This week’s guest is the youngest member to achieve British Association of Cosmetic Dentistry (BACD) accreditation.
And he is just getting started.
Multi-award-winning Dr Richard Field talks about his early training with the great Christopher Orr and discusses his laser-sharp focus.
He also lets us in on high-profile associate work at Elleven Dental on Harley Street, his recent move to the southwest and much more.
“I get very tunnel-vision when I’m working. Nothing else exists. Just the teeth.” – Richard Field
In This Episode
01.54 – Backstory
09.06 – BACD and VT
17.37 – On courses
21.29 – Management
27.52 – Large sums of money
33.58 – Aesthetics vs functional
36.27 – Drive
38.05 – Social media
44.18 – Elleven Dental
46.37 – Bristol
52.24 – Blackbox thinking
55.19 – Last day and legacy
About Richard Field
Dr Richard Field graduated from the University of Glasgow with honours in 2011. He completed his foundational year in Surrey and gained a postgraduate certificate in primary care dentistry from the University of Kent.
He is the youngest member to have been accredited by the British Academy of Cosmetic Dentistry and winner of several awards including Best Young Dentist 2014 and Most Influential Dentist 2015.
Richard Field: So I think we shouldn’t get used to seeing that much money. We shouldn’t just take it for granted. We should respect it, because it’s money, and it’s often huge amounts of money, but you’re there providing a service and you are worth that money, but you should never take it for granted.
Speaker 2: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.
Payman Langroud…: On the podcast today, one of the young dentists that I consider to be one of the most talented young dentists that I’ve come across, Richard Field, I’ve known since fourth year of dental school, Richard?
Richard Field: Yes. Something like that, yes. Long time.
Payman Langroud…: Yes, and-
Richard Field: [inaudible] dentist.
Payman Langroud…: I’ve been following his career from that time, since I think you were a student helper type at the BACD, and since then we’ve done quite a lot together. We’ve been on conferences together. Richard’s helped teaching on the Mini Smile Makeover course, but I think it’s going to be a very interesting interview, Rich, because you’ve had a bunch of very, if you like, high profile associate jobs, and now got the title of the youngest dentist ever to become accredited by the BACD. That’s quite an achievement in itself, but I think for someone who’s trying to make it out there, a young dentist, the blueprint of following what you’ve done in your career really will be helpful to a bunch of people. Good to have you, buddy. How are you?
Richard Field: Thanks for having me. All good. Had a nice weekend, it’s been good. This is a nice way to round it out.
Payman Langroud…: Yes, so your dad’s a dentist.
Richard Field: Yes, or he was. He retired last … No, a year and a half ago.
Payman Langroud…: Oh, really? And as a child, was there much pressure to become a dentist? Or how early on did you decide you wanted to be a dentist?
Richard Field: Dentistry was actually quite a late decision for me. I’d say, if anything, my dad tried to not put me off, but he certainly didn’t encourage it, because I don’t think he particularly enjoyed the business side of it. He enjoyed the practical side of it, but there was never any push at all, really. I actually only did work experience, so I could tell people to stop asking me do I want to be a dentist like my dad? So I really only did the work experience almost out of spite, to be like all right. I’ve done the work experience. I don’t like it. I’m not going to be a dentist, but I actually found that I did the work experience, I realised that I had no idea what a dentist did. Really, actually, quite enjoyed myself, and actually, from there, I’ve never looked back. Yes, it was-
Payman Langroud…: So you surprised yourself.
Richard Field: I surprised myself, yes, completely.
Payman Langroud…: What were you thinking of becoming?
Richard Field: Well, I originally wanted to be a vet, and I’m allergic to most animals, so that quickly ruled that out. And then, before I got my exam results in fifth year, which is the second last year of school in Scotland, I was all set to go to catering college, because three of my four grandparents, they were chefs. And I was actually all set to go to catering college, and then I ended up doing the dental work experience. I got better results in my exams than I was expecting and that just went from there.
Payman Langroud…: Ah, because I was going to come onto the foodie side of things. One of the few people who I will really trust with restaurant recommendations anywhere in the world. In fact, most of the time when we go on these conferences and things, Richard is the social secretary who plans out all the meals, so that’s interesting. I didn’t even know that then. I had no idea that there was that in your background. What does your brother do?
Richard Field: My brother’s just finished his PhD in, actually, not dental related, but he did it in Sheffield Dental School, and I think it really annoyed him when someone came up to him, and he thought he’d got away from me, and said, “Are you Richard Field’s little brother?”
Payman Langroud…: So what’s he done?
Richard Field: I might get this wrong. He has done his PhD in nerve regeneration, so I think a part of it actually was to do with ID nerve damage. He’s much smarter than me, so I don’t quite understand a lot when he talks, but it’s something to do with nerve regeneration, and I know a part of it was with Sheffield Dental School and the ID nerve.
Payman Langroud…: So, as a dental student, where did you study? In Edinburgh?
Richard Field: Actually, Edinburgh Dental School is now a vodka bar. I’ve had most … During dental school, but no, I was in Glasgow University. That was good fun. I did apply to London, and Cardiff actually was my second. It was either going to be Glasgow or Cardiff. If I’d gone to Cardiff, I think that’s where Tom went, so I could have met Tom a few years earlier, Tom Young.
Payman Langroud…: That’s where I went too, not that we would have met each other, but how much knowledge of dentistry did you have? Outside of the obvious. Had you decided then, once you decided to become a dentist, did you then start taking more of an interest? How much of an advantage is it to have a dad who’s a dentist? I know there’s quite of a lot of you guys, people like Simon Chard and Christian Coachman.
