A phone call from out of the blue marked an unexpected entry into the world of dentistry for this week’s guest.

Dental mergers and acquisitions specialist Max Bazzucchini tells us how he became one of the profession’s most trusted valuation advisors.

He shares his thoughts on the UK market and dispenses some insider tips and wisdom for both buyers and sellers.

“If you are in the moment – in the present moment – and you work very hard, you can have it all.” – Max Bazzucchini

In This Episode

00.48 – Backstory
10.03 – Love at first sight
15.54 – An offer you can’t refuse
20.49 – A kid in a candy store
26.08 – Growing value
30.17 – The valuation process and EBITDAR
36.41 – Lending and purchasing
42.23 – The art of the deal
50.54 – The COVID effect
55.08 – On flipping
59.08 – Buying and selling mistakes
01.01.16 – Thinking of Italy
01.09.09 – Last day and legacy

About Max Bazzucchini

Max Bazzucchini gained business studies qualifications in Perugia, Italy, and completed physiotherapy studies at St Mary’s University, Twickenham.

Following the purchase and sale of a gym in Italy, Max became a certified business valuer in the dental sector. 

In 2008, he joined ADP Group as head of mergers and acquisitions, supporting the purchase of 132 practices.

Max is currently a director and partner of Pluto Partners – a specialist healthcare valuation and advisory business based in Kent.

 

 

Max: And a good deal is always on a win-win basis. You want to maximise the price on the sellers and you want to make sure that the buyers are paying the right price, which is sometimes over the asking price, more often than not it is over the asking price, but not crazily as an independent specialist and independent buyer, which you will never recover the money that you would pay. So the biggest mistake for buyers [inaudible 00:00:25].

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: Max, welcome to the Dental Leaders Podcast, we’ve had numerous conversations regarding just the marketplace of buying and selling dental practises, you’ve educated me a lot during our conversations, and I’d like you to not only share that knowledge with our community but also tell us a little bit about yourself as well. So welcome to the podcast, Max, and just kick off by telling us a little bit about your backstory; where you grew up and your upbringing.

Max: Thank you, Prav, thank you Pay, absolute pleasure talking to you on this podcast. Yes, I’m a 43 years old kid, Italian, I was born in a very small village in the centre of Italy, on the border with Tuscan and Umbria, and I was lucky enough that my family were a strong family altogether, growing up in the same house that my dad actually built. So he’s a very skillful and charming man, skillful builder.

Max: I’m the third, number three of three boys, and there’s a fairly big gap in between me and my brothers, which is justified by the fact that my dad was offered a life changing job opportunity. So he went from being a builder and earning enough on every month to have enough food and enough comfortable life, to as you know in Italy there are lots of mountains, so there is a need, a necessity for tunnels and roads. So he actually was offered a job to be with his friend, an engineer from our village, to be his assistant director. He started building roads and tunnels.

Max: Then in this gap, in between having my brothers in myself, he made enough money and then I was born. So I would say I was born in a completely different situation from my brothers and never really experienced what they had to go through before, but having said that my dad never really gave me anything for free. He made me work for absolutely everything. He gave me, provided for me for private educations and so on and so forth, a comfortable life, but he made me work for absolute everything, even holidays, first motorbike, first car. Which is great, I appreciate that because he gave me an understanding of working towards something and the value of some things.

Max: I guess when he was building roads, one of them was near to our house, the advantage of that is that I was learning to drive when I was very young. So when I did my driving test exam, I passed within two or three lessons because I was driving better than the examiner really.

Max: So I then went to university in Perugia at the age of 18, nearly 19, I left my house. I went to study sports physiotherapist, which it was kind of an evolution from playing basketball, I liked the anatomy and physiology of the human body, so I went to study that. I used to live in the centre of the city, Perugia, beautiful mediaeval town.

Max: Then I used to go to a gym near to my flat, near to my apartment, and I became a very good friend with the owner, a guy called Angelo. I went the first month, I paid the membership, the second month I paid the membership, and I remember the third month going to the gym and saying to Angelo, “I’m not going to pay you this month but I’m going to make you an offer, I want to buy half of your gym.”

Max: The reason why I said this to him is because I noticed that the gym was never really full to its potential. There was a lot of people living in the area but not many people were going there, so I spotted an opportunity. So we had it valued. I guess there was my first experience in valuation of a business, really, on a business I wanted to buy.

Prav: How old were you then?

Max: I’m 19.

Prav: Wow.

Payman Langroud…: Did you buy half of this gym at 19?

Max: I did, yes. We had it valued and it was valued 200 million liras, which in today’s money would have been just over €100,000. So I went to my dad and he lent me the money, he gave me just over €50,000, I bought half of the gym, I renamed it, I called it Magic Body, the love of English language kind of was born in there already.

Max: The first few months I did nothing because I think business grow through evolution. You don’t want to go and make changes straight away. So the first two or three months I wanted to understand completely how the business was run. Whilst I was studying, my sport physiotherapy qualification, then we started to implement changes and some of the changes were for example, I contacted my good friend Alejandro, a Cuban world class dancer, and then he started doing Latin American classes. Then my friend Dmitri in doing martial arts, my friend Lenny from Greece who was doing some modelling, she was studying international law and she went to do yoga.

Max: So the business went from we basically quadrupled the number of members when we started to implement these changes with minimum investment costs. My advice was to invest in marketing and expand the level of services. Well, we provided this service for free providing that you were a member of the gym. So we kind of quadrupled the number of members.

Max: So my dad when he gave me the money, he said, “I want the money back within four years, interest rate.” Two years and a half later we had the gym valued again and it was worth over double of what it was valued, and I got very much involved in that process of valuations of the business and that’s kind of where I started to love business valuations and growing some sort of business, and I thought this is a way to have fun and make money, rather than working every day on my sports physiotherapy. So I had to do a lot of treatments to make the same money I just made by buying and growing a business.

Max: So I got the money back, I give it to my dad, I’ve got enough money then to buy an apartment, which is still today in today’s rented out, after 14 years. I lived in the apartment for a while and then after I sold the gym I decided I’ve been working very hard… I was also going out partying because I think, I feel, you can have it all. It’s not like if you study you can’t do this. I think you can have it all. The same you can have a career and you can have a family. If you are in the moment, in present moment, and you work very hard, you can have it all. That’s my mentality anyway.

Max: So then I sold the gym, I bought myself a nice little car as well, which used to belong to a football player [inaudible 00:08:15], nearby from Forenza.

Payman Langroud…: What car was it?

Max: Oh, beautiful black fiat coupe.

Payman Langroud…: Okay, cool.

Max: Loved it, absolutely loved it. I was about 22, 21, 22. And going with this, my long hair, fiat coupe, and I paid, I remember, €10,000 for a six months old car, brand new, with a cost 24. So I thought that’s a bargain so I don’t really want to buy a brand new car.

Max: But then I decided, after that, I wanted to travel because I really loved travel and I didn’t have the opportunity to do it in the times I was in Perugia. I made a lot of friends, which was the benefit of being there, which still have lots of good friends in there but I didn’t have the chance to travel. So I wanted to work and travel so I decided then to go, which this is something that me and former Italian prime minister [inaudible] have in common, which is not the party or anything that you might think of, but we both started working on a cruise ship. It was a pianist on a cruise ship and I decided to be a spa manager.

Max: So I travelled for a year and a half, two contracts. The first contract was in Europe, south Europe, Spain, Portugal, Greece, Italy, and then we went to the north of Europe, the Nordic Sea, St Petersburg, Norway, absolutely stunning places. Then the second contract was in the Caribbean in central America, Guatemala, Honduras, so I travelled a lot and also while I was working.

Prav: So Max, what was your plan at this stage because you’d done your physiotherapy, you’d got your qualifications I’m assuming, learnt your craft. You’d bought and sold a business. Was there a master plan here or did you just think, you know what, I’m just going to take a few years out, go and travel the world and enjoy myself, earn a bit of money to keep myself alive while I’m doing this and then roll out the master plan? What was going on in your head at this time?

Max: I didn’t actually have a plan. I just wanted to… Luckily I graduated, I finished my university and I didn’t have… I was debt free, so I had enough money and I had an apartment, which when I was travelling did make some sort of income, which was not many of my friends were in my situation really in where I was. So I was quite comfortable, so I didn’t have a plan.

Max: When I went working on a cruise ship, trust me the last thing you’re thinking is about getting married. So you are 24, you go working on a cruise ship, you just want to go and enjoy life. Literally I remember I embarked in May, beginning of May, and at the end of May we were having an absolutely fantastic night in the middle of the sea having a crew party under the stars, beautiful, beautiful time, and I was sitting and drinking something with my friend the fitness instructor Johann [inaudible] from Romania.

Max: And I see this girl and I’m thinking wow, she is absolutely beautiful. I know it sounds a bit cliché but I still remember today what she was wearing and how she was walking, all of those things. So I turned around to my friend and I say, “Johann, I like this girl, you know what? I think I’m going to marry her.” He was like, “Yeah right, that’s crazy.”

Max: Then I started to get to know this girl, she was a dancer on the ship, and we started to get together a bit more, then we went together on my second contract in the Caribbean. I then decided actually, I do want to marry her because as crazy as it sounds I think she’s the love of my life, I think I found her. Slowly she got there as well, I got there straight away, she eventually got there as well. I wanted to buy a ring and I had a ring made in someone Puerto Rico but a ring maker in the back of his garage, platinum ring. I bought the diamond in Key West, I had the diamond made, I had the right made, and then in Antigua we were in sandals on a day that we were having a day in Antigua from the ship. We went in the sea, I had my ring, and I proposed to her and she said yes.

Max: So after that we came back to Europe and back then we didn’t have the mobile phone or anything, communications with family was quite scarce. So we get to Tenerife after crossing the Atlantic and we are in a queue waiting to make a call back to family. So I said to her, “You go first.” And she called her parents, mum and dad, and I called mine after. I said, “We’re coming back. By the way, we’re getting married.” They said, “Who are you getting married to?”

Max: So my parents, [inaudible] now I’ve got kids, I think is absolutely crazy, but my parents were like, “Well if you’re sure, if you love her, go for it.” And it’s the same, my parents-in-law, they did the same thing and we’re still married together, we’ve got a beautiful family, two kids, 15 years later. So I’m a bit like that. If I think something is right, I go for it.

Payman Langroud…: This is how you ended up in England because she used to be-

Max: This is how we ended up in England. We got married in England in a beautiful village in the south of England in Kent, and then we had also a small party in Italy, about 400 people turn up as you do, probably you do the same with Indian weddings. And we’d been in Italy for a while, for about a year. My wife at the time was a professional dancer and she was predominantly working in England and most of our work was in England in the West End. She did one contract in Rome but even for that contract she had to go and audition in London [inaudible 00:14:34].

Max: She was spending most of the time in England, and in that year I spend a lot of time doing business studies, the equivalent of an ECCA valuation courses and learning valuations and the methodology of the valuations of businesses. So I decided I don’t really want to spend time apart. If you are together you want to be physically together. So we decided okay, let’s go to England, let’s give it a go, and see how it is.

Max: So I then rented out my apartment, and I went from like many Italians moving to England, moved to London, and I went from… the first few days it was quite hard, it was quite challenging. There wasn’t one hard thing, it was kind of a combination of several factors, but obviously I had my focus that no matter what I wanted to make a success of staying in England and most of all I wanted to make a success of my relationship and build a family. So this was my, at the plan, my main plan. I want to have a family, I want to be with my wife, and something good will come out of this, and eventually it did. So we moved to Putney, I believe not far from where you are Payman, beautiful place.

Prav: So Max, I’ll kick you off. From there your plan was you move to the UK and your number one plan was you wanted to make a go of your relationship. What about your career plan, Max? Did you have an idea, you talked about you started doing these qualifications about valuing businesses, et cetera, et cetera, right? What was the career plan at that point and then fast forwarding, how did you get into dentistry or was there a transition? Did you do something else before you went into dentistry?

Max: Yes, I did, and I did it whilst I was studying English. So the first thing I wanted to do was improve my English, which was not very good at the time, so I went to study English whilst I was applying for several jobs and I wanted to work for, still in the business of buying and selling valuations, so apply for working with some private equity. My English wasn’t great, so that’s what… it kind of was my weakness at the time.

Max: So I needed to focus on improving my English, which I did, and the work I was doing at the time, I was working as a medical sales rep for a pharmaceutical company. You had the basic salary, and it was a limited commission level, so I really went for it. I was making good money, consistently one of the top three in the country for my company, a company called Nutricia, part of the Danone group. I did it again whilst I was studying English, which I studied in [inaudible 00:17:32], I was going there in a college and then working for this company, very early, meeting GPs and going to work in hospitals and then studying during the day and working in the evenings. So long day, long hours, but that’s what you’ve got to do when you’ve got a couple of things to do at the same time, really.

Payman Langroud…: Max, what was the first time when you got into something to do with dental? What was the first time you saw something to do with dental?

Max: It was the summer of 2008 and I am in a carpark in St Georges [inaudible] Hospital, I just finished a meeting with dieticians there, closed a good contract on the stuff we were selling them, and I have a call from this guy talking to me with a very low, deep voice in American accent. He sounded a bit like Corleone from The Godfather.

Max: So I imagine, low voice, right? So we’re having this really low, deep voice conversation. This guy says, “I’m calling from a private equity called [inaudible 00:18:33], we’re just to cover a group of dental practises called ADP Dental after the Icelandic bank [inaudible] collapse in 2008. We are looking for someone who can help us to grow through acquisitions of dental practises.” At the time I didn’t even know you could buy and sell dental practises.

Max: So I went to the interview and I remember going to this office in Reigate. It was full of all of these seniors, let’s call it senior people with the suit and tie in their offices, and there was me going to the meeting with my pink trousers and my blue jacket and sunglasses on my head. They probably thought the pizza delivery guy turned up. I had this interview and I remember talking to this really call guy and he’s talking to me with so much passion about what they’re doing and their vision and what they want to do, which I bought into his passion without actually fully knowing what they wanted me to do.

Max: His name was Nick Rolph, which then became my business godfather, my mentor, my friend, and now my partner in Pluto Partners. So that was back in 2008. I spent the first-

Payman Langroud…: So what was the situation? What was the situation with ADP at that point? How many practises did they have, how many were they looking to buy?

Max: They had about 50 practises, and I spent about five, six months of my first time there learning about the business of dentistry, I didn’t know what UDAs was or anything like that, so they told me everything. I have to say I-

Payman Langroud…: What was their plan? Did they say to you, “We want to expand to 100,” or what were they saying?

Max: Yeah, they wanted to grow to at least 100, but having organic, consistent growth through positions of quality practises, not just the quantity, not just getting anything. At the time they wanted to grow through acquisitions of single sides, maybe small little groups, and not much tendering because the tendering was only providing low UDA value, which from a group perspective was not really profitable. You needed about 25, 26 UDA value in order to make it profitable.

Payman Langroud…: In that situation does it feel like you’re like a kid in a candy store in a way because these private equity, it almost feels like you’re spending other people’s money isn’t it? Was there loads of money, was money not a problem?

Max: Money was not a problem but there were very strict, prominent criteria for the type of practises that I needed to buy. So I needed to make good deals and my role was I was kind of the conduit between the practise sellers and the investors, so I was the middle man trying to do a good deal for everybody, it wasn’t about buying cheap because otherwise they wouldn’t sell to the group. But equally I could then waste someone else’s money. Even it wasn’t my money, I never really throw money away anyway so I always value that, nice to [inaudible] at the right price because you make money when you buy, you don’t make money when you sell, you have to buy, right, in order then to sell at an enhanced multiple.

Max: So then we grew to 132 practises through a combination of single size acquisitions and groups. I remember my very first deal, and as many brokers will tell you, or a positions manager or former acquisitions manager will tell you, you remember your first deal and you remember your last deal. My first deal was a group of practises in [inaudible] with a bank account in the Cayman Islands. And I’m thinking, that’s great, I’m going to go back. The lawyers say, “No, you’re not, that’s not how it works.” But I was a bit naïve anyway at the time, and that was a good deal, very good deal for everyone.

Max: As I said, I remember now my last deal as advisor as opposed to buyer, which was done just before Christmas. So going back anyway to ADP, then we then sold or shall I say our investors [inaudible] got together with Carlyle, the biggest investors owning IDH Group, to put together this super group which was the biggest dental group in Europe at the time, and that happened in February 2011. So I went through learning and understanding. Nick Rolph was more instrumental in this deal but I was kind of shadowing him and learning and understanding an exit strategy at high level.

Max: So we then work for IDH for a period of time, about a year and a half, continuing buying practises for them and grow, network owner of IDH, David Hadley, exited the company a couple of years later, and he decided to invest in another project, a consolidation of GP practises, and then he asked me to go and work for him, which I did for a couple of years. So I have some experience in another healthcare sector, which is now helping me to understand and bring something else, something different to the table in the business of dentistry.

Payman Langroud…: What happened with that business? What happened with David Hadley?

Max: So as you know, GPs don’t know they have sellable commodities because you can’t really sell a GP practise but you can do it through [inaudible] partnerships anyway. So it’s not that you are calling a dentist and they know they can sell a dental practise, which is relatively easier as opposed to a GP practise.

Max: So it deals on a one-to-one basis, we’re kind of taking a longer time than the dental deal so you’re looking at about 12 months end-to-end for a deal completion. So we decided to approach a group and we brought a group of about 45 GP practises for the morning health and at the time I’m thinking the buying and selling is what I like to do, I don’t really like the integration into the group.

Max: But me and Nick Rolph, since selling ADP, we always wanted to set up an advisory firm in advising groups and large practises on their exit plan and maximising on the value, but when he was ready I wasn’t ready and vice versa. So when I was ready he was working with Sherry Blair on a big fan project, then he went working with Dentex as a chief operating officer. Then he was ready and I was ready and then we are back in 2018 now, so we start putting together the plan to set up Pluto Partners, and one of the things I wanted to make us different I guess from anyone else out there, I wanted to have a dentist as a clinical partner and clinical advisor because we are advising dentists on how to maximise on the value and nobody better than a dentist can understand how to run and help on the exit transition. So we have a practising dentist with experience also in buying his own practises, advising us on every deal that we take on the table.

Payman Langroud…: So if someone wants to sell their practise, how long before they sell their practise should they start growing the turnover or reducing the costs, how long should that process take?

Max: I think it’s difficult to say a specific time, but the longer process it takes the better, the more timing advance you start planning the better it is. I would say if you are thinking about selling in five years’ time then start now. I think it also depend on the type of practises that you have. If you have a fully associate practise and you’re running it, you could sell tomorrow really if you are ready. There are always things that you can maximise, I don’t know, for example reducing lab costs and making sure that the income is equally spread amongst associate, perhaps, rather all on one associate, but if you are the main performer in the practise then we advise try to make yourself less indispensable, because it’s not that you can’t sell, you can still sell, but if it’s a group buying your practise, if it’s a corporate buying your practise, they’ll probably ask you to stay for a period of time to minimise the risk on the investment, and if you want to sell and exit, then you need to try to make yourself less indispensable. I would say try to plan in advance two or three years before, really.

Payman Langroud…: And how much do you think… I mean what kind of percentage change can you make… I’ve got a friend, he’s thinking of selling his practise, and it’s a nice practise, it’s a nice practise. I think it probably turns over, I don’t know, a million pounds. He says he’s not going to do any of that, he’s just going to sell his practise. What percentage change do you reckon you could make to the selling price if he spends a couple of years cutting cost and trying to push up revenue and all the little tricks that… I mean, I guess it’s not a trick, it’s just the way it is, right?

Max: Yeah, of course.

Payman Langroud…: What percentage difference could you make by focusing?

Max: Well, the key part is in making the changes in advance and not doing last minute changes. I mean for example, what we noticed recently, not just in dentistry but everywhere, is how digital technology has become a lifeline for so many over the last few months. What I see that the practises, they are implementing digital dentistry for example. They are becoming more profitable as they are instantly reducing their lab costs.

Max: Typically our clients, if they have an 8% lab cost, after their investment if they invest maybe on a [inaudible] machine for example, they can reduce their cost by 2% in the first year. On a million pound revenue practise as you mention, 2%, that’s £20,000. This can possibly affect the profit margin and instantly can improve the valuation by, if we say on average seven times multiple on EBITDAR, then it’s £150,000 added value to your business. So obviously there are certain things that you can save.

Payman Langroud…: So each pound you save is worth £7 on the sale if it’s a seven times EBITDAR obviously.

Max: Yes, every pound you save is going to be a £7 added value to your business, providing that it’s a sustainable change. If you make a change and you go below the average, so if you go around it… let’s say for example support staff cost average for practises, you’re looking about 17% right now, and if you reduce that massively because you want to sell to a 10% or an 8%, that is not going to be sustainable from a new buyer’s perspective. So obviously you have to make changes that are going to be sustainable going forward. And the lab [inaudible] cost, for example, is one of them, as well as of course improving the… reducing, for example, the [inaudible] time you can reduce or certain other improvements that you can make with implementing digital transformation.

Prav: Max, would you mind just in real simple terms summarising for us how a practise is valued, and I know there’s numerous ways of doing this, but on the whole how a practise is valued. But also, what are the deals that present themselves on the table that practise owners may or may not be aware of, and the things I’m thinking about is retention period, how long they’re required to stay on, what does that deal look like for them, what are the consequences for them if they don’t hit certain targets? What are the usual pitfalls they need to look out for when looking at a deal of how a practise is valued and on the face value they may think okay, they’re going to get X for their practise, but in reality they’re getting 60% or 40% deferred over five years, and hitting that deferral target may be more challenging than they anticipate. Would you mind just summarising those few points?

Max: Yes, so okay, let’s talk about the defer first and then we talk about how we value practises. So in terms of the defer consideration, that is the part of the deal price that is paid over a period of time, provided that certain targets are met. Different groups… Usually this is done by corporate purchases, not much from independent buyers. So certain groups will apply different types of criteria and KPI and key performance. We, as valuers and advisors, we always advise to our clients to make sure that the targets are achievable, but in reality Prav, what you get is the payment on completion; the rest, I consider it a bonus.

Max: So the higher the payment on completion the better it is, so we always try to negotiate on behalf of our clients, but equally buyers want to make sure that the risk on their investment is minimised anyway. So certain groups have the target of EBITDAR growth, which to me is difficult really, because giving a value to a business based on growth is a difficult concept for a seller, and as in EBITDAR as the target, also can potentially create some arguments. So I would say having revenue instead as the target I think is an easier black and white, much simple concept for [crosstalk] consideration.

Prav: Just explain to me very quickly, what is EBITDAR? Just in very simple terms to a practise owner. I’ve spoke to loads who don’t even know what that means, and why should they, right? If they’re not in the process of selling or buying practises.

Max: Yeah, the EBITDAR, the actual meaning of EBITDAR is an acronym which is made out from other different words and it’s the earning before interest, tax, depreciation and amortisation. In simple terms, it’s the true operating profit of the practise, after all costs, essentially. If you are a practise owner and we have an associate level valuation model, corporate level valuation model, then obviously they need to include the costs of your clinical income added back to the valuations and then you will have usually 15-18% of the profit margin on a million pound [inaudible] practise would be EBITDAR.

Max: The multiple that are applied at the moment is around seven times on average, so obviously the higher the EBITDAR level the higher would be the multiple, and we think just-

Payman Langroud…: Max, sorry to interrupt Max, how does that compare with other industries? I mean, let’s look at other professions, I don’t know, lawyers, architects and accountants, or just real companies, software companies or whatever. You’re in the valuations world. Are dentists in an over… are we in a bubble or have we got further to go as far as EBITDAR multiple?

Max: Yeah, it’s funny you mention bubble because this is a word that’s been mentioned many, many times, and the bubble never really burst. There was kind of people were expecting this to reduce, the EBITDAR multiple. Compared to other industries, the EBITDAR applied to dentistry is really high. Compare even, and we see this, we do this exercise quite a lot, compared to the same industry in other countries, it’s also very higher. In England the average is, at the moment, on transactional EBITDAR level 6.7 across all type of practises on associate led model. In Italy you’re looking about four times, in USA you’re looking at 2.5 times EBITDAR. So England is a very higher EBITDAR multiple. Pharmacies also have a much less EBITDAR, you’re looking at four, five.

Max: So dentistries are a very profitable business from… you’ve got a high multiple in dentistry in the UK. I guess it’s driven also by the NHS revenue and the fact that you’ve got guaranteed income on a monthly basis and investors really like this, and no one else in Italy, 96% of business is private and you do get high quality treatments, you also get very low quality because of the lack of regulations and standardisation, and there is no government income given to practises on a monthly basis, like in England on the NHS… I guess one of the point is that, and we’ve seen it now during the pandemic and during last year, prices really…

Max: And we did say this, me and Nick back in March and April last year, we were expecting prices not to change and in fact prices didn’t really change, the multiples remained the same. Obviously what is changing and what has changed is the multipliers. What we are multiplying might be changed but the multiple applying to the EBITDAR, that has not changed, and banks are still providing valuations based on a pre-COVID level, and that’s what we do. So to answer to your question, Prav, how we value-

Payman Langroud…: So are the banks lending?

Max: Lending is happening. There are 14; 13, 14 major banks still lending. The criteria has changed so you would need a higher amount of deposit, but the confidence in the sector is still there. The demand is there and the confidence is still there.

Payman Langroud…: So what kind of percentage are we looking at, deposit wise?

Max: You’d be looking at 20% as opposed to 5-10% pre-COVID at the moment.

Payman Langroud…: 20.

Max: I’m pretty sure. Yeah, 15-20 on an unsecure level.

Payman Langroud…: So then when you look at the market now compared to… I’m not even going to go pre-COVID, I’m going to go six months ago, what are the differences? We had Andy Ecton on from Frank Taylor, and he said there was a bunch of associates who wanted to buy their own practise now because of the nightmare of being an associate during this pandemic period. If they were thinking of buying a practise, that’s kind of accelerated them wanting to buy a practise. Have you seen that too?

Max: We did see this, yes. We experienced a 17% increase in the number of associates registering with us to want to buy their own dental practise. So we now have about just under 5000 registered buyers, probably active 25% of them. There are 750 practises coming to market on a yearly basis. Probably a little bit more now.

Max: Associate… That’s the biggest change, really, that we see during the last six months of last year. Prices have not changed, what has changed in the market is the change has affected the associates most of all in two ways, I would say. The first way is that principals are working more in their practise, therefore they’re reducing the level of income to the associate. And also, the associate, they are asked to work. Most of the time they are to accept a reduction in the pay. So their percentage went down from 40, 45, to 35 for example. So they had a reduced level of income.

Max: So that [inaudible] triggered them obviously to buy into a security of a job for the future, so buying their own dental practise. But the other thing I notice is I don’t know how you would define it because it’s something quite new, but there are new associate that instead of buying that practise, they are building and developing their own brand within the existing practise.

Payman Langroud…: Yeah. Super associate.

Max: Probably I call it [crosstalk 00:39:31].

Payman Langroud…: We call them super associates on this show.

Max: Yeah. Super associate might means they are better than other associate. I’d probably say brand associate, but yeah. So what they’re doing, they are building their own brand within an existing practise. I think it’s great in the short-term for a practise owner, in the long-term and added value to the business, I don’t know. It’s questionable. There will have to be a strong relationship and a strong contract in place. For example, if you are a practise owner and you have two or three different brand associate or as you call it super associate over the course of three years then you can justify to a buyer that you had three different type of these associates. So they can have the same. But if you have one of them, and they maybe are responsible for 40% of your income, they can leave the day after you sell your practise. So buyers are not naïve.

Max: I guess from a practise value perspective, it’s difficult to give a value to that, but in the short-term certainly can improve revenues. So that is the biggest change, really.

Payman Langroud…: Max, do you ever work on behalf of the buyer or are you always on behalf of the seller?

Max: We do. We work for the deal and we work for the good deal, and we either work on behalf of the buyer or on behalf of the seller. We never get paid from buyers and sellers, so we are very transparent in our front. When we work on behalf of a buyer, usually we worked with large groups and we advise them on several deals. A couple of years ago we actually advised one of the largest group, [inaudible 00:41:24], on the acquisitions of a group on Nottingham in south Wales, which was, at the time, the biggest deal that we brokered, and I guess the biggest deal done in 2019 with the value and the number of practises.

Max: So we advise buyers in terms of large groups as advisory firm but we predominantly work with sellers. It’s one or the other. You can’t work on behalf of both. So we either get paid from one or the other.

Payman Langroud…: But as an individual, do you ever get an individual coming to you and saying, “Look, I want to buy a practise and I want to pay you to find me the right practise.” Is that a thing?

Max: We give a lot of advice, we don’t go in searching for a practise specifically from an individual, but we advise and we educate what to look for, and we sometimes help them on a negotiation process but we don’t specifically go out and find them a practise.

Prav: Max, I want to sell my practise and I could go directly to one of the corporate acquisition department for example, deal directly with them, hire a good lawyer, and do the deal myself. Why should I pay somebody like you to take a cut of that deal if I can just keep the full slice of the cake of the deal and then-

Payman Langroud…: Is it to save the 1%… How much is it, Max? Is it 1%, 1.5%? What is it?

Max: Yeah, we charge 1.5%.

Payman Langroud…: Oh, man. The way I would think of it is he’s going to get me 2% more.

Prav: Yeah, of course. Because I’ve not finished asking my question yet.

Payman Langroud…: Sorry.

Prav: With that in mind, can you illustrate any deals where you’ve actually acted on behalf of somebody selling it and to what extent you’ve increased the sale deal.

Max: Yeah. I like to say I have a good relationship with most of the groups and the acquisitions team and the M&A guys and ladies working in the groups. When they see my involvement, they instantly become aware there’s going to be tough negotiation and it’s not always the case if you go and approach them direct. Most of the time, a practise owner will do this once in a lifetime, they will sell their practise and they will have only had one opportunity. They again offer and they maybe think this is the best and final. And maybe they don’t… they might be great clinicians but they’re not great at negotiating, they don’t know what buttons to push.

Max: Now my experience and my background obviously is buying practises so I know what buttons to push in order to increase the value, we know what can improve the valuations and the negotiation, we know what we can achieve. So sometimes we see an initial offer and it’s not just about the price but it’s also about the terms and the amount that you get on the defer basis.

Max: In terms of example, I can give you an example which is quite exceptional, really, there was a practise in Buckinghamshire who came to us with an offer on the table for 1.8 million.

Prav: They came to you and said, “I want 1.8 million for my practise.”

Max: No, they said, “We have an offer for 1.8 and I think it’s good.” And he was from one of the groups. So I analysed the figures and then of course we can talk about how we value and prices and a minute. Then I thought it’s a good offer but I think we can improve on that offer of 1.8. The way that you can improve it is by creating a nice competitive tension, not just with that group, but introduce either two or three potential buyers that you think they’re a good match, and we did so.

Max: So consequently, we started to get offers, and the same group who offer 1.8 and it was the best and final, a couple of months later they offer 2.4. So obviously it wasn’t the best and final. But then eventually the deal closed at 2.7, which I was very surprised, but I think I’m pleased with what we did there and the clients were pleased. So he ultimately ended up selling to another group, not to the same group.

Max: So your 1.5% save I would say is more than justified by involved someone like us that can introduce and bring to the table different groups, and sometimes also trying to maximise on the current offer that you might have from the same group.

Prav: So even if you’re mid-deal with a corporate or a buyer, it’s still not too late to engage a professional like yourself.

Max: No, it’s not. Obviously you need to try to find the balance in not to upset the buyer but it’s in your best interest, you need to maximise, it’s your chance, it’s your opportunity, and it’s probably once in a lifetime opportunity and it’s an exciting time to sell your business and you want to make sure that you… Especially if you ended up working with a group, there is not a sentiment in the value that you got, so you need to make sure that you get the right value before you sell, not realising it after by talking to your friends and say actually I could have sold for more or my conditions could have been better. So you have to explore all avenues and make sure you get a good deal in terms of value and in terms of terms.

Prav: What’s the right… one of the conversations I have with a lot of practise owners is well, when is the right time to sell? Can you time the market when a corporate is about to exit so you can get a higher multiple value at that point? Is there a right time to sell? Are we at a point where the EBITDAR multiple is at such a peak at the moment, now is a good time to be having these conversations, and if we left it a few years that may drop? Is there any insight you can give us on that?

Max: The right time is always when it’s right for you as a seller. And it’s always about approaching a buyer at the right stage of the cycle. You will have groups, if you’re talking about corporates right now, you will have groups that we go through different cycles in their acquisition strategy. So at the beginning of their acquisition strategy after the initial investment, they want to go in a very aggressive way, so their multiple there might be quite competitive compared to other groups.

Max: Equally, towards the end of the cycle when they have an offer from a private equity or a different groups or a bigger group perhaps, then they will be thinking if they buy a practise or they buy 100 grand of EBITDAR at seven times, for example, immediately this will add 10 times value to their existing group.

Max: So the end of the cycle and the beginning of the cycle for a group is always when you want to approach them. Sometimes, like we did in one of our biggest deal, is also for groups they are potentially kind of a midlife in the cycle, but they are behind on their acquisition strategy, so they really want to push up their acquisitions by making one group purchase or buying several practises and just boost the pipeline and it’s just about always being in touch with groups and understanding where they are at the moment, so there’s no point approaching someone for example now, like Bupa for example they exited the market.

Max: And I have to say, nobody never ever exit the market. If the right opportunity comes to the table they might consider it but they’re not actively as they were two years ago or a year and a half ago. So you always have to try to approach everyone with a specific emphasis on who is more active and where they are in their cycle.

Prav: Do you have insight into where various corporates are in their… Like, as a practise owner, I’d have no idea where a corporate is in its cycle, so to speak. How did you find this information out? Is that something you’ve got insight to for any of the corporates, or…

Max: Yeah, we do have. My partners are incredibly experienced in the world of private equity and they have lots of connections so they know what’s happening and they can refer back to me. So we at Pluto Partners, this is for partners, essentially. I’m representing 25% of the partnership and I’m kind of the face of the business and I’m also going out and about, but we’ve got obviously as I mentioned the dentist, who’s the clinical advisor. The other two partners, they’ve got incredible experience and transactional knowledge so they know exactly what’s going on in the private equity world. So we do know there’s going to be some changes in groups coming very, very soon in this year, and there are talks about what’s happening also in 2022, which are groups that are preparing to serve, therefore they would boost their acquisitions campaign in order to prepare for a 2022 exit, providing no big changes are taking place.

Max: If you look at COVID, most groups will discount this as exceptional, so almost not even considering, like nothing ever happened really, because in the life cycle of a group or a private equity, six months or a year is nothing compared to 10 or 15 years kind of disruption. So this is what is happening, and again it’s what is driving valuations at the moment.

Max: So we see figures up to February, March 2020, and then we work backwards and I ask you also for the last three years of the account. Of course, we want to see what’s happening since the reopening. The situation is creating winners and losers. Typically there are now businesses who are picking up new patients from other businesses in dentistry and in other businesses, they are potentially partially opened.

Max: We see most of our clients in private practises especially, the revenue’s increased since reopening back in June and July and most of them, actually. And I feel that the new patients potentially will stay with the new practise, because they’re going to show a degree of loyalty that perhaps it wasn’t shown by their existing practise. Not to their fault, because they might not be able to operate in full so they are partially open. So this is what we see happening.

Payman Langroud…: COVID seems to have accelerated a few things, online shopping or whatever, but definitely that one. There was a bunch of people who were on the brink of becoming private patients or had enough money to be private patients, but were still being seen at their NHS place. Then when they couldn’t be seen there anymore, looks like that’s helped the private sector quite a lot. What are your predictions going forward? What do you think will happen with prices, maybe we’ll get you back in a year’s time and see if your predictions come true. What’s your prediction on prices, on multiples, on corporates, give me some of your… if you had to make a bet, what would you say?

Max: I think prices will stay the same and slightly improve, depending on a couple of groups exit multiple they will achieve. So what we saw in 2015, when Oasis Bupa deal happened, really boost prices for private practises, which at the time the multiple was about 1-1.5 below NHS prices, and after the Oasis Bupa deal private practises were selling on the same level of NHS practises, and this has kind of stabilised that.

Max: If we see large groups selling for multiples below 10, then of course that could potentially negatively impact valuations of single size, because as a single site, how can you ask a higher multiple than a group? Potentially there would be an argument from the buyers. I don’t think it’s going to be the case anyway, I think the groups will always sell for double digit and more in terms of multiple, I think we will see a couple of deals happening this year. I think one is going to be… it’s not too far from happening. I think we’re a few weeks away, which is going to change slightly the way the practises will be purchased and the multiple paid. I feel prices will stay the same and slightly increase during this year.

Payman Langroud…: Can you expand on that one or not? You’re not in a position to delve into that?

Max: The point I would like to make perhaps there is that another factor driving prices is demand. Demand is still there, and then of course if there is demand, which is still outstripping supply, it’s another factor that can also drive prices.

Payman Langroud…: Yeah no, but this deal you were talking about, can you talk anymore about that deal or no?

Max: We can talk about it next year. I don’t want to get in trouble.

Payman Langroud…: No, fair enough.

Max: I think it’s very confidential.

Payman Langroud…: Your business is all about confidentiality, there’s no problem with that at all.

Max: Absolutely.

Payman Langroud…: So the thing that we’ve been talking a lot about is on the selling side, but it’s interesting, your business, you’ve got these two totally different types of people that you talk to, right? You’ve got the young guy who’s just getting in and then you’ve got potentially the older guy who’s just getting out. But what I’m quite interested in is you know cats who are different to that model, people who I don’t know, you must have stories, people who buy a practise, sell it two years later at a profit or a loss, have you got any of those stories?

Max: I do, I have plenty of stories.

Payman Langroud…: Are any of those sellers flippers of dental practises? Do they exist? That that’s what they’re up to, they buy and sell.

Prav: Like houses?

Payman Langroud…: Like houses, whatever. Like shares.

Max: Yeah, there are, obviously. It takes time to improve on a business and I also have clients who buy a practise who think that just because they’re friends of a practise and maybe there is not that passion, and also it’s a profitable practise, completely change their life and pretty much ruined their relationship as well. So they come to me six months later saying, “I want to sell it, it’s a great practise, but I don’t want a divorce from my wife or my husband.” So you have to sell it sometimes to save your relationship.

Payman Langroud…: Wow. What about groups, like how fast have you seen people grow their groups? What kind of stories have you got there? I mean, I remember a guy in Nottingham, I don’t know if you guys have come across him, Dr. Sheikh. Do you ever come across this guy?

Max: Yeah.

Payman Langroud…: Fantastic guy. He had one practise, Prav, I don’t know, have you come across him, Prav? He had one practise, it was the size of Sainsbury’s, it was a gigantic place. Everyone in Nottingham will know this place. Is he still around? Has he sold his group? What’s he done? Do you know him? Are there others like him?

Max: I lost contact, but a couple of years ago I remember he was still around.

Payman Langroud…: So other groups, tell me about other groups, people who have grown groups and sold them to corporates. What kind of deals have you seen?

Max: I think what I see in the successful groups are the groups that put an emphasis, never on the profit, they’re groups that actually put an emphasis on the dentist first, then the patients, then the profit come after. We saw that when we were with ADP and I thought we were obviously buying for profit, but they were always treating the dentist fairly because there is nothing worse than going to a group, to a practise of a corporate, and then you’re always seen by a different dentist. You want some more consistency. Ultimately we also create underperformance.

Max: So the group that are more successful are the one that treat the dentist well and they don’t put a focus and an emphasis on just the profit and the cost savings, because automatically you will have no dentist to perform your business and your profit and practises will just go down.

Max: And as I said before, you make your money when you buy, not when you sell. So there is no point buying for vanity 20 practises and paying a 10 times multiple if you don’t have your exit multiple in mind, and if your exit in mind is only going to be 10, you essentially make less money with the 20 practises in your group than if you just own one practise and you’re running well. So it’s about doing it right. They used to say turnover is vanity and profitability’s sanity. So you’ve got to focus on the profit and you’ve got to focus on where you pay when you buy your practise, in terms of the group, and buy at the right price, really. Because then you will happy to exit and make some money.

Payman Langroud…: What are the most common mistakes people make when selling or when buying? What are the things you wish people knew? I mean that one that you just mentioned.

Max: The most common mistakes when selling is just accepting the first offer and just go for it without negotiating, without involving other groups and other buyers, because you might think you don’t want to upset this buyer because you might think it’s a good offer, but as I say you’ve got one chance, you want to make sure that you do it right. So you just involve… You can still do that confidentially, which we do sometimes, because we’ve got enough connections and buyers to bring to the table just to do an off the market conversation if that is the wish of our clients.

Max: But you need to involve six or seven good buyers because obviously you’ve got a price that is driven by your financial figures, and then you’ve got a price that is driven by what buyers are prepared to pay. And that you will never know that if you don’t involve more than one buyer. So that is the biggest mistake from a seller’s perspective.

Max: From the buyer’s perspective, it’s just buying on emotion and just overpaying for a business that you might end up working for free for the next seven to eight years, and then you just end up selling on a loss. So it’s about finding the right balance, really. And a good deal is always on a win-win basis. You want to maximise the price on the sellers and you want to make sure that the buyers are paying the right price, which is sometimes over the asking price, more often than not it is over the asking price, but not crazily especially as an independent buyer, which you will never recover the money that you would pay. So the biggest mistake for buyers is overpaying.

Payman Langroud…: You’ve been in the UK for the last, what, 14 years did you say?

Max: Yeah. I arrive on the 5th of November, 2005, sense the fireworks that you Brits are doing every year, thank you.

Payman Langroud…: What are the things you miss most about Italy when you’re here? I think I can guess, and what about the other way around, what do you miss about the UK when you’re there?

Max: That’s true, you know what, that is absolutely true. The thing I miss about Italy is something called [Italian 01:01:36], which is you go out for a walk and it doesn’t really matter about the destination, you just go for a walk and you meet someone and you say to them, “Let’s go for a [Italian 01:01:48],” which just means go for a walk and you just relax and you have a nice walk in the summer. That is what I miss because if I go out where I live, I’m likely to meet a fox or a deer but I don’t really see many people.

Payman Langroud…: Are you in Kent?

Max: Yeah, I’m in the countryside of Kent, but if you see someone outside university they come for a walk with me, they’re probably thinking this guy’s crazy. That is kind of what I miss. When I’m Italy, after a few days I miss the buzz and the things happening much faster and quicker than in Italy, in England. So I miss the things that they happen much quicker, which is why I love being here. I love being here because you can make a career if you are good at something. If you are good enough you don’t stay behind, you can make a career out of something.

Max: In Italy it’s more about who you know and it would take a long time and you might never get there. So I like the fact that in England, if you’re good and you work, you can be and do anything. So that’s what I love about it, that’s what I love about my adopted country.

Payman Langroud…: You’re saying it’s more of a meritocracy, it’s less about who you know and more about what you know.

Max: That’s correct.

Payman Langroud…: Yeah. I can see that happening in Italy as well. Coming from where I come from there’s a lot of that about, there’s a lot of that. Of course by the way, who you know is very important here too isn’t it? We mustn’t paper over that issue.

Max: Yeah. You can’t just rely on that, you have to work, and if you’re good you will succeed, ultimately. However, you’ve got to work for it. In Italy, you can see sometimes in positions of power not necessarily people who deserve to be there. That’s because it’s just about who you know, it can’t just be about that otherwise there’s never a progression into something good, really.

Payman Langroud…: How did you feel about Brexit when it was all going down? I know it all got superseded with COVID, but in that period how were you feeling about it?

Max: I never really got the point that people were talking about racism or anything like that. The only thing is that I hope that it won’t change for people like me who are able to come and have, I like to say, kind of a successful career and life and establish myself in England. I hope that people will have the same opportunities that I had in the future. So that’s the thing I really hope. In terms of [crosstalk]

Payman Langroud…: Italians won’t, will they? If I’m an Italian who wants to come to the UK now, I’ve got the same chance as someone from Nigeria who wants to come to the UK now. So that has changed, hasn’t it?

Max: It is, yeah. So hopefully it won’t deter people coming because there are many opportunities in this country that might not be in other countries, if you like this sort of lifestyle. So I hope in the future it won’t change too much. I know it’s changed a little bit. So we’d like to just wait and see, really. So that’s my only thing, really. And in terms of being your master of your own destiny and things like that and the £350 million on the NHS. They’re all promises. I don’t really want to go into politics too much, I just hope that people will have the same opportunity that I had in the future because we all deserve it really. If you want to go for it, I don’t see why we need to have an opportunity as you want to have.

Payman Langroud…: You think you’re going to carry on… I mean, I’m sure you are for the meantime you’re going to do this, but do you think you’re going to make a move back into corporate dentistry at any point? Are you going to be with a friendly Russian billionaire opening your own corporate chain? You’re perfectly positioned for that.

Max: Do you know over the last couple of years, I had several offers working and going back in those M&A acquisitions at director level or partners level. I have a massive degree of loyalty and respect and trust to my partners. I want Pluto Partner to succeed. I know we will, I know we are bringing competition into the marketplace, which is a great thing, because competition makes people less complacent, less lazy, and that’s what we like to do. I want, and I will, make Pluto Partners a success and that’s my only focus right now.

Payman Langroud…: Yeah. But will Pluto Partners itself change other than practise broking? Do you think going forward you guys are going to do other activities?

Max: Yeah, that is the plan, that is the long-term plan. So if you just think about Pluto, instead of being a planet or a rock, think about Pluto as the sun with other services orbiting around Pluto Partners. So we have in the pipeline in 2021 and 2022, kind of a subsidiary businesses coming at the back of Pluto Partners all linked and related to not just dentistry but healthcare. So we are in the process of expanding, so we grew year on year since we started two and a half years ago, we have our pipeline now is stronger than ever, and I’m very pleased and grateful for this, and we’re just growing by adding additional services to dentistry first, and then to healthcare after, because my experience again is not just dentistry but it’s also in a GP practises. Nick Rolph has experience in pharmacies and vet.

Max: So at the moment, we are taking our experience to provide a different service to dentistry but we then want to then expand and going back to other healthcare services, so that’s the plan going forward.

Payman Langroud…: Sounds great, man, sounds great. If I sell my-

Max: [crosstalk] that’s the main thing really.

Payman Langroud…: If I sell my practise and get £2 million for it, whatever, would you guys help me invest my money as well? Have you got that side of it? The well management side?

Max: We do, one of our partner, one of the four, [inaudible] company providing a wealth management service, he’s got lots of dentists in it, so that’s something that we provide, wealth management advising on freehold, commercial freeholds, [inaudible] disposal and accountancy part of it, tax services. Yeah, we do, we can help. Not me personally, but we’ve got experts that can help on how to best invest and spend the money.

Payman Langroud…: So I don’t know if you’ve listened to this podcast before but Prav likes to end it with his final question.

Prav: So Max, it’s been great speaking and I know from personally having conversations with you that business aside, family and health are incredibly important to you and I see that on your social posts as well as the conversations we’ve had. So I’ve got a final question I usually ask at the end of the podcast, a couple of questions, then I’ve got a new question for 2021 as well. So you’ll be the first one we’re testing this out on Max. So first question comes back to imagine it’s your last day on the planet and you’ve got your loved ones around you, and you need to leave them with three pieces of advice. What would those pieces of advice be? Secondly, the second question is how would you like to be remembered, and then the third question I’m going to let you know after you’ve answered those first two.

Max: Okay. Travel the world, live your life with passion, and eat good food in good company.

Prav: Beautiful. So all that revolves around enjoying your life. Me and Payman had a discussion about this yesterday, didn’t we? If someone was to summarise your legacy, how would you like to be remembered Max?

Max: Something like what would be written on… oh, he was something like… Max was, something like that

Prav: Max was, yeah, Max was… Finish the sentence.

Max: Max was only 100 years old.

Prav: Awesome. And then my final question-

Max: Okay, very important to me Prav, Max a good father. So that would be the best achievement, really.

Prav: Yeah. And listen, I kind of know that from the conversations we’ve had and the passion and everything, it all revolves around family. So my final, final question is this. You’ve got 12 months left on this planet, you know that, it’s a fact, yeah? How’s your life going to change over the next 12 months, what are you going to do?

Max: I actually continue to do what I’m doing because a couple of days ago it was my birthday and I started the day and I had a day and I absolutely did, it was a special day, but you know what? It was like the day before and the day after. So I had my kids come in and nagging me, I had my wife next to me, which I love and adore. I have everything I need and I’m doing something I really love doing, I found my passion and I kind of developed it. So I carry on doing what I’m doing.

Payman Langroud…: What if you only had 12 days left, would you go to work for those 12 days?

Max: Yeah. And I probably ran more than anything, maybe do more stuff with my family really. In terms of work, I don’t kind of-

Payman Langroud…: What about 12 hours, if I said to you you’ve got 12 hours left, would you go to work for nine of those?

Prav: I know what Payman would do. I’m going to take that secret to my grave.

Payman Langroud…: This is a new question, I like this new question, but go on, go on. I like what you said.

Max: As long as my kids are with me and we’re doing something together, then it doesn’t really matter. I’d probably go on a cruise ship, actually, I’d go on a cruise.

Payman Langroud…: Oh, that’s nice.

Prav: Nice, nice.

Payman Langroud…: That’s nice. I think we’ve got to work on this question, man, 12 months is a long time. It just feels like a long time. You’ll get that answer from a lot of people, man.

Prav: But I think, you know what, if you were to…

Payman Langroud…: One month, one month.

Max: Here is my answer then. I’d go one month, I take my family, my mum and dad, my kids, my wife, and we go on a world cruise.

Payman Langroud…: Lovely.

Prav: Beautiful.

Payman Langroud…: Lovely, lovely. Prav, we’ve got to close it but Max, this has been just really lovely having you on. Hearing your backstory has been wonderful and then diving heavily into what’s going on right now, you’ve been very open with it so it’s been an education. Thank you so much.

Max: My absolute pleasure. Thank you.

Prav: Thank you Max, thank you.

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: 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.

Prav: And don’t forget out six star rating.

 

 

After graduating in 1994, Sanjay Sethi quickly made a name as a leader in aesthetic dentistry. So, when brother Nik graduating almost two decades later in 2009, expectations were high.

In this week’s episode, Payman gets the brothers together for a frank conversation on their early years; how each followed their own unique career path; the highs and lows of working together, and much more. 

Enjoy!

“I think really we’ve been, on balance, really good because we have our own strengths. And yeah, there’ll always be some differences we’ll have along the way, and I’m not going to deny that. But on par, it’s sorted out on the day and we just move on. We have a laugh. We have a great time together!” – Sanjay Sethi

In This Episode

01.08 – Backstory
07.54 – On excellence
09.54 – Influence and associations
19.02 – Heroes
20.27 – Sharing work
23.55 – Square Mile
25.38 – Expectation, motivation and inspiration
35.51 – Buying in
38.55 – Friends vs colleagues
40.40 – Dark times and COVID
41.20 – Pricing
46.53 – Teaching and lightbulb moments
50.00 – Clinical mistakes
54.30 – New practise
57.44 – On family
58.46 – Digital dentistry
01.06.51 – Predictions
01.17.52 – AEsethiX
01.20.28 – Last days and legacies

About Nik and Sanjay Sethi

Brothers Nik and Sanjay Sethi are co-owners of Square Mile Dentistry in the City of London. 

Sanjay graduated from Guy’s in 1994 and pursues a special interest in aesthetic and restorative dentistry.

Nik graduated in 2009 from King’s College London and is passionate about composite bonding and smile makeovers.

In addition to Square Mile Dentistry, Nik and Sanjay also co-own a practice in Essex and the AEsethiX dental training academy.

 

 

Sanjay Sethi: Knowledge is nothing without application. It doesn’t matter what you’ve learned. You can have all these facts in your head, but if you can’t apply it, whether it be in dentistry in life, life lessons, whatever, it meant nothing, did it? And you don’t want to be sitting there full of regrets. So you’ve got to apply and evolve all the time.

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…: It’s my great pleasure to welcome Sanjay and Nik Sethi, onto the podcast. Some of the brothers in arms, brothers in the industries, there’s a few groups of those. Isn’t there? Good to have you guys.

Nik Sethi: And thanks [crosstalk 00:00:54].

Payman Langroud…: It’s weird Nik because I didn’t know you existed until you became a dentist. I have known Sanjay a long time-

Nik Sethi: He tries to keep me under, [inaudible] secret.

Sanjay Sethi: But at least, I’m not going to hold him back.

Payman Langroud…: What is the age difference between you guys?

Nik Sethi: Do you want to tell him?

Sanjay Sethi: 14 years. I was working out today actually, when I first went to uni back in ’89, he was only three years old.

Nik Sethi: And I remember actually I used to guilt trip him. Because Sanjay is like another father. Growing up, we were all super close to our dad as well. But he being 14 years older, he was like another dad. And it would be a Friday night when he’s 21, he’s getting ready to go clubbing. And Sanjay used to have this really real wild hair. And he must have spent more than an hour with the hairdryer, with the Brew cream, having it all up and ready to go. And then I didn’t want him to go out, so I went to play. And I’ll keep guilt tripping him. He’d leave. And then, because I’d be crying, literally about 10 minutes later, drive back and come in and cancel the night just to… I wouldn’t have done that for anyone when I was 21 going out clubbing.

Payman Langroud…: Was it just the two of you?

Sanjay Sethi: Just the two of us, yeah.

Payman Langroud…: Is your dad or your mom, or your parents involved in dentistry or how did it happen?

Sanjay Sethi: No. No, not at all. My dad’s sister in India, she is a dentist. But that had no influence on me. I think it was just one of those things. When you grew up is the standard Indian profession, isn’t it? You’ve go doctor, dentist, lawyer, accountant, and I wanted to do medicine really, but I just didn’t like the idea of people dying on me. So then I thought the next thing was dentistry and that was literally how I fell into it. So I went and watched people, like my dad had a few friends. I went and watched them and that was how I got into it, but I didn’t know much else.

Payman Langroud…: So a lot has happened. But Sanjay, I remember I came to a lecture once where you were lecturing. I don’t know where it was, man. It might’ve been one of the first FMC events or dentistry show, one of the first ones. And I remember it was the first time where I saw a composite that blew me away by a UK lecturer. I had been in America once, but it just blew me. I think it was a Durafill composite.

Sanjay Sethi: Payman, you’ve got a really good memory. Yeah.

Payman Langroud…: Like a highly polished, invisible, composite and up to that point. I’d never seen that before. And you were very active on the lecture circuit at that time. I mean, you were the composite guy.

Sanjay Sethi: Yeah. I got a name for doing composites in this country. I kind of just fell into it. I was very lucky with how I was brought up and how my career developed and I fell into the composite side of things. I was doing everything, but I was gradually expanding with all other sides. But you get known for doing one thing. I liked teaching composites. I still like teaching composite stuff. I think it’s a great topic. Well you’re passionate about composites, as you know.

Payman Langroud…: Yeah. I’ve gone that way now, but at the time you were the undisputed King. It was ages and ages ago man.

Sanjay Sethi: They gave me up too much now, I just-

Payman Langroud…: It was before Jason was around, it was just a long time ago.

Sanjay Sethi: I’ve got a lot more grey hairs than most, so yeah. It’s funny how your memories will make you seem even better.

Payman Langroud…: How did you fall into it? What was the story with that? Did you go abroad or something?

Sanjay Sethi: I was really lucky. My story started when I finished my VT and I met a guy who said, “Look, come and work with me. I’m in NHS and I’ll teach you how to make money.” So I thought, “It doesn’t sound quite what I want to do, but I want to learn dentistry. This guy seemed to be doing everything.” So I went to go and work with him and he said, “Look, come along. There’s a conference this weekend. We’re going to go clubbing here. We’re going to do this. We’ll go to this conference.” And I just by accident, I said, “Well, I’m going to go.” Because I just fancied going out that weekend. And I had nothing else to do. And we ended up in this place just North of Leicester called Belton Woods. And it was a BAAD Conference, British Academy of Aesthetic Dentistry. And I didn’t know anything about it. It was their secondary year. And I walked in and the first lecture just blew me away.

Sanjay Sethi: And I honestly felt like leaving dentistry because these guys were doing provisionals and I didn’t even know what a provisional was. And I thought, “I’m just qualified. I should know everything.” And I just wanted to do what they did. And I literally started from there. So met some of the guys and they were really good to take me under their wing. I was fortunate to have my dental dad, as I call him Tidu Mankoo. He allowed me to shadow him for a long time and then do his year programme. And he since then has always mentored me. So it’s been great to have him for his support. And then a number of other guys throughout the Academy have just taught me Lambert Fig, Shane Gordon, David Winkler, so many people. And then from there, you branch out. They always have that saying, if you surround yourself with excellence, you adopt that way of thinking and things happen to you. So I fell into that and I just happened to start watching people doing composites like I never thought could be done. And I thought, “Well, I want to do that as well.”

Payman Langroud…: Did you go on courses?

Sanjay Sethi: No, I did loads of… At one point, I think I did every course I could get my hand on. Literally, if I had the time, I’d literally be spending 10s of 10s of thousands-

Payman Langroud…: There weren’t that many courses back then I remember-

Sanjay Sethi: You had to go abroad. Everything was abroad. We’re spoiled now.

Payman Langroud…: Which year did you qualify Sanjay?

Sanjay Sethi: ’93. December ’93.

Payman Langroud…: Yeah, so I qualified ’95. And I remember thinking, “I want to be a cosmetic dentist and go on a course.” And there was only two. There was Howard [inaudible 00:06:40], I don’t know if you remember him. He had this sort of thing where he would test materials out or something. But it was called a cosmetic course. And then it was Larry in New York.

Sanjay Sethi: Yeah. That’s what I was saying. Everything was abroad really. I did most of my stuff abroad because at that time we weren’t as spoiled, those speakers didn’t come over here that often. And so you’d go to them or you’d go to these big conferences. But I think that was part of the journey. Wasn’t it? The fact that you were doing something different, but then trying to apply it back here was hard. You weren’t given that… I was in NHS practise back then, not now. I used to look really young. I barely could get into a bar without showing my ID, let alone trying to sell any high-end treatment to anyone. No one would believe me.

Sanjay Sethi: So I’d try and get jobs in private practises. And no one would employ me. I went to some really good places. And eventually there was this one guy who was holistic, Tom Nyerges, he was in Luton and he took me on to do one and a half days a week. And that’s when I started to get my hands in. And like I said, all the time, I was just getting all this knowledge and just soaking in, soaking in, and I just wanted to do it. So I’d practised in all my NHS practise patients. So my boss hated me because I had no money.

Payman Langroud…: But where do you think it comes from? Both of you have got this excellence idea. Like you want to be the best. And when I’ve even spoken to you on this course of yours, that you guys… We’ll get to it, but this is AEsethiX thing. And I was saying, “Well, how are you making the numbers work and all this?” And you were going “Well, the number’s not really what we’re interested in, we’re interested in the learning for ourselves.” Where do you think that comes from? Is it your dad? Where does it come from? Why do you want to be the best and not the biggest and the richest or whatever it is. Where did the quality thing come from? Both of you have it.

Nik Sethi: We’ve got amazing family of people around us, but I think that actually comes a lot from Sanjay. Naturally, I’ve got a good brain. I’m quite academic. I love reading. But Sanjay’s passion to just be the best he can be, but not just for the sake of being that, to deliver the best for his patients. And he’s one of these people that he may not, and he won’t mind me saying this, he may not get something as quick as maybe I do academically, but no one will work harder than him to then practise, practise, practise, practise. There’s no secret. Whenever people say, “How do you do this? How do you get your composite looking like that? How do you do that? As you know Payman, there’s no secret. You’ve got to follow protocols, meticulously. You’ve got to time things. If you’re told to X something for a certain number of seconds, you get a timer and time it.

Nik Sethi: And this is what Sanjay did. He took every little part of the protocol and just practised it religiously, again and again and again. And he would breathe down my neck when I first tried at Square Mile. And every day I’d have to show him before and after, and he’d have my nurse spying on me to tell him where I was going wrong. And that’s honestly the kick up the butt that I needed. But it’s how he lives. Literally every single day. Just learning, practise, practise, practise, practise.

Payman Langroud…: How much of an influence was Sanjay in becoming a dentist for you Nik? Did you Sanjay, did you actually plot and say, “I’m going to turn him into a dentist.” Or how did it happen?

Sanjay Sethi: I think when he was about 14, 15 years old, he won’t mind me saying it. Man, we didn’t even think this guy was going to get any GCCEs. We were worried, where’s he going to end up? We thought like, “We’re going to start having to look at something to set him up with.” Because we didn’t know what he… He was just wanting to play sports. And he’s always been full of life. And then we were just chatting and I said, “Look, I can’t help you with much in terms of business or whatever, but the only thing that I could give you direction in and give you the head start.”

Sanjay Sethi: Like me and you Payman, we went through the hard way of learning because that was all we had. We didn’t have any other routes really. And at that time, institutionalised academia was not necessarily the way to do the high end dentistry. Not that there’s anything wrong with it. I’ve really learned to appreciate that so much more as the years have gone on. But all I said was, “I think that’s the only thing I can help you with.” And he was literally like a son to me. And he just looked at me, goes, “Yeah, all right then.” And that was it. I don’t think he really knew what he was getting into. Because he goes, “Yeah, all right then.” But then suddenly something clicked in him and he just started getting amazing results and just excelling.

Payman Langroud…: Nik what about from your side. How did that feel? Was that how it went down?

Nik Sethi: He’s absolutely right. When I was, 11, 12, 13, all I wanted to do is play tennis four or five times a week. That was all I wanted to do. I had no interest. Then I had a hip injury and I had to have quite a major hip operation. I was homeschooled for a year, I missed the whole of year nine. And through support of the family, I had a great life. I just got to stay at home, playing PlayStation every day, which was brilliant. But I had an amazing tutor that was given to me by the local council to help me with schoolwork. And he just allowed me to see certain subjects like chemistry, biology, and make it relevant to the competition of having myself when I was playing sport. And suddenly I loved it.

