounts are we talking?
[00:15:25] So they’re like 25 year loans. So yeah, I don’t know. I mean, I forget now. I mean, I.
[00:15:32] I’m like $1,000 or was it like 5000?
[00:15:35] There’s a minimum payment. But I didn’t I didn’t want to keep I wanted to get rid of these loans. So I try to pay them off in like. I don’t know, like four or five years, I try to pay them all off. I just work like crazy. Yeah, I was done. I think I was done by, like, 31, 32. I paid it all off, but I didn’t. But there’s a difference, right? So now I look back, I would tell my 24 year old self, just make minimum payment, all that money, buy a bunch of properties. And then all those properties would be millions right now. Right. But I didn’t know because I’m very debt averse because just think on my upbringing. My parents always like don’t take risks. Look, you know, like we did this and we lost this. Like, just be be conservative and this and that. So until like I started like establishing myself, I wouldn’t really I would have given me more stress. So I just knew one thing I can earn. I’ll pay off these debts. At least that’s gone. But what I realise is once the debt’s gone, I felt good for a little bit. And then what’s the next thing you know? So the real thing about money and finance is how to leverage things. And some debts are good debts, some are not good, you know.
[00:16:43] Well, you know, hindsight is 2020, right? I mean, if you if you qualified in 2007 and given yourself that advice, that would have been really bad advice. Right? Right. So there is risk in in everything. You’re right. If your number.
[00:16:56] One thing was 1000 a month, I don’t know, three or four if I was I had to dig in. Right. I mean, otherwise, no, in most payments might be 2500 a month and you’re paying many interest. Here’s the other problem in America. If you make, I think, over 100,000 or whatever or something like that, you can’t write off the interest. You cannot so it’s it’s that’s why right now certain with Biden and what he’s said I think a lot of because of all the political things I think right now people have student loans he’s put a hold on interest payments. So they they’re not paying anything right now. They just it’s good. And he may forgive it. He may forgive some of those debts. But I’m guessing people who make a lot that he’s not going to do that. You know, so it’s all just they move the money around.
[00:17:38] You know, that debate, that debate is going on. Isn’t it about non-professional degrees and whether the amount of money they cost has been worth it to all these people? You know, people have been sold this idea of get an education and then at the end of it, not getting jobs that pay. But I think dentistry where we’re, you know, bit better on that front. So then tell me you qualified. What was the next thing you did?
[00:18:04] So I finished in 2005 and to be honest, I didn’t know what to do. I was like, Oh, I don’t know where I’m supposed to go back. Then I remember I was following Rosenthal like just a little bit on on back then there was no Instagram, no Facebook just started. So I was.
[00:18:21] I was just doing.
[00:18:22] Magazines and stuff. I was I was looking at magazines. I would I would like read about stuff. I would fly out to some small courses, but I was I don’t know what I’m supposed to do. So then I was, you know what? I know how to do some things, but I’m unconsciously incompetent. I was at that level, I didn’t know I was doing things wrong. So then I was like, I need to get to consciously incompetent, then I need to get to consciously competent, and my ultimate level is unconsciously competent. I knew that. So then I was like, Dude, right, I’m going to take a residency, I’m going to do a one year here. We have, we don’t have VTE here. So I learnt about that a little bit because I’m going to actually what happened was I did the one year it was, it’s called Advanced Education, Dental Dentistry. Another programme is called General Practise Residency. They’re very similar, but one is more hospital based. I’m one of the more private practise space, so in that one year I got about five years of private practise experience. I did. I did a lot of fixed price, a lot of removable, a lot of endo implants, just everything I wanted to do as a private doctor, dentist. And so that was great. When I finished that, that’s when I entered the workforce. And then I was like, Oh, okay, let me try to live in LA.
[00:19:29] I want to I want to work on Rodeo Drive. What’s that like? So I drove down. I drove like 600 miles down from Norco. So Cal and the jobs were I mean, I don’t know, they were kind of shit, to be honest, you know, they were like, here’s, here’s a base pay of X amount and you do all this kind of stuff. I can’t even cover rent, let alone my payment for loans, right? So I said, You know what? I don’t think I can do this right now. I think I’m going to have to live in Northern California. The jobs are better, and maybe I’ll just find something more corporate, which I didn’t want to do. But there was a new company back then that initially they were good. So I got a job, I got a job and it gave me a good start and I learnt a lot of things, but then a lot of things changed and it became very production based and and just no time and patience. And I had to do hygiene. I started going down this spiral. I was like, This is not what I want to do. Then my mind started thinking about different things. I was like, Don’t want to go to school, don’t want to go to school, then want to go to a surgery school because a lot of my friends were in residency and from a US was still although I was like, maybe they’re doing something right, I should look into this.
[00:20:31] And then I started thinking, I think I want to come to England to do a residency. So I googled all that stuff. So what’s it like to go to England? You know, because I’ve kind of missed I felt like I missed out on on my time in England at that time. I was like 25, I was 24, was like, what if I did a year or two in England? I know it must be cheaper out there and maybe I can learn something different and come back. So I started researching some programmes and then I got more in-depth emails. It’s not cheap actually, and then I’ll say, Wait, I got payments, I got to do this stuff. And so then I scrapped that idea and I realised you have to have a licence to work there. I can’t just even though I’m a citizen of us and Great Britain, I don’t have a British licence and so I seemed like a bit more complicated, take exams and all this kind of stuff. So no, I just, I just started focussing on SEO side of really taking whatever I could at wherever it was in America and just started building on that.
[00:21:23] To just explain to us as an associate what’s the what’s the sort of standard percentage that associates get paid?
[00:21:32] So it depends where you are. So there’s a there’s a great dentist and you probably heard of him. Howard and I took all his 30 day MBA classes and all this kind of stuff on online. And he was saying, you know, most associates, when they get out, they want to live and practise in New York City, L.A., Chicago, right where there’s so many dentists and the kind of job you’re going to get there, you might get a base pay of me for 5500 back then, maybe like a hygienist kind of pay. And well, the best thing to do is go more in a rural area or maybe a city that’s not so large. You’re going to get more opportunities. You have potential to have unlimited income. You could make base pay, but then a percentage of collection of production, maybe 25 to 30 or 35%. So if you’re a specialist, you could make 40 to 50%. As a general dentist, I would be very happy with 30% adjusted production or 35% collections. At the beginning I was getting around 25 to 30. I was happy with that, you know. I mean, I was more interested in just learning my skills. I, I never really I could have made a lot, a lot more money as an associate, but I didn’t want to put myself in risk situations and then deal with problems when I left the practise, because litigation, I thought litigation was bad in the US, but I found out that UK is.
[00:22:44] Yeah, I did not know that and I started hearing about it and I was like, Oh, that’s not not good. What’s going on over there? So something changed so that.
[00:22:54] Yeah, yeah. Basically we’ve got one law firm who changed the whole picture. They, they basically lobbied government. They buy dental cases, they advertised ambulance chasers. Has the dentist hurt you? And then they they they really push hard. And they literally it’s it’s sad to say, our profession has been I mean, society as a whole has become more litigious here with our profession basically in the UK has been turned over by one law firm which which by the way, a couple of dentists set up, you know, like really qualified dentists and lawyers here. It’s awful. It’s awful that we haven’t managed.
[00:23:38] Yes. Together. Yeah.
[00:23:39] Well, you know, they became dentists first, I guess, and then I then did LLP or something. So but this 25% that you just mentioned for the associates is is that is that around the number you’re paying your associate right now? Is that is that the kind of thing is that normal?
[00:23:55] Yeah, I would say, like I said, I pay based on what they do. So there’s no adjustment unless there was like, you know, maybe the patient paid $100 and there was a 5% discount. So they’re going to get 95 rate of 95. I’m not going to. Yeah, that’s what it just means. But yeah, 30%. That’s very fair. I’m covering all that bill. I’m covering you pay the bill anything you want. Yeah, I’ll take care of everything.
[00:24:20] Okay. So I was a slightly different. The associate shares the lab bill 5050, but then a standard kind of percentage here is 40 or 45% now. But that’s recently changed. I mean, it used to be 50% for years and years and years and the last sort of five years it started moving. And then since COVID, which we should we should talk about COVID. Tell me about COVID. Did they force you to close? How long did you close for?