Richard Field: I think it depends. My dad, he is more into oral surgery. He didn’t really enjoy the restorative side of dentistry. We never talked about dentistry ever really, so from my side of things, it wasn’t really an advantage or a disadvantage. It wasn’t really anything from my experience, but I know with some people, if their parents have practises or they’re going to go into the family business, then that can make a difference, but from my side of things, it didn’t really play out. Other than the guy interviewing me at Glasgow was in my dad’s year and I didn’t know if they were friends or not, so that could have gone …
Payman Langroud…: What were you like as a dental student? How did you find the dental course? Were you a high flyer? Because when I met you in that fourth year, I did think you were quite ambitious, focused, at that point even.
Richard Field: Well, I do remember getting pulled off [Pete’s] for being difficult, because they wanted you to put [inaudible] and put it on a micro brush, and I felt that wasn’t accurate enough and I didn’t do that. I remember getting pulled aside for that and saying, “Just do what you’re told.”
Richard Field: I did have my own composite kit. I think it was Dentsply used to run a competition, I think it’s a Ceram.x competition, and when they gave a kit of composites to each dental school. And I found it in one of the tutor’s office and I was like, “Can I have this?” They were like, “Yes, okay.” So I was probably that guy.
Richard Field: Taking photographs at dental school was really, they made it into a big thing. You have to prebook. You can take your own photos. You had to prebook the photographer. He then made a big song and dance about how complicated photographs were to be taken.
Richard Field: He’d just go on to clinic with his cameras, or you’d have to go down to this massive photo studio, and there was a couple of cases that I was photographed, but they made it out as if it was this really complicated difficult thing, which I think was the wrong thing to do for a dental student. They should have been more open about how photography is, and not make it this mystical art.
Richard Field: I probably did annoy my tutors. I probably annoyed them a little bit, but it was like school. There’s ones who relish questions and there’s ones who want you just to shut up and listen, and I got on better with the ones who liked questions than the others. I had one particular, my class tutor, he was very, Dr. Watson. He was very encouraging, and then there was Andrew Carruthers, who was our restorative tutor.
Richard Field: He’s the one that gave me the composite kit, and he had a CEREC in his office again, that no one used, and we got to use that, which was great. There was a few that if you showed an interest they really enjoyed that, and there was a few that just were there to teach and didn’t really want your feedback or your input.
Payman Langroud…: As a fourth year turning up to a BACD conference, how does that feel? Because in my day BACD didn’t exist, let alone turning up to a conference at that age. Did it blow you away? Was that a major influence?
Richard Field: I had no idea what I was going to. There was an email saying, “Anyone want to help out at this conference?” And I was thinking, well, some time off uni. That’d be fun, so I actually had no idea what I was going to, but one of the tutors said he was disappointed in me for going to help all the cowboys at the conference, so there’s definitely the-
Payman Langroud…: Oh, because it was anti cosmetics.
Richard Field: Yes, so there’s definitely some positive feedback from the dental school, some negative feedback, but from my point of view it changed my life, that conference. I can say it without sounding too cheesy. That conference changed my life, because I wouldn’t be here today if I hadn’t gone, if I hadn’t met those people, if I hadn’t seen what you could actually do as a dentist, besides from fillings and removable dentures.
Richard Field: The key turning point was there was one lecture. It was a panel discussion between Chris Orr, Ken Harris and James Russell, and that was the defining moment. Going to that lecture and seeing these three guys present these three cases, doing things that I’d never seen nor thought were possible. That was really amazing.
Payman Langroud…: I would recommend it to any ambitious student who wants to understand what’s going on in the big wide world, to turn up to that thing. Everyone who did turn up ended up having a great career from where I could see. It’s one of those things that you have no idea about, until you have the idea about it, isn’t it? Okay. Then you qualified. Where did you do VT? Up in Scotland?
Richard Field: I did VT in Horley, which is a small town near Gatwick. I lived in Brighton for a year. I actually moved to London for a few months. London then terrified me. I wasn’t ready for that, so I moved to Brighton and I commuted from Brighton to Horley near Gatwick for VT, and then I was very close, actually, to going to Australia.
Richard Field: I did interviews with on Skype, lining them up, and then I just ended up getting an offer from a practise in Islington, because I’d made the decision if I was going to go to Australia I wasn’t going to come back, because it’s a long way to go for a year, go for two years. I know people do that, but I got the offer from the place in Islington and it was a massive, massive practise.
Richard Field: It had 54,000 UDA contracts I think. There was no, you couldn’t book an appointment. You just had to turn up, and when you were finished with your patient you went downstairs and you pulled the next file out from the waiting patient’s paper file. And you call the patient, and they stood up off the ground if there wasn’t a seat, and you take them up, get their treatment, and then their notes were thrown back in the pile, until the next time they wanted to turn up for a checkup. That was-
Payman Langroud…: Can’t imagine you stayed there very long.
Richard Field: I was there for six weeks, and I got fired-
Payman Langroud…: Six weeks.
Richard Field: Yes. I got fired. I don’t mind saying that.
Payman Langroud…: What happened?
Richard Field: I don’t really know, to be honest. I got accused of gaming and I didn’t really know what that was, and I think that I’d wanted to see this person again three months after, because they had an abnormal lesion and I wanted to put fluoride on them, and the boss was a bit, I don’t really know. He didn’t like me.
Richard Field: He said I was gaming the system. I couldn’t work there, and this is at lunch, and next Friday would be my last day. Then my next patient came in after lunch and said, “How are you doing?” I burst into tears. That was an interesting afternoon, but I don’t regret it.
