Alfonso Rao has never let the lack of a big plan get in the way of success. He’s the owner of a succsesful chain of clinics and Delta training academy—one of the UK’s leading implant training facilities.
Alfonso sits down for a chat with Prav about moving to the UK from his native Italy, his journey from associate to entrepreneur and how he is passing on his family’s medical heritage to the next generation.
In This Episode
01.00 – Background
06.33 – Coming to the UK
13.03 – First jobs
21.34 – Practice purchase and growth
31.43 – Teaching and Delta Academy
41.19 – Teaching Vs dentistry
44.42 – Children, family life and fatherhood
51.25 – Definition of success
55.08 – State of the profession
59.02 – Blackbox thinking
01.03.59 – Last days and legacy
About Alfonso Rao
Alfonso graduated from the University of Chieti in Italy in 2007 and moved to the UK in 2009, where he took up associate positions in London and Lincoln.
He is the owner of the Queens Square group of dental practices and Delta Academy, a leading centre of excellence for implantology and restorative training.
[00:00:00] There is almost like each practice as go. A story. A story is not been something where we’ve done try to approach. Even one of the last one in wings or we bought through common friends with the previous owner. So we often find that our way of getting contact with the practice owner is through recommendation word of mouth. So we’re going back to what we were discussing at the beginning is the personal relationship that creates that strong bond that probably for people that are like minded, the mind is more important than £20,000 more.
[00:00:42] 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.
[00:01:00] So Alfonzo, just to introduce yourself and tell us about your upbringing, where you grew up and what your childhood was like.
[00:01:07] So my name is Alphonso and I’m a dentist in Bristol, althought I’ve got other practice. I was in Bakersfield Windsurf and different partners and different rangers. I’m also the co-founder of Delta Dental Academy. That is a teaching academy that is based in Bristol, but we run courses also from other parts of the UK. So going back to your question, I grew up in Italy in Caserta. That is a town about ten miles from Naples. I’m the only child and both my parents were working. My dad is a doctor. He’s an eye surgeon. And my mom, she was a teacher. She just retired a couple of years ago. So I had really, I would say, an happy childhood growing up with all my cousins and with the family around. And I always knew that I want to do medical or dentistry something. I always had a passion. And one of the my vocation was for health care.
[00:02:06] And is that because of your dad? Because your father was into the medical sector eye surgeon, and was there an inspiration from his friends, colleagues, him or.
[00:02:18] I think, yeah, definitely it was I mean, it was not one of those things that, you know, he’s never done anything to force me or to to try to push for one in the direction. I mean, all of my family, there are a lot of doctors and medical in the family. So probably was what I saw almost as normal. I think I was telling earlier that like I go for tuna. My daughter, she was with us a couple of weeks ago doing the surgery and we joke together and every delegate that was on that day, they were shocked because then I was playing a video where I was doing implant surgery, so there was blood and Fortuna was just watching and say, Are you not going to screw?
[00:02:58] And she’s she’s eight years old. She’s six, six, six years.
[00:03:01] I think it’s just one of those things that, you know, I’m not doing anything to influenza, but she’s coming in my office in a while. I’m preparing a presentation or I’m editing a video. She obviously sees me doing those things and she just probably wants to spend time with her dad and start. Question And she’s interested. She’s at that age where she’s asking questions about everything without doing anything to influence. But you often have got your parents as role model. And if you see what they are doing and you you like what you’ll see, I think that probably become an an unconscious influence that then when you are in the stage where you need to make the decision of what you want to do, become okay, I know that I’m quite shocked of that. I often see that people, they, they either hate the parents of doing because they might have seen the stress or the negative aspect or whatever or they can be quite shocked. And in my case, I think I was attacked, but I wouldn’t say that was done anything from their side to push me in that direction.
[00:04:04] And as the only child growing up, you mentioned you were with your cousins and this and that. So was it like quite a big family network that you had where where you didn’t feel you missed out because you didn’t have brothers or sisters because your cousins were your extended family anyway?
[00:04:22] Yeah, correct. So then for me, you know, like I always felt that I had the best of both the world because I had like kind of like a brother said, then you can return in the evening.
[00:04:32] So, you know, having fun.
[00:04:34] We were playing together, but then in the moment they were start to fight with each other. Everyone was going back to his old man and was fine. And we’ve kept a really close relationship, especially. I mean, I’ve got a lot of cursing, but I’m really close roughly. I mean, I grew up with my mum’s brother, family close, so we were both living close to my grandmother and they are three. So we basically grew up, all four of us. We were every afternoon my grandmother was kind of picking up us from school and we stayed all the afternoon together and then I’ve got probably another seven or eight girls in the Caserta is a relatively small place, so we were kind of seeing almost each other every day playing football, especially, you know, about 13, 14 years old, really nice. The things, for example, when you grow up in Italy, I think we were speaking about that earlier about like the public school is that you grow up in an environment where you’ve got really huge variety of personality, social classes all together. But I felt that that was really beneficial for me because I really feel that I’ve learned to deal with all sorts of people, and I think it’s something that I quite enjoyed at the time. And I’m still. Good friend with a lot of my friends from schools that they’ve done completely different careers. So there is someone then they’ve got their own shop. There are people that they are successful solicitors, but there are people that are really humble and they might even work in a farm. And, you know, like I think it’s nice, we all we grew up together, so we respect each other and really what we’re doing or the amount of money that we’re making doesn’t really make any difference. And when we manage to catch up, usually once a year when we’re all back home for Christmas, we still have a really nice time together.
[00:06:33] It’s lovely. And then sort of growing up. So you’re talking about around 13, 14, you know, with your cousins and your friends and all the rest of it. So just in terms of your education, how far did you take it in Italy before coming to the UK?
[00:06:50] So I graduated in Italy, so I did the high school up to 18 in my own town, and then I did university in Katy Pescara that is about 3 hours away. And that was already quite big things because in Italy again, often people tend to do university in the city where they grow up as long as there is university close by. So I think that out of all my school group, I think was probably three out of 30 that we went somewhere else to do the university. But that also was really valuable experience. When you’re when you leave home at 18 and you learn how to survive, manage yourself, you know, you can do all those things. So that is also been a really positive and important experience I think for my development. And then I moved to UK one year after. So after they graduated I worked in Italy for a bit and then I moved to UK when I was 24. So I got really young. I was the youngest of my year so I got it kind of two years earlier than the average.
