Dental Unscripted

Welcome to Dental Unscripted.

Where Mike D'Inzio and Paula

Quinn break down the

practice ownership journey,

one episode at a time.

Starting up,

buying and running a

successful dental practice.

What's going on, guys?

Welcome,

welcome back to another episode of

Dental Unscripted.

My name's Michael D'Incio,

and I got my co-star, Paula Quinn,

on the show.

Hey, what's up, Paula?

Hey, not much.

How's it going?

We're doing another one of these things.

Yeah, it's been a minute.

I know, I know.

It's been a minute,

so hopefully you guys are

still following us.

try to put out as much content as we can,

but it's kind of the busy

season and we're doing the best we can.

But today we got a really

good episode because it's

just Paula and I rapping

today about hygiene and all

things kind of how to grow your practice.

And so we're just going to

talk a lot about like how

to get hygiene departments

to produce more and who

better to have on the topic is Ms.

Paula Quinn.

So we're just going to kind

of get into it.

But

Before we do,

a little housekeeping if you

haven't heard it.

If you're watching this on

Startup Unscripted,

get over to our other

channel called Dental Unscripted.

That goes for the same as

those of you watching on

Acquisition Unscripted.

We're just merging all to

Dental Unscripted.

Yeah, no,

this is going to be the place for

all of our podcasts moving forward.

And the topics are going to

be about startups, about acquisitions,

and also about practice management.

So today's kind of a

practice management topic

of how to grow practice and

get things going.

So let's just kind of get into it.

Do I get to just be the guest?

I just get to sit here and be the guest?

You can be the guest.

Do you have any housekeeping

to add to that?

No, I'm the guest.

Yes, you are the guest.

You know, we were thinking today about,

you know,

topics on how to just grow

practices and a hot topic is hygiene.

And like in a world where

hygienists are just so expensive,

dollar wise, a pretty big range.

Paula,

where do you think the range is on

pay these days for hygienists?

Statewide or just kind of?

Countrywide.

Countrywide.

I mean, it's all over the place.

Why did I say statewide?

Yeah, countrywide.

Yeah, countrywide.

I mean,

I would say it can be as low as forty,

but that's pretty unusual,

especially here in the West.

But I would say that there

are probably some southern

states that it could be lower.

But I would say average we're looking at.

probably forty seven to seventy five.

Yeah.

Northwest and some parts of

California were up in the

seventy mid seventies.

Yeah.

Yeah.

So like in that in that kind

of mindset and also not only pay,

but but also like I know

it's not it's probably not as bad.

But do you remember post

covid when you couldn't literally find

a hygienist anywhere.

Just because you're talking

to hygiene departments and

practice owners all day.

I feel like it's less of a problem,

but it's still a problem.

How would you kind of frame

up the void that they've kind of left us?

You, I can say you guys,

because you're a hygienist.

The void that you guys have left us,

has it rebounded?

Is it worse in some areas?

in the country than others.

Yeah, I think that it's it's worse.

It kind of seems like, in my opinion,

what I've heard,

it's like the higher pay

regions are the hardest ones to find.

Those of us, for instance, Arizona,

that didn't change a lot.

I think it's still fairly easy to find.

You know,

it's almost like the higher they

the higher they got paid,

the more I,

and maybe they did that because

they weren't willing to

work unless they got a lot of money.

I don't know.

It's it,

but that's kind of the trend is

the higher they're paid,

the less you'd be able to

seem to be able to find them.

And then I think it

definitely is area specific, you know,

it's, it's just like any other,

employees though you know

some areas are just harder

to find employees in

general you know if you're

in in a remoter area versus

other areas but um

you know, I don't know, but yes,

the answer is I do think

that it's rebounded a little bit.

I definitely see, I mean,

we had dentists practically in tears,

but I also will say dentists,

a lot of dentists have been

become accustomed to doing

their own hygiene.

I mean,

so I think there's also just less

complaining because it's almost like they,

they found a plan B and,

and kind of just said,

I just got to do this.

Uh,

you know, and we won't get into it on this,

but, you know, even here, you know,

in the state of Arizona,

pass a law where assistance, you know,

can take a certain amount

of hours and do some scaling.

