Siamack Bagueri: His thing was, he said to me, if you can persuade a lender [00:00:05] to lend to you, you’d be silly to say no. As long as you can convince [00:00:10] the other individual, the case is good to invest in you, and [00:00:15] there’ll be an interest rate or a partnership or whatever it may be. You’d be silly [00:00:20] not to say yes to it. So in this day and age of leverage, you know, you know, I [00:00:25] am leveraged. Of course I’m leveraged. I am one to say that. Look, I keep taking [00:00:30] the risk. And during the past 35 years of my career, I’ve done a [00:00:35] lot of good. I’ve failed a few times, I’ve sold a few practices. Now I’m [00:00:40] embedded into, you know, ten solid practices that all being well, as long as we [00:00:45] meet the KPIs, the contracts will renew. And it’s a nice little business bringing in, [00:00:50] you know, bringing us healthy revenue per annum run by specialists under [00:00:55] whom we’ve got the therapist and the ancillary staff. So the system really, really works. [00:01:00]

[VOICE]: This [00:01:05] is Dental Leaders. The podcast [00:01:10] where you get to go one on one with emerging leaders in dentistry. Your [00:01:15] hosts Payman Langroudi and [00:01:20] Prav Solanki.

Payman Langroudi: It gives me great pleasure to welcome to [00:01:25] the podcast, maybe better known by his pseudonym of Mac Bagheri. [00:01:30] She is a highly successful orthodontist that owns ten [00:01:35] large ortho practices with his wife, Peta. And um, if [00:01:40] I may say so. So nice to have you here finally, because you’re a real inspiration to the Iranian [00:01:45] dentist community. People often cite you as the reason they were into ortho. [00:01:50] Yes. Thank you. Even dentistry. Um. I came to the UK [00:01:55] like a lot of us, you know, in a hurry. Yes. My dad had a accountancy firm. He had [00:02:00] a couple of English guys working there. And when. When the UK embassy said leave, he [00:02:05] told us to leave. And, um, me and my mum and my brother came on the same day [00:02:10] the Khomeini came to Iran on that day. It was a busy day at the airport. Yes, yes. What was your story? [00:02:15] How did you end up here? Yeah.

Siamack Bagueri: So basically, um, my sister and I, she [00:02:20] formed earlier than me. We came in the mid 70s. So before the revolution. [00:02:25] Before the revolution. So my, my parents, um, both worked for Nioc, the national [00:02:30] Iranian oil company at the time. And I suppose there [00:02:35] was a vogue at the time to send your kids abroad. I don’t think anybody really predicted [00:02:40] the revolution in the mid 70s. It was a, you know, 70s was wonderful in Iran.

Payman Langroudi: So [00:02:45] you came with your sister boardings.

Siamack Bagueri: Yeah. So basically she she came before me and we went [00:02:50] to, uh, I went to a prep school in Seaford, which is very dreary place [00:02:55] in East Sussex. And then for, you could say for the newlyweds, the nearly deads. [00:03:00] It was quite, it’s quite, it’s quite dreary. How are you? I hated it, I was about 12 [00:03:05] at the time and then my sister was already there and the school down the road. So, you [00:03:10] know, she was in a girls school. I was in a boys prep school.

Payman Langroudi: Parents were back home, parents.

Siamack Bagueri: Were initially my [00:03:15] mum came for six months and she went home so very much in the in the mid 70s we were going [00:03:20] quite a lot to Iran as holidays. I couldn’t for the life of me think, why have they [00:03:25] done this? Because we’re a very sort of a nice life, comfortable life. Then I’ve been dumped [00:03:30] into a prep school and forced to have a bath with four other people naked. [00:03:35] And I thought, this is odd because I, you know, I never I why they’re having a bath, I [00:03:40] didn’t the concept of a bath was quite amazing, you know. And anyway, that was, that [00:03:45] was a shell shock and, and sleeping in a dormitory that was a shell shock wearing shorts. Yeah. [00:03:50] It was just, it was just having a matron. It was the whole thing was quite surreal. And I kept asking [00:03:55] myself, why have they done this? Why have they done this anyway? But then the bedded in. There was a few [00:04:00] other Iranians in the in the school, and then from there onwards [00:04:05] I went to another school again, boarding school for five years. I went to a school [00:04:10] called Haileybury, which is in north of London, in Hertfordshire. But yeah, I mean, I don’t think [00:04:15] my I think if you think about because I was quite young then I didn’t [00:04:20] really realise the political oscillations that was happening in Iran. Perhaps [00:04:25] my dad would, but I think reading quite a lot of people were sending kids. [00:04:30] Yeah, even the 60s and the ehm, the mandate was to get education and go [00:04:35] back and, you know, build a life for yourself.

Payman Langroudi: And so how did dentistry [00:04:40] come into the. Yeah.

Siamack Bagueri: Good point. So basically what happened is quite an interesting [00:04:45] question. So obviously being an Iranian parents always want you [00:04:50] to do either, you know, medicine or engineering or so on. So when I was doing my [00:04:55] A-levels at the time, I was quite good at maths actually, and my teacher said, look, [00:05:00] you really should do computing because, you know, I was doing sort of advanced maths in Iran. [00:05:05] They teach you maths in a good level and.

Payman Langroudi: Yeah, imagine where you’d be now.

Siamack Bagueri: Yeah, [00:05:10] exactly. Exactly. I would, I would have been a different thing. And that’s in some ways I [00:05:15] love computing and I love the whole way AI is going to completely it’s going [00:05:20] to be a paradigm shift in dentistry. I think that’s we’re living in extremely exciting times. [00:05:25] You know, contrary to popular belief, dentistry is going to go leaps and bounds [00:05:30] with the advent of AI and tech, and you’re the forefront of it. So, you know, [00:05:35] I’m quite proud of what you’re doing. So now going back to why I did dentistry, I [00:05:40] went for a half time visit to see my sister. She was living in Bristol. She was in [00:05:45] second year chemistry and I went spending time with her. And then she said, [00:05:50] oh, by the way, a friend of mine is doing dentistry, and as soon as a pretty bubbly girl [00:05:55] probably had a secret crush on her, I was, you know, and then I went and spend the whole [00:06:00] day with her, and she was just so enthusiastic. And she took me to the little [00:06:05] dental department at Bristol. She was just she was very pretty, [00:06:10] smelt. And she she just sold the whole thing. You were in love. Yeah. And I thought, I [00:06:15] suppose what I suppose. What she. The element of it that she sold to me was the [00:06:20] concept of seeing patient, looking after patients, getting in 1 to 1 with patients, [00:06:25] which, you know, I’m going to give you two examples in a minute. But then really not having [00:06:30] the burden of medicine, uh, seeing people die emotionally, getting involved with [00:06:35] them. And, and I think that attracted me to the industry. You made your own decision.

Payman Langroudi: It wasn’t like, I think.

Siamack Bagueri: Son, [00:06:40] I think my my O-levels. I was dentistry’s fine round about that time. You’re [00:06:45] now middle of the, you know, middle of the Iran-Iraq war. Fund transfer was very difficult. [00:06:50] So already your.

Payman Langroudi: Parents come by this.

Siamack Bagueri: Time? No, they were still in Iran. And then at [00:06:55] that stage, the parents very much were restricted with with the subjects that we could study [00:07:00] anyway, which is kind of resonated with what they wanted to do. In any case, I [00:07:05] always had fond memories of my dentist in Iran. Always. He was always very turned out smell [00:07:10] nice. I was never really worried about going to dentist. He was really kind, although I [00:07:15] had loads of fillings done. So I think, you know, I, I fell into it slightly. [00:07:20] Sometimes I have regrets, you know, like I say, you know, you look at computing, oh my God. And if I went [00:07:25] to something like Nvidia I’ll be in a different league right now. But it’s a decision I made at the time. You [00:07:30] make decisions with the wisdom of the time and what’s given to you. You can’t really predict all the ways. [00:07:35] And you went to Bristol. I went to Bristol, did my dentistry in Bristol for five years, four and a half years. [00:07:40]

Payman Langroudi: What were you like?

Siamack Bagueri: Um, I was good initially I was Babylonia. I would, I wouldn’t, [00:07:45] you know, and I think I spent the first year or two pretty [00:07:50] much listening to the radio, uh, because [00:07:55] worried censors about parents. Yeah. Um, you know, dying with a Saddam [00:08:00] in the bombings. And actually, then I just I need to I need to tell you that now. [00:08:05] So imagine we’re Middlesbrough. So I’m an Iranian kid. Fees [00:08:10] are really high. Parents that were sending the money and so on. I distinctly remember [00:08:15] a couple of times ringing my dad saying, look, dad, you know, the kind of, you know, chasing me for you. Don’t worry, [00:08:20] I’ll send it to you. And then many, many years later, we’re talking 20 1718. [00:08:25] I went to Iran and then I, uh, [00:08:30] I was walking with dad round about where we used to have a house. Then he took me down a side [00:08:35] street. He said, do you recognise this street? I said, no, not really. He said, what do you what [00:08:40] do you what do you observe about the street? I said, well, there’s a lot of new builds in the streets. Well, you’re right, [00:08:45] because do you remember when you called me in the 80s, and pretty much a day or [00:08:50] so later, one of the missiles landed and completely flattened the street, [00:08:55] and I said, where were you? He said, well, I was in our house. I said, did you not did [00:09:00] you not want to leave? He said, well, I had no choice because you asked me to, you know, [00:09:05] I had to support you and your sister.

Siamack Bagueri: And then that story, I you know, every time I [00:09:10] talk about it, it brings up a lot of emotions. I tried to pass that on to my kids. [00:09:15] And I think, you know, when in times of atrocity, times [00:09:20] of difficulty, you make decisions as a human, whatever you are. And [00:09:25] we’re now in a politically, we’re going through lots of mayhem and we all have to make decisions. And that [00:09:30] made that decision. And he’s still living in his 90s. He’s living in LA. He’s he’s very happy. [00:09:35] But every time I think about those few conversations, because he didn’t really speak that much, [00:09:40] my dad and I was more writing in those days. The phone calls were impossible, but Bristol [00:09:45] very much. I was initially a bit of a loner and listening to radio. I was really worried, but then I gelled [00:09:50] in that I had a really good groups of friends. Majority were either, uh, Jordanian, [00:09:55] uh, um, the Palestinian, Malaysian of the good [00:10:00] overseas group, which I’m still friendly with. And I was in one of the houses, the other all [00:10:05] very successful. All we’re doing master’s courses as a result of me doing a three year, [00:10:10] four and a half, five year course. They were doing effectively a six year course because they’re doing the Masters. [00:10:15] So I got to know a lot of them and it was wonderful. Really. Are you like.

Payman Langroudi: A Swotty student [00:10:20] or were you a not really no animal? No, no.

Siamack Bagueri: No, I think I think what I, what I was very good at [00:10:25] is to leave things to the bitter end, but then [00:10:30] cram it. I was very good at parrot fashion learning dentistry [00:10:35] when you’re taught at school and like a lot of things, you know a lot. There’s a lot [00:10:40] of useless facts that you’re you’re given, which is totally unnecessary. They’re trying to separate [00:10:45] the men from the boys, I suppose, but learning, let’s say intricate anatomy [00:10:50] or the odd nerve that exists in 3% of the population yet [00:10:55] is exciting to be able to remember those things, but they’re utterly useless to what we’re [00:11:00] doing, what we ultimately do. But I was good at that. I was very good at anatomy. I got a prize [00:11:05] and I was good at remembering things. I think what I wasn’t very good at, I wasn’t [00:11:10] very good at chairside my chairside manner was awful, awful, awful. And [00:11:15] that’s something I. From the improved on and I’m still improving on. I was [00:11:20] punished a few times because if you have a poor chairside manner, [00:11:25] a lot of problems land on your doorstep and litigation and so on. So [00:11:30] I think we’ll touch upon that later. But I think that’s the one thing that I [00:11:35] improved on. But I wasn’t a Swot, but I was good at, I was good and I passed everything. [00:11:40] Pretty much anything I failed in my life is my driving test three times because I [00:11:45] lived in Bristol, very.

Payman Langroudi: Bad.

Siamack Bagueri: Habits, very hilly and I was awful [00:11:50] at Hill at Hill Start. But every time I would go the car would go back. Immediate fail. [00:11:55] So that’s the only thing I really failed on.