[00:07:59] And moving from Italy to the UK, just in terms of the difference in the dental system and all of that, did you have first of all, do you have any exams or anything to transfer or.
[00:08:12] It was the only time that I actually at the time was an English exam, so it was like kind of language proficiency exam. But I did the University of Bath and it was a specific sermon on dental, and that was relatively easy at the time because obviously, especially a lot of the dental worlds, they are similar anyway. Yes. And then I had to do all the GDC application with the CPD, good standing and things like that. But the system obviously is completely different because in Italy it’s all private. And I remember when I first moved here was really difficult for me to understand the NHS, how they work, the UDA and all that aspect. But yeah, it was quite steep learning curve because we moved first to London really to improve the English and to finalise all my applications. But then my first job was in Lincoln, so I went from living in Rome, London to Lincoln.
[00:09:09] And what was the what was the difference in culture like for you? So you go from Rome to London. Was it was there a big difference in culture for you?
[00:09:19] I mean, you know, probably at that time was as my English was not great I that in London probably they were more Italian than in Rome.
[00:09:29] So I was.
[00:09:30] Not speaking in Italian, probably more than I used to speak at home. I mean, obviously London was completely different in terms of size of the city, cost of living and everything compared to Italy and completely different lifestyle. But London was still obviously a big city where everything was open at every time. I then for me, moving to Lincoln was really the biggest shock because, you know, in Italy we used to go out for dinner at nine, 10:00, especially in the south in Naples, where I come from, because otherwise it’s too hot. And in Lincoln, I remember that at 5:00 all the shops were closed and most of the kitchen, and after 8:00, probably they were not serving any food. So for me, like 8:00 was not even the time of an aperitif at that time. You know, going out and don’t be able to get anything at the beginning was a bit strange. But then obviously Lincoln was the opposite than London because there was no one else speaking Italian I think was just me and the bottle that we were Italian in there. So then I had to learn and practice English, which was kind of one of the main reasons, also because we moved there.
[00:10:37] So when you moved from to the UK, where was your first dental job? Was it?
[00:10:43] Lincoln was my first dental job.
[00:10:45] So when you were in London, what were you doing? Just finding your feet.
[00:10:48] Yeah, yeah, it was finding the feet and studying English. Because when I moved to UK. Again, I had to obviously see to that exam, but my first class was like a beginner. I was not really able to speak English. And as you can see, after 12 years, I still not improved as instructor. I still have the need for every word that I’m saying with my Italian accent. And at the moment, I’m sitting on my hands, don’t move the hand. And no, but leave that aside. Yeah, it was really an experience. I mean, I’ve never had like a gap year and as I mentioned earlier, I qualified really early. So I quite enjoy to say, okay, I’m going to have a three or four months of break, I’m going to study English, but I’m also going to just take a bit of time off for myself as well. And that was useful.
[00:11:36] And you moved here? We were already married before you came to the.
[00:11:39] No, I move. I moved with the genes that it obviously is now my wife, but at the time was my girlfriend and she was the one that really wanted to move to UK. So we’ve met in Italy and we were, we stayed together one year before move together to UK and she always was really keen to do postgraduate education in UK. She really liked the idea of a university here in the UK and that was kind of the drive that really took us to. To relocate. To relocate. Yeah.
[00:12:11] So then you moved to Lincoln?
[00:12:14] Yeah, Lincoln. And then after Lincoln, she then basically also shattered to get the eias. So the English test, that is a lot more difficult, especially if you want to do to some of the most prestigious university. They tend to have quite high rank. And so she hated the the states she passed. So she was studying in Lincoln. And then she got what we said at the time and said, look, if you want to apply for university, try to apply to a city, wherever. I also can get a job and as a city where we can stay at least for four or five years. And then she applied Leeds, Lincoln, but York and London. And I think she got the offer from Leeds, York and Bristol. And then we decided to stay in Bristol as there was one with the the closest airport to Naples.
[00:13:03] So when you first came to this country, you were just figuring life out as a couple, getting to grips with English. Yeah. Willing to take any job that life threw at you because, you know, you think, oh, well, I’ll take a job in Lincoln. Fine, we’ll go to Bristol now. Follow where my wife wants to go, that sort of thing. But there was no there was no inkling or thought of building this empire that you have now. Was that ever in your sights? Was it just about I just want to get a job as a dentist and be able to speak English to my patients. What was going through your mind then?
[00:13:36] Afonso Yeah, I mean, I’ve always kind of no, I’m not a type of person, but like a long term plan. I always like to live my life thinking about what I feel that is the right thing to do and what make me happy at the time and obviously within respect of my family, my value in all those things. So even like when at the moment I think we were chatting last time about how do you decide what you want to buy a practice or not? I still strongly believe on my vibe. So when we’re going to say a place, if I like the practice, if I like the team and I feel that is a team that I want to work together, then I might consider if there are the right conditions then to buy as well. So it’s never been kind of something planned on the offset to say, okay, my five year plan is this, I want to achieve that by the age I’ve always lived life based on what life was throwing me and and try to do the best in every occasion.
[00:14:33] So what was your first job like in Lincoln?
[00:14:37] So basically what happened is.
[00:14:41] I remember that.
[00:14:42] I was with one of these recruitment agencies and they said, look, we’ve got this perfect job for you is really, really nice practice. And I didn’t know anything because I didn’t have any opportunity to compare. So I’ve got this couple that they had. This practice was actually not even in Lincoln, was in Louth. That is a small town outside Lincoln. And I remember that mean at that time I didn’t have any money and I was like, try to look how to save money living in London, that is expensive. And I remember they sent me to pick me up in London with a mercedes to take me to Lincoln for this job interview. So they took me and my wife there, really nice hotel. They took us for dinner and was a lovely couple. And, and I really didn’t thought much about the fact that they didn’t show me the practice.
