An Unlikely Match: Football & Dentistry with Sia Mirfendereski
This week, the banter is on as Payman goes head to head on football knowledge with chairman of the British Dental Association and Chelsea FC dental consultant, Sia Mirfendereski.
Sia talks about combining his two loves, sports and dentistry.
He also shares words of wisdom on dealing with difficult patients and reveals his thoughts on being successful in practice.
In this episode:
04:52 – Early influences
08:02 – Owning a practice
12:54 – Marketing and growth
14:42 – Selling up
16:15 – A word on sports dentistry
29:18 – Working at Wimpole street
36:13 – Sia’s person-centered approach
40:35 – Recruiting and hiring
46:50 – Early mistakes
48:15 – Handling complaints
About Sia Mirfendereski
Sia Mirfendereski qualified from the Royal London Hospital in 1991 and received his Masters at the Royal London Hospital in gerodontology in 1995.
He is currently principal at Wimpole Dental Office and Dulwich Dental Office, as well as dental consultant for Chelsea Football Club. He is also the chairman of the British Dental Bleaching Society and has lectured extensively on bleaching.
Sia has formerly held the positions of honorary associate clinical professor and honorary clinical teaching fellow in education and development at the University of Warwick.
He is a passionate advocate for preventative care and fundamental adherence to duty of care.
As I always do, I sit back and I don’t react with an email or pick up the phone and start ranting and raving. I’ve learned that through managing a High Street practice, digest the information because the first thing that will come out of your mouth is usually the wrong thing. – Dr. Sia Merfendereski
Connect With Sia Mirfenereski
Connect with Prav and Payman:
Payman: What kind of a boss are you?
Sia M.: Hugo Boss.
Speaker 3: 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.
Payman: So, today we’ve got my good friend Sia Mirfendereski joining us, and I’ve known Sia a long, long, long time.
Sia M.: Many years.
Payman: Many years. And, Prav, you have too-
Prav Solanki: Yeah. Absolutely, we’ve met a few times.
Payman: And, it’s an interesting career you’ve had Sia. But, do you remember the first time you thought I want to be a dentist?
Sia M.: Yes, I do. It was approximately 1983, ’84 I think. My dad was adamant that I should follow in the footsteps of my uncle and become a doctor, as is quite common in our culture to follow a vocation, as opposed to go study some arty course at university. And, funny enough, it was at one of my parents’ evening dinners that we had a family friend whose son had just graduated from Guy’s, and he was doing his houseman year, and he was telling me… As a doctor, and he was telling me about his weeks and what he was doing and the number of hours he was working.
Sia M.: And, the more I kept listening to him about the volume of hours that he was doing, heading towards 90 to 100 hours a week, the more I was shying away from the idea of even thinking of going to do medicine. Not that I was lazy, but I just thought the idea of working 90 hours a week and at the rate that they were working and how difficult it was and how hard the course was, I was slowly thinking to myself, “I’m not quite sure this is really what I want to do long-term.” Although, I was quite science-based, and I was good at the science courses at school, and I thought to myself, “What are my other options?” And then, I started looking at dentistry, but it wasn’t one of things that for years I was keen on working with teeth or anything like that. It’s just one of those things that just happened.
Payman: So, how old were you, like 16?
Sia M.: Yeah, 16, 17. I was… I think even started doing A levels, but I was doing the math, chemistry, biology classic courses to be able to then consider doing medicine. Although at school-
Payman: You’re the youngest, right?
Sia M.: Yes, the youngest of three.
Payman: So, your brother was an engineer.
Sia M.: My brother had already gone to UCL doing civil engineering. My sister followed in the footsteps of my parents to study architecture. And, I was always interested in some aspect of medicine, but at the same time, I always had a very effervescent character and social character. And, the more I kept listening to this guy, and he was a good family friend’s son, the more I was thinking, “I’m not quite sure that’s what I want to do.” And, I think I feel into dentistry as option B, and that’s where it all started.
Payman: Were you boarding school?
Sia M.: I was at boarding school when we first came here for a year and a bit. And then, I became a day boy.
Payman: And so, you went to London Hospital.
Sia M.: I went to the London Hospital before it got its royal stamp. Started off in 1986, the dental school, and it all started from there.
Payman: You stayed on there to teach.
Sia M.: No, what I did is I qualified in 1991. I briefly went and worked in a practise in Essex. Then, I went back to get a letter of good standing or whatever from one of my old tutors, and it just so happened that him and his wife who have a practise in south London had a vacancy, and he asked me if I was keen to go and work at his practise, and that’s Dr. Eddy Lynch, who’s now Professor Edward Lynch. And, I started working there in one of his surgeries that I now own in south London in 1992.
Sia M.: I then through his guidance decided to do an MSC at the London between ’93 and ’95, and that’s when I got approached by the oral surgery department because they’re always very keen on me doing oral surgery and medicine to teach the undergrads from 1995, but I was not too keen on going and being double qualified and going and doing another 5 years of medicine as it was back then. Nowadays, I’m not quite sure what I think people can skip the preclinical years, but they still have to do the clinical years, and that wasn’t part of my biology as it were. But, I did teach undergraduates and postgraduates oral surgery between ’95 to about 2002, and at the same time, because I was doing an MSC, I started teaching restorative for the undergraduates and then post graduates in the same year bracket as it were.
Prav Solanki: How much of an influence was Eddy Lynch on your career trajectory and pathway. We’ve heard from a few people today who say that first mentor or that – you talked about him giving you guidance – almost shapes your career path. What influence did he have on you?
Sia M.: Eddy had a lot of influence in the sense that I had quite a tough last 6 months of my dental programme, and it was back then when one of the subjects was separate to finals, and I was struggling to get past that. Having, not cruised, through the first 4 years, but I was always passing the exams, but I struggled with prosthetics for some reason. I think also because I fell in love, and I wasn’t really studying as I should’ve been. So, after having failed, I then took a while to pass that exam, and I was at a time that I was thinking, “Is this really what I want to do?” And, it was when VT wasn’t compulsory, and I got put back 6 months, which was quite hard hit for me to take personally.