Payman Langroudi: What kind of touch on. Before we move on with [00:12:00] your career, this question of, you know, we’re kind of formed by our struggles. [00:12:05] Yes. And so you had these struggles. Yes. And you know who’s [00:12:10] paying for university? Yes, yes, yes. Worried about your parents war, all of that sort of stuff. And [00:12:15] I guess you must feel like you got some strength and it formed you. Yes. But then do you not [00:12:20] worry that your kids have had this sort of very soft, easy life [00:12:25] haven’t been formed true, by the struggles? And how do you reflect on that? [00:12:30]

Siamack Bagueri: I think I think I think what you have to what you have to do, you have to remember that [00:12:35] what we can’t keep telling our kids is that in my time was like this in [00:12:40] my this can be a very irritating to them. And you can occasionally reminisce [00:12:45] and say, look, this is what happened in our time, but I think it can fall on [00:12:50] deaf ears. Definitely. They’ve got a much more privileged life than we have, but they [00:12:55] also have a very tough time. I mean, you know, kids, my boys are both in their 20s. I [00:13:00] keep reminding them that when I was 22 or 21, I had a flat [00:13:05] in my own name, with my own hands, with my own mortgage. Now, because I’m at the time, [00:13:10] the mortgage rates were five 6%, same as today. But when I was 22, [00:13:15] property was far cheaper than today, and I was given 120% [00:13:20] mortgage by a building society.

Payman Langroudi: Which says as soon as you.

Siamack Bagueri: Qualified. Yeah, pretty much a [00:13:25] hero. So I so so so and then with the, with the vocational training income [00:13:30] that I had pretty much I was a third of my income was mortgage, which is very [00:13:35] plausible. Surely after the interest rates went 13, 14% then obviously [00:13:40] there was a lot of headache. Took me ten years to come out of negative equity. But now fast [00:13:45] forward to our kids. Yes, they had a privileged life. For sure they do. But [00:13:50] you know, very, very few of them are able by themselves to [00:13:55] get on the property ladder. It’s just not possible. Yeah. Even the ones who do in dentistry, even if they’re [00:14:00] really good and earning £150,000, which are very few, do you [00:14:05] can’t really you can’t really buy anything you can’t rate.

Payman Langroudi: They’ve got their own challenges.

Siamack Bagueri: They’ve got their own challenges. [00:14:10] I think I think what you what is good to remember is because my dad would have [00:14:15] his own, his his siblings were nowhere near as successful as he was. I listened to [00:14:20] him. Obviously I’ve listened to him and I’ve seen his trials and tribulations. I think [00:14:25] there’s there’s generational oscillation. I would say [00:14:30] all the generations are oscillating, and during those oscillations we become what we [00:14:35] become. So my boy is a kind of a reflection of my dad oscillating [00:14:40] via me, because each of us have got separate, you know, and then nothing [00:14:45] is exactly the same. But then, okay, if we.

Payman Langroudi: Were going to distil that down to lessons, [00:14:50] would you say the lessons are the same but the circumstances are different? Yeah, I would say so.

Siamack Bagueri: I think [00:14:55] the.

Payman Langroudi: Lesson did you learn from your dad?

Siamack Bagueri: I think what I learned, I think what I learned from my dad, which [00:15:00] I definitely passed on. I would say, don’t dote [00:15:05] on your failure, and then don’t gloat on your success, [00:15:10] because both those things you can, you know you can, you [00:15:15] can, um, you can grieve when something goes wrong and you can celebrate [00:15:20] when it goes well. But you mustn’t make either of those events too long. Uh, and I [00:15:25] always, with both the boys, are loving football. And I say, look, often what happens if a, if a, you [00:15:30] know, footballer misses a penalty or if he scores a superb free kick? Both [00:15:35] those celebrations all commiserate are very short lived because he’s got to go back to job at hand. [00:15:40] It’s good to have that. I think that’s one thing my dad was very good at was to not allow [00:15:45] failure to depress him, admit there was, admit something disastrous has [00:15:50] happened. But you’ve got to get up and say, you know something. It is what it is. [00:15:55] I am where I am. I’ve got to keep going. And you know, and then and [00:16:00] not pat yourself too much on the back either. Uh, have the occasional, you know, [00:16:05] um, have the occasional sweet in life. But really, I think that’s what I’m trying [00:16:10] to instil in them. Uh, but boys or kids, you can’t over lecture them. [00:16:15] So you have to bring when you. When I’m talking to my boys, I often do that when we go into a football match. [00:16:20] I try to bring it into line. And when they goof up and they have [00:16:25] messed up a lot, I don’t really, I don’t sometimes I do, but I [00:16:30] try not to amplify it. But then when the time comes, I say, look, you know, you’re mentally really [00:16:35] messed up.

Siamack Bagueri: Just you got to just get over it because worst could happen. Just [00:16:40] get home with it and then get up. Um, and I distinctly remember, like two years [00:16:45] ago, my son was going a really, really bad stage. And my [00:16:50] wife is much, probably much, much, uh, more disciplined than I am. [00:16:55] And my son was going to throw the towel in and saying, look, I want to take a year out because I think I’m going to manage [00:17:00] this course. What was I studying? It was studying philosophy at King’s, and his brother [00:17:05] had done the same at Oxford. He did very well. He’s always like in the shadow of his older brother. So my, [00:17:10] my wife basically, you know, blew a gasket, said, there’s no way you’re going to throw [00:17:15] the towel in because you’re being ridiculous, you know? And as it happens, after much [00:17:20] persuasion and screaming and shouting, he did. And he got it first. So, you know, I think occasional [00:17:25] what we call uh, and we occasionally scream and we [00:17:30] so and sometimes we tear up. So I think that’s really my modus operandi when it comes [00:17:35] to kids and myself as well, because, you know, it’s been a really tough time, I think, of [00:17:40] late for all of us and for me anyway, I’m almost 60 next April, and it’s been [00:17:45] a really, really tough couple of years. And I don’t, you know, sometimes I’m thinking to myself, [00:17:50] am I going to survive this? You know, when my in my 40s, I really thought, My God, [00:17:55] I can actually stop working now. But now at the age of 60, I’m working. So, you know, it’s [00:18:00] one of those things, you know, I think you have to, uh, so.

Payman Langroudi: Let’s kind of kind of on that subject, let’s [00:18:05] fast forward a little bit. Yeah. Go on. What would you say is the difference between the vast majority [00:18:10] of us dentists and orthodontists will have one practice and kind [00:18:15] of try and perfect that one. And then there’s the odd enigma, like you and [00:18:20] several others, though, who go to two, go to three, go to four, go to five, go to [00:18:25] what’s the what’s the mindset. And by the way, there’s no there’s no [00:18:30] saying one’s better than the other. Not sure. But what’s the mindset, the difference between [00:18:35] those two.

Siamack Bagueri: Yeah, I like it. The first of all I think one is, is really boils down to [00:18:40] in in orthodontics I would say. And when you [00:18:45] are dealing with the funder, the funder is NHS. So in our case 70% [00:18:50] of our income is NHS. The mandate is very clear. So [00:18:55] and so getting from A to B or A to Z in an NHS scenario is [00:19:00] not that difficult to deliver. And now, with the advent of orthodontic [00:19:05] therapy, remote monitoring and a lot of the host of stuff [00:19:10] that tech has allowed us to do, you don’t really need to be hands on [00:19:15] anymore, as long as you’ve got people doing it for you and you’re liable, you’re [00:19:20] vicariously liable. You’re they’ve got corporate liability for that work. So I think in our [00:19:25] case, I would say significant amount of NHS orthodontics need [00:19:30] not be done by specialists, can be prescribed and diagnosed by [00:19:35] specialists, can be occasionally intervened by specialists. But a lot [00:19:40] of the episodes can be done by a therapist. Same. The same realm is happening [00:19:45] now in in medicine, when it comes to prescription, you don’t need to see a GP to [00:19:50] be prescribed antibiotic for, you know, for a cold, you know, pharmacies [00:19:55] now getting prescription, uh, licenses. So so I.

Payman Langroudi: Think you could [00:20:00] have all of that happening in one chapter.

Siamack Bagueri: You can. But and that’s.

Payman Langroudi: What most people do, right? I mean, [00:20:05] I both my kids went through author. Yes. And both there were two different orthodontists. Both of them had one [00:20:10] practice. Yes. But this notion of two three. Yeah. Reinvest risk. [00:20:15] Yeah.

Siamack Bagueri: I think I think what it comes to, there’s a commerciality side of it which [00:20:20] attracts me. Um, I’ve always been one to always be one to dive [00:20:25] and then learn to swim. I’m not one. I’m not one to perfect swimming before diving. [00:20:30] Even when I started skiing when I was six and I would go off piste, I had no [00:20:35] idea that what will be ahead. But that risk, that element of risk, [00:20:40] always enthused me, I think. And yeah, of course there’s a, there’s a, there’s a reward, there’s [00:20:45] a commercial reward to it. And there’s been a lot of failures as well. [00:20:50] But I think what are your.

Payman Langroudi: Parameters regarding risk? I find risk really interesting because yeah, you know, the [00:20:55] some people will say some entrepreneurs will say I’ll. Ever risk the business? Yes. [00:21:00] On an idea. Yeah, yeah. But let’s imagine, you know, you’ve got a great [00:21:05] idea. Then it’s worth risking the business. I mean, like Elon Musk risk. So. [00:21:10] So how do you see risk. You know, the risk return equation. Yeah [00:21:15] I would say quite low risk. Or would you say you’re I’m definitely.

Siamack Bagueri: I’m definitely medium to high risk. I remember [00:21:20] one of the first principles I worked for Anthony Phillips Jewish guy. I think [00:21:25] probably he’s dead now. His thing was he said to me, if you [00:21:30] can persuade a lender to lend to you, you’d be silly to say no. [00:21:35] And as long as you can convince the other individual, the case [00:21:40] is good to invest in you, and there’ll be an interest rate or a partnership [00:21:45] or whatever it may be. You’d be silly not to say yes to it. So in [00:21:50] this day and age of leverage, you know, you know, I am leveraged. Of course I’m leveraged. I am [00:21:55] one to say that. Look, I keep taking the risk. And during the past 35 [00:22:00] years of my career, I’ve done a lot of good. I’ve failed a few times, [00:22:05] I’ve sold a few practices. Now I’m embedded into, you know, ten solid [00:22:10] practices that all being well, as long as we meet the KPIs, the contracts will [00:22:15] renew. And it’s a nice little business bringing in, you know, bringing us healthy revenue per annum [00:22:20] run by specialists under whom we’ve got the therapist and the ancillary [00:22:25] staff. So the system really, really works. So I. [00:22:30] And so those those.

Payman Langroudi: Where I’m going with it is, you know, there’s another [00:22:35] individual who might be sitting here saying, I want 300 of these beds. Yes. [00:22:40] Yeah. And that might be you. Yes. Or it might have been you 20 years ago or whatever. And, you [00:22:45] know, that cat might have risked all ten of them. That’s right. To get to 30. That’s right. Or whatever [00:22:50] it is. So, you know, how does it stop at ten. Yeah. Well, [00:22:55] how did it get to ten? And have you had moments in your career where you’ve risked the [00:23:00] whole company on a.

Siamack Bagueri: No, definitely not. I think first of all, when you’re talking about a corporate structure [00:23:05] or I’ve known people who’ve gone, you know, gone from 10 to 100 and. [00:23:10] Definitely. I think there’s there’s a critical number [00:23:15] whereby beyond that the personal touch is lost. [00:23:20] So I know pretty much now with the advent of WhatsApp groups and so on, pretty [00:23:25] much I know that 60 people that work for us, you know, ancillary stuff, I [00:23:30] know where they are, roughly know their birthdays or birthdays. Everybody knows where their birth is.

Payman Langroudi: Is it 60? Not [00:23:35] including the orthodontics.

Siamack Bagueri: Not including so. So pretty much the ancillary staff. If you like the window [00:23:40] of the practices who are running the show. Yeah, we know them. I know them especially knows the ones [00:23:45] in London. I know the ones outside London. We have a personal touch with them. You know, I may [00:23:50] have a, you know, a few of them. I joke with them with their dogs or I know where they’re going through [00:23:55] a hassle if they’re going through divorce or pregnancy, whatever it may be. So I think when it comes [00:24:00] beyond ten, I think you kind of start losing that. Then [00:24:05] you have to have regional managers. Yeah. And then you are then, then when you go to, you know, dealing [00:24:10] with private equity, let’s say, let’s say Portman or such, like you’re then really are answerable [00:24:15] to an investor, to a shareholder at that point in time, [00:24:20] really you start you are tempted to cut corners. So perhaps [00:24:25] you’re tempted not to employ fully, you know, fully qualified specialists, [00:24:30] you know, tended not to use the best materials, plus.

Payman Langroudi: Someone else sometimes calling the shots. [00:24:35] Yeah. And then right then you become.