[00:15:34] So I signed the contract.
[00:15:36] I had this conversation with them about all those things. We don’t even see the practice.
[00:15:40] But you were blown away by the Mercedes and the fancy.
[00:15:43] Like, you know, look like that is.
[00:15:45] Really they really want me there. They really look after me. So I felt important at the time. And then when I went in there and that was like another fun experience because by then we bought a cat.
[00:15:58] A cat, a cat.
[00:15:59] So, well, this cat is really and we went in there and the estate agent because they use an agency to arrange all our move, they forgot to say to the landlord that we had the cat. So we arrived in this house and they said, No, you cannot get in with the cat. So he had the man with the van.
[00:16:19] In the.
[00:16:19] Car park. We don’t have luggage. We changed my life crying with this cat because she didn’t want to give this cat away. And that was like my first day in Lincoln. And then I remember that the landlord actually then was there, worked, and he then started to speak to us and he said, You know what, I’m fine. I have the cat anyway. So we kept the cat.
[00:16:41] On the day he said that. Yeah, yeah, yeah.
[00:16:43] After 5 hours in this car park and we try to finding another place in Lincoln where the cat was allowed.
[00:16:50] And chinchilla crying.
[00:16:52] She’s crying on the other corner.
[00:16:53] I don’t want to be here with other cats. So.
[00:16:57] And then what was it? An NHS job.
[00:16:59] Was an NHS job. So basically when I went there the first time, I didn’t really understood like the NHS system and I remember that I went in there and there was no dentists allowed or there was no any other is there for many years. So my first day I think I had like 40 patients booked and they didn’t really understand the UDA and everything. So I didn’t last long because there were other issues as well. So coming from a really high end, nice private practice in Italy, Naples and Rome, where I used to work, I was not too impressed with some of the level of the, let’s say, decontamination cross infection control. As I remember that surgery. And at the time they had like the autoclave, which was one of these old autoclave in the rooms. In the while you were trying to speak with the patient, the autoclave was tough to steam out. Pain was, you know, the nurse was never been a dental nurse was someone round up. So it was a it was a bit different than what I thought. So it was a little bit of a shock at that time. I say, look what I’m doing in Louth in this in this condition. But then I found another practice in Lincoln that was a really nice practice. And I remember that there was the other associates that working in there. They were really nice and kind to us a bit older. There was there were an Indian couple, Kapil and Becky, and they really helped us to settle in Bristol. They helped me to guide my career. You know, we were discussing about postgraduate, so they really inspired me to try to improve and do better and better. And also I’m not in touch with them as much as I would like. I still got really nice memory of all the help that we had from there.
[00:18:47] And so your first job in Bristol, where was it?
[00:18:50] First job in Bristol was a mixed practice not far from where we had dinner yesterday. So Gloucester Road, Home Field, really nice practice. There are quite a lot of funny stories about that practice as well because there were three expense sharers and that was working for associate of one of these expense sharing and they had argument between them and I turned up to work one day and Nadia actually she probably remembers that. And the night one of the partners, he removed the dental chair in the surgery.
[00:19:23] So I went to work. It was an empty room with nothing.
[00:19:28] In that and I think we had a patient booked and then I think it was the time that it was also staff. Placing implant implant kit away so that Nadya at the time, she led me one of this trauma kit alone. And then we’ve placed the implant on that week and then obviously they got things sorted between them. But yet there are quite a few funny stories about the practice as well. But again, was another really a good learning experience because it was a mixed practice. The target of patient in Bristol, really different than the type of patient in Lincoln. So that was also something that really helped me to understand a lot more or of the patient management, probably more than anything else.
[00:20:09] And so moving on from there, what was your next what was your next move from that practice.
[00:20:15] To at that point? I I’ve kind of I’ve lost faith in the NHS. So one of the things is when I moved to UK at the beginning, I really liked the concept of, you know, like the NHS healthcare for everyone, whether needs. But then I realised that there were a lot of things in the system that were not really allow me at least to perform high end dentistry within that system. So then I’ve quit the job without even having another job. And then I started to work as a visiting implant ologist placing implant for Jim’s heart. At the time, he was still the owner of Jim Sally’s group. So they also helped me quite a lot to try to get into the implant world. And then one of my friends, Joe, that is the orthodontist, that is my business partner as well. He was working in Green Square and unfortunately the previous owner, he went off sick and they needed someone to try to cover almost as quick as possible. And because I could get a job, I was free. So then that is how I started in Green Square. And then the previous owner then decided to take longer time off and offer me to to buy the practice.
[00:21:34] Knew owning Queen Square was a complete sort of mash together of consequences. It wasn’t a plan right at that point. You’d left that job and in your mind you didn’t think, right now I want to go and open my own practice? No, no. You went and took this job as a almost like a part time locum cover for someone who’s ill.
[00:21:56] And then as you were covering, the guy had sent a message to you. I’ll let you know that. Do you want to buy it? Is that right? He approached you. Do you want to buy it? And at this point, did you think, well, I’m not a business owner, I haven’t owned a business before. You just shrugged your shoulders like you do with most things and say, Why not?
[00:22:14] Yeah, exactly. So as you can see, like the theme from everything you were saying is that there is nothing that has been planned. You know, I went to Lincoln because they sent me a cup to pick me up and then they left the job because I felt it was not the right things for me to stay there and in the same way about the practice. So yeah, it was really kind of why not? So I often like, I think about like, why not?
[00:22:37] Could you afford to buy the practice?
[00:22:39] That was tough. But I have to say that at the time the bank was really supportive. I had a an existing relationship with the bank manager, and I think that they were seeing that as an associate. I was doing quite well and they were quite relaxed because I was already in the practice. So that was one of the criteria at the time that they felt a lot more relaxed because it was kind of a smooth transaction from their side. And the other thing is that when I bought Queen Square, the practice was obviously not what it is at the moment. So it was only two surgery was only open three days a week. So that was a squat with the previous owner set up like four or five years before. So it was never really been pushed to the full potential as yet. Also the practice so was relatively affordable obviously with the support with the support of the bank.