[00:24:47] In this country. I was closed for three months because I felt it was the right thing to do, but there were offices that were open. They can’t force you to close. There was a guideline and then there were some practises that I know of and dear friends, they were open and obviously nothing happened. But to be honest, personally for me, I bought my first practise in 2014 and it’s a large dental complex, so there’s other practises in it. So slowly over the years I’ve been buying out all the practises in this building and I keep merging them into mind. So then right before COVID, I was talking to one of my mentors in the building and he’s, he’s. To be honest, I feel like he’s his level of education and training is in there time and age. But he was close spirit kind of level. And I don’t know in England who are the guys or women that are that kind of level? To have someone like that help me and train me is priceless. He’s like, You know, I want you to buy my practise. I approached him. I was like, You know, I’ll be interested in buying your practise when you retire. He’s like, You know, I really like that. I really like you. And I’ll be honoured if, if we could merge together. So we started doing that and then COVID happened and I’ll say, Oh, is this going to happen now? You know, and then best thing ever happened. I mean, I don’t like that could happen, but it was a good thing because it gave me three months off to merge my practises with him, to merge all our systems. I’ve never in my career had time to strip the whole practise down, go fully childless, go fully everything I ever wanted. I systemise from from A to Z and it’s increased. Like my happiness here is increased obviously the efficiency and profitability. But main thing is, is that I, I’ve just kind of set it up the way I like it now. And he finally retired a few months ago. And it’s been a very good transition, a very smooth transition.
[00:26:33] So did you not have that oh shit moment where you know you’re not going to get any income?
[00:26:38] Oh, I did not. I did. But then we got in this country, we got what’s called a p p p e loan or something. So the government gave up some money, you know, to all businesses. If without that, I was in trouble. Yeah, I had, I had one day I came to the office and I was like, you know, what the hell am I going to do? You know, because I got payroll, you know, the whole country was like that, though, like all the staff, you know, how are they going to pay their bills? But then the government came up and we got these business loans and they were forgiven. So that was good. So we basically injected cash. Yeah, they injected cash in our practise. They go off they go off your monthly payroll and they’ll times that by X amount and say That’s how much you get. So you have to give all your tax returns, all your pals, all that stuff, and then they gave some grants out. This is all this money they were just pushing out there. You know, we got to pay it back in different ways now, probably very different tax rates and all that kind of stuff, but it helped help stabilise the economy and it was necessary. Without that there’d be a lot of practises.
[00:27:38] Yeah, we had this similar, we had a similar scheme.
[00:27:41] Yeah. But with that.
[00:27:43] Also what they did is they paid 80. Oh. On top. Yeah.
[00:27:48] No. Yeah. Because I bought the practise. I got a loan for that.
[00:27:50] Um, ha ha ha ha. I get it with as they paid 80% of the salaries of all the staff. For that three month period, actually a bit longer than that if you wanted to. But when you brought people back to work, then, then they stopped paying them. But you’re right, there would have been carnage. And you’re right that we will all be paying for it some other way.
[00:28:11] Yeah, I mean, it’s fine without that, even our patients wouldn’t able to come see us say everyone needed it. Right. Because they all have businesses they all employed somewhere. It would just be a complete disaster. I mean, I can’t imagine what would have happened. I mean, there would have been criminal activity, looting. I mean, it was a little bit of that was happening, right? People were just smashing downtowns. And it was there was many, many things that were going out of control. I’ve never seen it as, like, a movie, you know, like, just. There was just so many people were getting really messed up and.
[00:28:42] Tell me this. Yeah, my, my. I’ve come. I’ve been to America a lot because all our suppliers are American. I’ve got family there and so on. My, my feeling about America. And one of the dangers of America is that if you fall, you can you can fall a long way down. You know, the safety net, you know, just from the from the health care perspective, we’ve got the NHS, you know. You know if you, if you get ill you’ll be kind of alright. People can argue about the standard of care in the NHS or how long it takes to get the care. But, but tell me that I mean maybe, maybe, maybe that’s the reason why suddenly violence or criminality and so on. But they were desperate people.
[00:29:23] Yes, I would say that the one the one thing about Great Britain is the access to health care is very important. Yeah. If you if you’re if you don’t have a stable income or just someone to or it depends where you live, too, but that is taken away. You live in paycheque to paycheque, you know, and with health care costs, I mean, you can get treatment done, but that there’s going to be a bill that’s coming and then you’re going to be credit lines gone, this and that. So it’s just a cycle. So in America, there’s no limit to how far you can go if you want to pursue whatever you want to pursue. But if you fall a slip up or you get ill and you don’t have the money to cover your health expenses, you could get in a lot of trouble. I mean, you’ll still be taken care of, but your financial distress is going to be quite severe, you know, but that’s the one thing about Great Britain that I do think is very good and even I don’t know much about dentistry with my own experience was I went a few times as a kid and I absolutely didn’t want to go, but I think I never like going to a dentist as a kid. I didn’t know anything about it. And I remember I had a shop, we had a shop in Wandsworth and Vauxhall area, and the dentist was right next door to the shop and it always smell of mercury. Now I know is mercury or amalgam, but I didn’t understand back then. I just didn’t like going there. But yeah, I think I don’t know much. I feel like if you live in London, it’s not easy either. I mean, it must be very expensive to even afford to live there more than it was before. So I don’t know how people and.
[00:30:51] It’s tough also, you’re right because, you know, we’ve got 40 people work for us and, you know, some of them travel used to anyway. Now, now there’s a lot of working from home going on. Yeah, some of them used to travel an hour and a half to get to the office. And I know in America that’s not a big deal. But here you remember, that is a big deal here. And we all drive here.
[00:31:11] There’s no public.
[00:31:12] Bus. Yeah, yeah. But but as I say, working from home has been a big difference for us in our business. Obviously, our business isn’t a dentistry business. We we supply dentists with stuff. So it’s actually rather than expanding our buildings, we’ve just now got people working from home more and more and more and more, and we’re sharing the same buildings, basically. Tell me this, but when you buy someone else’s practise, are you literally only talking about buying their patients?
[00:31:41] No. There’s two ways to buy a practise.
[00:31:45] In that building. In that building.
[00:31:47] Right, right, right. No. So no. I bought it’s practise. So I bought. Yeah. Because a patients alone, the only reason you would buy a patient base is if that lease is up and the equipment is up for sale and it’s like it’s like a fire sale, like they’re just trying to get rid of charts. This is a practise you’re buying the staff. But in this situation is unique because I own the building. So I if I didn’t own the building, oh no. Then I got a I got to pay. That’s different. Then I would I would probably be like, you know, I don’t need your what I do with the space. I need to do a different deal here where I just want the patient base. But he may not have sold it to me that way. So what I did is I bought the practise. I move all his stuff to my practise because my practise is twice the size, so I have plenty of chairs. And then his suite, I had another guy come in and we have an oral, one of my good friends, he’s an oral surgeon, so we do all implants there, so he pays me rent. So it’s worked out really nice to have a dental building, which is a dental implant centre, restorative centre or whatever, but they’re separate entities and I like it’s worked out nice for me but yes, normally, yes, you’re going to have to negotiate the. Or you have to buy the condo suite if that’s available. But typically, most people, they’re going to set up a four, 5 to 7 year lease with options to renew. And you’re buying the practise and that’s that’s what it is.
[00:33:10] But so for our listeners up and Patel dot com that’s your main place where you work are there are others. Are there other practises that are different websites.
[00:33:19] Yeah, they’re all separate entities. So it’s just yeah, it’s just, it’s just like if you had an office building and there’s six other dentists in that building, we all have our own practises.
[00:33:27] They’re paying you rent, basically.
[00:33:28] Mostly, yeah. I’m the landlord. Yeah, I’m the landlord. But eventually, you know, you never know. Maybe the guy next to me, he’s a periodontist, he’s married. He’s going to retire one of these days, if, you know, I don’t know what’s going to happen five, ten years from now, but it’d be great if another guy boys practise or woman and the periodontist is there. But maybe in the future, as many things I want to do if it gets going with all the digital, all on X and all this kind of stuff, maybe I can, I can have a lab, you know, that is in that in my building. Maybe they can pay me rent, but I have it in house lab. That might be cool. Or maybe a paediatric practise because we have a orthodontics in the building also. So there’s many options I think. But it’s always nice to have the cash flow to have option, I guess.
[00:34:12] So tell me this. But as far as the choice between specialising or not, which specialism is the one that is thought of as the most sort of high level or the most prestigious? Is that all surgery in America?