Nik Sethi: So then I just got fully into education, from being literally in the bottom set of everything. Then I ended up being straight A’s GCSE and the same in A-levels. And I just got obsessed with it, but I can’t lie to you and say, “Dentistry was my path.” I was very torn between medicine, dentistry and economics. And I’ll be honest, Sanjay said, “Come and watch me for a day.” And when you’re watching someone spending an hour and a half on a composite and you don’t know anything about it. It’s really boring. I remember thinking, “There’s no way I’m doing this for the rest of my life, man. This is crazy. I should have gone to watch the NHS practise.” But I just thought, “Well, if I did dentistry, if I didn’t like it, it’s a great degree to have. I could then branch out and do something else.”

Nik Sethi: And as I then went through the degree, I started to have a much deeper appreciation with the biology, the chemistry, the actual understanding of the human body. And then once I’ve qualified, similar to Sanjay, I had Sanjay’s influence, which was monumental in my career and still is to this day. But the British Academy of Aesthetic Dentistry, again, Sanjay forced me to come. I didn’t want to go, I didn’t want to go to a conference. And the first lecture I saw, it couldn’t have mapped out my career better. The first two people I saw to back was Didier Dietschi talking about posterior rehabilitations in composite and Kenny Malament talking about posterior rehabilitations in e.max crowns.

Nik Sethi: And I was sitting there watching both of their arguments and thinking, these are both incredible Kenny Malamed talking about the cycles of lithium disilicate at the time, which was pretty nudity e.max at that time. And I thought this is amazing, but very destructive in some of the cases that it has been prescribed for. And then you’ve got Didier Dietschi who was taking a putty essentially in his hands and making a masterpiece. And I remember thinking to myself, “Okay, I appreciate these guys both, but I know where I want to lie on this spectrum.”

Nik Sethi: And it was very much towards the adhesive more minimalistic conservative way. And that, Sanjay’s influence and the people around BAAD just helped me feel protected in this environment of excellence. I was never allowed to learn bad habits. I was very lucky to have people around me. And that’s one of the things that a lot of young dentists miss, I think is that mentorship, that camaraderie that an Academy or having a-

Payman Langroud…: I think BAAD was very influential in my thinking as well. And it’s in a very similar way to what you’re saying, I went very early to a BAAD. And just all the way from the quality of the AV to the quality of the audience, to the quality of the speaker. And you know that feeling that I used to get all the time at dental events was, “Why can’t the coffee be a bit better, man? Why can’t the bloody screen be a bit better, man? And then when the lecturer’s speaking, why can’t they bring up slightly a better lecture?” Everything could have been a bit better. And then I remember going to BAAD and thinking, “Oh, it actually exists here where the quality is higher.” And then when BACD came along, and it was a bit… I don’t know you guys, what your feeling on why that came along and how it felt like BAAD was difficult to get into or something, was that sort of feeling, but it isn’t. But I think that was the feeling. You have to be recommended or something. Was that the thing?

Sanjay Sethi: No, there was a whole… I think that was the thing is, it was difficult to understand and maybe it wasn’t made clear at the time, clear enough. But it felt like people thought we were being maybe a bit too selective. But there was a thing you could come along, you could be invited as a guest. And then if you want to apply to join, you’d have to be sponsored by two people there-

Payman Langroud…: It was just old school golf club way of doing life things.

Sanjay Sethi: It was like that kind of thing. But I think it got a bit maybe misinterpreted and I think BACD did a wonderful job. I think what they did was, they took on everybody and they catered for everybody, which is the hardest thing to do. To make everyone happy in a room is probably the hardest thing to do. And there was some brilliant guys back in the day, what Chris Orr achieved and started from to make it the second or third biggest organisation in the country? It must be, after ADI and BDA must be. I think it’s phenomenal, the job that they’ve done and the guys that are on there, many of them have been my friends from the start and I’ve got many more friends from there. So actually, we’re two different entities. And I think BAAD knows where is that. We’re not looking to take thousands of people, but everyone’s welcome to come. If you want to come to us, some people, they don’t feel it’s for them? And it’s just one of those things. But I think it has its own special place.

Nik Sethi: Over the years, there’s less of that golf club mentality now. It’s got more open door. The energy there is fantastic as with the BACD, both fantastic organisations. And especially it’s been instrumental in my career. And I was a no one when I started, and I was welcomed with open arms. I know many people have benefited. Nowadays, you can’t afford to have that attitude where you’ve got to be selective. Everyone has a right to learn. Everyone has a right to have their journey to become the best. It’s not the Royal family for God’s sake. Everyone has a right to do the same. We’re all doing the same career. We have the same rights. So I think the BACD, BAAD, even the therapist academies, they’re all working towards the same mission of providing that safe network to expand. And like we discussed off air earlier, talking about your errors and failures, which it can be daunting to discuss with your fellow professionals talking about failures.

Payman Langroud…: Yeah. It’s a shame that these things become factional sometimes but from my perspective, Enlighten became very involved with BACD and not so involved with BAAD. Simply because of no follow-up, no one came and said, “Do you want to buy a stand at BAAD, ever. And you know how it is, if someone comes to you and says, “Do you want to buy a stand?” And then follows you up and so on, you end up just going that way. That’s why follow up works so well. But, what’s interesting for me is when we get calls to our office, people say. “I’m just thinking about a composite course. I’m thinking about coming on Depeche’s course, or I’m thinking about this other one.” And almost like, “Sell it to me tell me. Tell me why yours is better than the other one.”

Payman Langroud…: And the way I always say to them is, “Go on both, go on three or four.” The way you guys think about education, I’ve noticed, particularly Nik now, it’s almost like you’re constantly in education. And if I want to be the best composite guy, and let’s just say in my practise, it’s going to take more than coming to one course. I want to be the best composite guy in my postcode area. And then it depends on what you want, man. Some people want to be the best composite guy in the country or the world or whatever. You better go to a few courses, man. You better go to a few courses. Deciding whether to go to PACD or whether to go to BAAD, if you want to go anywhere, do both. It’s the way I would-

Sanjay Sethi: Have you ever watched that series, Heroes?

Payman Langroud…: No.

Sanjay Sethi: There was a guy there who had no powers, but his one power, which he did develop was to absorb other people’s powers. His name was Peter Petrelli. So that’s exactly it. The more courses you go on, the more you absorb and your idea is to absorb all of their superpowers and make it your own. And that’s literally how you can become the best or the best at whatever you do or in your practise or whatever. So it’s going back to that way of thinking. I 100% agree with you. If you just do one course, you’d only have one way of thinking, one way of doing it. And when you’ve got another problem that doesn’t solve that issue, that course didn’t fill you, if didn’t fill your whole world up with how to resolve different problems.

Payman Langroud…: You guys now in the practise, I know Sanjay you’re involved quite a lot with implants as well, do you guys in a sort of organised way, decide, “All right, your implant… So, Nik’s not going to do the implant side and Nik’s going to do the minimally invasive side.” Is that how you actually think about it? Or do you think about it more like you’re going to have to learn it all of you, both of you are going to have to learn it.

Nik Sethi: That’s a really good question. So essentially for the first few years, Sanjay maybe do everything. I have to learn it the way Sanjay understood it. And I had to then obviously bring on what I knew from courses and learning. And I was doing the endos, the perios, I was doing composite, everything that Sanjay sew I did. And then before I started getting into surgery and implants, I suddenly thought to myself, “Well, I’d love to be a partner in Square Mile one day.” I love the practise dearly. It’s been such an instrumental part of my life. I love the team there. I love everything about the practise. And I thought, “Well, if I’m going to be a partner here, it doesn’t make sense to be exactly the same as Sanjay because Sanjay is Sanjay. He’s got his patient base for 20 years and why be exactly the same?” And so we then had a good discussion and I decided, “Well, I’m not going to go down the implants route.” Never say never.

Nik Sethi: But Sanjay, I’ve got a good knack with restorative dentistry. I’d like to think that I can produce nice results now, always learning. But for me to then get to that next level to where Sanjay surgically, that’s a whole another career. And what Sanjay has developed with his handling of soft tissues, it’s not just placing an implant in. His provisionals, he’s handling of soft tissue grafting, it’s such a niche, that I think he’s so good. Why do I want to go down that path? He’s the man. So the idea is now to pull. And recently we have been, Sanjay doesn’t do the endos. He doesn’t do as much of the composite stuff. And refocusing more on the surgery. I take on more of the adhesive ware cases. We’ve got wonderful clinicians in the practise. We’ve got Elaine Mo who comes on and does-

Payman Langroud…: I love, she’s seriously very good.

Nik Sethi: She’s the shining beacon for the next generation. She’s amazing. And her energy. And she does exactly what I do. She treats the practise like her own. She’s the first one in, she’ll stay well late. She’ll help the girls clean up. She-

Payman Langroud…: When we did that hands-on in Square Mile with Depeche, Elaine was on her hands and knees cleaning up, doing my job.

Nik Sethi: She is part of the family, she gets stuck here. So it’s exactly how I always was. So it’s been wonderful. So she does the ortho restorative and the composites, and we’ve got Amit Patel who-

Payman Langroud…: Yeah. Amit’s there.

Nik Sethi: TC’s son. So Amit comes on and does more of the prosthetic work with his university training. And he’s got some fabulous skills. So between us, we’re now differentiating and hopefully going to turn our practise into more of a referral base where we can teach dentists around us to improve their daily dentistry because we’d love to do that. And if there’s certain cases, they feel that they’re not comfortable with, they know that they’ve got us around the corner to be able to then help them and then send the patient back once our GT’s done.

Payman Langroud…: Sanjay, take me back to when you started Square Mile, because back then the idea of a practise in the city was quite innovative thinking in itself, wasn’t it?

Sanjay Sethi: Yeah. You know what it was for me was, I realised that no one’s really going to employ me in a private practise. Like I said, I just looked really young. And the only way that I was going to do it was to get a practise, but I didn’t have the balls back then to just go and buy it on my own. So I bought it with a friend of mine who is in the year below me. Selema Podany, unfortunately she’s now passed away. So it’s really sad. But we bought it together and we took a practise and just did the dentistry that we wanted to do.

Payman Langroud…: It was an existing practise?

Sanjay Sethi: Sorry. It was an existing practise, yes.

Payman Langroud…: Oh, it was. Okay.

Sanjay Sethi: It was a private practise. It had been there for about 12 years, but again, it was like one of those things, whoever had taken over it never developed it. And then I took over it with Selema and few years down the line, then I bought her out and then took it in the direction I wanted to go. I just wanted to keep going in this pathway no matter what. My thing was, it was just a journey. And it was like my excuse to practise the best industry. My philosophy has always been, money can’t buy you contentment, but ultimately we’re health professionals. And so as a health professional, we have a duty of care. I think dentistry can be seen as a business and healthcare, but it’s got to be healthcare first. And so taking all of that side of things, what you realise is when you want to try and do what these guys were doing on the stage, and I was learning from, it’s not easy, it’s really not easy. And that last little bit is painstaking to achieve. And the only way I could do it was if it was in my practise. Now if I was prepared to take a bit of a loss, not great business sense.

Payman Langroud…: We just had Tom Young’s on the podcast. I don’t know if you remember him either of you, but he was one of these young guns who was really into it. And then he’s quit dentistry. And he was saying the idea that the better job you do, the less money you make. Was really annoying to him. And it’s a difficult thing because, let’s say a lawyer the alignment of the patient goal with the dentist goal is the ideal situation. Isn’t it? That you can say, all right, this thing’s going to take me three hours or whatever it is. And I’m going to get paid for my three hours. But we know because we work in that, “20 years. Is this thing I’m going to doing now, when is it going to fail? And what can I do to minimise that and make it a 30 year.” But you can always do a bit more, can’t you? And he was saying that that used to just break him. The idea that that’s the situation

Sanjay Sethi: A 100% agree with them. But every time I go in with that thought, as soon as I’ve got someone in front of me with their mouth open, I just have to deliver. The way I see it is like, if you’re saying-

Nik Sethi: Careful how you say that, buddy.

Sanjay Sethi: I’m not going to rephrase it, but yeah, you get what I really mean. Yeah. But, you just have to deliver. I just always thought of it that if Usain Bolt is expected to run under 10 seconds every time, the 100 metres, that was his standard. And if he ran more than 10 seconds, that was a really poor race. So my idea of not trying to break the world record every time was to try and run that. And yeah, it came at a price, but you do get better. You do get quicker, but you might not be putting Ferrari’s in your front drive. And I totally get that way of working. It’s not for everyone. There’s no one course which fits everyone. And there’s no one way of being a business-minded that fits everyone as well. I’m not saying it’s the wisest thing, but for me, it was just right. I did it-

Payman Langroud…: I feel like we’re really lucky guys here. Because it’s a difficult job. By the way, I don’t practise anymore, so I know what I’m saying. But it’s a difficult job but there’s a bunch of us, or a bunch of you who adore their job, love their job. So what would you say for you, is the thing that you love most? Is it that? The fact that the trust issue… That’s the way it’s coming over Sanjay. This person’s come and he’s trusted you with his health and you take on that responsibility or is it the Meccano side? Some people are really that way involved. They want to put bits together. You implant guys that are a bit like that. Or is it this minimally invasive? For me, when I was a dentist, I used to enjoy just meeting people. That was my favourite thing about it, talking to people and all of that. Well, what is it for you?

Sanjay Sethi: Nik? Do you want to go?

Nik Sethi: I think I know what it is for you mate. Because it’s the love of what you do. Of course, you love meeting people, but Sanjay will go… We’ll have a business meeting, which the aim of it will be to discuss how we did last week and how the practise took last month. And within five minutes, we’re talking about a grafting case. And, “How I manage these like…” “Oh, you should have seen the suturing. It was just amazing. I was so happy how it came down.”

Sanjay Sethi: I sounded really sad though, don’t I?

Nik Sethi: [crosstalk 00:28:57], do it later. I’m like, “Yeah. That’s great. So shall we…” But that’s what he’s always the most to you, I say. Is just-

Sanjay Sethi: Yeah, I just found it addictive. I’ve always found it addictive that if you can achieve something, then you want to try and do better. My thing was when I first qualified and started getting to his courses, these guys at BAAD that were my mentors, my initial mentors. And since then I’ve had many, were all BDS. Hardly any of them had a postgraduate qualification yet they were blowing professors and teachers all over the world, out of the park with some of the dentistry that they were doing. And they were just BDS. So for me, what I learned was if my eyes and hands can do what my head is being told, then I’m on to something and if they can do it and they’re just BDS, well, then any one of us can do it. And that’s the way I’ve always taught it, that there’s nothing to stop anyone from being able to achieve it. But it’s, “Can you achieve it every day, day in, day out?”

Nik Sethi: For m it’s slightly different. I love the dentistry. I love the chemistry behind it. I love the science. I love the adhesions side of it. I love looking at the light curing. So the teaching for me, my future, as much as I love clinical practise, I do believe that my future lies in academia and teaching. And that’s why the education Academy stuff that we’re trying to do is very close to my heart because it’s just what I find lovely. Seeing the light in someone else’s eyes when they’ve understood something that was taught so complex, like occlusion or adhesion, it’s some myth in university. And even to this day, when I do a composite course, the first thing I always get asked is, “How do you get your composite so shiny?”

Nik Sethi: And I say, “Let’s forget all of that. What bond are you using?” Half the room won’t know. “What light cure unit are using? What’s the wavelength? What’s the power? How far away are you from the thing? Answer me these questions first, because these are the building blocks to everything else that you can achieve in the rest of your career.” And so shining the light where I have been so lucky to be taught by incredible people for me, that is so inspiring and I’m always learning from that. So that’s probably what I love the most about my career. Is being involved in that side of things.

Payman Langroud…: Who are the people who really inspired you? Sanjay mentioned to do, and I’m sure there’s others. But who are the people for you Nik?

Sanjay Sethi: Man, there’s so many, UK based, I would say you’ve got fantastic people. You’ve got Gavin [inaudible] doing amazing composite. And actually, I have to say, even though he’s my age, or maybe a year younger, even watching Depeche really, really inspired my love for anterior composites. And that’s what I’m known for doing. And I was really proud of watching Depeche, considering all the lovely things he said about Sanjay in the past and learning from Sanjay, it was really nice to watch Depeche absolutely nail what he does. It was fabulous. And then on the more prosthetic side of things, I suppose I went to watch Mauro Frediani last year in Italy, 12 days, and bear in mind I’m 10 years in. And it made me rip up my rule book for treatment planning totally. Just to see things in a whole different light about how to treatment plan a patient properly from start to finish, how to charge properly for it and believe in that. And also how to meticulously make sure you’re doing what you’re talking every single step of the way-

Payman Langroud…: It’s a 12 day course, is it?

Nik Sethi: The 12 day’s masterclass. So you go there for three months and you do-

Sanjay Sethi: That was three months?

Nik Sethi: Yeah. Three, four days at a time, he was fabulous. But in the UK, again, the A courses have been on Basil Mizrahi for me. He again reminded me a lot of Sanjay. Yes, he’s doing great for himself. And he deserves to, but he really punishes himself on the standards he expects. The temporaries, the finals, and you can tell even when he shows a case, he never shows a case and says, “Isn’t that amazing?” You can tell what he’s looking at. And he’s thinking, “I just wish…” And it’s that. That for me inspires me.

Sanjay Sethi: You never want to see someone break down a case more than Basil Mizrahi, I’ll be really surprised because that guy is phenomenal the way he breaks it down. Even the number of stages he takes to do just one or two things, let alone a rehab.

Payman Langroud…: Yeah. And we’re having him on actually. I’m looking forward to having him on.

Sanjay Sethi: He’s awesome.

Nik Sethi: But it’s not just dentist for me Payman, I have a massive amount when it comes to communication with people and not just patients, but also other dentistry teaching from the trade. So one person for me that deserves a big singling is David Ultram. He was obviously a managing director of Optident. Now a big part of Henry Schein. David Ultram, funny enough, I met him at that first BAAD conference I went to in 2011 and we just started talking at the bar and I had no idea who he was. We just really got on. And a couple of days later, he got my details from Sanjay and we met up for a couple of drinks. And we came up with an idea of this thing called The Diary Of An Aspiring Dentist, whereas where I’d get to write a blog or articles for FMC on my experience where I’ve failed, things I’ve learned, because I was never afraid to talk about things I’ve failed.

Nik Sethi: And Sanjay always taught me that, we all mess up. I was going to say the F word there. We all mess up and you learn from it. So we did a series of articles on my experiences. And David gave me my first chance to give a composite lecture, which was horrible. Back in 2013, I tried to teach about 10 days worth in one day. And I look back at the lecture slides and they were awful, but you learn. But also how to talk to people, how to manage difficult conversations. I watched him when I’d help out on the stand for Optident, I’d watch him talk to dentists. How much is this? Without understanding what a product is. It’s like someone coming to you saying, “How much do you charge for your licence. Without understanding the story or the benefits or what it can do for your practise growth. You get these questions all the time. Learning-

Payman Langroud…: David’s influence on the profession. A lot of people don’t know him because in the trade, we all know him very well. But David’s influence on the profession’s being huge.

Nik Sethi: He’s amazing and he’s taught me a lot about people skills. So I owe him just as much as I owe Sanjay, Bazil and all the other people I mentioned as much credit and people don’t often get to trade enough credit. These are the people that teach us about materials that we use on a day-to-day basis.

Payman Langroud…: Yeah. That’s true. There’s a lot of information even from a salesman, who the receptionist is taught to keep away. Let’s talk pre-COVID when they used to actually visit. The nightmare the salesman has to just get his foot in the door is such a funny thing. Because the amount of information that’s in the salesman’s head about materials, about what’s coming next, about what other people are doing. It’s like free education you can get from a salesman. A lot of dentists spend their whole time keeping salesmen away because they think they’re being sold to. The best salesman, as you said, partners, aren’t they? The way you’ve just mentioned someone in the trade who has a massive influence on you. I like that. So now that you’ve bought in to the practise, how did that change your relationship with the team and with Sanjay? Is it basically that you’re now financially involved and everything stayed the same? Or did you actually make a change? To Sanjay, did you step back on some things and Nik took over or how’s that working out?

Nik Sethi: The buy in hasn’t completed yet for Square Mile as of now. It’s going to be soon. We completed on the [inaudible] one this week, the buy in is almost there. Essentially I, for the last-

Sanjay Sethi: I have stepped back in terms of running things because it’s not my bag. And he’s just literally for the last two years has put so much effort into the practise. So in [crosstalk 00:37:27].

Nik Sethi: I’ve treated it like I’ve been partner for the last few years, I’ve always treated like family. And I can say a lot of the team has been there for many years and they’ve known me since the kids. And it’s been easy in terms of getting them on board because it’s all running in Sanjay’s vision, but just bringing it forward to what I feel the practise could be to be able to be financially more successful, but also be doing more of the cases that we are known for doing and feel that we have the skills to do. And I think the team have bought into that new vision of pushing the practise forward of how special, the work we feel. And I do feel that some of the dentistry that we provide is life-changing. I know it sounds silly to say that, but I do feel that is, I’m very proud of that.

Nik Sethi: The work we put in, the blood, sweat and tears that goes into it, not just the dentist, but the nurses. I mean, Sanjay’s nurse Shaz. She’s like a second mum to me. She’s been there for 18 years. When she nurses with me, I’ll be doing preps on teeth, and I’m really tired and I’m not sure I want to prep the last two. And Shaz would kick me and look at me and say, “Go on. Carry on. We are two hours after the end of the day, she could easily be rolling her eyes. And yet she’s pushing me say, “No, come on. Your brother would finish it. You’re going to finish it.” It’s incredible the people we have around us.

Payman Langroud…: What about the thing, the tension between being the boss and being a friend and all of that?

Sanjay Sethi: I think really we’ve been, on balance, really good because we have our own strengths and yeah, there’ll always be some differences we’ll have along the way, and I’m not going to deny that. But on par, it’s sorted out on the day and we just move on. We have a laugh, we have a great time together. We enjoy each other’s company. He’s a crazy dude. This is my brother is just one Nutter. If you’re with him and it gets to midnight, trust me, his evening is just beginning. I remember once we went out and at the end of the night, I’m thinking, “Listen, it’s two o’clock. I’ve got to get back because I’ve got so much to do tomorrow.”

Sanjay Sethi: And it was like an old boys reunion with like say, Rob Beretti, some of the guys that you all know, we were all together. And he goes, “All right, no worries.” He goes, “Can you order an Uber?” And I’d never even used an Uber App. “I’m used to all this stuff.” He goes, “Don’t worry, I’ll order you something.” So he orders me an Uber. I get into this car. I didn’t know what the hell I’m doing. I’m just sitting there. And next thing I know, we’ve gone around the corner, we’ve picked someone else up. I’m thinking, “What’s going on?” He must’ve gone around East London to all these different estates. I thought I was going to get raped in the back of this car. Some of the people [inaudible 00:40:17]. I got home at six. And I’m phoning him, he left at five and he got home before me.

Nik Sethi: I got him an UberPool. I wanted to save about 10 quid.

Sanjay Sethi: [crosstalk] I don’t let him get me a cab anymore. Forget it.

Payman Langroud…: That’s funny man.

Sanjay Sethi: Yeah. We’ve had some good sometimes.

Payman Langroud…: You’ve had some good times, what about dark times Sanjay? In this evolution, there must’ve been some.

Sanjay Sethi: Oh, with me and Nik?

Payman Langroud…: No. In the practise-

Sanjay Sethi: Yeah. I’ve been really lucky in life that I’ve had fantastic parents. I’ve married my soulmate and she’s been a rock to me. I’ve got wonderful kids, wonderful family, wonderful friends. And so for me, when I look at dark times… I look at all the things that are around me, how dark is it really? And okay, we suffer for three months. We don’t get this. We don’t get that, but I’ve been blessed. So I can’t really complain. And if-

Payman Langroud…: What about COVID? And the fact that you’re in the city, has that been like a challenge?

Sanjay Sethi: It is ghost town around here. Fortunately we’re busy, people are coming in to see us. But it’s ghost town. If you walk around there, it’s airy. It’s picking up now that restaurants and bars are coming.

Payman Langroud…: But patients are still coming?

Sanjay Sethi: Patients are still coming. Yeah. Touch wood. Let’s hope so. [inaudible] right now,

Nik Sethi: It was a difficult year and difficulty for all of the profession, but especially in the run-up to COVID because we didn’t know about a fallow scheme in the beginning. The hardest thing about this all is trying to navigate the questions from the team, because it’s their livelihood. Luckily we’re in a profession where I’d like to think all of us have a little bit of a nest egg, that we have some savings that we can afford a couple of months if shit hits the fan. But a lot of our team aren’t maybe as fortunate. So having to navigate that situation where we were trying to talk about shorter working hours, it was tense times. And luckily with the fallow scheme, a lot of that was helped out.

Nik Sethi: Obviously, all practises didn’t get as much help as would have been nice from the government. But equally, as Sanjay said, it was a rare opportunity for us to look at the business about where we want to come back. And I was sure that I didn’t want to come back and I don’t want to compete with local practises. I don’t want to compete on them for times we take for treatment, for prices we take on treatment. I want to be like what Sanjay said, take the time we want to take, do the treatments you want to do, charge appropriately for that, and you look back and you see, “What patients do we want to treat in the practise? Do we want to see everyone and anyone or do we want to see the patients that value us? And obviously we value them.” So it was a nice time for us to reset and look at what type of practise do we want to be coming back after COVID.

Payman Langroud…: What would you pitch it, as far as the pricing, are we right at the top?

Nik Sethi: No, I don’t think so. We charge on an hourly rate, but I would like to be where, not necessarily top in Harley Street prices, but we’re certainly not cheap. The people could definitely go and get… And I always say to patients, “Don’t feel pressured by this plan. Go and get a second opinion.” Just like what you said Payman about going on different composite courses. I’ve always believed in planting the seed. I feel that we do one of the most comprehensive checkups around with-

Payman Langroud…: I had Coray on and he said he charges 400 pounds for the checkup and it’s a loss leader. He loses money on it.

Nik Sethi: I think we’re 120 and –

Payman Langroud…: It sounds beautiful. It sounds amazing. He really meant it. He really meant it. He was like, the amount of hours he puts in after that examination, that 400 pounds, he’s losing money. And so it’s really interesting because I don’t know, in an NHS situation, whatever, how much is that check up there? I don’t know. I have no idea. And you know, there were different outlooks on these. And then I remember as a dentist, the treatment plan numbers. I remember the first time I heard 20,000 pounds treatment plan. I couldn’t believe it was real.

Payman Langroud…: And then, first time I heard a 60,000 pound treatment plan, couldn’t believe that was real. And it just goes up and up. And it’s a funny thing because if I turned around and said, God forbid, that a family member’s ill, and it’s going to cost 80,000 pounds to get the best doctor to fix this person. A lot of people who even didn’t have the means would find the 80,000 pounds if they thought that that was the real situation. And so it’s funny because people who’ve got a bit of money, then we’ll certainly do it. Understanding that people value what you just said, about people valuing you.

Nik Sethi: Well, our ethos is a little bit different and this is where our associate, [inaudible 00:45:42]. But we have, I would like to thank especially Sanjay the skills to and that the cases to back up big plans, 30, 40, 50,000 pounds that Sanjay skills are incredible. And I’d like to think I’ve got a bit of experience myself, but we’ve always had this ethos that we will talk to a patient, look at what they can afford. And we don’t have to do all of that at once, you don’t have to just jump into a mega plan. We can get a plan that can get them stable for a few years, not kick the can down the road, but if we can improve them and get them stable, then if we plant that seed, when times are right, we can then go back to do a quadrant and then another quadrant. So we’ve never been the practise to turn over 50 grand cases. We’re the practise that will spend 15 years doing that case. I think that’s fair to say, isn’t it Sanjay?

Sanjay Sethi: Yeah. I’ve been there nearly 21 years, this January and that’s right. So you’re staging it, you get there, but it doesn’t sound… Again, I just did it my way. Is it ideal? No. But it’s got everyone buy in, you stabilise control, make sure and they know it’s part of the bigger picture.

Payman Langroud…: Sanjay, tell me about, you’ve been there for 21 years. Tell me about the thing Tiff talks about, about being in the same place for a long time being the best teacher of them all.

Sanjay Sethi: Yeah. I think it’s joy, but it’s also very painful sometimes to see some of your work.

Payman Langroud…: So tell me about that. Let’s talk about, we were asking everyone this question.

Sanjay Sethi: It’s really interesting because what I learned over the years, and that’s why I got involved with the teaching more and more, was the fact that it’s all great when you see these cases that have been done and you’ve got a week postdoc or six month post-op, but really if you’ve invested so much in your dentistry, even if you’ve just done one restoration, don’t you want it to look like that five, 10 years down the line? Ideally we know things are going to tie up, but we want to see can it last that long. And it’s those little nuances, those little things that you learn that can actually make things last, but it’s not every time. And I’d be lying to say that we don’t get failures or based on how you manage you failure.

Payman Langroud…: Can you give me a couple of examples of light bulb moments of something that you thought you did right 15 years ago, and seeing it now you realise that now you would do it differently because of seeing that ageing. Couple of examples.

Sanjay Sethi: My first one would definitely be at the beginning, probably a lot of the guys wouldn’t know this, there was this thing called Open Sandwich Technique with glass ionomers [crosstalk 00:48:21]. And there was some great guys that were advocates of glass ionomer like Jeff Light from Australia back then, but we were all taught, “Glass ionomer, glass ionomer.”

Payman Langroud…: This is a wonder because it realised fluoride, remember?

Sanjay Sethi: Yeah just fluoride everywhere. Well I’ve taken glass ionomer out restorations and there’s been carries underneath. So it’s not completely true. And I’m sure anyone that’s been around long enough would have seen that themselves. But I’ll tell you what, when that starts to go and ware, and you get the hygiene is scraping away at it because it feels rough after about five to seven years, it literally looks like another cavity underneath. See you’re back to where you started almost. Maybe you’ve got something sealed. But that was probably one of my light bulb moments when I thought, “Listen, if you’re going to do it, seal it all in.” I think the other thing was knowing the limits of what you could achieve with the material and then being the superhero idiot that I can be sometimes push those limits all the time.

Sanjay Sethi: And surprisingly, some of it just works like what Nik was saying, you take a case on, and back then we were doing direct… Well I was doing this before he was qualified, direct composite, full on lays and full teeth, almost like crowns in direct composite back in early 2000s and then using materials that getting better and better and better. And then eight to 10 years down the line, they’re still there. They don’t look as well polished, but they’re not really stained. And you’re thinking, “Did I do the wrong thing?” And then you’re seeing other people talk about it now. And maybe we were onto something back then, but I don’t think if I go back, would I want to do it all that way again? No, because I get a lot of backache because of it. It’s hard work.

Payman Langroud…: What about you, Nik? What’s the biggest clinical mistake you’ve ever made?

Nik Sethi: Wow. Many, first of all. And that’s why I always say when I’m teaching, and one of my mentor, Shane Gordon always said to me, “The minute you’re sweating, when you’re treating someone is when you’re out of control.” And believe me, I’ve spent a lot of time sweating in the last 10 years. It’s not necessarily a clinical, I’ve got lots of clinical examples, but one of the most recent ones was actually only about three, four months ago. It was a communication issue, which I took very personally because I’d pride myself from being quite good with my patients communication. And it was one of the times where I took my eye off the ball a bit and paid the price or lost the case.

Nik Sethi: And it was a patient referred to me where I’ve seen the rest of their family. I’ve treated his wife, I’ve treated the son and they all love the work I did. I’ve transformed their smiles, really got them happy with the dentist again when they’ve had terrible experiences. And so I saw this patient who didn’t have much of an aesthetic issue, but post-steria, he was in real trouble. His bite was collapsing, ware, clenching, fracturing everywhere. So his plan was actually a lot more complex and a lot more costly than the rest of his family’s.

Nik Sethi: And normally for every patient with a significant plan over a couple of thousand pounds, I will put together a PDF. I like to do a presentation. I do a zoom call. I put together the photos. I annotate them. I spend a lot of time in my free time doing this because I believe that no patient should start treatment with us until they fully understand what they need done. And with this chap, I was kind of going on holiday that week. And I said, “Okay, I’ll put the plans.” [inaudible] normal plan eight crowns, back, go do this to do that, however, many thousand pounds it was, and I just sent it.

Nik Sethi: And I had a chat with him and it was a really awkward chat because he said, “Oh, how did you just pluck this figure out of thin air? And what this you’re charging me, wants the provisional then charge me again for finals, is it because you like getting paid twice?” And at the time I was angry. I kept it together on the phone, but I was only thinking, “Do you know how much hard work this is going to take?”

Nik Sethi: And it’s only after I calmed down I realised I handled that totally wrong, totally wrong because I broke protocol. I pride myself on planting the seed and having as many interactions with that patient as possible, they call it touch points. Touch points, touch points, touch points, zoom calls, reviews, whatever it needs to be done. Let’s talk plan and see, if they go somewhere else and get it done. That’s fine. But at least they know what they need. And with this chap, I broke protocol. And actually it really ruined my weekend knowing that I didn’t communicate with this person as well as I could have done.

Nik Sethi: And it made me really reaffirm. And to all young dentist up there, I think a lot of the reason why there’s a lot of litigation of profession is communication. Clinical skills are one thing, but having that patient on the side from the beginning, if they know what to expect, they know why, they know the limitations. And they’re much more understanding when things do go a little bit pear-shaped. So that was bad. It really beat me up and I wish I handled that better.

Payman Langroud…: Sanjay, with your reputation, you must get that type of patient that turns up and says, “I know you’re the best.” And it’s always, I hear this a lot from people who’ve got big reputations, is that the patient turns up and starts picking them up. And it’s kind of like alarm bells, have you had many of those?

Sanjay Sethi: Because we’re not trained as psychologists. We’re not trained to spot it. We just want to do the work. We see the case and we literally want to get in there and do what we know we can do. And I think one thing that I’m still not the best at, excuse my French but it’s spotting a nut job. And I’m not the best at it because I just want to do the work and I know what I can achieve. I know what’s possible. And I set realistic aims for it, but sometimes it’s just never enough on a different level. I don’t-

Payman Langroud…: Sometimes the problem is psychological rather than physical if you just thought about it.

Sanjay Sethi: I really don’t spot it. Like he said, I bury myself into clinical and yet I love to communicate with patients. I love to get involved, but that kind of psychology, I just don’t spot it. I just literally just want to get in and do the work. I think I can help, that’s the way I look at it. And then like all of us as professionals, we can all help.

Payman Langroud…: Where’s this new practise you’ve bought?

Nik Sethi: We just bought a practise in Essex in Langdon Hills, which is a native Basildon. We bought that with a good friend of mine, Dev Patel, part of Dental Beauty Group. So looking forward to-

Payman Langroud…: Existing practise?

Nik Sethi: Existing practise, yes. Which is going to be a mixed practise. And our plan is to really bring that kind of Square Mile standard to Essex. I’ve always been asked by my mates, local, “When are you going to get a place in Essex?” And finally I thought, “Okay, this was the opportunity.” And I’ve known for a while now that for any associates out there that think owning a practise is easy, it’s not. Because since I’ve been part of helping out with the operations at Square Mile, and now at Basildon, it is a lot of work. And again, it’s like learning a totally new skill for me there, so I’m very excited about what we can bring to Essex, bringing that patient care. Even for NHS patients, we’ve made a protocol that our new patients are going to get a 45 minute examination, which is unheard of. So that we can explain to them what’s going on in their mouth, educate them, help them rather than patch them up, help them towards kind of a better future. And also-

Payman Langroud…: I didn’t know what you were going to do next year, but if I had to make a bet, I would have thought… Because you guys are real like homey. You were saying you both live one street away from where you grew up in Brentwood or where… Is it Brentwood? Near Brentwood.

Sanjay Sethi: It’s near enough.

Nik Sethi: Yeah. I live one mile from him and we live one mile together from my mum and dad.

Payman Langroud…: So I thought what you would do is go for one of these experiential squat jobs like get a warehouse and turn it into this unbelievable thing.

Nik Sethi: That would be the dream.

Payman Langroud…: Is that in the pipeline? [crosstalk 00:56:18]. A high risk idea.

Sanjay Sethi: We don’t have to blame you Payman.

Nik Sethi: The light bulbs are going. No. But the reason why I teamed up with Dental Beauty is because it allows me to be clinical director, bring in the clinical standards, teach the team, teach the dentists, and learn from them as well.

Payman Langroud…: No, no. Let’s look about my idea again. Let’s talk about-

Nik Sethi: Yeah. I will do it. One day I won’t do that.

Payman Langroud…: You know what I’m saying you’d do? Because Essex, there’s a kind of a can do. It’s what I love most about Essex. It’s like the America of Britain. There’s kind of a can do, is going to happen. Let’s just do it.

Sanjay Sethi: It is [crosstalk] and people want to have good stuff and they’re not [crosstalk 00:57:07].

Payman Langroud…: You want to try new stuff.

Sanjay Sethi: Yeah, they like it.

Payman Langroud…: Everyone’s a bloody property developer builder type. Like if you wanted to make something extraordinary inside this book, I don’t know if you’ve seen Robbie’s place in Liverpool. Like he’s done that. It’s a box. On the outside it’s just a box and then you go inside and it’s like, “Whoa.” [crosstalk 00:57:28]. You should do it man.

Nik Sethi: Great. Next time we meet mate, you’re going to be like-

Sanjay Sethi: Stop giving him ideas. He’s going [inaudible] with ideas. I haven’t got enough time in the day to keep up with him. Please don’t give him anything else right now.

Nik Sethi: I’m so terrible. I like it. One day let’s see what happens.

Payman Langroud…: Tell me about your situation as far as family, kids and all that. Sanjay, you’ve got a couple of kids, have you?

Sanjay Sethi: Yeah. I have. My son has just, unfortunately he didn’t get to celebrate his 18th birthday. That happened last month because it was in lockdown. So I felt really sorry for him, but he’s a really good lad. He’s the Apple of our eye. And then I got my daughter and again-

Payman Langroud…: Are they going to be dentists?

Sanjay Sethi: No. They just look at me and say, “Dad, you work too hard. We don’t want to do that.” He wants to go into economics and finance. I don’t think he knows what’s going to hit him. But that’s [crosstalk 00:58:15]. He’s good at all of that sort of stuff.

Payman Langroud…: And your daughter?

Sanjay Sethi: She’s 12. We still see her as baby. She’s creative. She likes drama and she’s sort of just finding her way. So yeah, she’s still daddy’s girl, which is great.

Payman Langroud…: And what do you do? Do you work five days or less than that?

Sanjay Sethi: I’m four days now. And actually that was Nik. So that’s actually… Nik had a great influence in trying to make my life a bit easier. And then when he sees that I have a gap in something, then he’ll give me something else to do. He’s quite quick to find me something to do, to be honest. But it’s all good. I like the-

Payman Langroud…: Have you gotten on with the whole digital, I’m not talking Instagram, I’m talking digital dentistry scanners? Because I saw that stuff you sent me was with… Was that [inaudible 00:58:58]?

Sanjay Sethi: That probably was done an extra cat by the lab. I’m still learning it. I think I’m still finding my feet with it. I’m getting better and better at doing the actual scanning and procedure. It does take a bit of time to understand it, the limits of where you can push digital dentistry. I’m still not so comfortable. The problem is when you’ve got this old school technique that just works really nicely, it just becomes difficult to switch. And when you do push it and it doesn’t work rather than [crosstalk 00:59:30], “Let’s do it this way.” I just go back and then I have to literally get-

Payman Langroud…: I was exactly the same thing with Nik CEREC, it was in the powder days where it wasn’t very good. But I remember thinking, I’ve got something that I know how to do. It’s fully predictable, an inlay prep or whatever inlay. And then I’m doing it with steric and it’s introduced all this unpredictability into it. And like you said, unless you… There’s a kind of, Andrew Dogwood was calling it the technology chasm. You get into something new and then you think, “Oh, what the hell did I do?” And like you said, you’ve got to go through that. And like you said, it takes energy.

Sanjay Sethi: I’m getting there. I’m always a bit tentative, but I’m doing it more and more. I found that some techniques, interestingly enough, like implant impressions, the technicians with who I work with, I work with some fantastic technicians. They prefer-

Payman Langroud…: Who are they?

Sanjay Sethi: Sorry, who are they? One is called… Well, I’ve got a number of them. Daniele Rondoni I’ve got Eva Force at fusion. There’s Eddie Marker. There’s a number of technicians that I worked with over the years. And I’m sorry if I’ve forgotten anyone else at the moment, but they actually still prefer with certain things like soft tissue work to have it on a stone model rather than doing it from digital and they can manipulate things a bit better. So maybe that’s their understanding. Maybe that’s the way that I’m expecting things of them. I don’t know. So haven’t quite found my feet, but actually to me it’s quite impressive going back to CEREC. I’ve seen patients with CEREC restorations over 20 years old in their mouth. They don’t look pretty. I’ll be honest, but they’re working.

Payman Langroud…: 20 years ago, [inaudible] as well. Nik.

Sanjay Sethi: Yeah. [inaudible] Payman.

Payman Langroud…: I wish. Nik what about you as far as digital? Are you digitally native or you just take too easily.

Nik Sethi: No, I don’t think I am. I’m really enjoying the scanning side of things. I never loved taking impressions, I guess because I knew scanners were already available when I was in-

Payman Langroud…: [crosstalk 01:01:37], guys?

Nik Sethi: Yeah. We’ve got the TRIOS 4 four. And at the new practise we’re going to have the CEREC [inaudible 01:01:45]. So we’re going to have [inaudible] and CEREC going as well. I really love the fact that I have to take impressions. I just think that’s such a patient centred-

Payman Langroud…: It goes way beyond that, doesn’t it? It’s not just about the gap, it’s everything else.

Nik Sethi: Well, actually the communication with the lab is fabulous. I really do enjoy the fact that I can get that digital design. I agree with Sanjay, at some phase that when things are working so well with someone like Eva Force from fusion who is phenomenal. When her wax ups were coming back, stunning, handmade racks ups, you can’t get that on a computer. And if you do get it on the computer, you certainly won’t get it when they print it. So it’s not that same level to that end degree, but it has made communications so much quicker. And even from clinically, the fact that you can just scan and check your clearance. Because one of the things I always make a mistake when you ask me about clinical mistakes, I always used to under-prep the occlusal surface for [inaudible] in the-

Payman Langroud…: That’d be so minimal, right?

Nik Sethi: Yeah, exactly. So I’d always end up having these ultra thin on lays sent back or having reduction [inaudible] that I don’t have to manually correct. Or getting the patient back for an adjustment. So being able to just check your clearance and go again, for me has been a real triumph for me. But I wouldn’t say I’m the quickest at getting adapt to all the new smart design stuff that’s coming out around 10 years in. I’m not old. I am a little bit old school.

Sanjay Sethi: I like waving a wand and then looking at the patient go, “Wow.” And then thinking… This is so great. You’re just literally showing them it. And they’re just literally like putty in your hands when they’ve seen it. When all the other stuff that I did for the years meant nothing to them just by seeing their teeth in a digital format.

Payman Langroud…: I think a mistake some dentist make though on the communication side, you know this thing you were saying about Basil and it’s never right. And all of this, I’ve seen this happen before. Some young dentists and particularly some very good dentists. When they’re looking at the work on the patient, they start talking in that way and for the patient, the patient doesn’t see that as a top dentist being hyper-critical. The patient sees that as, “What did you say is wrong with it?” Between us, we understand. If I’m this hyper-critical [inaudible 01:04:11], “It could be just a little bit better.” We get it right. But when you’re a patient, you put yourself on the patient’s position, but then she’s just looked at it and instead of going, “Wow, it’s amazing. I’m really happy with that.” He’ll go. “Yeah. I’m happy with it. I’ll be even happier if X, Y, or Z.” And the patients then thinking, “Well.”

Sanjay Sethi: Where we qualified back then, if you told patients they needed six crowns, they go, “Yeah. All right, let’s do it.” Now you have to justify everything. Show them, take pictures and everything. It’s all different. Now. Because they don’t trust dentists and doctors like they used to.

Payman Langroud…: Quite rightly. Yeah. The world’s better in that respect. You know one thing that is interesting for me, when we talk about bedside manner, chairside manner, and soft skills and hard skills. And we got to a situation my wife needed an operation and we were trying to choose the right surgeon for the job and crazily bedside manner. The manner of the surgeon was probably the most important thing in deciding which surgeon to go with. And it’s counter-intuitive, because you’re thinking from our perspective, you want the hands and the eyes and the brain. And yet the guy who was most understanding was the one we went with.

Sanjay Sethi: He might have not been the best, or she might not be the best-

Payman Langroud…: Yeah, he might not have been the best. The prickly one might have been the-

Nik Sethi: You reminded me of a great story. Someone we know I won’t mention the name or where they were, someone we know years ago told us of a story where they were doing an endo and the file fractured down a root canal. And they sat the patient up and they said, “You know these files we used, they’re handmade in Switzerland with the highest technology of steel. And they’re designed to be hard as they’re so strong. Your teeth have such an incredible shape on them. Amazingly, that file fractured. And you know what the patient turned around and said?

Payman Langroud…: Separate it.

Nik Sethi: She said, “I’m so sorry that I did that. Do you want me to pay for the file?” Can you imagine now someone like me I’d get slapped around the face. It’s ridiculous.

Payman Langroud…: I have to pay for the endodontist to get the fractured file out. I’ll remember that.

Nik Sethi: We’re not mentioning where they worked, remember.

Payman Langroud…: So we’ll need to get from both of you, a couple of predictions. Predictions, as far as clinically, what’s going to be hot? Where do you see clinical dentistry going? Whichever way you want to say that? Are we talking short-term or go bizarre and tell me what things will be like in 50 years time, if you want. Whatever you like. And number two, as far as the dental world in the UK, what are your predictions going forward? Like let’s not leave that 50 years. Let’s call that, next year.

Nik Sethi: I’ve got a good and bad prediction. A good prediction, I think that we’re not allowed with the whole COVID thing with the whole aerosol risks, I think the quality of adhesive dentistry is going to go through the roof because more dentists than ever now finally have a good excuse to use rubber dam. So I think we’re going to see less composites failing. And when I’ve been teaching recently, a lot more dentists that weren’t using rubber dam recently were over that Hill, as you know Payman, it’s just practise, practise, practise. It’s not rocket science.

Nik Sethi: So forgetting all the digital stuff and all the things that are going to be incredible, I think going back to building blocks, which is what you probably gathered me and Sanjay are all about. I think basics are going to improve. I think finally, we’re going to lose this amalgam mentality of GV black cavity preparations. I think finally people are going to embrace these open infinity margin preparations rounded, composite doesn’t want a margin. I think isolation is going to be a big deal. And when the bonding Asia is getting so versatile with these universal bonding agents, I think we’re going to see these adhesive restorations finally achieving in everyone’s hands what amalgam did over the next few years, which will be amazing. They may not last as long, but they’re certainly much less harmful to the teeth in the longterm. That’s my hope anyway.

Sanjay Sethi: Yeah, I just think that dentistry is becoming faster and faster, more and more efficient. And sometimes maybe we’re forgetting basic principles, especially with things like implant dentistry. Some teeth are being taken out where they could have been saved. And it’s a bit sad to see it because, if you’ve got someone that’s in their 40s and could live into their 90s to a 100s, they could’ve kept teeth for another 15, 20 years, maybe even 30 years. I’ve seen really great perio and teeth lasting. And I just think biology takes time. If you can save teeth first, you can stabilise, then you’ve got a chance to reassess. But people want to go in fast, fast, fast, and see results.

Sanjay Sethi: And I think on the one hand, that’s great business, it’s great money, but it’s almost like the old school ethos. I think that’s where dentistry is changing. It’s become more from my point of view, maybe from what I’m seeing it’s more business orientated and maybe the healthcare side of things, the love, that little part that was actually very important to some of the old school generation is changing or has changed because business, marketing, speed, efficiency, profit timelines, everything has just become more important.

Payman Langroud…: So that’s a bleak future analysis.

Sanjay Sethi: Not really because if you find the right people and there are a lot of good people out there as well. It’s like any profession, there are good accountants, there’s bad accountants. It’s like in any profession, there are a lot of good people out there that have good ethoses and work hard. So I think that’s not bleak. I still think it’s just a case of finding someone that is prepared to take the time. And are you prepared to spend that.

Payman Langroud…: I fully agree with both of you about the basics. Just in a little bit of dentistry that I know something about bleaching all about the basics. Get a good impression, you’d be amazed the number of poor impressions that come in for enlightened. A large number of poor impressions come in. Just that, start with that.

Sanjay Sethi: I was thinking, another 30 seconds of putting the impression-

Payman Langroud…: It makes a massive difference to the results. And then you go to the next bit, understanding the basics is really a key, key, key thing. You’re absolutely, absolutely right both of you. What about for the profession as far as NHS private, what’s going to happen next? What are going to be trends? What’s caught your eye? I’ll tell you what’s caught my eye and it goes opposite to what you guys are saying. This story with digital and the idea that we can take the dentist variable out of the equation and have a system that anyone can use. Like what’s happened with Invisalign and we all know that you still need to know what you’re doing when you’re using Invisalign. But that idea that the system can take over. What’s the name of the… Sorry man. It’s late on a Sunday.

Sanjay Sethi: [crosstalk] diagnosis and all of this sort of thing, everything in digital in that way?

Payman Langroud…: Yeah. For instance, the avant-garde with Robbie. Robbie’s whole idea is that the dentist skills should be minimum and the system should be able to make it so that the dentist skill is minimum in it. And he’s right, if you’re looking for that, it’s the notion that a big Mac is a big Mac in Moscow as it is in Tehran, as long as the formula is the same.

Nik Sethi: It’s really funny you say that. And I can’t tell you where I was or the company that it was for because I have signed an NDA. But I saw this most incredible robotic arm, which is totally pressure sensitive when you’re moving it. And you can push it fast, you can push it slow, and it’s totally adapted to what you’re doing. And it’s like a dead straight surveyor. You imagine prepping with something that is dead, accurate, everything around. And I think just like we have done with the hair transplant industry, these machines that just come in, we all know where this is going.

Payman Langroud…: Touch your hair then Nik.

Nik Sethi: Yeah. Well, you never know. I am feeling a little bit, but I have to say, we know where this is going. What I saw in that robotic arm was incredible. And you think for dentists-

Payman Langroud…: Why should a dentist hold a drill, man? But that’s really one.

Nik Sethi: In one way, I love this whole thing of the geeky science and how things work. But in the other way, I don’t necessarily think… There’s a lot of people out there that think you have to be able to layer in 50 layers. You have to know how to put these translucent bits in with your hand. You have to be able to manipulate composite in a way, and you’re thinking, “Well, if I have something that could do that bit for me but I was still prescribing it and diagnosing it properly and getting a result, I couldn’t achieve freehand. Am I doing anything wrong for the patient? I think we’ve got to drop our egos and accept that things are going to very much change.

Payman Langroud…: Have you seen that DSD thing where they make a prep [inaudible 01:14:00]?

Nik Sethi: Yeah. And the veneers are pre-made. We saw that in Poland. Sanjay and I lectured at the-

Sanjay Sethi: Well, I think what’s possible is incredible. And once it becomes mainstream, you’re absolutely right Payman. If it takes that level of skill as expected out of the dentist away, but then they’re able to achieve the same, actually they’ve done the profession a favour, haven’t they?

Payman Langroud…: But see along the way, there will be pitfalls just like the sandwich technique, the glass ionomer, just like composite, when it first came out, Sanjay, you remember. Posterior composites were a disaster.

Sanjay Sethi: You didn’t use them.

Payman Langroud…: Not when they first came up. But when people first started doing posterior composites, it was disastrous what was beaming. So there will be errors along the way. There will be pitfalls like Smile First, it’s amazing the way that the market’s taken that up.

Nik Sethi: What’s funny is that I-

Sanjay Sethi: It’s the same reason. It’s the same reason that the system can take over where the artistry of the dentist isn’t as important anymore.

Nik Sethi: We both know [inaudible] really well. Actually, I feel sorry for some of the backlash that he was getting on Facebook totally unfair by some prominent minds that I won’t mention.

Payman Langroud…: Did he get backlashed?

Nik Sethi: Yeah. Because they were like, “This is taking the R out of it. You’re layering composite over the two, you’re doing this.” You’re thinking, “Well, people are doing freehand five to five, horrendous, direct composite veneers out there at the moment. But if you can systemize, as they’re getting a beautiful result in a predesigned manner, that’s easy to replicate and less likely to fail then it’s going to help raise the general level of dentistry. There’s always going to be the depression. There’s always going to be the me, the science, think of in the past, we’re always going to want to do things to that next level. But if we, as a collective and systems like Smile First can raise the level of UK dentistry as a general like Bioclear for example, and other companies, I think actually it’s a good thing.

Payman Langroud…: If they can, right? If they can. That’s a key point. You’ve got the long-term implication. This is what I’m trying to say, we don’t know, do we? And by the way, we didn’t know with Enlightened, right we said, we’re going to make bleaching better. That by itself was a big thing to say, but we were going to make it better. We didn’t know long term there was going to be problems or not. We didn’t know for sure. You’re trying your best to do everything right. But it’s funny the tension between progress and doing things exactly the same as they’ve always been done. And I was talking to Tiff about this as well, would he have even bothered doing all the work he did in the current GDC environment? The risks.

Nik Sethi: I was talking to two young dentists I’ve just taken on for basil them. And they’ve missed out a lot because of COVID in a time where it’s so important to have the experience, you just learn your hand skills. And a lot of that’s been robbed from them and it’s scary, they’re scared shitless of what they’ve got to now jump into because now it’s the real world. They haven’t got demonstrators checking what they’re doing. They haven’t got a mentor over their shoulder for every single case. And litigation’s at an all time high. So for the younger generation is very, very scared. And I really do feel for these FD dentists that I’ve been training a lot recently. And this, again, comes right back to where we started this whole thing today about surrounding yourself with an Academy, whatever it may be, Bart, BACD, therapist academies, something that makes you feel safe and a camaraderie to be able to discuss your failures and learn quick. Because if you don’t learn quick and you’re already lacking experience, it’s trouble.

Payman Langroud…: I know you guys are so humble, you’re not even pushing your own boat up, but tell us a bit about this Aesthetic. Do you call it Aesthetics?

Nik Sethi: Aesthetics. That’s all training we do under-

Sanjay Sethi: [crosstalk] say it properly Nik, Aesthetics.

Nik Sethi: Aesthetics. But Sanjay and I, we’ve been doing this for a little while. And as you know, you generously supported us with [inaudible] last year, it was fabulous. We ran 10 days. We became really close with another fabulous clinician, Riaz Yar, who is just one of the most prominent minds in UK dentistry. Just takes understanding to another level. He’s finally made me understand occlusion, and if I can understand occlusion, then we all can. So we’ve teamed up with Riaz to start a company called Elevate Dental and essentially that’s Aesthetics and Riaz together. And we’re going to be doing online education, which we’ve already had recorded. We’re going to update short courses on minimal prep onlay preparations, which I’ve been doing a lot of. And Riaz’s talking about simple occlusal assessment with onlay preparations. Sajay is going to be doing a two day course with Riaz on vertical preparations and occlusion.

Nik Sethi: And then we’re also releasing next year, a two year diploma, which is going to be down South with Dental Beauty Dentists, and then up North, we’re going to be running it in collaboration with a Smile Academy. So there’s some really exciting things going on behind the scenes, that I can’t wait. There’s a lot of hard work, but I’m putting into it with many others. But again, it comes back to what we said that we love being able to inspire the younger generation to be as lucky as I have been to have people like Sanjay around me. And if I can be part of their journey to improve, then I will be over the moon and surrounding ourselves with wonderful people like Sanjay, Riaz, Depeche, Elaine, Amit, yourself. I do think we’ve got some fantastic people in this profession. So I do think despite challenges ahead with good minds together and good opportunities, I think there’s going to be some exciting times for young dentists going forward.

Payman Langroud…: Prav is not here, but I don’t know if you listened to this show Sanjay. Prav, he likes to end it with a particular question and it’s funny we got some feedback on it. Someone said, “I don’t like this question because it mentions death.” But the question is, if you’re on your death bed and you’ve got your family around you, what are three pieces of advice that you’ll leave?

Sanjay Sethi: Nik, you go first. On the death bed? I don’t remember that being a question.

Nik Sethi: On my death bed, that’s really tough. I would say, don’t be afraid of being wrong. I feel like I wasted a few years just following the status quo, doing whatever Sanjay said, whatever [inaudible 01:20:52], and I maybe stifled myself with starting the education company today a bit later than I would have wanted to. Don’t be afraid of being wrong and making new challenges. And if you fail, get up and go again. Knowing your limits clinically. In life, just knowing your limits and being prepared to take on challenges when you’re genuinely ready to. Don’t just do it because you think you can, because you can fail very quickly and very hard.

Payman Langroud…: Those two are in opposition with each other there, isn’t it? Don’t be afraid of being wrong. [crosstalk] I like it.

Nik Sethi: I felt I was ready to start an education company a few years ago, but I stopped because I was worried I was too young and people wouldn’t take it right. Like, “Oh, who are you Nik? You’re only 30 years old.” So I don’t mean it in terms of don’t do stuff. I mean, take on a new challenge when you know you’re ready, but know your limits of what you can do. Like the few speeches you hear from, one out of Denzel Washington have dreams, but make sure you have goals because dreams without goals are just dreams. And I love that saying.

Payman Langroud…: And what’s the third one?

Nik Sethi: Have a laugh all day. Sanjay and I have always done that. We have a few drinks. We have a good time and we know when it’s Friday night, we put everything else aside, just switch off, enjoy with your loved ones. I’ve got a beautiful wife who I cherish more than anything. Beautiful family, love my niece and nephew, just have a blast while you’re doing to, COVID for, everyone’s been a stressful year. But for me, honestly, financially aside, which is a bit crap, I probably had the best year of my life. I learned to cook. We made a stupid song, Raving in Lockdown, which was-

Sanjay Sethi: That was good [crosstalk 01:22:40].

Nik Sethi: We had such a laugh drinking in each other’s gardens and zoom calls. And just spending time at home, spending more time interacting with the parents and stuff. Just put your phones away every once in a while, get digitally disconnected and go back to the roots, get bored. I remember being young and wondering, we had four channels on TV and Sunday used to last forever. I remember sitting there thinking, “Well, when is this day going to end?” Now, I don’t know where the year goes, let alone the day. Unplug make yourself bored every once in a while and enjoy that feeling.

Sanjay Sethi: That was good.

Payman Langroud…: Sanjay?

Sanjay Sethi: All right. So I’d say it’s got to be a little bit dentistry related, but it’s still alive. I’m no Dalai Lama, but I’m just saying in terms of dentistry and profession, I think patience and perseverance. If I could say to anyone who’s young and in dentistry, even at-

Payman Langroud…: In any endeavour.

Sanjay Sethi: Patience and perseverance, take your time and enjoy the ride. I think that’s really important. That’d be my first one. Second one would be hindsight is a really powerful thing and it’s easy when someone says, “What would you go back and change if you were on your death bed?” Well, nothing really. Because that was all part of your learning experience, which puts me down to this one saying that I gave my kids and my son wrote it on his wall. Knowledge is nothing without application. It doesn’t matter what you’ve learned. You can have all these facts in your head, but if you can’t apply it, whether it be in dentistry in life, life lessons, whatever it meant, nothing did it? And you don’t want to be sitting there full of regrets. So you’ve got to apply it and evolve all the time. And third one, I agree with Nik. And again, I say this to the kids all the time, life is all about moments and making them so go out there and go and have them enjoy it.

Payman Langroud…: I like that buddy. And how would you like to be remembered?

Sanjay Sethi: Just a great guy and great friend. I think that was what I’d love to be remembered for. I think that would be the way you want to be in someone’s heart, not just for doing a great composite. What’s that?

Payman Langroud…: Nik?

Sanjay Sethi: Make a difference.

Nik Sethi: I think just a similar of having energy. Have energy, just do things. Whatever your dream may be, I always did things in my life with a lot of energy. So I’d like to just be remembered the guy that had a lot of energy really.

Sanjay Sethi: He’s definitely got that, trust me.

Nik Sethi: The Duracell Bunny.

Payman Langroud…: It’s been lovely having you guys on. Thank you so much, guys.

Nik Sethi: Thanks so much.

Sanjay Sethi: Thanks so much.

Payman Langroud…: Take care.

Nik Sethi: Cheers. Bye-bye.

Payman Langroud…: Bye-bye.

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.

Nik Sethi: Thanks for listening guys. If you’ve 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 had to say and what our guests has had to say, because I’m assuming you’ve 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.

Speaker 2: And don’t forget our six star rating.

 

 

Since launching the show way back in June 2019, we’ve had the privilege of chatting with some of dentistry’s most inspirational figures. 

In this week’s new-of-year special, we look back on some of the best answers to Prav’s final questions on legacy and advice for the next generation.

Kicking off with the legendary, late Anoop Mani we’ll hear words of wisdom from the dental leaders who’ve made the show possible over the past year.

Enjoy!

 

Where were you when Boris cancelled Christmas in 2020? Right here, catching up on dentistry’s finest podcast. 

In this end-of-year special, Prav and Payman take look back on the annus horribilis that was 2020.

But it’s not all doom and gloom, and it isn’t long before our dental royals are round to talking shop, with conversations on management, hiring, firing, working with ninjas and much more. 

Enjoy! 

“I guess that thing our parents told us about people will always need teeth.” – Payman Langroudi

In This Episode

00.34 – Cancelling Christmas
09.32 – Bust and boom
14.23 – Lockdown lessons
18.48 – Family values
24.41 – Ninjas
31.55 – Hiring
45.05 – Firing
52.29 – The third home
54.38 – Shining examples
59.58 – Wrapping up

 

 

Prav Solanki: I truly believe there’s a hybrid future. You ask the question, “Imagine COVID disappear tomorrow. What you going to do? Go back to working full-time in an office?” Not a chance. No way.