Richard Field: Actually, after that, it was an interesting time. I was unemployed for about four months, and I was sleeping on a lie below on the floor of one of the other associates in the practice’s spare room, until he got drunk one night and was like, “Mate, when are you moving out?” I was like, “Oh, yes,” and then I moved in with a friend from school for a little bit, and Tif then offered my job, and again that was Tif Qureshi, and that was my stepping stone from VET into private practise. Was a bit-
Payman Langroud…: Amazing, so you went to Kent to do that job.
Richard Field: Yes. Kent, so I got two jobs at the same time almost. I got the job with Tif. The interview was terrifying. He got me in and is like, “This is my business partner. He needs a two year composite,” and I was like, “Sorry?” Is like, “Yes, go back to the store and do his filling.”
Payman Langroud…: Wow, really?
Richard Field: That was a baptism of fire, but Tif was a fantastic mentor. We were never on the same day, but you could email him any time of day. 3:00 in the morning or whatever, and he replies in five minutes. Obviously, got the experience within the liner, with the CEREC, with the ABB cases. I didn’t want for any material, anything, so that was a fantastic opportunity, and within a few months I cold called a bunch of practises with CVs, and one of them was quite far away. It was [inaudible] one of your previous guests, Andy Moore.
Payman Langroud…: Andy Moore. What a legend.
Richard Field: He is. Still, to the day, one of my favourite places I’ve ever worked. He knows how to run a practise and he knows how to keep his staff happy. He’s a good guy, really good guy.
Payman Langroud…: Yes, so Advanced Dental wasn’t the most beautiful practise I’ve ever been to. What were you doing there? Were you just a general dentist in that implant situation?
Richard Field: Funnily enough, I was there for about six months and I was like I’ve got a real sense of déjà vu of this place, and it turns out, I went back to my university lecture notes and we’d had a lecture on surgery design, and the example they used was the surgery that I was working in, in Andy’s practise, and so that was a funny-
Payman Langroud…: I see.
Richard Field: Funny roundabout, and I was there, I was a general dentist. Obviously, I got all the bonding cases, ABB stuff, in use. They had a CEREC machine and that was my … I say CEREC was an interesting one, because it really taught you how to prep well, because you saw your margins on screen, so I’m saying I don’t necessarily, I’m not a huge fan of CEREC in terms of aesthetics.
Richard Field: I know it can be beautiful. You’ve got to put a lot of the work into it, but the one thing I was very grateful for CEREC for was teaching me that you’ve got to prep well and see your margins, because if you can’t see them on a 15 inch blown up monitor your technician’s not going to see them in your little stone model, so that was-
Payman Langroud…: Did you take the opportunity to learn about implants while you were there?
Richard Field: Yes and no. It was obviously always there, and I could see if I wanted to. Implants has never really interested me, surgery side of it. The restorative side, absolutely, but I’ve placed some implants with my current boss, with Alfonso. 100% success rate, place two. Still there, but it’s not something that really interests me at all, surgery. It’s something I feel you’ve got to be doing day in day out, like anything, 10,000 hours to get good at.
Payman Langroud…: I’m the same. Scared of blood. So along the way you’re saying you’ve had the fortune of working for some of the best there, right? With Tif Qureshi and Andy Moore, but which courses were you attending?
Richard Field: The courses thing I actually started quite early. I started doing courses actually in the fifth year of dental school through the BACD, and one of them was with Ivoclar and it was a composite course. I think it was one of the regional study groups, and I’m really glad I did that course, because a month or so after I’d had a patient booked in the clinic. Was one of my good friend’s girlfriend, and she had a big old class four in her tooth, and I in my infinite wisdom had said, “I’ll replace that for you. We’ll do a crown.”
Richard Field: Obviously, having no idea that a single central crown is one of the hardest things you can do as a dentist, but actually after this composite course, that actually maybe I could do this another way, and I got speaking to the Ivoclar guy. It segues into one of my motto. If you don’t ask you don’t get, and I asked, I was like, “Can you send me some composite? I’ve got this young girl.”
Richard Field: And he sent me this composite kit, and we ended up booking out two, three hour clinics to do my first big class four, and my friends go, which is actually still there today. I did it in 2006. No, 2006. 2011, and it’s still there almost 10 years later. I actually got that, the Ivoclar guy in to do one of our VT study days. So the course thing is since before I was graduated, and the one that’s made the biggest impact for me was Chris Orr’s course. The yearlong one.
Richard Field: I did that straight out of ET, and if I hadn’t done that course, because I was obviously straight out of ET. It was the job at Tif’s and the job at Andy’s. It was sink or swim. If I hadn’t done that course I wouldn’t have had the beginnings of the skills to do, or have the confidence to do the cases that I needed to do, so of course it’s from as soon as you can would be my advice.
Payman Langroud…: It’s interesting, because Chris himself didn’t used to take people that early.
Richard Field: No, he didn’t. I was the first, actually.
Payman Langroud…: Were you?
Richard Field: I was the first that he allowed, because you used to have to have done at least one year in clinic, one year in general practise, before you could do his course, but I was the first that he let in and straight from BT. And I think now actually he does that routinely, because if you don’t have to unteach bad habits to people I suppose they’ve got a better starting point, a better foundation, but that course, I’d recommend it to everybody. I know there’s other courses out there that are similar, but he’s the man. He’s the original-
Payman Langroud…: It’s a great course. Somehow, he manages to combine depth and breadth really simply. It’s an interesting … I always think about courses as either depth or breadth, and somehow he manages to get both into the same course. Now, look, you’ve worked in some of the highest profile practises around. It’s just a list of who’s who of London really. You’ve worked at the Andy Moore’s, we said, Harley Street Smile Dental Studio. You’ve worked at Elleven Dental. Ten Dental as well.