So that's kind of what the

hygiene profession has pushed to happen,

you know, demanding hygiene.

Let's talk about that.

I mean, I,

the whole point of this episode is,

is exactly what you're,

kind of throwing out there

that dentists have had to

get really creative to fill this void.

And we tell our clients all the time,

if you can't get a hygienist,

then you're stuck in the

chair doing a two hundred,

three hundred dollar PPO

kind of procedure and

instead of doing fifteen

hundred dollar procedures.

And so that just never

that's just never going to

really pencil the way you want it to.

And so

yeah like I of course you

have to do what you got to

do to keep your business

going and we saw a lot of

that in covid with the

doctors doing that but now

that some hydrants have

come back which is a good

thing they've come back um

let's kind of get into like

okay so we can't really

find hygienist and so when

we do find one we pay them

a lot more like you said um

so the supply and demand is

off and if this if the

If the demand's really high

and the supply's really low,

then prices are going to go up,

just like they have in Seattle.

So if prices have gone up,

the only way to combat that

is to produce more, to justify the ROI,

right?

Okay, fee for service.

Unless they're fee for service.

And so that's the big topic for today,

is how to get more out of

your hygiene department

knowing that you're paying in some cases,

seventy dollars an hour or more?

And how do you it used to be

three times their wage, right?

Is that what you used to say?

Yeah, that was the bare minimum.

Three times the wage.

Bare minimum.

So what?

So would it be would we be

lucky to get three times today?

With seventy five dollars an hour?

Well,

with well-trained hygienists

and motivated hygienists,

you should get three times

your wage still.

Still.

Yeah.

Still.

Okay.

There's so many other, I mean,

there's so many other things,

which I guess, you know,

we can get into a minute,

but there's so many other

things that hygienists can

do and bring to the table

besides just the act of scaling,

you know?

Yeah.

That's one piece to the puzzle.

let's get into it what are

the so when you think about

hygienic hygiene and and um

trying to get the most out

of those patients how how

what what do you think the

top things are like where

do we even start this

conversation about getting

more uh dollars per patient

in that chair in the

hygiene chair what where

does your head where does

your head go I mean

I would say first is diagnosing right.

I think with a good perio

program and a good

understanding and a

refresher every once in a while,

sometimes just doing your local,

what you have to do for

your CEs isn't enough.

It's really making sure that

you're diagnosing correctly

the first time.

There's always so much

opportunity and I just see

it over and over again, not happening.

Yeah.

yeah I mean when you say

diagnosing you're talking

to a layman here um I'm

sure the dentists know a

lot more about it but what

when you like what are you

seeing that when you say

that like what are you

seeing in the hygienist

today not diagnosing like

what does that mean yeah

well I wouldn't say it just

today I I think it's you

know historically um

I always, whenever I'm coaching hygienists,

I think it's a very natural

instinct when you're a

caregiver to sort of want

to minimize issues,

not shame the patient and sort of,

you know, usually people,

I feel like usually you go

into certain fields, whether it's,

you know, you ex-banker, you know,

hygiene,

and a lot of the behavior styles

are the same with hygienists and they're

a little bit more reserved.

Um, not all, not all, there's a lot of,

a lot of, you know,

different personality types out there,

but, um,

they don't want to hurt people's

feelings.

They,

they're caregivers cause they want to

give and coddle and, and take care of.

And so when you have that,

it's hard to have the, the,

the person that's okay with

a little bit of

I wouldn't call it confrontation,

but having those hard,

tough conversations,

do you know what I mean?

And so I just find that they

like to gently plant seeds

or they like to avoid,

or if a patient's already

been through something or

even complained about

another office doing something,

they'll retreat and like

not even touch that, you know?

So I feel like,

those can be challenging situations.

And the general personality

of the hygienist doesn't go

with the general,

what kind of the job it's

almost like upfront when

you got to collect the money,

it's like a little bit

harder and that's not usually.

So, I mean,

all you want me to explain what

I mean by dying correctly.

Is I would say most of the

hygienists I talked to

don't even know what forty

three forty six is or that

there's a gingivitis

therapy code out there or

they've heard of it and they tell me, oh,

insurance doesn't pay for that or.