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…: 2020. What a crazy year it’s been. Prav and I decided to have a little conversation about 2020, at the very end … This is probably going to go out in the first couple of weeks of January, Prav, right?

Prav Solanki: Yeah, there or thereabouts, or maybe somewhere in between depending on when our team can get this out. But I think-

Payman Langroud…: Yeah. Today is the first Christmas got cancelled. It’s a bit like one of those 9/11, who shot Kennedy, Princess Diana moments. “Where were you when Christmas got cancelled?” Because it’s a shocker, bit of a shocker, I think. I am in London and we just got promoted up to Tier 4 and you guys brought back down, right Prav?

Prav Solanki: We’re 2. I think we’re 2. To be honest, I’m losing track. But the thing is, when it doesn’t have impact on you, doesn’t affect you in the same way as let’s say when we spoke this morning Pay and you said, “What’s happening?” “Family coming round,” etc. etc. We’re fortunate enough to be going on holiday. But imagine being in Tier 4, having booked a family holiday and being told, “It’s cancelled,” right?

Payman Langroud…: Yeah.

Prav Solanki: Imagine the plans you’ve made for your family and getting together. All this time you’ve been waiting in suspense and then all of a sudden it’s cancelled, yeah? Devastating.

Payman Langroud…: It’s one of those moments. We were talking about the silver linings of corona and I’m sure we’ll talk again. But what I was saying to you once was our lives, and our kids lives particularly, very formulaic and very simple, and outside of … If we’re talking about silver linings, outside of getting ill and losing your business, if those two things don’t happen then I was saying to you one of the silver linings of it is to have challenge.

Payman Langroud…: We’ve talked about on the podcast, when you talk to people about, “Why? Why are you the person who achieved this, that and the other?” And people talk about challenge. You always talk about your dad and going off working in the factory and the taxis and the corner shop, “I’m doing this so you guys don’t have to,” and how that stuck with you.

Payman Langroud…: For me, the challenge of COVID … I remember back to the revolution in Iran when we were … I was six years old when it happened. And there were moments in that, there were quickening moments, and for one of them, for instance, was when the lights didn’t go on. A power cut. And it was a proper power cut. The lights just didn’t go on again for a long time. It was a quickening. Up to that moment, we were very much like now, stuck in our houses, there was martial law. They said, “Anyone who leaves the house after 9:00 at night gets shot,” so that was a situation. Yeah?

Prav Solanki: I bet.

Payman Langroud…: Then the quickening of that situation, when suddenly the lights didn’t come on … Now, in corona, what happened today with Boris and Christmas, kind of a quickening moment. But because I’ve lived that revolution I’m okay. What I mean is our kids haven’t had anything like this. And in a way, as long as they’re healthy, in a way it’ll strengthen them. What do you think?

Prav Solanki: I kind of agree. I know you mentioned the challenge, right? But sometimes I look at a challenge as almost like a … In my mind, I look at a challenge as something voluntary, right? Okay.

Payman Langroud…: Mm-hmm (affirmative).

Prav Solanki: And I see this more as a survival game.

Payman Langroud…: Yeah.

Prav Solanki: Do you see what I mean? You’re kind of forced into that situation, and how you respond or how you react to that situation is really important, right? In any aspects of our life, whether it’s life, business, you’re making decisions, right, you are in total control of the outcome simply based on how you respond to that situation. Yeah?

Payman Langroud…: Yeah.

Prav Solanki: And so here, maybe Christmas is cancelled, that’s a survival thing. Maybe being a little bit too dramatic there in that sense. But in the whole situation of what corona’s brought upon us, right, when the initial shock hit us, right? The conversations me and you had about, “Oh my god, business is over. Are we going to diversify? Are we going to do different things? Are we going to look at different business models? What about our team? What about this, what about that?” And we had 101 conversations with each other, right, about the what ifs?

Payman Langroud…: Mm-hmm (affirmative).

Prav Solanki: But ultimately, the way we responded with our teams, our families, our loved ones, once we’d absorbed all that information and said, “Right, okay, this is what I’m going to do,” is what’s paved the way for the outcome of where we are today, right now, what’s happened during lockdown and what the future holds.

Payman Langroud…: Yeah, but we were lucky, Prav. Yeah?

Prav Solanki: Incredibly.

Payman Langroud…: I mean, what I mean by that is it’s easy to survive and thrive when the key things haven’t broken from under you. We’re lucky enough we paid our mortgage, we’re lucky enough we kept our teams. I didn’t have to lose anyone. You didn’t even stop anyone working, did you?

Prav Solanki: No.

Payman Langroud…: You just carried straight on.

Prav Solanki: No, just carried straight on.

Payman Langroud…: But that might not have happened. What I’m saying is, there’s plenty of people out there, people I know, I know people who own nightclubs that are still suffering like hell.

Payman Langroud…: And as a profession, I think we’ve had some disagreements and we’re having some disagreements right now, but as a profession we got to thank our lucky stars for what’s happened. When we were in lockdown, we were having all these conversations with all these people from BAPD and all these profs and so forth.

Payman Langroud…: And a lot of what I thought was going to happen next did happen next. But one thing I got completely wrong, and thank god I did, was that I was seriously worried patients weren’t going to come into dental practises. If you remember, when people were coming onto TV and all that, I was saying, “Don’t mention the virus in the air story,” if you remember. I was [crosstalk 00:07:01].

Prav Solanki: I remember the whole conversation was, “Just keep aerosol out of the mix,” right?

Payman Langroud…: Yeah.

Prav Solanki: Because from my understanding, and having spoken to people like Dominic O’Hooley, who I think educated the entire industry on the science of this whole situation, right? His intellect and his understanding and ability to take complexities and simplify it for the group is phenomenal, and I think as a community we owe Dominic a lot in terms of what he’s given the industry. That in itself I think helped us all just to absorb information at a rate at which we could just make sense of it.

Prav Solanki: But going back to the aerosols, people didn’t know what to say, people didn’t know what to think. And they weren’t making statements based on evidence-based fact, scientific, sound reasoning. So, the moment you mention viral, aerosol, dental practise all in one sentence, patients are like, “That is the last place I want … ” Even though it was probably one of the safest places they could come to, right?

Payman Langroud…: Prav, it didn’t happen. Yeah? It didn’t happen.

Prav Solanki: Yeah, no, it didn’t.

Payman Langroud…: Although some did. If you remember, we did this influencer campaign where we were trying to get the mom influencers into the practises.

Prav Solanki: Yeah, yeah.

Payman Langroud…: And I see those communications coming in on the social media and some of the moms said, “I’m not confident to go to a dental practise yet.” I saw some of those. But overall, I don’t think anyone could complain. Not private practitioners, not NHS practitioners, not mixed practitioners. I mean, some people had a hard time. My wife’s an associate who was earning more than £50,000 and didn’t get a penny over that period, and we were okay.

Payman Langroud…: But I often thought if my wife was a single mom looking after three kids, and she was an associate earning whatever she was earning, 70 grand a year or whatever it was, that family would have been in proper trouble. And there are families like that out there, yeah? In dentistry even, who are in proper trouble. Let alone the country’s on its knees and we’ve done well. We’ve done well. I guess that thing our parents told us about people will always need teeth, yeah?

Prav Solanki: Yeah.

Payman Langroud…: Dentistry definitely is recession-proof to some extent. But one other really lovely thing I’m noticing, Prav, is that we’re getting to have our cake and eat it in so much as when there’s an upturn, cosmetic dentistry flies, when there’s a downturn dentistry doesn’t suffer in the same way as some businesses do. We get the best of the upturn and we’re recession-proof, whereas let’s say a doctor might be recession-proof but he’s not getting the upturn part. Since cosmetic dentistry has become a thing in the last 10 years or so-

Prav Solanki: Just on that note there, I’ve got a couple of theories on that. If we just talk about medicines not getting the upturn, right? I look after a lot of private GPs, and the conversations I’m having with them … Let’s talk business and numbers, right?

Payman Langroud…: Yeah.

Prav Solanki: Conversations I’m having with them is their income’s gone through the roof with patients who want private tests, fit-to-fly certificates. Home visits, they’re charging a premium for that. Patients are willing to pay etc. etc. Right?

Payman Langroud…: Mm-hmm (affirmative).

Prav Solanki: So, they’ve noticed a massive upturn as well. Dentistry may be slightly different because obviously-

Payman Langroud…: It’s on an upturn now. I’m not talking about that, now. Now’s a downturn.

Prav Solanki: We’re seeing an upturn. We’re seeing an upturn.

Payman Langroud…: I know you are but I’m saying as an economy, the economy’s down, yeah?

Prav Solanki: Yeah.

Payman Langroud…: Medicine and dentistry’s been okay. Now, when the economy flies, yeah? When-

Prav Solanki: Cosmetics flies.

Payman Langroud…: Cosmetics flies. So, it’s a nice thing that we can get both the ups and be protected against the downs.

Prav Solanki: Yeah.

Payman Langroud…: And I think it’s because of cosmetics, because of the wants … It’s almost like we can push the wants when people want, and then we can keep the needs when people need.

Prav Solanki: Yeah. One of the things I fear at the moment is what we’re seeing in private practise at the moment is the furlough money.

Payman Langroud…: That’s true.

Prav Solanki: I know, even if I just look at all my team members in my agency, they’re not driving to work. They’re not buying lunch. They went through months and months where they couldn’t spend any of their earnings. And for the first time in their lives, they started accumulating significant savings, right? And it’s the same for a lot of people who were either furloughed or not furloughed but working during this time-

Payman Langroud…: Your team was a hundred percent this period?

Prav Solanki: My team was on a hundred percent. None of them were furloughed, right? But scratch that to one side.

Payman Langroud…: Even if they were-

Prav Solanki: There was no commute, right? Living expenses went down. There were no holidays. Okay? They couldn’t go anywhere and spend their money.

Payman Langroud…: Mortgage holiday.

Prav Solanki: Mortgage holiday. All of that. So, you accumulate this cash, right? Imagine that across the nation. You’re accumulating this money whether you’re working, whether you’re not. Whatever you’re doing. You’ve got this furlough money, so to speak.

Payman Langroud…: Yeah, you’re right, you’re right. There is that.

Prav Solanki: What do they do with that? You’ve got these people who want to feel good about themselves, want to smile, want to be happier. “Invest in your smile. Invest in your teeth.” Then we start seeing dentists’ marketing campaigns rolling out. Okay, this information gets pushed in front of people who’ve got a few extra thousand pounds in their bank account. “Hey, why not spend it on a beautiful smile?” I think we’re seeing a lot of that right now.

Payman Langroud…: Yeah. I mean, Enlighten’s had the best quarter we’ve ever had just now, which I really wouldn’t have predicted, dude, when everything was shut.

Prav Solanki: No.

Payman Langroud…: I would not. I think you’re right, furloughs were part of it. I think the AGP issue helps us because there isn’t AGP during bleaching. Maybe that’s another reason. Who’s to say when that’s going to dry up? I guess they’ve just extended it to end of April.

Prav Solanki: Yeah.

Payman Langroud…: At the end of April, there will be massive job losses if the virus is still around. It feels like it’s still going to be around. The vaccination thing isn’t going to happen properly.

Prav Solanki: Agree. And also, one of the things with the furlough that sometimes we don’t think about, because you just think, “Okay, the government are backing this,” right?

Payman Langroud…: Mm-hmm (affirmative).

Prav Solanki: You still need the cashflow to fund it and pay it, claim it back, pay it, claim it back. Whatever, right? Some businesses can’t survive like that. So, there’ll be some that will bottom out way before April. There’s some that have already have, yeah?

Payman Langroud…: Yeah.

Prav Solanki: Had to make that decision. Because in addition to wages and things like that, obviously, there’s loads of other overheads and stuff. Even in my own business. Come on, we’ve got an office that we’ve probably done six days in.

Payman Langroud…: In total?

Prav Solanki: In total, since Boris announced the first lockdown. Six days-

Payman Langroud…: What are you going to do, Prav, if … Let’s just imagine we can switch off corona tomorrow.

Prav Solanki: Yeah.

Payman Langroud…: What will be the work situation? What are you going to tell your team? Do they have to come in, don’t they? What are you thinking?

Prav Solanki: Listen, if you’d have floated this idea with me pre-corona, yeah?

Payman Langroud…: Yeah.

Prav Solanki: I’d have told you which bus to get off on. Yeah? Seriously, it just would not have happened. Right?

Payman Langroud…: [Sanja’s] the same. My other partner, Sanja.

Prav Solanki: Even if you’d have told me, “Look, let your team work one day, two days a week from home,” yeah?

Payman Langroud…: Yeah, Sanja wouldn’t even give them the morning, not a morning even.

Prav Solanki: Uh-huh (negative). Not a chance mate, right? But we were talking about survival earlier, weren’t we? And we were talking about okay, sometimes situations put … You get put into situations that you’ve got no control over and this is one of them. When I was sat in my office that day, team had gone home, packed the computers up, and I just sat in the middle of the room and just cried for a bit, right? Then thought, “Right, okay. We all start working from home as of tomorrow,” right? Or was it Monday? I can’t remember. And every element of let’s call it the lack of trust … Let’s be upfront, right? Let’s call it lack of trust, call it whatever, of working from home, it disappeared into thin air. We came together as a team, right? And actually, the reverse. I was getting messages at 10:00 at night, 8:00 at night, early in the morning from my team, at times when I didn’t think they’d exist in my business.

Payman Langroud…: What do you do when they’re in the building? How closely are you looking at them anyway? I mean, my point on this is just because the guy’s in the building doesn’t mean his brain’s in the building.

Prav Solanki: Yeah. No, no, no, listen. I’m with you now, right?

Payman Langroud…: Yes.

Prav Solanki: Totally, totally with you. Even when they were in the building, call it old-fashioned mentality, whatever you want, but there’s a certain magic that happens when you’re all together. You cannot take that away. When your team is together versus when they’re remote, there’s a different type of magic that happens.

Payman Langroud…: That’s true, that’s true.

Prav Solanki: I truly believe there’s a hybrid future. You asked the question, “Imagine COVID disappeared tomorrow. What you going to do? Go back to working full-time in an office?” Not a chance. No way. [crosstalk 00:16:42].

Payman Langroud…: That’s for yourself? That’s for yourself, right?

Prav Solanki: No, no, the team as well, mate.

Payman Langroud…: The team as well. So how-

Prav Solanki: The team as well, mate.

Payman Langroud…: How many days a week do you reckon you want them in? Because we’re working, right now, we’re working on one day a week.

Prav Solanki: I would say one to two days a week max, yeah? But I’ve got to decide now, we’ve got an office for what, 15 people, right?

Payman Langroud…: Yeah, what to do with that, right?

Prav Solanki: At the moment, I’m still paying rent. Full whack. Last week, I stopped paying for my car parking space. What an idiot. I’ve been paying for a car parking space since lockdown one, yeah? And only last week I decided, “Well, I better cancel that because it’s doing me no favours whatsoever.” Tried to cancel my super-expensive broadband and all the rest of it, my direct fibre line. They wouldn’t let me do that. But here’s the thing. Do I downsize my office now? Do I double up on equipment because I’ve had to send the team all home with their hardware, software, everything, whatnot? Do I double up on that? Do we just have get-together meetings in a swanky hotel once a month? Right?

Payman Langroud…: Yeah.

Prav Solanki: And treat everyone.

Payman Langroud…: Yeah. That’s what I would do. It’s different for us because we’ve got a lab on site and everything.

Prav Solanki: Yeah, yeah.

Payman Langroud…: But if I were you, I would use a WeWork or something.

Prav Solanki: Yeah.

Payman Langroud…: And you’re right, make it a really funky one, and meet up and eat and-

Prav Solanki: Yeah.

Payman Langroud…: It’s more a culture thing. Now, the question of people knuckling down and helping and all that, I get that completely. Look, I know my people, right? We hired them, we spent all that time together. So, on that trust subject I trust them when they’re at home. What’s your view on a new hire who doesn’t get into the culture?

Prav Solanki: [crosstalk] I’ve hired three people in lockdown.

Payman Langroud…: How have you got them to get into the culture? Is it just like an online culture?

Prav Solanki: Well, prior to lockdown I wouldn’t have said so, right? The culture is the culture, it’s the vibe, it’s the thing you can’t describe, it’s the energy, it’s the camaraderie, it’s the values that you live and breathe. Right?

Payman Langroud…: Yeah.

Prav Solanki: One of the things that we did during lockdown is we started focusing on our own brand values as an agency, where we’ve come from, what’s happened, and we used part of that lockdown to sit down and establish essentially what they were as a team.

Payman Langroud…: What does that mean? It sounds good. What does it mean?

Prav Solanki: I think if you think about what we represent, there’s different ways of looking at it. There’s what we represent as an agency to our clients. Okay? And then there’s what we represent to each other as a team. Okay? We sat down and we figured out and we said to ourselves, “Well, what are our values?” Right? And so we communicate on this tool call Slack and we have Zoom calls every day and we figured out, we said … I’ll run through our values for you because I think that’s going to be the easiest way to answer your question. Right?

Prav Solanki: Value number one. Right? We put family first. Okay? That’s always been my ethos right from the beginning, is the work can go wherever it wants to go but family comes first. But what does that mean in my business, right? That if Joanne’s son is ill and a client needs something doing, I’ll give priority to the first thing. And as a client, you must respect that. Does that make sense?

Payman Langroud…: Yeah.

Prav Solanki: Yeah. Number one, we put family first. Right? We love where we work but family’s where the heart will always be. Okay?

Prav Solanki: Number two. We love what we do. Yeah? Just watch my developers’ eyes light up when they talk code.

Payman Langroud…: Yeah.

Prav Solanki: Watch my designers’ eyes light up when we talk user experience. Yeah? Watch my eyes light up when Bob hands me a strap-line or a piece of copy that is just purely magical flow of words. Right? We really love what we do. Yeah?

Payman Langroud…: Mm-hmm (affirmative).

Prav Solanki: And with that comes our next value, which is we give a shit. Yeah? With love comes care. And there’s not a single piece of work we look at and we say, “There’s no pride behind that.” And there’s been numerous times where a piece of work has been subpar. We’ll over-deliver and lose money on that rather than release something that we’re not happy with. Yeah?

Payman Langroud…: But do you not find what that means is you hire based on talent and then talented people sometimes aren’t organised people, for the sake of the argument?

Prav Solanki: That’s where project managers come into the mix, right? That’s something I’ve learned during lockdown, especially when you need to manage people without presence. Yeah? Numerous Zoom calls a day. I figured out in my team very quickly who are the doers, who can manage, who’s organised, right? For example, there’ll be certain members of the team who can put together some really cool marketing copy. Yeah? Could they organise and structure the entire project for a website? Probably but not as efficiently as Joanne could, who can do it 10 times better than me hands down. Right? And we learned that very quickly during this lockdown. So, yeah, talent supersedes anything else, but where other people have talent, maybe in project management, maybe in video editing, maybe in writing words-

Payman Langroud…: Look, what I mean is, because now I’ve gotten involved in hiring creatives-

Prav Solanki: Yeah.

Payman Langroud…: I always used to outsource that but now I’ve got an in-house team of creatives. And you taught me the process with a creative, to give them a task in the interview.

Prav Solanki: Yeah, yeah.

Payman Langroud…: And give them all the same task and see. So, I’ve done that. Let’s say for a videographer, a designer, whatever, I’ve found the most talented person for the job.

Prav Solanki: Yeah.

Payman Langroud…: Now, sometimes with that talent comes ego. Sometimes with that talent comes working slowly, let’s say. Someone might want to be a Tarantino but I’m asking him to produce 12 movies a day. Yeah? So, it’s really important what you’re saying because you’re saying, “Look, our core values are … ” right?

Prav Solanki: The values are this, right? That number one, let’s say we know our stuff, one of our biggest values is to be constantly improving. We love to learn, improve and teach. So, we all need to pass the baton, we all need to carry on teaching each other, but we need to be profitable. Okay? And that is really, really important. Right? We are running a business. Okay? Everyone needs to understand their measure of profitability. That doesn’t mean I’ve got everyone on an hourly, minute rate, measuring productivity. No, no, no, nothing like that.

Prav Solanki: But imagine if that person is editing a video for a client, and let’s say we charge a couple of hundred quid for that video and it takes my editor six days. You and I both know I’ve lost a lot of money on that video edit. Okay? So, there’s a balance to be struck. That comes with time, mate. You can’t expect someone who’s a solo video editor, or a solo whatever, to understand profitability and talent and how those come together and connect and mix. But it’s my job as a leader to teach them that. Yeah? Then-

Payman Langroud…: You’ve got these practises, yeah?

Prav Solanki: Yeah.

Payman Langroud…: And in some of them, they have a social media ninja type.

Prav Solanki: Yeah.

Payman Langroud…: Let’s take it to that. Firstly, do you reckon that? I guess it comes down to the size of the practise. I’m thinking of your guy at Dental Suite.

Prav Solanki: Yeah, Christian. He’s amazing, right? And so-

Payman Langroud…: I like what he does, like what he does a lot. I mean, what is his role? As a dental practise, let’s say I’m a dentist, and I want a … What’s his role? What do you call him?

Prav Solanki: I’ve had this question numerous times with dentists and the one thing is, “Oh, I haven’t got enough to give a full-time team member the ability to create let’s say social content, edit social content, produce social content.”

Payman Langroud…: Yeah.

Prav Solanki: One of the lessons that I’ve learned from this whole process, anyone you take on like that, for them to get where you think they need to be today, is going to take 12 months. Right? They are not going to step into that role today and be that person that you want them to be today, but they will be in 12 months’ time. Now, as long as you can identify the talent, know that that person’s coachable and receptive to coaching, and responds with change, then you’ll have that person in 12 months’ time. And so what’s that person’s job role, right?

Payman Langroud…: Go through the jobs. Go through the jobs. What does that person do?

Prav Solanki: Okay.

Payman Langroud…: [crosstalk] full-time?

Prav Solanki: Yeah.

Payman Langroud…: Yeah.

Prav Solanki: Full-time social media manager, right? So, what’s that person doing? Number one, coming up with ideas. Storyboards. Creating content. Behind the scenes footage. Photography. Writing posts. Writing blogs. That person will also at some point start answering all your DMs. Okay? Responding to them. Learning how to book them into the practise management system. Following up treatment plans. Okay? So, that entire job of content creation, dealing with the consequences of that content creation, the direct messages, the Facebook adverts, the Instagram adverts and all of that-

Payman Langroud…: Wait a minute. Hold on, hold on, hold on. What are you saying, that person manages the page as well?

Prav Solanki: No. No, no, no, no, no.

Payman Langroud…: No.

Prav Solanki: Definitely not.

Payman Langroud…: But you’re saying manages the response from the page?

Prav Solanki: Manages the response from the page. But how do they do that, right? In my mind, they’ve got to spend time shadowing people in clinic. Yeah? What-

Payman Langroud…: Clinicians?

Prav Solanki: Shadowing clinicians. You may think, “What the hell does a social media manager need to spend time watching an implant surgeon, or watching someone fit brackets on?” Okay? Do you know that micro detail of behind the scenes footage, “What colour are these elastics? How do you tie them round a brace thing? What are the different implant tools?” There’s all these tiny little things, behind the scenes content and these questions they have, when they create this content and understand it, that’s what makes your practise [crosstalk 00:27:48].

Payman Langroud…: Yeah. Me and you both know a couple of ex-nurses who’ve gone this route.

Prav Solanki: Yeah, yeah, yeah.

Payman Langroud…: Yeah. And who’ve been very successful at it. I guess that means they’ve got that existing knowledge of what happens in the clinic already and the vocab of dentist-to-patient and patient-to-dentist. But what would you say to someone who thinks … This is what people say to me. They say, “Oh, I’m going to put so-and-so on it. She’s always on Instagram.” My view on it is just because I like watching movies doesn’t mean I know how to make a movie. Yeah?

Prav Solanki: No.

Payman Langroud…: And so-

Prav Solanki: And here’s the thing, right-

Payman Langroud…: A lot of dentists make that mistake, don’t they?

Prav Solanki: A lot of people. Here’s the thing. That person giving that person the role, doesn’t even know the role. Okay?

Payman Langroud…: Yeah.

Prav Solanki: Number one, easy to get the wool pulled over your eyes. Number two, you actually don’t know what that person’s doing, whether they’re any good, or how to measure them. Okay? So, unless you’ve got that in place … Listen, I’m not saying that person’s going to be lazy. But if you don’t give someone targets and you don’t give someone goals and they don’t know how they’re being measured, how do they get a value of self-worth, right? [crosstalk 00:28:57].

Payman Langroud…: So, then you’re saying the dentist has to have a knowledge of it themselves, the principle?

Prav Solanki: Listen, someone needs to be able to benchmark this individual or this person, right? Or they need to come to you and say, “Look, for your practise, I will do this, this and this.”

Payman Langroud…: “These are the milestones.”

Prav Solanki: “I will deliver this. I will create this many posts today. I’m going to deal with every DM within this period of time.” Right? “I’m going-”

Payman Langroud…: I mean, look, what you’re saying about following up DMs and following up treatment plans, then suddenly the value of the person becomes very obvious, doesn’t it? I mean, before you said that piece I guess people are thinking, and I was thinking, “Well all right, 20 grand a year just to create some content seems quite high.” But as soon as you bring the other side of that into it, of follow-up, probably we’ve had this discussion a million times, the follow-up is the number one biggest flaw or advantage that a practise has. Do you [crosstalk 00:29:54]-

Prav Solanki: And look, let’s think about this patient journey. Yeah?

Payman Langroud…: Yeah.

Prav Solanki: Whatever that person delivers, whatever that person produces, they need to take ownership of it. I’m huge on this, right? I’ll give you a simple example. Let’s imagine you’ve produced a piece of copy for me, right? And that piece of copy is a piece of email marketing. I want you to own that. So, when you write that copy, I want you to know where it’s gone, who it’s gone out to, and how that button was pressed to deliver that, and what was the outcome of that copy that you wrote so you can learn from that, right? What was the result. You take ownership of that.

Prav Solanki: And in the same respect, if you’re a social media content creator, in-house, I truly believe you need to take responsibility for the consequences of that. The DMs, the engagement, the activity that comes off it. Right? But the other thing is if you’re non-dental, someone asks you, “How much is a single-tooth implant? I can go to Turkey.” Yeah? Christian has now got himself in a position where if a patient says, “I can go to Turkey and get that done for five grand,” up his sleeve he’s got a video that he took of the patient who came to us after having their train wreck in Turkey and spending another 20 grand for us to put it right. And this woman is making a plea on this video saying, “Whatever you do, don’t go to Turkey.” Right? And he’s turned patients around just with that piece of [crosstalk 00:31:36].

Payman Langroud…: I bet that works well.

Prav Solanki: Well, mate-

Payman Langroud…: What was he doing before he was doing this job?

Prav Solanki: Social media manager for Derby College.

Payman Langroud…: And where did you find him? Did you put an ad in Indeed or something?

Prav Solanki: Yeah, Indeed. You know very well that I’ve got a pretty slick process when it comes to recruitment.

Payman Langroud…: Yeah, yeah, yeah. Go through that process, buddy, because the times I’ve used your process for hiring it’s just transformed the game for me. Especially if we’re talking in this sort of area, but it could work in any area, right dude?

Prav Solanki: I use it whether I’m looking for a lead ninja, so someone who’s just dealing with leads, whether I’m looking for somebody who’s a copywriter, whether I’m looking-

Payman Langroud…: Go through the process. Go through the process, because it’s an interesting one.

Prav Solanki: Okay. The first thing I want to do is identify the role, right? Who is it that I’m looking for? Then the second thing I want to identify is, well, what are these persons’ values and how can I articulate that these are our values so they align? So, basically so that my advert attracts the people with the right values and repels the others. Right?

Prav Solanki: So, if I give you an idea of mine, it’s that, if I say something like, “We don’t clock watch. We don’t do half measures. And we can all use the mop,” that’s really important. Now, listen, if you need to change a word on someone’s website, and that’s something as simple as using a word processor, my senior of my most senior developers will do that and my most junior of junior team members will do that, and they all feel comfortable doing it. And guess what? So will I. Yeah?

Prav Solanki: We don’t clock watch. Let me tell you something. If our clients need us at 9:00 P.M., not that that’s written in any contract, not that that’s enforced by me, James, Josh, Neil, Joanne, whoever it is, will crack their machine open and jump to the task.

Payman Langroud…: Take care of business.

Prav Solanki: Yeah? And so in the ad we really make it clear. I’ll give you a simple example, right? I am not looking for a 9:00 to 5:00 individual. Yeah? Our customers don’t expect 9:00 to 5:00. We don’t expect 9:00 to 5:00. Yeah? And we’ll say we don’t watch the clock. We absolutely love what we do. I’ll use terminology in my job adverts that speak in an informal way. Yeah? I’ve had people respond to my job adverts saying, “This is the most unprofessional job advert I have ever seen. I would never work for you.” I’m like, “Thank god. That job has done its job for me.” Right? It has repelled [inaudible 00:34:34]-

Payman Langroud…: Has that happened?

Prav Solanki: Yeah, loads of times.

Payman Langroud…: Has it?

Prav Solanki: Yeah. Some people have said it’s arrogant. Call it whatever you want, right? I lay out my set of … “These are the rules that we live and breathe by.” Yeah? “This is the type of individual that I want. And if you want to work with us, and if you want a job with us, the first thing you need to do is write me a cover letter with an interesting opening line. If I read past that, maybe we’ll get somewhere.” Some people might see that as bloody downright arrogant, and other people see it as a challenge they want to jump to. Right? Yeah? Look, let’s go through-

Payman Langroud…: All right, all right. That’s the advert.

Prav Solanki: That’s the advert. So, we go through the advert.

Payman Langroud…: Typically, how many responses are you getting let’s say? Just give us an example.

Prav Solanki: 1,800, right?

Payman Langroud…: 1,800?

Prav Solanki: 1,800. 1,500 to 1,800 responses to a typical ad.

Payman Langroud…: Oh my god.

Prav Solanki: Yeah?

Payman Langroud…: And then?

Prav Solanki: But we filter from there, right? From that 1,800, I guarantee you that the application criteria, we’ll be left with about 150.

Payman Langroud…: Yeah, but who does that? Joanne?

Prav Solanki: Automated, mate.

Payman Langroud…: What do you mean?

Prav Solanki: Automated. Basically, they will have to either respond with a certain headline, fill out an application form where we expect certain things to be ticked off.

Payman Langroud…: So, 90% fail on that?

Prav Solanki: Yeah, 90% fail on that. The other thing we used to have in our application form how far away … This is something that’s changed, right? “How far away from the office do you live door-to-door?” And we give them our postcode. Anything more than 45 minutes, automated, they get eliminated from the procedure, process. Right? Because [crosstalk 00:36:16]-

Payman Langroud…: You’ve automated even that?

Prav Solanki: Even automated that. But listen-

Payman Langroud…: But you’ve changed your position on that now?

Prav Solanki: Changed my position on that now, right?

Payman Langroud…: Yeah, yeah, yeah, yeah.

Prav Solanki: Changed my opinion on that.

Payman Langroud…: All right, all right, all right. So, you’ve literally automated that if such and such a bit isn’t filled out, or if the value of such and such is more than that, or, “Do you smoke?” “Yes,” or whatever it is-

Prav Solanki: Whatever it is.

Payman Langroud…: … [crosstalk] those values, they’re all-

Prav Solanki: Yeah.

Payman Langroud…: And that itself filters out 90% of the process?

Prav Solanki: Filters that out, right?

Payman Langroud…: All right.

Prav Solanki: Based on the automation, right?

Payman Langroud…: Yeah.

Prav Solanki: We then literally send that 100 and 150-odd applications a congratulations message. Yeah?

Payman Langroud…: Yeah.

Prav Solanki: And we say, “Congratulations-” first name, ” … you have made it through to the next round.” Yeah? “Out of 1,800 applicants, you’ve made it down to the last few. In order to get through to the next stage, I need you to do the following.” Right? And we give them a task. Now, the beauty of that is 70% of the people won’t even … They’ll just be turned off. It’s too much work for them. Right? The sort of task I’m setting them should take them anywhere from 45 minutes to an hour. Yeah?

Payman Langroud…: The task is relevant to the role, obviously?

Prav Solanki: Completely relevant to the role. Tests their creativity. [crosstalk 00:37:37].

Payman Langroud…: If it’s a creative role, right?

Prav Solanki: If it’s a creative role. We give them flexibility. Whatever that is, right? Now, one of the things we find during this process is some people will take some initiative and send me a personal message on LinkedIn to stand out from the crowd. Some have sent me direct mail.

Payman Langroud…: Yeah.

Prav Solanki: [crosstalk] pink envelope, which I’ve posted on Facebook before, right?

Payman Langroud…: Yeah.

Prav Solanki: That sort of stuff stands out. That doesn’t guarantee them a job, but it gets them right to the front of the pack, it gets them noticed. So, we go through that process.

Payman Langroud…: Okay, so now you’re down to how many?

Prav Solanki: 15 people.

Payman Langroud…: Based on the task, right?

Prav Solanki: Based on the task. We’re down to 15 people.

Payman Langroud…: Now?

Prav Solanki: Now, based on that task, I will have one of my team review that task, whoever it is on my team. And they will do a quick yes, no filter. Right? We’re now down to half a dozen.

Payman Langroud…: Yeah.

Prav Solanki: Okay? Based on that yes, no filter, if it’s a yes then I will look at the task. Yeah? I’ll look at the information. I’ll liaise with-

Payman Langroud…: That’s the first time you’ve looked at it?

Prav Solanki: That’s the first time I’ve looked at it, yeah.

Payman Langroud…: Oh my goodness.

Prav Solanki: Yeah.

Payman Langroud…: I love that. I love it. Okay, now we’ve got six now you’ve looked at it.

Prav Solanki: Got six.

Payman Langroud…: And you bring it down to two from that?

Prav Solanki: Yeah. I’ll tell you what will usually happen at stage is Zoom interview now, right? It would normally have been an in-person interview.

Payman Langroud…: Yeah.

Prav Solanki: But Zoom interview on that stage. Do you know what it is? I just really want to get to know this person, yeah? Who they are, where they live, what they do outside of work for shits and giggles, right? What makes them flow?

Payman Langroud…: Will they fit in? Will they fit in, right?

Prav Solanki: Will they fit in and will we fit with them? Do our values align? I will ask questions along the lines of, “If I gave you … ” It might be a Thursday the interview, yeah? And I say to them, “Look, on Saturday we’re doing a website launch. It’s at 7:00 P.M. There’s four of us on it. I might need you till 9:00 in the evening. The team are all mucking in. How do you see that fitting in?”

Payman Langroud…: Yeah.

Prav Solanki: Yeah? You can usually, through the whites of their eyes or their response, get a feel for are they clock watchers, are they-

Payman Langroud…: Yeah, but that’s not your only criteria is it though?

Prav Solanki: No, no, no, it’s not my only criteria, but look there’s a-

Payman Langroud…: It’s sounding a bit like that.

Prav Solanki: Well, it’s important. It’s important, right? And the reason for that is this, it’s not that I’m working all the time, but imagine Josh needs a wing man to help him do something, right?

Payman Langroud…: Yeah, I get it, I get it.

Prav Solanki: [inaudible] need to ask.

Payman Langroud…: Okay. You’re down to two.

Prav Solanki: Yeah.

Payman Langroud…: Pre-COVID, you were bringing the two into the office for a day or was it a week?

Prav Solanki: A day or two, right? If we were down to two, what we normally do is we invite them both into the office to spend a day with us. We actually just dish out some work to them, throw them right in at the deep-end, and for one day I give them somewhere between two and a half to three days work to do. Okay? What I want to truly understand is number one, how do they prioritise, yeah?

Payman Langroud…: Are they clock watchers? Number one, two, and three, are they clock watchers? Number four … Yeah, go on.

Prav Solanki: Are they clock watchers? And number five … No, no, no, no, not at all mate. Although it’s sounding like that it’s nothing like that. How do they prioritise, right? They’ve been given a load of tasks to do. How do they work with the team? Do they ask the relevant questions? Do they sit there in silence, rabbit in a headlight? Some of them have just walked out at lunchtime and switched their phone off. Yeah? Literally, took their bag, gone to lunch, switched their phone off, end of mission. Yeah?

Payman Langroud…: We’re back to clock watching again, bud.

Prav Solanki: Yeah.

Payman Langroud…: You’ve got a clock watching problem, man.

Prav Solanki: [inaudible 00:41:46]. But that’s it, right? They’ve gone, they’ve not survived it and there was too much stress for them. But by the end of that we get an idea. Can they produce a piece of decent work? Can they communicate with the team? And at the end of that process, I get all of my team to vote. It’s not up to me at this point who gets the job.

Payman Langroud…: Really?

Prav Solanki: No, no, no, no, no, no.

Payman Langroud…: And you still get it wrong sometimes. That’s the crazy thing about it.

Prav Solanki: They’ve cocked it up so many times.

Payman Langroud…: Yeah.

Prav Solanki: Yeah, yeah. Because look-

Payman Langroud…: You do a version of that for a dental practise as well?

Prav Solanki: Well, we did that with our social media one. I’ve just been through that process with the lead ninja we’ve just hired, Rebecca, who’s really, really good. So, I think despite whatever, however my process is and whatever values you think that seem to sit strongly with me, that you can use the same process, the automation, the filtering, all of that, to make that person jump through the hoops that you think they need to to work for you, right? But you’ve got to live up to their expectations. You can’t just give them this job. I tell you what one of my values is, is that no matter what job you’re working in with me, I want you to spend 70% of your time doing something that you absolutely fricking love, and 30% of the time doing stuff that you just have to because it’s part of the job. Right? Okay. And do you know what? The stuff that I hate doing is someone else’s 70% out there. Yeah? And the 70% that someone else doesn’t like doing is someone else’s 70%. Yeah? That’s the constant thing that as people evolve and say, “Right, okay, well this is getting a little bit mundane for me. Let’s find a junior who would absolutely love doing this.” Right? And that’s-

Payman Langroud…: We’ve talked about this before, Prav, right? The more you hire, the more you need to hire.

Prav Solanki: So true, mate.

Payman Langroud…: It’s such a weird one.

Prav Solanki: Yeah.

Payman Langroud…: You feel like when you hire someone that’s a job taken care of, but as you said, and to me … Let’s say I hire an ad buyer.

Prav Solanki: Yeah.

Payman Langroud…: That ad buyer’s going to now need content, so now I need a video maker. That ad buyer’s now going to need money to buy ads, so now I need to raise more financing. It’s an interesting thing. We’ve digressed from what we were looking at, talking about, but I like that, Prav, I like that. And your process actually definitely does bring some results. Now, tell me about next after that. Let’s look at it from a dentist’s perspective too. You said one year before you know whether that social media ninja really is any good or not or-

Prav Solanki: No, no, no, no, no.

Payman Langroud…: No, you give them a year to immerse, right?

Prav Solanki: In a year’s time, you’re going to be getting incredible value from this individual, right?

Payman Langroud…: Okay. Don’t expect it straight away you’re saying?

Prav Solanki: Don’t think that, “Listen, I’m hiring this guy or girl or whoever it is, and in three months’ time this person is going to be setting my social media world on fire.”

Payman Langroud…: Yeah.

Prav Solanki: Yeah?

Payman Langroud…: But let’s talk about it. Let’s talk about it because we’ve gone through the hiring process of someone new, for me, there’s a definite … I’d give them three months, four months, before I even think about, “Is this person any good or not?” But what about you? Are you paying closer attention than that? I mean-

Prav Solanki: A hundred percent. And look-

Payman Langroud…: You’ve fired people way before that, haven’t you?

Prav Solanki: Yeah, within the week.

Payman Langroud…: Within the week?

Prav Solanki: Within the week.

Payman Langroud…: Have you?

Prav Solanki: Yeah. And look, this-

Payman Langroud…: Go on, go on, tell me about that. What is it about that person that within a week you know?

Prav Solanki: So, you go through this [crosstalk 00:45:42].

Payman Langroud…: It’s the clock watching, isn’t it?

Prav Solanki: It’s not clock watching. Listen-

Payman Langroud…: Because I’ve never, ever, ever done that, ever.

Prav Solanki: Listen, you go through this intense recruitment process, right? And when you’re involved at the level I’m involved and you’ve invested the time, the energy and the emotion into hiring this person, you think they are someone who you think they are. Yeah?

Payman Langroud…: You’ve built them up.

Prav Solanki: Let’s just leave that statement where it is, right?

Payman Langroud…: You’ve built them up to something.

Prav Solanki: You’ve built them up to where … And you think you’ve hired somebody, right?

Payman Langroud…: Yeah.

Prav Solanki: There becomes a moment in time very, very soon after that, when if you’re wrong, yeah, you realise very quickly. Okay? Now, you’ve got a few options. Ride it out for three months, knowing that you’re just going to make the process even more painful for yourself in three months’ time because your gut’s telling you it’s not right. Okay? Or you just grow a pair of balls and get on with it the next day.

Payman Langroud…: Yeah. But, Prav, you’ve had this conversation with numerous dentists, right, including your brother, where some member of staff is wrong for their job and the dentist just can’t bring themselves to get rid of them or to have the conversation or, “What will it do to the team?” or, “Are they following process?” What’s your advice? We’ve all come across that member of staff, right? It’s that grumpy receptionist or whatever it is.

Prav Solanki: It’s really, really easy for me, right? And-

Payman Langroud…: You don’t suffer with this problem [crosstalk 00:47:17].

Prav Solanki: No, I don’t mean it’s easy to get rid of somebody, because no matter how many times you’ve done it, it gives you the sleepless night before, it raises your heart rate. Okay? If you’re a human being, yeah? And if you’re doing it at lunch time, forget about breakfast and forget about any work before then, because your heart’s racing all the way up to there, right? So, it is an awful feeling.

Payman Langroud…: But you get this call all the time, right?

Prav Solanki: I get this call all the time. “How do I break the news?” So to speak. “What do I do?” and all the rest of it. When I said it’s really easy, this is what I mean, is ultimately you’re a leader in your business, you’re responsible for driving that train, steering that ship, call it whatever you want. Okay? And the rest of your crew are singing along at the same pace, doing everything they should be doing in the way they should be doing and not holding back. Right? According to all your values. Let’s say one of them is just totally out of line, yeah? Number one, it’s not fair on the rest of the crew.

Payman Langroud…: Yeah, yeah, yeah. But go on, let’s get down to the nitty gritty.

Prav Solanki: Yeah. And number two, I like to feel comfortable in my own house. Yeah? Imagine walking around your house, imagining not being able to walk around your kitchen with your boxer shorts on. Yeah?

Payman Langroud…: Yeah.

Prav Solanki: Do you understand where I’m coming from? I like to feel comfortable in my own home, right?

Payman Langroud…: Yeah, but you are uncomfortable when someone’s watching the clock or whatever, yeah? Some other people, like me, I start making excuses for the person. I blame myself.

Prav Solanki: Listen, I don’t expect everyone to work … I tell my team, “Right, listen, do one. Yeah? Get gone, get home, get some rest.” Yeah? I’m all for that. And I’m actually all for switching off from work, because having that break makes you bounce back stronger, whether it’s over a weekend, whatever.

Payman Langroud…: Yeah, but okay, let’s get back to this dentist. Let’s get back to this dentist. There’s a receptionist who’s been there, incumbent receptionist, been there for 20 years.

Prav Solanki: Yeah.

Payman Langroud…: We’ve made new plans. We’re trying to increase our implants and Invisalign and whitening or whatever it is. And we’re trying to become a more customer-centric place and this person’s grumpy but she knows a lot of [crosstalk 00:49:46]-

Prav Solanki: Time to get off the ship, mate. Time to get off the ship.

Payman Langroud…: She knows a lot of patients and she’s part of the community. How do you handle it, dude? You don’t just say, “Go.” What do you do?

Prav Solanki: Well, first of all, I’m not a HR professional, right? Okay?

Payman Langroud…: Yeah.

Prav Solanki: The view that I take it from is, “This is the end result that needs to happen, and it needs to happen as quickly as possible.” Now, if it’s a recent hire, it’s far easier. Yeah?

Payman Langroud…: Yeah.

Prav Solanki: If it’s someone who’s been there for 20-plus years, take some legal advice. But you know that that individual is not part of the future makeup of where you want this business to go, and you also know that that individual is going to be a constant hindrance into the direction you want that business to go. Right? So, there’s no question, if you want that-

Payman Langroud…: Tell me, Prav. This has come up for you so many times before. When that individual has gone-

Prav Solanki: Yeah.

Payman Langroud…: … is there a sense of weight off people’s shoulders and-

Prav Solanki: Euphoria mate.

Payman Langroud…: But I’m not just talking about being happy. I’m saying from the practise perspective, can one receptionist really break a practise like that? I mean, I think we all know they can, yeah?

Prav Solanki: Mate, one tiny little bit of cancer spreads like wildfire and can impact the rest of the body. In the same sense, in that business you just need one bad egg to drop the mood and it screws with the whole practise, especially if that person has been there a long time, sits in a position of authority, either in terms of age, number of years served, or position. Yeah? And I’ve seen practises completely transform. Yeah?

Payman Langroud…: Mm-hmm (affirmative).

Prav Solanki: In terms of the motivation of junior team members. I’ve seen it in my own business. I’ve cut cancer out of my own business a few times, right? And having had it left there and rot for two to three years right in the early days. And when I cut it out, that’s when I finally like I could walk around my own business in my boxer shorts, mate. Yeah? When I think about it as a business owner, I want to feel comfortable amongst my team. Yeah? If I want to swear, I want to know I can swear. If I want to be politically incorrect in the way I speak, I want to know that I can be comfortable speaking the way I speak and they can feel comfortable … Do you understand where I’m coming from?

Payman Langroud…: I do. Be careful with that one though.

Prav Solanki: Oh, I know. I know. And listen, I’m not saying I’m walking around being non-PC all the time, right? But the point I’m trying to make-

Payman Langroud…: Okay. No, I do know.

Prav Solanki: … is I want to be comfortable in my own house, in my own business.

Payman Langroud…: It’s interesting, Kunal Patel, who we both know well-

Prav Solanki: Yeah.

Payman Langroud…: … he’s not like … We all run our businesses differently, yeah? So, some of the stuff that you saw to me, if I stood up and said it I would feel a bit cringey saying it. You know what I mean by that?

Prav Solanki: I get it, mate.

Payman Langroud…: But listen, I’m not saying it’s wrong. It’s actually right. What you’re doing is working, it’s correct.

Prav Solanki: Listen, it’s right for me.

Payman Langroud…: It’s right for you?

Prav Solanki: Yeah.

Payman Langroud…: And Kunal does it in a whole different way in his practise. I think we’ve both seen that, right?

Prav Solanki: Yeah.

Payman Langroud…: The one thing he says to his team, which I found a really interesting idea, I really like the idea, is that, “Out there we’ve all got problems, but in here we don’t have problems.” Something like a really interesting idea, that work is the rest from life.

Prav Solanki: Beautiful, isn’t it?

Payman Langroud…: It’s a beautiful idea. It’s what I’ve always wanted Enlighten to be and try and get, “Oh, let’s get a ping pong table and let’s get food delivery and stuff,” and try and be all like a lovely place. But he really put it into these nice words, that you come to work to get away from the hassles of your life.

Prav Solanki: Do you know what that reminds me of? Starbucks’s values.

Payman Langroud…: Is that what [crosstalk 00:53:52]?

Prav Solanki: Yeah? The third home, right? When they created Starbucks, the whole thing was it was the third home. Yeah? The place between work and home that you go to treat yourself, whatever, flip your laptop open, whatever. And it wasn’t really about the coffee, right?

Payman Langroud…: Mm-hmm (affirmative).

Prav Solanki: And I guess the same thing with Kunal is, it’s such a beautiful way of putting it, that, “Here, we’re a family, right? We don’t have problems.” Yeah?

Payman Langroud…: [inaudible 00:54:19].

Prav Solanki: And I know from having numerous conversations with him, and especially Lucy, the way they look after their team with appropriately-named love teeth, it’s with love and care and you see that. It’s very, very much a family-driven ethos and-

Payman Langroud…: What are the best practises that you’ve seen amongst your … Look, we both have a lot of dentist customers. You’re much more intertwined in your clients’ businesses.

Prav Solanki: Yeah.

Payman Langroud…: You visit them all the time. What are some of the other best practises that you’ve seen?

Prav Solanki: Amongst team members, staff and that sort of thing?

Payman Langroud…: Yeah. Culture. Because dentistry has got a real problem, dude. I mean, you’re not a dentist. But one big issue with dentistry is there’s no career pathway for nurses. Like this thing you’re saying about in your business, that if someone … do 70% of the stuff you love and then hand that over to someone else, there-

Prav Solanki: That’s the dream.

Payman Langroud…: I know, but there isn’t that much in nursing or reception. That’s a real problem with the industry, that we can’t get proper career progression for our people in a dental practise. What have you seen out there? Who does it well? I’m thinking of Andy Moore’s practise. That-

Prav Solanki: Listen, Andy Moore-

Payman Langroud…: That vibe. That vibe in that place.

Prav Solanki: Listen, I tell you something mate, if you could bottle up Andy Moore’s magic and ship it round the country, yeah? Whoever’s handling or processing that, yeah, even for 10% commission mate, I could give up everything I’m doing right now. Yeah. Do you know what? Sometimes, I think it truly comes down to leadership, mate. There is no magic formula, right? Forget this career progression and all that sort of stuff. You step into that breakfast and you get that warm Ready Brek feeling. Okay? You get that glow.

Prav Solanki: And it’s so evident, from the person who’s greeting you that she’s absolutely tickled pink that you’ve walked the practise and dead happy, to his associates, to his nursing team, to his implant coordinator, whoever it is. But it’s not just when you step in, mate. You pick up the phone and have a conversation with one of these people, they’re delighted to speak to you, yeah? Mate, even if I’m picking up the phone and speaking to someone who pays the bills they’re delighted to speak to you. Right?

Payman Langroud…: Yeah, but you’re saying you don’t know why? You don’t know what they’ve done to make this …

Prav Solanki: [crosstalk 00:56:56].

Payman Langroud…: I’ve noticed Natural Smiles, do you know Natural Smiles?

Prav Solanki: I know of-

Payman Langroud…: Bhavnish?

Prav Solanki: Yeah, I know of Bhavnish, yeah. But even if you ask Andy, right? If we go back to Andy, even if you go back and ask Andy, “What is it?” even he says-

Payman Langroud…: He won’t know.

Prav Solanki: No, he tells you he doesn’t know, right? Then he says, “Maybe it’s the environment.” Yeah? He’s a really nice guy. Do you know what? He’s super-successful, clinically great at what he does. He’s an IRONMAN athlete or whatever. He’s got a pretty cool lifestyle and all the rest of it. Really humble and lovely with it all. Yeah? Really, really humble and lovely with it all. He’s just a really nice human being, mate. Do you know what? If you break it down to the simplicities, if you treat people well and if you’re nice to people you’ll get it back.

Payman Langroud…: Yeah. It sounds simplistic to me but it sounds a bit-

Prav Solanki: Sometimes, the most successful things are simple.

Payman Langroud…: Yeah but-

Prav Solanki: I can’t put more of a formula on it-

Payman Langroud…: Yeah, but really-

Prav Solanki: … than that.

Payman Langroud…: Really nice human being is my grandmother and she’s not running a dental … You know what I mean? Really nice human being is one thing. It’s running an elite business while being a really nice human being that’s amazing. I mean, that’s an elite business isn’t it?

Prav Solanki: Oh-

Payman Langroud…: And you look at the throughput of work that goes … They’re working hard, yeah? They’re not just sitting around-

Prav Solanki: And the quality, mate. And the quality, yeah?

Payman Langroud…: And the quality. They’re not sitting around being nice to each other. You know what I mean? There’s an X-factor.

Prav Solanki: There is mate. Honestly, I think that’s written in Andy’s DNA. Yeah. I couldn’t pluck that out for you.

Payman Langroud…: Well, I think you’re doing it in your business, dude. I think you’re doing it in yours. The amount of work you guys are putting out with 15 of you. Yeah?

Prav Solanki: Yeah, but-

Payman Langroud…: It’s a lot of work.

Prav Solanki: We are. We are, right? I think we’ve become a closer team over lockdown, that’s for sure. There’s numerous projects that we’ve done, the standards that we deliver at, the quality that we’re producing now is on a completely different level. And I truly believe if it wasn’t for this COVID malarkey, we definitely wouldn’t be outputting at the quality we are today.

Payman Langroud…: I mean, we’ve talked to people like Alfonso, yeah?

Prav Solanki: Yeah.

Payman Langroud…: Who we both know, the way Alfonso operates is he sizes you up as a person and at one point he says, “Yes, we’ll … ” You’re either his best buddy or he’s not working with you, kind of thing. Maybe that’s how he operates with all his team as well, yeah? It’s the person. I’m sure he gets on with most people.

Prav Solanki: Yeah.

Payman Langroud…: Then you’ve got so many different ways of doing it. You’re right, I guess it’s a bit unfair to say, “Hey, what’s the magic sauce?” But there are lots of ways of handling practises. Anyway bud, I think we should wrap it up.

Prav Solanki: I think we should wrap it up here mate. Do you know what? It’s been a great year despite the ups and downs, mate. I feel like we’ve got to spend more time together, even though we’ve spent less time together. I’m looking forward to those days where I’m back in London, I can give you a quick call and say, “Hey Pay, I’m in London. What are you doing? Let’s go hang out. Let’s eat some food.”

Payman Langroud…: Yeah. Your IS courses, are they completely back on?

Prav Solanki: IS courses are back on now. Fully booked. We’re noticing we’ve got bookings going through until the middle of next year. Online courses. Dentists have pivoted to online education now and investing in I guess being able to be educated in the comfort of their own homes. Do you know what I mean? What are you guys seeing with MSM? I mean, Dipesh’s courses have always been over-subscribed. I know whenever I’ve recommended any colleagues to get on your course, you’ve got to squeeze me in some special favours to get them in on the course, which obviously you can’t do with current circumstances. But how are things looking for Mini Smile Maker over the next year?

Payman Langroud…: Yeah, we’re busy. We are busy. I mean, it’s funny because it’s hands-on isn’t it?

Prav Solanki: Yeah.

Payman Langroud…: So, it’s one of those things that can’t be done online. Should we have an online element? We probably should. We probably should. You guys have both, right? You have a hands-on element and an online element?

Prav Solanki: Do you know one thing that we explored during this … And Tiff has said specifically this has been a game-changer, right? Is a hybrid course, where you’re actually forced, or it’s a prerequisite to do some online training. So, you’re given the online training prior to coming to the hands-on. So, number one, you get more hands-on. Yeah?

Payman Langroud…: Yeah.

Prav Solanki: Number two, you’re armed with more knowledge so you’ve got a minimum standard of informational knowledge when you arrive. Then the other thing that we’re playing with at the moment are these semi-hybrid courses where you have online. We send the models out to their practises, and they do the hands-on element via Zoom, right?

Payman Langroud…: Yeah, yeah.

Prav Solanki: And send the models back for assessment.

Payman Langroud…: Yeah. Cosmedent is doing quite a lot of that in the US, our manufacturer. They’re charging a lot for it. They’re charging the same as we do for proper hands-on courses, although the prices are a lot higher in America for education for some reason.

Prav Solanki: Yeah.

Payman Langroud…: All right man. It’s been nice having a little catch-up and talking about the way you handle all of your recruitment and so on. In summary, for me, as a profession I think we should be counting our lucky stars man, that we’ve managed to bounce back the way that we have, albeit with the hassles of fallow time and PPE and all of that. And looking forward to a whole lot more Dental Leader podcasts happening next year. We’ve got some great guests lined up. I just spoke with Basil Mizrahi as well, who’s going to be on, so that’s going to be fun.

Prav Solanki: Amazing. Amazing. Yeah, it’s my favourite non-working workday when we’re interviewing [crosstalk 01:03:22].

Payman Langroud…: Do you mean you prefer being with your family than doing this?

Prav Solanki: Yeah.

Payman Langroud…: Screw you, man. I prefer this, man.

Prav Solanki: I think I even prefer being with your family. I’m kidding man. It just all depends, right? I really, really-

Payman Langroud…: Enjoy Dubai, buddy.

Prav Solanki: I will.

Payman Langroud…: You deserve it and in Tier 2 you cannot do it, whereas we’re about to hunker down to a Christmas on our own. So, have a good time. Pleasure speaking to you, bud.

Prav Solanki: Thank you.

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.

Prav Solanki: And don’t forget our six-star rating.

 

 

This week’s guest is one of dentistry’s few true household names. Uchenna Okoye has found success as a cosmetic dentist and clinical director of London Smiling dental group.

But she is perhaps best known as the dental consultant on Channel Four’s Ten Years Younger program.

Uchenna tells us how it all started and we get round to discussing race and gender in dentistry, non-nonsense management and much more.

Enjoy! 

“I don’t understand the jealousy and all that nonsense. There’s enough teeth for everybody.”  – Uchenna Okoye

In This Episode

01.12 – Backstory
05.19 – Race and gender
24.01 – Cosmetic dentistry
26.44 – TV and PR
32.21 – Fitting in
36.21- Patient journey
43.21 – Training
50.31 – Motherhood
55.34 – Day in the life
58.52 – Being strict
01.04.38 – Being a brand
01.14.25 – Last day and legacy

About Dr Uchenna Okoye

Cosmetic dentist Dr Uchenna Okoye graduated from Guy’s Hospital, London.

She is perhaps best known for her role on Channel Four’s Ten Years Younger makeover programme and is a frequent contributor to radio and TV.

Uchenna is the clinical director of London Smiling Dental Group. She is a member of the American and British Academies of Cosmetic Dentistry (BACD) and former BACD board member.

 

Uchenna Okoye: But I make it very clear that this is what you’re signing up to. And sometimes people say, “Do you actually want me to work here?” And I’m like, “Yeah, but if you’re going to go to Oxford and Cambridge, you know what you’re up against. You don’t have to come to Oxford and Cambridge, you can go somewhere else. But if you want to join us, it’s not easy. And I know that it’s not easy.” So yeah, I don’t know, does that make me an evil witch?

Payman Langroud…: Yeah, yeah. It does, yeah.

Intro Voice: 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…: It’s my great pleasure to welcome my long-time friend Uchenna Okoye on the podcast. Uchenna’s had a brilliant career in dentistry, one of the most high-profile dentists in the country right now, and for a long time now. Welcome to the show, Uchenna.

Uchenna Okoye: Thank you. It’s good to be here. It’s taken you a while, you’ve finally pinned me down haven’t you?

Payman Langroud…: You’re a busy woman, that’s why. Uchenna, let’s just start with where did you grow up, when did you think you want to be a dentist, why?

Uchenna Okoye: Well, I was born in Nigeria, so I’m the oldest of six. And I grew up there, came over to England when I was about seven, and all I remember is how cold it was, and it’s still cold, I hate the cold. And yeah, I went to school here. I went back to Nigeria for a year when I was about 10, 11. And then came back to England after that. So yeah, been here for a long time.

Payman Langroud…: And what brought you back and forth, Uchenna?

Uchenna Okoye: We came because my mom is a pharmacist, so she came to do her master’s. And we were never meant to stay here, so then my dad was like we were becoming too anglicised. He used to moan that my brother started talking through his nose, he had a posh accent, so we went back to boarding school, and I went back for a year. I kind of went thinking… yeah, I grew up on all these St. Trinian’s and Malory Towers, and I thought I was going to a Swiss boarding school. And instead it was like the middle of the jungle and snakes and all that kind of stuff, which now was a great experience, then I thought my father hated me. So, I went for a year. And it was great though because it helped keep me… I have a real love of Nigeria. So, if somebody asks me where I’m from, even though I’ve lived most of my life in England, I’d say Nigeria, that’s where it resonates. And then I got ill, and I came back just after a year, and then never left really.

Payman Langroud…: What made you become a dentist?

Uchenna Okoye: It was a tossup between dentistry and medicine. Traditional African family, you could be a lawyer, dentist, accountant, all that kind of stuff. So, originally it was going to be medicine because my uncle was a doctor. And then I did work experience in the hospital, and realised that the doctors didn’t do anything, it was the nurses that did the caring, didn’t like the hospital environment, which I still don’t. And yeah, dentistry’s just great, and I love it. I love it because I get to be my own boss, I get to be artistic, and it’s just the best job. But at the time, when I’d told my dad I was going to be a dentist, he was very dismissive. He was like, “You’re not.” In Nigeria, we have great teeth, that’s not a proper job. It’s not a proper doctor kind of thing. But yeah, he was very proud in the end.

Payman Langroud…: What does your dad do?

Uchenna Okoye: Oh, I had a wonderful childhood. He’s passed unfortunately, quite a while ago now, but he had a ice cream factory.

Payman Langroud…: Oh, really? Wow.

Uchenna Okoye: The holidays was in the ice cream factory, and it’ll be like one scoop for me and one scoop for… He was way ahead of his time. He was an amazing entrepreneur. And I wish he was alive now because there’s so many questions I’d ask him. And I’d say sorry to him, because as kids we’d be like, “Why can’t you take our holiday? It’s your factory, you can just take time off.” Now I own my own business, I’m like, “Now I understand.”

Payman Langroud…: And where did you study dentistry?

Uchenna Okoye: I went to Guy’s when it was Guy’s. So yeah, so I did primary school, secondary school. Went to Guy’s which wasn’t the best experience. I think Guy’s was fabulous from the perspective of teaching. And even now… well, it used to be that I could tell the difference between the Guy’s graduates, the things that we were taught and how we were taught. But I honestly did not like being at uni. So yeah, it is what it is.

Payman Langroud…: [inaudible 00:05:18].