Siamack Bagueri: A little bit, you know, you think to yourself and, and the reason why [00:24:40] I know that because I started working for a corporate structure so many years ago. If I ran [00:24:45] the corner from here, there was a there’s a company called White Cross, I remember. So so I was the [00:24:50] first one to work in the practice in Kentish Town. And in fact, I learnt a lot [00:24:55] from the chap who started White Cross Avenue as a ex-mossad [00:25:00] guy, accountants, super bright, super, super bright. And when they [00:25:05] sold to Idi at the time, and I’ve never loved [00:25:10] the practice, Abner had about had five practices. I pretty much started three of them. [00:25:15] I started the one in Holloway Road here and also in Paddington Street, and when they [00:25:20] sold the idea and I’d came over and took over. In a nutshell, Abner [00:25:25] jumped in front of the tube and ended his life. So because he hated the fact that someone’s [00:25:30] come over a regional managers come over and taken over and it’s a story that you can read. Wow. [00:25:35] Um, so that was the one lesson for me back in the early 90s [00:25:40] that I don’t want to go down the corporate route. A lot of my [00:25:45] friends have sold to corporates. Corporates been on my doorstep umpteen times, [00:25:50] but I’ve always shied away from it because I think to myself. I [00:25:55] was speaking to our private bank. The bank called the whole bank the whole based [00:26:00] in Fleet Street.

Siamack Bagueri: Now they have 350 year [00:26:05] history. Eight partners, all whores. Pardon the pun. All [00:26:10] whores. And they’ve got 6 billion. And they. They [00:26:15] just lend 2 billion. They don’t. They’re family. And that’s the sort of legacy that I want [00:26:20] for my practice. And I think I definitely have got there now, you know, [00:26:25] because I really love the people that work with us from head of department [00:26:30] or professor at guy’s or dean of the faculty of Royal College. You know, these guys [00:26:35] are highly, highly respected. They’ve stayed with us for 25 years. I love [00:26:40] it, you know, it’s just incredible. You know, I’ve got a patient who was ten, 25 [00:26:45] years ago and she’s now working for us. She’s a fully qualified orthodontist. Ariane, [00:26:50] who you may know. Oh, so. So I was treating her when she was ten. Her sister [00:26:55] was nine, you know, and both of them become incredible dentists, the Dental sisters. [00:27:00] You probably can see them on Instagram. Yeah, I’ve had them on so so so so, so having them, [00:27:05] you know that. That’s what I mean. Loads of people have gone through our practice have either become [00:27:10] nurses, therapists, dentists and a few of them become orthodontists. So I think that’s [00:27:15] a few of them have gone on to max facts. So I think that’s quite nice. And you can’t because [00:27:20] the currency of success is not purely financial.

Siamack Bagueri: The currency is you want to sit down and [00:27:25] talk about characters like Ariane and say, you know something? Ariane was little and look [00:27:30] where she is now. And then we kind of were in the journey. At some stage. We infused [00:27:35] that into the whole concept of dentistry. Both three of my nieces [00:27:40] and nephews, you know, since the age of zero, they’ve been with us. They’ve all done dentistry. Two of them [00:27:45] have become orthodontists. So that currency, I get really excited when I think, [00:27:50] my God, this kid was, you know, one, they’re now 28 [00:27:55] and he’s an orthodontist. It’s incredible. I think, my God, we must have done something right. So I [00:28:00] think I think when it comes to not expand, there’s I think the critical number [00:28:05] beyond which you lose the personal touch. And once you lost that personal touch, your [00:28:10] answerable to another person. Right now, I’m answerable to the bank. I’m not answerable to any partner, to [00:28:15] any private equity, to any shareholder who’s sitting on my head saying, you’ve got to [00:28:20] give this certain profit. I can dip and dip into our finances [00:28:25] in and out. I can take the risks. I’m answerable to myself and I’m not really answerable [00:28:30] to anybody else. I don’t need to divulge too much to the lender, you know, [00:28:35] uh, whereas the private equity going to be extremely transparent. And that [00:28:40] would be very restrictive for my mindset, I think.

Payman Langroudi: So then you’ve said all these nieces [00:28:45] and nephews went and became orthodontist. Did you did your kids never show an interest? No. [00:28:50]

Siamack Bagueri: It’s interesting that I the boys didn’t because the boys at when they were in when [00:28:55] I was in school, they both loved humanities, they loved history and politics. [00:29:00] But interestingly, I think both will end up being involved because the older one is [00:29:05] now gone into safety of AI, ethics of AI. And I think in some form or fashion, he’ll be involved. [00:29:10] The middle boy has been very much involved in management of the practice, and he [00:29:15] is going to do consultant management, probably in in London business school or maybe [00:29:20] you or Imperial. I think when he comes out and he’s worked [00:29:25] in a good firm and he’s learnt the ropes, I would love him to manage [00:29:30] the practices because I’m very much managing it anyway now.

Payman Langroudi: Yeah. So what’s the org chart [00:29:35] now? You’ve got you and Perry.

Siamack Bagueri: So, so basically yes. So basically the so each [00:29:40] practice has got. If you are on site. [00:29:45] Manager or nurse. Practice each practice. Got one? Yeah. Uh, and [00:29:50] then that individual could be the one who does the ordering and does a rota management [00:29:55] and so on. So. And then each few of them have got a head. [00:30:00] Who organises that. We’ve got an ordering form, let’s say on [00:30:05] a WhatsApp group. We’re going to Rota manager who manages for practices. So depending on [00:30:10] where they are. So Kent let’s say we have two practices that’s going to there’s a there’s an ecosystem [00:30:15] in Kent whereby they deal with their own laboratory, with their own staff, with their own Audrey. [00:30:20] But what we’ve done, we’ve, we’ve, we’ve I’ve, I’ve delegated various things [00:30:25] to various managers to make them, not to make them important, but are delegated [00:30:30] them so they have net worth. So they’re really realise that they see progression. Yeah, [00:30:35] they can see that. You know, that individual one, one girl, for example, was desperate to do therapy. She [00:30:40] was probably in her late 40s and I thought, hmm, she’s probably a bit too old to start in therapy, but [00:30:45] I need to keep her. I need to do something that she needs. She feels worth it. Okay, [00:30:50] now you deal. Now you’re. I said you’re too. You’re too clever to do [00:30:55] this. But you’re really good at this, you know, and I’m put you on a better hourly rate, [00:31:00] and you deal with running 20 people. And then. But there’s one individual [00:31:05] who runs the whole, you know, if you like. She’s, she does all our payments. So [00:31:10] she’s the one with the key card for all our practices. So all sort of, you know, all [00:31:15] roads lead to her when I, when they come to pay people or when there’s often a [00:31:20] sort of a dispute they can’t handle, uh, HR problem, then you’re gonna.

Payman Langroudi: Have to give me hope.

Siamack Bagueri: Yeah. So she she’s [00:31:25] she’s been with she’s been with me now since 92. Um, and so how much.

Payman Langroudi: Autonomy [00:31:30] did the managers have? I mean, do they, can they hire and fire?

[TRANSITION]: Uh.

Siamack Bagueri: Pretty much [00:31:35] I would say no. I would say when it comes to the London [00:31:40] practices, pretty much clear. And parental carita would be the one, you know, [00:31:45] talking to them, disciplining them or discussing with them. I think, uh, [00:31:50] when it comes to the, the, the legal aspects of it, we use a company called [00:31:55] Peninsula you may have heard of, but even in my opinion, they’re quite useless. But [00:32:00] they, they they’ve got a narrative which we’ve plagiarised. We use their narrative [00:32:05] and we know the rules. The our accountants very much know the employment [00:32:10] rules. We’re now shying away more and more from employing people long term, [00:32:15] post-Brexit. Very much. I think significant portion of our workforce [00:32:20] is done through locums and temp agencies. Uh, I think the gig economy is [00:32:25] very much discouraging people from becoming long term employees. A lot [00:32:30] of our home-grown nurses who, uh, if you like the white girls, for want of [00:32:35] a better word, they they just don’t want to work more than 20 hours, because if they do anything more than [00:32:40] 20, they will not get the benefits that, you know, they will get housing or child or whatever. [00:32:45] So we’ve got and then we’ve got the other girls who really good. Some of them are Eastern European [00:32:50] and they come to us as temps. There was a time we would offer [00:32:55] them a full time job, but these days they don’t want it. They want to work 3 or 4 [00:33:00] days. They don’t. They’re not particularly bothered about annual leave or bank [00:33:05] holidays.

Siamack Bagueri: What what entices them is the gig economy. [00:33:10] They can they can dip in and out of it. Uh, they’re getting a relatively good salary from [00:33:15] the temping agency. Temp agency charges quite a bit. And I think that’s [00:33:20] the way workforce is going. People are shying away from employing people long [00:33:25] term much more into albeit the outside practice is a much [00:33:30] more stable in London, we find is much more temp agencies. [00:33:35] Recruitment is a very big headache. It’s been exacerbated post Brexit [00:33:40] but really is a difficult problem. And even if the ones that want [00:33:45] to be long term, they all want to become therapists and you can’t make everybody therapist. So [00:33:50] every time somebody wants to go on therapy, whilst you whilst you celebrate, you kind [00:33:55] of losing a good nurse as well. Yeah. And you can’t pay a good nurse. So there’s a sell by [00:34:00] date with some of these good nurses. You can’t give them more than X amount per hour because [00:34:05] it becomes it becomes economically not tenable. So um, but I think, [00:34:10] I think going back to your. How he’s managing ultimately now, [00:34:15] with the advent of computers in Texas on and lots of it is done on my phone, Dropbox [00:34:20] and phone is just incredible. So I’m very quick at navigating between practices [00:34:25] and jumping onto the local Dental software. We use different Dental softwares. I [00:34:30] know the individual managers quite well. Uh, let’s say one of them is their Scouser, so I follow football with [00:34:35] her.

Siamack Bagueri: So with bantering all the time, one of them is Italian and one of them is [00:34:40] South African. So I kind of know the nuances and I’m not. How do I say I’m not pretending [00:34:45] I actually do like it. And when it comes to football banter, I do love talking to about football. [00:34:50] She’s very knowledgeable. So I just I think what Britain are good at is that [00:34:55] once a member of staff, we grab them in terms of them [00:35:00] as a character, we really enjoy being with them. You know, we don’t if we take them out for lunch, [00:35:05] it’s not because we’re saying, are we taking them out for lunch so they can work harder is genuinely we [00:35:10] actually enjoy being with them. And then the offshoot is that okay? Then we’re buying them some some loyalty. [00:35:15] Not always. I mean, we’re taking people out for lunch and they haven’t been loyal to us. [00:35:20] So, uh, we’ve had we’ve had our hands burnt there. But but I think, you know, right now we’ve got [00:35:25] a nucleus of staff that are would really swear on. I mean, there’s a few of them that [00:35:30] are really would really swear that they are loyal. And a few of them have said [00:35:35] we will not retire until you retire. A few of them said to me, Mike, if you sell to any corporate, we’re [00:35:40] out of there because I’ve heard what’s happened to their friends. Yeah.

Payman Langroudi: So so that’s [00:35:45] sort of the operation side. What about the clinical side? I mean, what’s a good orthodontist [00:35:50] for you? I mean, when you’re hiring someone. Yeah, I suppose the. [00:35:55]

Siamack Bagueri: Good especially is like, you know, they’re going to be going through it. They’re going to be on the specialist register. [00:36:00] Yeah. Yeah. So and then once they’ve done that I think. Majority [00:36:05] of specialists have gone through the mainstream orthodontics. Okay. [00:36:10] So very much the fixed appliances and that’s what the NHS is paying. They’re not paying [00:36:15] for aligners or anything, anything outside the outside the ordinary. So [00:36:20] few of them do do things slightly differently. [00:36:25] And I do allow some clinical freedom. You know we mentioned Ariane. Ariane [00:36:30] is very much into you know, she’s spreading her wings. She’s doing different things. But I’ve got [00:36:35] to remember she’s a lot younger than I and they’ve got aspirations [00:36:40] and things are moving extremely quickly when it comes to functional dentistry, when it comes [00:36:45] to aligner technology, when it comes to collaboration with general dentistry, [00:36:50] one mustn’t poo poo it, you know? You know, orthodontics in the [00:36:55] adult has very much now become the forte of general dentist because Invisalign [00:37:00] has kind of hijacked. It, has empowered the dentist to do minor cases. [00:37:05] And a lot of dentists now do those either in-house orthodontists or they do it themselves, [00:37:10] and they normally piggyback that on top with veneers and composite [00:37:15] build ups. So I, I think then orthodontics for adults has changed and [00:37:20] you have to allow it to develop and evolve. Currently with NHS [00:37:25] it’s very binary. They only pay for certain things and so [00:37:30] be it. And it pays. It pays okay. So so when it comes to specialists, I do like [00:37:35] people to be mainstream. I would like that. And even if they’re not [00:37:40] mainstream, I think the funder being the NHS forces them to be mainstream, [00:37:45] because anything you do outside the ordinary is not going to be remunerated so [00:37:50] that the system is telling them this is what you should do now, within that, they obviously [00:37:55] everyone does their private work and what they do is up to them, really what they do. I mean, [00:38:00] I’m probably the only only one in the group of practices that do lingual orthodontics, [00:38:05] and I’ve done it for years.

