Dentistry has made significant advances over the past decades, and millennials coming into the field now have grown up with technology, a sense of worksharing and collaboration, and greater understanding of the connected systems of health. So why are we still operating private practices from an antiquated, 70-year-old business plan?

Within these pages, you’ll be able to find a methodology and road map for financial freedom and a sensible work-life balance, while practicing Complete Health Dentistry, rejecting the encroachment of corporate firms, and having fun along the way. Join Kristen and Nick as they meet ninjas, superheroes, and one magical hipster. You just may have a devil of a time learning the ins and outs of ...

Dentistry for Millennials. $19.95 ISBN 978-0-692-94221-5 51995>

9 780692 942215

Dentistry for Millennials

Copyright © 2017 by Gary Kadi

All rights reserved. Printed in the United States of America. No parts of this book may be used or reproduced in any manner whatsoever without written permission by the author, except in the case of brief quotations embodied in articles and reviews.

ISBN: 978-0-692-94221-5

Dentistry for Millennials books may be purchased in quanti- ties for educational, business, or promotional purposes. For information go to www.gabeworks.com.

First Edition

Printed on acid-free paper

Printed on partially recycled paper

CAREER SUCCESS GPS

TABLE OF CONTENTS

Acknowledgements 7 An Invitation 9 Chapter I The Couple that Practices Together ... Gripes Together 17 Chapter II A Dance with Devil Dental 25 Chapter III Enter ... Gabe 37 Chapter IV Welcome to Modernity 47 Chapter V We Got Game 56 Chapter VI I Dream of … an Accountability Coach 67 Chapter VII I Love It When They Call Me 'Big Data' 79 Chapter VIII DentFlix and Chill 89 Chapter IX It's Getting' Hot in Here So Put on SPF 99 Chapter X Happily Ever After: The Molar of the Story 109 Book Snapshot TL;DR (Too Long; Didn’t Read) 117

ACKNOWLEDGEMENTS

Millennials seem to get a bad rap everywhere, but this is nothing new. The next generation always gets poor press because their style, trends, and ideas interrupt the sta- tus quo.

The backlash seems particularly magnified today. After all, the combination of a young, digitally connected generation, and the constant technological changes of our modern era has led to major disruptions in the most bureau- cratic industries: taxis, hotels, media, retail, and even poli- tics.

But the way I see it, being a millennial is a mindset, not an age. It’s a willingness to adapt, to learn how technol- ogy and new forms can spring us forward. On behalf of those of us born before 1980, I want to say “thank you.” Thank you for being part of an innovative generation that is not afraid to challenge old practices to make a better world.

So my first acknowledgment is for my many peeps born after 1980, who are helping me and others of my gener- ation adopt the innovative creativity that embodies “millenialness.” Even though my year of birth is [redacted], I have felt a strong desire to understand the needs, wants, and honest desires of the generation I believe will usher us to a brighter future.

I also want to acknowledge you baby boomers, who’ve have the courage to reinvent yourselves in order to serve your millennial team, and attract new millennial pa- tients.

Much respect to the amazing millennial teams and doctor-owners who will set the new normal: fully automated 8— Dentistry for Millennials

so that you can work easy, play hard, and do some seriously epic s#$%.

Mom and Dad: I hope you know you did your job as parents, and with each further year as a dad, I have a deeper love and respect for you.

To my tractor-trailer-driving granny, Vera: you con- tinue to inspire us. Though you may be a centenarian, you are a true millennial. You teach us that we can invent and create anything that we think is possible, and that a future that excites us is how we truly stay alive, regardless of age.

On that note, I wouldn’t be alive right now were it not for the day my wife finally said, “You don't have to quit drinking Mr. Party Fresh, but if you continue, you can't stay here.” That was the life-changing moment when I broke out of my personal prison and turned my life into one dedicated to serving others. Judith, that’s the kind of woman you are. You stand for greatness and make me a better person.

To my son Rome who teaches me #lit stuff every single day. For you I am grateful for the gift of fatherhood.

And finally, a big shout-out to the ingenious team of people at Nextlevel and Gabeworks. Thank you for bringing a new, simple, and effective way of owning and operating a private practice into existence.

AN INVITATION

Don’t think of this as a how-to book. In fact, don’t even think of this as a book at all. Think of this as a roadmap. A teachable fable. A game plan to help you create a life well-lived in dentistry, as a doctor or a team member— a life of balance that will leave you wealthy in terms of ex- citement, your heart and soul—and, of course, your bank account.

But before we talk about your future, let’s talk about the past. Let’s dial it back to America in 1950. We’ve sup- ported the Allied victory in WWII, and we’re the undisputed leader of the free world. It’s economic boom time. Dentistry and medicine have seen some pretty important advances, including the advent of health insurance benefits.

You’re a 1950 dentist? Great! It’s easy to hang a shingle and get to work filling cavities.

But let’s think about changes in the field since then. Fluoride toothpaste. Sterile, disposable needles and high- speed drills. Reclining patient chairs. Television advertising that extolls the benefits of white teeth. Better bonding mate- rials. Electric toothbrushes. Lasers. Male hygienists! And patients who are better-acquainted with their oral health.

And now? Dentists are beginning to rethink their role in their patients’ overall health. And America is getting on board as well. Gone are the days of throwing shade on dentists (and dentists throwing shade on themselves!) as mo- lar jockeys. Gone are the days of hygienists being thought of as gum gardeners and tooth polishers; dental professionals are now healthcare advocates. Gone are the days of assistants being “just” the people who clean rooms and sterilize in- struments; they’re now versatile, all-purpose, and recognized for their great hearts and unparalleled level of trust with the 10— Dentistry for Millennials

patients. Gone are the days of an office manager hiding be- hind paper and fielding phone calls; they’re now team lead- ers. Gone are the days of “money gals” issuing the bills; they’re now financial freedom fighters, helping patients fit dental treatment into their lifestyle.

Here’s a fact: Dental teams are the healthcare heroes of the twenty-first century. We’re at a point of Complete Health Dentistry™. Thanks to reams of proof from peer- review journals and continued scientific discovery, this is something healthcare professionals acknowledge: Total body health begins with the mouth, and taking care of the gums and teeth is important for preventing and treating systemic illnesses. For example, 50 percent of heart attacks are trig- gered by periodontal disease!1 We’re at a place when prac- tices need to step away from reactive, symptomatic care and move toward the Healthy Mouth Baseline and preventive care.

Preventive care? Craziness! And yet, think about how much money Americans spend taking care of problems after they happen, instead of being front-footed and making sure problems never arise in the first place. Instead of treat- ing the symptoms of a disease, and just waiting for the next symptom to sprout up, why don’t we attack the cause, and ensure the heart of the problem is addressed?

So goodbye, molar jockey. Hello, oral health spe- cialist. Yep, the times they are a-changin’.

So let’s say you’re a part of the Millennial Genera- tion, born sometime after 1980. You grew up a digital native.

1 “Up to 50% of Heart Attacks Triggered by Oral Bacteria.” OSH News Network. 19 Mar 2014. http://oshnewsnetwork.com/2014/03/19/50-heart-attacks- triggered-oral-bacteria/ (Accessed 19 Jul 2017) An Invitation —11

You’ve seen the waste and mistakes of the older world; you saw your parents toil for forty years to buy a house, send you to college, and save for their retirement. You didn’t study dentistry to just make money; you entered the field to make a difference, to do meaningful dental and health work. This is not an “Or” world for you—it’s an “And” world. You want to minimize waste and consumption and maximize return on investment for time, energy, money, and fun. You’re on board with the idea of Complete Health Dentistry™— because it just makes sense! You healthcare heroes are com- ing into the professional world looking to do what you love—practice dentistry and #LiveYourBestDentalLife.

And yet, the business model in your field is operat- ing from the 1950s, as if Harry Truman were still in office and Hula Hoops were still a thing. Drilling, filling, and bill- ing. Take on a bunch of patients, ask them questions like, “Well hey, Bert, what brings you in today?” and deal with the symptoms rather than exploring the roots (pun intended) of the problem.

Nobody told you it was gonna be like this. The years of dental school; the piles of student loans, the grim first year of your practice. Doesn’t corporate dentistry seem like an easy way out? You can join the first firm that cold-calls you, work fewer hours, and start paying down your loans immediately. Who cares if it’s soul crushing and you have to cross-reference a spreadsheet for how many crowns you’ve sold? You’re still doing dentistry, and what’s more, you don’t have to use your precious brain cells on billing and paperwork.

Okay, now imagine you’re part of a dental team, and you’ve been doing this since before the new dentists who took over the practice were born! Now changes are coming fast and furious. Referrals are drying up. Corporate dentis- try’s taking all the talent—and with them, your patients. 12— Dentistry for Millennials

Everyone’s relying on technology and they expect that you will, as well. Dentistry seems to be moving away from the tried and true process of preparing patients for crowns and inlays and toward something that has to do with ... chronic disease?

Do these two outlooks seem familiar? Hello, tipping point. The old models aren’t working; there’s a problem that needs fixing. We’ve got to adapt or die.

As millennial dentists, you can see what the problem is and know how to fix it; you just have to bring people on board. As another member of the dental team, you may fit into one of three categories: an early adopter of the solution, welcoming the new thinking and change; a resistant and fearful adopter who’s biding your time, hoping that this is just a fad the dentist is thinking about; or you’re in the mid- dle, a willing-but-cautious adopter who wants to see it suc- ceed before you can commit to it.

It’s kind of like climate change, right? There’s an old model of stagnation, procrastination, and stasis, and it isn’t serving anybody; in fact, there seems to be a whole lot of fiddling (and analysis and paralysis) while dentistry and the world burns.

In his book The Pendulum, Roy Williams and Michael Drew observed that society moves through forty- year cycles of “Me” and “We” eras.2 The Baby Boomers were just entering school and the professional world in the early 1960s, and they were focused on wealth, celebrating the individual, and hailing attractive heroes. No wonder the 1970s were called the “Me Decade,” and the last days of

2 Roy Williams and Michael Drew, Pendu- lum: How Past Generations Shape Our Present and Predict Our Future (New York: Vanguard Press, October, 2012) An Invitation —13

Boomerism brought a wealthy real estate developer with brand-name recognition into the White House.

The We mindset, on the other hand, is now in as- cendance as the pendulum swings in the other direction. This mindset celebrates personal responsibility, productivity on a team, humility, and the creation of a better world; it also strengthens a society’s sense of purpose.

Welcome to the conflict between Millennials and Baby Boomers.

Williams and Drew trace the first year of the previ- ous “Me” cycle to 1963—the same year Bob Dylan wrote, “The Times They Are a-Changin'.” As Dylan says in that song, “you better start swimmin,’ or you’ll sink like a stone.” In other words, adapt or die.

And goodness knows, everybody better take swimmin’ lessons if the effects of climate change come to pass. More than 90 percent of Millennials say climate change is occurring … versus 74 percent of those sixty-five and older.3 Is it a priority and a danger? Yes, say 84 percent of female and 77 percent of male Millennials … but just 55 percent of male Baby Boomers agree.4

Houston, we have a problem.

So what does this have to do with dentistry? Well, think about it this way: You Millennials know we’ve gotta

3 “Millennials’ Strong Views on Climate Chan- ge.” UT News. 27 Oct 2016. https://news.utexas.edu/2016/10/27/millennials-views-on- climate-change-could-impact-election (Accessed 18 Jul 2017) 4 “The Age of Ecology.” SaveOnEnergy. https://www.saveonenergy.com/the-age-of-ecology/ (Accessed 18 Jul 2017) 14— Dentistry for Millennials

get ahead of climate change. We need to confront it before it happens, so we’re not paying for it with dollars and lives in the future. Dentistry is in a similar situation. The healthcare heroes of the twenty-first century are confronting the healthcare crisis by addressing problems so we don’t pay for them in the future—also with dollars and lives. After all, what’s a good day for a dentist? When we save a smile. A great day? We save a life.

The world’s finally realizing that climate change af- fects how we live, and Millennials will be the leaders in fighting it. These leaders in the dental industry are also real- izing that there’s a dental climate change: a change in the way we perceive dentistry and in how doctors and teams perceive themselves. We know that practices must transform to fit the times.

The antiquated notion that work is the be-all and end-all isn’t prized by today’s twenty- and thirty- somethings. As opposed to living to work, the net generation works to live—to get more out of life. They prize accounta- bility and responsibility—making work fun and interactive and incentivizing performance. They share with and learn from their peers. And they use technology to seek better ex- periences and to change behavior. They’re not looking for products to buy, but for experiences and connections.

Yes sir and ma’am, the times, they are a’changin.’

Is there a place for the old dentistry business models of the 1950s in today’s world? What we’re looking for is a modern story and journey—a GPS that can help you young professionals navigate this new world and avoid working your asses off and being slaves to your practices. Step-by- step, this book will lay out the route to success that will help you compete with corporate firms, retain patients and ac- quire new ones, buy other practices, enjoy multiple revenue An Invitation —15

streams, and retire with no financial burdens. The destination is freedom to focus on your life’s work and to practice caring dentistry that rewards you with monetary and ethical wealth.

For dental teams, this GPS can show how integral you are in the new model. By embracing the critical thinking of the twenty first-century model, you can grow personally, professionally, and financially. You can rise from being the low person on the totem pole, reinvigorate your passion, and blow past the plateau in your career where most naturally stop and resist. Your destination is accountability and re- sponsibility, as well as recognition for the significant and impactful work you do as part of a team. It’s not Me Dentis- try, but We Dentistry.

For older dentists, you may read this as a recovery game plan, so you can turn it around late in the fourth quar- ter and storm downfield to victory. It is possible that you can retire financially free and enjoy your golden years with the same kind lifestyle you did while working chairside. This is the reward for a life well-lived; you can work because you want to, not because you have to; leave a legacy that you’re proud of; and enjoy the financial fruits of a long career.

If these all sound like familiar concerns, the follow- ing fable will offer that GPS. Join our heroes—Kristen, Nick, and their team—as they learn the triple-win practice and career management system in which patients win by re- ceiving affordable, total-body healthcare; the team members win because they grow personally and financially; and the GPs win by being part of the 5 percent of dentists who retire financially free. This blueprint will help guide our heroes (and you!) toward financial freedom as well as feelings of value and indispensability—with the assistance of a Millen- nial named Gabe. 16— Dentistry for Millennials

Gabe is an all-purpose, all-star employee. However, contrary to the tale that follows, he’s not a real person. He’s an intuitive model for modern dental practices and a product of the combination of years of business wisdom and ad- vanced, twenty-first century technology and concepts. So let’s see how Kristen and Nick get along with Gabe and how they can live their best dental lives in these rapidly changing times.

CHAPTER I

THE COUPLE THAT PRACTICES TOGETHER ... GRIPES TOGETHER

Friday. 6:33 p.m. Kristen and Nick were the last ones in the office. Again.

Ding. For yet another week, Kristen ignored the nu- merous texts from friends about evening plans. Ding. She tried not to freak out over the Instagram pix of her friends enjoying long weekends on beaches, on a mountain top, or in foreign cities. Ding. Oh cool, Heather has a timeshare in Cabo. Whatever. Ding.

Kristen turned her phone over and looked across the office at Nick; he was swiping through some digital radiog- raphy imagery. The hardware was necessary, but all Kristen could see was the price tag. Their eyes met, and both knew what the other was thinking: “Another Friday afternoon, and what do we have to show for it?”

They never thought it would be this difficult.

The couple had met at dental school and began da- ting immediately. After all, they had so much in common: love for the Wolverines; passable imitations of Gollum from Lord of the Rings; enthusiastic agreement about the connec- tion between oral hygiene and health, and the notion of the mouth’s healthy baseline; and an ability to recite the regres- 18— Dentistry for Millennials sive dentist jokes in Seinfeld. It was no surprise that they married so soon after graduation.

They moved to a new city and took over a practice, like many of their classmates, entering the world of private dentistry to make a difference. They planned to build wealth ethically and responsibly—and have fun doing it. They were confident that, with their integrity, work ethic, unflappable patience, optimism, and effort, their new business would thrive.

Not so much.

There were a number of factors they hadn’t consid- ered. First off, and weighing heavily on their minds, were the sizable student loan debts they carried. Both of them came from modest upbringings and were the first in their families to get advanced graduate degrees. But they figured that the loans they took out for both college and dental school would be paid off in short order, thanks to a hip, modern, and flour- ishing practice.

Again, not so much. Their practice wasn’t founder- ing, but its mast was torn, the wooden beams were rotting, the first mate was looking through her spyglass backwards, and the sharks below were looking pretty hungry.

It really shouldn’t have been this difficult. The prac- tice they bought even came equipped with a team that knew how things worked and could help them get their feet wet. They probably should have realized that wet feet and wires don’t mix—which is to say that their office wasn’t exactly wired to win.

Kristen and Nick were both born in the mid-80s, and they proudly wore their Millennial badges as proof of an adaptive mind. They were always early adopters of new technology: the first to get iPods, upgrade to the latest gener- Chapter I —19

ation of iPhones, or wear Fitbits. When it came to storage, even hard drives were passé to them. “Give me the Cloud, and I will move the Earth!” is what Archimedes should’ve said.

But here they were, with paper—dead trees— overflowing from file cabinets. (File cabinets? What fresh hell was this?) Stefanie, the office manager, was a bit slow on the digital uptake. That might also explain the fact that, more than two years into their practice, they were still using an html website from circa 1997. Their internet presence was technological equivalent of wooden dentures: barely func- tional and pretty off-putting. But who had the time or know- how to hire a web designer? Kristen and Nick may have been digital natives, but some of the front-office folk were digital dinosaurs.