Richard Field: Ten Dental as well. Not related. That was with Nick and Martin. I’m still at Elleven. Spend there two days every other week and the rest of the time with Alfonso in-
Payman Langroud…: Now, finally, with Alfonso, who’s one of my favourite people in the world, so tell me this. It’s quite a lot of … I’ve only worked in my whole career in, I gave up dentistry, but I worked only in three practises and each one taught me a bunch of stuff. By the way, some stuff, things not to do, but if you had to distil, you’ve worked at these places where they’re right at the top of the field. If you had to distil some nuggets on how to run a practise, I know you’ve always been on the associate side in these practises, but what are the key things you’ve learned about practise management, patient management, team management, products, whatever it is?
Richard Field: I think, if you take Andy for example, I was there, I think I was there 2012, 2015, and if you look at who is still working there in terms of staff, is everyone bar people who’ve retired. So I think the first thing is keep your staff happy, because you’re screwed without them, really.
Richard Field: Treat your staff well and keep them happy, and I know there’s probably people listening to this who’ve worked with me thinking what’s he talking about? I know I can be quite difficult. I know I’m difficult to work with, but I think in the last few years for sure it’s hammered home that definitely keep your staff happy.
Payman Langroud…: Why are you difficult to work with? Do you have very high standards, and someone does something wrong?
Richard Field: I have very high standards for myself, and I have very high standards I suppose for the people around me, but I think the big thing is I get very tunnel vision when I’m working. Nothing else exists. Just the teeth, and I think if you don’t know me I can potentially, I assume I come across as quite, I could come across as quite stern. Or I get very focused in, so I go very quiet, and a lot of our appointments are maybe three, four, five hours long. I suppose it can be quite intimidating sitting next to someone who doesn’t really speak for that much time.
Payman Langroud…: How do you stop that spilling over into the patient? You’ve got these high standards, but bedside manner is definitely part of that, isn’t it?
Richard Field: For sure. A lot of the time, before these big long appointments, I’ll have spent a lot of time with these patients building up trust, building up conversation, but the nurses that I work with are very good and they will talk to the patient. Obviously, I’m not going to be silent for that long, but there’ll be portions of time where I’m just looking and I’ll put my hand out for something, and most of the time I’ll-
Payman Langroud…: If that thing doesn’t fall into your hand, now you’re really pissed off.
Richard Field: I never, I’m not someone who throws things around, I’m not someone who shouts, I’m not someone who does any of that. I just think it’s because I’m silent, that it might come across as quite like I’m angry. I don’t get angry in the surgery. I don’t get … I know a lot of dentists, or not a lot. I know of dentists who throw things around. That’s not me. I’m just quite a focused person, and if you’re new to working with me I suppose it can come across as either rude or indifferent maybe, but certainly there’s no intention behind it. If I ever work with someone new I’ll always say to them when I work I can get quite tunnel vision. Nothing’s ever personal. I get quite quiet, but it’s just the way I work.
Payman Langroud…: Tell me other stuff you’ve learned from these practises. Okay, so treat your staff well.
Richard Field: Treat your staff well. I don’t know if it’s what I’ve learned from these practises, but it’s something that I’ll often talk about with UR qualified dentists. Is don’t make the patient’s problem your problem, and I think it takes a good few years to acknowledge that, because you haven’t given the patient the care. You haven’t given them parity, or you didn’t do the last bad crown.
Richard Field: Don’t internalise your patient’s problems. You’re there to help them. Don’t get stressed about that, and generally I think it takes three or four years to get around to that way of thinking, and that’s something that I think is very important. In terms of from these practises, it’s a difficult one to answer, because I don’t really know any different.
Payman Langroud…: How about the differences between them? Do some of them have morning huddles and some of them don’t?
Richard Field: I’ve only worked in one, it was a morning huddle, and actually that was very good. That was 52, so the morning huddle, it was what were the problems from yesterday? How did they get sorted? Who have we got in today? Do we have any VIPs? Do they need any special things? Have we got lab work going out? Who’s dealing with the lab work? Who’s going to the post office?
Richard Field: That was very useful, and I know that taking 15 minutes out of the morning of your day with getting all your staff together can be quite challenging. 52, I think the first patient was a half nine in the morning huddle. I think it was 9:00 to 9:15, so everyone was in, even the dentists, half an hour earlier.
Richard Field: That’s a weird way of, as a self employed dentist, having to be in half an hour before you work. It’s a different way of thinking, but actually so many problems were avoided from that morning huddle. It’s worth its weight in gold, for sure.
Payman Langroud…: As a young dentist, you’ve probably been exposed to more VIPs. Have to talk about bigger prices than you were comfortable with. These are expensive practises that you’ve worked at. Take us through that, for instance. Leave the VIPs out of it for a moment. When you go to a practise, I remember working in a place where I thought, listen, I definitely couldn’t afford to be a patient in this place, and getting used to those numbers was a challenge.
Richard Field: That’s something actually, that again, I learned on Chris’ course, because there was a day, I can’t remember which day it was, where the homework was go home, look at yourself in the mirror and practise saying large sums of money … About saying is that okay?
Richard Field: I think a lot of us are hoping, so your insurance is going to be £15,000. Is that okay? No. You just stop talking, and silence is again from, I think it was Chris’ course. It was don’t fill the gaps with extra speaking, so you’re going to make, I’m talking about making an investment in your teeth, so I’d never say I know this is a lot of money to pay for your teeth.
Richard Field: I’d say we’re going to be making an investment in your smile. This is, I know it’s a lot of money to invest in your teeth. It’s something you’re going to be having for a long time. It’s adding value, not apologising and knowing your worth, and again, I think that goes hand in hand with not making the patient’s problems your problems.