[00:23:35] And what was the deal back then was was it is it a leasehold building freehold.
[00:23:40] So was really a good deal that I did again another unconsciously again like you know one of those things because was a leaseholder but it was owning the freehold as well and we’ve managed to agree a first refusal of the freehold. So then a few years later, then we decided to sell the freehold and I had the first refusal on the job. So then I was able to buy the field as well. But that worked well for me because I wouldn’t have been able to afford the freehold at the beginning. So I was only able to just with Stretch and with the support of the bank, just to get enough to get that goodwill. That was not really a lot, a lot at a time.
[00:24:21] So had you been offered the freehold back then, someone else would have become your landlord and you probably wouldn’t have had the opportunity to get it right.
[00:24:28] Right? Yeah, probably.
[00:24:29] It’s funny how these things work out, right. In terms of. I mean. Yeah, stuff. So it was a couple of surgeries. Did you like build it out into more surgeries at that point? We renting the whole building and oh, did you expand up and take more of the building to build more surgeries?
[00:24:46] So basically what was happening is that we were only on the ground floor, first floor, and then there were offices upstairs that he was renting to other businesses. Sure. And then when there was the opportunity to buy the freehold, which was like I think three years later, the turnover of the practice was already triple what was when I bought. So then we were in a much stronger position. So then that was the time where then I bought the freehold and then expanded and the surgery and the teaching centre were Delta started at the beginning on, on, on that top floor.
[00:25:21] And so initially from you taking over three years time tripled the turnover. And where did that tripling of turnover come? Was it from purely from your own hands or or an associate led initiative.
[00:25:34] Was mainly my own hands. However, I already had that kind of a vision at the time, which was one of the first leaders in this area of the multi specialist approach. And again, I think, you know, been doing more postgraduate education in the meantime, the Eastman or other international courses, I’ve seen a lot of other successful dental business practice offices that they were working with that multidisciplinary approach. And I strongly believe that if you want to do something at the best of your ability, you often need to focus just in one sector and try to do as good as you can. So that was one of the first practice that was run almost as a multi specialist approach. So we were having different specialists or people with special interests coming to the practice and working. And that was difficult because everyone at the beginning I remember said that was a concept that could work in London but cannot work in Bristol because the people in Bristol, they want to see the same dentist that does their end and then does their crown and then does their implant. And then that’s the barrier. But then I remember that, you know, explaining to people the benefit of that type of approach to that. A lot of patients, they really bought in that concept and they were seeing that we were able to offer a better quality of care than some other practice where there was one associate try to do a bit of everything and I think that really helped a lot growing because if you remember the first few years we’ve never had any marketing agency, we were not doing anything was really word of mouth the way the practice was growing.
[00:27:18] But when you’ve got a practice, you start it off essentially as a as a small squat, right? Like how do you how do you go from that to attracting the group of specialists to then deliver that higher level of service? If you don’t have the patients to serve them, you might like you’ve got one, probably one of the world’s most experienced and sought after end dentists, right, working at Queen’s Square. Massimo Right. And how do you attract someone like him when you don’t have a line full of.
[00:27:51] The secret is get them for dinner and get them drunk.
[00:27:55] And take them to dinner in a mercedes.
[00:27:56] Yeah, I think now I think again, like I said, that I’ve always been quite persuasive in terms of I don’t like to have a promise and I think that I’ve got the reputation over the years that if I had a vision and I worked out, then ultimately that worked and it worked in the best interest of everyone. I always try to be extremely fair with all my associates and really understand from their side what they like, what they want. And I always try to don’t limit their growth or expansion. And I often find that every person is different, that there are people that they like to just get the 95 job. There are people they might want to feel that they are part of the decision making. There are people that they might want shares. So I think it’s really there is no one set approach that works for everyone. But I find that probably the personal relationship that was the motivation at the beginning to create that. And then as we’ve thankfully been successful with a few projects like that, I think now is a lot easier for other people to believe that I’ve done that over a few times and we hopefully can try to do this again with some of these new practices as well.
[00:29:19] Sure. And so you grew Queen Square and that was the first practice, right? And then you started doing some direct to consumer marketing, growing the practice and. From there. When when did the vision come that you were going to have practice number two, three, four or five? How did that all come about? So what was practice number two?
[00:29:41] So finally, number two was this one so High Street Dental Clinic, and again was another one that, as always, I didn’t really thought about. So basically what’s happened is that the previous owner of this practice, one day they’ve just turned up in Green Square and they say yoga, go practice close by. Would you like to buy us out because we want to retire? And I thought, okay, you know, I mean, do I really want to practice close by? But then at that time, I was also thinking there were not many practices in the city centre of breeze. And for me, buying the second practice relatively close was also from a strategic point of view, an opportunity to stop some competitors to come. And I felt that obviously the two different practices had different strengths and probably also different target of patients. So I didn’t really feel that there was something where it was in conflict but was more like complementary. So I guess why not that one? And then number three is up and in a similar way that an agent approached me and said, I’ve seen that you bought to practice in Bristol. I’ve got the practice in Portishead. And at that time, me and Joe, we were discussing the idea of potentially opening a practice together. So again, we said, why not? And we bought the practice in Portishead. So there is almost like each practice as go a story. A story is not been something where we’ve done and try to approach even one of the last one in wings over we bought through common friends with the previous owner. So we often find that our way of getting contact with the practice owner is through recommendation word of mouth. So we’re going back to what we were discussing at the beginning is the personal relationship that create that strong bond that probably for people that are like minded, the mind is more important than, you know, £20,000 more.
[00:31:43] And so when did the teach in actually feature in all of this? Alfonzo You come into this country, you can barely speak a word of English. And fast forward to today. Yeah, you’re teaching Native dental students how to place implants, right? Talk me through that journey. Is that another? Why not.
[00:32:08] Another? Why not? I mean, I always had that. I always enjoyed the teaching side. So even at the university I was involved with with the oral surgery department, doing some teaching for the undergraduates.
[00:32:23] Well, how did that come about? So you came to this country, you were working in Lincoln. At what point did you get involved with the Universities University graduate?