Well, not all of them. Some of them were eager and excited to get trained with the two new tablets, and jump into exploring the software updates from Dentrix ... but others were a bit nervous about all the changes. Their jobs were difficult enough. The team ended up putting the brakes on implementing some tech advancements in order to protect the most vulnerable among them. Their loyalty was admira- ble ... but unfortunately, it meant the practice wasn’t able to move forward.

But man, now 2020 was around the corner. Their of- fice wasn’t fully on point with text confirmations, and their patient contact management software was operating at less than 5 percent in total capability! The office wasn’t just old- fashioned; it was like Charlemagne-riding-a-pterodactyl ar- chaic. It was like the dentists and the team members were speaking two different languages, and there was no translator in sight. 20— Dentistry for Millennials

Ding. Kristen rubbed her temples and ignored the latest text. Every club and group she and Nick had ever been a part of was fun, collaborative, and cool. But it seemed like as soon as they met the team at the practice, there was fric- tion. Was it because of the age difference? It didn’t help that a retiring dentist patronizingly joked that they’d be too busy “doing a Twitter” to do surgery or lead the Monday Morning huddle. The irony, of course, was that they weren’t the ones inappropriately using social media in the office. (Cough— front desk—cough.)

Ding. Ding. Kristen tossed her phone onto the near- by desk. Nick grabbed it. “Hey, Kris. Ashley, and Brandon finally set a date. Last week of August. In Costa Rica! Awe- some! I finally get to see howler monkeys.”

Kristen snatched her phone back. “We can’t leave the practice for a week for Costa Rica. That would be totally irresponsible.”

Nick glumly agreed. If only they had anybody they could trust to steer the ship in their absence. They both knew this disappointment would be simmering between them to- night. Another dream deferred, along with like a million oth- er things. #FOMO much?

Neither Kristen nor Nick had wanted to end up like their parents, who worked so hard at their jobs for minimal returns. They wanted the work-life balance that many of their friends bragged about. They tried to make it a priority. They had even planned to start trying for a kid at the end of the year, but at this rate ...

At this rate, they’d be working weekends until Ant- arctica was a beach-front destination.

Dental school could’ve spent, you know, more than twenty minutes on private practice business management to Chapter I —21 fill this gaping cavity of knowledge. Sure, they had to cover oral disease prevention, periodontics, endodontics, surgery, etc. Sure. But it probably would’ve been a bit helpful to learn the managerial stuff, considering how many of their colleagues entered the industry and were like ¯\_(ツ)_/¯.

And here they were again. Friday evening. They should have been thinking about a great weekend with an outdoor concert or a nice romantic dinner for their first date on the town in, like, months. But instead, they were going through the backlogged paperwork.

And where was their team off to in such a hurry? They used to want to stay late to help, but now some of them were out as soon as the clock struck 5:59. Maybe the rising stress levels hadn’t helped. Kristen would be the first to ad- mit that she’d been applying some pressure and asking a bit more. Though they’d bent over backwards to help in the past, now they seemed a bit testy. For instance, two hours ago, Kristen had asked Karen, a dental assistant, to review Mrs. Roth’s charts for the next day. Karen had smiled tightly before closing her bag and saying, “Sorry Doctor. Like you said earlier, I’m just an assistant.”

Yeah, Kristen had said something in front of the team about Karen being an assistant, but ... well, she was. What’s the problem here? Why the tension?

Okay, granted, Kristen and Nick had more to gain than the rest of the team, but they were the ones with skin in the game. They were the ones who had taken over the entire practice and ponied up the cash for modernization, including the intraoral cameras, cone beam imaging, and the latest CEREC unit—which some of the team seemed reluctant about. Well, not that Nick had done a great job helping them figure it all out. But who could blame him? The front desk 22— Dentistry for Millennials

was still using first generation Dentrix for basic office manage- ment.

While some of the team were able to figure out how the G6 Dentrix would make their lives ten times easier, fear won out again, and the team protected their own.

Speaking of “first generation,” Dr. Salyers, the older dentist who stayed with the practice when it changed hands, was something else. If he wanted to retire, he should have; he’d earned it. But if he was gonna stay on, he should be diagnosing and treating, not hiding out in the back, checking his stocks and playing Candy Crush.

Maybe the older doc was immune to stress, but clearly the pressure had gotten to Beverly at the front desk. She was so burnt out that when a patient called to cancel, she quickly responded, “Great, thanks very much, bye-bye then.”

Similarly, the hygienists were feeling the pressure of fitting too much into a one-hour appointment. Marisa, for example, was just going through the motions of cleaning and tersely answering questions from patients, but not really en- gaging with them. When Kristen tried to broach the subject, Marisa replied that it was not that she didn’t care; rather, she didn’t have the time to get more involved with each patient.

On the other side of the room, Nick rubbed his eyes and shut down the tablet. He opened up the online appoint- ment scheduler and began cross-referencing it with Dentrix for the upcoming week’s schedule.

“Kris, you all set for the trade show next week?”

Kristen rolled her eyes. “Who’s got time for a trade show? How’m I supposed to sit through a full day of presen- tations under fluorescent lights?” Chapter I —23

“You have to. You lost the coin toss.”

Kristen shook her fist at Nick and the two of them smiled; the first legit smile they had shared in, what, days? That didn’t ease the pain of that trade show, though. Ugh. Kristen obviously valued the face-to-face time with peers in the field, but trade shows with old-school lectures ... couldn’t she just watch them on her laptop through a webinar plat- form?

Ding. Kristen braced herself for a text consisting solely of martini and wine emojis, but instead, it was a re- minder for the climate change march she’d signed up for tomorrow ... which she’d just have to skip. Back to the schedule.

They frowned. Monday and Wednesday sported a veritable Who’s Who of patients undoubtedly primed to change their appointments at the last minute, costing the practice thousands of dollars. And Tuesday and Thursday featured those likely to plead poverty and get their bill de- ferred for another day ... though who knew when that day would come? The other day, the situation had actually boiled over with a patient (let’s call him Mr. Nowallet), when he crassly said to Nick in passing, “Yeah, I know, I gotta pay for this crown sometime. After all, you probably need money for your fancy twenty-foot fish tank or Prius, huh?” Nick, normally so upbeat and optimistic, let the stress of the day get to him and fired back, “You mean pay my team’s salaries and try to put a dent in my student loans? Yeah, I’d love to be paid some time.” Even though it had given him a sense of victory, it was hollow. Nowallet was probably searching for another dentist by now.

Not that Kristen hadn’t had her share of flare-ups with patients, like that guy who actually raised his eyebrows when he found out that she was the dentist and not an assis- 24— Dentistry for Millennials

tant. I mean, come on! For the last five years, half of gradu- ating classes at dental school were women.

Their life shouldn’t have been this difficult. Kristen and Nick had a plan to build a collaborative, fun atmosphere in their workplace. Money mattered, of course—they weren’t gonna work all their lives, and they had seen how debt was still hurting their folks—but they also needed bal- ance. There just had to be a way to get what they wanted out of their careers: practice good, caring, healing dentistry; make money; pay back loans; grow their business; and, at the same time, have a family and, say, go to Costa Rica for a wedding. This didn’t seem crazy.

But here they were: scrounging for patients, strug- gling to pay bills, at odds with an older team that didn’t trust them, and burning the midnight oil once again.

Ding. Ah, there was the martini-and-wine text she expected and would now ignore. Across the room, Nick re- signed himself to bringing home the folders and some scans. Yay. Another dinner at home before poring over work from the office.

After Nick fumbled with the voicemail redirection on the phones (again), Kristen punched in the alarm code, hit the lights, and exhaled. Homeward bound.

CHAPTER II

A DANCE WITH DEVIL DENTAL

Home again, home again, jiggety-jig. Kristen and Nick were back in their sparsely-decorated, two-bedroom apartment in the luxury high-rise they called home. Two years in and still four boxes left to unpack. What was going to be a nursery at some point had become home to the over- flow filing system for their practice. It hurt Kristen’s head to even look in there.

She picked at the remains of her Thai food as Nick uploaded some files to cloud storage for their lab. They’d exchanged all of four sentences over dinner; three of them had to do with how awesome Costa Rica was, and the last one was a bet over which assistant would be the next to quit. With the takeout boxes still crowding the table, Kristen pop- ulated her iPad with the practice’s monthly invoices. She grimaced as she clicked through the bills that were due at the end of the month.

Anxious, she checked in with the online appoint- ment book.

“Nick, honey, I’m looking at the schedule for the upcoming weeks. We’ve got too many open spots. We really need to book some patients. I’m worried here.”

“I know, Kris. Let’s do some outreach to the three women who’ve been putting off their crowns. We’ve got Strauss, Handley, and—” 26— Dentistry for Millennials

“It’s not just that. Look at the week after next. We’ve got huge holes we need to fill.”

Nick was about to make a lame joke about implants, but Kristen stopped him cold.

“I’m serious, Nick.” Kristen turned her tablet around to show him the evidence. “Our situation is gonna be unten- able in less than a year. Between student loans, car pay- ments, the rent on the practice, salaries, maintenance ... ugh, I just can’t with all this.”

Nick rubbed her shoulders. “Soon, Kris. We just have to get the team on board with the new tech, make a harder push for referrals, and—”

Lightning and thunder crackled outside. Kristen went over to the window; the sky had been totally cloudless a couple of minutes ago. Huh. Guess it was okay that she hadn’t been able to make the outdoor beer garden opening—

BZZZZZZ. Nick and Kristen jumped at the intercom and nervously laughed. Clearly, all the stress was putting them on edge. The front desk informed them they had a visi- tor from a dental firm who had some “timely information.” Another crack of thunder reverberated through the apart- ment. Kristen and Nick conferred and agreed to let him up.

When the elevator doors opened down the hall, the first thing that grabbed their attention was the suit: dark and well-tailored over a crisp, white shirt with French cuffs. Wing-tip shoes. A black fedora. Eerily well-groomed finger- nails. A persistent rumble of thunder continued outside, as the visitor reached out a hand.

“Hello there! Kristen and Nick Barrow, yes?” Chapter II —27

“Uh, yeah?” said Nick, shaking the outstretched hand. “And you are ...?”

The stranger doffed his hat and flashed a pearly- white smile. “Alastair. I’m with Devil Dental.” He whipped out two business cards from his jacket pocket and presented them between his slender fingers. Nick and Kristen cautious- ly took the thick, ivory-colored cards; the flames on the side were an ominous touch. They smelled like ... ash?

“May I come in? I’d love to discuss your practice. And an opportunity.” Lightning flashed again, like right out of a cheesy movie.

“Oh. Yeah, sure.” Nick stepped aside, and Alastair glided in. Peering around, he flung his hat up on a hook that had been meant to showcase their diplomas, but ... well, work.

“So, Devil Dental,” Nick said. “You guys have been calling us pretty regularly.” Kristen shifted uneasily. There was something about this guy. She couldn’t quite put her finger on it. Maybe it was that wolf outside that kept howl- ing whenever Alastair opened his mouth.

“We sure have been calling you! We’re persistent when we like what we see. And we like you kids. You’ve got the goods! We want to turn your fortunes around.”

“You’ve got a bunch of new patients you want to un- load on us?” joked Kristen, scanning the business card. Kinda weird to throw a tail and horns on the back. The pitch- fork likewise seemed unnecessary.

“Ha! Not exactly.” Alastair motioned to the kitchen chairs for them to sit. “We want you both to come to work for us! How does that sound?” 28— Dentistry for Millennials

Silence. They avoided his gaze, slowly pulling up chairs across from their guest. Alastair flipped through a couple of pink invoices scattered near him. “Still paying off the intraoral cameras and software, huh? That’s gotta be a pretty penny.”

Kristen gathered the invoices up and replied, “It’s fine. We’ve got it under control.” She mumbled something about increasing case acceptance. Ugh, why had they let this guy in here? And wait, why was Nick getting him something to drink?

“You took over your practice twenty-five months ago. Pretty soon after graduation, right? After the wedding, which you’re probably still paying off?”

Creepy. How did he know that?

“Okay! First things first!” Alastair opened his brief- case and spilled out brochures for the new Devil Dental of- fices in the city. Nick’s jaw dropped when he came back with a glass of sparkling water. Whew. It was tempting, no doubt about it.

Alastair continued, “With our dazzling, downtown, state-of-the-art facility, we’re looking to profit off a wide range of consumers spanning four sectors of demographics.”

“Wait,” Kristen interjected. “You mean help people learn more about oral hygiene and overall health, and help fix their teeth, right?”

“Sure, that works too! You guys are the pros! We’re just here to make your job easier. Ok, so here’s the deal. Sell your practice. Or just leave. Yeah, leave it by the side of the road like an old fridge with an unhinged door. Come aboard Devil Dental. We’ll have you onboarded with our practices Chapter II —29 lickety-split, and we’ll get you serving consumers soon after that.”

“You call them consumers?” Kristen nose felt prick- ly. She swore she smelled sulfur.

Alastair looked confused. “What do you call them?”

“People?”

“Sounds good!” Alastair collected some of the bro- chures. “Anyway, after a couple of classes in high-pressure sales, you’ll be ready to get chairside and do what you do best. Do either of you have experience with telemarketing or canvassing?”

They both thought back to their summers working for nonprofits, stopping people for donations, and how they were instructed to wheedle and cajole. But that was for a good cause. And we were talking about dentistry here, not sales. Right?

Alastair leaned forward, staring intensely at Nick. “Dentists of your considerable skills? You shouldn’t be steri- lizing instruments and chasing patients, right? You should be practicing all those cool restorations on bombed-out teeth, and bringing in the ducats! Right?”

“Yeah!” chimed in Nick reflexively. Kristen el- bowed him.

“Check it out,” Alastair continued. “You’ll be bring- ing your crazy talents to our firm, and getting all those con- sumers set up with crowns! And then the next time they come in? Another crown!” Alastair put his hand up for a high five. 30— Dentistry for Millennials

“Ah, that’s if they need them. There are often other paths we can take—”

Alastair waved Kristen down and flashed that big smile again.

“Right, absolutely. But let’s be honest. Some of the- se customers come in saying they just want a cleaning, but they open up their word hole, and it’s like seventeenth- century Britain in there. So it’s clear they’re gonna need work done sooner or later. May as well be sooner!” Alastair lowered his voice. “Look, we want to provide quality dental care to all people. And if they haven’t seen a dentist in a while, they’ll need a lot more than just a cleaning.”

Kristen and Nick nodded; that made sense, despite his less-than-artful language.

“You know,” Nick said, “a lot of those underserved patients ... they may not have the money for some of these procedures. How do you guys deal with that?”

Alastair laughed. “Don’t worry your heads there. Remember, we do the billing, you do the filling. Anyway, we’re getting those underserved communities into our chairs and leaving with a smile as big as mine, see?” His smile was impressively big—like he had just eaten Little Red Riding Hood’s grandmother.

“Now, then. Let’s talk numbers. How much debt are you kids carrying? A lot, right?”

Kristen’s face flushed. Nick clenched his jaw. “Yeah, like seven figures between us.”

Alastair leapt up. “What? That’s terrible! You guys are healthcare professionals. You just want to fix some teeth! Chapter II —31

And you’ve gotta pay all that back? Tsk. That’s a crying shame.”

He produced a golden sheet of paper from thin air, and scribbled a number down. His eyes gleamed, and as he slid the sheet across the table, whispered “Here’s we’re of- fering for a first-year salary.”

They leaned in together. Nick whistled and leaned back.

“And that’s just the base,” Alastair added. “We ha- ven’t even talked about the benefits package. And compen- sation also includes bonuses that increase as key thresholds are passed. You start giving those customers this list of pro- cedures and you’ll dwarf that in a heartbeat.”

Nick and Kristen looked over the list. It was lengthy. And there were procedures on there that they weren’t totally adept at. “Who are the endodontists you refer to?” Kristen asked, pointing. “I mean, you need specialists for some of these ...”

Alastair smiled. “Kristen, the word ‘specialist’ comes from the word ‘special’ and the superlative ‘est.’ Like, you guys are the most special-est dentists I know!”

“Uh, I don’t think that’s true,” Kristen tried to inter- rupt.

“So that’s the good news! You kids will be doing all of these! Can I get a what-what?”

Nick started to give him a “What,” but Kristen re- plied, “Let’s say we don’t consider ourselves to be qualified to do, say, crown lengthening or guided bone regeneration?” 32— Dentistry for Millennials

“Don’t worry about it! You guys seem smart. You’ll figure it out. By the fifth time, you’ll be pros. And anyway, that’s what malpractice insurance is for! Hey, check this out.” Alastair circled pictures of dental equipment on a brochure. “Betcha getting tired of scrounging for bucks for…”—he scanned an invoice under Kristen’s hands—“this new cone beam? Right? Devil Dental makes those purchases for you! You want something new and flashy? We’ll get to your money-making procedure room before you can say ‘deviled eggs’!”

“Well, that would be nice,” Kristen allowed.

“It sure is. Make some cold hard bucks to start pay- ing down that ball and chain of debt you’ve got attached to your ankles. Don’t you want to go to, say, Costa Rica or something?”

Creepy as this guy was, some of his points were good. Specifically the one about making more money. But Kristen was experiencing a real ethical tug-of-war. “So, like, who would be our bosses? Because we do prize autonomy, and we need some independence when it comes to our deci- sions.”