Richard Field: Don’t be apologetic for the fees that you’re charging, because you’ve done five years of dental school, you’ve done thousands upon thousands upon thousands of pounds worth of courses. You’ve got glasses around your neck, magnify. You’ve got loops around your neck that cost £4,000. You’re in a surgery that’s filled with tens of thousands of pounds worth of material.
Richard Field: You’re valuable and the patient’s there for your help. Don’t be sorry for charging it. It is difficult and it’s not something that you’ll get used to quickly, but for sure it’s just knowing your worth I would say.
Payman Langroud…: By the way, I’ve had the opposite situation as well. Once you get used to those high prices, then you go somewhere where the prices are lower, that feels strange as well.
Richard Field: Well, on that side, it’s also not good to get used to it, because I do find myself just looking at this as numbers and not this filling. And it’s just numbers, but you realise, actually, that’s a month’s wages for someone or that’s a holiday. That’s repairing the car that they might not …
Richard Field: We’re just looking at those. Well, my hourly rate isn’t, I should have charged more for that, because I’ve earned a little bit less on this, but you’re thinking do you know what? That filling is potentially someone’s week, that’s the food budget, so I think we shouldn’t get used to saying that much money. We shouldn’t just take it for granted.
Richard Field: We should respect it, because it’s money and it’s often huge amounts of money, but you’re there providing a service and you are worth that money, but you should never take it for granted.
Payman Langroud…: I like that. You’ve grown up in the era of GDC problems.
Richard Field: Yes.
Payman Langroud…: How much does that weigh on you? Again, when I was your age it was a thing, but it was nowhere near the biggest thing, and I think from the day you qualified until now it’s been maybe the biggest thing of all. How defensive are you? Expand on that.
Richard Field: I would say I’m very defensive, to the point where I’ve turned people away before we even started, because I don’t think that I can either meet their expectations or I just get a funny feeling from someone. I’ll almost, I don’t know if this is an actual sales tactic that people use, but I try …
Richard Field: It’s not a sales tactic, but I really want people to want the work. I’ll never sell anything to someone, and again, I know I keep mentioning Chris, but in every single consultation that I do I say, if you had a magic wand, would you change anything about your smile?
Richard Field: If they say no, then, even if I could see the world’s ugliest crown on their front tooth, I won’t mention it. I won’t dwell on it, because I don’t want someone to do something, because I want to do it. I want them to do something, I’ll say to them …
Richard Field: Well, someone says, “Is there anything that you’d do?” And I was like, “Well, there’s lots that we can do, but if it’s not the first thing you think of in the morning and the last thing you think of before you go to bed then you’ll never be happy, because you don’t want to make the change.”
Richard Field: If you come in one day and say, “Right, I want to do X,” then absolutely I’ll do that for you, but I would rather someone ask me to do something and really want it, than give someone a £20,000 treatment plan and they do it, because they think it’s the right thing.
Richard Field: I obviously ask your question, are you happy with the colour of your teeth? Because nine times out of 10 someone will come in and say they want whiter teeth, and tell you that. I think that’s a very soft, nice approach in dentistry, but if someone just comes in and says what would you do?
Richard Field: Well, aesthetics is a very subjective thing, so what I think would look nice isn’t necessarily what you think would look nice. Is there anything that you’d change? If they say no, then move the conversation on.
Payman Langroud…: How much of your work is aesthetics and how much of it is functional? I know they go together, but-
Richard Field: You mean how much is general and how much is aesthetic?
Payman Langroud…: Well, do you do any wear cases, that sort of thing?
Richard Field: I’d say nowadays I do more bigger, I do more wear cases than I do simple bonding.
Payman Langroud…: Really?
Richard Field: I don’t do as much bonding I think, as people think I do. I don’t do as much bonding as people think I do. I’m happy doing general dentistry and one new big case a month I can work on, because I plan things more than I think I probably should, which is something I got from Ian Buckle. Again, after Chris’ course, Ian Buckle, the inclusion programme is the best thing that I’ve done, because I was turning away a lot of cases that I didn’t know how to treat. And then I think it was about maybe four years ago, I did Ian’s course. Three, four years ago. 2020’s disappeared. I can’t remember it.
Richard Field: I think about four years going Ian’s course, and it taught me how to approach the bigger wear cases. It taught me how to plan things and now I do a lot of my own … I don’t do my aesthetic works up, so I make that very clear. I don’t [inaudible] and then I send that to my lab, for my lab. A lot of the time I’m using a guy in [inaudible] we do a lot of the big wear cases together. And how much of my work is cosmetic and how much is restorative?
Richard Field: I’d say about 50/50. We’ve got new people in the practise now, who are doing more of the day to day restorative work, so the plan is to move more single tooth dentistry onto the new sort of, and for me to free up time in my book to do more of the bigger cases, which is what I really enjoy doing. Working as part of a multidisciplinary team with orthodontists, with implantologist, with the [inaudible] because I think it’s the patient’s getting the best person for everything, the bigger multidisciplinary stuff.
Payman Langroud…: What aspect of it is what drives you? Some people love the planning part, some people love the-
Richard Field: I love the planning part, because it makes me feel safe, and like we say, I’m quite a defensive dentist. I want to make sure what we’re doing is right, and it’s explaining that to the patient. They might come in and say, “I want these two teeth fixed,” and we look at the planning and we can say, “We can fix these two teeth, but we need to fix these nine others as well,” or, “We need to move this here and move this there.” So again, maybe making things fit together, but I wouldn’t claim that I know inclusion.