Payman Langroudi: Why do you still practice?

Siamack Bagueri: But no, I now I’m [00:38:10] slowing down completely because as of, uh, as of, I don’t know, middle of June, [00:38:15] I’m going cutting down to two days a week. So Mondays. Um, but why? I [00:38:20] think I do like the intellectual stimuli I love. You could get intellectual stimulation. [00:38:25]

Payman Langroudi: Yeah, you could look into I, I.

Siamack Bagueri: Know, I know, I.

Payman Langroudi: Lingual, backbreaking [00:38:30] work.

Siamack Bagueri: Yeah. I’ve pretty much stopped lingual. Now I don’t do it anymore, to be honest. I [00:38:35] tell you I tell you a couple of examples of.

Payman Langroudi: Is there some sort of you’ve got to you’ve [00:38:40] got to keep your hand in in order to have credibility with your. No, no, with your orthodontics. Yeah. I [00:38:45] think.

Siamack Bagueri: I think in order because the, because the therapists are working [00:38:50] under you. So really the patients are your patients. [00:38:55] You’re getting them to see. Now you’re paying the therapist [00:39:00] an hourly rate to see those patients. You cannot let them do the whole work without [00:39:05] you observing it. And there are certain scenarios. There are certain episodes [00:39:10] in treatment that need intervention. You need intervention because [00:39:15] if the therapist has put the wrong wire in and the truth potentially, why [00:39:20] you.

Payman Langroudi: Why not an orthodontist? Yeah, but.

Siamack Bagueri: Because the orthodontist are expensive. So so therefore what [00:39:25] you do is that. So let’s imagine a case. It’s eight months into treatment [00:39:30] and the therapist is saying, look, such and such thing is happening. Okay. And [00:39:35] then I would say to him, okay, either if I’m there, I’m consulting and I say, let’s [00:39:40] have a look, or I will say to do a 3D scan on Itero or whichever product [00:39:45] you’ve got, and I’ll look at it and I’ll remotely tell them what to do. So really wet finger dentistry [00:39:50] I’m doing less and less and less. So from middle of June I’m going to do one day a week, really [00:39:55] private cases. I’m kind of running out because I’m hoping by the age of 60 I will still [00:40:00] have remote monitoring responsibility because ultimately the patients are under my duress, [00:40:05] the cases that I’m treating. And if I was to get somebody else to do [00:40:10] it, of course I’m going to remunerate them then that’s quite interesting. Then it becomes it becomes not.

Payman Langroudi: No [00:40:15] one day wet handed or two days wet handed dentistry. How many patients [00:40:20] are under your under your care with all of these.

Siamack Bagueri: So I would say I would say [00:40:25] the way to work it out is that how many cases can I start [00:40:30] by remote by remote work or [00:40:35] physically being there, seeing the patient let’s say, and then prescribing it. So I would [00:40:40] say per annum I could probably start about a thousand. Wow. Start [00:40:45] a thousand. Right. That’s the start of that. So that’s the if I can start a [00:40:50] thousand and I’ve got, let’s say eight therapists running the show for me, I still need to monitor [00:40:55] it, you know.

Payman Langroudi: And are the other orthodontists using therapists as well.

Siamack Bagueri: And some of them [00:41:00] are. Let me just quickly check to make sure, because often what they do, uh, some of them are [00:41:05] some of them would like to do themselves because therapists cost money. So the senior [00:41:10] the senior associates do do do use them. But [00:41:15] it’s a it’s it’s it’s it’s it’s financially very you know negative [00:41:20] for them. So the younger associates like you know some [00:41:25] of the young they don’t they do themselves because they’re younger. They want to do it themselves. They want to change the wires [00:41:30] and so on and so forth. The older ones who’ve now got quite a lot of the contract, it’s quite sizeable. [00:41:35] It’s just not physically plausible for them to do it. So I think there’s [00:41:40] a natural progression. As they get older, they get tired, they get they’re not as quick as what [00:41:45] they were. And they can kind of say, okay, I can forego, I can relinquish the percentage of my income [00:41:50] and I will let the therapist to do it. But I could then use my time to perhaps [00:41:55] sell Invisalign or aligners or whatever it is they’re selling. So I think having [00:42:00] therapists has been a complete lifeline for us. I certainly couldn’t have managed some [00:42:05] of the contracts that we’ve got without the help of therapists. And also the extended role [00:42:10] of dental nurses in our dental nurses are fully on board the Tcos, [00:42:15] uh, treatment coordinators, they do all the 3D scanning, they do all the [00:42:20] X-rays on the prescription, they do all the photography and all the oral hygiene instruction. [00:42:25] They do all the post retainer or post appliance education. They [00:42:30] do all the triads. So every case we’ve got a WhatsApp phone, [00:42:35] either on the phone or on the computer. So the patients are in touch with the nurses constantly [00:42:40] for triaging. So I would say 60% of those [00:42:45] tragedies are dealt with by the nurse and the nurses on 12, 15, 16 point [00:42:50] an hour before they even walk into the practice. So they and just [00:42:55] the fact that he’s got that ability to discuss it with somebody on a WhatsApp [00:43:00] on a per second basis is a really is a one.

Payman Langroudi: Way using the Dental monitoring. [00:43:05]

Siamack Bagueri: I’m not using the other monitoring because I they’ve been they’ve been on my back for many, [00:43:10] many years now. The reason why I haven’t used dental monitoring is the following. [00:43:15] Dental monitoring, as for some of you may know, involves a little [00:43:20] gadget that you put on the phone and you put it in the mouth and they will just measure where you are. Now, when [00:43:25] it comes to NHS orthodontics, it really isn’t financially [00:43:30] tenable because you’ve got to pay. For that [00:43:35] gadget. Obviously you’re paying a monthly fee, which is fine. And then if [00:43:40] something is broken per se and the AI of Dental [00:43:45] monitoring picks it up, that base is going to come in anyway. So that element [00:43:50] already is being done by human in our practice. So the nurses, like [00:43:55] the nurses have got during that week, they’ve got a very nice if you like. The remit is not just [00:44:00] nursing. So Dental nurse could be on one day on record taking, [00:44:05] which means they don’t come across any doctor. Their job is purely record taking. [00:44:10] There’ll be another day they’ll be triaging. They’ll be basically walking around with the WhatsApp phone and dealing [00:44:15] with patients, and there’ll be three days. Maybe they’re working 1 to 1 with patients, with doctors. [00:44:20] So it’s a nice journey for them now. And I think on [00:44:25] the patient side, they always prefer to speak to a Dental nurse than a receptionist [00:44:30] because the receptionist skill set is limited. So therefore and they’ve got access. [00:44:35] So I’m kind of thinking, would they prefer speaking to an AI than [00:44:40] a dental nurse? Of course, attentiveness to Dental knows exactly. What’s that knowledge was there when he put the [00:44:45] braces on. So had they got very good understanding of what’s going on. And when it comes to, let’s [00:44:50] say, the other stuff.

Payman Langroudi: We use it for private.

Siamack Bagueri: Yeah.

Payman Langroudi: Always dental monitoring. [00:44:55]

Siamack Bagueri: No, I don’t know. Now for dental monitoring again privately when it comes to aligner [00:45:00] treatment. Yeah. Now I know people like Clare Nightingale use it and few people use it. I [00:45:05] am not a massive aligner user, right? I do do aligners. We [00:45:10] do our own. A lot of people use Invisalign in our practice, but again. If [00:45:15] you were to give, let’s say, I don’t know, 20 aligners to an individual [00:45:20] and you say, right, I’m going to monitor you remotely. We now know that [00:45:25] is a wrong thing to do, right? We now know that the eye that that [00:45:30] prescribed those 20 aligners in an Invisalign setting is [00:45:35] totally biologically just not correct, because teeth [00:45:40] are not set in an articulator in a wax. Contrary to popular belief, [00:45:45] and often with Clincheck and Invisalign, it leads you to believe that, in fact, the [00:45:50] pair of dental arches are a wax model, and in fact, it is not the case because you’ve got [00:45:55] so much other, uh, you know, anatomy going around muscles, compliance, [00:46:00] goodness knows what. So what we do, in any event, [00:46:05] are aligner protocols. Very much five 4 to 5 [00:46:10] aligners come back and we rescan you for the next set of aligners. We’re [00:46:15] not one to say, here it is. I see you in six months time. Pay [00:46:20] on your way out. We’re not that way at all. Therefore, remote monitoring locks.

Payman Langroudi: Do do [00:46:25] that though, right?

Siamack Bagueri: A lot do that incorrectly. So those remote monitoring it [00:46:30] is akin to what happened to Smiledirect. So what happens is Smiledirect they [00:46:35] send the scan them, they send them excellent number of aligners. They gave [00:46:40] them even interproximal reduction for the patient to do it themselves. The reason why I know this, because I see the patients [00:46:45] now who’ve now the 63,000 patients with smile director Linus, who [00:46:50] don’t know where to go. I’ve seen a few of them and I know exactly what Smiledirect do. Remote [00:46:55] monitoring does not work because teeth are not. [00:47:00] Enamel set in wax.

Payman Langroudi: Let me let me tell you my experience.

Siamack Bagueri: So I would I [00:47:05] would definitely see them regularly.

Payman Langroudi: Let me tell you my experience. My son [00:47:10] had the fixed appliance with a traditional orthodontist. [00:47:15] Well, he was kind of facially driven, and I want to I want to get to that, actually. [00:47:20] That’s interesting. My daughter had aligners and dental monitoring and, [00:47:25] um, from the patient perspective that if you if you set it aside from I [00:47:30] know what’s going on, but as a patient.

Siamack Bagueri: The better.

Payman Langroudi: Much [00:47:35] better. I mean, I didn’t have to go to Harley Street every. That’s right. Four weeks. That’s right. Hey, [00:47:40] in congestion charge, people sit there for him to move things around. Now. Okay, [00:47:45] maybe my daughter’s outcomes not going to be as good as my son’s, I don’t know. Yeah, my wife, who’s dentist, [00:47:50] kinda felt shortchanged by dental monitoring. Insomuch as, you know, [00:47:55] we only went three, four times. She’s well into her treatment. But I was trying to explain [00:48:00] to my wife that, you know, we see it hourly rate thing. Um, but from a patient [00:48:05] perspective. Well, if you can make it much better.

Siamack Bagueri: Yeah.

Payman Langroudi: Make it easier, but but then from a business perspective, [00:48:10] if you can pull off a complete treatment in 4 or 5 visits.

Siamack Bagueri: With [00:48:15] that, with that, with that. Yeah.

Payman Langroudi: So now it’s the only challenge is how many patients can you get. [00:48:20] That’s right. Yeah. Of course in a in a private setting if that’s all marketing and word of mouth and all [00:48:25] of that jazz. Right. Yeah. But from a business perspective it’s extraordinary, I [00:48:30] think.

Siamack Bagueri: I mean, I think you can treat.

Payman Langroudi: Five, six times a number of patients.

Siamack Bagueri: Right? I think that’s why there’s that. That’s why [00:48:35] if you think about the evolution of aligner technology, which started with Invisalign, [00:48:40] then went on to, you know, small, direct, bright me and then they’ve gone [00:48:45] south. Now we’ve got remote monitoring. We’ve got friends of mine [00:48:50] who used to be in Total orthodontics. They’re now bought out by Bupa. They’ve [00:48:55] set up their own monitoring, if you like, specialists who are sitting there looking [00:49:00] at at the 3D models, planning it for the specialists, planning it for the dentists. [00:49:05] It’s almost like having saying, okay, we’re going to do the scan, but rather [00:49:10] than doing clincheck, which we know is through an eye, we’d rather send it to a specialist like [00:49:15] Mark and he will say, okay, do this. The other do five aligners so the person’s [00:49:20] holding hands. I think there’s definitely if aligners. If aligners [00:49:25] can be used for minor to mild to moderate cases, fantastic. [00:49:30] I would agree with you. But there’s plenty of evidence out there that [00:49:35] aligners don’t always succeed in moderate to severe cases, because the [00:49:40] way the Invisalign I blame Invisalign in some ways promises the [00:49:45] dentist that you can do much more than you really can. And then there’s.