[00:34:28] I would say it depends on the person. So I would say just historically or my office, because you can get a six year programme. We have MD and then there’s four year programmes. Yeah. You’re saying oral surgery for a four year programme is the same exact thing, except you haven’t done those two years of medical school. So it’s nice to have MD because then you can get some hospital privileges and billing codes that help out. So I have a number of friends that are and even from my from me personally, yeah, I always feel like they like the oral surgery, you know, like got to respect a little bit more or whatever it is. It’s just there’s an aura about it. But looking back, to be honest, like.
[00:35:04] Do those guys earn a lot more as well?
[00:35:07] Yes. I mean, if you just took everyone baseline like an average general, dentists, average, endo average, I would say all surgery owns the most. But as you know, exceptional general dentist can earn more than anyone, right? Sure. An exceptional paediatric dentist can earn more than anyone. So I think it’s more about.
[00:35:28] Well, well, not here, not here, not here, not exceptional paediatric dental. Unless you’re talking about ortho. Yeah.
[00:35:34] No, no, just Peter.
[00:35:35] Not. Not, not here. Not here.
[00:35:38] It’s just I mean, there are there’s the odd, you know, kids only practise. Oh, okay. But they’re not they’re not making loads of money and people expect their kids to be treated for free. And there isn’t the culture of saving money for your kids teeth. I mean, there is the cultural thing.
[00:35:54] Too. You know, I figured a lot of paediatrics would be seen by. Yes, you’re right. Yeah, yeah, yeah, exactly. Yeah.
[00:36:00] It’s a different culture, you know, it’s like we’re just getting around to the point of people spending money on their own teeth. You know, that’s a big deal here. Things like cosmetic dentistry have changed that a little bit. So you might have heard we were talking on the podcast, you know, when we talk about, you know, the bartenders having Invisalign. Yeah. And it wouldn’t, it wouldn’t have been the case 20 years ago.
[00:36:21] No, I never saw that when I was there. You’re right. I just even here when I go from England, doesn’t everyone have bad teeth? I’m like, I mean, not really anymore. I think people are really want want my teeth.
[00:36:33] Yeah. Things are changing. Things are changing. So tell me about your team and you know, how many people are you responsible for?
[00:36:42] So I have a seven operator practise. So I have a three dental hygienist. I have two dental registered dental assistants, I have one associate doctor and I have one office manager, one patient coordinator and one benefit coordinator. So three front desk. So it’s nice because ideally as I have my associate pick up more days with me right now she’s part time. So the ultimate I work four days a week and she works. She used to work too, but then she took time off to start a family. So I’m trying to bring her back two days and then by next year I’m hoping to bring a three. And my long term goal is for me to work three days in her to work three or four. I mean, it’d be nicer to have like one more assistant as a floater, but I don’t need it right now and and the way I practise. And if you want, I can go into more detail about the different. It’s like three different American models.
[00:37:36] Yeah. Are you jumping between chairs?
[00:37:38] No. No. So when I first started as an associate, I worked pretty much what most practises are in the US. There’s in every insurance driven. So one method is called an HMO. That’s health management organisation where you’re the practise signs up with basically insurance company and. I send you a capitation check per month? Whether you see the patient or not, it doesn’t matter. You’re going to get checked, but you’re going to get a lot of patients. But they may not show up. They may not listen. That when they show up, a lot of stuff’s covered. It’s free. But when you need to do a crown, you’re going to upgrade them. Maybe instead of a metal crown, you might want to do a zirconia crown. They’re going to pay full price cash for that. So it’s more about numbers with that. And I never liked that and that’s what I had to do when I first started because I needed a job.
[00:38:22] And in hygienists it’s more like our NHS.
[00:38:26] But the thing with these models is if you’re in business, you can own multiple of these practises and have multiple chairs and you can make a lot of money, but that’s not clinical based. The second model is PPO, so preferred provider organisation where you can be in-network. So you sign up with insurance company and they say, okay, your crowns, are you going to cost $600 and your family is going to be X amount of dollars and you’re cleaning $50. But when the patient looks up your name on our website, you’ll be a provider, so they’ll pick you. Now they’re this one. You don’t get a monthly check. But what’s happening is, is that your marketing budget? Maybe it’s ten, 15,000 a month. Just making a big number right here. Instead of paying marketing, you’re getting those patients. Right. But what happens is, is that you still got to see multiple chairs, because how can you spend 2 hours with someone doing, you know, a number 2/2 molar crown and and you’re doing it for like half your fee, right? And then you’ve got to go do a hygiene check, which is half your fee, and then you got to do a cement. So you have to run multiple shows.
[00:39:29] That’s why they’re running multiple chairs.
[00:39:31] Yeah. And then you have a but then also that’s very profitable. If you have assistants that are trained in this our country, you can have them trained to take impression to symptom. Yeah. So that’s the second model. Again, very profitable if you want large scale.
[00:39:47] Is that is that the model that how the foreign runs in his Arizona.
[00:39:51] He may he may be out of network too. I’m not I’m not sure I think that is at his peak it might have been in a network but but and it works just fine. You don’t have to see multiple chairs. But I’m saying you’re going to get a lot of patients and and you can have multiple doctors work for you and it’s great. And the final model is more like what you what you kind of have, which is cash, but you’re out of network. So that’s purely relationship based and it takes a long time for someone to say, I’m going to come see you. Let’s just say I’ll make an example. Let’s say your your filling is $400. If you were in network, the filling would have been $95. That’s all you would have got for the occlusal in on number 30, I can set my fee to whatever I want. So if I say it’s 400, I know the insurance is going to pay 100. The patient owes me 300, so I’m going to use your insurance as a limitation benefit. You get something out of it. It’s like a gift card, maybe 2000 a year you get for that. But you come in to see me because I’m going to spend as much time as I can with you and do the best that I can.
[00:40:46] And you come in and see me because you want to see me, not because I’m on the list. So there’s a lot of practises in this country, especially after COVID, that are going at a network of fee for service. That’s what it’s called. And what that does is it opens up your whole like rest of practise career. You don’t have to kill yourself, break your back, you know, see multiple patients with a I might see and I see one patient at a time. So my typical day is I’ll see two procedures in the morning, two in the afternoon, maybe one or two cements. I’m done. And then I have hygiene checks, but I’m only doing hygiene checks once a year and that’s just an emergency, etc.. So it’s given me a lot more longevity to my career. And you can attract better associates because they where else they’re going to get a job like this. No one’s going to give them a job that it’s almost like they have all the perks of being an owner where they get good income and also getting good quality patients, you know, in terms of they pay the bill on time. Also, they want the best level of care and they’re loyal. So they will hopefully refer other friends and family that are similar in that mindset.
[00:41:46] But but you’ve got inverted com. I’m holding my fingers up marketing costs now right.
[00:41:53] Yeah someone get to that. So right now I mean all my growth since I’ve started my career has always been organic. What does that mean like that? I mean, that means word of mouth. Yeah, word of mouth. And it’s just been internal referral and I’m happy with I can go like that probably the rest of my career. It’s fine, but I have to work, right. I want to now start looking into how can I do some type of digital marketing and maybe some personal marketing I have to do in the community, perhaps outreach somehow so that I can start selecting the cases that I want to do, which is primarily hopefully more orthodontics and implant restorative revision dentistry. And that’s the next level I’m trying to look at, which I haven’t spent any time or money on yet, but that would make sense so that.
[00:42:39] You’ve got an Instagram page and there’s a lot of I mean, there’s hundreds and hundreds of cases on that Instagram.
[00:42:46] I mean, these are 20 years I’ve done 20 years worth of cases. You know, that’s my and then also I bring it that’s my catalogue that I show patients in the office. Right like this I’m gonna do this I don’t use Instagram for. I use it mainly to so I can look up tennis and squash and fun stuff and like restaurants I want to go to. I look at some dentists and I’m like, Yeah, that’s cool. I like that. And I pick and I also learn about people like, Oh, that’s a good course to go to. Or He or she is really cool. Okay, I never thought of that, but I noticed Instagram is good if you already have a very good baseline and good knowledge of what dentistry is and you can pick up some tips and tricks, but if you’re if your training is very novice level, you can get quite overwhelmed and thinking you have to be that straight away. And I can see if I was a dental student at 24, 25 and an Instagram was around, I might have I might have gone nuts, like just thinking, I’ve got to be this like within a few years, like, how can I do this? It takes a long time to become like that. It takes at least ten years to get to an excellent level of dentistry where you you feel like you made enough mistakes and you know how to fix a problem. And it’s great that it’s out there because back then I didn’t have people unless it was local, to see what kind of dentistry they do. I had to fly to a course or something like that, you know?