Why would they even be talking insurance?

That's what's always fascinating to me.

You really want to go down

that rabbit hole?

I mean,

maybe you've got doctors on the

other end of this thinking, you know,

I mean,

it is part of the conversation

that a lot of offices,

by the leadership of the dentist,

they allow their team to

really have the insurance

company dictate what they

tell the patient.

Well, I know when I, when I, I know,

I know it's like,

I'm opening up a can of worms,

but I have an answer.

For,

for those of you that aren't watching

online,

it is classic right now that Paula

is talking to us.

Hold up your right hand real quick,

please.

No, your left hand.

Now don't switch what's in your hand.

What did you do?

You just had a flasher.

Yes, you did it.

She literally has a flosser in her hand.

I was flossing.

You couldn't be more cliche right now.

But anyway.

Anyway.

Yeah.

So, like, again, I don't know.

I mean,

we're talking about diagnosing correctly.

That kind of to me means

that they don't have the

insurance company telling

them what to diagnose.

Wait.

They shouldn't be diagnosing

based on the insurance company's stuff.

Well, what I find happens is, you know,

this isn't meant to be bad,

so sorry if your name is Mary Sue,

whatever.

You know,

Mary Sue up front will submit and either,

yes, it can be...

They can use an alternative code.

It can be what I want to say.

Gosh, I have a lot.

Stephanie's going to be so

disappointed if she's

watching this right now.

They can downgrade.

Sorry.

There's a lot of things that

happen with like, for instance,

we'll just give the forty three forty six,

for example.

There's a lot.

There's three or four

different scenarios that

can happen with a forty three forty six.

So I imagine Mary Sue says, Paula,

don't use that code again.

It didn't get paid.

And it just confused the patient and dah,

dah, dah, dah.

Or they just downgraded it anyways.

We might as well submit a one on one zero,

which is an adult pro fee.

And then that's in the hygiene mind now.

Um, so, you know,

if you're not set up for

success from front all the

way to the back, then sometimes, you know,

submitting certain,

especially different codes

that we're not used to can fail you.

So whenever I'm going in,

I'm really arming, not just the hygienist,

but the practice with how

do we do this and how do we

do it successfully?

But I do agree with you, Michael, it,

you know, the coding.

the coding is only to submit

to insurance what's really

happening in the chair is

are a couple different

things and so we've got to

talk I'll try not to get

over educate here but we've

got to talk in the

patient's language and when

a patient comes in and we

code them a prophy okay so

think about this you come

in with gingivitis pretty

bad and I do a prophy

you leave and it's covered

at a hundred percent and

then I put you on three

months you're gonna say why

and I'm gonna say well you

know you have gingivitis

you're gonna say yeah but

my insurance covers every

six months I'll be back

then you don't get the gist

of what just happened there

um so I like to I call it

call a spade a spade and

make sure the patient fully

understands whether it

hurts in their pocketbook

whether it hurts by having

to come back in four to six

weeks for an additional now pro fee,

I want the patient to be

educated in that.

And if the insurance denies

it or downgrades it or

there's a copay with it, well, I mean,

you waited two years to

come in or you don't floss.

Yeah.

or you're not, you know, it's, it's really,

you have to diagnose what you see.

If we went to a medical doctor,

they wouldn't diagnose

something completely

different because insurance

wasn't going to pay.

They would say, Hey, Paula, you, whatever,

you need to be treated for this.

It's, it's, this is what it is.

It doesn't matter.

Now the front office has to be armed with

the knowledge so they can

help explain that to a

patient because we never

want to do something

without patient's knowledge

and understanding and

agreeing to treatment,

but it shouldn't change the

diagnosis in the back.

So long, long story short,

what I see often is we are

doing bloody proffes.

We're giving away perio.

We're giving away gingivitis

and we're coding a prophy.

And so

It's bogging down our chair.

It's bogging down our time.

The office now who's already

limping along because

they're getting reimbursed

crap for a pro fee is now

getting reimbursed crap for

a free gingivitis therapy.

You know what I mean?

And what I'm thinking about

here is like the doctors

are always saying to us, well,

the insurance company is the problem.