“Totally. Hey guys, I hear you. No pressure at all. We’ll just have a couple of daily check-ins. The execs at our firm are these fine-looking guys.” Alastair pulled out a leather-bound portfolio containing stock charts and bios and pictures of a dozen guys in silk ties and pinstriped suits ... all of whom eerily looked alike.

“Ok. Where did they practice?”

“Practice? Oh. Oh no, you have the wrong idea. These killer dudes are MBAs. Their business plan is A-one when it comes to bringing the oral to the masses.” Chapter II —33

“Businessmen are in charge of this place?” Kristen was not comfortable with that.

“No, dentists have to own the practices.”

Kristen smiled. “Ok, that’s good. I was wondering.”

“But that’s only because of silly state laws. Actually, it’s a private equity firm that’s technically in charge.” Alastair snapped the portfolio shut and slid it back in to his briefcase.

Kristen frowned. “Wait. How do they have the pa- tients’ considerations at heart?”

“Great question. Great question.” Alastair took a long drink of water. “Look, if an equity firm is gonna invest, they’re gonna invest in something that’s sound, right? Why would they invest in a company that mistreated its patients? Trust me.”

Kristen broke an awkward silence. “Well, how do you guys make sure that we keep patients coming back, and checking in on their total health?”

“It doesn’t quite work like that,” Alastair chuckled. “We have a lot of dentists, and we wanna keep everybody rotating in and out.”

“But one of the great things about caring dentistry is cultivating meaningful relationships with our patients.” Kris- ten thought about the patients they had treated, and how she had kept track of gum inflammation over the months.

“Uh-huh. Kristen, I hear you. But I would argue the opposite is true. Think about how much some of them annoy you. The ones who don’t pay? The ones who break appoint- ments? The ones who ignore your advice and put off proce- dures? Let us take care of scheduling the patients. You guys 34— Dentistry for Millennials

just do your best work, and clear your heads of all this other noise.”

Kristen hated to admit it, but this guy could sell ice to an Eskimo. Their patients could be a hot mess sometimes. Nick was clearly receptive. You could practically see his pupils turning into cartoonish dollar symbols as he sat there staring at the base salary on that glittering golden paper.

Alastair opened another brochure depicting a shiny team of sharp-looking assistants and hygienists on the front who were interacting with the dentists. They looked ... hap- py.

“Speaking of tough relationships, maybe you’ve been having trouble with your team? Maybe you can’t seem to get them on the right page?”

Kristen and Nick slowly nodded.

“Hey, it happens! But leave your team to us. We’ll take care of all the hiring and firing. After all, we’re really good with fire. I mean, firing. We’re good with firing.”

Kristen knew their team had not been totally relia- ble. But wasn’t that a two-way street? Kristen and Nick hadn’t always done their best in communicating.

Alastair clapped his briefcase shut and made his fi- nal pitch. “Think about it, guys! You don’t have to pay for equipment. No more worries about finding new patients or assembling your dream team of assistants and hygienists. No more brain space devoted to overhead or marketing. We’ve got all that covered. You just worry about scrubbing, scrap- ing, and scaling some chompers! I’ll let you discuss.” Chapter II —35

He uncoiled up from the seat and glided to the win- dow. A wolf howled in the distance, an owl hooted, and lightning flashed: a trifecta of spooky.

Nick turned to Kristen and whispered, “We could just sign on for a year, you know? Get our finances on track?” Kristen squeezed his hand. These corporate firms could be sneaky. She’d heard horror stories: the woman on a fixed income who went in for a routine prophy and left with five pulled teeth and dentures. But overselling was common at a lot of practices, right? And they did serve an awful lot of people who couldn’t otherwise get care ...

Nick was gazing at the second bedroom. Well, the office. It could become a second bedroom with two of those salaries between them. And really, a lot of their friends had migrated over to corporate firms. Those companies could be relentless in calling new grads carrying lots of debt. No wonder it was Friday at 9:00 p.m., and here was this super- coiffed guy in a crisp suit, looming in their kitchen with a briefcase full of sparkly brochures and pamphlets.

“I don’t know,” she whispered back.

Nick shrugged. “What do we have to lose? It’s not like we’re selling our souls, right?”

Thunder cracked outside; Alastair wheeled around and, beaming, produced a shimmering golden pen from the inside of his pocket. Two contracts had materialized on the table in front of his briefcase.

Kristen felt her heart racing. This was a tremendous decision. But maybe Nick was right. It’s not like they were selling their—

Ding-dong. The doorbell jangled.

CHAPTER III

ENTER ... GABE

Alastair froze, pen in hand, golden contracts on the table itching for signatures. A measure of impatience ran across his face as the bell rang again and Nick rose to open the door. There stood a short, older, scraggly-white-haired man in a ratty blazer, a beaten-up felt hat, a dotted bow tie, and orthopedic shoes. He peered over his gigantic, tortoise- shell glasses.

“Hello, son. I hope I’m not disturbing you? My name is Gabe. I’m on the, ah, thirty-sixth floor.” He lowered his glasses and looked around the apartment, landing briefly on Alastair. “My, what a lovely apartment!” Alastair clicked his pen noisily. Kristen stood and smiled, “Thank you, sir. Is there something we can help you with?”

“Oh, I’m just informing my neighbors that a car is being vandalized in the parking lot.”

“That’s great, old-timer,” Alastair said, clicking his pen noisily. “Thanks for the concern. Nick? Kristen? How about we settle up?”

Kristen ignored him. The old man snapped his fingers and added, “Oh, also, it’s a black BMW i8, license plate ERM—”

The pen-clicking stopped. “My car! My precious car!” Tossing the contracts aside, Alastair bolted out of his 38— Dentistry for Millennials

seat. Nick and Kristen watched him run down the hallway toward the stairs as the old man chuckled and gently closed the door.

“Spoiler: I wasn’t totally honest with you,” he said, backing the couple into the room.

“This night’s becoming real creepy,” Nick whis- pered as Gabe began to adjust his bow tie, releasing some kind of glittering dust into the air. As the dust billowed about him—OMG, was it sparkling?—the old man seemed to shed years, doing a kind of Benjamin Button before their eyes.

The dust settled and the visitor smiled. “Hey guys, don’t worry. I’m still Gabe. Just a … slightly different ver- sion of Gabe.”

That was an understatement. Standing in front of them was no longer the shambling older man who had first appeared at the door: his white hair had become brown, though still unkempt; the moth-eaten blazer had become fit- ted and chic, and the tortoise-shell glasses had become black Warby Parkers. His old felt hat had sharpened and become a trilby, and the orthopedic shoes had become Vans. Goodbye hip replacement, hello hipster.

“Okay,” Nick said, “that was pretty awesome. But what is going on here?”

“It’ll all make sense in a hot sec. Sorry about the subterfuge; just had to buy some time from corporate. I’ve got to hurry, because the Alabama Shakes concert is starting in—” Gabe flipped through some screens on his Apple watch—“whoops, like an hour. Good thing I’ve got a little bit of magic up my sleeve.” Gabe wiggled his ears. “So let’s get down to it. Kristen, Nick.” He narrowed his eyes. “Come with me if you want to live.” Chapter III —39

“Wait … what?” Startled, they gripped each other.

“Nah, jk. That’s from Terminator. But I love starting with that.” He laughed mischievously, hopping up to take a seat on the table. “So. You’re dentists. Your private practice is in trouble. Your team’s in trouble. You’re in trouble— financially, personally, and psychically. You’re worried about the future.”

Kristen smiled. “That’s … wow … a good way to put it.”

“You guys seem like you have strong moral com- passes. Let me ask you something: Did that flashy suit seem like he was guiding you in the right direction?”

They grimaced. “No. But his points were valid. We’re sinking here.”

“Gotcha. The waters are rising and disaster’s com- ing, and it’s so overwhelming you have no idea what to do, huh?” They nodded. Gabe smiled. “If only there were some way to stop this cataclysm, some way for you to get strong footing and not sink into the ocean.”

“Yeah,” they answered.

“Welcome to Dental Climate Change. Kristen, Nick, I’m here to show you how you can continue to be good den- tists; concentrate on doing your best, caring work; have fun; and at the same time, maintain and grow a successful, kick- butt practice so you can end up with real financial freedom in your golden years. What do you think about that?”

“Uh, sign us up for seven,” joked Nick.

Gabe jumped off the table, straightened his pink bow tie, and tapped his Warby Parkers. The lenses of his glasses 40— Dentistry for Millennials

glowed and holograms filled the room: images of Kristen and Nick in front of their practice; happy patients with pristine smiles; and a confident dental team—motivated hygienists, engaged assistants, treatment coordinators ethically closing cases, and appointment coordinators scheduling patients.

They were being treated to a prismatic silent movie of themselves buying a new practice … and then another, and then another. They saw themselves incorporating new hires and more dentists, resolving conflicts within their or- ganization, and becoming pillars of their community, helping generations of patients care for their teeth, gums, and overall physical health. Finally, they saw themselves aging and sell- ing off pieces of their—dare they think it?—empire. The show went by in the blink of an eye, but Kristen and Nick felt like they had watched a full movie of their lives.

They gasped. Gabe looked up at them with those warm, inviting eyes, and tapped his glasses again. Lightshow over. Softly and confidently, he said, “It’s vital that we help you young women and men who are entering the field of dentistry. We need to relieve you of your debt so you can work for the public good and not be tempted by corporate profiteers like the dude who just graced your kitchen. We need to help the dental teams, so they can likewise grow and become an integral part of the changing face of oral health.

“Private practices have to be saved, and that’s gonna be accomplished by caring. And by that I mean—the CARE system. It’s ethically and socially responsible, and hugely profitable.”

Sprinkles of dust rearranged in the air, spelling out:

CARE: Case Acceptance, patient Retention, Experi- ence for the new patient. Chapter III —41

“Kristen. Nick. How much did you buy the practice for? If it’s not overshare?

“We paid $700,000,” replied Nick. “The guy gouged us. They weren’t doing more than $650,000 in business.”

“Man, sorry about that.” Gabe paused for effect be- fore adding, “But what if I told you that he undervalued your practice by about $1.5 million?”

Kristen could always tell when Nick’s heart started racing, because he would begin to bounce on the balls of his feet.

Right now it looked like he was primed to jump off a diving board. Kristen touched Nick’s arm. “Could you, ah, explain that?”

Gabe raised his eyebrows. “I thought you’d never ask. Ready for some mathe-magic?”

His bow tie glowed and spun out sparkling dust, which arranged itself into numbers dotting the air.

“Okay. So this is the special sauce. This is the secret that’s gonna make that book The Secret look like a week-old tabloid. The practice you bought two years ago has the standard case acceptance rate, right?”

“Yeah, I guess,” answered Nick. “We go in and tell, like, Mrs. Strauss she needs a crown, and she nods, leaves, and—”

“And does the six-month boogie in the parking lot, right?”

Kristen and Nick giggled. 42— Dentistry for Millennials

“Right, so your case acceptance is somewhere around 30 percent for your existing patients, and 15 percent for your new ones.”

“Which new patients?” snorted Kristen.

“And speaking of that,” continued Gabe, “how many of your patients do you think come back twice in a year?”

“One in … five?” guessed Nick.

“Twenty percent!” exclaimed Gabe. “Right-o. So you’re telling me that you bought your practice for seven hundred grand?”

“Yeah.”

“Now work with me here, guys. Let’s take a look at the capacity of your practice with a sound patient education system. The average adult, each year, will invest in a crown and build up. A PPO will pay out, like, a grand for that. And average patients also get two prophys a year, two exams, and a set of bite wings? And that’s, like, $300? So the average adult should be giving your practice $1,300.”

“Uh, yeah?”

“How many active patients do you have in the last twelve months?”

Something was dawning on Kristen and Nick. It was so simple, and it had been in front of them this entire time. But potential capacity had not been on their radar at all.

“A thousand.”

“So, Kristen and Nick, that’s $1.3 million.” Chapter III —43

Now it was Kristen’s turn to start bouncing on the balls of her feet.

“Oh, one more thing,” their new, stylish team mem- ber added. Kristen and Nick paused, bracing themselves for bad news, but they were surprised when Gabe said, “We ha- ven’t even talked about new patients. Fifty new patients a month? That’s 600 a year? At an additional $1,300? That would come out to another $780,000. So put that all togeth- er, and the potential capacity of your practice is—”

Nick interrupted him; he was hyperventilating, but he could still do math: “It’s $2.18 million. Oh my god.”5

“Haha, right. Your total potential capacity is over two million dollars. But even without adding any new pa- tients, you could almost double the value of your practice, operating solely on the CARE system. With team training and the Five-Step Patient Education blueprint, we’ll increase your case acceptance numbers to 67 percent; we’ll raise your patient retention to 80 percent; and we’ll make the experi- ence of your practice such that you have lifelong relation- ships with your patients and continue to acquire new ones.

“Growing your practice from the inside out, you'll explode in a matter of months, but also keep expenses static. You can pay off student loans and the bank loan for your practice. And down the road, you’ll go from one revenue stream of salary to three income streams for financial securi-

5 NB: Not all practices are the same! The number of patients and capacity is different for each one; the GABE system can help you customize your goals based on your specific practice. For Nick and Kristen’s journey, we’ll use the standard of 1,000 patients and the capacity of just north of $2 million. 44— Dentistry for Millennials

ty. During this Dental Climate Change, you’ll need to slather on the SPF.”

Kristen had barely asked, “SPF?” before Gabe’s bow tie burst out the words:

SALARY PROFIT FREAKIN’ EQUITY

“Your salary, the profit from the practice, and the equity from selling the parts down the road. SPF. This is gonna be lit. So … wanna hear more?”

Kristen shook herself out of her reverie. “That was … on point, no question,” she said. “But as gross as Alastair was, he had specifics. Devil Dental takes care of the pur- chases, marketing, and hiring. I mean, look at us. It’s Friday night and we’re going over invoices.”

Gabe nodded and raised an eyebrow. “I understand, Kristen. He made a pretty sweet sell. But like his briefcase, he’s all snake with nothing inside. Let me show you what a future with corporate dentistry would look like.

”He opened his jacket and beckoned for Nick and Kristen to gaze into the black void that suddenly appeared. It was very Dickens’ Christmas Carol. They felt themselves swallowed up into the darkness. Opening their eyes, they found that they had been dropped into a black-and-white world: the antiseptic offices of Devil Dental. They saw shadow versions of themselves as dentists, treating patients in gleaming chairs with beautiful equipment.

“So what’s wrong with this?” asked Nick, peering at his shadow self and a kindly lady who lay back in the chair. “Looks like I’m giving her a final once-over. An inlay. Sure.” Chapter III —45

Behind them, three suited executives strode into the room, holding a sheet with bar graphs. They pulled Shadow Nick over to the corner of the room and revealed a spread- sheet. “Dr. Barrow,” they said, “it seems you’re well behind your quotas for the month.” While Kristen and Nick watched, the executives pulled out lists highlighting proce- dures. “You have until five p.m. today to reach $80,000 in sales for this week. And may we suggest you start with”— they all pointed to the older woman in the chair—“her.”

Nick watched, stricken, as his shadow self glumly went over to his patient and advised a root canal. The wom- an’s face dropped as the invisible travelers yelled. “No! You don’t have to do that! That’s the wrong diagnosis!”

Suddenly, Gabe whisked them to another office, where Shadow Kristen was prepping to treat a patient for … periodontitis? “Wait,” said Kristen, peering into the patient’s open mouth—where she saw no sign of any such condition. “I can’t do that,” she protested. And yet she could only watch as Shadow Kristen wheeled up to this poor, unsus- pecting patient to begin an almost certainly unnecessary pro- cedure.

Kristen was horrified, and once again, Gabe trans- ported them to another room, and another after that. The scenes began to meld together, each more macabre than the last. Hygienists forced to use dull instruments instead of dis- posing of them; Shadow Nick and Kristen being yelled at by a team of a dozen bankers for not making quotas; a down- trodden man being handed a thoroughly itemized bill for $9,500; hygienists being hurried from patient to patient, un- able to answer questions, just churning out procedures. And finally, the capper: A little girl with corkscrew curls and bright eyes being clamped down into a seat while her mother held her hand. She began to cry as Shadow Kristen told the mother, “We’re going to have to put stainless steel crowns 46— Dentistry for Millennials on three of her teeth.” Before long, they were treated to a flash of Kristen operating as blood pooled in the girl’s mouth.

Enough was enough. “Take us back, Gabe! Take us back!”

With that, Kristen and Nick were back in their kitch- en, expelled from Gabe’s cardigan, shaking and sweating, kneeling, and smelling oddly like fluoride. “Please,” mum- bled Nick. “Never again.”

Gabe helped them up. “Sorry for the horror show,” he said, “but that’s what I call the ‘scared stiff’ maneuver. The thing is, that’s not exaggerated. It can really be like that. Private equity firms are turning dental practices into factory- like crown mills. They don’t care about patients; they care about their shareholders.”

The couple slowly pulled themselves together. “We can’t end up there,” murmured Kristen to her husband. Nick straightened his clothing. “We want to make money, lead a fulfilled life, and retire comfortably. But dentistry has to be patient-centric, not pushing unnecessary procedures.”

“Yeah,” Kristen added. “At the end of the day, it has to be about total health and well-being of the patients. Okay, Gabe. Help us. What can we do?”

“I’m glad you asked,” Gabe said. He winked, doffed his trilby, and was about to reach into it when he was sud- denly interrupted: BANG. BANG. BANG.

CHAPTER IV

WELCOME TO MODERNITY

On the fourth bang, a lightning flash outside por- tended Alastair’s arrival before Nick even opened the door.