Payman Langroudi: All that stuff about [00:49:50] not using the clincheck and not using correcting.

Siamack Bagueri: And then so on, and then you get a recession [00:49:55] and so on. So I think you need to have in order to have a successful [00:50:00] practice, you can’t just give somebody I mean, a lot [00:50:05] of remote monitoring, let’s say with attachments or oral hygiene and so on, is communicating [00:50:10] with the patient regularly. Now, there’s nothing wrong with saying [00:50:15] that, which I do that myself anyway. I have zoom meetings with patients or I FaceTime [00:50:20] them if they’re abroad. If I’m confident that they can wear the aligners, [00:50:25] I will definitely say, look, here’s ten, uh, let’s speak in three weeks time. But [00:50:30] I think patients will feel upset if you don’t put that half an hour aside [00:50:35] to talk to them and they will feel short changed. And why am I paying for AI [00:50:40] and why is he charging me X amount when I can go to smiledirect that charge me two grand? [00:50:45] Why is he charging me six? So I think there is that element that if you are and if orthodontists [00:50:50] privately were that busy that they couldn’t [00:50:55] time have time to scratch their heads, then yes. But the truth of the matter is [00:51:00] they’re not that busy. I can tell you that because I work in the West End, very few private [00:51:05] orthodontists are so busy that I’ve got zero time to sort of, you know, see somebody. [00:51:10] So I think, I think if somebody’s paying you a few thousand pounds is nice to see them [00:51:15] every 6 to 8 weeks, even if it means remotely seeing them rather than an AI. [00:51:20] So I’m kind of Dental monitoring have been on my back for the past year and a half. I’d have a look [00:51:25] I haven’t looked because I know.

Payman Langroudi: You’re a businessman from the from the business perspective, it’s just amazing. Yeah, it’s [00:51:30] a beautiful thing. Yeah. And I want to get to. So we took our kid for an author assessment. [00:51:35] We’re both dentists. And yet in that moment when [00:51:40] the guy started talking about your child’s face. Yes, we turned into patients. [00:51:45] And basically I was like, take my money. Whatever, whatever it is, have [00:51:50] it. And, you know, the psychology of what you’re going to, what [00:51:55] giving your child a brace is. Yes. Yeah. I would encourage all of them just to mention the [00:52:00] face.

Siamack Bagueri: Yes, sure.

Payman Langroudi: Because as soon as you said face, I was like, here’s my son.

Siamack Bagueri: That’s right, that’s right, [00:52:05] that’s right. Now I think we take extra photographs and I often look [00:52:10] at the person’s profile. Yeah. And I will speak to them [00:52:15] to the patient. And I say, look, you know, in your in your child’s case, if, for example, [00:52:20] we were to remove teeth, it will not be very and I’ve got loads of, you know, [00:52:25] uh, computer imagery which shows these cases, [00:52:30] previous cases and some cartoons saying what could happen. And then I do a lot [00:52:35] of therapeutic diagnosis, which basically means you start the treatment without taking [00:52:40] teeth out, and then you then park the decision on a later date. Uh, do you have to see [00:52:45] the kid earlier? I personally don’t, but there is a massive school of [00:52:50] thought now that you could treat people or see people early at the age of six seven. [00:52:55]

Payman Langroudi: Interceptive.

Siamack Bagueri: Interceptive expand them. There is some, um, there’s in fact, a couple of cases [00:53:00] in the GDC going on right now whereby, um, mu John, your son [00:53:05] is expanding the arch kind of semi promising that parent [00:53:10] that the cognitive behaviour of the child will be improved because the actual space [00:53:15] will be improved breathing. There’s very scant evidence on that. So I don’t really [00:53:20] promote that. Having said that, I do treat people slightly early if if [00:53:25] there are certain parameters, if the teeth, if there’s very narrow upper arch or [00:53:30] okay.

Payman Langroudi: So if I’m a generalist, I’m a GDP. Yes. And I’ve got a seven year [00:53:35] old kid in front of what should I be looking out for? And I would I would say.

Siamack Bagueri: I would say [00:53:40] if a seven year old fronted a really sticking out, I think that’s important because that’s potential [00:53:45] trauma. If they’ve got an underbite or reverse bite, you know the tooth is in crossbite [00:53:50] again, that person could develop a displacement. So [00:53:55] correcting it is dead easy. Uh, correcting an overjet is easy in a young child [00:54:00] if the upright is narrow, overtly narrow. Crossbite. Yeah. Or narrow, I [00:54:05] would say it’s not a bad idea to see them early, because you can expand now with aligners [00:54:10] because they don’t have it doesn’t have to be that. Yes, the years you put [00:54:15] an arm or a quad helix a bit more of a it’s quite labour intensive now. [00:54:20] These days you can do it aligners and I know people who do it. I again I’m in [00:54:25] the twilight in my career so I’m not really one for doing that. Definitely. I know individuals [00:54:30] that are very much into that and I do not Pooh Pooh it at all. [00:54:35] Uh, so.

Payman Langroudi: Gdp with seven year old kids should be looking for narrowing of the.

Siamack Bagueri: I [00:54:40] would say so I would, I would say if they’ve got a narrow upper arch, high arched palate, overjet [00:54:45] underbite. Yeah. Those are, those are a few of the parameters. I [00:54:50] would say that they’re worthy of referral, whether you refer again. Don’t [00:54:55] forget, the majority of patients do not want to have [00:55:00] their kids treated privately. You know, even even the more well-to-do [00:55:05] parents, you know, there’s not much left in the pot after paid school fees [00:55:10] and so on and so forth. So there is that element that they still want NHS treatment. So within [00:55:15] NHS we can’t really treat anybody before the age of ten because we don’t get paid. [00:55:20] So therefore you got that fictitious age group that we don’t, we can’t [00:55:25] see patients, we can’t see them or we can’t do much. But even in those age group, I do do interceptive [00:55:30] orthodontics privately, we don’t charge a lot. But certainly [00:55:35] functional appliance therapy in a young child with a marked overjet [00:55:40] definitely works because it’s non-invasive. It’s not [00:55:45] that intrusive. You win. The kid to your side is not a full time appliance. [00:55:50] So and you get the kid, you get to know them much earlier. You’re not really [00:55:55] you’re not really affecting them really in their school. Because [00:56:00] in a lot of these appliance can be worn night time. So I would say, yeah, a marked [00:56:05] overjet would be my like top of the list, top of the list to do something about it. [00:56:10] Obviously caries and decay, loss of six goes, you know, goes without saying, but we’re talking about [00:56:15] large overjet underbite with a displacement and a narrow [00:56:20] upper arch crossbar. I think those are the cases.

Payman Langroudi: So does that mean the NHS? Payment [00:56:25] structure is causing way more extractions to [00:56:30] happen than need to happen. No, I.

Siamack Bagueri: Think, I think, um, I think first of all, the percentage [00:56:35] of people who fall in that bandwagon, which I just mentioned are quite small, [00:56:40] right? Number one, now, majority of kids who have got [00:56:45] mild to moderate crowding and there are mixed dentition. You can’t [00:56:50] there’s no there’s no rhyme or reason to do anything about it. Now, if those [00:56:55] individuals are referred early or are encouraged by the dentist, oh, we should do something [00:57:00] about it now. I think, unfortunately it’s because the dentists [00:57:05] knowledge is not good. And then if they fall into wrong specialist [00:57:10] who says, actually, you know something, we should start them early and then they end up [00:57:15] putting fixed appliances on for young from in a young age group or Invisalign. [00:57:20] I think a lot of that is financially driven. Certainly we see that a lot from [00:57:25] Florida and from New York. You know, from the states. We see cases have been treated [00:57:30] for five years. Uh, and obviously braces or aligners or attachments [00:57:35] for a long period of time. You’re encouraging gum disease and decay. So and [00:57:40] the insurance system or the way the patients are, you know, I went to an orthodontic [00:57:45] meeting about a year and a half ago. And this German guy. His rationale [00:57:50] was these days we don’t get referrals from general dentists [00:57:55] anymore. The general dentist is doing their own Invisalign or they’ve got their in-house [00:58:00] orthodontists. So referral rate for [00:58:05] orthodontists has gone down unless they’re referring NHS wise here as well.

Payman Langroudi: You’re here. [00:58:10]

Siamack Bagueri: So his his argument was that okay we’ve lost that group of people. So now [00:58:15] we’re going to go early. We’re going to go really early and let’s treat them at [00:58:20] the age of six. And we grab them. And as we grab them by by osmosis we’re going [00:58:25] to grab the sibling, the parent and so on and so forth. As he was giving the lecture, [00:58:30] there was quite a few eyebrows that went into spasm in the group of orthodontists because we thought, [00:58:35] what’s this guy saying? Having said that, quite a lot of people that I know. Within [00:58:40] the West End, who I know they refer rate has plummeted. [00:58:45] They’ve had no reason. They’ve had no choice but to do that, because [00:58:50] in the end they’ve got a mortgage to pay, they’ve got a lifestyle to lead. And there’s come a time that [00:58:55] reverberated, just dried out, completely dried out, so I can see why they’re doing [00:59:00] it. Um, I’m in a fortunate position. I don’t need to do that because, you know, [00:59:05] I can’t. I can’t see the reason to do that. [00:59:10]

Payman Langroudi: For outcome wise. Are you not saying that it’s a better outcome if you get [00:59:15] to them earlier? I think if.

Siamack Bagueri: You get to them earlier, there is you could argue [00:59:20] if decay and gum disease could be avoided by protracted [00:59:25] orthodontic treatment, which often can’t. You could argue that, yes, the bone [00:59:30] is much more malleable at the seven year old patients. Compliance often is better [00:59:35] in a young child, and you don’t have to do anything too complicated [00:59:40] in in a in a young age group, you can make it simple and you grab them early. [00:59:45] Yes, there is that argument. There is that argument. I again, because [00:59:50] in my career it hasn’t happened that way. I can’t condemn people to do [00:59:55] it. So when this fellow did speak what he did and I came away and I thought, this is interesting [01:00:00] because this guy in his late 30s, early 40s, I can see what he’s saying. I [01:00:05] can understand what he’s saying. He’s in a different he’s in a different evolutionary [01:00:10] path to what I am. So if I have got younger specialists [01:00:15] and as the years go on, we’re going to get younger and younger and younger, [01:00:20] especially as compared to in relative terms. And if they want to do [01:00:25] orthodontics that we didn’t do right, I’ve got to be totally open about it. [01:00:30] You know, there was a time that everybody would be fixed. I reckon in about ten years time, [01:00:35] 90% of stuff will be done by aligners, maybe even sooner. A significant portion [01:00:40] of dental monitoring will be done by eye. There’s no question about it. That’s the way things are going. So [01:00:45] you’ve got to just be embracing and say, okay, we know this is going to happen.

Siamack Bagueri: How are we going to [01:00:50] make it work for us and not be closed minded about not be? I [01:00:55] did it my way. Therefore that’s the only way to do it. That’s the worst thing to do. I went down Mainstream [01:01:00] tree and I went and got an morph. Now, having said all of that, I still [01:01:05] think a period of. Post-graduate [01:01:10] education is quite important because you’re going to see the case through [01:01:15] and you’ve got to be you’ve got to bounce ideas with your senior peers. And that could [01:01:20] only happen in an educational environment. It seldom happens in a practice by [01:01:25] yourself. It doesn’t happen that readily if you are doing it [01:01:30] remotely. It happens when you’re in person. So we often all [01:01:35] our therapists are under our supervision. We’re showing them afterwards, you really messed [01:01:40] up there or you did really well there. You can’t really do that remotely. So I still [01:01:45] very much a proponent of postgraduate education being an implantology [01:01:50] and all the faculties of dentistry, it cannot be [01:01:55] done by generalists, certain easy cases. Yes. But [01:02:00] you ask a generalist to root filling up a seven. It’s not, you know. Yes. [01:02:05] Sometimes you’ll do it well, but more often than not things go wrong. You know, they go wrong [01:02:10] because you really got to have those difficult cases, the cases that come back to bite [01:02:15] you, to realise when they go wrong, they go horribly wrong. And then you really are before the docs, [01:02:20] either before the GDC or you’ve been sued. Yeah.