Sia M.: But, when I approached Eddy, who was my restorative teacher, he said to me, “What you want to do in these 6 months is use the time on the clinic.” Because I’d passed so many of the other exams. I just had to pass the final exam and prosthetics, which I did together. And, he said to me, “what you want to do is use these 6 months, as opposed to all your friends who qualified in December, now that you’re going to hopefully qualify in July, use these 6 months to gain extra clinical experience, so that you don’t have to go and then do VT.” And, that was a huge, huge thing which he got me to do, and I was doing more complicated restorative work, crown and bridge work, which at undergraduate level was unusual to do unless you were one of the high-flying students. But, easy to do because you passed the exam, so you had more clinical time.
Sia M.: And, that allowed me to enter practise without having to do VT, and from a experience point of view, when I would sit down with my friends who had qualified 6 months earlier, after I finished, we were all pretty much at the same level, so I was very indebted to him for giving me that advice and also strongly giving me the confidence to stick at it and not give up, and don’t worry about the fact that you failed and exam. And, I’m sure the second time around or whatever, you’ll pass it. Use the time carefully. So, that was very, very influential. And, hence, why I went back to him to get a letter, so that I could apply for another job, and it all rolled on from there because he had a vacancy with his wife in one of their offices, and I never looked back.
Prav Solanki: What is he like as a boss?
Sia M.: Pretty different to what it was like as a tutor. As a tutor, you had to rewrite essays about three times. But, as a boss, it was mostly his wife who was the boss. He had more of a background role, because he was tutor at the London, and his wife… She was a wonderful lady. Sadly, she’s no longer with us. Sad story, but a wonderful lady. Very kind and both of them very accommodating. Very nice bosses to have more like friends and right now, he is one of my very close friends, and I hold them in very high esteem.
Payman: How long was it before you decided I want to go out on my own, open a practise?
Sia M.: I stayed as an associate, unlike most of my friends because I really enjoyed the time off that I used to have, and my cousin that you know very well, used to always label the famous 17-day trips that I’d go and see him in the US two or three times a year. Which, I still have very, very fond memories of, and I didn’t like the idea of taking the responsibility of having my own practise, and I delayed it and delayed it until I got my postgraduate work done in ’95, and then I eventually got onto the specialist register for prosthodontics. Sadly, I didn’t get onto the oral surgery one, which was a bit of a controversy, but I’ll come back to that if you ask me later.
Sia M.: And, around 1999, 2000 as I got into my 30’s I thought, “Right, it’s about time that I start,” and I was a specialist, I came across a colleague who had a practise that he was thinking of moving from in central London in Wimpole Street, and I jumped in, started at Wimpole Street. I was still working part time with Ed’s practise and his wife’s, and slowly I cut that down and focused more and more on Wimpole Street-
Payman: Did you start it, or did you buy it?
Sia M.: I bought it. He had a pool of patients, but he was honest enough, and he was also a tutor at the London, to say that he wasn’t retiring. He also had another practise in Richmond. And, the commute was long, and if I’m not mistaken, had started a family and it was very difficult for him to be in Wimpole Street, teaching and in Richmond. So, I knew full well that a bunch of his patients were likely to be moving with him to Richmond. So, I inherited a pool of patients, and I also had a pool of patients myself, which were happy to come from south London. And then, slowly but surely just built it, and one of my ex colleagues, who used to have a practise in Cavendish Square always used to tell me in the west end, it will take you a year to build up a day, so it took a good two or three years to get this up and running.
Payman: That must have been nerve wracking.
Sia M.: It wasn’t easy.
Payman: The costs are quite high.
Sia M.: Yeah. Costs were high, but at least you didn’t have the compliance stuff that’s going on now, where the one man bands up and down Wimpole and Harley Street I know for a fact are really struggling or have gone because the costs have gone so high. I’m not saying incorrectly. That’s just the world that we live in these days, so you have to tick all the boxes, and a lot of people now have joined or they’ve got two or three chairs, so that they can spread these costs. But yeah, it was definitely a challenge the first two or three years, which led to the fact that I then started a practise up the road in Baker Street, because I had a shop front. Because, Wimpole and Harley Street, as you know full well, there’s no shop front. So, there’s no walk in trait. A lot of it was through referrals, my ex-students, and then when I purchased the practise near Baker Street, that one had a shop front, and then I would do promotional offers, et cetera, et cetera. So, I collected a few other patients through that.
Payman: So, the whole process of starting, you talk about opening up a dental practise like buying a Mars bar from a shop. It seems like it’s just… We all know it’s not, but it seems like quite a simple process. Talk us through what happened. You had this practise in Wimpole Street. You then go and purchase a practise in Baker Street, you’re juggling two babies-
Sia M.: It was a squat practise. It was one of my patients who had this building in Baker Street, and the ground floor was a mini cab office, and I think with the mini cab office, the tenants he was getting were clearly not happy because mini cab offices pre Uber days were 24/7/ trade, especially on the weekends, where you get people strolling out of pubs, et cetera, et cetera. Wasn’t good for him, so he was delighted about the fact that there was a chance that he could change it from a mini cab office to a dental practise, which has got much more set hours. So then yeah, I started that as a squat practise.
Sia M.: That was definitely a challenge, but the fact that I had a shopfront, and I designed it, I think, in a very nice manner. So, it did attract a lot of new patients, and the patients that were then appropriate to then take to Wimpole Street for more specialist, I did, and at that time, I found another professional partner who had different skills in being a specialist in endodontics and vast experience in implantology. So, it was a good area to be able to get the patient, the walk in trade, and then take them down towards Wimpole Street because I always find the problem with the Wimpole and Harley Street practises are the lack of walk in trade and you’re relying on referrals, and referrals even then had started to dwindle as more and more practitioners who had high street practises were bringing in specialists in their own offices to carry out specialist work, and the referrals were diminishing as it were.
Prav Solanki: Back then, your Baker Street practise was the majority of your new business coming because you had a shopfront presence-
Sia M.: Yes.
Prav Solanki: That was-
Sia M.: Definitely.
Prav Solanki: Was there any marketing?
Sia M.: Did I do any marketing? I did. I did a lot of brochures. I did a lot of leafleting. I did some adverts in the local newspaper. Back then, foolishly, I wasn’t doing nay website. I wasn’t doing any marketing through website, and I didn’t even understand the power of how that would work. But, just through local advertising, local marketing, and having offers, keeping the cost of the consultation, keeping the cost of the initial examination low, and with my relationship with Enlighten, having teeth whitening offers certainly helped bringing in the walk in trade.