“Whew!” he panted, beaming that tungsten-halogen grin again. “All good, guys! Not my car after all. Must’ve been some other high-class vehicle—the kind you could buy after joining Devil Dental. Okay! So where were we?”

He breezed past Nick into the room. Nick briefly panicked and was about to stop Alastair, but … well, there was old Gabe. Their helpful aide had morphed back into the old codger, haplessly playing with his buttons.

“Ah, I see our fourth wheel is still with us,” Alastair sniffed, returning to his briefcase and flicking a couple of errant raindrops off his suit. “Nick, Kristen, I believe you were about to sign on the dotted lines here.” He held up the glittering pen again and pushed the contracts toward the couple. They gulped and looked down.

“Oh,” said Kristen, barely containing a laugh. “I think you may have mixed something up. This doesn’t look like a contract to me.”

Alastair scowled as he looked down. “‘Cod, paprika, two lemons, four avocados.’ What is this?” 48— Dentistry for Millennials

Gabe peered over his clunky glasses. “Sounds like a grocery list, young fella.”

Alastair glared at him. “I know what it is. But how did—?” his eyes narrowed. “Never mind! Our offices are pretty close! That’s another selling point, right? I’ll jet over there, pick up new contracts, and be back in a jiff!” He snapped his briefcase shut and headed toward the door, turn- ing back to them briefly to say, “See you real soon.” And with that, he slipped out and into the night.

“That dude may be a good dresser, but he’s creepy AF,” commented Nick.

Gabe stood up. Another sprinkling of dust, and he was once again the friendly, humble dental Dante leading Kristen, Nick, and their team members through limbo.

“So you thought it was gonna be pretty simple, right? Take over a practice, be BFFs with your team, have it all running easy like Sunday morning, and make money hand over fist—right?”

The couple nodded.

“It’s never like that. Just as teeth can decay, so can a dental practice. The trouble starts as some spots, but over time, it spreads to the roots. Then the teeth can’t function. We’ve gotta fix it.

“Lemme ask you something. How would you define yourselves? Kristen?”

“I don’t know,” Kristen said, taken aback. “That’s pretty difficult to say right off the—”

But Gabe was already flipping through his iPhone. Chapter IV —49

“Okay, I’m just opening up one of your online da- ting profiles,” Gabe said. Reassuring Nick, he added, “Oh, don’t worry, buddy. It’s from before she met you. Okay, here we go: Fun. Spontaneous. Caring. Responsible. Com- petitive. Industrious. Sound about right, Nick?”

“Yep.”

“And same goes for you too, right? That’s why you lovebirds work so well together?”

Nick and Kristen grinned.

“Right. You love being dentists. You care about the steps in the process. You want to do a hell of a job and make money, but you also want to blow off to Central America for a week every once in a while. I’d describe you like this: You want more than just making a living. You want a life.

“So here’s the deal. I’m gonna show you how those attributes fit perfectly into our game plan for you and your team. Working from your strengths, we’re gonna deep dive into this four-pronged solution. Think of these elements as the porcelain onlay that will stop your practice from rot- ting—a strategy to return and refine your system to total health. Is it gonna work for you guys? I’ll bet my VIP pass to Coachella on it.”

Gabe swirled his trilby around, releasing more magic dust (which Kristen couldn’t help but think just might be powdered nitrous oxide).

“So, Kristen! You’re spontaneous and fun and com- petitive?”

“I like to think so, yeah!” Kristen answered.

“Do you have a Fitbit on right now?” 50— Dentistry for Millennials

“Of course I do,” Kristen said with a roll of her eyes. “I mean, how else am I gonna know how many steps I’ve taken today?”

“Right,” replied Gabe. “It’s fun trying to outdo your past records! Now what if you were able to compare your progress to your friends’ progress—or other people across the city?”

“That would be awesome. And it would totally give me incentive, too!”

“Interesting.” Gabe sprinkled some dust in the air; Kristen’s Fitbit glowed, and from it shone a bright light, cre- ating an illuminated word around them.

GAMIFICATION

“Gamification. You know what this is, guys?”

Nick stammered, “Ah, yeah, totally. It’s a country west of Ghana and south of—”

Gabe jumped in. “It’s a way of making learning and work fun. It’s using game principles and techniques in other fields.” Sprinkles in the air created visions of board games, video games, dice, and puzzles.

“You want to satisfy the video game geek in you that came of age when PlayStation was getting big? Gamification. You wanna ensure that the whole team is mo- tivated to collaborate, continue education, progress together, responsibly increase the team’s personal income, and make the practice profitable? You’ve got to make it fun.”

“But how?” Nick asked.

“We’re gonna make it fun by incorporating bench- marks and individual goals,” Gabe answered. “The entire Chapter IV —51

team will take responsibility to create interdependency—just a fancy word for working well together—and we’ll figure out how to overcome the game’s barriers. Then we’ll layer in some rewards. The team will be stoked to play and eager to learn the steps.”

Kristen and Nick nodded. Pretty cool! She reached up to touch one of the dust visions of Monopoly, but it scat- tered around her, rearranging into an oil lamp like the one Aladdin owned.

Gabe pointed to the tennis rackets in the corner. “I see you guys play tennis together. Pretty sporty! Who usual- ly wins?”

They both pointed to Kristen. Gabe laughed.

“Okay, how’s your form? Pretty good?”

“Could be better,” Kristen answered. “I wouldn’t mind some more pointers.”

“Well, let’s say you could have somebody on call to make sure you were executing to the best of your capabili- ties. Let’s say you had an extra set of eyes to make sure eve- rything was running smoothly. That would be cool, yeah? Now let’s see that extra set of eyes.”

Gabe’s bow tie twirled and the oil lamp released a smiling genie—but she wasn’t from any kind of 1950s tele- vision show. This genie was an updated, sharply-dressed woman wearing a headset.

“Let’s say that extra set of eyes could be used in your office to monitor everything that’s going on; to teach you best practices, keep everything rolling, and ensure that you guys were increasing case acceptance. Let me introduce you to the—” Gabe sprinkled the air again … 52— Dentistry for Millennials

ACCOUNTABILITY COACH

“Wouldn’t you like to have access to some kind of genie in a bottle you could conjure up?” Gabe said. “We’ve got some of those ready to help you on any number of is- sues.” The modern-day genie wiggled her nose as she floated amid a group of dentists, hygienists, assistants, and treatment coordinators, taking notes and nodding sagely.

“This outside advisor is able to look at your data, examine your interpersonal team dynamics, and give you feedback in real time.” In the air, the genie wiggled her nose again, and the team glowed with a golden aura.

This was getting exciting. Kristen and Nick liked what they were seeing. Gabe snapped, and around them an assortment of graphs, charts, and numbers shimmered.

“Remember that first time you used Google—or any kind of search engine? Everything ever in the world boiled down onto your screen! Freakin’ amazing, right? Guys, we’re living in the world of Big Data. It’s all at our finger- tips—our Fitbits, our iPhones, tablets, smart watches. We can see metrics for everything: how much we walked, what our heart rate is, how well we slept. What if there was a way we could update all of our info in real time? Something that could tell us how we were doing on a ton of different benchmarks?

Gabe waved his trilby in the air, and the dust rear- ranged to reveal—

BEHAVIOR DASHBOARD

“Back in the 1950s, we were doing things on paper,” said Gabe. “But now we’re walking around with powerful five-inch computers glued to our hands. We can find infinite Chapter IV —53 information instantaneously. Everybody’s using Big Data to improve performance.”

“Yeah,” offered Nick. “Like professional sports, and the stock market.”

“Exactly,” Gabe continued. “So let’s start tracking numbers. The practice is stagnating; you need some metrics to review that can show you downfalls and pitfalls, and how to rectify them. We know we have to improve performance and numbers—but how do we know exactly what to tackle? This dashboard right here.”

For a brief moment, a futuristic interface filled the air around them; pie charts, tickers, and—could it be?—a brief glimpse of the words “67 Percent Case Acceptance.”

Within an instant, the display was gone. “No! Bring it back!” Kristen yelped.

“Haha, soon,” replied Gabe, wiping the air again. He went on. “Hey Nick, I like those shelves over there.”

“Thanks! I hung them myself.”

Gabe chuckled, “Right, I figured. How’d you learn how to do it?”

“I watched a video on YouTube. This guy gave easy, step-by-step instructions. All I had to do was get my tools.”

“Totally. You learned from a video. A video you could watch at the office, or at home, or even on the go.” Gabe swished the air, again rearranging the nitrous oxide dust.

ENGAGED LEARNING 54— Dentistry for Millennials

Gabe’s eyes twinkled. “Imagine being able to access the Great Library of Alexandria—a vast repository of knowledge and training, right at your fingertips. Now imag- ine you didn’t have to be in Egypt to get to it. A treasure trove of videos awaits you!”

Dozens of screens filled the space—televisions, computers, tablets, and phones—all playing short films and being watched intently by team members.

“What if your team had videos for easier onboard- ing, helping them learn the foundations of being a team, what their roles are, maximizing output and input, the healthy mouth baseline, the complete health curriculum, be- ing a team leader, building trust with the patient, collabora- tion, case acceptance, and dozens of other topics? We can eradicate the fear of change in your team through education. How about that?”

Kristen and Nick were speechless.

“So what do you guys think? You onboard?”

Onboard? Nick and Kristen were on the train, in the café car ordering coffee, getting their tickets ready for the conductor to scan, and asking for sleeping-car accommoda- tions. Gabe recognized the looks of excitement and relief in their eyes.

“So, put it all together,” Gabe said as he wiped the air again with his hat. The dust settled:

Gamification

Accountability

Behavior Dashboarding

Engaged Learning Chapter IV —55

“Wow,” Kristen mouthed.

Gabe continued, “And these steps can help at any point in your career arc.”

Nick raised his eyebrows as he spelled it out. “Ohhhh … G-A-B-E. As in Gabe!” Kristen and Gabe smiled at his slow realization.

“Exactly,” said Gabe. “So say hello to your newest employee: me! With my help, we’re gonna build the practice from the inside out. We’ll put all the controls in: the incen- tives, the coach, the metrics, the videos. These will ease ten- sion on the team and help them willingly improve the num- bers. They’ll increase patient attraction and conversion, and that will bring back their work-life balance. We’re gonna redefine what’s possible, benchmark with peers, and give you a platform you can use for your entire career.”

Gabe bowed deeply. “Kristen, Nick. Welcome to the rest of your life. Now let’s dig in!” With a slight wave of his hand, he scattered three of the words; only “Gamification” remained.

CHAPTER V

WE GOT GAME

“Gamification” was still sprinkled in the air as Gabe twirled his trilby. Suddenly, the old dentist at their practice, Dr. Salyers, appeared in a hologram between Kristen and Nick. There he was, hidden in the storage closet, playing Candy Crush Saga.

“Gabe, I really don’t think we need to see this,” Nick moaned. “God knows we see it enough at work.”

“I think there’s something right under your nose that you’re missing about him. Sure, he checks his stocks and looks at pictures of his grandkids. But why is this Baby Boomer so entranced with this game?”

“I mean, who isn’t?” said Nick. “Everybody’s play- ing that or Clash of Clans or Subway Surfer. Everyone likes those games on their phones and tablets. Kristen stays up late playing—”

“Ok, I really don’t think Gabe wants to hear about that,” interjected Kristen, blushing.

Gabe’s eyes twinkled. “Exactly. We’re all playing them. It’s just a way of life now. Gaming isn’t just for kids. Every demographic, every age group—we’re all playing some kind of game. And guess what? Businesses are incor- porating the idea of games, and they’re getting great results! In fact, it’s estimated that close to 80 percent of major organ- Chapter V —57

izations are using gamification in at least one area of their business.6 It’s being used for employees, customers, personal performance, education, and of course, health.”

“But isn’t it a fad?” Nick asked. “I mean, yeah, I to- tally downloaded Angry Birds, and I played video games when I was a kid. But people grow tired of them, right?”

Gabe’s glasses glowed, and projections of athletes competing filled the room.

“How old is the Olympics? Couple of millennia? Have we gotten tired of games? No way. We’re actually fig- uring out ways to make our lives more game-ified!”

As the twinkling athletes threw javelins, ran, jumped, and swam in the air between them, Gabe continued. “We talked about the different personality traits you guys have. Kristen, you’re competitive, you care, you like organi- zation and meticulous attention, and you wanna have fun. Well, these are exactly the four personality traits that team members can show to various degrees: Competitive, Human- ist, Methodical, and Spontaneous. And guess what? All four quadrants are gonna get a kick out of gaming.”

Kristen’s Fitbit glowed brightly again. “Pretty cool invention there, right?” asked Gabe. “Hey Kristen, how many times have you walked around your apartment just trying to get to that next benchmark of steps?”

“Uh, every now and then,” Kristen began.

6 “Gartner’s Gamification Predictions for 2020.” Growth Engineering. http://www.growthengineering.co.uk/future-of-gamification- gartner/ (Accessed 30 July 2017) 58— Dentistry for Millennials

“Every. Freakin.’ Night.” Nick cut in. Kristen play- fully hit him on the arm.

“Ok, I like the challenge. But it’s good for my health! And I’m just figuring out how best to make it work.”

“And it’s fun too, right?” asked Gabe. They nodded.

“In those two lines, we just described all four per- sonalities. A Fitbit is the perfect example of gamifying health. It satisfies the competitive, humanist, methodical, and spontaneous personalities. And it’s just a smooth little wear- able on your wrist that tells you how much you’re walking. Now imagine that idea exploded all over your dental prac- tice.”

Nick was doing that rocking-on-the-balls-on-his-feet thing again out of sheer excitement.

Gabe continued. “Think about all the data a Fitbit can show you: not just steps, but also calories, heart rate, quality of sleep, time tracking, and your friends’ stats, too! And it shows you all that in real time. It doesn’t download it to an offsite server, where it’s compiled into a lengthy report and then mailed to your house through the Pony Express— like with your current dental software system.”

“Right,” Nick groaned.

“The fact is, gamification is all around us. From loy- alty rewards given by brands like Starbucks, to the praise your shiny avatar gets for leaving reviews on Yelp or giving feedback on Waze, your life caters to the game—not the oth- er way around. So let’s help your dental practice get into the twenty-first century by tapping into this.”

“How?” Nick and Kristen asked simultaneously. Their vague curiosity was quickly becoming dogged interest. Chapter V —59

Gabe jumped to his feet and did his best Tom Cruise in Jerry Maguire imitation: “Show me the numbers!” His Warby Parker specs projected a 3-D chalkboard, replacing the Olympic athletes. The numbers from before returned:

CARE: Case Acceptance, patient Retention, Experience.

$1300 annual average revenue per adult patient per year 1,000 active patients in previous twelve months = $1,300,000 per year (Adding no new patients!)

“Now guys, here’s what happens in your practices. You’re giving people tasks, right? You’re telling the front office people to answer phones; you’re telling the treatment coordinators to explain the treatment plans to the patients; and so forth, right?”

“Yeah. Everybody has a job to do. And we dele- gate,” Nick said.

Gabe nodded. “I want you to start thinking about it this way: Delegate the roles and outcomes—not the tasks.”

Nick and Kristen looked at Gabe like he was speak- ing Mandarin. The blackboard lit up.

“Hold on to your hats, y’all. We’re gonna reverse engineer this.” Gabe started scribbling in the air quickly and furiously. “How much would you like your practice to make this year?”

“Uh,” Nick and Kristen looked at each other. What was realistic?

“Tell me your dream,” said Gabe. “Throw it out there.”

“Two million?” Nick asked hesitantly. 60— Dentistry for Millennials

“A bit louder, Nick. Lemme hear you.”

“Two million!” he shouted, high-fiving Gabe.

“Ok. So.”

The blackboard sparkled: $2,000,000.

“You’ll need to increase production for that 10 per- cent write-off. So it’ll have to be $2,200,000,” said Gabe. “Now how many weeks off do you guys want?”

“Just one,” cautioned Kristen. “One. For our Costa Rica wedding. That’s it.”

“Come on, Kristen,” said Gabe. “You’re fun. You want to get out there and live.”

“Ok! Four! Four weeks off,” Kristen gushed. “That would be an awesome honeymoon. Can you imagine?”

“Great!” Gabe replied. “That’s 184 days working at the practice. Let’s give your hygienists and the entire team the same number of weeks off. For two hygienists? That’s 368 hygienist days in the practice. So how much can they produce? A thousand a day? That’s $368,000.”

The blackboard glowed as the writing went quicker:

$2,200,000 - $368,000 = $1,832,000 for doctors to produce annually $1,832,000 / 184 = $9,956 for doctors to produce per day

Kristen studiously took notes as Nick continued rocking on the balls of his feet.

“Ok, the methodical doctor is copying away,” ob- served Gabe. “So let’s round this up to $10,000 bucks, just Chapter V —61 to give us a little bit of a cushion. This is our Daily Primary Outcome, our DPO. Now, our optimal case acceptance is actually around two-thirds, or 67 percent, right? So we need the benchmark for how much (in treatment dollars) needs to be presented per day. And don’t worry: we will never pre- sent treatment that’s not needed. Let’s go to the blackboard!”

10,000 x 0.67 = $14,925.

“So let’s round that up. Kristen and Nick, this $15,000 is how much treatment should be presented each day if you want your practice to make two million bucks each year. Because there’s two of you, that’s $7,500 each per day. That’s an Invisalign case and three crowns a day. That’s what you’re gonna have to deliver every day to stay on track.”