Payman Langroudi: Leads me [01:02:25] neatly on to yes, the favourite part of my yeah, which discusses failures [01:02:30] and mistakes. Yes. So based on Black box thinking, which is about [01:02:35] plane crashes and how people learn from them and no one gets blamed and the whole community shares [01:02:40] the information. Yeah. Rather than in medical dental circles where [01:02:45] we’re also worried about blame. And we hide all of our errors. When I say clinical [01:02:50] errors, what comes to mind? What happened to you that someone else can learn from?

Siamack Bagueri: Yeah, I. [01:02:55] Well, 2003 two and three four was 20 years ago [01:03:00] now, um, I treated an adult banker who was [01:03:05] probably I was five years into treat treating people with lingual orthodontics. [01:03:10] Really? I was in a, I was I was a lingual juvenile. [01:03:15] You know, I was not really fully understanding the repercussions of [01:03:20] lingual orthodontics yet. I embarked on it, uh, and [01:03:25] I charged him at the time I remember was £5,000. I charged him halfway through treatment. [01:03:30] He had a brain tumour, and when he had the tumour removed, [01:03:35] he had kind of personality change. But notwithstanding that, [01:03:40] it was a very hard lesson for me because he started from becoming somebody who’s very, [01:03:45] uh, agreeable. There’s somebody very confrontational and [01:03:50] the treatment went from bad to worse. I managed to finish the case. And when [01:03:55] we finish the treatment before, because I knew it was going that way. On that very [01:04:00] last day when I took the appliances off, I as I gave him the retainers, [01:04:05] I gave him the check for £5,000. I said, look, I really, you know, I know you’re not happy. [01:04:10] Here’s the money back. So no, no, no, I’m going to sue you. I said, oh my goodness, here you go. As [01:04:15] it happens, he sued me and he lost. But my lesson it took ages. We [01:04:20] had to have it took at least two years of my life and we had an expert witness and [01:04:25] so on. In the end, he didn’t win. But what the lesson that I learned was [01:04:30] case selection. So case selection doesn’t matter.

Siamack Bagueri: Forget money [01:04:35] for time being. We’re just talking about, let’s say, a seven year old with an overjet or an adult [01:04:40] with a minor problem. So the period of time you take [01:04:45] before you tell your client what they need, you’ve got to spend some time [01:04:50] doing it. As a young dentist orthodontist, you mustn’t be too, too [01:04:55] impulsive to do treatment. Oh, and never really start the treatment. In the first visit [01:05:00] in yester years I even remember case would come in. Patient was really [01:05:05] keen, I was really keen and I would say, you know something? I could start now, right? [01:05:10] And that I stopped that years ago, I stopped that. So I would say that one case [01:05:15] stuck in my mind, and I’ve had since that case, I’ve had maybe two other cases [01:05:20] where I’ve given the money back to them because I realised that especially now with cost [01:05:25] of living and everything. And recently there’s a case that I discussed [01:05:30] with you, the bleaching case, that it was just not worth it. You know, something’s [01:05:35] not worth the headache. If somebody starts complaining, you kind of [01:05:40] within reason. You want to give in and say, you know something? We’ve out of all the thousands I’ve treated, very [01:05:45] few have complained. Handful and a few that have complained. Kill [01:05:50] it quickly. Close it, make them happy. Even though it may hurt you. Don’t let your pride [01:05:55] get to you, because think about all the other thousands that haven’t complained. [01:06:00] So. But what was the mistake? My mistake was.

Payman Langroudi: A case selection. My, my.

Siamack Bagueri: My [01:06:05] mistake in this particular case was I administered treatment [01:06:10] outside my skill set. My skill set wasn’t there to do what [01:06:15] I did. I should have really stuck to conventional orthodontics. I shouldn’t have been [01:06:20] dissuaded by the patient’s desire to have an invisible appliance. You know, cases [01:06:25] come to you. But then.

Payman Langroudi: Look, every time we do anything new or something, [01:06:30] move forward, we’re doing something for the first time. Right. And so how do you decide [01:06:35] what’s in your skill set and what isn’t? It’s very difficult. I mean, yeah, I think this particular case went south. [01:06:40] Yeah.

Siamack Bagueri: I think I think when it comes to doing complex orthodontics and I certainly know [01:06:45] and you know, some of these individuals who have done really complex [01:06:50] orthodontics, having not been a formally trained orthodontist, using [01:06:55] Invisalign and getting to a lot of hassle, a lot of trouble, I just think, remember, 4 or 5 [01:07:00] years ago, a colleague came to me, uh, series of cases he was doing and I and [01:07:05] I said to him that, look, some of these cases that you’re doing are really outside [01:07:10] the ability of Invisalign. And he insisted that, no, no, no, no, the Invisalign [01:07:15] are telling me that they’re going to do it. I said, yes, Invisalign is not a human. It’s a [01:07:20] is a is an I telling you, in reality, you’re not going to be able to correct the severe crowding [01:07:25] and an underbite with Invisalign. He didn’t listen because he was a platinum user. He was incredible, [01:07:30] blah blah blah blah blah. Anyway, he’s no longer on the dental register. That’s a nutshell. So [01:07:35] that’s what happens. Uh, it doesn’t take that many cases for you to [01:07:40] be in front of the doc. And then for let’s get to.

Payman Langroudi: That, to that basic question for maybe a young [01:07:45] dentist. We have a lot of students listen to this as well. Yeah. Let’s say let’s say I’ve done [01:07:50] some ortho training as a GP. Yes. Even though I know one year, one day a month, whatever it [01:07:55] is. Yes. Where’s where are the red lines regarding whether I should treat it myself or whether [01:08:00] I should refer. Yes, well, the obvious ones. And then what are the more sort of I would say.

Siamack Bagueri: In a nutshell, [01:08:05] if you’ve got a case which, you know, you can go back [01:08:10] to the drawing board and say, okay, if you’ve got a case and you’re you’re just dealing what we call the social [01:08:15] six, they call it social sex, whereby the front either side expanded, they’re slightly [01:08:20] chipped. And you’ve got a first of all, ask yourself, okay, I’m going to give this case to go [01:08:25] with some very simple aligners. You know, maybe what Invisalign light or a few aligners [01:08:30] with angel aligners or whoever you want to use. But really, whether the end game [01:08:35] for me is to perhaps with some composite build ups, some veneers maybe. So you’re [01:08:40] looking at it holistically. You’re looking at it as a general case, right? Knowing that [01:08:45] the end result is going to be very nice because you’re going to do all these other fancy stuff. So [01:08:50] those cases are fine. I would say definitely treat them. The cases [01:08:55] that are slightly more moderate. Carridine do not be fooled by what aligners [01:09:00] can do, because often aligners or the people who are prescribing the aligners may [01:09:05] promise you something that is not attainable. And it doesn’t take long for any [01:09:10] aligner not only to not align, but actually [01:09:15] cause a worse malocclusion. Often. Orthodontic appliances. [01:09:20] Iatrogenically caused a malocclusion to worsen [01:09:25] and it happens extremely quickly.

Siamack Bagueri: So, for example, let’s say in a fixed appliance [01:09:30] case, and we often see that done in an untrained pair [01:09:35] of hands. And the patient says, oh, I can do this with your social six easy. [01:09:40] I can put brackets on the upper 3 to 3 and it’ll be alive. Now they put a wire [01:09:45] in the patient made DNA once and before you know it, you’ve got canines [01:09:50] that are really have come out at the line of the arch apart from the recession is then [01:09:55] becomes a really complex case to bring those roots back in. So you’ve [01:10:00] got to be you have to realise that orthodontic forces [01:10:05] are much the side effects are horrendous, even an elastic [01:10:10] put incorrectly unsupervised. With a pandemic, we saw a [01:10:15] lot of cases coming to us and if you put the wrong wire in, you could extrude and you can, you can, you [01:10:20] can extract the tooth. So you’ve got to you’ve got to respect appliances [01:10:25] and a lot of cases that smiledirect were sued or [01:10:30] obviously sorry, not sued are cases that were unsupervised and [01:10:35] led to irreversible gum recession because of overt expansion. [01:10:40] So I would say if you’re going to do something a bit more moderate, seek [01:10:45] advice, ask somebody.

Payman Langroudi: But when you say moderate, are we talking about the amount four. [01:10:50]

Siamack Bagueri: Millimetres of displacement. So between two teeth anything which is four [01:10:55] millimetres of displacement between the edge of the enamel and the, let’s imagine a lower incisor, [01:11:00] the mesial tip, if it’s more than four millimetres from [01:11:05] the medial tip to the distal tip of the lobe, that that is more democratic. Uh.huh. [01:11:10] So I would say in those cases it is not you [01:11:15] know, you’ve been to a course and at some of these courses have been run by specialists. Right. [01:11:20] And there’s nothing wrong with you going back to that person and saying, what would I do here? [01:11:25] Right. You know, and I’ve got dentists who I work with. [01:11:30] I don’t condone everything they do, but they ask me, what should I do here? Right? [01:11:35] They often get the terminology totally wrong. Why? Because they haven’t done it. But I do [01:11:40] not, because some of them are my friends anyway. I’m not one to criticise them or [01:11:45] say to them, belittle them in any way I would. I would rather hold their hand [01:11:50] and say, look, okay, you want to do this? I’ll tell you what to do. This is what you should do. And then often [01:11:55] what happens? The side you know, the benefits that they refer a lot more [01:12:00] patients because they realise I think they realise the skills that I remember. [01:12:05]

Siamack Bagueri: Good mate of mine went on to a, um, implant course, [01:12:10] a weekend implant course. What’s the one with begins with b bi or something. So. [01:12:15] So maybe he when he started and he came back from the course all [01:12:20] fired up, he said this is fantastic. So so easy, so so easy. Well [01:12:25] it took him less than a year to say, oh, he made mistakes. He had horrendous problems. And [01:12:30] he hasn’t touched implants since because unfortunately when it goes wrong, it goes horribly [01:12:35] wrong. And then he kind of regrets it. You think, my goodness, why have I done [01:12:40] this? And and what’s happened? I think a significant number of dentists, [01:12:45] if you do orthodontics a lot as a general practitioner, you do it [01:12:50] regularly. Of course, you can become good at it. Like anything, there’s nothing. There’s nothing magical about [01:12:55] orthodontics. There’s nothing magical about getting an immortal degree. It’s just that in [01:13:00] an immortal degree, you are in a controlled environment where others with a pair of eyes are looking at you. [01:13:05] You know, I taught the Eastman for seven years, and I saw the problems and I [01:13:10] taught them.

Siamack Bagueri: So I think it’s nice to have to be in that [01:13:15] environment. Not if you’re by yourself in a practice. And all you’ve got [01:13:20] is a scanner and your only teacher is clincheck and an eye, [01:13:25] well, that’s a recipe for disaster. If you’re going to do a lioness, you know, use people [01:13:30] like angel aligners, use the people who are. There are plenty of people out there. Richard Cassidy does it. [01:13:35] There’s lots of, you know, Richard Jones does it. The total orthodontics boys, they will look at your [01:13:40] scanner scans, scan and advise you what to do. They will tell you my [01:13:45] goodness, you are now this is beyond the realms of aligners. Do not be fooled [01:13:50] by Invisalign light package of £1,200. They can get something [01:13:55] aligned in 17 align. If that is not correct, you will get into problems and [01:14:00] the problems become worse and all you then have to do is to put porcelain veneers 4 [01:14:05] to 4, which is not not the mandate of of aligner treatment. [01:14:10] You know, orthodontics mandate is enamel preservation. You’re not pushing [01:14:15] teeth into a different malocclusion and veneering them. I don’t think that’s the right thing. That’s quite [01:14:20] unethical in my opinion.

Payman Langroudi: There’s a lot of that going on. Um, I wouldn’t call it all unethical [01:14:25] insomuch as, um, you know, the contact lens for the sort of no prep veneer. It’s [01:14:30] become quite a treatment. Yeah.

Siamack Bagueri: The APA, APA does a lot of destiny.

Payman Langroudi: He likes to prep, but [01:14:35] but but you know, the getting the tooth to the right position so that the prep is very, [01:14:40] very, very.

Siamack Bagueri: Minimal.

Payman Langroudi: I you’re right. There’s people use that sometimes to make it a more [01:14:45] expensive treatment. And it gets you out of orthodontics naturally that you shouldn’t have gotten [01:14:50] into in the first place. So you’re right there. Is that quite interested in you know, you’ve got ten [01:14:55] big clinics, like how many chairs are in each like.

Siamack Bagueri: Between [01:15:00] on average, about four.

Payman Langroudi: For.

Siamack Bagueri: The 4 to 8. I mean, some [01:15:05] of them are huge, but.

Payman Langroudi: They have you got what’s the biggest one?