[00:44:03] Look at it, looking at your work. It’s definitely sort of restorative implant based.
[00:44:08] Where did you get the education? Was it Khoisan Spear? Have you done both of those?
[00:44:13] Yeah. I mean, I think when I finished my first level of training was that one year residency I did. And oh yeah, that was that was all hands on and it was all clinical and it gave me about 4 to 5 year head start. But to be honest, the best thing you can do is document your cases from day one. In this country, I notice in England that you have a lot of different qualifications and I don’t know much about it. It’s something to do with Royal College of Surgeons and MD, JD and all this stuff and stuff is but it sounds cool, but here we have, you know, there’s many organisations, a AICD is a AGD or Academy of General Dentistry, so that organisation does have a very significant pathway for comprehensive training in all 16 levels of disciplines of dentistry. So I first did like a fellowship that was like 5 to 600 hours of C and you know, taking classes and an exam. And then I did a monster ship course that was like four or five years took me. So I did like three, 4000 hours worth of C over like ten years, you know. And so that’s what my DDS says, Magdy F du f ICU or whatever it is. And then, you know, all college of ontologies, they have fellowship programmes.
[00:45:20] So initially I just kept doing all this stuff. I found it just more and more like minded people that I would learn from. But then at some point I was like, You know, I’m just I need like a real course. And the course was that course. Ever since I’ve taken course, it just changed the whole way of practise dentistry. And in my opinion, he’s one of the best educators on the planet, period. And then I also did Spear, I did a lot of spear study club in this country. We have it’s called Spear Study Club where local dentists, we all get together and once a month as a club and we go over cases. But Spears provides the case presentations, things like that. So you have a periodontist, orthodontist or oral surgeon in general. Then as we all get together and just kind of dissect the case and then one of the best courses I took last year and it really was more of a tips and tricks kind of course, strop and drum in. He came out to San Diego, but they have it online now too. I really put a lot of stuff together, but I wouldn’t have understood that course to the full extent if I didn’t take course first.
[00:46:17] So what’s that course called again? Say that course again.
[00:46:20] Strop and drum.
[00:46:22] Strop and drum.
[00:46:23] Yeah, they have an excellent Facebook group. So just add join that Facebook group. Excellent cases in there. And they’re there in Clearwater, Florida.
[00:46:30] I believe. Yeah, I know. Yeah, yeah, yeah, yeah, yeah.
[00:46:35] He is excellent. And his and his new. Yeah, but.
[00:46:39] For someone who’s not fully familiar with voice or spear or voice and spear, I mean, for someone it’s rare to come across people here who go to both of those because it’s you know, it’s such a expensive travel nightmare and all that. And the courses themselves are very expensive. What would you say is the difference between those two schools of thought and, you know, should you do both or should you do one or the other, or should you go right to the top of one or do what are what are your thoughts?
[00:47:07] So there are I’m going to talk about maybe four or five of them. There’s Dawson, Pankey, Spear, Kois and La, and they’re all great. I would say Spear is in I think it’s in Arizona and I don’t think Frank Spear talks personally anymore. I think he’s retired, but and it’s a larger group. It’s an excellent course. I think either one pick one. Personally, I like the personal hands on approach of John Cox, and he’s always up to date with all evidence based scientific data. And the thing about course is you kind of meet people who are only interested in a similar thing that you’re trying to do there, and you learn from them actually, because they’re also starting their journey or they’re they’re interested on us, they’re periodontist, they’re lab technicians. They’re it’s almost like the top 1% of dentists that want to be the best. They go to these courses. So you not only learn from John Kois or Frank Spiro, you know, the Pankey course of Dawson, but you’re learning from your peers and you’re a mentor to people maybe younger than you and then someone older than you. You’re learning. You’re learning from them. And then you make friends. And then when you leave, you keep in contact with people. So it’s more about network. But but the context.
[00:48:17] What does it mean? Yeah. What does it mean to you as a dentist? Are you now looking at full mouth?
[00:48:22] Yes. So before I think the best thing would be like I didn’t know some of the stuff I was missing. Like I didn’t understand why there was tremendous in a case how to how to predict, predictably, why there was constriction in the case, why there’s dysfunction, why there’s attrition, why these things happen in with biology, how to break down a case into gum and bone, how to break down a case and care and caries or biomechanical or functional or aesthetics. You want to break a case down in four parts, but a systemised way and spear does the exact same things to a different verbiage. And once you break down a case like that in your treatment plan, start to finish and how your whole office is aligned. That way, it’s very easy to communicate. For patient, whether it’s in hygiene, whether it’s with associate, whether it’s front office. And also when you refer to specialists, they also appreciate that you’ve taken the time to figure out why we’re doing this. And it just it just makes everything more it’s almost like a manual. It gives you a guidebook to kind of help you dissect something, because the key to any part of dentistry is not how good your hands are. It’s diagnosis. If you’re excellent, if you’re the best diagnostician, that’s when the best, probably the best dentist or doctor, because you can be excellent in radiology.
[00:49:34] But if you don’t know how to like if you don’t understand the dynamics of your CBC or your pano or your or your bite wings or pars, and you’re missing some education level there. You’re going to miss things all the time if you don’t understand how to use the correct burr or the finishing systems or why certain segments are better than others. Not just what some rep tells you. Because what typically happens is that you buy a product, you buy equipment, and the least qualified person, which is the dental rep, is going to train you on it and then you’re training the same stuff through your systems. But if you have someone who has gone through all this data and done the evidence based analysis, you know what you’re going to put in someone’s mouth, I think, and also that there’s studies to show that. So I think it’s for me personally, I’m more technical based. I want to know why I’m doing something and how to do it versus just randomly get into the endpoint. So it’s a good it’s almost like a not a cookbook but a like it’s it’s a manual that you can refer back to.
[00:50:29] And I’m going to have to defend dental reps now because dental reps have a real tough, tough time even getting in front of you. And I get I get your point. I get your I get your point, I get your point, I get your point. I get your point, I get your point. You want to be trained by John Kois, not by, you know, the three MB rep. I get it, I get it. I get that. But but the one thing that dentists should, should pay more attention to is that dental reps have a wealth of knowledge about what’s going on out there.
[00:50:58] And you’re right. It’s the wrong place to get your knowledge. Yeah, but you know, what a lot of dentists do is, is train their team to keep reps out completely. And, you know, and it’s an error. It’s an error because you can learn a lot from a rep. I wouldn’t trust the rep on, you know what he’s talking about his own product over another one necessarily. Necessarily. But there’s a lot of great reps out there. Now, let’s talk.
[00:51:23] I agree. I agree with you.
[00:51:24] I know you do. I need you to let’s talk about how far you went in voice and how long it took, how much it cost. What did it return?
[00:51:33] Yeah, let me when did I start? So I think the last couple of years. What I’ve noticed to be all these continuum, they’ve rapidly expanded. A lot of younger professionals are really taking them straight away. And in the old days they wouldn’t. It was a lot of older doctors because it was Instagram. It’s just given in Facebook, especially. Instagram is just throwing the light what’s possible out there. And people are thirsty for this knowledge and and they’re okay take spending their money on dentistry instead of buying a fancy car or going on a holiday because they’re getting the return out of it, too, you know. So I think I forget I took me two years, though, because you can probably do it in one year, but only one person I know has done that. It’s one of my close friends who actually is a mentor that he just went back to back to back to back. And but most of the courses sold out. So you want to book your your courses. I think there’s like seven, eight, 7 to 8 continuous. You’re there for like a week or something like that. Total cost, I think 50,000. That’s just for the course fees. And you can pay for flight time, hotel time and then also that amount of money away from the practise.