Kristen looked skeptical. Gabe nodded. “Now, I know. You’re no crown factory, I’m with you. That’s just an example, though. These are just benchmarks that you have to present. With a healthy mouth baseline established, if you presented everything that was needed and wanted, you could never get to all the dentistry. There wouldn’t be enough hours in the week.”

Gabe, arched his eyebrows and grinned. “Now, get this. Forget about having your team members be activity- based, concentrating on answering phones and filling out reports and turning rooms. Instead of having them fulfill their tasks, we’re gonna get them goal-based. We’ll have them fulfill their roles and break this down by person. It’ll become a game.”

“Ok, but how?” asked Kristen. “We’re just seeing a bunch of numbers.”

“Right,” answered Gabe. “A bunch of numbers. Just like what you have on your Fitbit. You’re held accountable 62— Dentistry for Millennials

for those steps you take, right? And if Jimmy NoName from Oklahoma is beating you by ten steps, won’t you work a lit- tle harder to overtake him?”

“You’d better believe it.”

“Ok. So let’s say each member of the team—the dentists, associates, hygienists, assistants, treatment coordi- nators, appointment coordinators—has their own score- board.”

The chalkboard endured some fierce scribbling:

POSITION DPO Appointment Coordinator Schedule doctor $10,000 Schedule hygiene $1,000 Treatment Coordinator Present $15,000 per day Close 67 percent or $10,000 Assistants Produce $10,000 per day Hygienist Produce $1,000 per day Present $7,500 per day per hygienist

Gabe pointed to the text. “Everyone’s responsible for generating a certain amount per day. And with these ver- bal agreements in place, they’re focusing on their role. You’re not micro-managing, and everyone is trusting each other. All of this quantifies the game for us, so we can play it and be in control. Check it: everybody on the team has a po- sition, and they’re all in the game.”

“And the game is everybody’s shared responsibility ...” started Kristen.

“... of getting to $2 million?” Nick joined in.

“Exactly,” said Gabe. “The appointment coordina- tors schedule each doctor to produce $10,000 a day, and hy- gienists for $1,000 a day. The treatment coordinator will pre- Chapter V —63

sent $15,000 per day, which will let her close 67 percent or that $10,000 a day. And as we went over, the doctors’ DPO should be $10,000 per day. And assistants? Well, they also have to produce the doctor amount a day: $10K.”

Gabe grinned. “Now we’ve got a full-on behavior change. That’s how you build a practice: one day at a time, one DPO at a time. You guys! We’re changing the skin we’re in. The whole team is now working together—first and foremost—to get your patients healthier. Then, in turn, your practice will naturally grow to a certain outcome. Eve- ryone’s working to do their best. All of your team members begin recognizing the opportunities of the game.

“It works for every type of person. Your competitive personalities want to shine and love the challenge; the hu- manists recognize that this is for the betterment of thousands of people’s health; the spontaneous team member loves how fun this is, making the Monday Morning Huddle; and the methodical personality is digging the scoreboard and calcu- lation—”

“That’s true,” added Kristen, still taking notes. “Like Warren Buffett said, ‘If you can’t read the scoreboard, you don’t know the score. If you don’t know the score, you can’t tell the winners from the losers.’”

“I do love me some Buffett,” said Gabe. “So, by im- plementing this strategy, you’ll be able to look at your met- rics and your key performance indicators. You can compare them not only to your own past performances, but against other practices in North America—all the ones that have brought me aboard. And guys, you know what? There have been a lot—and many more are to come. And remember Johnny No-Name in Oklahoma, Kristen? If you find out he’s able to generate $50,000 in treatment from his chair with a 64— Dentistry for Millennials

70 percent conversion rate, think that’ll inspire your team as well?”

“It better!” growled Kristen, feeling those competi- tive urges.

“Yeah! That’s what I’m talkin’ about. Gamification. We’re making work fun, competitive, and friendly, all for the sake of better dentistry and changing the landscape of oral health in America.”

“This really is great,” said Kristen thoughtfully, “but what about some kind of extra incentive? The team needs a bit more than just thrill of the hunt, I think.”

Gabe gave Kristen a thumbs-up. “You’d better be- lieve it. It can be monetary. Your hygeniuses, NINJAs, DOFIs, and financial freedom fighters go past their DPOs? Boom! Then the individual bonuses kick in. Or think about the hashtag-swag potential. T-shirts, hats, buttons, any- thing—all promoting their A-plus work!” He winked. “Now then. We’ll move on in a sec to talk about those incentives, as well as metrics and improvement. But all of this just gives you the basics of where we’re coming from, right?”

“Yeah,” Kristen and Nick nodded. They understood, except for one small thing. “Wait,” said Nick. “Hy-genius? DOFI?”

Gabe smiled. “I was wondering if you’d pick that up. Associates who are leaders among leaders, spouses who are VIPs, hygeniuses, NINJAs, DOFIs, and financial free- dom fighters. It’s not the Avengers; it’s your team. Part of the gamifying process is incentivizing your supersquad to reach and exceed those benchmarks. But for that, we should bring in the accountability coach.”

KNOCK. KNOCK. KNOCK! Chapter V —65

The sound that interrupted them was pretty insistent.

“Hey, that must be the coach,” remarked Nick, mov- ing to the door. “I’ll get it.”

Gabe put a finger to his lips. “Ah, nope. Not the coach.” He whirled around and was back in his doddering, retirement-home get-up as Nick opened the door to reveal the black-suited tempter.

Alastair had returned, contracts in hand. Once again, the lightning flashed outside.

CHAPTER VI

I DREAM OF ... AN ACCOUNTABILITY COACH

Nick stood in the doorway, unsure whether to let Alastair pass. The corporate rep proudly held out two con- tracts with sticky notes flagging where their signatures should go.

“Front desk guy let me up. He remembered me,” ex- plained Alastair. “You mind if I …?” Alastair slipped by Nick and into the apartment, greeting the others with his toothy grin.

Kristen eyed him warily as he scooted a chair in be- tween her and (old) Gabe, who was mischievously twirling his bow tie.

“Now then, I believe we were discussing how your first-year salary will absolutely obliterate some of your loans, and—”

A ringtone to the tune of the Rolling Stones’ “Sym- pathy for the Devil” began.

“Oh, you’ve got to be kidding me!” Alastair grum- bled, flipping his Bluetooth on. “Yes? Hello? Hello? HEL- LO?”

Gabe poked Kristen and winked. 68— Dentistry for Millennials

Getting the hint, she said, “Hey Alastair, sometimes you have to, uh, go outside to get a better signal.” Alastair threw back a thumbs-up and stalked outside. Gabe trans- formed back to Hipster Gabe and lit up the room again as Nick locked the door.

“So let’s talk about accountability. Pretty important to you, right?”

“Hell yes,” said Kristen. “It’s not my job to take out the trash. And if there are greasy fingerprints on the x-rays— ”

“That was one time, and it was because I ate pop- corn chicken,” answered Nick.

Gabe jumped in, “Okay, so we’re in agreement that accountability is important in a small business, correct? And we gotta get out of the mold of you guys being the center of the practice, and you getting stuck there on a Friday figuring out scheduling and billing.”

“Most definitely,” said Nick.

“To do that, we need to rethink the way you regard your team and the way they think of themselves. Remember how integral they are to achieving your two goals of overall patient health and hitting that benchmark of a $2 million practice.”

Kristen and Nick nodded.

“Now, we agree dentistry is the first fortification against chronic disease, right?”

“It sure is,” the couple agreed.

“In our new world of Dental Climate Change, we’re looking at our squad like the heroes they are.” Chapter VI —69

Gabe’s black-rimmed specs projected images, and Kristen and Nick looked up at a NINJA, a mustachioed pro- fessor, a caped crusader, a tuxedoed concierge, and an army general. The couple poked at the holograms, their fingers running straight through them.

“Welcome to your supersquad,” grinned Gabe. “Oh, they have their daytime identities. But make no mistake: this is the strongest illness-fighting posse you’ve ever seen. And they’re working alongside you right now.”

The foursome disappeared, replaced by a vision of a woman cleaning instruments in one of the rooms at the prac- tice.

“That’s Karen,” offered Kristen. “She’s an assis- tant.”

“Or is she something more?” asked Gabe. In an in- stant, Karen was transformed. Wearing a jet-black costume, she turned the room, quick as lightning, then reviewed a chart and eased into a chair next to a patient.

“Super-fast, super-efficient, and ultra-versatile. Ka- ren is a NINJA. It stands for, ‘No, I’m Not Just an Assis- tant.’”

The acronym appeared in the air above Nick and Kristen. Gabe added, “And what’s more, assistants are the most trusted members of your team. Their powers of trust and ability to communicate with your patients are without equal.”

In the holographic vision, Ninja Karen and the pa- tient talked and, in a matter of a few minutes, the patient’s facial expression changed from concern to understanding to delight. 70— Dentistry for Millennials

“Unbelievable. She is a ninja,” Nick marveled.

“That’s right,” said Gabe. “Empower them with that bond of trust with patients, and you’ll see your NINJAs edu- cate patients and improve their lives. The benchmarks the NINJAs have to meet are the ones for the doctors and hy- gienists. Every time the dentist hits $10,000 in production, you award a twenty-dollar bonus for the NINJA. Then just watch those rates of case acceptance rise and rise. After all, what’s $360 a month? That’s a new Michael Kors bag every month. Boom!”

Karen yanked off her ninja mask and with a jaunty eyebrow raise, accepted her Michael Kors bag happily.

Gabe’s bow tie twirled again; the nitrous puffed out and formed another holographic projection. “Now let’s talk about these folks.”

Nick and Kristen recognized their two hygienists, Robert and Marisa, and watched as their hair grew white and fluffy and they both sprouted bushy mustaches. Now wear- ing lab coats, they were the spitting images of ... Albert Ein- stein?

“Welcome to your hygeniuses,” said Gabe. In this new age of Complete Health Dentistry™, they’re more than tooth-cleaners. They’re your patients’ healthcare advocates and the main contributors to your patients’ total oral well- being. They’re the first ones to see inside a patient’s mouth, and as such, they’re the first guard against systemic disease.”

In the vision, the Einsteins peered into a patient’s mouth, filled beakers, and scribbled on a chalkboard. Gabe went on. “These wizards can tell if gum inflammation or saliva test results will reveal diabetes, heart attack, stroke, and any kind of inflammatory disease. They’re the only healthcare professionals that spend two full hours with Chapter VI —71

somebody each year. They hold the key to detecting sickness and diseases in their early stages.”

One of the Einsteins made a “Eureka!” face and showed the patient an image from the intraoral camera.

“What might happen if you incentivize your hygeniuses by giving them an extra ten percent of any treat- ment income that’s over and above the $1,000 per day they’re already responsible for generating? That financial reward, combined with preventive care advocacy, will guar- antee they consistently overcome time barriers to educate your patients. And guess what? That’ll drive up case ac- ceptance as well.”

The Einsteins disappeared and the patient got up and moved to the front office, where she was greeted by another team member.

“Hey, that’s Jill,” offered Nick. “She’s our—”

“Don’t say it,” cautioned Gabe.

“—money gal!”

As Nick finished his thought, a cape clasped around Jill’s neck.

“I think you mean Financial Freedom Fighter. These treatment coordinators aren’t just there to take money from your patients. They’re there to help fit treatment into the pa- tients’ lifestyles. They can break down the money barrier and make total health and wellness financially feasible. And if the dentists and hygeniuses make their benchmarks? Your freedom fighters get one percent of total accepted work, paid at the time of case presentation.” 72— Dentistry for Millennials

Gabe showed Superhero Jill and the patient going to a quiet, private room.

“In a secure, safe place, away from other patients, Jill can employ her superpower: confidentiality and the as- surance of a financial plan that can work. By offering multi- ple options—like paying all up-front for a courtesy, third- party financing, or monthly payments—your Financial Free- dom Fighter can elicit more trust and secure the care your patients need, helping them towards their overall health and—”

“Case acceptance! Okay, now we’re talkin’!” en- thused Nick. “But what about our receptionists? How do they fit in?”

“Glad you asked,” said Gabe, his Warbys projecting a different hologram. This time, Beverly, the harried woman operating the phones, morphed into a bright and cheery con- cierge. Dashing and smart in a British tux, she gave off the kind of welcoming and genuinely caring vibe reserved for long-lost friends.

“She’s no appointment coordinator. She’s a DOFI— a Director of First Impressions. Your charming and disarm- ing DOFI is like a five-star hotel concierge, providing world- class customer service and hospitality. She’s showing new and existing patients that this practice is not your same-old, same-old. Here, you’ll be treated well, and with respect. And if your DOFI is focusing solely on coordinating appoint- ments and welcoming patients, she’ll be able to emanate se- renity and happiness, bathing each and every guest with warmth and joy.”

As Beverly answered phones and greeted patients in the vision, her aura spread throughout the room. “Because every missed appointment costs the practice hundreds of dol- lars,” Gabe continued, “it’s essential for DOFI’s to focus on Chapter VI —73

scheduling, rescheduling, and setting the tone of the practice. Being positive and welcoming has a huge payoff: it converts new patients into long-term ones and ensures existing pa- tients reschedule. After all, these are lifelong relationships you want to cultivate. And every time the hygeniuses and the doctors reach their DPO, your DOFIs receive $10 per indi- vidual provider benchmark met.”

Kristen and Nick smiled at each other.

“Guys,” Gabe said, “these are the fundamental members of the care team. There are other very important members of the team as you expand: associates, insurance coordinators, and even spouses. Your patients listen to and respect them, and they understand—on a whole new level— why treatment is necessary.”

“Okay, but wait a sec,” said Kristen. “Where do we fit in? We’re the dentists here!”

“You sure are,” said Gabe. “And you are also mem- bers of the team. Remember, we’re not delegating tasks an- ymore, we’re delegating roles and responsibilities. Each of these valuable team members is integral towards total well- ness. You two have the vital role of treating diseased teeth and gums, to restore health. You guys want to diagnose and treat—not clumsily fumble with the voicemail service, right?”

Nick blushed.

“With your NINJAs, DOFIs, freedom fighters, and hygeniuses doing the groundwork, you’ll accrue more free time to do your very best, kick-ass dentistry.”

“And the office manager?” asked Nick. 74— Dentistry for Millennials

“Not office manager,” Gabe winked, sprinkling the air again with his bow-tie nitrous, “but Team Leader. Stefan- ie is your grizzled general. She’s fighting in the trench against the real enemies of team success: passivity, incon- sistency, and procrastination. Your team leader is a strategist who can energize your team and keep their focus on sustain- able implementation for your practice.”

Kristen and Nick saw Stefanie with a chewed-up ci- gar and helmet, deploying the NINJAs, freedom fighters, hygeniuses, and DOFIs throughout the office, making sure they were staying on task.

“She’s dynamic, competent, and engaged,” Gabe said. “She’s the one responsible for keeping everything rockin’ and rollin.’ She’s proactive and empowering the team. And with everybody taking care of their own roles, she’s free to Measure, Monitor, and Make sure things go right.”

The room lit up with “TRIPLE M!”

“Once a week, she’ll have a summary meeting with you two to ensure you know all the pertinent info about the practice. You, as healthcare warriors, will finally be rid of paperwork and billing. Once your practice is as profitable as can be, it frees you to plan some romantic dates, attend that howler monkey wedding, and give back to your communi- ty.”

The team of Dental Climate Change heroes struck various poses in the air between Kristen and Nick. This was better than any action movie! This was an actionable movie, and one the couple was excited to direct and star in.

“So that’s your supersquad, guys,” concluded Gabe. “Your mofos that will keep you from feeling the fomo. You’re thinking higher of them, they’re thinking higher of Chapter VI —75

themselves, and they see the big picture. The practice wins, the team wins, and the dentists win.”

The room went dark. Nick started to applaud, but Gabe cut him short.

“Now hold on there. We’ve got another ingredient to add.”

Gabe’s bow tie sprinkled again and the stats and data returned. He reached out his hand and the numbers swooped toward him.

“We know what the metrics are,” Gabe said. “We’ve got data coming in from case acceptance and patient reten- tion. We’ve got stats on missed appointments and cancella- tions. We know what kind of treatment is being presented and accepted. And all of this is sent to you in real time. You know, as opposed to downloading all the data to that offsite server, getting it stacked together, and then mailing it over.”

“Well, that would be fantastic,” said Kristen. “We want to take action on the data, but by the time we get it, it’s way out of date and totally useless. These old-school prac- tices use software programs that were clearly designed by engineers, not business people.” “Yeah,” added Nick. “The only way we know if our case acceptance is down is by looking at our sad bank account at the end of each month.”

Gabe nodded. “Right. So this is the difference be- tween our module’s leading data and your lagging data. Hey, it’s the twenty-first century. We’ve got numbers and data continuously being pushed at us in real time by our phones. No reason why your practice’s stats should be any different.”

“But Gabe,” interrupted Kristen. “Who has time to look at these things? We’re busy enough, and with our 76— Dentistry for Millennials

supersquad focusing on their roles, I think we’re down a per- son.”

“You sure are. You’re actually down a coach. An accountability coach. Hey, how do you guys feel about ana- lyzing numbers? Sitting at home with a spreadsheet?”

“Hate ‘em. They’re just awful,” Nick quickly snapped. “I can’t deal with numbers.”

Gabe laughed. “Right, you and 98 percent of den- tists. So what if there was somebody devoted to looking at your metrics—somebody whose responsibility it was to re- ceive and analyze your numbers and then alert your team leader when something was amiss?”