[00:32:30] No, that was my faculty. So I always had that kind of passion. I always kind of enjoyed the teaching side and the opportunity to really learn from each other. Because I find that I think the two nice things for me with the teaching is one I often have. I have got the opportunity to audit my own work when I prepare representations or I’ll view the literature. So I find that I learn a lot, just even preparing the lecture or preparing the course. And the second is that I always find that, you know, even when people say, okay, you’re going there, you’re teaching every day, you learn from each other. So I feel blessed that I’ve got delegate. They come here and we all learn from each other because I don’t know, everyone does something slightly differently or from the other of the coming year. And I think as long you’re open minded is always nice to pick like things that people are doing slightly differently, that they can improve your daily practice. The way that is happening UK was that I did an implant course at a time and one of the the person that was in charge of the course then asked.
[00:33:35] Would you like to to work with us? Would you like to stay with us? So it, it’ll be more and in that way then I’ve been with them and then slowly start. I was more like mentoring more than teaching properly.
[00:33:49] So you were on a course and they asked you to help assist teaching on that course.
[00:33:54] Start with these things. And then I think what’s happened is that they were opening, they were increasing the number of courses. And obviously in the meantime I was doing also the diploma instrument. So they said, why you don’t work with us a little bit more? And then that is the way that it started.
[00:34:12] I think I think I remember we spoke about this around that time.
[00:34:16] Yeah, that was the time when we spoke.
[00:34:18] Only when we met. And I think if the conversation serves me right, you were like, Hey, prof, these guys are teaching. They’re getting patients in to have implants done on the, shall we say, at a discounted rate. I think it’s a good idea. Yeah. What do you think? Should. Should I give it a go? Why not?
[00:34:40] Was it again like another thing that is up and it was kind of almost. Why not? Because it was not just that, but was also that at that time. Then that was start working with trauma and I was approached by Strawman UK, although it was an HQ project and that was the time that they were running the first smart course, which was the the course that and was planning to run in a lot of different countries with the standard format coming from University of Zurich. And they asked me to be one of the pilot to do the course in UK, but then we had a terrible course in UK. It’s unlikely that is going to work because there are a lot of really well structured university course. So why someone should come to a private course? That is just a theory. So then I suggest a strawman. Great idea about why I cannot have the clinical aspect of treating the patients, which was the part that I was doing with the other provider. So I’ve kind of merged these two idea, of course, and that is how then we started. So is another thing that is often because.
[00:35:49] Strawman approach to trauma has to be at the right time.
[00:35:54] And I say, why not?
[00:35:58] And so was that when Delta was born, or is that something you just did independently with? Was that a strong and branded smart course and you stuck live patients on the end of that course? Well, how did I vote?
[00:36:10] Yes. So that at the beginning was again, was a pilot. So within the pilot, we were able to just tweak the course based on the need of the country. So the education measures trauma. At the time when I suggested the option of treating life patients, either there was great idea. So the first few smart calls, we run as a trauma branded course. So that was of course where technically was a strawman, taking the booking, taking the delegates, and I was just kind of looking after the. The running of the course more than anything else. And then when? Then Strawman decided to dismiss the course. In the meantime, me and Massimo, we were also starting to think about this concept. It was working really well of treating life patients and really show the delegates how to implement whatever is possible. We done zone with life surgery and new skills on the patients and then is something we saw was working well. Feedback from delegates was great. So then we say why not doing alone? And that is how we started us.
[00:37:17] And so Massimo, was he already working for you in Queen Square as an end? Adonis Then, was he already teaching somewhere else as well or.
[00:37:26] Yes, so Massimo was I think is Massimo has been teaching postgraduate at King’s for quite a while and he was also having a lot of other project with the style Italian or I think it was with University of Moscow, Spain. So we’ve kind of both had our own pattern of education. I mean, I was doing things for strongmen and for other companies as well. Massimo was doing his own things and we were obviously working together, but also good friends. So then we say why? We don’t join that together and start that also using our Italian connection to bring more speakers or to try to do something slightly different in terms of education, at least in Southwest.
[00:38:11] And so Delta was born. Yeah. And what were the first courses that you that you launched obviously and then didn’t take one and implant one.
[00:38:19] So we started with the implant and within the course again at that point, we basically part of the conversation with trauma was that they were happy for us to rebrand the course, which was the is how implant fundamentally started. So that was like our own version of what was the math course from from strawman with few other change. So that is, is a course that is evolved a lot over the years. So I feel that it’s getting better almost every year. So I was looking after that aspect and then Massimo started using similar setting to do the implant based course. And so in the course.
[00:39:02] And then as time has gone on, you’ve not only gone to launch your own Andela courses, but you’ve become a key opinion leader. And I see your photograph on randomly on social media that you’re doing this international lecturer or that lecture for this company and that company. How do all these opportunities come along?
[00:39:24] Again, I think it’s still a lot about relationships. So there are kind of all things that have happened randomly, relationships that I had. So for example, we guys in specific and the person that I’ve met, it’s trauma. He left trauma and then a few years later he joined Guy’s Village and we stayed in contact because we had like a few nights out in Basel when I was going to HQ to prepare. This is my of course, and then when you join guys a few years later we got in touch and say, you know, I’m head of education of guys teaching these, this, this country. Would you like to. We work together. And again, I think because when we were working with trauma and we did the two or three project together, and I think one of the the things that I’m often get as a feedback is that I’m relatively easy to work with, so I’m not too precious. I’m really committed. So if I say to you that I’m going to do something, I’m going to do it. Otherwise I rather don’t say it at all. And I find that a lot of companies, they really value that, like a non diva approach and quite proactive approach as well. So yeah, I think with a lot of companies has been building a relationship and I think it’s important also to try to get a win win situation where again myself and the company we feel that we can work together and have a mutual benefit I think is also lot about be credible. So if there is a company or if there is anyone that offered me a product that I’m happy to try, but then if I don’t like it, they know that I will not be able to talk or use that product because I will only use and will only promote a share whatever I feel is the best for myself and for my patients.