[00:52:36] If you’re gone for a week, I mean, let’s just say on the low end, 10 to 20 to 30 to 40000 is gone. Depend on what you do. Right. But that doesn’t matter because when you come back, it’s not like I’m treatment planning for mountain people. It means now I know even if it’s single tooth, I feel very confident in telling the patient why I’m doing something, what’s going to happen, predictability, why it fails, why it doesn’t fail. And also, if I have a full mouth case, I’m more they can see. I’m more confident in explaining why it would help them. So if they have questions, I can answer them very easily now versus before I kind of make up some stuff in my head, which was correct, but I didn’t have like it was just kind of like my experience. But now I know it’s evidence based, it’s in literature and and it’s always evolving. So if I want to access stuff from then I can just log on and see what’s up to date and they have a yearly symposium to. So I’m not just plugging, I’m going to say SPEAR Thank you. Dawson They’re all great. Whatever, whatever system, whatever.
[00:53:31] Programme finished the whole thing.
[00:53:33] Yeah, of course.
[00:53:34] Yeah. Amazing, amazing. And I mean, I guess the reason why younger and younger dentists are going into it and by the way, we run courses over here and younger and younger dentists are going to courses here as well is they’re trying to get out of that HMO, PPO system. And if you want to give someone an associate job and they tell you, I’ll finish Coinbase, you’re more likely to to consider them for your kind of practise, right?
[00:53:58] That’s true. You know, a lot of times associates don’t know. Maybe what the best path is. And it’s nice. I’ve had a lot of mentors and they gave a lot of free advice and if I need anything that always there, I can call them. And, and also I mentored a lot of other people too, but for my own associate to help get started and part of its own initiative too, I paid for some of the initial course costs. Just the first one. Yeah, because I want I don’t want if someone’s going to work for me, it makes sense for me to get them aligned if, if they’re loyal and they’re going to be with me a long time. I don’t want to just throw money and then you’re gone in a month or two, right? So I know that my associate, my team members, unless something drastic happens, they’re going to stay with me. And so I’ll invest in them because these are not liabilities. Any employee, any person in your practise, they’re all assets. They’re not liabilities. So in the old days, I think I’m thinking, oh, what’s your overhead? Well, payroll is 25%. It’s a liability. It’s it’s not I mean, you’ve got to be careful how much you’re paying within reason. But but if you invest in your team, you’re going to get exponential return over all, not just financial, but a good camaraderie. And also patients notice this. They’re like, oh, the same person is here all the time. It must be something good. You guys get, get, get along well. You work well and patients do say that. They’re like, you guys are like seamless. You guys know what you’re thinking each other thinking without even talking, that kind of stuff. It’s nice to hear that, you know?
[00:55:21] Yeah. I mean, you know, to ask your patients to make your ask your staff, your team, to make your patients delighted. Yeah, you’re going to have to delight your staff a little bit. Yeah. You can’t you can’t whip people into delighting people, right? No. Absolutely right. Let’s go through some fees, because it’d be interesting for people over here to, first of all, caveat that with the £1 million it costs to qualify $1.
[00:55:50] Million, that’s an extreme example. If you did if you went full. I mean, I’m I’m going to say nowadays undergrad and dental school, eight years, let’s just call it 300 and to 400,000. That’s to say.
[00:56:01] That’s correct. 400,000. What are you charging what do you what do you charge for a standard, let’s say just crown.
[00:56:09] About 1600, but would build 1800 1800 is a fee and that that that is again you might go to New York and some might charge 3000 or 5000. So so yeah. But I think fair market value where I’m at 1802 thousand makes sense that.
[00:56:29] The positioning of the practise I mean are you positioned at the higher I know you’re at the higher end because you’re not doing those models, those PPO, HMO models. But but when it comes to this sort of non non insured. Yeah.
[00:56:41] Yeah. 99% on. Oh really. Yeah. In this where I practise. Yeah. Now if I was in San Francisco.
[00:56:49] I know. Few competition.
[00:56:50] More. Yeah. Yeah. I mean, I’d say more competition, but to be honest, I’ve never been worried about competition. I think there’s enough patience for everyone. It’s just it’s kind of patient you want to treat and also, personality wise, who get along with as many patients I wouldn’t get along with. And that’s fine. They don’t see me, but there’s a certain demographic I really get along with and I know what my niche niches. But yes, I would say I would say fair market value around average for the whole country. At the highest percentile. Let’s call 1800 for a crown.
[00:57:19] Yeah. What about like an mod competition?
[00:57:23] Like for 95?
[00:57:24] For 95, that’s higher than we get in general. In general, what about, let’s just say skin polish, cleaning, hygiene.
[00:57:35] Like a trophy? Yeah. 150.
[00:57:40] 150 an examination. Just like a six month examination.
[00:57:47] What about implant?
[00:57:50] Start to finish or just the fixture.
[00:57:52] Start to finish.
[00:57:53] 5000. No bone graft though. So it would be like, you know, 2000 for the crown, maybe 2500 for the implant plus some tissue stuff. So 5000.
[00:58:03] Yeah, sinus lift. If you hadn’t a sinus to add another 2000. If you add in GBR and Ridge augmentation, add another 1200.
[00:58:11] So how about you know, because you’ve been trained. So I bet you’re doing some big, big cases. What’s what’s been your biggest case?
[00:58:19] I mean, to be honest, I’m very different in terms of. I don’t do a lot of stuff anymore. Like when I first qualified, I did everything I did endo. I did all surgery. I did p do. I did. I never did really a lot. Although, to be honest, I never trained in all of those. But like, I mean, biggest case, I mean, it’s full mouth, full mouth all on X or full mouth crown and bridge like 28 teeth. So you can add that up, you know, 28 tooth times, 1500, whatever that is. But because I needed it, so my kind of practise, the kind of patients that I see, I don’t have full mouth every day. I might I’ll be very happy if I got one once a month. That’d be great. But my favourite case is seven through ten. No occlusion changes seven through ten composite seven through ten veneers seven through ten crown with some cor bleaching. I think you have enlightened, is that correct. Yeah. With the white whitening product. And then I finish a case with a pair of attacked or something like that and just good hygiene protocol.
[00:59:17] What’s Perrier protect.
[00:59:19] It’s, it’s basically a tray that’s kind of like a mouth guard kind of material tray, and it’s scalloped to your gum measurements and you load it with 1.2% peroxide with xylitol and and they wear it for about 10 minutes once a day. I’ve noticed significant decrease in bleeding points and plaque build up plaque build-up is much less so. But yeah.
[00:59:41] I looked at that. I looked at that. But the, the resistance from periodontitis on that product. Yeah, it’s gigantic. I mean, like over here I just, I didn’t have the stomach to, to, to, to argue with Periodontist about it. But, but you’re right. Just just by looking at bleaching patients, you can see their gums getting so much better.
[01:00:00] I mean, you don’t want to like I have a team, right? So I have three or four periodontist that I refer to, three or four ended on as I referred to. I have a network so they know what I like to do. I’m referring patients to them so they don’t want to piss me off. So we have a I’m the lifeline for their practise and then I’m they’re helping me with cases that I can’t do. But in order to answer to your question, I predominantly do revision dentistry. My main patient base is 55 plus. I have no kids in my practise. Maybe I have like a handful, like five or six young professionals a little bit, but my predominant patient base is retirees and 55 plus baby boomers. And I love treating them because the best. Yeah, you know, they want the best work done there. Most dentistry is root decay, zero stoma implant work and they’re not in aesthetics. It’s much easier on them. It’s either I do the whole mouth or I just fix the quadrant of the front tooth and they’re happy. They don’t complain too much. You know, some of the middle high maintenance is true, but they just afraid and things like.
[01:00:56] That in general, they’re respectful as well. Right. They’ve got the old school feeling about the doctor.
[01:01:02] Yeah. And then they stick with you unless they’re going to move, you know. And yeah, I’m happy with that. And they actually happy coming to the dentist because it’s, it’s almost like it’s their routine. They go in the dentist, they go in the grocery store now they’re going to the MD and they’re going and then they love a hygienist because they’ve been seen the hygienist for like last ten, 15, 20 years or whatever it is. So I like that. Then that’s what I’m going to try to market more now, and that’s kind of the cases I’m looking for anyway, where patients want locate a denture or they want a little bit Invisalign. But what I’m hoping is the younger professionals would come and see my associate and then she can focus on Invisalign and some cosmetics and I can.
[01:01:37] I think that that demo you’re going to find on Facebook, right?
[01:01:41] Yeah. So that so my cousin actually works at Facebook in the marketing division. So I’ve been talking about this. I’m like, Hey, I need to get involved with some type of Facebook ads at some point and maybe I should look into how to do that because I haven’t done it before.