Uchenna Okoye: There was loads of racism, so I guess we might as well dive straight into that. One, I didn’t know if I wanted to be there, because obviously the parental thing, my dad’s attitude towards dentistry impacted me quite a bit. So, initially my first year was about changing to medicine, because that’s what my parents felt was the right thing to do. But there weren’t many people that looked like me at Guy’s. I made friends and it was a great education, but Guy’s was… I still remember it. The comments like, you know how you’d have demonstrators and stuff? And they’d come and they’d look at my work and they’d be like, “Oh, that’s a really good filling Uchenna for you.” So, there was always that what I call subtle British racism type thing. And a few of us had a rough time there.

Uchenna Okoye: But it’s part of who we were, because in Nigeria we have tribalism, so we have different tribes. So, I’m kind of… that happens. And my parents very much you just be the best that you can be and nobody cares who you are kind of thing. So, it’s just stiff upper lip. So, I found the whole Black Lives Matter thing quite interesting.

Payman Langroud…: Yeah, let’s tackle it. Because I mean it was a whole different era as well back then. I mean, we’re a kind of similar age me and you, so I can relate to that idea that what’s acceptable to say back then is different now. But being a Nigerian lady, and we’ll get to the lady part as well. Being a Nigerian lady, take us from experiences that you’ve had that you would class as racist, race-related experiences, getting jobs, has that been an issue? Patients walking in and being shocked or whatever? I know people who wear hijabs sometimes say that. They say a patient comes in and immediately you can tell. And bring it right down to today. Are we saying today it’s all over and there isn’t so much racism, and with all Black Lives Matter and all that? Give us some of your comments about race in your growth from being a teenager to…

Uchenna Okoye: I mean, I guess upbringing has a big role to play in one’s perception of stuff. Because okay, my first memory of school in England when I would have been about seven or eight, I was really proud of my English, because although Nigeria has loads of languages, English is actually our official first language, so I could speak English, [inaudible 00:08:18]. I was being asked in primary school to read a story, and the whole class bursting into laughter because of my thick Nigerian accent. So, it’s kind of like from that beginning things, or kids asking me about worms in my hair or being called rubber lips. Now patients want me to inject filler so that their lips look like… I mean, I just find the whole thing quite bizarre.

Uchenna Okoye: So, it’s kind of always there, you’re aware of it. But for me it’s just you just get on with it. It’s not something that defined me or I spent a lot of time thinking about. And I think for me it was more difficult as well because you’re a black woman in a very male, chauvinistic, white world, or whatever. So, I’d get stuff of the woman bit where it’s, “Oh, are you the nurse?” Type stuff. Or the letter’s addressed to Mr Okoye and all that kind of stuff.

Uchenna Okoye: The blacks thing, I haven’t had a direct spit in your face, “You’re black” type experience. What have always known and was always told from day one, “You’re black so you have to work harder.” But then my family is, and my mother especially, is like classic African, “Well, why are you second? Why are you not the one that was first?” And so, it’s just always been there. [inaudible] that psyche, yeah.

Payman Langroud…: And so, what do you think about Black Lives Matter?

Uchenna Okoye: I found it really interesting on lots of different ways. I mean I’m glad that the conversation is being had and it’s long overdue. I found it irritating that a lot of friends were looking to me to almost absolve them, or to tell them what they should do, or they’re like, “We’re sorry this happened to you.” And all this kind of stuff. I’m just like, “What do you want me to say or what do you want me to do?” And they’re like, “Oh, teach us.” I’m like, “It’s not up to me to teach you. You need to go and find out for yourself kind of thing.” So, that was my bit on the one hand. I mean, I’m glad that they wanted to know and all the rest of it. But it felt again that the burden was on me to make them feel better about themselves, or to give them the information that they needed to know. I’m like, “No, you need to… It’s your turn to live in my world.” So, that was one.

Uchenna Okoye: But then the other thing that it did was it made me think about stuff that maybe you just ignore. And I think that’s probably what I found the most uncomfortable. To just sit back and think, “Oh, right, there was that time and whatever.” But I really didn’t dwell on it. I think I’m glad it’s happened. And I’m one of those people that I’m like, “Absolutely. That whole affirmative action thing.” I know some people feel that it’s a bad thing or whatever. It’s not about putting people that can’t do the thing in the posts, it’s about giving them an opportunity. And as a woman, it’s exactly the same scenario. Whether it’s you’re black or a woman, it’s other people to encourage you and mentor you. And there’s not enough of that in dentistry at all.

Payman Langroud…: We’ve talked about this a few times, me and you I think in the past at some dinner somewhere. But you really think it’s a lot harder being a woman than a man?

Uchenna Okoye: Yeah. It’s good that you’re where you are and I’m where I am, because of course it is. I’d be slapping you about the face. Of course it’s

Payman Langroud…: But listen. Is it harder being a black woman or a black man? I’d rather be a black woman.

Uchenna Okoye: Why?

Payman Langroud…: Because I’m not going to get the cops stopping me and thinking I’m a criminal every five minutes.

Uchenna Okoye: That is true. That is true, I definitely agree with you that. But then there comes another baggage you have to carry where-

Payman Langroud…: I’m making an example, yeah? An example of where it is advantageous to be a woman over being a man. I’m not pivoting my whole argument on that. What I’m saying is there are advantages to being a man, there are advantages to being a woman. When you say it’s harder to be a woman than a man, let’s go to dentistry. Let’s go to dentistry, go on, tell me.

Uchenna Okoye: Yeah. So, why it’s harder to be a woman? I think-

Payman Langroud…: By the way, by the way, outside of childcare, yeah? Because that’s obvious, yeah?

Uchenna Okoye: No, you can’t just take the childcare thing out. That’s-

Payman Langroud…: Oh, oh, oh, okay, okay.

Uchenna Okoye: That’s a huge thing, because the guys should be involved in the childcare as well. Nobody asks the dude, “Oh, who’s looking after the kid here whilst you’re in your work?” And all that nonsense, do they?

Payman Langroud…: But my point is, if we just crop children out of the equation, yeah?

Uchenna Okoye: Yeah.

Payman Langroud…: Children out of the equation, because obviously to have a child you have to have maternity, you have to look after kids. And kids, a lot of them tend to look to their mother and all of that. But I’m saying let’s just say, let’s leave childcare out of it in terms of career progression. Just as a man dentist, as a woman dentist, where are the problems?

Uchenna Okoye: Number one, you can’t leave children out of it. So, sorry, I don’t agree there at all.

Payman Langroud…: No, but let’s say before you have children. If you’re a 25-year-old who’s never had children, a guy or a girl, there’s no children, so-

Uchenna Okoye: Yeah. But still, because I think as a women, generally I think a lot of the things that women are really good at is not… what’s the word? I don’t

Payman Langroud…: [inaudible 00:14:38].

Uchenna Okoye: Huh?

Payman Langroud…: Confrontational stuff.

Uchenna Okoye: Yeah. Women, we’re into… we’re nurturers, we’re team-builders. If I’m in a room and we’re discussing a problem, my natural thing is to ask everybody and get everybody involved and all that kind of stuff. And that’s not something that is… I don’t know if encouraged is the right word, or admired or whatever. It’s the bloke that doesn’t know what the hell he’s talking about, but opens his mouth first and shouts out whatever, is then perceived to be like, “Oh yeah, he’s got something to say and he’s making a contribution.” Whereas women, we tend to sit back, and we tend to be much more inclusive and want to try and involve people. So, I think that can create a problem.

Uchenna Okoye: And I think in dentistry, so how can you have a profession where the majority of… even at my time in dentistry, it’s 50% women. Now it’s probably more. Women are the key elements that’s going to keep things going. But you don’t see women up there on the podium. You’re one of the few people that… Like when I did a couple of things with you and it tends to be more… you tend to have a few women smattered in there. But a lot of times the women aren’t there, but I don’t think it’s necessarily because… It’s just like not being aware. It’s like the Black Lives Matter thing. It’s just not even-

Payman Langroud…: Listen, it’s been levelled at me. I think Berty was the one who said it to me. We had a conference, The Minimalist. I spoke, Prav spoke, and there was nine speakers and there was only one woman amongst them. And I hadn’t really thought about it. I wasn’t really thinking about that question. And Berty said to me, “You should have had half and half.” And I found it a bit difficult, because I wanted to make the best conference I could make, and I was thinking, “I want someone from orthodontics.” It was minimally invasive. “Someone from orthodontics, someone from crown and bridge, someone from whitening, a marketing person.” I’m thinking, “Who are the best people I know for it?” Rather than trying to find a woman. So, there’s that. But the other thing is that, and I’ve discussed this before as well, is that if you really cared about women in dentistry, wouldn’t you look at nurses, hygienists, receptionists? They get a really rough deal in dentistry, yeah? They’re the ones-

Uchenna Okoye: Are you asking me?

Payman Langroud…: Yeah. The fact that you’re not seeing dentists on the podium, that’s not the big issue about women in dentistry. The big issue about women in dentistry is that that group, the ones I said, the DCPs, are overwhelmingly women, yeah? And their career prospects, what happens to them? The way they’re talked down to by their bosses, all of that stuff, yeah? That’s the real problem with women in dentistry.

Uchenna Okoye: No. [inaudible 00:17:57]. I don’t know what you’re talking about, mate.

Payman Langroud…: Really? Go on The Hygienist Forum, see the way some hygienists are treated by their bosses, right?

Uchenna Okoye: Yeah, but that’s just… I think it has to start from the top. Because part of the thing of having more women on the podium, one is from an inspiring perspective, but two, to reflect the reality of the profession. Even within dentistry, dental school.

Uchenna Okoye: So, I mean there’s a slightly off the cuff relevance this, but I had this fall out with quite a well-known journalist from a national magazine, where we were talking about… I was flicking through the magazine one day, stick with me, there is relevance to this. And I was just suddenly thought, “There’s nobody in this magazine that looks like me.” I get this magazine all the time, and I love it and I love the articles and all the rest of it. And I just flicked through the whole thing, “Where am I?” And there were like about two adverts or something that had somebody with colour.

Uchenna Okoye: And so, I knew her, and it was like about midnight, I must have been quite grumpy or something. So, I sent her an email, a message, and I’m like, “Dah, dah, dah.” And she replied, and so we got into this altercation. I mean we’re friends, where she was like, “I can’t believe you’re trying to say that I’m racist.” I’m like, “I’m not saying that at all. I’m just saying I’m going through your magazine, I can’t see anybody that looks like me.”

Payman Langroud…: Was it fashion magazine or something?

Uchenna Okoye: It was a Sunday magazine type thing, like Style, Stella, whatever.

Payman Langroud…: Yeah.

Uchenna Okoye: And so, she was so affronted that she went through all the trouble of getting all the magazines, sending me a PowerPoint of all the things that had pictures or articles of people, of black people. And so, I smiled, I’m like, “Yeah, there’s Beyonce here, there’s Will Smith, there’s whatever.” I’m like, “That’s all great. But I’m talking about people like me. I’m talking about doctors, dentists.”

Uchenna Okoye: And then that particular week, it was interesting that there was a feature about lipsticks, and they’d put lipsticks on loads, it was like a whole page of different lips, and there was not a single black, brown lip there. There was just nothing. So, I’m like, “It’s about this. It’s about the fact that nobody has thought about this. That I’m not…” I know that you’re all wonderful or whatever. You’re just going for that which you know and that which you’re around.

Uchenna Okoye: So, you obviously don’t hang around with enough fabulous women, that when you put on your lecture, they didn’t even occur to you. Or maybe if you’d hung around them more, you’d know it was more of an issue and you’d do something.

Payman Langroud…: I do get it. I’m not rejecting it outright. I do get.

Uchenna Okoye: I know you do. I know you. That’s why I love you.

Payman Langroud…: I do get it. But what I’m saying is that I couldn’t find the best people. That was my-

Uchenna Okoye: Oh, that’s a load of rubbish. No, no, sorry.

Payman Langroud…: No, no, I didn’t engage even the best men, yeah?

Uchenna Okoye: No. You didn’t look hard enough.

Payman Langroud…: I looked. I looked.

Uchenna Okoye: No, no. You just went to your buddies that you knew. “Hey, can you…” The guys that you hang out with, all the rest of the… And this happens so many times. And I will… no, I won’t, so.

Payman Langroud…: No, go ahead. Go ahead.

Prav Solanki: Go for it. Go for it.

Payman Langroud…: We’ll cut it out, go on.

Uchenna Okoye: I will go there with for example you did ask me before about VAPD, and that they’re doing a great job and all the rest of it. And I’m not going to go into it. But that’s a classic one of what you’ve just said. So, this group of great guys who I know most of them, nobody… you know that picture? That picture where there was all these men, that they’d had their conference when the organisation first set up. And I’m just like, “There is not one single woman there.” And none of them saw that. And then you ask what the hell happened, and it was like, “Yeah, we’re all buddies. We all hang out together. And some of us just thought, ‘Hey, guys.’ And we just happened to have this conference call.” And nobody there was thinking about it at all.

Uchenna Okoye: So, that’s why the conversation needs to be had, because it’s scientifically proven that an organisation that’s got that diversity is so much better, is so much more effective, it just functions better, than just people that all… Yeah, anyway. So, that’s all I’m going to say about that. So, that’s why. And even when you’re talking about the thing about DCPs or hygienists or whatever, it’s again having the women there that will bring their problems to the front so to speak. So, I don’t know if it’s Facebook. What’s her name? The woman that’s… oh, brain’s gone. Huh?

Payman Langroud…: The woman that what?

Uchenna Okoye: Oh, what’s her name?

Payman Langroud…: The woman that what? What did she do? I’ll tell you.

Uchenna Okoye: No, isn’t it, is she one of the CEOs of Facebook now? It’s not Arianna. Is it Arianna?

Payman Langroud…: Oh, the one that came from Google?

Uchenna Okoye: Yeah. Anyway, her.

Payman Langroud…: Yeah.

Uchenna Okoye: We’re talking about the fact of it wasn’t until she got pregnant, so she suddenly realised that there was no parking, she had to park for miles to waddle to wherever she needed to be. And so, it was something that affected her, none of the guys had thought about it, none of them had, it wasn’t there at all. And so, that affected a change because she was there and she had something about it.

Payman Langroud…: Sheryl Sandberg. Sheryl.

Uchenna Okoye: That’s it, Sheryl Sandberg, thank you.

Payman Langroud…: Yeah.

Uchenna Okoye: Yeah. She’s one of the people that I would love to sit and have a coffee with.

Payman Langroud…: Definitely, definitely. When did you stop becoming just a regular general dentist, and look to cosmetic dentistry? Because that’s definitely what you’re known for.

Uchenna Okoye: Yeah, I mean I still consider myself a regular dentist. I am a regular dentist that just happens to be on TV. I didn’t go seeking to be doing what I’m doing. I think I got involved with cosmetics because, one, I’m dental phobic, I’m afraid of… I had some really bad experiences. And going to AACD, and I can’t remember how I got to AACD the first time. And it just totally blew my mind. It just opened me up to a whole world that I wasn’t even aware of, and that kind of started my journey.

Uchenna Okoye: And I started with quite a lot of people. It’s why sometimes, it’s the thing that dentists do that I get really cross with people that behave as if they’ve always known what they know now. They forget what it was like to know nothing. There was a time I didn’t know what a Zenith was. And sometimes I’ll see some well-known people putting other people down. And I’m like, “I was on the same course as you when you didn’t know any of this as well. So, you need to be kind to each other.”

Uchenna Okoye: And so, yeah, that kind of started the journey and I’ve just loved it. And I’ve always gone to America because I find it’s more forgiving, more… I’m not a dentist dentist as you have told me many times before. And in fact, I was saying to one of my team that if you had a yearbook of Guy’s, I’d probably be the person that people would say least likely to succeed. But they are quite amazed I’m told apparently with my success, which is a bit irritating, but a part of me is like, “Neh, neh, neh.” But it is.

Uchenna Okoye: I was a nerd at dental school. I was a Mr Bean kind of dental student. If you’re disclosing somebody’s teeth, I would be the person that would drop the disclosing tablet on the patient’s white shirt. That was me. So, I have a lot of affinity and empathy for people that don’t know what they’re doing. That whole imposter syndrome thing, it’s always something that I always struggle with. I’m told it keeps me humble, so that’s good.

Payman Langroud…: You’re definitely humble considering everything you’ve achieved, that’s for sure. But how did the TV thing happen?

Uchenna Okoye: Just busy minding my business doing what I do, and they just approached me. It wasn’t because I was sleeping with the producer, as one very well-known dentist told me.

Payman Langroud…: Is that the kind of thing you mean about women?

Uchenna Okoye: Yeah. I mean, who would go and ask a guy that kind of ridiculous question?

Payman Langroud…: [inaudible 00:27:18].

Uchenna Okoye: So, they just came one day and they-

Payman Langroud…: But why you? I mean, did you have a PR working for you at the time? Why you? I mean, they could have gone to anyone.

Uchenna Okoye: No, I think there was stuff in press about me.

Payman Langroud…: Okay.

Uchenna Okoye: So, I had a part-time PR person. Did I have her then? I don’t think she was with me then. I can’t remember.

Payman Langroud…: You were very strong on your own PR weren’t you? Because where the practises are, they’re very near journalistic centres.

Uchenna Okoye: Yeah.

Payman Langroud…: And you’ve always… well, what’s always surprised me is how strong you are at PR yourself, without using professionals. I mean, it’s almost like you treat these people isn’t it? That’s the… The rest of us have to get PR people to bring these journalists in.

Uchenna Okoye: Them in.

Payman Langroud…: You’re just their dentist.

Uchenna Okoye: Yeah. But the thing is though, it’s the thing that I say to people, especially now in this whole Instagram era where don’t do the work for the picture or for the PR or for the article, do it because it’s the right thing to do. So, the reasons that I have a lot of journalists and people at my practise is because they might come…

Uchenna Okoye: Like I had one, Hannah, who came for a whitening feature for I think it was The Telegraph. And she’d had whitening before, like about three years ago by another dentist who I knew, and she was quite nervous, and she was like, “It was so painful before.” I’m like, “This one had so much recession. It would have been like pouring acid in a wound. I don’t understand how anybody could honestly.” But this person, the remit is, do whitening, one hour of my time or whatever and have articles.

Uchenna Okoye: So instead, I did buccal composites everywhere, sealed everything off, she was like, “Oh, my God, so this is what people that don’t suffer with sensitive… This is how teeth are meant to feel?” Then I did the whitening. It was only the whitening that appeared on the article, but that’s okay. And I didn’t charge her for the bonding because it’s a PR thing. But that’s the right thing to do, so.

Payman Langroud…: use the right whitening system for that.

Uchenna Okoye: You haven’t come along then. And that’s why they’ll stay. And that’s why, even though they might do an article, then they come back. And so, with the 10 Years Younger, they just came, they came, they spoke to patients, they look at pictures I’d done, they did a screen video thing et cetera. And then they just turned round and said, “We really want you to do it.” And I’m like, “Yeah, sure. So, is it going to be both of us?” Because at that time [Serinda] was also doing it. And they were like, “No, no, no, it’s just you.” So, I was a bit… They came to me saying that they were going to change the format for it to be a magazine style, so I thought they were going to… And I know that they were talking to different dentists at the time.

Payman Langroud…: For a while there you were the most famous dentist in the country definitely. And it was kind of before the internet properly took of, right? How famous were you? Did you used to get recognised? I remember once we were having dinner and someone recognised you.

Uchenna Okoye: Yeah.

Payman Langroud…: [inaudible 00:30:40].

Uchenna Okoye: But I’m not a very good famous person, whatever that means. Even with the show, I could have done it smarter, or if I was more millennially, but I would do the dentistry. And so, there’d be somebody, and I’m like, “But she’s a stable hand. I know having bright bleach shades isn’t going to work for her, she’s just going to stick out like a sore thumb.” Making sure that she can manage it afterwards. To me, the people is key.

Uchenna Okoye: So, I was so busy doing all the dentistry, I don’t know, I think I told you. Did I tell you that story about the guy? Me coming out of the station, it was so funny. It was on the Sunday morning, and I looked rough, man. I’m like real Sunday rough stuff on. And he was like, “Aren’t you that dentist from the show from 10 Years Younger?” And he actually goes, “You look rough, man. Can’t you afford a car?” He’s like, “I thought you’d be in a proper… You look like you’d be in a BMW or something.” It was so embarrassing, it was just… But for me that meant that I’d… even now, I don’t consider myself famous. I find the whole

Payman Langroud…: Do you get recognised quite a lot?

Uchenna Okoye: Not now, because the show hasn’t been around.

Payman Langroud…: Yeah, but back then, you used to?

Uchenna Okoye: But I do get recognised because it’s easy to recognise me, it’s the black woman, there are not many kind of… So, I’ve learned to just smile at everybody. So, yeah. But I feel very blessed to be doing what I love doing, so yeah. But it’s not easy.

Payman Langroud…: Uchenna, one thing about you that I’ve over the years gathered yeah, is that you’re not interested in fitting in. So, when you say you were the oddball whatever in dental school, just for the sake of the argument, you used to say to me, “I’m never going to use website people that dentists use.” You’d always look outside of dentistry. Your practise, I remember when I came there, everyone’s talking about guests, no one’s talking about patients. And I remember you saying you recruit from outside dentistry. And it’s kind of fashionable now, but you were talking about this 15 years ago. You used to recruit from hotels or wherever it was. Give me a little, first of all, why’d you do that? Does it work well for you? And secondly, why are you that cat that’s trying to be different?

Uchenna Okoye: But I don’t think… I’m not trying to be different. I’m not purposefully trying to be an outlier as they say. I mean I kind of say to people I am incredibly shy, as I told you, and everybody just laughs. But actually I really am. So, to be one of the worst things anyone could ask me to do is [inaudible] into a room that people I don’t… I’ll just find the one person and stick to them like a leech. But then I will notice people that are uncomfortable, and I will force myself to overcome whatever to try and make them feel better, if that makes sense, yeah.

Payman Langroud…: Yeah.

Uchenna Okoye: So, I think that’s part of what drives how I am in practise. And which is why most people assume… I always find it so weird where people who have never met me just have these preconceived ideas. I have people that are friends now, that they were like, “Oh, we just heard or we assume that you’d have an attitude or that you’re really aloof and you don’t hang out with…” And I’m just like, “But why? Why would you say that?” But it is what it is.

Uchenna Okoye: So, I like the non-dental thing because dentistry. Now it is, as you said, but before it never used to be about customer service. So, I had to go outside of dentistry in the UK to get that kind of vibe and customer service.

Payman Langroud…: You were definitely one of the first. You were definitely one of the first that was looking at it directly from the customer perspective. I certainly felt that. Everything about your practise. From the morning huddle, to the decorations, to the way you talked about your patients, was very much patient-focused. Which is, as I say, very fashionable now, but you were ahead of the game on that. Was that partly to do with the phobia? And some people get into dentistry and forget what it was like not to be a dentist. And as others, and people like Rhona now, Shaadi’s another one that I’m very interested in, who completely want to take it the other way and just talk to the public and demystify. But you were definitely one of the first who did that, yeah? And you still do I guess?

Uchenna Okoye: Yeah, I mean for me it’s I’m interested in people. So, it’s always been about the people. And I’ll be the first one to be like, “There are so many dentists with much better hands than me.” That I’m like, “I can only aspire to do the kind of work that they do.” Me, I’m kind of like… don’t get me wrong, I do good work, and I invest a lot in courses, I know my limitations. But I’ve always been about the people. So, it’s about making people feel good about themselves, making them be the best that they can be.

Prav Solanki: So, just talk me through your patient journey. I’m a patient walking into your practise for the first time. Just talk me through the entire experience from walking through your door, to actually having a conversation, consultation with you. What’s your consultation process?

Uchenna Okoye: Gosh, I’m still trying to redefine it in the COVID-era. I’m actually struggling with it because I’m a hugger and a kisser, so I-

Prav Solanki: Let’s go pre-COVID. What would happen?

Uchenna Okoye: Pre-COVID would be schedule the appointment, and I guess [inaudible 00:36:56], but most people come in to see my know it’s going to be an investment, and they are looking for me, or they’re asking for me. So, they’d come in, they’d come to reception, we have a bag, all the forms they’ve got, what kind of lip balm they want and all that kind of stuff that I’ve learned from… So, everywhere I go on holiday I always hang out with the HR people, so Ritz-Carlton and all the rest of it. And I pick little bits that will work. I’m always thinking about what will work when I come home. So, we have that, the service menu, then I’m always the one that comes and meets them, brings them in, we sit at a desk in my surgery. I don’t have a big, posh space. My surgery’s from IKEA, that kind of thing. I’m a proper [inaudible] girl. So, we sit on one side, talk about how can I help you, what’s going on? Just that engagement.

Prav Solanki: What do you do to cater towards phobics? Because you mentioned earlier on that obviously you had a bad experience earlier on in your life and you’re a phobic. Do you cater to their needs? Is there anything different that you do to help people who are nervous about dentistry?

Uchenna Okoye: I think just be interested. All that old adage of nobody cares how much you know until they know how much you care. Is just literally being interested. I am so interested. I have friends that will be like, “I’ve known this person for 10 years, and you’ve found out in five minutes more about them than I have.” Because I genuinely love to find out about people. So, once with the trust.

Uchenna Okoye: I mean, they love the fact that I am a phobic, so that’s always a good thing. And I address that right from the onset. So, I always say when we’ve finished talking and we go to the chair, and I’m like, “I’m going to do this. You’re in control. If I’m wittering on, you want me to stop, you just let me know.” And all that kind of stuff. And then I’m just always, “Are you okay? Let me know.” It’s just it’s a two-way. And so for most of the time, just that in itself is enough.

Uchenna Okoye: I’ve never had… And I had one woman that it took us about six weeks to get her up the stairs. So, each appointment she’d go up two steps til she got to the top. It’s very rare. I’d say that maybe two, three people that we need to have to do sedation or anything like that. But for most patients, just the appointment’s longer, and it’s just time. I mean, we’ve got the DVD glasses and iPhones and all that stuff for them to listen to music, that helps.

Uchenna Okoye: So, finish talking, sit them in the chair, do all the normal stuff that one would do, take pictures. Then we go back to the side table, show them their pictures, talk about what I see, what they see. And then do a treatment plan. And I’ll-

Payman Langroud…: Do you do it there and then? Or do you do it at a different time?

Uchenna Okoye: The treatment plan?

Payman Langroud…: Yeah.

Uchenna Okoye: No, what I always try and do is find something small to bring them back with. So, if it’s so they’re coming back for the hygienist and maybe I’ll do one filling, and then I’ll give them the treatment plan then. If it’s something really straight… if it’s, “Hey, I know that this is going to be a Smile or whatever.” And I will give them the fee for maybe doing the articulated models or something. And then they’ll come back for that, and then I give them the… yeah.

Payman Langroud…: And what kind of treatment plans are you doing? I mean in terms of value, are you hitting the 20, 30 grand numbers?

Uchenna Okoye: Yeah.

Payman Langroud…: And are some people just completely shocked by that? What I mean by that is there’s a lot of people who don’t know you could spend 30 grand on your teeth.

Uchenna Okoye: Yeah, I had somebody today actually.

Payman Langroud…: Did you?

Uchenna Okoye: And I was so angry in fact that I was going to do a video about it, where this woman had juvenile periodontitis, she’s been wearing a partial denture since she was 21. She’s head downcast, doesn’t smile, saw me on the show, wants to come and see what can be done. She’s lost her job, she’s an office worker, she hasn’t got a lot of money. And I’m just like, “But has nobody talked to you about implants?” She was like, “No.” But she has tried inquiring with her dentist, but he kind of said that it was really expensive and she shouldn’t bother. And she’s divorced, and she’s just hasn’t had a new relationship because she doesn’t want to have to address that thing.

Uchenna Okoye: So then, she’s like, “How much is it going to be? What do you think?” And I’m like, “Well…” I mean, I used the analogy of a car, because she had no idea. And I said, “If I told you it was going to be like a car.” And she kind of looked at me in shock. And I said, “You should ask me what kind of car.” And we had a laugh about that. And then I said, “If it’s going to be 25, £30,000.” And she was like, “Oh, my God, I don’t have that. How can I?” And then I said to her, “Look, even the so-called celebs. Nobody has money. I don’t have that money. Everybody uses finance.” And she was like, “Oh, I can do finance? Really?” And the conversation just changed. I mean, I guess that comes with confidence. But to me I was angry on her behalf at this person that judged her.

Payman Langroud…: No one had ever told her anything.

Uchenna Okoye: Yeah, no one told her. So, she’s going to go ahead and have treatment. I mean, I’ll be referring her, so it’s not that I’m keeping the money or anything like that. But I’m just like, “Oh, my God, you’ve been wearing a denture since you were 21.” And I guess that’s part of the thing of the passion. And I’m like, “If you were my sister”, I was like, “You have to have implants. I’m not going to make you a new denture, you have to.” And she’s going to do that because that’s just the best thing for her really, it’ll make such a difference to her life.

Payman Langroud…: You’ve done a lot of the Spear.

Uchenna Okoye: Yeah, I love Spear.

Payman Langroud…: Tell us about that. I mean, if I’m a young dentist who wants to be like you, is it a good idea?

Uchenna Okoye: 100%.

Payman Langroud…: And how soon and how quick and how much?

Uchenna Okoye: I mean, all the Spear courses like the workshops are about $10,000. And the thing that I will-

Payman Langroud…: Each?

Uchenna Okoye: Yeah, yeah. And the thing I will say, because I still remember, because I started with Larry, I’m part of the Larry groupies.

Payman Langroud…: Me too.

Uchenna Okoye: I love Larry.

Payman Langroud…: That’s where the car thing comes from.

Uchenna Okoye: Yes. And so, honestly I remember paying for this with my credit cards, not knowing if the cards would work or not, that kind of thing. So, a lot of people… and I have to say, this is me. I’m not saying this is what other people should do. I admire people that sit there, and they work on a plan, and they save up, and that is seriously the best thing to do. But I didn’t want to wait. I just had this thirst for knowledge. So, I did all my things in America. I didn’t want to be in England because he was there and it was a totally different experience. So, I did that. I did all of Pete Dawson’s stuff.

Payman Langroud…: Did you? Did you?

Uchenna Okoye: I did the whole thing up to master’s. And then Frank, oh my God, he is just amazing. Teaching occlusions so that literally it’s like, “Yeah, they’re just these dots here. And if you get the dots around here then occlusion starts.” I mean, I know I’m exaggerating, but it was really there. And Scottsdale’s an amazing facility. And every time I just love it. And there’s [Garridy] Wood. And it’s just such a great.

Payman Langroud…: Because I don’t know anything about… I mean, I’ve spoken to people who do it, but I’ve never been there. But I’ve seen pictures, yeah? But how do they keep people coming back and spending another 10 grand? I mean, is it the quality of the teaching is so amazing that the penny drops and you’re like, “I need more”?

Uchenna Okoye: Yeah, absolutely. Because even me, I’ve been doing Spear for 10 years, more than 10 years, maybe 12, 14. And I’m still spending 10k on new courses that are evolving. And it’s the combination, it’s a safe space to learn, it’s a great place to be away and to learn, the quality of the education.

Uchenna Okoye: I mean the Kois, I know that there are people like Scheniqua loved Kois, and I’ve never actually heard him. But both Kois and Spear used to work together. And like lots of boys you all go and fight with each other and things happen. But it just means that there’s even more choice for people.

Uchenna Okoye: So, I would say to somebody, “Hone your craft. Do your dentistry at least two, three years before you start jumping into all these courses and all the stuff.” Because you… I remember, actually I think it was about a year or two years after dental school, I did the Mike Wise course.

Payman Langroud…: Oh, well done.

Uchenna Okoye: Well, it was a waste of time and money. I didn’t know what the hell… I didn’t know what they were talking about.

Payman Langroud…: It was like another planet, yeah.

Uchenna Okoye: It was just… And I was at the course at the same time as Koray I think. And it was like way… I mean, it was good because it started me on that journey. But I’d have gotten more out of it if I’d waited a little, done a couple of years of things failing.

Payman Langroud…: So, how much of your work is the simple align, bleach, bond type? How much of it is porcelain aesthetics? And then how much of it is the full-mouth rehab, that kind of work?

Uchenna Okoye: See, I so desperately want to do align, bleach and bond. It would be so much better for my back. But I was saying to somebody that my niche is middle-aged menopausal women like myself. So, their mouths are complicated. So, it’s all multi-disciplinary. So, if I’m doing all my Invisalign is comprehensive, it’s part of implants, it’s part of whatever else.

Payman Langroud…: Do you place implants as well?

Uchenna Okoye: Oh, God, no. I hate implants. Ugh. Meccano. No, no. I send implants out. Fillings I do.

Payman Langroud…: To Koray?

Uchenna Okoye: Yeah. So, to various people. Each time I keep thinking I should get somebody in-house, but I quite like it being somebody else’s problem. So, bread and butter dentistry for me generally tends to be part of bigger treatments. So, I’m still doing the fillings and all the rest of it. Although at the moment I’m probably thinking of getting an associate so that I can have somebody a day or two a week that I can do, because all the plans take so long to do.

Payman Langroud…: How do you handle the fact that people want to see you, and they don’t want to see your associates? I mean, how many practises are you on now?

Uchenna Okoye: Two.

Payman Langroud…: You were three at one point, right?

Uchenna Okoye: Yeah, but that one, so the Harley Street one is kind of the best day of my week, I just sit there and chat to people.

Payman Langroud…: So, you’ve got [inaudible 00:48:56]. I remember Jasmine used to work for you as well.

Uchenna Okoye: Yeah, yeah. She’s.

Payman Langroud…: So, how do you get round that issue of people who want to be seen by you? Are you able to deflect them into associates, or is that not…

Uchenna Okoye: No, it’s fine. So, I did a thing which I learned from I think it was Frank. I don’t know if it was Frank or Garry, where so all your guests initially I see first. Because what I was finding was like maybe they were having routine treatment, then I might see them for something, and then I’d be like, “Oh, have you thought about having braces?” And then he’s like, “Oh, really?” And then it’s that kind of thing. Whereas, I guess I have the confidence to do that, so it became a thing. And I learned it from somebody, I didn’t think of it. So, everybody walks in and I see them. And then I’m like, “Okay, you’re going to go and see this person, or you’re going to go and do that.” And it’s fine. And I think for me they don’t know any better. It’s a matter of fact. It’s like this is how we do it here, and they trust me, so they’re okay with it. As long as it’s in-house, they don’t like going out, which sometimes can be a problem, they want to just stay in, because then it means that-

Payman Langroud…: Is the price the same if you do a veneer and if one of your associates does a veneer, is the price the same?

Uchenna Okoye: Yeah. I don’t do the two-tier thing. We’re the same, yeah.

Payman Langroud…: I like that. So now you’re a single mum.

Uchenna Okoye: Yeah.

Payman Langroud…: Tell us that story.

Uchenna Okoye: Yeah. That’s actually the hardest thing that I’m doing right now. And maybe if I was a mum earlier, I don’t… no, it would have been okay. But I’m a late mum not by choice. You assume it’s going to work, and it didn’t. But she’s awesome. She’s the best thing ever. But it’s hard. It’s hard because you’re constantly juggling. You just don’t switch off. You’re here, you’re there, you’re trying to…

Uchenna Okoye: I remember, this is funny, so we were filming, and it was in the middle of filming, and so I have to have my phone with me because I don’t know what’s happening with her. And something happened with the nanny, so I’m seeing the person, the camera’s there, the phone’s here, I’m texting trying to find another babysitter. In the end I had to say, “Look, you guys need to down tools.” And they had to bring her to the surgery, and then a babysitter came and took her home, because we were running late and it was just… So, that’s just the nature of how things are.

Uchenna Okoye: And it’s nice now because I think people are more forgiving. So, one of my first ever mentors, Linda Greenwall, I know you’ve had Linda. And she’s so inspiring. And I still remember her, she opened her practise a few days after she’d given birth, and the kids were there. And that’s way ahead of her time. That can happen now, but in those days that just was not.

Payman Langroud…: She’s a superwoman with four kids.

Uchenna Okoye: Oh, hugely.

Payman Langroud…: And then everything else. Tell me about being a single mum. I mean, it must be difficult, right? So, you must rely heavily on nannies and the like?

Uchenna Okoye: It is hard. And some days you just think what’s the point, where… So, we’ve just finished filming, and for a week I didn’t see her.

Payman Langroud…: Wow.

Uchenna Okoye: And I would leave at 6:00 in the morning, and I’d get back and she’d be asleep. And so, it’s quite off-putting finally actually on the Saturday of that week when she comes in. Because what I used to do was I’d leave a note and a present. And she was really disappointed that I was there. “Oh, no present today, mummy?”

Uchenna Okoye: But I think that’s one of the thing where you talk about women, men, type thing. Is a feeling of guilt. I feel like I’m guilty of stuff all the time. Patients are hounding me because I haven’t done their treatment plan, or I’m supposed to do appraisals or something with team. Or the other day there was something I was supposed to have put in her schoolbag that I forgot about, so I’m like, “I’ve failed there.” Or at the school gate and she’s refusing to go to school, so now I’m like, “They’re all judging me because I don’t drop her off enough here, and that’s why she’s clinging to me like a limpet and she won’t go.”

Uchenna Okoye: But the nice thing about doing it as a late mum, is that there isn’t anything else I’d rather be doing. It’s just she’s amazing. She’s my world. And because she was chosen, so she calls me, I’m her heart mummy, because she was adopted. Yeah, that makes it all… Every time I want to moan to a friend, they’re like, “You know you chose this? You wanted this, enjoy it.” So, I’m trying to. But it’s the most rewarding thing. So yeah, love it.

Uchenna Okoye: Yeah, I love my life. I love everything I’m doing. I mean I think it’s hard. It’s so hard. There’s some days that you’re just like, “What’s the point of this? There’s only one of me.” But there isn’t anything that I would drop. I just feel beyond blessed. It is hard work, and it’s constant. And sometimes people say things like, “You’re so lucky.”

Uchenna Okoye: There were days, I remember the early days that I would literally, I’m not kidding, sleep in the surgery. It’d be like 2:00 in the morning, and there’s no point going home, and I would, I have a shower here, [inaudible] now, and you just wished I had a flat upstairs because you just so much work to do and all that kind of stuff. And you just do what you have to do. But I’ve always had that kind of work ethic. You just have to do what you have to do.

Prav Solanki: What’s the typical day for you, Uchenna? Day in the life. What time do you wake up? How does it all start? How long are you at work?

Uchenna Okoye: Yeah. Typical day. Normally wake up about 5:00, so if I’m asleep at around 6:00 that’s a lie-in and I feel behind. So, I wake up, I’m a Christian so I pray, I try and stretch because my back is having issues. And if I’m lucky I can do all that. If I’m unlucky, a little person comes in. She’s an early bird, so she normally wakes up between 5:30 and 6:00 as well. So, right at the moment we will spend about half an hour together, so she’d be reading or I’d be reading to her. She generally just wants to watch something, but I don’t let her. And then I will leave home about 7:00, quarter past seven, come to the practise. I like to have the first hour for myself, so to just catch up on stuff and determine what’s-

Payman Langroud…: But does the nanny come in at that point or does she live with you?

Uchenna Okoye: No, do you know, COVID has made me more resilient. Because before that I’m like, “I don’t want anybody living with me and all the rest of it.” The nanny used to come in. But me and a four-year-old for all those months, I’m sorry, it was hell, I cannot lie. It was just so hard. And because she was so little she wouldn’t leave me alone. There was all these people having all these conference calls and all the CPD things, I didn’t get to do any of that at all, I was so jealous. So, she lives with… she’s in there with me, so that’s really helped.

Uchenna Okoye: So, I leave, I come here. We have a morning huddle. Normally the team would have sent me the night before, we do what’s called a day list, so my nurses write, I have a list of things, the occupation, what happened the last time they came in, what they’re coming in for today, any problems. So, I read first beforehand. Then we have a morning huddle, and then the day starts. And each day is different. Sometimes-

Payman Langroud…: And what time do you get home again?

Uchenna Okoye: Now I try and get home by 6:30. So, my job is to… it’s funny how I’ve changed. I used to be like, “I have to get home in time to give her her bath.” But that’s actually really boring, and I’m tired. So now the nanny does the bath, and I read the stories and put her to bed, and then collapse.

Payman Langroud…: And what time do you go to bed?

Uchenna Okoye: Usually about midnight.

Payman Langroud…: Wow.

Uchenna Okoye: Yeah, so.

Prav Solanki: Midnight to 5:00 AM?

Uchenna Okoye: Yeah.

Payman Langroud…: Every day?

Uchenna Okoye: Well, my dad growing up. Yeah, I’ve always done that. My dad used to say sleep was practising death.

Payman Langroud…: Yeah, I agree.

Uchenna Okoye: So, you have eternity to sleep. So, we’ve always in my house growing up, no matter what time you went to bed, 6:00 AM, morning prayers, everybody’s dressed, seated round for breakfast kind of thing. So, friends didn’t like coming to my house.

Payman Langroud…: Uchenna, I’ve got a couple of other things I want to address with you. Correct me if I’m wrong, but you’re a very, very strict boss, right?

Uchenna Okoye: Oh, terribly so. I’m told I… well, I know that you know that I’m known for that.

Payman Langroud…: Yeah, yeah. But tell us about… The last time I asked you this was a while ago, but you went, “Yeah, I’m a dictator.”

Uchenna Okoye: No, no, I’ve been told I’m a dictator. I don’t.

Payman Langroud…: It’s hard work. Maybe it’s that Nigerian work ethic thing. That to you might seem like a normal, but you’ve got very high standards.

Uchenna Okoye: Yeah.

Payman Langroud…: And people do it exactly as you tell them to do it or they’re out.

Uchenna Okoye: Yeah.

Payman Langroud…: Not even denying it.

Uchenna Okoye: No, I’m not. What I say is I honestly, the God’s honest truth is, I could not afford to see me. I could not afford to be treated by me right now. So, somebody’s coming in for, and they’re going to spend 20 grand, even if it’s five grand, they’re people that have saved for years to even get something like whitening, we have to be on our game. You can’t come in and say, “Oh, the reception was perfectly pristine, it’s just that one moment with that one patient.” Because that’s their experience. And part of why I’m like that is how I was at dental school. So, I don’t want the control thing. And the problem is people come in and they don’t realise that it’s for their benefit. So, I have a new nurse say, the trainee or whoever, and I’m like, “Look, you need to do this and this and this.” Because if you’ve prepared and there’s a problem, you can address a problem. Hopefully you’ve over-prepared, so there’s not going to be that problem.

Payman Langroud…: I get the military side of it.

Uchenna Okoye: Yeah.

Payman Langroud…: Of course, yeah? But the bit I don’t understand is that the staff have to be super happy in this high-end place, right? Because you want to be happy for the patients. And how do you manage that tension between bloody strict boss and happy staff? And you’re going to tell me some people want that, right? And you… Yeah.

Uchenna Okoye: Yeah, yeah. It’s finding that. It’s difficult. I think it was one of the team talked about… Like Patty Jameson talks about a championship team, and we used the analogy of Team GB. You want to be part of the Olympic team. There are thousands of great sprinters, and just think of how many people they have to get through to pick the people that are going to be in the team. And I consider us as Team GB.

Uchenna Okoye: I mean, I am the best boss from a nurturing, I notice if people are poorly and I will look after you and all that kind of stuff. What the problem is that, I now know that the term is emotional intelligence, being able to separate the loving, kind Uchenna that will lend us lots of money and take us to America and whatever. With the Uchenna who’s like, “Okay, right, it’s time to deliver what we need to now.” And that’s often hard. And yeah, it’s work ethic.

Uchenna Okoye: I remember saying to one of the girls, and we were talking about me growing up for example. So, I failed my A-levels, so I had to resit my A-levels. And my parents didn’t have the money to send me to a Crammer’s college, because I had read that that’s where to go to get the best learning to do it again. And I was here with my brothers and sisters, so I was looking after them. I would wake up in the morning about 3:00 AM, get on the night bus, it was the bus 25, at that point I was working in the warehouse in Harrods, so I chose well. So, the bus would go from Ilford to Harrods. I would do the job there, I would go to school, I would finish, I’d go home, cook for everybody, put them to bed, then I’d go and I had a cleaning job in Tesco’s, which I would then do in the evening.

Uchenna Okoye: So yes, I get it, that I have a really strong work ethic and not everybody aspires to or understands. But I make it very clear that this is what you’re singing up to. And sometimes people say, “Do you actually want me to work here?” And I’m like, “Yeah, but if you’re going to go to Oxford and Cambridge, you know what you’re up against. You don’t have to come to Oxford and Cambridge, you can go somewhere else. But if you want to join us, it’s not easy. And I know that it’s not easy.” So yeah, I don’t know, does that make me an evil witch?

Payman Langroud…: Yeah, yeah. It does, yeah.

Uchenna Okoye: But I love the fact that, because just for the listeners you had… was it a nurse or receptionist? Who was the person that used to work for me that came and worked with you?

Payman Langroud…: I think it was an ex-nurse of mine who came to see you for a while, something like that.

Uchenna Okoye: Yeah, but then it made me really happy that you turned round and you said, from talking to her and from working with her, that I walked the walk and didn’t just talk the talk. So, when she came to you and she was talking about guests.

Payman Langroud…: Yeah, yeah. Oh, that one. Yeah. It was a different one. That was a different one. That was the one who came from you to me.

Uchenna Okoye: Yeah.

Payman Langroud…: Yeah, yeah, that’s right. One other question. Look, I’ve always maintained you’re particularly strong om marketing, and you always claim you’re not and all that. But you certainly, I mean in the print age and the TV and print age, you’ve dominated. I mean absolutely dominated. You really were maybe the highest profile dentist in the country. Now that we’re in the internet age and the social media age, and we can see all these youngsters dominating because they’re… I mentioned Shaadi before, I don’t know if you’ve come across her, she started her TikTok account in lockdown, yeah? In lockdown. Now has 100,000 followers.

Uchenna Okoye: Oh, wow.

Payman Langroud…: And TikTok is that kind of platform. It’s got massive reach. What I’m saying… By the way, I don’t know anything about it myself. But my question is, how have you transitioned? Do you think marketing’s less important than it was before? Have you transitioned? I myself have a chasm, yeah? While Prav became one of the most important marketeers in dentistry because he’d mastered Google, I myself had a problem when we went from print to digital. I was very good at the Joop age spread ads in dentistry magazine, and then when it came to digital I didn’t know what the hell to do.

Uchenna Okoye: Yeah. I think marketing… they’re coming for me, the police. Is vital actually, especially in this day and age. I don’t think you can fight it. The world has changed. It’s just like, “Just embrace it.” I mean for me, I love Instagram. It’s like this black hole that you can just get sucked into, so you need to be careful. And I recognise if I’m feeling insecure and bad about myself, stay away from Instagram because it just makes you feel worse because everybody just best.

Payman Langroud…: It’s the highlight reel isn’t it?

Uchenna Okoye: Yeah. And for me it’s interesting, because I treat all these journalists and people are sitting there, and maybe they’ve just finished sobbing in my chair, they’ve just had a breakup, they look rubbish. And then you just see, “Hi.” And it’s just 10 minutes later and I’m like, “This is so fake.” But as long as people are aware of that. But the thing about the digital age is it’s allowed… There are people that I’ve met that I could never have met, whether they’re in Egypt or Syria or whatever the case may be. So, it’s made the world a smaller place.

Uchenna Okoye: How have I adapted? I think the thing I find challenging is just finding the time. It’s finding the time to do the things, to learn how to do it. I’ve dabbled in having other people do stuff, but it’s never the same, it’s not authentic, it needs to be my voice. And I’ve learned, I like doing lives because people are there. It’s a bit like this, you’re just chatting to them and you don’t have to do all this hashtag type stuff.

Payman Langroud…: It’s interesting because a lot of people are very uncomfortable in lives. I am myself. But I’ve noticed you’re living all the time.

Uchenna Okoye: Yeah, I like live. But I don’t know why you don’t like lives, because looking at you, you’re doing great.

Payman Langroud…: No, because this is audio, yeah? If this was video I’d be like…

Uchenna Okoye: Really? [inaudible 01:08:13], you’d be good at it. Yeah, I don’t mind that, because I can… I guess that’s why I do the TV well, because I can switch off. I can forget that there’s a camera there because I’m so interested in the person that I’m engaging in. And also, I now realised that I’m taking it much more seriously because it is actually starting to bring patients, which it didn’t before, not my kind of patients, number one.

Uchenna Okoye: And then the DM thing is amazing. I mean sometimes I think I give people too much free info. Because people are asking me questions and I’m like, “You need to ask your dentist to do blah, blah, blah.” So, somebody yesterday was like, “Thank you so much.” She started Invisalign, she’s up somewhere in Scotland, “And you encouraged me to do it, and I just wanted to let you know it’s going well.” So, that’s-

Payman Langroud…: I think there’s a massive opportunity for someone like you, yeah? In terms of the multiplatform story. So, if someone’s seen you on TV, then DMs you on the mobile, that is a different level of engagement, in terms of awareness engagement, than someone who’s only found you on the internet. And so, there’s a massive opportunity. And then the other side to it is what you just said, that clearly you’re comfortable talking to the camera, which I’d say 95% of people.

Prav Solanki: Are not.

Payman Langroud…: 99% of people, are not. I’m certainly. I don’t pick up the mobile and start talking to it, I just don’t do that, man. Prav does, right? But those two things. The fact that you’re comfortable talking to the camera, and the fact that you’re on other media, makes it just a really important thing for you to go all-in on I think.

Uchenna Okoye: I mean I guess for me, the USP has always been about education. I don’t want people to feel about the dental experience the way that I do, because I hate it, everything to do about dentistry is just awful. So, it’s kind of to empower people, to give them knowledge, to be able to make their own informed decisions. Because you’ll notice on my Insta, I’m not a tooth-posting dentist.

Payman Langroud…: Why is that?

Uchenna Okoye: Because that’s not what… I mean I can’t say that’s not what I’m interested in or whatever. But my thing is, I would hope that people would know that if they were going to come and see me, that the work would be okay, that it would be good work. So, I might be wrong, I don’t know. Maybe I should be posting more stuff.

Payman Langroud…: You should, because they work well, that’s the thing.

Uchenna Okoye: They what? Do what?

Payman Langroud…: They work. They work really well, the before and afters.

Uchenna Okoye: Yeah. And also, I judge. I’m like, “Nothing is good enough to post.” There’s that aspect as well.

Payman Langroud…: That perfection paralysis thing, that’s a whole story of its own. So, Uchenna, you listen to this podcast don’t you? Tell me you listen.

Uchenna Okoye: Yes, I do.

Payman Langroud…: Oh, thanks.

Uchenna Okoye: I do, it’s very good actually. The other day I sent a DM to… you did one with [Kunal 01:11:25], and I loved his story about Prague. I was like, “I didn’t know this about you. Oh, my God.”

Payman Langroud…: Yeah. So, Prav likes to end it on his question.

Prav Solanki: So, Uchenna.

Uchenna Okoye: Said very much, Prav. Sorry.

Prav Solanki: Pardon?

Uchenna Okoye: I said we’ve been wittering on without you.

Prav Solanki: I’ve been listening. I’ve been listening.

Payman Langroud…: You know he’s been dieting, he’s not eating for 21 days, you know this?

Uchenna Okoye: No. Really?

Payman Langroud…: He’s… yeah.

Prav Solanki: Yeah, I’ve not had a meal in nine days.

Uchenna Okoye: Why?

Prav Solanki: It’s just something I’m giving a go.

Payman Langroud…: It’s what he does.

Prav Solanki: It’s a 21-day fasting challenge. So, no food, just black coffee, water, electrolytes, salts.

Uchenna Okoye: Are you sure coffee is meant to be part of it?

Prav Solanki: Black coffee’s good.

Uchenna Okoye: Ah.

Payman Langroud…: He’s done a lot of research into it.

Prav Solanki: Yeah.

Uchenna Okoye: But do you feel good? How do you feel?

Prav Solanki: I feel fantastic. About this time of day over the last couple of days I start flagging, start feeling tired. But other than that I’m feeling great. I’m productive at work, I’m still training in the gym.

Uchenna Okoye: Maybe I should try it.

Prav Solanki: After day three it becomes really easy.

Uchenna Okoye: Really? Okay.

Prav Solanki: Yeah. Hunger just disappears.

Uchenna Okoye: Really?

Prav Solanki: Completely disappears.

Payman Langroud…: But he has a lot of vitamins and things, I don’t know if that helps.

Uchenna Okoye: Okay.

Prav Solanki: It doesn’t help with the hunger thing.

Payman Langroud…: Does it not?

Prav Solanki: No. No, no, not at all. But it helps with the fact that I’m not going to be nutritionally…

Payman Langroud…: Challenged.

Prav Solanki: Challenged, yeah, yeah. So, makes sure I get all my vitamins, minerals. The main thing is the salts. If you don’t have the salts, you don’t have the magnesium, your neurons are not firing, you start cramping up, all that. And that’s what I did. The first time I did it I really messed up, right? So, now I’m drinking six to seven litres of water a day, 10 to 12 salt capsules. My vitamins are all packed in here so I just rattle my way through them throughout the day. And it just works.

Uchenna Okoye: Oh, can you send me details? I’d love to try it.

Prav Solanki: Absolutely. Yeah, no problem.

Uchenna Okoye: Okay.

Prav Solanki: I’m actually at the end of this 21-day fast I’m going to write a blog, because I’ve had so many questions about the supplementation, about the process, the mindset, and the reasons that I do it, yeah? And the reasons that I do it are multifactorial, right? So, on one of them is building mental resilience and mental toughness, and the fact that if I can function and go without food for 21 days, then it opens my mindset up to other challenges, right? And also, when I get smaller challenges in life, then I should be able to handle them quite easily. So, a part of it is about… And then the other part of it is I’m probably a little bit crazy as well.

Prav Solanki: But Uchenna, onto more important things, which is the final question. Imagine it’s your last day on the planet, and your little one, or not so little one at this time is next to you. And you’ve got to part giving three pieces of advice. What would they be?

Uchenna Okoye: Oh, yeah. Three pieces of advice. I’d say stay in your lane. Just be you. I know it’s that thing of just be you.

Prav Solanki: Focus on yourself.

Uchenna Okoye: Yeah. Well, it’s not even focus on yourself, but just be the best that you can be, rather than trying to please anybody else, because you never will. So, just be true to yourself, listen to your gut. Which I’ve not been very good at, but I’m getting better. Surround yourself with positive people. That’s so important. People that will lift you up, that will encourage you. Yeah. I don’t know. I guess the last thing would probably be, a bit of my mantra, which is from the bible, which is nothing is impossible with God. So, if you just try it, and even if… That for me there’s no such thing as failure, it’s just another opportunity to do the thing better.

Prav Solanki: Of course.

Uchenna Okoye: So yeah, I don’t know if that answers the question?

Prav Solanki: It does, it does. And just to finish that off, Uchenna, how would you like to be remembered? Uchenna was…

Uchenna Okoye: Uchenna made a difference. At the end of the day that’s the thing I want on my tombstone. Whether it’s a difference with the patients that you’ve affected, with the team. It’s funny being really tough. I get team that have left all the time sending me letters saying, “Oh, now I understand what you were trying to get me to do 10 years ago.” Or family, friends, kind of thing.

Uchenna Okoye: But I lost my sister about five years ago unfortunately. She’s like my best friend and it just came out of nowhere, and it really helped… you realise that when all’s said and done, all you have is the memories of the things you did, the people you touched, and nothing else matters. It’s that. So yeah, that’s what I’d tell my daughter as well. Make good memories

Payman Langroud…: Did you question your belief at that point?

Uchenna Okoye: No, not at all. I mean I was angry. I was angry with God because I just didn’t… She I would say was the heart of us. She was the best of us. And even now… people say it gets better with time, but it doesn’t, you just… I feel, just thinking about her. Because she helped run the practise for a while, so whenever I’m here there’s always reminders of her. But you just get used to the whole being there all the time. So, I just have to trust that God knows why, and when I get to heaven I’ll find out.

Uchenna Okoye: But yeah, I would never be like, “Oh, it was for the best or whatever.” Because it was pants. It was horrible. And she was gone too soon, and it was hard. But I still trust Him. And just like a parent isn’t it? That’s the whole premise of a relationship, or my relationship with God, in that in the same ways my daughter will get upset with me, deep down she knows I love her, she knows it’s for her best, and she has that trust whether she likes what I’m doing to her or not.

Payman Langroud…: Yeah, that’s really well answered. Thank you so much for doing this.

Prav Solanki: Thank you.

Uchenna Okoye: [inaudible] been on the phone for an hour and a half.

Payman Langroud…: I knew you’d be good at this. We’ve always enjoyed talking to you. Maybe that’s the reason why Prav couldn’t get a word in. Hopefully when times are a bit better we can have a nice drink together or a dinner together.

Uchenna Okoye: Yeah, I miss your parties.

Payman Langroud…: Yeah, exactly.

Uchenna Okoye: Yeah. And it’s nice to see you, Prav. I think you guys are doing a really… this is my favourite podcast I have to say, because-

Payman Langroud…: Oh, thank you.

Uchenna Okoye: No, it’s true. Because it gives a different insight. There are very few, in fact I can’t think of any that’s not just about not dental-based. I think the thing that we as dentists need is to just try and get to know each other a little bit better and forget… I mean there’s enough teeth. I don’t understand the jealousy and all that nonsense. There’s enough teeth for everybody. It’s just like support one another and just build each other up. So, thank you, keep on keeping on.

Prav Solanki: Cheers. Thanks a lot.

Payman Langroud…: Lovely to have you, Uchenna. Thanks a lot.

Outro Voice: 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 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.

Prav Solanki: And don’t forget our six star rating.

 

Less than two years into his career, this week’s guest was on his way to being one of dentistry’s finest.

But Tom Youngs had other callings.

At age 28, he left dentistry to pursue ski instruction and life as an unpaid intern in tech startups.

Tom now works as a website analyst while developing his own online sustainable beauty business. He shares his story, regrets, wins and words of wisdom for anyone who’s ever wondered if there is life after dentistry.   

“I kind of was like, okay, I’d like to go onto the next thing.”  – Tom Youngs

In This Episode

03.31 – Two degrees
07.48 – Into VT and ‘underground’ dentistry
13.38 – Aspiration and achievement
19.29 – The move from clinical
37.52 – Time for reflection
42.22 – Entrepreneurialism
48.39 – Regrets
53.53 – A day in the life
57.20 – Last day and legacy

About Tom Youngs

Former biomedical scientist Tom Youngs spent two years in dentistry before moving into tech entrepreneurship.

He now works in eCommerce and is developing  Vyable Beauty – an online sustainable beauty products retailer.

He runs a successful YouTube channel and writes a monthly newsletter at www.tomyoungs.co.

 

 

Tom: … experience. Experience this world. This world is an incredibly beautiful and rich piece of rock in this universe. You have the opportunity you’ve been given to be a part of this existence, don’t waste it. Experience as much as you can. Experience it with as many people as you can. Don’t feel like you’re trapped in a bubble. Get outside your bubble and live a rich, fully experienced life.

Intro Voice: 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.

Tom: Langroudi, Prav, man. How’s it going, mate? Good to be here.

Prav: I’m good, mate. How are you, Tom? You okay?

Tom: Oh mate, I’m stunning. Absolutely, so privileged to meet you. I’ve heard so much about you. And it’s yeah, I’m actually buzzing to have a chat and speak to you boys.

Prav: Awesome.

Tom: How are you doing, mate? And congratulations on your weight loss, by the way.

Prav: Oh, thank you. Thank you, mate.

Payman: He’s in the middle of a 21-day fast right now.

Tom: Oh, fuck.

Payman: But I didn’t really realise, Prav-

Tom: Are you actually serious? How many days are you on?

Prav: Well, my day nine now.

Tom: Oh mate.

Payman: When you called me, Prav, when you called me and said, “Are you in a restaurant?” I forgot you were bloody fasting.

Prav: Makes no difference, mate. Makes absolutely no difference at this stage.

Tom: Oh my God, are you all right? Pay, do we have to be a bit worried that he’s going to throw a brick through our screens at some point?

Prav: No, mate. I haven’t gotten the hungries or anything, mate. I’m absolutely fine.

Tom: Mate, fair play. That is incredible. Yeah. Definitely some-

Payman: You know what, Prav? You know what happened yesterday? I gave Alex his breakfast, quite a big breakfast, yeah?

Tom: Of course, of course.

Payman: Two eggs, smoked salmon, the whole thing. And then he was going to school at one o’clock and he goes, “Should I eat again?” I said, “What do you mean? Just had a massive breakfast.” He goes, “Yeah, but I’m not going to eat till six.” I said, “Think about Prav.” And he looked at me and went, “Yeah.” [inaudible 00:02:10]. Is there a life after dentistry? I’ve got the great pleasure of inviting Tom Youngs onto the podcast. I go back a long way with Tom. I remember him … Was it pre-qualifying, Tom?

Tom: Do you know what? I actually think it was just after qualifying, just after qualifying. Obviously, I was very aware and familiar with you, but yeah, I think we only met right just after qualifying.

Payman: Yeah. So the question’s been coming up a lot in dental circles about if you do leave dentistry, what’s life like afterwards, does your dental degree get you anywhere? And I’m sure we’ll get to it, but Tom’s story is an interesting one because from my perspective, a super engaged dentist. I mean, someone had a fantastic future ahead of him in dentistry. I think you designed your own instruments. He was very, very into dentistry.

Payman: We went to AACD together in America, but then decided to leave and pursue other things. And so traditionally people would think maybe people who leave dentistry just hate teeth, but that certainly wasn’t Tom’s situation. So it;s really good to have you. Tom, give us the backstory first. I mean, dentistry was your second degree, wasn’t it?

Tom: It was my second degree. Firstly, I would just like to say it’s an absolute privilege to speak to you guys. I’ve known you for probably like five or six years. No, it is probably longer than that now. About seven years. I’ve travelled all over the world with you. I’ve got to know you extremely closely. I look towards you as probably definitely somewhat as a mentor. And I know we’ll dig into this a little bit, but probably one of my main inspirations for actually making that leap out of clinical work. So yeah-

Payman: Oh blood hell.