[00:41:19] And then moving on from that, like doing the dentistry, the teaching, which one’s more fun? Which one? Which one’s? Where is Alfonso? In his zone of genius. The absolutely is in his element and loves doing it. Is it the treating patients or is it the teaching?
[00:41:36] Lecturing side of things is difficult because I think like they both find each other. So I. That I would probably get both to do only one without the other. So in order for me to be able to do the teaching, I feel it is essential for me to treat the patients. And I still love dentistry. I always say that I was still happily due for free. If someone said, Look, I’m looking after all your bill, you just go there and work. I would happily do that still because I really enjoy the aspect of helping patients and to see sometimes with some of the treatment that we offer, how we can change and improve their life is really emotional and is really rewarding. But then at the same time, as I mentioned earlier, I really enjoy the teaching element. I really feel that when I’m with delegates, with I’m a dentist, and often a lot of the delegates are even people older than me. When they’re coming to the course, I really feel that I can learn and almost punch their brain and try to get things. And I think that is really stimulating because I think one of these dentistry and again obviously is not my case but can be a little bit like a lonely job. You know, you get isolated. Isolating, yeah. You can be in the room and do some sort of dentistry day in and day out. And this is often when I get that say, okay, I hate this job, but I don’t really find the motivation. I think it’s because, you know, they’ve been doing the same things all the time. They are probably fed up to be disliked by patients because let’s be honest, a lot of people don’t like to go and see the dentist, and that is just creating a pressure that I think if you are able to largely change and tweak your routine and your working life, I think that is a lot more sustainable in long term and is a lot more interesting. Yeah, of course. Of course.
[00:43:33] And so do you think you’ll always do both what you want, move over just to solely teaching later on or.
[00:43:40] I mean, I have to say that obviously, you know, he is a tough to try to get the balance because then on top of that, I’m probably also I’ve got the old the business side because with all the practice I’m in daily contact with all the different practice manager or, you know, with yourself discussing the marketing. So I’m also need to try to get that side of the business as well, which I also enjoy a lot. You do? Yeah. You like that side as well. And then obviously there is all the the family balance that is important as well. So again, I’ve got two young daughters that I want to spend time with. Why? So I need to the parents so that they are still in Italy. So I need to try to get that balance where I try to spend my free time as much as I can with the people that they love and the things that they enjoy. But then at the same time, when I’m at work, I’m not shy to work as hard as I need to be and and at the same time try to do things that I enjoy more than anything else.
[00:44:42] Tell us about the kids.
[00:44:44] Yeah, they’re great. So it’s amazing, like how different they are. So 4 to 6. And Victoria, she’s three and four two nice is really similar to her mum. So he’s a little bit more introverted, he’s a little bit more shy, but she’s really bright and she’s really, really funny. But she always takes about the first half an hour just to warm up so everyone knows that it’s cool, you know, like it’s you’ll drop out of school and the first 5 minutes she cry or you know, the teacher needs to say she has to be the special, but then as soon as she goes there, then she enjoys and she likes the other one. She’s she’s the opposite and it’s probably a lot more similar to me is a lot more extroverted, a lot more friendly. She’s completely fearless. So as we were speaking, she was definitely at the moment with my wife, they start already the holiday and I enjoy them like soon. And they were just playing in this farm with the horses and then she decided to jump on this horse without telling the horse and she’s been beaten. So my wife just sent me a photo of a bruise that she’s got lying on her leg because, you know, she was not even scared of this horse that was probably six times taller than her. And she’s always she’s the one, you know, like she’s she’s a trouble maker. Like last month, she cut her fingers. The months before, always something happened to her. Yeah, but she’s really positive, really smiling, really friendly and confident. But it is great to be able to spend time with them. And it’s amazing how you’ll see their personality development and you really realise that they grow so quickly that you want to spend time with them.
[00:46:29] Yeah, so quickly. I remember, you know, it only seems like yesterday that Fortuna was born, right? How have you changed since becoming a father? So you can pay yourself like six, seven years ago before for. Sheena was born. And then what? What changed for you? Can you remember? Can you remember the day she was born?
[00:46:49] Yeah. Really? What? I remember the time. One thing I have to say is that go memory. That is not extremely useful. But I remember everything. I remember how I was dressed a patient ten years ago. Like all of my staff is amazed now without reading a note. You know, I said, I remember when I saw you ten years ago. You are going on holiday to Canada. How was it? And the patient looked at me and said, This is a bit spooky.
[00:47:15] I really don’t remember going at all.
[00:47:20] I remember everything. But obviously something like the day that your first child is born is obviously unforgettable. I would say that is really the biggest change, at least for me, has been the big changes in life. You know, getting married is great, but we are living together for many years. So that was not really you choose a lot of then, you know like obviously have to have another person in the world that you need to look after. It really changed the perspective. I would say, like I’ve definitely changed a lot and with whoever knows me well, they say that especially over the last couple of years, I’ve changed a lot and I think as being locked down, that helped me from that point of view because again, I’ve got really busy life and even when my daughter was born, I took the time off and I always tried to spend my free time with that. But I think what was happening was that I had my working life, which obviously I’m doing because I enjoy, but also to look after them. And then I had my family time, but then I really put myself almost like at the bottom of the list of the priority without really realising, because I think sometimes in life you do things without really sitting and say, okay, I’m going to do this.
[00:48:31] You don’t plan it.
[00:48:32] I don’t plan anyway.
[00:48:33] So, you know.
[00:48:36] And then know during the lockdown, I think it’s been one of those times where, you know, I’ve been spending a lot more time with them and then realised that I had to make few changes in terms of my priority and try to get a different life.