Payman: When was it? You started lecturing for us, I remember. When was it in that time that you opened Baker Street? Remind me.
Sia M.: I opened the Baker Street one, if I’m not mistaken, around 2002. And, we started working together in the initial days… Was it 2004? 2005?
Sia M.: 5?
Payman: 5, 6. So, your Baker Street one, explain this to me. You spend some money. You set the place up. There’s no patients.
Sia M.: No patients.
Payman: How long did it take before it was busy two days a week.
Sia M.: Not long. A few months. But, I did have a lot of offers, and I’d done a bit of homework. There weren’t that many practises in that region. It was a bit further up from Baker Street, up on Gloucester Place. I don’t know if you know it. I think Frances Holland’s junior school has a branch there. The walk in trade, it was good. And, I think the whole thing about teeth whitening was really expanding. It was pre the home kit, so it was all the light activated ones, and because I would offer it at what I felt was a discounted rate, it brought in a lot of patients through the promotions that I would have through leafleting and advertising in the local newspapers.
Payman: You sold that practise when?
Sia M.: Sold it in 2007, but I sold it because the professional partner that I had who was the specialist in endodontics and implants, not a specialist in implant, but I’m sure you understand what I mean. We got busier and busier at Wimpole Street, and our referrals started to get more and more. And, it then became too much for me to handle, and I put it on the market through a Frank Taylors, and I was offered what I thought was enough to pay me back what I’d put in it and more. I actually got a generous offer, which I was delighted with. Happy days as it were.
Prav Solanki: That practise still there?
Sia M.: Yes, it is. I actually walked past it the other day. It’s not got the same name. I’m sure it’s the same owner. But yeah, it’s still there. Had a lot of interesting because people wanted to purchase it.
Payman: What’s the name of the practise now?
Sia M.: Ivor Dental, I believe. On Gloucester Place.
Payman: How’s that feel when you walk past a place that you started, and it’s still there all those years later? Do you get a sense of fulfilment that I did that?
Sia M.: Kind of, but I didn’t think that I took it as far as it could’ve. I felt that I had to go because my commitments back at Wimpole Street got more and more, but I got the right offer for it, and I wish the chapter took it on all the best. And, the fact that it’s still there, because it’s not on Baker Street high street itself. It is off Gloucester Place, but never the less, it has a shopfront, so the fact that it’s there, I’m sure they’re doing very well.
Payman: So, you’re the dentist for Chelsea Football Club, and you said-
Sia M.: Dental consultant. There’s no formal title, and I’ve always shied away from that.
Sia M.: It’s more the go-to person in terms of dental advice. It all started from-
Payman: Yeah, how did that start? So, I know you’re a football nut.
Sia M.: That’s a bit harsh, but I’ll come back to that. Guru.
Payman: Watch this. Watch this. What was the score in the FA cup final in 1978?
Sia M.: FA Cup Final 1978?
Sia M.: Ipswich down one, Arsenal nil. Roger Osborne. Is that right?
Payman: I’m Googling it right now.
Prav Solanki: I think if you are right, then nut is definitely the right-
Sia M.: Guru, guru.
Payman: No seriously though he-
Prav Solanki: Is it right?
Payman: You ask him another question while I check this out.
Prav Solanki: I don’t know enough about football.
Payman: Go on, explain how you got into the football thing.
Sia M.: Not by knowing the stats, no.
Payman: He’s right, he’s right.
Sia M.: Osborne goal scorer. One nil Ipswich.
Prav Solanki: Wow.
Payman: One nil Ipswich.
Sia M.: Anyway. I used to play a lot of rugby at school, and I had a bad accident during a game, and I nearly broke my neck, so when I went to uni, because back there in your other forms, rugby was always very much looked upon, and London had a very big rugby team. I’m not saying that was the reason that they let me in, but I started playing football at the London, and the football team was predominantly nurses and physios. Most of the people that came to the medical and dental school had a private school education and predominantly played rugby, so there wasn’t that many of the male students that were footballers.
Sia M.: But, the football team had a big old boys unit, and we would always get together in Cambridge or near Cambridge for a day of golf or tennis and plenty of beers for the FA Cup Final. And, a lot of the guys who then graduated as physios started getting jobs be it assistant at Tottenham, assistant at Ipswich, Crystal Palace, and eventually in the mid 90s, good friend of mine, Mike Banks, became the Chelsea physio. And, for years, he always used to say to me, “Sia, if ever you open up a practise in Fullham Broadway, let me know.” I didn’t open up a practise in Fullham Broadway, but by the time I got onto the specialist list, he was still at the club, and I sent him an email saying, “Mike, I’m not in Fullham Broadway, but I’ve got a private practise in Wimpole Street.” Footballers were all beginning to get the image of pop stars, and they wanted their own privacy in that little quiet waiting room in the back as opposed to a shop front with a waiting room with 4 or 5 other people.
Sia M.: And, I sent him an email saying this is where I am. If ever you need me, call me. And, they had some dental issue literally that weekend that I’d sent him the email, and one of the players had had a bad elbow in the face and had some dental issues. And, I fixed him, and then slowly one by one, the odd player started trickling in, and I came up with the idea of dental management, and sports but particularly with the football of having screens and making sure that the players were dentally fit. And, it took off from then. I then set it up so that the players would have a dental screen. It wasn’t compulsory if they choose to have it. Otherwise, if they chose not to have it, we would put into their medical records. And, it started from then.
Payman: But, did you formalise it? Did you talk to the club?
Sia M.: I talked to the club about it, yes. I talked with the medical staff, and there was an incident in 2004/5 prior to a semi final game between Chelsea and Liverpool, where I got a call from the medical secretary saying we have an emergency. And, I thought, “Gosh, I hope I didn’t miss anything.” And, she said, “No, it’s a member of the opposition.” And, funny enough, the manager of the opposition was convinced that I was a Chelsea fan, and I was going to maim this guy. And, naturally, I acted professionally and to this day, I still get nail for acting professionally because they beat Chelsea, but anyway.