“But we don’t have room for an extra team mem- ber!” Kristen wailed. “You saw that Dr. Salyers is always in the broom closet. And he can get very possessive—”

“Guys, guys, chillax. This person works virtually. She’s always plugged in, and always ready to send you noti- fications. Think of her as that genie in the bottle.”

The nitrous rearranged in the air, bringing an Arabi- an lamp back to the forefront. The genie—that sharply- dressed woman wearing a headset—rose out of the spout.

“Your accountability coach is the final ingredient that helps you turn this supersquad into a super-duper squad.”

In the image, the Coach took all of the virtual num- bers from Gabe and began doing tricks with them—juggling them and then stringing them together, like paper dolls.

“Cool, huh?” asked Gabe. “This accountability coach is a true genie; she’s the outside eye, more in touch Chapter VI —77

with your functionality than even you are. We’ve got 450 algorithms in the data we’re pulling from your practice, and she’s able to do a deep dive into all of them.”

The numbers formed a pool around her; she wiggled her nose and dove in headfirst.

“Now let’s say she sees the numbers for case ac- ceptance in a certain area start dipping.” As numbers began shrinking in the pool, the genie leapt out and summoned the team leader.

“She can contact your team leader to alert her. They do a one-on-one chat to discuss the hows and whys behind the dip, and they determine the proper course of action.

“What’s more, once a quarter, this accountability coach has a longer virtual meeting with your team leader to discuss issues and obstacles. She can help your army general troubleshoot and acquire the skills needed to communicate with, train, re-train, and onboard your squad members. She’s compassionate, and she understands what it takes to run a successful business. She knows the benefits of macro- managing over micro-managing; and she knows that em- powering your team is the best way to get results, instead of through brute force and fear. She’s a genie in a bottle, my friends.”

On cue, some other genies began sprouting from the Arabian lamp, all in slightly different get-ups, and they joined the accountability coach in a circle.

“Wait, what’s happening now?” asked Nick. Gabe turned to Kristen.

“Hey, Kristen. Betcha not looking forward to that trade show this week.” 78— Dentistry for Millennials

“Yeah, no kidding,” she commented.

“What if we could discuss best practices virtually with your peers and expert coaches in the field, all hosted by your genie?”

“I would be very, very psyched.”

“Exactly. With community-wide virtual events, your accountability coach can hook your team leader up from the comfort of the office or home. Think about it. You’ve got an outside eye working on your metrics, consulting your team leader proactively on overcoming obstacles, and connecting your team with leaders in the field across the nation. This isn’t just the ‘A’ in GABE. It’s the A-plus.”

A super team of NINJAs, hygeniuses, five-star con- cierges, and freedom fighters. A genie that could crunch numbers and help their team reach their wildest benchmarks. Not to mention Gabe himself, whirling around (virtually) in their office. For the first time in two years, Kristen and Nick were feeling like some sort of game plan was coming to- gether—something that could, just possibly, turn that over- flow filing room into a nursery or turn Costa Rica from a pipe dream to “Okay, booking tickets now, thank you.”

“Now let’s talk about metrics, stats, data, and num- bers,” Gabe said, tapping his Vans together.

The presentation would have to be put on hold though. The wolf howl outside could only mean one thing: Alastair was on his way back, and they were running out of diversions. Gabe slipped back into his orthopedic shoes and ratty jacket, as ...

KNOCK. KNOCK. KNOCK.

CHAPTER VII

I LOVE IT WHEN THEY CALL ME ‘BIG DATA’

“Funny thing,” said Alastair, brashly walking in af- ter Nick had once again opened the door for the corporate representative, “but there didn’t seem to be anybody on the phone! And I went all the way into the street to look for a signal.”

“Must’ve been a wrong number,” Kristen offered. Alastair gave her a sharp, sideways glance, and then broke into a wide grin.

“You know what? I’m feeling like Devil Dental needs to sweeten the deal with you guys! What if we includ- ed a signing bonus?”

Kristen and Nick looked at each other anxiously. At that moment, old Gabe began clutching at his chest. “Oh! My pills!”

The couple rushed to him as Gabe did some expert flopping about and then looked directly at Alastair. “Young man, would you be so kind to get me my pills? My apart- ment’s right upstairs.”

“Come on!” said Alastair—but when he noticed Kristen’s shocked look, he relented. “Fine. What floor?” 80— Dentistry for Millennials

“Thirty-sixth. Thank you, son. You’re a lifesaver.” Gabe handed over his keys. Alastair snatched them from his hands, squinting at the hunched, white-haired figure. Some- thing about him seemed … familiar. Alastair left, closing the door behind him. A moment later, they heard his voice from the hallway:

“The elevator’s out? No WAY!” The stairwell door had barely slammed before Gabe snapped back into the haute couture of the young, all-purpose advisor and team- mate.

“Nick, you mentioned that stats are being used all over the place these days, right?” Gabe darkened the room, and green and white numbers—binary code, percentages, fractions, equations—surrounded them.

“Yeah,” replied Nick, “I was just thinking about fan- tasy sports, political polling, weather forecasting, advertis- ing—”

“And on and on, right? Hey Kristen! How many steps have you walked today?”

Kristen looked at her Fitbit. “Huh. Not enough,” she replied, and began pacing around the apartment while Gabe spoke on.

“Exactly. We live in a world where everything is quantified, crunched, pushed to us, and used for better prac- tices. The aggregating of data feeds our competitive spirit. Data gives us actionable tasks, can make us healthier and wiser, and is downright fun, yeah? The sheer number of stats out there are a huge turning point for every industry; the more info we have on the way we work, the greater the pos- sibility of changing ourselves for the better.” Chapter VII —81

With a simple tap on his Warby Parkers, Gabe swirled the numbers around them, ensconcing them in screens of bar graphs, pie charts, and lines with zig-zagging slopes. They’d have been tempted to call it science fiction … only this was no fiction.

“Man, you’ve gotta tell me how that magic comes out of your fingers,” marveled Nick.

“With this interface, we’ve all got magic at our fin- gertips. You can access it at the office, at home, or on your way to work on your tablet or phone.”

More charts appeared, specifically breaking down Kristen and Nick’s practice. All of the names of their staff— the hygeniuses, NINJAs, DOFIs, and financial freedom fighters—were there, including how much they were on track to produce. Gabe opened his arms and let the charts spiral around the couple.

“It’s created by the data from your existing dental software system. Remember the genie in the bottle? These are the numbers your accountability coach is looking at all the time. She’s checking ‘em out as they’re updated in real time, and she’s ready to alert you when she sees funky trends.”

The genie reappeared, still studiously taking notes on all the numbers. She nodded to Gabe and winked at Kris- ten and Nick.

“She can see areas of success … and areas that need work. Data reveals past behaviors of your practice, what the overall capability is, and how the practice can grow and change. The interface is sleek, smart, and hip, and it makes the Morning Huddle a breeze. Welcome to the Behavior Dashboard, my friends.” 82— Dentistry for Millennials

“Great!” enthused Nick. “Just, uh, two questions. Dashboard?” Gabe smiled.

“You know why all of these cool data interfaces are called a dashboard? Let’s say you’re sitting in a car, and you want to get a handle on all of your necessary info: your gas levels, your engine temperature, your speed, your lights— everything that will help you steer your vehicle. If your prac- tice is the vehicle, all these stats will give you tremendous insight into how it’s functioning.”

“Gotcha.” Nick nodded. “And, uh, ‘Behavior’?”

Kristen rolled her eyes at her loving husband’s thickness. “I think the point is to change our behavior,” she said, “right?”

“That’s it exactly. Pound it out.” Gabe and Kristen bumped fists. “The point is to improve your and your team’s work style! What’s going on here that’s keeping your prac- tice from reaching that $2 million threshold? We’ve got cer- tain benchmark ratios we wanna ethically hit, and our awe- some interface will keep you attuned with them without force.”

Like a news crawl, some stats ran across the room:

Patient Retention: 80 percent Patient Reappointment: 90 percent Case Acceptance: 67 percent

“And in our interface? We’ve got more than 400 al- gorithms all ready to be utilized, dissected, carved up, roast- ed, and served with some nice hollandaise sauce for your practice, in order to get your stats up to those marks—and all without fear and force, just great training. Chapter VII —83

“Total visits? Check. Total production? Check. Re- storative cases presented and closed, hygiene cases presented and accepted? Check, check. Production from a variety of types of procedures, spliced by day, week, month, year, whatever. And this data is pushed right to your smartphone.”

“Okay,” said Kristen, “but how does this help us on a day-to-day basis?”

“There’s my methodical doctor. Great. Lemme take you on a tour of your Morning Huddle. Here’s how you guys operate now.”

Gabe’s bow tie scattered some nitrous in the air. As the dust settled, it recreated an image from the team’s huddle the previous Monday. Kristen cringed as the holographic film strip showed her and Nick entering a room to meet the team.

Holographic Nick spoke: “So who do we have on the docket for today?”

The appointment coordinator chimed in, “Packed with six prophys, some re-care patients who have incomplete treatment work, Mrs. Fletcher’s whitening, and somebody needs a redo.”

“Great. And how much money is that?” asked Nick.

Vacant stares around the room.

“All right,” said Kristen, “anybody know if these patients need more work? Or if they accepted all of our treatment suggestions?”

Again, vacant stares. 84— Dentistry for Millennials

Holographic Kristen threw up her hands, stood up, and spilled her coffee all over her pantsuit. Nick grabbed some napkins, but ended up making it all a bit worse.

FLASH. Film strip over.

“Okay,” Kristen turned to Gabe, “I don’t think you needed to show that last part.”

Gabe’s eyebrows raised. “And here’s what it could be.”

FLASH. New film strip. It was the same scene as before: Kristen and Nick strode into the conference room, this time with a bit more bounce in their step.

“How are we looking for the goal today of total den- tist and hygienist production?” asked Kristen.

The appointment coordinator pulled up the Behavior Dashboard graphs on a screen in mid-air. “We have twenty- one patients today, for a planned twenty-eight total hours. While we have a scheduled $3,680 worth of work, our total goal of $6,240 means a gap of $2,560.”

“Okay,” Nick responded, “let’s see how we can fill that gap by looking at our patients’ total health and well- ness. I’m seeing that there’s a real need for perio treatment on three of our folks here. Why don’t we have Marisa dis- cuss perio with them when they arrive today?”

“Check,” the team nodded in unison.

“How does tomorrow look?” Kristen asked the co- ordinator.

“Our estimated collections of $6,987 puts us $1,310 above our daily goal there. Our dentists will be producing $18,025, which is $3,025 above our goal. We’ve got two new Chapter VII —85

patients, and our treatment acceptance of 69 percent puts us two points above the goal.”

The doctors were pleased. Kristen replied, “Not bad. Not bad at all! How do our numbers compare to last week?”

“You’ll be happy to know that we’re operating at 12 percent over that mark.”

“And how do we compare to Dental Blocks, that new practice on the other side of town?” asked Nick.

“They’re operating at 76 percent case acceptance.”

“Now that’s pretty good,” Kristen looked at Nick. “Maybe we can have a best practices discussion with them.”

The team wrapped up the huddle, rose from the ta- ble, and began a specially-choreographed team handshake.

Gabe sprinkled nitrous oxide over the group, and they disappeared.

Kristen and Nick were paying rapt attention; this was the best movie they’d seen in months. Nick leaned over to Kristen and whispered, “Do you think we can get Andrew Garfield to play me? Would that be weird?”

Gabe went on. “When we can see the Behavior Dashboard metrics, responsibility and accountability natural- ly steps up. Imagine being a baseball player. You’re at the plate, and on the sixty-foot Jumbotron, you see the score of the game and your own stats. Seeing how you can impact the game and help your team score some runs can get you revved up, and help you dig down and locate the why. It can be the same at your dental practice. And all of a sudden, your supersquad is watching patients getting healthier, the 86— Dentistry for Millennials

collections ramp up, and their bonuses roll in. Everyone wins.”

Gabe showed different shots of the GABE interface on desktops, laptops, tablets, and phones. “The Behavior Dashboard has a performance board and a collections board; it’s got the ninety-day collection percentage, and basically any handy metric you can think of. And all of this—all of this—is being continuously analyzed by your accountability coach. Now check this out.”

Gabe showed a re-care pie chart. The list of patients who hadn’t been to their practice for more than a year and a half took up more than a third of the pie.

“You know what I see there?” asked Gabe.

“Patients who’d better be flossing seven times a day?” joked Nick.

“I see unhealthy patients. I see more than $70,000 your practice is leaving on the table! But our Behavior Dashboard presents this information, and it prompts your appointment coordinator—or your dedicated re-care coordi- nator—to jump on the ball to get them in.

“This, and all the other activity from patients, will help the appointment coordinator stay on top of her numbers. We can see what gaps need to be closed for active patients, and how many patients haven’t re-scheduled, and we can have her focus on those numbers. We can also dissect cases and discover why they weren’t accepted, which lets us work on solutions.

“And all of this is to honor our CARE system—Case Acceptance, patient Retention, and Experience—and help you guys and your team reach that ultimate goal: a $2 mil- Chapter VII —87

lion practice. Say it with me. Two. Million. Dollar. Prac- tice.”

Kristen and Nick repeated, “Two! Million! Dollar! Practice!” They were really getting into it.

Like a philharmonic conductor, Gabe swiped at the air with both hands; the images shot away, and the darkness snapped back to the lights of the young dentists’ apartment. The third lesson ended, all three instinctively looked to the door, apprehensively waiting for the return of the corporate suit … but there was nothing.

“Huh,” said Kristen. “Those must be really long flights of stairs. What’s next, Gabe?”

“The last letter of my name, E. It’s for ease, educa- tion, epiphany, and, of course, engaged. Here we go.”

CHAPTER VIII

DENTFLIX AND CHILL

Gabe tightened the laces on his Vans as he launched into the fourth plank.

“So this is the final facet of Gabe: It’s the “E” in my name, and the “E” in my game. Now, we’ve got the idea be- hind how we’re gonna get those benchmarks up for your CARE system: gamification. We’ve got your team willingly accountable for their numbers, and the accountability coach monitoring their progress. And we’ve got the dashboard met- rics that track case acceptance and retention. So what’s the final ingredient? What’s the thing that brings it all together?”

“We get to shoot nitrous out of our hands too?” joked Nick.

“Close,” laughed Gabe. “It’s the fourth prong—all the learning you’d ever want. Oh, it’s not in any book. And it ain’t in any lecture that you sit through for a weekend, writ- ing chicken scratch notes and praying that the boring intel doesn’t go in one ear and out the other.”

“Yeah, like the trade show I’ll be hitting next week,” grumbled Kristen.

“Check this out.” Gabe’s hipster glasses glowed again and radiated another holographic vision. They could see Karen and Blake, the two dental assistants—whoops, 90— Dentistry for Millennials

NINJAs—reclined on the reception area couch, clearly watching a movie on the overhead screen.

“What?” said Nick. “They’re just hanging out there? When was this? Wait, is that chipotle popcorn? Why was I not invited? Oh, are they dating?” His shock subsided, how- ever, when he saw the NINJAs turn off the video.

Hologram Karen said,“Let’s put Ms. Walker’s per- sonal motivator in her file so we can pull it up later.”

To which Blake responded, “Yeah, if she’s planning on starting a family soon, we can talk about total body health as an important factor before getting pregnant.” The two wrote down some notes, put it in the folder, and ex- changed a fist bump.

Nick and Kristen stared, agog, at the productivity they’d just witnessed.

“WHAT BLACK MAGIC IS THIS?” Nick asked. Gabe’s glasses dimmed.

“It’s not witchcraft. It’s your Library of Alexan- dria—an off-the-hook database with components that can be accessed and absorbed in ten to thirty minutes. They can solve a problem or build a skill. This data will get your team on the same page, always working toward the CARE system and unleashing your potential capacity.”

“Two million dollars. Absolutely,” said Kristen. “But they’re … videos?”

“A treasure trove of videos,” Gabe replied dreamily. The powdered nitrous in the air showed a vision of the an- cient Library of Alexandria, but replete with screens, all of which featured Gabe teaching business, team development, and patient education on basic through advanced levels. Chapter VIII —91

“Over the first eight weeks, it’ll help you set up eve- rything for your practice—like Standard of Care, Roles and Responsibilities, and Vision, Purpose, and Values—and more practical items like setting up the consult room and calculating your goals and Daily Primary Outcomes. That means you don’t have to micro-manage! With this automat- ed system in place, you can just chill. Well, DentFlix and chill, that is.”

“I like, I like,” Nick nodded as the visions around them changed from the ancient library to their entire dental supersquad, assembled in the air. Their smartly-dressed ac- countability coach spoke to the team leader, who recom- mended the correction. The squad gave thumbs-up signs and dispersed to their own super consoles—their tablets, desk- tops, laptops, and phones—to watch their own specific bun- dles of videos.

“Aha. The second step of DentFlix.” Gabe pointed to each of the avatars. “Learning modules or curricula for each of your team members. Your Financial Freedom Fighter can watch the treatment coordinator videos for her best practices. The NINJA watches the dental assistant videos for his edu- cation and edification.”

“Is there overlap?” Kristen asked.

“Sure is! We all have to know what the practice’s Healthy Mouth Baseline is, right? We all have to be on the same page when it comes to the DPOs, right?” The couple agreed.

“And on that note, lemme ask you something.” Gabe pointed to a gauzy new holographic video. “Does this seem familiar?”