Tom: … preface that by saying it’s a privilege for me to be here. And I’m really looking forward to digging into some stuff and talking about kind of the backstory behind things. But I think the phrase that you were looking for, you were digging around for it. But I think if you asked my friends that knew me from dentistry, they would call me a turbo dog when it came to dentistry. I was absolutely, as a lot of the guys that have been on this podcast have been as well, complete insane … Passion isn’t even a word. It’s like an obsession, is the word. And I was there, and I was for a few years, I was seeing the crystals of enamel as being the only thing that was the light at the end of the tunnel, which now I’ve kind of had the opportunity to take a step away from things. It seems like there’s more to life than enamel, which is kind of crazy.

Payman: When you did your first degree, what made you then choose to do dentistry? What was your first degree?

Tom: So yes, my first degree, probably similar to a lot of people … Or maybe not a lot of people actually, as post-grad dentistry is now kind of difficult in this country, to get into, but it was biomedical sciences. So probably best to start from a scratch. I went into dentistry originally because my parents were both medics. They were both in the medical profession and I grew up knowing medicine as the only thing, as probably a lot of people can relate to, like the only career path possible. There was nothing out there apart from obviously you wanted to be a professional footballer until the age of six. And when I realised I just had absolutely no talent, realised that, okay, my dad seems to have a good job. My mom seems to have a good job. They both seem really happy. They’re able to provide a really fantastic life for myself and my siblings. And I was like yeah, mad keen on being a surgeon as my dad was.

Tom: So initially, my path towards that was actually to do medicine. And I did my GCSCs, did absolutely shite. There was no opportunity to get into medicine, first off. So went into biomedical sciences. And during the process doing biomed in Dundee in Scotland, my dad was like, “Look, I don’t know if medicine is the right path for you to go down.”

Tom: All of my dentist mates, who had a few dentists mates, seemed to have a better lifestyle, much more balanced, less stressful, which is kind of ironic as I expect we’ll talk about that. I think both medics and dentists look at each other and they think, “Oh my God, you guys have got the most stressful job ever,” or. “We’ve got a more stressful job.” I think at different times of the day, that probably comes and goes.

Tom: But yeah, it was biomedical sciences. And my dad was like, “Look, consider this.” So I went and shadowed my dentist, my dentist back at home. And was like yeah, cool. Let’s do this. This seems like a much more logical path to where I wanted to get to, which is using my hands. Like I always wanted to do the surgery side of things. I was like, so medicine, it seemed to be, if you’re going to be a surgeon, good luck. You’re going to have to wait 10 years before you can be a surgeon. Dentist, you’re a surgeon from day one, mate.

Tom: So yeah. I was like, okay, yeah. Let’s do this. Applied, was very lucky to get into a few places. And I can’t say enough about the experience that I had at Peninsula down in [Ecsta] and Plymouth. And the experience I had that was phenomenal. The facilitator they have, the professors, everything about that course I thought was A-star. Had a fantastic time there. I felt so well equipped when I went into VT.

Prav: And then where did you go from there, Tom? So you went into VT. Tell us about your VT experience. And I’ll just go a couple of steps ahead of that, because when speaking to Payman before about this and actually speaking to Payman about you before, he said to me, “Look, there was a time in dentistry where there was some leading lights, some young up and coming amazing dentists.” And always turned to Payman, I know dentistry in terms of, I can look at a set of teeth that a dentist has done and say, “Wow, that looks really good.” And I can tell good from bad, right? I think Payman’s got a better eye and he can tell good from great or great from excellent.

Prav: And one of the things he said to me is, “This guy’s dentistry is on a completely … He is amazing. He’s excellent.” Right? So just talk me through your journey from VT to becoming this dentist in the short space of time that was able to deliver what someone like Payman would consider to be an excellent standard of dentistry? And then obviously from there onwards, we can talk about what happened next.

Tom: Yeah, cheers. Yeah. I really appreciate that. Yeah, I think that probably stems from within the first year or so of dental school, I really felt like for the first time in my life that I found something that I felt like I could excel in. I really felt like this is something that you got out what you put in. And I seemed to be doing well within the actual course. And I was at a course with people that graduated from Oxford, Cambridge, and I was somehow doing better than them. And I was like, shit. Okay. Well, I’ve probably got a chance here. I’ve got a chance to be good.

Tom: That’s something that’s probably stayed with me my whole life, is that I’ve always wanted to be the best at what I’m doing. Like no matter what it was. So when I left dental school, kind of graduated towards the top of our class and felt like I’d laid a pretty good foundation. And during dental school, I started to kind of dig into the underground scene of the dental world, which Payman will know is the OG dental town where it was … I kind of have to, and this guy will come up because probably my biggest inspiration whilst I was doing it, it was seeing Jason Smithson’s work online, was the real like inspirator to me to be like, this is a guy who works an hour down the road from me, and he is churning out what is quite obviously the best in the world of what he’s doing.

Tom: And as soon as I saw that, I was like, I want to see this guy. I want to see this guy, I want to meet this guy. I want to be as good as that. The attention to detail was artistic. He took the scientific side, mixed it with the artistic side. And I just thought that it was amazing.

Payman: Did he teach you as well in Peninsula?

Tom: Never teach me, no. Watched loads of his courses. When I shadowed him, he was very, very kind to let me shadow him a number of times. So went down and shadowed him. I was also very kind of like an art collector, very proud to have a number of fillings with Jason’s initials etched into my own mouth, which is quite unique. Kind of … Yeah, a weird form of art collection. But yeah, he was the one who really inspired me. And so, give complete credit to that.

Tom: And coming out of dental school, I started to get really into this underground scene. What felt like underground, because none of my mates had any clue existed, was this online scene of international dentists who were just showing off their best work. And I was like, this is where I want to be. This is my crowd that I want to be known within. And that’s how Payman popped up, because Payman was also within that crowd. He was like firmly seated within that crowd, the online community. And from then on, just probably to provide some context for people that … Obviously, I don’t imagine really anyone knows about me or my story, but I left dentistry after exactly two years of clinical work.

Tom: So I did VT, I did half a year of DF2. So I went into DF2 and then I completed half a year of that in Cardiff. And then I did half a year at Ahmad Nounu’s practise in the Black Swan Dental Spa, which I’m sure some of you will be familiar with. So two years was my kind of the length of time I practised for.

Tom: But in that first year, once I qualified, I was like, okay, I have no interest in working for the NHS. The reason was it was becoming really clear to me that there was this equation where you were only going to make money if you churned out a lot of volume. And when I was getting inspired by guys like Jason, who was turning out work which was of incredible quality and finesse, I was like, that’s what I want to aim to. So how do I get to that position?

Tom: So in VT, doing DF1, I made it my plan to … I set out a really clear plan. I was like highlighted maybe five to 10 of the biggest names within the British scene of dentistry. All of the guys that you’ve had on your podcast. So the James Goolniks, and so forth. Again, guys that let me shadow them; James, Zacky, all of these guys that let me into their surgeries, let me sit by their side in the corner and watch them work at their world renowned practises. So that’s what I did in VT, which no one else seemed to be doing.

Prav: Quick question, Tom.

Tom: Yeah.

Prav: What did you do, just pitch to them, I want to come in … It doesn’t seem-

Tom: Yeah.

Prav: … like the sort of thing that any dentist would do, any old dentist, anyways. Obviously, you cherry picked these guys and said, “Look, I’m inspired by these guys. They’re at the top of their game.” And you reached out, email pitch or-

Tom: Yeah, it’s quite simple. It’s business development, isn’t it? It’s networking. I highlighted these guys as the pioneers within the industry, within the BACD, within British dentistry, within international dentistry. And probably emailed them, messaged them. I have no idea how I did it, but I probably prefaced it by saying that I was inspired by you. And most of them, if not all of the ones … I mean, just to paint a bit of a picture here. So in my surgery in DF1, I was in this tiny little town in just south of Merthyr Tydfil, in the Welsh valleys. So a small town as it gets. And on my wall next to my surgery desk, I had a whiteboard, a little tiny whiteboard. And on it, I had a list of 10 things that I wanted to get done during that year that would allow me to put me in a position in year two to potentially work in a fully private practise.

Tom: So on the top five things, the top five, it was shadows Zachy Cannon, shadow James Skolnick, shadow Jason Smithson. All of these names that I highlighted. I was very lucky to have already chatted with Jason. But probably at that point, our relationship was a little bit more … Yeah. Well, relatively advanced. But yeah, literally laid out a plan. Met those guys, ended up going to the conferences, met Payman. And probably jumping ahead a bit, but within that year, Payman had invited me to get involved with his courses.

Prav: Tom, just going back there, because shortly after that, as you’ve alluded to, you exited from dentistry, but you were mapping out your roadmap, your future on the whiteboard. And you were sort of saying, “Right, if I want to be a good private dentist, these are the people I want to shadow.” Did you have a plan for the next five years or 10 years, or sort of think to yourself, “One day, this is the type of dentist I want to be?”

Prav: Beyond becoming a good private dentist, was it teaching? Was it being that inspirational, Jason Smith-esque character for the younger generation, or was it actually practising a level of dentistry that was world-renowned and people would travel miles to come and … Do you see what I mean?

Tom: Yeah.

Prav: You must’ve had some kind of idea of this is who I want to be. Because the type of guy who writes this down on the white board is not every dentist that I speak to, that’s for sure. It’s like you have a clear vision ahead of you.

Tom: And I’ll say this without hoping to not sound like a dick, but my aim at the time was to be the best in the world. So the pathway that I plotted out was to aim to be that person. At the time, I definitely considered Jason to be up there, top five in the world with all of the other top names that would typically go to any of the conferences. You’ll see guys that I was very fortunate to meet. But yeah, it was quite clear. I was like, I want to be the best in the world.

Tom: It was at a time when social media was kind of taking off but really hadn’t, really it was 2013. So dentistry in Instagram wasn’t a huge thing, but I was definitely seeing the likes of people like Max and Belgrade who were starting to pump out content, high quality content, inspirational content. And I was like, that’s who I want to be.

Tom: So yeah, absolutely teaching was probably the end game. But before then, the step to get there was I need to get myself into a private seat-

Payman: Of course.

Tom: … as soon as possible. And looking around and looking at my peers and being like, okay, well, how long is this going to take me? Realistically, I was like, yes, this might take me five years to get there. But by putting myself in the same room as people like Ahmad, who ended up giving me a job, guys like Payman, all of these guys that I networked and met within the first year, I would go to conferences, regional conferences, there’s local conferences, national conferences, I networked so that I could get me my seat as soon as possible. And I was extremely fortunate that Ahmad gave me that opportunity a year and a half after graduating.

Payman: So look, we’re mapping out this sort of beautiful thing. When was the first time that you started to have doubts?

Tom: So this is the irony, in that I assumed it would take me five years to get to that position. Right? And I thought it would take me like five years to put myself in a position where I’m seeing as many patients as I want to see a day. I’m only doing the procedures that I want to do. I can use the materials that I want. I can do whatever the hell I want.

Tom: The reality was is that I reached that within 15 months of graduating. I had my perfect life. And I just had a day where I was like, oh my God, this is it, isn’t it? And it was then. It was then when I had my perfect set up, I had an incredible team I was working with, I had all the materials [inaudible 00:19:07], if it was two patients a day, whatever it was. And I was creating content for teaching. I was starting to teach. And then I was like, oh, this is it, isn’t it? And it was probably after a bit of a stressful day. And yeah, that was probably the seat.

Tom: And I’ll be honest, Payman, it was spending a significant amount of time with you over the course of the next kind of year. And it gave me some insight into a nonclinical direction.

Payman: I didn’t realise that. But look … I mean Depeche and Richard Fields were spending a significant amount of time with me as well, but they decided to carry on.

Tom: With me as well, mate. It was three of us. We spent a lot of time together.

Payman: No. My point is, how come they decided to carry on and continue? I mean, a year and a half in is not very long. I mean, you must’ve had something in your head that said, you need to stick at something a bit longer. Or why was it so clear that you wanted to leave? I mean, that’s the key question. Was it being hired by me to leave? [crosstalk 00:20:27].

Tom: No, it was a multitude of things. So I think as I was growing older, I’ve kind of done seven years of university straight. I’d never taken an opportunity to really reflect on what I’d done, what I’d accomplished, where my direction was going. It was just bang, next thing. Bang, next thing. Plan next thing. It was just a constant road that I never got the opportunity to pause and reflect.

Tom: At that time when I started to like question, okay, is this what my lifestyle is going to be like? Working three days a week in a practise I’ve … A few things started to really pain me. I’ve never felt like I could be myself around a patient, like never. I never felt like I could let my true personality, the fact that I let out quite a few swear words, the fact that I have quite a dark sense of humour, the fact that I’m a bit of a weirdo. I really struggled. I really, really struggled feeling like I was containing that character. And that probably, it was around the same time when I was like, ah, yeah. I’ve got this ideal lifestyle right now and there’s something within me just doesn’t feel like this is me. This isn’t-

Payman: So you think you like teeth more than you like people?

Tom: Probably at the time, yeah. At the time, I was probably like teeth more than I like people. Because teeth, I could focus on and I could forget the rest. And I really felt like I couldn’t be myself.

Payman: Because for me, it was the exact opposite. I like people. I didn’t like teeth as much as I like people. And what I miss is the people, not the teeth. So then, okay. You decided, you had a moment and yet you thought, “Right. I’m thinking of stopping. And Payman stopped and he’s all right.”

Tom: Yeah.

Payman: You said it to yourself.

Tom: So yeah.

Payman: Did you talk to anyone? Do you talk to your parents?

Tom: Oh yeah, yeah. Of course. Of course. Of course. [crosstalk 00:22:24].

Payman: I remember me saying, “Stick at it.” That’s what I said.

Tom: Yeah.

Payman: Did you speak to your mentor, Jason?

Tom: Yeah. Yeah. Yeah. I spoke to everyone. I did that. Probably jumping ahead, but one of the biggest things I’d always been obsessed with was entrepreneurial-ism. That’s something that I read The 4-Hour Workweek. That was probably what spoiled it, was I read The 4-Hour Workweek in my second year of university, so …

Tom: And already, I’m thinking, “Okay. Well …” So now, and I’m sure a lot of you who’s listening has read this book and it’s my favourite book. It’s my favourite book for one reason. The reason is, is that it’s … And the real beauty in that book is that for anyone that hasn’t read it, it’s Tim Ferriss’ 4-Hour Workweek, and at the beginning of the book, he explains how we really have only a couple of really precious commodities in life. Most precious one is time. Time is all of our most precious things that we need to hold on to. And the second thing, and in my opinion, I can’t remember if you said this, but the second thing is health. Health, I hold that as the most important thing in my life. Health is the most important thing.

Tom: And I really started to question like, okay, well is being a clinician the best way I’m going to have wealth in time? So kind of look at it from a commodity perspective in time and also health. And I was seeing cracks. I received my first complaint towards the end of when I ended my career there. And that was one of the things which was like, oh my God, you’re doing the right thing. All the steps were very close to when I ended, like within weeks. And it was a case where-

Payman: Did you think it was unfair, the complaint?

Tom: Absolutely. It was a gold standard case. I’d been referred a 16-year-old boy from a friend, for the hospital, to help treat some white lesions on his front teeth. Treated it with the classic … So it was icon at the time, so kind of bonding, whitening and bonding. Got rid of it. The kid was getting bullied at school. Unfortunately, there was an issue with the billing. So the mum didn’t want to pay basically. And she made a complaint to the GDC. So I had to go through that whole process. I was very fortunate that at that time I had already made the decision that I was going to leave. And I had the time. It was within the next few weeks so I wasn’t as stressed about it as I probably would have been, but it was probably the moment that made me feel vindicated with my choice. I felt like I was making the right choice because I had absolutely no kind of … I didn’t want to have to go through that process of feeling that way, knowing that my livelihood was on the line, depending on other people’s experiences.

Tom: So at that point, I was like done. Absolutely done. So yeah, I was kind of lucky to have that moment. But my heart goes out to anyone that has been through those processes. They’re gut-wrenching. So yeah. [crosstalk 00:25:41].

Prav: Were you nervous about speaking to, let’s say your dad, who advised you-

Tom: Yeah, of course.

Prav: … [crosstalk] dentist? And obviously, he must’ve been very proud of you when you qualified and whatnot. What was that conversation like?

Tom: It was tough, obviously. It was very tough. But I’m extremely fortunate to have a wonderful parents. Very enlightened, extremely hardworking. I do think I’ve kind of been lucky in that I’ve received my work ethic from both of my parents, my mum and my dad, are the most hard working people I know. And yeah, I feel like they saw the pain that I was going through. Yeah, I think it was tough for them, but they supported me. And you know what? It’s still taken a few years. Even a year or so ago, I think my mum like, you wouldn’t go back?

Tom: And I think now they understand and they see how happy I am. Yeah. But yeah. I think it was challenging for them, really challenging because you don’t want to see your children go through that, I suppose.

Payman: No.

Prav: Then Tom, I left dentistry, but I kind of stayed in dentistry. Right? But you made a complete break and went towards … What was your next thing you did? What were you thinking? So you said, “All right, I’m not working, I’m not going to be paid now.” So was that when you went to ski instructor?

Tom: Yeah. And a little bit before then. So when I was in VT, I was like inspired by The 4-Hour Workweek. And I was like, I want to make my own tools. So obsessed with like these tools, I want to make my own. So I also in parallel to when I was in my VT years, I was kind of going through the process of getting a set of tools, sample created in Bangladesh, paying for that to come over to me and really enjoyed that process. And that to me was keeping the kind of inspirational juices flowing, the thought of that. And then it came down to like, I was towards the end of VT and I was like, okay, maybe time to … It was at that time I was thinking about moving on.

Tom: And I was like, the guy, the business I was working with in Bangladesh were like, okay, for us to progress this, you’re going to need to place an order. And the order is going to have to be 1,000 units. And as you can imagine, 1,000 units of an instrument that costs a couple of quid each, it starts to add up when you were taking into account all of the risk involved with that. So I was like, I’m not really keen on this now. I would progress this project if I was going to stay within dentistry. But at that point, I had made the decision on what next. And it was the technology industry. So the technology industry was the next area that I had an interest in.

Tom: I felt it was a growing area. Lots of opportunity, lots of different pathways that I could go down. So I laid out a bit of a plan, kind of like how I did in VT. And so, yeah. My plan was I’m going to have to do some internships. So at the same time that I was very fortunate to work at Ahmad’s space. Black Swan, I’d work there on Thursdays, Fridays and Saturdays each week. I would then drive back to London, and I worked at two internships within tech companies in London. One, they were both in what are called accelerator funds, so for small seed startups. Worked one within the Google campus. And I worked one within the [inaudible] within London as well. So I was working six days a week, three days a week doing internships unpaid, and then three days a week working still with Ahmad in … Yeah, the Black Swan.

Payman: How did you feel you were equipped to handle those internships in the tech companies? Did you feel like you were as good as the other interns there and …

Tom: Really great question, because I think that … Yeah, that this opens up the sad reality … No, it wasn’t sad, but the reality was that I offered nothing. Yeah. I turned up to these guys. I had a biomedical science degree. I had a dentist degree and these guys who when I applied for these unpaid internships were probably looking at each other thinking, “Who the hell is this bloke?” He’s just two years out from being a dentist and you’re saying that you don’t want to do it anymore and you want to be an unpaid intern? But yeah, I think that’s the only thing that got me those jobs, was the fact that I could kind of prove that I was hardworking.

Payman: Did you literally Google, ‘internship tech company’ is that what happened or did you [crosstalk 00:30:45]?

Tom: Yeah. Do you know what? Probably. Yeah, probably.

Payman: Didn’t know someone?

Tom: No. No. No. No. I knew absolutely no one. There are a couple of websites that I used back then. So one was called Escape The City, which was … Yeah, kind of ironic. It’s a website for people who were within previously in like the financial industry within the city of London who didn’t like the corporate life and wanted to work for young, interesting startups. So Escape The City was one website that I used. And that was actually yeah, that was the one. And then there was Work In … We work in startups, so Work In Startups, which is the other one I used. And applied for a bunch, got very lucky and then worked there. Worked to those kind of concurrently with working at Black Swan for about … It must’ve been about four or five months.

Tom: The aim was always to be able to build myself something on my CV that showed that I had an intent to work in the tech industry. And after a few months, I kept on applying for some full-time jobs. And eventually, managed to get a job at an incredible startup called Technology Will Save Us. They’re essentially a toy company of the future. And I ended up getting a job there as a business development manager and ended up looking after their UK retail operations for two years.

Payman: So what was that? You were going into retailers and online retailers trying to sell more of their stuff?

Tom: Absolutely. Yeah. So the business that I worked for had a range of toy kits, and my job was to find businesses within the UK and Europe to sell those into. And I kind of again, wrote down a list. I was like, great. I want to be in all of these stores. And a year later, I was running in between on Oxford street at Christmas time, I was running into John Lewis going and checking our stock. I was going next door into Urban Outfitters, next door into Top Shop. In and out of these stores, making sure that our stuff looked good. So it was a big shift from, well doing a class two cavity on an upper left six.

Payman: How many people were these companies? I mean, was it very early startup or how would you …

Tom: This company, so Tech Will Save Us was a slightly larger startup. So would be just, they’re seed funded, but they had about 30 people working for them at the time in Hackney in London. And my role was as one of two people within the sales team to yeah, to sell those products into all the businesses in the UK.

Payman: So what happened next?

Tom: Yeah. That’s kind of when I, again, two years working for them. And I realised that yet again, I’d still not had a chance to take a step back and reflect.

Payman: Now Prav, are you seeing a pattern?

Tom: [crosstalk 00:33:32]. Prav, you seeing a pattern? Yeah. So-

Prav: Tell you what I’m seeing, the first time I realised you’d left dentistry is I saw a video on social media and you were cracking eggs into a bowl. And I think you might’ve been chopping some avocado or something like that [crosstalk 00:33:50].

Tom: Yeah. Yeah.

Prav: And I thought, “I swear this guy’s a dentist. What the hell is he making videos about making scrambled eggs?” And then I rang Payman, he’s like, “Mate, this guy is one of the most talented dentists I know, and just left.” So that’s when I realised you’d left.

Tom: Yeah.

Payman: Tom, what happened next? Go on.

Tom: So yeah-

Payman: You put your feet up, you didn’t want to be a salesman anymore?

Tom: That job was so, so good. It was epic. I was going-

Payman: Did you get an insight into the management side, the [crosstalk] side? All of the …

Tom: Everything, because it was such a small company. We were working like living and breathing it. It was intense. It was fast paced. I was visiting businesses all over the country. I was kind of like yeah, going to talks with the Maplin head office and negotiating these big deals. It was just perfect. It really was. Absolutely phenomenal job. The people that I worked with were great, the job itself was just so fun. And I felt like I actually did a pretty good job as well. I managed to get our products in the likes of Selfridges and Harrods and like nationwide, and John Lewis. I felt like I’d done really good there.

Tom: Unfortunately, along with that intensity and speed was a fair bit of stress. I won’t go into details, but it was difficult seeing that, being so close to management owned by a wife and husband team where their livelihood depended on the success of that business, and they’d invested so much into. So yeah, it was at that stage where I kind of was like, okay, I’d like to go onto the next thing. But at that stage when things were probably getting a little bit high-pressured, I was like, maybe it’s time for me to do a gap year. And I was 28, and I decided to have my gap year at the age of 28. So yeah, that was kind of where my next step was. So I decided that yeah, for two years, I’m going to act like a slightly older teenager.

Payman: What did you do?

Tom: Yeah. What did I do? What didn’t I do? So I lived a very fast, wild and loose lifestyle, living in the French and Austrian Alps for two years, to put it shortly. But yeah. Within those two years, I saw a lot, I experienced a lot and had the very, very best days of my life and-

Payman: And you were a very keen skier, I seem to remember.

Tom: Yeah. I love skiing. That was one of the main reasons I wanted to do it originally. I wanted to do a ski instructor course, but those costs 10 grand and I didn’t have 10k lying about. So yeah. I was like, I’m going to go and I’m going to be a driver for a chalet company in Val d’Isère. And I spent six months of my life … Most of the time I was drunk driving around the French Alps, with poor customers in the back of my van scraping off ice. And yeah, so it was a loose lifestyle, but that’s the way it was. And I met some amazing friends for life that I see regularly. And I have a wonderful girlfriend that I met three years to this day in Austria. And it’s been … Yeah, it was the best years of my life for sure, were those two years when I had the opportunity to just let loose.

Prav: And then during that time, is that when you got the time to reflect on the future or …

Tom: Yeah, definitely. Definitely. It was the time when I really … I didn’t have that whiteboard, so I had the opportunity to be like okay, things probably didn’t go as you expected your 20s to go, but damn, you’ve had the best two years of your life, so I was-

Payman: Tom, do you reckon that this white board … I’m sure Prav relates to this more than I do because I’ve never had a whiteboard myself, but do you reckon that you were one of these guys who is quite hard on yourself as far as … Or was quite hard on yourself as far as what you need to achieve by when and so on, even as a kid? And then there was a degree of burnout of that kind of behaviour, and you needed these two years to just be yourself and not be ambitious and all that.

Payman: Because your ambition was on a par with some of the most ambitious people I’ve come across. And yet, you chopped and changed a lot. And I get a feeling, yeah? That those two years where your time to be yourself and not have to always strive towards something. I’m expecting Prav to take two years out to be the promoter soon, because he’s got the same problem.

Tom: You know what? You nailed it. It was exactly that. It was a two-year period where I had the chance to meet people outside of this medical field bubble. So just people that had completely different perspectives to life than me. And it was amazing. And I think the fact that I was in my late 20s and I’d experienced that … Yeah, exactly like that. That I need to achieve this. I need to do this, and just live this 100% lifestyle for so long. And I kind of missed the big picture of like actually, life is not about that. Life is about who you meet, who you spend time with. The experiences you have. And those two years, funnily enough, went to Ibiza, had one of the best times ever. I did get to experience things that I probably had missed out on in my years where that whiteboard was set up there with that list of things.

Tom: But it’s funny because just before we got on the call with you today, I opened up my notebook and it was actually, it’s opened up to my page from just about a year ago, where I’d laid out all of my 2020 goals and habits. Quite funny, because I kind of quickly was like, oh that’s quite cute. Reading through them, things like 10-minute morning mobility routine, daily journaling, 100 pushups a day, no two days off. And I’m like, oh damn, I’ve literally done none of these. I’ve done none of these.

Tom: And then in the middle of the page, there’s five words. And it’s; health, wealth, happiness, relationships and career. And I’m like okay. Well, I’ve got all these tactics that I have not done any … Well, I haven’t done consistently any of these, yet when I look at each of those main things like my health, am I happy with my health? Absolutely. Am I happy with my wealth? Absolutely. Like my ability to manage money this year has gone to another level. My happiness, I had a time in the middle of this summer when I was the most … I was laying in bed, it was the most content I’ve ever felt in my life, and I have no idea why. And I think it was part of that was just … Yeah, I don’t know. It was weird. And yeah, relationships, absolutely. Career. Yeah. Pretty damn happy. Yeah, it’s kind of weird. But [crosstalk 00:41:06]-

Payman: What are you doing now? What are you doing now? You have this wonderful time, which sounds to me wonderful. And then you decided, enough of that lifestyle, time to get back to work.

Tom: Yeah, sure. It was-

Payman: The back in tech, right?

Tom: Yeah. I must have been … Yeah. 29. Unfortunately, that two years actually put a bit of a … Yeah, it wasn’t as easy to get a job again after basically just being permanently drunk for two years. It was very difficult for me to get a job. So I started from scratch again. Managed to get a job working at this kind of software startup, which was again, fantastic. Had a great experience there, working there for a year. And for the last year, I’ve now been working for a fantastic startup called Contentsquare, who are a user experience analytics platform for websites, with the hopes of going public within the next 12 to 18 months.

Tom: So a very exciting time. And that’s probably where I see my … If someone would say what I do now, my role is as a website analytics expert. And yeah, recently just launched my own company, which I’m quite excited about.

Prav: Tell us more.

Tom: Yeah. So about a year ago or a year and a half ago, I met up with one of my colleagues at the time. Lovely girl called Claudia. And we worked within the retail space. So we worked with clients from a software perspective. We work with online clients, like Feelunique, like beauty brands, Space NK, all these big beauty retailers. And I was like pitched this to her. I asked her, “Do you think that there’s an online space for sustainable beauty products?” She said no. So since then, we’ve been on the hunt to find some of the best sustainable beauty products within the world and put them all in one place on a platform online which we have called Vyable Beauty. So we have a fledgling business, which has been … I cannot tell you how fun it’s been like growing this.

Payman: And Tom, I remember, I asked you about this. And I said, “Well, you’ve been in this startup world with a seed round, round A, round B. Is that what you’re going to do now, you’re going to raise funds?” And you said to me, if I remember, that you’ve seen the stress that that causes.

Tom: Yeah.

Payman: Tell us more about that. I mean, first is the company you’re at, at the moment, that must be quite a huge place now, right? If it’s going public.

Tom: Absolutely. So it’s a business that I think it has … I can’t remember the numbers, but it’s around $140 million of revenue annually. About seven to 800 people in the business [crosstalk 00:43:49]-

Payman: So you’ve seen these startups from sort of the very fledging ones and the 30-people. And now we’ve got this one with $140 million of turnover looking at listing. And you’re saying that journey’s not for you or not yet?

Tom: Yeah. So it depends on the type of business, right? So that business is a software business. It is they’re selling a service to other biggest businesses within the world. So some of my clients are the likes of Tommy Hilfiger, Rolex, those guys. So they’re my clients that I look after. The platform that I’m building, that’s definitely going to be designed as being more of a slow burner. The reality, we’ll never go public. It’s not going to be that type of company. So the investment requirements for that type of company are different.

Tom: But yeah, absolutely. The answer to that is, I don’t know how we’re going to fund things indefinitely. We’re open to any and every option. And I think that’s just part of the process. As you guys know in your own businesses, you have to take what you can see in front of you, make decisions based on that. Perhaps you’ll pivot, as I know that you are, Pay. You’re going to be slightly pivoting, or at least making branches to your business.

Tom: So yeah. I don’t know is the answer. At the moment, we’re just trying to set the foundation for the company. So making sure all of our sales channels, marketing channels are set up correctly and working well. Getting that foundation set so that hopefully over the next few years we can scale.

Prav: And Tom, you’re essentially at the moment, an employee at one company.

Tom: Yeah.

Prav: Earlier on in the conversation, you mentioned entrepreneurial-ism or however you say that, right?

Tom: Yeah.

Prav: And that’s something that sort of fuels you, right? It drives you. And then you’ve got this, what I’ve considered to be a side hustle. And so what’s going on in your mind right now? Is where you’re working at the moment almost like a stepping stone to the bigger picture where you see yourself maybe having multiple side hustles to the point where you think, “Do you know what? The income level on the side hustle is enough to sustain me, and then I’ll go 100% in,” or are you at some time going to say, “Do you know what? I’m just going to take this risk and jump and go 100% into [crosstalk 00:46:11], or whatever it is.”

Prav: And there’s always that tipping point, isn’t there? Where you think, “Right, I’m going to go all in now.” Have you thought about that?

Tom: I don’t know. I flip that question to you guys, because that is something … Yeah, I’ll be honest, I battle with that daily. I ask myself that question daily. I don’t know the answer to that. I do know that yeah, I’ll be completely frank. My venture is something that I would love to spend 100% of my time on as soon as possible. Reality is, as you said, this is a side hustle for me at the moment. It is just trying to make things work, trying to make sure I perform at my job. And hopefully like maybe this resonates with people, like trying to do multiple projects on the side. It is just a balancing act. I’m just trying my hardest to make sure that I perform my full-time job and also spending nights, evenings, and weekends doing my side hustle.

Payman: One thing I would say, bud, is anything worthwhile tends to take three, four years to sort of really [crosstalk 00:47:16].

Tom: Yeah.

Payman: I mean, we have to say, we lost money for three years at Enlighten. Even when you look at overnight successes, there was three or four years before that moment that they were working … Of course, you could be super lucky and the right celebrity or whatever it is, but there is that sticking with something for a bit longer-

Tom: Yeah.

Payman: … question.

Tom: Yeah, yeah. So I think realistically, I’m looking forward and I’m thinking minimum, a couple of years before I’m going to be able to take the full dive into it. So yeah, I’m well aware of that. I’ll do everything within my power to make that jump soon as possible. I’m very fortunate that my full-time role, it feeds directly into what my business and myself. It’s understanding how to optimise performance of websites, which is exactly what I’m trying to do that with my own business, as well as my founder, who I work with as well.

Tom: So yeah, they feed in with each other. They are very complimentary. Frankly, I love my job at the moment. So my full-time job again, is I’m very lucky. I’ve got a great job. Yeah. It’s extremely complimentary to what I’m doing with my own business and-

Payman: Tom, Tom.

Tom: Yeah.

Payman: You’re not the kind of guy to regret stuff. Yeah?

Tom: Yeah.

Payman: But, I want to dig into that a little bit. If there was a regret regarding leaving dentistry, what is that regret? Because I regret it, I regret you left. I think you could have made a contribution for sure, or you already had even as a VT. So by the way, it would take 10 years to really become the dentist you wanted to become. But regret-wise, do you regret it? Do you at all regret it, if there was a regret, what would it be? And for someone thinking of leaving dentistry now, maybe people haven’t got that sort of … You’d seem to be very, very, very comfortable jumping about, doing things. And not everyone’s got that. I mean-

Tom: Yeah. Of course. Of course. Of course. So-

Payman: What’s your advice? What’s your advice about that? And tell me about regrets.

Tom: Yeah. Let’s start with regrets. I want to be careful with this because I obviously know the audience that you guys have and-

Prav: Just speak your mind, mate. [crosstalk 00:49:48].

Payman: Yeah, yeah. [crosstalk 00:49:50].

Tom: So yeah. I don’t have any regrets. I’ve had the best five years of my life without completely objectively, I can look at that and I’ve had the best times of my life. I feel like I’m in a position where my career is now taking off in the direction that I kind of probably was more aligned to me, what I should have done originally. I went down a path of being a dentist based on the experiences that I had with my family. That was what pushed me down that route.

Tom: I think these days, social media has meant that the prospects of entrepreneurial-ism is more accessible to people at a younger age, whereas our generation probably just, we didn’t have that. So it took me reading a book by Tim Ferriss to kind of have my eyes, perhaps, the blinders pulled back a little bit.

Tom: So do I have any regrets? I don’t. Sadly, I’m still on WhatsApp groups with my good mates from university who are still dentists. And every time a message comes through … Well, not every time. We obviously have a lot of banter and stuff, but there’s a lot of times where I’m like, I count myself extremely lucky I’m not in that position anymore. I will always say this, I’ve done dozens of jobs, dentistry was by far the most stressful.

Payman: Really?

Tom: By a long, long, long way. I’ve had some really … What people consider some stressful jobs. I’ve worked in hospitality, a lot in hospitality. Yeah, I’ve worked in technology. And dentistry, nothing will ever touch the stress that-

Payman: How does it go down when you tell someone from a recruitment perspective that you were a dentist, how does that go down?

Tom: I mean, usually back maybe a couple of years ago, it’s a bit more of a different conversation because I think then people were asking me the same questions that you guys are like would you … Well, they were like, are you never going to go back? And I’d have to be like, no. That ship sailed. It was a chapter of my life. I’m proud of that chapter. I feel like I contributed.

Tom: It’s funny, I have one of the most viewed videos on YouTube for class one composite. It’s over half a million views on YouTube and I’m proud of that, I’m proud of that. And I feel like I left a contribution there, but it was a chapter in my life that I have absolutely no regrets. I do think that there’s a lot of people within dentistry that wish they could make that jump. I figured when I was very early on that it was something that I needed to make sooner rather than later.

Payman: Yeah. But look, someone wants to leave, they’ve got all the sort of standard options. They could go into dental public health, or they could go into the medico-legal. But if you go into something completely separate, when you say I was a dentist, does that kind of go down well?

Tom: I think I had some assumptions when I first made the jump, that it was going to be a really important factor in helping me get to where I wanted to get to next. It wasn’t. And that was because I did the full leap out of dentistry. So I cut chords and therefore, there was no ties. It was like okay, great. You got a dentist’s degree. You can-

Payman: Like any degree.

Tom: … do a filing. Yeah, exactly. So perhaps there’s a little bit, the fact that it’s a medical degree, there’s a little bit more prestige with that. It’s a really interesting thing for people … We have a conversation about, whether it’s employees, they do like it, people do like it. One think about it, it’s definitely not cool. It never will be cool being a dentist or an ex-dentist, sadly, as we all know. We all think that we’re these … Yeah, cool, cool people. But no, the medics got that one. So there’s nothing cool about that, but it is interesting. It’s a good topic that, it’s a good discussion topic. It’s always people, brings a smile to their face [crosstalk 00:53:53].

Prav: And take us through either a day in the life or a week in the life, or whatever paints the better picture of somebody who has got a full-time role at another place, running your side hustle, the passion that you’ve got for that, and what that entails from morning routine, right from you race home from work, you’re on this next bit where maybe there’s a switch of mindset and then where does your other half fit into the picture as well?

Tom: Yeah. So I think obviously, at the moment in time, so we’re going through this pandemic where that has been a huge … It’s given me back like 15 hours or so of my life every week, where I’ve been able to invest that time in my business. So instead of spending an hour and a half commuting every morning and every evening, I’ve now got three hours in a day where I can now actually invest that in my business, in the evening for example. So yeah, the full working day, 9:00 to 6:00. And then in the evenings, I’ll do a couple of hours of work, a couple of hours of work. And then weekends, again, we’ve kind of been in this kind of weird pandemic time where everything’s been locked down-

Payman: What does that working day look like? What do you do?

Tom: So my working day usually, it involves two things. So I’m either on calls with our clients. So the businesses that we work with, like I said, the likes of Tommy Hilfiger, whoever they may be. Last week, for example, I was working with the Oliver Bonas team. And so working a couple of hours a day with them, teaching them how to analyse their own website. And then the rest of the day will be working on actually doing analysis of people’s websites. So understanding how users behave on the websites. So that’s my day. So my day is either client facing. My role is a client facing role. Obviously, under these circumstances, we’re doing everything via Zoom. Typically, I’d be expected to be travelling around Europe, going to these businesses’ offices.

Payman: So it’s a bit of software that tracks mouse movements and all of that.

Tom: Exactly, exactly. Yeah. So we know exactly what … And anonymously, we know what users do when they come to a website, where they’re clicking, where they’re hovering. I’m not going to lie, when I did my interview and they kind of explained that this was what the product did, I was like, “What the hell? Are you kidding me?” So yeah, I was very naive to how advanced technology is these days.

Payman: All right. [inaudible 00:56:28].

Tom: Yeah. So that’s what a day in the life looks like. A week in the life is work 9:00 to 6:00. Since not having to commute to work, that’s given me back 15 hours of time, which I’ve been intent on making sure I invest into my business. But yeah, I’m not going to lie, like we’re going through a time where there’s nowhere near enough hours in the day for me to be able to do what I would like to do. So I’m really having to make sure I prioritise, I’m thinking very strategically about my time is going to be going towards the business and learning stuff all the time. That’s the one thing that has never left me. I just love learning new stuff.

Payman: Well, it’s lovely to hear you’re happy and you’re doing so well. Prav likes to end it on his particular question.

Prav: I don’t think it’s relevant, mate.

Payman: I think it is.

Prav: You do?

Tom: Hey, mate. Say it, say it, say it.

Prav: You do? Okay. And the reason I said that is, I think there’s just so much more in Tom’s future and so much more experience for him to gain. But Tom, one of the questions that I ask all of our guests is imagine it was your last day on the planet and you had your loved ones around you, whoever they are, and you had to leave them with three pieces of advice, what would they be?

Tom: Great question. Yeah, it’s funny because I listened to your podcast with Dominic O’hooley a couple of weeks ago. And the question you asked him was what would you do outside if you weren’t a dentist? And he said, “I’d be a philosopher.” It’s funny because I never got to meet Dominic. Always swam him on all of the forums and all the threads and very inflammatory bloke, but a very interesting bloke as well. So yeah, shout out to Dominic who I never got to meet.

Tom: What three things would I tell them now? There’s a few things that I think that I’ve kind of seen to be consistent with my life and what I think leads to my happiness. One of them is gaining some sort of control, a feeling of control over your life. Whether that’s directionally, health-wise, whatever it may be.

Tom: So one of that is figure out what makes you feel like you’re in control. That’s something that I feel has been able to directly help my happiness, directly prevent anxiety, is feeling what that is and understanding what that is. And that’s a process that takes years to understand. I feel like I’m kind of getting there, but understand what helps you feel like … Feels like you’re in control of yourself, your situation, your direction.

Tom: The other thing will be to work hard. I really do believe that working hard is one of the meanings of life. You’re put on this planet. You are given … If you’re an able-bodied, if you are … I recognise that I’m very privileged. I’ve come up in a very privileged position and that’s probably the one thing that drives me the most, is feeling that I have privilege and really wanting to make sure that I give back to this life that I feel extremely blessed to have been given. So work hard would be my second thing.

Tom: Third thing would be, it’s kind of probably along the lines of experience, experience this world. This world is an incredibly beautiful and rich piece of rock in this universe. You have the opportunity you’ve been given to be a part of this existence, don’t waste it. Experience as much as you can, experience it with as many people as you can. Don’t feel like you’re trapped in a bubble, get outside of your bubble and live a rich, fully experienced life.

Prav: Lovely, Tom. Lovely. And one final question. What would you like your legacy to be? I.e. how would you like to be remembered above and beyond the YouTube video?

Tom: Mate, I’m pretty happy with that, to be honest. My legacy, I would like people to look back and say, “He worked hard. He had fun. He laughed.”

Payman: Good. Good.

Tom: That’s all I can … Yeah.

Payman: I think Prav, it was the right question to ask.

Prav: Yeah, I agree. With hindsight.

Payman: But it’s lovely having you on. And I know you didn’t need to do this, so it’s lovely that you agreed to do this.

Prav: [crosstalk 01:01:08]. Thank you so much.

Tom: Yeah. No, thank you so much for having me. I do you think like it’s … Like I said, Payman, you’ve been an inspiration to me over the years and continue to. And yeah, likewise to you, Prav. I think the stuff that you were interested in is there’s definitely a lot of crossover with the things that I’m interested in at the moment. And hopefully yeah, to those people, I do get people messaging me quite frequently from seeing my videos. And I’m just trying to understand why am I not a clinician?

Tom: For anyone that might be questioning things, I’m always open there to have a cover chat, have a conversation about either how I did it, why I did it? It’s a huge thing, so please do feel free to reach out-

Payman: What’s your Instagram, buddy?

Tom: So it’s Tom_Youngs_. So Tom Youngs. Just search for with Tom Youngs on Instagram, find me, messaged me on Instagram. And I’m more than welcome to have a chat to you. Yeah. Not an easy thing to come to terms with, so …

Payman: There’s actually a Facebook group for people looking to leave dentistry.

Tom: Is there?

Payman: I’m going to post it. Things have changed a bit from your time.

Tom: Yeah. Well, okay. Well, yeah. So maybe the support is there already, so you don’t need to have a chat. But anyway-

Payman: No. No. No. I’m saying you might get a bunch of calls.

Tom: Yeah. I know it’s a big thing. So please do use me to ask any questions that you might.

Payman: All right, buddy. Well, lovely to have you and see you soon.

Tom: Thank you so much. Yeah.

Prav: Really [crosstalk 01:02:38].

Tom: Love seeing you guys. Bye, guys.

Prav: Take care.

Outro Voice: 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: Thanks for listening guys. If you’ve got this far, you must have listened to the whole thing. And just a huge thank you both for 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: 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.

Prav: And don’t forget our six-star rating.

 

 

 

If anyone was born to be a dentist, it’s this week’s guest. Avi Sachdev is a surgeon with Croydon’s Gentle Dental Group, which he co-owns and runs with dad Kam, brother Mish and other family members. The eight-clinic group is the very definition of a family-owned business. 

Avi lets us in on what working with family, talks us through life under lockdown and shares ideas about how UK dentistry could benefit from a more unified approach.

Enjoy!

“Always use Enlighten.” – Avi Sachdev

 

In This Episode

29.00 – Family business
11.52 – Running the group
16.42 – Avi in lockdown
21.40 – New whys
24.20 – Acquisitions
28.06 – Family, roles and recruitment
31.54 – Advice to associates
37.49 – Clinical tips
41.25 – CEREC
43.34 – Blackbox thinking
54.18 – Croydon Dental Seminars
57.14 – In an ideal world
01.05.20 – No-fear mentality
01.07.40 – Avi’s plans
01.13.34 – Last day and posterity

 

About Avi Sachdev

Avi Sachdev graduated from King’s College London and gained his MFDS from the Royal College of Surgeon in Edinburgh.

He went on to complete a master’s degree with the University of Kent. He is a surgeon at Gentle Dental, a family-owned group of eight clinics based in Croydon.

Avi: I think one of the things that we don’t really acknowledge is, the team behind us are so important. They work so hard. I’m really, really proud of our team.

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: It gives great pleasure to welcome Avi Sachdev to the podcast. Avi comes from a family full of dentists. Welcome, Avi.

Avi: Thanks, Payman. That’s quite an intro.

Payman: Yeah. I met your dad… You were probably in school when I met your dad the first time, how old are you bud?

Avi: I’m 32.

Payman: Yeah. I was thinking about it this morning. I think I met him 15, 16 years ago.

Avi: Yeah. Probably. Yeah.

Payman: Correct me if I’m wrong, I think it was a mixed practise in Croydon?

Avi: Yeah, yeah.

Payman: A very average-looking practise, nothing out of the ordinary, but there was something about your dad. For a start, 16 years ago, he was asking for Enlighten in his mixed practise in Croydon. Even today, mixed practises have difficulty beginning. He had a glint in his eye and he said to me, “I’m going to build something.” And I said, “Wow. Okay,” and then he did. He built up the spaceship of a practise, the Gentle Dental in Croydon around the corner. And now you guys are up to how many practises?

Avi: Last year we picked up our eighth.

Payman: Eighth. Wow.

Avi: We picked up our eighth, yeah.

Payman: What was it like?

Avi: Dad had a plan.

Payman: What was it like as a kid? I mean, were you totally immersed in dentistry as a family? How was it that all of you went into dentistry? Was that a plan? Or how was it? Tell me about your childhood.

Avi: I think as kids, it was fairly normal. I think we had a really happy childhood. I think we were in our little bubble, every kid is. We don’t really know what’s going on around us. We used to have dad do the school run in the morning. Mom sometimes picked us up, always running a few minutes late, but whenever dad picked us up, it was always on time, dead on time.

Avi: He always used to leave at like 3:00, if he was having to pick us up. So he was around a lot and took really good care of us, but I also think it was a case of… They never let us know how hard they actually worked for us. They used to take us on holidays and trips and things that we just take for granted, but you see them pulling weekends, you see them working on the books late at night. You saw an idea of just how hard they actually worked to keep everything kind of going and to keep our lives really, really good. We were lucky. We went to private schools all of us.

Payman: Did you live around Croydon?

Avi: Yeah. So they’re still in our family home. So I think that they moved into that when I was two. Shiv, my older sister was three, and Mish was six at the time. I don’t really have many memories of the first home that we had, but I’ve got the memory of the home where we lived down in South Croydon. It was really, really good. There was a lot of fun growing up there.

Payman: So you’re the youngest?

Avi: I’m the youngest. Yeah. I’m the youngest.

Payman: So you watched Mish and Shiv become dentists?

Avi: Shiv took a year out, and so we were in the same year at King’s.

Payman: Oh, is Shiv not much older than you?

Avi: She is a year older than me. She is what? 15 months or so. Mish is four years older so I saw him become a dentist, I saw how close my dad and him were. I never really wanted to do dentistry. Shiv was much more keen to do dentistry, but kind of we were spoonfed our grades. So we got kind of our 11 GCCEs. We got five As at A-level. It was very perfunctory to just sit there and achieve things because of the schools we went to.

Avi: I remember getting my grades and thinking I did okay. And I remember my friends, my year group saying, “Actually, you know what? Out of the 600,” or whatever UMS it was, I remember out of that, the guys that I was with used to get 580, 590 out of the 600. And when I kind of still got my A, they would be just like, “How did you not get 100 out of 100 on this and this and this?” So we were really, really lucky. Our schools really pushed us and our parents worked tirelessly for us. So it was pretty amazing as a kid.

Payman: Was there the propaganda of, become a dentist take care of the family business or not?

Avi: There wasn’t that at all. I think dad really enjoyed Mish becoming a dentist. I think I was too young to really understand what that looked like and that closeness definitely no cush… I mean, it’s funny. I think I wanted to do something in economics or in medicine. My dad arranged my work experience at St Helier’s, the hospital, but he arranged it on the renal unit. So I was surrounded for my two week stint I want to become a doctor, by dialysis patients. I don’t know if you know the smell there. I don’t know if you know how-

Payman: I can imagine.

Avi: Yeah. So I don’t know if there was a little bit of subterfuge going where he’s actually seeding, “Oh, this is what your life could look like, or you could become a dentist.” But no, I didn’t really want to do dentistry even throughout dental school. Kind of I remember year one was mostly sciences, it wasn’t great. So-

Payman: Did you all [inaudible] the dental school as well?

Avi: So dad went to Guy’s back in the day, Mish went there, and then my sister and myself. Yeah. We’re all kind of [inaudible 00:05:45]-

Payman: Family tradition, man.

Avi: Yeah. I know. I think that there was Prof. Hutchinson, I want to say, who taught my dad and then also taught us, which was a weird one.

Payman: So, did your dad come here before university? Where was he before?

Avi: Yeah. So my dad came to university. He was from originally from Kenya, both my parents are from Kenya. Came here before university. Dad worked incredibly hard. He worked in a sweet shop. He worked in a whole bunch of jobs to try and put him and then his brothers, he’s got three younger brothers, through school, through university. The reason he became a dentist was actually to put his youngest brother through kind of school [crosstalk 00:06:23]-

Payman: I hear this story from Kenyans specifically. I don’t know if you’ve listened to the other podcasts here. That same story from Vishal, Bru, from Anup [inaudible] Mani about his dad. I think he’s from Uganda or was it Kenya? But that, it’s a Kenyan thing. It’s like, “Come struggle, put your family through.” And well it’s borne fruit, so that’s nice. So you’re saying you didn’t enjoy being a dental student?

Avi: I don’t know. I enjoyed the student aspect, but I never wanted to do dentistry. I think it was, I remember, halfway through my third year. You know the aesthetic advantage course? You had Larry on?

Payman: Larry. Yeah.

Avi: And the aesthetic advantage course we did. So my brother did that and he kind of did his level one and dad was doing his level three at the time with Larry and Mike. And I think I was Misha’s nurse, which was great over there. So in third year of dental school, we took a trip to New York and I think it was my third or fourth time. It’s one of my favourite cities.

Avi: I sat in the audience, bored out of my head because I didn’t want to be there because I don’t like dentistry. I remember sitting in the audience and I couldn’t really relate to anything because it was all really super cosmetic, high level, higher-end dentistry. This little, young 30 something, 20 something came on, and I was listening, I was captivated by it and I had a chat with him afterwards and-

Payman: [crosstalk 00:07:57]?

Avi: … he was talking to me about the colour of his background and how he’d spent ages picking out and selecting the exact colour. When I was chatting with him, there was something about that conversation, his persona, his kind of, not arrogance, but just confidence, that really resonated, and I think it was off the back of that. I remember walking back to the hotel and thinking, “Actually that’s the kind of dentist I want to be.”

Payman: That the penny dropped?

Avi: That was it. Yeah. And I think actually we have that on tape somewhere. The old recorders with a little mini-

Payman: Yes. Yeah. [inaudible 00:08:36].

Avi: Yeah. So we have those. We actually have that lecture on tape and I saw it, I want to say, last Christmas? I remember looking at myself and I remember looking at a young Mike [Epper] and Larry and the team there, and Jay and even Kathy. It was one of those things where I was like, “That was the moment.” It was a very clear in my head where I was like, “I don’t want to do dentistry, I want to do that.”

Avi: Then kind of we’ve been really, really lucky. We exchanged numbers and actually over lockdown, I actually shot him a few messages and he’s doing really, really well.

Payman: Mike. Yeah.

Avi: He’s doing quite well.

Payman: Mike’s doing pretty well.

Avi: Very, very well. It’s great that he’s so successful yet he’ll still turn around and pick up a message. He’ll still turn around and help. It’s a really good trait, a really good characteristic.

Payman: And so at that time, Mish wasn’t a specialist?

Avi: Mm-mm (negative). Yeah. [crosstalk 00:09:27].

Payman: So when did he decide to do that? How many years was he… ?

Avi: Okay, that was dad. That was that dad.

Payman: Oh, really.

Avi: That was dad for sure. So dad didn’t love perio. So he was like, “Oh, you know what? I think you should do this. I think you should do this.” That was dad. That was all dad. So he qualified and then had a couple of years. I think he did his VT, which is not allowed now. I think he did his VT with dad, which was great. Then a couple of years, I think he did a house job, and then went into perio at [Easton 00:09:53].

Payman: So now, I mean, we’ll go through the story of how it happened, but if we fast forward now, is Mish more the clinical kind of director and you’re more like an operationals guy? How’d you guys split? I mean, managing this sort of eight practise beast, how does it split as far as responsibilities? What does your dad do? What does Mish do? What do you do? What does Shivani do? And you said Shivani’s husband is also a part of [crosstalk 00:10:23]?

Avi: Yeah. So Soro is-

Payman: Soro. Sorry.

Avi: We have a story around Soro. He’s my brother-in-law. So I remember he met everyone in the family except me and I came home and I met him by chance and he was lying down. I think my sister was kind of was sitting there and he was lying down and I think their shoulders were touching. I remember walking in and then suddenly he jumped up. So, Soro and I, we didn’t start off on the best grounds, but actually he’s like a second brother to me. He’s amazing. So Soro is one of the directors now, Mish is one of [crosstalk 00:10:55]-

Payman: So who does what? Who does what?

Avi: Soro does a lot of the clinical. So he works probably the hardest clinically out of all of us. Mish does his specialist work three and a half four days a week, and dad works clinically. I mean, last week I was struggling with a case and I didn’t have the space to see the patient myself. So dad came and did four hours of really high-end cosmetic, smile, makeover stuff to help me out. It was amazing. So dad still does very much [inaudible] dentistry and I work on the operations and the management. Still do two or three days a week, but that’s kind of how we split our time. So, really not-

Payman: So you’re the main sort of operator of the business, is that right?

Avi: I don’t think I’m the main operator. I think I’m really supported well clinically by the other guys, but a lot of the management decisions, a lot of the planning decisions, we kind of sit down and we have a chat and then a lot of the time I’m executing some of the stuff behind it, but it’s really good. It’s a lot of fun.

Payman: But okay, so I was looking at the list of practises. You’ve got a practise in Kent somewhere, Orpington.

Avi: Mm-hmm (affirmative). [inaudible 00:11:59].

Payman: There’s a manager there?

Avi: So that practise at the moment is part-time, so it’s three days a week. It’s kind of [crosstalk 00:12:08]-

Payman: What are the other ones? What are other ones that is working? You’re not there. You’re not there.

Avi: We have quite a lot of really great staff. We have Head of Finance, we have Head of Marketing, we have a group PM. We have some senior receptionists, nurses that really help and support us. We’re not as corporate as maybe we should be, or we could be, but I think we’re really, really lucky. I mean, I’m looking over, I’ve got a couple of whiteboards just literally behind you. Here’s the majority of my work. So we’re just planning management structures now. We’re rejigging things. We’re planning to go into a bit more of a flattened pyramid, so try and promote internally and recruit newbies for some other positions, but it should be good. It should be fun.

Payman: So, that Head of Marketing and Head of Finance are centralised? They’re like head office people?

Avi: Mm-hmm (affirmative).

Payman: Are they the only two?

Avi: So I think our PM is somebody who does travel between sites, but she’s usually based out of one, but we only have three kind of what we call potentially management people. We’re really lucky we have…. So the nurse that I work with, she does a lot of our ordering, a lot of our stock control, helps me with a lot of my admin support. We have Mish’s nurse again that helps Soro’s team that really helps. So we really share the responsibility. So we don’t have a huge management team, a lot of our… If there’s a problem, they’ll just come and speak to me directly, and the team will message me directly. So we don’t really have a hierarchy.

Avi: We don’t really have a structure where they feel removed from us, not too dissimilar from where you’re at, where the team can just walk up to you and say, “I have a problem.” And then you kind of empower them to fix their own problem rather than saying, “Actually that’s not my bag. Go and speak to X, Y, Z.” Because otherwise I think the team doesn’t really grow. They don’t feel the pain of, “Oh, I need to learn some more information. I need to do something new.” That’s what we found works well. I’ve heard a lot of the other podcasts and it’s [crosstalk 00:14:03]-

Payman: There are different ways of doing it.

Avi: Yeah, there are very different ways of doing it.

Payman: What’s the head count? So how many people work for Gentle Dental Group?

Avi: Dentists and-

Payman: All in.

Avi: 70?

Payman: It’s a lot of people there. It’s [inaudible 00:14:15].

Avi: We’re really lucky. We’re really lucky. We’re really lucky. Again, my mom’s very much involved in the business. She married dad, got involved. She used to be an accountant, married dad, got involved and does everything from sedation so she’s a sedationist through to PM roles. So again, we’re very much family run. We don’t have this massive corporate mentality. We should. We should, yeah.

Payman: I know what you mean, dude. I mean, like you say, we’re similar at Enlighten. Yeah, it does feel more like a family. I mean, you guys actually are a family, but it depends on what the plans are, right?

Avi: Yeah.

Payman: If the plans are to triple by 24 practises, then it does make sense to systemize everything and have extra people, but if the plans aren’t to do that, then it doesn’t make sense. But [crosstalk 00:15:05]-

Avi: You know like you’re asking me what the plans are there?

Payman: Yep. Well, what are the plans?

Avi: So, I think pre-lockdown, all of this pre-pandemic stuff, I think I had a plan of a number of practises. I had a plan of what I wanted to achieve. We had goals, we had visions we had set. I think the lockdown has kind of allowed us to take a minute and ask really why we’re doing that, and I think that’s happened for a lot of people.

Avi: I’ve spoken to a lot of the dentists from some of the courses. I’m sure have run into you and said, “Life’s different. Life’s changed.” A lot of it is in a good way, but I think one of the things that we’re kind of taking stock of is actually, why are we doing a lot of this expansion? Why are we doing a lot of this growth? Because if we’re doing it for the sake of saying we’ve got a number of practises we’re trying to turn over X, Y, and Z, but actually that’s taking [inaudible 00:15:58]-

Payman: Vanity metric.

Avi: Yeah. I mean, we’re probably not that well-known in the industry. We try and just keep our head down and do our own thing and keep a low profile. I know a lot of people who have kind of even not put the fact that we’re running the National Dental Seminars and the Croydon Dental Seminars together. We are very, very… We try and be quite humble and we try and be quite quiet.

Payman: Yeah, there isn’t one of you who is a social media gangster, right?

Avi: No. [inaudible 00:16:28]. It’s strange. I think I’ve got like six or 7,000 followers, but it’s not something that we use a huge amount and it’s something we need to do, for sure. It’s not something that was a choice. It was something that we just need to get around to do it.

Payman: Well, go on. Explain to me what was it with… I mean, let’s go through lockdown because I think it’s valuable. You’re absolutely right. To me it seems, I don’t know, like a light was shone on your world from a different angle and you see things differently, don’t you? You’ve seen first of all, what’s truly important, right? Health. Health. Health. And you’ve realised, that’s it. That’s the number one most important thing.

Payman: But then as a business, how did it feel on that first day when you were locking down? What did you tell your people? What were you thinking? And then take me through what… You’re saying it changed the priorities of why you’re doing your why. What did the why feel like before, and what does it feel like now?

Avi: Okay. So you’re asking some really good questions there. It’s going to take me a minute to just go order by order, question by question. I think where we first started with this kind of process, this journey years ago, we wanted to grow ourselves. We wanted to grow our footprint in Croydon, in Bromley and Sutton. It makes sense for market share. It makes sense for our CEO. It makes sense for how we’re known.

Avi: Our patients are predominantly from certain areas. If we have practises there, it’s more convenient for them. Actually, to us the fact that they travel 30 minutes is lovely, but if they didn’t have to, it’d be better for them. So our philosophy, our mentality was more, we’re getting patients travelling quite far. It would be lovely to have sites that they could visit locally that are called [inaudible] dentistry locally for them.

Avi: Then I think as lockdown happened, kind of my immediate reactions, emotions were actually that, I don’t know how other people were doing, but we were setting up to acquire sites, so we had cash resource to actually fuel growth, which then went into being sustainable. We were really lucky our bank, NatWest supported us. We’re really lucky that we got some loans. Again, this is all a question of timing and luck that we managed to do all of this. But I think immediately, we kind of were telling our people, “It’s okay. Your jobs are safe.” Whether we had the job retention scheme, or we didn’t, we were saying, “Your jobs are safe. Don’t worry.”

Avi: And I think it was much more reassuring them and our dentists than actually thinking about what I was thinking or feeling. I think it was probably three or four weeks in where we started realising, this is going to be with us for some time. That’s when I started being a bit more introspective.

Avi: You said health is the most important thing. I think over lockdown, we’ve lost some really good people through kind of mental health. It’s really, really important and we’ve lost some really good people through suicide. I think it’s something that Lauren, I think in your earlier podcasts, she kind of touched on, she kind of spoke about. I think that that was kind of a wake-up call. Because you think that you’re about to call that person, you think you’re about to think that that person’s going to turn up to your seminars next week? So that was tough. That was tough.

Avi: I think it’s sitting there and communicating that with your team, saying that things will be okay. I remember doing runs to drop off toilet roll. You know there was that shortage?