[00:48:48] Work. What instigated that, Alfonso? So, you know, sometimes it can be your kids or you know, for me there’s some moments of realisation when your kids can vocalise themselves and how they feel about you. You know, like I’m here today on a Saturday, right? Yesterday, Friday I was in Surrey teaching my course and Thursday afternoon I left the family home. Right? And my two girls knew I wasn’t going back till Saturday night. Yeah, as I said goodbye. And as I’m leaving, they run into the garden and both give me a hug. And they both squeeze me as hard as they can possibly do. Right. I’m going to miss you, Daddy. I’m going to miss you, Daddy. Don’t go right. And you know it pulls on your heartstrings, right? I love it. Makes you feel great as well that I’ve got two human beings here who want nothing more than to spend time with their daddy. Yeah, it’s an amazing feeling, right? Even as you’re leaving, it’s a wonderful feeling. But it pulls on your heartstrings and makes you realise. Actually, for me, you know what? If you invest in your children at a young age and when I mean invest in them, I don’t mean that. I mean send them to private school and buy them nice things, but just give them that. Yeah. That you’d like to think when you get to older age. Yeah. That investment in that relationship with them when they’re younger is a much nicer relationship when you’re when they’re adults. Right. That’s, that’s my dream anyway.
[00:50:19] I don’t know, like if maybe it was you that didn’t, because that is exactly my thought. You know, like you is the point where you realise that, you know, you can buy them a bike, you can buy them clothes, what they want, especially at that age, they won’t spend time with you and you realise that if you don’t do that, that distance between you and them is going to become greater and greater and then will become a lot more difficult to get that. So yeah, for me it is something similar and it’s amazing. You know, we can say kind of similar story. I mean as you know now I’m with defined and with Ben in Beaconsfield and what’s happened is when I go to working there, I usually leave the Tuesday night and I stay there on the Tuesday night and then I work Wednesday in Beaconsfield with Benji and last time Fortuna stopped me and say that they I don’t really think that is fair that you are going to Benji all the time. Why Benji doesn’t come to Bristol now.
[00:51:10] So, you know, like these are doesn’t understand.
[00:51:11] She doesn’t.
[00:51:12] Understand. So she say, okay, you are going there, right? So now is his term. You stay home and Benji come to stay with us. So but that kind of really shows, as you said, he’s the same than the alpha that you were mentioning a minute ago.
[00:51:25] Yeah, yeah. It’s so powerful, right. That what that balance is. And then and then what is Alfonso, what is the definition of success? Right. You know, is it the money? Is it the nice house, the nice clothes, the fancy cars, the. Ability to go and eat in any restaurant that you want and all of that. Right.
[00:51:46] Is that success for me? No, but that is the reason because like, you know, when people tell me, you know, success successful, I don’t feel that it’s not because I think, like, you know, success is be able to reach your goal in life. And the goal in life doesn’t have to be financial. I mean, I don’t mean to be disrespectful or I’m grateful for what I’ve got and I’m really happy and grateful for everything. But ultimately, for me, it’s not the main goal. So, you know, if if tomorrow I cannot afford a watch, a car or the Vespa is not going to change. My personality is not going to. You know, these are things that come and go. So this is is the same way. Like, I try to enjoy what I’m doing and and what I’ve got. So people say, okay, but are you wearing your watch? And what happens if you get scratched? And but it’s an object that is made to be used and to enjoy the people that they, they, they prove an enjoyment just owning something and they want to keep the safe. And I respect obviously that as well. But for me, if I got something, it’s because I want to enjoy it and we only live once, so why not?
[00:52:59] And so what is the what is your definition of success, Alfonso? You know, you say you’ve got you have a goal and you achieve it or whatever. But take yourself, cast your mind, you know, what are you 38 now? 58, 48, 58. Let’s take you to 68 now. Fast forward 30 years. Yeah, if you could if you could look back 30 years from today, what must have happened in that time for you to be happy both professionally and personally?
[00:53:30] But, you know, like I think again is be happy more than anything else. And, you know, if you ask me, how would you be happy? I mean, in the personal life, obviously, you know, hopefully health of the family and all the people that I love comes first. So be able to stay with my daughters and make sure that everyone is happy and healthy and.
[00:53:53] Well at this point, Fortune is 36.
[00:53:55] Yeah, I know. So she will probably still live with.
[00:54:00] Like proper Italian style.
[00:54:04] And cooking for.
[00:54:06] Now. So, you know, like again, hopefully, you know, they will have fun. They will find someone that they love and they can build a family. So that will be something that will be great.
[00:54:16] The dad approves of.
[00:54:17] Of this. Yeah, of course.
[00:54:18] Yeah, yeah, yeah.
[00:54:19] I think there is still like at the moment the granddad needs prefers I’ve got my dad that is more jealous than me and, and then like, you know, like professional, for example, you know, we are going back to the point that you often tend to your role model that can be of parents. And I was chatting with my dad a couple of days ago. He’s 68. So first you mentioned in his head of consultant, he’s been successful in his profession. He’s got great reputation. A lot of people respect him a lot, asking advice and he’s always helped everyone. So it’s quite nice that wherever we are going, I’ve got a lot of people, they say, Oh your, that was great. You did this for me, did this for that. And I think it’s quite nice. And I say that why you don’t retire. I mean, you know, like in Italy as a consultant, you can retire.
[00:55:07] Still working?
[00:55:08] Yes. An extension. And you say, but I enjoyed work so much, so why should I retire? So from a professional point of view, I don’t know what is going to happen in the future. And I have to say that I’m slightly concerned because the dentist treated are living at the moment in UK. I don’t feel that it’s the dentistry that I signed up for, but if in 13 years in the future I can do something that I enjoy, I think professional will be happy.
[00:55:38] What did you sign up for?
[00:55:40] I signed up for that to see where I was more like about a health care job. So where we were there to help patients and help patient doesn’t mean obviously only get them out of pain, but was really kind of to fulfil their expectations or improve the quality of their lives, give confidence back with a smile other than at the moment. I think after COVID, the things that change a lot is getting really litigious. There is a lot of defensive dentistry and it’s really sad, especially when we do this course that I speak with young dentists that they don’t want to work full time anymore. They find that it’s too stressful and they only want to do certain type of dentistry. And the type of that is they want to do is what they find is the most rewarding, probably financially or socially on social media, rather than really caring and helping patients. So I’ve seen dentists that they don’t do root canal anymore on a molar because they see that it’s something that someone else has to do. And if the patient is in pain, they don’t even know how to open a tooth anymore. Some of the of the new generation and I think that is a bit sad because ultimately from my point of view, if you signed to be a healthcare professional, your main duty of care is to make sure that you look after the patients. And if the patient is in pain, you need to try to help them. You need to do whatever is the right things for the health of their mouth before then. From your financial gain or from cosmetic, whatever, then I’ll see that there is a lot of shift toward the cosmetic. The I mean, I would say this is a generation of these Invisalign bonding and whitening is what, eight out of ten dentists now they’re interested, which nothing wrong with that, but it’s hard work. There are no people keen to, I don’t know a patient who is go paleo or even diagnosed with repair or an end, which I think is the foundation of the dentistry, really.