Richard Field: I really find it satisfying to see things fit together. To see how this tooth will change this tooth, and how sometimes, even though we’re looking at this tooth, we need to involve other aspects of the mouth as well. I find that quite satisfying, when you put the needs together, and all the blue and red dots are in the right place. I find that quite satisfying.
Payman Langroud…: Would you say on the day of the fit you’ve done all that planning, that you know it’s all going to be fine, or is there stress? Listening to you now, sounds like you’re very stressed the day of the fit, right?
Richard Field: The day of the fit’s the worst day in the world. Fit days, go home and have a few gin and tonics after, and just be glad it’s over. I enjoy the planning, I enjoy the preparation, the impressions. I’m glad when fit day is over, but it is very satisfying. Fit day’s the worst day.
Payman Langroud…: Listen, bud, I remember back in the day, I don’t know how many years I’m talking about, maybe seven, eight years ago, maybe a bit after, but you were the original social media dentist that I remember. You were the first one to have your own logo, and I remember you getting quite a lot of chip for it. I remember you getting attacked quite a lot for it. Maybe because you were the first and it wasn’t a thing, right? Then you withdrew from social media quite a lot. Tell me about it, first of all.
Richard Field: I think social media is something that I think is really important to talk about, so I was the first one with a logo. My friend at uni, Ben, he made me a logo as part of his university course, so he used the same one today. Had a logo. I put stuff on Facebook, when Facebook was still a thing, and people commented, and not always for the best.
Richard Field: You’d have to build quite a thick skin quite early, and there was a couple of things that happened a few years later, that I don’t really want to massively get into, but it really left a sour taste in my mouth. I was like I don’t need that in my life, and maybe to my detriment and not by having fully embraced it again ever.
Richard Field: I know there are people that’ve built their businesses on Instagram who have filled their books up months in advance from Instagram, years in advance. There’s people that have no other marketing, other than Instagram, so I think it is fantastic, but it’s also quite dangerous. Not only for dentists, but potentially for patients as well, especially the younger ones wanting Instagram smiles.
Richard Field: To put that in perspective, I have a very secret, and I’m not going to tell you what it is, I have a secret pizza Instagram where I post all my pizzas that I make in my home oven, and I sent a picture of my smile from that Instagram to a dentist. I have a small gap in my upper right lateral [inaudible] and I said what do I need for a nice smile? The answer was 20 zirconia crowns, so-
Payman Langroud…: Was this dentist in Turkey?
Richard Field: It might have been, but the reply I got was 20 zirconia crowns, and I was like okay. Some dentists have asked me about bonding and he said no, that won’t work. Crowns is better. It’ll be £3,000. 20 units, you’ll have two appointments and it’s time to go to pictures, and it looked from a layperson’s really good, and that’s what we’re up against.
Richard Field: We’re up against dentists and the general public, who doesn’t know anything about dentistry. Sees the nice smile for a nice price and it’s very difficult to compete with, and on the flip side in the UK there’s a lot of, I have to be very careful what I say.
Richard Field: It’s a lot of makeovers with composite, and I love composite. I think it’s fantastic, but I don’t think what these patients are being told is the maintenance longterm, so you’re seeing a lot of people with big composite smiles on virgin teeth. Very young. Not knowing the maintenance for the future, and I’ve already had a couple in.
Richard Field: You’ve had these full mouth composite veneers done for a very small amount of money. They’ve already started to fail and can’t afford to fix it, and I’m not saying this is every dentist. There are dentists out there doing phenomenal work with composite that will last years and years, and years and years, but there’s also a lot there that aren’t. And I think we’ll be in a very interesting position in three or four year’s time, when all these influencers or young people who want influencer teeth need it all redone, and I wonder who’s going to do it.
Payman Langroud…: It’s definitely an issue, although I don’t know how you knew that people aren’t telling people. You’ve spoken to these patients, but you can’t always trust patients about that. I understand where you’re coming from. Sometimes a trend picks up and it has its own legs, and then I had Shaadi Manouchehri on the podcast, and she was talking about TikTok. She’s massive on TikTok, and-
Richard Field: I know nothing.
Payman Langroud…: Well, yes. So just to think, on TikTok, the things that trend are they have juicy headlines and something really, like the Turkey thing’s trended on TikTok. People going to Turkey and having their teeth done, and it is problematic with composite, because it can go very wrong very quick if it’s not done very well. The problem’s amplified, don’t they? It’s a tiny little scratch in the composite ends up as a big stain later on, so I do agree with you on that.
Richard Field: I think what Instagram’s done is they’ve taken the medical aspect away from dentistry, and it’s more of a beauty treatment. Say people have their hair done, have their nails done, have their teeth done, and I think it is important that the patients understand that what they’re having done, it might be a little it invasive, but it’s not reversible. I think that’s the side of it, which broadcast or understood.
Payman Langroud…: Yes, especially the no drilling, no injection, that thing, makes it sound like it’s just nothing, and that’s something that a lot of people use for their marketing, don’t they? Tell me about Elleven Dental. One of the most beautiful practises I’ve ever been to, but you’ve worked in all the most beautiful practises. One of the most beautiful practises I’ve ever been to.
Richard Field: I have worked in a room once, with no windows. That was-
Payman Langroud…: What was that, Tif’s place?
Richard Field: [inaudible]
Payman Langroud…: Tell me about the patients you get in Elleven Dental, for instance. Who are they? What’s the patient profile?
Richard Field: To be honest, I think that’s a really interesting question. I find the patients that I treated at Harley Street Smile Dental Studio and Elleven easier to treat than, for example, the patients I treated in Clapham when I was at Ten Dental.