They're not paying us enough money.

Damn, damn it, Paula,

the hygienist is costing me

seventy five dollars.

I should just do my own hygiene.

And what I just heard you

say was that the front

office kind of slap is

slapping the hygienist hands.

The doctor's not stepping in and saying,

no, we're diagnosing what it is.

nancy joe or whatever you

said mary sue at the front

quit dictating back to us

as clinicians so in a lot

of ways it's a leadership

issue by the doctor not

stepping in and saying hey

it's not always mary joe or

whatever's fault because

sometimes the hygienists

just don't want to have

those difficult conversations

So we can't blame,

I'm saying sometimes when I

hear those myths,

I know that's coming from

the front because the

hygienists have no idea if

a claim got paid or not.

Now there's a whole nother

problem where hygienists,

whether it's because, like I said,

it's their personality,

it's the difficult conversation,

whether they're just not fully

And I know they're educated

because they have hygiene degrees.

But for instance,

the forty three forty six, you know,

unless you just graduated

in the last few years,

isn't isn't common knowledge.

So it's understanding, number one,

the code is out there.

Number two, what constitutes using that?

And number three,

how do we explain that to our patients?

And even help our front office, like, Hey,

it doesn't matter.

This is what it is.

This is what we're doing.

So yes.

And then it's a leadership.

If the doctor, you know, sometimes they,

well,

what I've seen a lot of times is

they don't even look at the gums.

They just trust the hygienist and they,

so they're trusting their team, you know,

and they should, but

at the end of the day,

we can all look at a perio

charting and if there's no

bleeding points,

someone probably isn't marking it.

And if there's.

Thirty percent of the mouth or more,

we can all look at it and say, OK,

this is no longer a prophy.

You say.

I hear you talk about

statistics and you know,

I don't know the clinical

part that like you do and all of that,

but I do know numbers and

I think,

and I do a lot of practice

analysis with our buyers

and I see a lot of, not even,

I see a lot of ten to

fifteen percent perio in

practices and that's low.

And you've taught me and the

industry says that thirty

percent is probably

probably perio above the age of what,

thirty, thirty, thirty, fifty percent,

fifty percent of the

population over the age thirty.

Has period or has kind of a

has perio happening, like maybe not.

You don't have kind of perio,

you have perio or you don't have perio.

I see.

So gum disease can incorporate gingivitis,

but periodontal disease is actually,

it's affecting the bone and

the surrounding structures,

your periodontium.

So that's whether you have

it on one tooth or one area

or entire mouth,

you have periodontal disease.

It's target,

it's certain bacteria that cause it.

Well, before we pivot away from diagnosing,

unless we just want to keep going here,

but-

We do see a lot of forty

nine tens maintenance

versus full blown scaling and root plan.

And I hear you say a lot of

times that people go into

like this maintenance phase

when they shouldn't be just

sitting in maintenance the whole time.

OK,

so you can't get to a forty nine ten

without having perio treatment.

But what I say,

what you heard me say is

sometimes offices will have

high perio percentages

because whoever was there

before or historically,

they had this and then the

patient goes into a maintenance,

a forty nine ten.

But there's no new perio coming through.

So they'll have like a

thirty percent perio

because they have so many

forty nine tens.

But then when you look at

the actual active periotherapy,

forty three, forty one or forty three,

forty two,

those will be super low because

no one's still diagnosing.

But then doc or everyone's like, oh,

we've got a thirty percent, you know,

perio in our practice.

It's like if you figure if

fifty percent over the age

thirty have periodontal

disease and you're getting

twenty new patients on.

realistically,

ten of those should be put

into active perio.

At minimum, they have gingivitis.

I know it.

I've done this for lots and lots of years.

And what hygienists,

I don't know if they forget or they,

again, are scared.

When it's on your watch, okay,

let me rewind to when I was

a younger hygienist.

It wasn't until someone gave

me permission to

that people go back into

active perio that I was the

same way because I thought

I failed my patient.

I did perio therapy.

They came every three months.

A year later, two years later, I was like,

oh my goodness,

this patient still has perio.

What's going on?

I felt like I can't tell them.

They've been doing exactly what I said.