[01:01:52] But very different, right? The kind of you know that now we’re talking about a lead, the kind of lead that comes from Facebook ad is very, very different to patient who comes from word of mouth. And to start off with, that’s going to annoy the hell out of you.
[01:02:06] Yeah, yeah. Word of mouth. They don’t. They don’t. They tend to show up. They don’t.
[01:02:09] Like. Well, they show up. They show up. Sold.
[01:02:12] Yeah. They’re like so-and-so referred me, you know, I’m like, oh, great. Say hi to.
[01:02:17] There is such a thing as digital word of mouth that exists, right? And so it’s kind of a hybrid between between normal word of mouth and the digital marketing thing. I forgot to ask you, Invisalign, what do you charge for that?
[01:02:31] Oh, I think full cases like $6,000.
[01:02:35] That’s similar. That’s similar.
[01:02:36] But then I have my okay, so I have friends in Orange County that are fee for service. I mean, I’ll give you a difference in price right now so you can see the difference. His whole office, he’s he’s fully digital. So he has his own lab. He’s got every single implant lab system you can think of. He he hasn’t used a lab in the last ten years. He’s amazing and he’s a voice instructor and those kind of stuff. So his fee for an anterior crown would be 2500, his fee for all in upper and lower. All next, you might be looking at 80,000, right? But he does all the surgery himself. I don’t do any implant surgery anymore. I kind of just focus on restorative. That’s my I like doing that. And I have a surgeon like 20 seconds for me that we get along great together and I supply him with all the patients. But the thing is our case acceptance is exceptional because I say something, it’s a complimentary consult with the surgeon. He doesn’t charge a console or CBT, and then he agrees. And then they come back to me and there’s no pressure to do anything. I’m just here, no agenda, just to advise them on what I see. And they like that they get a second opinion or that we’re in a team together and it’s just no stress and no pressure. That’s how I kind of like to come off. And I’ve noticed, like, they do accept the treatment unless it’s financial or they just have a stigma about, well, my cousin or so-and-so had a bad experience with implants. I’m like, Whenever you’re ready, we’ll wait. We’ll wait for you and you let me know when you want to start and I’ll help you. That’s all you can do.
[01:04:00] It makes a lot of sense to stick to the bit of it that you enjoy and your most predictable on. Yeah, because what you said before about the confidence in your voice. Yeah, just comes through. It just comes through. And then you don’t, you don’t feel like you’re selling anything. You’re just you’re just telling them you’re, you know, what you know in your head. And people are saying, yes, you know, and you forget sometimes the how tiring it is to have to worry about people saying, yes, it’s tiring. And mainly it’s tiring when it’s an area you’re not 100% comfortable in. That is when you’re comfortable when it’s your area, you know. And for you, it’s this this sort of implant restorative mix or you said revision work, then it doesn’t feel like selling, it feels like educating.
[01:04:48] And I mean, it’s not easy. I mean, of course the case is not easy, but I’m not like I don’t act like, hey, you got to start today. When I worked when I worked in these corporate offices, the whole model was get the patients start right now. Otherwise you’re going lose the case. So patients can tell like you’re like hungry, you know, like it’s not right, you know? And I remember I mean, you can ask me later if I had some bad experiences and I’ll go into them and they were all pretty much is associate. But if you don’t have proper roadmap in the case you can get lost real quick, you know, and you can’t fix me can fix it kind of, you know, what you’re doing. But if you don’t like I think people sue you when they don’t like you, they don’t trust you and you feel like they’ll be taking advantage of their your friend or, you know, you’re looking out for the best for them. Even if something goes wrong, they’ll be like, okay, doctor, I come here because I know that you take care of me. You’re going to you’re going to handle it or whatever it is, you know. Yeah, that’s really it.
[01:05:43] So tell me tell me what was let’s, let’s get on to the darker side then what? But let’s start with what was the best move you’ve made professionally. And then and then let’s move on to mistakes, errors. The worst move you.
[01:05:54] Make like my clinical or just dental?
[01:05:58] Anything hit me.
[01:05:58] Just hit me. Okay? It comes to me. So like I said, I’m not graduating in 2005. I thought I wanted to be a Rodeo Drive or New York City dentist because I wanted that London feeling. I used to draw. I used to go to work in a three piece suit like Dolce and Gabbana, all that kind of stuff, right? I thought, This is me because I’m a London boy. You know, I’m from Wimbledon. I’m like, I’m going to I’m going to.
[01:06:18] That was that was going to be your brand.
[01:06:20] Whatever. I’m going to be like that aesthetic, whatever. And I didn’t know the whole world was kind of thinking like that initially anyway. You know, everyone wants to be that kind of thing. And then I realised these patients are not cool. They’re like really demanding. They don’t, they don’t care about who I am and stuff like that and what I can do for them. They just actually not as nice. The nicest patients are the ones that actually aren’t as wealthy and they’re they just have a problem. You’ve got to help them get out of pain, you know. But yeah, basically initially I tried all that and I came back to Sacramento. Sacramento maybe like kind of like maybe it’s a city, it’s a capital of California, but I don’t want to disrespect any London, U.K. cities. But maybe Leicester’s a big city. But it is kind of like that. It’s not.
[01:07:00] Like that. Been there. I’ve been there. Yeah, yeah. It’s nice.
[01:07:03] Yeah. So it’s very hot. But so I did a jobs there and then. Then I try to go to San Francisco in the bay. Same thing. I couldn’t. I couldn’t find anything I liked. It was just underpay. Patient quality was poor. And I was like, you know, I’m in Sacramento. It’s right here in front of me. It’s right here. Let me just start looking for something here. I found something straight away in 2014, I found an old guy. He was an ex lab tech and. And the dentist too, and, you know, Caucasian. Practise in a friendly neighbour. And yeah, I bought his practise and that was the best thing I ever did because it was a gold mine. So much amalgam. No digital X-rays like Handbook of Charts. Nothing. So I could just went in there, took my time. I remodelled the whole place. I made it my own over time. Of course, there’s a lot of turnover with old staff and this and that because they don’t like change, you know? But I had so much experience by then. I was an associate for like eight years by then.
[01:07:58] And to be honest, in retrospect, I wish I had become an owner much sooner. But if I had, I wouldn’t have got this practise. So I bought the first one and then I was still a tenant then. And then I the office next door to me, she would have it. She was having a hard time. She just bought the practise and there was a war between us and at the beginning like one year. And she said, Can you buy my practise? I’m like, I don’t, I can’t buy this. I just started looking back. I should have, but then I bought it later from her. But by that time, most of the patients had gone. But I got some patients, so then I had a bigger space. And then I approached the landlord, who is my friend and mentors like, Hey, whenever you want to retire I’ll, I’ll buy your building. And it came up. So I bought the building and then eventually he’s like, I want to sell you the practise. I bought his practise, so I.
[01:08:41] Used it to get the finance. And when you tell a bank you’re a dentist, does it help a lot?
[01:08:46] Yeah, yes. I don’t know how it is in England, but here you can put a00 down.
[01:08:51] Oh, really?
[01:08:52] Yeah. Zero down. So you can get 100% finance. And it could be a five, ten, 15, 15 year loan. You’re looking at 3 to 4%. And then that includes working capital equipment loan plus the practise. So average practise, let’s say practises is producing 700,000, right? Maybe you’re going to pay 475 for that and maybe 60%, 65%. And maybe you need a working capital of 50,000 equipment loan at 100,000. So now, you know your loan is like five 5600.
[01:09:20] When you say when you say produce, do you mean producers in income or do you mean.
[01:09:24] Oh, no, no, I’m sorry. Just collection. Collection per year. Collection not not vacant. Yeah.
[01:09:30] Oh so that’s, that’s actually quite low that our practises are valued much higher than that.
[01:09:35] So it depends where you are though, right. If you’re like I’m going to, I’m going to say average practise. Like if you’re in like San Francisco, Sacramento, L.A., New York, it really depends what kind of practise you have to. If I saw my practise today, I probably want up to 90 200% of my practise, like what I produce because it’s a big value to what I’m bringing. My the practise is very unique. If you have average PPO in-network practise in an average community, it could be 65 to 70% of collection if it’s doing average.
[01:10:07] Still low, though, still low compared to what’s happened here is the I guess it’s the corporates here. I know you have corporates too, but but the prices have there used to be like this, what you’re explaining. But now it’s like I don’t know eight times take home.