They were treated to an image of a new hire, an ap- pointment coordinator, walking into the office a few months 92— Dentistry for Millennials

prior. Cringing, Kristen remembered the scene: With the rest of the team too frazzled or busy to help get her acclimated to the practice, the poor woman was left stranded, trying to get her bearings. She ended up desperately looking for files in all the wrong places, unsure what kind of schedule to operate from, and in the dark about which procedures were which. It wasn’t a total shocker when she quit a few weeks later.

“Pretty hard to onboard a new team member, huh?” Chagrined, they nodded.

“What if we could automate that process as well? Yep, DentFlix’s Fresh Team Member bundle gets your new compadre integrated into your culture and structure. They learn how they figure into the squad and how best to teach the value of overall health for the patients’ betterment and their own. You’re here to improve people’s lives, and your new colleagues are ready to join you. Imagine what could be.”

A new hologram replaced the befuddled woman; this one showed a new hire approaching the practice. As she opened the door, she was greeted by the supersquad, all hap- py to have her onboard. She received a “Fresh Team Mem- ber Bundle” containing a documentary video DVD of “Say Ahh,” and checklists of roles and responsibilities, goals, and rules of engagement. The new hire was whisked from moni- tor to monitor at the practice, learning as she went, watching videos. Finally, with a huge smile on her face, she joined the other team members and struck a heroic pose.

“Wait,” Nick said, “all we have to do is show new hires DentFlix … and we can chill?”

Gabe laughed. “Maybe a little more than that. But hey, that’s what the platform is for. The videos are the main component of Engaged Learning, but this interactive module is not only that.” The air filled with images of sheets and Chapter VIII —93 files swirling around the young couple. “There are also a ton of downloadable resources like e-books, performance re- views, goal sheets, the Morning Huddle Motivator work- sheet, a DPO tracker, and more.”

Nick spoke slowly, putting all the pieces together.

“Okay, so gamification is our model for making the practice fun and competitive, and all in the service of the Triple Win for the team, the practice, and the patients. We use the dashboard to make sure the metrics are hitting the benchmarks. The accountability coach watches to make sure everything’s on track. And if she sees numbers begin to dip …”

“Give this kid a gold star,” Gabe said with a smile. “Then she hooks up with the team leader and figures out what kind of kink is in the engine. If one of the hygeniuses is dropping the ball with case acceptance, she’s primed to watch the relevant videos from the DentFlix vault, and we’re back to the races. Look at that: Full. Integration.”

While Nick restrained his instinct to hug Gabe, Kris- ten raised her hand.

“But we’re not in sales, Gabe. How do we make sure that the case acceptance is gonna go up? This is all great, but we still have to improve the CARE model, right?”

“You’d better believe it. You’re not in sales. You do not sell. You share intelligent ideas with intelligent patients, and they make intelligent decisions for their overall health.”

“But how do we make that happen? With some of these people, I’m practically ordering them to get crowns, and with others, I’m trying to bribe them. And it’s all for their own health!” 94— Dentistry for Millennials

“I hear ya,” said Gabe. “It can get frustrating. So let’s talk about the—” He scattered some glittering dust from his trilby across the air and the dust formed the words:

Five-Step Healthy Patient Blueprint

“Remember,” Gabe said, “you’re not salesmen, and these procedures aren’t products. This is all about how to make their healthy lifestyle incorporate what you’re suggest- ing. Folks, this is practice management made simple!

“First step? The Personal Motivator. People buy emotionally. Appeal to their reasoning for wanting to get the work done. Like Ms. Walker, wanting to start a family.

“Second step? The Healthy Mouth Baseline. You’re not operating a patch-and-watch facility, and your team and patients will know that. Get this objective criteria into the patients’ heads, and make it their responsibility to achieve that baseline.

“Third up is PCS: Problem, Consequence, Shhh. You present the problem in your patient’s mouth; you tell her what the consequences to her overall health will be; and then you just zip it. You wait for her to make the decision to take care of her health. And then you give her the dental so- lution that will keep her healthy.

“Fourth. Very important. The Five-Time Trust Transfer. We can call this the Patient Hand-Off 2.0. Make her hear five times (from the back of the office to the front) what the problem is, what the consequences are, and what the solution is. The repetition will help her truly and deeply absorb it and own it as her problem, and understand that it’s her responsibility to solve. This is a team working efficiently and speaking highly of each other—right in front of the pa- tient. All this builds trust. And what does this result in? No six-month boogie, but treatment acceptance. Chapter VIII —95

“Finally, fifth. Fit this into their lifestyle. You can’t talk to patients about their dental budget if they don’t have one! Awaken their desire for a healthy lifestyle, and make the treatment plan part of that lifestyle. Give them different options; work with CareCredit patient financing. A large bill can be disaster for case acceptance. Turn a five-thousand- dollar investment into $200–250 a month. By turning the big monster into something manageable, you can close the larger cases.”

“Amazing,” breathed Kristen.

“And here’s the important thing,” Gabe added. “Much like all the helpful DentFlix videos, you and your team can always return to the Five Step videos if you ever need clarification. It’s at the tips of your fingers, just like this”— he sprinkled more glittering dust in the air—“is al- ways at mine.”

The air glowed with nitrous and an image appeared of ancient Greeks milling about an ancient agora. Kristen and Nick waved their hands through the toga-clad philoso- phers.

“Ah-ha,” said Gabe. “One final component of the platform. If DentFlix is the Library of Alexandria, then the peer-to-peer coaching we offer on the platform every week is the meeting of minds and sharing of information that ancient Greece specialized in.”

The bearded philosophers talked amongst them- selves as Gabe continued: “Our objective is saving private practices, one at a time. Along the way, we’re building a community—a dental community of other teams across the nation, all using the GABE system. Much like in the forums in Rome and Greece, we can come together, ask questions, and benefit from others’ wisdom. Because you know what? It can get lonely out there with the methodology. So once a 96— Dentistry for Millennials

week, team members from different practices can check in and touch base in a sort of ‘office after-hours,’ where you can speak live with a coach about any questions or problems that arise. It’s an opportunity for you to get some feedback and answers for your own team. No predetermined lesson plan. No planned content. Just whatever different teams from across the national community want to talk about. Lady and gent, this is … the Friday GetDown.”

No sooner had he said it than the Greeks were re- placed by the dental supersquad, who began dancing in the air around them: twerking, the Nae Nae, Gangnam style, and the Dougie. The sparkling nitrous glittered out “Friday GetDown” around them; Gabe joined the dancing holo- grams, and it wasn’t long before Kristen and Nick followed suit.

After all … this! This was a platform for them and their generation. Tech consisting of fun and easily digestible videos, helping build their practice’s structure, breaking down the roles and responsibilities for the different team members, efficiently acclimating new hires, and giving them and their entire supersquad the vocab and tools they needed.

It all came together. The CARE system; the gamification; the genie; the NINJAs, professors, DOFIs, and healthcare heroes; the data; the benchmarks; the videos, the continuing education.

Dancing with abandon, Kristen and Nick were flooded with optimism for the first time in years. Illuminated (literally!) in front of them was a blueprint, a road to success. And to think how close they had been to signing on with Alastair, that wolf in sheep’s clothing.

Huh. Speaking of Alastair, it had been a while since they’d heard from him. Gabe whisked away the sparkling Chapter VIII —97 dust and holograms, and as the lights in the apartment re- turned to normal, they saw him.

There, standing at the doorway—panting and out of breath—was the very corporate representative who had tried so desperately to steal Kristen and Nick.

CHAPTER IX

IT’S GETTIN’ HOT IN HERE, SO PUT ON SPF

“Wait a minute” Alastair said, looking around the room as the dancing slowly came to a halt. “Craft beers. Or- ganic fruit. Vinyl records. Something’s fishy here.” He spied young Gabe. “Ah-ha. My arch-nemesis. I should have known it was you.”

“Because I said my name was Gabe? And sent you to the thirty-sixth floor of a thirty-story building?”

“Because of all of it!” Alastair sputtered. He turned to Nick and Kristen. “Hey now, kids. Don’t listen to this smooth talker. What did I tell you about Devil Dental? You’ll be paying your loans back in no time. That first-year salary will kill whatever you get at your flailing private prac- tice.”

“Working for a Wall Street firm that only cares about shareholders doesn’t seem too appealing now,” re- sponded Nick.

“Hey, we totally care about customers’ pie holes,” Alastair reflexively said. He paused, the charade over. “Look, who cares where the funding comes from? It’s a good investment! Everybody needs dental care.” 100— Dentistry for Millennials

“Sure,” said Kristen. “and that’s why we want to practice Complete Health Dentistry™. To help our patients achieve total body wellness—not just to meet quotas.”

“Well, peeps gotta get paid,” Alastair said, cough- ing. “Am I right?”

“We can get paid without giving folks unnecessary procedures,” Kristen countered. “Gabe here has shown us the path to financial success. We can get there without giv- ing up any of our self-respect.”

“Who cares about that? Everyone’s in it for them- selves,” Alastair hissed. “The sooner you realize that, the sooner you’ll start hashtag winning. You Millennials, with your big ideas about how the world works! It ain’t like that. You think corporations give an ounce of thought to the envi- ronment—or so-called humanity?”

Gabe used his powers to snap off the lights, and his Warby Parkers glowed anew. The nitrous sprinkled out “B Corps” around them. Images of verdant gardens, sunshine, and a mass of healthy people blossomed around them.

“These Millennials are leading the way, Alastair. Thanks to the forward-thinking, globally-inclined net gen- eration, we’re seeing the rise of Benefit Corporations. Social enterprising companies look for value creation in three sec- tors: their employees, the local community, and the envi- ronment. It’s time we all realize that while we’re working for money, we’re also working to live and to contribute to this world and people.”

“That’s right!” added Kristen. She grabbed some ni- trous from Gabe’s trilby, much to his surprise, and threw it in the air. ‘Triple Win!’ shot across the air. “B Corps are just like our triple win! Not just the bottom line, but ourselves, the team, and the patients!” Chapter IX —101

Gabe was impressed.

“What kind of hippie nonsense is this?” Alastair asked, recoiling from the light show.

Nick got into the act, tossing some nitrous into the air as well. All around them floated the avatars of the team, including the team leader and the accountability coach. “And it’s not just us. It’s also our supersquad! Our team members will hold up their end of the bargain.”

Alastair smiled crookedly. “But can you be sure of that? We’re offering you a contract—a sure thing. How can you be so sure that your team will help you succeed?”

“Easy-peasy!” said Nick. “By gamifying the prac- tice. We set a goal, and we’re reverse-engineering from there. Everyone’s accountable and responsible for their own Daily Primary Outcome and for living up to their agree- ments; and there are extra eyes on everything. We can moni- tor the metrics that make up our practice. Our team members have fun competing against themselves and others. And as they meet their benchmarks and surpass them, they reap re- wards, financial and otherwise.”

“Oh, benchmarks,” Alastair snorted again. “You mean like our dreaded quotas?”

“No, nothing like quotas,” replied Nick. “We have a basic goal for engaging our patients to be responsible for their own well-being. Our bottom line is healthy patients. We establish a healthy mouth baseline for them.”

“Healthy mouth baseline?” snorted Alastair. “That sounds like a 1980s hair metal band. The ‘baseline’ is what- ever you say it is. You’re the professionals! Lemme tell you something about Devil Dental. We know you guys, the den- tists, are the most important people in the room. Everybody’s 102— Dentistry for Millennials subservient to you, and if your staff members aren’t per- forming, we have ways to light fires under their asses.”

Shocked, Kristen spoke up. “That’s a terrible way to create a thriving, profitable, socially responsible business. We’re inlaying trust all over the place. We’re making sure everybody wants to grow the practice and improve them- selves, financially, professionally, and personally. Compa- nies these days are practically bending over backwards to give team members a share in the business, because it just makes good financial sense.”

“Bah,” scoffed Alastair. “That sounds like some pie- in-the sky dream. Just come on over to Devil. We’ll buy you glittering equipment and help you do chairside procedures over and over. Sign here. Sssssssign here!” Alastair hissed that last ‘S’ something fierce as he shoved the contracts to- ward them.

Kristen and Nick grabbed the contracts, took a step back, and tore each one cleanly in half. “We’ve heard enough from you,” Nick said, as Kristen added, “Get out of here!”

Alastair glowered; he snatched his golden pen and disappeared into a cloud of black, sulfurous smoke, bellow- ing, “You haven’t heard the last of me!” And with a loud POP, he was gone. Nick frowned. He was gonna spend all Saturday cleaning up the soot marks, no doubt.

Gabe patted the young couple on the back. “Pretty impressive, guys. The students are quickly becoming the teachers.”

Outside, the rain storms subsided; a beautiful clear night was giving way to a crisp dawn. It was the first day of— Chapter IX —103

POP. The black cloud returned. Alastair’s arm reached through it.

“Sorry, left my briefcase behind. Just gonna grab it.” He felt blindly around before grabbing the snakeskin and disappearing again, with another growl of “I’ll be back!” POP.

They all exhaled. Nick thought for a sec, then asked, “Hey Gabe, I understand how this works for our practice, but you mentioned three streams of income. Where does that come in?”

“Ah yes,” Gabe said with a smile, spinning his bow tie. “The final ingredient in your financial freedom. Here’s one last light show.”

Glowing around Nick and Kristen was New York’s freshest skyscraper, stretching into the clouds. “You know how they built the new One World Trade Center? They built one floor. And then they built it again—103 more times. And that’s what we’re gonna do with our practice.”

“Replicate and scale?” Kristen asked.

“Exactly. We’ll build you, one practice at a time, and you’ll get there through scalability, which will allow you to go wide and have multiple units; interchangeability, which will allow all our doctors and dental teams to work at these multiple units; and duplicability, which will allow you guys to essentially duplicate the same practice over and over again, thanks to the common philosophy you and your team share.”

“But how can we be sure that all the practices we’re buying will be undervalued?” Nick asked. 104— Dentistry for Millennials

“Cold hard facts: For every four Baby Boomer den- tists retiring right now, we’ve got three dentists coming into the profession. That makes it a buyers’ market. And what’s more, these old-school docs are undervaluing their practices. You saw it with the guy who made the deal with you two years ago. They’re selling based on their collection revenue amount—not their capability. You buy it at that rate, and within a year or three, you can pay off the loan you took to purchase the practice.”

An image of Kristen and Nick buying up new prac- tices flooded the room.

“You build that floor. And then you keep building it, over and over. You buy a practice at its underestimated val- ue, and immediately grow it from the inside out. And then you start replicating this model. With Gabe by your side—”

“Does that mean you’re gonna come back here again? Awesome!”

“Well, no,” Gabe chuckled. “But thanks, Nick. I like you, too. The GABE module will be with you. And you’ll be able not only to fulfill that CARE equation you’ve reverse- engineered, but also keep the philosophy—the vision, pur- pose, and values for your practice—consistent in all team members’ minds. As you purchase multiple practices, you’ll be able to interchange your doctors and team members among the practices, so you’ll want to keep them in fairly close proximity to one another. It won’t be long before you’re zooming around to your empire of practices. Then, once you’ve got all these profitable practices, you can sell pieces of them off and invest the money. That’s another stream of income working for you—while you’re still work- ing. And then, at the end of the career, you can sell the entire remaining percentages off. That will allow the two of you to retire financially free.” Chapter IX —105

Gabe saw Kristen starting wistfully at the second bedroom. It was becoming possible. Really, finally, truly.

“Now, when I say interchangeability,” Gabe added slowly, “you know why that’s important? Kris, you’ve been gazing at that second bedroom like it’s full of golden uni- corns.”

“Whaaaat? No, it’s just all of Nick’s files are, uh, flowing over, and—”

“It’s okay. You guys are planning to have a family.”

“At some point!” Nick yelled.

“Okay, at some point. And by necessity, that takes Kris out of the game for a little while. What was the gender breakdown of your class in dental school again?”

Kristen proudly replied, “A bit more than 50 percent were women.”

“And do you think any of them want to have fami- lies, too?”

She nodded. “Of course.”

“And guys are realizing that paternal leave is also pretty important,” Nick put in.

Gabe went on: “This is an important facet of the mil- lennial generation: the work-life balance. Telecommuting when you can, and having a flexible work schedule that al- lows you to raise a family. So there will be women who can only work three days a week, and then you’ve got three women doing the work of two dentists. So this interchangea- bility becomes really important. All of our doctors and team members need to know the ins and outs of the practice. And the GABE modules will make sure of that. 106— Dentistry for Millennials

“It’s Dental Climate Change, guys. And if you’re gonna make it work for your career, you’ll need to put on that SPF—the three streams of income. That’s Salary from your business, Profit from increasing the value of your prac- tices and paying down loans, and Freakin’ equity from when you sell off segments and finally when you sell all of it. And then you can breathe easy and become an associate in the practices you used to own.”

The holographic vision they’d seen at the beginning of the evening made so much sense now. Nick and Kristen getting their team onboard with new guidelines; helping pa- tients understand their Healthy Mouth Baseline; seeing their practice increase in value within a matter of months; paying off loans and debts. And then replicating that model to the point where they were able to buy numerous practices and install the same culture.

Gabe looked at his watch. “Well, I’ve totally missed the Alabama Shakes concert. But one of my buds just texted me about this all-night bowling alley with a Swedish DJ. Y’all in?”

Kristen and Nick politely declined. It had been a long evening, to say the least. Gabe flipped his trilby back on, adjusted his glasses, and said farewell. He left as calmly and easily as he’d come.

Kristen and Nick sat down, exhausted, and looked at each other. Both said, “Huh.”