And now they have active perio again.

Somebody has to say, it's okay.

It happens.

It's not you.

It is the mouth.

It's so it's the, it's the environment.

It's the oral habits and

it's just part of nature.

You've got pockets in there

that never really healed

those bacteria or,

and the patient never stays

on the exact ninety days on,

on the clock.

It's like saying you're a

gym trainer and you come to

me for your fitness and I

put you on a program and nothing,

you don't get the results you want.

Well, the other,

however many days you're on your own,

you're eating whatever, you're not,

you know what I mean?

I can't just because I see

you every six months, every three months,

I'm not responsible for you

or your mouth or what happened.

Okay.

So on that and that,

so you're saying someone, again,

I don't want to cover

things that our audience already knows,

but if you go into a forty nine ten,

there's never a situation

where they would need

scaling and replanting again.

I would almost say there's

always a situation they

would need it again.

That's what I'm, that's where I was going.

I would say I would be

shocked if you did

periotherapy once in a

lifetime on a patient.

Yeah.

So that's the point is you,

you see these huge forty

nine ten maintenances and

you see very little SRPs and your SRPs,

the

the big dollars let's talk

about dollars guys we're

talking about how to get

more out of your your

freaking hygiene chair

those dollars are a lot

bigger on the srp than pro

fees and maintenance both

bigger and so okay so if we

got a lot of maintenance

and we've got a lot of pro

fees and we got very little

srps there's two buckets

that feed the srp the new

patient like you said

and some people that need to,

to jump from maintenance back over.

And I, um, I think it's really good.

I think it's really good

that you were vulnerable there and said,

Hey, look, the first, whatever, ten,

fifteen years of being a hygienist,

you needed that permission.

And it sounds like you have

to be that coach sometimes

with these hygienists on

giving them that same permission because,

um,

yeah yeah I think that's

good I think that's good

and and with that too we we

talked about the forty

three forty six you know

there's there's other

coding that comes with

perio to that you know we

we don't have to get into

it today but there are

other you know even your

exam code looks different

and and doctors aren't

using that exam code for

perio that gets them more

money so there's a lot

there's a lot being missed I feel um

In that in that whole

situation of diagnosing

right the first time,

not worrying about planting

that seed and then properly

coding all of that stuff.

So you're getting more bang for your buck.

You're doing the work.

You're doing it.

Get paid for it.

Yeah.

And it's not doing the

patient any good to sugarcoat it.

You have diabetes, you have diabetes,

you have some other disease, you have it.

Medical doctors never do it.

Oh, you know, you got a little,

got a little diabetes, you know, or.

You got stage one cancer.

It's fine.

Figure it out.

Yeah.

We'll see you back in six months.

Yeah.

Let's watch it.

Let's see if it goes to stage two.

Let's just watch phase one cancer.

Yeah.

It's really just clinically

calling out what you see.

Whenever I do the coaching program,

this is what I say to every hygienist.

I don't know if they listen to me or not.

This is what I say.

If they were free...

And it was your own mouth or

your spouse's mouth or your

parents' mouth.

It was free.

Didn't have to worry about insurance.

How would you treat them?

What treatment would you do for them?

What would you say?

What would you tell your partner?

What would you tell your parent?

Would you tell them that

they have parents?

Of course you would.

You'd say, I'm going to do...

I'm going to do a periotherapy on you.

You've got periodontal disease.

We don't get you back every month.

That's right.

Yeah.

What are you going to say?

We talked over.

I said, in fact, we talked about someone,

you know,

that has perio and it's a hard

conversation.

And, um, they're hygienists as a friend.

That's totally different.

They were in my chair.

I wouldn't have a problem.

You wouldn't have a problem

because you got the loops

on your doctor at that point.

Okay.

What are some other things

that you think we're thirty

minutes in and we had a

diagnosing conversation?

Well, I think that's important,

but I'm sure you have

fifteen other things that you could add.

It's kind of how these episodes go.

We get into it and next thing you know,

we're out of time.

But if you had to choose one other thing,

what would it be that would

Yeah,

just one that would drive more

revenue into that chair

that could offset this

seventy dollar wage that

we're paying for a whole column.