Sia M.: What I found out was that the player involved had actually had a dental issue and had not seen it through. He was at a temporary phase, and because he hadn’t seen it through, hence this issue had developed prior to a game. And, Chelsea had just changed Chief Medical Officer, so I approached the new medical officer. And, I said to him, the background of this, and I said I’m sure the last thing you want having now walked into a new club as prestigious as Chelsea was, and they were going through their boom of the early [inaudible] years of wanting to have this hanging over your neck. If a player’s got a problem, where clearly it’s the player’s responsibility, how about if we offer players to have a dental screen? And then, if they decline to have it, it’ll go in their medical record, so heaven forbid, in the morning of a important match or an evening of an important match, if a player has a dental issue, we look back in the medical slash dental records and see if the player was given every opportunity to have the issue resolved and they hadn’t, it’s the player that gets fined and not have everything crack on the medical officer’s head, which is effectively what happened at Liverpool. Because I do know that the medical team there got nailed. But, when you looked at it, it was actually the player’s responsibility. So, it started from there. And then-
Payman: So, that’s become the pitch that you used for-
Sia M.: Pretty much. And, I think then it expanded through to the academy, so I now do mostly of the academy, and I’ve also got a colleague now who helps out with me with the ladies’ team and the first team predominantly. And, I’m happy seeing the junior players, because after a while, it’s quite a responsible job to have, and as much of a football guru that I am, it is quite limiting in the sense that on the weekends, it does limit your chance of going away for a brief holiday or anything like that. And, I was up until this year, predominantly unless it was international break, I would make sure that I was always around in London. I wouldn’t travel with the club, and I don’t sit in the dugout. It’s not like a dental injury occurs.
Payman: Does the club pay, or do the players pay?
Sia M.: If it’s any dental issue that’s football related, the club pays. If it’s anything aesthetic, cosmetic requirements, wives, girlfriends, et cetera, obviously then it’s the player’s responsibility.
Prav Solanki: What’s it like treating celebrity footballers? I know some people, some dentists, who treat footballers up north. And, the general consensus I get from them is that they don’t respect their appointments, turn up, and think they’re incredibly special. And, much, much harder to deal with and higher maintenance than, say, Mrs. Smith down the street. What’s your experience?
Sia M.: There’s definitely a point about that, but I think because of the number of years that I’ve been there, I’ve become a bit part of the furniture. So, there is a level of I always say to the Chief Medical Officer, or whoever’s in charge on that day and at the moment there’s a chap who’s more of the head physiotherapist, and I always say, “Guys, whenever there is a new player in town, as long as you do the introduction, I will then make sure that I gain that level of trust if the player wants to give it, and to make them understand what the whole point about the screening is.” And, therefore, because I have a setup for just a consultation at the training ground, not for treatment as it were, but just for consultation, it breaks the ice. Of course, you’re always going to get the prima donnas who will last minute change their mind, et cetera. But, I think what I try and do is as a dental officer, make sure that the chief medical officer and the people in the know are aware that such player needs X and Y done. And, I usually try to put them towards the end of the day in the sense that if they suddenly cancel at the last minute or they don’t turn up, I just go home. It’s not the end of the world.
Payman: Do you ever get starstruck by treating one of your heroes? Does that ever happen?
Sia M.: Well, funny enough, because I’m a Nottingham Forest fan, when I first started it, it wasn’t as it I was a fan of Chelsea Football team. Over the years, naturally because you have this link with them you are obviously then going to be following them. And, I do support them quite avidly now. In the early days, definitely. But, they are all human beings, and the one thing that I think helps is if you know a little bit about football and you’ve got a good personality, so you know the banter, you know the sort of things to say, I think that goes a long way.
Payman: They appreciate that.
Sia M.: The appreciate it. There was a player who came in, he’s actually a very good pal of mine now after all these years. And, as he walked in, of course I was a bit starstruck, and I had a chat with him about his history, and the fact that he found out that I knew who he played for in Portugal, a team called Boavista, so it’s not one of the standard Benfica or Sporting Lisbon or Porto. He looked back and straight away you build that level of trust, and the banter goes a long way in the sense that if you don’t have that, they also don’t know who you are, and it doesn’t break the ice. So, that certainly helped. And then, I think because I’ve been there for so many years, that barrier, I think, was broken.
Sia M.: The thing I find now, which is nice, because I have a colleague who helps with the first team, is as I’ve got older, when I first started, most of these players were maybe 4, 5 years younger than I am. And then, maybe 10, 12 years, so that generation gap hadn’t happened, so you still have that camaraderie, and they still know the same music or whatever. Whereas nowadays, some of them are so young, they could be my kids, so that barrier is a little harder to now fill. Hence, why the work that I now do with the academy I enjoy a lot because they’re so much younger, and they haven’t become super stars yet. They are definitely there waiting to learn and listen and they follow all the instructions that they need to from a dental point of view, and they get terribly excited when certain facts I know about them, and they haven’t even made it yet. They’re a 17, 18 year old, in the academy team, and yet I know what position they play, and-
Payman: I bet you reckon you’re quite good at spotting future stars then.
Sia M.: Yeah, I think so.
Payman: Who are they?
Sia M.: Callum Hudson-Odoi.
Payman: Callum Hudson?
Sia M.: Callum Hudson-Odoi
Payman: Oh, [inaudible]
Sia M.: He’s a football player. He’s definitely a special talent.
Payman: How old is he?
Sia M.: 18, I think. 17, 18. Very special talent. And, there’s a few others in the pipeline who if you ask me, if they keep their head down and remain focused, I think the problem with football, in my opinion, is too much too young. How ambitious would you be paid, or how ambitious would you be if at that age, you were earning 20, 25 grand a week? At that age? If you’re earning over a million pounds at the age of 17, 18, where is the ambition to want to become the future Cristiano Ronaldo or whoever is earning 4,500 grand a week when you’re earning that amount of money, and I think-
Payman: Well, that’s interesting, isn’t it?
Sia M.: Yeah, something-
Sia M.: Needs to give for the good of football, I think. There needs to be a pot, a bit like the American sports, where they have the college, and there’s a fund, and there’s a pot where all this money goes into. So, it keeps their ambition. And also, for the poor kids that don’t make it because there’s a lot of them that don’t make it. A lot of people of what footballers earn, but if you’re in that environment, and you see so many come and go like I have, so many of these youngsters coming and going, and imagine suddenly at the age of 20, 21, you’re not even being picked by a league two or a non-league outfit with little education, where are you going to go?