Siamack Bagueri: Uh, the biggest one we’ve got is probably [01:15:10] about seven.

Payman Langroudi: So. Yeah. So ten clinics dealing [01:15:15] with the government in terms of, you know, your payer is the NHS 70%. [01:15:20] You said of you. Yeah. Of course.

Siamack Bagueri: Yeah.

Payman Langroudi: How does that work. How do you how do you secure [01:15:25] that contract. And okay so before you buy it is.

Siamack Bagueri: So [01:15:30] so there’s a good question. So so first of all for a specialist [01:15:35] or a dentist matter who wants to purchase an orthodontic [01:15:40] contract. Yeah. So there are plenty of orthodontic contracts.

Payman Langroudi: So I know there’s a process. But how [01:15:45] do you win at that process. Yes.

Siamack Bagueri: So so if you are, if you for example, [01:15:50] right now post 2018. Right. Pretty much let’s [01:15:55] say south east of England, all the contracts have been district. So they did [01:16:00] they did their what they call needs assessment. They went around looking at the population. What [01:16:05] percentage of 12 year olds need orthodontics. They used some very sort of basic metrics. And they said [01:16:10] okay we’re going. Allocate X amount for this region and then for each clinic maximum [01:16:15] number of what we call euros or units of orthodontic activity. We’re not going to give them between [01:16:20] 10 to €15,000. Right. So then those contracts that [01:16:25] those practices that were doing orthodontics, they bid for those contracts. [01:16:30]

Payman Langroudi: Yeah. How’d you win that bid?

Siamack Bagueri: So therefore that so so if those ten as [01:16:35] AB is tendering is now kind of die to death now. But let’s go back in time. Five [01:16:40] years ago, six years ago when we did it. Yeah. That there is a arduous tendering [01:16:45] process. It’s called a competitive tender. Yeah. Often you have to involve somebody [01:16:50] who can write the tender for you, an accountant who can, who can predict [01:16:55] what will happen financially. All the regulatory stuff from CQC, health [01:17:00] and safety, everything else. There’s quite a plethora of paperwork and there [01:17:05] is, if you like, narrative, it’s about 40 page narrative whereby they ask you for [01:17:10] certain things. For example, what languages will you offer on the front desk? [01:17:15] And you’re going to then say offer the foreign languages, and then we’ve got Google Translate and so on. Do [01:17:20] you open on a Saturday? Yes we do. They have, you know, do you have disabled access? Yes. What is it. [01:17:25] So then the narrative that you write in the tendering process, which [01:17:30] has been invigilated anonymously, each section by different person, the narrative [01:17:35] is a bit like doing a personal statement. So, you know, you’ve got to use fancy [01:17:40] words like championing or aspiring.

Siamack Bagueri: There’s certain language that you learn [01:17:45] to use, and I’ve done so many of them because I can find the right one with my eyes shut. But so, [01:17:50] you know, I spent a good year and a half writing them. We we employed [01:17:55] three different tender writers, and there are plenty around. You know, the [01:18:00] NHS does competitive tender in all spheres, not just orthodontics but the oral [01:18:05] surgery could be endo and so on. So if the benefit of a tender [01:18:10] is that you’re not buying a good will, you’re saying, okay, are they in Dunstable [01:18:15] there’s a contract going for orthodontics to treating 500 patients. So [01:18:20] what do you do as a as a fledgling. Then you say, right, I will first will do my research. I do my [01:18:25] needs assessment. I will go there, find the site, make sure it’s got either [01:18:30] the one use ability to dentistry or potentially one use. You start getting [01:18:35] your local dental company to come and draw for you where you would how you would set [01:18:40] up that dental practice. Access is in the air train station, is it parking [01:18:45] and so on. Some basic stuff that when you come.

Payman Langroudi: Isn’t everyone doing that.

Siamack Bagueri: Everyone doing [01:18:50] that. So yes.

Payman Langroudi: Where’s the so.

Siamack Bagueri: So so that so therefore your USP when [01:18:55] it comes to difference between you and somebody else who’s writing it ultimately [01:19:00] is, is to do with what you providing. So there is fundamentally [01:19:05] they will say to you, okay, what you are a value. Can you do it at. [01:19:10] And you know, obviously you can’t do that £1 of uagh and you can’t do it at £100 of eurgh. So [01:19:15] you can then size up mathematically, do your math, do your do your maths, [01:19:20] get your accountant to get your accountant to to help you, to give you [01:19:25] predicted profit and loss with potential profit of whatever it is [01:19:30] per annum between 18 and 22%. There’s that fair amount of work [01:19:35] that you can do, but you can win or lose a contract by 1 or 2%. [01:19:40] You know, you could be in one of the paragraph. A friend of mine just did one for emergency [01:19:45] dental care in in West London. And he’s very good. [01:19:50] He you may know I mean, you know him remains anonymous for this podcast, but [01:19:55] he did it. He spent hours doing it. Hours. He lost it [01:20:00] to another friend of mine who I know. I know them both now. Both did it as an emergency [01:20:05] dental out-of-hours. It was a substantial amount of money and [01:20:10] he didn’t employ a tender writer. I’m not saying the other one did, but the other one [01:20:15] had done at least a dozen tenders, so he knew what to write in each [01:20:20] paragraph. So it’s like.

Payman Langroudi: And they said, do they take it into account that you’ve won other tenders? [01:20:25] No. Running up is.

Siamack Bagueri: Anonymous.

Payman Langroudi: Oh, it can be anonymous.

Siamack Bagueri: Anonymous. So each segment there’s let’s say 40 [01:20:30] segments, 40 paragraphs. They would say to you, okay, pay is [01:20:35] the skill set is in constant running the bleaching. I mean there was a bleaching question [01:20:40] and then there were you will be you will be examining. You’ll be saying, oh, this guy is using, [01:20:45] uh, you know, really strong peroxide, which is totally wrong. So therefore [01:20:50] off, cross off. And, you know, so this guy is talking correct. He’s using correctly. So [01:20:55] they will get people with predominantly majority of the legislators are non dentists [01:21:00] are basically normal managers who are just some of it I [01:21:05] dare say will probably be be uh tested by AI as well.

Payman Langroudi: It’s [01:21:10] super interesting because look this this organisation that you’ve built up is so impressive, right. [01:21:15] You’ve got the bit we talked about at the beginning about the, um, running [01:21:20] of the show, the hiring, the firing, the inspiring, the becoming friends with these people, taking [01:21:25] for lunch, making sure that the team’s happy. You’ve got the clinical aspects right, which. And [01:21:30] doing the work, hiring the right orthodontist. But this aspect [01:21:35] really ends up being a key aspect, because.

Siamack Bagueri: With that, there.

Payman Langroudi: Would be no [01:21:40] business.

Siamack Bagueri: No business. I mean, we know, we know. During the tendering process, another very [01:21:45] good friend of mine who had spent 25 years building a very successful [01:21:50] practice, uh, NHS and private, and he he bid [01:21:55] for his own contract, you know, and somebody else bid for that contract, and [01:22:00] he lost it. So he lost his livelihood, you know, he.

Payman Langroudi: Lost his own practice.

Siamack Bagueri: Yeah. Lost a [01:22:05] practice that was turning over 2 million. Wow. Went to nothing. So I knew he [01:22:10] became depressed.

Payman Langroudi: So is that what keeps you up at night then? Well, that.

Siamack Bagueri: That particular year, 2018, [01:22:15] I must say, when on the day when we were, when [01:22:20] we were granted the tenders for our London contract. But already you see going back, [01:22:25] going back to the reason why I did started investing in outside London practices, [01:22:30] I foresaw that one day this will happen. So even in [01:22:35] the early part of 20 1213, I started saying, this is going to happen and [01:22:40] we may lose our contracts in London. So then I started buying practices. I [01:22:45] started spreading my wings. I thought really, I could have existing practices, existing practices. [01:22:50] I could have just stayed in London and not done that, just stay to the three practices that [01:22:55] we had. But because I wasn’t sure, I started investing [01:23:00] and then I got a good partner in the commercial arm of Lloyds, [01:23:05] and then I thought I did one and I tried to that I did, I done a business [01:23:10] and I tried to open up bleaching teeth in markets which went south. You know, I [01:23:15] lost a couple of hundred grand. It wasn’t a big deal, but I learnt to fail. You [01:23:20] know, I learnt to fail in later and later because I was like just shy of 50. Then I [01:23:25] learned to how do I present it to outside investors? How to raise money, [01:23:30] a lot of intricacies about running a new business. And then on the back [01:23:35] of that I thought, you know something? This is not my skill set. My skill set is the orthodontic. Let me [01:23:40] stop buying orthodontic practices because I don’t know, in five years time, my London practice may be [01:23:45] taken away from me as it happened, clearly in this friend’s case.

Siamack Bagueri: So I was really happy. [01:23:50] I was quite confident that, okay, worst case scenario, I’ve got these other practices. [01:23:55] Worst case, you know, some of them went to competitive tender and in one of them we [01:24:00] multiplied it by three. So I thought, okay, that means I’ve written nicely here. [01:24:05] So if I multiply contract by three and they allowed us to spread our wings, it gave [01:24:10] me a little bit of, you know, empowered me a little bit. But we lost some as well. They [01:24:15] gave me wrong. But we then lost our existing practices. We lost. We applied for one in, [01:24:20] um, Amersham, which I really thought I put a lot of effort into that. We [01:24:25] lost that somebody else. But some of the other contracts that were won by [01:24:30] corporates. Uh, the corporate structures didn’t deliver. They [01:24:35] abused the pandemic and the furlough scheme, and they’ve now closed. All those contracts [01:24:40] are closed. They couldn’t deliver. It’s one thing winning it. Pay is one thing delivering it. Of course [01:24:45] it’s one thing keeping it. Because if you don’t have the right skill set in, the skill in the mix [01:24:50] doing it, you can go south very, very quickly. I mean, we’re [01:24:55] training some therapists right now and we went to Bristol and there are ten [01:25:00] therapists, ten. Ten specialists training these therapists. So [01:25:05] already one of them has lost his orthodontist. Now, don’t ask me why. [01:25:10]

Siamack Bagueri: It could be Portman. Could be someone else. Bottom line, the guy halfway through this poor guy’s, [01:25:15] uh, course. And he’s packed up. I don’t know why. [01:25:20] Maybe they’ve messed up. I’m not sure what it is, but in the very fine line between [01:25:25] success and failure, very fine line. So you’ve got to keep your head above water, have [01:25:30] multiple, you know, and I think I learned when I did [01:25:35] that little bleaching thing, I learned that this is just not really me. And I think if I did that I would have alienated [01:25:40] my referral base. And you kind of touched upon it at the time. And I kind of thought, you know, he’s talking sense [01:25:45] here. Um, so I shied away from it even at that time. I remember 2017 [01:25:50] distinctly. Remember a friend of mine said, Matt, we want to start a aligner [01:25:55] company which will compete with small direct, compete with Smiledirect. So [01:26:00] I said to him, okay, fine, I can let me have a look at it. And he had about 100 million behind [01:26:05] him. I went and saw the guy in LA and they knew that the marketing was incredible. [01:26:10] Packaging was incredible, just like enlightened, really, really fancy, fancy, fancy. And [01:26:15] they said, we just want to have a name so we can put that name on our thing, and [01:26:20] we want you to show us how to do it. Scanners hadn’t come out then, so I went through [01:26:25] it with them, and we did some prototypes with my technician, and I [01:26:30] kind of knew how to do it, and it was not difficult.

Siamack Bagueri: Then when the chips were down, I said, Daniel, [01:26:35] I’m not sure what I want to do this, to be honest, because I’m kind of happy where I am. I’m [01:26:40] gonna it’s not, you know, it’s going to alienate my referral base. Okay? I’m not breaking, [01:26:45] you know, I’m not doing any earth shattering, but I’m kind of happy. Anyway, fast forward, [01:26:50] they started the company. Bite me, bite me. They started the company. [01:26:55] And I kept telling him, I said, look, uh, Daniel, there will be a class action against what [01:27:00] you’re doing because what you’re doing is strictly going to be very frowned upon by the orthodontic fraternity. [01:27:05] Yeah. Fast forward December 21st, then split. Bought them [01:27:10] for a billion. Wow. Rebellion. I’m not sure how much he got out of it. Maybe [01:27:15] about ten, I’m not sure. But as it happens, then they closed up anyway because they followed [01:27:20] by Smile direct. So I said to him, because he’s a serial entrepreneur, his mandate is always [01:27:25] to exit before he’s even begun. So that was he’s done that for the past 35 [01:27:30] years. That wasn’t my thing. I’m not one to exit, you know, going back [01:27:35] to the very beginning of the pod. And one definitely want to pass on the legacy to the kids. [01:27:40] I want to keep it. I don’t want exit. There’s no exit. Exit is death. That is going [01:27:45] to be my kids. And hopefully they just carry on.