Eight hours.

Like what's the what's

what's another thing?

A little nugget.

Well, I'm going to I'm going to name it,

too,

but I'm not going to talk about the

second one.

I just I just want to say

don't underestimate.

patient experience and

creating value and that

whole relationship.

Just don't underestimate it.

It's probably one of the biggest things.

However,

it's a slower moving needle

because it's not direct money.

It's kind of like just

something that organically

happens based on how you

treat patients and how that

whole experience looks.

But for time's sake,

When we're talking about ROI

and the hygiene department

and getting more out of it and stuff,

I would go to adjunctive

services because that's an

immediate direct reflection

on what happens to the

production for the day.

Yeah.

What's that mean, adjunctive services?

Adjunctive, additional services.

I'm from Ohio.

You say adjunctive services.

I probably didn't even say it right.

I'm from Indiana.

Well, it's as simple and as complicated.

The simple is fluoride, sealants,

irrigation,

depending on the treatment you're doing.

It could be incorporating

lasers into your practice

for gum tissue laser, for hygiene,

a dial laser,

and as big and complicated

as clear liner therapy, night guards,

and things like that.

We're educated and skilled

to assist and discuss all

of these things.

you know,

if clear aligners aren't a big

part of your practice,

that might be a little scarier.

And, you know, of course,

I always cover that in my program.

And then there's direct, you know,

if you sign up with a clear aligner,

there are typically some

training that comes from

those particular companies.

But, you know,

so that might need a little bit,

but just adding, you know, fluoride,

just adding,

if it's even adult tooth that

doesn't have any decay, no signs of

issues uh whipping out a

couple c I can whip out a

sealant in you know two

minutes as long as it takes

to put some etch on rinse

it and put a curing light

on you know sealants I

always wondered like why

why is why are sealants so

um focused on in pediatric

dentistry we have a lot of

pedo clients but then

Because they're not covered, Michael.

They're not covered by insurance.

That's why.

It's always surprising that

a hygienist to date, my entire life,

me personally,

has never brought up a

sealant as an adult.

Not one time.

And I haven't had too many

cavities in my life.

So it's kind of surprising

that there's options that

providers are not having that discussion.

So that's your answer.

It's mostly if I talk to an office,

they'll say, well,

adult sealants aren't

covered by insurance.

Now, if you break it down again,

getting all hygiene and

technical as a hygienist,

we never want to be the

decision maker in that

because if there is stain

or some kind of bacteria

down there and they say,

if you put a sealant over it,

you could seal the cavity.

And however,

most sealants today have a

fluoride releasing component to it.

that they've done studies

where it actually can stop

that growth and be good for the tooth.

So I think, again, it's education,

it's leadership, it's the doctor,

it's the owner, the dentist,

the doctor doing some research,

incorporating it into their

practice and stating, hey,

let's all be in tune and aware of this.

I would say,

if not a hundred percent of

hygienists are gonna want

okay of the doctor before

placing it but we won't get

into when I like the exams

but if you get in early

enough please don't please

I won't I won't but if but

if the doctor comes in

early enough we have time

especially on an adult to

do a couple sealants now

children and tongues and the

Suction can be a little bit

tricky doing by yourself or

in a matter of a couple minutes,

but an adult can typically

keep their mouth open.

They can even help you suction.

You can whip out a sealant

if you've got some extra time,

especially on those adult

pro fees that are pretty slam dunk.

We usually don't need a full hour.

And if the tray is ready,

and that's the other reason

why it doesn't happen.

It's insurance doesn't cover it.

It's they're afraid to do it

unless they get the okay by the doctor.

And the last thing is

they're not set up for success.

So if I got to go get a tray

and etch and sealant,

and I'm asking the assistant,

I just lost my five minute opportunity.

But what a simple thing for

a business owner.

Oh yeah.

And they're like,

I wish I had this for Bonnie,

but an adult sealant probably pays, I'm,

I'm totally guessing fee

for service is probably so,

seventy bucks.

But what, I guess,

I guess that's what I'm saying.

That's what I'm saying is like, what,

like folks, if you're listening,

in my opinion,

a lot of this is leadership.