Payman: What happens to footballers when they retire? Do they get depressed like actors, famous-
Sia M.: Hard for me to-
Payman: What happens to them?
Sia M.: Hard for me to comment because I don’t know it that well, but yes. I have heard that. That they can get depressed and not having-
Payman: Limelight and-
Sia M.: Exactly, and X amount of people following you in a stadium, especially if you’re a superstar. I’m sure it has that moment for sure.
Payman: You’ve got the football. How much of your life, how much of your week, your month, is devoted to the football bit?
Sia M.: I used to do one day a month. Now, I do one day every 6 or 7 weeks, because I split it-
Payman: At the football-
Sia M.: At the training grounds.
Sia M.: And then-
Payman: They come to you otherwise?
Sia M.: Yeah, then they come to me for their treatment. I now deal mostly with the academy, as I said. And, there’s plenty of work that they need doing, and they don’t really have a say in terms of whether they’re going to come or not, because if they are having any form of a dental issue, it’s compulsory for them to pretty much come, and if they don’t come, it works against them. Whereas with the first team, there’s a little more leeway, and I try and shy away from that a bit now.
Payman: What are some of the nuances of working on Wimpole Street? What’s the best thing about it? What’s the worst thing about it?
Sia M.: I think the prestige and the address.
Payman: People you think a patient that comes in and is more likely to want comprehensive care because they’ve come to Wimpole Street?
Sia M.: I don’t think nowadays anymore. Certainly maybe when I first started, the fact that I was also a specialist registered. I certainly think that helped. I think with the whole digital marketing, I think the fact that dental practises being designed, at first by architects and whoever nowadays. There are really nice looking flash dental practises up and down the country that I think provide very high standard of dentistry. And, Wimpole had Harley Street, in my opinion, no longer hold that prestigious address. Maybe for the patients who are foreigners, it still has that mystique of being the crème de la crème, but I wouldn’t think so.
Payman: And, what’s the worst thing, the fact that you don’t get the walk-by traffic?
Sia M.: Definitely. That’s clear, so you need to rely on your pool of referring practitioners, and your pool will get less and less, in my case I find because I stopped teaching in 2002, and most of my referrals came from my graduates who then went into open practise. And, they would refer patients, but now most of them are pretty much very experienced practitioners, so probably doing most of the work themselves, and quite rightly so. That’s why they are dental practitioners.
Prav Solanki: Sia, you mentioned earlier about not getting on the oral surgery-
Sia M.: Yeah.
Prav Solanki: Specialist list, and you had a little story about that.
Sia M.: Yeah, sad one really, and I’m not happy being on the prosthodontics specialist list, and I say that because every dentist is a crown and bridge specialistic. It’s a common understanding, and it’s something that I think is not given the credit that it should be. The reason I was disappointed was that I taught oral surgery for 7 years, and I was at a level of higher than registrar, the fact that I couldn’t be given a higher label than that was that I wasn’t double qualified. I unfortunately, when the grandfathering system came from the GDC to go on to the specialist register-
Prav Solanki: Mm-hmm (affirmative)
Sia M.: There was a end date, and I was just a bit carefree, and not lazy, but I just didn’t send the application in enough time, and there were definitely people who were teaching far shorter than I had who got grandfathered on. Then, at the very end when I applied, they were being very difficult and not understanding as to how can I be a specialist in prosto and a specialist in surgical dentistry. So, I had to go and present my case at the GDC panel, and I took the head of department from London with me, Dr. Anne Aitkin, lovely lady for her, and a couple of other referees to explain why I should be on it. But, the panel was one from community dentistry, one from paediatric dentistry, and they just couldn’t see eye to eye, so I got the prosto one, but I should’ve challenged it, because my surgical dentistry, I still think is, if not as strong, stronger. And, in my NHS practise, I had a minor oral surgery contract because of my clinical skills for oral surgery, so I’m still a bit disappointed that I’m not on that list.
Prav Solanki: All because you filled an application form out too late?
Sia M.: In my opinion.
Prav Solanki: Yeah.
Sia M.: Because there were people that were teaching oral surgery for far shorter than I was-
Prav Solanki: Wow.
Sia M.: Who applied for the application, and they got on it, so I thought this is going to be a walk in the park, and I just applied a bit too late. But, funny enough, one of my colleagues who taught me oral surgery at the London, applied. He got rejected, and he had to go through the whole panel thing, but his focus was mainly on surgical dentistry, and he eventually fought it and got it. My one, I was a bit naïve, and I just thought, “Well, you know what? I’ve got the proto one. Maybe that’s good enough.” But, looking back on it in hindsight, as I said, tongue in cheek, every dentist is a crown and bridge specialist. We’re a surgical dentistry specialist carries, in my opinion, a lot more weight.
Prav Solanki: Do you think it would’ve shaped your career in any different way, or do you think you’d be in a different place right now?
Sia M.: Quite possibly. Maybe I’d be doing more implant placements, as opposed to doing implant restorations.
Prav Solanki: Just by having that title?
Sia M.: I’m a very cautious person.
Prav Solanki: Right.
Sia M.: I only practise things that I think that my credentials allow, and I don’t sale close to the wind. I’m very particular about that, and if somebody looks you in the eye and says, “Are you a specialist in this?” I’m not one of these practitioners that tries to-
Prav Solanki: Wing it.
Sia M.: Disguise… They’ll wing it. I’m not. And I think had I been, I would’ve been a bit more, not daring, but a bit more-
Prav Solanki: Confident.
Sia M.: Yeah, confident to say go and do the whole surgical side, because that’s what I’ve been labelled as a specialist. But, because I didn’t have that… Being a dipsy or a dentist with special interests, for me, is just not strong enough if ever you hit any complications. So, yeah. Quite possibly.
Payman: Yeah, me and Sia have had a long time disagreements on the doctor title for dentists. Long time, long time-
Sia M.: Because we’re not doctors.
Payman: He doesn’t think we’re worthy.
Sia M.: No, no. Not worthy is-
Payman: You just… wanna be doctor.
Sia M.: Your way of putting words in my mouth. Nothing you do had not been worthy. We are misters, because we’re dental surgeons.