Payman: Yeah.

Avi: I remember doing runs to drop off toilet roll to some of our nurses, some of our receptionists. Just making sure that everyone was okay, touching base with them. We did Teams calls, maybe not enough, maybe not as much as we could have. We tried really hard not to lay anyone off, or to let anyone go, but I think for the overall business, we decided we wanted to make sure that we prioritised the happiness and wellness of our team. And we didn’t really want to keep growing and expanding and putting more strain on our system and then…

Avi: Because I think one of the things that maybe isn’t mentioned with growth is, you can have your idea, you can have your vision, and although you’re working phenomenally hard for your vision and your plan, it’s kind of yours at the end of it. I think one of the things that we don’t really acknowledge is, the team behind us are so important. They work so hard. I’m really, really proud of our team. And it’s one of those things that I think changed over lockdown, where we said, “Actually, you know what? We want to try and stabilise where we are. We want to try and improve our systems.” So, all of these mindless errors or issues that are happening internally, whether it’s… I don’t know, just simple things, running out stock or something taking two days to fix rather than a day, we want to try and optimise that. We want to try and be slicker.

Avi: We want to try and communicate more with our team and take better care of them if we can. Not only just from a financial, we pay you a bit more, but actually let’s look at their workload. Let’s see actually, are they snowed under? Is it something where actually Monday morning, everyone hates their job? So, we took a minute to do that.

Payman: Go on then. From the perspective of, what was your why before? It was, you’re telling me you were thinking growth, growth, growth. Now, if you had to summarise what you just said with going forward, what is your why now? Creating a happy environment for people to work?

Avi: Yeah, I think creating a happy environment for patients to come in and see us. Really creating the environment for them to be happy and treated by a team that’s happy to see them and not just a social media, five minutes like, “Oh, check it out. Our receptionists are so cool. They’re so happy to be… ” I mean genuinely happy.

Payman: Yeah, you’re right.

Avi: We have some… I mean, there’s a receptionist I’m thinking of, and they turn up to work and they are funny and they are energetic and they are enthusiastic, but I would show you this person years ago and you’d be like, “Oh, you’ve got to get rid of this person. They’re terrible,” but this person has grown and transformed. Their life is happier as a direct result of coming in. You look at actually their purpose, their being, their friendships. Obviously pre-coroner, they meet up outside of work. Even old people that have left us are still in touch with our staff. It’s still-

Payman: I think that’s one of the loveliest things about being in business because there’s quite a lot about it, which is difficult as well. You’ve got all the responsibility, you’ve got the risks, you’ve got so many things, but one of the loveliest things is watching people grow and facilitating people’s growth. It really is. And it’s not often thought about as one of the benefits of being in business.

Avi: Even Georgiana with yourself from where she started to where she is now, it’s [inaudible 00:23:22].

Payman: Exactly. Exactly. On your point about happiness, I’ve say to my people that when one of our users calls Enlighten, I want them to feel like that was a much better call than they made to any other company, not any other dental company, but any other company. By the way, I don’t know if we’re achieving that, but for that to happen, the person has to be happy to start with. There’s no doubt about it. I mean you can’t put on that happiness if you’re pressured and overrun and snowed under in your job. You’re absolutely [crosstalk 00:24:03]-

Avi: I mean, I still think, I don’t think we’re doing it. I mean, I think we do well-

Payman: No, but [inaudible 00:24:08]-

Avi: … but I think if you ask my team, “How does he look?” They’ll say, “Oh, he looks tired. He looks stressed. He doesn’t…” You ask my team, they’re going to say something completely different. But that-

Payman: That’s the goal.

Avi: Yeah, that’s what we want to try and get to.

Payman: What about acquisitions? I mean, are you constantly on the lookout or have you been? How does that work? And is that you? Who is it in the business who does that?

Avi: So a couple of… I think it’s led by our finance guy. So that goes into… The finance guys sees if the numbers make sense, if the cash runs make sense, then we get the first part of the postcode, it comes into me. We have a look. Is it something that we want?

Avi: Went to see a practise about three weeks ago? Had my-owner practise since… I don’t know, since I was a kid? Drove past it on my way when we went to play football as kids and we’ll see how that pans out. We got another one that we went on the weekend. And it’s trying to find the right practise and find the right person behind it. A lot of the time, these people who are selling, it’s not just about, “I want to buy, or I want to sell a practise.” It’s about trying to find the right buyer to take care of the patients because you start building that rapport, you start building that relationship with the patients and actually-

Payman: [inaudible 00:25:18].

Avi: … and you know quite a lot about your patients. I mean, a lot of the patients I’ve seen… So I graduated 2011? So a lot of patients I’ve been seeing after VT, so I’ve been seeing them for eight years? Seven years? Eight years? I know enough to make sure that actually whomever is treating them as the associate, you want to make sure that they’re in a good, safe pair of hands.

Payman: Of course. So, are you always looking for the same type of practise? Would you buy an NHS practise?

Avi: So, last year we had the acquisition of a mixed site. The year before was private practise, the year before that was private practise. So we’re happy with mixed. We’re happy with the private practises, we’re happy with predominantly NHS practises. As I said, it’s the location, it’s the right fit. [crosstalk 00:26:06]-

Payman: Are you expecting the outgoing guy to stay on a bit?

Avi: To be honest, we’re pretty flexible. We have a few dentists in the family that are happy to kind of help out, but I think we want to try and make sure that whomever we’re partnering with, if they want to stay on, they’ve got a job for life. If they don’t want to stay on, then we transition to a clean exit. That’s fine. As long as we communicate well, and I think that’s the big thing here-

Payman: I guess you would prefer it, right? I mean, it’s funny I’m asking you these questions. I’ve never bought a practise before. I’m not really clear, but would you pay more for a practise if the guy was going to stay on and run it essentially?

Avi: I think, without trying to get into practise valuations, which are a little crazy, sometimes, you look at the [crosstalk 00:26:54]-

Payman: Personally, I’m talking about you. You. You’re looking at this practise, the same practise the guy’s going to stay on for 3, 4, 5, 6, 10 years, or the guy says, “I want out.”

Avi: Yeah, I mean, if you’re buying a 7, 8, 9, 10 surgery practise actually it’s less important if they stay on. It’s much more important if you’re buying a short, the kind of one and two-man band practise that you’re trying to hold and keep hold of and so on and so forth. It’s much harder for us to try and build an entire ship around one and two-man bands if the associate doesn’t want to stay on. Yeah. Nina has literally just walked in. So I moved out for a lockdown and she’s literally wandering over.

Payman: Cool.

Nina: Hello.

Payman: Hi, hi.

Avi: Yeah, I know. Well, I moved out for a lockdown and we’ve got our grandma at home. So Nina very, very kind managed to drop off some [inaudible] sweets. We’ve got Diwali on the weekend.

Payman: Congratulations, man, congratulations.

Avi: Yeah. Sorry. I forgot [crosstalk 00:27:58]-

Payman: Were you-

Avi: … but I think it would be great if they can stay on it. It’d be great. That’s the idea.

Payman: Were you all living together before?

Avi: So, my brother and sister married, a couple of kids now, so they live in their own houses. My brother lives about five minutes from mum. My sister originally got married and moved to Leicester and then she managed to find a practise just up the road from us in Sutton, so moved with Soro back and now they found a house that’s less than five minutes from home as well.

Avi: Then I moved out just for the lockdown kind of phase and period because my grandma’s at home. She’s 50 years older than me, so she’s 82. So just because we’re still seeing patients and there’s a small chance of anything-

Payman: Sure.

Avi: … we’re just being hypervigilant with her.

Payman: Tell me about associates, getting them, retaining them, getting the most from them, for them. What do you look for? Do you think you’re good? Do you do the interviews yourself?

Avi: Our structure’s changed, I would say, over the last year. One of the things about growing is, before I used to try and do as much as I could. So I used to do everything from first interviews through to hiring, through to contracts, through to everything. Now, we have, Shiv, my sister’s involved quite heavily in recruitment and one of our finance guys that help and they support that recruiting pathway.

Avi: For the associates, it’s more my sister. So it’s more Shiv that does a lot of that kind of recruitment side of things. It’s funny, we actually had a call this morning because one of our associates is moving up to Liverpool, I think-

Payman: Yeah. You told me.

Avi: Yeah. So in terms of recruitment, in terms of… A lot of the time… Actually I think you’ve found two or three of our associates for us. So a lot of the time it’s reaching out to our professional network. And those guys they stay, you treat them well. And again, Millie, who I think you introduced us to, fantastic associate. Fantastic. It’s actually a great pair of hands, great mind, really affable.

Avi: But again, you don’t really know that in an interview. So you really do rely on those recommendations. If someone says, “Oh, I think this person’s good,” you really do put some weight behind that.

Avi: In terms of retaining them, most of our associates, I would say, probably stay with us for three to four years. There’s a few that have stayed significantly longer. We had one Chinese guy who stayed with us 12, 13 years. We take really good care of him, but we’re aware that also we’re in Croydon. There’s sometimes the allure of actually working in Wimpole Street, Harley Street, Central London. Because also their life moves on. A couple of them, they get married and move away. And as much as you want them to commute an hour and a half for your nine to five, nine to six job and wonderful is that relationship is, and that we can support them and help them, there’s also their family. It’s one of those things where we’re aware that a lot of them will go with our blessing, with all of the support we can give them and we still keep in touch with them. We still kind of have regular chats and regular catch-ups with most of them.

Payman: Imagine if this young associate, who’s never done any private dentistry before and you guys, a lot of your chairs are private, aren’t they?

Avi: Yeah.

Payman: So, for someone who lives, I don’t know, anywhere south of the river at all, then you’ve got… There is a Gentle Dental… By the way, are they all branded the same or are they not?

Avi: So, there’s seven sites that are same. My brother-in-law’s is the denture and implant clinic in Sutton. So they just do dentures, full-on-full implants. Really, really good. Really, really good quality dentures with a lab on site. So it makes a massive Difference.

Payman: But the rest are all called Gentle Dental?

Avi: Yeah, the rest are all branded the same.

Payman: So, look, let’s say I’m, I don’t know, two years out. I’ve done VT. I’ve done a year of NHS and I don’t like doing NHS dentistry. I want to do private and you’ve got… Let’s say I introduced this kid to you. He’s a good kid. He came on my composite course and he’s all right. What do you want to see from, I don’t know, a portfolio perspective? And what’s your advice to someone like that? If they’re trying to leave the state system, the mix system and get into the private system, what are the key strengths?

Avi: So, for us, I think that’s a really good question again. So for us, we look at people that are really affable and really, really [crosstalk 00:32:39]-

Payman: The soft skills?

Avi: … day, like from minute one, they need to be affable and they need to be incredibly, incredibly persistent. I think that we’re very aware that there’s somebody who will send around their CV, and then that’s the only contact we’ll have from them. We’ve had people reach out on social media saying, “Hey, I know you may not be looking for an associate. Here’s my CV.” And that’s the last we hear of them.

Avi: But there’s… I think someone comes to mind that reached out on social media saying, “Hey, how are you?” And started talking to me and saying, “I’m a dentist. I need some advice.” And about three months later, they’re like, “Actually, do you have a job going?” And at that point, you’ve kind of got to know them a little bit. So I think they need to be affable, because again, you want that quality. You want that rapport-building quality in that dentist.

Avi: So, when you’re saying, what do we look for? We look for that person to be relatively persistent with us, actually tried to get to know us, get to know the business. I mean Ashley [inaudible] had something on Facebook actually the other day, where he said he wanted to buy a product and the person hadn’t researched him, hadn’t looked at his website, hadn’t said anything about him. So again, you need someone to know a little bit about you, before they’re trying to interview.

Payman: Agreed, but this-

Avi: I mean if we [crosstalk 00:33:56]-

Payman: … this question of soft skills. So you’re telling me you can’t teach those. You can’t learn those?

Avi: Oh, no. Not at all. No, no. For sure. No, actually, sorry, let me correct. Sorry. You can learn those. I’m naming Ashley because actually we did… I think I’ve done this course, like, I don’t know, six times or something? Ridiculous.

Payman: You’re kidding.

Avi: [inaudible 00:34:17]. And we actually caught up a couple of weeks back. Again, Ashley taught me a lot about communications as he’s, I’m imagining, teaching a lot of the listeners and so on a lot about communication skills, a lot about soft skills. It’s being able to actually do that in a pattern.

Avi: I was fine talking to people before from a social perspective, but actually to get to know a patient, you want to be able to build that rapport within 5 to 10 minutes. You want them to really be interested in you and you to be interested in them. That’s, I think… I don’t think that’s a skill you can just wake up and have. I think that is a hundred percent a taught skill or experience skill.

Payman: Yeah. Look, I agree with you. Some people have just got that X-factor. Look at Larry or Mike or with other… There’s several here as well. They’ve just got something that they’re just… When they see another human being, they make instant rapport. But my question is like-

Avi: And you think Mike has that?

Payman: Yeah.

Avi: I think Mike didn’t have.

Payman: Yeah, maybe you’re right.

Avi: I think that he’s grown.

Payman: Maybe you’re right.

Avi: I think Larry-

Payman: Larry-

Avi: Well, I certainly… I think-

Payman: Larry came out singing. But my point is this, that as the advice to this junior is, “Okay, go on Ashley’s course. That’s nice.” But I see it all the time, where people give people jobs because they just get on with them and you feel like, “If I get on with this person, they’re going to get on my patients and the clinical will come one way or the other.”

Avi: Yeah.

Payman: And I understand why it happens, but I’m surprised how easy it is to get a job, a quite a good job if you’re kind of a good-looking, cool dentists. I’m surprised at that. I’m surprised at that.

Avi: I think that there’s a nepotism angle there, there’s a contact, there’s networking angle, but actually we’ve got some really good dentists that have been introduced to us through reps or through people like yourselves. Actually, it’s not just about the courses they’ve been on because you’ll never get the chance to show your clinical ability if you can’t communicate to the patient the benefits of what you’re doing, how it’s going to change their lives. So actually, I think communication has to be there as the number one skill to have.

Avi: Of course, you’ve got to back up with your clinical ability, but if there was a young dentist that wanted to apply to work with us, it would be reaching out whether it’s on social media, whether it’s by email, whether it’s anything, coming down obviously not with COVID at the minute, but coming down and even saying, “I just want to watch how you work.” The number of people I’ve reached out to, and that have watched us do, whether it’s a CEREC or whether it’s scanning with invisalign, whether it’s seeing what kind of ortho cases I do, seeing what kind of implant cases Mish does, visiting the laboratory over at Sutton. Even just sitting down and grabbing lunch together, we’ve probably, I don’t know, I’ve lost count of how many times that’s happened. We’ve helped a lot of people and guided them into opening doors, I’d say.

Avi: Whether it’s this guy who maybe move up to local and take a job with your colleague, whether it’s you even introducing us to Millie, it’s about making that initial connection and seeing what you can do to help them. So if there’s anyone who actually wanted to do that, just reach out.

Payman: Let’s get into the clinical a little bit.

Avi: Mm-hmm (affirmative).

Payman: Clinically, what are you doing? You’re doing ortho?

Avi: So, I would say about 70% of my work is kind of small ortho, so invisalign. I, again, I do a lot of my own GDP work. So again, I’ll still see a lot of my own recall examinations years later. I used to do a lot more veneers and smile makeover work partly because of the influences from when I was younger. Still, as I said, I’m just… There’s a 10-unit case on a South London footballer we’re doing. Again, it’s that kind of smile makeover, really cosmetic work, which I really enjoy.

Payman: Give me some tips, some Avi tips, clinicals Avi tips.

Avi: Clinical Avi tips?

Payman: Yeah, and listen man, it doesn’t have to be groundbreaking.

Avi: So, what would you like it on? Ortho or would you like it on-

Payman: Whatever.

Avi: … [inaudible 00:38:40]?

Payman: Whatever, yeah. Cosmetics.

Avi: Always use Enlighten.

Payman: of course. Of course, but outside of that.

Avi: So, I think a lot of the time, especially with some veneers and smile makeover work that we, do a lot of the time our preps can be excellent, our preps can be average, our preps can be good, you’re going to have good days and bad days. We always use [expansol 00:39:07]. So really, really good product for… instead of [crosstalk 00:39:10]-

Payman: So, the paste, the [inaudible] paste that [inaudible 00:39:11]-

Avi: Yeah, yeah. Always use Expansol. Again, work with a really good laboratory. So we’re quite lucky we have a few laboratories we work with. Work with a really high-end laboratory. They will always make you look good.

Payman: Yeah, that’s so very true, isn’t it?

Avi: And they’ll also give you the feedback.

Payman: Yeah.

Avi: They’ll say to you, “Actually, you know what?” I had actually, I took a digital scan with iTero a couple of weeks back and we took a physical impression as well. They kind of said, “Actually, you know what? When you were scanning, you couldn’t see this and this. Actually thanks for taking the physical things.” They’ll give you feedback.

Payman: Yeah, you learn a lot from a good tech. I mean, I remember I had a technician when I was a dentist, I had a technician who I didn’t know was one of the top technicians in the country, but he was. He was super, super good. The amount of stuff that… I basically thought I was an amazing dentist, that’s what I thought. I thought, “My God, I’m good. Everything fits. Nothing’s got to be [occlusally] ground in as much.” I was only one year after VT, and I thought I was amazing. I had older patients as well, and as a tip to anyone, if you go for an interview and the patients are, let’s say where there a seaside town, or something ,older patients. As a young dentist, sometimes you think, “Oh, I don’t want to be treating all these older people,” but they are by far the best patients, by far. They’re respectful, they don’t suffer from the sensitivity or whatever. And they tend to take things more easily than… They handle pain more, they tend to be able to pay for things.

Payman: So, I had a patient base who were older and this amazing technician and I convinced myself I was a brilliant dentist. And then the next job, I went to Central London in the city with these city guys. And I thought, “That’s it, I’m a brilliant… I’m going to have these city guys down. Everything’s going to be all right.” With a different technician, this guy retired, and boy did I realise, “Nah.”

Avi: No, as I said, we’re really blessed. We work with a couple of labs. We’re really, really blessed. And we got really good feedback as well. But in saying that they also call us on our stuff when it’s not that level.

Payman: Do you like CEREC?

Avi: So, you kind of brought it back with… Do you remember Hannah? Hannah Newell? From Shine, she was the rep at the time and Rob?

Payman: Nope.

Avi: So, I kind of bought it. We bought two units back in 2013? Yeah. 2013? 2014? As the CAMs at the when they were, I think they were relatively new. I really enjoyed them at the time. I really got into it, and I still do, I would say, maybe a couple a month, but actually I think that as my role in the business has evolved, the number of hours I’m doing clinical dentistry has changed.

Avi: So, I used to do five days a week. I used to work the occasional Saturday. And as my role has changed in the business, I’m doing less and less. So actually where I’m not doing as much routine crown and bridge, the associates are very comfortable scanning now with iTeros and Omnicams and sending it. It’s now, I think, something that is more specialist almost, it’s not something that we would do routinely. It’s something where a patient would come in.

Avi: So, we had a patient come in from Poland who requested a CEREC because that’s what she had had in the past. You sit there and you do it, and it’s really enjoyable. You kind of closed an hour and a half. I know there’s people that book exams over things and try and manage that. I don’t do that. I feel like I want to enjoy the dentistry. So I’m sitting there and I’m enjoying the dentistry that I’m doing with CEREC and I’m enjoying the staining, the glazing. You get to go back to being a little artist and sitting there and painting. Something therapeutic about it. Even when I came down to do the a mini smile makeover course, and you’re sitting there and you’re just working with composites, it’s just something really [crosstalk 00:43:18]-

Payman: I used to stick on classical music and pretend I’m really an artist, and with the brush [crosstalk 00:43:24]-

Avi: Have you been to see [inaudible 00:43:24]? Are you going to see the class [inaudible 00:43:27]? Again, [inaudible 00:43:28]? Very, very good. Very, very good.

Payman: Is it?

Avi: Definitely [inaudible 00:43:33].

Payman: So, go on. Sticking on the clinical then, we’ve been asking everyone. It sounds like you listened to the podcast, but based on the blackbox thinking, the idea that we can all learn from each other’s mistakes. In medicine, that’s true. We don’t tend to talk about our mistakes enough. Take us through your clinical errors that you’ve made.

Avi: I think I was saying, you mean this week, this month? Yeah, I think there’s an element where we all make mistakes, whether it’s something simple in terms of getting an extra piece of, I think it was listening to Andrew, whether it’s an extra piece of paper signed in terms of consent.

Payman: Andrew Darwood, yeah.

Avi: Yeah, again, it’s listening to these guys and sharing those mistakes because I think for us, we make mistakes all the time, whether it’s non-clinical or clinical. The thing is, it’s the impact of those mistakes.

Avi: So, there was a patient where we needed to do a gingivectomy. It’s a surgical gingivectomy, cut and dry. So certainly we don’t get involved. Took a scan to work out actually how much we needed to pull up and looking at it, actually, a lot of it was actually just very thick, soft tissue. So we came up with a treatment plan. You’re talking three and a half, four ml worth of gingiva here from dodgy restorations. We sat down and we tried to do that with a laser across 10 teeth.

Payman: Wow.

Avi: And then prep on the same day and then fit temps and so on. And maybe we bit off more than we could chew there, but again, when I say that was a mistake, I think that’s definitely something I can learn from. And when the patient really backed me into a corner and I tried to do something nice for them, backfired a little bit and had some swelling, had some issues, but that’s just one. I mean, I think we’d run out of time if I went through the mistakes I’ve made.

Payman: Was the mistake that you didn’t leave that one to Mish?

Avi: So, actually, we had a really good chat with Mish, but again, a lot of the work that these periodontists do, a lot of the surgical stuff they do, they’re brilliant with a scalpel. They are so talented. So, we’re lucky to have Victoria, and I think one of your guests, Simon? I think there’s Simon Short? Victoria works with him. So we have Victoria that works with us. So she’s very, very, very skilled.

Payman: Victoria who?

Avi: Rincon. She’s very, very skilled. Lovely girl as well. But it’s these people that say, “Actually, you know what? I think that we should do this surgically.” The patient couldn’t afford to have four weeks of downtime. Patient’s extremely active. They were going to get on flights. They were going to run around and do things. So again, we couldn’t afford to take that surgical approach.

Avi: Again, that’s just on. Another one is again, where we sometime-

Payman: Go on. I’m quite enjoying this. Go on.

Avi: Another one is just [inaudible 00:46:26]-

Payman: Because you seem very open with these. It’s a refreshing change, man.

Avi: No, I think we’ve all made mistakes. I was speaking to one of my friends. She’s in hospital. She took out a tooth. Patient was under GA. Tooth was sitting on top of the airway. The tooth poked… This is a kind of baby teeth. They pop, they don’t just come out straight. They just pop and fly. So she’s popped that tooth now. That’s again, it’s a mistake, but what would she do massively differently? There was a throat pack there. There’s more experienced colleagues. It’s hard to get around it. So you’re always going to make mistakes. We don’t work in a job where it’s going to be perfect every time. It’s why we call it dental practise. Right?

Payman: Yeah, I agree. I [crosstalk] I think-

Avi: [inaudible 00:47:08].

Payman: I mean, the kind of mistake where you drop an endo file or whatever it is, I mean, bearing in mind, you’ve put some rubber down there, but that type of mistake, you’re not going to beat yourself up about hopefully, but even in my short dental career, there were some times where I felt like I let that patient down.

Avi: Oh yeah, for sure.

Payman: You know?

Avi: There’s times where you… Especially if there’s lab work delays or there’s something where you’ve consented a patient-

Payman: No, no. My decisions. My decisions.

Avi: No, so what I’m saying, there’s time where I’ve-

Payman: During the Larry period, for instance, there was some eight veneers that I did that I saw three short years later. They didn’t look great.

Avi: I’m really, really lucky that some of those veneer cases that I’ve done when I was slightly younger, they seem to have stuck. I’m not saying that they’re all going to stick. Some of them may have come away and they’ve just not come back and see me, but I’m quite lucky that we’ve got quite a good stable patient base so we see a lot of our reviews, seven, eight years down. I have photos, despite the fact I only qualified relatively recently, I have photos eight years post-op, which you really would expect them to still be in, but I still have photos from when I first fitted them.

Avi: I think there’s been a few times where maybe I’ve over promised and not been able to deliver. There’s a few consent issues where I’ve brought the consent form, and I’ve added every risk under the sun, and I’ve spoken to the patients and there’s one tiny risk. Like I’ve put some… You know a trial smile?

Payman: Mm-hmm (affirmative).

Avi: So, done a really nice trial smile where I’ve taken a kind of a still tech putty index, gone over with lots, attempt to preview and consent the patient to make sure we’re all on the same page, disappeared for four months, came back and said, “Oh, I’m going to get married. Can I leave these on before?” “Sure.” Eight months go by, and she just comes back in having paid, I don’t know, 200 pounds for the trial smile and she says, “Oh, I want to take them off, and I don’t want to go ahead with treatment.” And then very gently removing, I nicked her upper central. I made a dent that’s less than half a millimetre by a quarter of a millimetre, and that was one where I just looked at that and thought, if she’d told me she was getting married, would I have done the case? Probably. I still may have actually done that, but I would have warned her to say, “Instead of coming back in four months, you’ve got to make sure you turn up in two weeks.” It’s not something where I’m now going to turn around and leave that in the patient’s mouth. I’ll take it out straight away. We’ll get some therapies, we’ll get some photos.

Avi: But again, as I said, it could be a denture case. It could be being more prescriptive on my lab docket. I think every mistake I’ve… I haven’t taken out the wrong tooth or dropped an endo file yet-

Payman: [inaudible] it is.

Avi: … but I’m sure I will do these things. it’s not wrong to make mistakes. It’s wrong probably just not to learn from them.

Payman: I mean, on to your point about over promising, I think it’s a young dentist’s error because you think that if you over-promise, then you’ll get case acceptance. But firstly, that statement itself isn’t necessarily true.

Avi: I think I’ve over promised on… My worst ones were actually ortho cases. So I’m getting married in December next year. Will I be done by then? You look at the case and you think this is kind of straightforward. It should be okay. Three months on, and you realise the patient’s not wearing their alignments. And then you think, “Okay, what I’m going to do is put some brackets on.” You finally put brackets on, four months later… it was despite you’ve been doing all of this and all of this, you realise actually the patient hasn’t turned up to two reviews. So you’ve seen them bond up and then you’ve seen them four months later. You’ve chased them, and they’ve said they’ve been busy. And that’s where actually I feel really bad. I know that maybe I couldn’t have done more, maybe I could have, I don’t know what I could have done differently [crosstalk 00:51:08]-

Payman: But then what happened? There was like two days before the wedding and it was wrong?

Avi: So, actually like that case, no… So that was the Saturday, Sunday, Monday case. So we came in Saturday, Sunday, Monday to correct and fix everything that we was trying to do all of the… Instead of going for ortho, we actually ended up doing a restorative solution, but that was so much stress. My nurse at the time was just like, “Never again. Never are we working a weekend and a bank holiday Monday.” The lab weren’t happy and it was one of those things that’s a mess. Yeah, you’re right. It is maybe a young person’s but that’s also experience, right?

Payman: Of course.

Avi: Like, the teeth don’t move like they’re meant to move.

Payman: What have you learned? What about errors you’ve made in management that you’ve learned from?

Avi: Again, plenty. I’m sure there’s plenty.

Payman: Oh, I’ve made loads.

Avi: I think… Sorry?

Payman: I’ve made loads of mistakes.

Avi: I think don’t be scared to fail and don’t be scared to make a bad decision. You can sometimes be strangled by the lack of inertia. Sometimes you can feel that actually where you’re at, there is no kind of panacea where you’re going to be that, and that’s the only good decision. Sometimes you just need to take a step forward. Even during this lockdown is a great example, there is no management handbook for a pandemic. You communicate as much as you can. And again, some of the team I know, they said to me afterwards they didn’t feel like this happened or this happened, and this happened. It’s one of those things you’re always learning.

Avi: I’ve let some really good people go. In management, I maybe could have handled that better. I’ve lost some staff that I’ve wanted to retain. I’ve probably not paid as much attention to certain members of the team, not maybe rewarded them as much, but, Payman, we’re incredibly hard on ourselves, we really are. Or I think that’s one of… We always talk about what’s your worst quality, but it’s not even being a perfectionist. We are incredibly hard on ourselves.

Avi: All of the good that we do, we still think, “Oh, I could have done that.” I mean over lockdown is a great example. I picked up the phone and spoke to, I don’t know, 60 or 70 dentists. Some people got in touch and just said they weren’t feeling great. It happened to be that one of the dentists that I didn’t speak to was one actually that was quite unwell. So do your thing.

Payman: You’re right. You’re right. I mean, I was pretty hard on myself, but it took me two months to even think about, “Hey, let’s use this time to train the team.” Or online courses… It was just like rabbit-in-headlights sort of situation for a bit there. When you’ve got 70 people to worry about, as well as yourselves and family and health and all that, it’s not easy. On the other hand-

Avi: [crosstalk] think there’s also… We have, I don’t know. So I’m just looking at the board behind you. We have about six projects on the go that I’m not directly involved in running the dental practises as well. There’s a lot of stuff that we do behind the scenes. The seminars, for example, so we’ve got that.

Payman: Yeah, tell me about that. When did that start? So Croydon Dental Seminar’s been going a long time, right?

Avi: Yes, that was Mish. We’re really, really proud of him. He started it as a referral kind of system and to get busier, that was the original kind of idea we put on free-to-attend seminars and the food was crap and it was out of a golf course, a kind of bar or something. I didn’t even go to the first three. I was terrible at supporting him early on. As kind of I got more involved, I was like, “Look, the reason we’re not getting people is we need to be [inaudible] Croydon.” So, Mish kind of moved us over to Hampton by Hilton, over in Croydon. We put on some decent food, numbers picked up and he’s done a phenomenal job from back in 2013, 2014, when it first started. I think for the November course that we’ve running, it’s about 460 people. [crosstalk 00:55:11]-

Payman: Yeah, it’s amazing. The one that I went to was pretty packed, man, pretty packed.

Avi: Which one was that?

Payman: One of the ones in Croydon. [crosstalk] speaker-

Avi: We’re very-

Payman: Who was the speaker?

Avi: Minesh, or… ? We’re really lucky. We’ve had some really great speakers come.

Payman: So then you turned into national.

Avi: Yeah. We tried to go with Barry Alton, went to Leicester. Again, we’ve got, I mean, Birmingham on our radar, we’ve got a few other bits that we wanted to do again. Over lockdown, we’ve been doing some kind of more casual conversation stuff that we did. We’re really lucky with Raoul, with Ian Gordon. We got the guys from the BDA kind of Eddie Crouch involved. We got some other guys in, so we were really, really lucky, but it’s allowed us to connect with dentists.

Avi: And one of the things that, I think kind of alluding to the point you were saying earlier, as the young dentists, we’re in our little bubble and dentistry is quite isolated. Hearing Lender [Cruise] say, “I don’t really know what I’m going to speak to my staff about. I don’t know how I’m going to describe what we’re doing.” Just hearing someone with that much skill and ability, and he’s an absolute diplomat. The guy is so poised. He’s just so elegant when he speaks, and just to hear him say, “Yeah, I don’t know what to do,” it’s lovely.

Payman: It’s almost that if you look at experts, a lot of being an expert is about knowing the basics very, very, very well. And what I’ve found is, that if you know the basics very well, you can say, I don’t know with authority, because it’s not the basics, whereas on another subject, like me and you, if we’re not experts at something, we’ll say, I don’t know, without authority, is a totally different I-don’t-know.

Avi: So, we had [Tiff] have a really lively debate. There were a few subjects where just went into break and you could just hear, “Actually, you know what? I’m going to pop back. I don’t know about this.” These guys are mega. These guys are big in the industry. So I think it was probably to get to know them. So that was cool. That was really, really good, but that’s been going now for seven or eight years kind of in one way or another. Next year, again, trying to work out what we want to do with it, how we want to take it forward. It’s good.

Payman: If you could change something about dentistry in the UK, what would you change?

Avi: That’s a good question, actually. Couldn’t prep this one. I don’t think you’ve asked that many people this one.

Payman: Normally I’ve got perhaps interrupting me, asking you about your children.

Avi: You can go into that. I think in what I would change, I think that we need to be more aligned as the community. I think lockdown’s helped with the rise of kind of BAPD. We need to be more aligned as a community. We can’t have so much… Whether it’s the LDC or BDA or BAPD even, we need to be more aligned. We need to have our vision more aligned in dentistry, whether it’s when we go to government and try and negotiate. Even now, I know there’s contract negotiations happening from friends and colleagues, I’ve heard about what’s going on and listening to some of the largest groups in dentistry, asking for different things to the paymaster. The paymaster just says, “Actually I can always negotiate with whomever I want here because-

Payman: Divide and rule, right?

Avi: Yeah, and so sometimes you have these massive focus groups or you have these big organisations that mean so well, but they aren’t sometimes aligned with other organisations. So if there was, I’m not saying one voice or one body, but if there was more alignment in dentistry, still [inaudible] and how that is an internal conversation.

Payman: You’re completely right. You’re completely right about that. I remember worrying a lot about these same issue, but it seems so obvious isn’t it? It just seems obvious. But the reason why it happens is because… Let’s just take the example of BAPD and the BDA, which, by the way, I hear they’re talking. But the BAPD came about because the BDA wasn’t addressing private dentists concerns. And because of that fact, that’s where it came from. Then you get that sort of clique mentality sort of starts coming into it. But you’re absolutely right. That’s a good one. You’ve picked a good one, if you could change something.

Avi: I don’t know about the BDA not representing anyone or of the BAPD doing this. I’m very aware that I have friends in both organisations. I’m very aware that no organisation starts off to isolate any organisation. I think that it would be lovely… I know they’re talking, I know there’s the ADG involved. I know there’s other groups involved. It’d be lovely for them to sit down and say, “Look we’ve got 15 points, we’ve agreed 10. We’re not going to bring up the other five.”

Payman: And you know that there’s only two questions that need answering, maybe/. What’s best for patients? What’s best for dentists? And aligning those. That’s kind of the whole game.

Avi: Let me tell you something that maybe I shouldn’t be saying on this kind of-

Payman: No, we’ll dit it out if you decide.

Avi: I mean, [inaudible] because you’ve also got so much commercial opportunity. I’m going to give you an example, okay?

Payman: Go on.

Avi: If I say that the… We were told about the vaccine on Wednesday last week. Okay? Markets obviously picked up yesterday with Pfizer’s nuts. So, let’s assume we were told on Wednesday. Actually, if we were told on Wednesday, we should broadcast that news. Right? We should tell everyone we were told about, but actually there’s so much commercial gain in not saying anything and positioning yourselves in such a way. So even now with some of the contract reform conversations, I can see some people who’ve been in that higher level chambers, I’m going to call them, speaking to CEOs and speaking to people in the NHS kind of set-up, and beginning to position things. And it’s really strange because you think, “Surely, if you’re having those levels of conversation, surely if you’re saying, ‘Oh, the contract reform’s going this way or that way,'” you’d want to tell everyone, you know? But actually there’s, especially organisations that can pivot and move with massive resource, I’m talking massive resource-

Payman: Go on. Go on.

Avi: … [inaudible] positions.

Payman: Spell it out, man. Go on.

Avi: I mean, massive resources should be enough, but they can pivot and position quickly. So if I said that, let’s say you need to have therapists or you need to have othotherapists or X, Y, and Z. If you know that now, guess what? Tomorrow you’re placing an advert for othotherapists, or therapists, or-

Payman: Yeah, yeah, yeah.

Avi: … specialists or level two, whatever and whatever. It’s things that… Again, if I vocalised and said, “Okay, so there’s this,” to everyone, everyone would be like, “Okay, let’s collectively make a pathway where we all can succeed.” But commercially, there’s some organisations and some people in those organisations that have to account to other people. They’re not just family-run organisations. They have to account to-

Payman: They call it stakeholders.

Avi: Yeah. It’s that kind of stuff, which I think if we were more aligned on, that would be a lot better for the profession.

Payman: I hear what you’re saying. So you’re saying it would be great if we were aligned, but to get us aligned, information would have to be open-

Avi: That’s it.

Payman: … and business isn’t always about open information, and often it’s about… it’s [inaudible 01:03:16]. You’re quite right.

Avi: If you look at inequalities, whether it comes to education. I mean, I told you I was super privileged in the schools that I went to, right? I was [inaudible 01:03:24]… My parents worked their butt off to get us, whatever it was, like eight a grand a term fees. It was stupid, but-

Payman: Where did you go?

Avi: I went to Whitgift, in South… To give you an idea of this, we have peacocks in our school, we have a zoo. It’s crazy. It’s a crazy place, a crazy school, but we were so lucky to be there. Again, the way that we were taught, if I say this to anyone who’s done A-levels, you’re taught the mark scheme. You’re not really taught the information. You’re taught how to get an A.

Payman: How to get an A, yeah.

Avi: Yeah, but actually, if that information was disseminated to everyone, it would be really hard for people to not get good quality grades. It’s the same thing, and it starts from that. It starts from your education. You look at the inequality. If information was disseminated quicker and faster in a better form, it would be so much better overall. But yeah, you’re right.

Payman: Do you think where we are today, I often think about this myself, but let’s say I want to get into something or I want to find out about something. Today, I’ve got more information available to me than anyone in history ever had. When I think about our parents, when they had to set up businesses, or whatever, I mean, this is a silly… Let’s say, I said to you, “Listen, Avi. You’ve got to get yourself a metal, what do you call it? A brass name thing outside one of your practises.” Obviously they don’t do them in brass anymore, but you would have to wait for the BDJ to arrive, go to the back of the BDJ and find the one guy who’d paid for that, and you wouldn’t know who’s gone and used that. Whereas, today you can go straight on reviews and so… ” so, my basic point is, we’ve got more information than anyone’s ever had before.

Avi: Yeah, sure.

Payman: So, I guess there’s optimism in that, right?

Avi: Oh for sure. I mean, I’ve met a lot of my dental friends. I’ve met a lot more people during a lockdown. I’ve kind of got introduced. I think you were on [Shadi’s] podcast?

Payman: Yeah.

Avi: And then just listening in some of my friends are doing these weird and wonderful things. And the way that we’re connecting right now is great. I think what I’m saying is, that there’s people still in those conversations that may be on 32, 34-

Payman: True.

Avi: Now, again, I’m speaking really positively with Sanjay from Together Dental. Again, Smile Over with [Gene] and then kind of his troop. It’s lovely to see right now these guys at that sort of level, the way that they’re communicating with me, because I look up to them and I think that that’s what needs to happen more. I feel like, again, we were talking about young dentists earlier, but if you need advice or you need help, it’s a case of actually just looking up to that person and reaching out and not being scared.

Avi: I mean, there was a story around Steve Jobs going to pick up… When he was actually trying to get a job, he went and picked up the phone to the guy who ran HP, Bill Hewlett, sorry. He actually picked up the phone to him in a phone book and said, “Do you have any spare parts?” He actually came down and worked on the assembly line. If you just think about that, Steve Jobs working in the assembly line of that massive company. And that’s how he got to learn parts of the system, parts of the process. Obviously, you’ve seen what he’s done like and then what he did, but you need to have that kind of no-fear mentality. Those people with this, if they’re wanting to do something, what’s the worst that’s going to happen? Somebody’s going to say no.

Avi: I’m lucky with this NDS stuff, that the people that we wanted to really get, we approach, we didn’t turn around and say, “Actually [inaudible] too big for us.” Actually, we turned around and said, “We really want Raoul Dhoshi on this. We really want Tiff [inaudible 01:07:19]. We really want these people.” All they say no. They’re going to feel flattered. Os, I think that’s been quite good, but if we can, as a profession, get those people to speak to these people, it would be lovely. I don’t know if it’s going to happen because as I said, there’s too much commercial gamer. That sounds cynical, but it’s also realistic.

Payman: Why did I ask you what you want to change? So I think we’re coming to the end of our time, but I want to ask a couple of questions about your personal plans. I mean, what are your personal plans? Are you thinking of-

Avi: [crosstalk] where I am right now.

Payman: Are you thinking of settling down?

Avi: Yeah, I think everyone has that journey and has that progression, right?

Payman: Not everyone. Not everyone, buddy.

Avi: I think sometimes though, they’ll have that thought, I’ll say. Maybe not journey, but I think everyone has that thought. I think probably being a little too honest right now, and it is because it’s you-

Payman: Cheers me.

Avi: I think when I’ve been younger, I’ve probably had my heart broken a few times, and I [inaudible 01:08:22]-

Payman: Oh, well done then.

Avi: [crosstalk 01:08:24]-

Payman: Well-done for bringing that out, man.

Avi: … I’ll wait for some… As in, you do. You go through these things, and I’ve probably done it to a few people as well, but I think it’s trying to find someone to settle down with and is trying to find that part of your life. I’ve seen my brother and my sister do it, and it’s definitely something that’s on my mind. But I think more personally, I’m very much focused on trying to work and get that balance right, right now. Right now, I haven’t maybe exercised as much as I want to. You can see the gym on, just like in the background.

Payman: Yeah, I did, yeah.

Avi: I want to try and take good care of myself and to be at a point where I’m able to balance that commitment. That’s probably the most honest you’re going to get out of me.

Payman: I like that, I like that. What about for the business? What will be like the dream with the business?

Avi: I think for the business, it would be, I hate using the word consolidating. It somehow means we’re settling, but it would be running in a slicker operation so that the team who are pulling crazy hours right now, they’re doing such an amazing job. They are able to do a nine to five, nine to six, be really enthusiastic and passionate and then switch off their laptops and switch off their computers and spend time with their family. I think a lot of that has been brought into light with lockdown. A lot of that has happened as a result of the past few months. So I really feel that if we want ourselves and our business to do well, we’ve got to take excellent care of our team, excellent care of ourselves as well, for sure. Really, really work hard with the team around us.

Payman: Yeah, but what about the business?

Avi: The business, I think, will continue to grow. I think the business will continue to expand. As I said, we’ve seen some practises in the last month we’ve been expanding and we’ve been growing. So we’re still looking at opportunity. Those practises that we’re seeing kind of in Croydon, in Sutton, in Bromley. We’re still in regular contact with these guys-

Payman: Dude, [inaudible] how much do you love your job? If I gave you the proverbial 100 million, what would you do? What would you do if you were a dentist. Perhaps let’s go straight there.

Avi: Probably something in economics. I really enjoy… So you know when we were talking about how the internet has changed things?

Payman: Hmm.

Avi: So, I got into trading maybe 2013 and actively trade. So really it’s one of our side projects, I actively trade. I really enjoy that part of my life. That’s that’s not just for the money, it’s actually the [inaudible 01:11:10]-

Payman: The game, [inaudible 01:11:11].

Avi: Yeah, and it’s enjoyable there. I think something in economics, again something in… I really enjoy that, and I’m really passionate about that. I think when we’re saying, if I wasn’t a dentist, it’s quite hard to imagine. I think a dentist can mean so much. So right now, I’m doing three or four days clinical, and then a lot of admin, a lot of management, a lot of other side projects, having a good balance. So I think that that’s probably what I would do for if I wasn’t a dentist, but I really enjoy what I do. I just sometimes feel like in any profession, in any walk of life, even in personal professional relationships, you can feel a little overwhelmed.

Payman: Yeah, of course.

Avi: [inaudible] really got to keep that in check, but I love what I do. And if I didn’t [crosstalk 01:11:54]-

Payman: Well you look pretty happy at work, man. I mean we’re in contact quite a lot, but it’s nice to say, you didn’t really want to become a dentist, you didn’t really enjoy dental school, but now you’re really enjoying your career, you know?

Avi: [inaudible 01:12:09]. I really am blessed. I’m really lucky, like family around me, like you’ve seen dad in his bow ties and you’ve seen my mom and you see how they interact, but I’m just, I’m really honestly, really, really lucky.

Payman: Yeah, it’s a special atmosphere at Gentle Dental. I don’t want you to be overrun with people, but you won’t be, it’s corona. But if someone hasn’t seen that practise, it’s one of the most beautiful practises I’ve been to, and I’ve been to a lot of practises. So it’s-

Avi: I remember when you came down and you said that, “What’s the plan?” and you said, well, build Mecca and they’ll come. I think that was your phrasing. I think we’re really lucky. Dad’s got great vision and-

Payman: I’m a sucker for your architect anyway because my other favourite practise is Andy Moore’s. I haven’t been to Robert [inaudible] but I’ve seen pictures and they look [inaudible 01:12:59], but I really do like the way yours pops out of the end of that building.

Avi: [inaudible] is lovely. Been down there because i think Dad [inaudible] kind of the implants cost and he still would like an implant tutor. Andy is a lovely guy. I haven’t spoken to him in a long, long time, but he is, he’s so hard working [crosstalk 01:13:18]-

Payman: Great guy. Great guy.

Avi: I think he does this… He’s had this line of, every four or five weeks. I need to take a a week [inaudible 01:13:26]. That’s [inaudible] style. That’s really [inaudible] style.

Payman: [inaudible 01:13:27].

Avi: [inaudible 01:13:27]. Yep.

Payman: All right man, because Prav’s not here, I’m going to have to ask his final question. Prav doesn’t like asking his final question when the guest is young, but I quite like it because, we should never take anything for granted as far as health and life and crossing the road. So, Prav’s final question is, you’re surrounded by your family. It’s your last day on the planet. What three pieces of advice would you give them. Your future kids and your family and your family. And finally, how would you like to be remembered?

Avi: That’s a good question. I think, firstly, without sounding too cheesy, I think you have to be kind. You have to be kind because you have no idea what other people are going through. So always, always, always be kind, whether it’s grabbing a donut and giving a quarter or a half of it away to the homeless person, just outside the shop or whether it’s picking up the phone when you don’t want to do it, whether it’s dropping someone or picking someone up at the airport, just be kind as much as you can do good things. If you’re still treating the waiter differently to how you treat someone like yourself, to me it’s not ideal. So try and be kind, [inaudible] no idea what other people are going through.

Avi: Trying maybe to accept praise or my second piece would be the best version of yourself. You can always try and copy someone, but you got to be authentic and original to you. Be the best version of you. Your best might not be someone else’s best. That’s okay. If you wake up and do your best, 9 times out of 10, maybe 99 out of 100, you will be successful. You’ve got to get up. You’ve got to put the hours in.

Avi: We were privileged to get where we were. We were very, very lucky to be born into the families we were, and speaking from where I am, I acknowledge that privilege, but I’m very aware of how many hours I’ve put in. So I think if that’s maybe the only thing to take, just to be the best version and say, just to try your best at all times.

Avi: Maybe touching on that point from earlier to always give back, to always try and pay it forward. So from Lauren’s kind of podcast, that was one thing which I picked up. I think I actually emailed I think I actually emailed and reached out on Facebook actually pretty quickly, to the mental events when I was like, “Look, what about this? And what about this?” And try and help out where you can. Always-

Payman: I’m going to say that with all of your events as element of giving in all of them. And that’s always been a lovely thing to see.

Avi: You’ve been amazing and supported us. And it’s really good to have people like you to lean on and to bounce ideas off, but also, we were talking about the younger generation that will really transform the way we do dentistry. I think it’s trying to help them always remembering that actually you’re never too big to help somebody. You’re never too big to answer a phone or an email or a WhatsApp message. So I think those are maybe my three.

Payman: How would you like to be remembered?

Avi: This is a hard one. This is a hard one. So probably as someone who always had time for people, no matter how busy, always wanting to help. Again, probably the worst quality I have is trying to help someone to a fault, even if they’re not particularly the best person for me to help, but always wanting to give and always wanting to help. And I suppose someone maybe that was successful or otherwise, but I don’t really think about how I want to be remembered. I focus much more on just what I’m doing every day, because I feel like your every day could end tomorrow. If you focus on trying to be remembered and building this massive thing, then you can forget about the person’s life that you can change.

Payman: Yeah, but you could say, “I want to be remembered for being a nice guy,” end of story. But beautiful, man, beautiful. I know it’s a difficult question to ask for a modest person. So, I know that was harder for you than most people.

Payman: Lovely to speak to you and hopefully we’ll have a chance to speak to Cam as well, but I know it didn’t work out this time.

Avi: Yeah, I mean, we’ve been-

Payman: Cam and Mish.

Avi: Yeah, right, we’ve been-

Payman: Yeah, I know-

Avi: [inaudible 01:17:53], and I think again, it’s where they are. They’re lucky to be practising and working hard and enjoying themselves. But thank you so much, Payman. It was lovely.

Payman: Thanks for doing it, bud.

Avi: Yes.

Payman: Take care then.

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: 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 had to say and what our guest has had to say, because I’m assuming you got some value out of it.

Payman: 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.

Prav: And don’t forget our six-star rating.

You’d never know that this week’s guest was a man without a plan when he first arrived on UK shores from native Italy some 11 years ago.

Since then, Dr Alfonso Rao has launched an expanding group of clinics and a dental training academy while also building a name as one of the Southwest’s foremost implant dentists.

And he’s achieved all of this before the age of 40, seemingly without ruffling a single feather.

We probe Alfonso on the secrets of his success, life in the UK, work-life balance and much more.

Enjoy!   

“I don’t really often like to be told what to do. If someone tells me and explains to me and I see the reason I’m fine. But if someone says, “you have to do that because it is the way you have to do it,” I’m not too good following.”  – Alfonso Rao 

In This Episode

01.19 – Backstory
08.27 – Italy vs the UK
11.28 – Practice ownership, expansion and work-life balance
19.48 – Teaching
24.37 – The plan
29.00 – Associates
32.03 – On mistakes
37.09 – Out of the clinic
40.11 – Thinking of Italy
43.37 – USPs
45.08 – Exit strategy
46.21 – Last day on earth

About Alfonso Rao

Alfonso Rao graduated from the University of Chieti in 2007 and spent time in practice in Italy before moving to the UK.

He opened a series of clinics in Bristol and Portishead which he later consolidated under the Apollonia Group brand.

He also founded the Delta Training Academy – a leading dental and implantology training centre.

Alfonso is a member of the British Academy of Aesthetic Dentistry and the Association of Dental Implantology.

He is also a key opinion leader and brand ambassador for Strauman, Geitlich, NSK and several other dental technology brands.

Payman: Well, you know my best advice to you buddy?

Alfonso: Yes. Please.

Payman: Keep doing what you’re doing.

Speaker 3: This is Dental Leaders. The podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts, Payman Langroudi and Prav Solanki.

Prav: It gives me great pleasure to welcome the original Style Italiano of UK dentistry, Alfonso Rao, to the podcast. Me and Alfonso met quite some years ago now, and I remember that conversation because it was all done in Italian flair. He’s a straight-talking kind of guy. He doesn’t beat around the bush. He tells you what he wants. He tells you how he wants it, and it always ends with, “And I don’t want any bullshit either.”

Prav: And that’s him through and through. We’ve, during this period of time, become good friends. As well as helping him out with his practises. And Alfonso, I want you to just take us back to your childhood. Where you grew up. What your upbringing was like, and just give us your backstory buddy.

Alfonso: Yeah, thanks very much Prav. Yeah, I fully agree with everything you say. It’s been a great pleasure to know you for the last few years and it is really nice that we are friends as well as working together. So I obviously am born in Italy in Caserta, close to Napoli. And quite like you, in terms of the background and the grow up. So, my dad is an eye surgeon and most of my background in the family they are all medics. However, one of the things that is probably one of the main difference between Italy and the UK is that most of us are going to public school. So it’s quite nice, because with the public school in Italy you really got variety of class mates. So you can get someone who is the son of the probably, someone extremely rich and wealthy. Someone, son of a professor. You might get someone with a lot more humble background. And I really like that part- [crosstalk]

Prav: I may be the son of a shopkeeper or something, Alfonso.

Alfonso: Right. Yeah, that is my point is that it doesn’t really make any difference, the family and the background. Especially when you’re young, you don’t have any of this pre-concept. So you treat everyone as a friend and you grow up with your main interests that might be the football, or cars, or whatever you’ve got. Without having any pre-judgement . And that is great, because you really learn to deal with a lot of different type of people. And I think that is extremely valuable in your life, because I personally feel comfortable in every context. I’ve got no problem if I’m in a gala dinner but I’ve got no problem if I have to be in a market where there is no toilet and no… any place where to have a seat on a table with a fork and knife. So, from that point of view I think yeah, Italy that can teach a lot. Because obviously you learn and you are dealing with all sort of people. Some good and some less good.

Alfonso: But then you learn how to treat the different people. That’s one thing that has been definitely one of, a valuable point of growing up there. In terms of other things, again family background. I’m the only child so I’ve always been quite supported, let’s say that. However, I’m really grateful to my parents because they never really felt me the only child in terms of the freedom of whatever I want to do without feeling the pressure of succeed or do what my dad did, or anything like that. So I’m quite lucky in that aspect.

Payman: What made you become a dentist, Alfonso?

Alfonso: I always thought that I want to be in medics. And when I was 15, 16, my idea was to become a doctor. And again, I don’t know how much you unconsciously… you obviously look your parents, they are role model. You want to become like them. You might want to please them unconsciously as well. And my uncle is a dentist. And I remember that when I was kind of the point where I was starting to do some work experience, I realised that one of the problem with the medicine and being a doctor is that, for example, at that age when you’re 18, be a surgeon is really, really cool. But then you realise that you got lot of, out-of-hours call. You have to work in a hospital. You’ve got no freedom. So I was a little bit scared of that part of lifestyle that my Dad had. Because he’s been always a head consultant and head of department, which means he’s always been on call almost 24 hours.

Alfonso: But then I always felt that my uncle was a dentist, because he had this private practise, he probably had the slightly better life balance with work and his own life. So that was the bit at the time attract me of dentistry rather than medicine. But I always had the passion of healthcare, involved and helping people. And helping them sorting out their problems.

Payman: And when you qualified as a dentist, how long did you stay around your family area? Did you study near your family or did you go somewhere else?

Alfonso: Oh yeah. No, I left home when I was 18. And yeah, I graduated really quick, so I was one of the youngest graduates of my year. So I basically, I was qualified dentist I had just turned 23. And then at the time I worked a little bit in Rome and around the area where I qualified, which is Abruzzo, Pescara, so the Adriatic Coast. And then the idea was for me eventually to go back and work in my uncle’s practise. So then I went back year, year and a half later and started to work with him. But we’ve got quite similar personality and that clashed. Plus, probably one of my limit as a personality, maybe Prav can confirm that, is that I don’t really often like to be told what to do. If someone tell me and explain me and I see the reason I’m fine, but if someone say, “You have to do that because it is the way you have to do it,” I’m not too good following. [crosstalk]

Prav: I think your response to that sort of request usually is in two words and the second word is off.

Alfonso: Yes.

Prav: With the typical Italian hand gesture. Yeah?

Alfonso: Yeah. Yeah. So really, I went back home to work with my uncle and then basically we start have argument. And he’s my mom’s brother, so that was bit of a drama at the time because it was, “Okay, what should I do?” I cannot really work and for one of his competitors and have a competition in my own town with my uncle there. That would really upset my mom and cause tension in the family. And so I said, “You know what? I’m just going to take my gap year and go to UK to study English.” And that is how I then moved here 11 years ago.

Payman: Oh, so you never went back after that.

Alfonso: No, I did. Two, three years after. Once, I was start to get more established in UK, at one point I almost had a bit of crisis where I was, “God, now I’m not going to be able to go back again.” Because then I was starting to lose contact with colleagues and a way of working. So then I opened a practise. I think Prav, when I met you the beginning, I had a practise in… I set up a practise in my own town. And I was working in Bristol from Monday to Thursday. Thursday night drive to Gatwick. [crosstalk] Stay there overnight. Fly Saturday morning. Go in practise at 9:00 in the morning until midnight Friday and Saturday and then fly back on Sunday. And then drive back Sunday down to the Bristol and then start again on Monday.

Payman: Bloody hell.

Prav: I remember. I remember.

Payman: What were your impressions of the UK with regards to dentistry when you first got here, and outside of dentistry. Why Bristol? How did that happen?

Alfonso: I mean, no. Like all Italian, my first step was London.

Payman: Oh.

Alfonso: Everyone goes to London first. Because again, the idea was to study English more than really to do dentistry. And then I remember that I was in this English course in London, and everyone say, “Well you have to present.” I was unable to speak English. Now I’m much better, but I was even worse at the time. So I was like a beginner, it was my first class. And everyone had to stand up and say, “My name is Alfonso.” I say, “I am a dentist.” And everyone say, “Ah, you’re a dentist. You should make so much money and you’re here doing this class.” And then I start to understand a little bit more about how the system worked. And I really, really liked the idea of the NHS in terms of the social system for everyone able to get healthcare and dental care. Because in Italy we don’t have anything similar.

Alfonso: And as I said earlier, I always had a passion of helping people. So I thought, that’s great. I can get good lead in that, helping people and do dentistry, which is kind of what I like. So, that was my first impression, which unfortunately that was completely different then when I start working some of the NHS practise. And I realise that the quality of dentistry that I could offer was not really what I was hoping to offer. And then I had to make some decision and start to work and move to a private practise.

Payman: Alfonso, [crosstalk] just as an idea. If I walk into a random restaurant in Italy, I’m going to get better food than if I walk into a random restaurant in London, right? But what would be the same story with dentistry? If I walk into a random practise in Rome, am I going to get better dentistry than if I walk into a random practise in London?

Alfonso: Definitely not. So Italy, what we usually say is that you’ve got, is like an S, you’ve got the peak. So in my opinion, UK you’ve got some standard. Then you might don’t get the highest quality that you might reach in Italy, but you don’t really have the really lowest peak of quality that we reach in Italy as well. So in Italy, this is how it is. You can go somewhere where you can get some fantastic, incredible clinician that can do amazing work. But you can also go somewhere where you find that dental technician, they work as a dentist illegally. And the level of what they’re doing is terrible. So that is the problem in Italy. Everything is a little bit less regulated, and that is why you tend to get this peak.

Payman: Yeah, I can get that.

Prav: Alfonso, how did the whole practise ownership come around?

Alfonso: That is another really nice story that I don’t think you really knew, because at that time I was working in a mix practise in Bristol. And there were three expense share and I was hoping to buy into this expense share practise. But then I think, there was an argument between them. And one day, one of the partner went there overnight and removed all of the dental chair. So we went to work and there was no dental chair there. So I realised that I was not really keen to get involved in that type of situation and that’s why then I resign and I left. And at the time I was working as a visiting implantologist for James Hall. And then Joe, that is my partner now in some of the practise, he was working in one in the Queen’s Square, the practise now I own. And unfortunately the dentist that owned the practise at the time, he had some problem. So he was unwell, so he was off. So they asked me to just help them, just as local because I had some spare base, because I was in between jobs.

Alfonso: And then unfortunately, he was not really able to get back to work. And as I was there and I had really good relationship with the practise manager, with the staff, then he offered me to buy. And then I just bought the practise at the time.

Payman: But I mean, this domination that you’re doing in Bristol feels like, to me, you and my old pal Touraj Razavi, buying up all of Bristol. Was this a plan from the beginning?

Alfonso: Oh no. That definitely was not the plan.

Payman: There’s seven practises that you own or part-own now, is that right?

Alfonso: Yeah, correct. They’re not all in Bristol. And now, we are moving a lot more down the M4 corridor. So now we are, yeah. Prav, is where that we’ve got this 10-town clinic project and we’re moving from, ideally from Cardiff moving toward London. And I know Touraj really well as well. And yes, we… it’s nice because we’ve got good relationship, and a respectful relationship with each other. So, although we are competitive, we’ve got really nice relationship which I really like. But was never been the plan. The original plan was I buy my own practise, at least I can be my own boss. As I said earlier, I’m not really good to be told what to do. And then I talk and I start to realise how many headaches I have in one practise, and I thought, you know what… if I have three, I probably have got the same three headaches. But then I remove practise, but then it was not the case. So now I’m trying to say, “Okay, if I am seven. This is got to at one point be getting any better.” I don’t know the answer yet, but yes, we’ll see.

Prav: But Alfonso, you talk about headaches. I tend to get, although we’ve spoke about many stresses that you have of practise, ownership and dealing with certain individuals. You tend to handle stress quite pragmatically and quite simply, I think, as a business owner. Some people really let it get to them. What’s your way of just, handling these stressors… two practises, three practises, up to seven. And then you’ve got this idea, and you can talk to about it later of growing this empire, right? But how do you let these things not get to you and just flick it off your shoulder the way you do.

Alfonso: You know it’s one of those things and we had this conversation. I don’t know. I think again is a little bit my background. I try to take things with the proportion. Like sometimes, I stop and I think, “What’s important in life?” It’s family, health. This is at least my kids, my wife. And I’m lucky. I’m lucky that I do a job that I like. I’ve got almost everything in the world, and that is what is really important. So I always try to take things in proportion and understand that yes, there are a lot of these things that they are, complaints and they can cause stress, but in the proportion with important things in life, they are just things that don’t… the daily bit that can annoy every one.

Alfonso: But I don’t think it should really affect my health or my nature. And this is how I try to manage that. And yeah, I have to say, a lot of people that make comments at how I can be so relaxed with all those things. I don’t know. I honestly sometimes look my phone and I’ve got 25 message, 100 email a day or something like that, and-

Payman: You certainly make it look easy buddy. On your Vespa with your handkerchief hanging out of your coat. Prav, you don’t know, he took us out in Mini Smile Makeover when we came to Bristol. And to this day, the team, we talk about our favourite Mini Smile Makeover, it was that one. He took us to some, where was that place you took us to, the Richard said something about the pizza place that was really-

Alfonso: Yeah, yeah. Bosco, yeah. I remember that.

Payman: Fantastic food and we drank and we had a great time. And then Dipesh rode his Vespa and had an accident. And then he was limping around the next day. But you do make it look easy. I know it’s not. I know it’s not. Of course, it’s not. How many employees do you have now?

Alfonso: We’re at about 50.

Payman: 50.

Alfonso: Yeah.