[00:57:50] But it seems to me like there’s this new generation of younger associate dentists, right, who want to be you know, there’s this term of super associates that you hear a lot, right? And all they want to do is the sexy dentistry. Right? Right. And even in our practice, we see some associates join us. And as you don’t have this, the full restorative skillset to do everything in a patient’s mouth. And so they’re just treating the the doing the AB or the edge bonding or the composite veneers and all the rest of it. But when that patient needs maintenance, a tooth fails or something like that, it ends up becoming someone else’s problem.
[00:58:32] Yeah, they really struggle. And the other thing is that also is everything about the short term gain. You know, often there is not, you know, you’ll see a lot of dentists interested in the sexy dentist, as you say it is that they tend to move from one practice to the other. But then I think for me was extremely important to be in the same practice for ten years and really learn from my failure of my mistakes. And that is one of the things I was mentioning with the teaching. You know, when they review a case that I’ve done ten years ago, I look and I say, God, why did I do that incision in that way? Why did they do that in that way? But dentistry is changing, and I think the only way to improve is to be critical with yourself and try to.
[00:59:16] To push.
[00:59:17] It to improve all the time. But there are not many people prepared to do that.
[00:59:22] And so speaking about errors and mistakes, Alfonzo, can you can you think of what your biggest clinical mistake was? You know, one of those moments where something happened in the moment and you thought to.
[00:59:35] Yourself, shit. I mean, I’ve got quite a lot.
[00:59:40] Those. I mean, especially with the courses. So for example, talking about courses and being here, we did the course once on immediate placement and to join the course, the dentist had to have quite a lot of experience already and we were working and basically the dentist was trying to place this implant and I don’t know how because again, he’s an experienced dentist, he just dropped the implant into the sinus. So then it was one of the moment I said, Oh shit, with life surgery, with everyone around. So then we had to retrieve Yeah. Vision out and then open and then social design is back and then thankfully everything was fine in the end. But this was one of the time where, you know, like you are on the course lasting, you want something to go wrong and then have old people around. But as I said earlier, that is part of dentistry. Things can go wrong and you need to deal with that. I also feel that sometimes. And I feel that probably about a year ago I was a little bit more. I always struck all of my patients and they will review failure, success, conversion rate and all those things.
[01:00:51] So again, I’m really keen on audit my work from all the point of view and never noticed, like an increase of failure and problems. And I remember like all these people on Facebook started speaking about the level of stress, the vitamin D, which I’m sure they will also go like a part and and a role on things that we might not know. But then I really start to kind of analyse myself and say, what’s changed? And what’s happened is that I was getting more and more confident and I think I was push the boundaries probably a little bit more than I should have done. And then I realised that there were things that I said, okay, let’s go back to some of the basics and let’s maybe start to to play safer, whatever. Then sometimes you’ll do a complex case and everything goes well and you say, okay, I can do something even more complex next time. I can do something even more complex then I think is important to understand your limit and and step back.
[01:01:47] Just gives you that false sense of confidence that, yeah, I can keep and keep doing more, right? Correct. Have you ever had a moment where it was just you in the patient and you did something wrong, you know, pulled the wrong tooth out, perforated yourself when doing a root canal or whatever.
[01:02:07] Yeah. So I think like the biggest mistake that I did was many, many years ago where I still remember like, like really when you say like shit and then like become like to be paid. I was doing root canal for this patient and I didn’t need this endo on the side and I didn’t realise, I mean there was wrong chart or something like that. I’m not making excuses, but basically at the end of the eighth thing it was the last tooth. And then when I took the X-rays, the PR, I mean I was like really tricky and I said, This patient has got really strange anatomy with this. So I did all the angle. And then when I took the pay, then I saw three molars. So I said, okay, so that is not a seven something. So because all my x rays were on the last one and sometimes after you put the rubber down and if you have not really looked properly, which tooth you are treating, once that is in there, you just carry on treating the tooth. So, you know, from that I’ve learned a lot, you know, I’m I don’t do any more.
[01:03:17] So that’s the lesson, right? Yeah.
[01:03:19] But I remember like, you know, like, as you were saying was, was difficult to have that conversation with the patient to say, look, I’ve done I mean thankfully was an eight that was not something was so crucial obviously we had to do everything we had to do to put it right. And the patient in the end was like he was try to cheer me up, said.
[01:03:40] Well, you know, these things can happen. So no, no, no.
[01:03:43] I was I was so upset when that happened because I really felt that, you know, I’ve caused damage to someone. But I mean, unfortunately, it is a part of the risk of our job where sometimes we can do things and things can go wrong. And, you know, we’re human. We may all make mistakes.
[01:03:59] And so, Alfonzo, let’s let’s cast life much, much further ahead to the time where perhaps it’s your last day on the planet, you know, all being well, your loved ones are around you to spend that last moment with you. And what would you say to the girls? The last three bits of advice for you all for your girls from Teddy.
[01:04:21] I mean, definitely will be, you know, like on the theme of why not live your life with no regrets? And I think, you know, that is is really, really important because we really we only live once and we need to try to enjoy as much as we can and do the best that we can do. I think that is definitely one of the things, one of the most important point that I’ve learned second probably will be really give the right importance to the right things. So there are a lot of things where we might get to stress so upset or nervous that, you know, if you really take in the grand scheme of everything in life, probably they don’t really deserve so much importance because there are a lot of things that they are that are more important. So live with no regrets, get the right priority, and enjoy every minute that you’ve got on this right.
[01:05:18] Brilliant. Thank you, Alfonzo.
[01:05:19] You’re welcome. Pleasure.
[01:05:24] 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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