[01:10:23] Oh wow. That’s yeah. I mean that’s that’s if you’re buying I mean I have a number of friends now in our age group now like, you know, in their forties where they’ve, they’ve started like selling all the practises to the, to the corporate rate. And so they’re getting a payout initially maybe 70% payout and then 30% reinvest in with them and then maybe five, six, ten years from now they’ll do it. So they’re going to get a big, big payout. It’s great, but they’re going to have become employee four or five, six years. I don’t know what it is.
[01:10:49] Yeah, we have that too. We have that too. Yeah. So let’s quickly jump into before we go on to your biggest errors, let’s quickly jump into corporates there. Are there corporates in all of these different levels of you said the HMO, the PPO, do you have corporates doing high quality fee per item as well or no.
[01:11:07] I wouldn’t say corporate in fee for service. I would say you got guys like just make an example like you got Appa. You know, he’s got multiple offices around the world. You have many clients. Yeah, they’re not. Not this a brand, right? Yeah. And you got like people are very low key, but they have many, many offices and you don’t even know about them. But they’re all fee for service. I mean, they just don’t hear about it, that’s all. But they just one owner or there’s a bunch of partners, but they haven’t sold out anyone. They may as their final cash out, I don’t know. But in general, no. There’s a lot of people who are non dentists, MBAs or whatever it is and they’ve got together with dentists. And yeah, the new model is to buy a lot of offices and, and just grow them and then sell to venture capital and cash out and people do. That’s fine, you know, that’s a way to retire at 50 or 45 or whatever it is. And it’s excellent. And if you can still keep the quality of dentistry, you just have to find the right model and stuff like that. Yeah.
[01:12:09] Let’s, let’s get to the things. What was your biggest mistake that you’ve made now? Now I do want both business and clinical. Does that make the biggest some some mistakes? I mean.
[01:12:21] It’s not a mistake, obviously. I wish I became an owner sooner. That would have been the best thing I ever did. But there was an opportunity but to do that mistake wise when I was an associate, like I said. Back then they would just say like some treatment coordinator does, they start the case straightaway. So a couple of times this happened and I would get random like message from office manager, especially one case in particular. I did a full upper arch decay everywhere and I finished it. But the patient at the end, there was a lot of recession in the case after a while and so she started seeing it was a Coptic case, I believe back then I was using Coptic.
[01:12:56] She started seeing this gold and black hue around the gum line or whatever. It wasn’t my fault. Patient didn’t care. Take care of the teeth. But you know, I started getting letter from the board for case review and this and that was like, you know, I need to handle this. I haven’t done anything wrong, but I don’t care about the money, you know, like, let me let me have her sign a non-disclosure or whatever, and just give her back the money, whatever it was. I don’t care. But make sure she signed this paperwork and she did, luckily. And I just refunded everything. And she, you know, she probably did it on purpose. In my case was fine. It wasn’t a big deal, but I didn’t want to deal with that as an associate. What I realised as I work more and more, the patient is unhappy. I can’t make them happy unless it’s something for something psychological. You know, I might have missed it that beginning and sometimes a certain case you shouldn’t take on, even if especially when they say to other dentists through other dentists they can’t help me. And, and those are the cases I’m talking about. And when I was young, oh I can do it, I’ll do it. Yeah. You know, and then and then you’re stuck with them, especially like denture cases or like no one wants to pay the teeth out. And I did it and oh, I’m in so much pain now. I need all these drugs. I’m like, I just took out your teeth and your denture is going to be sore. It looks fine, but now you’re the one that they’re blaming, you know? So I would say mainly I haven’t gotten a lot of trouble, but there are some instances cosmetically as an associate where, yes, it could have it could have become something more like, okay, we want to actually go further by just refunded them, you know.
[01:14:21] Other than this sort of spidey sense that you’re sort of talking about of I guess I guess we call that experience one.
[01:14:26] There’s one thing.
[01:14:27] Yeah. Yeah.
[01:14:28] But I mean, obviously, back as an associate, I had to rely on assistants to do some of the auxiliary work, which nowadays I do everything myself. She took off a temporary on number 31, the second molar, and she tried in the gold crown to take a bite. And I was in the other room. And the next thing I know is there was a crown. I always followed it. I’m like, Oh, okay. The guy said, Yeah, I swallowed it. I’m like, No, man, you have to go to the hospital right now. You know, it’s not it’s not coming out. There’s a possibility it could be stuck somewhere in your lung or whatever it was. So but they didn’t go all the way in. And so I didn’t have to do surgery. But luckily I told office manager, hey, whatever it is, I’ll pay for it. I don’t care. They were kind of blowing it off. I was like, No, they need to go now and I’ll take care of whatever it is. And they were able to get it out without anything invasive, but that could have become something. So what I notice is when you’re an associate, sometimes the manager, the doctor’s not on site, you have to just kind of make the call. But ultimately it’s your licence on the line. End of the day, your assistant, your front office, whatever.
[01:15:31] Nothing’s going to happen to them. You know nothing. You are still the one that’s liable. So you have to make sure that you really. That’s why I don’t see multiple chairs anyway. But I make all my own temporaries. I spend the time and do all this kind of stuff. I want to make sure that patient knows that I they’re paying me for a premium like I’m going to take care of, start to finish everything that you need. And if there’s a mistake, it’s my fault. No one else’s. Yeah, yeah. But yeah, the docs. The darkest day, though, was nothing to do dentistry in terms of clinical. When I was an associate, I used to work six, seven days a week initially to pay off these loans, and I was working in random places. I didn’t want to work, but I had to. And one day I was doing a little hygiene. I woke up and I couldn’t move my neck. I couldn’t move my arm. Oh yeah. I had severe impingement of C five, six or whatever it was. I had brachial plexus pain. I went to neurologist, chiropractor. It was a bad idea. It was a chiropractor and I was out for that year. I was out six, seven months. I really thought I couldn’t work. No. I was like, I’ve got to figure out something.
[01:16:31] I had loans. I just bought a brand new car. Was like the first car I ever bought back in zero eight. And I was like, Crap, what do I do? Do I go to auto school because I don’t know if I can pick up a handpiece? I was literally I couldn’t move anything and I was under a lot of stress back then too from other things. What happened was I took time to take that year off in a way that that year I saved by finishing dental school, one year, early undergrad one year. I kind of lost it there, but it doesn’t matter. And then I found a practise that I liked. It was slow practise, it was a private practise. And that’s where I met my office manager that she works for me now. Eventually, you know, he sold that practise and it gave me time to work in a real practise on my own. I was the only doctor there, so it felt like I owned it, but I was just the associate. But I didn’t make that much money. But I was able to take the class that I wanted and rehabilitate myself. And that was a turning point where I was like, Crap, I could be disabled. Like, what does that feel like? I can’t do anything.
[01:17:27] And, you know, interestingly, often the worst moment in your life actually brings out something, you know, you wouldn’t have met that office manager. There’s many things you might not have done. Yeah, no, no.
[01:17:37] But now, looking back, yeah, it happened the way it happened because that’s what I needed.
[01:17:41] You know? But. But, but I can understand. I mean, I’ve woken up with a bad nick.
[01:17:47] Sometimes it’s bad, but.
[01:17:49] Six months, a year of it.
[01:17:50] I mean, I couldn’t because I try to work and it just bend in my neck. I could I couldn’t see anything.
[01:17:55] How did you fix it? Did you have to have an operation or something?
[01:17:57] No, I went I went to the the I went to all these different doctors and there’s a family friend, neurologist I finally went to. And by that time it was like four or five months I was going to a chiropractor. And there’s different levels of chiropractor. This one was maybe it wasn’t. Maybe it was like going to a very bad dentist, like they actually made it worse. And now I don’t go to chiropractors now, but if I really needed to, there’s one person I found is physical therapy, is what is needed in conjunction with a chiropractor and a good one. But just like a bad dentist can perforate a canal, you can not have bandanas. But. But if they’re really doing it all the time, right, like that, they can have certain chiropractors that just doing stuff and collecting money. They’re not really helping you. And I notice I was feeling worse. But anyway, no, I went to everyone and then I just found a good physical therapist. I it’s because of dentistry. I was hunched over a lot, even with loops. I’m very tall. I’m like six two, six three. I was working in clinics that weren’t fit to me. So my office now every single chair and item is built to me like special, like certain chairs that I like, certain ergonomics that I like. And when you work for someone else, you can’t do that. So I was it wasn’t my it’s almost like when you’re a dentist, it’s your operating room, you know, it’s your it’s your canvas. And you should be able to paint and, and work how you see fit. But you really can’t do that unless it’s your own. So that, that realised like I need to get my own thing, you know, this is, this is not good. So.