Payman: So what’s the secret of that? Do you have managers on each site that you really trust? How does it work? What’s the corporate structure?

Alfonso: Yes. We do have a manager on each site. The truth is that I’m at the sites at the moment and it’s why I say maybe growing my headaches. I’m at the sites at the moment where we’ve got practise manager on each site and I trust them a lot. However, I don’t really have the office back up yet, which I what I hope is going to make things easier moving forward. That’s why, again… joke aside, I’m not really aim to become like a corporate or anything big. But I think if I can get to that 12, 13-practise size, we’d probably be a nice group size where I can still have control of the clinical standard, hopefully in some of the benefit of having the group management. But I still do a lot of micromanagement in terms of, the dealing of the daily staff, with everyone. I think it’s important to build the relationship and to give people the opportunity, to empower people to make the decisions. So they know that they need to make the decision and I will be there to support their decisions. And yeah.

Payman: So then what kind of a boss are you buddy? Are you firm or are you fun or what are you? What’s it like working for Alfonso?

Alfonso: I can ask, there is a practise manager around the corner. I can get her [crosstalk] I’m intense in the way that I usually, am all my relationships. So I give 100% and I often present 100%. For more point of view, I do have a personal relationship with a lot of them, and most of my managers are my age or they’re older than me. So that obviously something that play a part as well. I’m type of person that when is the time to work I’m 100% focused, it’s work, work, work, work, work. But then outside I try to always be, really friendly relationship and I almost always try to support them in a personal aspect or life as well. Because I think it’s important to be there for them and they usually, that is building a relationship that works on both sides and they will be there for me. So there is a lot of respect on both side.

Payman: And you still work how many days as a dentist? Do you do mainly implantology now?

Alfonso: Yeah, so I do only implant and Invisalign. So some cosmetic. I do three and a half days clinical. I work, like this week where I’ve done four clinical days and then we are running a course today and tomorrow with the academy. So I will end up doing six days.

Prav: And Alfonso, how did the teaching come about? Because I remember when we first met we were having our initial discussions were on, “Hey I’ve got this company who want me to teach for them. I’ve got this company who want me to teach for them. This one wants to give me X. This one wants to give me Y,” et cetera, et cetera. I remember those conversations so vividly. So how did you, coming from Italy to here, being as young as you are, how did you get yourself recognised as, ‘Hey I can teach.” Or, “I want to teach.” Or what was your teaching journey?

Alfonso: That is something that I always really, really liked since my time at university. I think that everything you said is obviously completely correct. It’s not something that has been taught. Like a lot of things. I’m not extremely good sitting and making business plan and say, “This is going to open now. This is going to open next.” I can do a lot of things as I feel are right for me, for my colleagues, for my practise and for my family. So a lot was that I was invited to teach for different companies in a different aspect.

Alfonso: Now at that point, I start to feel that, that was not enough. Because I was doing things for others rather than for myself. And I think especially when you do teaching, it’s extremely important to be as independent as possible. Obviously, I do work with a lot of company and I do make a relationship with them as well. But I wouldn’t have shown or discuss in the course something that I honestly don’t really use in my clinical work every day, because there is obviously dignity and ethics. I don’t think that otherwise I would be good at explaining either.

Alfonso: So that is the reason, because we started the academy, so okay. Rather than teach for other people or teaching or a company, why don’t we reverse-engineer that. Why I’m not having my academy, I’m happy to deal with the company, I usually work with my clinical staff anyway, but basically in my way, in my rule, in my time. And I decide how to do it. But teaching is something that I find extremely rewarding. From a clinical point of view, I find that, that help me to be a better dentist. Because since, you remember, this was conversation where the beginning. At the beginning I was not taking enough clinical photos, but now I do photos of almost every cases, because obviously I need for the teaching.

Alfonso: And then when I review my photos because obviously I have to prepare a lecture or presentation, I often try to be self-critical and say, “Okay, I should have done this in a different way. I should have done this in a different way.” And I’m not too competitive with people around me, that’s why I was saying even with Touraj, I’m really relaxed about my competition and my competitors. But a lot competitive with myself. So I always want more from me.

Payman: And what do you guys teach? Obviously implantology. And Massimo does endo, is that right?

Alfonso: Yeah, so I do all the implant side. Massimo does endo. But then we also use our entire connection the last few years to do some prosthetics course or restorative course. We are doing courses from Rubber Dam to oral surgery, from GDP, to full large cases, so microsurgery. So we always try to do course with the different level. But one of the nice things that we try to do is keep the academy as nice and fun place to be. And that’s why we realise that a lot of people, they are coming to the academy for one course and then they’ll end up doing the whole journey with us. So-

Payman: Is the academy part of Queen’s Square? Is the building, or is it a separate place?

Alfonso: No, it’s a separate building. So it’s part of the High Street Dental Clinic at the moment. Ultimately, our dream and goal is to have dedicated centre with the proper facility in there, but at the moment is a dedicated centre but is within the practise. The top floor of the practise. [crosstalk]

Payman: And the name Delta Dental Academy. Is that a different name to, what’s the group called? Is it called Queen’s Square?

Alfonso: No, so the group now. The new setup of the group is called Apollonia. Apollonia Clinics. That was started as a Queen’s Square group but now is getting bigger and is becoming Apollonia. The name of that was for, is an acronym of my and… now I can’t remember what that is…

Payman: Prav, you need to get on to the branding.

Alfonso: Yeah, Prav.

Payman: Get everything in brand.

Prav: Alfonso, where is all this going? Because we have conversations and they’re so random mate. So sometimes you’ll buy a business in the same way Payman or Destat is in a restaurant, mate. Yeah? So just to give everyone a little bit of insight into that, we go to a restaurant and Payman says to me, says to the waiter, “Yeah, we’ll have everything in your starter list.” And the waiter looks at him like there’s something wrong with him, right? And then as he looks at him, he holds two fingers up and says, “Twice.” Yeah?

Alfonso: I’ve seen that. I’ve seen that.

Prav: You’ve seen that. Right? In the same respect, I’ll get a phone call from you and go, “Yeah Prav, I’m just buying that practise across the road and there’s another practise down there I’m going to buy and there’s another two practises here I’m going to buy,” and for me, looking at it from the outside I’m looking at this and thinking, “I don’t think he’s looked too much into these businesses, it just seems like a good idea.” And you’ll say, “What’s the worst thing that’s going to happen? I’m going to lose a bit of money. But let’s just give it a go anyway.” Is there a plan?

Payman: But, but, but… where does the confidence come from yeah? To get up, go to another country. Go to some random town at the end of the day Bristol for you, being from where you came from, and open seven dental practises. Where does… were you always super confident?

Alfonso: The answer is probably yes. In terms of-

Payman: What’s the answer to Prav’s question? Do you look into these businesses or do you work more off emotion?

Alfonso: No. So, okay. So to articulate a little bit the answer. In terms of confidence, is that in a little bit is again, going back to the background. So I’ve always been probably again, married to my parents. They support me but with the right distance at the least, well I felt that. And I kind of feel confident because I know that I’ve got my family behind, which means I know that important things are fine. And they will be there for me. If I’m successful or not, so I don’t feel that the success is something that obviously is going to change the relationship that I care. And is why I don’t feel that I’ve got much to lose, because I’ve got them anyway.

Alfonso: In terms of how I decide to buy business, I honestly trust my feeling a lot. And I also choose the business based on the people. So I do believe a lot in having that feeling when I see people, and I do like… I like to make sure that I buy business where there are people that I can work with. A business that I feel that I can add the value to their business and we can work together as a team. So for example, I’m never really attract to buy a business that is extremely successful and say, “This is what I really want.” I rather to get involved in a project, where I know that I can go there, work hard and try to succeed.

Payman: So what is the vision man? Where is it going to go when you say 13 practises? What’s the vision? What’s your five-year best case scenario that you would really like to achieve?

Alfonso: I enjoy dentistry too much. So there are some people they say, “Okay, now you…” I think I will still be in five years. So let’s say, best case scenario in five years time, I will be able to do only the bit that I like of dentistry. So really, which is… I’m quite already quite liking the position. I only do implant and Invisalign. I would probably do only the implant case that I want and the Invisalign case that I want.

Alfonso: And then, I quite like the business side as well. So in terms of, the management of the practise, or take a practise that from smaller to [inaudible 00:28:31]. Support my younger associate. So if I can get, I realise that being in clinic and trying to be at high level 4 or 5 days a week is too much. So I find that doing the bit of teaching, business and clinic help me be sharp in all the different things.

Payman: What about- [crosstalk]

Alfonso: I’ve got different view. From the different perspective.

Payman: What about associates? How do you handle associates? What pisses you off about associates? What’s the best associate and the worst associate? I don’t mean names.

Alfonso: No, no, no, no, no. Not going to do any names. So again, I’ve been quite lucky, because I’ve never been in the position where we have to, really rarely we have to advertise for the associate. So again, like you said, I know a lot of people in dentistry. Through the Academy we’ve been able to know delegates and they’ve become associates over the years as well. Which has been really positive as well.

Alfonso: But then sometimes the associate is often, they don’t really appreciate the work that is behind the scene. So what I mean is that, a lot of the associates they see, the bit that is nice of owning the practise, being able to make the decision, and they don’t really realise that for example, this morning before I run the course at High Street and Delta, I went to Queen’s Square at half seven to look at the rotor. We had an autoclave broken. So I spoke with an engineer about that. We’ve got one of the receptionists, that have flatmate test positive, so she’s off. So we’re to make arrangement about who is going to cover what.

Alfonso: And they don’t really see all that amount of work that is behind, not just by myself, but by my practise manager and everyone else. And they turn up to work and they say, “But why the coffee machine is not working?” And you think we don’t respect you, obviously we want the coffee machine to work as well. But there is a lot more that is behind. And like everything in life, you need to choose what you want. There are some people that they prefer to come to work, do their bit and then go home. And there are other people like myself, that I enjoy to look the 360 degree package. But some people, they don’t really understand that, and they would like to pick and choose, and that is what annoy me with an associate.

Alfonso: I really like the associate on the other side, that they work as a team player. Because I think one of the key of the success of some of my practise in Bristol has been always the [inaudible] approach. So every associate, and you can speak with all of them, they’ve got full clinical freedom. I really rarely interfere with any decision. I only interfere if I start to see things that they, abuse the clinical standard that we want to produce as a practise. And I think that empowering people works for everyone.

Prav: Yeah. But we’ve been asking everyone this question in order to try and learn from each other’s mistakes. Because in medical, people tend to hide their mistakes. And there’s a book, I don’t know if you’ve read it, Black Box Thinking. It’s about-[crosstalk 00:32:02]

Alfonso: Yeah.

Prav: So what’s been your biggest clinical mistake that you’ve made? If you’re happy to talk about that.

Alfonso: Yeah, no problem. If I have to generalise, as a clinical mistake, I would say the biggest mistake is when I didn’t say no. When you’ve got that patient on the chair and they start to make pressure, and the pressure can be from every different source. There are some type of pressure is financially, if I’m prepare to pay whatever. And I am being completely honest it doesn’t affect me at all much and often is a counter-productive sign. Because I feel that they are trying to buy me and I don’t like that.

Alfonso: But the most common, I think for us, and for a lot of dentists, the ego, when they say, “No one else was able to do that. I heard that you’re the best. I think you can do that.” And you almost feel that you want to prove something. That to the patient, to yourself. And when I didn’t say no, and I start cases where I realise that other people, if they make a mistake, there was a reason because they made the mistake. So when I was trying to re-do something and that didn’t work. So for example, I don’t know, you might… with an implant case, you see a case where the implant fails and you say, “Okay, the case failed because the reason, we wait and see.” You re-do it, and then yours fail as well. And then you realise that maybe was nothing wrong with the clinician and in the implant, but maybe was the genetic of the patient, or the overall hygiene, or medical conditions, or other factors.

Alfonso: And so, to generalise the answer is, my advice is never to say no. This is probably the main thing that I’ve learned from my mistakes.

Payman: I like that man. The level of work that you’re doing. The complex implant work… there’s going to be failure, isn’t there? That’s something that anyone who does complex implant work knows. But learning from it’s the key. If I wanted to get a job at your practise, what would be the best thing for me to do?

Alfonso: Again, as I said earlier, for me it’s really important building relationship. And often, I think it’s important for me to choose the person, not just the clinical skills. I strongly believe that you can train and teach clinical skills, but everything you can teach. You can teach skills. But you can’t easily change the nature of the person. So for me, if I know that you’re the nice person and I think you’re the person that we can work together because we’ve got similar value, similar ethics, I think that for me is more important than probably everything else.

Payman: So look, building such a massive organisation. It’s easy to look at it now and say, “Hey, he’s got a great life.” But along the way, where was the pitfalls? What would you do differently? What was your darkest time in building this thing?

Alfonso: I think the most difficult part for me was when… So when I first moved in UK, I think I was telling you about, went to London, studied English. And then I was looking for a job. And I was speaking with one of these recruitment company, they say, “Oh, I’ve got perfect job for you in a nice practise.” And I didn’t obviously understand a lot of the things at the time. So I went to work in the [inaudible] dentist, outside Lincoln-

Payman: Oh yeah. [crosstalk]

Alfonso: It’s a really, really… It’s a beautiful town. Really, really nice. And I have to say, when I look back at my time in Lincolnshire, people were really nice and friendly and they helped us a lot. But I went to work in this practise and the clinical standard of that practise, they were really, really low. And at that time, I remember that I moved from London to Lincoln, with my girlfriend at the time that is my wife at the moment, with a cat hidden in my car, because I was not allowed to have a pet in this apartment. We don’t [inaudible] in the car, but the flat that we rented was not ready when we arrived in Lincoln, so we had to live in the car for weeks and I went to work and they didn’t even have an autoclave.

Alfonso: So I say, “What am I going to do now in Lincoln?” Quite a few miles away from Naples. With the cat, and the girlfriend in the car on the phone and not even a place to live. So that probably was one of the most difficult time where I thought, why I’m here, why I’m not back home, why… And was raining outside.

Payman: Wasn’t it. Your frontier.

Alfonso: When everyone in Naples was probably on the beach with an apéritif, or having… But then I think like everything, you need to go through that part and learn from the mistake and be prepared to work hard. So again with my family, my ethics, my values always been work hard and hopefully the reward will come eventually. And I always felt that that was probably my way of working out.

Payman: Yeah.

Prav: Alfonso, obviously life outside building this empire, what’s it like for you? And how do you maintain that balance? Because I think you’ve got a really, really good way of doing this. The work-life balance, and what from I think it revolves around levels of intensity in both aspects of your life, right? So just tell us, typically, what does Alfonso do outside of work and how do you manage that work-life balance as a multiple business owner with a family as well, and a young family at that.

Alfonso: I have to say, and I’m not saying that because you are here. But this is a conversation where at a lot of times, and I remember at the beginning when I was work, work, work, you always say, “Look, think about that. Think about that.” And a lot of my changing about my life balance is been from conversation with you. So I’m happy to give you this merit in this conversation. And again that is also part of testament of our friendship. You see, you were telling me things that you didn’t get reward with the second part of.

Alfonso: And I think it’s really, really important to try and understand. To try and divide it. So when I work, I 100% focus on my work. But when I go home, I try to switch different half and I like to spend my time with my wife, my girls and try to enjoy the time that I spend with them. Obviously, I work out to try and give them more opportunity, a better life, and see they are happy with their life. For me is really rewarding. And that is part of what makes me happy. I always try to also try to have… I agree with you, I’m happy with my balance. I think I should try to find a bit more time for myself. Because I try to spend a lot of time with my family, a lot of time with my work. Probably not enough for just myself. Like things, training.

Payman: Yeah, what would that look like if you had a day to yourself? What would be your ideal day?

Alfonso: Probably watching 6, 7 game of Napoli, one after the other. I really like football, I like, and I’m massive support of Napoli. Sometimes for me, time for myself is just really time of, even go for a walk and have time to think about, a bit of exercise. But I’m no massive fan of a gym, but I like play sport, like tennis or football. Something that is social is well. And then social time with friends. Having time to have a chat with them. Catching up. Nice pizza and a beer. Just talk about stupid things that they don’t necessarily matter. Just a bit of distraction.

Payman: What do you miss the most from living in Italy?

Alfonso: The seasons. So, here the thing that for me is most difficult is when in the spring here, after we’ve got nice weather. But in Italy, especially when you come from close to Naples like myself, from April to June, July, when the weather is nice, you work til Friday and then on the weekend you are going on the seaside. You are going on a boat. You are staying on the beach. There is only apéritif on the beach, restaurant outside. That is the thing that I miss. That part of the lifestyle. And I have to say-

Payman: I thought-

Alfonso: …as a lifestyle, there is a little bit less stressful than in UK. Everyone is a bit more relaxed, little bit more with the good and bad.

Payman: What don’t you miss about it tell me? Is it that thing you said about lack of regulation and…

Alfonso: Yeah, working in Italy. So when I set up my practise in Italy, I remember I said, “Okay, I liked the way I worked in UK. I’ve got microscope, I’ve got this.” So I give the appointment, first patient at 2:30, second patient 3:00, third patient 4:00. I went there at 2:00, no one there. 3:00, no one in there. 4:00, no one in there. Everyone turned up at 5:00. Planning to have a treatment now and there. And I said, “But your appointment was, you don’t even…” “Yeah, but my daughter, she was… I had to drop her to school, I had to do that.”

Alfonso: So then, you end up working until midnight because this is what everyone does. No one complains because you are running late. Everyone accept. They are sitting in the waiting room, talking with other people, there for hours. But then they get in the lifestyle, then where is the time with my family. Then I’m there until midnight, and probably to get the same income I would have get if everyone was turning up in time and I was finished at 6:00. And that is the bit that I don’t really like.

Payman: And what’s the bit you don’t like about the UK? Apart from the weather. The food, huh?

Alfonso: No, the food’s lovely. We’ve got a lot of Italian deli around. Great restaurant. One of my best friend in Bristol is at the Michelin-star restaurant, Peter.

Payman: Actually the food’s really improved a lot in the UK.

Alfonso: Yeah, yeah. The food in Bristol is really nice.

Payman: Yeah.

Alfonso: The thing that I don’t like sometimes in UK is that sometimes I feel that there is a lot of stress and pressure for things that are not important. So you’re going to back to what we were saying, getting stressed. And I remember when I owned the practise, one of the first complaints that I received, a patient wrote me a letter to say that we didn’t have Home and Garden, one of these magazines? Why are you spending half an hour of your life writing a letter because there is no magazine room. By the way, it was in the waiting room. It was back and she couldn’t find. And sometimes I’m thinking, that is just creating negativity forever, for me. And I think is an unnecessary negativity.

Payman: And so, Alfonso, there’s this group that you’re… call it, you’ve been winging it to get there, right? Just buying a practise here and buying a practise there and now you’re formalising the Apollonia group, right?

Alfonso: Yeah. Correct.

Payman: And you’ve got this loose strategy.

Alfonso: Yeah.

Payman: Want to start acquiring practises down the corridor, right? What are you bringing different to the table in comparison to other corporates who are out there buying practises? What is it? What’s your point of difference that you’re bringing to the table?

Alfonso: I think the main point for us is that I’m a dentist, and for me is everything about the clinical work. My view of dentistry is that if you do good dentistry, and if you do high quality level of dentistry, the financial aspect will always naturally follow. And I think that a lot of dentists, especially if they decide to sell their practise, they often are scared of getting corporate and going down. They try to micromanage and change the way that they are doing dentistry. Then our view is that we want to improve the quality of dentistry to get the practise to succeed. And I think that view, I know there are a lot of corporate that say that they will have a similar view. I don’t think there are many that are really doing that. So, we’ve got great retention of clinician and staff when we buy a practise because we treat them well.

Payman: What’s the exit plan, dude? Are you saying you love it so much you’re not going to exit? Or what are you saying?

Alfonso: I’m 36, Payman. So for my exit, there’s always…

Payman: Is that all? My goodness.

Alfonso: I look a lot older since I start to work with Prav, I’m losing hair. But I’m only 36. [crosstalk]

Payman: Same thing happened to Payman.

Alfonso: So my view is that if your practise are profitable and are successful, why sending? So you know, I would be happy to go another 10, 15 years to working as a dentist 2 or 3 days a week and then as a business owner and teaching the rest of the time. So that is something that I really don’t have a long-term exit plan.

Prav: You’ll figure it out as you go along, right?

Alfonso: Yeah, you’ve seen by now. This is a lot about me. I find out how, what I will do.

Prav: Listen Alfonso, I know we’re running out of time, so let me just ask you the final couple of questions.

Alfonso: Yes.

Prav: Imagine you’ve got your girls around you, it’s your last day on the planet and you’re going to leave them with three pieces of advice from Daddy. What are they going to be?

Alfonso: It’s a really good question. I think would be, be yourself. Do only what you are feel comfortable and happy to do, because the main thing is to be happy. And you only live once and I think it’s important to try and be as happy as possible. Be respectful because it’s extremely important to be respectful to everyone. Because if you want to be respected, you need to be respectful to everyone. And I think that this is something extremely important as a value to have. And the third part is probably, to don’t have any regret. Do everything that you feel is the right thing to do and enjoy.

Prav: And then, finally Alfonso, how would you like to remembered after passing? So imagine somebody years after you’ve gone turns around and says, “Alfonso was…” and then just complete that sentence.

Alfonso: I’m glad Prav, that you can only see the first part of my body not the second. In Italy, I’m quite romantic on these things. Alfonso was a nice person in terms, helpful with everyone, is what I always try to be. Happy and smiling, so you know, a pleasure to have around other than be grumpy and be moaning about problems. And I think that is really what I hope people that will think of me. And yeah.

Prav: I think it’s definitely a fair summary. That you’re a pleasure to be around and certainly one of the people when this rings and your face pops up, it always brings a smile to my face. Because I know it’s all going to start with, “Ciao, como esta?” And it’s always a pleasant conversation. So-

Payman: And a real, real pleasure to have you on, man. Thank you for doing this.

Alfonso: Thank you very much, and really it’s a pleasure to be invited and to have time to share and my experience with you. And again, hopefully people that can… I hope I can inspire some people as well. I’m honest, because again, my experience was move to UK without any plan and the moment I’m happy with what I’ve achieved so far. So I think that working hard hopefully pay off in the end.

Payman: You know my best advice to you buddy?

Alfonso: Yes please.

Payman: Keep doing what you’re doing.

Speaker 3: This is Dental Leaders. The podcast where you get to go one-on-one with emerging leaders in dentistry. Your hosts Payman Langroudi and Prav Solanki.

Prav: 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: 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.

Prav: And don’t forget our 6 star rating.

In the business of buying and selling practices, this week’s guest is the dental leader.

Back in 2000, Andy Acton co-acquired Frank Taylor & Associates (FTA), which he went on to grow into the UK’s leading name in dental practice acquisition, valuation, development and sales.

Andy takes us through the business’ early years, explains how COVID has effected the market and dispenses an encyclopedia’s-worth of wisdom on purchasing and growing practices.

Enjoy!

“The craziest situation I’ve ever had…is somebody bought a practice and – I kid you not – he went and changed his name by deed poll to the name of the person he bought the practice from.” – Andy Acton    

 

In This Episode

00.55 – Buying the business
08.32 – The competition
14.11 – Selling for free
17.10 – Deregulation
20.45 – Signs and scenarios
27.42 – Deferred income
33.06 – COVID and acquisitions
40.43 – Then, now, growth
48.31 – Darkest day in business
52.16 – Squats, small practices ambition
01.02.14 – Super associates
01.04.23 – Owning a practice
01.06.03 – Last day on earth

About Andy Acton

Entrepreneur Andy Acton is a director of the FTA group of companies providing business services for dentistry.

The group now incorporates FTA Finance, FTA Wealth and Management, FTA Law, FTA recruitment and FTA media.

Andy is also a popular public speaker on leadership, management and practice development.

Andy: I see so many people doing things that they don’t enjoy, and it’s heartbreaking. I would say, above all, enjoy yourself.

Intro Voice: 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: It’s my great pleasure to welcome Andy Acton on the podcast. I mean, we call it the Dental Leader’s podcast. That doesn’t mean everyone has to be a dentist. Andy’s actually dominating, if that’s the right word, the practise sales side as Head of Frank Taylor & Associates. Andy, thanks for coming on the show. Lovely to have you.

Andy: Thanks for having me.

Payman: It’s a pleasure. Tell us how you got into this, buddy. I mean, when you think of practise sales, you think of Frank Taylor completely. I mean, I envy your sort of brand position. Was Frank Taylor the first or how did this happen?

Andy: Yeah. He was the first, yeah. So what happened was back in the 1980s, there was a Frank Taylor and his business partner Sandra Rhodes. And they worked for Claudius Ash, who you’ll probably both be familiar with, the dental supply company. So they were going out and they were visiting practises. And as a result of visiting a number of different practises, a question started to come up, which is, “So what’s my practise like compared to the one down the road?” So Frank would say, “Well, it’s better than the one down the road, but it’s not as good as the one in the next town.” And then he goes to another practise, and the same question will come up time and time again. And sure he didn’t realise actually what people were asking was really, where did their practise rank in terms of value?

Andy: So Frank and Sandra went back into Claudius Ash and said, “Look, we’ve got an idea. We think there’s an opportunity to value dental practises.” So Claudius Ash being quite progressive said, “Well, that’s a good idea. Do you want to try that?” So they gave it the name, which in hindsight, probably wasn’t a great one. They called it Confidential Services, which has different connotations. But I kind of understand why, because what they were doing and what we do now is very confidential. So they trotted out and they started evaluating dental practises. And that was the very first time it had ever become an independent market in its own right. Because prior to that, dental practise has changed hands by basically people going down to the pub, or sitting in a cafe and talking to somebody and they sold to someone they know. But now suddenly, there was an independent market.

Andy: And then 1988 came along, and Claudius Ash did a strategic review, didn’t feel that Confidential Services fitted with the core strategic direction. So Frank and Sandra said, “Well, do you mind if we take this out on our own in this venture?” They said, “Well, go with our blessing. And good luck to you.” That was the start of Frank & Taylor Associates back in 1988. And they valued the sole dental practise, that’s what they did. They continued to do that through to 2000, and I bought the business back in 2000 with my still co-director and shareholder Christopher Evans, because we were working together in the city. And we’ve been working together for… Well, I’ll come back to how long we’ve worked together for in a second. But we’ve been working together in Bank of Ireland, developing solutions for the professionals such as lawyers, dentists, doctors and other health care professionals.

Andy: I joined this bank, the back end of 1999, just before we clicked over to the 2000s. So this was November, 1999. By March 2000, Chris and I decided to buy a business together, which, when I advise people now on entering partnerships, or buying a business together, the thought of knowing somebody, because I didn’t know Chris at all, before this period, to buy a business and get involved after four months seems crazy. It’s slightly distorted, because we worked intensely on a project. So we were working 16, 18 hours a day together. And through that process, what we found is we got on really well with a classic Venn diagram, I cut out some stuff, he cuts out the other. And we got on really well. So initially, we approached the bank to buy the business because we thought it would be a really good idea for the bank, because then they could provide the finance for the acquisition of dental practise. And the bank said, “We don’t want to do that because it’s too niche.” And we were like, that’s the point. The point of doing it is to capture a market. But they didn’t want to do it.

Andy: Quite incredibly, the bank gave us their blessing to buy the business ourselves, which was great. So we were two guys, we were working in the city, had good jobs in the city, we now owned a business on the side, which in our mind was going to pay us a great big dividend. And we were on cloud nine. Then in month three or four of business ownership, we realised that we had no money and we couldn’t pay salaries. Because what had happened is the people we bought the business from, Frank and Sandra, they weren’t involved anymore, so they didn’t care about the business. Sure they were doing a good job, but they weren’t responsible for running the business. And that was like a business Lesson One, is that when you own the business, you’re the person in charge, and the buck stops with you. So we had to change our attitude and mindset very, very quickly.

Payman: Andy, quick question there. Was the business on the market for sale at that point? Or did you approach them and say, “This is the ideal business we want to buy.”

Andy: It wasn’t on the market. We approached them and said, “Would there be an opportunity…” We knew they were of an age where selling was probably going to be on their horizon at some point. And then I think what starts happening is, even if it’s not on the market, when you start conversations, the art of the possible and the what ifs started gaining traction. So when that conversation started, both Frank and Sandra thought, “Well, we could sell and we could work on as consultants, and this could be a pathway to retirement.” And suddenly it started to snowball. But no, it wasn’t openly available as a business, which in many ways was good for us, because it meant that we could have lots of private conversations without there being a competitive situation.

Payman: How were the earlier years? Were you struggling?

Andy: It was hard. And the reason it was hard is that we didn’t commit. We kind of dabbled and we kind of had it on the side. So we bought the business in 2000, and we did this probably for a couple of years. It was 2001, 2000. So both Chris and I were full time in the business by 2003. Chris did an amazing thing, he actually moved over part time. He left the city, he worked the business part time, we both committed to make sure that it worked. But when we joined full time in 2003, that’s when it started to motor, that’s when we really were able to capitalise on the opportunities, but also build out the strategy. Because remember, this was a business that valued and sold dental practises like it does today. And that’s what it’s well known for, and what I believe is it does really well. But from a business point of view, there’s a massive risk, because if that sector of dentistry catches a cold, we’re out of business.

Andy: So early on, we worked out, that we need to start bolting things into this business to make ourselves safer in terms of our livelihoods. But also there were real added value services that dentists needed that weren’t being serviced out there, for example, arranging finance. Back in 2003, dentists just went to their local bank manager and hoped they got the result. So we introduced a brokerage and we helped them from that side of things. But it was difficult. And I guess one of the things that people tend not to see, they only see that whole social media and they see stuff on social media and everything looks so easy and straightforward. But in the early years, it’s hard.

Andy: When we first bought the business, I wasn’t actively involved in a day to day basis, so I worked in the city full time. So I’d start early, I’d get into the city by 7:00 in the morning, and I’d leave at 3:00 in the afternoon, I then head over. The office was then in Potters Bar, I’d get to the office by 4:00 o’clock in the afternoon, Chris and I would then work together till 9:00, 10:00 in the evening, and I’d repeat that. I did that for the first 18 months, two years of owning and running a business. New guys would have done the same and thousands of other people have done the same, but that never really gets talked about, because all people really want is, “What’s the quick fix? How do I go to from zero to a million in 24 hours?” And the reality is, it does exist, but it’s exceptionally unusual for it to happen. And actually, it’s the years of graft and hard work that gets you to a position when you’re in the market.

Payman: Absolutely. So then, at what point did these other competitors come along? Were there competitors in the early days?

Andy: In the early days, there weren’t really. There was an organisation called [Hemi Pirlo 00:08:46] Group. They started at a similar time and they were doing a thing like us. They were based in the south as well. So in reality, we had a clear run for an awful long while. And then a major change that happened, because back then the value of dental practises was relatively low. It was somewhere between 25 and 40 or 50% of turnover. It’s changed in terms of how value practises are valued. But that was kind of a rule of thumb. But then what happened was around about late 2005, 2006, when what was called the new NHS Contract came in, there was a massive shift, because effectively if you have an NHS Contract, your income is capped. Associates felt vulnerable, so we had hundreds of associates coming to us on a regular basis wanting to buy a practise. As a result of that, value shot up.

Andy: My business works on a commission basis, so we get paid on completion of the deal. We get paid by the person selling the business. So as values went up, when you earn a commission on your increased value, it became more lucrative and more attractive, and I think it was probably that [inaudible] brought other people into the market. As we are today, there’s probably about a dozen companies that do what we do across the UK to varying degrees of standards and success. Some of them fell out of recruitment businesses that said, “Well, we do recruitment.” So that’s matching people to jobs. So matching people to buy as a practises kind of things. Some specialise in it, absolutely. Others were just valuation companies that perhaps provide evaluation services to banks, and then branched out into doing the brokerage side. So there’s a mixture. I think the difference is that Frank Taylor & Associates set out to do this. This was kind of a plan of what they wanted to do, so it was a slightly different start point.

Payman: Andy, when you had no competition, and then fast forward in today, where there’s, let’s say, a dozen or so people in the market, maybe fighting for these people who want to sell their practises or people who want to buy. Do you feel back then maybe you were a little bit lazy and complacent, and then competition makes you kind of like up your game? If you look back then, looking at where you are now, are there any differences? Would you have done anything different?

Andy: I don’t think we did anything different. We were lucky back then, because we were a couple of guys who didn’t really know what we were doing. We were winging it. And because there wasn’t competition, it definitely did give us a breathing space to hone our skills, learn what we’re about, and gain our 10,000 hours. So we were able to do it at a time when competition wasn’t advanced. The reality of where we are now, I love competition, because without it, it absolutely does make you lazy, it makes you complacent. And there’s nothing worse than a situation where you have to use somebody, because there is no competition. And you know that is dire, you know it’s awful, but you just have to do it. You know how many monopolies are out there where you just think, “Well, I’ve no choice.”

Andy: If you want to get on a train, okay, I know some is privatised that kind of the rolling stock on the line today, there isn’t really much choice, you just have to accept mediocre service. So for me, competition means that we constantly have to stay on our game and make sure that we’re always improving and staying better because some of these champion our heels. And for me, it’s great because my view is legacy doesn’t mean a thing. It doesn’t mean… N really cares where you’ve been around for six months or 20 years. It’s what are you doing now? What are you doing today? And what are you going to be doing tomorrow? And that’s where, for me, it’s about consistency of what we do, always about we have to be consistently excellent. But also, if the marginal gains, I think competition makes you think about those 1% improvements, because you can’t [inaudible 00:12:33]. For me, I love competition. I love it.

Payman: If I was looking at selling my practise, is the massive unknown playing field out there haven’t got… Let’s assume I don’t know how a practise is valued, I just know I’ve got to that point in my life I want to sell my practise. There’s 12 people to choose from. How on earth do I go about making that choice of who to go to, to trust with my business to get me the maximum value? Or actually, irrespective of who I choose, is my business going to be valued on a multiple of my adjusted profits? And that multiple give or take a little bit, I’m going to end up with the same end result. And imagine, I know nothing about this, let’s say, so educate us.

Andy: The reality is that most people in your situation, most people will only go through this process once. And that’s dangerous. If you think about the first time you do anything, and you don’t know what you’re doing, you feel really vulnerable, you feel quite exposed. It’s where do you go for reliable information. For us, fortunately, because we’ve been doing this a long time, there’s a bunch of people out there that have worked with us and been through the process, and it’s gone well. So speaking to friends and other people within the profession, to get a guide on kind of who the good guys are, is a really good start point. But in terms of the approach we take, we are unique in how we go about our business, because one of the things that we do is I charge the seller for their service. So I’m going to engage with you as the practise owner, we’re going to have a letter of engagement, I’m going to act for you. But differently to the other people that operate in this market, I’m going to charge you for my service.

Andy: There’s a lot of talk in the market that you can sell your dental practise for free. As soon as you say the word free, people love it. So if you go to a train station, and there’s somebody handing out breakfast bars, there will be a queue of 50 people waiting for breakfast bar because it’s free. They might not even want the breakfast bar, but because they’re going to get something for free, they love the idea of it. So you then translate that into so your dental practise for free is highly attractive. The danger with selling dentist practise for free is you’re not the person that is paying for the service and there’s only other one person in that transaction and that’s the buyer, so the buyer is going to be paying the broker to sell the practise. So where the buyer is paying the broker who’s acting for you, it makes no sense. It’s illogical, because there’s a conflict of interest. And normally in my world, if I’m paying for service, I expect that service for me.

Andy: So as a seller of a dental practise, you really don’t want to move into an environment where you sell for free, because actually, it’s the buyer that’s paying for it. And I recently watched that programme, Social Dilemma, and in Social Dilemma you say, “If you’re not paying for the product, you are the product.”

Payman: Very true.

Andy: And if you’re selling your dental practise for free, then someone’s making money off you, and that’s not right. So going back to the value side of things. In essence, it’s a multiple of adjusted net profit. But also it needs to be considered in the context of so many things; the location, how the fees are generated, who generates the fees? Is it freehold or leasehold? What sort of dentists has been delivered? What are the core costs? I know that staff costs should be about 20% of turnover. Are they at 20%? Are they higher or are they lower? Who delivers a dentist within the practise? Typically, a principal would produce a gross of somewhere between 250 and 300,000 pounds, which is quite reasonable. If your principal is producing five or 600,000 pounds, then there might need to be adjustment, because that might not be something that could be achieved by the incoming principal. So you might have to add in some additional social costs.

Andy: So what you need to do, is you need to rebuild a practise based on what it would look like for somebody else buying that practise. But also, the multiple applied is important in the context of what’s that being applied to. So if you’re working to an EBITDA number of say 500,000 pounds without kind of getting too technical about it, and you had a multiple of five times, that would be two and a half million pounds. But if you had a smaller EBITDA with a higher multiple, you could end up with a higher number. So because you’ve got lots of different numbers and elements in this formula, it’s really important to work with a broker that is able to explain to you how they got to their value.

Andy: The other thing that’s important is if you’re a practise owner and you’re looking to sell, you got to be sure that the broker you’re working with can actually get that price, because there’s no point in giving you a flat in new value, if what you’re actually looking to do is so.

Payman: Andy, when you were growing your business, it was about the same time that the corporate started deregulating first. Do you remember the time when it was only like eight companies allowed in it. Suddenly, there was that deregulation, that massive influx of cash from the corporates. What does that mean to you day to day? I mean, what do they do? Do they work with the likes of you or do they have their own full on people trying to find practises for them? How does it work?

Andy: Some. They don’t like guys like me, because my job is to… We never fall out with them. I don’t think I’ve ever fallen out with anybody, but what they don’t like is my job is to get the best price I can for the seller. Their job as a buyer is to get the practise for as cheap as possible. We just stay opposite ends of the spectrum, and that’s just business and how it is. So what they tend to do, is they tend to approach people directly. They’ve got a good sales network, and they talk through their model and how they work. The bit from a seller’s point of view that you need to be careful with, is the corporate approaches you and invariably what the corporate will do is the corporate will value the business for you, and they want to proceed and buy that business.

Andy: The issue I have is, if you, say you’re sitting in your home, you own your home, somebody knocks on your door and says, “I’d like to buy your house. What I’m going to do, is I’m going to tell you what your house is worth, and then I’m going to buy your house. Is that a good idea?” It probably isn’t. And don’t get me wrong, I’m not saying don’t sell to a corporate. A corporate is a good exit route for somebody. What I’m saying though, is you should really get it valued by somebody else as well, to make sure that the value of the corporate you’re suggesting is a reasonable and fair value.

Payman: I guess it’s like going into court and saying, “I’ll just use the opposition’s lawyer for some advice.” Right?

Andy: Exactly. Not the best idea today.

Prav: No.

Payman: They have sort of inflated prices or in the past anyway, so I guess that influx of cash has helped your business a lot, right?

Andy: It has, yeah. I mean, what’s happened over the years is there’s lots of small and large corporates. So we’ve got smaller corporates. And at the bottom end, if you’ve got eight or 10 practises, I’d say you a micro corporate. And we go all the way through to the end of my dentist and [inaudible 00:19:25]. And you guys are coming on in leaps and leaps and bounds at the moment. But what you’ve got is you’ve got the corporate market is very much designed around. They acquire lots of practises for a multiple, make it bigger and sell it for a bigger multiple. That kind of the logic that goes with it. That’s great if market conditions are such that when you decided to get out, there’s appetite to sell at that high multiple. If there isn’t, and at the moment, we’re seeing an awful lot of small and midsize corporates with practises that aren’t necessarily making money on an individual basis, because they were hoping and expecting to get at a mega multiple.

Andy: I always say that if you’re going to grow a group of practises, make sure that each of those practises on a standalone basis makes money in its own right. Because if they do, you can hold them away for the market conditions to improve. If they don’t, then you could be in a sticky position. I think that one of the things that corporates generally don’t do is reevaluate their portfolio often enough, they don’t they don’t churn it. It’s that classic. Look at the bottom 20% and see what’s not working. Because lots of practises just don’t work in a corporate model. They lend themselves to be owned and run by somebody in the practise on the ground there on a day to day basis, produces a gross, and motivating and inspiring their team.

Payman: Let’s go through that, then. Let’s say I own one practise, and I’m seeing all this activity, and I think I’m going to buy a second practise, which is going to be associate led. What are the key performance indicators that I’ve got to look for? What would you say is healthy, and what can I expect from a practise that turns over revenue to half a million pounds? What should I be looking for as far as what’s a healthy practise to buy and how much can I get out of that practise, from a percentage perspective?

Andy: If you already own a practise, the start point will be to work out whether you want to stay working in that one practise, and leave the other one completely associate run, or whether you’re going to split your time between the two.

Payman: Let’s say for the sake of the argument, does everything leave the other one completely associate run.

Andy: So it’s going to be a completely associate run. So it will then come down to the profit would probably show on the accounts, somewhere between 22 and 25%, which is quite typical for general dental practise on an adjusted basis, EBITDA or reconstituted net profit. It’ll probably go to something like 35, 40%. But because you’re not going to be working there, you are going to be solely reliant on associates working that practise. So the 22 to 25% fee isn’t going to work, because you’re going to need to increase your associate fees. So you’re going to probably come down to somewhere between 10 and 12%, as a net profit by not working that practise. The challenge that it brings is, and this is where the corporates tend to favour the three, four, five associate practises is that you really need to be a certain size, because you need somebody in that practise, so in managing money, you ideally need a practise manager.

Andy: And when I say practise manager, I mean a business manager. I mean, somebody who’s going to be a meanie you who is in there, actually kind of grinding the cogs and make sure that things happen. Because if you’re the owner of your practise, but you’ll never have this practise in your line of Associates, the reason that people are working in a business is because they’re happy having that life and being in that sort of environment. If they were business owners, they wouldn’t be working with you, then they’d left, and they’re gone set up their own thing. So on a day to day basis, they’re happy working, so things slip. So your materials. Your materials, perhaps should be at six or 7%. If you’re on the ground, managing and keeping an eye on it, they turn into 10 to 12%. And that trickles through the business, you get out of these inefficiencies.

Andy: So in a smaller practise, you either have to split your time between the two, or what you have to do is bring in a business manager. The problem that that brings is the business manager is probably somewhere between 40 and 50,000 pounds, because this isn’t a practise manager or glorified practise manager who’s just going to get in there, make sure that things happen. And that is the challenge, because quite often there isn’t the profit in the business to pay that person. And that’s when you go back to the earlier comment, which is where you get principal splitting cells between two practises, because the numbers don’t quite work.

Payman: Andy, on the flip side, I mean, I work with a lot of dentists who were at various different stages in their personal life or business journey. So you get the one who’s got towards the end of their career and they just want to throw the keys in and walk away. You get the ones who think, “I’ve got another eight to 10 years left in me. I’m happy to hang around for five of those tied in.” And you see all of these deals coming in whereby what you get this value where you’re tied in for so long, and you’re on this rate, et cetera, et cetera. Can you just sort of describe the different scenarios that people find themselves in. I guess the right deal is only the right deal if it’s the right deal for you in terms of your lifestyle and how long you want to hang around for versus handing the keys and then whatnot, and where did your experience come in advising people?

Andy: 100%. And that thing about the right deal is the right deal based on your situation. I got this thing that I think that practise ownership, I think people start to suffer fatigue around about the 10 to 12 year mark. The amount of people I see who were associates only run a business and to start with they love it. They go through a period of growth, things flatten out. They flatten out and then about five years later around the 10 to 12 year mark on down, and sadly, so many of them still really enjoy their clinical dentistry. It’s just the grief and the hassle that goes with [inaudible 00:25:11], the favour of the duty. And quiet for many people it never manifests into anything, but just that kind of the Sword of Damocles hanging over them. And the exit depends on what you want.

Andy: If you exit and you sell to an independent dentist, that will typically look like possibly a three-month handover period, but it is the classic case of [inaudible 00:25:35]. You collect all your money on completion and you don’t go back to the practise. A slide on that same scale might be you sell, particularly if it was a private practise, because you might want to do a handout to make sure that those patients were integrated to the new principle. You might have a hand over a period of three to six months, you’ll be retained on an associate basis, so you would still receive all of your money on completion for sale price that would come across your completion. When you start moving into the corporate model, what they tend to do is they tend to agree a price with you. And then they would typically pay 70% of that sale price upfront. Sometimes it’s 60%, but typically 70%. And the 30% deferred is paid to you over an agreed period of time. And typically, that’s somewhere between three and five years.

Andy: So you continue to work with the corporate as an associate being paid, and that pay rate would be down to negotiation, but it could be anywhere between 35 and 45% as an associate. You will then be paid your associate rate for delivering your dentistry for three to five year period. So long as certain KPIs, key performance indicators, will match year on year, you would then get your deferred element paid out over that three to five-year period. If those KPIs aren’t met, there is a risk that you don’t get the deferred element. So going back to that, what’s the right deal for somebody? If you want the sale and get out, send it to an independent dentistry, is the more attractive route because you get all your money and you get to go.

Andy: If what you’re saying is, “Well, I want to get my money out, I want to stay on, and I want to work in an environment where I still want something to add on, and I don’t mind leaving some money in the business and being paid out over a period of time,” then the corporate model works. So it’s really about understanding what people want to achieve, and then matching the buyer to suit the seller. In my experience, the majority of people want to sell, get their money, and go. And I think that’s because so many people start the process of thinking about selling probably about two to three years before they talk to me.

Payman: Andy, just going back to that deferred income argument. I’ve had numerous conversations with people, and the advice I’ve heard sort of thrown around is that if you’re happy with what’s being offered on day one, i.e, your 70%. Just consider that’s what you’re getting. And your 30% if you get it, is a bonus. And then, how can you expect your business to meet the KPIs that they’re setting for you that are based on when you own the business and you control the marketing budget, blah, blah, blah, all these different variables in your business, and all of a sudden they come along, change the pricing structure, change the marketing strategy, and the KPIs are on that. So there’s numerous conversations I’ve had. Do they ever intend on paying that 30%? Is there an engineering of, “Hey, we’re getting in this practise for 70%, and we’re never going to pay that because we can change the game”?

Payman: Just playing devil’s advocate there. And obviously, you’ve got more experience about seeing these deals come through. How often do you see the full deferred value being paid versus not being paid? I know for some of my friends, I’ve seen it not happen several times. But I’d like to hear what your thoughts are on this.

Andy: Yeah, I think if we go pre COVID, the payments were… different corporates work in different ways. Some corporates put in incredibly stringent and stretching targets. And then they do play around with the costs. They don’t make it impossible, but they make it incredibly difficult to hit those triggers. And bearing in mind, you could be looking at a two million pound practise. So 30% of two million quid, that sits on 1000 pounds. That’s quite a differed chunk. Therefore, from a commercial point of view, if that 600,000 pounds didn’t have to be paid across, you can see why that might be of interest. Having said that, to be fair to the corporates, I don’t think that they genuinely set out to not pay this amount of money. I think they do intend to pay that money. I think sometimes the deals aren’t structured in a way to help achieve that being delivered. From where we are now, unfortunately, there are lots of deferred payments aren’t being paid.

Andy: In reality, what you said is right. If the upfront payment is good enough, then that deal should work for you. If you get the deferred over a period of time, then that’s good news, and is a bonus. I think for many people, practise values have been high for quite a while now. So if we roll back to the mid 2000s, when values were shooting up quite high, lots of people were really surprised at the value of their dental practise because they were used to them being woefully undervalued. Whereas now, lots of people have a pretty good idea what it’s worth. So when you take 30% of that figure, for lots of people, the 70% isn’t quite enough. That deferred argument, they do need that deferred anyway, and they expect to see it come through. And the challenge for lots of people setting is the reason that lots of people who say, if they don’t want the grief, perhaps, so the management, the people issues, everything that goes with it.

Andy: But if you’ve got 30% of your value still retained in that business, you can’t really just completely walk around being associate, you’ve got to continue doing those things, because you want to get your 30% sale. So for many, the corporate world doesn’t quite meet all of their objectives, because they continue having to be actively involved in the business, because they’re protecting this 30% that’s deferred.

Payman: Part of your value add, do you help in the negotiation of what those terms are, about how those retention figures are met, or what the structure is, in terms of their guidelines, or is corporate is pretty strict that this is what it is, walk away? Is there some movement in that when you’re speaking to them?

Andy: Yeah, we do. We negotiate on their behalf. And I think the start point and where people negotiate with corporates directly, they’re incredibly good at just setting out an offer. And that’s their offer because for many of them, they’ve done this time and time before. The buyer side of sellers often assume that there isn’t any negotiation, but there’s always negotiation, there’s negotiation on everything. My wife finds it renders the embarrassing whenever we go anywhere, on negotiating all over the place. I love it for fun, but it you should be negotiating. You should be improving the percentage that you’re being paid as an associate, you should be shopping the differed terms, you should be trying to reduce the amount that’s deferred, but critically thought about those KPIs as well. Because at the moment, it’s challenging times. And if they put in some growth measures that are coming over the next two or three years, we don’t quite know what’s coming down the line. And it’s small things like if you miss your target in the first year, can that be rolled over into year two?

Andy: So let’s just, for ease of numbers, let’s say there’s 300,000 pound deferred, and it’s 100,000 pound in year one, same in year two, same in year three. So if year one’s mixed, does that mean you lose it, or could it be rolled into year two? For me, that’s the sort of thing that should be negotiated. Because if you fall short in year one, but you’re on target to have a cracking year two, that actually that should be paid in year two. But if that wasn’t part of the agreement, then potentially you missed out on that first portion. So yeah, but for my part, everything’s up for negotiation, or it should be.

Payman: Andy, what’s COVID done to practise acquisitions’ prices the way people are thinking, the psychology. Because from where I’m looking, a lot of associates now are getting a much tougher deal than they had before. And the ones who are able to are looking to buy practises. Is that right?

Andy: Yeah, absolutely. Normally, when big change happens, we see a flock of associates coming to us to get on to practise ownership. And I think what happened is through COVID, associates mostly earned over 50,000 pounds a year, there was no government support, but basically what it meant, you start dipping into your savings. Life being what it is, we all know that we should always have three months to clear savings to cover our outgoings as a slush fund. That kind of works for lots of people. Some people didn’t have that slush fund set aside. But when dental practise is shut three months, they burned through that quite quickly. Then when we got the end of COVID, and practise started to reopen, a few things happened. One, principles didn’t take associates back as quickly as they were hoping to because they were starting to deliver that dentistry in themselves. And when you factor that at the time, everything else it was difficult for them to work at the pace they were pre COVID.

Andy: Lots of practise also ran back to the associates and said, “Look, times are really hard. And I know I used to you used to be paid 45%, but I’m really sorry that now and these look more like 35%. 30%. 25%.” So their pay rates got reduced. And they also felt battered and beaten up because they were vulnerable. And so now you’re absolutely right, Payman. The amount of people that are coming to us associates that say, “I can never put myself and my family in this situation again. I need to buy a practise.” And don’t get me wrong. Owning a business as you guys know, hasn’t been easy through the pandemic. It wasn’t kind of a licence to print money. It wasn’t easy. But we had assets to go back to. We had an asset and a business to return to, so we can keep going, where’s an associate, you’re vulnerable.

Andy: So the amount of socialists that have come to us who are wanting to buy a practise has has really spiked. But what’s also happened is the values of dental practise have held up really well, because the true value’s point of view, what I need to do is I affected you need to remove the lockdown period, because you have to, because we all know the reason why they weren’t able to deliver dentistry. Since practise reopened, the ones they could have opened from the 8th of June, in reality, most were back on their feet sometime in July. But when you look at their August, September and October numbers, they brought it back to pre COVID levels, which, obviously from a professional point of view deserves a massive pat on the back, because they’ve had to factor in increased PPA, fallow time, some people work in between two surges.

Andy: So to get their numbers back to where they were pre COVID is nothing short of remarkable. But what it does mean is there’s values of held up really well. But importantly, that’s also been supported and backed up by the banks, because the banks independently have practises valued before they lend money. And the bank valuations are saying the same thing as we are. So it’s not just me as a broker kind of trying to talk the market up and say, “Oh, no, everything’s fine.” [crosstalk]

Payman: Andy, you must know. I mean, I certainly came across some distressed practises and some extraordinary deals for practises over that COVID period. Whether it was guys who just did not want to look at the whole PPE nightmare, or people who ran out of money, that happened, didn’t it? Some people got practises really cheap.

Andy: There were some practises that people picked up cheaply. I think it’s easy to look at COVID and say that was the reason. I think when you look at lots of those practises, they were in unknown distress pre COVID. This three-month period was the thing that tipped over the edge. These were practises that weren’t being well run. And it was the COVID thing-

Payman: Is that Warren Buffett thing about when the tide goes out, you see who’s swimming naked?

Andy: Who is swimming naked, is actually right. There are lots of people who didn’t have their causes on for sure.

Payman: All right, so tell us about, over the years that you’ve been doing this, you must have seen some wonderful stories, right? You must have seen some people who’ve really… we’ve had them on the show, people who started with 50 grand and opened 20 practises or whatever it is. And you must have seen the opposite side of it as well. In fact, within the same deal, I’m sure some practise [crosstalk 00:37:41]. Tell us about the horror stories. I mean, what should people more people know about practise sale and practise, purchase, and consider that they don’t?

Andy: I think on the purchase side of things, I think the thing where people seem to get it wrong time and time again, is the biggest change a business can go through is a change of ownership. So bearing in mind, a person that’s selling has probably owned that business for 10 or 12 years. So the team know them intimately. All the processes, the system, all those cogs. There is a well oiled machine, the patients know the consistency of visiting that location and what it looks like and feels like. So a change of ownership is massive. So anybody who buys a business who goes in and then start chucking their weight around by moving Rebecca off the front desk and bringing in Matthew, or repainting, or adding in another surgery or changing the branding, stop, stop it. Don’t do it. Do nothing for six months. Just move into the practise, and watch and listen. Just don’t do anything. Just be a dentist, and just get a feeling and understanding as to who does what and how it works.

Andy: Talk to your team, then start making changes, because you’re going to do it with your team on site. Patients are going to know you’re a good person, and you can meet them in a considered way. And I get why people do, [crosstalk]

Payman: Exciting.

Andy: It is. They spent a lot of money, it’s their practise, they want to make their mark, but honestly, it’s the worst thing you can do. There was a guy who bought a practises, sorry. And he went in and did exactly that. He changed everything. It was a small village. It was a really well established practise. The team didn’t like it, half of them left. The patients didn’t like. It was a private practise. There were other choices in town, the patient started to drift away, it was a disaster. If he’d have just done nothing for six months, I think the outcome would have been really different. Which it’s a shame, because he spent a lot of money on the practise.

Payman: So that’s a common thing. I hear that a lot of when people tell me they’re going to buy a practise. They come to us looking for photos and pictures for the new designs and all this. And I always tell them, “Look, evolution, not revolution.”

Andy: Absolutely.

Payman: Exactly what you said. The staff and the patients… in fact, it would be ideal if they had no idea.

Andy: The craziest situation I’ve ever had, and you’ve got to be careful, you don’t take this to an extreme. If somebody bought a practise, and I kid you not he went and changed his name by depot to the name of the person he bought the practise from.

Payman: What a-

Andy: Honestly. The thing is they were from different ethnic backgrounds, that when he turned up, and he said, “No, I’m Dr. so and so.” They’re like, “Well, no. Are you?” He says, “No, I am.” And he thought by changing name, it would be good. It’s like, why was it ever going to be a good idea. There are some incredibly strange things that go on.

Prav: Loss. Absolutely loss. Andy, when you started your business back in the day, you used to talk about doing those 18-hour shifts, call it the art of graph getting you 10 pounds, 1000 hours in and whatnot. How has that changed now? So talk me through the contrast between then and now. And so what is your role? And also the people in the organisation now who we used sort of steering?

Payman: Take us through the separate divisions as well, because I know you’ve got law, marketing and several others.

Andy: Yeah. So we had FTA, Frank Taylor & Associates, and basically, that was our one legged stool. And in 2009, we said, “Look, it makes sense to formalise the finance side of things.” So David Brewer was the leading range of healthcare financing dentist in the UK who’s with RBS. And one of the great things that fell out in the banking crisis is David wanted to change, he wanted to do something different. So he came and joined us, and we started FTA Finance, and FTA Finance now arranges about 160 million quid a year for dentists to buy dental practises across the UK, works with 14 banks. David’s a great guy, he’s the Managing Director of that business, and on a day to day basis, I don’t really need to be much involved in that business, he has it covered, which is fabulous.

Andy: Then in 2015, we actually bought a recruitment business, so we rebranded FTA Recruitment. Because we realise though, when you’re buying a practise, there’s going to be some churn, things are going to change. And associates, some are going to stay, some are going to go. Hygienists, some are going to stay, some are going to go. But actually, if you don’t have hygiene as part of your programme, your practise, you should, therefore you may need hygienists. So we’ve now got a recruitment business, and that primarily focused on delivering hygienists and associates in the practises. All the things we do add value, and are unnecessary business service to dental practises. If it doesn’t tick that box, we don’t do it. That was where the improvement came from. Then in 2015, we started through a licence agreement, FTA mortgages, so that’s residential mortgages and weren’t involved in that business at all.

Andy: We work with a team that help people through that residential mortgages. It is an important part of the mix, because quite often, where people are looking to buy dental practise, what they can do is take out the equity from their residential property. And that then becomes the cash contribution to buy dental practise. That was quite nice as a fit. In 2016, I set up FTA Law, and that was with Chris, my business partner from Frank Taylor & Associates. Also Lis Hughes, who’s the Managing Director of Frank Taylor & Associates, and Thomas Coates. Thomas Coates is a lawyer, been a dental specialist lawyer for a good number of years. He wanted to do his own thing, we thought he was a great fit. So we set up FTA Law, full service law firm in North of England, does transactional work, property litigation and employment and HR services, and the employees and HR bit through the pandemic has just blown up. It’s incredible how many people just don’t know how to manage conflict and furlough and job retention, and job support, but actually really valuable service.

Andy: Then in 2017, we set up FTA wealth. When you’re arranging finance, you obviously need insurance and protection. So you need life cover, probably some local insurance, perhaps critical illness as well. So we arranged that for dentists. But what we also do on the other side of things is when people sell their dental practise, surprisingly, quite often lots don’t quite know what to do with the lump sum. So we provide them with advice and suggestions and guidance on how they can invest that money to get a return. So that’s FTA Wealth. Then in 2018, we set up FTA Media, which is a video marketing agency. Honestly, I’m getting towards the end, Payman. Hang in there. Hang in there.

Prav: Very impressive, mate. Very impressive.

Andy: What we did, in 2018, we set up FTA Media, and that sort of fell out of nowhere. What we realised was that, from a marketing point of view, we were words and pictures. And what we weren’t doing is we hadn’t moved ourselves into the video marketing game. And I read that by 2020, 80% of our social media feed was going to be video based. And I thought, well, if we’re not there, we’re not going to get a thing. So we started out as an internal project and we turned the camera on Chris and myself, and we did some short videos and response was really good. And going back to that point about people like to know the people behind the business, it gave it a personality who could find out a bit more about us and who we are, and what motivates us, and what drives us.

Andy: As a result of that, we were approached by a pair of dentists who said, “I’ve seen you doing video, I think that we need to do video, could you help us?” So out of that fell FTA media. We’ve now got a full videography team and editing suite where we go into dental practises and we provide video for marketing purposes for websites. It’s patient journey staff, it’s patient testimonials, that side of things. And then in the last year, we’ve been working on a new project, which is FTA Academy, which is effectively trying to pull together all the materials that we’ve produced over the years for how to value practises, things you should do if you’re buying, things you should do if you’re selling and just sharing our content and insights so that dentists can find all that material in one place. So yeah, we’ve had we’ve had lots going on.

Payman: I like your style, one a year for a lot of years there, huh?

Prav: Yeah.

Andy: Yeah. We-

Payman: Maybe you get bored easily or something. And is that you who is always looking for this sort of growth?

Andy: Yeah, I think I’m quite impatient. But also, I think the thing that I seem to have a knack for is coming up with ideas and starting new businesses and getting them to a certain point. And then other people can kind of run it. But going back to your previous point about kind of what is he doing on a daily basis now? I spend most of my time strategically making sure that the groups are aligned, are they all looking and feeling like FTA type businesses? Are we maximising the opportunities for our clients benefit by introducing different elements of the group so that people get the best advice and best service possible? I’m also constantly looking for new things we can be doing to improve the services that we deliver, those 1% improvements all the time, and new ideas. That consumes my time and honestly, because when you multiply that up across six or seven businesses, I’m not doing 18 hours a day anymore, but it still keeps you busy.

Payman: Very nice, man.

Prav: And what does Andy do outside of running all of these businesses and keeping them all ticking and whatnot? What’s life outside of work for you?

Andy: So I try to keep myself fit. I think it’s a really important element. My daily life could be quite sedentary, it could be sitting in front of a computer or sitting on a phone call. So I like to keep active. As a kid, I played a lot of badminton to a reasonably competitive level. So I still play badminton occasionally. I enjoy that. I swim quite a bit. I’ll try and swim a few miles each week in the pool, which I really enjoy. I’m married, I’ve got four kids, I recently had a granddaughter turn up on the scene. So I’ve got this new job within the family as the elder statesman.

Payman: You don’t look old enough. Are you telling me you’re a grandfather, buddy?

Andy: I prefer the term grand dude, to be honest. I think grandfather’s not… I don’t want to be a grandfather. That makes it sound like some weird old, I would say. But it is lovely. So just with the kids, that consumes quite a bit of time. I enjoy going to sporting events when we can, it’s been an interesting year for that. So I’m consuming much of that through the television at the moment.

Payman: Andy, what was your darkest day in business?