Payman: Yeah, yeah.
Sia M.: And, as you know in the medical world, when they become surgeons, they revert from being a doctor back to a mister. And, if you call them doctors, they actually get upset. Us, in my opinion, being called a doctor is being a life-saver. I don’t consider us as life-savers.
Payman: I do. When you get those teeth really white, you’re saving lives.
Sia M.: Saving a life. You’re saving a life, interesting. We may have to come back to that off-air. Saving lives. I don’t think that’s life-saving. Making life more pleasant, sure. But, life-saving-
Payman: I find interesting-
Sia M.: Do you whiten someone’s teeth who’s having a cardiac arrest?
Sia M.: No, so you’re not saving a life, are you?
Payman: I think what I find interesting about you, the fact that you’ve got the specialist hat, if you like, the football hat, and then chess interest. It’s very interesting that you’ve got all those different things. You’d expect someone who’s got the specialist thing going on… your other practises would be a private practise. But, I think knowing you well, I think you’re the kind of person who can relate to the king or Jordan, and to the guy cleaning the building or whatever. What is that? What’s that word for that kind of person? Talk to anyone?
Sia M.: The person who’s stacking shelves in Ireland? That poor lad? That you got nailed on. Anyway, that’s another story.
Payman: But, what is that.
Sia M.: Definitely.
Payman: Definitely that guy.
Sia M.: Definitely so. I find that I can relate to all types of people. I found the NHS window… It all dropped in my lap in 2005, and it was part of a surgery slash property. My ex-boss was wanting to sell this practise that I was working in up until 2001, two, because I was working part-time then at Wimpole Street. And, the offer came to buy that practise, but because the building was also involved, inadvertently, I thought, “That’s one that I show a lot of interesting in.” Cut out agent’s fees, we agreed on a fee, and it was just when the new contract was about to happen on the NHS, and I had a gut feeling in side, and I wish I had the balls to borrow more family money and buy a chain of these practises. I had inside information about the new contract, and if you were bright enough, you could figure out that the government was going to put a ceiling on the volume of new NHS practises. And, the reason why I got into it was I felt the value of NHS practises was going to rocket, because no more squat NHS practises were about to be allowed to start. That’s how I fell into it.
Sia M.: And then, I bought one. I sold one. The one that I currently have, because it’s in a very gentrified area, and I have to thank my ex-receptionist and nurse for many, many years ago, a surgery in east Dulwich which technically was Peckham, not that there’s anything wrong with Peckham. Peckham is actually very trendy now, but when I first graduated, and I worked there, I was glad I got to my car alive. It was not a very pleasant area at all. And, it’s become extremely gentrified. A lot of yummy mummies, as they’re called. A lot of young professionals spill over from Dulwich village, where mums and dads used to live, but they can’t afford to live there, and it’s not spilled into east Dulwich, so there is a lot of patients who want and feel they have the right for NHS access. But, if you were in a affluent enough area, they are definitely willing to listen to the, as you say… What is it, the shake and prize that goes with it, or what’s that phrase that you sometimes say?
Prav Solanki: Do you want fries with that?
Sia M.: Exactly. So, it definitely helps, and I find I take quite a high volume of my implant patients that come through the walk-in and/or existing patients of that practise because the practise has become so gentrified, so much so that I was running a stat on it recently. When I qualified there, the volume of benefits patients that I had I’d say was over 90, maybe even 95%. I think it’s less than 5% now in that area, and I think that’s the key if you want to have an NHS practise and why their values are so high and why the value of their private intake is multiplied higher than, say, if you just owned a private practise. If you’re getting a practise valued because you’ve got NHS access. You’re always going to have that contract value. You’re always going to have the guaranteed income.
Sia M.: Whatever happens with a new contract. I can’t imagine it changing much considering the stink that we’re involved with, Brexit, and all the uncertainty with governments. I can’t imagine a new government, be it labour or the conservatives wanting to change the dentistry world so much to upset the general public. You need to just spot out where your dental practise is. If it’s in an affluent enough area, and yet you’re offering NHS access, I think is my success. I’m not saying it works for everyone.
Payman: But, two totally different ways of working. With the private, you’re having to invest in marketing not knowing whether you’re going to be busy in a couple of weeks’ time. And, with the NHS, the opposite situation, where you know you’re going to be busy, but you can’t spend the money.
Sia M.: Don’t underestimate the power of SEO.
Sia M.: And, my practise in Dullich is not on the high street. It’s down one of the streets upstairs to a pharmacy. When I bought it, it was a one man practise. It was barely working three days a week. It had the volume to expand. Now, it’s three chairs, so that’s 15 slots Monday to Friday of which three are now taken by hygienists, including evenings. And, the others are by dental practitioners. I work there occasionally. I’ve been doing more hours recently because I had to cover for one of the associates that left, and I didn’t find the appropriate one to replace, but-
Payman: What do you look for when you’re hiring an associate?
Sia M.: You live and learn. You can’t go by their interview there and then. They’re hard to find a good one. References certainly helps. Their qualifications, their interests, and you ask them key questions about what their interests are, what weaknesses they have, which particular area are they weak in. And, what volume of work have they done, be it endodontics, be it crown and bridge work, and what’s their estimate number of UDAs that they would do. It’s easy to have 30 patients a day and do 30 UDAs, for example. If you’re just doing check-up, out, check-up, out, check-up, out. That’s not the kind of person that you’re looking for. You’re not looking for someone whose practising unethically either. It’s not easy, but I’ve learned the references go a long way, definitely.
Payman: Do you check those? You call-
Sia M.: I call up. Oh yeah.
Payman: You talk to those?
Sia M.: Oh yeah, I physically call, and I will persist on speaking to at least two if they can provide it, and if they don’t provide it, that’s usually a bad sign. Because, you get good ones, you get hungry ones, and then you get ones that are just drifters. It’s important to try and find the right one.
Payman: What kind of a boss are you?
Sia M.: Hugo Boss.
Payman: Nice diversion. What kind of boss are you?