Richard Field: I think the difference is the patients in Harley Street and the patients at Elleven, they are from a better off background, so they’re not saving up to come and see you. And I think when the patient saves up to come and see you there’s a feeling of ownership from the patient. They own you. They’ve paid for your house, they’ve paid for your car.
Richard Field: They’re giving you all of their money and investing everything. They’ve taken out loans and they’ve done this, and I think that’s a very unnerving position to work in, whereas the patients in Elleven Dental or in Harley Street, they’re coming to you, because they want the best or what they perceive is the best.
Richard Field: They’re not going to be financially broken from paying for it, and it’s a lot, it’s a more … I find it actually a more relaxed way of working, because, although, of course, they’re paying a lot of money and you want to do the best job for them possible, but treating the patients that have saved up or taken out loans. I find that really stressful, because their expectations of you are, it’s like they’ve put everything on you, everything on that.
Payman Langroud…: That’s interesting. How about Bristol? How does Bristol … You made the move to Bristol, when was it? A couple of years ago.
Richard Field: End of 2016.
Payman Langroud…: I bet the Bristol patients are easier than all of these.
Richard Field: It’s a real mix, actually.
Payman Langroud…: Is it?
Richard Field: I would say it’s a mix between 11 and 10, Clapham and Harley Street. You’ve got your general dentistry, and then you’ve got your people who’ve moved out of London for whatever reason, or retire to the country, so it’s a complete mix. You can’t judge anyone. Well, you can’t judge anyone at any practise really, so you have no idea who’s going to walk through the door, and especially, because everyone sounds like a pirate in Bristol. It’s very difficult to judge, but it’s a real mix, and we get people who travel. A lot of London patients aren’t London patients. A lot of London patients don’t live in London, a lot of Bristol patients don’t live in Bristol, so it’s a real mixed bag.
Payman Langroud…: Alfonso has several practises, right? So-
Richard Field: I can’t keep up, really.
Payman Langroud…: Yes, so as far as your autonomy in that practise, is he there enough for you to have to talk to him about what you do, or does he just leave you to it?
Richard Field: Well, we do a lot of cases together. He was, up until a few months ago, in the room above me three days a week, but he’s just opened a clinic in the building directly opposite our practise. He’s now there, so it’s a bit more difficult to pin him down, but-
Payman Langroud…: Is he as much fun to work for as it looks? It just looks like every minute is fun with him.
Richard Field: Always, it’s better if the patients don’t go to get the water from the fridge, because there’s always bottles of beer or Prosecco [inaudible] after work or to a party, so no, he’s really good. He’s a lot of fun, for sure. It’s one of the more you feel part of the decisions, rather than an employee, which is nice. He’s very into the team aspect and he’s very into the dentistry, which is rare from someone who owns multiple practises. His main thing is the dentistry. It was one of my attractions to going to work there.
Payman Langroud…: Why did you move to Bristol? Was it [Mena]?
Richard Field: Actually, it was quality of … I’d only been to Bristol once, actually. I met Alfonso at the BAAD, and he just said in passing, “You’re Richard. I’ve seen your stuff. Come work for me in Bristol,” and I was drunk, and I took his card and I said do you know what? This guy seems nice. I’ll give him a call, and I gave him a call and we spoke, and I ended up doing some work experience, some shadowing for a couple of days, and then Mena came through and we stayed over in Bristol.
Richard Field: She went to university here, and I saw Bristol, and then there was a time when I was only really working two and a half days a week, so I had a lot of free time. And I ended up having a deal with Alfonso where for six months I’d go through on a Thursday and a Friday and I’d work there, and if after six months I didn’t like it then we shook hands and I walked away, or if I liked it then I’d have to do more days, which were moving through, so I did the six months.
Richard Field: Loved it, moved through and reversed my commute to Elleven, so instead of commuting from London to Bristol I just reversed the move and commuted to London when I needed to. I remember the first night I got home from work in Bristol, and it was half past six and we had dinner, and it was eight o’clock and we’re like what do we now?
Richard Field: In London, you get home, you have dinner. It’s half past nine, ten o’clock you go to bed, so we got home and we’re like, well, what do we now? We didn’t have a TV at this point, because we just moved in. We ended up going to Asda and doing our shopping at 11 o’clock at night. If I want to walk to work. Takes me 20 minutes. On days where I’m feeling especially lazy, the Italian practise has got Vespas. Vespa to work takes me six minutes, so very different quality of life. It’s much easier to have a work life balance.
Payman Langroud…: Yes, it’s a fantastic town.
Richard Field: I love London. I wouldn’t do anything differently. I’d still do everything the same, but I think there comes to a point where, unless you love the London lifestyle, it’s time to leave, and I was getting to that point.
Payman Langroud…: Now, when you come to London, you stay in an Airbnb.
Richard Field: Pre COVID, yes. I did, and I loved it, because I got to meet friends for dinner, I got a good night’s sleep. Yes, it was great. Now, at the moment, I’m going there and back each day, which is hard, but it’s not an issue, but I’m hoping that once, if COVID dies down, I can get back to staying over, but yes I was Airbnb-ing. It was nice, catching up with people in the evenings and going for a Chinese, and ordering by sections of menu with you.
Payman Langroud…: I’m a massive, massive customer of that Chinese. I went through a phase of ordering it every day for delivery in my office, because my office is actually very close to that. I was looking on Deliveroo and it was 1.3 miles. I was like wow. I was going through the menu, because one of my buddies who I go with, he’s Muslim, so I could never order pork. As you know, the Chinese are huge on pork, so I was just going through the whole pork part, but you are my food don, buddy. I want to get a question regarding the stakes. Have you read Black Box Thinking?