[01:19:19] So you’ve got, you’ve got. I see behind you the London Underground and the map, and you’ve got the Wimbledon Championships logo and thing. What do you miss about the UK?
[01:19:33] I get that question a lot. I think it’s my childhood, really, because when I when I go, I go back every 4 to 5 years and I notice when I go back now I feel like a tourist, you know? But I just miss I think I miss my memories of growing up. And I think I was mentioning earlier, I just watched Doctor Strange recently the multiverse. And sometimes I think like what if I actually didn’t come to America when I was 18 and I actually went to university in London, what would I become? Would I become a pharmacist or a dentist? And if I did, where would I have lived? I know where I would have been and where I always envisioned I always envisioned myself having a nice house in Wimbledon Village next to the championships, up off the road, you know, having if I had, you know, having friends and family around that area, my friends I grew up with, that’s what I envisioned when I was younger. But, you know, it might still happen in the future if I decide as possible one day.
[01:20:25] But no, but but as a comparison of of life, life there and life here, what is it about here that’s better than there?
[01:20:32] I think socially it’s nicer in England because people aren’t so far away here. I have a lot of friends from undergrad and dental school, no high school friends obviously, because they’re all in England, but people live far away. And when you go to university here, people could be from New York, but they come to new university in LA, people, you know. So I might talk to them on the phone, but like I’m going to New York end of this month for a week. I haven’t seen my old college roommates for about 15 years together as one, so we’re all going to be there for a week, but it doesn’t really happen. You know, everyone’s in their own lives. So I would say socially I miss like just and also the city of London. I love London. I love New York. I’m a city person.
[01:21:09] City guy.
[01:21:10] I am. But you have to make sacrifice career wise. I’m very happy with my career in Sacramento. Like I love my patient base here. I wouldn’t I probably wouldn’t function as well in a in a city practise the way I like to work in the clientele I want to see. But it doesn’t mean I can’t get on a plane and go somewhere, which I used to do that quite a bit. But because of COVID, I can’t stop doing all that. But yeah.
[01:21:33] And and I noticed you said you mentioned squash. Yeah. You played a really high level, right?
[01:21:38] Yeah. So, you know, back when I was younger, I don’t know what it’s what was it like in your cultural, cultural family? But it was always like, come studies come first and all this kind of stuff. And my parents had a shop. They always say, you know, this is just for fun. Like if you don’t study, you’re going to end up in a shop. You don’t want to do that or whatever it is. We’re doing all this work so you can go to the best school and you can become something because we ain’t doing this for nothing, you know? So I felt this pressure. I’m the oldest in the family. I always felt this pressure I’ve got. I’ve got to do something. I mean, obviously, in hindsight, I wish I had opportunity to to at least take a year or two out and try to play on the professional circuit and then go to dental school or university. But that’s not what happened, which is fine. But yeah, I love squash. I played it for Surrey, you know. And then when I came to America, I thought it was done. I didn’t think they had squash shoe in the first in two years, three years. I didn’t play anything because I was in Stockton once I moved to dental school in San Francisco. They actually have a very big squash community in the Bay Area. So I got back involved and yeah, I do play regularly. I actually got injured last year, so I’ve been dealing with that.
[01:22:41] But you talk about sliding doors, right? And if let’s imagine if your parents had moved or got their green card three years earlier and you’d moved when you were 15. Yeah. And you could have maybe got a scholarship into dental school, you know, and actually and actually done squash, you know, like squash to a higher level. I mean, life is so strange like that. It’s all the water. Yeah, we have amazing.
[01:23:08] I mean, it’s fine. You know, I got to play like now as I became a dentist, I got to on my own terms, you know, I played like a little bit satellite professional tournament. So local amateur tournament is fine. It’s just it’s nice when you’re younger to have the energy, right? That’s all, of course.
[01:23:24] How old are you now? 42. 43, 41, 41.
[01:23:26] Sorry. Yeah.
[01:23:31] That was close.
[01:23:32] In my head. And I was, I was like 39 and then suddenly I turned 40. So it’s cool right now. I don’t like the sporty sound, but it’s okay now.
[01:23:41] We’ve come, we’ve come to the end of our time. So I’m going to finish it with our usual questions. Let’s let’s start with the fantasy dinner party.
[01:23:50] Three guests, dead or.
[01:23:52] Alive, who do you have?
[01:23:54] So I’m a I’m a big fan of Roger Federer. I would love to have Roger Federer one on one. I really feel like I get along quite well with him. Dennis Bergkamp I’m a big Arsenal fan, but from the old days, like Bergkamp these both these guys are professional, but also they seem like a lot of fun. And I’m going to I’m going to say Michael Schumacher, but if not him, this is more of a spiritual thing. Now, I’m Hindu, so I would I would like to meet Lord SAMINI and or Lord Krishna in person, but that’s more of a spiritual thing. But yeah, that would be good.
[01:24:27] You can have that dinner party if you want that dinner party ready. Yeah. And what about. Perhaps. Final question. I know he’s not here, but that’s bad. I’m sorry to. To bring you down. Your nearest and dearest around you. Three pieces of advice for them. For the world.
[01:24:47] I say. If you wait until later. You’re going to be waiting forever. Take risks and follow all your dreams, especially when you’re younger. You have so much time to to make mistakes. And also mistakes on mistakes that you learn from those experiences are actually, you know, good, good things within reason. I think happiness comes from what. You do so living and making memories of people that you love leave a legacy based on relationships, not just wealth, and be present. I think especially during COVID, I realise like I can’t see people, this is I mean, all this stuff you can do on your own, there’s nothing you can really do that much you and you need people to, to share things with, you know. And then the main one for me personally, this is more like what I’m really like the power of discipline, work ethic and consistency. I think the ingredients of success and luck is when preparation meets opportunity. That’s why I really like Federer and Bergkamp and Schumacher. I really feel like, you know, they really embody these things. And and that’s why I would say.
[01:25:53] Like there are like all three of those very much alike. All three of those very much. But yeah, to younger colleagues, it’s amazing the number of younger people who listen to this show. I keep getting, getting, getting told. Dental students and other younger colleagues take risks early, for sure. For sure. You know, you’re absolutely right about about that. And the other two things, very, very nice.
[01:26:16] Let me ask you a question. Yeah. If you could go back in time to any period, where would you like to go?
[01:26:22] I got asked this question, like if it’s a fly on the wall story. Yeah, I would. I wouldn’t mind being there when whoever decided to. To assassinate.
[01:26:31] Kennedy. Oh, really?
[01:26:34] But. But. But if it’s not a war, then dinosaur, you know that that moment when. When the dinosaurs became extinct.
[01:26:45] The earth and and and, you know, you know what? Not all animals became extinct. The dinosaurs did. I’d love to see that moment. What about you?
[01:26:56] I’d like to go to the Egyptian era. I want to know how the pyramids were built, you know.
[01:27:01] Have you seen the pyramids?
[01:27:03] I’m going to sound like a Philistine now, dude. When. When I. When I went to see the pyramids in Cairo. But, like, you know, they’re not that great.
[01:27:10] In all their glory. It seems like it’s just the architectural or even Roman time, one or the other. I just. Gladiator. It’s gladiatorial. Just that. The whole civilisation either or. I just like architecture, you know, and.
[01:27:24] The different time periods. I mean, it’s just something where you, you study a lot of it. I mean, especially in England, you know, I had to learn Latin and all that kind of stuff. So I don’t remember any of it anymore, but be nice to actually live it at school. I went to Hampton School in New Hampshire. Hampton Court Palace.
[01:27:40] Oh, nice.
[01:27:41] Took the I took the Southwest train pass Kingston and they took the 111 bus. I mean.
[01:27:49] It’s a massive pleasure to have you, buddy. I really, really enjoyed that. Thank you so much for being so open and giving us an insight into your life over there. And please stay in touch.
[01:27:59] But I will. Thank you.
[01:28:00] Thank you. Amazing.
[01:28:04] This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts Payman, Langroudi and Prav. Solanki.
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