Sia M.: I think I’m a fair boss. Funny enough, I always compare it to being a football manager. As you know, I’m a football guru, as you said. But, you have to manage all sorts of personalities. I’ve got in my team, three part-time associates, two part-time hygienists, and about 4 auxiliary staff, and it’s always the way that the auxiliary staff consider themselves on par, and perhaps they should, with the dental practitioners and the hygienists. And yet, the dental practitioners always think that they are one level higher than the auxiliary staff. They may be in terms of clinical education, but in terms of the standing within the hierarchy of the practise, they’re not, but it’s very difficult to manage them and keep them all happy. And, that comes through experience, and I’ve had some good ones. I’ve had some difficult ones. But, slowly but surely you want to try and get the right team, and that’s hard to manage, because one person’s having a bad day. One person says this to the other. So, you’ve got to put your arm around someone. Sometimes you’ve got to give someone a kick in the backside. Sometimes, you got to be a bit hard. And, I live and learn. I’m sure I’m not the easiest boss, but I think underneath it, they all know that my bark is a lot worse than my bite. And, I think I’m fair. I’m not unfair and ranting and raving all the time.
Prav Solanki: Sia just pointed to something that I’ve just picked up on, and I think we discussed it earlier, which was when you own your own business, sometimes you’ve just got to roll your sleeves up and do anything and everything, right? And, you mentioned that you lost and associate, and now you’re having to fill some hours in there. You’re a specialist. You work in Wimpole Street, but you’re also doing NHS work. Is that right?
Sia M.: Yes. At the moment. It just happened. It’s been about a year and change. And it happened as I was looking for an associate who I interviewed, and this is a prime example of when you get it horribly wrong. I interviewed. I vetted. She seemed very, very, suitable for the position, and we had her starting on a Monday. I think it was the latter part of July last year. And, I had a full book ready, and they were going to be doing part-time, I think Mondays and Thursdays or something like that. And, we’re all set, full book, and I got not even a call. I got an email saying that my life circumstances has changed, and I’m moving to Cambridgeshire. Hence, I can’t start on Monday.
Sia M.: Now, I had a minor coronary, and I scratched my head and I thought, “What a load of nonsense.” And, as I always do, I sit back, and I don’t react with an email or pick up the phone and start ranting and raving, and that I’ve learned through managing a high street practise. Digest the information, because the first thing that will come out of your mouth is usually the wrong thing, and it’s a reactive comment.
Prav Solanki: Good advice.
Sia M.: And, so I sat down, and I thought, “Right.” But then, the more I thought about it, I wrote her an email back saying I’ll let this go, but be very cautious because technically speaking she could’ve been up for GDC referral for professional misconduct because you’ve effectively signed onto a practise, and you’ve got a full book waiting for you on Monday. You send me this email on Friday in writing. You’re pretty much shooting yourself or hanging yourself. But, I thought take the stance of being more advisory to this colleague by saying don’t pull this off, because if it were somebody who were not as friendly or wanted to be difficult, they could make your life quite miserable because I think technically speaking, I think your in breach of… Would you agree? For professional misconduct, if you’ve got a full book? It’s not a good thing to do.
Prav Solanki: No.
Sia M.: By all means, if your life is changed, or at the very least call. Or at the very least come to the practise and do a week as locum because such a thing… I’m not saying it didn’t occur, but such a life changing situation, you don’t just email somebody that you’ve interviewed a couple of times. That’s a bit off, but associates are strange characters these days. You get some really odd ones.
Prav Solanki: So, how did you deal with Monday.
Sia M.: I had to go in.
Payman: Roll your sleeves up.
Sia M.: Yeah, I had to go in, roll my sleeves up. Went in, and within… Because it was July and August, being the summer months being usually quieter, productivity went up about 20, 25%, which shows what were the staff exactly doing. I had already asked them what were you guys up to. Productivity went up, and then I noticed how affluent the area is, and the comment I was making to you about the NHS access. Don’t underestimate that. If you’ve got your own successful private practise, and you’re doing your private work for a number of years, excellent. But, there are practitioners who are in this middle grey area. There’s a lot of good quality dental work that can be done in practises that have an NHS access and private scope.
Payman: What would you do differently career-wise?
Sia M.: I’m glad I didn’t start too early, because I had a great time between 1995 to about 2000, when most of my friends were starting practises. What would I do differently. Definitely, I would’ve bought a lot more of the NHS practises when I realised where the business was going. I should’ve bought 10. And, I knew it. That was the whole point. I had inside information, not inside trading information. Don’t come knocking on my door. It wasn’t anything like that. I just worked it out that if you’re going to put a ceiling on the expenditure by the government, effectively they had no ceiling of what the annual expense was for dentistry. If you look at it in simple term, if the annual expense was limitless, or with no limit, now they’ve got a limit. And therefore, you can’t have a squat practise. It doesn’t take a genius to figure out, if you’re already in that pot, what you own is going to have a lot of value.
Sia M.: The government did try a lot to claim that the practises technically that the contracts were there, as in you couldn’t sell them on. I can remember his name, but there was one chap in Birmingham who fought this underside and made it possible that dentists could sell contracts. And, it wasn’t NHS owned, although where that goes now, I don’t know, but that’s definitely something that I would’ve done. Because I knew it was happening. I just didn’t have enough guts to borrow money off family, and I didn’t want to go to the bank man.
Payman: What’s your lowest point in your professional life?
Sia M.: I’m glad you said professional life, because many football low points, but… Champions league final being knee deep in urine in Moscow. Being held back when Man United had won on penalties really was harsh. But, that was harsh.
Payman: I don’t know what the hell you’re talking about.
Sia M.: Champions League final in 2008. It was harsh being held back in Moscow. Raining. Billeting. Knee-deep in urine in the stadium because urinals had overflowed with Chelsea fans. Not in the best of moods.
Sia M.: But professionally, litigation.
Payman: Has that happened?
Sia M.: It happens to everybody. It gets you tense. It gets you nervous. You’ve just go to deal with it, be a bit tougher. I find I’m quite sensitive, and I take it very personally, if there’s ever a complaint, and you try and fight your corner. And, you just need to take it and just deal with it accordingly, because I find sometimes, when it’s personal, and it’s not to do with clinical work being long, some of the accusations, which have never gone anywhere, have been personal. And, I find those… I think a person who would have an issue about that, I think a person like that has issues themselves. And, I think it’s sad that in our world, legal teams sometimes don’t stand up and listen to you enough by saying, “This is a personal attack. It’s got nothing to do with the clinical issues,” yet all they want to do is wash their hands often or just settle, just move on.