Richard Field: No.
Payman Langroud…: It’s about plane crashes. A plane crashes, they don’t look at who’s at fault. They look at the black box, and the whole point of it is how do we stop this ever happening again? He actually does switch it into medical and says, “In medicine we’re always looking for blame, and for that reason everyone’s hiding their mistakes,” so on this podcast, the idea of trying to learn from each other’s mistakes. What have been some of yours?
Richard Field: I got my big mistake out the way in I think third or fourth year. I think it was third year of dental school. It was one of my first posterior composites, and I tried to use a Sof-Lex disc on the back molar and I got it stuck inside the cheek of the patient, so you imagine putting the disc, and then imagine that getting wrapped up in-
Payman Langroud…: Mustn’t laugh.
Richard Field: Calling the tutor over to-
Payman Langroud…: What do you mean you couldn’t get it out?
Richard Field: No, it was completely wrapped up inside the person’s cheek-
Payman Langroud…: Oh, wrapped.
Richard Field: Yes. I had to detach them on drill. I had to unwind it. Patient needed-
Payman Langroud…: Oh my goodness.
Richard Field: You only do that once, for sure.
Payman Langroud…: That’s a goodie. I love that one.
Richard Field: That was a good one. The only, this is one for the rubber dam uses, if you sandblast make sure you wipe your rubber dam completely clean of the powder, because once you’ve got bond in that tooth, if you knock the rubber dam and the powder goes in the bond, you’re not getting that back out.
Payman Langroud…: Very good point.
Richard Field: You only do that once, and you only glue veneers together. Only do that once-
Payman Langroud…: What do you mean? You mean you didn’t clear in between the teeth?
Richard Field: Yes. When you cemented a case and your teeth are stuck together, or if you’re stuck. You only do that once. A lot of things you only do once.
Payman Langroud…: That’s a good one too.
Richard Field: Normal stuff.
Payman Langroud…: I like that, so Prav isn’t here, but Prav always ends it with the same question, unless you aren’t a listener to this podcast. The question is you’re sitting on your deathbed. You’ve got the five or 10 people who are closest to you, around you, hopefully some kids. I should have asked you about kids, but hopefully some kids and all that by that time. What are three pieces of advice that you’d leave the world with, or your closest people with?
Richard Field: I’d say set yourself goals, no matter how outlandish you think they are, because you might be surprised yourself. It gives you something to work towards.
Payman Langroud…: Did you set yourself the goal of becoming the youngest ever person to be accredited by the BACD?
Richard Field: Goal thing’s quite funny for me, because I set myself youngest, I wanted to be accredited before 30. I wanted to work in private practise full-time, and it was weird, because I hit all of my goals really soon, really early. I think it’s something Tom said, and it leaves you in this really weird limbo, where you don’t really know what to do.
Richard Field: I was in private practise within a year of graduating, and I got my accreditation a month before, on my 30th birthday. And then 30 was really weird for me, because I was in private practise, I had a flat, I was accredited. I didn’t really know what else to do, so then I was just like, well, my goal is for the next few years I’m not going to have any goals. Like you didn’t set an alarm clock for a year I think-
Payman Langroud…: Yes.
Richard Field: It was just nice to just focus on the dentistry, and I didn’t do any courses and I didn’t really go to any conferences, and I just focused on the work and life, which was what was going to be my last bit of advice. There’s more to life than teeth. There’s more to life than whatever job you are, and I think lockdown or COVID’s definitely helped with that. We’ve all had to wait, three, four months where we weren’t working, so set of goals. There’s more to life than teeth or work.
Payman Langroud…: You became a cook extraordinaire, you told me.
Richard Field: Yes. Do you know what? It was terrible, but it did have its good things.
Payman Langroud…: Definitely.
Richard Field: I’ve always loved cooking and it gave me a chance to experiment, which was good fun. My last bit right now I suppose would be don’t compare yourself to others, because you never know the full story, and don’t care too much about what other people think of you.
Payman Langroud…: Definitely. I like that. What are you plans for the future buddy?
Richard Field: Spend more time with my god. I think it goes back to the goal thing. I’m quite content at the moment. I don’t want to want to practise ever.
Payman Langroud…: Really?
Richard Field: Ever, no. Never ever. I can’t think of anything worse.
Payman Langroud…: I would have thought, the kind of control freak that you are, that-
Richard Field: On the dentistry, so I couldn’t deal with everything else. I’m in my surgery. It’s my safe space. I know where everything is, I know where everything’s going, I know I can do good work and I don’t want to have to think about the admin, I don’t want to think about the politics. I don’t want to have to think about anything. I just want to do the work. Want to go home and I want to spend time with my dog, and make pizza.
Payman Langroud…: Yes, so I’m still yet to taste this pizza, and I will be getting the name of that account from you after the podcast. Well, it’s been a pleasure to have you buddy. It’s been a pleasure to have you, and hopefully, when COVID gets a bit better, we can get back to dinners and all the things that we used to do, but it’s been lovely. Thanks a lot for taking the time to do this.
Richard Field: Thanks for having me.
Payman Langroud…: Of course.
Speaker 2: This is Dental Leaders, the podcast where you get to go one on one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.
Prav Solanki: Thanks for listening guys. If you got this far you must have listened to the whole thing, and just a huge thank you, both from me and Pay, for actually sticking through and listening to what we’ve had to say and what our guest has had to say, because I’m assuming you got some value out of it.
Payman Langroud…: If you did get some value out of it think about subscribing, and if you would share this with a friend who you think might get some value out of it too. Thank you so, so, so much for listening. Thanks.
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