And I think it always comes

back to leadership.

And

the doctors don't want to

have hard conversations

with hygienists and, and you know, I said,

they're smart.

Yeah.

Well,

but you're the business owner and you're,

you're the business owners

are telling me that damn

Delta dental for not doing

all this things.

But, but the truth is,

is we're not talking to our

patients about the things that they need.

And,

And the other thing that I would, a setup,

get three setups every day

and just have it ready.

Like just build that in.

Like what is so, that's easy.

Just do that.

And then, and then, and then it's,

I guess the other thing is, is like,

I'm wondering, do, do hygienists,

if they sold a sealant,

does that production go to

them if they sold ortho?

They sold ortho.

Does that go to them?

Usually if they scan,

if they start and scan,

not the full amount.

I mean,

I think you should definitely track.

Usually we create either

there's a scan code.

or there's photo codes,

there's codes you can use,

or you could make up an

initial conversation code.

And so as a hygienist,

you could put that code in

and then as the patient

journey through the practice,

if doc goes and enrolls that,

then you would know that it

started with a hygienist

and there could definitely be a piece.

I mean,

you wouldn't probably get all the

credit because you're,

obviously like you're not

doing half the work, but absolutely.

I think,

especially when you scan a patient

and you identify

malocclusion and then

you're talking to the

patient and the doctor

comes up and you're like,

here's your softball, um, you know,

Paula did a hundred percent.

It should,

there should be some sort of

split there of what

production counts toward

the hygiene team and what, you know,

Well, I guess I'm thinking like in,

in normal business terms, right?

Like I forget dentistry,

just forget it for a minute.

Okay.

When, when you're in the business world,

you, you pay who,

who gets paid the most in

any company it's people.

And then,

and then who of all the people

make the most sales salespeople.

Why?

Because it's hard to do that.

And that skill set's difficult.

So like, to me, if I'm a dentist,

I'm going to try to get,

most dentists aren't great salespeople,

quite frankly.

If I have a hygienist,

the best salespeople in

dentistry are the hygienists.

There's no question about it.

If I'm a dentist,

I'm trying to figure out

how to compensate them for

their efforts and making

that really easy because

compensation talks, money talks.

And I know there's a lot of

hygienists out there that don't want to,

be a salesperson,

but it's not sales if

someone needs something and

if it helps them and if

it's better for that patient.

And I'm just like sitting

here disappointed that

never once in my entire

relationship with Dennis

has anybody talked to me

about sealants and I would

have paid for it and I

would have paid for it.

And so is it sales?

Is it sales?

If you're just simply telling me that, hey,

this is an option and then

I get to choose if I want to pay for it.

I mean, that's not sales.

Sales is like almost trying

to push something that

maybe someone doesn't want

or trying to convince them

that sales really this is just education.

So if you're educating me

that there's options out

there and I get to say yes or no,

no pressure.

Cool.

But like you guys, ladies, dentists,

business owners.

figure out a way to

compensate your sales

people and give them credit

where credit's due because

you probably were not going

to sell that ortho case you

probably were not going to

sell that sealant so make

it easy make the systems

simple I also just think as

you know if high

you know, one,

this is totally off the subject,

but I'm going to go here anyways.

I wish hygienists were paid on production.

I wish that we were paid

like associates because I

guarantee a lot more of us

would be looking for those

things like sealants, Invisalign,

fluoride, lasers, or clear liners,

any of that,

because our wage would be banked on that.

And

And quite frankly, we're producers.

We should be treated like producers.

But somewhere along the line,

we just got this astronomical wage,

whether we're doing

trophies all day long or

we're a rock star,

co-diagnosing with our dentist,

doing wellness scans and, you know,

constantly looking at that stuff.

And it creates a... Oh, you know,

any hygienist out there is

going to kill me who hears me.

It creates a...

a comfort or I was going to say lazy,

but I wouldn't call it lazy.

I don't think any hygienists are lazy,

but it's contentment.

And it's kind of like I get

paid whether I do a pro fee,

whether I do for, you know,

it's all the same.

So why?

Why kill myself in that hour?