Prav Solanki: Is there one particular case that stands out in your mind of a personal attack that had the biggest impact?
Sia M.: Two. One when I was very young.
Prav Solanki: Mm-hmm (affirmative)
Sia M.: And, I’d spent hours trying to avoid doing a root canal on a patient where the tooth was vital, and I put in dressing, brought the patient back, and this is in the days of fee per item. And, I must have spend 5, 6 hours at least. And, the patient came back, and they thanked me, and they said thank you very much. The tooth doesn’t hurt, doesn’t need a root canal, and invariably, as you know, posterior teeth with a root canal if it’s got a large area, you’re then also looking at coronal recovery. And, it was fee per item, so there was no incentive for financial gain, and the patient had some sabiacal sensitivity, where they had a bit of a fraction, I thought.
Sia M.: So, I placed some glass inomers on two or three buckle areas. And, the patient wrote me a letter. And, back then, this was unheard of. This is 1992. Patient wrote me a letter saying can you please outline the advantages and disadvantages of amalgam and glass inomers, and why did you use amalgam on the back tooth and glass on the front tooth. And, I’m like perplexed, so actually went to Eddy Lynch, and I said, “Ed, what do I do with this?” And, Ed said, “I’ve never seen that.” And, Ed just said you write a polite letter back, and saying that I’m delighted that you’re no longer in pain. I’m delighted that you needed a root canal. But, I would guide you towards the British Dental Association and the British Dental Association’s library, where you can find out what the advantages of these particular materials are and why I’ve used them. I said, it’s because for the back teeth, back there you want to be using amalgam and for the sabiacal lesions because you want to do the non invasive, do the glass inomer’s bonding properties is what you want to use.
Sia M.: So, I gave them a hint of what they advantages were but not chapter and verse on why you use one and not the other. And, he went for it and got started sending letters-
Payman: He was unhappy with that answer.
Sia M.: Yeah, about why did you do this? I never wanted to have this done, blah, blah, blah, blah. But, his original letter had thanked me, and this went on and on, and it went to… I can’t remember the phraseology. It was before misconduct stuff. It went on to a local meeting of – in Lambeth, Southwark and Lewisham, with a panel and two or three dentists. And, the guy had gone onto describe his story. Then, I went on to describe my story, and the judge said, “but, you keep referring to the fact that the patient thanked you.” And I said, “Yeah, he did. It’s in this letter that my legal team would’ve had.” And for some reason, the judge or the panel never got it, and the judge looked at the letter, ripped it up and said, what a complete and utter waste of time. What are we here for? So, that one, for me was like, what a complete, utter waste of time, and why was this particular complaint then not pursued by saying thanks for wasting court time? Someone should’ve been help liable for that. That was the first one.
Sia M.: The second one was just… They were accusing of the staff laughing at them, and laughing at them when they were rinsing their mouth. I’m like, why would the staff want to laugh at you when you’re rinsing your mouth. Accusations that were just downright wrong. And, when the accusations were this wrong, and the patient was found to be lying, and it turned out that the… Wasn’t the patient that was making the complaint. It was the patient’s daughter, who was a legal secretary. I then, went to my legal team, and I said, “Clearly, we’ve proven that they’ve lied. There’s got to be some sort of action towards libel and all this time that’s been wasted, including my annual rate going up for my payments for my insurance.” And, all they were just like, just let it go and move on. I don’t think that’s right. So, those two really stood out. And, they were unnecessary.
Payman: What would be your advice, I mean, with the GDC situation right now, there must be so many people who’ve got something going on. What’s your advice? Because, I know the thing that hurts the most is you tried your best for that patient, and now the letter or the accusation is that you’re substandard. And, that must hurt. That does hurt. I’ve had complaints letters myself when I was a dentist. What’s your advice?
Sia M.: The advice is don’t take it personally.
Sia M.: Yeah. Do not take it personally, and defence of the GDC, the first thing that it says is that they are acting on this particular request. No one’s been accused. No one’s been proven to have done something wrong. They are acting on a request of a complaint. So, the first thing to do it to not take it personally. Sit back again with the same advice. Don’t react. Don’t start throwing your toys out of the pram claiming your innocence. Sit back, swallow, relax, and then start gathering all the facts. You’re always going to get bad eggs in any profession. And, I don’t think there are many dental practitioners out there who go out of their way to cause harm for patients.
Sia M.: If you make a mistake, put your hand up. Try and be as courteous and as polite. It’s a lot more than, say, 15, 20 years ago when I was working. You need to be a lot more… I’m not saying courteous, but you need to be a lot more attentive towards patients. They like to feel special in whatever environment they’re in, and they should not be any difference drawn between NHS and private. Every human needs to be dealt the same, but don’t take complaints personally. Sit back. Take a deep breath. Look at the facts. I’m sure 95% of the time, you’re right. But, don’t try and justify the fact that you’re right. Provide the facts. You leave that in their hands. And, if there is something to answer for and you’re not guilty, just allow the time to ride.
Sia M.: It’s stressful. I’m not saying that it’s not stressful. I’ve had a couple of friends actually go to the next level. Thankfully, that’s not happened to me, but the next level ones are extremely stressful. But, you just got to deal with it.
Payman: I’m conscious you can’t be with us much longer, but I want to finish with one question.
Sia M.: Tell me. Is this going to upset me?
Payman: European Cup.
Sia M.: Okay.
Sia M.: European Cup Final 1981. Liverpool one round Madrid nil. Allen Kennedy.
Payman: Where was it?
Sia M.: Parque de France, Paris.
Payman: How the hell do you- encyclopaedia. Once he said to me because you’re not into football you should be a lot further in your career than you are. Thanks a lot for taking the time Sia.
Payman: It was a real pleasure having you on the show. Thanks.
Sia M.: A pleasure to be here, as always.
Payman: All right. Thanks, buddy.
Prav Solanki: Cheers, buddy.
Speaker 3: 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.
Payman: Thank you for tuning in, guys, to the Dental Leaders podcast. Just got a little request to make. If you’ve got a suggestion of somebody else who we should be interviewing or somebody who’s got a really strong story, powerful story to share with us, please send us a message and help us connect with that individual, so we can bring their story to the surface.
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