Nobody had ever told them that it was gonna be like this, either: A Friday night that culminated in a demonic tal- on poking through a black cloud to grab a snakeskin brief- case, while a hipster in a bow tie gave them the roadmap for the betterment of their careers, their practice, and their team. But here they were. Chapter IX —107

And then they grinned at each other. They couldn’t think of a better place to be: the first day of the rest of their professional lives.

CHAPTER X

HAPPILY EVER AFTER: THE MOLAR OF THE STORY

By the time Monday rolled around, Kristen and Nick were champing at the bit. Though they had been able to en- joy a Saturday evening on an actual date to the movies, they found themselves impatiently waiting for the weekend to end so they could act on their newfound wisdom. So when the time came for the Monday Morning Huddle, Kristen and Nick confidently strode in to meet their team and promptly declared that the practice would be a $2 million operation within a year.

Whether the laughter that ensued had to do with that declaration or their story about a humble, cool, business- savvy millennial … well, it was probably a mix. And much of the team initially assumed this was another instance of that trope about doctors having a great plan and then losing interest a day later. But after a couple of minutes, they could tell that Kristen and Nick were both serious and committed.

Sensing some hesitation around the room, Kristen said, “We know this is new to you. But life begins where our comfort zone ends—and we have a proven strategy that we all are going to implement.”

With the new discovery of their ultimate goal in place, the couple acknowledged that the practice would have to make some changes. In fact, they’d have to “blank 110— Dentistry for Millennials slate”—i.e., get rid of all of the old thinking, protocols, and methods that were no longer working for them. They freely admitted that this would include ditching their own micro- managing. But it also included other failed habits, like allow- ing existing patients to go so long between payments, letting a year or more go by between re-care visits, remaining on first-generation Dentrix, and so forth.

They then set about co-creating the new Plan— building the foundation of their new practice. And that foun- dation, of course, was GABE. As Kristen and Nick ex- plained the methodology behind the system, and how they would implement the interface and undergo some training with Gabe’s assistants, the team soon understood that this was no temporary fad. This was the real deal.

Armed with a new, steely resolve, the ambitious couple explained how gamification—as well as adding benchmarks and rewards for the team’s DPOs—would keep them all inspired. And while Kristen and Nick reiterated that the days of their micromanaging were over, they’d be setting up a Management by Agreement protocol: putting verbal contracts in place to ensure that each member of their supersquad knew exactly what was expected of them.

Kristen and Nick explained that instituting the GABE methodology would help the doctors and team mem- bers think bigger than just the tasks they were minutely in- volved with—and bigger than each checkup or procedure, or even each patient. This would be a sea change in conceiving of the practice.

“Here’s the deal,” Nick said, preaching like a true Gabe acolyte. “We’re gonna start looking at everything we’re doing in the context of systemic health issues for all of our patients. Also, we all have to start looking at our own roles and responsibilities in the context of our careers, for Chapter X —111

professional and financial gain.” He paused for dramatic ef- fect, before adding, “When I say ‘Triple,’ you say ‘Win.” Triple!”

The team slowly looked at one another, unsure how to proceed. It was Karen, the new NINJA, who tentatively spoke up first.

“Win!”

“Triple!” said Kristen and Nick again.

“Win!” More of the team responded that time. By the third “Triple!” everyone in the room shouted, “Win!”

It was that simple. It started with an easy verbal agreement for a shared goal and belief, and the first hint that the new collaboration was underway.

The couple went on to talk about how these founda- tional changes through GABE would transform and restruc- ture their practice. Everything would be synergistic and team-based. Everyone would know who was accountable for what, and how each team member would be in charge of pulling his or her own weight.

Thanks to the implementation of the GABE system, the team would be able to quickly hone in on how the prac- tice was working, and rectify what wasn’t by using the three M’s: Measurement, Monitoring, and Making Things Right. Kristen and Nick showed how they could track all aspects of the practice through the new GABE dashboard.

The baby powder Kristen had brought to sprinkle in the air didn’t have quite the same effect as Gabe’s magical nitrous, but it still made the point as she narrated: “It’s a dazzling array of stats and numbers that can help us better care for our practice, patients, and team members. By using 112— Dentistry for Millennials

the first two M’s, we can figure out what’s going on, and we’ll know how to fix the situation with the last M. Thanks to the Dashboard, we’re gonna know case acceptance rate, whether we’ve all met our DPO benchmarks, and how many patients are behind in their scheduling. And if marks aren’t being met, then it’s troubleshooting with the accountability coach and over to the DentFlix vault. We’re automating all these steps, so it’ll be a well-run, humming machine.”

Their enthusiasm for a consistent philosophy and strategy was infectious. The Monday Morning Huddle be- came more of a Monday Morning Rave, but with fewer glow sticks.

That renewed energy and sense of purpose flooded out into the practice. Now, granted, the team wasn’t too keen on actually dressing like ninjas, scientists, concierges, or caped crusaders. But the intent was greatly appreciated, and the respect and dignity they felt couldn’t be matched.

And so it went. Within a year, the practice was a to- tally different animal than before Gabe’s arrival. Team members were high-fiving each other in the hall, forging new and improved relationships with one another and the patients. They were holding one another responsible, but also consistently exceeding benchmarks and enjoying their autonomy. The peer-to-peer think tank and the new account- ability coach were an absolute boon to business. And with monetary rewards in place in the form of Triple Win bonus- es—and the knowledge that they were following exact, well- managed steps to help others live healthier lives—the team members felt real freedom and success in their jobs.

The old doctor? Well, he found that gamifying the practice where he’d been working for decades was a lot more fun than Candy Crush. He came out of the back room and started paying attention to his own stats. He, too, was able to Chapter X —113

strike a better life-work balance, as he began to work only because he wanted to—not because he had to. As a result, he started making his hours at the practice more manageable, which made everybody else’s life a bit easier.

Obviously, this all translated into for rewarding per- sonal lives for everybody at the practice. Families were breath- ing a bit easier because everyone on staff was more confi- dent and more financially secure.

Within five years, Kristen and Nick had not only paid off most of their loans, but they had also taken the dive: they’d had their first child, and Kristen was pregnant with a second. But the really big dive came with the purchase of a second practice. And then a third, and a fourth. And they brought GABE along for the ride, onboarding new teams along the way with no hiccups.

Kristen and Nick were successful enough, and their practices automated enough, that they were able not only to carve out substantial time for their personal lives, but also to give back to the community. Along with speaking knowl- edgeably through media outlets to the few who were yet un- converted to Complete Health Dentistry™, the couple set up pro bono dental services for the underprivileged, and they both became more involved in nonprofits.

Kristen and Nick’s generosity echoed Gabe’s hopes that private practices across the nation would keep from turning into “crown mills.” Just as Gabe wanted to help edu- cate a new generation of dentists to stop the expansion of corporate dental firms beholden to shareholders, Kristen and Nick wanted to pay forward Gabe’s teachings. They remem- bered how the twenty minutes afforded to business manage- ment in dental school had left them and their classmates in a precarious position upon entering the real world. 114— Dentistry for Millennials

So what did they do? They established scholarships for students still in dental school. Any doctor who brought the seemingly-omnipresent Gabe on as an employee would see a student from his or her alma mater get a free ride, as well as access to the platform, through which they could at- tend live events and take virtual classes. The received les- sons of Gabe’s module would assist new grads in resisting the allure of corporate dentistry, by teaching them the basics of leadership, team development, simplicity, and manage- ment. Everything they learned would help them ultimately set up profitable, patient-first, private practices.

The dentistry profession kept growing, but with eve- ry advancement made in the design of dentistry equipment, Kristen, Nick, and their subsequent teams were able to adapt to changes seamlessly. After all, they were the pioneers of sinking or swimming, and they had learned to be adaptable. As early adopters of technology and proponents of collabo- ration and teamwork, the doctoring couple and their teams helped lead the way in revitalizing the industry.

If there was any knock on these lovely, successful pillars of community, it was that they were prone to occa- sionally telling an unbelievable tall tale of a night that pitted a simple, humble (and possibly magical) young dental enthu- siast against a devil in their living room, fighting over their oral souls to show the best path forward for their careers.

* * *

Now, this all may have been a fable, but it’s a fable based in reality. The women and men leaving dental schools are operating under an old, outdated, drill-and-fill, patch- and-watch business model for private practices. This leaves many young and talented doctors vulnerable to heavy loans and predatory corporate firms. But this is anathema to the values of the millennial generation (or however the genera- Chapter X —115

tion would prefer to call themselves), which is leading the charge for ideas like B-corps: Maintaining interest in finan- cial accomplishment and in social change for the betterment of our culture and of humanity.

The blueprint for succeeding in this endeavor is real, too. All those lessons Kristen and Nick learned throughout the course of their wild night? Your team members and den- tists can learn them as well! This is a step-by-step manual on how to achieve the practice of your dreams, dictate your hours, have collaborative relationships at the office, and re- tire to a financially golden and fulfilling life.

Our hope is that by 2020, thirty million people across America will be healthier, thanks to better oral pre- ventive care. We want to effect that change by instituting the GABE system in 20,000 practices across the nation that have an average of 1,500 patients each. We want to get the word out quickly, and we want to make a difference. With GABE and Millennials at the forefront, we are optimistic that—in the wake of changing perceptions amid a Dental Climate Change—private practices will flourish, dental teams and doctors will be properly compensated, young doctors will be business-savvy, and our citizenry will be on its way to com- plete health.

BOOK SNAPSHOT

TL;DR (TOO LONG; DIDN’T READ)

Life is short. There are millions of things to do, and we don’t have time to accomplish everything we’d like ... such as reading this book, despite the fact that it’s a neces- sary primer for all those in private dental practices. There may be those for whom this novella will elicit a “too long; didn’t read.” We understand! So below is a summary of the main takeaways.

The following book is a roadmap to financial, pro- fessional, and personal success for millennial dentists, teams, and older dentists. It is a GPS for those who want to balance their work-life schedule and life schedules and still be able to retire financially free. It’s a story about two young den- tists, a married couple who graduated from school together with a hefty student debt, and who took out a loan to pur- chase a private practice. With little business acumen—which certainly wasn’t taught at their dental school—the two are struggling to keep their practice afloat. Trouble is in every corner: two dentists who micro-manage and don’t seem to be connecting with their overworked, stressed, and disillusioned team; patients who cancel appointments and don’t pay on time; and an untenable practice that is operating on an anti- quated business plan.

That business plan, in general, has been in place for the better part of the last century, and we jokingly call it 118— Dentistry for Millennials

“drilling and billing.” It consists of examining the patient merely to see if he has a cavity or needs a crown, doing the patchwork job, and ignoring any of the issues that may arise in the future. But these two young doctors know—and you do, too—that we’ve moved into a new phase of oral care: Complete Health Dentistry™. We recognize that preventive care is better than reactive care, and that the mouth is the gateway to the entire health system. But how can our protag- onists transform their practice into a twenty-first century op- eration? How can they resist the allure of corporate dentistry, which is tempting to so many young grads with promises of big money through fundamentally unethical practices? And how can our stalwart heroes (and you!) grow their reputa- tions and financial success while also achieving a genuine work-life balance, practicing caring dentistry, and making time for their social needs and personal lives?

Enter Gabe, a millennial hipster. In the story, this “assistant” is, in fact, the personification of a four- pronged approach for revitalizing and modernizing a prac- tice: Gamification, Accountability, Behavior Dashboarding, and Engaged Learning. GABE knows how to get the team and doctors on board. He has a sophisticated, but easy-to- use, computer interface to help them along the way. Gabe, the humble, selfless millennial, shows our heroes how using the CARE system—Case Acceptance, Retention, patient Ex- perience—will allow doctors to figure out the total capacity of their practice: how much they’d be able to make if pa- tients accepted treatment at the benchmark average amount of work, and the practice retained an average rate of patients per year. From there, the dentists can reverse engineer a “blue sky” vision of what their ideal practice would look like in terms of how much money they would make and how many days they would work. Moving backwards, they can then figure out what the Daily Primary Outcomes (DPOs) of each team member should be to achieve that outcome. Book Snapshot —119

Gamification is the idea of setting personal goals for dental teams that helps all members have fun while working to reach the practice’s benchmarks of service, care, and prof- itability. All of these team members are more important than they (or you) realize. They begin to fulfill responsibilities, not just tasks, as we reimagine what their titles and roles ought to be:

▪ Assistants are NINJAs (No, I’m Not Just an Assis- tant): Able to not only prepare treatment rooms, they become healthcare advocates using intraoral cameras and proactively looking at patient charts, while being honored as the highest level of trust with the patient. ▪ Hygienists are hygeniuses: Healthcare advocates who spend two hours a year with individual patients and are most equipped to stand against future illness and disease. ▪ Treatment coordinators are financial freedom fight- ers: Able to find ways fit an affordable payment plan into a patient’s lifestyle. ▪ Appointment coordinators are DOFIs (Directors of First Impressions): Filling the practice with an invit- ing serenity, the DOFI makes patients feel welcome and ensures their return. ▪ Office managers are team leaders: These organiza- tional mavens map out strategies for their teams and ensure that they stay focused and driven.

Each of these team members and doctors has a high purpose and a financial incentive to meet and exceed their benchmarks. Using the automated, “gamified” system, eve- rybody can watch their own metrics, personally and willing- ly holding themselves accountable, and enjoy friend- ly competition with colleagues and their own past perfor- mances. 120— Dentistry for Millennials

The system also comes with an accountability coach, an off-site advisor who tracks all of the metrics and sends real-time notifications to the team leader when things go awry. All of the metrics (more than 400 algorithms) are crunched and quantified in an interactive dashboard that is used to assess progress and recommend best practices. Every statistic pertaining to the practice (e.g., case acceptance and appointments) is monitored in the “Behavior Dashboard” by the coach and team leader, and any problems that arise are rectified by troubleshooting and changing behavior.

Live conferencing and teaching are also features of the accountability coach application. The coach holds quar- terly discussions with the team and hosts the “Friday Getdown,” a peer-to-peer online gathering of leaders in the field who are able to answer questions from different prac- tices across the nation. Meanwhile, the dashboard also con- nects the team statistically with other GABE users so that team members can compare metrics against their own past performances as well as the stats of other practices.

Finally, the Engaged Learning feature of GABE is a platform for hosting easy tutorials and key information about the practice’s vision, values, and goals for both exist- ing team members and new hires. With a large vault of vide- os covering everything from customer service to boosting case acceptance and establishing trust, this aspect of GABE makes learning fun and consistent with the rest of the practice’s philosophy.

Once GABE is installed as a team member, he’ll get to work immediately helping practices right the ship finan- cially, giving doctors and their team members the confidence and autonomy needed to meet their DPOs and making their ultimate blue-sky number a reality. The practice will be able to increase case acceptance using steps like PCS (presenting the problem and the consequence to the patients, and let- Book Snapshot —121 ting them realize that treatment is a must) and the Five-Time Trust Transfer (repetition of the proposed treatment and

Gabe, our millennial team member, explains to our young protagonists how, once the new systems are put into place, the CARE system will be fulfilled—or should we say “fun-filled.” Case acceptance will go up, patient retention will be stellar, and the experience at the practice will attain an A+ across the board.

In this fable, our protagonists easily reject the corpo- rate temptation in favor of establishing a new dentistry busi- ness model within their practice, and they move on to ful- filling exactly the life charted out for them with GABE. Once the doctors find their footing, they can pay back their student loans as well as their initial loan for purchasing the practice. Soon enough, they’re able to buy a new practice at a low cost, since retiring Baby Boomers are undervaluing their assets using the old business model and not paying at- tention to potential capacity. In purchasing new practices, the young dentists can use GABE to implement the same philosophy and design, educating and incentivizing new team members in the same way they did at the first practice, and they replicate success, using scalability, duplicability, and interchangeability. Now doctors and team members are able to go between practices in the “empire,” as all are on board with the same knowledge and strategies.

Owning multiple practices, the young couple will truly be in a position to retire financially free when their time comes, and to enjoy their lives throughout and beyond their careers. They have SPF: Salary from their practices, the Profit they’ve turned by boosting the earnings, and the Freakin’ equity they get when they begin to sell off pieces after increasing their capacity. 122— Dentistry for Millennials

With booming bank accounts, excellent work satis- faction (because they’re chairside and not taking care of ex- traneous tasks), and balanced personal and professional lives, these millennial-generation dentists can live their best dental lives. Furthermore, they can give back to their com- munities and future generations of oral healthcare specialists. In the same way, by following the roadmap that this book sets out for you, you too will discover financial success do- ing what you love, having fun along the way, and being an active participant in bringing about Dental Climate Change.

And finally ... since dental schools don’t teach busi- ness management, there’s a need for this wisdom in the hands of any freshly-minted doctor. For any practice that brings Gabe on as an “employee,” we’ll offer a scholarship to a dental student from the alma mater of the practice’s lead doctor, as well as access to the GABE interface, so the stu- dent will be able to take online classes, attend live events, and watch training videos. Dentistry has made significant advances over the past decades, and millennials coming into the field now have grown up with technology, a sense of worksharing and collaboration, and greater understanding of the connected systems of health. So why are we still operating private practices from an antiquated, 70-year-old business plan?

Within these pages, you’ll be able to find a methodology and road map for financial freedom and a sensible work-life balance, while practicing Complete Health Dentistry, rejecting the encroachment of corporate firms, and having fun along the way. Join Kristen and Nick as they meet ninjas, superheroes, and one magical hipster. You just may have a devil of a time learning the ins and outs of ...

Dentistry for Millennials. $19.95 ISBN 978-0-692-94221-5 51995>

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