Andy: Darkest day. Probably right back in the early days when we couldn’t pay those salaries. I think it was when we thought we knew it, or we thought it was all so straightforward. And we hit the buffers. I think that was the point, and we’ve all gotten there at different times, when you realise the importance of cash. Actually, nothing else in business matters if things aren’t producing cash. You can have the best ideas in the world, you can be the brightest strategic thinker, you can go and you can develop things. But if the thing you’re doing don’t produce money, at some point, you’re going to grind to a halt. Fortunately, for me, that happened really early. Because I think if it had happened quite late, the danger is if you just keep doing something, you don’t know how to do it differently. But because it so happened so early for me, I’m like, “Oh, okay, right. So we need to change what we’re doing. And we just adapt it.”

Andy: Yeah, that was a horrible moment. Horrible.

Payman: And going forward. How do you see practises valuing? I mean, I know it’s not in your interest to talk about a bubble bursting, but grand dude to dude. Dude to dude, take us through best case scenario, worst case scenarios, what might happen. Because people have been talking about bubbles bursting for a few years now.

Andy: Yeah, I think it’s simply economics. It’s willing buyer, willing seller, supply and demand. And at the moment, and it’s been the case for a long while, demand has outstripped supply for lots of practises by 2030:1. So until we get to a position where demand and supply can’t catch up with demand, because there aren’t enough dental practise in the UK. So I’ve got just about 5400 people wanting to buy a dental practise. And there’s about somewhere between 1000 and 1500 dental practises change hands every year. So we’ve got a 5:1 immediately. So until that, that kind of scales of justice starts to balance itself, that bubble won’t burst in terms of values. And I don’t see that situation changing because with five and a half thousand people, if we apply the 80/20 rule, I’ve got 1100 people, and I’ve got 1100 practises. So there’s one of everybody who wants to buy a practise at the moment.

Andy: And it’s genuinely not kind of me being a broker trying to talk to market. It’s just a simple numbers, there’s so many people wanting to buy a practise, and there isn’t enough practise out there. What has been interesting this year that has changed is, if we roll back a year, if you had a dental practise that was in a major city that had a football club, which I know is bizarre, if you think of cities that have football clubs, they always very popular for people to buy. And also towns where there’s a dental school, if you kind of go 50 miles away from dental school and draw a circle, they’re always popular, because lots of people kind of hang out in the area where they qualified. Those areas were always the hotbed to where people wanted to buy dental practises. But what’s happened this year, and we’ve seen it in our own behaviours, people tend not to be going to the city centre as much this year as they used to, and people are staying locally.

Andy: And what that’s starting to do is that’s starting to change people’s behaviours in terms of where they want to buy dental practises. And we’ve seen a real upsurge of people wanting to buy regional dental practises, which is quite interesting. So wherever it used to be major towns, major cities, the metropolitans always doing really well. We’ve seen lots of practise that might have been on the market for nine or 12 months, having renewed interest, because people are saying, “Do I really want to commute? Do I really want to go into the big city? Or it’s another way of doing it?” So there’s good things that come out of this as well.

Payman: Andy, do you do anything for someone who wants to start a squat?

Andy: We do. We help people. We don’t [crosstalk 00:52:24]. Yeah, we don’t have a specific service for them. I mean, through the pandemic, I’ve done a number of webinars and taught lots of people. And it’s increasingly people are asking about setting up squats. My own view is, I think there’s more people talking about it, they’re going to do it. Because I think a lot of people like the idea of it. And when they sit down and they talk to their mates about it, they get from zero to a successful practise over two or three points. You guys will talk to a lot of people that it doesn’t quite work like that. One of the things that I do as a start point is when I have a conversation with somebody who wants to set up a squat, I talk them through the important things about finding location, what services do you want to deliver? Where you want to be in the country? What sort of size space you want? What do you see looking like at a perfect practise in a few years time?

Andy: Just to make sure that they’ve actually done some thinking in terms of where it’s at. But what I’ll always do is I will always send a blank cash flow forecast, and then into a business plan structure. And I say, “Look, this is what you need. You need to lay your ideas down. Don’t worry about whether it’s finished or not, but lay them down in a business plan structure, and put some loose numbers based on how you work at the moment as an associate onto a cash flow forecast and come back to in two weeks.” I’ve had that conversation probably 30 times this year. And at the moment, nobody’s come back to me.

Payman: Yeah, but I don’t know. I think for me, the squat thing is probably feeling more seductive for more people. Firstly, because the value of practises is so high, firstly. But secondly, because the experiential side of patient journey has become a thing for having an experience that you can really design the way you want. I think a lot of these young guys will be thinking that existing practises isn’t what they want as the experience, they want something other, whether it’s we’ve got Robbie in Liverpool, that beautiful sort of boutique situation, or there’s lots. There’s lots of interesting experiences out there. But also post COVID, I was I was talking to Prav about this, I live just up from Fulham Road. And on Fulham Road, there’s something like 25 empty shops now, because of the shops that didn’t make it through COVID, I guess. And so for a dental practise where you have to be in bricks and mortar, in a way that’s an opportunity, isn’t it?

Payman: And so we bring all those things together. But existing practises are expensive, experiences are becoming the thing, and there’s this retail space now that was probably under priced, and you can have that dream come true positioning. I don’t know anything about, but I reckon there’s going to be more squats coming. Maybe you want to add like a Frank Taylor Architectural. [inaudible]

Andy: It might be at least something else to do. But I think you’re right. I think the difficulty and the challenge is, and it goes back to dental school, dentists are trained as technicians, which from a patient point of view is what I want. I don’t really care whether my dentist can read a [inaudible] or not, I want him or her to be a good dentist. That doesn’t translate well into setting up a squat, because setting up a new business from ground up isn’t easy. And that’s why most people want to buy an existing practise. I think if you have the ability or the wherewithal or the support to create a new practise, it’s brilliant news. Because one, what it does is it creates new dental practises. Two, it becomes your own vision, you can create exactly what you want, you have control over it, and you don’t pay for the goodwill. And from a sales point of view, what it does is it restocks the pond in terms of creating new dental practises, which in the future can be sold on.

Andy: I’m really supportive of people that want to set up small practises. But I’m disappointed by the amount of people that never quite get there. Because guys like Robbie, I mean, what Robbie’s done is incredible. But he’s an outlier. That’s not normal dental behaviour.

Payman: I meet a lot of younger dentists who want to be him now. And others, don’t get me wrong, but that experiential thing. I guess it started with DSD, with life changing videos and all that. And Prav, you must come across this?

Prav: All the time, mate.

Payman: People are saying, “Look, rather than give that money for goodwill, I’ll give that money to you for marketing. Because we’re going to-

Prav: I think the thing is here, is that there’s a lot of naivety around that. Okay, you’re paying for goodwill, but you’re buying into cash flow from day one, you’re hitting the ground running, you pulled some finance, okay, you pay a little bit over the odds. But you know the gross figures that are going to be coming in every month are going to be a certain amount. If you do your numbers correctly, you actually know you’ve got room to grow the business and okay, you don’t map out the Gucci experience from day one. But you’ve got money coming in. And if we go back to Robbie’s story, what was he doing day one? He was working in this practise that-

Payman: Yeah, you’re right, he bought an existing practise.

Prav: He bought an existing practise, and he was working in this practise that was nowhere near what his vision is. But he used that to maybe accumulate cash or whatever it was, and then build the thing. I guess it’s what’s right for that person, what risks they want to take. Many associates, they get themselves into a job where they’re working well, they’re making decent amount of money. And then it’s a case of forfeiting. I speak to associates who want to carry on doing three days at their current practise to pay the mortgage, and then launch a squat in two days a week. And it ain’t going to happen. It is not going to happen. I mean, only last week, I had a conversation with someone. And the conversation was, “Well, I support you turn it over at the moment, and it’s like, 10 grand a month.” That conversation he was having with me, I think he was-

Payman: Groceries.

Prav: Groceries, 10 grand a month, right? And I think he was expecting me to be impressed. But his idea of that is so pigeonholed because he’s isolated as a business owner, he doesn’t know how to compare that to other practises in the market. And I said to him, “Listen, mate, the best advice I can give you now is if you believe in your business, give Euro the job bob, borrow some money and throw it into that business, because 10 grand a month…” And I said, “Where do you want to get it to in 12 months time?” “I’d love to be at 13 grand a month.” I said, “Not ambitious enough for me.” Sometimes that is what we’re dealing with, is there’s a lot of naivety in the market. I’m not a practise seller, I’m a practise owner, right? But I can see the mistakes that people are doing and the vision that they’ve got, because it’s probably what we were thinking back in the day, or what we’ve seen.

Prav: I’m just going to say someone like Andy, who’s bought and sold more practises than anyone else in the UK, you can spot these mistakes a mile away, can’t you? And squats are suitable for certain individuals, and then buying an existing business. I don’t know about you, Andy. But I guess you’ve been buying existing businesses over the last four or five years. And so that may be your default advice is to say, “Look, we’ve got something that’s ready. We’ve got customers, we’ve got cash flow. It kind of makes sense to buy an existing business and then throw our sort of brand on top of it and do something better.”

Andy: Yeah, exactly. And I think as well, I don’t want people to lose sight that it’s okay to be an associate. Being a dentist is a phenomenal job. And I think over the past few years, there’s a danger that being a business owner or an entrepreneur is kind of the new rock star. And so there’s lots of people wanting to jump on the bandwagon, and own a business because it’s the cool, trendy thing to do. But it’s a cool and trendy thing to do for people to post on Instagram about it. But that’s not the day to day reality. And if you’re not set up and equipped for the hard grind, that goes with, let alone not even a squat, just owning a business. I think it’s that thing where it’s still phenomenal to be a dentist. And the impact they make on people’s lives is ridiculous. It really is life changing stuff. And if people feel pressure to move on to being a business owner, because that’s kind of the next rock star thing to be, I think people should back off.

Andy: If it was what they want to do and they’ve got a really good reason and a driver for why they want to do it, and absolutely buy a business to have a squat, that kind of don’t just get swept along with it because being a dentist isn’t good enough. Being a dentist is awesome. It’s an incredible career, and I think people kind of get swept up with this business side of things. I think for lots of people, it is okay to be a dentist, you just don’t have to buy a practise because you majored on practises.

Payman: A very good point.

Prav: And you know what, I think there’s a middle ground here guys, is that I’m seeing now associates coming to me. And this is brand new, right? That ordinarily, a client will typically come to me and say, “Look, help to grow our practise.” I’m having associates approach me said, “I’m an Associate at this place, but I want to carve out my own business inside that premises. So I want my own marketing strategy. I bought my own. I’ve invested 27 grand in a 3D scanner. About the practise, I bought it myself. Totally unheard of right? And I’ll take that wherever I go. I’m going to create my own patients. But guess what, I’ve not paid for business, I’ve not paid for goodwill, I’ve not paid for the building. But I’m allowing myself to create that. And for a practise owner, how amazing is that? Oh, I’ve got a chair available one day a week. You come in use it and fill the book as well. Happy Days.”

Prav: I think this is a new breed of super associate entering the market right now.

Payman: Andy, how does that come across in practise sales? I mean, if I’m owning a practise with a couple of these social media super associates on my associates, I’d expect that’s a more vulnerable situation because they can move anytime they want and take their patients away. Does this come into the conversation?

Andy: We’re not there yet, because it’s still quite a new phenomenon. But [inaudible] practise is spot on, you end up with these super associates. And because they inevitably operate in the private market, there’s patient choice and they follow the clinician. So from a practise owner’s point of view, it really comes down to what agreement you’ve got with that associate in terms of who owns those patients. Because if you have a practise of delivering a growth of a million pounds, but actually plus my super associate, and he’s knocking out 700,000 pounds of that. Realistically, can that be valued into the equation? Because there isn’t some locking that says that you’re going to be sticking around post completion for a period of time. Then the risk is the person buys it, they’re not actually buying a million pounds worth of fees, what they actually buy is 300,000 pounds because 700,000 pounds is going to be off, because you’re going to move down the road and you’ll be welcomed anywhere else.

Andy: So it is kind of an evolving model that’s happening below the scenes. And I think for practise owners, I think just to deny it and say, “Well, no, they’re my fees, it doesn’t work like that,” is probably naive. I think you need to work out an arrangement with those super associates that says, “Oh, look, actually, perhaps they don’t own those fees, and the associate owns those fees.” But the pay rate and the deal you have with them an ongoing basis, is you rent them space to deliver their business within your environment. Because ultimately, with patient choice, and with social media these days, I can tell patients where I am at a moment’s notice, and there’s a risk to a practise owner, that they decide to go somewhere else. But I think they need to work on a model to engage with these people, as opposed to just deny it and say, “Well, that doesn’t work for me.”

Payman: Andy, you’ve got quite a lot, probably more experience of running a practise than a lot of people from seeing all these stories. You’ve obviously got access to practises for sale. Have you never considered practise ownership yourself?

Andy: No, I think it’d be dangerous to. I think it’s a little bit like… Well, I think there’s a conflict, but also I think it’s a bit like somebody that spends a lot of time in the pub doing committees so you can run a pub. I’m an outsider, I see an awful lot in the business side of what makes a dental practise work and not work. That’s one of my skills. One of my skills is to value businesses based on how they’re performing and make suggestions to make it improve. Sure, I like to think my work well, we’ve kind of leading my team of people, but I don’t understand the mechanics of the clinical side, of the systems and processes needed to own your own dental practises. There have been cases in the past where people similar to me have gone into practise ownership, and it’s not worked out well for them. So I’m a firm believer too. I know what my core skills and strengths are, and that’s in providing business services to the dental profession. So until I run out of ideas in that area, I’ll stick to my field.

Payman: This isn’t going to happen soon.

Andy: Hopefully not.

Payman: Well, it’s been a real enlightening conversation. You do listen to this podcast? I know you do, Andy.

Andy: I do. Yeah, and I enjoy it very much.

Payman: Prav has a final question here. So I’m sure you’re aware of. Prev, go on.

Prav: Andy, imagine it’s your last day on the planet. You’ve got your kids around you. And you need to leave them with three pieces of advice. What would those three pieces of advice be? And then after that, how would you like to be remembered?

Andy: I think the advice for them would be enjoy yourself. I see so many people doing things that they don’t enjoy, and it’s heartbreaking. And I always say, above all, enjoy yourself. I’d also say, be kind to people. I don’t think you ever really know what people’s backstory is or what’s going on in their world. And it costs absolutely nothing to be kind to people. And lastly, be loyal. I think loyalty is something that in the modern world seems to be falling away at a rate of knots. So I think if they could enjoy themselves, be kind and loyal. I think they’ll have a really good life.

Prav: And how would you like to be remembered, mate?

Andy: I think similar. I think I’d like to be remembered as somebody who’s loyal. I think if somebody does something for me, I value it in the highest order. And I will always show ultimate loyalty to people. I think it’s really important that if people are doing the right thing by you, you do the right thing by them. And I think if more people as a community were loyal to one another, we all move forward together.

Payman: Thank you-

Prav: Thank you, Andy.

Payman: … so much for your insight into your world, Andy.

Andy: You’re really welcome. It’s a really good job, talking to you guys, it’s been good fun.

Prav: Been great.

Payman: [inaudible]

Andy: It has, hasn’t it?

Payman: Thank you so much, buddy. Hopefully see you soon, man.

Andy: Yeah, [inaudible]

Prav: Take care guys.

Payman: Take care.

Operator: 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: Thanks for listening, guys. If you got this far, you must have listened to the whole thing. And just a huge thank you both for me and Pay, for actually sticking through and listening to what we had to say and what our guests had to say because I’m assuming you got some value out of it.

Payman: 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.

Prav: And don’t forget our six star rating.

Reader’s around orthodontics will be familiar with this week’s guest and author of one of the best blogs around.

Kevin O’Brien’s Orthodontic Blog is an exploration of orthodontic issues and debunking of some of the bad science, 

These subjects are just a small part of today’s discussion. The professor emeritus in orthodontics and former dean of the University of Manchester talks us through his student days in the city. We also chat about the limitations of orthodontic training, the state of play in the UK Vs the rest of the world, and much more.

Enjoy! 

 

When you look at trials of surgery, for example, it is not necessarily always the technique that comes up with the best results. It’s the skill and the care of the surgeon. And that’s the same with orthodontics. – Prof. Kevin O’Brien

 

In This Episode

01.36 – Backstory
08.05 – UK Vs the US
11.06 – Deanery, teaching and academia
21.29 – GDC
27.13 – GDPs and ortho
34.02 – Aligner science and new treatments
41.42 – On limitations
44.26 – The blog
55.02 – Ortho for cosmetics and health
01.00.35 – The future of orthodontics
01.05.19 – A quick plug
01.05.34 – Last day on earth

 

About Kevin O’Brien

Prof. Kevin O’Brien is a former Dean and current professor emeritus in orthodontics at Manchester University.

He is also a former chair of the General Dental Council and the author of Kevin O’Brien’s Orthodontic Blog – an ‘occasionally irregular’ exploration of evidence-based orthodontics.   

Kevin O Brien: Ross’s right, is what you don’t know is the problem. And when people think they know it all and that they go back to saying that they think they know it all and can do everything with Invisalign. For example, that’s where they run into problems. It’s not the appliances. It’s the operators and it’s the way they behave. And some of them, unfortunately don’t recognise their limitations. They’re working outside their scope of practise, and that’s where harm occurs.

Intro Voice: 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: It gives me great pleasure to welcome professor Kevin O’Brien onto the podcast. Kevin’s got one of the worlds, correct me if I’m wrong, Kevin, the world’s biggest blog in orthodontics, but an illustrious career in academia. And for us, what we want to get out of this obviously is your backstory and so forth, but all those become such a controversial subject ever since it’s grown so massively with the GDP community in the UK. And so there were so many areas of it that need to be addressed. So welcome to the show, Kevin.

Kevin O Brien: Thanks so much for interviewing me on the second day of lockdown on a sunny day in Manchester.

Payman: Yeah. Nice to have you, Kevin give us your backstory. Where were you born? When did you decide to become a dentist? All of that stuff.

Kevin O Brien: Okay. So I was born in Edinburgh, so I am Scottish and then my mother moved to the Midlands in a small country village in North Westshire. where I was bought up. I then came to the university of Manchester in 1975. At that point, Manchester was not the city that it is now, there is a sort of in the depths of depression and I sort of suffered a major cultural shock coming from a small country village, slap bang into the centre of Manchester, which at that point was starting to become a much more multi-ethnic city. And I still remember going and having my first curry when I was 18. And that shows the isolated living that I had.

Payman: Did they have the Curry Mile back then?

Kevin O Brien: They did, but it was mostly sweet centres rather than curry houses.

Payman: On winslow road?

Kevin O Brien: Yeah, I think nine out of 10 of the restaurants were sweet centres.

Payman: Amazing.

Kevin O Brien: But again, that was quite a cultural shock for a boy coming from the country village where I’d look out the window and just see cows.

Payman: What was the first curry you had?

Kevin O Brien: It was terrible. It was a chicken biryani in a restaurant in Manchester called the Plaza, which was very famous among students because it was truly terrible. It would cost you 50P. Chicken was cold just thrown on top of the sort of watery sauce. And you only really went there late at night. A few of us, about five years after we qualified, went back and we realised what a terrible place it was. You wouldn’t recognise it as food nowadays.

Payman: What kind of a student were you Kevin? I mean, did you feel like these, the big city, bright lights, did you go a bit berserk on the social side or were you one of those?

Kevin O Brien: No, not really. Not really because I’m quite a quiet person anyway. And so now I think I was a pretty average student, when I was made Dean of the dental school in Manchester. One of the first things I did was go and look at the old student records, because they’re all kept in your office. So I looked back at the records for my year. These were the comments that were made on everybody. The only comment that was made for me was mostly average. That sums up my five years in dental school.

Prav: And so then you did some general practise. You were telling me.

Kevin O Brien: I had four sort of very happy years. I went into general practise straight from dental school. So there was no foundation training or vocational training in those days you went straight out and I worked just off the Langley estate in Middleton, which is an area of very high deprivation for a really nice guy called Allen Kershaw. It was a very simple, it’s a very basic practise and it really was great fun. I then moved to a practise in the centre of Chorlton in South Manchester and was there for another year and a half. They had to take me up to four years.

Kevin O Brien: But during that time I was sort of becoming more interested in sort of hospital dentistry in general. I was beginning to feel that general practise wasn’t quite a hundred percent for me. It wasn’t that I didn’t enjoy it. I just felt that it wasn’t for me in the long term. And then one night I was driving home on the, what is now the M 60 with my wife and six months old daughter and a guy hit us in the rear in the traffic jam, ripped our car off sort of flat in the back of the car and put me off work for six months with a whiplash injury. And then after I had announced that to one of my friend saying right, I’m off for six months, it’s going to be brilliant. He turned up and gave me a box full of books and said, right, it’s now time to start studying again for fellowship exams.

Kevin O Brien: This is your chance. And so I sat down for six months and studied for the fellowship in dental surgery, which put me an inroad back into hospitals. And I took it shortly after that. I took a job as a house officer at the dental school of the dental hospital in Manchester. And I did house office job there, did a job in Newcastle as ass hr and registrar in oral surgery. And then I was very fortunate enough to get on the post-graduate special training course in Manchester led by the absolutely brilliant Bill Shaw, who is professor of orthodontics at that point. And we were the first group of students to go through that musters programme, which was a classic. So two years master’s programme where Bill taught us to be critical and very analytical about research. And that’s where my sort of research interests really peaked.

Kevin O Brien: And it became a very vibrant place to be a postgraduate student. Following on from then. I again was very fortunate to get a medical research council research fellowship for three years to do my PhD. And I did that within three years and then just as I finished there, I was offered a post as a sabbatical at the university of Pittsburgh in the United States where I worked for a year, came back, made senior lecturer. And then about two years after that, they made me professor at Manchester. So that’s really my background.

Payman: When you were looking at orthodontics, what were you talking late seventies?

Kevin O Brien: I started orthodontic training in 1984.

Payman: Okay. Early eighties. So at that point, orthodontics was pretty established as a specialisation. But what would you say were the biggest differences between UK and US orthodontics back then.

Kevin O Brien: Yeah, at that point because of the way that dentists were paid to do orthodontic treatment. UK orthodontics was dominated by simple removable appliance treatment. I can’t actually remember the nuances of the payment system, but in many ways it was a sort of a very high volume delivery of care with what was shown to be very low standards. During that time, I worked with Steve Richmond who is recently retired as professor at Cardiff, and Steve was doing some real groundbreaking work on occlusal disease and quality of treatment. And Steve showed that during that time, the quality of care in the UK orthodontic services, which were, I think it was something like 80% removable appliances, most children or high number of children actually ended up worse than they were before they started because of the very simple system.

Payman: Clearly did.

Kevin O Brien: And what happened was, is that work from Steve led directly to several government inquiries, which then led to, I think it was a change of the method of payment and then fixed appliances sort of burst onto the scene quite suddenly. And I think part of that was due to the advent of smaller appliances, but also it was the method of the payment. In those days, remember dentists were paid on per item of service. So actually the thing that drove prescription patterns was how much you got paid for individual items. So orthos was lowly paid high volume, very basic. Whereas of course, nowadays things have changed quite dramatic. Yeah. To what Orthodontics service should be, which is mostly fixed appliances.

Payman: And the US at the time was way ahead because of this.

Kevin O Brien: US it’s always been based on fixed appliances rather than removable appliances. There were various reasons for that. First of all, the US trained more orthodontists at time than Europe. But secondly, if you sort of go back to the end of the second world war, the European States, and certainly the UK didn’t have much in the way of steel and steel was very expensive. So if you were to provide orthodontic treatment, you provide it with plastic appliances, with minimal amount of steel. Whereas the US of course, was steel rich and they could use fixed appliances probably far more than we could at that point. And then once you established a system of care, built around a very simple method, removal appliances it continues sort of driven by government and health service policy.

Payman: And when you became Dean of Manchester, was that sort of moving into the management side and away from the clinical side for awhile?

Kevin O Brien: I mean, well, one of the things that’s, I don’t know whether it’s fortunate or unfortunate about an academic career, but once you start to do good research. Because I was running a research team there. I picked up another grant from the Medical Research Council for 10 years funding to look at the effectiveness of early treatment for children with very prominent teeth. We were also piling research out every patient in the dental school, in the orthodontic department was part of the research project. I was working with people like, Steve Richmond, Nikki Mondale, who have all gone on to have great careers. And again, many young trainees that I worked with who are now quite high profile ortho dentists all came out of Manchester at that time because it was incredibly vibrant. So we were piling away at research. And then one of the problems is they going to ask you to take on an admin role if they see your research and you built a research team.

Kevin O Brien: I was made research director of the dental school. And then that often you often from that position to end up stepping up as Dean. So, that’s what happened. I ended up as Dean and well, rather reluctantly, I have to admit, I didn’t particularly want to do it. But when the university sort of says, well, we think you should do it. And this isn’t necessarily a request. It’s a sort of a, we’re making an offer you can’t refuse here. And that’s really what happened. I ended up as Dean, which I did for three and a half years.

Payman: That’s mentorship. You’ve taught thousands of students of both dentistry and orthodontics.

Kevin O Brien: Yeah, I think so.

Payman: First of all, can you tell someone’s going to be good early on and how early can you tell? And secondly, it must be like a source of real pleasure to you to see people blossom, who you’ve taught. I mean, is that what keeps you going in an academic role? Because as a private orthodontists, I’m sure you could have done very well, but you never did that.

Kevin O Brien: Yeah. I mean, my mom always used to say, why aren’t you a private orthodontist? There’s all sorts of terms that I have wondered that myself, I was once flying to… I’ll come back to your question in a minute, I was once flying to the American Orthodontic Conference in San Francisco. And as I was sort of sitting at the gate in the economy queue a load of specialists orthodontist, half of whom I had trained were boarded into business class. When I got on the plane, I found I was in the second row of economy. And of course you can see into business class in those days. And they were all waving to me and giving me food. But they came back and had a chat with me and things like that. It was a busy flight. So yeah, it does give me a great… I’m proud I think of all the people that I’ve trained in both specialists and general practitioners.

Kevin O Brien: It does surprise me actually, how many I’ve trained when I go to the orthodontic conferences. There’s always plenty of people that of course recognise me, that come up and talk to me. Yeah. It’s one of the things you look back on and think, well, yeah, that was great to have trained so many people. I actually don’t know how many, I worked at the university for 40 years. So you’ve got to think you’ve got an intake of 60 to 70 undergraduates a year.

Payman: And how soon can you see talent in even undergraduate and also.

Kevin O Brien: In undergraduates very quickly.

Payman: Really.

Kevin O Brien: We didn’t teach them much in the way of clinical orthodontics because that wasn’t our aim. Because we were treated them to be training dentists who were sort of to screen and refer at the right time and give advice because you can’t cover complex orthodontic treatment in the undergraduate curriculum. But I used to do seminars for students in years two, three, and five and lectures some critical work, but you could always tell them really good students within about one or two seminars. They would be expressing an interest. You wouldn’t have to prompt them, you’ll know the type. And you also know the people who are not going to do perhaps so well in these are the ones that tended to not engage or turn up late. And things like that.

Prav: Got sent to the Dean’s office.

Kevin O Brien: There were never sent to the Dean’s office but they got to know pretty quickly that if my seminar was timetable to start at nine o’clock, it started at nine. And that if they turned up 10 seconds late, the door was locked and they’d be whimpering outside knocking at the door asking to come in.

Payman: Prav asked that question because he spent quite a lot of time at the Dean’s office himself.

Prav: Yeah. So have you got any interesting stories where someone was sent to the Dean’s office.

Kevin O Brien: No. In those days, again, dental school has changed quite dramatically. The Dean of the school is… Once you took that job, you didn’t often come across the students on a day to day basis because it was a surprisingly high level job. And so you would delegate most of the day-to-day contact with people down to really, which was sub deans. So I worked very well with, there were associate deans in those days, two people a guy called Ian Mackey, actually, who was a brilliant undergraduate teacher and Ian dealt with all the undergraduate issues. I didn’t have to think about them because Ian had devoted his entire life to treating and teaching undergraduates. And it was only very occasionally Ian came to see me and said, we’ve got a problem. And that’s the way it tends to work. It’s a management role with a management structure beneath it.

Payman: Kevin, you spoke about your education, your specialism and the approach was very much a scientific approach, reviewing the literature, becoming a critical thinker. Has that changed in current day in terms of how the training is structured and what the output is?

Kevin O Brien: Yeah. In orthodontics in the UK, all the courses are pretty much the same. We have to teach the same curriculum. And that includes courses on research methods, obviously critical appraisal and everybody still has to do a master’s thesis which has changed over the years. It’s not as extensive as it used to be. So every specialist orthodontist in the country has had training in research methods, critical appraisal, and they’ve done their own piece of research or be it a small piece of research. So they know how to appraise the literature and how to appraise it critically. It’s not the same in other countries. European countries are pretty much the same. The US, I don’t think is anywhere near Europe in terms of training the specialists in science. I’ll try in english, it’s straight ahead out of the United States than within Europe.

Payman: What about the hands-on element side of things in terms of how much wire bending go or practical aspects of the course have changed? I know I was speaking to a couple of dentists, probably sort of my age or a little bit older, and they were just shocked and surprised at how, when they were at dental school, not obviously specialists, but when they were at dental school, the volume of dentistry they were doing as a student compared to students coming out now it’s like night and day.

Kevin O Brien: Yeah. I mean, it’s something that people often say. And certainly when I look back at my undergraduate training. I remember we used to go into sort of, as an example, here, we would have a block in war surgery, which lasted two weeks. And during that two weeks, I think you sort of had a requirement to take out at least a hundred teeth and do I think it was 29 oral surgical procedures. So at the end of the day, we certainly could take teeth out quite nicely. And we also used to do a lot of amalgams and a lot of restorative work and dentures and things like that. But those were the days where dental disease was absolutely rife. I think people who took a at modern dentists now and said, okay. And they say, they came to look at my clinic list in Middleton.

Kevin O Brien: They would be completely amazed at the amount of restorative work that we were doing. We were doing wall-to-wall amalgams and composites day in, day out because of the high levels of dental disease that we were dealing with. Clearances, dentures, immediate dentures, it was nothing like I imagine general dentistry is now. And I think that’s quite important. We were trained for the times, which was high volume, dentures, fillings, everything like that. And not necessarily to the same standards that people practise nowadays. I think that’s quite important. And then the biggest difference between an undergraduate newly qualifying now, and somebody qualifying when I qualified was the people understand what they’re doing more now than we did. We just did it.

Kevin O Brien: It’s as simple as that. You saw some caries. I mean, you didn’t have to look closely to see the caries. There was none of this agonising over, is this just a non [inaudible 00:21:14]? More often my thoughts were how close to the pulp is this before I get cracking. So times have changed and it’s often a mistake that people make to look back and think we weren’t taught the way they used to be.

Payman: And Kevin, you then took a role of the GDC, the way you’ve described yourself. It seems that would be a counter-intuitive move for someone who’s so into the teaching. And so into the research. How did that come about.

Kevin O Brien: One afternoon I spotted an advertisement from the GDC inviting applications for the chair of the specialist, dental education board. I’d always been interested in specialist training. And that was most of my work actually, to be honest. And so I thought that sounds quite interesting. I didn’t think about it being the GDC. I thought here’s an opportunity to help and perhaps change and improve specialist training for throughout the country. Because this was really, the GDC viewpoint on specialist training, right across all specialties. So I applied for that, trotted myself down to learn them. I didn’t prepare very much because I was busy. I think I was still Dean at that point. And I got the job. Hugh Matheson was the GDC president at that point and they appointed me and I did chairman of specialist dental education board for about two years.

Kevin O Brien: And then we came to the advertisements for the first appointed members of council. And I’d actually really enjoyed working with the GDC at that point. It was refreshing to see another outlook on dentistry from the point of view of protecting the public and that is their entire vision today. And I got more and more interested in this and this wasn’t protecting the public just in terms of fitness to practise. It was protecting the public in terms of levels of training, monitoring, audit, everything like that, that goes with it. So I applied to be a member of the council and I was completely amazed. Again, I was interviewed and I was completely amazed when I got an email one day, a few weeks later saying I was one of the appointed dentists on the council.

Kevin O Brien: At that point, the council was very large. It was 24 people. So I was one of the eight dentists on council and we had a 50 50 split between lay and sort of professional members. And that went quite well. And then Alison Lockie resigned. It was then going again for another chair. And my feeling at that time was that there was an inevitability and it is sort of a graduation that the chairs of regulators are laypeople. And most of the councils at that point had lay people as chair. But I felt that GDC wasn’t ready for that at that point. And so I got myself a bit cross. I was just in a cross mode and everything that was sort of going on with the GDC. So I thought I’m just going to do this. So I put an application in and was elected chair, which completely amazed me. I was quite stunned at this. My wife was completely shocked. I think a lot of people were shocked at it.

Payman: You don’t seem like the type of person who’s good at politicking, but correct me if I’m wrong, but I would’ve thought to become the chair of the GDC. You need to be that type, am I wrong about it.

Kevin O Brien: You need to be good at politics and it’s one of the things I’m not very good at politics. I’m pretty useless in many ways, but at that time, the politics weren’t that complex. It was getting the BDA back on board which I think was very important. It was getting the dentists back on board and I just quietly went about the job. And one of the things when I do look back that council did an awful lot of really good work in putting building blocks in place, right across the board, in terms of standard scope of practise, direct access specialist training, quietly got on with it.

Kevin O Brien: We made mistakes. Every organisation makes mistakes, but we just quietly got on with it. And I was quite pleased at the end with the work that we’d done. And my sort of feeling when I look back on it is, I’m quite happy now when I look back on it, because there are people that say to me, why you the chair of the council? And I said, yeah. And they said, well, we didn’t notice you. Well, that’s the best chair of a regulator you need is the person that I think is someone who just sits there, gets the job done quietly. And nobody really remembers them in about 10 years’ time because it was smooth and straightforward. And we sorted a lot of things out.

Kevin O Brien: I still managed to upset an awful lot of people and I wasn’t necessarily that popular in some areas of government. But I look back on that and I think we did a good job. And then that sort of leads us through to really a lay chair. The issue of lay chair is very interesting in the councils because the job has changed like all these things over the last 20 years, most of the regulatory bodies now have a lay chairs. I think the only one that doesn’t is the GMC. And that’s really unusual. I mean, I’m fairly confident in saying this. I probably am the last dentist chair of the General Dentist Council

Payman: Kevin, moving on from there and talking about GDP orthodontics. And there’s been a massive surgence of that, I think over the last decade or so. First of all, I guess I just want to get your opinion on how you feel about GDPs doing orthodontics. And what do you think is the appropriate training pathway for a GDP who wants to treat patients and straightened teeth and whatnot, and where do you feel the compromises are in a GDP assessing, diagnosing and carrying out orthodontics when obviously you’re comparing it to someone who’s had extensive specialist training.

Kevin O Brien: Yeah. So again, it’s always helpful to look back to sort of help you look forwards. When we look back, for example, in the time that I said orthodontic treatment was not carried out very well, I think I can’t remember the figures exactly, but I think it was about, there were a fair number of general practitioners who used to do orthodontics again with oral appliances, but there was also a group of practitioners who worked as critical assistance with consultant orthodontist, and actually the common pattern of care in sort of hospital-based orthodontics. And it’s not really hospital-based orthodontics as we know it now. Because the hospital consultant was often the only person providing orthodontics for quite a wide area because there were very few specialists. But what they used to do is they used to see patients, they used to write out treatment plans and either send that treatment plan back to the general dental practitioner that had referred the patient or send to one of the dentists in their district who would also do the treatment using simple methods.

Kevin O Brien: So they were doing simple compromise treatments in many ways under the supervision of a consultant. So [inaudible] orthodontic was not unusual at that point. Then of course, we moved into fixed appliances and this is where there is sort of a degree of a dilemma because it depends what you’re trying to do. So for example, on the undergraduate orthodontic course, there is absolutely no way I could teach eight year undergraduate students to be competent in fixed appliance treatment. Even the diagnosis that’s necessarily behind that. There’s no doubt that that is a specialist subject is most fixed appliance treatments for children are specialist level. That’s not to say that a general practitioner, who’s got a lot of experience in treating children with fixed appliances should not be doing it. And there are many of those around, to be honest, who do a very good job, despite the fact that they’ve not had a specialist training, they’ve sort of learned it over the years.

Kevin O Brien: Yeah. As an example of that, and it’s a bit of a spin off when membership in orthodontics first started, there was one year where there was a moratorium in a way, they called it a moratorium, but I refer it to the called an opportunity. Where experienced general practitioners could come and sit the specialty exam. If they wanted to give it a shot, they had no specialist training. And I examined it in those days. And they were, I think it was about 10 to 15 people who were experienced general dentist who actually took the specialist exam and they passed it easily. They’d have 20 years of experience. So there’s that sort of experiential way of gaining sort of specialist level experience in orthodontics. But really it’s now a dilemma in many ways, because I’ll go back in and there’s no way I think that anybody can quickly and with a reasonable length of time, learn to provide specialist level of orthodontics to children without going on a specialty training programme.

Kevin O Brien: That’s always my advice. Lots of people ask me what do I do to be a specialist or to get good at orthodontics? I’d say your first course of action is always consider specialty training programmes because that’s where you learned to do it very well properly and very effectively. But then we’re sort of getting to that middle stages. Are there groups of people who can have orthodontic treatment that doesn’t require specialist training? And the difficulty here is recognising when you can compromise because you can’t argue that in order to take the decision on whether to compromise and make a treatment simple, you have to be a specialist and specialist thoughts, compromise orthodontics is nothing new. Specialist orthodontists have been doing it for years. You sort of look at people and have discussions in terms of what sort of treatment the people want to undergo. And for years, and I’ve done it with a lot of the kids, I used to treat in the children’s hospital in Manchester who had severe medical conditions.

Kevin O Brien: They couldn’t cope with lengthy orthodontic treatment. And we’d go for a compromise, which in effect would be straightening up those front six teeth. That sort of the concept to the social six. And that I think where mentoring schemes come in now and sort of a certain GDP courses is that there’s nothing wrong. I know several people do this online now, there’s provide online advice to dentists about what treatment can be done as a compromise that would do someone a reasonable amount of good because a lot of adults just want their front six straightening. They’re not interested in the molar relationships or extractions based closures or anything like that. They want to improve their smile by having their front six teeth straightened.

Kevin O Brien: And as long as they know that that’s the compromise and it’s being done by a general practitioner under monitoring, for example, and in a way that perhaps is the contemporary sort of model for the consultant orthodontics service monitoring treatment that I talked about previously, then I think there’s nothing wrong with it. What is clearly wrong though is people being sold courses? Oh yeah, we can do treatment better than a specialist. You just have to come to an airport for a couple of days to learn how to stick brackets and change the wires and off you go.

Kevin O Brien: So that is not correct, but monitored GDPs learning on the job as they go through over several years, creating relatively straightforward adult cases isn’t a problem. I don’t think there’s any orthodontist would disagree with that, to be honest.

Payman: But, Kevin, if a young dentist was going to go on a two day clear aligner course and then provide clear aligner treatment, you were saying that’s compromised treatment. Right. Is that where you’re at?

Kevin O Brien: Yeah. I mean, to be honest, I might get criticised for this. A lot of the aligner treatment is compromised treatment anyway, in many respects, I think it’s-

Payman: Let’s get to that. Yeah. How good is Invisalign from your reading. Is Invisalign better than the other clear aligners and then how do they all compare to fixed?

Kevin O Brien: Okay. So research is showing and research is now starting to be done. And it’s difficult to do research in this area because aligner treatment is very different from fixed appliance treatment. So if someone really needs fixed appliances, they should be getting it. I think that’s the first call. Certainly I’ve never done a aligner treatment. It’s bypass me completely. But in discussions that I’ve got with specialist friends of mine who do aligners, their first offer of treatment is for works fixed appliance treatment. And then that sort of explain that anything else is a compromise. Aligner treatment has to be quite a compromised because you haven’t got the control that you have with fixed appliances. You do see aligner treatment and some practises that are a hundred percent aligners. But research is showing actually that fixed appliances are still providing a better sort of finish and better standard of care.

Payman: How far behind is generally research from, for instance, I’m sure, if you spoke to the people that align they’d tell you, look, what we provide this year is a lot better than what we were providing three years ago because of machine learning and whatever they want to say. Yeah.

Kevin O Brien: Yeah. People always say that. They’ll always say, there’s always something better around the corner. And that’s what we like to hear. Isn’t it? That there’s always something better and companies do that. And it’s perfectly within their rights to do that because it’s the job of the salesman or the salesperson is to sell them appliances.

Payman: No, I get it. Like a healthy dose of scepticism, definitely from someone like you needs to be, that’s really super important. Right. But as a question, if a Tif Koresh type person, not someone in the highest echelons of ortho, yeah. Someone in practise actually came up with a breakthrough. How long would it take before that breakthrough gets onto an MOF course in Canada? I would say 30 years.

Kevin O Brien: Yeah. I mean, that’s the way things are. Research takes time because of course the length of treatment is lengthy. There’s no doubt about it. You’re looking at two and a half years, the average course of treatment, the early treatment class 11 studies that we did that took 10 years to do. And it was one of the studies that completely changed the viewpoint on orthodontic treatment with functional appliances and there were several studies doing similar sort of thing. And we changed the way orthodontics was done.

Payman: So how long was it from the time you started that work to? Is that now taught on Mos all over the world?

Kevin O Brien: Yeah. It’s-

Payman: What the timeframe?

Kevin O Brien: The first part of the studies took five years to do the papers came out very quickly. So they were on the courses within five years. And then they’re classic papers. It is one I think.

Payman: You’re highly prominent person. Yeah. So if you discover something it’s going to get onto the course as much more quickly than if for even Align, discover something. But.

Kevin O Brien: It’s the quality of the research that’s done. So I think the issue is I’m always going to be faced with this is that we need to be… There’s nothing wrong with producing new treatments and saying that things are changing. Self-ligating Classic, absolutely classic thing is self-ligating was heavily promoted. It was going to reduce extractions. Everything would be much faster. It was going to be brilliant and the companies promote it that quite strongly. Then key opinion leaders started talking about how good self-ligating was. And self-ligating became very popular, but then what happened is the research caught up. Actually there is absolutely no difference between self ligating bracket treatment and classical fixed appliance treatment. And we’re seeing this constantly, we’ve got things like AcceleDent the orthodontic vibrator, everybody was making claims that that speeded tooth movement, but it didn’t. Yeah. Vibration doesn’t work, all sorts of things, speed treatment just don’t work. There’s no evidence that they work.

Payman: Does that decortication speed up treatment.

Prav: Does that the one they drill in.

Kevin O Brien: That doesn’t work either.

Prav: That doesn’t work either.

Kevin O Brien: No. The thing that influences the speed of orthodontic treatment is the operator. If you’re a good operator and you see your patients every four to five weeks, it’s quite surprising how fast your treatment goes. Potions, pills, trauma, vibration doesn’t help anybody even the good operators. When you look at trials of surgery, for example, it is not necessarily always the technique that comes up with the best results. It’s the skill and the care of the surgeon. And that’s the same with orthodontics. If you know what you’re doing and you see your patients regularly, you finish them quickly.

Payman: Kevin, How did you feel when you first saw Invisalign. Did you think?

Kevin O Brien: I was very interested in it. In fact, we approached Invisalign to say, do you want us to do a trial?

Payman: Really.

Kevin O Brien: Because we were trialling everything. We had Invisalign managing come over and meet us in Manchester. And we explained to them what a trial would involve and everything like that. And the time and the cost. And all we got was at the end of the day was the bottle of Californian red wine, which was nice, which they left for us.

Prav: Which year was that?

Kevin O Brien: Crikey, I can’t remember it must’ve been mid 1980s when Invisalign was first coming out. So there’s nothing wrong with the aligner treatment. I need to stress this. Aligner treatment is fine. It works. Expertise got to be really good at it. And you do see some nice results, but because it’s a removable appliance, you’re never going to have the control that you’re getting fixed appliances, but it’s revolutionised orthodontic treatment, it’s revolutionise adult orthodontic treatment without a doubt. But most of it is a degree of compromise, but there’s nothing wrong with that compromise. The danger you get is when someone goes on a course and they think they’re a master of the universe and can do everything. And that’s where things go as wrong. And that’s down to the individual practitioners and their confidence and their scope of practise and overall professionalism.

Payman: Just going back to the GDP also. Have you seen many cases that come back to you having gone to an airport course attendee where you look at those cases and you think, Oh dear, if only they knew how to identify and the reason I’m mentioning this is numerous conversations with Ross Hobson have the main takeaway point from him is always, you don’t know what you don’t know. And the most important part is knowing when to refer and when not to treat.

Kevin O Brien: Yeah, that’s it. I mean, we try and teach undergraduate when to refer and when not to treat, I think that’s the most important thing. Yeah. I’ve seen loads of people who have actually had harm from being treated badly by people who have got involved with some of the airport courses. Where we’ve taken years to get them back on track. Having said that it’s subjective. And again, talking to colleagues, I can’t help wondering if that started to die down a bit. We go back into the 1990s and there was a fair few people peddling, quite poor treatment to the airport courses, both with fixed appliances and unremovable appliances and expansion plates, and thinking that you can grow jaws and all that business that sort of died out recently. I can’t help wondering if there’s sort of been an evolution. Perhaps with great opportunities that really interested practitioners have had to sort of be mentored and work with other people.

Kevin O Brien: Yeah. The whole thing about it is you can be trained in something. It doesn’t necessarily need to be a three-year course, and you can be trained in anything with mentorship programmes or working alongside people. Remember that was the way it used to be done. That was the way dentists used to be trained. But what you’ve got to understand as a professional is your limitations and you don’t know your limitations, you should know your limitations completely. Ross’s right. Is what you don’t know is the problem. And when people think they know it all, and that they go back to saying that they think they know it all and can do everything with Invisalign. That, for example, that’s where they run into problems. It’s not the appliances, it’s the operators and it’s the way they behave. And some of them, unfortunately, don’t recognise their limitations. They’re working outside their scope of practise and that’s where harm occurs.

Prav: SO, Kevin, tell us about your website. How did that come around? When did you have the idea or the brainwave to say, hey, I’m putting up a website and published some information online.

Payman: And how massive it is.

Prav: So my blog now is read pretty much half a million times a year.

Payman: Lord.

Kevin O Brien: I’m a little bit worried. I’m getting obsessive about it this year now. Because it looks as though we’re going to fall below half a million. We took a big hit in the COVID crisis, which surprised me is readership dropped during the world lockdowns. I think that shared the state of mind and that degree of worry that people have hard and are still having, so this of course is a funny year. So I started it as I’ve just finished as GDC chair. And I was getting a bit bored really. And I’ve always been interested in computers, right from the start I’ve bought things like [inaudible] and everything like that. My son is also pretty heavily involved in social media infact that what he does for a job.

Kevin O Brien: So he was sort of talking to me about blogs and that sort of business. So I thought why don’t I start a blog. So I ordered a book on how to write a blog, which just takes you through a step-by-step on how you set it all up. And this is a surprisingly interesting, easy thing to do. So I went to a web hosting company, which charged me 10 pounds a month, read my own blog using free WordPress software, which again was fairly straight forward. And I published my first post five years ago when the British Orthodontic Conference was in Manchester. And I just learnt about the latches that I’d been to see and what I thought of them and I just sort of posted it up. I mentioned it to a few people and it was read by 20 people in a week.

Kevin O Brien: And I was quite pleased with that. And it continued just to slowly grow. And then suddenly after about six months again, I was talking to my son and saying, I’m doing all right and getting about a thousand reads a month. What can I do to boost it? And he sort of looked at me and he said dad, have you heard of Twitter and Facebook? I said, yeah. He said, okay, open those accounts. Set a Facebook page up, I’ll give you a little bit of a hand with the phrasing and let’s see what happens. And the whole thing exploded at that point. The readership just increased massively. And so now it’s read all over the world. Each post is read at least 6,000 times on its first day. As you know probably had to upgrade my website and servers because I was crushing the servers that I was hosted on.

Prav: Is proud thing your website.

Kevin O Brien: I did the website.

Payman: What I found really interesting Kevin, when you came to see me is I was just absolutely amazed at how you’d set it all up on your own and you right it is incredibly easy, but it’s surprising at how many people can’t do that.

Kevin O Brien: I have always messed about with computers.

Payman: Yeah. And no disrespect to your age or anything, Kevin, but when someone you comes along and then you’ve got a website and it’s got so much traffic, I was looking at it thinking, wow you’ve achieved this all by yourself, but you’d got it to the point where it was crazy. And I don’t know if you mind me saying so, but I remember you sticking the donation page on there to sort of open and fund it and just speaks true testaments to the followers and the value, they get out of it. When you sort of put an ad out there to say if you’d like to donate to support this, and you can tell the story if you want Kevin in terms of what happened after that.

Kevin O Brien: Yeah. I mean, that was it. I mean, I used to support it for my lecture fees and things like that. An honorarium that I received from giving lectures. But then I thought the decision that I was going to stop lecturing because I wanted to spend more time with my family and as great as it is being an academic, being flown all over the world to give lectures. And it’s not being churlish or not grateful, but it takes up a lot of your time if you’re giving lectures at large conferences. So I’d taken the decision. I was going to stop doing that. So the source of income from a plug had dropped also coupled with the fact that if you want to professionally written website and professionally hosted, it cost a reasonable amount of money.

Kevin O Brien: Hosting isn’t costing 10 pounds a month anymore. So I decided let’s just see what happens. And when I open donations page. And I had to close that page within a week because my accountant said, if you’re not careful, you’re going to be paying tax on the donations here. And people aren’t giving you money to pay tax to HMRC. So yeah, we closed the first donations after a week. I think I’ve got about 9,000 pounds on that within a week.

Payman: Wow.

Kevin O Brien: Interestingly, a lot of this was from the year US, the big donations were from the United States where people sort of have a giving culture, and I think they get various tax breaks. And there are people now working up the donations page, every April, I’ll do it about April the fourth for the tax year. And there were two Americans immediately donated a thousand dollars straight away and having being so consistently. And so I covered my running costs. The donations page this year took a little longer because I think of the times, but I had to close it after about two and a half weeks this year. And people still come into me and say, can we make a donation? I say, now I can’t, because I can’t make a profit from donations. It would be the wrong thing to do.

Payman: And there Lies the answer to why you decided not to become a private orthodontist.

Kevin O Brien: Yes.

Payman: Can I give you some money, Kevin? No, thanks.

Kevin O Brien: No, it is that several people have said to me, why don’t you charge for this one? You charge a pound to read it, because obviously that would make a considerable amount of money. But all I’m doing is sort of I’m writing posts on my viewpoint, which is occasionally controversial, but all I’m doing is putting my interpretation of research papers and explaining the good and the bad things about them. I’ve also been joined by Patrick Fleming, he is professor of orthodontics down at the London hospital. And so there are now two of us writing the posts, but we both believe that education in many ways should be free. And I think it is important to think that actually there’s an awful lot of the readers of this blog are from, When I look at the readership, most of it is United States because of the concentration of orthodontists and then sort of the Western part of Europe.

Kevin O Brien: But then we move into other countries in which training isn’t always available, resources aren’t available to the degree that they are. Dentists and orthodontists generally are not as wealthy as they are in other countries. And so we get a lot of readers who are actually very grateful to be having something for free because they haven’t got the money, for example, the spend money. So it is that concept, that education, if we can do it for free, it should be free. And that’s what people’s donations in fact are paying for, which I think is good.

Payman: Do you get much stress from it? Does the AcceleDent contact you and say you just ruined our business. Do you get trolled?

Kevin O Brien: The times when I’ve turned it up. There’s times when I’ve crossed the line with people and I’ve thought, shall I post this? And I thought, yeah, maybe, and then I’ll hit send. But no, it’s not stress. I quite like doing it. It only takes me about half a day, a week to do it. Doesn’t take long to write one most of the time. And then the remaining time is editing it and getting search engine optimization and all the other stuff that goes with blog posts, so it doesn’t take me long. I like doing it. It’s something that I like writing and I like writing about stuff and explaining things to people. And Patrick does the same. The only time that I got stressed a lot was when I was sort of attacked by quite a few key opinion leaders in the United States. They said some pretty unkind things about me. It caused me a bit of stress, but then I thought, hey, how.

Payman: Because of what you were saying about them, were you were saying-

Kevin O Brien: It was a pretty blunt attack on key opinion leaders who are promoting treatments without evidence. They were sort of being clinical salesmen. I was blunt and they let me have it, but a lot of their comments weren’t nice and it troubled me a bit. But then I thought, well, this is the world of the sort of social media. They can sue me if they like, I thought, yeah, my business that supports the blog is worth a pound. And I don’t intend to go back to America for quite a long time. So it was more tougher ducks back, but it did trouble me for a couple of days, but then that’s why I think that’s a fact of life. Occasionally, if you’re not upsetting people, sometimes you’re not getting anywhere.

Kevin O Brien: And it is something that I feel quite strongly about is paid key opinion leaders. You get six figure sums from some of the companies and you start lying about the products that they’re trying to sell. So yeah, this not as a key opinion on slot every couple of months or so just to knock them back into shape. And that’s one thing that the blog does quite nicely, but it’s mostly educational. I’d hope it’s mostly educational.

Payman: I think I’m conscious, we’re both running out of time. So one thing I wanted to address Kevin, I’m fascinated by the sort of the aura that orthodontics has managed to get for itself. I get the same dentist saying to you, I don’t know if you know, Kevin but we’re in teeth whitening and composite bonding. I get the same dentist said to me I’m not interested in teeth whitening that’s cosmetic treatment, but refers loads and loads of kids and things for ortho. And in the back of my head, I’m thinking, well, orthodontics is a cosmetic treatment. I mean, how much of orthodontics has health benefits and I’ve noticed that there’s quite a lot of dentists selling orthodontics based on the health benefits of it. How do you feel about that?

Kevin O Brien: Well, we’ve just done a paper that was published in the American Journal of Orthodontics that in fact said that there was the surprising lack of evidence for the benefit for orthodontic treatment across the board. Now that’s not to say that that isn’t a benefit. And I think it’s very important to stress that is we didn’t find any evidence for it or much evidence for it. And the reason for that is that we’ve been asking the wrong questions. And most orthodontic research for example, is involved with how straight are the teeth, what someone’s skeletal pattern and things like that. Which we haven’t sometimes very little in a way of actually asking patients the way that they benefit, how do they feel? And those are very important factors. So when you look at the benefits of orthodontic treatment, you’ve got the various non cosmetic benefits such as treatment of impactions, large overage that are subject to trauma in young children, severe crowding, which may lead to tooth decay and periodontal Poppins.

Kevin O Brien: But that crowding has to be severe. The crowding that most of us see even on a referral practise is not going to lead to increase caries or periodontal disease. So then you sort of look and think, well, the cosmetics that is important too. We go back to the appearance of people’s teeth. And again, over the years, this has changed quite dramatically, predominantly I think because people becoming more aware of themselves and their appearance and societal norms have changed. And again, we’re all much more aware of our appearance than we are used to be. And just in terms of the way we look our way to narrow and all that, because we’re photographing ourselves all the time. And when you then transfer that back down to the generation of teenagers now, and certainly for the last five years with selfies and photographs and posing and everything like that, I would say, and this is just a hunch because there’s no science behind this that are sort of young people that we treat or seeking treatment are very different from those from 20 to 30 years ago.

Kevin O Brien: And they are concerned with the appearance of their teeth because of that great importance that’s placed on appearance. And that’s what you’re treating, you’re treating someone’s appearance. Now the next question then is that treatment of someone’s appearance cosmetic. And at what point does improving or changing someone’s appearance become a health benefit in terms of their overall way they feel about themselves and their self-esteem and their various interactions, because then you sort of move into sort of mental health benefits. So there’s only been one study that has ever really looked properly at self-esteem and orthodontics, and that was done by us. And it was part of the class 11 studies that we did looking at interceptive treatment of class 11 problems in young children. And we found that a group of children who received functional appliance treatment these were kids with big overjet. When that overjet was reduced, their self-esteem boosted, and they were getting teased less.

Kevin O Brien: What then happened when we followed them through for the next five years, the kids who didn’t get treatment early caught up with them in terms of their self esteem. So there was no difference in their self-esteem when they were 16, but there was when this group of patients were nine or 10, and that might’ve been very important and we didn’t measure it really now I’m kicking myself to say, if I did that study again, what would we do many other things. So there is something to it. It’s easy to say it’s just cosmetic.

Payman: I’m all for it being all cosmetic, don’t worry. But it’s the fact that it’s wrapped up as health that I’m interested in because teeth whitening has health benefits, by the way.

Kevin O Brien: That’s what we don’t know about artist. It depends what you call health.

Payman: Well teeth whitening is good for the gums in terms of the peroxide is good for Gingivitis. You get less plaque adhesion to the teeth. You get less root caries but we don’t talk about that because it’s the cosmetic side we talk about, but-

Kevin O Brien: But you don’t measure you see remember health isn’t just bodily health. It’s also mental health. WHO definition of health.

Payman: Of course.

Kevin O Brien: And it is, I can’t quote it exactly at the moment, but there is something about social, psychological health.[crosstalk 01:00:34]

Prav: Sorry to interrupt you. But you’ve been very evidence-based and looking at research and all of that. I’m going to ask you a question. That’s maybe counter-intuitive now, what’s your hunch. I know you probably don’t like talking about hunches cause you like evidence, but what’s your hunch on the future of orthodontics? I mean, what’s got your attention in the near future and talking a bit further ahead, is this idea of machine learning AI and all that. Do you think that’s really going to work? Do you think direct consumer is going to get to a point where we don’t need orthodontists because of the technology?

Kevin O Brien: Yeah. Orthodontics reinvents itself every few years because there’s the cycle after cycle of new appliances, nothing is new, self ligation wasn’t new. It’s been around for years for example. So breakthroughs in orthodontics I would like to see a method of making teeth grow faster and in the hands of good operators, you’d see no reason why that shouldn’t happen. There must be improvements in the cosmetic look of our appliances. We are moving that way. There’s got to be a movement away from steel. We’ve had ceramic brackets for a while, but they’re still not as good as steel in many ways. So we’ve got to move away from that. I think the trouble with direct to consumer care is I don’t understand how you could do it in terms of looking after the patients properly.

Kevin O Brien: I think that’s the key issue. Tele dentistry and everything that is fine and it does work. It’s worked telemedicine and tele dentistry is working. So there’s a lot of scope for that, but all that involves is constant monitoring and looking after people. So I think that at the moment, direct to consumer, no matter how fancy they try and dress it all up is not going to compensate for the orthodontist or dentist detecting something going wrong and changing their treatment.

Prav: At the moment I think it is a disaster, but do you think going forward it could become a thing or?

Kevin O Brien: I don’t understand how it could without that contact of the professional, with the person who knows what they’re doing. I think that’s the issue.

Payman: Kevin, What you were saying earlier is a dentist who’s done a five-year degree, has been on an airport course and sees the patient’s mouth in their chair can still mock it up. And now we send some Potsy off to the patient and say, take your own impression, sunshine, and we’ll straighten your teeth.

Kevin O Brien: Yeah. So that’s the issue there the dentist working outside their scope of practise, it’s not the system of care that’s causing the problem. It’s the dentist. And we will never eliminate people who work outside their scope and make mistakes. It’s a risk that we all take. And that probably is quite small. If you think about it. Because I think most dentists are sense of a line. Most health care professionals don’t want to harm people.

Payman: No.

Kevin O Brien: They don’t mean to. They don’t like mistakes, but mistakes happen and that’s life. But if you’ve got nobody looking after the patient, even if it is just simple aligner treatment, it can go wrong. And I think it, from the point of view, protection of the patient, that’s quite important is that the patients still need protecting.[crosstalk 01:04:22]

Payman: If Kevin O Brien was going to design a direct to consumer system. What would it involve? Would it have a dental monitoring thing with a patient taking a picture every day or what?

Kevin O Brien: Yeah. That’s how, I mean, orthodontics is delivered like that in some countries, it’s the way that some people are, I think people that live in remote areas, the orthodontist is on the end of a computer instructing dentists on what they should and shouldn’t be doing, that is remote treatment. Is not direct to consumer though that’s the issue. The thing that’s missing out of the direct consumer is the protection of the patient by the professional. We always have to go back to that is as we’re all professionals and that’s the way we should be acting. And you take that out. You’re going to have problems.

Payman: Kevin, give your blog a quick plug so that people know how to get to it. And then Prav ask one final question. I know you-

Kevin O Brien: Yeah. Getting to the blog is easy. Just type Kevin O’Brien’s orthodontic blog into Google and you’ll find it.

Prav: Excellent. Kevin, my final question, we ask everyone this, imagine that your last day on the planet, and you’ve got your family around you, what three pieces of advice would you like to leave them with? And to finish that question off after that is how would you like to be remembered?

Kevin O Brien: I would always say in terms of advice to people is be kind, be calm be mindful. Don’t stress too much about everything, how I’d like to be remembered. I suppose I’d like to be remembered as someone who did make a difference to orthodontics and dentistry really. I’m quite pleased with what I have done. And I suppose I’d like to think, well yeah right I helped good changes to dentistry and orthodontics in what I’d hope is be quite a gentle, but very occasionally a bit of an aggressive indefinite way. And I suppose that would be about it.

Payman: Brilliant.

Prav: Thirdly, you certainly have made a massive difference to orthodontics and dentistry. No doubt about that. It’s been wonderful. Thank you so much. I’m sorry. We had to run out of time like this. I know you’ve got to run yourself, but it’s been brilliant. I feel like we need to see you again.

Payman: Likewise.

Kevin O Brien: Anytime you like. I’m off to go and increase the income of a local vet.

Prav: Thanks, Kevin. Thanks a lot.

Kevin O Brien: Okay. See you soon. Take care.

Prav: Bye.

Outro Voice: 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: Thanks for listening guys. If you’ve got this far, you must have listened to the whole thing and just a huge thank you from me and Pay for actually sticking through and listening to what we had to say and what our guests has had to say, because I’m assuming you got some value out of it.

Payman: 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 much for listening. Thanks.

Prav: And don’t forget our six star rating.