But then you have the other

end of the stick where

these doctors are already

paying us fifty to seventy

five and now they have to

incentivize on top of it because

the only way to get us to

talk about a sealant is to

pay me extra for it or I'm

not going to do it.

So it's kind of a shame the

way the industry fell and

the way we do this.

And I told you in the past,

the way we paid our hygienist,

they own the business, you know,

and there's something to be

said for that because I

could get her on the show

one day and that I never

met a more motivated

hygienist in my life that

made hundred fifty thousand

because she knew what she

needed to do to run her business.

So, you know, it's it's it's a fine line.

We are health care providers.

We hundred percent want to

take care of our patients

and do what's right for them.

And we want to, you know,

walk with caution and not feel salesy,

but it's, but it also is a business.

And like you said,

if it's something that I need,

it's not selling.

It's, it's, it's something I need.

It's,

I don't understand why we're afraid

to talk about it.

It's almost supervised

neglect when we don't talk

to you about a ceiling.

No, that that's where I was going to go.

I was going to go where I

was going to go there and

kind of end the program on that.

And that is, and that is like,

like in all the practices

that you and I have coached

over the last whatever

years I can't think of one

client that was salesy and

aggressive and did some

it'll never happen yeah and

and so I just this word of

sales is ridiculous to me

because I know what sales

is and what we're talking about here

is supervised neglect.

It's not sales telling me

that there's a sealant option.

That's not sales.

It's an option.

Like now, yeah,

you feel kind of cheated now.

You're like, wait a minute.

I real quick story.

I always tell when I'm teaching, it's like,

I always,

it drives me crazy when I go and

like drop my car off and

they do some stuff to it

and I get it back and they're like,

you know, filter it's, it's red.

And I'm like, why didn't you,

call me and tell me I would

have changed the filter you

know and then you have the

other people that are like

yeah and they were trying

to sell me a filter you

know so it's I don't know

it's hard but I yeah I

don't think I'd ever met a

dentist or a hygienist that

I would ever constitute as

too aggressive in this in

the enrollment or sales

category and I think if

they two-folded it they

would still be uh safe um

and again there's lots of

like instagram videos of like dentist

like the funny comedians

making fun of dentists

about pushing dentistry.

I don't think there's ever

been an Instagram video or

comedian on a hygienist

selling me on a sealant.

Like, come on,

what are we even talking about here?

So I just think it's really interesting.

And that idea of running a

hygiene department off a percentage,

this isn't a new concept.

You did it twenty years ago.

I'm just kind of surprised

why we haven't adopted a

more sophisticated way of doing this.

And unfortunately,

people have gotten complacent.

So at the end of the day,

there's lots of things that

we didn't even probably

touch half of what you were

prepared for today.

But it's almost, yeah,

there's room for a part two.

Folks that are listening,

it's not Delta Dental's fault.

They definitely have a part of this.

It's not.

It sounds like... I'd be careful there.

Well,

but my point to that is we just

uncovered forty minutes of

all the things that you

could do to offset stupid

Delta Dental's fees.

And I could say that at

least eighty percent of our

our clients today,

even the ones that you coach, you,

it takes so much effort to

turn this mentality around

just to get the whole ship.

And if the doctors just really push this,

in fact, Paula,

if you could think of the

clients that were totally

on board with what you were

telling the hygiene team

and the doctor went in and said,

we're doing this now, did those,

did that hygiene team turn

it around quick?

and then the doctors are

like guys paula just left

she talked about a lot of

crazy things like sealants

how do you how do you feel

about that do you get the

same results you're shaking

your hand no so again

leadership just believe in

what you're doing

and drive it and and and

guess what the team will

follow um so I guess with

that with that let's sign

off on this bad boy but I

appreciate your brain paula

and this topic and maybe we

do do a part two um

anything else to add before

we shut this you know you

better not get me started I

mean I like that my my

brain is all over the place

but yeah no it's good we'll

we'll uh maybe do a part

two at some time nope I

think it was great

All right, guys.

Well,

another episode of Dental Unscripted.

Thanks for having me on.

Thanks for having me on.

Yeah.

Thanks for having me on.

Get out of here.

All right, guys.

Talk to you later.

All right.

Bye.

Thanks for listening.

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