Payman Langroudi: You know, what would you have done differently? I mean, if you look back. [01:27:50]

Siamack Bagueri: If I’d done differently, I would first of all, would I have done dentistry.

Payman Langroudi: And within [01:27:55] dentistry? So let’s say we could rewind 30 years. Yes. And knowing what you know [01:28:00] now.

Siamack Bagueri: I think definitely the speciality of orthodontics would [01:28:05] I would have not chosen any other uh, that’s for sure. I [01:28:10] suppose all oral maxillofacial surgery was quite a sexy special specialist [01:28:15] practice to go in. I do regret that because I do. I would have really [01:28:20] enjoyed that. I did a little bit of that when I was a Great Ormond Street in UCL. I really liked [01:28:25] that, I must say. Having said that, when I looked at my peers who did [01:28:30] do oral surgery, some of them are like a nervous wreck. So I think fast forward, okay, [01:28:35] they may have had loads more patient satisfaction. The kudos of, [01:28:40] you know, resecting someone’s head and neck cancer or making someone orthographically [01:28:45] much. Yes, there’s a massive kudos in that. It’s if you if I’d [01:28:50] done that, it would be purely for the love of it. It wouldn’t be for the it wouldn’t be at all [01:28:55] for financial gain. It couldn’t have been. It’s not possible.

Payman Langroudi: But what about with the business? I mean, what. [01:29:00]

Siamack Bagueri: I think with my business, probably what I would have done differently. I [01:29:05] would have invested much sooner. I would have in [01:29:10] 2003 as I was. I’m, you know, 2005. I was 40 [01:29:15] in 2003, I think I was engaged with this case, which I mentioned. [01:29:20] Yeah. And it definitely did suck my energy in my 40s. [01:29:25] I would have probably expanded quicker. I expanded a bit later on in life. [01:29:30] So I think I expanded in my early 40s, late 40s. So [01:29:35] if I was to do what I’ve done. But having said that, had I done that, I would [01:29:40] have been probably burnt out quicker. So in some ways it was okay that I did a bit later and I did [01:29:45] it purely because of need. To be honest, I didn’t do it. I need had [01:29:50] this threat of a contract being hijacked from us not being there. [01:29:55] I wouldn’t have bothered, but because it was, it kind of almost forced my hand. I had [01:30:00] to protect. I thought, what if, what if, what if I’ve got to have.

Payman Langroudi: What keeps you up at night now [01:30:05] about the business? Like what I think actuality.

Siamack Bagueri: Right now, the [01:30:10] way the practices are running, I absolutely no, no problem at all. We’re going to really [01:30:15] good skill case mix of you know we’ve got a good great team I would say [01:30:20] from. But what do you.

Payman Langroudi: What do you worry about.

Siamack Bagueri: I think like always I think running [01:30:25] is financially. It is it is much tighter than ever before, much [01:30:30] tighter through the cost of just gone through the roof. You know, I occasionally I will [01:30:35] wake up like in the beginning of April, I woke up and I wrote to all [01:30:40] my managers there, right for the next five weeks, you’re not allowed to order anything. We’re going to go [01:30:45] back to their wardrobes, back to our cupboards. I want you to spend all this time finding [01:30:50] out what we actually have. We have so much stock and you guys are just ordering just like crazy. [01:30:55] So I banned them from ordering. In fact, one of them ordered something. I said, right, I want you to package [01:31:00] that and send it back. So well, Mark, you know, and it was £4,000 of coloured modules. They look [01:31:05] we then need coloured modules. We’re not being paid for coloured modules on the NHS. [01:31:10] Everybody will have grey modules. Doesn’t matter. You have to work with the time. So [01:31:15] sometimes I do react. I think my goodness will I make it. Despite [01:31:20] if I made it for 30 years back in my head, I know I will make it, but [01:31:25] so many of my peers in different realms, not just dentistry, [01:31:30] have gone to even they’re 60 or 60 5 or 70 and have [01:31:35] failed. And I’ve gone to administration, 70 practices.

Payman Langroudi: No, no.

Siamack Bagueri: 70 years old, age [01:31:40] of different ages different. And they have they’ve gone into admin or they’ve gone south. So [01:31:45] I think none of us are exempt. You can’t close your eyes.

Payman Langroudi: It’s sobering. Right. It’s sobering. It’s some [01:31:50] some guy sitting hasn’t even opened a single practice and would think that if someone owns ten [01:31:55] ortho practices, you’d be okay. They don’t hit cash crises. Yeah, of course you have cash crisis. But we all do something.

Siamack Bagueri: Because [01:32:00] because you’ve you’ve you’ve bitten a lot. You’ve leveraged. Yeah. People have lent you money [01:32:05] and then you, you know, you probably overspend. Uh, we’ve had to really [01:32:10] recalibrate our lifestyle. You know, our sort of, you know, the, our lifestyle, you know, [01:32:15] go to less holidays or but I think we, we look upon it now that we’ve done quite [01:32:20] a bit over the past 30 years. We don’t miss any of it, to be honest. We’ve done, you know, you name it, [01:32:25] we’ve done it. So I’m not particularly fussed about not going on holidays. It’s okay. I totally [01:32:30] get it that right now the whole country is going through a really difficult time [01:32:35] and it is what it is. We can’t, you know, a new government is not going to change it before.

Payman Langroudi: Right? [01:32:40] It’s it’s not the first time.

Siamack Bagueri: It’s not the first time. But I think this.

Payman Langroudi: Time dentistry though does do quite well. [01:32:45] I mean.

Siamack Bagueri: Generally everything goes.

Payman Langroudi: Well in a recession.

Siamack Bagueri: Yeah. I remember my mum always said to me, [01:32:50] um, because a good relative of ours was, uh, ophthalmic surgeon [01:32:55] and I always loved that. So I would love to be an eye surgeon. And my mum said, [01:33:00] you know, she said to me, oh, but, you know, um, uh, patients, people [01:33:05] have got 32 teeth, but they need to one pair of eyes, so you’re likely. We can [01:33:10] fill it, drill it, move it, remove it. And I said to her, that’s such a wise thing. And then [01:33:15] she’s right. You know, I’ve found this surgery would have been lovely, but, you know. But no teeth [01:33:20] are teeth. People like to keep teeth, you know, and more and more and more and, uh, you [01:33:25] know, I think orthodontic dentistry is fantastic, but you have plenty [01:33:30] of totally unsuccessful dentists who don’t charge correctly. They undercharge, [01:33:35] uh, they don’t do it properly. They did halfheartedly. Uh, [01:33:40] they then really spend time perfecting whatever it is they may do, [01:33:45] you know, even down to basic veneer, you know, you got to do it properly. Got [01:33:50] to go. And of course, do it correctly so that it stays, it looks good so that the next person comes through. [01:33:55] You can’t blag good dentistry. You can’t blag it. I don’t think you can, contrary [01:34:00] to some people’s belief.

Payman Langroudi: Agreed. Not in the long run. Um, we’ve come [01:34:05] to the end of our time. That’s a bit quick. Okay, end it with the usual questions. A [01:34:10] fantasy dinner party? Yes. Three guests, dead or alive, that [01:34:15] you have.

Siamack Bagueri: So I would have around because obviously I play a lot of tennis, [01:34:20] so I would love to have Borg. Bjorn Borg, Bjorn Borg [01:34:25] I would definitely have him around the table.

Payman Langroudi: Not McEnroe. Not more interesting.

Siamack Bagueri: Yeah, but [01:34:30] I like Borg because I really I used to, I used to he was my hero. And [01:34:35] I would like to because he’s a, he’s a, he’s a quite a calm character and I [01:34:40] you know, I’m probably more like McEnroe myself. So. No, I don’t want him around the table. Uh, [01:34:45] on a political arena, I would probably have someone, I [01:34:50] would say, who do I really, um, you know, I don’t want to say something basic, like. [01:34:55] Yeah, I would probably like to have the Shah of Iran. I think [01:35:00] he he has a lot. He’s extremely intelligent. Very well read, man. [01:35:05]

Payman Langroudi: He could answer a few.

Siamack Bagueri: He could answer a few questions, you know, in that [01:35:10] I would really like. So that’s the more to my, my, my heritage. And then I [01:35:15] also would like, I would like to have a lady around the table and I’m thinking of who I [01:35:20] would like. I would say someone like Martha. I [01:35:25] would like Martha. I mean, around the table. Wow. I would like I would like to have someone, [01:35:30] a Kurdish girl, innocent girl who just loves life, [01:35:35] who is like an epitome of what our youth in Iran are going through. It’d be nice [01:35:40] to have around the table. Yeah. Be nice to see what’s what she’s got to say for herself. So [01:35:45] yeah, I want youth in her. I definitely want a young person around that table. [01:35:50] I want someone who’s incredible in tennis. And then. Yeah. Shah of Iran. [01:35:55]

Payman Langroudi: You. Björn Borg’s gonna feel a little bit left out of this. I know, I know, but you’d be wonderful to the party [01:36:00] conversation. But it’s a good list. It’s a good list. Now, the final question. On [01:36:05] your deathbed?

Siamack Bagueri: Yes.

Payman Langroudi: Surrounded by your loved ones? Yes. Anyone who’s [01:36:10] important to you, hopefully many years from now. What are the three pieces of advice you’d leave for them? [01:36:15] For the world?

Siamack Bagueri: I would say, um. I’d [01:36:20] said that at the beginning of our part, but I think I’m going to say it again. I would [01:36:25] say definitely don’t. Grieve [01:36:30] too much on your failure. So whatever failure or.

Payman Langroudi: Your [01:36:35] success which was.

Siamack Bagueri: Beautiful or or gloat on your failure, don’t dote on your success, on [01:36:40] your failure too much. There’s a there’s a there’s a book in the Bible which I always [01:36:45] quote to patient to people and the book of Ecclesiastes in the Old Testament. [01:36:50] And, and this is an incredible particular chapter. And it says, [01:36:55] there’s a time to cry, there’s a time to laugh. There’s a time to dance. There’s a time to [01:37:00] sleep. And you’ve got to take every life is, is [01:37:05] quite is like a sine wave up and down. So that’s for sure I would [01:37:10] say definitely. Then I would put those to one, one, one thing. Don’t gloat. Don’t gloat on [01:37:15] your success or failure. Remember as well, if you stand still, you [01:37:20] die. I often say to my to my to my son, to my daughter. I said, look, if you stand [01:37:25] still, you’re going to be still for a hell of a long time in the coffin. So [01:37:30] don’t stand still. Move, move, whatever it is you want to do, [01:37:35] move. Because that whole concept of moving, the journey, that’s [01:37:40] all you have got in this life. Because otherwise you’re going to be in that, in that coffin for a hell of a long time.

Siamack Bagueri: I was saying [01:37:45] that. Then I would say, yeah, I would say, don’t get angry [01:37:50] because anger would definitely deplete [01:37:55] your heart, your blood, your cognitive behaviour. There’s a lot of research on anger, [01:38:00] sort of quench your anger, replace it with something else. [01:38:05] Anger is not good. Is a negative, is a negative emotion. Don’t get angry with life. [01:38:10] There’s plenty for us to get angry about, but replace it with [01:38:15] a little bit of a bit of Bjorn Borg, you know, replace that with just that calm [01:38:20] manner, and then that way you can hit a good shot, because if you’re angry, [01:38:25] you know, if you speak to someone like McEnroe, a lot of his problems came from his anger. [01:38:30] Had he not been had he been a Roger Federer? Roger Federer had terrible temper issues, but [01:38:35] he managed to organise his anger. And he then most people who don’t know [01:38:40] Roger Federer, they think he’s such a placid guy. Yeah. But actually his temper issues. So if you [01:38:45] can control your temper, your anger, you can do a lot more in life.

Payman Langroudi: Amazing, [01:38:50] amazing. Been a massive pleasure. Thank you so much for coming.

[VOICE]: This [01:38:55] is Dental Leaders, the podcast where you get to go [01:39:00] one on one with emerging leaders in dentistry. Your [01:39:05] hosts. Payman Langroudi and Prav Solanki.

Prav Solanki: Thanks [01:39:10] for listening, guys. If you got this far, you must have listened to the whole [01:39:15] thing. And just a huge thank you both from me and pay for actually sticking through and listening [01:39:20] to what we had to say and what our guest has had to say, because I’m assuming you got some value out [01:39:25] of it.

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